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Gonnelli S, Briot K, Cormier C, Teboul S, Roux C, Koumakis E. Multiple brown tumors: a bone complication due to long-term untreated pseudohypoparathyroidism. Osteoporos Int 2024; 35:195-199. [PMID: 37644196 DOI: 10.1007/s00198-023-06878-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023]
Abstract
Bone lytic lesions are a possible complication of pseudohypoparathyroidism type 1B, in undertreated adult patients. Whole body [18F] F-fluorocholine PET/CT is a useful imaging tool to assess brown tumor progression in this context. We describe the case of a 33-year-old woman, referred for the diagnostic evaluation of lytic bone lesions of the lower limbs, in the context of asymptomatic pseudohypoparathyroidism. She had been treated with alfacalcidol and calcium during her childhood. Treatment was discontinued at the age of 18 years old because of the lack of symptoms. A femur biopsy revealed a lesion rich in giant cells, without malignancy, consistent with a brown tumor. Laboratory tests showed a parathyroid level at 1387 pg/ml (14-50). Whole-body Fluorocholine PET/CT revealed hypermetabolism of bone lesions. The final diagnosis was brown tumors related to hyperparathyroidism complicating an untreated pseudohypoparathyroidism. Genetic testing confirmed PHP type 1B. Pseudohypoparathyroidism with radiographic evidence of hyperparathyroid bone disease, is a very rare condition due to parathyroid hormone resistance in target organs, i.e., kidney resistance, but with conserved bone cell sensitivity. It has been reported in only a few cases of pseudohypoparathyroidism type Ib. Long-term vitamin D treatment was required to correct bone hyperparathyroidism. With this rationale, the patient was treated with calcium, alfacalcidol, and cholecalciferol. One-year follow-up showed complete resolution of pain, improvement in serum calcium, and regression of bone lesions on [18F]F-fluorocholine PET/CT. This case illustrates the usefulness of [18F]F-fluorocholine PET/CT for the imaging of brown tumors in pseudohypoparathyroidism type 1B, and emphasizes the importance of calcium and vitamin D treatment in adult patients, to avoid the deleterious effects of high parathyroid hormone on skeletal integrity.
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Affiliation(s)
- S Gonnelli
- Université de Paris-APHP.Centre, Service de Rhumatologie, Hôpital Cochin, Centre de Référence des Maladies Rares du Métabolisme Phospho-calcique, Paris, France
| | - K Briot
- Université de Paris-APHP.Centre, Service de Rhumatologie, Hôpital Cochin, Centre de Référence des Maladies Rares du Métabolisme Phospho-calcique, Paris, France
| | - C Cormier
- Université de Paris-APHP.Centre, Service de Rhumatologie, Hôpital Cochin, Centre de Référence des Maladies Rares du Métabolisme Phospho-calcique, Paris, France
| | - S Teboul
- Université de Paris-APHP.Centre, Service de Rhumatologie, Hôpital Cochin, Centre de Référence des Maladies Rares du Métabolisme Phospho-calcique, Paris, France
| | - C Roux
- Université de Paris-APHP.Centre, Service de Rhumatologie, Hôpital Cochin, Centre de Référence des Maladies Rares du Métabolisme Phospho-calcique, Paris, France
| | - E Koumakis
- Université de Paris-APHP.Centre, Service de Rhumatologie, Hôpital Cochin, Centre de Référence des Maladies Rares du Métabolisme Phospho-calcique, Paris, France.
- INSERM UMR 1163, Imagine Institute, Paris, France.
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Bosco P, O'kelly J, Briot K, Mehsen-Cetre N, Fabre A, Lassalle R, Abouelfath A. Efficacité en vie réelle des traitements de l'ostéoporose sur le risque de fracture: une étude de cohorte en population française. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Launois R, Cabout E, Benamouzig D, Velpry L, Meto E, Briot K, Alliot F, Perrin L, Grange L, Sellami R, Touboul C, Joubert JM, Roux C. Freins et leviers de la mise en place d'une politique de prévention secondaire de l'ostéoporose : étude EFFEL. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.09.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Briot K, Liu J, Williams A, Wood S. OP0048 FIRST INTERIM ANALYSIS OF THE INTERNATIONAL X-LINKED HYPOPHOSPHATAEMIA (XLH) REGISTRY: ADULT POPULATION BASELINE CHARACTERISTICS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundX-Linked Hypophosphataemia (XLH) is a rare, progressive, lifelong, hereditary phosphate wasting disorder characterised by a pathological increase in fibroblast growth factor 23 concentration/activity.1 Despite XLH being increasingly recognised as a chronic progressive disease, there are few data documenting its natural history or the impact of treatment and other medical interventions on patient outcomes.2 The multicentre, international, XLH patient registry was established to address this lack of information in XLH to help inform future clinical practice.ObjectivesTo report data from the first interim analysis of the International XLH Registry (NCT03193476), focusing on baseline characteristics of adults (aged ≥18 years [y]).MethodsThe International XLH Registry was initiated August 2017 to collect information on the natural history of XLH and will run for 10 years, aiming to recruit 1,200 people with XLH. Subjects diagnosed with XLH were enrolled from 81 sites in 16 countries (Last Patient In: 30/11/2020; Database Lock: 29/03/2021). Parameters collected at baseline included demographics, medical/treatment history, and clinical presentation.ResultsIn total, 217 adults were eligible for inclusion in this analysis (18–<30y, n=56; 30–<50y, n=96; ≥50y, n=65); and 150 (69.1%) were female. Mean (SD) age was 41.9y (15.5y); median 41.1y. Mean height was 155.8 cm (n=79); mean weight, 70.0 kg (n=96); mean BMI 26.5 kg/m2 (n=48). Most subjects resided in the UK (50.7%, n=110) and in France (18.9%, n=41). Treatment data were available for 118 subjects: conventional therapy (phosphate salts and active vitamin D), 83.9% (99/118); burosumab, 11.0% (13/118); no treatment recorded 5.1% (6/118). Of 163 subjects with available data, a genetic test result was recorded for 68 (41.7%), of whom 62 (91.2%) had a confirmed PHEX mutation. Data on XLH family history were available for 187 subjects; 56/140 (40.0%) reported their biological mother was affected; and 22/141 (15.6%) reported their biological father was affected. The mean time to diagnosis from first symptoms was longer in older vs younger adults: 18–<30y, 25 months (mo) (n=21); 30–<50y, 21mo (n=21); ≥50y, 112mo (n=13).Retrospective XLH clinical data were available at study entry for 110 adult subjects. Among these subjects, joint conditions were reported by 36.4% (40/110), with osteoarthritis of the knees (60%), hips (42.5%), and shoulders (22.5%) the most frequently affected. Skeletal abnormalities were noted for 71.8% (79/110) of subjects; most common conditions were genu varum 53.2% (42/79), genu valgum 26.6% (21/79), and enthesopathy 21.5% (17/79). Historical fracture data (“yes/no”) were available for 111 subjects; 41 were reported to have had a fracture. Femur fracture was reported for 22 subjects, and hip fractures for 5 subjects.Details of historical orthopaedic surgery were reported for 99 adults; osteotomy was reported for 89 subjects, and hip replacements reported in 14 subjects.ConclusionThe demographics and baseline characteristics of subjects in the International XLH Registry are as expected for adults with XLH. The shorter time to diagnosis in younger vs older adults may indicate improved recognition and diagnosis of XLH in recent years. The analysis of this young population treated with conventional therapy highlights the frequency of musculoskeletal involvement (osteoarthritis, enthesopathies, etc). The information collected within this rare-disease registry during these 10 years provides an exciting opportunity to integrate large-scale real-world evidence into clinical practice, with the aim of improving the care and quality of life of people living with this debilitating disease.References[1]Haffner D, et al. Nat Rev Nephrol 2019;15(7):435–455.[2]Padidela R, et al. Orphanet J Rare Dis. 2020; 15:172.AcknowledgementsThe authors acknowledge the contribution of all members of the International XLH Registry Steering Committee.Disclosure of InterestsKarine Briot Speakers bureau: Speakers bureau from KKI, Amgen, UCB, Alexion, Jonathan Liu Employee of: Employed by Kyowa Kirin International, Angela Williams Employee of: Employed by Kyowa Kirin International, Sue Wood Employee of: Employed by Kyowa Kirin International.
