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Marked Increase in Bone Mineral Density Post Liver Transplant Using Zoledronic Acid in an Adolescent Boy
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Abstracts
Table 2. Bone mineral density Femoral neck (g/cm2)
Circuit exercise (n520) Tai Chi (n521) Control (n520)
Spine AP (g/cm2)
Spine lateral (g/cm2)
Baseline
12 week F/U
24 weeks F/U
Baseline
12 weeks F/U
24 weeks F/U
Baseline
12 weeks F/U
24 weeks F/U
0.618 0.110 0.608 0.108 0.657 0.114
0.633 0.110* 0.619 0.112 0.647 0.115*
0.626 0.121 0.617 0.110 0.650 0.109
0.878 0.143 0.854 0.174 0.872 0.133
0.878 0.142 0.869 0.140 0.878 0.131
0.875 0.148 0.864 0.148 0.886 0.135
0.654 0.107 0.872 0.133 0.643 0.147
0.657 0.109 0.878 0.131 0.655 0.143
0.659 0.101 0.886 0.135 0.640 0.103
All data were expressed as mean SD * p value ! 0.05 when compared with baseline
of 12th week and the end of 24th week. Independent investigators were responsible for the data collection and statistics. Results: A total of 20 participants in the CE group, 21 participants in the TC group, and 20 participants in the control group completed the study. The BMD after 12 weeks revealed benefit of circuit exercise training in mean femoral neck BMD with a significant mean difference in change (0.015 g/cm2) (p50.02), and no significant difference in change in the TC group. Though the control group showed a significant decrease of BMD (-0.010 g/cm2) (p50.015) in femoral neck region after 12 weeks. ANOVA test revealed that CE and TC group both showed their efficacy in maintaining BMD (neck BMD change, 2.68%, p50.005; 1.80%, p50.027, respectively) when comparing with control group. (Neck BMD change, -1.64%). The efficacy on BMD was not maintained after cessation of the exercise while evaluating in the 24th week. In addition, the CE group and the TC group both showed improvement in the physical fitness including muscle strength, quickness and flexibility after 12 weeks training. The CE group even had a better performance in quickness and flexibility than TC and control group. Conclusion: Circuit exercise training and TC exercise can significantly improve BMD and performance in fitness in postmenopausal women with osteopenia. Circuit exercise is more effective than TC exercise in reducing bone loss. These findings suggest circuit exercise should be incorporated into the medical management of patients with low BMD. Acknowledgement: Thanks to Zhao-Ling Lai and Jun-Hao Fan for the help in the data collection and statistics. Disclosure of Interest: None Declared
P180 MARKED INCREASE IN BONE MINERAL DENSITY POST LIVER TRANSPLANT USING ZOLEDRONIC ACID IN AN ADOLESCENT BOY M. McKenna1,*, S. M. van der Kamp1, M. T. Kilbane2; 1DXA Unit, 2Metabolism Laboratory, St. Vincent’s University Hospital, Dublin, Ireland Aims: Transplantation osteoporosis post orthotopic liver transplantation (OLT) is a consequence of prior end stage liver disease and of steroid therapy as part of a immunosuppressive regimen after OLT. Fractures rates are high particularly during the first year. We and others have reported high rates of bone turnover with very negative remodelling balance, and accelerated bone loss during first year following OLT, but recovery in BMD is possible. Bisphosphonate therapy has been shown to ameliorate the reduction in BMD post OLT in adults. Little is known about the treatment of transplantation post OLT in adolescence. We report a case study of transplantation osteoporosis in a 16 year old boy. Methods: A 16 year old boy presented 1 year post-OLT with vertebral fractures. Baseline and after therapy, he had DXA of spine and whole body less head (WBLH), vertebral fracture assessment (VFA), and bone turnover markers: serum bone-specific alkaline phosphatase (bone ALP), serum procollagen type I N-propeptide (PINP), and urine N-terminal crosslinking telopeptide (NTX). Zoledronic acid 5 mg infusion was administered yearly on 3 occasions, in conjunction with a supplement containing calcium 500 mg/d and vitamin D3 10 mg/d. Results: At presentation, spine Z-score was ???, and WBLH Z-score was ???. VFA demonstrated ???. Bone turnover makers were markedly increased: bone ALP5216 mg/L (N:3.7-20.9); PINP5830 mg/L (N: 22-96); NTX5323 nMBCE/mmolCr (N:25-72). Following the course of zoledronic acid, BMD by 149% at spine and by 38% at WBLH. Z-scores were -1.0 at spine, -1.7 at WBLH, -1.0 at hip, and -0.5 at femur neck. Bone turnover markers decreased markedly: bone ALP532.6 mg/L; PINP5129 mg/L; and NTX572.5 nMBCE/mmol Cr. Conclusion: We report a case of severe transplantation osteoporosis in a 16 year old adolescent who presented with multiple vertebral fractures. Following a 3-year course of yearly zoledronic acid infusions, BMD increased markedly to within the normal reference range for his age. Concomitantly, bone turnover markers reduced
