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Multiple myeloma is still incurable malignant neoplasm of plasma cells, which is characterized by the presence of osteolytic bone disease, the latter resulting from increased osteoclast function accompanied by decreased osteoblast activity. Myeloma bone disease is associated with the risk of skeletal events, such as pathologic fractures, spinal cord compression, or a need of palliative bone treatment or surgery, and may be related to decreased survival. In this review article, the results of the studies analyzing treatment options for myeloma bone disease and its complications are summarized. In addition, up-to-date guidelines based on those results are presented. Indications for therapy with bisphosphonates, the route of their administration and the optimal treatment duration are presented. Moreover, methods used for management of myeloma bone disease complications are discussed, including local radiotherapy, kyphoplasty and vertebroplasty.

Oncogenic osteomalacia (OOM) is a rare paraneoplastic syndrome induced by tumor produced phosphaturic factors, i.e. phosphatonins. The disorder is characterized by renal tubular phosphate loss, secondary to this process hypophosphatemia and defective production of active form of vitamin D. The clinical course of oncogenic osteomalacia is characterized by bone pain, pathological fractures, muscle weakness and general fatigue. Osteomalacia-associated tumors are usually located in the upper and lower limbs, with half of the lesions primarily situated in the bones. Most of them are small, slow-growing tumors. Their insignificant size and various location coupled with rare occurrence of the disease and non-specificity of clinical symptoms lead to difficulties in reaching a diagnosis, which is often time-consuming and requires a number of additional tests. The average time between the appearance of the first symptoms and the establishment of an accurate diagnosis and the beginning of treatment is over 2.5 years. The aim of this study is to discuss the pathophysiology of disease symptoms, pathomorphology of tumors, diagnostic methods and treatment of oncogenic osteomalacia.

The most common treatment option for postmenopausal osteoporosis are the bisphosphonates which inhibit osteoclast function. Bisphosphonates interfere with cellular metabolism and in large clinical trials reduce risk of vertebral and non-vertebral fractures. Zoledronic acid is a potent bisphosphonate also approved for the treatment of postmenopausal osteoporosis. In addition zoledronic acid reduce relative risk of any new clinical fracture after surgical repair of low-trauma hip fracture. Also the reduction in the relative risk of death was observed after repeated once-yearly intravenous infusion. In conclusion, this is another interesting option for the treatment of the patients affected with osteoporosis and previous hip fractures.

In this paper we present indications for usage of oncological prosthesis in the treatment of metastases in proximal femur. According to our experience, based on clinical material of 78 patients treated between year 1997 and 2007 in Spine Surgery, Onclological Orthopaedics and Taumatology Clinic, University of Medical Sciences in Poznan, the indications are: massive bone loss, second surgery in the same place, damage of articular surface, small possibility of stable union, threatening patological fracture. At the appropriately selected group of patients application of onclological prosthesis lets for restoring the function of the limb, reducing or bearing pain complaints or removing the entire methastasis.

Background: The number of people living more than 90 years is increasing. This population is at high risk of osteoporotic hip fracture and the rates of a good outcome after surgical treatment are lower than in younger patients. The aim of this study was to evaluate psychophysical status and survival time following hip fracture surgery in nonagenarians., Material and Methods: Forty-two nonagenarian patients included in the study were assessed retrospectively using our own 16-point scale. Evaluation was made on several occasions: prior to injury, at discharge from the hospital and during a follow-up examination, at least 6 months after surgery. Medical data were obtained from medical records and from telephone information given by patients, their family members, carers or social welfare employees. Statistical analyses were performed using average point values and standard deviations., Results: 48% of the operated patients died within 1-9 months after surgery. Considerable deterioration of psychophysical status following surgery was reported for 24% of patients., Conclusions: Operative treatment in patients 90 years of age and over with hip fractures was associated with a good outcome, i.e. the recovery of psychophysical status comparable to that prior to the injury, only in 36% of the patients.

Mandibular fractures are some of the most frequently occurring injuries in the maxillofacial region although pathological fractures state only 2% of them. Bone cysts are common lesions of mandible and maxilla. Their long asymptomatic development causes extensive deformation and bone damage. A case report presents fracture of mandible affected with massive odontogenic cyst. Presentation, diagnosis and management of fracture and intraosseus pathology is discussed.