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Bosco-Levy P, O'Kelly J, Briot K, Mehsen-Cetre N, Abouelfath A, Droz-Perroteau C. Efficacité en vie réelle des traitements de l'ostéoporose sur le risque de fracture : une étude de cohorte en population française. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.01.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Herrou J, Godart N, Etcheto A, Kolta S, Barthe N, Maugars AY, Thomas T, Roux C, Briot K. Absence of relationships between depression and anxiety and bone mineral density in patients hospitalized for severe anorexia nervosa. Eat Weight Disord 2021; 26:1975-1984. [PMID: 33085062 DOI: 10.1007/s40519-020-01045-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 10/03/2020] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Low BMD is frequent in anorexia nervosa (AN), depression, and during SSRI treatment but relation between these elements in AN is not established. The aims of this study were to assess the relationships between depression and anxiety, SSRI prescription, and (1) low BMD during inpatient treatment and (2) BMD change 1 year after hospital discharge. METHODS From 2009 to 2011, 212 women with severe AN have been included in the EVHAN study (EValuation of Hospitalisation for AN). Depression, anxiety and obsessive-compulsive symptoms and comorbidity were evaluated using psychometric scales and CIDI-SF. BMD was measured by dual-energy X-ray absorptiometry. RESULTS According to the CIDI-SF, 56% of participants (n = 70) had a lifetime major depressive disorder, 27.2% (n = 34) had a lifetime obsessive-compulsive disorder, 32.8% (n = 41) had a lifetime generalized anxiety disorder and 25.6% (n = 32) had a lifetime social phobia disorder. Half of the sample (50.7%; n = 72) had a low BMD (Z score ≤ - 2). In multivariate analysis, lifetime lowest BMI was the only determinant significantly associated with low BMD (OR = 0.56, p = 0.0008) during hospitalization. A long duration of AN (OR = 1.40 (0.003-3.92), p = 0.03), the AN-R subtype (OR = 4.95 (1.11-26.82), p = 0.04), an increase of BMI between the admission and 1 year (OR = 1.69 (1.21-2.60), p = 0.005) and a gain of BMD 1 year after the discharge explained BMD change. CONCLUSION We did not find any association between depression and anxiety or SSRI treatment and a low BMD or variation of BMD. LEVEL OF EVIDENCE Level III, cohort study.
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Affiliation(s)
- J Herrou
- INSERM UMR-1153, Paris, France.
- Department of Rheumatology, Cochin Hospital, 75014, Paris, France.
| | - N Godart
- Fondation de Santé des Etudiants de France (FSEF), Paris, France
- UFR des Sciences de la Santé Simone Veil (UVSQ), Versailles, France
- CESP, INSERM, UMR 1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France
| | - A Etcheto
- Université Paris Descartes, Faculté de Médecine Paris Descartes, 75014, Paris, France
| | - S Kolta
- INSERM UMR-1153, Paris, France
| | - N Barthe
- Department of Nuclear Medicine, CHU Bordeaux, Bordeaux, France
| | - A Y Maugars
- Department of Rheumatology, CHU Nantes, Nantes, France
| | - T Thomas
- Department of Rheumatology, Hospital Nord, CHU de Saint Etienne, INSERM 1059, Lyon University, Lyon, France
| | - C Roux
- INSERM UMR-1153, Paris, France
- Université Paris Descartes, Faculté de Médecine Paris Descartes, 75014, Paris, France
| | - K Briot
- INSERM UMR-1153, Paris, France
- Université Paris Descartes, Faculté de Médecine Paris Descartes, 75014, Paris, France
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Minonzio JG, Bochud N, Vallet Q, Ramiandrisoa D, Etcheto A, Briot K, Kolta S, Roux C, Laugier P. Ultrasound-Based Estimates of Cortical Bone Thickness and Porosity Are Associated With Nontraumatic Fractures in Postmenopausal Women: A Pilot Study. J Bone Miner Res 2019; 34:1585-1596. [PMID: 30913320 DOI: 10.1002/jbmr.3733] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/21/2019] [Accepted: 03/10/2019] [Indexed: 01/02/2023]
Abstract
Recent ultrasound (US) axial transmission techniques exploit the multimode waveguide response of long bones to yield estimates of cortical bone structure characteristics. This pilot cross-sectional study aimed to evaluate the performance at the one-third distal radius of a bidirectional axial transmission technique (BDAT) to discriminate between fractured and nonfractured postmenopausal women. Cortical thickness (Ct.Th) and porosity (Ct.Po) estimates were obtained for 201 postmenopausal women: 109 were nonfractured (62.6 ± 7.8 years), 92 with one or more nontraumatic fractures (68.8 ± 9.2 years), 17 with hip fractures (66.1 ± 10.3 years), 32 with vertebral fractures (72.4 ± 7.9 years), and 17 with wrist fractures (67.8 ± 9.6 years). The areal bone mineral density (aBMD) was obtained using DXA at the femur and spine. Femoral aBMD correlated weakly, but significantly with Ct.Th (R = 0.23, p < 0.001) and Ct.Po (R = -0.15, p < 0.05). Femoral aBMD and both US parameters were significantly different between the subgroup of all nontraumatic fractures combined and the control group (p < 0.05). The main findings were that (1) Ct.Po was discriminant for all nontraumatic fractures combined (OR = 1.39; area under the receiver operating characteristic curve [AUC] equal to 0.71), for vertebral (OR = 1.96; AUC = 0.84) and wrist fractures (OR = 1.80; AUC = 0.71), whereas Ct.Th was discriminant for hip fractures only (OR = 2.01; AUC = 0.72); there was a significant association (2) between increased Ct.Po and vertebral and wrist fractures when these fractures were not associated with any measured aBMD variables; (3) between increased Ct.Po and all nontraumatic fractures combined independently of aBMD neck; and (4) between decreased Ct.Th and hip fractures independently of aBMD femur. BDAT variables showed comparable performance to that of aBMD neck with all types of fractures (OR = 1.48; AUC = 0.72) and that of aBMD femur with hip fractures (OR = 2.21; AUC = 0.70). If these results are confirmed in prospective studies, cortical BDAT measurements may be considered useful for assessing fracture risk in postmenopausal women. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- J-G Minonzio
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, CNRS, INSERM, Paris, France
| | - N Bochud
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, CNRS, INSERM, Paris, France
| | - Q Vallet
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, CNRS, INSERM, Paris, France
| | - D Ramiandrisoa
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, CNRS, INSERM, Paris, France
| | - A Etcheto
- Department of Rheumatology, Cochin Hospital, Epidemiology and Biostatistics Sorbonne Paris Cité, Research Center, INSERM U1153, Paris Descartes University, Paris, France
| | - K Briot
- Department of Rheumatology, Cochin Hospital, Epidemiology and Biostatistics Sorbonne Paris Cité, Research Center, INSERM U1153, Paris Descartes University, Paris, France
| | - S Kolta
- Department of Rheumatology, Cochin Hospital, Epidemiology and Biostatistics Sorbonne Paris Cité, Research Center, INSERM U1153, Paris Descartes University, Paris, France
| | - C Roux
- Department of Rheumatology, Cochin Hospital, Epidemiology and Biostatistics Sorbonne Paris Cité, Research Center, INSERM U1153, Paris Descartes University, Paris, France
| | - P Laugier
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, CNRS, INSERM, Paris, France
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Bemer P, Mendes M, Dicembre M, Briot K, Carlier R, Melchior JC, Hanachi M. MON-PO448: Bone Mineral Density Status and Evolution in Severely Malnourished Adult Patients with Anorexia Nervosa. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32281-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Schott AM, Briot K, Sanchez JP, Bendavid S, Bosquet L, Perot S, Etringer A, Chauny JV, Samama P, Désaméricq G. Étude observationnelle, prospective décrivant les caractéristiques et la prise en charge de femmes atteintes d’une ostéoporose post-ménopausique traitées par Prolia® et son utilisation en pratique clinique courante en France (étude PILOTE). Rev Epidemiol Sante Publique 2019. [DOI: 10.1016/j.respe.2019.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Kolta S, Etcheto A, Fechtenbaum J, Feydy A, Roux C, Briot K. Measurement of Trabecular Bone Score of the Spine by Low-Dose Imaging System (EOS ®): A Feasibility Study. J Clin Densitom 2019; 22:243-248. [PMID: 30120025 DOI: 10.1016/j.jocd.2018.05.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/23/2018] [Accepted: 05/23/2018] [Indexed: 10/28/2022]
Abstract
UNLABELLED Purpose/Introduction: Measurement of trabecular bone score (TBS®) of the lumbar spine on dual energy X-ray absorptiometry (DXA) devices improves fracture risk prediction. We conducted a proof of concept study to assess the feasibility of TBS® measured on the low-dose imaging system EOS®. METHODS TBS was assessed on both DXA and EOS® in 122 patients aged ≥ 50 yr, receiving no anti-osteoporotic treatment. The TBS® was computed on full-body EOS® images, focusing on the lumbar spine region. The patients were also scanned with a DXA bone densitometer (Hologic) and the spine and hip bone mineral density (g/cm²) were computed. RESULTS TBS® measurement on EOS® was not possible in 34 patients due to technical problems. It could be measured on both DXA and EOS® in 88 patients (28 with severe low-trauma fracture and 60 without fracture). TBS-EOS values were significantly lower in fractured patients compared to nonfractured patients. TBS-EOS was associated with the presence of fractures as reported by an AUC of 0.70. Odds ratio of TBS-EOS for the presence of severe low-trauma fracture was 2.00 [1.24-3.25], p = 0.005. CONCLUSIONS This proof of concept study, based on a prototype version of the TBS-EOS, demonstrated the feasibility of the measurement of TBS® on low-dose EOS® imaging devices. Results show that the TBS-EOS was lower in patients with severe low-trauma fractures compared to nonfractured patients independently from bone mineral density. Some technical issues need to be solved before its eventual use in routine clinical settings. Additional prospective studies are still needed to define the actual contribution of this new technique.