markedly. So it is possible to affect a marked BMD and bone remodelling response to zoledronic acid post-transplantation. Disclosure of Interest: None Declared
P181 ROLE OF SELF-EFFICACY BASED MODEL OF INTERVENTION: LEARN APPROACH IN REHABILITATION OF DISTAL RADIUS FRACTURE N. Dewan*, J. C. MacDermid, T. Packham; School of Rehabilitation Sciences, McMaster University, Hamilton, Canada Aims: Distal radius fractures (DRF) are one of the most commonly occurring fractures, and contribute to high health care costs. Rehabilitation of DRF is supported by empirical evidence but this is rarely placed within a theoretical foundation. Most interventions focus on upper extremity physical function with less regard for potentially complex behaviours exhibited by patients. Self-efficacy (SE) is a valuable theoretical construct that has been used extensively in rehabilitation for facilitating behaviour change. However, it has been less applied to acute injury like fracture. The purpose of paper is to present a brief overview and critically review current knowledge about SE and propose how this might apply to the DRF population. Methods: We introduce the innovative LEARN approach (Learn exercises, Encouragement or cueing, Addressing unpleasant symptoms, Role models/Reinforcement from other’s experience, No- say no to inability) for rehabilitation of DRF population. In a SE based model of intervention developed for rehabilitation of DRF, it is anticipated that the LEARN approach will enhance both efficacy and outcome expectations, and consequently modify behaviour and predict recovery/ outcomes Results: The critical review in this paper suggests that behaviour change brought about by SE theory based intervention might be beneficial in improving health outcomes in musculoskeletal rehabilitation. The proposed biopsychosocial LEARN model presented in this paper provides more specifics on how to address SE and implement empowerment in rehabilitation of DRF.
Journal of Clinical Densitometry: Assessment & Management of Musculoskeletal Health
Volume 17, 2014
Abstracts
Table 2. Bone mineral density Femoral neck (g/cm2)
Circuit exercise (n520) Tai Chi (n521) Control (n520)
Spine AP (g/cm2)
Spine lateral (g/cm2)
Baseline
12 week F/U
24 weeks F/U
Baseline
12 weeks F/U
24 weeks F/U
Baseline
12 weeks F/U
24 weeks F/U
0.618 0.110 0.608 0.108 0.657 0.114
0.633 0.110* 0.619 0.112 0.647 0.115*
0.626 0.121 0.617 0.110 0.650 0.109
0.878 0.143 0.854 0.174 0.872 0.133
0.878 0.142 0.869 0.140 0.878 0.131
0.875 0.148 0.864 0.148 0.886 0.135
0.654 0.107 0.872 0.133 0.643 0.147
0.657 0.109 0.878 0.131 0.655 0.143
0.659 0.101 0.886 0.135 0.640 0.103
All data were expressed as mean SD * p value ! 0.05 when compared with baseline
of 12th week and the end of 24th week. Independent investigators were responsible for the data collection and statistics. Results: A total of 20 participants in the CE group, 21 participants in the TC group, and 20 participants in the control group completed the study. The BMD after 12 weeks revealed benefit of circuit exercise training in mean femoral neck BMD with a significant mean difference in change (0.015 g/cm2) (p50.02), and no significant difference in change in the TC group. Though the control group showed a significant decrease of BMD (-0.010 g/cm2) (p50.015) in femoral neck region after 12 weeks. ANOVA test revealed that CE and TC group both showed their efficacy in maintaining BMD (neck BMD change, 2.68%, p50.005; 1.80%, p50.027, respectively) when comparing with control group. (Neck BMD change, -1.64%). The efficacy on BMD was not maintained after cessation of the exercise while evaluating in the 24th week. In addition, the CE group and the TC group both showed improvement in the physical fitness including muscle strength, quickness and flexibility after 12 weeks training. The CE group even had a better performance in quickness and flexibility than TC and control group. Conclusion: Circuit exercise training and TC exercise can significantly improve BMD and performance in fitness in postmenopausal women with osteopenia. Circuit exercise is more effective than TC exercise in reducing bone loss. These findings suggest circuit exercise should be incorporated into the medical management of patients with low BMD. Acknowledgement: Thanks to Zhao-Ling Lai and Jun-Hao Fan for the help in the data collection and statistics. Disclosure of Interest: None Declared
