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Hald JD, Langdahl B, Folkestad L, Wekre LL, Johnson R, Nagamani SCS, Raggio C, Ralston SH, Semler O, Tosi L, Orwoll E. Osteogenesis Imperfecta: Skeletal and Non-skeletal Challenges in Adulthood. Calcif Tissue Int 2024:10.1007/s00223-024-01236-x. [PMID: 38836890 DOI: 10.1007/s00223-024-01236-x] [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: 03/16/2024] [Accepted: 05/20/2024] [Indexed: 06/06/2024]
Abstract
Osteogenesis imperfecta (OI) is a Mendelian connective tissue disorder associated with increased bone fragility and other clinical manifestations most commonly due to abnormalities in production, structure, or post-translational modification of type I collagen. Until recently, most research in OI has focused on the pediatric population and much less attention has been directed at the effects of OI in the adult population. This is a narrative review of the literature focusing on the skeletal as well as non-skeletal manifestations in adults with OI that may affect the aging individual. We found evidence to suggest that OI is a systemic disease which involves not only the skeleton, but also the cardiopulmonary and gastrointestinal system, soft tissues, tendons, muscle, and joints, hearing, eyesight, dental health, and women's health in OI and potentially adds negative affect to health-related quality of life. We aim to guide clinicians as well as draw attention to obvious knowledge gaps and the need for further research in adult OI.
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Affiliation(s)
- Jannie Dahl Hald
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.
- Centre for Rare Diseases, Pediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.
| | - Bente Langdahl
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lars Folkestad
- Bone and Mineral Unit, Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lena Lande Wekre
- TRS National Resource Center for Rare Disorders, Sunnaas Rehabilitation Hospital, Oslo, Norway
| | - Riley Johnson
- Bone and Mineral Research Unit, Department of Medicine, Oregon Health & Science University, Portland, USA
| | - Sandesh C S Nagamani
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, 77030, USA
- Texas Children's Hospital, Houston, TX, 77030, USA
| | - Cathleen Raggio
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - Stuart H Ralston
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, Western General Hospital, University of Edinburgh, Edinburgh, EH 2XU, UK
| | - Oliver Semler
- Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Laura Tosi
- Division of Orthopaedics & Sports Medicine, Children's National Hospital, Washington, DC, 20010, USA
| | - Eric Orwoll
- Bone and Mineral Research Unit, Department of Medicine, Oregon Health & Science University, Portland, USA
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Hart T, Westerheim I, van Welzenis T, Semler O, Raggio C, Rauch F, Dadzie R, Prince S, Wekre LL. The IMPACT Survey: the economic impact of osteogenesis imperfecta in adults. Orphanet J Rare Dis 2024; 19:222. [PMID: 38831282 PMCID: PMC11149192 DOI: 10.1186/s13023-024-03218-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 05/15/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND The IMPACT survey aimed to elucidate the humanistic, clinical and economic burden of osteogenesis imperfecta (OI) on individuals with OI, their families, caregivers and wider society. Research methodology, demographics and initial insights from the survey have been previously reported. The cost of illness (healthcare resource use, productivity loss, out-of-pocket spending) and drivers of the economic impact of OI are reported here. METHODS IMPACT was an international mixed-methods online survey in eight languages (fielded July-September 2021) targeting adults (aged ≥ 18 years) or adolescents (aged ≥ 12-17 years) with OI, caregivers with or without OI and other close relatives. Survey domains included demographics, socioeconomic factors, clinical characteristics, treatment patterns, quality of life and health economics. The health economic domain for adults, which included questions on healthcare resource use, productivity loss and out-of-pocket spending, was summarised. Regression and pairwise analyses were conducted to identify independent drivers and associations with respondent characteristics. RESULTS Overall, 1,440 adults with OI responded to the survey. Respondents were mostly female (70%) and from Europe (63%) with a median age of 43 years. Within a 12-month period, adults with OI reported visiting a wide range of healthcare professionals. Two-thirds (66%) of adults visited a hospital, and one-third (33%) visited the emergency department. The mean total number of diagnostic tests undergone by adults within these 12 months was 8.0. Adults had undergone a mean total of 11.8 surgeries up to the time point of the survey. The proportions of adults using queried consumables or services over 12 months ranged from 18-82%, depending on the type of consumable or service. Most adults (58%) were in paid employment, of which nearly one-third (29%) reported missing a workday. Of the queried expenses, the mean total out-of-pocket spending in 4 weeks was €191. Respondent characteristics such as female sex, more severe self-reported OI and the experience of fractures were often associated with increased economic burden. CONCLUSION IMPACT provides novel insights into the substantial cost of illness associated with OI on individuals, healthcare systems and society at large. Future analyses will provide insights into country-specific economic impact, humanistic impact and the healthcare journey of individuals with OI.
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Affiliation(s)
- Tracy Hart
- Osteogenesis Imperfecta Foundation, Gaithersburg, MD, USA
| | | | | | - Oliver Semler
- Faculty of Medicine and University Hospital Cologne, Department of Paediatrics, University of Cologne, Cologne, Germany
| | | | | | - Ruby Dadzie
- Wickenstones Ltd, Abingdon, Oxfordshire, UK.
| | | | - Lena Lande Wekre
- TRS National Resource Center for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesodden, Norway
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Yu R, Zhou J, Zhu Q. Pregnancy complicated by severe osteogenesis imperfecta poses a challenge for the anaesthetist: A case report. J Int Med Res 2024; 52:3000605241260551. [PMID: 38863132 DOI: 10.1177/03000605241260551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
Pregnant women with severe osteogenesis imperfecta (OI) are uncommon, and there are limited data regarding anaesthesia for caesarean section in these high-risk individuals. The presence of anatomical and physiological abnormalities can pose technical challenges for the anaesthetist. This report describes the successful implementation of epidural anaesthesia in a parturient with severe OI. To our knowledge, this is the first documented use of ultrasound-assisted neuraxial anaesthesia and wrist blood pressure monitoring in such patients undergoing caesarean section. Understanding the pathophysiological changes associated with OI is crucial for ensuring safe administration of anaesthesia to these women.
