Does Zoledronic Acid Provide a Good Clinical Outcome in Patients With Chronic Back Pain Associated With Vertebral Osteoporosis?

Background Osteoporosis is a chronic, progressive, systemic condition of the skeletal tissue that is characterized by reduced bone density, microarchitecture deterioration, and fragile bones, making osteoporotic fractures or fragility fractures more likely to occur. This condition often remains asymptomatic and undiagnosed until it presents with fragility fractures. The condition is associated with a significant socioeconomic burden with disability, morbidity, and mortality. Therefore, early diagnosis, as well as treatment, is needed to prevent fractures. Intravenous zoledronic is an effective bisphosphonate with high patient compliance due to once-yearly dosing. The present study aims to determine whether zoledronic acid effectively treats chronic back pain in people with osteoporosis. Materials and methods Seventy patients above the age of 60 years presented with complaints of chronic low back aches to the outpatient department of orthopedics, R L Jalappa Hospital & Research Centre attached to Sri Devaraj Urs Medical College. The study was conducted between November 2016 and November 2018. Results All the patients found excellent clinical improvement following zoledronic acid infusion in early and long-term follow-ups. Additionally, it was found that zoledronic acid's effectiveness was excellent, with significant improvement in bone mineral density (BMD), T-score, and Z-score. Conclusion Early diagnosis and treatment of vertebral osteoporosis is the most important factor in preventing fragility fractures. Zoledronic acid, an antiresorptive drug with better compliance, is very effective in controlling low back pain, improving bone mineral density, and preventing the occurrence of atraumatic fragility fractures. With all the above factors, zoledronic acid is a preferable bisphosphonate for the treatment and prevention of osteoporosis compared to other modalities of treatment of osteoporosis.

Renal osteodystrophy: A historical review of its origins and conceptual evolution

Long considered an inert supporting framework, bone studies went neglected until the 17th century when they began as descriptive microscopic studies of structure which over time progressed into that of chemistry and physiology. It was in the mid-19th century that studies evolved into an inquisitive discipline which matured into the experimental investigation of bone in health and disease in the 20th century, and ultimately that of molecular studies now deciphering the genetic language of bone biology. These fundamental studies were catalyzed by increasing clinical interest in bone disease. The first bone disease to be identified was rickets in 1645. Its subsequent connection to albuminuric patients reported in 1883 later became renal osteodystrophy in 1942, launching studies that elucidated the functions of vitamin D and parathyroid hormone and their role in the altered calcium and phosphate metabolism of the disease. Studies in osteoporosis and renal osteodystrophy have driven most recent progress benefitting from technological advances in imaging and the precision of evaluating bone turnover, mineralization, and volume. This review exposes the progress of bone biology from a passive support structure to a dynamically regulated organ with vital homeostatic functions whose understanding has undergone more revisions and paradigm shifts than that of any other organ.

Social stratification reflected in bone mineral density and stature: Spectral imaging and osteoarchaeological findings from medieval Norway

This study presents skeletal material from five medieval burial sites in Eastern Norway, confined to one royal burial church, one Dominican monastery, and three burial sites representing parish populations. We combine osteological analysis and Dual Energy X-Ray Absorptiometry, studying the remains of 227 individuals (102 females and 125 males) employing young, middle, and old adult age categories. The aim is to assess bone mineral density as a skeletal indicator of socioeconomic status including stature as a variable. We detected that socioeconomic status significantly affected bone mineral density and stature. Individuals of high status had higher bone mineral density (0.07 g/cm2, p = 0.003) and taller stature (1.85 cm, p = 0.017) than individuals from the parish population. We detected no significant relationship between young adult bone mineral density and socioeconomic status (p = 0.127 and 0.059 for females and males, respectively). For males, high young adult bone mineral density and stature varied concordantly in both status groups. In contrast, females of high status were significantly taller than females in the parish population (p = 0.011). Our findings indicate quite different conditions during growth and puberty for the two groups of females. The age-related pattern of bone variation also portrayed quite different trajectories for the two socioeconomic status groups of both sexes. We discuss sociocultural practices (living conditions during childhood and puberty, as well as nutritional and lifestyle factors in adult life), possibly explaining the differences in bone mineral density between the high-status and parish population groups. The observation of greater differences in bone mineral density and stature for females than males in the medieval society of Norway is also further discussed.

