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Gross AM, Plotkin SR, Watts NB, Fisher MJ, Klesse LJ, Lessing AJ, McManus ML, Larson AN, Oberlander B, Rios JJ, Sarnoff H, Simpson BN, Ullrich NJ, Stevenson DA. Potential endpoints for assessment of bone health in persons with neurofibromatosis type 1. Clin Trials 2024; 21:29-39. [PMID: 37772407 PMCID: PMC10920397 DOI: 10.1177/17407745231201338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Neurofibromatosis type 1 is a genetic syndrome characterized by a wide variety of tumor and non-tumor manifestations. Bone-related issues, such as scoliosis, tibial dysplasia, and low bone mineral density, are a significant source of morbidity for this population with limited treatment options. Some of the challenges to developing such treatments include the lack of consensus regarding the optimal methods to assess bone health in neurofibromatosis type 1 and limited data regarding the natural history of these manifestations. In this review, the Functional Committee of the Response Evaluation in Neurofibromatosis and Schwannomatosis International Collaboration: (1) presents the available techniques for measuring overall bone health and metabolism in persons with neurofibromatosis type 1, (2) reviews data for use of each of these measures in the neurofibromatosis type 1 population, and (3) describes the strengths and limitations for each method as they might be used in clinical trials targeting neurofibromatosis type 1 bone manifestations. The Response Evaluation in Neurofibromatosis and Schwannomatosis International Collaboration supports the development of a prospective, longitudinal natural history study focusing on the bone-related manifestations and relevant biomarkers of neurofibromatosis type 1. In addition, we suggest that the neurofibromatosis type 1 research community consider adding the less burdensome measurements of bone health as exploratory endpoints in ongoing or planned clinical trials for other neurofibromatosis type 1 manifestations to expand knowledge in the field.
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Affiliation(s)
- Andrea M Gross
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Scott R Plotkin
- Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston, MA, USA
| | - Nelson B Watts
- Mercy Health Osteoporosis and Bone Health Services, Cincinnati, OH, USA
| | - Michael J Fisher
- Division of Oncology, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Laura J Klesse
- Division of Hematology/Oncology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
| | | | | | - A Noelle Larson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Jonathan J Rios
- Center for Pediatric Bone Biology and Translational Research, Scottish Rite for Children, McDermott Center for Human Growth and Development, UT Southwestern Medical Center, Dallas, TX, USA
| | - Herb Sarnoff
- Research and Development, Infixion Bioscience, Inc., San Diego, CA, USA
| | - Brittany N Simpson
- Division of Human Genetics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Nicole J Ullrich
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - David A Stevenson
- Division of Medical Genetics, Department of Pediatrics, Stanford University, Stanford, CA, USA
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2
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Ireland A, Riddell A, Prentice A, Eelloo J, Mughal MZ, Ward KA. Development of tibia & fibula bone deficits in children with neurofibromatosis type I - A longitudinal case-control comparison. Bone 2022; 154:116183. [PMID: 34600162 DOI: 10.1016/j.bone.2021.116183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/01/2021] [Accepted: 09/07/2021] [Indexed: 11/25/2022]
Abstract
Neurofibromatosis type 1 (NF1) is associated with lower bone mass and increased risk of fracture. Children with NF1 display faltering growth from mid-childhood. However, to date tibia bone development in children with NF1 across childhood and the role of body size have not been explored. Therefore, we recruited 24 children with NF1 (12 girls, mean age 8.2 ± 1.1y) and 104 children without NF1 (52 girls, mean age 11 ± 1.7y). Tibia and fibula bone characteristics were assessed at 4% and 38% distal-proximal tibia length in all children at baseline using peripheral quantitative computed tomography (pQCT). Longitudinal scans were obtained in 21 children with NF1 (12 girls) over 3.4 ± 0.3y and 71 children without NF1 (34 girls) over 1.1 ± 0.1y, such that at follow-up mean age of both groups (NF1 10.9 ± 1.3y, controls 11.4 ± 1.4y) were similar. Effects of group (NF1/control) on bone outcomes as well as group-by-age interactions, indicating differences in rate of change in bone outcome bone outcomes were assessed via linear mixed effects models with adjustment for sex, age, pubertal status and in additional models with adjustment for height and weight Z-scores. Group (NF1/control)-by-age interactions indicated a slower rate of tibia and fibula bone mass accrual in children with NF1 at all measured sites. These associations were attenuated by 25-50% by adjustment for height and weight Z-scores. At the 4% site, deficits in bone mass at older ages were related to slower trabecular BMD accrual. At the 38% site, group-by-age interactions suggested that bone mass deficits resulted from poorer accrual of cortical CSA and to a lesser extent cortical BMD. Lower limb bone mass deficits evident in children with NF1 appear to be progressive and emerge in mid-childhood. In part, they are related to development of a similar pattern of deficits in longitudinal growth and body weight in NF1. Interventions promoting muscle development or physical activity may be partially effective in attenuating bone mass accrual deficits in this population.
