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Valicek G, Karner M, Till I, Bergmann P, Niederbichler L. [Traumatic rupture of the ventricular septum after blast trauma]. Anaesthesiologie 2023:10.1007/s00101-023-01307-y. [PMID: 37405471 PMCID: PMC10400476 DOI: 10.1007/s00101-023-01307-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 05/23/2023] [Accepted: 05/31/2023] [Indexed: 07/06/2023]
Affiliation(s)
- Gerhard Valicek
- Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Dr. Karl-Dorrek-Straße 30, 3500, Krems, Österreich.
- Klinische Abteilung für Anästhesie und Intensivmedizin, Universitätsklinikum St. Pölten, Dunant-Platz 1, 3100, St. Pölten, Österreich.
| | - Marina Karner
- Klinische Abteilung für Anästhesie und Intensivmedizin, Universitätsklinikum St. Pölten, Dunant-Platz 1, 3100, St. Pölten, Österreich
| | - Irmtraut Till
- Klinische Abteilung für Anästhesie und Intensivmedizin, Universitätsklinikum St. Pölten, Dunant-Platz 1, 3100, St. Pölten, Österreich
| | - Peter Bergmann
- Abteilung für Herzchirurgie, Universitätsklinikum St. Pölten, St. Pölten, Österreich
| | - Lena Niederbichler
- Klinische Abteilung für Anästhesie und Intensivmedizin, Universitätsklinikum St. Pölten, Dunant-Platz 1, 3100, St. Pölten, Österreich
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Iconaru L, Charles A, Baleanu F, Moreau M, Surquin M, Benoit F, de Filette J, Karmali R, Body JJ, Bergmann P. Selection for treatment of patients at high risk of fracture by the short versus long term prediction models - data from the Belgian FRISBEE cohort. Osteoporos Int 2023; 34:1119-1125. [PMID: 37022466 DOI: 10.1007/s00198-023-06737-3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/27/2023] [Indexed: 04/07/2023]
Abstract
Our imminent model was less sensitive but more selective than FRAX® in the choice of treatment to prevent imminent fractures. This new model decreased NNT by 30%, which could reduce the treatment costs. In the Belgian FRISBEE cohort, the effect of recency further decreased the selectivity of FRAX®. PURPOSE We analyzed the selection for treatment of patients at high risk of fracture by the Belgian FRISBEE imminent model and the FRAX® tool. METHODS We identified in the FRISBEE cohort subjects who sustained an incident MOF (mean age 76.5 ± 6.8 years). We calculated their estimated 10-year risk of fracture using FRAX® before and after adjustment for recency and the 2-year probability of fracture using the FRISBEE model. RESULTS After 6.8 years of follow-up, we validated 480 incident and 54 imminent MOFs. Of the subjects who had an imminent fracture, 94.0% had a fracture risk estimated above 20% by the FRAX® before correction for recency and 98.1% after adjustment, with a specificity of 20.2% and 5.9%, respectively. The sensitivity and specificity of the FRISBEE model at 2 years were 72.2% and 55.4%, respectively, for a threshold of 10%. For these thresholds, 47.3% of the patients were identified at high risk in both models before the correction, and 17.2% of them had an imminent MOF. The adjustment for recency did not change this selection. Before the correction, 34.2% of patients were selected for treatment by FRAX® only, and 18.8% would have had an imminent MOF. This percentage increased to 47% after the adjustment for recency, but only 6% of those would suffer a MOF within 2 years. CONCLUSION In our Belgian FRISBEE cohort, the imminent model was less sensitive but more selective in the selection of subjects in whom an imminent fracture should be prevented, resulting in a lower NNT. The correction for recency in this elderly population further decreased the selectivity of FRAX®. These data should be validated in additional cohorts before using them in everyday practice.
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Affiliation(s)
- L Iconaru
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Place van Gehuchten 4, 1020 Laeken, Brussels, Belgium.
| | - A Charles
- Laboratoire de Recherche Translationnelle, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - F Baleanu
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Place van Gehuchten 4, 1020 Laeken, Brussels, Belgium
| | - M Moreau
- Data Centre, Inst. J. Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - M Surquin
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - F Benoit
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - J de Filette
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Place van Gehuchten 4, 1020 Laeken, Brussels, Belgium
| | - R Karmali
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Place van Gehuchten 4, 1020 Laeken, Brussels, Belgium
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - J J Body
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Place van Gehuchten 4, 1020 Laeken, Brussels, Belgium
- Laboratoire de Recherche Translationnelle, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - P Bergmann
- Laboratoire de Recherche Translationnelle, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Department of Nuclear Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Charles A, Iconaru L, Baleanu F, Benoit F, Surquin M, Mugisha A, Bergmann P, Body JJ. Are there specific clinical risk factors for the occurrence of multiple fractures? The FRISBEE study. Osteoporos Int 2023; 34:501-506. [PMID: 36598524 DOI: 10.1007/s00198-022-06663-w] [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: 10/04/2022] [Accepted: 12/28/2022] [Indexed: 01/05/2023]
Abstract
UNLABELLED This study showed additional clinical risk factors for the occurrence of multiple fractures with regards to a single fracture, with often higher hazard ratios. It would be important to include the risk of the occurrence of multiple fractures in future prediction models. PURPOSE To identify clinical risk factors (CRFs) which would specifically increase the risk of multiple fractures. METHODS Data of the 3560 postmenopausal women of the FRISBEE study were analysed. The CRFs and the fractures are collected annually. The cohort was divided into three groups: those who had no incident fracture, those who had a single incident fracture and those who had 2 two or more incident fractures (i.e. multiple fractures). Statistical analyses were performed using Cox proportional hazards models. RESULTS Among the 3560 subjects (followed for 9.1 (7.2-10.6) years), 261 subjects had two or more validated fractures during follow-up (146 were major osteoporotic fractures (MOFs)), 628 had one fracture (435 MOFs), 2671 had no fracture (2979 had no MOF); 157 subjects had two or more central fractures, 389 had only one and 3014 had none. The risk factors for those with multiple fractures at any site were age, history of fracture, history of fall, total hip bone mineral density (BMD), spine BMD and rheumatoid arthritis. For those with multiple MOFs, significant CRFs were age, history of fracture, parental hip fracture, total hip BMD and rheumatoid arthritis. CONCLUSION We found in a prospective cohort study that there were more CRFs and higher hazard ratios for the occurrence of multiple fractures than for a single fracture.
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Affiliation(s)
- A Charles
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium.
| | - L Iconaru
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - F Baleanu
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - F Benoit
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M Surquin
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - A Mugisha
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - P Bergmann
- Department of Nuclear Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Laboratory of Translational Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - J J Body
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Laboratory of Translational Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Iconaru L, Charles A, Baleanu F, Moreau M, Surquin M, Benoit F, Body J, Bergmann P. The effect of fracture recency on observed 5-year fracture probability: A study based on the FRISBEE cohort. Bone Rep 2023; 18:101660. [PMID: 36824480 PMCID: PMC9941353 DOI: 10.1016/j.bonr.2023.101660] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/18/2023] [Accepted: 02/04/2023] [Indexed: 02/09/2023] Open
Abstract
Introduction Prediction models, especially the FRAX®, are largely used to estimate the fracture risk at ten years, but the current algorithm does not take into account the time elapsed after a fracture. Kanis et al. recently proposed correction factors allowing to adjust the FRAX® score for fracture recency. The objective of this work was to analyze the effect of fracture recency in the FRISBEE cohort. Methods We identified in the FRISBEE cohort subjects who sustained a validated fracture during the first 5 years following an incident MOF. We calculated their estimated 5-year risk of fracture using FRAX® uncorrected, adjusted for recency and further adjusted for the MOF/hip ratios calibration factors previously derived for the Belgian FRAX®. We compared the fracture risk estimated by FRAX® before and after these corrections to the observed incidence of validated fractures in our cohort. Results In our ongoing cohort, 376 subjects had a first non-traumatic incident validated MOF after inclusion; 81 had a secondary fracture during the 5 years follow-up period after this index fracture. The FRAX® score significantly under-evaluated the observed incidence of fractures in our cohort by 54.7 % (fracture rate of 9.7 %; 95 % CI, 6.8-12.9 %) if uncorrected (p < 0.001) and by 32.6 % after correction for recency (14.5 %; 95 % CI, 11.1-18.2 %) (p = 0.01). The calibration for MOF/hip ratios improved the prediction (17.5 %; 95 % CI: 13.7-21.4 %) (p = 0.2). After correcting for recency and for calibration, the predicted value was over-evaluated by 22 % (fracture rate of 26.1 %; 95 % CI, 21.6-30.5 %) but this over-evaluation was not significant (p = 0.1). Conclusion Our data indicate that the correction of the FRAX® score for fracture recency improves fracture prediction. However, correction for calibration and recency tends to overestimate fracture risk in this population of elderly women.
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Affiliation(s)
- L. Iconaru
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium,Corresponding author at: Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Place van Gehuchten 4, 1020 Laeken, Brussels, Belgium.
| | - A. Charles
- Laboratoire de Recherche Translationnelle, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - F. Baleanu
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M. Moreau
- Data Centre, Institut J. Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - M. Surquin
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - F. Benoit
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - J.J. Body
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium,Laboratoire de Recherche Translationnelle, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium,Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - P. Bergmann
- Laboratoire de Recherche Translationnelle, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium,Department of Nuclear Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Bergmann P, Takenberg M, Ersoy F, Berger R. Biotechnological production of basidiomycetous pigments for textile dying. CHEM-ING-TECH 2022. [DOI: 10.1002/cite.202255400] [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: 11/07/2022]
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Charles A, Mugisha A, Iconaru L, Baleanu F, Benoit F, Surquin M, Bergmann P, Body JJ. Distribution of Fracture Sites in Postmenopausal Overweight and Obese Women: The FRISBEE Study. Calcif Tissue Int 2022; 111:29-34. [PMID: 35316360 DOI: 10.1007/s00223-022-00968-y] [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: 01/03/2022] [Accepted: 03/05/2022] [Indexed: 12/01/2022]
Abstract
The association between obesity and fracture sites in postmenopausal women has been little studied. We examined the most common types of fractures in obese and overweight postmenopausal women compared to subjects with a normal BMI in the FRISBEE study, a cohort of postmenopausal women followed since 9.1 (7.2-10.6) years. Chi-squared tests and logistic regressions were used to compare the percentages of fracture sites in overweight/obese subjects to subjects with a normal BMI. Their mean (± SD) age was 76.7 ± 6.9 years and their mean BMI was 26.4 ± 4.4. Seven hundred seventy-seven subjects suffered at least one validated fragility fracture with a total of 964 fractures in the whole cohort. Subjects with a BMI higher than 25 had significantly more ankle fractures and less pelvic fractures than subjects with a normal BMI (OR 1.63, 95% CI 1.02-2.56, P = 0.04 and OR 0.55, 95% CI 0.34-0.89, P = 0.01, respectively). There were no significant differences between overweight and obese subjects. Among those older than 75, there were significantly fewer pelvic fractures in overweight/obese subjects (OR 0.49, 95% CI 0.27-0.87, P = 0.01), but before 75, ankle fractures were significantly more frequent in overweight/obese subjects than in subjects with a normal BMI (OR 1.89, 95% CI 1.01-3.57, P = 0.04). In conclusion, the proportion of ankle and pelvic fractures in obese and overweight subjects differs from that in subjects with a normal BMI, but these differences are age dependent. Fracture prevention strategies should take into account the differential effects of excess weight according to age and the site of fracture.