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Affiliation(s)
- Rou Yu
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University), Chengdu 610041, Sichuan, China
| | - Jieshu Zhou
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University), Chengdu 610041, Sichuan, China
| | - Qing Zhu
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University), Chengdu 610041, Sichuan, China
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Westerheim I, Hart T, van Welzenis T, Wekre LL, Semler O, Raggio C, Bober MB, Rapoport M, Prince S, Rauch F. The IMPACT survey: a mixed methods study to understand the experience of children, adolescents and adults with osteogenesis imperfecta and their caregivers. Orphanet J Rare Dis 2024; 19:128. [PMID: 38515144 PMCID: PMC10956293 DOI: 10.1186/s13023-024-03126-9] [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] [Received: 07/27/2023] [Accepted: 03/03/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Osteogenesis imperfecta (OI) is a rare, heritable connective tissue disorder associated with a variety of symptoms, that affect individuals' quality of life (QoL) and can be associated with increased healthcare resource use. While some aspects of OI are well studied, others remain poorly understood. Therefore, the IMPACT survey aimed to elucidate the humanistic, clinical and economic burden of OI on individuals with OI, their families, caregivers and wider society. METHODS We developed an international mixed methods online survey in eight languages (fielded July-September 2021), aimed at adults (aged ≥ 18 years) or adolescents (aged ≥ 12-17 years) with OI, caregivers (with or without OI) of individuals with OI and other close relatives. All respondents provided data on themselves; caregivers additionally provided data on individuals in their care by proxy. Data were cleaned, coded, and analysed using the pandas Python software package and Excel. RESULTS IMPACT collected 2208 eligible questionnaires (covering 2988 individuals of whom 2312 had OI) including 1290 non-caregiver adults with OI, 92 adolescents with OI, 150 caregiver adults with OI, 560 caregivers for individuals with OI, 116 close relatives and 780 proxy care-recipients with OI. Most individuals with OI (direct or proxy) described their OI as moderate (41-52% across populations) and reported OI type 1 (33-38%). Pain (72-82%) was the most reported clinical condition experienced in the past 12 months and was also most frequently rated as severely or moderately impactful. Further, among adults, 67% reported fatigue, 47% scoliosis, and 46% sleep disturbance; in adolescents, fatigue affected 65%, scoliosis and other bone problems 60%, and mental health problems 46%; in children, fractures were common in 67%, fatigue in 47%, and dental problems in 46%. CONCLUSION IMPACT has generated an extensive dataset on the experience of individuals with OI, their caregivers and relatives. We found that, irrespective of age, individuals with OI experience numerous and evolving symptoms that affect their QoL; however, pain and fatigue are consistently present. Upcoming analyses will provide further insights into the economic impact, healthcare journey and caregiver wellbeing, aiming to contribute to improved treatment and care for the OI community.
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Affiliation(s)
| | - Tracy Hart
- Osteogenesis Imperfecta Foundation, Gaithersburg, MD, USA
| | | | - Lena Lande Wekre
- TRS National Resource Center for Rare Disorders, Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway
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Gooijer K, Heidsieck G, Harsevoort A, Bout D, Janus G, Franken A. Bleeding assessment in a large cohort of patients with Osteogenesis Imperfecta. Orphanet J Rare Dis 2024; 19:61. [PMID: 38347577 PMCID: PMC10860322 DOI: 10.1186/s13023-024-03054-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/29/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Osteogenesis Imperfecta (OI) is characterised by bone fragility. Among several features, easy bruising and multiple case reports on haemorrhagic events have been reported. This paper describes the diverse manifestations of bleeding and bruising in a large cohort of 328 OI patients. The aim of this study is to provide insight in the diverse aspects and therapeutic considerations of bleedings in OI. METHODS This descriptive cohort study was conducted at the National Expert Center for adults with OI in the Netherlands. Bleeding was assessed by the validated self-bleeding assessment tool (Self-BAT) The tool was distributed among 328 adults with different clinically confirmed types of OI. RESULTS 195 of 328 invited patients (completion rate 60%) with OI type 1 (n = 144), OI type 3 (n = 17) and OI type 4 (n = 34), aged between 18 and 82 years, completed the tool. Self-BAT scores were above the normal range in 42% of all patients. For males Self-BAT scores were increased in 37% with a mean score of 3.7, ranged between 0 and 18. For females the Self-BAT scores were increased in 44% with a mean of 5.4 and a range of 0-24. No statistical differences in OI subtypes were found. CONCLUSIONS Bleeding tendency appears to be a relevant complication in OI patients as this study confirms the presumption of bleeding tendency. There are specific recommendations to clinicians who treat OI patients to consider an assessment of bleeding tendency and use potential interventions to reduce haemorrhagic complications and improve quality of life.
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Affiliation(s)
- Koert Gooijer
- Expert Center for Adults with Osteogenesis Imperfecta, Isala Hospital, Dokter van Heesweg 2, PO Box 10400, 8025 AB, Zwolle, The Netherlands.
- Department of Clinical Genetics, Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
| | - Gabriëla Heidsieck
- Expert Center for Adults with Osteogenesis Imperfecta, Isala Hospital, Dokter van Heesweg 2, PO Box 10400, 8025 AB, Zwolle, The Netherlands
| | - Arjan Harsevoort
- Expert Center for Adults with Osteogenesis Imperfecta, Isala Hospital, Dokter van Heesweg 2, PO Box 10400, 8025 AB, Zwolle, The Netherlands
| | - Daniëlle Bout
- Expert Center for Adults with Osteogenesis Imperfecta, Isala Hospital, Dokter van Heesweg 2, PO Box 10400, 8025 AB, Zwolle, The Netherlands
| | - Guus Janus
- Expert Center for Adults with Osteogenesis Imperfecta, Isala Hospital, Dokter van Heesweg 2, PO Box 10400, 8025 AB, Zwolle, The Netherlands
| | - Anton Franken
- Expert Center for Adults with Osteogenesis Imperfecta, Isala Hospital, Dokter van Heesweg 2, PO Box 10400, 8025 AB, Zwolle, The Netherlands
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Jiang C, Bao C, Shu S. A pregnant patient with type II osteogenesis imperfecta pregnancy. World J Emerg Med 2024; 15:75-76. [PMID: 38188553 PMCID: PMC10765072 DOI: 10.5847/wjem.j.1920-8642.2024.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/26/2023] [Indexed: 01/09/2024] Open
Affiliation(s)
- Chenyu Jiang
- Department of Obstetrics, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Chenyi Bao
- Department of Obstetrics, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Shujuan Shu
- Department of Obstetrics, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
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Lee KW, Mok MUS, Chai HZ, Yang L. Monochorionic twin pregnancy in a patient with type III osteogenesis imperfecta: a multidisciplinary challenge. BMJ Case Rep 2023; 16:e255738. [PMID: 37967934 PMCID: PMC10660905 DOI: 10.1136/bcr-2023-255738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
A woman with severe type III osteogenesis imperfecta spontaneously conceived a monochorionic, diamniotic twin pregnancy. Due to the severity of her condition, her pregnancy required close follow-up involving a multidisciplinary team, including high-risk obstetricians, anaesthetists, pulmonologists and respiratory therapists. Eventually, the twins were delivered via caesarean section at 26 weeks' gestation.We discuss the challenges and considerations in managing her high-risk pregnancy, highlighting the importance of multidisciplinary care in achieving a safe outcome for mother and babies.
