pyrophosphate and Fractures--Bone

During the past ten years the range of treatments available for patients with osteoporosis has increased greatly. A decade ago the only proven therapy was oestrogen, while today the choice includes bisphosphonates, selective oestrogen receptor modulators, calcitonin, calcium and vitamin D supplementation and, in the near future, parathyroid hormone. Clinical trials involving bone mineral density (BMD) scans of the spine and femur have had an important role in the evaluation of these new therapies. Supplementary information about treatments has been provided by BMD scans of the total body and distal radius as well as by measurements of biochemical markers of bone turnover in serum and urine. Most important of all, the efficacy of treatments has been verified in large trials powered to show reductions in fracture risk. In routine clinical use, BMD scanning has an important role in identifying individual patients with osteoporosis and helping to make decisions about their treatment. However, in contrast to the use of BMD scans in clinical trials, their value for monitoring response to therapy in individual patients is less certain because in many cases the increases in BMD are too small to reliably distinguish between true changes and measurement error. However, experience with well established therapies such as oestrogen and bisphosphonates suggests that these treatments have a beneficial effect on bone in the large majority of patients and individual monitoring of BMD is probably not necessary.

Topics: Biomarkers; Biomedical Research; Bone and Bones; Bone Density; Bone Remodeling; Densitometry; Diphosphates; Diphosphonates; Fractures, Bone; Humans; Osteoporosis; Osteoporosis, Postmenopausal; Predictive Value of Tests

Topics: Animals; Bone and Bones; Diphosphates; Dogs; Fracture Fixation, Intramedullary; Fractures, Bone; Humans; Osteogenesis; Polyphosphates; Radionuclide Imaging; Rats; Technetium; Technetium Compounds; Technetium Tc 99m Pyrophosphate; Time Factors

Topics: Animals; Calcium Radioisotopes; Diphosphates; Dogs; Extremities; Fractures, Bone; Hormones; Humans; Lymphoscintigraphy; Minerals; Osteomyelitis; Strontium Radioisotopes; Technetium; Technetium Tc 99m Pyrophosphate; Wound Healing; Xenon Radioisotopes

Control of Paget's disease of bone has been possible through treatment with agents that decrease bone resorption; calcitonins, diphosphonates, and mithramycin. The pagetic lesion is not, however, cured. Etidronate disodium is one of the diphosphonates. The clinical improvement attained with this drug has to be set against adverse effects, of which pain is probably the most bothersome in practice. Clinical remission can last as long as 2 years after treatment is stopped.

Topics: Bone Resorption; Calcitonin; Clinical Trials as Topic; Diphosphates; Drug Evaluation; Etidronic Acid; Fractures, Bone; Humans; Osteitis Deformans; Osteolysis

Topics: Bone and Bones; Bone Neoplasms; Breast Neoplasms; Carcinoma; Diphosphates; Diphosphonates; Fractures, Bone; Humans; Lung Neoplasms; Male; Osteomyelitis; Prostatic Neoplasms; Radionuclide Imaging; Technetium; Technetium Compounds; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

The radionuclide investigation of skeletal trauma in the past was confined generally to scintimetry and an occasional bone scan. The development of improved radiopharmaceuticals, including 99mTc-labeled compounds with their enhanced sensitivity, and the refinement of imaging devices offering superior resolution and speed have allowed a more detailed assessment of conditions resulting from trauma. Practical approaches to the diagnosis of subtle bone injury resulting in stress fracture, the differentiation between delayed healing and nonunion, and early recognition of avascular necrosis and osteomyelitis are now available. The changing pattern of radionuclide uptake in bone following damage by radiation and other abnormalities as a consequence of trauma also can be easily studied.

Topics: Adolescent; Adult; Athletic Injuries; Calcium Radioisotopes; Child; Diphosphates; Female; Femur Head Necrosis; Fluorine; Fractures, Bone; Fractures, Spontaneous; Fractures, Ununited; Humans; Male; Middle Aged; Myositis Ossificans; Osteomyelitis; Radiation Injuries; Radionuclide Imaging; Radiotherapy; Strontium Radioisotopes; Technetium

Control of Paget's disease of bone has been possible through treatment with agents that decrease bone resorption; calcitonins, diphosphonates, and mithramycin. The pagetic lesion is not, however, cured. Etidronate disodium is one of the diphosphonates. The clinical improvement attained with this drug has to be set against adverse effects, of which pain is probably the most bothersome in practice. Clinical remission can last as long as 2 years after treatment is stopped.

