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Caffeine is a methylxanthine which permeates the placenta. In studies on animals, it has been shown to produce teratogenic and embryotoxic effects in large doses. The objective of this study was to assess the influence of caffeine on the development of bone tissue, with particular reference to elemental bone composition using an X-ray microprobe. The research was conducted on rats. The fertilized females were randomly divided into an experimental and a control group. The experimental group was given caffeine orally in 30 mg/day doses from the 8th to the 21st day of pregnancy, while the control group was given water. The fetuses were used to assess the growth and mineralization of the skeleton. On the basis of double dyeing, a qualitative analysis of the bone morphology and mineralization was conducted. For calcium and potassium analysis, an X-ray microprobe was used. In 67 fetuses from the experimental group, changes in skeleton staining with the alcian-alizarin method were noticed. The frequency of the development of variants in the experimental group was statistically higher. In the experimental group, a significant decrease in the calcium level, as well as an increase in the potassium level, was observed. The X-ray microprobe's undoubted advantage is that is offers a quick qualitative and quantitative analysis of the elemental composition of the examined samples. Employing this new technique may furnish us with new capabilities when investigating the essence of the pathology process. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To review recent advance in understanding the causation and management of Paget''s disease. Design and methods: We review recent publications concerning the aetiology of the disease and the use of biochemical markers of bone turnover in diagnosis and treatment. Results: Epidemiologic studies suggest that Paget''s disease is decreasing in prevalence and severity (implying that environmental factors are important) but there is also strong evidence of a genetic predisposition particularly through the SQSTM1 gene. Genome-wide association studies have identified polymorphisms at several other loci that are associated with the disease. Plasma alkaline phosphatase activity (ALP) is widely used, but less helpful in patients with disease of limited extent. Of the newer markers, plasma procollagen-1 N-peptide (PINP) performs best. Treatment with potent bisphosphonates usually produces long-term remission. Conclusions: Both genetic and environmental factors appear to be important in the aetiology of Paget''s disease. Effective long-term disease suppression can be achieved with bisphosphonate treatment. [Copyright &y& Elsevier]

Abstract: Osteomyelitis is an infectious disease located in the bone or bone marrow. Long-circulating and pH-sensitive liposomes containing a technetium-99m-labeled antibiotic, ceftizoxime, (SpHL-99mTc-CF) were developed to identify osteomyelitis foci. Biodistribution studies and scintigraphic images of bone infection or non infection-bearing rats that had been treated with these liposomes were performed. A high accumulation in infectious foci and high values in the target–non target ratio could be observed. These results indicate the potential of SpHL-99mTc-CF as a potential agent for the diagnosis of bone infections. [Copyright &y& Elsevier]

The bone reactions before functional demands and aggressions are different according to the local morphology, intensity and duration of the irritation and systemic state of the patient. In this work, initially it was sought to correlate these three important factors to comprehend the final result on the bone structure, especially from the imaging point of view. Then, it was presented the concepts of universally accepted names to identify inflammatory bone diseases, in order to facilitate the scientific and clinical communication between professionals. [ABSTRACT FROM AUTHOR]

Background: Lengthening of bones by gradually distracting bone fragments using an external apparatus by Ilizarov, is a long process with numerous complications. The greatest threats in limb lengthening are poor new bone formation as well as premature consolidation of the newly generated bone. The purpose of this study was to determine the importance of ultrasonography in evaluation of bone formation in limb lengthening. Patients and Methods: The study involved 31 patients, in whom 52 long bones were lengthened by the Ilizarov method at the University Clinic for Orthopaedic Surgery in Skopje from 2006 to 2010. The study revealed the results of ultrasonographic analysis of new bone formation at four various stages of limb lengthening. The analysis of the results of ultrasonographic examination of bones throughout the lengthening process was based on the form and dimensions of the obtained ultrasonographic parameters – indicators of new bone formation – as well as on the appearance of the cortical margin at the distraction site. Results: Tiny, solitary and confluent hypo-echogenic foci developed on sonograms approximately 2 weeks after distraction was commenced. At stage I a new cortical margin was detected in 30.77%. The number of initial small indicators significantly decreased throughout lengthening. At stage IV the solitary indicators rate was 9.51%, whereas the linear indicators rate significantly increased from 22.12% at the first stage to 54.3% at the last stage. the cortical margin was presented in all 52 bones at III and IV stage of lengthening. Discussion and Conclusions: Ultrasonography enabled an evaluation of the degree of new bone formation and it preceded the radiographic changes at the distraction site. This helped to determine the surgical lengthening and to avoid numerous complications. [ABSTRACT FROM AUTHOR]

Abstract: Physeal fractures account for approximately one third of all childhood fractures. Growth arrest is a serious complication of these injuries which, if not managed correctly, can lead to angular deformity, limb length discrepancy, or both. This in turn may cause pain, loss of function and disability. The article reviews the evaluation of a child with suspected traumatic physeal growth arrest including patient history, physical examination and imaging strategies for the early detection of physeal growth arrest and measurement of limb length discrepancy. Various anatomical classifications of physeal growth arrest are also presented. Finally, we discuss an approach to the management of a child with confirmed traumatic physeal growth arrest depending on the nature of the arrest and limb deformity. [Copyright &y& Elsevier]

Postoperative spondylodiscitis after anterior cervical decompression and fusion (ACDF) is rare, but the same occurring at adjacent levels without disturbing the operated level is very rare. We report a case, with 5 year followup, who underwent ACDF from C5 to C7 for cervical spondylotic myelopathy. He showed neurological improvement after surgery but developed discharging sinus after 2 weeks, which healed with antibiotics. He improved on his preoperative symptoms well for the first 2 months. He started developing progressive neck pain and myelopathy after 3 months and investigations revealed spondylodiscitis at C3 and C4 with erosion, collapse, and kyphosis, without any evidence of implant failure or graft rejection at the operated level. He underwent reexploration and implant removal at the operated level (there was good fusion from C5 to C7) followed by debridement/decompression at C3, C4 along with iliac crest bone grafting and stabilization with plate and screws after maximum correction of kyphosis. The biopsy specimen grew Pseudomonas aeruginosa and appropriate sensitive antibiotics (gentamycin and ciprofloxacin) were given for 6 weeks. He was under regular followup for 5 years his myelopathy resolved completely and he is back to work. Complete decompression of the cord and fusion from C2 to C7 was demonstrable on postoperative imaging studies without any evidence of implant loosening or C1/C2 instability at the last followup. [ABSTRACT FROM AUTHOR]