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Affiliation(s)
- Kai Wei Lee
- Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore
| | - May Un Sam Mok
- Department of Anaesthesiology, Singapore General Hospital, Singapore
| | - Hui Zhong Chai
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Liying Yang
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore
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Billich N, O'Brien K, Fredwall SO, Lee M, Savarirayan R, Davidson ZE. A scoping review of nutrition issues and management strategies in individuals with skeletal dysplasia. Genet Med 2023; 25:100920. [PMID: 37330695 DOI: 10.1016/j.gim.2023.100920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 06/19/2023] Open
Abstract
PURPOSE Skeletal dysplasia are heterogeneous conditions affecting the skeleton. Common nutrition issues include feeding difficulties, obesity, and metabolic complications. This systematic scoping review aimed to identify key nutrition issues, management strategies, and gaps in knowledge regarding nutrition in skeletal dysplasia. METHODS The databases Ovid MEDLINE, Ovid EMBASE, Ebsco CINAHL, Scopus, and Cochrane Central Register of Controlled Trials and Database of Systematic Reviews were searched. Reference lists and citing literature for included studies were searched. Eligible studies included participants with skeletal dysplasia and described: anthropometry, body composition, nutrition-related biochemistry, clinical issues, dietary intake, measured energy or nutrition requirements, or nutrition interventions. RESULTS The literature search identified 8509 references from which 138 studies were included (130 observational, 3 intervention, 2 systematic reviews, and 3 clinical guidelines). Across 17 diagnoses identified, most studies described osteogenesis imperfecta (n = 50) and achondroplasia or hypochondroplasia (n = 47). Nutrition-related clinical issues, biochemistry, obesity, and metabolic complications were most commonly reported, and few studies measured energy requirements (n = 5). CONCLUSION Nutrition-related comorbidities are documented in skeletal dysplasia; yet, evidence to guide management is scarce. Evidence describing nutrition in rarer skeletal dysplasia conditions is lacking. Advances in skeletal dysplasia nutrition knowledge is needed to optimize broader health outcomes.
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Affiliation(s)
- Natassja Billich
- Murdoch Children's Research Institute, Parkville, VIC, Australia; The University of Queensland, St Lucia, QLD, Australia.
| | - Katie O'Brien
- Royal Children's Hospital, Parkville, VIC, Australia; Monash University, Clayton, VIC, Australia
| | - Svein O Fredwall
- Murdoch Children's Research Institute, Parkville, VIC, Australia; TRS National Resource Centre for Rare Disorders, Sunnaas Rehabiliation Hospital, Nesodden, Norway
| | | | - Ravi Savarirayan
- Murdoch Children's Research Institute, Parkville, VIC, Australia; University of Melbourne, Parkville, VIC, Australia
| | - Zoe E Davidson
- Murdoch Children's Research Institute, Parkville, VIC, Australia; Monash University, Clayton, VIC, Australia
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Hu T, Chen T, Luo L, Zhou Y, Zhang Y, Fu Q. The anesthetic consideration of a gravid patient with osteogenesis imperfecta undergoing cesarean section: A case report. Clin Case Rep 2023; 11:e7179. [PMID: 37038532 PMCID: PMC10082349 DOI: 10.1002/ccr3.7179] [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: 02/26/2023] [Accepted: 03/23/2023] [Indexed: 04/12/2023] Open
Abstract
Osteogenesis imperfecta (OI) is a rare disorder of bone fragility. Gravid patients with OI usually need cesarean and may present multiple challenges. We present a case of an OI patient with severe scoliosis and an anticipated difficult airway undergoing cesarean section, with details on perioperative assessment and strategy of anesthesia.
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Affiliation(s)
- Tao Hu
- Department of Anesthesiology, Third People's Hospital of ChengduSouthwest Jiaotong UniversityChengduChina
| | - Tao Chen
- Department of Anesthesiology, Third People's Hospital of ChengduSouthwest Jiaotong UniversityChengduChina
| | - Lin Luo
- Department of Anesthesiology, Third People's Hospital of ChengduSouthwest Jiaotong UniversityChengduChina
| | - Ying Zhou
- Department of Anesthesiology, Third People's Hospital of ChengduSouthwest Jiaotong UniversityChengduChina
| | - Yu Zhang
- Department of Anesthesiology, Third People's Hospital of ChengduSouthwest Jiaotong UniversityChengduChina
| | - Qiang Fu
- Department of Anesthesiology, Third People's Hospital of ChengduSouthwest Jiaotong UniversityChengduChina
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Gan L, Yang P, Su Y, Zhang H. Management of anesthesia for cesarean in gravida combined osteogenesis imperfecta: A case report. Asian J Surg 2023:S1015-9584(23)00310-X. [PMID: 36925426 DOI: 10.1016/j.asjsur.2023.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/02/2023] [Indexed: 03/15/2023] Open
Affiliation(s)
- Lu Gan
- Department of Anesthesiology and Operating Theater, The First Hospital of Lanzhou University, China
| | - Peining Yang
- Department of Anesthesiology and Operating Theater, The First Hospital of Lanzhou University, China
| | - Yujie Su
- Department of Anesthesiology and Operating Theater, The First Hospital of Lanzhou University, China
| | - Hong Zhang
- Department of Anesthesiology and Operating Theater, The First Hospital of Lanzhou University, China.
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Rapoport M, Bober MB, Raggio C, Wekre LL, Rauch F, Westerheim I, Hart T, van Welzenis T, Mistry A, Clancy J, Booth L, Prince S, Semler O. The patient clinical journey and socioeconomic impact of osteogenesis imperfecta: a systematic scoping review. Orphanet J Rare Dis 2023; 18:34. [PMID: 36814274 PMCID: PMC9945474 DOI: 10.1186/s13023-023-02627-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Osteogenesis imperfecta (OI) is a rare heritable connective tissue disorder primarily characterised by skeletal deformity and fragility, and an array of secondary features. The purpose of this review was to capture and quantify the published evidence relating specifically to the clinical, humanistic, and economic impact of OI on individuals, their families, and wider society. METHODS A systematic scoping review of 11 databases (MEDLINE, MEDLINE in-progress, EMBASE, CENTRAL, PsycINFO, NHS EED, CEA Registry, PEDE, ScHARRHUd, Orphanet and Google Scholar), supplemented by hand searches of grey literature, was conducted to identify OI literature published 1st January 1995-18th December 2021. Searches were restricted to English language but without geographical limitations. The quality of included records was assessed using the AGREE II checklist and an adapted version of the JBI cross-sectional study checklist. RESULTS Of the identified 7,850 records, 271 records of 245 unique studies met the inclusion criteria; overall, 168 included records examined clinical aspects of OI, 67 provided humanistic data, 6 reported on the economic impact of OI, and 30 provided data on mixed outcomes. Bone conditions, anthropometric measurements, oral conditions, diagnostic techniques, use of pharmacotherapy, and physical functioning of adults and children with OI were well described. However, few records included current care practice, diagnosis and monitoring, interactions with the healthcare system, or transition of care across life stages. Limited data on wider health concerns beyond bone health, how these concerns may impact health-related quality of life, in particular that of adult men and other family members, were identified. Few records described fatigue in children or adults. Markedly few records provided data on the socioeconomic impact of OI on patients and their caregivers, and associated costs to healthcare systems, and wider society. Most included records had qualitative limitations. CONCLUSION Despite the rarity of OI, the volume of recently published literature highlights the breadth of interest in the OI field from the research community. However, significant data gaps describing the experience of OI for individuals, their families, and wider society warrant further research to capture and quantify the full impact of OI.
