C. S. H. Grace, K. W. B. Kelvin, C. T. Wei & T. B. Yeow
|
|
- Justin Howard
- 5 years ago
- Views:
Transcription
1 Stress fracture of the ulna associated with bisphosphonate therapy and use of walking aid C. S. H. Grace, K. W. B. Kelvin, C. T. Wei & T. B. Yeow Osteoporosis International With other metabolic bone diseases ISSN X DOI /s
2 Your article is protected by copyright and all rights are held exclusively by International Osteoporosis Foundation and National Osteoporosis Foundation. This e-offprint is for personal use only and shall not be selfarchived in electronic repositories. If you wish to self-archive your article, please use the accepted manuscript version for posting on your own website. You may further deposit the accepted manuscript version in any repository, provided it is only made publicly available 12 months after official publication or later and provided acknowledgement is given to the original source of publication and a link is inserted to the published article on Springer's website. The link must be accompanied by the following text: "The final publication is available at link.springer.com. 1 23
3 DOI /s CASE REPORT Stress fracture of the ulna associated with bisphosphonate therapy and use of walking aid C. S. H. Grace & K. W. B. Kelvin & C. T. Wei & T. B. Yeow Received: 16 March 2014 /Accepted: 1 May 2014 # International Osteoporosis Foundation and National Osteoporosis Foundation 2014 Abstract We report a case of a stress fracture of the ulna secondary to long-term bisphosphonate therapy and walking cane. Physicians need to have a high index of suspicion of stress fractures occurring in patients complaining of chronic upper limb pain if they are on bisphosphonate therapy and are using walking aids. Stress fractures of the upper extremities are rare and are usually associated with athletes; however, a few recent case reports have shown an association between stress fractures of the upper extremities and the use of walking aids. The association between increased incidence of upper extremity stress fractures and the use of both bisphosphonates and walking aids in patients has not been well studied, with only one previously reported case. Here, we report a case of a complete stress fracture of the ulna in a 77-year-old female, premorbidly ambulant with walking cane, on long-term bisphosphonates without any pre-existing medical conditions which could result in secondary causes of bone loss. Investigations did not reveal any causes of pathological fracture. This fracture is attributed to the use of long-term bisphosphonate therapy in conjunction with the use of a walking cane. This case highlights the importance of entertaining the possibility of such fractures occurring in any patient who is on bisphosphonate therapy presenting with stress fractures of the upper extremity. Keywords Bisphosphonates. Stress fractures. Upper extremities. Walking aids C. S. H. Grace (*) National University Health System, 1E, Kent Ridge Road, Singapore , Singapore grace_sh_chiang@nuhs.edu.sg K. W. B. Kelvin: C. T. Wei : T. B. Yeow St. Luke s Hospital, 2 Bukit Batok Street 11, Singapore , Singapore Introduction Osteoporosis is a major global public health problem especially with the rapidly aging population; the World Health Organization (WHO) data predicts average life expectancy of men to be 75 years and women to be 80 years. Worldwide, osteoporosis affects approximately 200 million women [1]and causes more than 8.9 million fractures annually leading to increased morbidity and mortality [2]. Osteoporosis-related fractures cause significant medical and personal toll on individuals and economic burden on the nation; the cumulative cost over the next two decades is estimated to be US$474 billion [3]. Osteoporosis can be diagnosed early and treated before fractures occur. There is a range of drug treatments available for osteoporosis, of which, bisphosphonates are the first-line therapy and the most widely used in view of their anti-fracture efficacy [4]. While studies have shown that bisphosphonates prevent future vertebral and non-vertebral fractures in patients with osteoporotic fractures, post-menopausal women with osteoporosis, and men with osteoporosis [5, 6], there has been increasing evidence of bisphosphonate use leading to atypical fractures especially of the femur [7, 8]. Limited data on atypical fractures of long bones other than the femur is available [9 11]. Prolonged bisphosphonate therapy has been associated with over-suppression of bone turnover and increased skeletal fragility [9]. Stress fractures result from the suppression of intracortical remodeling, hence impairing normal bone healing [10]. We report a case of atraumatic stress fracture of the ulna secondary to long-term alendronate use in a patient using a walking cane. Case summary A 77-year-old Chinese female was started on alendronate for osteoporosis in Nine years after starting alendronate,
4 she suffered an atraumatic fracture of the right ulna requiring surgical fixation. The patient had noted pain of her right forearm for 3 months; however, pain had worsened when she had transferred more weight to her right forearm whilst ambulating with a walking cane. X-ray of the right forearm showed a transverse fracture of the proximal shaft of the right ulna with increased sclerosis aroundthefracture(fig.1). She has a past medical history of multiple fractures. She had sustained a left medial tibial condyle and fibula neck fracture in 1999 after a fall which was managed conservatively. In 2001, she was discovered to have multiple vertebral compression fractures and she had been experiencing lower back pain and an X-ray was done. In 2004, she sustained a right intertrochanteric fracture after falling and underwent a bipolar hemiarthroplasty. Bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DEXA) revealed T-scoreoflumbarspinetobe 