Brief Background Oral exfoliative cytology is a diagnostic technique which is non invasive for an insight into the underlying disease process. Many modifications are in progress to identify simple, cost effective and efficient technique especially in diagnostic oral cytology. The present paper analyses the efficiency of a Concentrated Pull Smear (CPS) prepared by centrifuging oral rinse and comparing the quality and quantity of cells with a scrape smear. Materials and Methods Fifty dental students of 18 -25 years with normal oral mucosa were selected for the study. Oral scrape was performed with wooden spatula and the cells were smeared and fixed in alcohol. The CPS was prepared centrifuging the swished normal saline and the smear was prepared from the single drop of concentrated cell sediment and fixed in alcohol. Slides of both methods were stained with PAP stain. Discussion The CPS showed uniform spread of cells with minimum overlaps or clumping. The staining intensity of the cytoplasm was good, identity of individual cell was clear. Though the quantity of cells were comparatively lower it was sufficient for cytological diagnosis. Inflammatory cell overlap on epithelial was minimal in CPS. Summary and Conclusions The comparison of oral scrape smears of normal individuals with CPS was shown to be a simple, effective cytological technique. This technique could be utilized for the analysis of oral lesions. [ABSTRACT FROM AUTHOR]

Background Although common marmosets seem to be appropriate animal models to examine bone diseases, no data about the conclusiveness of less-invasive techniques are available. Therefore, the aim was to combine different techniques to analyse changes in bone metabolism of common marmosets with bone diseases. Methods Five monkeys were examined by X-ray, computer tomography (CT), histology and immunohistochemistry (IHC). Results Monkeys with lowest bone mineral density (BMD) showed increased bone marrow, decreased cancellous bone and decreased contrast in X-ray. Highest alkaline phosphatase (AP)-levels were detected in bones with low elastic modulus. Expression of osteopontin (OPN), osteocalcin (OC) and runt-related transcriptions factor 2 (RUNX 2) was detected in bones with high modulus. No expression was present in bones with lower modulus. Collagen type I and V were found in every bone. Conclusions In conclusion, CT, X-ray and AP are useful techniques to detect bone diseases in common marmosets. These observations could be confirmed by IHC. [ABSTRACT FROM AUTHOR]

Study design: Retrospective study. Objective: To identify the clinical significance of coexistence of lumbar spinal stenosis (LSS) with thoracic ossification of ligamentum flavum (OLF), and to study the surgical outcome of the thoracic OLF patients with or without LSS. Summary of background data: The OLF at the thoracic level (thoracic OLF) is a rare disease that causes acquired thoracic spinal canal stenosis. Thoracic OLF is frequently combined with other spinal disorders, such as LSS, and it is not uncommon for thoracic OLF to be misdiagnosed as LSS, resulting in delayed diagnosis. However, clinical impacts of the coexistence of LSS with thoracic OLF remain unknown. Methods: In the present study, 36 patients who underwent posterior decompression for OLF-induced thoracic myelopathy were retrospectively reviewed, and the adverse influence of the copresence of LSS with thoracic OLF was studied with regard to clinical features such as clinical symptoms and surgical outcome. Results: Out of 36 patients, 18 patients had LSS (combined group: C-group), and the remaining 18 patients had thoracic OLF only (thoracic group: T-group). No significant inter-group differences were found in terms of gender, age, follow-up period, and preoperative duration of symptoms. Regarding the etiology of LSS in the C-group, 12 cases had degenerative LSS, two cases had lumbar OLF, one case had degenerative LSS with lumbar OLF, one case had had degenerative LSS with lumbar OPLL, and two cases had traumatic LSS due to lumbar kyphosis after vertebral fracture. Clinical examination revealed that the T-group was significantly more likely to demonstrate Achilles hyper-reflexia, while the C-group was significantly more likely to demonstrate Achilles hypo-reflexia. The mean preoperative and postoperative JOA scores were not statistically different between the two groups. However, the mean recovery rate of the JOA score was 17.3% in the C-group, and 30.4% in the T-group. Statistical analysis revealed that the recovery rate of the C-group was significantly lower than that of the T-group. Conclusion: Thoracic OLF with LSS will show a more severe clinical manifestation than that without LSS. In this study, we clearly indicated that the coexisting LSS in thoracic OLF will have adverse effects on the surgical results in thoracic OLF. [ABSTRACT FROM AUTHOR]

Abstract: This review aims to overview key histopathological features and provide diagnostic clues for a selection of the fibro-osseous lesions of the jaws and facial bones. These form a diverse group of conditions with differing aetiologies but similar histological appearances and some may be part of more generalized systemic disease. It will become apparent that for this group of conditions, diagnosis cannot be made by examination of biopsy material by a pathologist in isolation and both clinical and radiological correlation are needed. However, there are some subtle histopathological features that can allow one diagnosis to be favoured over all others which will be outlined here. Identification of these in material sent for histopathological analysis should assist the multidisciplinary team in making a definitive diagnosis. [Copyright &y& Elsevier]

Abstract: Normal synovial fluid consists of a transudate of plasma from synovial tissue blood vessels supplemented with high molecular weight saccharide-rich molecules, particularly hyluronans. This produces in an acellular, aparticulate, viscous, non-clotting semi fluid. During primary inflammatory episodes such as rheumatoid disease and in secondary inflammatory arthropathies such as those caused by bacteria and crystal deposition, changes occur to the cell numbers, cell type, and crystals in the fluid. Endogenous and exogenous debris and particles, particularly those associated with degenerative joint disease, and prosthetic failure can be seen. These changes can be identified and quantified leading to the diagnosis of one of a group of arthropathies or a specific arthropathy. Synovial fluid microscopic analysis is a simple technique that requires little more than a microscope and experience. [Copyright &y& Elsevier]

Oral Diseases (2012) 18, 184-190 Background: Cleidocranial dysplasia (CCD) is a dominantly inherited autosomal disease characterized by typical bone defects including short stature, persistently open or delayed closure of the cranial sutures, and hypoplastic or aplastic clavicles. Oral features are frequent and include supernumerary teeth, delayed eruption or impaction of the permanent teeth, and malocclusion. Heterozygous mutations in RUNX2 gene, which encodes a transcription factor essential for osteoblast differentiation, were identified as the etiological cause of CCD. Objective and Methods: Herein, we performed physical and radiographic examination and screening for RUNX2 mutations in 11 patients from five families with CCD. Results: All patients demonstrated the classical phenotypes related to CCD. Families whose affected members had several dental alterations such as multiple impacted and supernumerary teeth demonstrated heterozygous missense mutations (R190Q and R225Q) that impair the runt domain of RUNX2. On the other hand, CCD patients from families with low frequency of dental abnormalities showed no mutation in RUNX2 or mutation outside of the runt domain (Q292 fs→X299). Conclusion: The current findings suggest a correlation between dental alterations and mutations in the runt domain of RUNX2 in CCD patients. Further clinical and genetic studies are needed to clarify the relationship between phenotypes and genotypes in CCD and to identify other factors that might influence the clinical features of this uncommon disease. [ABSTRACT FROM AUTHOR]