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Affiliation(s)
| | | | | | - Lena Lande Wekre
- TRS National Resource Center for Rare Disorders, Sunnaas Rehabilitation Hospital, Bjørnemyr, Nesodden, Norway
| | | | | | - Tracy Hart
- Osteogenesis Imperfecta Foundation, Gaithersburg, MD, USA
| | | | | | | | - Lucy Booth
- Wickenstones Ltd, Abingdon, Oxfordshire, UK
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Obstetrical Challenges in Robinow Syndrome. Case Rep Obstet Gynecol 2022; 2022:6481517. [PMID: 35909981 PMCID: PMC9337944 DOI: 10.1155/2022/6481517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/01/2022] [Indexed: 11/18/2022] Open
Abstract
Robinow syndrome is a genetically heterogenous syndrome that exhibits great pleiotropy, involving skeletal genital, cardiac, and craniofacial developmental anomalies. Fertility is not always compromised, and many individuals may be able to have a healthy pregnancy. Similar to other more common skeletal dysplasias and growth disorders such as achondroplasia, there are several challenges to be addressed in managing physiologic differences that occur in the context of pregnancy, and published literature centers on pregnant people with achondroplasia. We present a patient with Robinow syndrome (ROR2 variant), follow her clinical course through three of her pregnancies (one 20-week loss followed by two preterm cesarean deliveries at 36-week gestation), and highlight the major obstetrical considerations in her individualized care.
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Nthenge S, Smith L, Ho S, Mitra M. Experiences of Women of Short Stature During the Perinatal Period. J Obstet Gynecol Neonatal Nurs 2022; 51:418-427. [PMID: 35550125 DOI: 10.1016/j.jogn.2022.03.006] [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] [Accepted: 03/22/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To explore the experiences of women of short stature, including women with dwarfism and osteogenesis imperfecta (OI), during the perinatal period. DESIGN Qualitative descriptive. SETTING Telephone interviews with women of short stature from across the United States. PARTICIPANTS Nine women of short stature, including five with dwarfism and four with osteogenesis imperfecta, between the ages of 18 and 55 years who gave birth within the last 10 years. METHODS We used reflexive thematic analysis to analyze interview data. RESULTS Four themes represented the participants' experiences during maternity care: Clinicians' Lack of Knowledge, Sources of Information and EmotionalSupport, Clinical Considerations: Effects of Pregnancy and Disability, and Accessibility Barriers and Adaptations. Participants experienced respiratory difficulties and preterm birth. They expressed concerns regarding the lack of clinician knowledge and experience in administering epidural anesthesia to women of short stature and highlighted the important role of disability organizations in disseminating information about childbirth for women with disabilities. CONCLUSION Childbearing women of short stature require disability-specific maternity care. Our findings highlight the need for disability education programs for nurse-midwives, nurses, physicians, and other clinicians who provide maternity care to women of short stature.
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Koumakis E, Cormier-Daire V, Dellal A, Debernardi M, Cortet B, Debiais F, Javier RM, Thomas T, Mehsen-Cetre N, Cohen-Solal M, Fontanges E, Laroche M, Porquet-Bordes V, Marcelli C, Benachi A, Briot K, Roux C, Cormier C. Osteogenesis Imperfecta: characterization of fractures during pregnancy and post-partum. Orphanet J Rare Dis 2022; 17:22. [PMID: 35090500 PMCID: PMC8796450 DOI: 10.1186/s13023-021-02148-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 12/06/2021] [Indexed: 11/24/2022] Open
Abstract
Background Pregnancy and breastfeeding are associated with bone density loss. Fracture occurrence during pregnancy and post-partum, and its determinants, remain poorly known in Osteogenesis Imperfecta (OI). The aim of this study was to characterize fractures that occurred during pregnancy and post-partum in OI patients. Results We conducted a retrospective multicentric study including a total of 50 previously pregnant OI women from 10 Bone Centers in France. Among these patients, 12 (24%) patients experienced fractures during pregnancy or in the 6 months following delivery, and 38 (76%) did not experience any fracture. The most frequent localizations were: proximal femur (25%), spine (25%), distal femur (12.5%), and pelvis (12.5%). Fractures during pregnancy occurred during the third trimester and post-partum fractures occurred with a mean delay of 2 months following delivery. No fractures occurred during childbirth. We next compared the 12 patients with pregnancy or post-partum fractures with the 38 patients without fractures. Mean age at pregnancy was 32.7 ± 3.1 years-old in the fractured group, vs 29.3 ± 5.0 years-old in the non-fractured group (p = 0.002). Breastfeeding was reported in 85.7% of patients in the fractured group, vs 47.1% in the non-fractured group (p = 0.03). All patients with post-partum fractures were breastfeeding. Bone mineral density was significantly lower in patients with pregnancy-related fractures compared with other patients: spine Z-score − 2.9 ± 1.6DS vs − 1.5 ± 1.7DS (p = 0.03), and total hip Z-score − 2.0 ± 0.7DS vs − 0.5 ± 1.4DS (p = 0.04). At least one osteoporosis-inducing risk factor or disease other than OI was identified in 81.8% vs 58.6% of fractured vs non-fractured patients (not significant). Fracture during pregnancy or post-partum was not associated with the severity of OI. Bisphosphonates before pregnancy were reported in 16.7% and 21.1% of patients with pregnancy-related fractures and non-fractured patients, respectively (not significant). Conclusions OI management during pregnancy and post-partum should aim for optimal control of modifiable osteoporosis risk factors, particularly in patients with low BMD. Breastfeeding should be avoided.