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Affiliation(s)
- S Kolta
- Department of Rheumatology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR-1153, Paris, France.
| | | | | | - A Feydy
- INSERM UMR-1153, Paris, France; Department of Radiology B, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Paris-Descartes University, Paris, France
| | - C Roux
- Department of Rheumatology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR-1153, Paris, France; Paris-Descartes University, Paris, France
| | - K Briot
- Department of Rheumatology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR-1153, Paris, France
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Che H, Breuil V, Cortet B, Paccou J, Thomas T, Chapuis L, Debiais F, Mehsen-Cetre N, Javier RM, Loiseau Peres S, Roux C, Briot K. Vertebral fractures cascade: potential causes and risk factors. Osteoporos Int 2019; 30:555-563. [PMID: 30519756 DOI: 10.1007/s00198-018-4793-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 11/29/2018] [Indexed: 12/11/2022]
Abstract
UNLABELLED We performed a study to identify potential causes and risk factors of vertebral fracture cascade. Vertebral fracture cascade is a severe clinical event in patients with bone fragility. Only half of patients have an identified cause of secondary osteoporosis. INTRODUCTION Vertebral fracture (VF) is the most common osteoporotic fracture, and a strong risk factor of subsequent VFs leading to VF cascade (VFC). We prompted a study to identify potential causes and risk factors of VFC. METHODS VFC observations were collected retrospectively between January 2016 and April 2017. VFC was defined as an occurrence of at least three VFs within 1 year. RESULTS We included in 10 centers a total of 113 patients with VFC (79.6% of women, median age 73, median number of VFs in the cascade, 5). We observed 40.5% and 30.9% of patients with previous major fractures and a previous VF, respectively, and 68.6% with densitometric osteoporosis; 18.9% of patients were currently receiving oral glucocorticoids and 37.1% in the past. VFC was attributed by the physician to postmenopausal osteoporosis in 54% of patients. A secondary osteoporosis associated with the VFC was diagnosed in 52 patients: glucocorticoid-induced osteoporosis (25.7%), non-malignant hemopathies (6.2%), alcoholism (4.4%), use of aromatase inhibitors (3.6%), primary hyperparathyroidism (2.7%), hypercorticism (2.7%), anorexia nervosa (2.7%), and pregnancy and lactation-associated osteoporosis (1.8%). A total of 11.8% of cases were reported following a vertebroplasty procedure. A total of 31.5% patients previously received an anti-osteoporotic treatment. In six patients, VFC occurred early after discontinuation of an anti-osteoporotic treatment, in the year after the last dose effect was depleted: five after denosumab and one after odanacatib. CONCLUSION The results of this retrospective study showed that only half of VFC occurred in patients with a secondary cause of osteoporosis. Prospective studies are needed to further explore the determinants of this severe complication of osteoporosis.
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Affiliation(s)
- H Che
- Rheumatology Department, CHU Lapeyronie Montpellier, 371 avenue du Gaston Giraud, 34090, Montpellier, France.
| | - V Breuil
- Department of Rheumatology, BIAM - UMR E 4320 TIRO-MATOs CEA/UNS, Université Côte D'Azur, Centre Hospitalier Universitaire Nice, Nice, France
| | - B Cortet
- Service de rhumatologie, CHRU France et Université de Lille, Université Littoral Côte d'Opale, 59000 Lille, PMOI EA 4490 faculté de chirurgie dentaire, place de Verdun, 59000, Lille, France
| | - J Paccou
- Service de rhumatologie, CHRU France et Université de Lille, Université Littoral Côte d'Opale, 59000 Lille, PMOI EA 4490 faculté de chirurgie dentaire, place de Verdun, 59000, Lille, France
| | - T Thomas
- Rheumatology Department, CHU de Saint Etienne, INSERM U1059, Lab Biologie Intégrée du Tissu Osseux, Université de Lyon, 42055, Saint-Etienne Cedex 2, France
| | - L Chapuis
- Rheumatology Department, CH Simone Veil du Vitre, 30 route de Rennes, 35500, Vitre, France
| | - F Debiais
- Rheumatology Department, CHU La Miletrie Poitiers, 2 rue de la Miletrie, 86021, Poitiers Cedex, France
| | - N Mehsen-Cetre
- Rheumatology Department, CHU Pellegrin Bordeaux, Rue de la pelouse de Douet, 33000, Bordeaux, France
| | - R M Javier
- Rheumatology Department, Hôpitaux Universitaires de Strasbourg, 1 avenue Moliere, 67098, Strasbourg, France
| | - S Loiseau Peres
- Rheumatology Department, CHR Orléans, 14 avenue de l'Hopital, 45000, Orleans, France
| | - C Roux
- Rheumatology Department, INSERM 1153, CHU Paris Cochin, Paris Descartes University, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - K Briot
- Rheumatology Department, INSERM 1153, CHU Paris Cochin, Paris Descartes University, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
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Henriquez S, Dunogué B, Régent A, Cohen P, Berezne A, Le Jeunne C, Mouthon L, Roux C, Guillevin L, Briot K, Terrier B. Le tissu adipeux abdominal prédit la survenue d’évènements cardiovasculaires majeurs au cours des vascularites nécrosantes : étude prospective de 120 patients. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Roux C, Baron G, Briot K, Roux B, Cortet B, Thomas T. Management of oral bisphosphonates treatment by rheumatologists and determinants of therapeutic changes: a case-vignette-based study. Osteoporos Int 2017; 28:3339-3345. [PMID: 28852785 DOI: 10.1007/s00198-017-4188-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 08/01/2017] [Indexed: 10/19/2022]
Abstract
UNLABELLED Using case vignette methodology, this study shows that only 4% of patients are maintained on oral bisphosphonates over 5 years, and prescribers switch or stop the treatment in 20-30% of cases at each visit. There are few determinants of these changes. More information on appropriate follow-up could help in patients' management. INTRODUCTION Persistence to oral bisphosphonates, the most commonly prescribed anti-osteoporotic treatments, is low. The aim of this study was to evaluate the role of rheumatologists on the treatment patterns, and to assess the determinants of treatment changes. METHODS We used the methodology of case vignettes with the participation of 142 rheumatologists. Three baseline clinical vignettes were presented: (1) the physician was asked to indicate the most appropriate period to schedule the next visit over 5 years, (2) the physician was tested about parameters for follow-up (including traps), and (3) various results (both clinical, biological, densitometric, and radiological) were given by random and analyzed as determinants of treatment changes. RESULTS The study allowed assessment of 426 virtual clinical cases. Clinical examinations, patient's height, inquiries about falls, and adherence to treatment were deemed necessary in > 90% of cases. Bone mineral density was measured in 22, 40, and 71% of cases at 2, 3, and 5 years, respectively. Dental follow-up was recommended in less than 25% of cases. Only 4.2% of patients were maintained on the same treatment at 5 years, and a change of treatment (stop or switch) occurs in 20-30% of cases at each visit. Significant determinants were adherence to treatment, serum C-terminal crosslinking telopeptide of type 1 collagen (CTX) value, change in patient's height, and the occurrence of an incident vertebral fracture. CONCLUSION Our study shows that maintenance of oral bisphosphonate in postmenopausal women managed by rheumatologists is low; there are few determinants of these changes and more information on appropriate follow-up could help in patients' management.
