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1. Clinical role of bisphosphonate therapy

Author

Hampson G and Fogelman I

Subjects
Gynecology and obstetrics, RG1-991
Abstract

Geeta Hampson,1,2 Ignac Fogelman1,31Osteoporosis Screening Unit, Guy’s Hospital, 2Department of Chemical Pathology, St Thomas’ Hospital, 3Department of Nuclear Medicine, Guy’s Hospital, London, UKAbstract: Bisphosphonates (BPs) are synthetic analogues of pyrophosphate. They inhibit bone resorption and are therefore widely used in disorders where there are increases or disruptions in bone resorption. This includes postmenopausal osteoporosis, glucocorticoid-induced osteoporosis, Paget’s disease of bone, and malignancy-related bone loss. To best understand the clinical application of BPs, an understanding of their pharmacokinetics and pharmacodynamics is important. This review describes the structure, pharmacology and mode of action of BPs, focusing on their role in clinical practice. Controversies and side effects surrounding their use will also be discussed.Keywords: pyrophosphate, bone resorption, postmenopausal osteoporosis, glucocorticoid-induced osteoporosis, Paget’s disease of bone, malignancy-related bone loss

Published
2012

4. Survival data from the ZEBRA study

Author

Namer, Moise, Jonat, W, Kaufmann, M, Blamey, R, Cuzick, J, Fogelman, I, de Haes, H, Saubrei, W, and Schumacher, W

Published
2002

8. Comparison of clinical, radionuclide, and radiographic features of osteoarthritis of the hands

Author

Macfarlane, D.G., Buckland-Wright, J.C., Emery, P., Fogelman, I., Clark, B., and Lynch, J.

Subjects
Osteoarthritis, Health
Abstract

Osteoarthritis, rather than being a true disease, is a disorder in which joints disintegrate due to many causes. It is characterized by loss of joint cartilage, in reaction to which new bone forms at joint margins. Synovitis (inflammation of the joint lining) and fibrous thickening of the capsule surrounding the joint also occur. Trauma and abnormal development are implicated as causes in the hip and knee, while the factors contributing to osteoarthritis of the hands is unknown, but likely include genetic factors. Osteoarthritis is very common, but difficult to identify in early stages, so it is difficult to determine by X-ray which changes are due to the disorder and which to processes of aging. While X-rays indicate structure and show the result of repair and destruction, bone scans, or scintigraphy, can evaluate function and reflect bone formation and resorption activity and presence of blood vessels. Thus, bone scans indicate the response of bone to insults such as trauma, inflammation, or tumors. To better understand the disease process in osteoarthritis of the hand, results from scintigraphy, medical observation, and microfocal radiography (high-resolution X-rays) in evaluation of 32 patients (29 female) with osteoarthritis were compared. During the 18-month study, the number of mid-finger joints affected by osteoarthritis increased significantly, as did the joint size. The layer of subchondral bone (below joint cartilage) in the wrist was thicker than normal and increased significantly during the study. The number and size of osteophytes (bone spurs) increased significantly. There was an increase in radiolucencies (areas of decreased bone density on X-ray) near the wrist and finger joints, the significance of which is unclear. Joint space width narrowed in 47 percent of patients. Two thumb joints, one index finger joint, a middle finger joint, and a wrist joint had positive bone scans. Positive scans correlated with osteophyte size, joint tenderness, and number of osteophytes. Bone scan results did not correlate with subchondral thickening, joint space width, or radiolucencies. The study indicates that osteophyte formation seemed to be key in causing medical symptoms, and was a marker for subsequent joint disintegration, which was predicted by positive bone scans. (Consumer Summary produced by Reliance Medical Information, Inc.)