Thyroid physiology is linked to skeletal health. T3 and TSH independently affect bone growth and development, mineralization and remodeling. Thyrotoxicosis, a clinical syndrome characterized by excess thyroid hormone is one of the commonly recognized conditions of the thyroid gland. Thyrotoxicosis causes accelerated bone remodeling and serves as one of the risk factors for osteoporosis. Treatment of thyrotoxicosis leads to reversal of bone loss and decreases fracture risk. Though treatment of thyrotoxicosis leads to improvement of bone mineral density (BMD), it is not necessarily to normal levels. The effects of subclinical hyperthyroidism on the bone are controversial. Thyroidectomy and methimazole may decrease the risk of fractures in these patients compared with treatment with radioiodine. Hypothyroidism may also be risk factor for fractures. Replacement therapy with levothyroxine in hypothyroid patients may temporarily reduce bone density after initiation of therapy. However it is not associated with osteoporosis or increased fracture risk. TSH suppressing doses of levothyroxine may reduce BMD, especially in post menopausal women. Supplementation of calcium and vitamin D in hyperthyroid patients should be considered. There are limited studies in India pertinent to reversibility of these changes. In this review, we have discussed about the effects of various aspects of skeletal health in thyroid disorders. [ABSTRACT FROM AUTHOR]

The scaphoid is the most commonly fractured carpal bone, with frequent complications that are predisposed by its anatomical location, anatomical configuration (shape and length), and vascular supply. The most common mechanism of injury is a fall onto an outstretched hand. Imaging plays a significant role in the initial evaluation and treatment of scaphoid fractures and their complications. Radiography should be the first imaging modality in the initial evaluation and follow-up of scaphoid fractures. Computed tomography with its superb spatial resolution enables better visualization and characterization of the fracture line, and the amount of displacement and angulation of the fracture fragments. Using the metal reduction artifact with computed tomography allows good follow-up of scaphoid fractures despite surgical hardware. Magnetic resonance imaging without contrast is the imaging modality of choice for depiction of radiographically occult scaphoid fracture, bone contusion, and associated soft tissue injury; contrast-enhanced imaging aids assessment of scaphoid fracture nonunion, osteonecrosis, fracture healing after bone grafting, and revitalization of the necrotic bone after bone grafting. Proper identification and classification of scaphoid fracture and its complications is necessary for appropriate treatment. This article describes the normal anatomy,mechanism of injury, and classification of stable and unstable fractures, together with the imaging and treatment algorithm of scaphoid fractures and their complications with an emphasis on magnetic resonance imaging. [ABSTRACT FROM AUTHOR]

Diabet. Med. 29, 56-61 (2012) Abstract Aims To assess the outcome of patients with diabetes with suspicion of osteomyelitis of the foot who had undergone a percutaneous bone biopsy that yielded negative microbiological results, with focus on the occurrence of osteomyelitis at the biopsied site. Methods Medical charts of adult patients with diabetes with a negative percutaneous bone biopsy were reviewed. Patients' outcome was evaluated at least 2 years after the initial bone biopsy according to wound healing, the results of a new bone biopsy and bone imaging evaluation when applicable. Results From January 2001 to January 2008, 41 patients with diabetes (30 men/11 women; mean age 58.1 ± 9.6 years; mean diabetes duration 15.8 ± 6.7 years) met study criteria. Osteomyelitis was suspected based on combined clinical and imaging diagnostic criteria. On follow-up at a mean duration of 41.2 ± 22.5 months post-bone biopsy, 16 patients had complete wound healing (39.0%). Of the 25 other patients, 15 had a new bone biopsy performed, six of which yielded positive microbiological results, and among the 10 patients who neither healed nor underwent bone biopsy, comparative radiography of the foot showed a stable aspect of the biopsied site in six of them, for whom the data were available. Finally, osteomyelitis of the foot at the site where the initial bone biopsy had been performed was confirmed during follow-up in six patients (14.6%) and was suspected in four additional patients (9.7%). Conclusions The results of the present study suggest that, of patients with diabetes with the suspicion of osteomylelitis and a negative percutaneous bone biopsy, only one out of four will develop osteomyelitis within 2 years of the biopsy. [ABSTRACT FROM AUTHOR]

Etiopathogenesis of the pathologic lesions forms the basis for formulation of appropriate intervention and further prevention. There is still a vast unknown field that has to be explored to know the causative reason behind certain benign & malignant lesions. Idiopathic bone defects are nonodontogenic pseudocystic cavities that are seen in the long bones & jaw bones. Radiographic interpretation is at times inadequate in diagnosis of odontogenic & nonodontogenic radiolucent lesions involving jaw bones. Histopathology has different criteria to segregate this lesion. In this paper, we discuss a case of type B histopathological variant of idiopathic bone defect that may suggest an alternative pathogenesis from type A variant. [ABSTRACT FROM AUTHOR]

Background: The prevalence of metastatic bone disease in the US population is not well understood. We sought to estimate the current number of US adults with metastatic bone disease using two large administrative data sets. Methods: Prevalence was estimated from a commercially insured cohort (ages 18-64 years, MarketScan database) and from a fee-for-service Medicare cohort (ages $65 years, Medicare 5% database) with coverage on December 31, 2008, representing approximately two-thirds of the US population in each age group. We searched for claims-based evidence of metastatic bone disease from January 1, 2004, using a combination of relevant diagnosis and treatment codes. The number of cases in the US adult population was extrapolated from age- and sexspecific prevalence estimated in these cohorts. Results are presented for all cancers combined and separately for primary breast, prostate, and lung cancer. Results: In the commercially insured cohort (mean age = 42.3 years [SD = 13.1]), we identified 9505 patients (0.052%) with metastatic bone disease. Breast cancer was the most common primary tumor type (n = 4041). In the Medicare cohort (mean age = 75.6 years [SD = 7.8]), we identified 6427 (0.495%) patients with metastatic bone disease. Breast (n = 1798) and prostate (n = 1862) cancers were the most common primary tumor types. We estimate that 279,679 (95% confidence interval: 274,579-284,780) US adults alive on December 31, 2008, had evidence of metastatic bone disease in the previous 5 years. Breast, prostate, and lung cancers accounted for 68% of these cases. Conclusion: Our findings suggest that approximately 280,000 US adults were living with metastatic bone disease on December 31, 2008. This likely underestimates the true frequency; not all cases of metastatic bone disease are diagnosed, and some diagnosed cases might lack documentation in claims data. [ABSTRACT FROM AUTHOR]