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Affiliation(s)
- A Charles
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium.
| | - A Mugisha
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - L Iconaru
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - F Baleanu
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - F Benoit
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M Surquin
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - P Bergmann
- Department of Nuclear Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Laboratory of Translational Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - J J Body
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Laboratory of Translational Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Mugisha A, Bergmann P, Kinnard V, Iconaru L, Baleanu F, Charles A, Surquin M, Rozenberg S, Benoit F, Body JJ. MOF/Hip Fracture Ratio in a Belgian Cohort of Post-menopausal Women (FRISBEE): Potential Impact on the FRAX® Score. Calcif Tissue Int 2021; 109:600-604. [PMID: 34159447 DOI: 10.1007/s00223-021-00875-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/29/2021] [Accepted: 06/08/2021] [Indexed: 02/06/2023]
Abstract
The ratio between major osteoporotic fractures (MOFs) and hip fractures in the Belgian FRAX® tool to predict fractures is currently based on Swedish data. We determined these ratios in a prospective cohort of Belgian postmenopausal women. 3560 women, aged 60-85 years (70.1 ± 6.4 years), were included in a prospective study from 2007 to 2013 and surveyed yearly (FRISBEE). We analyzed the number of validated incident fractures until October 2020 by age and sites and compared the MOFs/hip ratios in this cohort with those from the Swedish databases. We registered 1336 fractures (mean follow-up of 9.1 years). The MOFs/hip ratios extracted from the FRISBEE cohort were 10.7 [95% CI: (5.6-20.5)], 6.4 [4.7-8.7], and 5.0 [3.9-6.5] for women of 60-69, 70-79, and 80-89 years old, respectively. These ratios were 1.7-1.8 times higher for all age groups than those from the Swedish data, which decreased from 6.5 (60-64 years group) down to 1.8 (85-89 age group). The overall MOFs/hip ratio in Frisbee was 6.0 [5.9-6.1], which was higher than any Swedish ratio between 65 and 85 years. Nevertheless, the decrease of the ratios with age paralleled that observed in Sweden. In this Brussels prospective cohort, MOFs/hip ratios were 1.7-1.8 times those observed in Sweden currently used for MOFs prediction in the Belgian FRAX® version. This discrepancy can greatly modify the estimation of the risk of MOFs, which is among the main criteria used to recommend a pharmacological treatment for osteoporosis in several countries.
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Affiliation(s)
- A Mugisha
- Department of Geriatrics, CHU Brugmann, Université Libre de Bruxelles, Place van Gehuchten 4 Laeken, 1020, Brussels, Belgium.
| | - P Bergmann
- Department of Nuclear Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Laboratory of Translational Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - V Kinnard
- Department of Nuclear Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - L Iconaru
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - F Baleanu
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - A Charles
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M Surquin
- Department of Geriatrics, CHU Brugmann, Université Libre de Bruxelles, Place van Gehuchten 4 Laeken, 1020, Brussels, Belgium
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - S Rozenberg
- Department of Gynaecology-Obstetrics, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - F Benoit
- Department of Geriatrics, CHU Brugmann, Université Libre de Bruxelles, Place van Gehuchten 4 Laeken, 1020, Brussels, Belgium
| | - J J Body
- Laboratory of Translational Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Charles A, Mugisha A, Iconaru L, Baleanu F, Benoit F, Surquin M, Bergmann P, Body JJ. Impact of non-hip fractures in elderly women: a narrative review. Climacteric 2021; 25:240-245. [PMID: 34806931 DOI: 10.1080/13697137.2021.1998433] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The association of hip fractures with adverse outcomes is well established, but for non-hip fractures this association still needs to be further investigated. The objective of this narrative review is to describe the state of the art with regards to the health impact of clinically relevant non-hip fracture locations in postmenopausal women. PubMed and Scopus databases were searched from January 2010 until December 2020. Studies were included when the crude rates and/or relative risk of 1-year subsequent fractures and/or mortality were reported as well as the precise fracture site. Twenty-three studies met the inclusion criteria. Regarding mortality rates, there was a high variability between studies, with higher rates for vertebral, proximal humerus and pelvic fractures. There was a small or no impact of wrist, ankle or tibia fractures. The mortality rate increased with age after vertebral, proximal humerus and wrist fractures. Moreover, proximal humerus and vertebral fractures were associated with a higher mortality risk. This narrative review indicates that, besides fractures of the hip, fractures of the vertebrae, proximal humerus or pelvis deserve more attention when trying to prevent adverse outcomes of osteoporosis. More studies on the topic of non-hip fractures are urgently needed.
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Affiliation(s)
- A Charles
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - A Mugisha
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - L Iconaru
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - F Baleanu
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - F Benoit
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M Surquin
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - P Bergmann
- Department of Nuclear Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium.,Laboratory of Translational Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - J J Body
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium.,Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium.,Laboratory of Translational Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Iconaru L, Moreau M, Baleanu F, Kinnard V, Charles A, Mugisha A, Surquin M, Benoit F, Karmali R, Paesmans M, Body JJ, Bergmann P. Risk factors for imminent fractures: a substudy of the FRISBEE cohort. Osteoporos Int 2021; 32:1093-1101. [PMID: 33411010 DOI: 10.1007/s00198-020-05772-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 10/13/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
UNLABELLED Multiple factors increase the risk of an imminent fracture, including a recent fracture, older age, osteoporosis, comorbidities, and the fracture site. These findings could be a first step in the development of a model to predict an imminent fracture and select patients most at need of immediate treatment. INTRODUCTION The risk of a recurrent fragility fracture is maximal during the first 2 years following an incident fracture. In this prospective cohort study, we looked at the incidence of recurrent fractures within 2 years after a first incident fracture and we assessed independent clinical risk factors (CRFs) increasing this imminent fracture risk. METHODS A total of 3560 postmenopausal women recruited from 2007 to 2013 were surveyed yearly for the occurrence of fragility fractures. We identified patients who sustained a fracture during the first 2 years following a first incident fragility fracture. We quantified the risk of a new fracture and assessed independent CRFs, associated with an imminent fracture at various sites. RESULTS A recent fracture was a significant CRF for an imminent fracture (OR (95% CI): 3.7 (2.4-5.7) [p < 0.0001]). The incidence of an imminent fracture was higher in subjects above 80 years (p < 0.001). Other CRFs highly predictive in a multivariate analysis were osteoporosis diagnosis (p < 0.01), a central fracture as the index fracture (p < 0.01), and the presence of comorbidities (p < 0.05), with likelihood ratios of 1.9, 1.9, and 2.2, respectively. An imminent fracture was better predicted by a central fracture (p < 0.01) than by a major osteoporotic fracture. The hazard ratio was the highest for a central fracture. CONCLUSION In patients with a recent fracture, older age, osteoporosis, comorbidities, and fracture site were associated with an imminent fracture risk. These findings could be a first step in the development of a model to predict an imminent fracture and select patients most at need of immediate and most appropriate treatment.
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Affiliation(s)
- L Iconaru
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Place van Gehuchten 4, Laeken, 1020, Brussels, Belgium.
| | - M Moreau
- Data Centre, Inst. J. Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - F Baleanu
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Place van Gehuchten 4, Laeken, 1020, Brussels, Belgium
| | - V Kinnard
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - A Charles
- Laboratoire de Recherche Translationnelle, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - A Mugisha
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M Surquin
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - F Benoit
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - R Karmali
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Place van Gehuchten 4, Laeken, 1020, Brussels, Belgium
| | - M Paesmans
- Data Centre, Inst. J. Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - J J Body
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Place van Gehuchten 4, Laeken, 1020, Brussels, Belgium
- Laboratoire de Recherche Translationnelle, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - P Bergmann
- Laboratoire de Recherche Translationnelle, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Department of Nuclear Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Sigusch HH, Bergmann P, Doenst T, Gerth J. Giant Aneurysm of the Right Coronary Artery: Multimodality Imaging and Interventional Management. JACC Case Rep 2021; 3:778-779. [PMID: 34317624 PMCID: PMC8311151 DOI: 10.1016/j.jaccas.2021.02.033] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 02/26/2021] [Indexed: 11/20/2022]
Abstract
A large (40-mm) circular structure in the right atrioventricular groove was detected by transthoracic echocardiography and was diagnosed as a giant aneurysm of the right coronary artery. Through invasive mapping by a guide extension catheter, the aneurysm could be excluded by implantation of 3 overlapping stent grafts. (Level of Difficulty: Beginner.).
