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Educational Case: Osteoporosis.

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How long do endoprosthetic reconstructions for proximal femoral tumors last?

BackgroundAs the life expectancy of patients with musculoskeletal tumors improves, long-term studies of endoprosthetic reconstructions are necessary to establish realistic expectations for the implants and compare them to other reconstruction approaches.Questions/purposes(1) What is the long-term survival of cemented bipolar proximal femoral replacements? (2) How does prosthesis survival compare to patient survival among patients with Stage I, II, and III disease? (3) Do modular implants outperform custom-built prostheses? (4) Do some proximal femoral replacements require conversion to THA?Pat

Joint-preserving palliative surgery using self-locking screws of intramedullary nail and percutaneous cementoplasty for proximal humeral metastasis in the advanced cancer patients.

BackgroundWe introduced a palliative joint-preserving surgery using proximal self-locking screws of intramedullary (IM) nail and percutaneous cementoplasty (PC) in patients with proximal humeral metastases, including the head and neck, and evaluated the outcome of the surgical method.MethodsTwenty-three patients (mean age = 63.0 ± 11.8 years, M:F = 14:9) had IM nailing with a self-locking screw system and PC for the treatment of humeral head and neck metastases. Usually, three proximal locking screws were inserted after IM nailing, and 20.9 ± 8.0 ml of polymethylmethacrylate (PMMA) bone cement

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… Recently, PC is combined with flexible or rigid IM nail for long bone metastasis [ 9 , 13 , 14 ] or hollow perforated screws for femur neck metastasis [ 15 , 16 ] and showed durable stability and effective local tumor suppression. …

Adult-onset hypophosphatemic osteomalacia as a cause of widespread musculoskeletal pain: A retrospective case series of single center experience.

BACKGROUND: Osteomalacia (OM) is frequently confused with various musculoskeletal or other rheumatic diseases, especially in patients with adult-onset widespread musculoskeletal pain because of its low prevalence and non-specific manifestations. AIM: To facilitate the early diagnosis and etiology-specific treatment of adult-onset hypophosphatemic OM. METHODS: A retrospective review of medical records was performed to screen adult patients who visited a physiatry locomotive medicine clinic (spine and musculoskeletal pain clinic) primarily presenting with widespread musculoskeletal pain at a s

Non-union after bisphosphonate-associated atypical femoral fractures: a review of the current literature.

BACKGROUND: This article explores the mechanism of action of atypical femoral fractures (AFF), specifically focussing on osteoporosis, management challenges, and the implications for clinical practice. Non-union of AFF can result in severe pain, deformity and restricted mobility-all of which will have a detrimental impact on the patients' quality of life. PURPOSE: This review consolidates the current literature regarding non-union after bisphosphonate-associated atypical femoral fractures, providing a revision tool for higher examinations. METHOD/FINDINGS: An extensive search strategy was co

Incidence of atypical femoral fractures in the treatment of bone metastasis: An alert report.

BackgroundAs the life expectancy of cancer-bearing patients has increased, more patients with bone metastasis are receiving long-term treatment with bone-modifying agents (BMAs; e.g., zoledronate and denosumab), which are a risk factor for developing atypical femoral fracture (AFF). In this study, we surveyed the risk of iatrogenic AFF using a clinical database on treatment of bone metastasis in the past 10 years.MethodsFrom April 2011 through October 2019, 721 patients with bone metastasis (436 men, 285 women; mean age, 65.7 ± 12.4 years) were registered under the bone metastasis consultation

Osteoporosis Drug Treatment Update.

The Brazilian population is aging and the prevalence of chronic degenerative diseases, including osteoporosis, is increasing. The diagnosis and treatment of osteoporosis have made significant advances in the last decade. The orthopedist and traumatologist can no longer be detained only in the surgical treatment of osteoporotic fracture. It is extremely important that we know: 1) what risk factors to evaluate, and the Fracture Risk Assesment Tool (FRAX) can be used; 2) which complementary tests should be requested, such as densitometry, radiography of the spine and pelvis, blood and urine tests

The burden of metastatic disease of the femur on the Medicare system.