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Affiliation(s)
- C Roux
- Paris Descartes University, Paris, France.
- Department of Rheumatology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, 27, Rue du Faubourg St Jacques, 75014, Paris, France.
- INSERM UMR1153, Paris, France.
| | - G Baron
- Paris Descartes University, Paris, France
- INSERM UMR1153, Paris, France
- Biostatistics and Clinical Epidemiology Center - Hotel-Dieu Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - K Briot
- Department of Rheumatology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, 27, Rue du Faubourg St Jacques, 75014, Paris, France
- INSERM UMR1153, Paris, France
| | - B Roux
- Fast 4 - Contract Research Organisation, Nîmes, France
| | - B Cortet
- Department of Rheumatology, Lille 2 - University, CHRU, Lille, France
- EA 4490, Lille, France
| | - T Thomas
- Department of Rheumatology, CHU, Saint-Etienne University, Saint-Etienne, France
- INSERM U1059, Saint-Etienne, France
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14
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Abstract
Systemic osteoporosis and increased fracture rates have been described in chronic inflammatory diseases such as rheumatoid arthritis, spondyloarthritis, systemic lupus erythematosus, inflammatory bowel diseases, and chronic obstructive pulmonary disease. Most of these patients receive glucocorticoids, which have their own deleterious effects on bone. However, the other main determinant of bone fragility is the inflammation itself, as shown by the interactions between the inflammatory mediators, the actors of the immune system, and the bone remodelling. The inflammatory disease activity is thus on top of the other well-known osteoporotic risk factors in these patients. Optimal control of inflammation is part of the prevention of osteoporosis, and potent anti-inflammatory drugs have positive effects on surrogate markers of bone fragility. More data are needed to assess the anti-fracture efficacy of a tight control of inflammation in patients with a chronic inflammatory disorder. This review aimed at presenting different clinical aspects of inflammatory diseases which illustrate the relationships between inflammation and bone fragility.
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Affiliation(s)
- K Briot
- Department of Rheumatology, Cochin Hospital, Assistance-Publique-Hôpitaux de Paris, Paris, France.
- Hôpital Cochin, Service de Rhumatologie, 27, Rue du Faubourg, St. Jacques, 75014, Paris, France.
- INSERM UMR 1153, Paris, France.
| | - P Geusens
- Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
- Hasselt University, Hasselt, Belgium
| | - I Em Bultink
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands
| | - W F Lems
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands
| | - C Roux
- Department of Rheumatology, Cochin Hospital, Assistance-Publique-Hôpitaux de Paris, Paris, France
- Hôpital Cochin, Service de Rhumatologie, 27, Rue du Faubourg, St. Jacques, 75014, Paris, France
- INSERM UMR 1153, Paris, France
- Paris Descartes University, Paris, France
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Couraud G, Souffir C, Gaigneux E, Kolta S, Roux C, Briot K. Adjusting FRAX® on TBS for identification of subjects at high risk of fractures. Bone 2017; 101:214-218. [PMID: 28479495 DOI: 10.1016/j.bone.2017.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/17/2017] [Accepted: 05/03/2017] [Indexed: 11/28/2022]
Abstract
The objective of this study was to compare the proportion of patients at high fracture risk according to FRAX® and FRAX® adjusted on TBS in patients hospitalized for a non vertebral fractures. Patients were selected from a Fracture Liaison Service FLS): clinical risk factors, bone mineral density (BMD) and TBS were assessed at the time of the fracture. Without considering the current fracture, we calculated FRAX® and FRAX® adjusted on TBS (TBS-FRAX®), and compared the proportion of patients with a high risk for major osteoporotic fracture (MOF)>20% according to FRAX® and TBS-FRAX®, and the proportion of subjects who should be treated according to current guidelines. Four hundred and thirteen patients were included for a non vertebral fracture (84.5% women, mean age of 73.9±11.7years), Two hundred and eight patients (50.4%) had osteoporosis (T≤-2.5 at least one site) and the mean value of TBS was 1.206 (±0.111). The proportion of patients with a risk of MOF≥20% before the fracture was similar with FRAX® and TBS-FRAX® (24.7% vs 25.4%). The proportion of patients identified with a risk of MOF above the threshold value of therapeutic intervention was higher using TBS-FRAX® than FRAX® for the age categories of 60-70years (38.3% vs 30.9%, p=0.01) and 70-80years (31.2% vs. 26.6%, p=0.04). This study showed that the proportion of patients at high risk of fracture is similar using FRAX® and FRAX® adjusted on TBS in patients hospitalized for a non vertebral fracture in a FLS.
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Affiliation(s)
- G Couraud
- Department of Rheumatology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - C Souffir
- Department of Rheumatology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM U1153, Paris, France
| | - E Gaigneux
- Department of Rheumatology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - S Kolta
- Department of Rheumatology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM U1153, Paris, France
| | - C Roux
- Department of Rheumatology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM U1153, Paris, France; Paris-Descartes University, Paris, France
| | - K Briot
- Department of Rheumatology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM U1153, Paris, France.
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16
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Abstract
The clinical significance of osteoporosis is in the occurrence of fractures and re-fractures. The main risk factor of sustaining a fracture is a previous one, but a recent fracture is a better fracture risk factor than fracture history. The role of the recency of fracture has been shown for both vertebral and non-vertebral fracture risk. This imminent risk is explained by both bone-related factors (underlying osteoporosis) and fall-related factors (including those related to postfracture care). Such a short-term increased risk has been shown also in patients initiating corticosteroids and in frail osteoporotic subjects with central nervous system (CNS) diseases or drugs targeting CNS, and thus a high risk of falls. Patients with an imminent (i.e. 2 years) risk of fracture or refracture should be identified in priority in order to receive an immediate treatment and a program of fall prevention.
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Affiliation(s)
- C Roux
- Paris Descartes University, Paris, France.
- Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, UMR U1153, Paris, France.
- Department of Rheumatology, Cochin Hospital, Assistance-Publique-Hôpitaux de Paris, Paris, France.
| | - K Briot
- Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, UMR U1153, Paris, France
- Department of Rheumatology, Cochin Hospital, Assistance-Publique-Hôpitaux de Paris, Paris, France
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17
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18
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Affiliation(s)
- J Fechtenbaum
- Department of rheumatology, Cochin hospital, Paris, France.
| | - S Kolta
- Department of rheumatology, Cochin hospital, Paris, France
- Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, INSERM U1153, Paris, France
| | - K Briot
- Department of rheumatology, Cochin hospital, Paris, France
- Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, INSERM U1153, Paris, France
| | - C Roux
- Department of rheumatology, Cochin hospital, Paris, France
- Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, INSERM U1153, Paris, France
- Paris Descartes University, Paris, France
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19
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Biosse Duplan M, Coyac BR, Bardet C, Zadikian C, Rothenbuhler A, Kamenicky P, Briot K, Linglart A, Chaussain C. Phosphate and Vitamin D Prevent Periodontitis in X-Linked Hypophosphatemia. J Dent Res 2016; 96:388-395. [PMID: 27821544 DOI: 10.1177/0022034516677528] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
X-linked hypophosphatemia (XLH) is a rare genetic skeletal disease where increased phosphate wasting in the kidney leads to hypophosphatemia and prevents normal mineralization of bone and dentin. Here, we examined the periodontal status of 34 adults with XLH and separated them according to the treatment they received for hypophosphatemia. We observed that periodontitis frequency and severity were increased in adults with XLH and that the severity varied according to the hypophosphatemia treatment. Patients who benefited from an early and continuous vitamin D and phosphate supplementation during their childhood presented less periodontal attachment loss than patients with late or incomplete supplementation. Continued hypophosphatemia treatment during adulthood further improved the periodontal health. Extracted teeth from patients with late or incomplete supplementation showed a strong acellular cementum hypoplasia when compared with age-matched healthy controls. These results show that XLH disturbs not only bone and dentin formation but also cementum and that the constitutional defect of the attachment apparatus is associated with attachment loss.
