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Two cases of pregnancy- and lactation-associated osteoporosis successfully treated with denosumab
Bone 105 (2017) 299–306
299
Contents lists available at SciVerse ScienceDirect
Bone j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / b o n e
Abstracts - Meeting 2016- Argentine Association of Osteology
Código: 3 Two cases of pregnancy- and lactation-associated osteoporosis successfully treated with denosumab A. Sáncheza, M.B. Zanchettab, K. Danilowiczc a Centro de Endocrinología, Rosario, Argentina b IDIM Instituto de Investigaciones Metabólicas, Buenos Aires, Argentina c Hospital de Clínicas, Buenos Aires, Argentina Two cases of osteoporosis related to pregnancy and lactation (a rare entity) are presented. Case 1 was a 35-year old woman who suffered acute low back pain in the 8th month of pregnancy. Pain worsened in the 4th month postpartum, and MRI showed recent deformation in L1 and older deformations in 3 other lumbar vertebrae. The laboratory was normal. BMD (DXA) was normal at the hip (Z-score −1.8), Highresolution pQCT showed cortical thinning and severe deterioration of trabecular bone in distal radius and tibia. She underwent kyphoplasty, and began biannual s.c. denosumab (Dmab). After one year there was improvement in bone microarchitecture: Trabecular volume had increased by 17% at the radius and 7% at the tibia; trabecular thickness had increased by 21% and 13%, respectively; the cortical compartment was unchanged. Case 2 was a primiparous woman, age 33, with acute back pain in the 3rd week postpartum; she was breastfeeding. MRI showed deformities of the superior plates of D5–7. Laboratory was normal except for mild vitamin D deficiency (25OHD 23 ng/ml). BMD (DXA) was low at the spine and femoral neck (Z-scores −4.6 and −2.5, respectively). She received nasal calcitonin briefly; she did not respond to strontium ranelate administered for 1 year, but had a good response to Dmab (+14% in spine BMD after 1 year). Both patients continued treatment with Dmab. We did not find reports of similar cases in the literature treated with this medication.
doi:10.1016/j.bone.2017.03.009
Código: 4 Osteonecrosis of the jaw (ONJ) and atypical femoral fracture (AFF) in an osteoporotic patient chronically treated with bisphosphonates A. Sáncheza, G. Bruchmannb, R. Blancoc a Centro de Endocrinología, Rosario, Argentina b Servicio de Traumatología, Sanatorio Británico, Rosario, Argentina c Instituto Universitario Italiano de Rosario, Argentina Case report: A.C., female of Italian descent, age 87 years, consulted in February 2013. She had a history of osteoporosis and had taken alendronate weekly for several years. She did not have densitometric studies. Due to low back pain an orthopedist had indicated i.v. zoledronic acid, 5 mg/year for 3 years (2006–2008). She was on simvastatin, carvedilol, enalapril, with occasional supplements of ergocalciferol. In 2009 she suffered a fall and sustained a subtrochanteric fracture of the left femur. She was operated on and recovered uneventfully. In 2012 she consulted a dentist due to loose teeth. She underwent the removal of a molar and was given a denture. She had discomfort when using the prosthesis, and developed a lesion in the gum of the lower jaw. After radiologic studies, the diagnosis was ONJ. She improved after surgical debridement, and local and systemic antibiotics. In early 2013 laboratory tests were normal except for a slight elevation of serum PTH and CTX. Calcitriol 0.25 mcg/day was indicated; after 3 months serum calcium, phosphate, PTH and CTX showed no variation. Two years later she experienced acute low back pain after a fall; MRI 8756-3282/$ – see front matter
showed recent crushing of D12, and chronic deformities of D11 and L1. She was treated with nasal calcitonin and analgesics. Comment: Although the association of ONJ and AFF was known in cancer patients treated with high doses of bisphosphonates, it is very rare in patients with osteoporosis treated with these drugs at usual doses. Only two cases have been reported, both in oriental women.