The aim of this study was to evaluate life quality in patients with disseminated neoplasmatic process after surgical treatment of pathological fracture due to metastasis to long bones. The examination group consisted of 33 patients (25 women, 8 men) treated surgically (av. age 67 years). Pathological fracture was revealed in femoral bone in 28 patients (bilateral in one patient) and in humeral bone in 5 patients. In case of femoral bone fracture unipolar arthroplastic of hip joint was used or stable osteosynthesis with the use of intramedullar nail or AO plate; while in case of humeral bone fracture elastic osteosynthesis with Rush nail was used. Survival period in patients after surgical treatment of pathological fracture was 6 months. Life quality in patients after surgical treatment was estimated on the basis of clinical scale. All the patients considered surgical treatment to be the purposeful improvement of the standard of the last months of life. The result of treatment presented in the scale of clinical assessment, turned out satisfactory in the examined grouped; the result was considered satisfactory in movement range of the operated limb, muscular strength and capacity of walking. The result of the evaluation of self-service capacity was estimated as more than satisfactory. In conclusion, the main advantage of surgical therapy in patients with neoplasmatic metastases into long bones is the decrease of pain and the improvement of self-service, even in the cases of serious degree of neoplasmatic process. Surgical treatment in those patients should ensure a fast comeback to possibly maximal functionality of the limb.

We report 6 children, aged 4.5- 16 years, with acute lymphoblastic leukaemia with back pain, exacerbated by walking as the first symptom of disease. Collapse of the vertebral bodies at multiple levels was shown on imaging. The presented group had good prognosis. In densitometric examination of BMD (bone mineral density) was observed loss in the thoracic and lumbar vertebrae in 5 out of 6 children. Chemotherapy resulted in decrease of pain and spontaneous remodelling of the vertebrae.

The authors treated 6 children with sarcoma telangiectaticum (SOT). Their average ages was 7.8 years (ranging from 4 to 15 years of age). In 3 children the tumor was located in the proximal epiphysis of the femur and in the remaining 3 cases in the distal epiphysis of the femur. Clinical symptoms were present on average 8.6 weeks (ranging from 2 to 20 weeks) before the final diagnosis was made. In 3 children the final diagnosis was made after performing 1 biopsy, while in the remaining 3 cases a second biopsy was required to confirm the diagnosis. All cases were given pre-op chemotherapy (Cisplatin, Adriablastine). In all cases quick growth of the tumor was noted and in all cases a pathological fracture occurred. In 2 children mutilating surgical procedures were performed, 1 child had an endoprosthesis implanted outside our facility and 1 child was treated for lung metastases. Two children are alive, but no information about their medical condition is available.

The aim of this study was to determine bone mineral density (BMD) of the forearm and of the femoral neck using DXA technique and evaluation of broadband ultrasound attenuation (BUA) and speed of sound (SOS) of the heel using QUS technique in patients with ankylosing spondylitis (AS). The group of 59 AS patients were involved in the study: 53 male and 6 female with average age (40.0 +/- 8.2 yrs), range 29 to 49. Average disease duration was 160.6 +/- 98.0 months, range 18 to 420 months. AS patients were compared to 60 healthy controls: 50 male and 10 non post-menopausal female (average age 38.2 +/- 7.4 yrs). FA-BMD (distal radius) was evaluated using DTX-200 (Osteometer Medi-Tech A/S Denmark) and FN-BMD using ECLIPSE (Norland Medical Systems, Inc., Fort Atkinson, WI). QUS parameters of the left heel (BUA and SOS) were measured by DTU-ONE (Osteometer Medi-Tech A/S Denmark). AS patients are related only to low bone mass of femoral neck (0.786 g/cm2 vs 0.901 g/cm2, p < 0.001). This group relative young patients with chronic inflammatory process is in the increased risk group of hip fracture. QUS measurements of the heel and DXA of forearm do not appear to be a good predictor for screening of AS pts with osteoporosis.

In this paper is presented a case of the 80 years old patient with femur fracture after unilateral hip arthroplasty because of femur neck fracture and knee arthroplasty following osteoarthritis. First was done the stabilization of the fracture using a plate. Because of second fracture and damage the plate stabilization next operation was done using intramedullary Küntscher nail which was non typically inserted and with additional fixation by bone cement. The result were good stabilization and healing of the fracture after 4 months.

