• Journal of Trauma and Injury
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• 제18권2호
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• pp.107-111
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• 2005

Backgrounds: To evaluate the effectiveness of conservative treatment in osteoporotic thoraco-lumbar compression fractures and to identify the factors influencing the progression of compression. Materials and Methods: From January 2003 to October 2004, Patients who were admitted to our hospital for osteoporotic thoraco-lumbar compression fractures were reviewed retrospectively with follow-up more than 12 months (ave. 14.6 months). With simple x-ray lateral view, we evaluate wedge compression ratio (WCR) and kyphotic angle (KA) at initial and final follow-up. We separate the patients into two groups baesed on the amount of progression of vertebral compression and evaluate a relation with BMD, vertebral fracture level, initial WCR, initial KA. All datas were statistically analyzed. Results: An average of T-score was -3.5 and the changes of KA between initial and final follow-up were average $3.5^{\circ}$. Compression of anterior column were progressed to 8.5%. The changes between initial and final WCR in Group I (N=24) was 17.8%, and Group II (N=18) was 3.3%. T-score in group I was -3.4 and group II was -3.8 (p=0.228). vertebral fracture level were 10 T12, 12 L1, 2 L2 in group I; 6 T12, 6 L1, 6 L2 in group II (p=0.156). Initail WCR was 0.74 in group I, 0.63 in group II, and there was statistical difference between two groups(p=0002). Initial kyphotic angle was $13.9^{\circ}$in group I, $16.2^{\circ}$in group II repectively (p=0.392). Conclusion: The conservative treatment with short-term bed rest and early embulation is effective and valuable method to patients who have osteoporotic thoraco-lumbar compression fractures. There was no statistical difference between two groups according to BMD, vertebral fracture level, KA. But in comparison with initail WCR between two groups, there was statistical difference. That means, in the case of small initial compression of anterior column, the progression of compression was bigger than else. In these patients, more strict use of appropriate brace and careful follow-up should be needed.

• Imaging Science in Dentistry
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• 제47권1호
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• pp.45-50
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• 2017

Purpose: The aim of this study was to investigate the incidence of bisphosphonate-related osteonecrosis of the jaw (BRONJ) after tooth extraction in patients with osteoporosis on oral bisphosphonates in Korea and to evaluate local factors affecting the development of BRONJ. Materials and Methods: The clinical records of 320 patients who underwent dental extraction while receiving oral bisphosphonates were reviewed. All patients had a healing period of more than 6 months following the extractions. Each patient's clinical record was used to assess the incidence of BRONJ; if BRONJ occurred, a further radiographic investigation was carried out to obtain a more definitive diagnosis. Various local factors including age, gender, extraction site, drug type, duration of administration, and C-terminal telopeptide (CTx) level were retrieved from the patients' clinical records for evaluating their effect on the incidence of BRONJ. Results: Among the 320 osteoporotic patients who underwent tooth extraction, 11 developed BRONJ, reflecting an incidence rate of 3.44%. Out of the local factors that may affect the incidence of BRONJ, gender, drug type, and CTx level showed no statistically significant effects, while statistically significant associations were found for age, extraction site, and duration of administration. The incidence of BRONJ increased with age, was greater in the mandible than the maxilla, and was associated with a duration of administration of more than 3 years. Conclusion: Tooth extraction in patients on oral bisphosphonates requires careful consideration of their age, the extraction site, and the duration of administration, and close postoperative follow-up should be carried out to facilitate effective early management.

• Journal of Yeungnam Medical Science
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• 제25권1호
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• pp.19-30
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• 2008