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Affiliation(s)
- Holger H. Sigusch
- Division of Cardiology, Department of Internal Medicine, Heinrich Braun Clinic, Zwickau, Germany
- Address for correspondence: Dr. Holger H. Sigusch, Division of Cardiology, Department of Internal Medicine, Heinrich Braun Clinic-Zwickau, Karl-Keil-Strasse 35, 08060 Zwickau, Germany.
| | - Peter Bergmann
- Division of Cardiology, Department of Internal Medicine, Heinrich Braun Clinic, Zwickau, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Jena, Germany
| | - Jens Gerth
- Division of Nephrology, Department of Internal Medicine, Heinrich Braun Clinic, Zwickau, Germany
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11
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Cappelle SI, Moreau M, Karmali R, Iconaru L, Baleanu F, Kinnard V, Paesmans M, Rozenberg S, Rubinstein M, Surquin M, Blard PH, Chapurlat R, Body JJ, Bergmann P. Discriminating value of HR-pQCT for fractures in women with similar FRAX scores: A substudy of the FRISBEE cohort. Bone 2021; 143:115613. [PMID: 32871273 DOI: 10.1016/j.bone.2020.115613] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/06/2020] [Revised: 07/29/2020] [Accepted: 08/21/2020] [Indexed: 11/30/2022]
Abstract
Areal bone mineral density (aBMD) has a low sensitivity to identify women at high fracture risk. The FRAX algorithm, by combining several clinical risk factors, might improve fracture prediction compared to aBMD alone. Several micro-architectural and biomechanical parameters which can be measured by high-resolution peripheral quantitative computed tomography (HR-pQCT) are associated with fracture risk. HR-pQCT in combination or not with finite element analysis (FEA) may be used to improve bone strength prediction. Our aim was to assess whether HR-pQCT measurements (densities, cortical and trabecular microarchitecture, biomechanical proprieties assessed by FEA) had an added value in predicting fractures in a subgroup of women belonging to the Belgian FRISBEE cohort. One hundred nineteen women who sustained a fracture (aged 60 to 85 years) during the initial follow-up of our cohort had a radius and tibia examination by HR-pQCT and were compared with controls matched for their FRAX score at baseline. We found that low distal radius total (OR = 1.41 [1.07-1.86] per SD, p < 0.05) and trabecular densities (OR = 1.45 [1.10-1.90], p < 0.01), trabecular number (OR = 1.32 [1.01-1.72], p < 0.05), intra individual distribution of separation (OR = 0.73 [0.54-0.99], p < 0.05) as several FEA parameters were significantly associated with fractures. At the distal tibia, impaired cortical density (OR = 1.32 [1.03-1.70] per SD, p < 0.05) and thickness (OR = 1.29 [1.01-1.63], p < 0.05) and apparent modulus (OR = 1.30 [1.01-1.66], p < 0.05) were significantly correlated with fractures. A low ultra distal radial aBMD (UDR) measured at the time of HR-pQCT was significantly associated with fractures (OR = 1.67 [1.22-2.28], p < 0.01). Women from both groups were followed further after the realization of the HR-pQCT and 46 new fractures were registered. In this second part of the study, low UDR aBMD (OR = 1.66 [1.18-2.35], p < 0.01), total (OR = 1.48 [1.08-2.03], p < 0.05), cortical (OR = 1.40 [1.04-1.87], p < 0.05) and trabecular (OR = 1.37 [1.01-1.85], p < 0.05) densities or apparent modulus (OR = 1.49 [1.07-2.05], p < 0.05) at the radius were associated with a significant increase of fracture risk. At the tibia, only the cortical density was significantly associated with the fracture risk (OR = 1.34 [1.02-2.76], p < 0.05). These results confirm the interest of HR-pQCT measurements for the evaluation of fracture risk, also in women matched for their baseline FRAX score. They also highlight that UDR aBMD contains pertinent information.
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Affiliation(s)
- S I Cappelle
- Department of Geriatrics, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium.
| | - M Moreau
- Data Centre, Bordet Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - R Karmali
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - L Iconaru
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - F Baleanu
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - V Kinnard
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - M Paesmans
- Data Centre, Bordet Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - S Rozenberg
- Department of Obstetrics and gynaecology, Université Libre de Bruxelles (ULB) and Vrije Universiteit (VUB), Brussels, Belgium
| | - M Rubinstein
- Department of Nuclear Medicine, Ixelles Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - M Surquin
- Department of Geriatrics, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - P-H Blard
- CNRS, Université de Lorraine, CRPG, F-54000 Nancy, France
| | - R Chapurlat
- INSERM Research Unit 1033-Lyos, Hôpital E. Herriot, Lyon, France
| | - J J Body
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - P Bergmann
- Department of Nuclear Medicine, CHU-Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
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12
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Iconaru L, Smeys C, Baleanu F, Kinnard V, Moreau M, Cappelle S, Surquin M, Rubinstein M, Rozenberg S, Paesmans M, Karmali R, Bergmann P, Body JJ. Osteoporosis treatment gap in a prospective cohort of volunteer women. Osteoporos Int 2020; 31:1377-1382. [PMID: 32128600 DOI: 10.1007/s00198-020-05339-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 11/20/2019] [Accepted: 02/06/2020] [Indexed: 12/11/2022]
Abstract
UNLABELLED Despite the availability of efficient drugs to prevent osteoporotic fractures, only a minority of women receives osteoporosis therapy after a fracture. The high treatment gap in our cohort consisted of unselected volunteer patients highlights the urgent need of additional education, especially for the medical profession, regarding the risk-benefit balance of treatment. INTRODUCTION Despite the availability of efficient drugs to prevent osteoporotic fractures, only a minority of women receives osteoporosis therapy after a fracture, with a treatment gap around 80%. This can have dramatic consequences for patients and the healthcare systems. METHODS In this study based on longitudinal data from the FRISBEE (Fracture RIsk Brussels Epidemiological Enquiry) cohort of 3560 volunteer women aged 60 to 85 years, we evaluated the 1-year treatment gap after a first major incident fragility fracture. RESULTS There were 386 first validated fragility fractures, 285 major osteoporotic fractures (MOF) and 101 "other major" fractures. The rate of untreated patients was 85.0% (82.8% for MOF versus 91.0 % for "other major" fracture sites) (p = 0.04), with a lower rate for spine (70.5%) and hip (72.5%) versus shoulder (91.6%) and wrist (94.1%) (p < 0.0001). More specifically, the treatment gap for patients with osteoporosis, defined by a T-score < - 2.5 SD was 74.6% versus 76.5% for patients with osteoporosis defined by the presence of hip, shoulder, or spine fractures, independently of DXA results. When considering age groups, the rate of untreated women was 87.9% for women 60-70 years old, 88.2% between 70 and 80 years and 77.8% above 80 years (p = 0.03), with a greater difference between women who were younger or older than 80 years at inclusion: 88.1% versus 77.8% (p = 0.009). A diagnosis of osteoporosis (p = 0.01) and age (p = 0.03) were the only clinical risk factors (CRFs) significantly associated with treatment initiation. CONCLUSIONS This study highlights the urgent need of additional education, especially for the medical profession, regarding the risk-benefit balance of treatment.
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Affiliation(s)
- L Iconaru
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium.
| | - C Smeys
- Department of Geriatrics, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - F Baleanu
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - V Kinnard
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M Moreau
- Data Centre, Inst. J. Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - S Cappelle
- Department of Geriatrics, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M Surquin
- Department of Geriatrics, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M Rubinstein
- Department of Nuclear Medicine, Ixelles Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - S Rozenberg
- Department of Gynecology, CHU St Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - M Paesmans
- Data Centre, Inst. J. Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - R Karmali
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - P Bergmann
- Department of Nuclear Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - J J Body
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Rozenberg S, Bruyère O, Bergmann P, Cavalier E, Gielen E, Goemaere S, Kaufman JM, Lapauw B, Laurent MR, De Schepper J, Body JJ. How to manage osteoporosis before the age of 50. Maturitas 2020; 138:14-25. [PMID: 32631584 DOI: 10.1016/j.maturitas.2020.05.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [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: 02/25/2020] [Revised: 04/23/2020] [Accepted: 05/08/2020] [Indexed: 12/16/2022]
Abstract
This narrative review discusses several aspects of the management of osteoporosis in patients under 50 years of age. Peak bone mass is genetically determined but can also be affected by lifestyle factors. Puberty constitutes a vulnerable period. Idiopathic osteoporosis is a rare, heterogeneous condition in young adults due in part to decreased osteoblast function and deficient bone acquisition. There are no evidence-based treatment recommendations. Drugs use can be proposed to elderly patients at very high risk. Diagnosis and management of osteoporosis in the young can be challenging, in particular in the absence of a manifest secondary cause. Young adults with low bone mineral density (BMD) do not necessarily have osteoporosis and it is important to avoid unnecessary treatment. A determination of BMD is recommended for premenopausal women who have had a fragility fracture or who have secondary causes of osteoporosis: secondary causes of excessive bone loss need to be excluded and treatment should be targeted. Adequate calcium, vitamin D, and a healthy lifestyle should be recommended. In the absence of fractures, conservative management is generally sufficient, but in rare cases, such as chemotherapy-induced osteoporosis, antiresorptive medication can be used. Osteoporosis in young men is most often of secondary origin and hypogonadism is a major cause; testosterone replacement therapy will improve BMD in these patients. Diabetes is characterized by major alterations in bone quality, implying that medical therapy should be started sooner than for other causes of osteoporosis. Primary hyperparathyroidism, hyperthyroidism, Cushing's syndrome and growth hormone deficiency or excess affect cortical bone more often than trabecular bone.