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Affiliation(s)
- Alex Ireland
- Musculoskeletal Science and Sports Medicine Research Centre, Department of Life Sciences, Manchester Metropolitan University, Manchester, UK.
| | - Amy Riddell
- Institute for Infection and Immunity, Paediatric Infectious Diseases Research Group, St. George's University of London, UK; previously at MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK
| | - Ann Prentice
- previously at MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK; MRC Nutrition and Bone Health Group, Cambridge, UK
| | - Judith Eelloo
- Nationally Commissioned Complex NF1 Service, Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - M Zulf Mughal
- Nationally Commissioned Complex NF1 Service, Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK; School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Kate A Ward
- MRC Lifecourse Epidemiology Unit, Human Development and Health, University of Southampton, Southampton, UK
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Medeleanu M, Vali R, Sadeghpour S, Moineddin R, Doria AS. A systematic review and meta-analysis of pediatric normative peripheral quantitative computed tomography data. Bone Rep 2021; 15:101103. [PMID: 34377749 PMCID: PMC8327482 DOI: 10.1016/j.bonr.2021.101103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 06/15/2021] [Accepted: 06/28/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Peripheral-quantitative computed tomography (pQCT) provides an intriguing diagnostic alternative to dual-energy X-ray absorptiometry (DXA) since it can measure 3D bone geometry and differentiate between the cortical and trabecular bone compartments. OBJECTIVE To investigate and summarize the methods of pQCT image acquisition of in children, adolescents and/or young adults (up to age 20) and to aggregate the published normative pQCT data. EVIDENCE ACQUISITION A literature search was conducted in MEDLINE and EMBASE from 1947 to December 2020. Quality of the included articles was assessed using Standards for Reporting of Diagnostic Accuracy (STARD) scoring system and United States Preventative Services Task Force (USPSTF) Study Design Categorization. Seven articles, encompassing a total of 2134 participants, were aggregated in the meta-analysis. Due to dissimilar age groups and scan sites, only seven pQCT parameters of the 4% radius, 4% tibia and 38% tibia were analyzed in this meta-analysis. EVIDENCE SYNTHESIS The overall fixed-effect estimates of trabecular vBMD of the 4% radius were: 207.16 (201.46, 212.86), mg/cm3 in 8 to 9 year-old girls, 210.42 (201.91, 218.93)in 10 to 12 year-old girls, 226.99 (222.45, 231.54) in 12 to 13 year-old girls, 259.97 (254.85, 265.10) in 12 to 13 year-old boys and 171.55 (163.41,179.69) in 16 to 18 year-old girls. 21 of 54 (38.9%) primary papers received a 'good' STARD quality of reporting score (<90 and 70 ≥ %) (mean STARD score of all articles = 69.4%). The primary articles of this review had a 'good' level USPSTF study design categorization. However, most of the normative data in these articles were non-comparable and non-aggregable due to a lack of standardization of reference lines, acquisition parameters and/or age at acquisition. CONCLUSION There is not sufficient evidence to suggest that pQCT is appropriately suited for use in the pediatric clinical setting. Normative pediatric data must be systematically derived for pQCT should it ever be a modality that is used outside of research. CLINICAL IMPACT We demonstrate the need for normative pQCT reference data and for clinical guidelines that standardize pediatric acquisition parameters and delineate its use in pediatric settings.
