Ilke Coskun Benlidayi

Oral Bisphosphonate Related Osteonecrosis of the Jaw: A Challenging Adverse Effect

Oral bisphosphonates are the most commonly prescribed antiresorptive drugs for the treatment of osteoporosis. However, there are several adverse effects associated with oral bisphosphonates including the bisphosphonate related osteonecrosis of the jaw (BRONJ). With a better understanding of this side effect, reported incidences for BRONJ in oral bisphosphonate users have increased in time. The pathogenesis of BRONJ has not been well determined. Several risk factors such as dentoalveolar surgery, therapy duration, and concomitant steroid usage have been linked to BRONJ. Conservative and surgical methods can be preferred in the treatment. Preventative measures are of great importance for the patients at high risk. In this paper, osteonecrosis of the jaw secondary to oral bisphosphonates was reviewed in order to increase awareness as well as to renew the current knowledge.Oral bisphosphonates are the most commonly prescribed antiresorptive drugs for the treatment of osteoporosis. However, there are several adverse effects associated with oral bisphosphonates including the bisphosphonate related osteonecrosis of the jaw (BRONJ). With a better understanding of this side effect, reported incidences for BRONJ in oral bisphosphonate users have increased in time. The pathogenesis of BRONJ has not been well determined. Several risk factors such as dentoalveolar surgery, therapy duration, and concomitant steroid usage have been linked to BRONJ. Conservative and surgical methods can be preferred in the treatment. Preventative measures are of great importance for the patients at high risk. In this paper, osteonecrosis of the jaw secondary to oral bisphosphonates was reviewed in order to increase awareness as well as to renew the current knowledge.

Vitamin D profile of patients with spinal cord injury and post-stroke hemiplegia: All in the same boat.

BACKGROUND Patients with spinal cord injury (SCI) and hemiplegia are at risk of fractures partly due to decreased bone mineral density with relation to the low levels of vitamin D. OBJECTIVE The objective of this study is to evaluate the vitamin D profile of patients with SCI and post-stroke hemiplegia. METHODS 25(OH)D levels of patients with SCI and hemiplegia were obtained from the electronic medical record database and compared with age- and sex-matched non-disabled controls. Furthermore, the effect of Functional Ambulation Category (FAC), American Spinal Injury Association (ASIA) level and Brunnstroms recovery stage, on vitamin D insufficiency, was studied. RESULTS The study sample consisted of 173 individuals (118 patients and 55 controls). Vitamin D levels and sufficiency rates of the neurologically disabled patients was significantly lower than that of controls (p= 0.000 and p= 0.000, respectively). However, there was no difference between patients with SCI and hemiplegia regarding the 25(OH)D levels and vitamin D insufficiency (p= 0.303 and p= 0.952, respectively). There were no statistically significant differences in vitamin D status by American Spinal Injury Association (ASIA) level and Brunnstroms score. However, regression analysis revealed that vitamin D insufficiency rate of non-functionally ambulatory (FAC = 0-2) patients was higher than that of functionally ambulatory (FAC = 3-5) ones (p= 0.044). CONCLUSIONS Vitamin D status of patients with neurological disabilities was lower than that of controls. Non-functionally ambulatory patients had higher vitamin D insufficiency rate than functionally ambulatory patients. Preventative measures including adequate supplementation of vitamin D should be directed to neurologically disabled subjects, particularly those with non-functional ambulation.

Does Lumbosacral Transitional Vertebra Have Any Influence on Sacral Tilt

Study design. Retrospective case‐control study. Objective. To compare the sacral tilt (ST) angle between patients with and without lumbosacral transitional vertebra (LSTV). Summary of Background Data. Although LSTV is a common malformation of the lumbosacral region, data regarding the effect of LSTV on the tilt of sacrum is limited. Methods. Anterioposterior and lateral lumbar radiographs of patients with low back pain performed between March 2013 and September 2013 were extracted from the medical electronic database. Among these radiographs, those belonging to patients with Castellvi types II, III, and IV LSTV were identified. The angle of ST was measured on lateral lumbar radiographs and compared with that of age‐ and sex‐matched controls without LSTV. Results. Of the 1588 radiographs extracted from the database, 96 (6.1%) were positive in terms of Castellvi types II, III and IV LSTV. 85 of them were found to be eligible for analysis. Patients with LSTV had significantly smaller ST angle than those without LSTV (p = 0.000). However, this angle did not differ among types (II, III and IV) of LSTV (p = 0.788). Conclusion. Results of this study revealed that patients with LSTV had less ST—that is to say more vertical sacrum—than those without this malformation. Level of Evidence: 4