BackgroundIn the United States, over 1,650,000 new cases of cancer are being diagnosed yearly with almost 50 % of them being the top five bone-seeking cancers. Since cancer risk increases with age, this suggests that orthopedic oncology services may be a strain on the Medicare system. The femur is the most common site of long bone metastases. Prophylactic fixation techniques prevent pathologic fractures, reduce morbidities, and enhance the quality of life of patients with femoral metastases. This study aims to assess the rate of metastatic disease to the skeleton and evaluate the use and finan

Sternum Metastases: From Case-Identifying Strategy to Multidisciplinary Management.

We aimed to overview the most recent data on sternal metastases from a multidisciplinary approach (diagnosis strategies, outcome, and histological reports). This narrative review based on a PubMed search (between January 2020 and 22 July 2023) using key words such as "sternal", "manubrium", and "metastasis" within the title and/or abstract only included original papers that specifically addressed secondary sternal spreading of cancer in adults, for a total of 48 original articles (14 studies and 34 single case reports). A prior unpublished case in point is also introduced (percutaneous incisio

Percutaneous osteoplasty for extraspinal metastases.

As an extension of percutaneous vertebroplasty (PVP), percutaneous osteoplasty (POP) refers broadly to percutaneous bone cement injected into various parts of the body and narrowly to cement injected into extraspinal bone lesions. POP mainly includes such surgeries as percutaneous sacroplasty, percutaneous acetabuloplasty, percutaneous femoral osteoplasty, and percutaneous iliac osteoplasty (Figure 1). Currently, POP is a positive and an effective treatment for extraspinal bone lesions in that it can rapidly relieve pain, effectively prevent pathological fractures, and partially inactivate tum

Progression of Femoral Osteolytic Metastases after Intramedullary Nailing and Subsequent Salvage Techniques.

Intramedullary nailing insertion from the proximal-to-distal femur is frequently performed for impending and complete pathological femur fractures due to osteolytic metastases. After nailing through cancer-laden bone, residual chemotherapy- and/or radiation-resistant tumor may progress. Progression of osteolysis risks future nail failure or pathological fractures. This study assesses the incidence of cancer progression following intramedullary nailing in a femur-only cohort and describes a percutaneous rod-retaining salvage technique. A single-institution, retrospective study was conducted to

Effect of exercise on bone-related outcomes in patients with cancer affected by bone metastases or bone loss: a systematic review and meta-analysis.

INTRODUCTION: This systematic review and meta-analysis aimed to evaluate the effects of exercise interventions on bone mineral density (BMD), bone mineral content (BMC), and bone turnover markers in patients with cancer and compromised bone health. MATERIALS AND METHODS: A comprehensive search of four electronic databases was conducted to identify randomized controlled trials evaluating the effect of exercise intervention compared to supplementation or bone-targeted agents only on BMD, BMC and bone turnover markers. Meta-analyses were performed using random-effects models to calculate effect

Bone-sparing effects of rituximab and body composition analysis in a cohort of postmenopausal women affected by rheumatoid arthritis - retrospective study.

ObjectiveOsteoporosis is the most common bone tissue disease and it is characterized by a reduced bone mineral density (BMD). The main physiopathological mechanisms converge on the uncoupling between bone formation and resorption, thus leading to an enhanced risk of fractures. Several papers have documented the inverse relationships linking high inflammatory cytokines, anti-citrullinated protein antibodies, rheumatoid factor, and BMD in rheumatoid arthritis (RA). Rituximab (RTX) is a chimeric monoclonal antibody directed against the CD20 receptor of B cells. Since the Food and Drug Administrat

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… BMD [g/cm 2 ] | Baseline ( n = 20) | After 18 months ( n = 20) | p -value Lumbar spine (L1–L4) | 1.031 ±0.11 | 1.110 ±0.10 | 0.0029 ** Whole femur | 0.848 ±0.15 | 0.853 ±0.14 | 0.622 (ns) Femur neck | 0.793 ±0.14 | 0.808 ±0.12 | 0.140 (ns) Fig. 1 Bone mineral density (BMD) modification after 18 months …

Comparative outcomes of internal fixation versus prosthetic reconstruction in the treatment of proximal femoral metastases: a systematic review and meta-analysis.