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Affiliation(s)
- Eugénie Koumakis
- Rheumatology Department, Cochin Hospital, Paris, AP-HP Centre-Paris University, Reference Center for Rare Genetic Bone Disorders-Cochin-constitutive site, Cochin Hospital, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France. .,Clinical Genetics, Reference Center for bone disorders, INSERM UMR 1163, Imagine Institute, Necker Enfants-Malades Hospital, AP-HP, Paris University, Paris, France.
| | - Valérie Cormier-Daire
- Clinical Genetics, Reference Center for bone disorders, INSERM UMR 1163, Imagine Institute, Necker Enfants-Malades Hospital, AP-HP, Paris University, Paris, France
| | - Azeddine Dellal
- Rheumatology Department, Cochin Hospital, Paris, AP-HP Centre-Paris University, Reference Center for Rare Genetic Bone Disorders-Cochin-constitutive site, Cochin Hospital, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Marc Debernardi
- Rheumatology Department, Cochin Hospital, Paris, AP-HP Centre-Paris University, Reference Center for Rare Genetic Bone Disorders-Cochin-constitutive site, Cochin Hospital, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Bernard Cortet
- Department of Rheumatology and ULR 4490 (MABLAB), Competence Center for Rare Genetic Bone Disorders, University-Hospital of Lille, 59000, Lille, France
| | - Françoise Debiais
- Department of Rheumatology, CHU Poitiers; CNRS ERL7003, University of Poitiers, Poitiers, France
| | - Rose-Marie Javier
- Rheumatology Department, Competence Center for Rare Genetic Bone Disorders, University-Hospital of Strasbourg, 67098, Strasbourg, France
| | - Thierry Thomas
- Department of Rheumatology, CHU Saint-Etienne, INSERM U1059, Université de Lyon, Saint-Etienne, France
| | - Nadia Mehsen-Cetre
- Service de Rhumatologie, Centre de Compétence MOC et Dysplasie Fibreuse, CHU Bordeaux-Tripode, Bordeaux, France
| | - Martine Cohen-Solal
- Biocar Inserm U1132 and Université de Paris, Hôpital Lariboisière, 75010, Paris, France
| | - Elisabeth Fontanges
- Department of Rheumatology, Hôpital Edouard Herriot, CHU de Lyon, Lyon, France
| | - Michel Laroche
- Centre de Rhumatologie, CHU Purpan, 1 place du Dr Baylac, 31059, Toulouse Cedex, France
| | - Valérie Porquet-Bordes
- Endocrine, Bone Diseases, and Genetics Unit, Reference Centre for Rare Diseases of the Calcium and Phosphate Metabolism, ERN BOND, OSCAR Network, Children's Hospital, Toulouse University Hospital, Toulouse, France
| | | | - Alexandra Benachi
- Departement of Obstetrics, Gynecology and Reproductive Medicine, Hôpital Antoine-Béclère - Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, France
| | - Karine Briot
- Rheumatology Department, Cochin Hospital, Paris, AP-HP Centre-Paris University, Reference Center for Rare Genetic Bone Disorders-Cochin-constitutive site, Cochin Hospital, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France.,INSERM UMR 1153, INSERM, PRESS Sorbonne Paris-Cité, Paris, France
| | - Christian Roux
- Rheumatology Department, Cochin Hospital, Paris, AP-HP Centre-Paris University, Reference Center for Rare Genetic Bone Disorders-Cochin-constitutive site, Cochin Hospital, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France.,INSERM UMR 1153, INSERM, PRESS Sorbonne Paris-Cité, Paris, France
| | - Catherine Cormier
- Rheumatology Department, Cochin Hospital, Paris, AP-HP Centre-Paris University, Reference Center for Rare Genetic Bone Disorders-Cochin-constitutive site, Cochin Hospital, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
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15
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Rao R, Cuthbertson D, Nagamani SCS, Sutton VR, Lee BH, Krischer J, Krakow D. Pregnancy in women with osteogenesis imperfecta: pregnancy characteristics, maternal, and neonatal outcomes. Am J Obstet Gynecol MFM 2021; 3:100362. [PMID: 33781976 DOI: 10.1016/j.ajogmf.2021.100362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 03/10/2021] [Accepted: 03/23/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Women with rare diseases, such as osteogenesis imperfecta, may consider pregnancy, although data regarding outcomes, specific risks, and management strategies are lacking. OBJECTIVE The Brittle Bone Disorders Consortium of the National Institute of Health Rare Diseases Clinical Research Network established an Osteogenesis Imperfecta Pregnancy Registry to collect and evaluate pregnancy, maternal, and neonatal outcomes in women with osteogenesis imperfecta. STUDY DESIGN This was a cross-sectional, survey-based study. Appropriate participants of the Brittle Bone Disorders Consortium Contact Registry were invited to participate in the study. Self-reported information regarding pregnancy characteristics and maternal and neonatal outcomes of women with osteogenesis imperfecta was compared with that of the general population, referenced by literature-based standards. Furthermore, compared with the general population, cohorts of women and fetuses with osteogenesis imperfecta were evaluated to determine whether the presence of osteogenesis imperfecta conveyed an increase in antepartum, intrapartum, and postpartum complications and an increase in adverse neonatal outcomes. RESULTS Here, a total 132 participants completed the survey. Compared with the general population, women with osteogenesis imperfecta had higher rates of diabetes in pregnancy (13.3% vs 7%; 95% confidence interval, 7.0-19.6; P=.049), cesarean delivery (68.5% vs 32.7%; 95% confidence interval, 59.9-77.1; P<.001), need for blood transfusion (8.3% vs 1.5%; 95% confidence interval, 3.9-12.8; P=.019), and antepartum and postpartum fractures (relative risk, 221; 95% confidence interval, 59.3-823; P<.001). Maternal hospitalization and cesarean delivery rates were higher in individuals with moderate or severe osteogenesis imperfecta than women who reported mild osteogenesis imperfecta. Neonates born to women with osteogenesis imperfecta had higher risk of being low (26.2% vs 6.8%; P<.001) or very low birthweight (13.8% vs 1.4%; P<.001) infants than the general population. Neonates born to women with osteogenesis imperfecta had a higher rate of neonatal intensive care unit admissions (19% vs 5.68%; P<.001) and higher neonatal mortality at 28 days of life (4.8% vs 0.4%; P=.026), regardless of neonatal osteogenesis imperfecta status. CONCLUSION Pregnancies for women with osteogenesis imperfecta are at an increased risk of complications, including hemorrhage, fractures, diabetes mellitus, and increased neonatal morbidity.
