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Influence of Vitamin D and C on Bone Marrow Edema Syndrome-A Scoping Review of the Literature. J Clin Med 2022; 11:jcm11226820. [PMID: 36431295 PMCID: PMC9696648 DOI: 10.3390/jcm11226820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/13/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022] Open
Abstract
Bone marrow edema syndrome (BMES) is a rare disease with a largely unknown etiology. The aim of this scoping review is to systematically evaluate and combine the available evidence about vitamin D and C and BMES. The analysis of the manuscripts was based on country of origin, number of patients, gender, study type, epidemiology, localization, bone mineral density measurements, vitamin status and therapy. Sixty studies were included. The overall number of patients was 823 with a male-to-female ratio of 1.55:1 and a mean age of 40.9 years. Studies were very heterogeneous and of diverging scientific scope with a weak level of evidence. The hip was the most affected joint, followed by the foot and ankle and the knee; 18.3% of patients suffered from multifocal BMES. Sixteen studies reported on vitamin D levels, resulting in a high prevalence of vitamin D deficiency (47%) and insufficiency (17.9%) among BMES patients. Three BME manuscripts were associated with vitamin C deficiency. Current therapeutic interventions include conservative measures (mainly unloading), various osteoactive drugs and iloprost. In summary, data about BMES in association with vitamin status is limited. A causal relationship between vitamin D or vitamin C status, osteopenia, and BMES cannot be determined from the existing literature.
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Gianakos AL, Abdelmoneim A, Kerkhoffs GM, DiGiovanni CW. The Pregnant Patient - Why Do My Feet Hurt? J Foot Ankle Surg 2022; 61:1357-1361. [PMID: 35637071 DOI: 10.1053/j.jfas.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 02/03/2023]
Abstract
Although hormonal and anatomical changes that occur during pregnancy have been well documented, how these changes affect foot and ankle function are less understood. Changes during pregnancy in body mass, body-mass distribution, joint laxity, and muscle strength can all contribute to alterations in gait pattern that can lead to pain or injury to the foot and ankle. This review provides an overview of the various foot and ankle anatomic, biomechanic, and kinematic changes that occur during pregnancy. In addition, this article presents the most common causes of foot and ankle symptoms expressed by the pregnant patient population and discuss the management and treatment of each condition.
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Affiliation(s)
- Arianna L Gianakos
- Massachusetts General Hospital, Department of Orthopedic Surgery, Boston, MA; Amsterdam University Medical Centers, Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
| | | | - Gino M Kerkhoffs
- Amsterdam University Medical Centers, Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Academic Center of Evidence based Sports medicine (ACES), Amsterdam, the Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), IOC Research Center, Amsterdam, the Netherlands
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Elman SA, Mazori DR, Merola JF. Pseudovasculitis: an etiology not to miss. Clin Rheumatol 2021; 40:2505-2506. [PMID: 33452938 DOI: 10.1007/s10067-020-05548-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/10/2020] [Accepted: 12/13/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Scott A Elman
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA, USA
| | - Daniel R Mazori
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA, USA
| | - Joseph F Merola
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA, USA. .,Division of Rheumatology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA, USA.
