Development of Lumbar Spinal Stenosis Caused by Lumbar Vertebral Compression Fracture

Spinal stenosis is a narrowing of the spinal canal by a combination of bone and soft tissues, which causes mechanical compression of spinal nerve roots.Diagnosis is made by computerized tomography, myelography, or magnetic resonance (MR) imaging. The aim of this case report was to present and discuss a patient with degenerative changes in whom spinal canal stenosis developed due to compression fracture and retropulsion of a fragment into the spinal canal following a simple fall

The Relationship Between the FRAX Tool and Bone Turnover Markers in Postmenopausal Osteoporosis

Aim: In this study, we aimed to show the correlation between the ten-year fracture risk, calculated with FRAX and bone turnover markers (BTM) in a group of postmenopausal women with osteoporosis. Material and Methods: Twenty-four postmenopausal women diagnosed as osteoporosis were included. Patients were assessed for duration of menopause, secondary diseases, medication, habits of nutrition, previous fracture, and family history of fracture. Weight and height measurements were obtained. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DXA), with a Hologic-QDR 4500 plus device. The ten-year risk for major as well as hip fractures were calculated with the FRAX tool. Serum calcium, phosphorus, magnesium, 25-OH Vitamin D, parathormone (PTH), alkaline phosphatase (ALP), and biochemical markers of bone formation (Osteocalcin, Bone-ALP) and resorption ( N-terminal collagen type 1 and C terminal collagen type 1) were determined. Results: The mean age of patients was 64.3±8.6 (46-80 years). The mean ten-year major fracture and hip fracture risks were 19.5±6.2% and 16.0±5.1%, respectively. There was a strong correlation between the duration of menopause and hip fracture risk (r: 0.878, p=0.022). There was also a strong relationship between hip fracture risk and NTX (r: 0.759, p=0.042). Conclusion: Resorption markers of bone turnover are relevant components in determining fracture risk. Rate of bone remodeling is a parameter which is not included in the FRAX tool. Since FRAX is an established tool for assessing the ten-year fracture risk, we assessed and found a correlation between hip fracture risk and NTX. Further studies, in larger groups of patients need to make clear the impact of BTM in this tool. (Turkish Journal of Osteoporosis 2013;19: 38-41

Renal Osteodystrophy

Chronic renal insufficiency is a functional definition which is characterized by irreversible and progressive decreasing in renal functions. This impairment is in collaboration with glomeruler filtration rate and serum creatinine levels. Besides this, different grades of bone metabolism disorders develop in chronic renal insufficiency. Pathologic changes in bone tissue due to loss of renal paranchyme is interrelated with calcium, phosphorus vitamine-D and parathyroid hormone. Clinically we can see high turnover bone disease, low turnover bone disease, osteomalacia, osteosclerosis and osteoporosis in renal osteodystropy. In this article we aimed to review pathology of bone metabolism disorders due to chronic renal insufficiency, clinic aspects and treatment approaches briefly

Evaluation of Clinical Findings and Treatment Results in Patients With Lumber Spinal Canal Stenosis and Osteoporosis Treated With Calcitonin and Physical Therapy

Objective: The role of osteoporosis in the etiology of degenerative lumbar spinal canal stenosis is debatable. The aim of this study was to evaluate clinic as well as therapeutic results in subjects with osteoporosis combined with lumbar spinal canal stenosis (LSS). Material and Methods: The study was conducted in İ.Ü. Cerrahpaşa Medical Faculty PMR Department on 40 patients diagnosed as spinal canal stenosis . Lumbar canal was imaged by computerized tomography (CT). Bone mineral content (BMC) was assessed by quantitative computerized tomography (QCT). Subjects were divided into three groups according to their BMC. Pain, motion, neurologic findings and walking distance were reevaluated after 1 months conservative treatment consisting of physical therapy IR, US, currents and exercises) and medical treatment (100 IU Salmon Calcitonin injections and calcium). Results: Pain parameters showed significant improvement in Group II and III(low and very low BMC). Walking distance showed greatest increase in Group II and III, with these results being statistically significant. Conclusion: In subjects with combined LSS and osteoporosis one months conservative therapy resulted in significant improvements in pain and walking distance parameters, especially in groups with low BMC .We suggest that BMC should be considered and treated in patients with LSS