Published
1991

17. Cardiovascular complications in CKD 5D

Author

Fusaro, M., primary, Fusaro, M., additional, Noale, M., additional, Tripepi, G., additional, D'angelo, A., additional, Miozzo, D., additional, Gallieni, M., additional, Study Group, P.-V., additional, Tsamelesvili, M., additional, Dimitriadis, C., additional, Papagianni, A., additional, Raidis, C., additional, Efstratiadis, G., additional, Memmos, D., additional, Mutluay, R., additional, Konca Degertekin, C., additional, Derici, U., additional, Deger, S. M., additional, Akkiyal, F., additional, Gultekin, S., additional, Gonen, S., additional, Tacoy, G., additional, Arinsoy, T., additional, Sindel, S., additional, Sanchez-Perales, C., additional, Vazquez, E., additional, Merino, E., additional, Perez Del Barrio, P., additional, Borrego, F. J., additional, Borrego, M. J., additional, Liebana, A., additional, Krzanowski, M., additional, Janda, K., additional, Dumnicka, P., additional, Krasniak, A., additional, Sulowicz, W., additional, Kim, Y.-O., additional, Yoon, S.-A., additional, Yun, Y.-S., additional, Song, H.-C., additional, Kim, B.-S., additional, Cheong, M. A., additional, Pasch, A., additional, Farese, S., additional, Floege, J., additional, Jahnen-Dechent, W., additional, Ohtake, T., additional, Furuya, R., additional, Iwagami, M., additional, Tsutsumi, D., additional, Mochida, Y., additional, Ishioka, K., additional, Oka, M., additional, Maesato, K., additional, Moriya, H., additional, Hidaka, S., additional, Kobayashi, S., additional, Guedes, A., additional, Malho Guedes, A., additional, Pinho, A., additional, Fragoso, A., additional, Cruz, A., additional, Mendes, P., additional, Morgado, E., additional, Bexiga, I., additional, Silva, A. P., additional, Neves, P., additional, Oyake, N., additional, Suzuki, K., additional, Itoh, S., additional, Yano, S., additional, Turkmen, K., additional, Kayikcioglu, H., additional, Ozbek, O., additional, Saglam, M., additional, Toker, A., additional, Tonbul, H. Z., additional, Gelev, S., additional, Trajceska, L., additional, Srbinovska, E., additional, Pavleska, S., additional, Amitov, V., additional, Selim, G., additional, Dzekova, P., additional, Sikole, A., additional, Bouarich, H., additional, Lopez, S., additional, Alvarez, C., additional, Arribas, I., additional, DE Sequera, P., additional, Rodriguez, D., additional, Tanaka, S., additional, Kanemitsu, T., additional, Sugahara, M., additional, Kobayashi, M., additional, Uchida, L., additional, Ishimoto, Y., additional, Kotera, N., additional, Tanimoto, S., additional, Tanabe, K., additional, Hara, K., additional, Sugimoto, T., additional, Mise, N., additional, Goldstein, B., additional, Turakhia, M., additional, Arce, C., additional, Winkelmayer, W., additional, Zayed, B. E.-D., additional, Said, K., additional, Nishimura, M., additional, Okamoto, Y., additional, Tokoro, T., additional, Nishida, M., additional, Hashimoto, T., additional, Iwamoto, N., additional, Takahashi, H., additional, Ono, T., additional, Sato, N., additional, Raimann, J., additional, Usvyat, L. A., additional, Sands, J., additional, Levin, N. W., additional, Kotanko, P., additional, Iwasaki, M., additional, Joki, N., additional, Tanaka, Y., additional, Ikeda, N., additional, Hayashi, T., additional, Kubo, S., additional, Imamura, T.-A., additional, Takahashi, Y., additional, Hirahata, K., additional, Imamura, Y., additional, Hase, H., additional, Claes, K., additional, Meijers, B., additional, Bammens, B., additional, Kuypers, D., additional, Naesens, M., additional, Vanrenterghem, Y., additional, Evenepoel, P., additional, Boscutti, G., additional, Calabresi, L., additional, Bosco, M., additional, Simonelli, S., additional, Boer, E., additional, Vitali, C., additional, Martone, M., additional, Mattei, P. L., additional, Franceschini, G., additional, Baligh, E., additional, El-Shafey, E., additional, Ezaat, A., additional, Zawada, A., additional, Rogacev, K., additional, Hummel, B., additional, Grun, O., additional, Friedrich, A., additional, Rotter, B., additional, Winter, P., additional, Geisel, J., additional, Fliser, D., additional, Heine, G. H., additional, Makino, J.