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De Houwer H, Van Beek N, Prinsen S, Van Riet A, De Roeck J, Verfaillie S. Bone marrow oedema syndrome of the foot and ankle in a paediatric population: a retrospective case series with serial MRI evaluation. J Child Orthop 2020; 14:440-450. [PMID: 33204352 PMCID: PMC7666800 DOI: 10.1302/1863-2548.14.190189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE By means of a case series we wanted to describe and correlate the clinical and imaging features of bone marrow oedema syndrome (BMOS) of the foot and ankle in children. METHODS A retrospective data study was performed on patients born on or after 01 January 2001 who underwent multiple MRI scans of the foot and ankle for pain symptoms. Six patients who presented with increased signal intensity on T2-weighted MR imaging without any underlying causes or concomitant pathology were included. RESULTS All patients, three boys and three girls with a mean age of 11 years (8 to 14), displayed patchy areas of increased signal intensity on T2-weighted and turbo inversion recovery magnitude (TIRM) images. On average, six tarsal bones were involved (4 to 8). In all patients, treatment consisted of rest and/or protected weight-bearing. The mean time for symptoms to improve during treatment was 6 months (1 to 16). The mean duration of treatment was nine months (3 to 16). In all patients clinical and imaging symptoms were strongly correlated and regressed in time. CONCLUSION BMOS as a pathological entity should be considered in paediatric patients with foot and ankle pain without a clear underlying cause, and characteristic T2-weighted and TIRM signal intensity increase on MRI images. As BMOS is transient and self-limiting, conservative treatment is advised while the oedema regresses. An early diagnosis of this pathology could prevent unnecessary diagnostic investigations and invasive treatments. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Hannah De Houwer
- Department of Orthopaedic Surgery, AZ Herentals, Herentals, Belgium,Correspondence should be sent to Hannah De Houwer, AZ Herentals - Orthopaedic Surgery, Nederrij 133 Herentals 2200, Belgium. E-mail:
| | | | - Sandra Prinsen
- Department of Pediatric Orthopaedic Surgery, UZ Leuven, Leuven, Belgium
| | - Anne Van Riet
- Department of Orthopaedic Surgery, AZ Herentals, Herentals, Belgium
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Mirghasemi SA, Trepman E, Sadeghi MS, Rahimi N, Rashidinia S. Bone Marrow Edema Syndrome in the Foot and Ankle. Foot Ankle Int 2016; 37:1364-1373. [PMID: 27587374 DOI: 10.1177/1071100716664783] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
UNLABELLED Bone marrow edema syndrome (BMES) is an uncommon and self-limited syndrome characterized by extremity pain of unknown etiology. Symptoms may include sudden or gradual onset of swelling and pain at rest or during activity, usually at night. This syndrome mostly affects middle-aged men and younger women who have pain in the lower extremities. The most common sites involved with BMES, in decreasing order of frequency, are the bones about the hip, knee, ankle, and foot. The diagnosis of BMES is confirmed with magnetic resonance imaging to exclude other causes of bone marrow edema. The correct diagnosis in the foot and ankle often is delayed because of the low prevalence and nonspecific signs. This delay may intensify bone pain and impair patient function and quality of life. The goal of BMES treatment is to relieve pain and shorten disease duration. Treatment options are limited and may include symptomatic treatment, pharmacologic treatment, and surgery. LEVEL OF EVIDENCE Level V, expert opinion.
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Affiliation(s)
| | - Elly Trepman
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Narges Rahimi
- Department of Physical Medicine & Rehabilitation, AJA Medical Science University, Tehran, Iran
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Muthusami S, Gopalakrishnan V, Stanley JA, Krishnamoorthy S, Ilangovan R, Gopalakrishnan VK, Srinivasan N. Cissus quadrangularis prevented the ovariectomy induced oxidative stress in the femur of adult albino rats. Biomed Pharmacother 2016; 81:416-423. [PMID: 27261621 DOI: 10.1016/j.biopha.2016.04.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 04/08/2016] [Accepted: 04/08/2016] [Indexed: 11/25/2022] Open
Abstract
UNLABELLED The increasing evidence suggesting the role of free radicals in bone resorption and bone loss prompted us to explore whether the consumption of antioxidant rich medicinal plant C. quadrangularis modifies antioxidant status in ovariectomized rats. METHODS Twenty four female adult rats, 90days old showing regular estrous cycles were used for the present study. The animals were divided into two groups. The Group-1 rats (n=6) were sham operated and Group-II rats were bilaterally ovariectomized (n=18) and treated with C. quadrangularis for sixty days (100mg/kg body weight and 250mg/kg body weight). After sixty days, the rats were killed, femora were dissected out, minced and homogenized in Tris-HCl buffer (pH 7.4) and the supernatant was collected and used for biochemical assays. RESULTS Ovariectomy registered a decrease (p<0.05) in the activities of SOD, GPx, GST, ALP, collagen content and increased (p<0.05) the activities of TRAP and lipid peroxidation. Simultaneous administration of C. quadrangularis maintained the enzyme activities in ovariectomized rats. CONCLUSION C. quadrangularis, a natural herb may be used to treat the estrogen deficiency/menopause onset and ovariectomy induced oxidative stress.
