Pathological Femoral Fracture due to Osteoporosis and Hypophosphatemic Osteomalacia Following Adefovir Therapy in a Patient with Chronic Hepatitis B

Adefovir dipivoxil (ADV) is a nucleotide analogue used in the chronic hepatitis B treatment. Proximal renal tubular dysfunction is one of the adverse effects of this agent and characterized with hypophosphatemia and osteomalacia. However, reduced bone mineral density with fracture due to ADV therapy has not been reported before. We aimed to report a 55-year-old male patient with proximal femur fracture who developed hypophosphatemic osteomalacia while using low dose of adefovir (10 mg/day) for chronic hepatitis B treatment for 10 years

A randomized controlled trial of Eye Movement Desensitization and Reprocessing (EMDR) Therapy in the treatment of fibromyalgia

BackgroundIn addition to pharmacological treatment, psychotherapeutic approaches are recommended for the treatment of fibromyalgia. There is a suggestion that eye movement desensitization and reprocessing (EMDR) therapy may be effective. This study aimed to investigate the impact of EMDR therapy on fibromyalgia symptoms, depression, sleep quality, and traumatic stress in fibromyalgia patients through a randomized controlled study (RCT).Materials and methodsThe sample for this study comprised 79 individuals diagnosed with fibromyalgia. Participants were randomly assigned to two groups: the “Treatment as Usual” (TAU) group and the TAU + EMDR group. Prior to the study and at six different time points (before starting the study, at the end of the 5th, 10th, and 15th sessions, 1 month later, and 3 months later), participants completed assessments, including the Fibromyalgia Impact Questionnaire (FIQ), Visual Analog Scale (VAS), Fibromyalgia ACR 2010 Diagnostic Criteria [Widespread Pain Index (WPI) and Symptom Severity Scale (SSS)], Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI), and Trauma Symptom Checklist-40 (TSC-40).ResultsThere were no differences in the sociodemographic variables between the study and experimental groups. Analysis of variance revealed a statistically significant group effect on VAS (p = 0.019), WPI (p = 0.018), BDI (p = 0.019), and TSC-40 (p = 0.21). After applying Bonferroni correction, EMDR was found to be effective for VAS, WPI, SSS, BDI, PSQI, and TSC-40 (p <0.05).ConclusionThe results of the current study suggest that EMDR therapy is a viable alternative treatment for fibromyalgia. We believe these findings offer robust evidence supporting the efficacy of EMDR therapy in treating fibromyalgia, particularly in the context of a randomized controlled trial (RCT). The application of EMDR therapy for the treatment of patients with fibromyalgia is likely to be beneficial.Clinical trial registrationClinicalTrials.gov, identifier NCT06265194

Bone Mineral Density in Men - Original Investigation

Aims: This study is designed to evaluate bone mineral density (BMD) in men who attend to Physical Medicine and Rehabilitation outpatient clinic. Patients and Medhods: 42 men were included into the study. They were evaluated in 3 groups according to their age (30-75); age between 30-45, 45-60 and over 60 yrs. BMD of lumbar spine (L2-L4) and femur neck were evaluated by using dual x-ray absorptiometry (DXA). Serum paratiroid hormone, osteocalcin, 25 (OH) D3 vitamine levels and urinary deoxypridinoline levels were evaluated. Results: Mean age of the patients were 51.24±12.23 yrs in femur neck and in lumbar region, 70% and 15% of the patients between 60-75 yrs, 53% and 7% of the patients between 45-60 yrs and 23% and 8% of the patients between 30-45 yrs have osteoporosis, respectively. Between the groups femur neck BMD and L2-L4 BMD were significantly different (p=0.043 and p=0.008, respectively). Serum PTH levels were high and serum 25(OH)D3 levels were low in all groups. There were no significant difference between the groups regarding bone turnover markers. Seven patients had osteoporotic fractures (6 vertebral, 1 hip). Correlation was found between fractures and L2-L4 BMD ( r=-0.322, p=0.043). Conclusion: Osteoporosis is common also in men, particularly in the middle and old ages. Routine analysis of blood biochemistry and DXA should be performed in adult men. (From the World of Osteoporosis 2007;13:1-5

Relationship Between Bone Mineral Density and Functional Parameters of Paraplegic Patients in Short-Term After Spinal Cord Injury-Original Investigation