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Affiliation(s)
- Maria Medeleanu
- Department of Physiology, Faculty of Medicine, University of Toronto, Canada
- Translational Medicine, Hospital for Sick Children, Canada
| | - Reza Vali
- Department of Physiology, Faculty of Medicine, University of Toronto, Canada
- Department of Diagnostic Imaging, Hospital for Sick Children and Department of Medical imaging, University of Toronto, Canada
| | | | - Rahim Moineddin
- Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Canada
| | - Andrea S. Doria
- Department of Physiology, Faculty of Medicine, University of Toronto, Canada
- Department of Diagnostic Imaging, Hospital for Sick Children and Department of Medical imaging, University of Toronto, Canada
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4
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Brekelmans C, Hollants S, De Groote C, Sohier N, Maréchal M, Geris L, Luyten FP, Ginckels L, Sciot R, de Ravel T, De Smet L, Lammens J, Legius E, Brems H. Neurofibromatosis type 1-related pseudarthrosis: Beyond the pseudarthrosis site. Hum Mutat 2019; 40:1760-1767. [PMID: 31066482 DOI: 10.1002/humu.23783] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 05/03/2019] [Accepted: 05/04/2019] [Indexed: 12/23/2022]
Abstract
Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder affecting approximately 1 in 2,000 newborns. Up to 5% of NF1 patients suffer from pseudarthrosis of a long bone (NF1-PA). Current treatments are often unsatisfactory, potentially leading to amputation. To gain more insight into the pathogenesis we cultured cells from PA tissue and normal-appearing periosteum of the affected bone for NF1 mutation analysis. PA cells were available from 13 individuals with NF1. Biallelic NF1 inactivation was identified in all investigated PA cells obtained during the first surgery. Three of five cases sampled during a later intervention showed biallelic NF1 inactivation. Also, in three individuals, we examined periosteum-derived cells from normal-appearing periosteum proximal and distal to the PA. We identified the same biallelic NF1 inactivation in the periosteal cells outside the PA region. These results indicate that NF1 inactivation is required but not sufficient for the development of NF1-PA. We observed that late-onset NF1-PA occurs and is not always preceded by congenital bowing. Furthermore, the failure to identify biallelic inactivation in two of five later interventions and one reintervention with a known somatic mutation indicates that NF1-PA can persist after the removal of most NF1 negative cells.
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Affiliation(s)
- Carlijn Brekelmans
- Department of Human Genetics, KU Leuven-University of Leuven, Leuven, Belgium
| | - Silke Hollants
- Clinical Department of Human Genetics, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Caroline De Groote
- Clinical Department of Human Genetics, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Natalie Sohier
- Clinical Department of Human Genetics, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Marina Maréchal
- Department of Development and Regeneration, Prometheus LRD Division of Skeletal Tissue Engineering, KU Leuven-University of Leuven, Leuven, Belgium
| | - Liesbet Geris
- Department of Mechanical Engineering, Prometheus LRD Division of Skeletal Tissue Engineering, KU Leuven-University of Leuven, Leuven, Belgium.,GIGA In Silico Medicine, University of Liège, Liège, Belgium
| | - Frank P Luyten
- Department of Development and Regeneration, Prometheus LRD Division of Skeletal Tissue Engineering, KU Leuven-University of Leuven, Leuven, Belgium.,Department of Rheumatology, KU Leuven-University Hospitals Leuven, Leuven, Belgium
| | - Lieve Ginckels
- Department of Orthopaedic Surgery, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Raf Sciot
- Department of Imaging and Pathology, KU Leuven-University of Leuven, Leuven, Belgium.,Department of Pathology, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Thomy de Ravel
- Department of Human Genetics, KU Leuven-University of Leuven, Leuven, Belgium.,Clinical Department of Human Genetics, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Luc De Smet
- Department of Orthopaedic Surgery, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven-University of Leuven, Leuven, Belgium
| | - Johan Lammens
- Department of Development and Regeneration, Prometheus LRD Division of Skeletal Tissue Engineering, KU Leuven-University of Leuven, Leuven, Belgium.,Department of Orthopaedic Surgery, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Eric Legius
- Department of Human Genetics, KU Leuven-University of Leuven, Leuven, Belgium.,Clinical Department of Human Genetics, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Hilde Brems
- Department of Human Genetics, KU Leuven-University of Leuven, Leuven, Belgium.,Clinical Department of Human Genetics, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium
