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Osteoporosis is a worldwide health concern. Although treatment with denosumab plus the active vitamin D alfacalcidol has been found to improve femoral neck (FN) and distal forearm bone mineral density (BMD), there have been no reports on the efficacy or adverse effects of denosumab plus eldecalcitol (ELD) in primary osteoporosis patients. Fifty-six treatment-naïve post-menopausal women with primary osteoporosis were recruited and divided into denosumab plus native vitamin D or denosumab plus ELD. Ultimately, 26 subjects in the native vitamin D group and 24 in the ELD group were analyzed. Lumbar and total hip BMD significantly increased in both groups. However, there was no significant difference in the percent increase of lumbar and total hip BMD between two groups. FN-BMD was significantly increased from 6 to 12 months in the ELD group compared with baseline. This study revealed that combination therapy with denosumab and ELD could improve FN-BMD more effectively than denosumab plus native vitamin D. Thus, the addition of ELD may enhance the effects of denosumab treatment for primary osteoporosis. [ABSTRACT FROM AUTHOR]

Background: Capitellar osteochondritis dissecans (OCD) is a focal injury of the articular cartilage involving separation of a segment of cartilage from the subchondral bone that is infrequently encountered in the dominantside elbow of adolescent throwing athletes. The literature suggests that patients may achieve better short and mid-term results when treated with certain types of surgical procedures. Selection of the appropriate surgical method should be based on the International Cartilage Repair Society (ICRS) OCD classification system. For lesions involving # 50% of the surface area of the capitellum, debridement with microfracture and/or loose body removal have shown excellent results. For lesions involving > 50% of the surface area of the capitellum and classified as ICRS OCD III or IV, autologous osteochondral grafting may be the most suitable treatment. Bone peg grafting (BPG) has been shown to be an effective treatment option for early-stage capitellar OCD that can preserve the local hyaline cartilage. Description: Using direct vision and with arthroscopy, the continuity of the capitellar surface and the stability of the capitellar lesion were evaluated according to the ICRS OCD classification. BPG was indicated for adolescents with ICRS OCD I or II. The elbow was opened between the extensor carpi ulnaris and the anconeus muscle (Kocher interval). Another skin incision of cm in length was made at the posterior aspect of the metaphysis of the ipsilateral olecranon. Three, 4, or 5 bone pegs of approximately 20 mm in length were harvested from the posterior ulnar cortex. A Kirschner wire of 3 mm in diameter was used for drilling holes in the lesion, and then the bone pegs were inserted with tweezers to a depth of 10 mm. Next, a flat-surfaced rod was placed on the head of each bone peg to press it to a depth slightly lower than the articular cartilage surface. Postoperatively, the elbow was immobilized for 3 weeks. Throwing was allowed at 6 months, and a return to competitive baseball at preinjury levels was permitted at 8 months after BPG. Alternatives: • Arthroscopic debridement of the lesion. • Arthroscopic bone marrow stimulation or microfracture. • Fragment fixation using metal implants or biodegradable materials. • Use of autologous osteochondral graft from the distal aspect of the femur or from a rib. Rationale: Our follow-up study after BPG revealed that 10 of 11 patients with ICRS OCD I or II capitellar OCD could return to their preinjury baseball ability and that 8 of the 11 lesions completely healed as seen radiographically. Radiographic and magnetic resonance imaging (MRI) findings showed that BPG could secure the lesion to the osseous floor as a physiological scaffold. Fragment fixation with metal implants or biodegradable materials carries a risk of damaging cartilage surfaces, and autologous osteochondral grafting is too invasive for this early-stage lesion. BPG is indicated for ICRS OCD I or II lesions, especially with central positioning and/or occupying < 7 5% of the size of the capitellum in the coronal plane. [ABSTRACT FROM AUTHOR]

This study aimed to clarify the effects of short-term bisphosphonate (BP) administration in Japanese osteoporotic patients retrospectively. Daily minodronate (MIN) at 1 mg/day (MIN group) or weekly risedronate (RIS) at 17.5 mg/week (RIS group) was primarily prescribed for each patient. We analyzed the laboratory data of 35 cases (18 of MIN and 17 of RIS) before the start of treatment and at 4 months afterward. The changes in 25(OH)D3, whole parathyroid hormone (PTH), serum pentosidine, and the bone turnover markers urinary cross-linked N-telopeptide of type I collagen (NTX), serum tartrate-resistant acid phosphatase (TRACP)-5b, bone-specific alkaline phosphatase (BAP), and undercarboxylated osteocalcin were evaluated. Overall, serum 25(OH)D3 was significantly decreased from 21.8 to 18.4 ng/mL at 4 months, with a percent change of -14.7%. Whole PTH increased significantly from 23.4 to 30.0 pg/mL, with a percent change of 32.1%. Serum pentosidine rose from 0.0306 to 0.0337 μg/mL, with a percent change of 15.2%. In group comparisons, 25(OH)D3 and pentosidine showed comparable changes in both groups after 4 months of treatment, whereas whole PTH became significantly more increased in the MIN group. All bone turnover markers were significantly decreased at 4 months in both groups. Compared with the RIS group, the MIN group exhibited significantly larger value changes for urinary NTX, serum TRACP-5b, and BAP at the study end point. This study demonstrated that serum 25(OH)D3 became significantly decreased after only 4 months of BP treatment in Japanese osteoporotic patients and confirmed that MIN more strongly inhibited bone turnover as compared with RIS. [ABSTRACT FROM AUTHOR]

