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Rodriguez Celin M, Kruger KM, Caudill A, Murali CN, Nagamani SCS, Smith PA, Harris GF. A multicenter study to evaluate pain characteristics in osteogenesis imperfecta. Am J Med Genet A 2023; 191:160-172. [PMID: 36271817 PMCID: PMC10399129 DOI: 10.1002/ajmg.a.63009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/02/2022] [Accepted: 08/11/2022] [Indexed: 01/27/2023]
Abstract
The objective was to describe pain characteristics and treatments used in individuals with varying severity of osteogenesis imperfecta (OI) and investigate pain-associated variables. This work was derived from a multicenter, longitudinal, observational, natural history study of OI conducted at 12 clinical sites of the NIH Rare Diseases Clinical Research Network's Brittle Bone Disorders Consortium. Children and adults with a clinical, biochemical, or molecular diagnosis of OI were enrolled in the study. We did a cross-sectional analysis of chronic pain prevalence, characteristics, and treatments used for pain relief and longitudinal analysis to find the predictors of chronic pain. We included 861 individuals with OI, in 41.8% chronic pain was present, with similar frequency across OI types. Back pain was the most frequent location. Nonsteroidal anti-inflammatory drugs followed by bisphosphonates were the most common treatment used. Participants with chronic pain missed more days from school or work/year and performed worse in all mobility metrics than participants without chronic pain. The variables more significantly associated with chronic pain were age, sex, positive history of rodding surgery, scoliosis, other medical problems, assistive devices, lower standardized height, and higher body mass index. The predictors of chronic pain for all OI types were age, use of a wheelchair, and the number of fractures/year. Chronic pain is prevalent in OI across all OI types, affects mobility, and interferes with participation. Multiple covariates were associated with chronic pain.
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Affiliation(s)
- Mercedes Rodriguez Celin
- Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Motion Analysis Laboratory, Shriners Hospitals for Children, Chicago, Illinois, USA
- Orthopaedic and Rehabilitation Engineering Center, Marquette University, Milwaukee, Wisconsin, USA
| | - Karen M Kruger
- Motion Analysis Laboratory, Shriners Hospitals for Children, Chicago, Illinois, USA
- Orthopaedic and Rehabilitation Engineering Center, Marquette University, Milwaukee, Wisconsin, USA
| | - Angela Caudill
- Motion Analysis Laboratory, Shriners Hospitals for Children, Chicago, Illinois, USA
| | - Chaya N Murali
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Sandesh C S Nagamani
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Peter A Smith
- Motion Analysis Laboratory, Shriners Hospitals for Children, Chicago, Illinois, USA
| | - Gerald F Harris
- Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Motion Analysis Laboratory, Shriners Hospitals for Children, Chicago, Illinois, USA
- Orthopaedic and Rehabilitation Engineering Center, Marquette University, Milwaukee, Wisconsin, USA
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Rodriguez Celin M, Simon JC, Krzak JJ, Fial AV, Kruger KM, Smith PA, Harris GF. Correction to: Do Bisphosphonates Alleviate Pain in Children? A Systematic Review. Curr Osteoporos Rep 2022; 20:226. [PMID: 33119810 DOI: 10.1007/s11914-020-00637-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | - Jacqueline C Simon
- Motion Analysis Center, Shriners Hospitals for Children, Chicago, IL, USA
- Orthopaedic and Rehabilitation Engineering Center, Marquette University, Milwaukee, WI, USA
| | - Joseph J Krzak
- Motion Analysis Center, Shriners Hospitals for Children, Chicago, IL, USA
- Physical Therapy Program, College of Health Sciences, Midwestern University, Downers Grove, IL, USA
| | - Alissa V Fial
- Research and Instructional Services, Raynor Memorial Libraries, Marquette University, Milwaukee, WI, USA
| | - Karen M Kruger
- Motion Analysis Center, Shriners Hospitals for Children, Chicago, IL, USA
- Orthopaedic and Rehabilitation Engineering Center, Marquette University, Milwaukee, WI, USA
| | - Peter A Smith
- Motion Analysis Center, Shriners Hospitals for Children, Chicago, IL, USA
| | - Gerald F Harris
- Motion Analysis Center, Shriners Hospitals for Children, Chicago, IL, USA
- Orthopaedic and Rehabilitation Engineering Center, Marquette University, Milwaukee, WI, USA
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Abstract
PURPOSE OF REVIEW The goal of this systematic review is to analyze the effectiveness of bisphosphonates (BPs) to treat bone pain in children and adolescents who have diseases with skeletal involvement. RECENT FINDINGS We included 24 studies (2 randomized controlled trials, 3 non-randomized controlled trials, 10 non-randomized open-label uncontrolled studies, 8 retrospective studies, and 1 study with design not specified). The majority of included studies assessed pain from a unidimensional approach, with pain intensity the most frequently evaluated dimension. Only 38% of studies used validated tools; visual analogue scale was the most frequently employed. BPs were used to alleviate bone pain in a wide variety of pediatrics conditions such as osteogenesis imperfecta, secondary osteoporosis, osteonecrosis related to chemotherapy, chronic non-bacterial osteitis, idiopathic juvenile osteoporosis, unresectable benign bone tumor, and cancer-related pain. Twenty of the 24 studies reported a positive effect of BPs for alleviating pain in different pathologies, but 58% of the studies were categorized as having high risk of bias. Intravenous BPs are helpful in alleviating bone pain in children and adolescents. It is advised that our results be interpreted with caution due to the heterogeneity of the doses used, duration of treatments, and types of pathologies included. In addition, this review shows the paucity of high-quality evidence in the available literature and further research is needed. TRIAL REGISTRATION Before the completion of this review, the protocol was registered to PROSPERO (International prospective register of systematic reviews), PROSPERO 2020 ID # CRD42020158316. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020158316.