-I., additional, Makino, K.-S., additional, Ito, T., additional, Genovesi, S., additional, Santoro, A., additional, Fabbrini, P., additional, Rossi, E., additional, Pogliani, D., additional, Stella, A., additional, Bonforte, G., additional, Remuzzi, G., additional, Bertoli, S., additional, Pozzi, C., additional, Pasquali, S., additional, Cagnoli, L., additional, Conte, F., additional, Buzadzic, I., additional, Tosic, J., additional, Dimkovic, N., additional, Djuric, Z., additional, Popovic, J., additional, Pejin Grubisa, I., additional, Barjaktarevic, N., additional, DI Napoli, A., additional, DI Lallo, D., additional, Salvatori, M. F., additional, Franco, F., additional, Chicca, S., additional, Guasticchi, G., additional, Onofriescu, M., additional, Hogas, S., additional, Luminita, V., additional, Mugurel, A., additional, Gabriel, V., additional, Laura, F., additional, Irina, M., additional, Adrian, C., additional, Bosch, E., additional, Baamonde, E., additional, Culebras, C., additional, Perez, G., additional, El Hayek, B., additional, Ramirez, J. I., additional, Ramirez, A., additional, Garcia, C., additional, Lago, M., additional, Toledo, A., additional, Checa, M. D., additional, Taira, T., additional, Hirano, T., additional, Nohtomi, K., additional, Hyodo, T., additional, Chiba, T., additional, Saito, A., additional, Kim, Y. K., additional, Choi, E. J., additional, Yang, C. W., additional, Kim, Y.-S., additional, Lim, P. S., additional, Ming Ying, W., additional, Ya-Chung, J., additional, Zaripova, I., additional, Kayukov, I., additional, Essaian, A., additional, Nimgirova, A., additional, Young, H., additional, Dungey, M., additional, Watson, E. L., additional, Baines, R., additional, Burton, J. O., additional, Smith, A. C., additional, Yamazaki, K., additional, Bossola, M., additional, Colacicco, L., additional, Scribano, D., additional, Vulpio, C., additional, Tazza, L., additional, Okada, T., additional, Okada, N., additional, Michibata, I., additional, Yura, T., additional, Montero, N., additional, Soler, M., additional, Pascual, M., additional, Barrios, C., additional, Marquez, E., additional, Rodriguez, E., additional, Orfila, M. A., additional, Cao, H., additional, Arcos, E., additional, Comas, J., additional, Pascual, J., additional, Ferrario, M., additional, Garzotto, F., additional, Sironi, T., additional, Monacizzo, S., additional, Basso, F., additional, Cruz, D. N., additional, Moissl, U., additional, Tetta, C., additional, Signorini, M. G., additional, Cerutti, S., additional, Ronco, C., additional, Mostovaya, I., additional, Grooteman, M., additional, Van den Dorpel, M., additional, Penne, L., additional, Van der Weerd, N., additional, Mazairac, A., additional, Den Hoedt, C., additional, Levesque, R., additional, Nube, M., additional, Ter Wee, P., additional, Bots, M., additional, Blankestijn, P., additional, Liu, J., additional, MA, K. L., additional, Zhang, X., additional, Liu, B. C., additional, Vladu, I.-D., additional, Mustafa, R., additional, Cana-Ruiu, D., additional, Vaduva, C., additional, Grauntanu, C., additional, Mota, E., additional, Singh, R., additional, Abbasian, N., additional, Stover, C., additional, Brunskill, N., additional, Burton, J., additional, Herbert, K., additional, Bevington, A., additional, Wu, M., additional, Tang, R.-N., additional, Gao, M., additional, Liu, H., additional, Chen, L., additional, LV, L.-L., additional, Liu, B.