Pregnancy-associated osteoporosis: a case-control study

The etiology and underlying mechanisms of pregnancy-associated osteoporosis (PAO) are still unknown, since no systematic analyses exist. Our results indicate that PAO is a heterogeneous, rare but severe disease including a substantial number of fractures with a significant delay from first symptom to diagnose.

INTRODUCTION

Pregnancy-associated osteoporosis (PAO) is a rare but severe type of premenopausal osteoporosis. Most common symptom includes acute lower back pain due to vertebral fracture predominantly occurring in the last trimester of pregnancy or immediately postpartum. The exact underlining mechanisms and risk factors of PAO are still unknown, and up to date, there are no published systematic analyses.

METHODS

We identified 102 PAO patients and matched them with 102 healthy controls according to age, region, and gravidity to evaluate risk factors in a large and homogenous population of women.

RESULTS

The baseline characteristics and anthropometric data of the two study groups were similar. Eighty-eight percent of the patients with PAO suffered from one or more fractures with a mean of 3.3 fractures per patient. The most common fracture site was the thoracolumbar spine, whereas 29, 37, 48, and 35% of the patients reported fractures at TH11, TH12, L1, and L2, respectively. PAO patients suffered more frequently from excessive dental problems in childhood (p < 0.001). The control group performed significantly more frequently sports both before (p < 0.002) and after puberty (p < 0.01). Compared to the controls, the patients with PAO reported twice as often severe diseases during pregnancy (p < 0.029). Hereby, the frequency of immobilization was twice as often in the PAO group compared to that in the control group (p < 0.005).

CONCLUSIONS

Our results indicate that PAO is a heterogeneous, rare but severe disease including a substantial number of fractures with a significant delay from first symptom to diagnose. Increased awareness is warranted to immediately start effective treatment.

Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

During pregnancy and lactation, female physiology adapts to meet the added nutritional demands of fetuses and neonates. An average full-term fetus contains ∼30 g calcium, 20 g phosphorus, and 0.8 g magnesium. About 80% of mineral is accreted during the third trimester; calcium transfers at 300-350 mg/day during the final 6 wk. The neonate requires 200 mg calcium daily from milk during the first 6 mo, and 120 mg calcium from milk during the second 6 mo (additional calcium comes from solid foods). Calcium transfers can be more than double and triple these values, respectively, in women who nurse twins and triplets. About 25% of dietary calcium is normally absorbed in healthy adults. Average maternal calcium intakes in American and Canadian women are insufficient to meet the fetal and neonatal calcium requirements if normal efficiency of intestinal calcium absorption is relied upon. However, several adaptations are invoked to meet the fetal and neonatal demands for mineral without requiring increased intakes by the mother. During pregnancy the efficiency of intestinal calcium absorption doubles, whereas during lactation the maternal skeleton is resorbed to provide calcium for milk. This review addresses our current knowledge regarding maternal adaptations in mineral and skeletal homeostasis that occur during pregnancy, lactation, and post-weaning recovery. Also considered are the impacts that these adaptations have on biochemical and hormonal parameters of mineral homeostasis, the consequences for long-term skeletal health, and the presentation and management of disorders of mineral and bone metabolism.

Presentation and management of osteoporosis presenting in association with pregnancy or lactation

In this review, we summarize our current understanding of the pathophysiology of fragility fractures that occur for the first time during pregnancy and lactation, and provide guidance on appropriate investigations and treatment strategies. Most affected women will have had no prior bone density reading, and so the extent of bone loss that may have occurred during pregnancy or lactation is uncertain. During pregnancy, intestinal calcium absorption doubles in order to meet the fetal demand for calcium, but if maternal intake of calcium is insufficient to meet the combined needs of the mother and baby, the maternal skeleton will undergo resorption during the third trimester. During lactation, several hormonal changes, independent of maternal calcium intake, program a 5-10 % loss of trabecular mineral content in order to provide calcium to milk. After weaning the baby, the maternal skeleton is normally restored to its prior mineral content and strength. This physiological bone resorption during reproduction does not normally cause fractures; instead, women who do fracture are more likely to have additional secondary causes of bone loss and fragility. Transient osteoporosis of the hip may affect one or both femoral heads during pregnancy but it involves localized edema and not skeletal resorption. Case reports have described the use of calcitonin, bisphosphonates, strontium ranelate, teriparatide, vertebroplasty, and kyphoplasty to treat post-partum vertebral fractures. However, the need for such treatments is uncertain given that a progressive increase in bone mass subsequently occurs in most women who present with a fracture during pregnancy or lactation.