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Affiliation(s)
| | - Jackeline C Simon
- Motion Analysis Center, Shriners Hospitals for Children, Chicago, IL, USA
- Orthopaedic and Rehabilitation Engineering Center, Marquette University, Milwaukee, WI, USA
| | - Joseph J Krzak
- Motion Analysis Center, Shriners Hospitals for Children, Chicago, IL, USA
- Physical Therapy Program, College of Health Sciences, Midwestern University, Downers Grove, IL, USA
| | - Alissa V Fial
- Research and Instructional Services, Raynor Memorial Libraries, Marquette University, Milwaukee, WI, USA
| | - Karen M Kruger
- Motion Analysis Center, Shriners Hospitals for Children, Chicago, IL, USA
- Orthopaedic and Rehabilitation Engineering Center, Marquette University, Milwaukee, WI, USA
| | - Peter A Smith
- Motion Analysis Center, Shriners Hospitals for Children, Chicago, IL, USA
| | - Gerald F Harris
- Motion Analysis Center, Shriners Hospitals for Children, Chicago, IL, USA
- Orthopaedic and Rehabilitation Engineering Center, Marquette University, Milwaukee, WI, USA
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Abstract
BACKGROUND Osteogenesis imperfecta (OI), a heritable connective tissue disorder with wide clinical variability, predisposes to recurrent fractures and bone deformity. Management requires a multidisciplinary approach in which intramedullary rodding plays an important role, especially for moderate and severe forms. We investigated the patterns of surgical procedures in OI in order to establish the benefits of rodding. The main hypothesis that guided this study was that rodded participants with moderate and severe OI would have lower fracture rates and better mobility. METHODS With data from the Linked Clinical Research Centers, we analyzed rodding status in 558 individuals. Mobility and fracture data in OI Types III and IV were compared between rodded and non-rodded groups. Univariate regression analyses were used to test the association of mobility outcomes with various covariates pertinent to rodding. RESULTS Of the individuals with OI, 42.1% had undergone rodding (10.7% of those with Type I, 66.4% with Type III, and 67.3% with Type IV). Rodding was performed more frequently and at a younger age in femora compared with tibiae. Expanding intramedullary rods were used more frequently in femora. In Type III, the rate of fractures per year was significantly lower (p ≤ 0.05) for rodded bones. In Type III, the mean scores on the Gillette Functional Assessment Questionnaire (GFAQ) and Brief Assessment of Motor Function (BAMF) were higher in the rodded group. However, Type-IV non-rodded subjects had higher mean scores in nearly all mobility outcomes. OI type, the use of expanding rods in tibiae, and anthropometric measurements were associated with mobility outcomes scores. CONCLUSIONS Current practice in 5 orthopaedic centers with extensive experience treating OI demonstrates that most individuals with moderate and severe types of OI undergo rodding procedures. Individuals with severe OI have improved mobility outcomes and lower fracture rates compared with their non-rodded peers, which suggests that early bilateral rodding benefits OI Type III. Our analysis showed a change in practice patterns in the final years of the study in the severe forms, with earlier and more simultaneous rodding procedures performed. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Karen M. Kruger
- Motion Analysis Laboratory, Shriners Hospitals for Children, Chicago, Illinois
- Orthopaedic Rehabilitation and Engineering Center, Marquette University, Milwaukee, Wisconsin
| | - Angela Caudill
- Motion Analysis Laboratory, Shriners Hospitals for Children, Chicago, Illinois
| | - Sandesh C.S. Nagamani
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | | | | | - Gerald F. Harris
- Motion Analysis Laboratory, Shriners Hospitals for Children, Chicago, Illinois
- Orthopaedic Rehabilitation and Engineering Center, Marquette University, Milwaukee, Wisconsin
| | - Peter A. Smith
- Motion Analysis Laboratory, Shriners Hospitals for Children, Chicago, Illinois