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Affiliation(s)
- Sridhar Muthusami
- Department of Biochemistry, Karpagam University, Eachanari, Coimbatore, Tamilnadu 641021, India; Department of Endocrinology, Dr. ALM Post Graduate Institute of Basic Medical Sciences, University of Madras, Taramani campus, Chennai, 600113, India.
| | - Vasudevan Gopalakrishnan
- Department of Endocrinology, Dr. ALM Post Graduate Institute of Basic Medical Sciences, University of Madras, Taramani campus, Chennai, 600113, India
| | - Jone A Stanley
- Department of Endocrinology, Dr. ALM Post Graduate Institute of Basic Medical Sciences, University of Madras, Taramani campus, Chennai, 600113, India; Department of Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843, USA
| | - Senthilkumar Krishnamoorthy
- Department of Endocrinology, Dr. ALM Post Graduate Institute of Basic Medical Sciences, University of Madras, Taramani campus, Chennai, 600113, India
| | - Ramachandran Ilangovan
- Department of Endocrinology, Dr. ALM Post Graduate Institute of Basic Medical Sciences, University of Madras, Taramani campus, Chennai, 600113, India
| | | | - Narasimhan Srinivasan
- Department of Endocrinology, Dr. ALM Post Graduate Institute of Basic Medical Sciences, University of Madras, Taramani campus, Chennai, 600113, India; Faculty of Allied Health Sciences, Chettinad University, Kelambakkam, Chennai 603103, India.
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Anagnostakos K, Orth P. Role of serum lipoprotein at the site of iloprost therapy in the treatment of painful bone marrow edema. Orthopedics 2013; 36:e1283-9. [PMID: 24093705 DOI: 10.3928/01477447-20130920-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The authors hypothesized that the emergence of painful bone marrow edema occurs through microembolisms in the bone marrow that may be reflected in elevated plasma parameters of hypofibrinolysis or a disturbance of the lipid metabolism and that treatment with iloprost may lead to a decrease in or normalization of the elevated serum parameters and, therefore, to pain reduction. Twenty-one patients (12 men and 9 women; mean age, 50 years [range, 22-70 years]) with painful bone marrow edema and elevated lipoprotein(a) (Lp[a]) serum values were treated with intravenous iloprost. Before and 6 weeks after iloprost therapy, the serum concentrations of Lp(a), apolipoprotein A1 (ApoA1), and apolipoprotein B (ApoB) were determined. At 6-week follow-up, 17 patients reported complete resolution of their symptoms. For these patients, complete bone marrow edema resolution was observed on magnetic resonance imaging. Four patients reported that their symptoms were either the same or had worsened but had partial bone marrow edema resolution on magnetic resonance imaging. In these patients, Lp(a) values either increased or remained the same. Hence, the total success rate of iloprost treatment was 86% at a mean follow-up of 17 months (range, 3-45 months). Before iloprost therapy, mean ApoA1, ApoB, and Lp(a) values were 159.8, 108.3, and 69.1 mg/dL, respectively. Six weeks after iloprost therapy, mean ApoA1, ApoB, and Lp(a) values decreased to 147.6 (P=.011), 98.4 (P=.042), and 38.3 (P<.001) mg/dL, respectively. The results of this study indicate a possible role of hypofibrinolysis or a disturbance in the lipid metabolism in the emergence of painful bone marrow edema.