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Affiliation(s)
- S Rozenberg
- Department of Gynaecology-Obstetrics, CHU St Pierre, Université Libre de Bruxelles, Brussels, Belgium.
| | - O Bruyère
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
| | - P Bergmann
- Honorary Consulent, Nuclear Medicine CHU Brugmann CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - E Cavalier
- Department of Clinical Chemistry, UnilabLg, CIRM, University of Liège, CHU de Liège, Domaine du Sart-Tilman, 4000 Liège, Belgium
| | - E Gielen
- Gerontology & Geriatrics, Department of Public Health and Primary Care, KU Leuven & Department of Geriatric Medicine, UZ Leuven, Leuven, Belgium
| | - S Goemaere
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium
| | - J M Kaufman
- Department of Endocrinology and Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium
| | - B Lapauw
- Department of Endocrinology Ghent University Hospital, Ghent, Belgium
| | - M R Laurent
- Centre for Metabolic Bone Diseases, University Hospitals Leuven, Imelda Hospital, Bonheiden, Belgium
| | - J De Schepper
- Department of Pediatrics, UZ Brussel, Brussels, Belgium, Belgium
| | - J J Body
- Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Sanchez-Rodriguez D, Bergmann P, Body JJ, Cavalier E, Gielen E, Goemaere S, Lapauw B, Laurent MR, Rozenberg S, Honvo G, Beaudart C, Bruyère O. The Belgian Bone Club 2020 guidelines for the management of osteoporosis in postmenopausal women. Maturitas 2020; 139:69-89. [PMID: 32747044 DOI: 10.1016/j.maturitas.2020.05.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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: 02/17/2020] [Revised: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To provide updated evidence-based guidelines for the management of osteoporosis in postmenopausal women in Belgium. METHODS The Belgian Bone Club (BBC) gathered a guideline developer group. Nine "Population, Intervention, Comparator, Outcome" (PICO) questions covering screening, diagnosis, non-pharmacological and pharmacological treatments, and monitoring were formulated. A systematic search of MEDLINE, the Cochrane Database of Systematic Reviews, and Scopus was performed to find network meta-analyses, meta-analyses, systematic reviews, guidelines, and recommendations from scientific societies published in the last 10 years. Manual searches were also performed. Summaries of evidence were provided, and recommendations were further validated by the BBC board members and other national scientific societies' experts. RESULTS Of the 3840 references in the search, 333 full texts were assessed for eligibility, and 129 met the inclusion criteria. Osteoporosis screening using clinical risk factors should be considered. Patients with a recent (<2 years) major osteoporotic fracture were considered at very high and imminent risk of future fracture. The combination of bone mineral density measured by dual-energy X-ray absorptiometry and 10-year fracture risk was used to categorize patients as low or high risk. Patient education, the combination of weight-bearing and resistance training, and optimal calcium intake and vitamin D status were recommended. Antiresorptive and anabolic osteoporosis treatment should be considered for patients at high and very high fracture risk, respectively. Follow-up should focus on compliance, and patient-tailored monitoring should be considered. CONCLUSION BBC guidelines and 25 guideline recommendations bridge the gap between research and clinical practice for the screening, diagnosis, and management of osteoporosis.
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Affiliation(s)
- D Sanchez-Rodriguez
- WHO Collaborating Center for Public Health aspects of musculo-skeletal health and ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium; Geriatrics Department, Rehabilitation Research Group, Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain.
| | - P Bergmann
- Department of Radioisotopes, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - J J Body
- Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - E Cavalier
- Department of Clinical Chemistry, UnilabLg, University of Liège, CHU de Liège, Liège, Belgium
| | - E Gielen
- Gerontology and Geriatrics Section, Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, University Hospitals, Leuven, Belgium
| | - S Goemaere
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium
| | - B Lapauw
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium
| | - M R Laurent
- Geriatrics Department, Imelda Hospital, Bonheiden, Belgium
| | - S Rozenberg
- Department of Gynaecology-Obstetrics, Université Libre de Bruxelles, Brussels, Belgium
| | - G Honvo
- WHO Collaborating Center for Public Health aspects of musculo-skeletal health and ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - C Beaudart
- WHO Collaborating Center for Public Health aspects of musculo-skeletal health and ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - O Bruyère
- WHO Collaborating Center for Public Health aspects of musculo-skeletal health and ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
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Baleanu F, Moreau M, Kinnard V, Iconaru L, Karmali R, Paesmans M, Bergmann P, Body JJ. What is the validity of self-reported fractures? Bone Rep 2020; 12:100256. [PMID: 32382588 PMCID: PMC7200867 DOI: 10.1016/j.bonr.2020.100256] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 02/13/2020] [Accepted: 03/06/2020] [Indexed: 11/25/2022] Open
Abstract
We assessed the validity of self-reported fractures, over a median follow-up period of 6.2 years, in a well characterized population-based cohort of 3560 postmenopausal women, aged 60-85 years, from the Fracture Risk Brussels Epidemiological Enquiry (FRISBEE) study. Incident low-traumatic (falls from a standing height or less) or non-traumatic fractures, including peripheral fractures, were registered during each annual follow-up telephone interview. A self-reported fracture was considered as a true positive if it was validated by written reliable medical reports (radiographs, CT scans or surgical report). False positives fractures were considered to be those for which the radiology report indicated that there was no fracture at the reported site. Among self-reported fractures, false positive rates were 14.4% for all fractures. The rate of false positives of 11.2% (n = 48/429) was not negligible for the four classical major osteoporotic fractures (MOFs: hip, clinical spine, forearm or shoulder fractures). In terms of fracture site, we found the lowest false positive rate (4.4%) at the hip, and the highest (16.8%) at the spine, with the proximal humerus and the wrist in between, at about 10% each. The global rates of false positives were 12.5% (n = 22/176) for other major fractures and 22.3% (n = 49/220) for minor fractures. Younger subjects, individuals with fractures at sites other than the hip, with a lower education level, or with a higher BMI were more likely to report false positive fractures. Our data indicate that the inaccuracy of self-reported fractures is clinically relevant for several major fractures, which could influence any fracture risk prediction model.
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Affiliation(s)
- F Baleanu
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M Moreau
- Data Centre, Inst. J. Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - V Kinnard
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - L Iconaru
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - R Karmali
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M Paesmans
- Data Centre, Inst. J. Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - P Bergmann
- Department of Nuclear Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - J J Body
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Iconaru L, Moreau M, Kinnard V, Baleanu F, Paesmans M, Karmali R, Body JJ, Bergmann P. Does the Prediction Accuracy of Osteoporotic Fractures by BMD and Clinical Risk Factors Vary With Fracture Site? JBMR Plus 2019; 3:e10238. [PMID: 31844826 PMCID: PMC6894722 DOI: 10.1002/jbm4.10238] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/27/2019] [Accepted: 09/03/2019] [Indexed: 01/08/2023] Open
Abstract
Several clinical risk factors (CRFs) have been shown to predict the risk of fragility fractures independently of BMD, but their accuracy in the prediction of a particular fracture site has not been extensively studied. In this study based on longitudinal data from the FRISBEE cohort (Fracture Risk Brussels Epidemiological Enquiry), we evaluated if CRFs are specific for sites of incident osteoporotic fractures during follow‐up. We recruited 3560 postmenopausal women, aged 60 to 85 years, from 2007 to 2013, and surveyed yearly for the occurrence of fragility fractures during 6.2 years (median). We analyzed the association between CRFs included in the FRAX (fracture risk assessment tool) model or additional CRFs (falls, sedentary lifestyle, early untreated menopause, diabetes, use of selective serotonin reuptake inhibitors or proton pump inhibitors) and the first incident validated major osteoporotic fracture (MOF; n = 362; vertebra, hip, shoulder, and wrist) or other major fractures (n = 74; ankle, pelvis/sacrum, elbow, knee, long bones). Uni‐ and multivariate analyses using the Cox proportional hazards model were used. For MOFs considered together, the risk of fracture was highly associated in uni‐ and multivariate analyses (p<0.01) with osteoporosis (T‐score < −2.5), prior fracture, age, BMD (assessed by DXA), and fall history (HR 2.34, 1.82,1.71, 1.38, and 1.32, respectively). For each site analyzed separately, prior OF, age, smoking, and total hip BMD remained independent predictors for hip fractures (HR 5.72, 3.98, 3.10, 2.32, and 1.92, respectively); osteoporosis, age, prior OF, glucocorticoids, and spine BMD for vertebral fracture (HR 2.08, 1.87, 1.78, 1.76, and 1.45, respectively); osteoporosis, prior OF, and femoral neck BMD (HR 1.83, 1.60, and 1.56, respectively) for wrist fracture; osteoporosis, prior OF, and spine BMD (HR 2.48, 1.78, and 1.31, respectively) for shoulder fracture; prior OF and diabetes (HR 2.62 and 2.03) for other major fractures. Thus, a prior fracture and BMD were the best predictors of fracture risk at any site. Other CRFs have a weaker predictive value, which is a function of the site of a future fracture. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- L Iconaru
- Department of Endocrinology CHU Brugmann, Université Libre de Bruxelles Brussels Belgium
| | - M Moreau
- Data Centre Institut Jules Bordet, Université Libre de Bruxelles Brussels Belgium
| | - V Kinnard
- Department of Internal Medicine, CHU Brugmann Université Libre de Bruxelles Brussels Belgium
| | - F Baleanu
- Department of Endocrinology CHU Brugmann, Université Libre de Bruxelles Brussels Belgium
| | - M Paesmans
- Data Centre Institut Jules Bordet, Université Libre de Bruxelles Brussels Belgium
| | - R Karmali
- Department of Endocrinology CHU Brugmann, Université Libre de Bruxelles Brussels Belgium
| | - J J Body
- Department of Endocrinology CHU Brugmann, Université Libre de Bruxelles Brussels Belgium
| | - P Bergmann
- Department of Nuclear Medicine CHU Brugmann, Université Libre de Bruxelles Brussels Belgium
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Abstract
Spirogyra is a green filamentous freshwater algae on which recent studies reveal several promising properties and potential application possibilities in biotechnology. However, little is known about cultivation of Spirogyra and even less about large-scale cultivations in closed growth systems. Therefore, the aim of the present study was to elaborate the growth kinetics of Spirogyra sp. in a commercially available and scalable photobioreactor. For this purpose, Spirogyra sp. was grown indoors in distinct flat-panel airlift photobioreactors equipped with culture-flow directing installations. Hereby, special attention was laid on light administration and specific light availability and it was found that Spirogyra sp., in combination with the photobioreactor in question, required high photon-flux densities (100 µmol m-2 s-1 gDW-1) for maximum proliferation which is in accordance with its abundance in epipelagial waters in nature. Applying photon-flux densities of up to 1400 µmol m-2 s-1, a maximum volumetric productivity and final biomass concentration of 1.15 gDW L-1 day-1 and 14.28 gDW L-1 were achieved, respectively, the highest to be reported for the alga. To the knowledge of the authors, this is the first report on the growth of Spirogyra in a flat-panel photobioreactor.