3.8 with a density of 0.54 g/ sq cm 2 and she was started on alendronate. In 2010, she sustained a left distal radial fracture after a mechanical fall, which was managed conservatively. Her risk factors were reviewed. She was quite active premorbidly, ambulating with walking cane for 6 years and carrying out daily activities of living independently. She did not have premature menopause. She is a non-smoker and nondrinker. She was not on any other long-term medications and no history of steroid use. There was no history of significant weight change or change in bowel habits. During physical examination, there was deformity of the right forearm with tenderness, but neurovascularly intact. Laboratory work-up showed corrected calcium 2.28 mmol/ L, 8:00 a.m. cortisol 435 nmol/l, thyroid stimulating hormone 2.16 miu/l, parathyroid hormone 4.6 pmol/l, and 25- hydroxy vitamin D level 35.8 μg/l. Myeloma panel was not suggestive of multiple myeloma. Her bone density did not decrease between 2005 and In 2012, the bone density of the spine was 0.56 g/sq cm 2 with a T-score of 3.8. Bone scan showed that there was no scintigraphic evidence of bone metastasis. Magnetic resonance imaging of the right elbow showed a midshaft ulna fracture; no underlying pathological lesions were seen (Fig. 2). In view of the atraumatic nature of the fracture, X-ray findings distinctive of atypical fractures, and further investigations excluding other causes of atypical fractures, the diagnosis of atypical ulna shaft fracture secondary to long-term alendronate use was made and alendronate was discontinued. The fracture was fixed with plates and screws. However, 3 weeks after surgical fixation, deformity over the right forearm open reduction internal fixation site was noted. X-ray of the right ulna showed a peri-implant fracture with displacement of screws. She subsequently underwent removal of the implant and re-fixation with bone grafting. She recovered well and was later discharged to a rehabilitation hospital for physical and occupational therapy. Fig. 1 Right forearm X-rays show a slightly displaced transverse fracture of the proximal shaft of the right ulna with increased sclerosis around the fracture. The bones appear diffusely osteopenic
5 Fig. 2 Magnetic resonance imaging of the right elbow shows a stress fracture of the midshaft of the ulna fracture as a linear area of low signal intensity. There isoedema within the soft tissues and at the site of the fracture. No underlying pathological lesions were seen Discussion Long-term bisphosphonate use has been found to increase the relative risk of atypical fractures [7, 8]. While there is strong evidence to suggest that bisphosphonate use is associated with atypical fractures of the femur [11, 12], the relation between bisphosphonate use and atypical fractures of the upper limb has not been well studied [13]. Prolonged use of alendronate may be associated with stress fractures [5]; it is believed that the long-term over-suppression of bone turnover impairs the ability of bone to remodel, causing microdamage to persist which compromises bone strength leading to stress fractures [11]. Common clinical features of atypical fractures associated with bisphosphonate use are prodromal pain occurring for weeks to months prior to the fracture, typically sharp and well localized [11]. These fractures are usually atraumatic. Radiographic features of atypical fractures associated with bisphosphonate use are a transverse fracture line, beaking of the cortex on one side and bilateral thickened diaphyseal cortices [9]. Upper extremity stress fractures are rare and can occur in athletes [14, 15] and those using walking aids [9, 16, 17]. It is postulated that the likely mechanism of injury with walking aids is a combination of tractional and torsional force, together with direct pressure on the proximal forearm bones. In our patient, it is probable that the fracture was a stress fracture secondary to both long-term alendronate use and walking aids. This patient had presented with an isolated transverse midshaft ulna fracture; however, it was atraumatic unlike the usual mechanism of injury for isolated midshaft ulna fractures which is a blunt trauma to the forearm when it is being held in protection across the face. Furthermore, she presented with classical symptoms associated with atypical bisphosphonate fractures; radiographic findings likewise showed the typical transverse fracture line and increased sclerosis around the fracture. Investigations done for this patient did not reveal any cause of pathological fractures or secondary causes of bone loss. The patient reported here was ambulating with a walking cane. The stress fracture is likely to have resulted from the high tensional stress caused by weight bearing on the walking cane where the wrist is in a position of flexion and axial load is increased though the ulna. The longterm use of alendronate in this case may have resulted in increased brittleness of the bones as bone turnover is inhibited, thus leading to increased mineralization and accumulation of microdamage [8]. This case highlights that physicians need to have a high index of suspicion of upper extremity stress fractures occurring in patients who complain of chronic upper limb pain if they are on bisphosphonate therapy and are using walking aids. To facilitate early detection, it is essential that both physicians and patients be aware of the possibility of such fractures occurring and the signs and symptoms associated with these fractures. It is critical to comprehensively investigate such patients with radiographs looking for stress reaction and, if necessary, advanced imaging such as bone scan or magnetic resonance imaging should be considered. Bisphosphonates should be discontinued in patients with stress fractures secondary to bisphosphonate therapy. Conflicts of interest None.