Background: Denosumab is a fully human monoclonal antibody that inhibits receptor activator of nuclear factor kappa-β ligand (RANKL). Previous reports have shown that denosumab treatment of osteoporotic patients decreases bone resorption and fracture risk, but there have been no clinical studies on changes in bone turnover markers, 1,25(OH)2D3, or parathyroid hormone (PTH) in denosumab therapy with or without bisphosphonate (BP) pre-treatment in Japan. Methods: Here, we report such findings in 22 patients (11 in the denosumab alone group and 11 in the BP pre-treated group) with osteoporosis following 4 months of treatment. Bone metabolism had been inhibited by prior BP administration in the BP pre-treated group. Results: The bone resorption markers serum tartrate-resistant acid phosphatase type 5b and urinary type I collagen cross-linked N-telopeptide were significantly decreased from baseline values for the entire study period in both groups. The bone formation marker bone alkaline phosphatase was significantly decreased at 4 months in the denosumab alone group only, and N-terminal propeptide of type 1 procollagen was significantly decreased at 2 and 4 months in the denosumab alone group versus no remarkable change in the BP pre-treated group. In the denosumab alone group, 1,25(OH)2D3 and PTH were significantly increased at 1 week and decreased gradually thereafter, but these did not change notably in the BP pre-treated group. Conclusions: Our results suggest that treatment with denosumab causes a strong inhibitory effect on bone resorption markers and mild inhibitory effect on bone formation markers. 1,25(OH)2D3 and PTH were significantly increased by denosumab but these did not change in the BP pre-treated group. [ABSTRACT FROM AUTHOR]

The syndrome of pregnancy- and lactation-associated osteoporosis is a rare disorder whose precise etiology and treatment are largely unknown. We herein report two such cases occurring in the early postpartum period that led to multiple fragility compression fractures. Combination therapy of vitamin D and vitamin K enabled a marked gradual increase in bone mineral density. [ABSTRACT FROM AUTHOR]

We report the case of a 40-year-old woman with pseudoachondroplasia (PSACH), with a heterozygous mutation (c.806A > G, p.Asp269Gly) located in the Type 3 repeats domain of the cartilage oligomeric matrix protein gene, who complained of the unusual symptom of painful locking of the wrist. Her condition was caused by a non-traumatic enlargement of the extensor carpi radialis longus (ECRL) and brevis (ECRB) tendons along with bulbous swelling of the synoviums around them. Surgical treatment resolved these unusual tendon-related symptoms. Repetitive mechanical loading of the wrist in daily activities, including distal intersection tenosynovitis between the extensor pollicis longus tendon and ECRL and ECRB tendons, may have contributed to changes in the structural integrity of the tendons. We should pay more attention to tendon-related symptoms in patients with PSACH. [ABSTRACT FROM AUTHOR]

We evaluated bone turnover using biochemical markers in 273 women over 60 years of age with suspected osteoporosis. Their age range was 60–96 years, with an average of 72.7 years. Patients with disorders that might affect bone metabolism were excluded. Those complaining of back pain within 6 months before or after examination were assigned to the back-pain group. Serum bone-specific alkaline phosphatase (BAP) was measured as a bone formation marker, and the urinary N-terminal telopeptide of type I collagen (NTX) was measured as a bone resorption marker. Both BAP and NTX levels increased in individuals over 60 years of age; moreover, these markers were significantly higher in subjects aged over 80 years. Among elderly patients, both BAP and NTX levels were significantly higher in those with back pain than in those without, and in a similar way were observed to increase in parallel with age from the 60-year point. We found that both NTX and BAP increased with aging, and that the increase in these bone turnover markers was closely related to back pain. We also showed that NTX and BAP levels increased significantly in women over 80 years, and specifically in patients with back pain. [ABSTRACT FROM AUTHOR]

Twelve patients presented at our department with low back or buttock pain and were diagnosed as suffering from insufficiency fracture. All patients were evaluated with plain radiographs, magnetic resonance imaging, and/or bone scintigraphy. We also measured biochemical markers of bone turnover in these patients. Bone scintigraphy revealed a high uptake in the fracture site in all patients with insufficiency fracture. Biochemical markers of bone turnover were significantly increased in all patients, but decreased after the fracture healed and the pain was resolved. In those patients who complained of pain again, the biochemical markers of bone turnover had increased once more, and bone scintigraphy showed a new fracture at a different site. Because the changes in bone turnover markers were closely related to clinical symptoms of insufficiency fracture, we speculated that repeated measurements of bone turnover markers may be informative for discriminating insufficiency fracture from bone metastasis. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 62-year-old woman who was diagnosed with locked metacarpophalangeal (MCP) joint in the middle finger. Mentioned is the lipoma in the flexor tenosynovium as well as symptoms of tenosynovial lipomas. Also explored is the histological examination of the tumor originated from a lipoma.