골다공증은 골밀도와 골의 질로 구성되는 골의 강도가 손상됨으로 골절의 위험이 높아지는 골격질환이며, 최근 유병율이 점차 증가하고 있는 추세이다. 임상적으로 무증상인 경우가 많으며 방사선학적 검사인 단순 방사선 검사, 골 스캔, CT, MRI 등이 골밀도 및 골절의 진단에 유용하다. 골밀도의 정량적 검사로는 이중에너지 방사선 흡수법, 정량적 전산화 단층촬영이 사용되고 있다. 골다공증의 진단은 WHO 기준에 따라 T-score가 -2.5 이하일 경우 진단할 수 있다. 그 외에 생화학적 골표지자들도 진단에 도움이 된다. 골다공증 치료제는 골흡수억제제와 골형성자극제(formation stimulator)로 나눌 수 있는데 골흡수억제제로는 칼슘, 에스트로겐, 칼시토닌, 비스포스포네이트(bisphosphonate), 비타민 D 등이 있으며 골량을 증가시키는 골형성자극제로는 현재 부갑상선 호르몬이 유일하며 최근 strontium ranelate가 추가되었다. 일일 1200 mg의 칼슘과 800 IU 의 비타민 D 섭취가 권장되고 있으며, 폐경기 여성에서 에스트로겐이 효과가 입증되었고 골다공증으로 인한 통증에는 칼시토닌이 효과가 있다. 비스포스포네이트는 폐경 후 골다공증의 치료, 예방 및 스테로이드에 의한 골다공증 치료에 대해 FDA의 승인을 받았다. 폐경 후 골다공증의 치료, 예방에 사용되는 SERM은 골의 질을 향상시킴으로써 골절을 예방한다고 알려져 있다. 골형성자극제인 부갑상선 호르몬이 골절의 위험을 감소시킨다고 보고된 바 있으며, strontium은 최근에 개발된 약제로 3상 연구에서 골절 위험율 감소효과를 보였으나 더 많은 연구가 필요할 것으로 생각된다.

• Journal of Korean Neurosurgical Society
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• 제30권7호
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• pp.907-915
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• 2001

Objective : Percutaneous vertebroplasty is often complicated by the presence of multiple fractures or non-localizing pain in the patients with osteoporotic vertebral fractures. The purpose of this study is to estimate the value of preoperative radiologic studies in the localization of symptomatic vertebrae and to determine the factors which can influence on the clinical results. Materials and Methods : We retrospectively reviewed the clinical and radiologic data of 57 vertebrae in 30 patients underwent percutaneous vertebroplasty for osteoporotic vertebral compression fractures. Inclusion criteria was severe pain(McGill-Melzack score 3, 4 or 5) associated with the acute vertebral fractures and absence of spinal nerve root or cord compression sign. Acute symptomatic vertebral fracture was determined by the presence of signal change on MR images or increased uptake on whole body bone scan. Results : Pain improvement was obtained immediately in all patients and favorable result was sustained in 26 patients(86.7%) during the mean follow-up duration of 4.7 months(5 complete pain relief, 21 marked pain relief). Those who underwent vertebroplasty for all acute symptomatic vertebrae had significantly better clinical result than those who did not. Further vertebral collapse and eventual bursting fracture occurred in 1 vertebra which showed intradiskal leakage of bone cement and disruption of cortical endplate on postoperative CT scan. Conclusion : Preoperative MR imaging and whole body bone scan are very useful in determining the symptomatic vertebrae, especially in the patients with multiple osteoporotic vertebral fractures. To obtain favorable clinical result, the careful radiologic evaluation as well as clinical assessment is required. Control of PMMA volume seems to be the most critical point for avoiding complications.

• Genomics & Informatics
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• 제14권4호
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• pp.216-221
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• 2016

Osteoporotic fractures (OFs) are critical hard outcomes of osteoporosis and are characterized by decreased bone strength induced by low bone density and microarchitectural deterioration in bone tissue. Most OFs cause acute pain, hospitalization, immobilization, and slow recovery in patients and are associated with increased mortality. A variety of genetic studies have suggested associations of genetic variants with the risk of OF. Genome-wide association studies have reported various single-nucleotide polymorphisms and copy number variations (CNVs) in European and Asian populations. To identify CNV regions associated with OF risk, we conducted a genome-wide CNV study in a Korean population. We performed logistic regression analyses in 1,537 Korean subjects (299 OF cases and 1,238 healthy controls) and identified a total of 8 CNV regions significantly associated with OF (p < 0.05). Then, one CNV region located on chromosome 20q13.12 was selected for experimental validation. The selected CNV region was experimentally validated by quantitative polymerase chain reaction. The CNV region of chromosome 20q13.12 is positioned upstream of a family of long non-coding RNAs, LINC01260. Our findings could provide new information on the genetic factors associated with the risk of OF.