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Affiliation(s)
- M Biosse Duplan
- 1 Service d'Odontologie, Hôpital Bretonneau, HUPNVS, AP-HP, Paris, France.,2 Faculté de Chirurgie Dentaire, Université Paris Descartes, Montrouge, France.,3 Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphore, Plateforme d'expertise Paris Sud Maladies rares, filière OSCAR, Hôpital Bicêtre-Paris Sud, AP-HP, Le Kremlin Bicêtre, France
| | - B R Coyac
- 4 EA 2496, Faculté de Chirurgie Dentaire, Université Paris Descartes, Montrouge, France
| | - C Bardet
- 4 EA 2496, Faculté de Chirurgie Dentaire, Université Paris Descartes, Montrouge, France
| | - C Zadikian
- 1 Service d'Odontologie, Hôpital Bretonneau, HUPNVS, AP-HP, Paris, France.,2 Faculté de Chirurgie Dentaire, Université Paris Descartes, Montrouge, France
| | - A Rothenbuhler
- 3 Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphore, Plateforme d'expertise Paris Sud Maladies rares, filière OSCAR, Hôpital Bicêtre-Paris Sud, AP-HP, Le Kremlin Bicêtre, France.,5 Service d'endocrinologie, Hôpital Bicêtre, HUPS, AP-HP, Le Kremlin Bicêtre, France
| | - P Kamenicky
- 3 Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphore, Plateforme d'expertise Paris Sud Maladies rares, filière OSCAR, Hôpital Bicêtre-Paris Sud, AP-HP, Le Kremlin Bicêtre, France.,5 Service d'endocrinologie, Hôpital Bicêtre, HUPS, AP-HP, Le Kremlin Bicêtre, France
| | - K Briot
- 3 Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphore, Plateforme d'expertise Paris Sud Maladies rares, filière OSCAR, Hôpital Bicêtre-Paris Sud, AP-HP, Le Kremlin Bicêtre, France.,6 Service de Rhumatologie, Hôpital Cochin, HUPC, AP-HP, Paris, France
| | - A Linglart
- 3 Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphore, Plateforme d'expertise Paris Sud Maladies rares, filière OSCAR, Hôpital Bicêtre-Paris Sud, AP-HP, Le Kremlin Bicêtre, France.,5 Service d'endocrinologie, Hôpital Bicêtre, HUPS, AP-HP, Le Kremlin Bicêtre, France
| | - C Chaussain
- 1 Service d'Odontologie, Hôpital Bretonneau, HUPNVS, AP-HP, Paris, France.,3 Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphore, Plateforme d'expertise Paris Sud Maladies rares, filière OSCAR, Hôpital Bicêtre-Paris Sud, AP-HP, Le Kremlin Bicêtre, France.,4 EA 2496, Faculté de Chirurgie Dentaire, Université Paris Descartes, Montrouge, France
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20
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Rosine N, Etcheto A, Molto A, Taoufik Y, Chavez H, Roux C, Briot K, Dougados M, Miceli-Richard C. FRI0432 Increase in Il-31 Serum Level in Recent Spondyloarthritis: Data from The Desir Cohort. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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21
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Che H, Souffir C, Molto A, Kolta S, Etcheto A, Richette P, Dougados M, Roux C, Briot K. THU0396 Visceral Adipose Tissue and Cardiovascular Risk in Spondyloarthritis: Results from The DESIR and COMOSPA Cohorts. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Maman E, Borderie D, Roux C, Briot K. Absence of recognition of low alkaline phosphatase level in a tertiary care hospital. Osteoporos Int 2016; 27:1251-1254. [PMID: 26446772 DOI: 10.1007/s00198-015-3346-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 09/25/2015] [Indexed: 11/25/2022]
Abstract
SUMMARY Low serum total alkaline phosphatase level (ALP), the hallmark for hypophosphatasia (HPP), must be recognized to provide appropriate care of the patients and to avoid antiresorptive treatment. The prevalence of persistent low ALP in a clinical setting is 0.13% and the recognition is very low (3%). INTRODUCTION A low serum total alkaline phosphatase level is the hallmark for the diagnosis of hypophosphatasia. Although very rare, HPP must be recognized to provide appropriate treatment of non-union fractures and to avoid potentially harmful drugs, such as antiresorptive treatments. The aim of this study was to assess the recognition of persistent low ALP in a tertiary care hospital. METHODS Between the 1st of January and the 31st of December 2013, 48,755 patients had ALP assessment in the Biochemistry Department of our hospital. Sixty-eight patients had all serum ALP values persistently below 40 IU/l. Among them, six had potential causes of secondary hypophosphatasia. We consulted the summary discharges of the 62 patients in order to check for the notation of low ALP. Patients from the departments of rheumatology and internal medicine were contacted to fulfill a questionnaire about clinical manifestations potentially related to HPP. RESULTS 0.13% of hospitalized patients had persistently low value. They were 46.5 ± 17.7 years old, and 73% were females. The low ALP value was notified in the discharge summary for two patients (3%), without any comment. Twenty-four patients (46 + /-16 years old) were contacted. Eight patients had fractures; two had a diagnosis of rickets in the childhood; two had symptomatic chondrocalcinosis. Nine had dental abnormalities. Three were receiving a bisphosphonate; two of them had a fracture while being treated with bisphosphonate. CONCLUSION Our study shows that low ALP is not recognized in a clinical setting in adults hospitalized in a tertiary care hospital.
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Affiliation(s)
- E Maman
- Rheumatology Department, Reference Center for Genetic Bone Diseases, Cochin Hospital, Assistance Publique-Hopitaux de Paris, Paris, France.
| | - D Borderie
- Department of automated biological diagnosis, Assistance Publique-Hopitaux de Paris, Paris, France
| | - C Roux
- Rheumatology Department, Reference Center for Genetic Bone Diseases, Cochin Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
- INSERM U1153, Paris, France
- Paris Descartes University, Paris, France
| | - K Briot
- Rheumatology Department, Reference Center for Genetic Bone Diseases, Cochin Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
- INSERM U1153, Paris, France
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23
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Fechtenbaum J, Etcheto A, Kolta S, Feydy A, Roux C, Briot K. Sagittal balance of the spine in patients with osteoporotic vertebral fractures. Osteoporos Int 2016; 27:559-67. [PMID: 26272312 DOI: 10.1007/s00198-015-3283-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 08/05/2015] [Indexed: 01/03/2023]
Abstract
UNLABELLED This study aims to compare the sagittal global spinal balance of patients consulting for osteoporosis, aged above 50 years with and without osteoporotic vertebral fractures (VFs). Global spinal balance is abnormal even in subjects without VFs. VFs and age are determinants of sagittal global balance; however, pelvic parameters play a role in compensatory mechanisms. INTRODUCTION This study aims to compare the spine curvatures, pelvic parameters, and the sagittal global spinal balance of patients aged above 50 years with and without osteoporotic vertebral fractures. METHODS Two hundred patients (95 % women) aged 68.3 ± 9.5 years underwent full skeleton radiographs in the standing position, by EOS®, a low dose biplane X-ray imaging system. VFs were evaluated according to Genant's classification. Spinal (thoracic and lumbar Cobb's indices, thoracic and lumbar tilts) and pelvic (pelvic tilt, sacral slope, and pelvic incidence) parameters were measured. Sagittal spinal balance was measured using the C7 plumb line and the spinosacral angle (SSA). We compared these parameters in patients with and without vertebral fracture and assessed the determinants of abnormal sagittal spinal balance. RESULTS Sixty-nine patients had at least one VF. The sagittal spinal balance was significantly altered in patients with at least one VF, and there was an effect of the number and severity of VFs on parameters. Discriminative value for identification of patients with at least one VF, assessed by Area Under the Curves (AUCs) was 0.652 and 0.706 for C7 plumbline and SSA, respectively. Using multivariate analysis, parameters significantly associated with abnormal spinal balance (SSA) were the presence of at least one VF (OR = 4.96, P < 0.0001), age (OR = 1.07, P = 0.0006), and high pelvic incidence as a protective factor (OR = 0.93, P < 0.0001). CONCLUSIONS Global spinal balance is abnormal in subjects consulting for osteoporosis, even in subjects without VFs. VFs and age are determinants of abnormal sagittal global balance; however, pelvic parameters play a role in compensatory mechanisms.