-C., additional, Nikodimopoulou, M., additional, Liakos, S., additional, Kapoulas, S., additional, Karvounis, C., additional, Fedak, D., additional, Kuzniewski, M., additional, Paulina, D., additional, Kusnierz-Cabala, B., additional, Kapusta, M., additional, Solnica, B., additional, Junque, A., additional, Vicent, E. S., additional, Moreno, L., additional, Fulquet, M., additional, Duarte, V., additional, Saurina, A., additional, Pou, M., additional, Macias, J., additional, Lavado, M., additional, Ramirez de Arellano, M., additional, Ryuzaki, M., additional, Nakamoto, H., additional, Kinoshita, S., additional, Kobayashi, E., additional, Takimoto, C., additional, Shishido, T., additional, Enia, G., additional, Torino, C., additional, Tripepi, R., additional, Panuccio, V., additional, Postorino, M., additional, Clementi, A., additional, Garozzo, M., additional, Bonanno, G., additional, Boito, R., additional, Natale, G., additional, Cicchetti, T., additional, Chippari, A., additional, Logozzo, D., additional, Alati, G., additional, Cassani, S., additional, Sellaro, A., additional, Zoccali, C., additional, Quiroga, B., additional, Verde, E., additional, Abad, S., additional, Vega, A., additional, Goicoechea, M., additional, Reque, J., additional, Lopez-Gomez, J. M., additional, Luno, J., additional, Cabre Menendez, C., additional, Moles, V., additional, Vives, J. P., additional, Villa, D., additional, Vinas, J., additional, Compte, T., additional, Arruche, M., additional, Diaz, C., additional, Soler, J., additional, Aguilera, J., additional, Martinez Vea, A., additional, De Mauri, A., additional, David, P., additional, Conte, M. M., additional, Chiarinotti, D., additional, Ruva, C. E., additional, De Leo, M., additional, Bargnoux, A.-S., additional, Morena, M., additional, Jaussent, I., additional, Chalabi, L., additional, Bories, P., additional, Dion, J.-J., additional, Henri, P., additional, Delage, M., additional, Dupuy, A.-M., additional, Badiou, S., additional, Canaud, B., additional, Cristol, J.-P., additional, Sironi, E., additional, Pieruzzi, F., additional, Galbiati, E., additional, Vigano, M. R., additional, Anpalakhan, S., additional, Rocha, S., additional, Chitalia, N., additional, Sharma, R., additional, Kaski, J. C., additional, Chambers, J., additional, Goldsmith, D., additional, Banerjee, D., additional, Cernaro, V., additional, Lacquaniti, A., additional, Lupica, R., additional, Lucisano, S., additional, Fazio, M. R., additional, Donato, V., additional, Buemi, M., additional, Segalen, I., additional, Vinsonneau, U., additional, Tanquerel, T., additional, Quiniou, G., additional, Le Meur, Y., additional, Seibert, E., additional, Girndt, M., additional, Zohles, K., additional, Ulrich, C., additional, Kluttig, A., additional, Nuding, S., additional, Swenne, C., additional, Kors, J., additional, Werdan, K., additional, Fiedler, R., additional, Van der Weerd, N. C., additional, Grooteman, M. P., additional, Van den Dorpel, M. A., additional, Nube, M. J., additional, Wetzels, J., additional, Swinkels, D. W., additional, Ter Wee, P. M., additional, Khandekar, A., additional, Khandge, J., additional, Lee, J. E., additional, Moon, S. J., additional, Choi, K. H., additional, Lee, H. Y., additional, Kim, B. S., additional, Tuaillon, E., additional, Rodriguez, A., additional, Chenine, L., additional, Vendrell, J.-P., additional, Sue, Y.-M., additional, Tang, C.-H., additional, Chen, Y.-C., additional, Segura, P., additional, Garcia Cortes, M. J., additional, Gil, J. M., additional, Biechy, M. M., additional, Poulikakos, D., additional, Shah, A., additional, Persson, M., additional, Dattolo, P., additional, Amidone, M., additional, Michelassi, S., additional, Moriconi, L., additional, Betti, G., additional, Conti, P., additional, Rosati, A., additional, Mannarino, A., additional, Panichi, V., additional, Pizzarelli, F., additional, Klejna, K., additional, Naumnik, B., additional, Koc-Zorawska, E., additional, Mysliwiec, M., additional, Dimitrie, S., additional, Simona, H., additional, Mihaela, O., additional, Gabriela, O., additional, Radu, S., additional, Octavian, P., additional, Akdam, H., additional, Akar, H., additional, Yenicerioglu, Y., additional, Kucuk, O., additional, Kurt Omurlu, I., additional, Thambiah, S., additional, Roplekar, R., additional, Manghat, P., additional, Fogelman, I., additional, Fraser, W., additional, Hampson, G., additional, Likaj, E., additional, Caco, G., additional, Seferi, S., additional, Rroji, M., additional, Barbullushi, M., additional, Thereska, N., additional, Serban, A., additional, Carmen, V., additional, Cristian, S., additional, Silvia, L., additional, and Covic, A., additional