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Affiliation(s)
- Rashmi Rao
- Departments of Obstetrics and Gynecology (Drs Rao and Krakow)
| | - David Cuthbertson
- College of Medicine, University of South Florida, Tampa, FL (Mr. Cuthbertson and Dr Krischer)
| | - Sandesh C S Nagamani
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX (Drs Nagamani, Sutton, and Lee); Texas Children's Hospital, Houston, TX (Drs Nagamani, Sutton, and Lee)
| | - Vernon Reid Sutton
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX (Drs Nagamani, Sutton, and Lee); Texas Children's Hospital, Houston, TX (Drs Nagamani, Sutton, and Lee)
| | - Brendan H Lee
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX (Drs Nagamani, Sutton, and Lee); Texas Children's Hospital, Houston, TX (Drs Nagamani, Sutton, and Lee)
| | - Jeffrey Krischer
- College of Medicine, University of South Florida, Tampa, FL (Mr. Cuthbertson and Dr Krischer)
| | - Deborah Krakow
- Departments of Obstetrics and Gynecology (Drs Rao and Krakow); Human Genetics (Dr Krakow); Orthopaedic Surgery (Dr Krakow); Pediatrics (Dr Krakow), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
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16
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Hüner B, Handke-Vesely A, Lato K, Korzoum A, Janni W, Reister F. Mother and child with osteogenesis imperfecta type III. Pregnancy management, delivery, and outcome. CASE REPORTS IN PERINATAL MEDICINE 2020. [DOI: 10.1515/crpm-2020-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
Thanks to the advances of modern medicine it has become possible to reach a fertile age even in the case of serious illnesses, enabling those patients to realize their desire to have children. This is also the case with the extremely heterogeneous, often autosomal dominantly inherited osteogenesis imperfecta. Due to a disruption in collagen synthesis those patients are faced with multiple fractures, spinal deformities and a decrease in pulmonary capacity throughout the course of their lives, depending on the subtype and severity of the disease. Obstetricians as well as anesthetists face major interdisciplinary challenges in the case of a pregnancy in those patients because of pregnancy-associated risks like uterine rupture, preterm birth and postpartum hemorrhage as well as risks associated with the nature of osteogenesis imperfecta itself, like bone fractures, spinal deformities and decreased mobility in the course of the progressing pregnancy. Mode of delivery should be planned individually in order to minimize maternal morbidity and mortality. In cases in which the fetus is as well affected by the disease, this aspect must be taken into consideration when it comes to supervision of pregnancy and planning of the birth mode.
Case presentation
We report the case of a woman with osteogenesis imperfecta type III who spontaneously conceived a pregnancy with a fetus who was also affected by the genetic disease. This constellation has up to now been reported by only few sources and requires supervision by an experienced perinatal center.
Conclusions
Osteogenesis imperfecta is not an exclusion diagnosis for family planning and a successful delivery. Nevertheless, depending on the form of the disease, mother and child can be severely affected by the disturbed collagen synthesis. Each patient has to be individually advised and cared for with the specific risks due to the type of Osteogenesis imperfecta. In the case of type III, due to extreme scoliosis, pelvic deformity and small growth, only a primary cesarean section can be performed.
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Affiliation(s)
- Beate Hüner
- Department of Obstetrics and Gynecology , Ulm University , Prittwitzstr. 43 , Ulm , Baden-Württemberg , Germany
| | - Annette Handke-Vesely
- Department of Obstetrics and Gynecology , Ulm University , Ulm , Baden-Württemberg , Germany
| | - Krisztian Lato
- Department of Obstetrics and Gynecology , Ulm University , Ulm , Baden-Württemberg , Germany
| | - Andrea Korzoum
- Department of Obstetrics and Gynecology , Ulm University , Ulm , Baden-Württemberg , Germany
| | - Wolfgang Janni
- Department of Obstetrics and Gynecology , Ulm University , Ulm , Baden-Württemberg , Germany
| | - Frank Reister
- Department of Obstetrics and Gynecology , Ulm University , Ulm , Baden-Württemberg , Germany
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17
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Holopainen E, Vakkilainen S, Mäkitie O. Outcomes of 42 pregnancies in 14 women with cartilage-hair hypoplasia: a retrospective cohort study. Orphanet J Rare Dis 2020; 15:326. [PMID: 33213509 PMCID: PMC7678140 DOI: 10.1186/s13023-020-01614-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 11/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cartilage-hair hypoplasia (CHH) is a rare skeletal dysplasia characterized by disproportionate short stature, immunodeficiency, anemia and risk of malignancies. All these features can affect pregnancy and predispose to maternal and fetal complications. This study aimed to evaluate obstetric history and maternal and fetal outcomes in women with CHH. METHODS Among 47 Finnish women with CHH, we identified 14 women with ICD codes related to pregnancies, childbirth and puerperium in the National Hospital Discharge Registry and obtained detailed data on gynecologic and obstetric history with a questionnaire. Offspring birth length and weight were collected and compared with population-based normal values. RESULTS There were altogether 42 pregnancies in 14 women (median height 124 cm, range 105-139 cm; 4'1'', range 3'5''-4'7''). Twenty-six pregnancies (62%), including one twin pregnancy, led to a delivery. Miscarriages, induced abortions and ectopic pregnancies complicated 9, 5, and 2 pregnancies, respectively. Severe pregnancy-related complications were rare. All women with CHH delivered by cesarean section, mostly due to evident cephalo-pelvic disproportion, and in 25/26 cases at full-term. In the majority, the birth length (median 48 cm, range 45.5-50 cm; 1'7'', range 1'6''-1'8'') and weight (3010 g, range 2100-3320 g; 6.6 lb, range 4.6-7.3 lb) of the offspring in full-term singleton pregnancies was normal. CONCLUSIONS Despite CHH mothers' significant short stature and other potential CHH-related effects on pregnancy outcome, most pregnancies lead to a term cesarean section delivery. Since fetal growth was generally unaffected, cephalo-pelvic disproportion was evident and planned cesarean section should be contemplated in term pregnancies.
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Affiliation(s)
- Elina Holopainen
- Department of Reproductive Medicine, Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, P.O. Box 140 00029, Helsinki, Finland. .,Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland.
| | - Svetlana Vakkilainen
- Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland.,Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Folkhälsan Research Center, Helsinki, Finland
| | - Outi Mäkitie
- Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland.,Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Folkhälsan Research Center, Helsinki, Finland.,Department of Molecular Medicine and Surgery, Karolinska Institutet and Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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18
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Anabusi S, Berndl A. Osteogenesis Imperfecta Type V in a Mother and Baby Pair: First Case Report of Pregnancy and Delivery. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 43:S1701-2163(20)30684-8. [PMID: 34756406 DOI: 10.1016/j.jogc.2020.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/07/2020] [Accepted: 08/10/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Osteogenesis imperfecta (OI) is a rare condition with limited data on fetal and maternal impact for almost all subtypes. OI type V is a very rare, autosomal dominant, inherited subtype of OI. The care of pregnant women with OI is managed by an interdisciplinary team, and fetal diagnosis is possible through amniocentesis, which may assist in delivery planning. CASE This report is the first to describe a case of maternal and fetal OI type V. We detail maternal and fetal management during pregnancy and delivery planning. While no major complications occurred during pregnancy or delivery, the neonate developed multiple fractures in the first few months of life. CONCLUSION Our case shows favourable maternal and pregnancy outcomes with OI type V and emphasizes the importance of fetal diagnosis.
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Affiliation(s)
- Saja Anabusi
- Department of Obstetrics and Gynaecology, Division of Maternal-Fetal Medicine, Sunnybrook Health Sciences Centre, Toronto, ON; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON
| | - Anne Berndl
- Department of Obstetrics and Gynaecology, Division of Maternal-Fetal Medicine, Sunnybrook Health Sciences Centre, Toronto, ON; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON.