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Affiliation(s)
- J Fechtenbaum
- Department of Rheumatology, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Paris, France
| | | | - S Kolta
- Department of Rheumatology, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Paris, France
- INSERM U1153, Paris, France
| | - A Feydy
- INSERM U1153, Paris, France
- Paris-Descartes University, Paris, France
- Department of Radiology, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Paris, France
| | - C Roux
- Department of Rheumatology, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Paris, France
- INSERM U1153, Paris, France
- Paris-Descartes University, Paris, France
| | - K Briot
- Department of Rheumatology, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Paris, France.
- INSERM U1153, Paris, France.
- Hôpital Cochin, Service de Rhumatologie, 27 rue du Faubourg St Jacques, 75014, Paris, France.
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24
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Abstract
Patients with a high risk of fragility fractures, and those with recent fractures, must receive the highest priority for anti-osteoporotic treatment, because of the consequences of some of these fractures (hip, vertebrae, pelvis, humerus). Both non pharmacological and pharmacological treatments must be used. The duration of the treatment is based on the assessment of fracture risk.
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Affiliation(s)
- K Briot
- Service de rhumatologie, hôpital Cochin, université Paris-Descartes, Inserm U 1153, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - C Roux
- Service de rhumatologie, hôpital Cochin, université Paris-Descartes, Inserm U 1153, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
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Dunogué B, Briot K, Kolta S, Régent A, Cohen P, Berezne A, Puéchal X, Le Jeunne C, Mouthon L, Roux C, Guillevin L, Terrier B. La mesure de la graisse viscérale abdominale est un facteur de risque cardiovasculaire chez les patients ayant une vascularite primitive nécrosante. Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.10.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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26
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Briot K, Fechtenbaum J, Etcheto A, Kolta S, Feydy A, Roux C. Diagnosis of vertebral fractures using a low-dose biplanar imaging system. Osteoporos Int 2015; 26:2649-55. [PMID: 26048676 DOI: 10.1007/s00198-015-3190-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 05/27/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED Vertebral fractures (VFs) are independent risk factors for new fractures. However, spine radiographs cannot be used as a screening method. EOS® has a good diagnostic value for the diagnosis of VF with a better legibility of upper thoracic spine and a higher concordance between readers compared to vertebral fracture assessment (VFA). INTRODUCTION Vertebral fractures (VFs) are risk factors for new fractures. However, spine radiographs cannot be used as a screening method for both cost and radiation concerns. EOS® X-ray imaging system which allows the acquisition of biplane images in an upright weight-bearing position with low radiation dose was used. The objective of this study was to compare EOS® to VFA for the diagnosis of VF. METHODS We conducted a cross-sectional study in subjects aged above 50 years with indication for spine imaging. EOS® and VFA of the spine were performed the same day. Sensitivity (Se), specificity (Sp), negative predictive value (NPV), and the interobserver precision of EOS® were compared to VFA for the diagnosis of VF. RESULTS Two hundred patients (mean age 66.2 years) were included. At the vertebral level, 2.4 and 3.6 % of vertebrae were not legible using EOS® and VFA, respectively (p = 0.0007). The legibility of spine was significantly affected by scoliosis (odds ratio (OR) = 2.8, p < 0.0001, for EOS®, and OR = 1.8, p = 0.0041, for VFA). Sixty-six patients (33.0 %) and 69 (34.5 %) had at least one VF using VFA and EOS®, respectively. At patient level, Se, Sp, and NPV for the diagnosis of VF of EOS® were 79.7, 91.6, and 99 %, respectively. Concordance between both observers was very good for EOS® (kappa-score = 0.89), higher than for VFA (κ = 0.67). CONCLUSIONS This study shows that EOS® has a good diagnostic value for the diagnosis of VF with a better legibility of upper thoracic spine and a higher concordance between readers compared to VFA.
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Affiliation(s)
- K Briot
- Cochin Hospital, Rheumatology Department, INSERM U1153, Paris Descartes University, Paris, France.
| | - J Fechtenbaum
- Cochin Hospital, Rheumatology Department, INSERM U1153, Paris Descartes University, Paris, France
| | - A Etcheto
- Cochin Hospital, Rheumatology Department, INSERM U1153, Paris Descartes University, Paris, France
| | - S Kolta
- Cochin Hospital, Rheumatology Department, INSERM U1153, Paris Descartes University, Paris, France
| | - A Feydy
- Cochin Hospital, Radiology Department, INSERM U1153, Paris Descartes University, Paris, France
| | - C Roux
- Cochin Hospital, Rheumatology Department, INSERM U1153, Paris Descartes University, Paris, France
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27
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Castrejon I, Carmona L, Agrinier N, Andres M, Briot K, Caron M, Christensen R, Consolaro A, Curbelo R, Ferrer M, Foltz V, Gonzalez C, Guillemin F, Machado PM, Prodinger B, Ravelli A, Scholte-Voshaar M, Uhlig T, van Tuyl LHD, Zink A, Gossec L. The EULAR Outcome Measures Library: development and an example from a systematic review for systemic lupus erythematous instruments. Clin Exp Rheumatol 2015; 33:910-916. [PMID: 25797345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 01/09/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Patient reported outcomes (PROs) are relevant in rheumatology. Variable accessibility and validity of commonly used PROs are obstacles to homogeneity in evidence synthesis. The objective of this project was to provide a comprehensive library of "validated PROs". METHODS A launch meeting with rheumatologists, PROs methodological experts, and patients, was held to define the library's aims and scope, and basic requirements. To feed the library we performed systematic reviews on selected diseases and domains. Relevant information on PROs was collected using standardised data collection forms based on the COSMIN checklist. RESULTS The EULAR Outcomes Measures Library (OML), whose aims are to provide and to advise on PROs on a user-friendly manner albeit based on scientific grounds, has been launched and made accessible to all. PROs currently included cover any domain and, are generic or specifically target to the following diseases: rheumatoid arthritis, osteoarthritis, spondyloarthritis, low back pain, systemic lupus erythematosus, gout, osteoporosis, juvenile idiopathic arthritis, and fibromyalgia. Up to 236 instruments (106 generic and 130 specific) have been identified, evaluated, and included. The systematic review for SLE, which yielded 10 specific instruments, is presented here as an example. The OML website includes, for each PRO, information on the construct being measured and the extent of validation, recommendations for use, and available versions; it also contains a glossary on common validation terms. CONCLUSIONS The OML is an in progress library led by rheumatologists, related professionals and patients, that will help to better understand and apply PROs in rheumatic and musculoskeletal diseases.
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Affiliation(s)
- I Castrejon
- Division of Rheumatology, Rush University Medical Center, Chicago, USA.