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Reidy PT, Yonemura NM, Madsen JH, McKenzie AI, Mahmassani ZS, Rondina MT, Lin YK, Kaput K, Drummond MJ. An accumulation of muscle macrophages is accompanied by altered insulin sensitivity after reduced activity and recovery. Acta Physiol (Oxf) 2019; 226:e13251. [PMID: 30632274 DOI: 10.1111/apha.13251] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/05/2019] [Accepted: 01/07/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Mechanisms underlying physical inactivity-induced insulin resistance are not well understood. In addition to a role in muscle repair, immune cell populations such as macrophages may regulate insulin sensitivity. AIM The aim of this study was to examine if the dynamic changes in insulin sensitivity during and after recovery from reduced physical activity corresponded to changes in skeletal muscle macrophages. METHODS In this prospective clinical study, we collected muscle biopsies from healthy older adults (70 ± 2 years, n = 12) before and during a hyperinsulinaemic-euglycaemic clamp and this occurred before (PRE) and after 2-week reduced physical activity (RA), and following 2-week of recovery (REC). Insulin sensitivity (hyperinsulinaemic-euglycaemic clamp), skeletal muscle mRNA expression of inflammatory markers, and immunofluorescent quantification of skeletal muscle macrophages, myofibre-specific satellite cell and capillary content were assessed. RESULTS Insulin sensitivity was decreased following reduced activity and rebounded following recovery above PRE levels. We observed an increase (P < 0.01) in muscle macrophages (CD68+ CD206+ : 190 [55, 324]; CD11b+ CD206+ : 117 [28, 205]% change from PRE) and CD68 (2.4 [1.4, 3.4]-fold) and CCL2 (1.9 [1.3, 2.5]-fold) mRNA following RA concurrent with increased (P < 0.03) satellite cells (55 [6, 104]%) in slow-twitch myofibres. Moreover, the distance of satellite cells to the nearest capillary was increased 7.7 (1.7, 13.7) µm in fast-twitch myofibres at RA (P = 0.007). Changes in macrophages were positively associated with increased insulin sensitivity following RA (R > 0.57, P < 0.05). CONCLUSION These findings suggested that a dynamic response of skeletal muscle macrophages following acute changes in physical activity in healthy older adults is related to insulin sensitivity.
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Affiliation(s)
- Paul T. Reidy
- Departments of Physical Therapy and Athletic Training University of Utah Salt Lake City Utah
| | - Nikol M. Yonemura
- Departments of Physical Therapy and Athletic Training University of Utah Salt Lake City Utah
| | | | - Alec I. McKenzie
- Departments of Physical Therapy and Athletic Training University of Utah Salt Lake City Utah
| | - Ziad S. Mahmassani
- Departments of Physical Therapy and Athletic Training University of Utah Salt Lake City Utah
| | - Matthew T. Rondina
- Department of Internal Medicine University of Utah School of Medicine Salt Lake City Utah
| | - Yu Kuei Lin
- Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine University of Utah School of Medicine Salt Lake City Utah
| | - Katie Kaput
- Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine University of Utah School of Medicine Salt Lake City Utah
| | - Micah J. Drummond
- Departments of Physical Therapy and Athletic Training University of Utah Salt Lake City Utah
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Reidy PT, McKenzie AI, Mahmassani Z, Morrow VR, Yonemura NM, Hopkins PN, Marcus RL, Rondina MT, Lin YK, Drummond MJ. Skeletal muscle ceramides and relationship with insulin sensitivity after 2 weeks of simulated sedentary behaviour and recovery in healthy older adults. J Physiol 2018; 596:5217-5236. [PMID: 30194727 PMCID: PMC6209761 DOI: 10.1113/jp276798] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 08/31/2018] [Indexed: 01/01/2023] Open
Abstract
KEY POINTS Insulin sensitivity (as determined by a hyperinsulinaemic-euglyceamic clamp) decreased 15% after reduced activity. Despite not fully returning to baseline physical activity levels, insulin sensitivity unexpectedly, rebounded above that recorded before 2 weeks of reduced physical activity by 14% after the recovery period. Changes in insulin sensitivity in response to reduced activity were primarily driven by men but, not women. There were modest changes in ceramides (nuclear/myofibrillar fraction and serum) following reduced activity and recovery but, in the absence of major changes to body composition (i.e. fat mass), ceramides were not related to changes in inactivity-induced insulin sensitivity in healthy older adults. ABSTRACT Older adults are at risk of physical inactivity as they encounter debilitating life events. It is not known how insulin sensitivity is affected by modest short-term physical inactivity and recovery in healthy older adults, nor how insulin sensitivity is related to changes in serum and muscle ceramide content. Healthy older adults (aged 64-82 years, five females, seven males) were assessed before (PRE), after 2 weeks of reduced physical activity (RA) and following 2 weeks of recovery (REC). Insulin sensitivity (hyperinsulinaemic-euglyceamic clamp), lean mass, muscle function, skeletal muscle subfraction, fibre-specific, and serum ceramide content and indices of skeletal muscle inflammation were assessed. Insulin sensitivity decreased by 15 ± 6% at RA (driven by men) but rebounded above PRE by 14 ± 5% at REC. Mid-plantar flexor muscle area and leg strength decreased with RA, although only muscle size returned to baseline levels following REC. Body fat did not change and only minimal changes in muscle inflammation were noted across the intervention. Serum and intramuscular ceramides (nuclear/myofibrillar fraction) were modestly increased at RA and REC. However, ceramides were not related to changes in inactivity-induced insulin sensitivity in healthy older adults. Short-term inactivity induced insulin resistance in older adults in the absence of significant changes in body composition (i.e. fat mass) are not related to changes in ceramides.