6 References 1. Kanis JA (2007) WHO Technical Report, University of Sheffield, UK: Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. OsteoporosInt 17: Burden of Musculoskeletal Diseases in the United States: Prevalence, Societal and Economic Cost. Rosemont, IL, American Academy of Orthopaedic Surgeons. February Cummings SR, Black DM, Thompson DE et al (1998) Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA 280: Black DM, Schwartz AV, Ensrud KE et al (2006) Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial. JAMA 296: Meta-analyses of therapies for postmenopausal osteoporosis. II. Meta-analysis of alendronate for the treatment of postmenopausal women. Cranney A, Wells G, Willan A, Griffith L, Zytaruk N, Robinson V, Black D, Adachi J, Shea B, Tugwell P, Guyatt G, Osteoporosis Methodology Group and The Osteoporosis Research Advisory Group. EndocrRev. 2002;23(4): Girgis CM, Sher D, Seibel MJ (2010) Atypical femoral fractures and bisphosphonate use. N Engl J Med 362: Visekruna M, Wilson D, McKiernan FE (2008) Severely suppressed bone turnover and atypical skeletal fragility. J Clin Endocrinol Metab 93: Shane E (2010) Evolving data about subtrochanteric fractures and bisphosphonates. N Engl J Med 362: Shane E, Burr D, Abrahamsen B, et al. Atypical subtrochanteric and diaphyseal femoral fractures: Second report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res Giusti A, Neveen AT H, Papapoulos SE (2010) Atypical fractures of the femur and bisphosphonate therapy: a systematic review of case/case series studies. Bone 47(2): Giusti A, Hamdy NAT, Dekkers OM, Ramautar SR, Dijkstra S, Socrates E, Papapoulos SE (2011) Atypical fractures and bisphosphonate therapy: a cohort study of patients with femoral fracture with radiographic adjudication of fracture site and features. Bone 48(5): Yavropoulou MP, Giusti A, Ramautar SR, Dijkstra S, Hamdy NAT, Papapoulos SE (2012) "Low energy fractures of the humeral shaft and bisphosphonate use.". J Bone Miner Res 27(6): Iwamoto J, Takeda T (2003) Stress fractures in athletes: review of 196 cases. J Orthop Sci 8(3): Brukner P (1998) Stress fractures of the upper limb. Sports Med 26(6): Sørensen L (1992) "Bilateral symmetrical stress fracture of the ulna". Ugeskr Laeger 154(26): Venkatanarasimha N, Kamath S, Kambouroglou G, Ostlere SJ (2009) "Proximal ulna stress fracture and stress reaction of the proximal radius associated with the use of crutches: a case report and literature review". J Orthop Traumatol 10(3):
Drug Intervals (Holidays) with Oral Bisphosphonates
Drug Intervals (Holidays) with Oral Bisphosphonates Rizwan Rajak Consultant Rheumatologist & Lead for Osteoporosis GP Postgraduate Meeting April 2018 Contents Case presentation Pathway for Bisphosphonate
More informationChapter 39: Exercise prescription in those with osteoporosis
Chapter 39: Exercise prescription in those with osteoporosis American College of Sports Medicine. (2010). ACSM's resource manual for guidelines for exercise testing and prescription (6th ed.). New York:
More informationAtypical Femoral Fracture: 2015 Position Statement of the Korean Society for Bone and Mineral Research
J Bone Metab 2015;22:87-91 http://dx.doi.org/10.11005/jbm.2015.22.3.87 pissn 2287-6375 eissn 2287-7029 Review Article Atypical Femoral Fracture: 2015 Position Statement of the Korean Society for Bone and
More informationAtypical Femoral Fractures Insights and Enigmas
Atypical Femoral Fractures Insights and Enigmas Madhu Mehta, M.D. Clinical Asst. Prof. of Medicine Department of Immunology/Rheumatology The Ohio State University Abreviations used TFF- Typical femoral
More informationFemoral Shaft Cortical Pathology associated with longterm Alendronate Therapy: A New Classification
Malaysian Orthopaedic Journal 2013 Vol 7 No 3 Doi:http://dx.doi.org/10.5704/MOJ.1307.008 MK Kwan, et al Femoral Shaft Cortical Pathology associated with longterm Alendronate Therapy: A New Classification
More informationBisphosphonate-related bilateral atypical femoral fractures be aware and beware
Case Report Bisphosphonate-related bilateral atypical femoral fractures be aware and beware Ruben Depasquale, Claire Matthews, Victor N. Cassar-Pullicino Abstract Although bisphosphonates have a well established
More informationAtypical Femoral Fractures With Long Term Bisphosphonates Use
Atypical Femoral Fractures With Long Term Bisphosphonates Use There has been an increase in the number of atypical femoral fractures in pa4ents on long term bisphosphonate therapy (e.g Fosamax) Accordingly
More informationCan we improve the compliance to prevention treatment after a wrist fracture? Roy Kessous
Can we improve the compliance to prevention treatment after a wrist fracture? Roy Kessous Distal radius fracture in women after menopause is in many cases a first clinical indication for the presence of
More informationSubtrochanteric Femoral Fracture in a Patient on Alendronate Therapy: A Case Report
Subtrochanteric Femoral Fracture in a Patient on Alendronate Therapy: A Case Report K.C. Lakati 1, M.B.L. Lutomia 2 1 Nakuru Orthopedic Center, 2 Egerton University Medical School, Nakuru, Kenya. Correspondence