The accurate diagnosis of osteoporosis has gained increasing importance due to the aging of our society. Areal bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) is an established criterion in the diagnosis of osteoporosis. This measure, however, is limited by its two-dimensionality. This work presents a method to reconstruct both the 3D bone shape and 3D BMD distribution of the proximal femur from a single DXA image used in clinical routine. A statistical model of the combined shape and BMD distribution is presented, together with a method for its construction from a set of quantitative computed tomography (QCT) scans. A reconstruction is acquired in an intensity based 3D-2D registration process whereby an instance of the model is found that maximizes the similarity between its projection and the DXA image. Reconstruction experiments were performed on the DXA images of 30 subjects, with a model constructed from a database of QCT scans of 85 subjects. The accuracy was evaluated by comparing the reconstructions with the same subject QCT scans. The method presented here can potentially improve the diagnosis of osteoporosis and fracture risk assessment from the low radiation dose and low cost DXA devices currently used in clinical routine. [ABSTRACT FROM PUBLISHER]

Objective: The purpose of this article was to evaluate the radiologic findings of adult pelvis and appendicular skeletal Langerhans cell histiocytosis (LCH), emphasizing the CT and MR findings.Materials and Methods: The images of nine patients with pathologically proven LCH (five men and four women; mean age, 37.11 years) were retrospectively reviewed. Imaging analysis was confined to the long and flat bones. CT scans were performed in five patients and MR imaging was performed in eight. Images were assessed for the following features on CT and MRI: the location and number of lesions; the presence of cortical destruction, endosteal scalloping, and a periosteal reaction on CT or MRI; the margin of soft tissue masses, the presence of bone marrow edema, and a "budding" appearance on MRI; and the presence of sclerotic margins or septations on CT.Results: The involved skeletal sites were the pelvis (seven), femurs (five), humeri (two), tibias (two), fibula (one), clavicle (one), scapula (one), and sternum (one). Endosteal scalloping, a periosteal reaction, and a budding appearance were common on MRI or CT images. Although cortical destruction and the soft tissue lesion formation were rare, soft tissue masses had well-defined margins.Conclusions: Endosteal scalloping and a budding appearance with a periosteal reaction on CT and MRI may be helpful signs for differentiation of LCH from malignant tumors in adults. [ABSTRACT FROM AUTHOR]

The article presents abstracts on medical studies with topics including bone biopsies in postmenopausal women who discontinued denosumab, the treatment of osteoporotic spinal compression fractures and the association between vitamin D and the risk of colorectal cancer.

Abstract: The etiology and pathogenesis of Kashin-Beck disease (KBD) remain uncertain at present. A deficiency of selenium and iodine is considered common in KBD-affected areas. Supplying selenium and iodine for the prevention of KBD has been performed in the past few decades in affected areas in China. Supplying selenium and/or iodine has produced positive http://www.iciba.com/different/effects in most KBD-affected areas, but there are some affected areas where the effects have been unclear and supplementation with selenium and/or iodine has not eliminated this disease. From animal and vitro experiments, we explore whether a deficiency of selenium and/or iodine may be the environmental factor causing KBD. KBD may have multiple etiologies. The role of selenium and iodine in KBD mainly involves antioxidation and maintenance of thyroid function according to the present review. Other important roles of selenium and iodine in KBD and a certain etiology of this disease need further study. [Copyright &y& Elsevier]

Purpose: Preclinical data pointed to Tc-NTP 15-5 as a good candidate for single photon emission computed tomography (SPECT) imaging of cartilaginous disease. We set out to investigate and quantify Tc-NTP 15-5 ex vivo uptake by human articular cartilage relative to bone Tc-hydroxymethylene diphosphonate (HMDP) radiotracer. Methods: Three osteoarthritic human tibial plateaux and four tibiofemoral joints were incubated with Tc-NTP 15-5 and Tc-HMDP for 2 h. Affinity of tracers for cartilage was determined by visual analysis of SPECT/CT acquisitions and measurement of cartilage to cortical bone uptake ratios. Results: Cartilage to cortical bone uptake ratios were 3.90 ± 2.35 and 0.76 ± 0.24, respectively, for Tc-NTP 15-5 and Tc-HMDP radiotracers. Visual analysis of fused SPECT/CT slices showed selective, intense Tc-NTP 15-5 accumulation in articular cartilage, whereas Tc-HMDP binding was low. Interestingly, a cartilage defect visualized on CT was clearly associated with focal decreased uptake of Tc-NTP 15-5. Conclusion: The tracer Tc-NTP 15-5 is of major interest for human cartilage molecular imaging and could find clinical applications in osteoarthritis staging and monitoring. [ABSTRACT FROM AUTHOR]

The article focuses on a clinical review related to a disease Actinomycosis. It informs that the disease is caused by filamentous Gram positive anaerobic bacteria. It also informs that the disease sometimes misdiagnosed as malignancy and tuberculosis. It further informs that the bacterias which causes Actinomycosis are Actinomyces and are commensals of the human oropharynx, urogenital tract, and gastrointestinal tract. It is stated that an effective immune response is essential for controlling actinomycosis. It is also stated that the incidence of actinomycosis have declined due to better oral hygiene and broad range of antibiotics.

According to a pathological definition, a bony sequestrum is defined as a piece of devitalized bone that has been separated from the surrounding bone during the process of necrosis. However, the radiological definition of a sequestrum is different and refers to an image of calcification visible within a lucent lesion, completely separated from the surrounding bone, without referring to the vascular status and histological nature of the calcified tissue. The term "button sequestrum" has been used in calvarial lesions. The prototype conditions that may present with a bony sequestrum are osteomyelitis and skeletal tuberculosis. Other conditions such as radiation necrosis, eosinophilic granuloma, metastatic carcinoma, primary lymphoma of bone, aggressive fibrous tumors may also manifest as osteolytic lesions containing a sequestrum. In addition, some primary bone tumors produce a matrix that may mineralize and sometimes simulate a bone sequestrum. These include osteoid tumors (osteoid osteoma, osteoblastoma), cartilaginous tumors (chondroma and chondroblastoma), lipomatous tumors (lipoma), and benign fibrous tumors (fibromyxoma, myxoma, and desmoplastic fibroma). Therefore, various conditions may present at imaging as a small area of osteolysis containing central calcifications. However, a careful analysis of the sequestrum as well as the associated clinical and radiological findings often enables to point toward a limited number of conditions. [ABSTRACT FROM AUTHOR]

