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

Association of Obesity with Forearm Fractures, Bone Mineral Density and Fracture Risk (FRAX®) During Postmenopausal Period

Objective: The aim of this study was to investigate the association among obesity with bone mineral density (BMD) and subsequent fracture risk among postmenopausal women with a previous forearm fracture. Materials and Methods: The study enrolled obese (n=40) and normal-weight (n=40) postmenopausal women who had a previous forearm fracture. BMD measurements were obtained using a GE-LUNAR DPX dual energy X-ray absorptiometry scan for all subjects. FRAX® fracture risk scores were calculated taking into account former fractures and current risk factors of the subjects. Both groups were compared with respect to their BMD values, T scores, FRAX® risk scores and frequency of previous fractures. Results: No difference was observed between groups with regard to mean age, mean age of menopause onset and mean serum calcium, phosphorus and alkaline phosphatase levels (p>0.05 for all). Statistically, obese patients showed highly significantly greater mean BMD values at lumbar spine (L1-L4) and femoral neck in comparison to subjects with normal body weight (p=0.000 for all). Obese patients had a lower 10-year probability of a major osteoporotic fracture on average as determined by FRAX® fracture risk score compared to that in normal-weight subjects (p<0.05). Also, obese group had a lower 10-year probability of a hip fracture versus normal-weight subjects (p<0.01). Both groups were found to have a similar frequency of previous fractures. Conclusion: Although obese patients in this study had greater BMD values and lower FRAX® risk scores, the probability of subsequent fractures predicted for the obese group was not lower when compared to that predicted for normal-weight group. It should be kept in mind that obesity may not necessarily be protective against fractures and treatment algorithms based solely on BMD might be inadequate to predict future fracture risk

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

Evaluation of hepatitis serology and frequency of viral reactivation in patients with inflammatory arthritis receiving biologic agents: a multicenter observational study

To evaluate of hepatitis serology and reactivation frequency in patients with rheumatic disease receiving biologic agents. Our study included patients with inflammatory rheumatic diseases from 23 centers, who were followed up with biological therapy. Demographic and clinical characteristics of the patients, duration of drug use and hepatitis serology and the state of viral reactivation were analyzed. A total of 4060 patients, 2095 being males, were included in our study. Of the patients, 2463 had Ankylosing Spondylitis (AS), 1154 had Rheumatoid Arthritis (RA), 325 had Psoriatic Arthritis (PsA), and 118 had other inflammatory rheumatic diseases. When the viral serology of the patients was evaluated, 79 patients (2%) who were identified as HBs Ag positive, 486 (12%) patients who were HBs Ag negative and anti-HBc IgG positive and 20 patients (0.5%) who were anti-HCV positive. When evaluated on a disease-by-disease basis, the rate of HBsAg was found to be 2.5% in RA, 2% in AS and 0.9% in PsA. Viral reactivation was detected in 13 patients while receiving biologic agents. HBs Ag was positive in nine patients with reactivation and negative in four patients. Anti-HBc IgG, however, was positive. Six of these patients had AS, four had RA, and three had PsA. The development of hepatitis reactivation in 11.4% of HBs Ag positive patients and 0.82% of anti-HBc IgG positive patients due to the use of biologic agents is an important problem for this group of patients. Antiviral prophylaxis is recommended to be started especially in patients who are HBs Ag positive and who are using biologic agents due to viral reactivation. Therefore, it is important to carry out hepatitis screenings before biologic agent treatment and to carefully evaluate the vaccination and prophylaxis requirements