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Affiliation(s)
- Paul T. Reidy
- Department of Physical Therapy and Athletic TrainingUniversity of UtahSalt Lake CityUTUSA
| | - Alec I. McKenzie
- Department of Physical Therapy and Athletic TrainingUniversity of UtahSalt Lake CityUTUSA
| | - Ziad Mahmassani
- Department of Physical Therapy and Athletic TrainingUniversity of UtahSalt Lake CityUTUSA
| | - Vincent R. Morrow
- Department of Physical Therapy and Athletic TrainingUniversity of UtahSalt Lake CityUTUSA
| | - Nikol M. Yonemura
- Department of Physical Therapy and Athletic TrainingUniversity of UtahSalt Lake CityUTUSA
| | - Paul N. Hopkins
- Cardiovascular GeneticsDepartment of Internal MedicineUniversity of Utah School of MedicineSalt Lake CityUTUSA
| | - Robin L. Marcus
- Department of Physical Therapy and Athletic TrainingUniversity of UtahSalt Lake CityUTUSA
| | - Matthew T. Rondina
- Department of Internal Medicine & Molecular Medicine ProgramUniversity of Utah School of MedicineSalt Lake CityUTUSA
| | - Yu Kuei Lin
- Department of Internal Medicine, Division of EndocrinologyMetabolism and DiabetesUniversity of Utah School of MedicineSalt Lake CityUTUSA
| | - Micah J. Drummond
- Department of Physical Therapy and Athletic TrainingUniversity of UtahSalt Lake CityUTUSA
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Stagi S, Cavalli L, Cavalli T, de Martino M, Brandi ML. Peripheral quantitative computed tomography (pQCT) for the assessment of bone strength in most of bone affecting conditions in developmental age: a review. Ital J Pediatr 2016; 42:88. [PMID: 27670687 PMCID: PMC5037897 DOI: 10.1186/s13052-016-0297-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 09/15/2016] [Indexed: 12/13/2022] Open
Abstract
Peripheral quantitative computed tomography provides an automatical scan analysis of trabecular and cortical bone compartments, calculating not only their bone mineral density (BMD), but also bone geometrical parameters, such as marrow and cortical Cross-Sectional Area (CSA), Cortical Thickness (CoTh), both periosteal and endosteal circumference, as well as biomechanical parameters like Cross-Sectional Moment of Inertia (CSMI), a measure of bending, polar moment of inertia, indicating bone strength in torsion, and Strength Strain Index (SSI). Also CSA of muscle and fat can be extracted. Muscles, which are thought to stimulate bones to adapt their geometry and mineral content, are determinant to preserve or increase bone strength; thus, pQCT provides an evaluation of the functional 'muscle-bone unit', defined as BMC/muscle CSA ratio. This functional approach to bone densitometry can establish if bone strength is normally adapted to the muscle force, and if muscle force is adequate for body size, providing more detailed insights to targeted strategies for the prevention and treatment of bone fragility. The present paper offers an extensive review of technical features of pQCT and its possible clinical application in the diagnostic of bone status as well as in the monitoring of the skeleton's health follow-up.