Purpose: This paper assesses interscan, interreader, and intrareader variability of C-arm CT and compares it to that of flat-panel volume-CT (fpVCT) and high-definition multi-detector-CT (HD-MDCT).Methods: Five cadaver knee specimens were imaged using C-arm-CT, fpVCT, and HD-MDCT. Apparent (app.) trabecular bone volume fraction (BV/TV), app. trabecular number (TbN), app. trabecular spacing (TbSp), and app. trabecular thickness (TbTh) of the proximal tibia were measured by three readers. Interreader, intrareader, and interscan variability for C-arm CT was expressed as coefficient of variation (CV), standard deviation (SD), and intraclass correlation coefficient (ICC).Results: With the exception of app.TbSp (CV: 7.05-9.35%, SD: 0.06-0.09, ICC: 0.89-0.94), the variability of C-arm CT was low (CV: 2.41-6.43%, SD: 0.01-0.048, ICC: 0.65-0.98). Its interreader reliability (CV: 2.66-4.55%, SD: 0.01-0.03, ICC: 0.81-0.95) was comparable to that of HD-MDCT (CV: 2.41-4.08%, SD: 0.014-0.016, ICC: 0.95-0.96), and fpVCT (CV: 3.13-5.63%, SD: 0.009-0.036, ICC: 0.64-0.98) for all parameters except app.TbSp.Conclusions: C-arm CT is a reliable method for assessing trabecular bone architectural parameters with the exception of app.TbSp due to spatial resolution limitation. [ABSTRACT FROM AUTHOR]

Objective: To test the in vivo precision of a depth-specific topographic mapping technique (CT-TOMASD, computed tomography topographic mapping of subchondral density) for the 3D assessment of subchondral cortical and trabecular bone density in normal and osteoarthritic (OA) human tibiae.Methods: Fourteen participants were recruited (3 men:11 women; mean age: 49.9, SD: 11.9 years) and categorized as normal (n = 7) or OA (n = 7). Each participant was scanned using clinical quantitative CT (QCT) three times over 2 days. We assessed average subchondral bone mineral density (BMD) across three layers (0-2.5 mm, 2.5-5 mm and 5-10 mm) measured in relation to depth from the subchondral surface. Regional analyses included: medial plateau BMD; lateral plateau BMD; anterior/central/posterior compartment BMD; medial:lateral (M:L) BMD ratio; and average BMD of a 10-mm diameter "focal spot," which searched each medial and lateral plateau for the highest focal densities present within each plateau. Precision was assessed using root mean square coefficients of variation (CV%(RMS)) and intraclass correlation coefficients (ICC).Results: Average CV%(RMS) precision errors for BMD measures were 2.3%, reaching a maximum CV%(RMS) of 3.9%. ICC showed high repeatability above 0.98.Conclusions: CT-TOMASD offered precise 3D measures of subchondral BMD. This method has the potential to identify and quantify changes in subchondral BMD associated with OA in vivo. [ABSTRACT FROM AUTHOR]

Purpose: The novel protein osteopotentia (Opt) has recently been described as an essential regulator of postnatal osteoblast maturation and might possibly be responsible for some of the rarer types of osteogenesis imperfecta. Our aim was the evaluation of micro CT for the qualitative morphological assessment of skeletal abnormalities of Osteopotentia-mutant mice in comparison to radiography and histology.Materials and Methods: Four homozygous mice with insertional mutations in the Opt gene and three wild-type controls were examined ex vivo using radiography and micro-CT. Two of the homozygous animals were evaluated histologically (trichrome reagent). For the micro-CT evaluation three-dimensional (3D) surface reconstructions and two-dimensional (2D) multiplanar reformations (MPRs) were applied.Results: The Opt-homozygous mice exhibited severe growth. The radiographic examinations showed osteopenia and fractures with hypertrophic callus formation and pseudarthroses of the forelimbs and ribs. Micro-CT confirmed these findings and was able to demonstrate additional fractures especially at smaller bones such as the metacarpals and phalanges. Additional characterization and superior delineation of cortices and fracture fragments was achieved by 2D MPRs. Histological correlation verified several of these imaging findings.Conclusion: Micro-CT is able to screen Opt-mutant mice for osseous pathologies and furthermore characterize these anomalies. The modality seems superior to conventional radiography, but is not able to demonstrate cellular pathology. However, histology is destructive and more time- and material-consuming than micro-CT. Additional information may be gathered by 2D MPRs. [ABSTRACT FROM AUTHOR]

About 90% of individuals with multiple myeloma will develop osteolytic bone lesions from increased osteoclastic and decreased osteoblastic activity. Severe morbidities from pathologic fractures and other skeletal events can lead to poor circulation, blood clots, muscle wasting, compromised performance status, and overall poor survival. Supportive care targeting bone disease is an essential adjunct to antimyeloma therapy. In addition, the maintenance of bone health in patients with multiple myeloma can significantly improve quality of life. Oncology nurses and other healthcare providers play a central role in the management of bone disease and maintenance throughout the course of treatment. Safe administration of bisphosphonates, promotion of exercise, maintenance of adequate nutrition, vitamin and mineral supplementation, scheduled radiographic examinations, and monitoring of bone complications are among the important functions that oncology nurses and healthcare providers perform in clinical practice. [ABSTRACT FROM AUTHOR]

Raman spectroscopy has recently seen major advances in the area of deep non-invasive characterisation of diffusely scattering samples; this progress is underpinned by the emergence of spatially offset Raman spectroscopy and associated renaissance of transmission Raman spectroscopy permitting the characterisation of diffusely scattering samples at depths not accessible by conventional Raman spectroscopy. Examples of emerging research activities include non-invasive diagnosis of bone disease and cancer, rapid quality control of pharmaceutical formulations and security screening of explosives and counterfeit drugs through unopened translucent bottles. This article reviews this field focusing on recent developments with high societal relevance. [ABSTRACT FROM AUTHOR]

Objective: The description of femoral head sphericity and related risk for femoroacetabularimpingement is currently limited to an angular estimate-the alpha angle-whose relevance and accuracy have been challenged. We developed a three-dimensional approach for both automated digital measurement of the alpha angle and the detection of camdeformities. Accuracy and diagnostic relevance of the alpha angle estimated by means of the oblique axial and multiple radial plane protocol were compared with the computed results.Materials and Methods: Using subject-specific statistical information of the femur head and mid-neck region, a method was developed to accurately compute the maximum alpha angle and to define aspherical eccentric areas at the femoral head-neck junction. The method was evaluated on 102 dry cadaver femur specimens.Results: Average detection limit for bony prominences at the head-neck transition was 0.98 mm. Pixel size of the investigated CT data was 0.79 mm. Mean maximum computed alpha angle of the femurs with cam-type morphology as identified by the morphological method was 67.72° (range 53.04-88.02°). Mean maximum computed alpha angle of the femurs without cam deformity was 47.65° (range 38.67-59.81°). Alpha angle estimates obtained by means of the multiple radial plane protocol correlated better (R = 0.88) and showed higher diagnostic agreement (phi = 0.77) with the 3D computational analysis compared to the oblique axial protocol (R = 0.60; phi = 0.67).Conclusions: The alpha angle seems to be a relevant screening tool when obtained by 3D computed analysis or when estimated according to the multiple radial plane protocol. Estimates obtained by means of the oblique axial protocol have insufficient diagnostic and measurement accuracy. [ABSTRACT FROM AUTHOR]