More informationDifferentiating Pharmacological Therapies for Osteoporosis
Differentiating Pharmacological Therapies for Osteoporosis Socrates E Papapoulos Department of Endocrinology & Metabolic Diseases Leiden University Medical Center The Netherlands Competing interests: consulting/speaking
More informationCase Report Combined Effect of a Locking Plate and Teriparatide for Incomplete Atypical Femoral Fracture: Two Case Reports of Curved Femurs
Case Reports in Orthopedics Volume 2015, Article ID 213614, 5 pages http://dx.doi.org/10.1155/2015/213614 Case Report Combined Effect of a Locking Plate and Teriparatide for Incomplete Atypical Femoral
More informationCase Report Effect of Long-Term Use of Bisphosphonates on Forearm Bone: Atypical Ulna Fractures in Elderly Woman with Osteoporosis
Case Reports in Orthopedics Volume 2016, Article ID 4185202, 4 pages http://dx.doi.org/10.1155/2016/4185202 Case Report Effect of Long-Term Use of Bisphosphonates on Forearm Bone: Atypical Ulna Fractures
More informationRadiographic Appearance Of Primary Hyperparathyroidism With Atypical Parathyroid Adenoma
ISPUB.COM The Internet Journal of Internal Medicine Volume 6 Number 2 Radiographic Appearance Of Primary Hyperparathyroidism With Atypical Parathyroid Adenoma P George, N Philip, B Pawar Citation P George,
More informationFrequency of Incomplete Atypical Femoral Fractures in Asymptomatic Patients on Long- Term Bisphosphonate Therapy
Musculoskeletal Imaging Original Research La Rocca Vieira et al. Femoral Fractures in Asymptomatic Patients Musculoskeletal Imaging Original Research Renata La Rocca Vieira 1 Zehava Sadka Rosenberg 1 Mary
More informationBilateral Insufficiency Fracture of Medial Subtrochanteric Area of the Femur: A Case Report
CASE REPORT Hip Pelvis 25(3): 232-236, 2013 http://dx.doi.org/10.5371/hp.2013.25.3.232 Print ISSN 2287-3260 Online ISSN 2287-3279 Bilateral Insufficiency Fracture of Medial Subtrochanteric Area of the
More informationOTA Highlight Paper. Surgical Treatment Improves Clinical and Functional ACCEPTED. Outcomes for Patients who Sustain Incomplete
Journal of Orthopaedic Trauma Publish Ahead of Print DOI: 10.1097/BOT.0b013e31827240ae OTA Highlight Paper Surgical Treatment Improves Clinical and Functional Outcomes for Patients who Sustain Incomplete
More informationSubmission to the National Institute for Clinical Excellence on
Submission to the National Institute for Clinical Excellence on Strontium ranelate for the prevention of osteoporotic fractures in postmenopausal women with osteoporosis by The Society for Endocrinology
More informationPharmacy Management Drug Policy
SUBJECT: - Forteo (teriparatide), Prolia (denosumab), Tymlos (abaloparatide) POLICY NUMBER: Pharmacy-35 EFFECTIVE DATE: 9/07 LAST REVIEW DATE: 9/29/2017 If the member s subscriber contract excludes coverage
More information1/28/2017. Orthopedic Implications Of Osteoporosis Introduction. Orthopedic Implications Of Osteoporosis Introduction
The Orthopedic Implications Of Prolonged In Osteoporosis Donald A. Wiss MD Director Of Orthopedic Trauma Cedars Sinai Medical Center Orthopedic Implications Of Osteoporosis Introduction Osteoporosis Most
More informationOsteoporosis. Overview
v2 Osteoporosis Overview Osteoporosis is defined as compromised bone strength that increases risk of fracture (NIH Consensus Conference, 2000). Bone strength is characterized by bone mineral density (BMD)
More informationClinical Analysis of Femur Shaft Insufficiency Fractures
Original Article Clinics in Orthopedic Surgery 2012;4:227-233 http://dx.doi.org/10.4055/cios.2012.4.3.227 Clinical Analysis of Femur Shaft Insufficiency Fractures Sang-Bong Ko, MD, Sang-Wook Lee, MD, Chang-Min
More informationAssessment and Treatment of Osteoporosis Professor T.Masud
Assessment and Treatment of Osteoporosis Professor T.Masud Nottingham University Hospitals NHS Trust University of Nottingham University of Derby University of Southern Denmark What is Osteoporosis? Osteoporosis
More informationManagement of postmenopausal osteoporosis
Management of postmenopausal osteoporosis Yeap SS, Hew FL, Chan SP, on behalf of the Malaysian Osteoporosis Society Committee Working Group for the Clinical Guidance on the Management of Osteoporosis,
More informationSkeletal Manifestations
Skeletal Manifestations of Metabolic Bone Disease Mishaela R. Rubin, MD February 21, 2008 The Three Ages of Women Gustav Klimt 1905 1 Lecture Outline Osteoporosis epidemiology diagnosis secondary causes
More informationATYPICAL FEMORAL FRACTURES AFTER LONG-TERM BISPHOS- PHONATES THERAPY: CASE REPORT
Rev. Med. Chir. Soc. Med. Nat., Iaşi 2016 vol. 120, no. 1 INTERNAL MEDICINE - PEDIATRICS CASE REPORTS ATYPICAL FEMORAL FRACTURES AFTER LONG-TERM BISPHOS- PHONATES THERAPY: CASE REPORT Corina Găleşanu 1,3*,
More informationBalancing the Risks and Benefits of Osteoporosis Treatment: part I: 3 to 5 years treatment
Balancing the Risks and Benefits of Osteoporosis Treatment: part I: 3 to 5 years treatment Dennis M. Black, PhD Department of Epidemiology and Biostatistics, UCSF Financial Disclosures (past 3 years) -Consulting