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19
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Oestreich AK, DeCata JA, Akers JD, Phillips CL, Schulz LC. Fecundity is impaired in a mouse model of osteogenesis imperfecta. Mol Reprod Dev 2020; 87:927-929. [PMID: 32869432 DOI: 10.1002/mrd.23416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/27/2020] [Accepted: 08/15/2020] [Indexed: 11/11/2022]
Abstract
Osteogenesis imperfecta (OI), or brittle bone disease, is most often caused by mutations in genes encoding type I collagen or proteins that process it. Women with OI have a small, but significant increase in risk of serious pregnancy complications including uterine rupture. Here, the OI mouse, Col1a2oim/oim , was used to examine the effects of collagen mutation on establishment and maintenance of pregnancy. Picrosirius birefringence was faint in Col1a2oim/oim uteri, indicating diminished collagen in the myometrium and endometrium. There was some evidence of increased uterine gland number (p = .055) and size (p = .12) in (p = .055) virgin uteri, though the they were not significantly different than controls. There were no differences in the number of corpora lutea, or the time from pairing to delivery of pups between Col1a2oim/oim and control dams, suggesting that ovulation and conception occur normally. However, when examined at Gestation Day 6.5 (postimplantation), gestation Day 10.5 (midpregnancy), and Postnatal Days 1-2, Col1a2oim/oim dams had significantly fewer viable pups than controls overall. In pairwise comparisons, the loss was only significant in the postnatal group, suggesting the gradual loss of pups over time. Overall, the Col1a2oim/oim mouse data suggest that OI impairs uterine function in pregnancy in a way that affects a small but significant number of fetuses.
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Affiliation(s)
- Arin K Oestreich
- Department of Obstetrics, Gynecology, and Women's Health, University of Missouri, Columbia, Missouri
| | - Jenna A DeCata
- Department of Obstetrics, Gynecology, and Women's Health, University of Missouri, Columbia, Missouri
| | - Janae D Akers
- Department of Obstetrics, Gynecology, and Women's Health, University of Missouri, Columbia, Missouri
| | - Charlotte L Phillips
- Departments of Biochemistry and Child Health, University of Missouri, Columbia, Missouri
| | - Laura C Schulz
- Department of Obstetrics, Gynecology, and Women's Health, University of Missouri, Columbia, Missouri
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20
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Chougui K, Addab S, Palomo T, Morin SN, Veilleux LN, Bernstein M, Thorstad K, Hamdy R, Tsimicalis A. Clinical manifestations of osteogenesis imperfecta in adulthood: An integrative review of quantitative studies and case reports. Am J Med Genet A 2020; 182:842-865. [PMID: 32091187 DOI: 10.1002/ajmg.a.61497] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 12/03/2019] [Accepted: 01/03/2020] [Indexed: 12/16/2022]
Abstract
Osteogenesis imperfecta (OI) is a rare genetic disorder of the bones caused by a mutation in Type I collagen genes. As adults with OI are aging, medical concerns secondary to OI may arise. This integrative review sought to review, appraise, and synthesize the clinical manifestations faced by adults with OI. Four electronic bibliographic databases were searched. Published quantitative, qualitative, and mixed-methods studies, as well as case reports from 2000 to March 2019, addressing a clinical manifestation in adulthood, were reviewed. Eligible studies and case reports were subsequently appraised using the Mixed Methods Appraisal Tool and Case Report Checklist, respectively. Twenty quantitative studies and 88 case reports were included for review regardless of the varying methodological quality score. These studies collectively included 2,510 adults with different OI types. Several clinical manifestations were studied, and included: hearing loss, cardiac diseases, pregnancy complications, cerebrovascular manifestations, musculoskeletal manifestations, respiratory manifestations, vision impairment, and other clinical manifestations. Increased awareness may optimize prevention, treatment, and follow-up. Opportunities to enhance the methodological quality of research including better design and methodology, multisite collaborations, and larger and diverse sampling will optimize the generalizability and transferability of findings.
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Affiliation(s)
- Khadidja Chougui
- Nursing Research, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada.,Psychology, Universite de Montreal, Montreal, Quebec, Canada
| | - Sofia Addab
- Nursing Research, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada.,Experimental Surgery, McGill University, Montreal, Quebec, Canada
| | - Telma Palomo
- Bone Densitometry, Fleury Medicina e Saúde, São Paulo, Brazil
| | - Suzanne N Morin
- Department of Medicine, McGill University, Montreal, Quebec, Canada.,General Internal Medicine and Bone Metabolism Center, Montreal General Hospital, Montreal, Quebec, Canada
| | - Louis-Nicolas Veilleux
- Experimental Surgery, McGill University, Montreal, Quebec, Canada.,Motion Analysis Center, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada
| | - Mitchell Bernstein
- Orthopedic Surgery, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada.,Department of Pediatric Surgery, McGill University, Montreal, Quebec, Canada
| | - Kelly Thorstad
- Nursing and Patient Services, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada
| | - Reggie Hamdy
- Orthopedic Surgery, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada.,Department of Pediatric Surgery, McGill University, Montreal, Quebec, Canada
| | - Argerie Tsimicalis
- Nursing Research, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada.,Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
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21
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Chamunyonga F, Masendeke KL, Mateveke B. Osteogenesis imperfecta and pregnancy: a case report. J Med Case Rep 2019; 13:363. [PMID: 31822291 PMCID: PMC6905103 DOI: 10.1186/s13256-019-2296-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 10/16/2019] [Indexed: 11/18/2022] Open
Abstract
Background Osteogenesis imperfecta is a rare connective tissue disorder of varying phenotypic presentations. In pregnancies complicated by osteogenesis imperfecta, there is an increased risk to both the mother and fetus. Case presentation We present a case of a 34-year-old, wheelchair-bound, primigravid African (Zimbabwean) patient with short stature and skeletal deformities. Her care, requiring a multidisciplinary team approach, resulted in the delivery of a live baby girl with a birth weight of 2100 g, also with osteogenesis imperfecta. Conclusion Good outcomes are reported when a multidisciplinary team is involved in the care of patients with osteogenesis imperfecta. Pregnancies can be carried to term but require close antenatal surveillance. Prenatal diagnosis is possible with ultrasound and genetic testing. Delivery should be carefully planned by a multidisciplinary team. Decisions on delivery mode should be made on a case-by-case basis.