Abstract: Idiopathic avascular necrosis of the scaphoid, also called Preiser''s disease, has been diagnosed in only 150 cases. Its clinical and radiological description is well established, but there is no consensus regarding its treatment. We report the case of a 53-year-old woman, with an advanced disease; treated arthroscopically by partial resection of the scaphoid, and insertion of an adapted pyrocarbon implant. Preliminary results at 6months were satisfying in terms of pain. However, there was little improvement in range of motion, with a final range of 150°. [Copyright &y& Elsevier]

Background and purpose Slipped capital femoral epiphysis (SCFE) is often treated by surgical fixation; however, no agreement exists regarding technique. We analyzed the outcome of in situ fixation with Steinmann pins. Patients and methods All 67 subjects operated for slipped capital femoral epiphysis at Haukeland University Hospital during the period 1990--2007 were included. All were treated by in situ fixation with 2 or 3 parallel Steinmann pins (8 mm threads at the medial end). The follow-up evaluation consisted of clinical examination and hip radiographs. Radiographic outcome was based on measurements of slip progression, growth of the femoral neck, leg length discrepancy, and signs of avascular necrosis and chondrolysis. Results 67 subjects (41 males) were operated due to unilateral slips (n == 47) or bilateral slips (n == 20). Mean age at time of diagnosis was 13 (7.2--16) years. Mean age at follow-up was 19 (14--30) years, with a mean postoperative interval of 6.0 (2--16) years. The operated femoral neck was 9% longer at skeletal maturity than at surgery, indicating continued growth of the femoral neck. At skeletal maturity, 12 subjects had radiographic features suggestive of a previous asymptomatic slip of the contralateral hip. The total number of bilateral cases of SCFE was 32, i.e half of the children had bilateral SCFE. 3 subjects required additional surgery and mild avascular necrosis of the femoral head was seen in 1 patient. None had slip progression or chondrolysis. Interpretation In situ pinning of SCFE with partly threaded Steinmann pins appears to be a feasible and safe method, with few complications. The technique allows further growth of the femoral neck. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the reproducibility of US and to compare its efficacy with that of MRI and conventional radiography (CR) for the detection of bone erosion in RA patients.Methods. A systematic literature search was performed in the Medline, Embase and Cochrane databases up to August 2009. Trials evaluating the reproducibility of US for bone erosion detection or comparing the number of erosions detected by the three imaging methods at patient and/or joint level were included. This last parameter was assessed using the odds ratio (OR) and 95% CI with the Mantel–Haenszel method (OR < 1 favours US). We explored the heterogeneity between the studies by subgroup analysis.Results. Twenty-one studies including 913 patients were included in this meta-analysis. Intraobserver and interobserver reproducibility of US for erosion detection was good. US and MRI efficacies were comparable at both joint (OR = 1.19, P = 0.45; seven studies, 869 joints) and patient (OR = 1.76, P = 0.22; nine studies, 338 patients) levels. US detected significantly more erosion than CR at both joint (OR = 0.30, P < 0.00001; 4047 joints studied) and patient (OR = 0.31, P < 0.00001; 592 studied patients) levels. The number of patients to screen in order to detect an additional patient with an erosion in comparison with CR was 4, 95% CI (2.4, 5.9).Conclusion. US is more effective for erosion detection than CR and has a comparable efficacy to MRI with good reproducibility. [ABSTRACT FROM PUBLISHER]

The lengths of the digital bones of the fore- and hind-limbs obtained post mortem from 40 cattle of different ages were measured using digital radiographs. The lengths of the individual digital bones and the overall length of the digit were determined using computer software. The lateral metacarpal/metatarsal condyle, and lateral P1 and P2 were significantly longer than their medial counterparts, whereas P3 of the medial digit was longer than its lateral partner. Measured from the cannon bone epiphysis to the tip of the pedal bone, the mean increased length of the lateral digit was 0.8 mm in the fore- and 1.5 mm in the hind-limb. When the lengths of the digital bones were summed. the mean length of the lateral digit was 1.8 mm longer in the fore-limb and 2.1 mm longer in the hind-limb. Based on these findings, it can be concluded that the lengths of the paired digits differ in cattle. The majority of cattle have longer lateral digits in the fore- and hind-limbs. This asymmetry might explain why the lateral hind-limb claws are predisposed to sole ulcers on hard surfaces. In the hind-limbs, the impact is transferred from the pelvis directly to the longer lateral digit. In the fore-limb claws, the tenomuscular attachment to the trunk may be involved in a more even weight distribution and in a shift of weight to the medial claw. [ABSTRACT FROM AUTHOR]

Takayasu artehtis is a large vessel vasculitis that usually affects young female patients during the second and third decades of life. Less commonly, it can also be seen childhood. In this article, we describe a case of Takayasu arteritis in a 17 year-old-boy who presented with unilateral digital clubbing. The patient had also a one-month history of muscle weakness and myalgia in the left upper and lower extremity. There was no hypertension or abdominal bruit. Digital subtraction angiography revealed a total occlusion of the left subclavian artery and a severe narrowing of the right renal artery. The association of digital clubbing and Takayasu's arteritis is not common. To our knowledge, only two cases have been reported to date. [ABSTRACT FROM AUTHOR]

