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Osteoporosis
Published in Jason Liebowitz, Philip Seo, David Hellmann, Michael Zeide, Clinical Innovation in Rheumatology, 2023
Mazen Nasrallah, Marcy B. Bolster
Although not new within the past 10 ten years, DXA scans provide the gold standard for patient assessment for osteoporosis. Imaging by DXA scan received FDA approval for bone mineral density measurement in 1988 and represents the most widely used tool for measuring bone density. In DXA, two photon beams with different energies are used to measure the bone mineral content (BMC) and area of mineralized bone (BA). Measurements are typically made in the hip and lumbar spine, though can be performed at other body regions. The BMC is then divided by the BA to calculate a bone mineral density (BMD). Advantages of this technique include low cost, broad accessibility, ease of use, accuracy, and low radiation exposure. Drawbacks to this include underestimation of BMD in slim individuals (as a two-dimensional scanning technique, it cannot estimate the depth or posteroanterior length of the bone) and overestimation of bone density when a bone spur (common in degenerative disease of spine) is captured in the scanning field.2
Bone Health
Published in Carolyn Torkelson, Catherine Marienau, Beyond Menopause, 2023
Carolyn Torkelson, Catherine Marienau
Professional societies and the U.S. Preventive Services Task Force universally recommend routine osteoporosis screening with BMD testing for women 65 and older. Consider screening earlier than age 65 if you have any risk factors such as low body weight, parental history of hip fracture, and/or a smoking history. However, Medicare doesn’t typically start covering the cost of screening DXA tests until age 65, so you may need to advocate for earlier screening if you have risk factors.
Osteoporotic thoracolumbar fractures
Published in Peter V. Giannoudis, Thomas A. Einhorn, Surgical and Medical Treatment of Osteoporosis, 2020
Sustaining a vertebral fragility fracture increases the risk of another vertebral fracture fourfold and any other fracture twofold (99). Therefore, effective secondary prevention is needed to minimize this risk. With each subsequent fracture, there tends to be an associated increase in morbidity (100). An effective exercise program to reduce the risk of falls and fractures will minimize this risk. Other nonpharmacologic strategies to improve bone mineral density and minimize future fracture risk include stopping smoking and excessive consumption of alcohol; maintaining a well-balanced diet that is rich in calcium and vitamin D; ensuring adequate sunlight exposure; and promoting regular exercise with a focus on exercises that promote weight-bearing (101).
Management of cervical fractures in ankylosing spondylitis patients: immediate fixation effort via vertebroplasty with one-staged combined anterior and posterior fixation
Published in British Journal of Neurosurgery, 2023
Ming-Fai Tse, Yi-Hsin Tsai, Lin-Hsue Yang, Fu-Shan Jaw, Che-Kuang Lin
Spine fractures can develop in ankylosing spondylitis (AS) patients, even as a result of minor trauma, due to the associated altered vertebral bone composition and biomechanics. A previous study has shown that patients with AS have a four-fold higher risk of fracture during their lifetime than the healthy population.1 Osteoporosis or relevant low bone mineral density are reported in up to 62% of AS patients.2,3 Ectopic bone formation4 and osteopenia5 are two pathological pathways that account for the elevated fracture risk. The majority of fractures are located in the cervical spine, particularly the lower cervical spine or the cervicothoracic junction.6–18 The fractures of the ankylosed spine often involve through the anterior column to the posterior column, along with the fractures of ossified anterior and posterior ligamentous complexes and the surrounding tissue. For such cervical instability that lack of the usual stabilizing ligamentous support increases the demand of mechanical stabilization with fixation devices.6,9,11,17
Effectiveness of Physical Therapy Interventions in Children with Brachial Plexus Birth Injury: A Systematic Review
Published in Developmental Neurorehabilitation, 2023
Mariana Aguiar de Matos, Deisiane Oliveira Souto, Bruno Alvarenga Soares, Vinícius Cunha de Oliveira, Hércules Ribeiro Leite, Ana Cristina Resende Camargos
Some interventions, such as weight bearing exercises were applied in the experimental and/or control group.7,23–26 Weight bearing exercise programs have been used to promote bone mineral density.26 It is a hypothetical mechanism, but the increase in bone mass due to the result of the dynamic strains in bone tissues regulates bone growth and resorption in favor of osteogenic process. The overload-induced remodeling process is performed by the action of osteocytes that act as mechanical receptors of applied stress and by the release of stimulating chemical factor for osteoblast proliferation at the stressed area.41 In the study of Ibrahim et al.,26 a weight bearing exercise program significantly promoted bone mineral density improvement when compared to a group that realizes exercises without weight bearing or a minimal intervention group.
The Swedish national guidelines on prostate cancer, part 2: recurrent, metastatic and castration resistant disease
Published in Scandinavian Journal of Urology, 2022
Ola Bratt, Stefan Carlsson, Per Fransson, Jon Kindblom, Johan Stranne, Camilla Thellenberg Karlsson
Modern treatment of metastatic prostate cancer includes combining the castration therapy with some other systemic treatment. Evaluating the effect of the additional primary systemic treatment is essential for the subsequent management of the patient, both for the timing of the change to the next line of systemic treatment and for and the choice of the type of the next treatment. If there is no imaging between the initial, pre-treatment assessment and when PSA later starts to rise, it is often not possible to know whether there has been any radiological progression over the past few months. The Swedish guidelines therefore recommend a CT scan and a bone scan after 6 months of continuous additional systemic treatment, alternatively a few weeks after completing additional docetaxel treatment. In addition to routine clinical follow-up, a bone mineral density assessment is recommended as described in detail below.