The authors present the methods and results of treatment of 20 epiphyseal and low-metaphysis pathological knee fractures treated at the Department of Orthopedics of the Lublin University of Medical Sciences between 1962-1999. The average age was 39 years. Malignant tumours (2 lymphomas, 1 plasmocytoma, 1 hemangiopericitoma, 2 adenocarcinoma metastases) and benign lesions (10 giant cell tumours, 3 solitary bone cysts, 1 intraosseous extension of pigmented villonodular synovitis) causes 18 femur fractures and 2 tibia fractures. The fractures caused by lymphomas in 2 patients and plasmocytoma in 1 patients were treated with either a plaster cast or skeletal traction and healed within 16 weeks. Tumour resection and reconstruction with Rush rods, Kuntscher nail, plate and methylmetacrylate were performed in 2 cases. In 1 case with hemangiopericytoma hip exarticulation was performed. In 5 cases pain relief and weight bearing capacity of the limb was not achieved because of neoplasm recurrences; 5 deaths occurred within 6 months to 7 years after femur fracture because of pulmonary metastases. Benign bone lesions were treated by curettage of pathological tissues, burring bony walls of the lesions and filling the cavities with bone grafts or methylmetacrylate (1 case). Displaced fragments were reduced whenever possible. Limbs were immobilised in plaster casts. The follow-up period for patients with benign lesions was 8 years. All fractures healed. Arthritis with persistent pain and knee contracture was noted in 1 patient who underwent surgery 3 times for giant cell tumour recurrences, complicated by infection and varus deformity.

Unlabelled: The authors report their own experience with percutaneous vertebroplasty, one of the so called--minimally invasive methods, used to treat a certain group of spinal lesions affecting the vertebral bodies. The paper contains a brief review of the current literature, basic problems, indications and operative technique. The authors remark, that insertion of the needle into the vertebral body gives an access for biopsy before cement injection. This procedure was realised in the case of diagnostic uncertainty. Technical details of transpedicular biopsy are described. The authors present 2 representative cases., First Case: a female with pathologic fracture of the Th7 vertebral body of osteoporotic origin., Treatment: combination of biopsy and vertebroplasty by percutaneous transpedicular approach. Second case: a female with cancer metastasis in L1 vertebral body, vertebroplasty was performed to support the anterior spinal column. Needle insertion was controlled either by radiofluoroscopy or by CT. The authors confirm pain relief related to vertebroplasty.

The paper presents a retrospective evaluation of 47 patients with bone metastases treated surgically during the last 10 years at our ward. The mean age of the patients was 62.5 years. There were 31 females (mean age: 62.8 years) and 16 males (mean age: 62.3 years). In 37 cases (78.8%) it as possible to establish the primary localization of the tumour: breast carcinoma--16 cases, ovary cancer 5 cases, lung cancer--5 cases, prostate cancer--5 cases, kidney cancer--2 cases, stomach cancer--1 case, vagina cancer--1 case, hepatocarcinoma--1 cases and plasmocytoma--1 cases. In 10 cases (21.1%) we were unable to establish the primary focus of the tumour. The localization of the metastases was as follows: femur--32 cases, humerus--6 cases, tibia--3 cases, lumbar spine--1 case. Patients treated very briefly after qualification for surgery, in some cases during emergency service. In 2 cases of metastases to the tibia amputations at the femur were performed. The remaining patients were treated by local excisions of the metastatic tumours, followed by: in 33 cases internal osteosynthesis and bone cement application; in 7 cases osteosynthesis, in 4 cases hip arthroplasties and posterior spine instrumentation in 1 case. In 6.4% we had poor results because of the death of 3 patients. The mean follow-up was three months. In 93.6% we had good and very good results--no pain, good function and independence during daily activities. Mean survival time was 13.5 month (range 5-28 months).

Preliminary results of surgical treatment in 24 patients with pathologic fractures or metastatic long bone defects impending fracture are presented. Fourteen females and 10 males aged 36-72 years with femoral (18 cases), tibial (4 cases) or humeral (2 cases) involvement were followed-up for 6-48 months. In 12 patients the pain ceased or decreased, 3 patients occasionally required non narcotic analgesics, in 9 cases the pain continued. All patients with lower extremity involvement were able to ambulate with an aid of walking sticks, 2 patients with humeral fracture resumed activities of daily living. Nine patients with multiple metastases to the lungs and spine died on average 15 months after surgery. The longest survival rate was found in patients with kidney cancer-19 months, ovary cancer-17 months and breast cancer 15 months. No postoperative complications were found. In 2 patients fracture fixation lost their stability after 8 and 10 weeks due to excessive weight bearing.

Compression fractures of vertebrae were noted in 20 out of 1,700 children with the acute lymphoblastic leukemia. Usually prognosis in these cases has been favourable (70% of patients are alive from 5 months to 19 years). Percentage of recovery from compression fractures has been relatively high. Lymphoblastic leukemia with infiltrations localized in the spine is relatively non-aggressive, develops slowly, and despite extensive lesions to the bones its outcome results are favourable. Main symptom of spinal involvement include severe and persisting back aches which make walking impossible. Such symptoms should indicate the diagnosis of leukemia and advocate proper hematological examinations.