doi:10.1016/j.bone.2017.03.010
Código: 5 Systematic search of femoral radiographic abnormalities in asymptomatic patients treated with bisphosphonates for more than 5 years A. Sánchez Centro de Endocrinología, Rosario, Argentina In order to evaluate the frequency of femoral radiographic abnormalities which can predict high risk of atypical fractures (AFF), a series of 98 asymptomatic patients with postmenopausal osteoporosis chronically treated with bisphosphonates (BF) was evaluated. Those who had been exposed to oral or parenteral BF for more than 5 consecutive years (8.2 ± 2.9x ± s, maximum 18 years) and were still on treatment were selected. Age was 67.3 ± 8.6 years (range 52–87). The age of menopause was 49.3 ± 3.3 years (range 41–59). Of these, 17 had sustained fractures. Lumbar BMD (DXA, in T-score) was − 2.1x ± 0.1 (n = 59) and femoral neck BMD was − 2.0x ± s0.09 (n = 83). All patients had normal serum calcium, phosphate, creatinine, alkaline phosphatase, osteocalcin, and CTX. Fourty-one percent of patients had serum 25OHD values b 30 ng/ml; 12% had PTH values N 70 pg/ml. In only one patient focal bilateral thickening of the cortical diaphysis was found; multislice computed tomography did not find microcracks in these areas. Conclusion: in asymptomatic patients, the frequency of radiologic abnormalities usually associated with risk of AFF is very low (b1%). It is not cost effective to order femoral radiographs routinely.
doi:10.1016/j.bone.2017.03.011
Código: 6 Fructose produces oxidative stress and decreases intestinal calcium absorption V.A. Rodríguez, M.A. Rivoira, S. Guizzardi, N.G. Tolosa de Talamoni Biochemistry and Molecular Biology, INICSA (CONICET-UNC), Argentina Fructose (FRU) has important metabolic effects on the liver and has been associated with many of the components of metabolic syndrome (MS). Naringin (NA), a natural glycosylated flavonoid, is an antioxidant and has other biological properties. The aim of this study was to determine the effect of FRU, in absence or presence of NA, on the duodenal redox state and the intestinal Ca2 + absorption. Adult male Wistar rats were used: 1) controls, 2) FRU: treated with 10% FRU in the drinking water for 30 consecutive days, 3) FRU + NA: injected daily with NA (40 mg/kg b.w.) for 30 days. Intestinal Ca2 + absorption and Ca2 + uptake in mature enterocytes were measured.
299
Contents lists available at SciVerse ScienceDirect
Bone j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / b o n e
Abstracts - Meeting 2016- Argentine Association of Osteology
Código: 3 Two cases of pregnancy- and lactation-associated osteoporosis successfully treated with denosumab A. Sáncheza, M.B. Zanchettab, K. Danilowiczc a Centro de Endocrinología, Rosario, Argentina b IDIM Instituto de Investigaciones Metabólicas, Buenos Aires, Argentina c Hospital de Clínicas, Buenos Aires, Argentina Two cases of osteoporosis related to pregnancy and lactation (a rare entity) are presented. Case 1 was a 35-year old woman who suffered acute low back pain in the 8th month of pregnancy. Pain worsened in the 4th month postpartum, and MRI showed recent deformation in L1 and older deformations in 3 other lumbar vertebrae. The laboratory was normal. BMD (DXA) was normal at the hip (Z-score −1.8), Highresolution pQCT showed cortical thinning and severe deterioration of trabecular bone in distal radius and tibia. She underwent kyphoplasty, and began biannual s.c. denosumab (Dmab). After one year there was improvement in bone microarchitecture: Trabecular volume had increased by 17% at the radius and 7% at the tibia; trabecular thickness had increased by 21% and 13%, respectively; the cortical compartment was unchanged. Case 2 was a primiparous woman, age 33, with acute back pain in the 3rd week postpartum; she was breastfeeding. MRI showed deformities of the superior plates of D5–7. Laboratory was normal except for mild vitamin D deficiency (25OHD 23 ng/ml). BMD (DXA) was low at the spine and femoral neck (Z-scores −4.6 and −2.5, respectively). She received nasal calcitonin briefly; she did not respond to strontium ranelate administered for 1 year, but had a good response to Dmab (+14% in spine BMD after 1 year). Both patients continued treatment with Dmab. We did not find reports of similar cases in the literature treated with this medication.
