Effectiveness of Osteoporosis Drug in Postmenopausal Women with Spinal Compression Fracture: Combined Consecutive Therapy of Teriparatide and Raloxifene versus Bisphosphonate Single / 대한신경손상학회지

OBJECTIVE: Bisphosphonate, a typical bone resorption inhibitor, is an important first-line drug for treating osteoporosis. Recent studies show a novel paradigm in stimulating bone formation. Teriparatide, which is composed of recombinant human parathyroid hormone, stimulates osteoblasts and induces bone regeneration. Bone mineral density (BMD) that was used before and after the treatment with anti-osteoporosis drug was compared for the effectiveness in therapy between a combination of teriparatide and selective estrogen receptor modulator (SERM), and bisphosphonate. METHODS: We retrospectively reviewed the outcomes of 85 postmenopausal women who were concurrently diagnosed with osteoporosis and spinal compression fracture between November 2008 and January 2015. The targeted group were treated with teriparatide and SERM (TS group, n=26) and bisphosphonate (B group, n=59). RESULTS: In both groups, BMD of femur neck was not improved after the medication. In the TS group, on the other hand the BMD and T-score of lumbar spine has significantly improved. BMD ratio of lumbar spine was prominently higher than those of TS group. CONCLUSION: The combination therapy of teriparatide and SERM was very effective in treating the lumbar spine, compared to that of bisphosphonate. Although the period of teriparatide treatment has been relatively short, the preventive effects of compression fracture were considerable. Thus, combination therapy of teriparatide and SERM is highly recommended for patients who are concerned with spinal compression fracture from osteoporosis.

Risk Factors of Chronic Subdural Hematoma Progression after Conservative Management of Cases with Initially Acute Subdural Hematoma / 대한신경손상학회지

OBJECTIVE: Acute subdural hematoma (ASDH) patients are treated conservatively or surgically according to the guidelines for surgical treatment. Many patients with thin ASDH and mild neurologic deficit are managed conservatively, but sometimes aggravation of thin ASDH to chronic subdural hematoma (CSDH) results in exacerbated clinical symtoms and consequently requires surgery. The aim of this study is to evaluate risk factors that indicate progression of initially non-operated ASDH to CSDH. METHODS: We divided 177 patients, presenting with ASDH (managed conservatively initially) between January 2008 to December 2013, into two groups; 'CSDH progression group' (n=16) and 'non-CSDH progression group' (n=161). Patient's data including age, sex, past medical history, medication were collected and brain computed tomography was used for radiologic analysis. RESULTS: Our data demonstrated that no significant intergroup difference with respect to age, sex ratio, co-morbid conditions, medication history, ischemic heart disease, liver disease and end-stage renal disease was found. However, Hounsfield unit (hematoma density) and mixed density was higher in the 'ASDH progression group' (67.50+/-7.63) than in the 'non-CSDH progression group' (61.53+/-10.69) (p=0.031). Midline shifting and hematoma depth in the 'CSDH progression group' were significantly greater than the 'non-CSDH progression group' (p=0.067, p=0.005). CONCLUSION: Based on the results of this study, the risk factors that are related to progression of initially non-operated ASDH to CSDH are higher Hounsfield unit and hematoma depth. Therefore, we suggest that ASDH patients, who have bigger hematoma depth and higher Hounsfield unit, should be monitored and managed carefully during the follow-up period.