• 대한골대사학회지
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• 제25권4호
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• pp.267-274
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• 2018

Background: This prospective cohort study used nationwide claims data to investigate the incidence of fall and fragility fractures in association with urinary incontinence (UI) in the elderly, and to compare mortality after fragility fractures in elderly patients with or without incontinence. Methods: A total of 39,854 Korean adults (age, 66-80 years) who participated in health examinations between 2007 and 2012 and were followed up until 2015 were analyzed. Patient and comparison groups were classified according to the presence or absence of UI. The cumulative incidence of osteoporotic fragility fractures and falls in the 2 groups was assessed and compared. Hazard ratios for fragility fractures were calculated for the risk of UI in association with falls using a Cox proportional hazards model. Results: Of 39,854 elderly participants, 5,703 were classified in the UI group, while 34,151 were placed in the comparison group. Fall rates were significantly higher (20.8%) in the incontinence group than in the comparison group (4.7%) (P<0.001). Women in the incontinence group (13.9%) showed a significantly higher incidence of all types of fragility fractures than those in the comparison group (11.8%) (P=0.005). After adjustment for confounders, UI was not a significant risk factor for fragility fractures in men (P=0.878) or women (P=0.324). Conclusions: This study demonstrated that elderly women with UI have a significantly higher incidence of osteoporotic fragility fractures. In addition, elderly women are at higher risk for falls.

• Journal of Korean Neurosurgical Society
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• 제45권1호
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• pp.16-23
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• 2009

Objective : This retrospective study of 215 patients with 383 symptomatic osteoporotic vertebral compression fractures (VCFs) treated by percutaneous vertebroplasty (PVP), was performed to evaluate the clinical outcomes, and to analyze the various clinical factors affecting these results. Methods : The authors assessed the clinical outcome under the criteria such as the pain improvement, activity, requirement of analgesics, and the patient's satisfaction, and determined the relation to various peri- and intra-operative factors, and postoperative imaging findings. Results : The outcome was determined as 84.2% in relief of pain, 72.0% in change in activity, 65.7% in analgesics use, and 84.7% of satisfaction rate. More severe focal back pain, high uptake bone scan, and the lower mean T-score were related to the better pain relief following PVP. The longer the duration between fracture and PVP, the less severe focal back pain, low uptake bone scan, and leakage of PMMA into the paravertebral space were related to the less improvement in activity. Female and low uptake bone scan showed a correlation with more analgesic use. The longer the duration between fracture and PVP, low uptake bone scan, and the higher the mean T-score were correlated with the less the patients satisfaction. Conclusion : Our study suggests that PVP may be more effective in the acute phase of VCFs, more severe focal pain, and far advanced osteoporosis on BMD. Leakage of PMMA into the paravertebral spcae also could be affecting the surgical results.

• Journal of Korean Neurosurgical Society
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• 제37권2호
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• pp.116-123
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• 2005

Objective: Percutaneous kyphoplasty using a balloon-catheter is an widely accepted method which achieves the restoration of vertebral height and the correction of kyphotic deformity with little complication in osteoporotic vertebral compression fractures. The authors assess the results of 59 patients who underwent kyphoplasty, and analyze the factors that could affect the prognosis. Methods: From December 2001 to May 2003, fifty-nine patients underwent kyphoplasty. The patients included 49 women and 10 men aged 52-85 years. Average t-score on bone marrow density was -3.58. About 7cc of polymethylmethacrylate(PMMA) was injected into the fractured vertebral body using $Kyphon^{(R)}$ under local anesthesia. The vertical height of all fractured vertebrae was measured both before and after surgery. Outcome data were obtained by comparing pre- and post-operative VAS score and by assessing postoperative satisfaction, drug dependency and activity. Various clinical factors were analyzed to assess the relationship with the outcome. Results: The VAS score improved significantly, and the mean percentage of restored vertebral height was 53%. The mean improvement in kyphosis was $3.6^{\circ}$. Eighty-nine percent of the patients gained excellent or good results. Any of the clinical factors including the interval between fracture and operation, the degree of height loss, the degree of the vertebral height restoration or the correction rate of kyphosis did not affect the clinical results. Conclusion: Kyphoplasty is associated with a statistically significant improvement in pain and function with little complication. The clinical results are not affected by any clinical parameters. Further follow-up study is needed to determine whether the restoration affects the long-term clinical results.