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Kruger KM, Caudill A, Rodriguez Celin M, Nagamani SCS, Shapiro JR, Steiner RD, Bober MB, Hart T, Cuthbertson D, Krischer J, Byers PH, Durigova M, Glorieux FH, Rauch F, Sutton VR, Lee B, Rush ET, Smith PA, Harris GF. Mobility in osteogenesis imperfecta: a multicenter North American study. Genet Med 2019; 21:2311-2318. [PMID: 30918359 DOI: 10.1038/s41436-019-0491-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 03/07/2019] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Osteogenesis imperfecta (OI) is a genetic connective tissue disorder that causes bone fragility. Phenotypic severity influences ability to walk, however, little is known about ambulatory characteristics of individuals with OI, especially in more severe forms. The purpose of this work was to characterize mobility in OI using standard clinical assessment tools and determine if patient characteristics could be used to predict mobility outcomes. METHODS We collected mobility data at five clinical sites to analyze the largest cohort of individuals with OI (n = 491) to date. Linear mixed models were developed to explore relationships among subject demographics and mobility metrics. RESULTS Results showed minor limitations in the mild group while the more severe types showed more significant limitations in all mobility metrics analyzed. Height and weight were shown to be the most significant predictors of mobility. Relationships with mobility and bisphosphonates varied with OI type and type used (oral/IV). CONCLUSION These results are significant to understanding mobility limitations of specific types of OI and beneficial when developing rehabilitation protocols for this population. It is important for physicians, patients, and caregivers to gain insight into severity and classification of the disease and the influence of disease-related characteristics on prognosis for mobility.
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Affiliation(s)
- Karen M Kruger
- Orthopaedic Rehabilitation and Engineering Center, Marquette University, Milwaukee, WI, USA. .,Motion Analysis Laboratory, Shriners Hospitals for Children, Chicago, IL, USA.
| | - Angela Caudill
- Motion Analysis Laboratory, Shriners Hospitals for Children, Chicago, IL, USA
| | | | - Sandesh C S Nagamani
- Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital, Houston, TX, USA
| | - Jay R Shapiro
- Department of Bone and Osteogenesis Imperfecta, Kennedy Krieger Institute, Baltimore, MD, USA.,Department of Medicine at Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Robert D Steiner
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Pediatrics and Molecular and Medical Genetics, Oregon Health & Science University, Portland, OR, USA
| | - Michael B Bober
- Division of Medical Genetics, Alfred I du Pont Hospital for Children, Wilmington, DE, USA
| | - Tracy Hart
- Osteogenesis Imperfecta Foundation, Gaithersburg, MD, USA
| | | | - Jeff Krischer
- College of Medicine, University of South Florida, Tampa, FL, USA
| | - Peter H Byers
- Departments of Medicine and Pathology, Division of Medical Genetics, University of Washington, Seattle, WA, USA
| | - Michaela Durigova
- Shriner's Hospital for Children and McGill University, Montreal, QC, Canada
| | - Francis H Glorieux
- Shriner's Hospital for Children and McGill University, Montreal, QC, Canada
| | - Frank Rauch
- Shriner's Hospital for Children and McGill University, Montreal, QC, Canada
| | - V Reid Sutton
- Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital, Houston, TX, USA
| | - Brendan Lee
- Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital, Houston, TX, USA
| | - Eric T Rush
- Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Peter A Smith
- Motion Analysis Laboratory, Shriners Hospitals for Children, Chicago, IL, USA
| | - Gerald F Harris
- Orthopaedic Rehabilitation and Engineering Center, Marquette University, Milwaukee, WI, USA.,Motion Analysis Laboratory, Shriners Hospitals for Children, Chicago, IL, USA
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Rodriguez Celin M, Moosa S, Fano V. Uncommon
IFITM5
mutation associated with severe skeletal deformity in osteogenesis imperfecta. Ann Hum Genet 2018; 82:477-481. [DOI: 10.1111/ahg.12275] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 06/06/2018] [Accepted: 06/25/2018] [Indexed: 01/02/2023]
Affiliation(s)
| | - Shahida Moosa
- University Medical Center Göttingen Göttingen Germany
| | - Virginia Fano
- Growth and development Service Garrahan Pediatric Hospital Buenos Aires Argentina
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