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Affiliation(s)
- Veronika Vogel
- Faculty of Natural Sciences, University of Applied Sciences Esslingen, Kanalstrasse. 33, 73728 Esslingen, Germany
| | - Peter Bergmann
- Institute of Food Science and Biotechnology, University of Hohenheim, Garbenstraße 25, 70599 Stuttgart, Germany
- Subitec GmbH, Julius-Hölder-Str. 36, 70597 Stuttgart, Germany
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Bergmann P, Trösch W. Empirical operating strategy to reduce the light-specific energy consumption of a flat-panel airlift photobioreactor with intrinsic static mixers cultivating Thermosynechococcus elongatus BP-1. ALGAL RES 2018. [DOI: 10.1016/j.algal.2017.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Schieber G, Born L, Bergmann P, Körner A, Mader A, Saffarian S, Betz O, Milwich M, Gresser GT, Knippers J. Hindwings of insects as concept generator for hingeless foldable shading systems. Bioinspir Biomim 2017; 13:016012. [PMID: 29094682 DOI: 10.1088/1748-3190/aa979c] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Hingeless shading systems inspired by nature are increasingly the focus of architectural research. In contrast to traditional systems, these compliant mechanisms can reduce the amount of maintenance-intensive parts and can easily be adapted to irregular, doubly curved, facade geometries. Previous mechanisms rely merely on the reversible material deformation of composite structures with almost homogeneous material properties. This leads to large actuation forces and an inherent conflict between the requirements of movement and the capacity to carry external loads. To enhance the performance of such systems, current research is directed at natural mechanisms with concentrated compliance and distinct hinge zones with high load-bearing capacity. Here, we provide insights into our biological findings and the development of a deployable structure inspired by the Flexagon model of hindwings of insects in general and the hierarchical structure of the wing cuticle of the shield bug (Graphosoma lineatum). By using technical fibre-reinforced plastics in combination with an elastomer foil, natural principles have been partially transferred into a multi-layered structure with locally adapted stiffness. Initial small prototypes have been produced in a vacuum-assisted hot press and sustain this functionality. Initial theoretical studies on test surfaces outline the advantages of these bio-inspired structures as deployable external shading systems for doubly curved facades.
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Affiliation(s)
- G Schieber
- Institute of Building Structures and Structural Design (ITKE), University of Stuttgart, Stuttgart, Germany
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Cappelle S, Ramon I, Dekelver C, Rozenberg S, Baleanu F, Karmali R, Rubinstein M, Tondeur M, Moreau M, Paesmans M, Bergmann P, Body JJ. Distribution of clinical risk factors for fracture in a Brussels cohort of postmenopausal women: The FRISBEE study and comparison with other major cohort studies. Maturitas 2017; 106:1-7. [DOI: 10.1016/j.maturitas.2017.08.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/08/2017] [Accepted: 08/11/2017] [Indexed: 11/15/2022]
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Gielen E, Bergmann P, Bruyère O, Cavalier E, Delanaye P, Goemaere S, Kaufman JM, Locquet M, Reginster JY, Rozenberg S, Vandenbroucke AM, Body JJ. Osteoporosis in Frail Patients: A Consensus Paper of the Belgian Bone Club. Calcif Tissue Int 2017; 101:111-131. [PMID: 28324124 PMCID: PMC5498589 DOI: 10.1007/s00223-017-0266-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 03/02/2017] [Indexed: 12/11/2022]
Abstract
In this consensus paper, the Belgian Bone Club aims to provide a state of the art on the epidemiology, diagnosis, and management of osteoporosis in frail individuals, including patients with anorexia nervosa, patients on dialysis, cancer patients, persons with sarcopenia, and the oldest old. All these conditions may indeed induce bone loss that is superimposed on physiological bone loss and often remains under-recognized and under-treated. This is of particular concern because of the major burden of osteoporotic fractures in terms of morbidity, mortality, and economic cost. Therefore, there is an urgent need to appreciate bone loss associated with these conditions, as this may improve diagnosis and management of bone loss and fracture risk in clinical practice.
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Affiliation(s)
- E Gielen
- Gerontology and Geriatrics, Department of Clinical and Experimental Medicine, KU Leuven & Center for Metabolic Bone Diseases, UZ Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - P Bergmann
- Department of Radioisotopes, CHU Brugmann, Université Libre de Bruxelles, Bruxelles, Belgium
| | - O Bruyère
- Department of Public Health, Epidemiology and Health Economics, University of Liège, CHU de Liège, Liège, Belgium
| | - E Cavalier
- Department of Clinical Chemistry, UnilabLg, CIRM, University of Liège, CHU de Liège, Liège, Belgium
| | - P Delanaye
- Department of Nephrology, Dialysis, Transplantation, University of Liège, CHU de Liège, Liège, Belgium
| | - S Goemaere
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium
| | - J-M Kaufman
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - M Locquet
- Department of Public Health, Epidemiology and Health Economics, University of Liège, CHU de Liège, Liège, Belgium
| | - J-Y Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liège, CHU de Liège, Liège, Belgium
| | - S Rozenberg
- Department of Gynaecology-Obstetrics, Université Libre de Bruxelles, Bruxelles, Belgium
| | - A-M Vandenbroucke
- Clinical Department of Internal Medicine, UZ Leuven, Leuven, Belgium
| | - J-J Body
- Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, Bruxelles, Belgium
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Cavalier E, Bergmann P, Bruyère O, Delanaye P, Durnez A, Devogelaer JP, Ferrari SL, Gielen E, Goemaere S, Kaufman JM, Toukap AN, Reginster JY, Rousseau AF, Rozenberg S, Scheen AJ, Body JJ. The role of biochemical of bone turnover markers in osteoporosis and metabolic bone disease: a consensus paper of the Belgian Bone Club. Osteoporos Int 2016; 27:2181-2195. [PMID: 27026330 DOI: 10.1007/s00198-016-3561-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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: 01/25/2016] [Accepted: 03/03/2016] [Indexed: 01/22/2023]
Abstract
The exact role of biochemical markers of bone turnover in the management of metabolic bone diseases remains a topic of controversy. In this consensus paper, the Belgian Bone Club aimed to provide a state of the art on the use of these biomarkers in different clinical or physiological situations like in postmenopausal women, osteoporosis in men, in elderly patients, in patients suffering from bone metastasis, in patients with chronic renal failure, in pregnant or lactating women, in intensive care patients, and in diabetics. We also gave our considerations on the analytical issues linked to the use of these biomarkers, on potential new emerging biomarkers, and on the use of bone turnover biomarkers in the follow-up of patients treated with new drugs for osteoporosis.
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Affiliation(s)
- E Cavalier
- Department of Clinical Chemistry, UnilabLg, CIRM, University of Liège, CHU de Liège, Domaine du Sart-Tilman, 4000, Liège, Belgium.
| | - P Bergmann
- Department of Radioisotopes, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - O Bruyère
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - P Delanaye
- Department of Nephrology Dialysis Transplantation, University of Liège, CHU de Liège, Liège, Belgium
| | - A Durnez
- Pôle de Pathologie Rhumatismale, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - J-P Devogelaer
- Pôle de Pathologie Rhumatismale, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - S L Ferrari
- Department of Bone Diseases, Hôpitaux Universitaires Genève, Geneva, Switzerland
| | - E Gielen
- Gerontology and Geriatrics Section, Department of Clinical and Experimental Medicine, K.U. Leuven, Leuven, Belgium
| | - S Goemaere
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium
| | - J-M Kaufman
- Department of Endocrinology and Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium
- Centre Académique de Recherche et d'Expérimentation en Santé SPRL (CARES SPRL), Liège, Belgium
| | - A Nzeusseu Toukap
- Pôle de Pathologie Rhumatismale, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - J-Y Reginster
- Centre Académique de Recherche et d'Expérimentation en Santé SPRL (CARES SPRL), Liège, Belgium
| | - A-F Rousseau
- Burn Centre and General Intensive Care Department, University of Liège, CHU de Liège, Liège, Belgium
| | - S Rozenberg
- Department of Gynaecology-Obstetrics, Université Libre de Bruxelles, Brussels, Belgium
| | - A J Scheen
- Division of Diabetes, Nutrition and Metabolic Disorders, University of Liège CHU de Liège, Liège, Belgium
| | - J-J Body
- Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Winckelmann D, Bleeke F, Bergmann P, Klöck G. Growth of Cyanobacterium aponinum influenced by increasing salt concentrations and temperature. 3 Biotech 2015; 5:253-260. [PMID: 28324290 PMCID: PMC4434411 DOI: 10.1007/s13205-014-0224-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 04/29/2014] [Indexed: 11/17/2022] Open
Abstract
The increasing requirement of food neutral biofuels demands the detection of alternative sources. The use of non-arable land and waste water streams is widely discussed in this regard. A Cyanobacterium was isolated on the area of a possible algae production side near a water treatment plant in the arid desert region al-Wusta. It was identified as Cyanobacterium aponinum PB1 and is a possible lipid source. To determine its suitability of a production process using this organism, a set of laboratory experiments were performed. Its growth behavior was examined in regard to high temperatures and increasing NaCl concentrations. A productivity of 0.1 g L-1 per day was measured at an alga density below 0.75 g L-1. C. aponinum PB1 showed no sign of altered growth behavior in media containing 70 g L-1 NaCl or less. Detection of a negative effect of NaCl on the growth using Pulse-Amplitude-Modulation chlorophyll fluorescence analysis was not more sensitive than optical density measurement.
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Affiliation(s)
- Dominik Winckelmann
- School of Engineering and Science, Jacobs-University Bremen, Campus Ring 1, 28759, Bremen, Germany
- University of Applied Sciences Bremen, Am Neustadtswall 30, 28199, Bremen, Germany
| | - Franziska Bleeke
- School of Engineering and Science, Jacobs-University Bremen, Campus Ring 1, 28759, Bremen, Germany
- University of Applied Sciences Bremen, Am Neustadtswall 30, 28199, Bremen, Germany
| | - Peter Bergmann
- University of Applied Sciences Bremen, Am Neustadtswall 30, 28199, Bremen, Germany
| | - Gerd Klöck
- University of Applied Sciences Bremen, Am Neustadtswall 30, 28199, Bremen, Germany.