• 대한정형외과학회지
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• 제55권4호
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• pp.318-323
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• 2020

목적: 근감소증에 중요한 요소인 척추 주변 근육 감소를 수치화한 총 지방 침윤율(total fat infiltration rate, TFI rate)과 골다공증성 척추 압박 골절(osteoporotic vertebral compression fracture) 및 관련 수치와의 상관 관계를 찾는 것을 목표로 하였다. 대상 및 방법: 2012년 1월부터 2016년 12월까지 요추의 압박 골절 진료를 본 환자들 중 1) 골밀도(bone mineral density, BMD) T score -2.5 g/cm² 미만으로 골다공증을 진단받고, 2) 요추 골절로 경피적 척추성형술(vertebroplasty) 또는 경피적 풍선척추성형술(kyphoplasty)을 받았으며, 3) 요추의 한 분절만 골절된 4) 1년 이상 추시한 환자 98명을 대상으로 후향적 연구를 시행하였다. TFI는 Image J 프로그램으로 자기공명영상을 분석하여 확인하였다. 이를 바탕으로 다열근(multifidus) 및 척추기립근(erector spinae)의 TFI와 골다공증 요소들과의 연관성을 분석하였다. 결과: 다열근및 척추기립근의 평균 TFI는 14.66±10.16이었다. 척추 BMD는 고관절 BMD와 통계적으로 유의한 양의 상관 관계를 보였으나 TFI와 음의 상관 관계를 보였다. 고관절 BMD는 체질량지수(body mass index)와 유의한 양의 상관 관계를 보였다. 또한 비타민 D 수치는 척추 BMD와 고관절 BMD에서 모두 양의 상관 관계를 보였으나, TFI와는 음의 상관 관계를 보였다. 결론: 근육량은 근감소증 환자뿐만 아니라 골다공증 환자의 치료에 있어서도 도움이 되므로 주의깊게 보아야 할 것이다. 또한 비타민 D를 증가시키는 것은 근육 위축의 진행을 늦출 수 있으므로 이로써 골절을 예방하는 효과를 가져올 수 있다.

• Nutrition Research and Practice
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• 제5권2호
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• pp.150-156
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• 2011

Few studies have shown the correlation between metabolic syndrome and bone mineral density (BMD). The main pathogenic mechanisms of metabolic syndrome rely on chronic low-level inflammatory status and oxidative stress. There are few studies that examine the gender-specific effects of inflammation and antioxidants on BMD. In this study, we evaluated the relative contribution of these factors in patients with metabolic syndrome. We conducted a cross-sectional study of 67 men and 46 postmenopausal women with metabolic syndrome; metabolic syndrome was defined as having three or more metabolic syndrome risk factors. BMD, body fat mass, and lean body mass were evaluated. We also examined the levels of high sensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), adiponectin, vitamin E, and C in serum. Log-transformed hs-CRP levels were significantly higher in lumbar spine osteoporotic subjects than in normal subjects for women but not for men. There was no significant difference between the normal group and the osteoporotic group in other inflammatory markers. Stepwise regression analyses for BMD of the lumbar spine showed that lean body mass and vitamin E were significant determinants in men. Lean body mass and log-transformed hs-CRP were significant determinants in women Analysis for BMD of the femoral neck showed that lean body mass was a significant determinant for both men and women. There was no significant factor among the inflammatory markers or antioxidant vitamins affecting the femoral neck BMD for either gender. In conclusion, while hs-CRP is an independent predictor of the BMD of the lumbar spine in women, vitamin E showed profound effects on BMD in men but not women with metabolic syndrome.