Kinesio Taping for temporomandibular disorders: Single-blind, randomized, controlled trial of effectiveness.

BACKGROUND Data regarding the effectiveness of Kinesio Taping in temporomandibular disorders (TMD) is scarce. OBJECTIVE To determine the efficacy of Kinesio Taping (KT) in patients with TMD. METHODS Patients with TMDs were randomized into experimental and control groups. The experimental group (n= 14) received KT in combination with counseling and jaw exercise, whilst controls (n= 14) were given the regimen of counseling and exercise alone. Jaw movements, Visual analogue scale (VAS) scores and self-reported measures (functional limitation and masticatory efficiency) were evaluated at baseline, first and sixth weeks of the treatment. Biobehavioral questionnaire was filled out at baseline and at sixth week. RESULTS Active mouth opening improved more in the experimental group than controls (p= 0.003). In the experimental group, VAS for temporomandibular joint, masticatory efficiency and functional limitation improved significantly at the sixth week when compared to baseline (p= 0.011, p= 0.001 and p= 0.001, respectively), but not in controls. Subjective treatment efficacy was higher in the experimental group than that of controls (p= 0.000). Pain, depression and disability scores reduced significantly in the experimental group (p= 0.001, p= 0.006 and p= 0.01, respectively), but not in controls. CONCLUSION In conclusion, KT in combination with counseling and exercise is more effective than counseling and exercise alone in TMDs.

Lumbosacral morphology in lumbar disc herniation: a “chicken and egg” issue

OBJECTIVE The aim of this study was to analyze the relationship, if any, between lumbar disc herniation and lumbosacral morphology. METHODS Intervertebral disc angles (IDA), lumbar lordosis angle (LLA), lumbosacral lordosis angle (LSLA), lumbosacral angle (LSA), and sacral tilt (ST) were measured on lumbar magnetic resonance imaging of 224 patients with LDH (n=151) and without LDH (n=73) and were then compared. RESULTS Regarding LLA, LSLA, LSA and ST, there were no significant differences between the 2 groups. The smallest IDA of each level (except L2-L3) was detected at the same level with disc herniation. When the relationship between the grade of disc herniation and IDA was evaluated in patients with LDH, angles of L3-L4 and L4-L5 levels were significantly smaller in patients with extruded disc herniation (p=0.009 and p=0.013, respectively). CONCLUSION Despite changes in IDA by grade and level of disc herniation, no relation was found between lumbosacral alignment and LDH.

Is coxa valga a predictor for the severity of knee osteoarthritis? A cross-sectional study.

PurposeIn the present study, we aimed to evaluate the affect of the variations in hip anatomy and pelvic geometry on the severity of knee OA.MethodsIdiopathic knee OA patients fulfilling the clinical criteria of American College of Rheumatology for OA were enrolled in the study. Several measurements regarding the hip and pelvis were performed on pelvic radiographs. Each knee was graded according to the Kellgren and Lawrence (KL) radiographic system (0–4) along with a categorization in accordance with the medial tibiofemoral joint space widths (JSW).ResultsThe study group consisted of 111 subjects. The inner and outer pelvic diameters were getting wider as the JSW grade increased. Likewise, among the hip measurements, femoral head, neck and shaft diameters and hip axis lengths were linked with KL grade. There were significant differences in neck-shaft angle (NSA) between groups of JSW with a highest NSA in JSW grade 3. The optimal cut-off value for NSA in predicting the severity of knee OA was 134.4°. Furthermore, NSA beyond 134.4° was found to increase the risk of severe knee OA eightfold.ConclusionsVariations in pelvic geometry and hip anatomy are associated with the severity of knee OA. People with NSA of above 134.4° have eightfold increased risk of developing severe knee OA. Pelvic radiographies could be evaluated at younger ages—particularly in people with high genetic predispositions—to identify the individuals at high risk and in turn, to tailor the preventive measures to these subjects.