Topics: Bone Resorption; Calcitonin; Clinical Trials as Topic; Diphosphates; Drug Evaluation; Etidronic Acid; Fractures, Bone; Humans; Osteitis Deformans; Osteolysis

To investigate rates of assessment and treatment of osteoporosis among older women during the year after they have had fractures.. Observational, historical, population-based cohort study.. Manitoba, which maintains a comprehensive population-based repository of health care services provided and has a publicly funded health care system.. Women 50 years old and older who had suffered fractures between 1997 and 2002. These women were chosen from among approximately 175,000 women of this age in Manitoba.. We examined each woman's annual medical record between April 1, 1997, and March 31, 2002, to find any International Classification of Diseases fracture codes that have been consistently associated with osteoporosis. We looked for postfracture care during the first 12 months after fractures: bone mineral density (BMD) testing or treated with osteoporosis pharmacotherapy. Analysis was stratified by type of fracture: designated type 1 fractures (spine or hip) and type 2 fractures (not spine or hip).. Use of BMD testing or osteoporosis pharmacotherapy during the first 12 months following fractures.. For type 1 fractures, BMD assessment during the first year after fracture increased from 2.6% in 1997-1998 to 4.6% in 2001-2002 (P for trend .0004). Rates of therapy with osteoporosis medication increased from 4.9% in 1997-1998 to 17.6% in 2001-2002 (P for trend < .0001). Results were similar for type 2 fractures. In the final year of the study, only 20.5% of women with either type of fracture underwent any identifiable intervention (BMD assessment or osteoporosis pharmacotherapy). The intervention rate was substantially higher among women 50 to 64 years old (26.4%) than among those 75 years old or older (17.9%, P for trend < .0001).. Women at highest risk of future fractures are assessed infrequently for osteoporosis with BMD testing and given pharmacotherapy to prevent future fractures just as infrequently. This gap in care was particularly striking for BMD testing despite the fact that testing is free in Manitoba's publicly funded system. Data from this study could be educational for physicians treating osteoporosis and should encourage them to improve their practice patterns and optimize patient care.

Topics: Absorptiometry, Photon; Aged; Bone Density Conservation Agents; Comorbidity; Diphosphates; Female; Follow-Up Studies; Fractures, Bone; Humans; Manitoba; Middle Aged; Osteoporosis, Postmenopausal; Patient Care; Preventive Health Services; Selective Estrogen Receptor Modulators

Topics: Adult; Child; Diphosphates; Fractures, Bone; Humans; Osteomyelitis; Osteoporosis; Radionuclide Imaging; Spinal Diseases; Spinal Injuries; Spinal Neoplasms; Technetium; Technetium Tc 99m Pyrophosphate

Altogether 56 patients aged 20-55 with closed oblique fractures of the upper and lower limb bones were observed. Reparative osteogenesis was studied using 99mTc-pyrophosphate. An elevated RP accumulation at the ends of the bone splinters was found from the 1st day after fracture. By the end of the 1st month after fracture the RP activity increased up to 750% in the absence of splinter dislocation. In dislocation it was 50-80% less. The RP maximal activity in the place of fracture was noted on the 7-8th week, in the dislocation of splinters on the 9-10th week. By the results of radionuclide studies, the fracture consolidated right after a decrease in the 99mTc-pyrophosphate accumulation that made it possible to determine the optimum time of bone consolidation.

Topics: Adult; Arm Injuries; Diphosphates; Fracture Fixation, Internal; Fractures, Bone; Fractures, Closed; Humans; Leg Injuries; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Wound Healing

A total of 86 patients were examined by 99mTc-pyrophosphate in the course of therapy using the transosseous synthesis method. An elevated accumulation of the radiopharmaceutical was observed since the first day following a trauma. Maximum enhancement of metabolic processes in the absence of fragment displacement was noted on the 8th week and in the lack of displacement on the 9th-10th week. Then the intensity of bone formation got weaker. It was found appropriate that G. A. Ilizarov's apparatus should be removed exactly at that time. The content of mineral components in the regenerate was over 60% which demonstrated the bone ability to stand physiological loads.

Topics: Adult; Arm Injuries; Diphosphates; Fracture Fixation, Internal; Fractures, Bone; Fractures, Closed; Humans; Leg Injuries; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Wound Healing

A study was made of reparative osteogenesis and the content of mineral bone components in 60 patients with spiral fractures of the leg bones during treatment by transosseous osteosynthesis. The time of maximum labeled pyrophosphate accumulation was determined by a degree of the initial dislocation of fragments: in the dislocation to the cortical layer it was noted on the 42nd day, by 1/3 on the 45th day, by 2/3 on the 50th day, to the cross section on the 60th day. The demineralization of bone fragments in the dislocation to the cortical layer was 34%, by 1/2 37%, by 2/3 41% and to the cross section by 44%. The labeled sulphuric colloid accumulation by bone marrow cells was maximal in minimal dislocations and decreased with growing dislocation.

