Structural, densitometric and biomechanical evaluations of Chinese patients with long-term bisphosphonate treatment / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The association of long-term bisphosphonate treatment for osteoporosis and related safety problems such as atypical fractures were not clearly defined. This study was to evaluate the structural, densitometric and biomechanical properties of the prolonged bisphosphonate-loaded bones.</p><p><b>METHODS</b>Bone mineral density (BMD) at hip and femoral midshaft, bone cross-sectional area, moment of inertia of both femurs, bone formation and resorption biochemical markers were compared between 28 elderly with at least 4 years of bisphosphonate treatment from 2002 through 2006 and age-matched group of 37 elderly.</p><p><b>RESULTS</b>The total hip BMD and t-score were found not different between two groups. However, bisphosphonate treated patients were found to have significantly lower bone mineral content in the femoral shaft (P < 0.05); morphological study showed lower cross-sectional area in subtrochanteric and mid-diaphyseal region and thus significantly lower moment of inertia (P < 0.01). High resolution-peripheral quantitative computed tomography showed significantly decreased trabecular density, bone volume ratio, trabecular number but increased trabecular spacing in tibia and distal radius. Finite element analysis further confirmed significantly lower stiffness and failure load in tibia. Biochemical studies also showed lower bone resorption and severely suppressed bone formation activity (P < 0.001).</p><p><b>CONCLUSIONS</b>The unchanged total hip BMD between two groups confirmed the beneficial effects of bisphosphonate on trabecular bone, thus preventing osteoporotic fractures at large in previous studies. However, the inferior structural, densitometric and biomechanical properties at cortical bones, especially femur midshaft, need a special attention to look into the association between long-term bisphosphonate intake and the occurrence of stress fractures. When patients taking bisphosphonate complain of proximal thigh pain or discomfort, plain X-ray film can be the first line screening. All patients prescribed with bisphosphonate should be informed of such a complication though we must stress its rarity.</p>

Outcomes and satisfaction of patients with orthopaedic implants left in-situ for more than three years: a retrospective study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>There are no clear guidelines on implant removal. Few have assessed the long-term outcomes of patients with implants left in-situ, or removed. Therefore, removal of implants after fracture fixation remains controversial.</p><p><b>METHODS</b>In this retrospective study, we reviewed 53 patients with implant for fracture fixation in-situ for more than 3 years. All patients were younger than 60 years. Quality of life of each patient was assessed with the Chinese (Hong Kong) validated Short Form-36 and the pain was assessed with visual analogue scale (VAS). All patients were clinically examined and plain radiographs were taken.</p><p><b>RESULTS</b>The total SF-36 score of the patients was not statistically different from the Hong Kong norm (P > 0.05). Mean score of VAS was 2.08. Thirty-three patients (62.3%) reported limited range of movement, 9 patients (17%) complained of cosmetic problems, and 10 patients (18.9%) complained of weakness. Clinically, 82.6% of patients had no scarring, 84.7% of patients had full range of movement and all had no tenderness on assessment. Radiologically, no abnormality was detected except for one patient with known avascular necrosis of the femoral head after screw fixation.</p><p><b>CONCLUSION</b>As most patients were clinically and radiologically normal with quality of life scores comparable to the norm, removal of implants is not advisable as a routine practice.</p>

Type IIB human skeletal muscle fibers positively correlate with bone mineral density irrespective to age / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Age-associated decrease in type IIA/B human skeletal muscle fibers was detected in human biopsies in our previous study. The relationship between change in muscle fiber typing and bone mineral density (BMD) is, however, unknown either cross-sectionally or longitudinally. We therefore conducted a cross-sectional study to investigate their correlation using human muscle biopsies.</p><p><b>METHODS</b>Forty human subjects aged (53.4 ± 20.2) years were recruited. Histomorphometric parameters of their muscle biopsies were measured by ATPase staining and image analysis, including average area percentage, fiber number percentage, mean fiber area, and area percentage of connective tissues. Hip and spine BMD was measured by dual-energy X-ray absorptiometry. Partial correlation with adjusting age was performed.</p><p><b>RESULTS</b>Type IIB muscle fiber was found positively correlated with hip BMD irrespective to age and demonstrated significantly stronger relationship with BMD among all fiber types, in terms of its cross-sectional area (r = 0.380, P = 0.029) and size (r = 0.389, P = 0.025). Type IIA muscle fibers associated with hip BMD in mean fiber area only (r = 0.420, P = 0.015).</p><p><b>CONCLUSIONS</b>Type IIB muscle fiber may play an important role in maintaining bone quality. This may also be a relatively more sensitive fiber type of sarcopenia and osteoporosis. These findings further consolidate the muscle-bone relationship.</p>