Lessons learned from long-term side effects after zoledronic acid infusion following denosumab treatment : a case report and review of the literature

Background: Zoledronic acid is an intravenous, highly potent aminobisphosphonate for use in patients with primary or secondary osteoporosis. Zoledronic acid-induced prolonged side-effects are well known and quite common. However, severe side-effects can be a threat to life. We report a case of severe side-effects induced by zoledronic acid infusion, and its positive effect on long-term back pain. Case presentation: In 2012, a 62-year-old white native Finnish woman was operated on for an estrogen and progesterone receptor-positive breast cancer. After radiotherapy, an aromatase inhibitor (letrozole) was started. Nine months after the operation, the patient suffered a low-energy compression fracture of Th XII. She received denosumab to prevent fragility fractures and to improve bone mineral density. Letrozole was discontinued after 5.5 years, and the last denosumab injection was given after 7 years. Six months later, at the age of 71 years, the patient received a single intravenous zoledronic acid infusion. Suddenly, at 10 hours from the infusion, she complained of severe trismus, muscle twitching, spasms, and tingling, matching hypocalcemia and several other symptoms. Her serum 25-hydroxyvitamin D concentration was high (163 nmol/L), the concentration of serum calcium and calcium-ion was normal (2.32 mmol/L and 1.23 mmol/L, respectively). However, the neutrophil to lymphocyte ratio (NLR) was low (1.6). A complete recovery took 2 months. Zoledronic acid infusion also had a positive effect: for many years, the patient had suffered low back pain and strain, which came to an end after this single infusion. Conclusion: It is important that the potential patients receive sufficient information about the possibility of side-effects following the administration of intravenous zoledronic acid. To ensure that a zoledronic acid infusion is given as safely as possible, the safety information should include that the patient should not be left without monitoring for a minimum 24 hours after the infusion. Being alone and experiencing serious side-effects may lead to acute cardiac problems. Furthermore, the chronic low back pain and strain that our patient suffered for many years has clearly reduced for 16 months after infusion, so far. We conclude that this is a positive effect of zoledronic acid.Peer reviewe

Päihteet lisäävät tapaturmavaaraa : Käyttöön kannattaa hoitotilanteessa puuttua

Vertaisarvioitu. Teema : Tapaturmien ehkäisyPäihteiden käyttö lisää tapaturmariskiä ja vammojen vakavuutta. Vaara kuolla päihtyneenä tapaturmassa on miehillä kuusinkertainen naisiin verrattuna. Alkoholin aiheuttama kuormitus päivystyksissä lisääntynee uuden alkoholilain vuoksi. Päivystysyksiköissä on hyödyllistä testata tapaturmapotilaan veren alkoholipitoisuus ja keskustella testin tuloksesta. Päihdeongelmien varhainen tunnistaminen sekä potilaan tukeminen ja hoitoonohjaus ovat tärkeitä haittojen ehkäisemiseksi.Peer reviewe

Evaluation of minimal fracture liaison service resource : costs and survival in secondary fracture prevention-a prospective one-year study in South-Finland

Background Fracture liaison service (FLS) is a secondary prevention model for identification of patients at risk for fragility fractures. Aims This study was conducted to evaluate the number and costs of secondary prevention of low-energy fractures in the city of Kouvola in Finland. Methods Women aged >= 45 years and men >= 60 years treated in the emergency department with a low-energy fracture were identified. Laboratory testing, BMI, and DXA scans were performed. Fracture Risk Assessment Tool was used. The direct FLS costs were calculated. Survival was analyzed using univariate and multivariate analysis and the life-table method. Results 525 patients with 570 fractures were identified. The mean age of women was 73.8 years and of men 75.9 years. Most patients sustained wrist (31%), hip (21%) or proximal humerus (12%) fractures. 41.5% of the patients had osteoporosis according to DXA scans. 62% of patients used calcium and vitamin D daily and 38% started anti-osteoporotic medication. Protective factors for survival were: age <80 years, female sex, and S-25OHD concentration of 50-119 nmol/L. Excess mortality was highest among patients with a fracture of the femur. The total annual direct costs of FLS were 1.3% of the costs of all fractures. Discussion Many low-energy fracture types were associated with excess mortality. The use of anti-osteoporotic medication was not optimal. Conclusions FLS increased the catchment of low-energy fracture patients and was inexpensive. However, identification, evaluation and post-fracture assessment of patients should be expedited. Rehabilitation of hip fracture patients needs to be improved.Peer reviewe

No change in the use of alcohol among hip fracture patients over a 12-year period : a prospective study in south-eastern Finland

Excess alcohol use is a risk factor for hip fractures. The objectives of this study were to analyse serum ethanol levels among hip fracture patients and to compare the results with a similar study conducted 12 years ago in the same two hospitals covering the same geographic area. A prospective cohort comprising 245 Caucasian hip fracture patients was enrolled in the emergency rooms of two acute hospitals in south-eastern Finland over a 12-month period in 2015-2016. The serum ethanol concentrations (>= 0.101 g/L) were compared with the corresponding concentrations of a similar cohort analysed in the same two hospitals 12 years previously. Liver enzymes and mean corpuscular volume (MCV) were measured. The patients were asked about their use of alcohol during the 24 h period prior to the fracture. Of the 245 patients, 70% were women with a mean age of 81 years, whereas the mean age of the men was 78 years. In the total data, 5% of patients had a positive ethanol level. At the time of admission, 10% of the patients reported having used alcohol within the previous 24 h. Both results were in line with the results obtained 12 years ago. For all the tested enzymes except alanine aminotransferase (ALT), differences were recorded between the mean values in alcohol-positive and -negative females and males. Only 5% of the hip fracture patients had positive serum ethanol concentration on the day of admission to the emergency department. This result was similar to that obtained 12 years earlier.Peer reviewe

Cycling injuries and alcohol

Background: Most of the cycling accidents that occur in Finland do not end up in the official traffic accident statistics. Thus, there is minimal information on these accidents and their consequences, particularly in cases in which alcohol was involved. The focus of the present study is on cycling accidents and injuries involving alcohol in particular. Methods: Data on patients visiting the emergency department at North Kymi Hospital because of a cycling accident was prospectively collected for two years, from June 1, 2004 to May 31, 2006. Blood alcohol concentration (BAC) was measured on admission with a breath analyser. The severity of the cycling injuries was classified according to the Abbreviated Injury Scale (AIS). Results: A total of 217 cycling accidents occurred. One third of the injured cyclists were involved with alcohol at the time of visiting the hospital. Of these, 85% were males. A blood alcohol concentration of Conclusions: Cyclists involved with alcohol were, in most cases, heavily intoxicated and were not wearing a bicycle helmet. Head injuries were more common among these cyclists than among sober cyclists. As cycling continues to increase, it is important to monitor cycling accidents, improve the accident statistics and heighten awareness of the risks of head injuries when cycling under the influence of alcohol. (c) 2018 Elsevier Ltd. All rights reserved.Peer reviewe