More informationTREATMENT OF OSTEOPOROSIS HOLIDAYS OR NO HOLIDAYS? Nelson B. Watts, MD OSTEOPOROSIS AND BONE HEALTH SERVICES CINCINNATI, OHIO
TREATMENT OF OSTEOPOROSIS HOLIDAYS OR NO HOLIDAYS? Nelson B. Watts, MD OSTEOPOROSIS AND BONE HEALTH SERVICES CINCINNATI, OHIO DISCLOSURES Honoraria: Amgen, Merck, Shire Consulting : AbbVie, Amgen, Merck,
More informationDisclosures D. Black. Bisphosphonates: Background, Efficacy and Recent Controversies. Page 1. Research Funding: Novartis, Merck
Bisphosphonates: Background, Efficacy and Recent Controversies Disclosures D. Black Research Funding: Novartis, Merck Dennis M. Black, PhD Consulting: Amgen, Lilly, Zosano, Nycomed Dept. of Epidemiology
More informationUsing GE Lunar DXA to Quantify, Visualize, and Trend Incipient Atypical Femoral Fractures
Using GE Lunar DXA to Quantify, Visualize, and Trend Incipient Atypical Femoral Fractures The management of osteoporosis underwent a paradigm shift in 1995 with the approval of the first bisphosphonate,
More informationBuilding Bone Density-Research Issues
Building Bone Density-Research Issues Helping to Regain Bone Density QUESTION 1 What are the symptoms of Osteoporosis? Who is at risk? Symptoms Bone Fractures Osteoporosis 1,500,000 fractures a year Kyphosis
More informationCIC Edizioni Internazionali
Knowledge gap among general practitioners, endocrinologists and orthopedic surgeons regarding atypical lesions and fractures of the femur due to long-term use of bisphosphonates Eran Keltz 1 Igor Doronov
More informationCurrent and Emerging Strategies for Osteoporosis
Current and Emerging Strategies for Osteoporosis I have nothing to disclose. Anne Schafer, MD Assistant Professor of Medicine Division of Endocrinology & Metabolism December 12, 2014 Outline Osteoporosis
More informationSurgical Care at the District Hospital. EMERGENCY & ESSENTIAL SURGICAL CARE
Surgical Care at the District Hospital 1 18 Orthopedic Trauma Key Points 2 18.1 Upper Extremity Injuries Clavicle Fractures Diagnose fractures from the history and by physical examination Treat with a
More informationOsteoporosis/Fracture Prevention
Osteoporosis/Fracture Prevention NATIONAL GUIDELINE SUMMARY This guideline was developed using an evidence-based methodology by the KP National Osteoporosis/Fracture Prevention Guideline Development Team
More informationTreatments for Osteoporosis Expected Benefits, Potential Harms and Drug Holidays. Suzanne Morin MD FRCP FACP McGill University May 2014
Treatments for Osteoporosis Expected Benefits, Potential Harms and Drug Holidays Suzanne Morin MD FRCP FACP McGill University May 2014 Learning Objectives Overview of osteoporosis management Outline efficacy
More informationHorizon Scanning Centre March Denosumab for glucocorticoidinduced SUMMARY NIHR HSC ID: 6329
Horizon Scanning Centre March 2014 Denosumab for glucocorticoidinduced osteoporosis SUMMARY NIHR HSC ID: 6329 This briefing is based on information available at the time of research and a limited literature
More informationCASE 1 WHY IS IT IMPORTANT TO TREAT? FACTS CONCERNS
4:30-5:15pm Ask the Expert: Osteoporosis SPEAKERS Silvina Levis, MD OSTEOPOROSIS - FACTS 1:3 older women and 1:5 older men will have a fragility fracture after age 50 After 3 years of treatment, depending
More informationNE Nebraska Trauma Conference Tristan Hartzell, MD November 8, 2017
NE Nebraska Trauma Conference 2017 Tristan Hartzell, MD November 8, 2017 Traumatic arm injuries in the elderly Fractures Hand Wrist Elbow Shoulder Soft tissue injuries Definitions Elderly? old or aging
More informationFragile Bones and how to recognise them. Rod Hughes Consultant physician and rheumatologist St Peter s hospital Chertsey
Fragile Bones and how to recognise them Rod Hughes Consultant physician and rheumatologist St Peter s hospital Chertsey Osteoporosis Osteoporosis is a skeletal disorder characterised by compromised bone
More informationAnabolic Therapy With Teriparatide Indications Beyond Osteoporosis
Anabolic Therapy With Teriparatide Indications Beyond Osteoporosis Andreas Panagopoulos MD, PhD Upper Limb & Sports Medicine Orthopaedic Surgeon Assistant Professor, University of Patras Outline Teriparatide
More informationPharmacy Management Drug Policy
Clinical criteria used to make utilization review decisions are based on credible scientific evidence published in peer reviewed medical literature generally recognized by the medical community. Guidelines
More informationEMERGENCY PITFALLS IN ORTHOPAEDIC TRAUMA. Thierry E. Benaroch, MD, FRCS MCH Trauma Rounds February 9, 2009
EMERGENCY PITFALLS IN ORTHOPAEDIC TRAUMA Thierry E. Benaroch, MD, FRCS MCH Trauma Rounds February 9, 2009 MORAL OF THE STORY Fracture distal radius and intact ulna W/O radius fracture will most likely
More informationDEVELOPMENT OF A RISK SCORING SYSTEM TO PREDICT A RISK OF OSTEOPOROTIC VERTEBRAL FRACTURES IN POSTMENOPAUSAL WOMEN
October 2-4, Liverpool, UK EURO SPINE 2013 DEVELOPMENT OF A RISK SCORING SYSTEM TO PREDICT A RISK OF OSTEOPOROTIC VERTEBRAL FRACTURES IN POSTMENOPAUSAL WOMEN D. Colangelo, L. A. Nasto, M. Mormando, E.