Published
2012
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21. Bone mineral density in professional female dancers.

Author

Keay N, Fogelman I, Blake G, Keay, N, Fogelman, I, and Blake, G

Abstract

Objectives: To measure the long term effects of dance training and the contribution of the timing and duration of any menstrual disruption on bone mineral density (BMD).Design: Measurement of BMD in 57 premenopausal, previously professionally dance trained women and the relationship to menstrual and training history.Main Outcome Measures: Bone density measurements at lumbar spine and femoral neck by dual energy x-ray absorptiometry.Results: The average Z score for BMD at the lumbar spine in the amenorrhoeic dancers was significantly below that for the normal population. The average Z score for BMD at the femoral neck in the eumenorrhoeic dancers was significantly above that for the normal population. There was a significant difference between the average Z score for BMD at both the lumbar spine and femoral neck between the amenorrhoeic and eumenorrhoeic dancers. Significant negative relationships were found between BMD at the lumbar spine and (1) age at menarche, (2) duration of amenorrhoea, (3) BMD at the femoral neck, and (4) the variable of ideal minus lowest weight, which was independent of amenorrhoea. No significant relationships were found between duration of oral contraceptive pill usage and BMD at either the lumbar spine or the femoral neck in eumenorrhoeic or amenorrhoeic dancers. In order to quantify the effect of a combination of these significant factors, a model of BMD was constructed using multiple regression incorporating the variables duration of amenorrhoea, age at menarche, and ideal minus lowest body weight. In this model R2 was 33.6%, in other words 33.6% of the total variation in the Z score for BMD at the lumbar spine could be accounted for by these factors.Conclusion: Professional female dancers with a history of delayed menarche and amenorrhoea have been identified as another group of premenopausal women potentially at risk of developing osteoporosis because of a decrease in BMD at the lumbar spine. The femoral neck in dancers with a history of amenorrhoea was partially protected from loss of BMD by virtue of being the major weight bearing site in previous dance training, and in eumenorrhoeic dancers BMD was significantly increased at this site. [ABSTRACT FROM AUTHOR]

Published
1997

24. The accurance of volumetric bone density measurements in dual X-ray absorptiometry

Author

Sabin, M. A., Blake, G. M., MacLaughlin-Black, S. M., Fogelman, I., Sabin, M. A., Blake, G. M., MacLaughlin-Black, S. M., and Fogelman, I.

Abstract

New developments in dual x-ray absorptiometry (DXA) allow the performance of high precision anteroposterior (AP) and lateral scans of spinal bone mineral density (BMD, units: g/cm2) without the patient moving from the supine position. Data from both projections may be combined to give an estimate of the true volumetric bone mineral density (VBMD, units: g/cm3) of the lumbar vertebral bodies. This report presents a cadaver study designed to validate DXA measurements of volumetric bone density. Sections of whole lumbar spine were scanned in AP and lateral projections in a water tank to simulate soft tissue. Individual vertebrae were then divided to separate the vertebral body from the neural arch, and vertebral body volume was measured using the displacement of sand. The bone mineral content (BMC) of vertebral bodies and neural arches was measured by ashing at 250°C for 60 hours followed by 500°C for a further 24 hours. The results showed that DXA scanning systematically underestimated ashing data by 14% for AP BMC, 33% for vertebral body BMC, 23% for vertebral body volume, and 12% for VBMD. Despite these significant systematic errors, the DXA measurements and ashing values were highly correlated (r=0.979-0.992). The results suggested that after allowing for the systematic errors, lateral DXA parameters related closely to true BMC, volume, and VBMD.

Published
1995

27. Bone densitometry Is a valuable investigation

Author

Compston, J E, primary, Duncan, W E, additional, Stott, D M, additional, Burman, K D, additional, Change, A S, additional, Reid, D M, additional, Cooper, C, additional, Fogelman, I, additional, Eastell, R, additional, and Woolf, A, additional

Published
1994
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29. Guidelines for the Design and Conduct of AIDS Clinical Trials

Author

Cotton, D. J., primary, Powderly, W. G., additional, Feinberg, J., additional, Abrams, D. I., additional, Chaisson, R. E., additional, Wheat, L. J., additional, Finkelstein, D. M., additional, Tallman, V., additional, Zimmer, B., additional, Berzon, R., additional, Fogelman, I., additional, and Phair, J., additional

Published
1993
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35. CORRESPONDENCE.

Author

Abbas, Edgar, Gowans, J.L., Dudley, Hugh, Studd, John, Brincat, Mark, Magos, Adam, Montgomery, Julia, Bancroft, John, Clare, Anthony W., Jenkins, Rachel, Price, Jane, Higgs, C.M.B., Jones, Patricia, Goolden, A.W.G., Talbot, C.H., Eyre-Brook, I., Maisey, M.N., and Fogelman, I.

Subjects
MEDICINE, MENTAL illness, HYPERTHYROIDISM treatment
Abstract

Comments on several issues related to medicine. Interest of caring institutions for drug abusers; Association of women's mental illness with reproductive biology; Prevalence of inappropriate drug treatment in patients with hyperthyroidism.