Correlation of Vitamin D and Bone Mineral Density in Postmenopausal Women in 3 Different Regions of Turkey - Original Investigation

Aim: To find the correlation with regard to various age groups between bone mineral density (BMD) measured in spine and hip areas and Vitamin D level in 3 different cities. Material and Methods: The 3 cities (Marmara, Egean, South Turkey) were located in different geographical regions. BMD was measured with DXA in spine (L1-4) and hip (femur neck and femur total) areas by Hologic QDR4500. Serum Vitamin D and calcium levels were measured. Women over age 40 in these different cities were divided into 3 groups according to their age group. Results: A total of 558 woman were included in the study. Vitamin D levels in the 3 cities were found to be significantly different from each other (p<0.05). In Istanbul in both group 1 (40-49 years) and 2 (50-59 years) a weakly significant correlation was found between Vitamin D level and L1-4 T-score (r= -0.50, p<0.01) as well as serum calcium level and L1-4 T-score (r= -0.45, p<0.01) (r= -0.46, p<0.01). The significance for the correlation of femoral neck T-score and Vitamin D and calcium levels was weak (r= -0.26, p<0.05 and r=-0.30, p<0.05, respectively). No significant correlation between Vitamin D or calcium levels and T-scores at spinal or femoral neck and total hip T-scores existed for group 3 in Istanbul or any group in Izmir and Osmaniye. Vitamin D levels in Izmir was significantly higher than in Istanbul and Osmaniye. It can be concluded that in Istanbul in 3 groups there was a weakly significant correlation between Vitamin D level and L1-4 T-score (r= -0.44, p<0.001). Conclusion: In this study the most important result was correlation between BMD and low vitamin D levels. We concluded that correlation between BMD and vitamin D levels should be investigated in larger populations. (From the World of Osteoporosis 2010;16:49-52

Early Osteoarthritis and Osteoporosis Due to Spondyloepiphysial Dysplasia: A Case Report - Case Report

Spondyloepiphysial dysplasia (SED) is a rare diseases which causes delayed growth, short statue and involves the centre of the vertebral epiphysis. SED congenita and SED tarda are two different clinical forms of this disease. SED tarda with progressive arthropathy is another rare clinical appearance. SED is more frequently seen in male patients due to a genetic recessive transmission by chromosome X. The disease is characterized by a delay in the formation of epipysis, shortness of spine and extremities, kyphoscoliosis, coxa vara and platyspondily. In this case report we aimed to discuss an adolescent male SED tarda patient with early onset of osteoarthritis and osteoporosis, who was diagnosed as Scheuerman disease in the orthopedics clinic and treated with growth hormone for growth retardation in the pediatric endocrinology clinic. Important findings and labotatory investigation methods for diagnosis and treatment of this diasese will be outlined. (From the World of Osteoporosis 2009;15:79-82

Osteopoikilosis: A Cause of Elevated Bone Mineral Density on Dual X-Ray Absorptiometry Measurement in a Young Woman: Case Report

Osteopoikilosis (OPK) is an asymptomatic, rare bone dysplasia. It causes an increase in bone density. The etiology and pathogenesis is unknown. OPK is generally diagnosed incidentally on plain radiographies which were performed for other locomotor system symptoms. Diagnostic lesions of OPK are typically diffuse, round, symmetrically shaped sclerotic bone areas. Laboratory findings and bone scintigraphy are usually normal. OPK should be considered in the differential diagnosis of osteoblastic bone disorders. OPK is a benign disease and invasive diagnostic procedures as well as aggressive treatment modalities should be avoided. In young individuals who have elevated scores on dual-energy X-Ray absoptiometry measurement, OPK as well as other sclerosing bone disorders would be considered. (From the World of Osteoporosis 2010;16:25-8