More informationFrom Fragile to Firm. Monika Starosta MD. Advocate Medical Group
From Fragile to Firm Monika Starosta MD Advocate Medical Group Bone Remodeling 10% remodeled each year Calcium homoeostasis Maintain Mechanical strength Replace Osteocytes Release Growth Factors Bone remodeling
More informationPharmacy Management Drug Policy
SUBJECT: - Forteo (teriparatide), Prolia (denosumab), Tymlos (abaloparatide), Boniva injection (Ibandronate) POLICY NUMBER: Pharmacy-35 EFFECTIVE DATE: 9/07 LAST REVIEW DATE: 10/15/2018 If the member s
More informationModule 5 - Speaking of Bones Osteoporosis For Health Professionals: Fracture Risk Assessment. William D. Leslie, MD MSc FRCPC
Module 5 - Speaking of Bones Osteoporosis For Health Professionals: Fracture Risk Assessment William D. Leslie, MD MSc FRCPC Case #1 Age 53: 3 years post-menopause Has always enjoyed excellent health with
More informationAMERICAN COLLEGE OF RHEUMATOLOGY POSITION STATEMENT. Committee on Rheumatologic Care
AMERICAN COLLEGE OF RHEUMATOLOGY POSITION STATEMENT SUBJECT: PRESENTED BY: FOR DISTRIBUTION TO: Bone Mineral Density Measurement and the Role of Rheumatologists in the Management of Osteoporosis Committee
More informationInterpreting DEXA Scan and. the New Fracture Risk. Assessment. Algorithm
Interpreting DEXA Scan and the New Fracture Risk Assessment Algorithm Prof. Samir Elbadawy *Osteoporosis affect 30%-40% of women in western countries and almost 15% of men after the age of 50 years. Osteoporosis
More informationSimon M. Thompson, Tom M. Cross, Meryvn J. Cross & David G. Wood
Medial meniscal cyst as a cause of painful erosion of the tibial plateau Simon M. Thompson, Tom M. Cross, Meryvn J. Cross & David G. Wood Knee Surgery, Sports Traumatology, Arthroscopy ISSN 0942-2056 Volume
More informationNew Developments in Osteoporosis: Screening, Prevention and Treatment
Osteoporosis: Overview New Developments in Osteoporosis: Screening, Prevention and Treatment Judith Walsh, MD, MPH Departments of Medicine and Epidemiology and Biostatistics UCSF Definitions Risk factors
More informationOSTEOPOROSIS IN INDONESIA
OSTEOPOROSIS IN INDONESIA Hana Ratnawati Faculty of Medicine Maranatha Christian University Bandung - Indonesia 5th SBA Conference 2013 1 5th SBA Conference 2013 2 INTRODUCTION Indonesia is an archipelago
More informationRelative Osteopenia After Femoral Implant Removal in Children and Adolescents
Relative Osteopenia After Femoral Implant Removal in Children and Adolescents L. Johnson Patman, MD; Elizabeth A. Szalay, MD abstract Full article available online at Healio.com/Orthopedics. Search: 20130327-24
More informationNEW DEVELOPMENTS IN OSTEOPOROSIS: SCREENING, PREVENTION AND TREATMENT
NEW DEVELOPMENTS IN OSTEOPOROSIS: SCREENING, PREVENTION AND TREATMENT Judith Walsh, MD, MPH Departments of Medicine and Epidemiology and Biostatistics UCSF OSTEOPOROSIS: OVERVIEW Definitions Risk factors
More informationHip Fractures. Anatomy. Causes. Symptoms
Hip Fractures A hip fracture is a break in the upper quarter of the femur (thigh) bone. The extent of the break depends on the forces that are involved. The type of surgery used to treat a hip fracture
More informationRecurrent and Chronic Elbow Instability
Recurrent and Chronic Elbow Instability Elbow instability is a looseness in the elbow joint that may cause the joint to catch, pop, or slide out of place during certain arm movements. It most often occurs
More informationOsteoporosis: An Overview. Carolyn J. Crandall, MD, MS
Osteoporosis: An Overview Carolyn J. Crandall, MD, MS Osteoporosis: An Overview Carolyn J. Crandall, MD, MS Professor of Medicine David Geffen School of Medicine at UCLA Objectives Review osteoporosis
More informationCommon Orthopaedic Injuries in Children
Common Orthopaedic Injuries in Children Rakesh P. Mashru, M.D. Division of Orthopaedic Trauma Cooper University Hospital Cooper Medical School of Rowan University December 1, 2017 1 Learning Objectives
More informationMedicine and the Current Correlation Between Fosamax and Fractures
Medicine and the Current Correlation Between Fosamax and Fractures American Association for Justice Fosamax Telseminar June 22, 2011 2:00 3:30 pm EDT By: William B. Curtis Michael S. Wilson Curtis Law
More informationOsteoporosis Screening and Treatment in Type 2 Diabetes
Osteoporosis Screening and Treatment in Type 2 Diabetes Ann Schwartz, PhD! Dept. of Epidemiology and Biostatistics! University of California San Francisco! October 2011! Presenter Disclosure Information
More informationAn audit of osteoporotic patients in an Australian general practice
professional Darren Parker An audit of osteoporotic patients in an Australian general practice Background Osteoporosis is a major contributor to morbidity and mortality in Australia, and is predicted to
More informationBisphosphonate Use and Atypical Fractures of the Femoral Shaft
T h e n e w e ngl a nd j o u r na l o f m e dic i n e original article Bisphosphonate Use and Atypical Fractures of the Femoral Shaft Jörg Schilcher, M.D., Karl Michaëlsson, M.D., Ph.D., and Per Aspenberg,
More informationCIC Edizioni Internazionali
Naoki Kondo Takuya Yoda Junichi Fujisawa Katsumitsu Arai Mayumi Sakuma Hiroshi Ninomiya Hiroshige Sano Naoto Endo Division of Orthopaedic Surgery, Niigata University Graduate School of Medical and Dental
More informationEVOS MINI with IM Nailing
Case Series Dr. John A. Scolaro EVOS MINI with IM Nailing A series of studies Introduction Intramedullary nailing has become the standard for many long bone fractures. Fracture reduction prior to nail
