[Study of bone mineral density in adolescent handball players: about a study of 20 cases]

The physical activity during adolescence seems to correlate with bone mass at the end of the growth period. To determine the effect of handball regularly practiced by teenage girls on the anthropometric parameters and bone mineral density. Cross-sectional case-control, made in the rheumatology department of the Rabta hospital, has enrolled adolescent handball players of high level, which were compared to a control group matched by age and sex, but sedentary. We evaluated our two groups for anthropometric parameters and BMD. The lean mass [LM], fat mass [FM], the mean values of BMD at the lumbar spine and femur of our sports were significantly higher than that of sedentary controls. On bone mineral content [BMC], a statistically significant difference was observed between groups of sedentary and athletic teenagers. Positive and significant correlations were found between anthropometric parameters and measurements of BMD, BMC and of bone area. The regular practice of handball seems to be an osteogenic factor. It may be advisable in adolescents during the growth period to optimize the bone

[Bone metabolism, biochemical markers of bone resorption and formation processes and interleukine 6 cytokin level during coeliac disease]

Celiac disease [CD] is characterized by a malabsorption syndrom. The bone anomalies are one of the principal complications of this disease. The osteoporosis frequency is high: 3.4% among patients having with CD versus 0.2% in the general population. To study the bone mineral density during the CD, to compare it to a control group and to determine the anomalies of biochemical markers of bone turn over and level of interleukin 6 cytokin [IL6] in these patients. All patients with CD have a measurement of bone mineral density by dual-energy x-ray absorptiometry [DXA], a biological exam with dosing calcemia, vitamin D, parathormone [PTH], the osteoblastic bone formation markers [serum osteocalcin, ALP phosphates alkaline], bone osteoclastic activity [C T‚lopeptide: CTX] and of the IL6. 42 patients were included, with a median age of 33.6 years. 52. 8% of the patients had a low level of D vitamine associated to a high level of PTH. An osteoporosis was noted in 21.5% of patients. No case of osteoporosis was detected in the control group. The mean level of the CTX, ost‚ocalcine and the IL6 was higher among patients having an osteoporosis or ost‚openia compared to patients with normal bone [p = 0,017]. The factors associated with an bone loss [osteopenia or osteoporosis] were: an age > 30 years, a weight < 50 kg, a level of ALP phosphates alkaline > 90 UI/ml, an hypo albuminemia < 40 g/l and a level of CTX higher than 1.2. Our study confirms the impact of the CD on the bone mineral statute. The relative risk to have an osteopenia or an osteoporosis was 5 in our series. The measurement of the osseous mineral density would be indicated among patients having a CD

[Usefulness of magnetic resonance imaging in the diagnosis of early rheumatoid arthritis: a prospective study about 20 cases]

Diagnosing early rheumatoid arthritis is difficult and radiographic signs are often late. MRI detects erosions at an early stage and visualizes synovitis, bone edema and tenosynovitis. To assess the value of MRI for diagnosis of early forms of rheumatoid arthritis. Prospective study involving 20 patients who had non erosive rheumatoid arthritis lasting for less than 2 years. MRI of the hand was performed by sequences coronal and axial T1-weighted, T2 with saturated fat signal [FatSat] FatSat and T1 with gadolinium injection. The median age of patients was 52 years and sex ratio M/F of 0.05. The median disease duration was 9 months. Ten patients had antibodies Anti-Cyclic citrullinated protein positive. The MRI was abnormal in 75% of patients. This review found 36 erosions which 50% were in carpal bones, 55 joints with synovitis mainly localized midcarpal and metacarpophalangeal. Bone edema was found mainly in carpal bones. Tenosynovitis affected most frequently the flexor tendons. Seventy percent of patients without anti-Cyclic citrullinated protein had a pathological MRI. MRI has an important role in detecting infraradiological lesions in early RA. This contributes to early diagnosis and initiation effective treatment

[Pathophysiology of complex regional pain syndrome [CRPS] type 1]

If the pathophysiology of complex regional pain syndrome [CRPS] type 1 remains controversial, most authors agree on a combination in varying proportions, a sensitization of peripheral nerves. To describe the state of advances in the physiopathology of complex regional pain syndrome type 1. Bibliographic research and literature review performed by referring to databases [Medline, Science Direct]. The physiopathology of complex regional pain syndrometype 1 remains still poorly understood and controversial. Several arguments demonstrated both peripheral [inflammation, abnormal sympathetic ...] and central [neurological and cognitive] mechanisms. A better knowledge of the physiopathology of complex pain syndrome type 1 is necessary in order to adapt efficient curative therapy or to a better prevention of this syndrome

