Toyohito Segawa

Combined Effect of a Locking Plate and Teriparatide for Incomplete Atypical Femoral Fracture: Two Case Reports of Curved Femurs.

In surgical treatment for atypical femoral fractures (AFFs), reconstruction nail fixation is recommended for both complete and incomplete fractures. Although it has been reported that AFF is affected by many factors, The ASBMR Task Force 2013 Revised Case Definition of AFFs states that a curved femur is often seen in Asian patients. It is sometimes difficult to insert a nail into a femur in incomplete AFF patients with severely curved femurs. We report two incomplete bisphosphonate-related AFF patients with marked femoral curvatures treated by locking plates and teriparatide, showing early bone unions and favorable long-term outcomes.

Combined treatment with minodronate and vitamin C increases bone mineral density and strength in vitamin C-deficient rats

Objectives Reduced bone quality caused by vitamin C deficiency in older persons may lead to incidental fragility fractures during bisphosphonate treatment, although bisphosphonate increases bone mineral density (BMD). This study aimed to evaluate the effects of minodronate and ascorbic acid (Aa) on BMD, bone quality, and bone strength in Aa-deficient osteogenic disorder Shionogi (ODS) rats. Methods Six-month-old ODS rats were divided into four groups (n = 20 per group): (1) Aa supplementation (Aa+); (2) Aa-deficient (Aa−); (3) Aa supplementation and minodronate administration (Aa+ + Mino); and (4) Aa-deficient and minodronate administration (Aa− + Mino). BMD, bone strength, bone histomorphometry, and bone quality determined using Fourier transform infrared spectroscopy imaging (FTIRI) were evaluated after 4 and 8 weeks. Results BMD was significantly higher in the Aa+ + Mino group than in the Aa− group (p < 0.05). Bone strength was significantly higher in the Aa+ and Aa+ + Mino groups than in the Aa− group (p < 0.05). Furthermore, bone strength was significantly higher in the Aa+ + Mino group than in the Aa− + Mino group (p < 0.05). Minodronate treatment irrespective of Aa supplementation significantly decreased bone resorption compared with the Aa+ and Aa− groups (p < 0.05). No significant differences in the parameters evaluated by FTIRI were observed between the groups. Conclusions Aa supplementation improved bone strength in ODS rats. Combined treatment with minodronate and Aa, but not minodronate alone, improved bone strength and increased BMD. Aa is required for bone health because it is essential for osteoblast differentiation.

Limaprost or pregabalin: preoperative and postoperative medication for pain due to lumbar spinal stenosis

We aimed to evaluate the incidence of (and risk factors for) postoperative pregabalin and/or limaprost to treat persistent numbness and/or pain of the lower extremities after lumbar spinal stenosis (LSS) surgery.

The Serum 25(OH)D Level in Patients with Atypical Femoral Fracture

Objective: Excessive curvature of the femur has been considered to be one of the factors associated with atypical femoral fracture (AFF). Although we clarified that femoral curvature was markedly influenced by a low vitamin D level, very few studies have been conducted on the direct relationship between AFF and a serum low level of vitamin D. Therefore, we compared the serum vitamin D level between AFF and osteoporosis patients. Methods: A total of 48 consecutive AFFs in 36 Japanese patients were retrospectively reviewed using the medical records, and 12 consecutive AFFs in 9 patients (AFF group) whose 25-hydroxyvitamin D (25(OH)D) levels were examined were included in this study. As a non-AFF control group, 45 consecutive age-matched female patients with osteoporosis (Osteoporosis group) were enrolled. We compared some laboratory examination items, the bone mineral density, and curvature of the femur. Results: When univariate logistic regression analysis was performed to compare the 2 groups, Ca levels and lateral and anterior curvatures in the AFF group were significantly greater than in the Osteoporosis group (P < 0.05, P < 0.01, and P < 0.01, respectively), and the 25(OH)D level in the AFF group was significantly lower than in the Osteoporosis group (P < 0.01). We used discriminant analysis of these extracted items to exclude the mutual influence of factors and identify factors closely associated with AFF, and 25(OH)D, Ca and anterior curvature were identified as significant items to differentiate these diseases (P < 0.05, P < 0.01, and P < 0.01, respectively). Conclusion: AFF patients showed low vitamin D levels and marked femoral curvatures.

Occurrence of vertebral fracture more closely associated with decreased anteroposterior than lateral lumbar bone mineral density

Objectives While it has been pointed out that an anteroposterior (AP) view of the lumbar spine may lead to overestimation of the bone mineral density (BMD), a lateral view is expected lead to the early detection of BMD loss on scanning cancellous bone. Vertebral fracture is often seen in aged osteoporotic patients, and it is important to prevent this fracture. Therefore, we aimed to identify the optimal site for BMD measurement to assess the risk of vertebral fracture. Methods Forty-seven female patients with fresh osteoporotic vertebral fracture and BMD measurements were included in this study (Fracture group). As a non-fractured control group, 218 female patients with BMD measurements were enrolled (Control group). We compared BMD values based on AP and lateral views of the lumbar spine from L2 to L4 and the femoral neck. With a lateral view of the lumbar spine, we measured both the total vertebral body and vertebral body center, mainly composed of cancellous bone. Results BMD of the AP lumbar spine in the Fracture group was significantly lower than in the Control group (P < 0.05). In the subanalyses for comparisons between age-matched fracture and control groups, BMD of only the AP lumbar spine in the Fracture group was significantly lower than in the Control group (P < 0.01). Conclusions AP lumbar spine BMD is optimal for assessing vertebral fracture occurrence.