More informationFracture=Bone Attack:
Fracture=Bone Attack: Linking Hip Fractures to Osteoporosis Care Angela M. Cheung, MD, PhD, FRCPC Professor of Medicine, University of Toronto Potential Conflicts of Interests Industry Grants (to UHN)
More informationThe Surgical Management of Rickets & Osteogenesis Imperfecta
The Surgical Management of Rickets & Osteogenesis Imperfecta Dr Greg Firth Chris Hani Baragwanath Academic Hospital Department of Orthopaedics University of the Witwatersrand Rickets Inadequate mineralization
More informationPEM GUIDE CHILDHOOD FRACTURES
PEM GUIDE CHILDHOOD FRACTURES INTRODUCTION Skeletal injuries account for 10-15% of all injuries in children; 20% of those are fractures, 3 out of 4 fractures affect the physis or growth plate. Always consider
More informationWho cares about fractures! is more important. October 3, 2014 CSIM Workshop Brian Wirzba, MD, FRCPC, FACP Clinical Professor Grey Nuns Hospital
Isn t Osteoporosis just a T Score less than 2.5?? Who cares about fractures! is more important. Why do I need to know this? October 3, 2014 CSIM Workshop Brian Wirzba, MD, FRCPC, FACP Clinical Professor
More informationForteo (teriparatide) Prior Authorization Program Summary
Forteo (teriparatide) Prior Authorization Program Summary FDA APPROVED INDICATIONS DOSAGE 1 FDA Indication 1 : Forteo (teriparatide) is indicated for: the treatment of postmenopausal women with osteoporosis
More informationBisphosphonate-Associated Bilateral Atraumatic Ulna Fractures
International Journal of Medical and Pharmaceutical Case Reports 9(1): 1-6, 2017; Article no.ijmpcr.33170 ISSN: 2394-109X, NLM ID: 101648033 SCIENCEDOMAIN international www.sciencedomain.org Bisphosphonate-Associated
More information1
www.osteoporosis.ca 1 2 Overview of the Presentation Osteoporosis: An Overview Bone Basics Diagnosis of Osteoporosis Drug Therapies Risk Reduction Living with Osteoporosis 3 What is Osteoporosis? Osteoporosis:
More informationOSTEOPOROSIS: PREVENTION AND MANAGEMENT
OSTEOPOROSIS: OVERVIEW OSTEOPOROSIS: PREVENTION AND MANAGEMENT Judith Walsh, MD, MPH Departments of Medicine and Epidemiology and Biostatistics UCSF Definitions Key Risk factors Screening and Monitoring
More informationAmong the most important concerns regarding the
140 Osteoporosis An Update Stephen Honig, M.D., M.Sc., and Gregory Chang, M.D. Abstract The past year has been a dynamic one for clinicians and researchers with an interest in osteoporosis. This update
More informationPresenter: 翁家嫻 Venue date:
FOR THE TREATMENT OF OSTEOPOROSIS IN POSTMENOPAUSAL WOMEN AT INCREASED RISK OF FRACTURES 1 Presenter: 翁家嫻 Venue date: 2018.03.13 PMO: postmenopausal osteoporosis. 1. Prolia (denosumab), Summary of Product
More informationOsteoporosis: How to Manage Long- Term Use of Bisphosphonates AKA Now What? David E Feinstein, DO, CCD November 15 th, 2017
Osteoporosis: How to Manage Long- Term Use of Bisphosphonates AKA Now What? David E Feinstein, DO, CCD November 15 th, 2017 Introduction A fracture due to OP occurs every 3 seconds around the world. 1
More informationRADIOGRAPHY OF THE ELBOW & HUMERUS
RADIOGRAPHY OF THE ELBOW & HUMERUS Patient Position: ELBOW AP Projection in same plane Part Position: Hand in ; patient Centered to Humeral epicondyles Central Ray: Structures Shown: AP Elbow Criteria
More information7/23/2018 DESCRIBING THE FRACTURE. Pattern Open vs closed Location BASIC PRINCIPLES OF FRACTURE MANAGEMENT. Anjan R. Shah MD July 21, 2018.
BASIC PRINCIPLES OF FRACTURE MANAGEMENT Anjan R. Shah MD July 21, 2018 DESCRIBING THE FRACTURE Pattern Open vs closed Location POLL OPEN HOW WOULD YOU DESCRIBE THIS FRACTURE PATTERN? 1 Spiral 2 Transverse
More informationPage 1. New Developments in Osteoporosis. What s New in Osteoporosis
New Developments in Osteoporosis Eliseo J. Pérez-Stable MD Professor of Medicine Division of General Internal Medicine Department of Medicine July 4, 2013 Declaration of full disclosure: No conflict of
More informationDownload slides:
Download slides: https://www.tinyurl.com/m67zcnn https://tinyurl.com/kazchbn OSTEOPOROSIS REVIEW AND UPDATE Boca Raton Regional Hospital Internal Medicine Conference 2017 Benjamin Wang, M.D., FRCPC Division
More informationNutritional Aspects of Osteoporosis Care and Treatment Cynthia Smith, FNP-BC, RN, MSN, CCD Pars Osteoporosis Clinic, Belpre, Ohio
Osteoporosis 1 Nutritional Aspects of Osteoporosis Care and Treatment Cynthia Smith, FNP-BC, RN, MSN, CCD Pars Osteoporosis Clinic, Belpre, Ohio 1) Objectives: a) To understand bone growth and development
More informationOsteoporosis Management
Osteoporosis Management Lisa Voss PA C, CCD Laura Frontiero NP C, CCD Kaiser Healthy Bones Program San Diego Disclosures: Nothing to disclose www.zazzle.com 1 Overview How to diagnose Osteoporosis FRAX
More informationJuly 2012 CME (35 minutes) 7/12/2016
Financial Disclosures Epidemiology and Consequences of Fractures Advisory Board: Amgen Janssen Pharmaceuticals Inc. Ann V. Schwartz, PhD Department of Epidemiology and Biostatistics UCSF Outline Osteoporotic
More informationnogg Guideline for the diagnosis and management of osteoporosis in postmenopausal women and men from the age of 50 years in the UK
nogg NATIONAL OSTEOPOROSIS GUIDELINE GROUP Guideline for the diagnosis and management of osteoporosis in postmenopausal women and men from the age of 50 years in the UK Produced by J Compston, A Cooper,
More informationWhat is Osteoporosis?