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Charpidou T, Lang F, Langenegger T, Dedes KJ, Honegger C. Bilateral transient osteoporosis of the knee during pregnancy. Arch Gynecol Obstet 2012. [DOI: 10.1007/s00404-012-2628-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Limaye R, Tripathy SK, Pathare S, Saeed K. Idiopathic transient osteoporosis of the talus: a cause for unexplained foot and ankle pain. J Foot Ankle Surg 2012; 51:632-5. [PMID: 22608351 DOI: 10.1053/j.jfas.2012.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Indexed: 02/08/2023]
Abstract
A 53-year-old woman was investigated for several neoplastic, inflammatory, and infective conditions for her left foot, and ankle pain associated with swelling, which she developed unexpectedly without history of trauma or infection. Gross osteopenia in the talus raised the possibilities of several differential diagnoses, but a magnetic resonance imaging scan showed diffuse bone marrow edema in the talus. With negative infective and inflammatory markers, the condition was ultimately labeled as "transient osteoporosis." She was reassured and followed up regularly. At the end of 12 months, she was completely asymptomatic, and her radiograph and magnetic resonance images showed significant improvement, with a normal-appearing talus and ankle joint, and there was complete resolution of bone marrow edema. Although "transient osteoporosis" of the foot is an uncommon condition, clinicians should be aware of this. Unexplained foot pain, with osteopenic bone and diffuse bone marrow edema on magnetic resonance imaging scan, is a feature of this condition. However, the diagnosis is established once other causes are excluded. The condition is self-limiting, and watchful expectancy of a normal recovery is the mainstay of treatment.
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Affiliation(s)
- Rajiv Limaye
- Friarage Hospital, Northallerton, North Yorkshire, UK
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Sprinchorn AE, O'Sullivan R, Beischer AD. Transient bone marrow edema of the foot and ankle and its association with reduced systemic bone mineral density. Foot Ankle Int 2011; 32:S508-12. [PMID: 21733459 DOI: 10.3113/fai.2011.0508] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Transient bone marrow edema in the foot and ankle is an uncommon condition that should be distinguished from early avascular necrosis, stress fracture, or bone bruise. The diagnosis is based on the clinical presentation of pain with weightbearing without a history of trauma, combined with typical findings on magnetic resonance imaging. The etiology is not known, but recent case reports have suggested a possible link to systemic osteoporosis. This study examined the relationship between transient bone marrow edema of the foot and ankle and low systemic bone mineral density. MATERIAL AND METHODS Over a period of 2 years, ten patients (eight women and two men) who were referred to our foot and ankle clinic were diagnosed as having transient bone marrow edema. Their mean age was 59 years. All underwent dual energy X-ray absorptiometry (DEXA) scan and were tested for serum vitamin D levels. The patients were treated with either a controlled ankle motion (CAM) walker or a stiff-soled postoperative shoe and all recovered in 5 to 10 months. RESULTS Four patients were found to have osteoporosis and five had osteopenia. Only one patient had normal bone density. Serum vitamin D levels were low in nine patients, and normal in one. CONCLUSION Our study found a strong association with transient bone marrow edema in the foot and ankle and low systemic bone mineral density, which appears to be due to a vitamin D deficiency. We recommend that, when TBME is diagnosed, patients should be referred for assessment and treatment of their bone mineral density.
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Affiliation(s)
- Anna E Sprinchorn
- Victorian Orthopaedic Foot and Ankle Clinic, Epworth Centre, Richmond, Mebourne, Victoria, Australia
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Abstract
A 52-year-old man presented with a 3-week history of right knee pain, significant enough to prevent weight bearing. There was no history of knee injury or disease. On knee examination, an effusion and medial joint line tenderness was noted. Knee range of motion was full, but painful. Radiographs revealed minor osteoarthritic changes. Laboratory values were within normal limits, including those associated with infection. Magnetic resonance imaging showed decreased signal intensity on T1-weighted images within the medial femoral condyle and corresponding increased signal intensity on T2-weighted consistent with bone marrow edema as well as edema to the adjacent soft tissues. Bone scanning showed increased uptake of radioisotope in the medial femoral condyle. The patient was diagnosed with bone marrow edema syndrome, and managed medically with analgesics and continued non weight-bearing status. At the 1-month follow-up, his symptoms had improved significantly. The patient progressively increased weight bearing as tolerated over the subsequent weeks. At 12-week follow-up, symptoms had completely resolved. Magnetic resonance imaging showed no signal abnormalities in the affected knee. Transient osteoporosis is an uncommon and typically self-limiting condition that can be challenging to diagnose and treat. The clinician must be aware of this entity, as well as its typical course, to prevent unnecessary testing and invasive intervention.
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Affiliation(s)
- Vassilios S Nikolaou
- Athens University, 2nd Orthopaedic Department, Megalou Alexandrou 54, Maroussi, Athens, Greece
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