Urinary bone resorption markers (deoxypyridinoline and C-terminal telopeptide of type I collagen) in healthy persons, postmenopausal osteoporosis and patients with type I diabetes.

PURPOSE: Deoxypyridinoline (DPD) is a derivative of hydroxypyridinium, which is released during bone resorption into the blood stream and is eliminated unmodified with urine. A further collagen-derived marker of bone resorption is the C-terminal telopeptide of type I collagen (beta-CTX-I, here abbreviated as CTX), which is released in bone resorption and almost entirely excreted by the kidneys. The aim of our study was to investigate different well-described patient groups as well as normal probands in view of differences and expected correlations of these two parameters: patients with insulin-dependent diabetes mellitus, postmenopausal women with osteoporosis and healthy control persons. MATERIALS AND METHODS: We used a solid-phase chemiluminescence enzyme immunoassay (Pyrilinks D-IMMULITE) for urinary DPD measurement and for the assessment of urinary CTX we used a quantitative ELISA (Osteometer Biotec A-S, CrossLaps ELISA). RESULTS: We found a highly significant correlation between both parameters in the group of healthy persons (r = 0.75, p < 0.05, n = 28) as well as in the group of patients with diabetes mellitus type I (r = 0.79, p < 0.05, n = 65). Also, a significant correlation was observed between DPD and CTX (r = 0.583, p < 0.05, n = 88) in the group of female osteoporotic patients. CONCLUSIONS: Despite good correlations between DPD and CTX in all of the investigated groups, these urinary markers were of limited diagnostic significance in the group of postmenopausal osteoporosis due to a wide spread (few patients showed concentrations above the range of healthy persons) in this newly diagnosed drug-naïve patient collective.

Evaluation of human fibroblast growth factor 23 (FGF-23) C-terminal and intact enzyme-linked immunosorbent-assays in end-stage renal disease patients.

Hyperphosphataemia, calcitriol deficency and secondary hyperparathyroidism (sHPT) are common complications in end-stage chronic kidney diseases (CKD). Fibroblast Growth Factor 23 (FGF-23) is a phosphaturic peptide, secreted by the osteoblast precursors, that also inhibits renal 1-alpha-hydroxylase activitiy and tubular phosphate reabsorption by the inhibition of sodium-dependant renal phosphate transport (Na-Pi-IIa). Consequences are a decreaese of serum 1,25 dihydroxyvitamin D3 and phosphaturia. Therefore, FGF-23 plays a role in hyperphosphataemia in association with CKD and may be involved in the pathogenesis of sHPT. Increased FGF-23 may contribute to maintaining a normal serum phoshpate level in face of a processing CKD, but if the creatinine clearance is reduced to lower than 30 ml/min the capacity of this regulative mechanism ends and hyperphosphataemia results. In our investigation of end-stage renal diseases markedly increased serum FGF-23, associated with hyperphosphataemia, phosphaturia and decreased serum calcitriol and sHPT, were found. Furthermore preanalytical testing for the stability of FGF-23 was performed by comparing samples which were stored at -20 degrees C with samples that have been stored for 6 days at +4 degrees C. The simultaneous investigation of serum and EDTA plasma FGF-23 certifies the advantage of EDTA plasma in subjects with an intact renal function.

Orthopaedic limb salvage with a mega prosthesis in a patient with haemophilia A and inhibitors - a case report.

Inhibitors against FVIII or FIX in patients with haemophilia are a common and serious complication. Until recently, elective surgery was associated with major bleeding despite the availability of a sufficient substitution therapy. We report about the major orthopaedic reconstruction of the right limb in a patient with severe haemophilia A and inhibitors. This reconstruction was the after effect of a traumatic periprosthetic fracture of the right femur after total knee replacement 6 months ago. This fracture could be stabilized by internal fixation. Two months later, a non-traumatic femur fracture occurred. Therefore, we removed the distal part of the femur and the joint replacement, and implanted a custom made tumour prosthesis (Type MUTARS (c), Münster). These three successive operations, which included emergency and elective surgery, were performed within 8 months. This is, to the best of our knowledge, the first patient with inhibitors undergoing such a complicated reconstruction of a limb. We conclude that successful elective orthopaedic surgery could be accomplished safely in this patient with high responding inhibitors using recombinant FVIIa. After a follow-up of 9 months, no major complications were seen.

Pregnancy-associated osteoporosis: an underestimated and underdiagnosed severe disease. A review of two cases in short- and long-term follow-up.

Pregnancy-associated osteoporosis is an uncommon condition characterized by the occurrence of painful fractures during late pregnancy or lactation. To date the pathophysiology of this entity of bone disorder is still uncertain, and its therapeutical management is poorly defined. We report two clinical cases: a 10-years follow-up with pain medication and intermittent antiresorptive therapy courses, subsequent traumatic vertebral fracture and actually fracture of scaphoid after inadequate trauma. Beside this long-term course a young female patient with pregnancy-associated osteoporosis and painful lumbar and also thoracic vertebral fractures is described. She was treated with an osteoanabolic therapy, at the timepoint of first follow-up at 6 months of treatment a solid increase of bone mineral density and sustained pain reduction was observed.

[DVO guideline 2006. What changes have there been in the diagnosis, prevention and treatment of osteoporosis?]. / DVO-Leitlinie 2006. Was hat sich geändert in der Diagnostik, Präention und Therapie der Osteoporose?

The main changes in the updated DVO guideline 2006 on prevention, diagnosis and treatment of osteoporosis in postmenopausal women and in older men concern the evaluation of individual fracture risks and the selection of medicamentous therapy by means of new thresholds. A 30% risk of osteoporotic vertebral or hip fracture per decade is recommended as the threshold for implementation of pharmacological therapy. Evaluation of the individual absolute fracture risk is based on a combination of the results of densitometry at the lumbar spine and femur, age, gender, and other risk factors that are specifically associated with osteoporosis. Patient's mobility is assessed by carrying out special mobility tests. Further changes seen in the 2006 update of the DVO guideline are therapy proposals taking account of new pharmaceutical developments. New effective medications are rh-PTH (1-34), or teriparatide, strontium ranelate, and ibandronate (bisphosphonate) for monthly oral administration. Minimally invasive operative techniques for use in vertebral fractures in combination with medicamentous antiosteoporosis therapy are also included in the 2006 update of the DVO guideline. Thus, in the 2006 update of the DVO-guideline we have a practice-oriented 53 guideline that is adapted to individual fracture risk and gives recommendations on the prevention, diagnosis and treatment of osteoporosis.