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Sutoris K, Mráček M, Rohan Z, Bergmann P, Simša J. [Ileocaecal actinomycosis - a case report]. Rozhl Chir 2013; 92:395-399. [PMID: 24003880] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Abdominal actinomycosis as an aetiological cause of acute abdomen in immunocompetent patients is considered to be very rare. The authors present a case of a young patient with acute appendicitis in the terrain of specific colitis imitating caecal tumour. Especially nowadays, in the era of globalization, it would be an unnecessary mistake not to think of this aetiological unit when the pain and tenderness in the right hypogastrium with signs of peritonism are expressed.
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Affiliation(s)
- K Sutoris
- Chirugická klinika 1. LF UK a TN Praha.
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Bergmann P, Heethoff M. The oviduct is a brood chamber for facultative egg retention in the parthenogenetic oribatid mite Archegozetes longisetosus AOKI (Acari, Oribatida). Tissue Cell 2012; 44:342-50. [DOI: 10.1016/j.tice.2012.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 05/22/2012] [Accepted: 05/25/2012] [Indexed: 10/28/2022]
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Bergmann P, Cannie M. [Blood tests and imaging in thyroid pathology]. Rev Med Brux 2012; 33:246-253. [PMID: 23091928] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Circulating analytes used in the exploration of thyroid function are TSH and free thyroid hormones (FT4 and FT3). TSH is used as first line analysis in diagnosis because a normal value excludes almost always a thyroid dysfunction. However in the follow up of a treatment for hypo- or hyperthyroidism, free hormones are to be determined since TSH reaction is delayed and does not reflect precisely the restoration of euthyroidism. The measurement of anti-thyroperoxidase antibodies (anti-TPO) will show the presence of an autoimmune thyroiditis and that of thyroid stimulating antibodies (TSI) will establish the diagnosis of Graves' disease. The measurement of circulating thyroglobulin has no place in the diagnostic of thyroid dysfunction nor in the evaluation of a goitre but it is now the golden standard in the follow up of patients with a differentiated thyroid cancer after surgery and radioiodine ablation in patients without antithyroglobulin antibodies. Echography is the first line examination to evaluate thyroid morphology. It shows tiny thyroid nodules and gives precious informations on their structure, as well as paremchymatous diffuse abnormalities associated with thyroiditis. Thyroid scintigraphy with 99mTc allows establishing the functional characteristics of thyroid nodules (warm or cold) and to precise the origin of a thyrotoxicosis (autonomous toxic nodule vs Graves-Basedow, sub acute or silent thyroiditis). Whole body scintigraphy is mandatory after radioiodine treatment with 131I in order to visualize possible metastasis and establish their avidity for iodine.
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Affiliation(s)
- P Bergmann
- Services de Diagnostic et de Traitement par Isotopes, C.H.U. Brugmann, Bruxelles.
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Body JJ, Bergmann P, Boonen S, Devogelaer JP, Gielen E, Goemaere S, Kaufman JM, Rozenberg S, Reginster JY. Extraskeletal benefits and risks of calcium, vitamin D and anti-osteoporosis medications. Osteoporos Int 2012; 23 Suppl 1:S1-23. [PMID: 22311111 PMCID: PMC3273686 DOI: 10.1007/s00198-011-1891-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 12/19/2011] [Indexed: 12/11/2022]
Abstract
UNLABELLED Drugs used for the prevention and the treatment of osteoporosis exert various favourable and unfavourable extra-skeletal effects whose importance is increasingly recognized notably for treatment selection. INTRODUCTION The therapeutic armamentarium for the prevention and the treatment of osteoporosis is increasingly large, and possible extra-skeletal effects of available drugs could influence the choice of a particular compound. METHODS The present document is the result of a national consensus, based on a systematic and critical review of the literature. RESULTS Observational research has suggested an inverse relationship between calcium intake and cardiovascular diseases, notably through an effect on blood pressure, but recent data suggest a possible deleterious effect of calcium supplements on cardiovascular risk. Many diverse studies have implicated vitamin D in the pathogenesis of clinically important non-skeletal functions or diseases, especially muscle function, cardiovascular disease, autoimmune diseases and common cancers. The possible effects of oral or intravenous bisphosphonates are well-known. They have been associated with an increased risk of oesophageal cancer or atrial fibrillation, but large-scale studies have not found any association with bisphosphonate use. Selective oestrogen receptor modulators have demonstrated favourable or unfavourable extra-skeletal effects that vary between compounds. Strontium ranelate has a limited number of non-skeletal effects. A reported increase in the risk of venous thromboembolism is not found in observational studies, and very rare cases of cutaneous hypersensitivity reactions have been reported. Denosumab has been introduced recently, and its extra-skeletal effects still have to be assessed. CONCLUSION Several non-skeletal effects of bone drugs are well demonstrated and influence treatment choices.
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Affiliation(s)
- J.-J. Body
- Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - P. Bergmann
- Department of Radioisotopes, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - S. Boonen
- Center for Metabolic Bone Diseases, Katholieke University Leuven, Leuven, Belgium
| | - J.-P. Devogelaer
- Department of Rheumatology, Saint Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - E. Gielen
- Gerontology and Geriatrics Section, Department of Experimental Medicine, K.U.Leuven, Leuven, Belgium
| | - S. Goemaere
- Department of Rheumatology and Endocrinology, State University of Gent, Gent, Belgium
| | - J.-M. Kaufman
- Department of Endocrinology, State University of Gent, Gent, Belgium
| | - S. Rozenberg
- Department of Gynaecology–Obstetrics, Université Libre de Bruxelles, Brussels, Belgium
| | - J.-Y. Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
- Bone and Cartilage Metabolism Research Unit, CHU Centre-Ville, Policliniques L. BRULL, Quai Godefroid Kurth 45 (9ème étage), 4020 Liege, Belgium
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Mesquita M, Demulder A, Nazeri A, Bergmann P. Complete aortoiliac thrombosis in a patient during pretransplant cardiovascular evaluation. Indian J Nephrol 2012; 22:226-7. [PMID: 23087563 PMCID: PMC3459532 DOI: 10.4103/0971-4065.98773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Body JJ, Bergmann P, Boonen S, Boutsen Y, Bruyere O, Devogelaer JP, Goemaere S, Hollevoet N, Kaufman JM, Milisen K, Rozenberg S, Reginster JY. Non-pharmacological management of osteoporosis: a consensus of the Belgian Bone Club. Osteoporos Int 2011; 22:2769-88. [PMID: 21360219 PMCID: PMC3186889 DOI: 10.1007/s00198-011-1545-x] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 01/05/2011] [Indexed: 02/07/2023]
Abstract
This consensus article reviews the various aspects of the non-pharmacological management of osteoporosis, including the effects of nutriments, physical exercise, lifestyle, fall prevention, and hip protectors. Vertebroplasty is also briefly reviewed. Non-pharmacological management of osteoporosis is a broad concept. It must be viewed as an essential part of the prevention of fractures from childhood through adulthood and the old age. The topic also includes surgical procedures for the treatment of peripheral and vertebral fractures and the post-fracture rehabilitation. The present document is the result of a consensus, based on a systematic review and a critical appraisal of the literature. Diets deficient in calcium, proteins or vitamin D impair skeletal integrity. The effect of other nutriments is less clear, although an excessive consumption of sodium, caffeine, or fibres exerts negative effects on calcium balance. The deleterious effects of tobacco, excessive alcohol consumption and a low BMI are well accepted. Physical activity is of primary importance to reach optimal peak bone mass but, if numerous studies have shown the beneficial effects of various types of exercise on bone mass, fracture data as an endpoint are scanty. Fall prevention strategies are especially efficient in the community setting, but less evidence is available about their effectiveness in preventing fall-related injuries and fractures. The efficacy of hip protectors remains controversial. This is also true for vertebroplasty and kyphoplasty. Several randomized controlled studies had reported a short-term advantage of vertebroplasty over medical treatment for pain relief, but these findings have been questioned by recent sham-controlled randomized clinical studies.
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Affiliation(s)
- J.-J. Body
- Internal Medicine, Institut Jules Bordet, Brussels, Belgium
| | | | - S. Boonen
- Internal Medicine, UZ Leuven, Leuven, Belgium
| | - Y. Boutsen
- Department of Rheumatology, Mont-Godinne University Hospital-Université Catholique de Louvain, Leuven, Belgium
| | - O. Bruyere
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - J.-P. Devogelaer
- Department of Rheumatology, Mont-Godinne University Hospital-Université Catholique de Louvain, Leuven, Belgium
| | - S. Goemaere
- Unit for Osteoporosis and Metabolic Bone Diseases (9K12 IE), Ghent University Hospital, Ghent, Belgium
| | | | - J.-M. Kaufman
- Unit for Osteoprosis and Metabolic Bone Disease, Ghent University Hospital, Ghent, Belgium
| | | | - S. Rozenberg
- Department of Gynaecology-Obstetrics, Free University of Brussels, Brussels, Belgium
| | - J.-Y. Reginster
- Bone and Cartilage Metabolism Research Unit, CHU Centre-Ville, Policliniques L. BRULL, Quai Godefroid Kurth 45 (9ème étage), 4020 Liege, Belgium
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Stricker J, Safouris A, Divano L, Stadnik T, Bergmann P, Dachy B. [Frontal syndrome post cerebral malaria. Case report]. Rev Med Brux 2011; 32:473-476. [PMID: 22165525] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Cerebral malaria is one of the most serious complications of Plasmodium falciparum infection, this protozoa of the Plasmodium family is the only known to induce cerebral malaria. This case is about a frontal lobe syndrome post cerebral malaria in a young man living in an endemic malaria area. This complication is rare and most common during childhood.
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Affiliation(s)
- J Stricker
- Service de Neurologie, C.H.U. Brugmann, Bruxelles.