| | - L Carmona
- Instituto de Salud Musculoesquelética, Madrid, Spain
| | - N Agrinier
- University of Lorraine, APEMAC EA 4360, Nancy, F-54500; France & Inserm CIC-EC, 1433, Nancy, F-54500, France
| | - M Andres
- Seccion de Reumatologia. Hospital, General Universitario de Alicante, Alicante, Spain
| | - K Briot
- Paris-Descartes University, Medicine Faculty, Cochin Hospital, Paris, France
| | | | - R Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | | | - R Curbelo
- Instituto de Salud Musculoesquelética and Universidad de Valladolid, Spain
| | - Montserrat Ferrer
- Health Services Research Group, Medical Research Institute (Hospital del Mar), Barcelona, Spain. Coordinator of BiblioPRO
| | - Violaine Foltz
- UPMC Univ Paris 06, GRC-UPMC 08 (EEMOIS); AP-HP, Pitié Salpêtrière Hospital, Department of Rheumatology, Paris, France
| | - C Gonzalez
- Universidad Camilo José Cela, Madrid, Spain
| | - F Guillemin
- University of Lorraine, APEMAC EA 4360, Nancy, F-54500; France & Inserm CIC-EC, 1433, Nancy, F-54500, France
| | - P M Machado
- Coimbra University Hospital, Coimbra, Portugal; and MRC Centre for Neuromuscular Diseases, University College London, London, UK
| | | | - A Ravelli
- University of Genoa and Institute Giannina Gaslini, Genoa, Italy
| | - M Scholte-Voshaar
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - T Uhlig
- National Resource Center for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - L H D van Tuyl
- Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
| | - A Zink
- German Rheumatism Research Centre and Charité University Medicine, Berlin, Germany
| | - L Gossec
- UPMC Univ Paris 06, GRC-UPMC 08 (EEMOIS); AP-HP, Pitié Salpêtrière Hospital, Department of Rheumatology, Paris, France
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Fechtenbaum J, Briot K, Etcheto A, Kolta S, Feydy A, Roux C. FRI0284 Influence of Vertebral Fractures Severity and Pelvic Parameters on Global Spinal Balance in Osteoporotic Patients. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Briot K, Maravic M, Roux C. FRI0291 Decrease in Anti-Osteoporotic Drugs Prescriptions: Is there an Immediate Consequence on Hip Fracture Incidence? Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Che H, Roux C, Etcheto A, Rothenbuhler A, Kamenicky P, Linglart A, Briot K. THU0551 Quality of Life of Adults with X-Linked Hypophosphatemic Rickets. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Forien M, Moltó A, Etcheto A, Dougados M, Roux C, Briot K. Bone mineral density in patients with symptoms suggestive of spondyloarthritis. Osteoporos Int 2015; 26:1647-53. [PMID: 25627114 DOI: 10.1007/s00198-015-3044-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 01/18/2015] [Indexed: 01/26/2023]
Abstract
UNLABELLED Patients with axial spondyloarthritis (axSpA) have an increased risk of osteoporosis related to inflammation. We evaluate the performance of low bone mineral density (BMD) in diagnosis of axSpA for patients with symptoms suggestive of the disease. A low BMD (T ≤ -2) could be an additional tool for the diagnosis of axSpA. INTRODUCTION Diagnosis of axial spondyloarthritis (axSpA) can be challenging, especially in the absence of radiographic abnormalities. Patients with axSpA have an increased risk of osteoporosis related to inflammation. This study evaluated the performance of low bone mineral density (BMD) in diagnosis of axSpA for patients with symptoms suggestive of the disease. METHODS Medical files of patients that visited a tertiary centre for symptoms suggestive of axSpA were reviewed. Two hundred and sixty-seven patients were classified in confirmed axSpA or unconfirmed axSpA according to the diagnosis of a senior rheumatologist. BMD measurements results and percentage of patients with a low BMD (T ≤ -2) at either spine or hip were compared between the two groups. Diagnostic performances of low BMD (specificity, sensitivity, positive, negative predictive values and positive likelihood ratio (LR+)) were assessed. RESULTS Compared to patients with unconfirmed axSpA (n = 74), patients with confirmed axSpA (n = 193) had similar age, were more frequently male, with positive HLA B27, higher disease duration and higher C-reactive protein (CRP). Low BMD was more frequent at spine and hip, in patients with confirmed (40.3%) than unconfirmed axSpA (24.6%, p = 0.021). The LR+ of low BMD for an axSpA diagnosis was 2.60 and 3.12 at the spine and hip. In the subgroup of patients without any radiographic abnormalities (n = 128), the LR+ of low BMD for an axSpA diagnosis was 2.90 and 2.54 at the spine and hip. CONCLUSION In patients with symptoms suggestive of axSpA, a low BMD (T ≤ -2) could be an additional tool for the diagnosis of axSpA.
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Affiliation(s)
- M Forien
- Rheumatology Department, Cochin Hospital, INSERM U1153, Paris Descartes University, Paris, France
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Dunogué B, Briot K, Régent A, Cohen P, Berezne A, Puéchal X, Le Jeunne C, Roux C, Mouthon L, Guillevin L, Terrier B. Prévalence élevée de l’ostéoporose et des fractures chez les patients ayant une vascularite primitive nécrosante. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Maravic M, Briot K, Roux C. Burden of proximal humerus fractures in the French National Hospital Database. Orthop Traumatol Surg Res 2014; 100:931-4. [PMID: 25453923 DOI: 10.1016/j.otsr.2014.09.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 08/18/2014] [Accepted: 09/17/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe the characteristics of patients hospitalized for osteoporotic proximal humerus fracture in 2009 in France, in-patient mortality, and further hospitalizations for hip fracture. METHODS Data were extracted from the French Hospital National Database. We selected patients aged 40 years and over hospitalized for proximal humerus fracture in 2009, without cancer. Based on their unique identification number, we described the next hospitalizations occurring in 2009-2011 whatever the causes. Incidence, in-patient mortality, and hospital costs were calculated. RESULTS We numbered 10,874 patients (77% of women, mean age 72.5 years). The incidence per million was 477 and 163 in women and men, respectively. This incidence increased with age and was higher in women (i.e. 1374 and 320 in women and men aged over 74 years, respectively). Surgical treatment was applied in 56% of patients; median hospital stay was 5 days. Rehabilitation unit was necessary in 26% of cases. In-patient mortality was 1.1%. The overall hospital costs was €34 millions. Rehospitalizations occurred for 61% of the patients and had more co-morbidities than others. Near 8% of the rehospitalized patients were for hip fractures occurring in a median of 353 days after hospitalization for proximal humerus fracture. The hospital costs for these rehospitalizations was €52 millions. CONCLUSION Proximal humerus fractures incidence increases with aging, especially in women. These fractures are associated with a significant in-patient mortality and health care resources utilization. Patients with such fracture must receive high priority for optimal post fracture treatment.
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Affiliation(s)
- M Maravic
- Rheumatology, Lariboisière Hospital, 75010 Paris, France.
| | - K Briot
- Paris Descartes University, Department of Rheumatology, Cochin Hospital, and Epidemiology and Biostatistics Unit, Sorbonne Paris Cité Research Center, 75014 Paris, France
| | - C Roux
- Paris Descartes University, Department of Rheumatology, Cochin Hospital, and Epidemiology and Biostatistics Unit, Sorbonne Paris Cité Research Center, 75014 Paris, France
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Gras J, Canioni D, Briot K, Blanchais A, Lortholary O, Hermine O, Chandesris M. Une épidurite compressive et des lésions osseuses multiples révélant une mastocytose inclassable 20ans après une tumeur germinale non séminomateuse du médiastin : une association non fortuite. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.10.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Forien M, Moltό A, Paternotte S, Dougados M, Roux C, Briot K. SAT0482 Bone Mineral Density (BMD) Assessment: an Additional Tool for the Diagnosis of Spondyloarthritis (SPA). Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kolta S, Briot K, Fechtenbaum J, Paternotte S, Armbrecht G, Felsenberg D, Glüer CC, Eastell R, Roux C. TBS result is not affected by lumbar spine osteoarthritis. Osteoporos Int 2014; 25:1759-64. [PMID: 24687386 DOI: 10.1007/s00198-014-2685-6] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 03/11/2014] [Indexed: 11/28/2022]
Abstract
UNLABELLED The effect of lumbar osteoarthritis on bone density and trabecular bone score (TBS) was evaluated cross-sectionally and prospectively in postmenopausal women. Lumbar spine osteoarthritis was graded according to Kellgren and Lawrence grades. Lumbar osteoarthritis was found to increase lumbar spine bone density, but not TBS. INTRODUCTION Lumbar osteoarthritis overestimates lumbar bone density (areal bone mineral density (aBMD)). A new texture parameter, the TBS, has been proposed. Calculation of aBMD uses grey level value, while TBS uses grey level variation. Therefore, our hypothesis was that TBS is not influenced by lumbar spine osteoarthritis. METHODS Menopausal women participating in osteoporosis and ultrasound (OPUS) study were included. They had an aBMD measurement of the spine and hip at baseline and 6-year visit. TBS was calculated on lumbar spine dual-energy X-ray absorptiometry (DXA) scans in an automated manner. The presence of lumbar osteoarthritis was evaluated on baseline radiographs using Kellgren and Lawrence (K&L) classification. Grades range from 0 to 4. In our study, osteoarthritis was defined by at least K&L grade 2. RESULTS This study included 1,254 menopausal women (66.7 ± 7.1 years). Among them, 727 attended the 6-year follow-up visit. Patients with lumbar osteoarthritis had an aBMD higher than those without lumbar osteoarthritis at the lumbar spine, but not at the hip. However, the aBMD significantly increased in all sites with the grade of K&L. In contrast, spine TBS was not different between patients with and without lumbar osteoarthritis (p = 0.70), and it was not correlated with K&L grade. Spine TBS and aBMD at all sites were negatively correlated with age (p < 0.0001). Body mass index was correlated positively with aBMD and negatively with spine TBS (p < 0.0001). The 6-year change of aBMD was significant in the hip and nonsignificant in the lumbar spine. That of TBS was significant, with a 3.3 % decrease (p < 0.0001), independent of K&L grade (p = 0.28). CONCLUSION In postmenopausal women, lumbar osteoarthritis leads to an increase in lumbar spine aBMD. In contrast, spine TBS is not affected by lumbar osteoarthritis.