[Effect of inhaled corticosteroids on bone mineral density in asthmatic adults: a 20 cases study]

Inhaled corticosteroids are widely used in the treatment of asthma but their safety on bone density is controversial. To study in a population of adults with asthma receiving inhaled corticosteroids for long term, the effect of this therapy on bone mineral density. Prospective study including 20 asthmatics, aged from 20 to 45 years, treated with inhaled corticosteroids for 12 months or more, with no risk factors for osteoporosis. We compared osteodensitometric parameters in our patients, bone mass and T-score at vertebral and femoral witness to a population matched by age and sex. The average age of our patients was 35.45 +/- 5.43 years and the average BMI was 30.03 +/- 5.77 kg/m2. The average daily dose of corticosteroid was 925 +/- 133.27g of equivalent of beclometasone with an average take of 33.5 +/- 21.3 months. The vertebral site bone mass average was 1216 +/- 0106 g/cm2 in the studied group and 1201 +/- 0099 g/cm2 in the control group without significant difference [p = 0380]. At femur, the bone mass average was 1037 +/- 0143 g/cm2 in the patient group and 1056 +/- 0107 g/cm2 in the control group [p = 0380]. We did not find a significant link between bone mineral density and cumulative dose or the duration of taking inhaled corticosteroids, BMI and tobacco. Our work confirms like other previous studies the safety of inhaled corticosteroids on bone mineral density

[Rheumatic manifestations of genetic hemochromatosis]

Rheumatic manifestations of genetic hemochromatosis are frequent with axial or peripheral arthropathies [mono-, oligo- or polyarticular]. These manifestations are characterized by articular damage and osteoporosis. To review the rheumatic manifestations of genetic hemochromatosis. A narrative review of literature. The diagnosis should be brought to mind when we discover arthropathy resembling degenerative joint disease with involvement of unusual articular sites, almost identical to the arthropathy in calcium pyrophosphate dihydrate crystals deposition disease [chondrocalcinosis]. There is a significant bone loss in HC that cannot solely be explained by hypogonadism or cirrhosis and must lead to measure bone mass density to each patient with HC

C telopeptides of type I collagen inpostmenopausal women: an experience in a Tunisian clinical laboratory

The purpose of study was to evaluate the interest of C-telopeptides of type I collagen [CTX] in the diagnosis of osteoporosis in postmenopausal women and to define its cut-off value. A transverse descriptive study enrolled postmenopausal women: 139 osteoporotic [G1] and 39 non osteoporotic [G2]. The 2 groups were defined by bone density measurement. The followmg markers were measured: serum alkaline phosphatase [ALP] bone alkaline phosphatase [bone ALP], serum C-terminal telopeptide of type I collagen [CTX]. Statistical analyses were performed using SPSS 10, 5. The corresponding estimation of sensitivity and specificity of CTX have been presented as receiver Operating Curve [ROC]. There was no difference in the measurement of ALP and bone ALP in the 2 groups but CTX was statistically higher in G1 compared to G2 [p<0.001]. The percentage of osteoporotic women [G1] with CTX values>0.500 ng/ml was higher than that of non osteoporotic women [G2]. We have established a ROC curve to find the cut-off value of CTX that enables the distinction between osteoporotic women with high level of bone remodelling, and non osteoporotic women. The cut-off value of CTX 0.55 pg/mi was the best; it associated best sensitivity and specificity. The total increase and significance for CTX was greater in the group of osteoporotic women and appeared therefore to be a good bone turnover marker in the diagnosis of osteoporosis in comparison with ALP and bone ALP. The cut-off value of CTX 0.55 pg/mi may improve the sensitivity and specificity of prediction of future fractures

[Hypovitaminosis D in Tunisian osteoporotic post menopausal women and its relationship with bone fracture]

The purpose of this study is to evaluate the frequency of hypovitaminosis D in Tunisian osteoporotic women and to search an eventual association between vitamin D status and the fracture risk. A transverse descriptive study enrolled 134 osteoporotic menopausal women aged 50 years or more. We measured calcium, phosphorus, albumin, alkaline phosphatase, creatinine and 25 hydroxyvitamin D [25 [OH] vit D]. Bone mineral density [BMD] was measured for all and osteoporotic women were defined for a T-score of -2,5 or less in the spine, hip or femoral neck .Two groups were defined: G1 with fracture and G2 without fracture .We used SPSS 10.5, X2 tests and a statistical significance level of p< 0,05. Women in G1 [n= 102] were more aged than those in G2 [n= 32] and their menopause was more ancient. Hypovitaminosis D was found in 45,2% of all women, respectively in 50,98% of G1 and 25% of G2. The mean level of vitamin D was more important in G2 [27,5+ 15,1 vs 21,3 + 12,8 ng/ml; p=0,002]. BMD in femoral and lumbar were statistically lower when fractures are present [p< 0,001]. Our study shows that women with hypovitaminosis D [vit D < 20 ng/ml] are prone to osteoporotic fractures. All fracture in community in menopausal women, should be assessed with BMD and screening for 25 [OH] vit D. Increasing life expectancy in our country suggests that this public health problem will grow in the years to come, pointing out the importance of better management of osteoporosis and hypovitaminosis D to prevent fractures