What is Osteoporosis? 2000 NIH Definition A skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture. Bone strength reflects the integration of
More information4/28/2010. Fractures. Normal Bone and Normal Ossification Bone Terms. Epiphysis Epiphyseal Plate (physis) Metaphysis
Fractures Normal Bone and Normal Ossification Bone Terms Epiphysis Epiphyseal Plate (physis) Metaphysis Diaphysis 1 Fracture Classifications A. Longitudinal B. Transverse C. Oblique D. Spiral E. Incomplete
More informationCLINICAL PRESENTATION AND RADIOLOGY QUIZ QUESTION
Donald L. Renfrew, MD Radiology Associates of the Fox Valley, 333 N. Commercial Street, Suite 100, Neenah, WI 54956 10/13/2012 Radiology Quiz of the Week # 94 Page 1 CLINICAL PRESENTATION AND RADIOLOGY
More informationUse of DXA / Bone Density in the Care of Your Patients. Brenda Lee Holbert, M.D. Associate Professor Senior Staff Radiologist
Use of DXA / Bone Density in the Care of Your Patients Brenda Lee Holbert, M.D. Associate Professor Senior Staff Radiologist Important Websites Resources for Clinicians and Patients www.nof.org www.iofbonehealth.org
More informationUsing the FRAX Tool. Osteoporosis Definition
How long will your bones remain standing? Using the FRAX Tool Gary Salzman M.D. Director Banner Good Samaritan/ Hayden VAMC Internal Medicine Geriatric Fellowship Program Phoenix, Arizona Using the FRAX
More informationLocked plating constructs are creating a challenge for surgeons.
Locked plating constructs are creating a challenge for surgeons. Three recent studies examining supracondylar femur fractures show concern for the high degree of stiffness of locked plating constructs
More informationUpdates in Osteoporosis. I have no conflicts of interest. What Would You Do? Mrs. C. What s New in Osteoporosis. Page 1
Updates in Osteoporosis Jeffrey A. Tice, MD Associate Professor of Medicine Division of General Internal Medicine, University of California, San Francisco I have no conflicts of interest What s New in
More informationBreast Cancer and Bone Loss. One in seven women will develop breast cancer during a lifetime
Breast Cancer and Bone Loss One in seven women will develop breast cancer during a lifetime Causes of Bone Loss in Breast Cancer Patients Aromatase inhibitors Bil Oophorectomy Hypogonadism Steroids Chemotherapy
More informationUNDERSTANDING FRACTURE CARE CAUSES, DIAGNOSIS, AND TREATMENT
UNDERSTANDING FRACTURE CARE CAUSES, DIAGNOSIS, AND TREATMENT PremierOrtho.com UNDERSTANDING FRACTURE CARE CAUSES, DIAGNOSIS, AND TREATMENT Table of Contents Introduction...3 Causes...4 Who s at Risk?...5
More informationBilateral Femoral Neck Insufficiency Fractures after Use of a Long-term Anti-resorptive Drug Therapy for Osteoporosis: A Case Report
CASE REPORT Hip Pelvis 27(2): 115-119, 2015 http://dx.doi.org/10.5371/hp.2015.27.2.115 Print ISSN 2287-3260 Online ISSN 2287-3279 Bilateral Femoral Neck Insufficiency Fractures after Use of a Long-term
More informationMetastatic Disease of the Proximal Femur
CASE REPORT Metastatic Disease of the Proximal Femur WI Faisham, M.Med{Ortho)*, W Zulmi, M.S{Ortho)*, B M Biswal, MBBS** 'Department of Orthopaedic, "Department of Oncology and Radiotherapy, School of
More informationOsteoporosis. Treatment of a Silently Developing Disease
Osteoporosis Treatment of a Silently Developing Disease Marc K. Drezner, MD Senior Associate Dean Emeritus Professor of Medicine Emeritus University of Wisconsin-Madison Auditorium The Forest at Duke October
More informationLearning Objectives. Controversies in Osteoporosis Prevention and Management. Etiology. Presenter Disclosure Information. Epidemiology.
12:45 1:30pm Controversies in Osteoporosis Prevention and Management SPEAKER Carolyn Crandall, MD, MS Presenter Disclosure Information The following relationships exist related to this presentation: Carolyn
More informationParathyroid Hormone Analogs
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.30.36 Subject: Parathyroid Hormone Analogs Page: 1 of 6 Last Review Date: September 15, 2017 Parathyroid
More informationPROCTER & GAMBLE and SANOFI-AVENTIS v ROCHE and GLAXOSMITHKLINE
CASES AUTH/1803/2/06 and AUTH/1804/2/06 PROCTER & GAMBLE and SANOFI-AVENTIS v ROCHE and GLAXOSMITHKLINE Bonviva Once Monthly slide kits Procter & Gamble and Sanofi-Aventis complained jointly about two
More informationNAMS Practice Pearl. Use of Drug Holidays in Women Taking Bisphosphonates. Released April 1, 2013
NAMS Practice Pearl Use of Drug Holidays in Women Taking Bisphosphonates Released April 1, 2013 Dima L. Diab, MD 1, and Nelson B. Watts, MD 2 ( 1 Cincinnati VA Medical Center, Cincinnati, OH, 2 Mercy Health
More informationCASE NO: 1 PATIENT DETAILS : Occupation : Housewife Date Of Admission :11/06/15 Residence : Nalgonda IP NO :
CASE NO: 1 PATIENT DETAILS : Name : XXXX Age : 53yr Sex : Female Occupation : Housewife Date Of Admission :11/06/15 Residence : Nalgonda IP NO : 201518441 CHIEF COMPLAINTS : - Pain in the right knee since
More information