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Masquelier B, Taieb A, Reigadas S, Marchou B, Cheneau C, Spire B, Charpentier C, Leport C, Raffi F, Chene G, Descamps D, Leport C, Raffi F, Chene G, Salamon R, Moatti JP, Pierret J, Spire B, Brun-Vezinet F, Fleury H, Masquelier B, Peytavin G, Garraffo R, Costagliola D, Dellamonica P, Katlama C, Meyer L, Salmon D, Sobel A, Cuzin L, Dupon M, Duval X, Le Moing V, Marchou B, May T, Morlat P, Rabaud C, Waldner-Combernoux A, Reboud P, Couffin-Cadiergues S, Marchand L, Bouteloup V, Bouhnik AD, Brunet-Francois C, Caron V, Carrieri MP, Courcoul M, Couturier F, Hardel L, Iordache L, Kurkdji P, Martiren S, Preau M, Protopopescu C, Surzyn J, Taieb A, Villes V, Schmit JL, Chennebault JM, Faller JP, Mgy-Bertrand N, Hoen B, Drobachef, Bouchaud O, Dupon M, Longy-Boursier, Morlat P, Ragnaud JM, Granier P, Garre M, Verdon R, Merrien D, Devidas A, Sobel A, Piroth L, Perronne C, Froguel E, Ceccaldi J, Peyramond D, Allard C, Reynes J, May T, Raffi F, Fuzibet JG, Dellamonica P, Arsac P, Bouvet E, Bricaire F, Bergmann P, Cabane J, Monsonego J, Girard PM, Guillevin L, Herson S, Leport C, Meyohas MC, Molina JM, Pialoux G, Salmon D, Roblot P, Jaussaud R, Michelet C, Lucht F, Debord T, Rey D, De Jaureguiberry JP, Marchou B, Bernard L. Cellular HIV-1 DNA quantification and short-term and long-term response to antiretroviral therapy. J Antimicrob Chemother 2011; 66:1582-9. [DOI: 10.1093/jac/dkr153] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Lüth S, Bergmann P, Cosma C, Enescu N, Giese R, Götz J, Ivanova A, Juhlin C, Kashubin A, Yang C, Zhang F. Time-lapse seismic surface and down-hole measurements for monitoring CO2 storage in the CO2SINK project (Ketzin, Germany). ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.egypro.2011.02.268] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [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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Schmidt-Hattenberger C, Bergmann P, Kießling D, Krüger K, Rücker C, Schütt H, Group K. Application of a Vertical Electrical Resistivity Array (VERA) for monitoring CO2 migration at the Ketzin site: First performance evaluation. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.egypro.2011.02.258] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bergmann P, Body JJ, Boonen S, Boutsen Y, Devogelaer JP, Goemaere S, Kaufman J, Reginster JY, Rozenberg S. Loading and skeletal development and maintenance. J Osteoporos 2010; 2011:786752. [PMID: 21209784 PMCID: PMC3010667 DOI: 10.4061/2011/786752] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 11/06/2010] [Indexed: 12/12/2022] Open
Abstract
Mechanical loading is a major regulator of bone mass and geometry. The osteocytes network is considered the main sensor of loads, through the shear stress generated by strain induced fluid flow in the lacuno-canalicular system. Intracellular transduction implies several kinases and phosphorylation of the estrogen receptor. Several extra-cellular mediators, among which NO and prostaglandins are transducing the signal to the effector cells. Disuse results in osteocytes apoptosis and rapid imbalanced bone resorption, leading to severe osteoporosis. Exercising during growth increases peak bone mass, and could be beneficial with regards to osteoporosis later in life, but the gain could be lost if training is abandoned. Exercise programs in adults and seniors have barely significant effects on bone mass and geometry at least at short term. There are few data on a possible additive effect of exercise and drugs in osteoporosis treatment, but disuse could decrease drugs action. Exercise programs proposed for bone health are tedious and compliance is usually low. The most practical advice for patients is to walk a minimum of 30 to 60 minutes per day. Other exercises like swimming or cycling have less effect on bone, but could reduce fracture risk indirectly by maintaining muscle mass and force.
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Affiliation(s)
- P. Bergmann
- Department of Nuclear Medicine, Laboratory of Clinical Chemistry and Experimental Medicine, CHU Brugmann, Université Libre de Bruxelles, 4 Pl. Van Gehuchten, 1020 Brussels, Belgium,*P. Bergmann:
| | - J. J. Body
- Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, 1020 Brussels, Belgium
| | - S. Boonen
- Division of Gerontology and Geriatrics, Center for Musculoskeletal Research, Department of Experimental Medicine, Catholic Leuven University, 3000 Leuven, Belgium
| | - Y. Boutsen
- Department of Rheumatology, Mont-Godinne University Hospital, Université Catholique de Louvain, 1200 Brussels, Belgium
| | - J. P. Devogelaer
- Rheumatology Unit, Saint-Luc University Hospital, Université Catholique de Louvain, 1200 Brussels, Belgium
| | - S. Goemaere
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, 9000 Ghent, Belgium
| | - J. Kaufman
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, 9000 Ghent, Belgium
| | - J. Y. Reginster
- Department of Public Health Sciences, University of Liège, 4000 Liège, Belgium
| | - S. Rozenberg
- Department of Gynaecology-Obstetrics, Free University of Brussels, 1090 Brussels, Belgium
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Body JJ, Bergmann P, Boonen S, Boutsen Y, Devogelaer JP, Goemaere S, Kaufman JM, Rozenberg S, Reginster JY. Evidence-based guidelines for the pharmacological treatment of postmenopausal osteoporosis: a consensus document by the Belgian Bone Club. Osteoporos Int 2010; 21:1657-80. [PMID: 20480148 PMCID: PMC2931762 DOI: 10.1007/s00198-010-1223-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 02/22/2010] [Indexed: 12/27/2022]
Abstract
Several drugs are available for the management of postmenopausal osteoporosis. This may, in daily practice, confuse the clinician. This manuscript offers an evidence-based update of previous treatment guidelines, with a critical assessment of the currently available efficacy data on all new chemical entities which were granted a marketing authorization. Osteoporosis is widely recognized as a major public health concern. The availability of new therapeutic agents makes clinical decision-making in osteoporosis more complex. Nation-specific guidelines are needed to take into consideration the specificities of each and every health care environment. The present manuscript is the result of a National Consensus, based on a systematic review and a critical appraisal of the currently available literature. It offers an evidence-based update of previous treatment guidelines, with the aim of providing clinicians with an unbiased assessment of osteoporosis treatment effect.
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Affiliation(s)
- J.-J. Body
- Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - P. Bergmann
- Department of Radioisotopes, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - S. Boonen
- Center for Metabolic Bone Diseases, Katholieke University Leuven, Leuven, Belgium
| | - Y. Boutsen
- Department of Rheumatology, Mont-Godinne University Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - J.-P. Devogelaer
- Department of Rheumatology, Saint Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - S. Goemaere
- Department of Rheumatology and Endocrinology, State University of Gent, Ghent, Belgium
| | - J.-M. Kaufman
- Department of Endocrinology, State University of Gent, Ghent, Belgium
| | - S. Rozenberg
- Department of Gynaecology-Obstetrics, Université Libre de Bruxelles, Brussels, Belgium
| | - J.-Y. Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
- Bone and Cartilage Metabolism Research Unit, CHU Centre-Ville, Policliniques L. BRULL, Quai Godefroid Kurth 45, 4020 Liege, Belgium
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Huyge V, Garcia C, Alexiou J, Ameye L, Vanderlinden B, Lemort M, Bergmann P, Awada A, Body JJ, Flamen P. Heterogeneity of metabolic response to systemic therapy in metastatic breast cancer patients. Clin Oncol (R Coll Radiol) 2010; 22:818-27. [PMID: 20554438 DOI: 10.1016/j.clon.2010.05.021] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 04/06/2010] [Accepted: 05/24/2010] [Indexed: 11/18/2022]
Abstract
AIM The aim of this retrospective study was to describe the intra-individual heterogeneity of the ¹⁸F-labelled fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) response among lesions in bone-dominant metastatic breast cancer patients treated with systemic therapies. PATIENTS AND METHODS The metabolic response was analysed by comparing PET/CT scans carried out before and during a new treatment phase (n=46) in 25 bone-dominant metastatic breast cancer patients. Patients presented both bone and extra-bone metastases in 48% treatment phases. The metabolic response was analysed according to European Organization for Research and Treatment of Cancer (EORTC) criteria. A heterogeneous response was defined as the coexistence of responding and non-responding lesions within the same patient. RESULTS The lesion-based response analysis showed a heterogeneous metabolic response in 48% of treatment phases. In the subset with both bone and extra-bone metastases (n=20), PET/CT showed discordant responses between bone and extra-bone metastases in 6/20 (30%) treatment phases. Considering all the cases included in the study, the time to progression (TTP) was longer in cases with a metabolic response compared with the cases with a metabolic non-response (P=0.02). In cases with a PET/CT non-response, TTP seemed to be lower in those with a homogeneous non-response compared with those with a heterogeneous metabolic response (P=0.07). CONCLUSION Whole-body FDG-PET allows frequent heterogeneous responses after systemic therapy to be identified in bone-dominant metastatic breast cancer patients.
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Affiliation(s)
- V Huyge
- Department of Nuclear Medicine, Institut Jules Bordet, Brussels, Belgium.
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Brachet C, Boros E, Tenoutasse S, Lissens W, Andry G, Martin P, Bergmann P, Heinrichs C. Association of parathyroid adenoma and familial hypocalciuric hypercalcaemia in a teenager. Eur J Endocrinol 2009; 161:207-10. [PMID: 19423559 DOI: 10.1530/eje-09-0257] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [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] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Familial hypocalciuric hypercalcaemia (FHH) is clinically characterized by mild to moderate parathyroid hormone (PTH)-dependent hypercalcaemia, autosomal dominant pattern of inheritance, and normal to frankly reduced urinary calcium excretion in spite of a high serum calcium (clearance (Ca)/clearance (Cr)<0.01). FHH has a benign course and should be differentiated from primary hyperparathyroidism. It is usually caused by a heterozygous loss-of-function mutation in the calcium-sensing receptor gene (CASR). DESIGN We report the case of a 16-year-old patient with hypercalcaemia and a mixed family history of parathyroid adenoma and mild hypercalcaemia. Serum calcium was 14 mg/dl with a serum iPTH of 253 pg/ml. RESULTS A neck 99mTc-sesta MIBI tomoscintigraphy showed a definite hyperactivity in the left upper quadrant. A surgical four-gland exploration confirmed a single parathyroid adenoma. After surgical resection of a left superior parathyroid adenoma, the patient's hypercalcemia improved but did not normalize, returning to a level typical of FHH. An inactivating mutation in exon 4 of the CASR gene, predicting a p.Glu297Lys amino acid substitution was found. CONCLUSIONS Thus, this 16-year old patient presented with the association of FHH and a single parathyroid adenoma. The young age of the patient and the association of parathyroid adenoma and FHH in his grandmother argue for a causal link between CASR mutation and parathyroid adenoma in this family. This case contributes to illustrate the expanding clinical spectrum of CASR loss-of-function mutations.