Bone damage in children with chronic kidney disease (CKD) is a challenge for pediatric nephrologists. Areal measurements of bone mineral density (BMD) by dual x-ray absorptiometry (DXA) have been routinely performed to assess bone mass but recent international guidelines have concluded that DXA was of less value in CKD. The aim of this study is to evaluate bone quality in CKD children using new bone imaging techniques in a pilot cross-sectional single-center study. We performed bone imaging (high-resolution peripheral quantitative computed tomography, HR-pQCT, XtremeCT, Scanco Medical AG, Switzerland), to assess compartmental volumetric BMD and trabecular microarchitecture in 22 CKD children and 19 controls. In seven younger patients (i.e., under 10 years of age), we performed bone texture analysis (BMA, D3A Medical Systems, France) in comparison to 15 healthy prepubertal controls. Among older children, CKD patients had significantly lower height and body weight without significant impairment of BMD and microarchitecture than healthy controls. In univariate analysis, there were significant correlations between cortical BMD and glomerular filtration rate ( r = -0.46), age ( r = 0.60) and body mass index ( r = 0.67). In younger children, bone texture parameters were not different between patients and controls. Our results did not show significant differences between healthy controls and CKD children for compartmental bone densities and microarchitecture, but the small sample size and the heterogeneity of the CKD group require caution in the interpretation. Novel bone imaging techniques seem feasible in children, and further longitudinal studies are required to thoroughly explore long-term cardiovascular and bone consequences of phosphate-calcium metabolism deregulation during CKD. [ABSTRACT FROM AUTHOR]

We describe the clinical and radiological manifestations and outcome after treatment of 7 children who received a diagnosis of early yaws osteoperiostitis. Osteoperiostitis occurred some weeks after the primary infection, and the most common finding was hypertrophic periostitis of long bones. All treated patients had excellent responses to benzyl-penicillin therapy. [ABSTRACT FROM AUTHOR]

Description: Update of the 2002 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for osteoporosis. Methods: The USPSTF evaluated evidence on the diagnostic accuracy of risk assessment instruments for osteoporosis and fractures, the performance of dual-energy x-ray absorptiometry and peripheral bone measurement tests in predicting fractures, the harms of screening for osteoporosis, and the benefits and harms of drug therapy for osteoporosis in women and men. Recommendations: The USPSTF recommends screening for osteoporosis in women aged 65 years or older and in younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors. (Grade B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis in men. (I statement) [ABSTRACT FROM AUTHOR]

Nuclear medicine bone imaging has been the optimum diagnosis for the detection of bone disorders because the lesion could be detectable before the appearance of symptomatic and radiographic changes. Over the past three decades, 99mTc-MDP and 99mTc- HMDP have been used as bone scintigraphic agents because of their superior biodistribution characteristics, although they are far from optimal from a chemical and pharmaceutical point of view. Recently, a more logical drug design has been proposed as a concept of bifunctional radiopharmaceuticals in which the carrier molecules (bisphosphonates) and radiometal chelating groups are separated within a molecule, specifically, 99mTc-mononuclear complex-conjugated bisphosphonate. Some of the 99mTc-mononuclear complex-conjugated bisphosphonate compounds showed superior biodistribution in preclinical studies. Moreover, the drug design concept could be applied to 68Ga PET bone imaging agents. These studies would provide useful information for the development of radiometal-based imaging and therapeutic agents for bone disorders such as bone metastases. [ABSTRACT FROM AUTHOR]

Muscle forces are a strong determinant of bone structure, particularly during the process of growth and development. The gender divergence in the bone-muscle relationship becomes strongly evident during adolescence. In females, growth is characterized by increased estrogen levels and increased mass and strength of bone relative to that of muscle, whereas in men, increases in testosterone fuel large increases in muscle, resulting in muscle forces that coincide with a large growth in bone dimensions and strength. In adulthood, significant age-related losses are observed for both bone and muscle tissues. Large decrease in estrogen levels in women appears to diminish the skeleton's responsiveness to exercise more than in men. In contrast, the aging of the muscle-bone axis in men is a function of age related declines in both hormones. In addition to the well-known age related changes in the mechanical loading of bone by muscle, newer studies appear to provide evidence of age- and gender-related variations in molecular signaling between bone and muscle that are independent of purely mechanical interactions. In summary, gender differences in the acquisition and age-related loss in bone and muscle tissues may be important for developing gender-specific strategies for using exercise to reduce bone loss with aging. [ABSTRACT FROM AUTHOR]

Concern for bone fragility in children and adolescents has led to increased interest in bone densitometry. Pediatric patients with genetic and acquired chronic diseases, immobility, and inadequate nutrition may fail to achieve the expected gains in bone size, mass, and strength, which leaves them vulnerable to fracture. In older adults, bone densitometry has been shown to predict fracture risk and reflect response to therapy. The role of densitometry in the management of children at risk of bone fragility is less certain. This clinical report summarizes the current knowledge about bone densitometry in the pediatric population, including indications for its use, interpretation of results, and its risks and costs. This report emphasizes consensus statements generated at the 2007 Pediatric Position Development Conference of the International Society of Clinical Densitometry by an international panel of bone experts. Some of these recommendations are evidence-based, and others reflect expert opinion, because the available data are inadequate. The statements from this and other expert panels have provided general guidance to the pediatrician, but decisions about ordering and interpreting bone densitometry still require clinical judgment. Ongoing studies will help to better define the indications and best methods for assessing bone strength in children and the clinical factors that contribute to fracture risk. [ABSTRACT FROM AUTHOR]

The initial diagnosis of a sleeve fracture of the patella is key to a successful outcome with poor results well documented in the literature from delayed management. Diagnosis is difficult due to the rarity of this injury and thus the low likelihood the admitting junior doctor would think of this injury in their differential. They are very uncommon in incidence and have features on plain radiography that are difficult to interpret unless the surgeon is familiar with the anatomy of the immature patella. Missing the diagnosis can be disastrous for the patient. In this paper we describe the presentation of bilateral sleeve fractures in a healthy child, our initial investigations and subsequent management. We chose to repair with 5 Ethibond via 3 transosseous tunnels, initially reinforced with a circlage wire. On last review the boy maintains stable, pain-free knees with a full range of motion. The authors hope that this case and literature review will provide a valuable teaching aid and so assist in early, accurate diagnosis and cover the management options to achieve a positive outcome [ABSTRACT FROM AUTHOR]

Abstract: Bone scan analyses and clinical assessment are used to diagnose unilateral condylar hyperactivity (UCH). This review compares the diagnostic accuracy of planar and SPECT bone scans. Studies diagnosing patients with possible UCH using bone scans, published between 1968 and 2008, were included in this review. Of 15 articles that met the inclusion criteria, 7 presented results in sufficient detail to calculate index test characteristics. Three control studies show that the difference in uptake values of the left and right condylar regions in the normal population does not exceed 10%. The pooled sensitivity of the planar bone scan (n =130) was 0.71 (95% confidence interval: 0.57–0.82), which was significantly lower (p =0.04) than that of the bone SPECT technique (n =88), which was 0.90 (0.79–0.97). The pooled specificity of the SPECT scan was 0.95 (0.82–0.99), which did not significantly differ (p =0.58) from that of the planar scan (0.92 (0.83–0.97)). Future studies should include a diagnostic analysis of the data, including two-by-two contingency tables, so the accuracy of the diagnostic test may be evaluated. Bone scans are best performed using SPECT, conducting a quantitative analysis by calculating the percentile differences between the left and right condylar regions. [Copyright &y& Elsevier]