P180 MARKED INCREASE IN BONE MINERAL DENSITY POST LIVER TRANSPLANT USING ZOLEDRONIC ACID IN AN ADOLESCENT BOY M. McKenna1,*, S. M. van der Kamp1, M. T. Kilbane2; 1DXA Unit, 2Metabolism Laboratory, St. Vincent’s University Hospital, Dublin, Ireland Aims: Transplantation osteoporosis post orthotopic liver transplantation (OLT) is a consequence of prior end stage liver disease and of steroid therapy as part of a immunosuppressive regimen after OLT. Fractures rates are high particularly during the first year. We and others have reported high rates of bone turnover with very negative remodelling balance, and accelerated bone loss during first year following OLT, but recovery in BMD is possible. Bisphosphonate therapy has been shown to ameliorate the reduction in BMD post OLT in adults. Little is known about the treatment of transplantation post OLT in adolescence. We report a case study of transplantation osteoporosis in a 16 year old boy. Methods: A 16 year old boy presented 1 year post-OLT with vertebral fractures. Baseline and after therapy, he had DXA of spine and whole body less head (WBLH), vertebral fracture assessment (VFA), and bone turnover markers: serum bone-specific alkaline phosphatase (bone ALP), serum procollagen type I N-propeptide (PINP), and urine N-terminal crosslinking telopeptide (NTX). Zoledronic acid 5 mg infusion was administered yearly on 3 occasions, in conjunction with a supplement containing calcium 500 mg/d and vitamin D3 10 mg/d. Results: At presentation, spine Z-score was ???, and WBLH Z-score was ???. VFA demonstrated ???. Bone turnover makers were markedly increased: bone ALP5216 mg/L (N:3.7-20.9); PINP5830 mg/L (N: 22-96); NTX5323 nMBCE/mmolCr (N:25-72). Following the course of zoledronic acid, BMD by 149% at spine and by 38% at WBLH. Z-scores were -1.0 at spine, -1.7 at WBLH, -1.0 at hip, and -0.5 at femur neck. Bone turnover markers decreased markedly: bone ALP532.6 mg/L; PINP5129 mg/L; and NTX572.5 nMBCE/mmol Cr. Conclusion: We report a case of severe transplantation osteoporosis in a 16 year old adolescent who presented with multiple vertebral fractures. Following a 3-year course of yearly zoledronic acid infusions, BMD increased markedly to within the normal reference range for his age. Concomitantly, bone turnover markers reduced
markedly. So it is possible to affect a marked BMD and bone remodelling response to zoledronic acid post-transplantation. Disclosure of Interest: None Declared
P181 ROLE OF SELF-EFFICACY BASED MODEL OF INTERVENTION: LEARN APPROACH IN REHABILITATION OF DISTAL RADIUS FRACTURE N. Dewan*, J. C. MacDermid, T. Packham; School of Rehabilitation Sciences, McMaster University, Hamilton, Canada Aims: Distal radius fractures (DRF) are one of the most commonly occurring fractures, and contribute to high health care costs. Rehabilitation of DRF is supported by empirical evidence but this is rarely placed within a theoretical foundation. Most interventions focus on upper extremity physical function with less regard for potentially complex behaviours exhibited by patients. Self-efficacy (SE) is a valuable theoretical construct that has been used extensively in rehabilitation for facilitating behaviour change. However, it has been less applied to acute injury like fracture. The purpose of paper is to present a brief overview and critically review current knowledge about SE and propose how this might apply to the DRF population. Methods: We introduce the innovative LEARN approach (Learn exercises, Encouragement or cueing, Addressing unpleasant symptoms, Role models/Reinforcement from other’s experience, No- say no to inability) for rehabilitation of DRF population. In a SE based model of intervention developed for rehabilitation of DRF, it is anticipated that the LEARN approach will enhance both efficacy and outcome expectations, and consequently modify behaviour and predict recovery/ outcomes Results: The critical review in this paper suggests that behaviour change brought about by SE theory based intervention might be beneficial in improving health outcomes in musculoskeletal rehabilitation. The proposed biopsychosocial LEARN model presented in this paper provides more specifics on how to address SE and implement empowerment in rehabilitation of DRF.
Journal of Clinical Densitometry: Assessment & Management of Musculoskeletal Health
Volume 17, 2014