[Effects of risedronate on bone turnover markers in osteoporotic postmenopausal women: comparison of two protocols of treatment]

Bisphosphonates are powerful agents able to prevent bone loss. The objective of the study was to evaluate the efficacy and tolerability of risedronate once a week [35 mg] compared with risedronate 5 mg once daily in women with osteoporosis. A randomized, double-blind, active controlled study enrolled 102 postmenopausal women aged 66.5+7.5 years with osteoporotic fractures. All women received risedronate during 6 months. Group 1 [G1, n=51] received risedronate 5 mg once daily and group 2 [G2, n=51] received 35 mg once a week. Serum alkaline phosphatase [ALP], bone alkaline phosphatase [bone ALP], serum C-terminal telopeptide of type I collagen [CTX] were measured at baseline, 3 months and 6 months after treatment in the two groups. We noted no significant difference in markers between women of the 2 groups. After 3 months, bone ALP and CTX decreased [respectively -22.1% and -47.6%] in the 2 groups with no significant difference between them. After 6 months study, bone ALP and CTX decreased respectively by -46.5% and -62.9% with no statistically significant difference between study groups for bone markers. Our study found that treatment with once weekly risedronate 35 mg is able to decrease CTX and bone ALP compared with risedronate 5 mg once daily, in postmenopausal women with osteoporotic fractures. We didn't find adverse events with the 35 mg once a-week dose group compared to the once-daily dose group. Based on these results, the effects of risedronate 35 mg once a week are similar in efficacy to daily dosing and may lead less adverse events than once-a month dose. This therapeutic protocol may provide an alternative for patients who prefer once a week oral dosing

Effects of risedronate on bone turnover markers in osteoporotic postmenopausal women: comparison of two protocols of treatment

Bisphosphonates are powerful agents able to prevent bone loss. The objective of the study was to evaluate the efficacy and tolerability of risedronate once a week [35 mg]-compared with risedronate 5 mg once daily in women with osteoporosis. A randomized, double-blind, active-controlled study enrolled 102 postmenopausal women aged 66.5_7.5 years with osteoporotic fractures. All women received risedronate during 6 months. Group 1 [G1, n=5 1] received risedronate 5 mg once daily and group 2 [G2, n=51] received 35 mg once a week. Serum alkaline phosphatase [ALP], bone alkaline phosphatase [bone ALP], serum C-terminal telopeptide of type I collagen [CTX] were measured at baseline, 3 months and 6 months after treatment in the two groups. We noted no significant difference in markers between women of the 2 groups. After 3 months, bone ALP and CTX decreased [respectively-22.1%and-47.6%] in the 2 groups with no significant difference between them. After 6 months study, bone ALP and CTX decreased respectively by-46.5%and-62.9%with no statistically significant difference between study groups for bone markers. Our study found that treatment with once weekly risedronate 35 mg is able to decrease CTX and bone ALP compared with risedronate 5 mg once daily, in postmenopausal women with osteoporotic fractures. We didn't find adverse events with the 35 mg once-a-week dose group compared to the once-daily dose group. Based on these results, the effects of risedronate 35 mg once a week are similar in efficacy to daily dosing and may lead less adverse events than once-a-month dose. This therapeutic protocol may provide an alternative for patients who prefer once-a-week oral dosing

[Enzyme replacement therapy for gaucher pardiatric disease: the only Tunisian Experience]

We report through the first Tunisian experience with enzyme replacement therapy, the goals and consensus recommendations for treatment and monitoring of paediatric non neuronopathic Gaucher disease. Three children with Gaucher disease undergone enzyme replacement therapy with Cerezyme for severe visceral and/or bone involvement. Visceral, hematologic, bone, and growth parameters were assessed initially and under treatment. Two children presented with severe visceral or hematologic picture. One patient had myocardiopathy and primitive portal hypertension and another was diagnosed with cirrhosis related to Gaucher disease. Recurrent avascular necrosis and osteoporosis have justified treatment in another child. All patients received an initial dose of 60U/Kg/2 weeks. We have seen a gradual disappearance of hepatosplenomegaly and a rapid normalisation of hematological parameters in two patients. A resistance to treatment indicated splenectomy in one patient. The improvement in bone mineral density was slower. A significant growth gain was observed in patients with growth retardation. No patient had developed Cerezyme antibodies. Despite its effectiveness and safety demonstrated in these children, enzyme replacement therapy remains inaccessible because of its cost for emerging countries. The allogeneic bone marrow is an alternative therapy to encourage and to propose precociously for severe paediatric forms of Gaucher disease