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Affiliation(s)
- S Kolta
- INSERM, U 1153, Rheumatology Department, Cochin Hospital, Paris Descartes University, Paris, France,
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Abstract
Osteoporosis is a chronic disease, for which effective drugs are available. These drugs have reduced the risk of osteoporosis-related fractures in robust trials of 3-5 years duration. There is no evidence of anti-fracture efficacy for treatments of longer duration. The consequences of stopping treatments are very different for the different molecules. Bisphosphonates can be safely discontinued after 3-5 years of treatment if there was optimal adherence and if patients are no longer osteoporotic. This discontinuation cannot be applied in patients with recent fractures or for other treatments. Safety of prolonged treatment is a huge concern which must be managed appropriately. The decision of a prolonged treatment is driven by the underlying risk of fracture. This risk must be assessed regularly in order to share with the patient the benefit-risk ratio of prolonged treatment.
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Affiliation(s)
- C Roux
- Department of Rheumatology, Cochin Hospital, Paris-Descartes University, Paris, France,
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Nassar K, Paternotte S, Kolta S, Fechtenbaum J, Roux C, Briot K. Added value of trabecular bone score over bone mineral density for identification of vertebral fractures in patients with areal bone mineral density in the non-osteoporotic range. Osteoporos Int 2014; 25:243-9. [PMID: 24081509 DOI: 10.1007/s00198-013-2502-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 09/03/2013] [Indexed: 11/24/2022]
Abstract
UNLABELLED Detection of patients with vertebral fracture is similar for areal bone mineral density (aBMD) and trabecular bone score (TBS) in patients with non-vertebral fracture. In non-osteoporotic patients, TBS adds information to lumbar spine aBMD and is related to an index of spine deterioration. INTRODUCTION Vertebral fractures (VFs) are more predictive of future fracture than aBMD. The number and severity of VFs are related to microarchitecture deterioration. TBS has been shown to be related to microarchitecture. The study aimed at evaluating TBS in the prediction of the presence and severity of VFs. METHODS Patients were selected from a Fracture Liaison Service (FLS): aBMD and vertebral fracture assessment (VFA) were assessed after the fracture, using dual-energy X-ray-absorptiometry (DXA). VFs were classified using Genant's semiquantitative method and severity, using the spinal deformity index (SDI). TBS was obtained after analysis of DXA scans. Performance of TBS and aBMD was assessed using areas under the curves (AUCs). RESULTS A total of 362 patients (77.3% women; mean age 74.3 ± 11.7 years) were analysed. Prevalence of VFs was 36.7%, and 189 patients (52.2%) were osteoporotic. Performance of TBS was similar to lumbar spine (LS) aBMD and hip aBMD for the identification of patients with VFs. In the population with aBMD in the non-osteoporotic range (n = 173), AUC of TBS for the discrimination of VFs was higher than the AUC of LS aBMD (0.670 vs 0.541, p = 0.035) but not of hip aBMD; there was a negative correlation between TBS and SDI (r = -0.31; p < 0.0001). CONCLUSION Detection of patients with vertebral fracture is similar for aBMD and TBS in patients with non-vertebral fracture. In patients with aBMD in the non-osteoporotic range, TBS adds information to lumbar spine aBMD alone and is related to an index of spine deterioration.
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Affiliation(s)
- K Nassar
- Rheumatology Department, Cochin Hospital, Paris Descartes University, Paris, France
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Lebourdais P, Briot K, Pissarro B. Quand une recherche-action donne naissance à un guide pratique d’auto-évaluation des effets des démarches communautaires en santé. Rev Epidemiol Sante Publique 2013. [DOI: 10.1016/j.respe.2013.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Forien M, Molto A, Paternotte S, Dougados M, Roux C, Briot K. AB0547 Bone mineral density (bmd) assessment in patients with symptoms suggestive of spondyloarthritis: an accurate tool for diagnosis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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41
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Briot K, Cortet B, Thomas T, Guggenbuhl P, Roux C. AB1021 2012 update of the french guidelines for the pharmacological treatment of postmenopausal osteoporosis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.1021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Souffir C, Breban S, Neveu S, Paternotte S, Kolta S, Dougados M, Roux C, Briot K. FRI0111 Body mass index (BMI) is not a surrogate of rheumatoid cachexia. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Neveu S, Fechtenbaum J, Paternotte S, Breban S, Kolta S, Dougados M, Roux C, Briot K. SAT0083 Abdominal Aortic Calcifications are Associated with Cardiovascular Diseases and Vertebral Fractures in Patients with Rheumatoid Arthritis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Briot K, Durnez A, Paternotte S, Miceli-Richard C, Dougados M, Roux C. FRI0274 Decrease in lumbar spine bone mineral density in patients with early axial spondyloarthritis is highly associated with spinal inflammation on MRI: Results from the DESIR cohort. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Nassar K, Paternotte S, Kolta S, Fechtenbaum J, Roux C, Briot K. THU0414 Trabecular Bone Score: A Tool for Identification of Severe Spinal Osteoporosis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Briot K, Paternotte S, Miceli-Richard C, Dougados M, Roux C. OP0219 Use of Non Steroidal Anti-Inflammatory Drugs and High Body Mass Index Prevent Bone Loss in Patients with Early Inflammatory Back Pain: Results from the Desir Cohort. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hmamouchi I, Roux C, Paternotte S, Kolta S, Dougados M, Briot K. FRI0451 Early increase of visceral adipose tissue in patients with spondyloarthritis receiving anti-tumor necrosis factor alpha treatment. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Sparsa L, Kolta S, Geusens P, Briot K, Roux C. AB0302 Bone texture parameters measured at the hand as predictors of outcome in rheumatoid arthritis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Briot K. [Laboratory tests in osteoporosis]. Rev Prat 2012; 62:190. [PMID: 22408859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Ghazi M, Kolta S, Briot K, Fechtenbaum J, Paternotte S, Roux C. Prevalence of vertebral fractures in patients with rheumatoid arthritis: revisiting the role of glucocorticoids. Osteoporos Int 2012; 23:581-7. [PMID: 21350894 DOI: 10.1007/s00198-011-1584-3] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 01/11/2011] [Indexed: 12/17/2022]
Abstract
SUMMARY Vertebral fracture assessment (VFA) is a convenient tool for the diagnosis of vertebral fracture in RA. Optimal control of inflammation may be an effective means to protect against vertebral fractures. INTRODUCTION The aim of this case-control study was to assess the prevalence of vertebral fractures (VFs) in patients with RA using VFA technology. METHODS Consecutive women (N = 101, 56.1 ± 14.2 years) with RA (mean disease duration, 14.9 ± 10 years) were recruited in the study. Clinical and biological statuses and treatments including glucocorticoids were assessed. Controls (N = 303), randomly selected from the general population, were individually matched to each case for age. RESULTS The prevalences of osteoporosis were 55.4% and 10.5% in patients and controls, respectively. Among the subjects, 21.7% and 4.2% had a vertebral fracture in the RA and control groups, respectively. Compared with controls, patients with RA had an increased risk of VFs: odds ratio (OR) (CI 95%) adjusted on body mass index was 6.5 (3.1, 13.9). In a multiple logistic regression analysis, VFs were independently associated with presence of non-vertebral fractures (OR = 9.2 [2.5-33.5]), presence of a fall in the previous year (OR = 4.6 [1.2-18.3]), current use of disease-modifying anti-rheumatic drugs (DMARDs) (OR = 0.05 [0.004, 0.51]) and current use of steroids (OR = 0.17 [0.04, 0.67]). CONCLUSION Rheumatoid arthritis is a risk factor of VF (OR = 6.5). VFA is a convenient tool for this diagnosis. Presence of VF is inversely related to the use of DMARD and glucocorticoids, enhancing the hypothesis that an appropriate control of the disease may be a protective factor against bone fragility.
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Affiliation(s)
- M Ghazi
- Rheumatology Department, Cochin Hospital, Paris-Descartes University, Paris, France
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