doi:10.1016/j.bone.2017.03.009
Código: 4 Osteonecrosis of the jaw (ONJ) and atypical femoral fracture (AFF) in an osteoporotic patient chronically treated with bisphosphonates A. Sáncheza, G. Bruchmannb, R. Blancoc a Centro de Endocrinología, Rosario, Argentina b Servicio de Traumatología, Sanatorio Británico, Rosario, Argentina c Instituto Universitario Italiano de Rosario, Argentina Case report: A.C., female of Italian descent, age 87 years, consulted in February 2013. She had a history of osteoporosis and had taken alendronate weekly for several years. She did not have densitometric studies. Due to low back pain an orthopedist had indicated i.v. zoledronic acid, 5 mg/year for 3 years (2006–2008). She was on simvastatin, carvedilol, enalapril, with occasional supplements of ergocalciferol. In 2009 she suffered a fall and sustained a subtrochanteric fracture of the left femur. She was operated on and recovered uneventfully. In 2012 she consulted a dentist due to loose teeth. She underwent the removal of a molar and was given a denture. She had discomfort when using the prosthesis, and developed a lesion in the gum of the lower jaw. After radiologic studies, the diagnosis was ONJ. She improved after surgical debridement, and local and systemic antibiotics. In early 2013 laboratory tests were normal except for a slight elevation of serum PTH and CTX. Calcitriol 0.25 mcg/day was indicated; after 3 months serum calcium, phosphate, PTH and CTX showed no variation. Two years later she experienced acute low back pain after a fall; MRI 8756-3282/$ – see front matter
showed recent crushing of D12, and chronic deformities of D11 and L1. She was treated with nasal calcitonin and analgesics. Comment: Although the association of ONJ and AFF was known in cancer patients treated with high doses of bisphosphonates, it is very rare in patients with osteoporosis treated with these drugs at usual doses. Only two cases have been reported, both in oriental women.
doi:10.1016/j.bone.2017.03.010
Código: 5 Systematic search of femoral radiographic abnormalities in asymptomatic patients treated with bisphosphonates for more than 5 years A. Sánchez Centro de Endocrinología, Rosario, Argentina In order to evaluate the frequency of femoral radiographic abnormalities which can predict high risk of atypical fractures (AFF), a series of 98 asymptomatic patients with postmenopausal osteoporosis chronically treated with bisphosphonates (BF) was evaluated. Those who had been exposed to oral or parenteral BF for more than 5 consecutive years (8.2 ± 2.9x ± s, maximum 18 years) and were still on treatment were selected. Age was 67.3 ± 8.6 years (range 52–87). The age of menopause was 49.3 ± 3.3 years (range 41–59). Of these, 17 had sustained fractures. Lumbar BMD (DXA, in T-score) was − 2.1x ± 0.1 (n = 59) and femoral neck BMD was − 2.0x ± s0.09 (n = 83). All patients had normal serum calcium, phosphate, creatinine, alkaline phosphatase, osteocalcin, and CTX. Fourty-one percent of patients had serum 25OHD values b 30 ng/ml; 12% had PTH values N 70 pg/ml. In only one patient focal bilateral thickening of the cortical diaphysis was found; multislice computed tomography did not find microcracks in these areas. Conclusion: in asymptomatic patients, the frequency of radiologic abnormalities usually associated with risk of AFF is very low (b1%). It is not cost effective to order femoral radiographs routinely.
doi:10.1016/j.bone.2017.03.011
Código: 6 Fructose produces oxidative stress and decreases intestinal calcium absorption V.A. Rodríguez, M.A. Rivoira, S. Guizzardi, N.G. Tolosa de Talamoni Biochemistry and Molecular Biology, INICSA (CONICET-UNC), Argentina Fructose (FRU) has important metabolic effects on the liver and has been associated with many of the components of metabolic syndrome (MS). Naringin (NA), a natural glycosylated flavonoid, is an antioxidant and has other biological properties. The aim of this study was to determine the effect of FRU, in absence or presence of NA, on the duodenal redox state and the intestinal Ca2 + absorption. Adult male Wistar rats were used: 1) controls, 2) FRU: treated with 10% FRU in the drinking water for 30 consecutive days, 3) FRU + NA: injected daily with NA (40 mg/kg b.w.) for 30 days. Intestinal Ca2 + absorption and Ca2 + uptake in mature enterocytes were measured.