[Stress facture: epidemiology, physiopathology and risk factors]

The aim of this paper is to give an overview on the scientific information related to stress fracture risk factors. We searched the Medline and Embase databases using the keywords stress fracture, risk factors and bone microarchitecture. Only French and English articles were included and 52 were chosen because they corresponded to literary reviews, prospective and retrospective studies concerning individuals who participate in athletics, in military recruits or civil. Stress factures are common injuries in individuals who participate in athletics, in military recruits. Stress fractures of the lower extremity most commonly involve the tibia. A stress fracture represents the inability of the skeleton to withstand repetitive bouts of mechanical loading. To prevent stress fractures, an appreciation of their risk factors is required. Risk factors include intrinsic risk factors such as female gender, amenorrhea, lower bone density, inadequate muscle function and biomechanical features as well as extrinsic risk factors such as overtraining program, inadequate equipment and the energetic nutrition deficit. The coexistence of different risk factors makes so difficult the isolation of etiologic variables Several risk factors have been comprehensively assessed in numerous studies. Hence, to date, there is still no general screening tool available to identify individuals at risk. Bone texture analysis seems to offer new prospects in the identification of stress fracture susceptibility

[ interest of biochemical markers of bone turnover for monitoring treatment of postmenopausal osteoporosis]

Postmenopausal osteoporosis is especially female pathology, whose incidence increases with age. The purposes of this study are to evaluate the level of bone turnover by the determination of markers of bone formation [PAL, BAP] and marker of bone resorption [CTX] in the osteoporotic women, to study the correlations between bone biochemical markers, clinical parameters and radiological measurements and to assess the interest of biochemical markers in therapeutic monitoring after 6 months of antiresorptive treatment. The authors report a prospective study of 134 osteoporotic women classified in two groups according to the presence of osteoporotic fracture. Patients of the first group G[1] [n=102] with fractures, were treated by the bisphosphonates [risedronate], whereas the ones of the second group G[2] [n=32] without fractures, were submited to calcic supplementation and vitamin D. The analyses showed that the femoral and lumbar BMD were statistically lower in the presence of osteoporotic fractures. However, the values of CTX were statistically higher in the patients of G[1] group compared to those of the G[2] group [0,708 +/- 0,332 mg/ml versus 0,514 +/- 0,225 mg/ml]. The CTX were statistically correlated with the femoral and lumbar BMD [r = -0,21, p<0,05 and r = -0,348, p<0,001]. The hypovitminosis were observed in 50,98% [52/102] of women with osteoporotic fractures, whereas it was only 25% [8/32] in women without fractures. After 6 months of treatment by the bisphosphonates, the PAL, the BAP and the CTX have decreased with an average of, respectively, 19%, 46,5% and 62,9%. These variations were significantly more important in G[1] group. The biochemical markers of bone turnover, in particular those of the resorption [CTX], can predict the post-menopausal woman's bone loss evaluated by BMD, the risk of fractures and the efficiency of the bone treatments

synovirthesis: a reappraisal

The evolution of the rheumatologic practice involved a handing-over in question of the place and methods of application of the synoviorthesis. The last innovations, in particular the appearance of the biotherapies, allowed a better control of inflammatory rheumatisms thus making it possible to better select arthritis likely to profit precociously from a synoviorthesis before the installation of major articular destruction. Through a general review of the literature, we recall in this work the various means of synoviorthesis, their current indications and their results. An extensive electronic search of the relevant literature was carried out using medline. Key words used for the final search were: synoviorthesis, osmical acid, radiosynoviorthesis, arthritis, traitment. this systematique review allowed us to conclude that fields of application of the synoviorthesis is in addition widens because of the interesting results to see spectacular this technique in some other affections such as the haemophilia. In addition we have compared the efficiency and the tolerance of the different methods of synoviorthesis. The synoviorthesis constitutes a tempting therapeutic alternative of share its effectiveness and its good tolerance so much so that it constitutes an undeniable factor of articular protection. Its fields of application widened. Thus on the good knowledge of the indications and the precautions necessary to its realization its success willdepend