Topics: Adult; Bone and Bones; Bone Marrow; Diphosphates; Fracture Fixation, Internal; Fractures, Bone; Fractures, Closed; Humans; Leg Injuries; Middle Aged; Minerals; Orthopedic Fixation Devices; Osteogenesis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Technetium Tc 99m Sulfur Colloid; Time Factors

Topics: Adolescent; Adult; Aged; Diphosphates; Female; Fractures, Bone; Humans; Lumbar Vertebrae; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thoracic Vertebrae

Four cases of ankylosing spondylitis are presented in which radionuclide bone studies indicated focal abnormalities of the spine. In three patients, the area of abnormal nuclide uptake corresponded to a site of pseudarthrosis, and in the fourth an acute fracture was present. As such focal lesions on bone scans are unusual in cases of chronic ankylosing spondylitis in which a complication is not apparent, their presence can be a useful finding.

Topics: Aged; Diphosphates; Diphosphonates; Fractures, Bone; Humans; Male; Middle Aged; Pseudarthrosis; Radiography; Radionuclide Imaging; Spinal Injuries; Spine; Spondylitis, Ankylosing; Technetium; Technetium Compounds; Technetium Tc 99m Pyrophosphate

The potential role of bone scanning in the early detection of occult fractures following acute trauma was investigated. Technetium 99m pyrophosphate bone scans were obtained in patients with major clinical findings (e.g., pain, swelling, tenderness) and negative or equivocal roentgenograms following trauma. Bone scanning facilitated the prompt diagnosis of occult fractures in the hip, knee, wrist, ribs and costochondral junctions, sternum, vertebrae, sacrum, and coccyx. Several illustrative cases are presented. Roentgenographic confirmation occurred following a delay of days to weeks and, in some instances, the roentgenographic findings were subtle and could be easily overlooked. This study demonstrates bone scanning to be invaluable and definitive in the prompt detection of occult fractures.

Topics: Acetabulum; Aged; Bone and Bones; Coccyx; Diphosphates; Female; Fractures, Bone; Fractures, Closed; Humans; Radiography; Radionuclide Imaging; Radius Fractures; Sacrum; Sternum; Technetium; Technetium Tc 99m Pyrophosphate; Wounds and Injuries; Wrist Injuries

Topics: Adolescent; Child; Child, Preschool; Diphosphates; Evaluation Studies as Topic; Fractures, Bone; Humans; Spinal Injuries; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed

In 20 cases routine static bone scans were no value in the detection of delayed fracture healing. Using the 7.5-15 min net uptake of technetium labelled phosphate, disturbed fracture healing was detected in a series, of 37 cases. Normally healing fractures had an increase of 3 per cent per month and delayed unions less than half that amount. Non-unions had no net uptake.

Topics: Bone Transplantation; Diphosphates; Diphosphonates; Fracture Fixation; Fractures, Bone; Fractures, Ununited; Humans; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate; Tibial Fractures; Time Factors; Wound Healing

Topics: Adult; Bone and Bones; Bone Transplantation; Diphosphates; Fracture Fixation; Fractures, Bone; Humans; Male; Orthopedic Fixation Devices; Radionuclide Imaging; Technetium; Thoracic Vertebrae; Transplantation, Autologous

The clinical, laboratory, and radiologic picture of a unique patient with symmetrical fractures of the anterior tibial midshafts, dorsal ulnar cortices, and lateral metatarsals is presented. The findings are not compatible with a diagnosis of osteogenesis imperfecta or osteomalacia despite osseous fragility. The elevated serum pyrophosphate and low urine phosphate content suggest that abnormalities in phosphate metabolism may have contributed to the formation of bone which is biochemically and structurally deficient.

Topics: Child; Diphosphates; Fractures, Bone; Humans; Male; Metatarsus; Radiography; Tibial Fractures; Ulna Fractures

Activity levels of 99TC-labeled compounds, 18F, and 85Sr were obtained at 1, 3, and 5 hr. postinjection in normal and healing fractured bone and in soft-tissue rat specimens. Serial diagnostic bone images and blood and urine kinetics were obtained in patients with each of the TC-labeled compounds. Computer-processed images were used to evaluate in vivo kinetics. 99mTC pyrophosphate provides the best overall characteristics for bone imaging. Improved quality and bioassay procedures are required, however, before any one agent can be designated the radiopharmaceutical of choice for diagnostic bone imaging.