BACKGROUND: Metastatic disease frequently causes pathological fractures, particularly in the proximal femur, significantly impacting patient prognosis and quality of life. With the advancements in cancer treatment leading to longer survival, there is a pressing need to evaluate the outcomes of surgical interventions aimed at managing proximal femoral metastases. This study compares the outcomes of internal fixation (IF) versus prosthesis (P) in the treatment of proximal femoral metastases, focusing on survival times, complication rates, functional outcomes, and reoperation rates. METHOD: A sy

Osteoporosis case ascertainment strategies in European and Asian countries: a comparative review.

While many clinical guidelines recommend screening for osteoporosis for early detection and treatment, there is great diversity in the case-finding strategies globally. We sought to compare case-finding strategies, focusing on the approaches used in European and Asian countries. This article provides an overview of the current case-finding strategies in the UK, Germany (including Austria and German-speaking regions of Switzerland), China, Japan, and Korea. We conducted a review of current treatment guidelines in each country and included expert opinions from key opinion leaders. Most countries

Ambulation Recovery After Surgery for Metastases to the Femur.

BackgroundPostoperative ambulation recovery after surgery for femur metastases has significant implications for not only the patient's quality of life but also administration of further cancer treatment. Thus, identification of preoperative predictors of ambulation recovery is necessary to set appropriate expectations and guide treatment. This study aimed to assess ambulation recovery rate and identify predictors of ambulation recovery in patients undergoing surgery for femur metastases.Materials and methodsA total of 244 patients who underwent surgery for femur metastases at our institution w

Pertrochanteric fracture of an ankylosed hip with protrusio acetabuli treated by PFNA nail: A case report of a rare case.

INTRODUCTION: Hip fractures are the cause of significant morbidity and mortality, aggravated by the existence of an underlying hip pathology. The association of a pertrochanteric fracture with an ankylosed hip and acetabular protrusion is extremely rare. It has not been reported in the literature and the optimal management remains unknown. The surgical treatment indicated for trochanteric fractures allows patients to restore their autonomy quickly while avoiding complications. CASE PRESENTATION: We present the case of a 45-year-old patient who was followed for multiple myeloma and treated wit

Predicting Pathologic Bone Lesions Using Scout Computed Tomography (CT) Imaging.

The purpose of this study is to evaluate the benefit of reviewing scout CT images, obtained for routine oncologic surveillance, for the early identification of pathologic bony lesions. A retrospective review was conducted on patients who previously underwent surgical treatment by two orthopedic oncology surgeons at a tertiary care institution from 2009-2019 for pathologic lesions or fractures of the humerus or femur. Radiographic records were reviewed to identify patients in this cohort who had available scout views from CT imaging prior to official diagnosis of the bony lesion or fracture. CT

Множественная миелома с участием Лептоминге: исследование Three Расследования случаев диагностирования и лечения.

Участие центральной нервной системы (ЦНС) в многочисленных миеломах (ММ) является редким, но серьезным осложнением, которое создает значительные диагностические и терапевтические проблемы. Эта статья представляет three :: случаи участия лептомингелов в работе пациентов с MM, с уделением особого внимания различным клиническим представлениям, диагностическим подходам и применяемым методам лечения. Первый случай - 54-year-old Женщина, которая после первоначального лечения и аутологической трансплантации стволовых клеток развила болезнь CNS. Аналогичным образом a 73-year-old У самки развилось лепт

Comparative Outcomes in Metastatic Spinal Cord Compression and Femoral Metastatic Disease: Distinct Clinical Entities with Divergent Prognoses?

Background and Objectives: Acute metastatic cord compression (AMSCC) and femoral impending/pathological fracture negatively impact a patient's quality of life, morbidity and survival, and are considered significant life events. This study aims to compare AMSCC and FMD as distinct yet overlapping metastatic orthopedic emergencies, addressing whether they represent sequential disease stages or distinct patient subpopulations-an analysis critical for prognosis and treatment planning. Materials and Methods: Records of all patients who underwent surgery for a femoral metastatic disease (FMD) over a