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Affiliation(s)
- Stefano Stagi
- Health Sciences Department, University of Florence, Anna Meyer Children’s University Hospital, viale Pieraccini 24, 50139 Florence, Italy
| | - Loredana Cavalli
- Department of Surgery and Translational Medicine, Endocrinology Unit, University of Florence, Florence, Italy
| | - Tiziana Cavalli
- Department of Surgery and Translational Medicine, Emergency and Digestive Surgery with Oncological and Functional Address Unit, University of Florence, Florence, Italy
| | - Maurizio de Martino
- Health Sciences Department, University of Florence, Anna Meyer Children’s University Hospital, viale Pieraccini 24, 50139 Florence, Italy
| | - Maria Luisa Brandi
- Department of Surgery and Translational Medicine, Endocrinology Unit, University of Florence, Florence, Italy
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Adams JE, Engelke K, Zemel BS, Ward KA. Quantitative computer tomography in children and adolescents: the 2013 ISCD Pediatric Official Positions. J Clin Densitom 2014; 17:258-74. [PMID: 24792821 DOI: 10.1016/j.jocd.2014.01.006] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 01/14/2014] [Indexed: 12/24/2022]
Abstract
In 2007, International Society of Clinical Densitometry Pediatric Positions Task Forces reviewed the evidence for the clinical application of peripheral quantitative computed tomography (pQCT) in children and adolescents. At that time, numerous limitations regarding the clinical application of pQCT were identified, although its use as a research modality for investigation of bone strength was highlighted. The present report provides an updated review of evidence for the clinical application of pQCT, as well as additional reviews of whole body QCT scans of the central and peripheral skeletons, and high-resolution pQCT in children. Although these techniques remain in the domain of research, this report summarizes the recent literature and evidence of the clinical applicability and offers general recommendations regarding the use of these modalities in pediatric bone health assessment.
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Affiliation(s)
- Judith E Adams
- Department of Clinical Radiology, The Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester, England, UK.
| | - Klaus Engelke
- Institute of Medical Physics, University of Erlangen, Erlangen, Germany and Synarc A/S, Germany
| | - Babette S Zemel
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Kate A Ward
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK
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9
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Heervä E, Koffert A, Jokinen E, Kuorilehto T, Peltonen S, Aro HT, Peltonen J. A controlled register-based study of 460 neurofibromatosis 1 patients: increased fracture risk in children and adults over 41 years of age. J Bone Miner Res 2012; 27:2333-7. [PMID: 22692994 DOI: 10.1002/jbmr.1685] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Neurofibromatosis 1 (NF1, von Recklinghausen's disease) is an autosomal dominant neurocutaneous-skeletal syndrome in which low bone mineral density (BMD) and osteoporosis are common. Low BMD is, however, not the sole component of fracture risk. In the current study, 460 Finnish patients with NF1 were identified from the hospital medical records and their fracture risk was evaluated. The control population included 3988 appendectomy patients whose age and gender distribution was similar to that of the NF1 patients. Medical records of NF1 and control cohorts were screened for fractures according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) between January 2000 and October 2011. The results show that patients with NF1 had increased age-dependent fracture risk compared to controls. Specifically, patients with NF1 aged 41 years and older had a risk ratio of ×5.2 for fractures compared to controls, and children with NF1 had a ×3.4 risk ratio for fractures compared to children without NF1. In contrast, the fracture risk was not increased in NF1 patients aged 17 to 40 years. When fractures not traditionally related to osteoporosis such as fractures of fingers, toes, and skull were excluded, the results were essentially the same. No gender related differences were observed. In conclusion, patients with NF1 have increased fracture risk depending on age. We recommend considering prophylactic measures, such as lifestyle advice, to prevent fractures from occurring.
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Affiliation(s)
- Eetu Heervä
- Department of Cell Biology and Anatomy, University of Turku, Turku, Finland
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Alanne MH, Siljamäki E, Peltonen S, Väänänen K, Windle JJ, Parada LF, Määttä JA, Peltonen J. Phenotypic characterization of transgenic mice harboring Nf1+/− or Nf1−/− osteoclasts in otherwise Nf1+/+ background. J Cell Biochem 2012; 113:2136-46. [DOI: 10.1002/jcb.24088] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Abstract
PURPOSE OF REVIEW Neurofibromatosis type I (NF-1), affecting 1: 3000 people, is one of the most common disorders of the nervous system, and most pediatricians will care for a patient with this condition. It is imperative that careful attention be paid to screening for scoliosis and tibial dysplasia. Prompt referral to an orthopaedist at the time of diagnosis, as well as neurologist, ophthalmologist, and dermatologist, will provide a global spectrum of care for the individual. Patient care between surgical procedures will be inevitable, with 70% of patients with NF-1 undergoing hospitalization or surgery. RECENT FINDINGS This review provides a description of diagnosis, presurgical evaluation, and advances in understanding tibial dysplasia, scoliosis and malignant peripheral nerve sheath tumors. New pharmaceutical treatments such as lovastatin have improved bone healing in vivo and induced apoptosis in vitro. Multiple pharmaceuticals have shown neurofibroma arrest in vitro and are in phase II clinical trials. SUMMARY As animal models improve and clinical trials proceed, there is momentum toward eliminating the musculoskeletal morbidity associated with NF-1.
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