Topics: Animals; Diphosphates; Disease Models, Animal; Fluorine; Fractures, Bone; Humans; Isotope Labeling; Kinetics; Phosphates; Radioisotopes; Radionuclide Imaging; Rats; Strontium Radioisotopes; Technetium; Tibial Fractures; Wound Healing

Topics: Adolescent; Bone Diseases; Bone Neoplasms; Child; Diphosphates; Female; Fractures, Bone; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium

Osteogenesis imperfecta during pregnancy presents increased risk to mother and fetus. In addition to the well-known skeletal changes, other recently recognized metabolic abnormalities also may lead to maternal and fetal problems during labor and delivery. A discussion of risk factors and their managment is presented. The importance of considering the possibility of fetal osteogenesis imperfecta is stressed, and cesarean section is presented as the method of choice for delivery. Important genetic factors including the lack of correlation between the severity of involvement of parent and offspring and the use of pyrophosphate analyses are discussed. An illustrative case is presented.

Topics: Adult; Amniotic Fluid; Cesarean Section; Connective Tissue; Diphosphates; Epistaxis; Female; Fractures, Bone; Humans; Osteogenesis Imperfecta; Otosclerosis; Pregnancy; Pregnancy Complications; Tooth Diseases

99MTc pyrophosphate has restored bone scintigraphy to the position of respectability it had lost with radiostrontium 85 and 87m, and it has rapidly become the method of choice for the detection of osteogenic hyperactivity. In cases of tumor the histologic disorder is frequently detected prior to the morphologic changes seen in X-ray pictures. The biophysical properties of 99mTc pyrophosphate provide high quality imaging of the skeleton. The scans or scintiphotos render possible a more sensitive and earlier diagnosis than radiography, though bone scanning does not of course supersede radiography. The two methods are complementary. In present day oncologic practice, however, bone scintigraphy with 99mTc pyrophosphate replaces to advantage the conventional radiographic "bone survey". In neurology the change is already appreciable and has proved its worth. In the light of results in 78 neurologic patients attention is drawn to the significant changes bone scintigraphy has brought about in diagnosis and therapeutic planning. The indications which have already emerged from this new method of nuclear neurology are tabulated, discussed and illustrated.

Topics: Adult; Aged; Bone Neoplasms; Diagnosis, Differential; Diphosphates; Female; Fractures, Bone; Histiocytoma, Benign Fibrous; Humans; Male; Neoplasm Metastasis; Nervous System Diseases; Radionuclide Imaging; Skull Neoplasms; Technetium

Kinetics and clinical studies of bone scintiscanning with 99mTc-pyrophosphate in 92 patients with certified diagnosis allowed the following conclusions: 1. After i.v. injection 99mTc-pyrophosphate is distributed in 3 compartments, from which it is cleared with biological half-lives of 32.7 minutes, 5.1 hours and 22.54 hours respectively. The relative size of these compartments is 1 : 3 : 6. After application of the substance, an initially high renal excretion with a consecutive exponential drop can be observed. The optimal period for scintigraphic studies seems therefore to be from 3-6 hrs, as at this time there is still an adequate activity in bone structures, while the low background activity yields a good contrast on scintiscans. 2. The clinical results of bone scintigraphy with 99mTc-pyrophosphate with 88.6% correct diagnoses can be considered as "very good". This feature can partly be attributed to an improved correlation of radiographic and scintigraphic images by the use of a specially designed, combined radiographic-photoscanning detector system. 3. Preliminary results concerning the quantitative uptake of 99mTc-pyrophosphate in fractures of the extremities suggest, that the quantitative analyses of the registered data can provide valuable prognostic information in traumatic, inflammatory and neoplastic bone lesions.

Topics: Bone and Bones; Bone Diseases; Bone Neoplasms; Diphosphates; Fractures, Bone; Half-Life; Humans; Kinetics; Radiography; Radionuclide Imaging; Technetium

Topics: Bone and Bones; Diphosphates; Female; Follow-Up Studies; Foot; Fractures, Bone; Hand; Humans; Iron; Male; Middle Aged; Radiation Dosage; Radionuclide Imaging; Reflex Sympathetic Dystrophy; Skin Temperature; Strontium Radioisotopes; Technetium