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Affiliation(s)
- Felix Chamunyonga
- Department of Obstetrics and Gynecology, University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe.
| | - Kudzaishe Lloyd Masendeke
- Department of Obstetrics and Gynecology, University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe
| | - Bismark Mateveke
- Department of Obstetrics and Gynecology, University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe
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22
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Olvera D, Stolzenfeld R, Fisher E, Nolan B, Caird MS, Kozloff KM. Pamidronate Administration During Pregnancy and Lactation Induces Temporal Preservation of Maternal Bone Mass in a Mouse Model of Osteogenesis Imperfecta. J Bone Miner Res 2019; 34:2061-2074. [PMID: 31310351 PMCID: PMC6854294 DOI: 10.1002/jbmr.3831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 06/25/2019] [Accepted: 07/03/2019] [Indexed: 01/25/2023]
Abstract
During pregnancy and lactation, the maternal skeleton undergoes significant bone loss through increased resorption to provide the necessary calcium supply to the developing fetus and suckling neonate. This period of skeletal vulnerability has not been clearly associated with increased maternal fracture risk, but these physiological conditions can exacerbate an underlying metabolic bone condition like osteogenesis imperfecta. Although bisphosphonates (BPs) are commonly used in postmenopausal women, there are cases where premenopausal women taking BPs become pregnant. Given BPs' long half-life, there is a need to establish how BPs affect the maternal skeleton during periods of demanding metabolic bone changes that are critical for the skeletal development of their offspring. In the present study, pamidronate- (PAM-) amplified pregnancy-induced bone mass gains and lactation-induced bone loss were prevented. This preservation of bone mass was less robust when PAM was administered at late stages of lactation compared with early pregnancy and first day of lactation. Pregnancy-induced osteocyte osteolysis was also observed and was unaffected with PAM treatment. No negative skeletal effects were observed in offspring from PAM-treated dams despite lactation-induced bone loss prevention. These findings provide important insight into (1) a treatment window for when PAM is most effective in preserving maternal bone mass, and (2) the maternal changes in bone metabolism that maintain calcium homeostasis crucial for fetal and neonatal bone development. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Diana Olvera
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Rachel Stolzenfeld
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Emily Fisher
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Bonnie Nolan
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Michelle S Caird
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Kenneth M Kozloff
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
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23
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Lafage-Proust MH, Courtois I. The management of osteogenesis imperfecta in adults: state of the art. Joint Bone Spine 2019; 86:589-593. [DOI: 10.1016/j.jbspin.2019.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2018] [Indexed: 12/16/2022]
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Kawakita T, Fries M, Singh J, Al‐Kouatly HB. Pregnancies complicated by maternal osteogenesis imperfecta type III: a case report and review of literature. Clin Case Rep 2018; 6:1252-1257. [PMID: 29988651 PMCID: PMC6028402 DOI: 10.1002/ccr3.1549] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/22/2018] [Accepted: 04/03/2018] [Indexed: 11/10/2022] Open
Abstract
The restrictive lung disease can be exacerbated by growing fundus in women with osteogenesis imperfecta type III. Regional anesthesia can be performed in these women. Mode of delivery for women with osteogenesis imperfecta type III is generally cesarean delivery. Neonatal outcomes are complicated due to indicated preterm deliveries.
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Affiliation(s)
- Tetsuya Kawakita
- Obstetrics and GynecologyMedStar Washington Hospital CenterWashingtonDistrict of Columbia
| | - Melissa Fries
- Obstetrics and GynecologyMedStar Washington Hospital CenterWashingtonDistrict of Columbia
| | - Jasbir Singh
- Obstetrics and GynecologyAustin Maternal Fetal MedicineAustinTexas
| | - Huda B. Al‐Kouatly
- Obstetrics and GynecologyMedStar Washington Hospital CenterWashingtonDistrict of Columbia
- Obstetrics and GynecologySidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPennsylvania
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Watanabe Y, Shimizu N, Iwakawa M, Yamaguchi T, Ban N, Kawana H, Saiki A, Sakaida E, Nakaseko C, Matsuura Y, Aotsuka N, Bujo H, Tatsuno I. Successful Treatment of Rapidly Progressive Life-Threatening Esophageal Submucosal Hematoma in a Patient With van der Hoeve Syndrome. J Clin Med Res 2018; 10:154-157. [PMID: 29317961 PMCID: PMC5755655 DOI: 10.14740/jocmr3270w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 12/02/2017] [Indexed: 11/21/2022] Open
Abstract
Osteogenesis imperfecta (OI) is a rare inherited disorder of the connective tissue with many reports on its association with bleeding diatheses. OI patients with blue sclera, hearing loss, and bone vulnerability are classified as having van der Hoeve syndrome. Here, we report the first case of rapidly progressing, massive esophageal submucosal hematoma in this syndrome. Bleeding in OI is reportedly due to defective capillary integrity and platelet dysfunction; however, our patient did not show such findings. Multiple factors contributed to the bleeding diathesis, including dysfunction of platelet and platelet-endothelial cell interaction, which could not be proven in vitro.
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Affiliation(s)
- Yasuhiro Watanabe
- Center for Diabetes, Metabolism, and Endocrinology, Toho University Medical Center Sakura Hospital, 564-1 Shimoshizu Sakura, Chiba, Japan
| | - Naomi Shimizu
- Center for Diabetes, Metabolism, and Endocrinology, Toho University Medical Center Sakura Hospital, 564-1 Shimoshizu Sakura, Chiba, Japan
| | - Masahiro Iwakawa
- Center for Diabetes, Metabolism, and Endocrinology, Toho University Medical Center Sakura Hospital, 564-1 Shimoshizu Sakura, Chiba, Japan
| | - Takashi Yamaguchi
- Center for Diabetes, Metabolism, and Endocrinology, Toho University Medical Center Sakura Hospital, 564-1 Shimoshizu Sakura, Chiba, Japan
| | - Noriko Ban
- Center for Diabetes, Metabolism, and Endocrinology, Toho University Medical Center Sakura Hospital, 564-1 Shimoshizu Sakura, Chiba, Japan
| | - Hidetoshi Kawana
- Center for Diabetes, Metabolism, and Endocrinology, Toho University Medical Center Sakura Hospital, 564-1 Shimoshizu Sakura, Chiba, Japan
| | - Atsuhito Saiki
- Center for Diabetes, Metabolism, and Endocrinology, Toho University Medical Center Sakura Hospital, 564-1 Shimoshizu Sakura, Chiba, Japan
| | - Emiko Sakaida
- Department of Hematology, Chiba University Hospital, Chiba, Japan
| | - Chiaki Nakaseko
- Department of Hematology, Chiba University Hospital, Chiba, Japan
| | - Yasuhiro Matsuura
- Department of Hematology, Narita Japanese Red Cross National Hospital, Narita, Chiba, Japan
| | - Nobuyuki Aotsuka
- Department of Hematology, Narita Japanese Red Cross National Hospital, Narita, Chiba, Japan
| | - Hideaki Bujo
- Department of Clinical Laboratory Medicine, Toho University Medical Center Sakura Hospital, Sakura, Chiba, Japan
| | - Ichiro Tatsuno
- Center for Diabetes, Metabolism, and Endocrinology, Toho University Medical Center Sakura Hospital, 564-1 Shimoshizu Sakura, Chiba, Japan
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