Published
1986

37. THE VALUE OF SPECT SCANS IN IDENTIFYING BACK PAIN LIKELY TO BENEFIT FROM FACET JOINT INJECTION.

Author

DOLAN, A. L., RYAN, P. J., ARDEN, N. K., STRATTON, R., WEDLEY, J. R., HAMANN, W., FOGELMAN, I., and GIBSON, T.

Abstract

Lumbar facet disease is sometimes implicated in low back pain. Identification is difficult and this may account for a variable response. Single photon emission computerized tomography (SPECT) is a scanning technique which enables localization of facet joint pathology. We determined whether recognition of facet disease by this method improved the response to corticosteroid injection treatment. Fifty-eight patients with low back pain and displaying accepted clinical criteria for facet joint disease were evaluated by SPECT. Twenty-two had facetal uptake of isotope. These and the tender facet joints of 36 scan-negative patients were injected with 40 mg methylprednisolone and 1 ml 1% lignocaine under X-ray control. Pain was assessed by a blind observer using the McGill questionnaire (MGQ), Present Pain Intensity score (PPI) and a Visual Analogue Scale (VAS). VAS, PPI and MGQ were reduced in the scan-positive patients at 1 month (P = 0.05, P = 0.0005, P = 0.005) and MGQ at 3 months (P = 0.01), whilst scan-negative patients were unchanged. The percentage of scan-positive patients who reported improvement was 95% at 1 month and 79% at 3 months, significantly greater than the control group (P = 0.0005, P = 0.01). Within 6 months, pain improvement in the SPECT-positive group was no longer statistically significant. Tenderness did not correlate with increased uptake on SPECT scan. Osteoarthritis of the facets was more common in the SPECT-positive patients (P < 0.001), but did not correspond with sites of increased uptake on SPECT scan. These results suggest that SPECT can enhance the identification of back pain sufferers likely to obtain short-term benefit from facet joint injection. [ABSTRACT FROM PUBLISHER]

Published
1996
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44. Quantification of Skeletal Kinetic Indices in Paget's Disease Using Dynamic18F‐Fluoride Positron Emission Tomography

Author

Cook, G. J. R., Blake, G. M., Marsden, P. K., Cronin, B., and Fogelman, I.

Abstract

The purpose of this study was to quantify indices of regional bone metabolism in Paget's disease and to compare these indices with normal bone using dynamic18F‐fluoride positron emission tomography (PET). Seven patients with vertebral Paget's disease had 1 h dynamic18F‐fluoride PET scans performed. The scans included a diseased vertebra and an adjacent normal vertebra. Arterial plasma input functions were also measured. A three‐compartment, four‐parameter model was used with nonlinear regression analysis to estimate bone kinetic variables. Compared with normal bone, pagetic bone demonstrated higher values of plasma clearance to bone mineral (Ki; 1.03 × 10−1vs. 0.36 × 10−1ml/min per milliliter; p= 0.018) and clearance to total bone tissue (K1; 2.38 × 10−1vs. 1.25 × 10−1ml/min per milliliter; p= 0.018), reflecting increased mineralization and blood flow, respectively. Release of18F‐fluoride from bone mineral (k4) was lower in pagetic bone (p= 0.022), suggesting tighter binding of18F‐fluoride to bone mineral. The notional volume of the extravascular bone compartment (K1/k2) was greater in pagetic bone (p= 0.018). Although the unidirectional extraction efficiency from the extravascular space to bone mineral (Ki/K1) was greater in pagetic bone (p= 0.018), a lower pagetic value of k2(p= 0.028), describing the rate of transfer from the bone extravascular compartment to plasma, suggests that the18F‐fluoride that enters the relatively fibrotic marrow space of pagetic bone may be less accessible for return to plasma. These findings confirm some of the known pathophysiology of Paget's disease, introduce some new observations, and show how dynamic18F‐fluoride PET may be of value in the measurement of regional metabolic parameters in focal bone disorders.

Published
2002
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45. Morphometric X‐Ray Absorptiometry and Morphometric Radiography of the Spine: A Comparison of Prevalent Vertebral Deformity Identification*

Author

Dr. Rea, J. A., Chen, M. B., Li, J., Blake, G. M., Steiger, P., Genant, H. K., and Fogelman, I.