Aim: To determine the relationship between bone mineralization and functional activity level of paraplegic patients in short-term after spinal cord injury (SCI). Material and Methods: Thirty paraplegic patients and twentynine healthy controls were admitted to this study. Bone mineral density (BMD) and Z-scores, together with serum calcium, phosphorus, alkaline phosphatase, parathyroid hormone and 25-hydroxyvitamin-D levels, urinary calcium and deoxypyridinoline excretion were measured. All patients underwent a rehabilitation program including range of motion and progressive resistance exercises, upper body ergometry exercises, standing training with long leg orthosis, wheelchair ambulation or walking either by orthosis or walking aids five times/week during hospitalization. Results: There was no difference between the groups regarding BMD values and Z-scores. Mean serum calcium and parathyroid hormone levels were lower (p=0.016 and p<0.001, respectively), serum phosphorus and alkaline phosphatase levels were higher (p<0.001 and p=0.049, respectively) in the paraplegics as compared to the controls. Positive correlations were found between the radius BMD values and total duration of upper body ergometry exercise (r=0.550, p=0.027) and wheelchair use (r=0.622, p=0.010) and also between the femur BMD values and total duration of therapeutic standing (r=0.351, p=0.039). There was an inverse relationship between the femur BMD values and total duration of immobilization (r= -0.404, p= 0.033). Conclusion: Early rehabilitation interventions may prevent bone demineralization. Paraplegic patients should be followed and evaluated also in long term for the increased risk of osteoporosis. (From the World of Osteoporosis 2008;14: 57-61

A Case of Paget’s Disease with Scapula Involvement

Paget’s disease is a common bone disorder which is characterized by excessive bone turnover. This condition rarely involves sternum, patella, scapula, hand, foot and facial bones. A 65-year-old male patient was admitted to our outpatient clinic with the complaint of right-sided pain that radiated from his groin to his knee for the last 5-6 years. His physical examination revealed limited hip movements and pain. Whole body bone scintigraphy detected diffuse, increased activity in the right coxa and entire scapula. Elevated alkaline phosphatase (ALP) (367 U/L) was observed in laboratory results. Further investigations and examinations were performed in order to exclude possible malignancies (eg. prostate, lung) due to involvement of scapula which is atypical for Paget’s disease. Finally, poliostotic Paget’s disease with pelvic and scapular involvement was considered as the definite diagnosis. Treatment with risedronate sodium was started at a dose of 35 mg daily which led to marked improvement in hip pain and reduction in ALP level to 150 U/L after one month. While making a differential diagnosis of scintigraphic lesions at an unusual location such as scapula, consideration should be given to the fact that Paget’s disease may affect any bone in the body although this is rar

Association of Serum Vitamin D Levels with Disease Activity in Male Patients with Ankylosing Spondylitis

Objective: To examine the relationship between serum 25-hydroxyvitamin D [25(OH)D] level and disease activity in male patients with ankylosing spondylitis (AS). Materials and Methods: The study enrolled 51 male AS patients being followed at our hospital. Patient demographics as well as serum levels of 25(OH)D vitamin, C-reactive protein (CRP), calcium, phosphorus, alkaline phosphatase and parathormone, and erythrocyte sedimentation rate (ESR) at 1 hour were recorded. Patients were divided into two groups based on their serum 25(OH)D vitamin levels; one group consisted of 21 patients with 25(OH)D vitamin levels less than 20 ng/mL and the other group comprised 30 patients with 25(OH)D levels greater than 20 ng/mL. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores were evaluated in order to determine the disease activity. Results: BASDAI scores were statistically significantly higher in the group with serum 25(OH)D vitamin levels less than 20 ng/mL compared to the group with 25(OH)D levels above 20 ng/mL (p<0.05). There was no statistically significant difference between groups in terms of ESR, serum levels of CRP, parathormone, calcium, phosphorus and alkaline phosphatase. Conclusion: In the present study, an inverse relationship has been found between serum vitamin D levels and disease activity in male AS patients and it was concluded that serum vitamin D levels should also be taken into account while developing a treatment plan

The Effect Of Body Mass Index On Bone Mineral Density In Postmenopausal Women - Original Investigation

Aim: We aimed to determine the relationship between bone mineral density and body mass index in postmenopausal women. Material and Methods: 54 postmenopausal women were included in the study. Age and time of menopause were recorded. Smoking, alcohol and exercise status were also recorded. Weight and height were measured and body mass index was calculated. The patients were separated into four groups according to their body mass index, as underweight, ideal weight, over-weight and obese. Bone mineral density in all the patients was assessed via dual energy X-ray absorptiometry from antero-posterior lumbar and right proximal femoral regions. For L2-4 and the femoral neck, bone mineral density and t scores were determined. Results: The study was performed in 54 postmenopausal women, ranging in age from 51 to 79 years. 22 (%40.8) of the patients were obese, 24 (%44.4) were overweight and 8 (%14.8) had ideal weight. There were no patients in underweight group. There were no difference in age, smoking, time of menopause, bone mineral density and t-scores among the groups. There was statistically significant correlation between body mass index and bone mineral density of the femoral neck (r =0.407, p=0.002), and femoral neck t-scores (r =0.297, p=0.029). There was no significant correlation between the body mass index and lumbar bone mineral density and lumbar t-scores (p >0.05). Conclusion: Body mass index was found to be related to bone mineral density of the femoral neck. Our findings suggest that maintenance of adequate body mass is important for the prevention of postmenopausal bone loss. (From the World of Osteoporosis 2007;13:56-9