Non-Pharmacological Management of Hand Osteoarthritis: From A Perspective of Physiatry

Hand Osteoarthritis (OA) is a common disorder, particularly among female population aged 55 and above. It presents with pain and bony enlargements of the finger joints. Management of hand OA is based particularly on the non-pharmacological methods. These include joint protection education, use of splints intrapeziometacarpal joint OA and thermal agents for relief of pain and stiffness. In this article, a literature review was performed on the nonpharmacological management of hand OA, as a means of updating the current knowledge and revealing the level of evidence regarding the non-pharmacological modalities used for hand OA. Meta-analysis, systematic reviews, reviews and randomized controlled trials were included, whereas single case reports and non-randomized studies were excluded. In non-pharmacological management of hand OA, current evidence supports the beneficial effects of joint protection education, exercise treatment, splinting and heat application, whilst evidence on electrotherapy, aquatherapy, balneotherapy remains low. Magnetotherapy, yoga and acupuncture still require further well-designed studies with high methodological quality.

I have back pain

Vertebral column stands as a pillar inside the human body. It not only provides the erect posture but also serves as a hanger for thorax, limbs and the skull. With its various important roles, the spine is also prone to injury. Therefore, back pain is one of the commonest conditions worldwide. It is categorized into two as inflammatory and mechanical. Mechanical back pain aggravates with movement and physical activity, whilst resting can provide relief. Inflammatory back pain is usually chronic and not relieved by rest. Discriminating the type of pain is crucial to allow for timely diagnosis and for appropriate management. Back pain might be experienced either on the upper or on the lower part of the spine. The latter is more frequent and mostly is non-specific in origin. It is of great importance to rule out the specific causes which might refer to both spinal and non-spinal/visceral pathologies. To manage these conditions in time, both the physician and the patient should be aware of the signs and the risk factors related to these pathologies. These include fever, trauma history, night pain, unexplained weight loss, concomitant systemic diseases, immune-suppression and incontinence in general. Rheumatology INTERNATIONAL

Let us take care of the patient

Treating the patient—not only the disease itself—is important in daily clinical practice. Herein, a short text and a related cartoon on patient care are provided.Treating the patient—not only the disease itself—is important in daily clinical practice. Herein, a short text and a related cartoon on patient care are provided.

Fibromyalgia as a challenge for patients and physicians

Think about a disease with so many faces... A disease that deteriorates one’s health in so many ways... With a variety of features, fibromyalgia is a challenging clinical condition not only for patients but also for physicians. The challenge is related to diagnosis and management. The hallmark of fibromyalgia is generalized pain, which involves at least four regions of the body. Pain can be nociceptive, neuropathic, central, or mixed. It is just one of the numerous features of fibromyalgia, affecting patients cap-àpie. Headache, cognitive problems, mood disorders, fatigue, abdominal cramps, sleep disturbance, numbness/tingling in hands/feet, urinary symptoms, and dizziness/nausea make the clinical picture multifaceted and require differentiation from the numerous mimicking disorders. Personalized approach and patient education are the main drivers of successful treatment. The patients need easily understandable and perhaps graphical information about their symptoms, clinical course of the disease, and potential therapeutic options. Regular exercising, physiotherapy, and cognitive behavioral therapy are among the most effective nonpharmacological options. Amitriptyline, duloxetine, milnacipran, pregabalin, cyclobenzaprine, and tramadol are widely known drug therapies used for fibromyalgia. Fibromyalgia is a chronic, painful, but treatable condition in view of the reassuring patient–physician collaboration. With that in mind, I want to present a cartoon for this topic.