Abstract

Prevalent vertebral deformities are associated with a substantially increased risk of subsequent vertebral and nonvertebral fractures. Knowledge of vertebral fracture status is an important component in the prediction of further fractures in patients with osteoporosis. This study reports a comparison of the quantitative identification of vertebral deformities on morphometric X‐ray absorptiometry (MXA) scans and conventional radiographs (MRX) in 161 postmenopausal women (mean age ± SD, 64 ± 7.1 years) recruited from patients referred by their family doctor for bone density measurement (n= 119) and osteoporotic subjects with known vertebral deformities attending an osteoporosis clinic (n= 42). Each subject had MXA scans and MRXs of the thoracolumbar spine, to image the vertebrae from T4–L4, at a single visit. The scans and radiographs were analyzed by two trained observers using six points to quantify the shape of each vertebral body. From these points, three vertebral heights were measured: anterior, middle, and posterior. Vertebral deformities were identified using the algorithms proposed by Eastell and by McCloskey. Generally good to excellent agreement (per vertebra, κ = 0.87–0.93; per subject, κ = 0.81–0.91) was observed between the two algorithms used for quantitative vertebral deformity identification using MXA or MRX More moderate agreement (per vertebra, κ = 0.70–0.79; per subject, κ = 0.67–0.75) was seen when comparing the same algorithm between MXA and MRX Agreement between MXA and MRX for the McCloskey algorithm was better than for the Eastell algorithm, largely because of the lower number of false positives produced by the McCloskey methodology. Deformity identification by MXA was limited because of poor image quality, primarily in the upper thoracic spine. One in six MRX deformities were missed by MXA as they occurred in vertebrae not visualized sufficiently for analysis on the MXA scans. Deformity identification was poorer in the upper thoracic spine in analyzable vertebrae with a sensitivity of 50.0% for MXA in terms of MRX using the Eastell algorithm for the vertebral levels T4–T7, compared with 80.6% for L1–L4. MXA proved to be more effective at identifying moderate to severe MRX deformities producing a sensitivity of 22.0% for MXA in terms of identifying MRX grade 1 deformities using the Eastell algorithm, compared with 81.6% for grade 2 deformities. Although MXA image quality is inferior to that of conventional radiographs, MXA has distinct advantages such as a substantially reduced effective dose to the patient and acquisition of a single image of the spine. MXA is a potentially useful, relatively fast, low‐radiation technique to identify prevalent vertebral deformities, particularly moderate to severe deformities in the middle/lower thoracic and lumbar spine, in conjunction with morphometric radiography in some patients.

Published
2000
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46. Osteoporosis and chronic back pain: A study with single‐photon emission computed tomography bone scintigraphy

Author

Dr. Ryan, P.J., Evans, P., Gibson, T., and Fogelman, I.

Abstract

A group of 26 patients aged 47–81 years (average 67) with spinal osteoporosis and back pain for more than 6 months were investigated with planar and SPECT bone scintigraphy and anterior and lateral x‐rays of the thoracolumbar spine. Abnormal activity on bone scintigraphy was found in all patients, of whom 22 had multiple lesions. A total of 17 (65%) patients had abnormal activity associated with collapsed vertebral bodies, 5 (19%) had degenerative disk disease, and 21 (81%) had facetal joint disease. Of 112 lesions identified by SPECT, 60 (54%) were localized to the apophyseal joints. Facetal lesions were commoner in those patients with more collapsed vertebrae, and 32 facetal lesions (54%) were associated with collapse of the vertebra immediately above or below. Bone scintigraphy findings suggest that in some individuals with osteoporosis and chronic back pain, collapse of the vertebral body or degenerative disk disease are causes of pain. However, the high frequency of increased apophyseal joint activity suggests that the facet joints may also be an important site of origin of pain in these individuals. Bone scintigraphy may identify a subgroup of osteoporotic patients with chronic back pain who would benefit from treatment to the facet joints.

Published
1992
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47. The effect of 1α‐hydroxyvitamin D3on the mineralization defect in disodium etidronate‐treated paget's disease — a double‐blind randomized clinical study

Author

Ralston, S.H., Boyce, B.F., Cowan, R.A., Fogelman, I., Smith, M.L., Jenkins, A., and Boyle, I.T.