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Affiliation(s)
- C Brachet
- Pediatrics, Hôpital Universitaire des Enfants Reine Fabiola, U.L.B., 15, Avenue J.J. Crocq, 1020 Brussels, Belgium.
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Matrane A, Mariaule E, Martin P, Bergmann P. [Lower gastrointestinal bleeding: contribution of labeled erythrocytes scintigraphy]. Rev Med Brux 2009; 30:55-58. [PMID: 19353944] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The lower gastrointestinal bleeding is common and somewhat difficult to diagnose. Scintigraphy with 99mTc labeled erythrocytes is a non invasive procedure which allows to demonstrate bleeding and sometimes to locate its origin. We report the case of a 54 year-old patient admitted for repeated digestive bleeding with impaired haemodynamics. Initial radiological assessment including a gastroscopy, a colonoscopy, an angiography and an angio-CT, did not found any active origin of the bleeding. The red blood cells scan helped to localize the site of active bleeding. This investigation technique has taken a prominent position as it is non-invasive, harmless, easy to perform and its ability to detect intermittent bleeding.
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Affiliation(s)
- A Matrane
- Services de Médecine Nucléaire, C.H.U. Brugmann, Bruxelles.
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Bergmann P, Body JJ, Boonen S, Boutsen Y, Devogelaer JP, Goemaere S, Kaufman JM, Reginster JY, Gangji V. Evidence-based guidelines for the use of biochemical markers of bone turnover in the selection and monitoring of bisphosphonate treatment in osteoporosis: a consensus document of the Belgian Bone Club. Int J Clin Pract 2009; 63:19-26. [PMID: 19125989 PMCID: PMC2705815 DOI: 10.1111/j.1742-1241.2008.01911.x] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To review the clinical value of bone turnover markers (BTM), to initiate and/or monitor anti-resorptive treatment for osteoporosis compared with bone mineral density (BMD) and to evaluate suitable BTM and changes in BTM levels for significance of treatment efficiency. METHODOLOGY Consensus meeting generating guidelines for clinical practice after review and discussion of the randomised controlled trials or meta-analyses on the management of osteoporosis in postmenopausal women. RESULTS Although the correlation between BMD and BTM is statistically significant, BTM cannot be used as predictive markers of BMD in an individual patient. Both are independent predictors of fracture risk, but BTM can only be used as an additional risk factor in the decision to treat. Current data do not support the use of BTM to select the optimal treatment. However, they can be used to monitor treatment efficiency before BMD changes can be evaluated. Early changes in BTM can be used to measure the clinical efficacy of an anti-resorptive treatment and to reinforce patient compliance. DISCUSSION Determining a threshold of BTM reflecting an optimal long-term effect is not obvious. The objective should be the return to the premenopausal range and/or a decrease at least equal to the least significant change (30%). Preanalytical and analytical variability of BTM is an important limitation to their use. Serum C-terminal cross-linked telopeptide of type I collagen (CTX), procollagen 1 N terminal extension peptide and bone specific alkaline phosphatase (BSALP) appear to be the most suitable. CONCLUSION Consensus regarding the use of BTM resulted in guidelines for clinical practice. BMD determines the indication to treat osteoporosis. BTM reflect treatment efficiency and can be used to motivate patients to persist with their medication.
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Affiliation(s)
- P Bergmann
- Laboratory of Clinical Chemistry, CHU Brugmann, Université Libre de Bruxelles, Bruxelles, Belgium.
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Body JJ, Moreau M, Bergmann P, Paesmans M, Dekelver C, Lemaire ML. [Absolute risk fracture prediction by risk factors validation and survey of osteoporosis in a Brussels cohort followed during 10 years (FRISBEE study)]. Rev Med Brux 2008; 29:289-293. [PMID: 18949979] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Osteoporosis is a major public health problem. For the time being, the diagnosis of osteoporosis relies on densitometry (T-score < -2.5 by DXA), although the risk of fracture depends also on other factors than the bone mass. Osteoporosis diagnosis (DXA) must be distinguished from the individual risk assessment of fracture. Different risk factors complementary to bone mass have been already validated in different populations. These include an old age, a history of fracture after the age of 50, a familial history of hip fracture (father or mother), a low BMI (< 20), corticoid treatment (> 3 months), tabagism and excessive alcohol consumption. A WHO taskforce has combined these different factors in order to integrate them in a 10-years predictive risk model of fracture (FRAX**). This model should still be validated in different populations, especially in populations not included in its development, which is the case for Belgium. We are evaluating these different risk factors for fracture in a Brussels population of 5000 women (60-80 years) who will be followed each year during 10 years. We also assess the predictive value of other risk factors for fracture not included in the WHO model (tendency to fall, use of sleeping pills, early non substituted menopause, sedentarity, ...). In an interim analysis of the first 452 women included and with data yet available at the time of this writing, we could find a significant (P < 0.05) relationship between diagnosis of osteoporosis at DXA and the number of risk factors, age > 70 years, a personal history of fracture after 50 years and a BMI < 20.
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Affiliation(s)
- J J Body
- Service de Médecine Interne, C.H.U. Brugmann, Bruxelles.
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Bergmann P. [Clinical use of biological markers of bone turnover in osteoporosis]. Rev Med Brux 2008; 29:295-300. [PMID: 18949980] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Osteoporosis is "a systemic bone disease characterized by a decreased bone mass and altered bone architecture resulting in an increased propensity to fracture". It results from a rather long evolution where in most cases bone resorption is increased, and is not compensated by an equally increased bone formation. Besides the effect of this negative balance on bone mass, the increased resorption results in an increased cortical porosity and in trabecular perforations which alter bone resistance. The measurement of the apparent bone density (BMD) on which relies the diagnosis of osteoporosis cannot alone describe this situation. The measurement of the biochemical markers of bone turnover allows completing the picture; these markers appeared indeed as independent risk factors for fracture, independently of the BMD. Moreover, they allow following the early effects of treatments aiming to decrease bone resorption or to increase formation. This follow up is interesting because it allows controlling the treatment efficacy, which can be hampered by a low compliance. It allows also to predict the effect of treatment in terms of bone gain and fracture risk reduction, and to encourage the patient to persist with the treatment in the long run.
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Affiliation(s)
- P Bergmann
- Service de Diagnostic et de Traitement par Isotopes et Laboratoires de Chimie Clinique et de Médecine Expérimentale, C.H.U. Brugmann, Bruxelles.
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Devogelaer JP, Bergmann P, Body JJ, Boutsen Y, Goemaere S, Kaufman JM, Reginster JY, Rozenberg S, Boonen S. Management of patients with Paget's disease: a consensus document of the Belgian Bone Club. Osteoporos Int 2008; 19:1109-17. [PMID: 18504638 DOI: 10.1007/s00198-008-0629-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [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: 09/17/2007] [Accepted: 04/01/2008] [Indexed: 11/27/2022]
Abstract
Paget's disease of bone (PDB) is a potentially crippling condition. Pain, fracture, spinal stenosis, nerve entrapment, vascular steal syndrome, secondary osteoarthritis, bone deformity, dental problems, deafness, excessive bleeding during orthopaedic surgery, rare sarcomatous degeneration, and hypercalcaemia constitute complications that may impair the quality of life. The therapeutic approach varies from symptomatic (analgesics, anti-inflammatory drugs) to more specific drugs such as increasingly potent bisphosphonates. Studies such as the PRISM study should in the future help to determine the superiority or not of aggressive treatment over symptomatic treatment in the prevention of complications. Various oral and/or intravenous (i.v.) bisphosphonates have been tested and are currently on the market. The most recently available nitrogen-containing bisphosphonate, i.v. zoledronic acid, is the most potent therapy available for the treatment of PDB. Its therapeutic efficacy, its long-term effect on biologic activity and its good tolerance currently supports its use as a first-line therapeutic option in patients suffering from PDB.
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Affiliation(s)
- J-P Devogelaer
- Service de Rhumatologie, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, avenue Hippocrate 10, 1200 Brussels, Belgium.
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Huyge V, Flamen P, Bergmann P, Ameye L, Vanderlinden B, Garcia C, Alexiou J, Lemort M, Awada A, Body J. Whole body PET(CT) with FDG for treatment monitoring of patients with bone metastatic breast cancer. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.1088] [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: 11/20/2022] Open
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Affiliation(s)
- M Metz
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Charitéplatz, Berlin, Germany
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Lipská L, Visokai V, Bergmann P, Trubac M, Cech P, Strupová L, Levý M. [Colorectal carcinoma as a cause of acute abdominal illness]. Rozhl Chir 2008; 87:10-15. [PMID: 18432070] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Colorectal carcinoma (KCR) is the commonest malignancy in male patients and the second commonest in female patients in the Czech Republic. During 1990-2006, 1162 patients with colorectal carcinomas were operated in the FTNsP (Faculty Thomayer Hospital) Surgical Clinic. 212 patients aged between 39 to 94 y.o.a.(the median of 70 y.o.a) were managed urgently for acute abdominal illness. In this group of urgently managed patients, the mortality rate was 17% and the morbidity rate was 38%. Future prospects of any colorectal carcinoma patient with acute abdominal illness depend on the procedure's radicality, which is limited by the overall patient's condition. The preoperative care aims to improve the patient's overall condition to such a degree, to allow for surgery fulfilling principles of oncosurgical radicality. According to this report's data, such urgent surgical procedures do not result in increased mortality or morbidity rates, compared to these in planned procedures, and show the best results in this patient group.
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Affiliation(s)
- L Lipská
- Chirurgická klinika 1. lékarské fakulty UK a Fakultní Thomayerovy nemocnice, Praha.
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