Abstract: Objective: To present an up-to-date literature review of osteoporosis in spinal cord injury (SCI) patients, in view of the seriousness of this complication (with a high risk of fractures) and the complexity of its diagnosis, evaluation and treatment. Methods: A Medline search with the following keywords: immobilization osteoporosis, spinal cord injury, bone loss, dual energy X-ray absorptiometry (DEXA), bisphosphonate. Results: Our analysis of the literature noted a bone metabolism imbalance in SCI patients, with accelerated early bone resorption (particularly during the first 6months post-injury). Although dual energy X-ray absorptiometry constitutes the “gold standard” diagnostic method, the decrease in bone mineral density only becomes significant 12months after the injury. Bisphosphonate therapy has proven efficacy. Despite the frequent use of various physical therapies, these methods have not been found to be effective. Conclusion: Although our literature review did not identify any guidelines on the strategy for diagnosing and treating osteoporosis in SCI patients, several findings provide guidance on procedures for early diagnosis and preventive treatment. [Copyright &y& Elsevier]

Background/Aims: Elevated parathyroid hormone (PTH) is used to diagnose high turnover bone disease in chronic kidney disease (CKD). The diagnostic accuracy of PTH in kidney transplant recipients with CKD is unknown. Methods: We examined kidney transplant recipients with CKD stages 3 (n = 498) and 4 (n = 141) to determine the sensitivity and specificity of the Kidney/Dialysis Outcome Quality Initiative (K/DOQI)-recommended PTH levels in detecting elevated serum β-CrossLaps (CTX) or osteocalcin (OC) levels. We performed receiver-operator curve analyses to determine CKD stage-specific PTH levels that provide optimal diagnostic accuracy. Results: PTH below the lower limits of the K/DOQI ranges (35 and 70 pg/ml in CKD stages 3 and 4, respectively) showed sensitivity of >90% in diagnosing increases in biochemical markers. The upper limits (70 and 110 pg/ml), however, showed poor specificity. A specificity of >90% for detecting increased biochemical markers was seen with PTH of >140 and >240 pg/ml in CKD stages 3 and 4, respectively. Conclusion: Currently applied cutoffs for PTH in kidney transplant recipients with CKD stages 3 and 4 do not appear to adequately detect increased biochemical markers of bone turnover. Diagnostic uncertainty exists in patients with CKD stage 3 and PTH between 35 and 140 pg/ml, and CKD stage 4 and PTH between 70 and 240 pg/ml. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Biopsy is a critical step in the diagnosis of musculoskeletal malignancy. As an alternative to open biopsy, percutaneous core needle biopsy techniques have been developed. As many studies combine office-based, image-guided, and operative biopsies, the accuracy of office-based core needle biopsy is not well documented. Question/purposes: We asked whether (1) office-based core needle biopsy for the diagnosis of malignant musculoskeletal neoplasms would have few complications and diagnostic and accuracy rates comparable to those cited in the literature for core needle biopsy, (2) diagnostic errors related to office-based core needle biopsy would result in surgical treatment errors, and (3) tissue core quantity and tumor type would affect accuracy. Patients and Methods: We retrospectively reviewed 234 patients with 252 core needle biopsies of malignant bone and soft tissue neoplasms at one institution between 1999 and 2007. Biopsy accuracy and errors were determined on the basis of histologic evaluation of prior or subsequent biopsies and/or resected specimens, when available. We eliminated 19 patients who had needle biopsies: three had the core needle biopsy completed in the operating room and 16 had insufficient documentation or followup, leaving 233 for study. Results: Of the 233 core needle biopsies, 212 (91%) were diagnostic and accurate for malignancy. Fourteen (6%) biopsies were nondiagnostic. Major errors, defined as a benign diagnosis in a malignant tumor, occurred in seven cases (3%). Minor errors, defined as errors in histopathologic diagnosis or grade, occurred in 24 biopsies (10%). All nondiagnostic and major core needle biopsy errors were identified and addressed with either a diagnostic open biopsy or definitive wide local excision, resulting in no surgical treatment errors. Accuracy was not influenced by core number; however, myxoid lesions showed a correlation with biopsy error. There were no biopsy-related complications. Conclusions: Office-based core needle biopsy for diagnosis of malignant musculoskeletal neoplasms has high diagnostic and accuracy rates without associated complications. Level of Evidence: Level II, diagnostic study. See the Guidelines for Authors for a complete description of the level of evidence. [ABSTRACT FROM AUTHOR]

Abstract: Bone undergoes continuous remodeling under physiological and pathological conditions. Failure of the regulation of this process leads to several disorders involving bone erosion. This series of events is mainly based on the action of proteinases, particularly matrix metalloproteinases (MMPs). MMPs have been recently suggested as potential bone resorption markers which could be added to the commonly used ones, in order to predict outcome of disease processes and healing, and to monitor disease response to treatment. As for classical biochemical bone markers, MMPs are far from being applied in primary clinical diagnosis, but they could be promising in some cases for disease prognosis. MMPs as bone remodeling biomarkers could provide information that boosts our understanding of the prognosis, disease activity and pathogenesis of bone disorders. Clarifying the MMPs’ role in bone remodeling and healing could potentially help predict disease progression and the effects of direct specific therapy. [ABSTRACT FROM AUTHOR]

Lytic bone disease is a frequent complication of multiple myeloma (MM). Lytic lesions rarely heal and X-rays are of limited value in monitoring bone destruction during anti-myeloma or anti-resorptive treatment. Biochemical markers of bone resorption (amino- and carboxy-terminal cross-linking telopeptide of type I collagen (NTX and CTX, respectively) or CTX generated by matrix metalloproteinases (ICTP)) and bone formation provide information on bone dynamics and reflect disease activity in bone. These markers have been investigated as tools for evaluating the extent of bone disease, risk of skeletal morbidity and response to anti-resorptive treatment in MM. Urinary NTX, serum CTX and serum ICTP are elevated in myeloma patients with osteolytic lesions and correlate with advanced disease stage. Furthermore, urinary NTX and serum ICTP correlate with risk for skeletal complications, disease progression and overall survival. Bone markers have also been used for the early diagnosis of bone lesions. This International Myeloma Working Group report summarizes the existing data for the role of bone markers in assessing the extent of MM bone disease and in monitoring bone turnover during anti-myeloma therapies and provides information on novel markers that may be of particular interest in the near future. [ABSTRACT FROM AUTHOR]