Abstract

A double‐blind randomized study of 29 patients with symptomatic Paget's disease was conducted comparing the clinical, biochemical, and histomorphometric responses to 3‐month treatment with placebo (10 patients), low‐dose disodium etidronate (EHDP) (5–7 mg/kg/day) (10 patients), and low‐dose EHDP plus 1α‐hydroxy‐vitamin D3(1αD3) 0.5 mcg daily (9 patients). In placebo‐treated patients no significant changes were observed in symptoms, biochemistry, or bone histomorphometry. Histologically apparent mineralization defects developed after 3 months of therapy in 90% of patients in the EHDP group, compared with 45% of patients in the EHDP/1αD3group. In 19% of the patients treated with active medication, the mineralization defects in pagetic bone were accompanied by histological evidence of continued osteoclastic resorption. The development of mineralization defects was not related to serum levels of vitamin D metabolites, alkaline phosphatase, or intestinal calcium absorption but did correlate with the occurrence of hyperphosphatemia during treatment, which was most marked in patients treated with EHDP alone. Although mineralization defects were less frequent in the EHDP/1αD3group, these patients also responded less well symptomatically, thus limiting the potential usefulness of this drug combination in Paget's disease. It is suggested that the diminished response in the EHDP/1αD3group and the lower frequency of mineralization defects may have been related to an alteration in the intestinal absorption of EHDP by the vitamin D metabolite.Of patients treated with EHDP alone, 90% had symptomatic and biochemical improvement, suggesting that this agent is generally an effective and safe treatment in Paget's disease. However, in view of the high incidence of mineralization defects, we would continue to advise caution in the use of EHDP where there is significant deformity of, or lytic lesions, in weight‐bearing bones.

Published
1987
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48. Review. Management of male osteoporosis: report of the UK Consensus Group

Author

Reeve, J., Eastell, R., Reid, D., Boyle, I., Compston, J., Russell, R., Stevenson, J., Cooper, C., Fogelman, I., Francis, R., Purdie, D., Ralston, S., and Hosking, D.

Abstract

Although osteoporosis is generally regarded as a disease of women, up to 30% of hip fractures and 20% of vertebral fractures occur in men. Risk factors for osteoporotic fractures in men include low body mass index, smoking, high alcohol consumption, corticosteroid therapy, physical inactivity, diseases that predispose to low bone mass, and conditions increasing the risk of falls. The key drugs and diseases that definitely produce a decrease in bone mineral density (BMD) and/or an increase in fracture rate in men are long-term corticosteroid use, hypogonadism, alcoholism and transplantation. Age-related bone loss may be a result of declining renal function, vitamin D deficiency, increased parathyroid hormone levels, low serum testosterone levels, low calcium intake and absorption. Osteoporosis can be diagnosed on the basis of radiological assessments of bone mass, or clinically when it becomes symptomatic. Various biochemical markers have been related to bone loss in healthy and osteoporotic men. Their use as diagnostic tools, however, needs further investigation. A practical approach would be to consider a bone density more than one SD below the age-matched mean value (Z&lt;-1) as an indication for therapy. The treatment options for men with osteoporosis include agents to influence bone resorption or formation and specific therapy for any underlying pathological condition. Testosterone treatment increases BMD in hypogonadonal men, and is most effective in those whose epiphyses have not closed completely. Bisphosphonates are the treatment of choice in idiopathic osteoporosis, with sodium fluoride and anabolic steroids to be used as alternatives.

Published
1998

49. Management of the solitary thyroid nodule

Author

Watkinson, J C, Sherry, M, Shaheen, O H, Clarke, S E, Fogelman, I, and Maisey, M N

Subjects
Pathology, medicine.medical_specialty, business.industry, Biopsy, Needle, Thyroid Gland, General Medicine, Thyroid Diseases, 030227 psychiatry, 03 medical and health sciences, 0302 clinical medicine, Solitary thyroid nodule, Medicine, Humans, Thyroid Neoplasms, 030212 general & internal medicine, business, Radionuclide Imaging, Research Article
Published
1989

50. Pseudohypoparathyroidism presenting as severe Parkinsonism.

Author

Pearson, D. W., Durward, W. F., Fogelman, I., Boyle, I. T., and Beastall, G.

Subjects
INBORN errors of metabolism diagnosis, BRAIN diseases, CALCIUM, INBORN errors of metabolism, METALS in the body, PARKINSON'S disease, CALCINOSIS, DISEASE complications
Abstract

A case of pseudohypoparathyroidism in a middle-aged female presenting with severe Parkinsonism is reported. Correction of serum calcium led to marked clinical improvement suggesting that symptoms and signs were exacerbated by hypocalcaemia and tetanic spasm. Calcification of the basal ganglia was not detected on skull X-ray but was revealed by computerized axial tomography. [ABSTRACT FROM PUBLISHER]

Published
1981
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