We present a highly unusual case of massive pulmonary embolism with secondary paradoxical systemic embolisation that was successfully resuscitated with veno-arterial extracorporeal membrane oxygenation (ECMO). This enabled subsequent successful bridging to pulmonary embolectomy.
BackgroundSome studies had looked at the long-term effect of anti-osteoporotic therapy on risks of different cancers in the general population. But epidemiological studies have consistently reported a reduced risk of breast cancer in bisphosphonate users. so there is little data to establish definitive conclusions.ObjectivesThis study aimed to determine if anti-osteoporotic therapy can influence cancer risk in patients with osteoporotic vertebral fracture.MethodsThis retrospective study reviewed of cases of osteoporosis patients with acute vertebral fractures between 2001 and 2015. Anti-osteoporotic therapy were recorded (alendronate, ibandronate, zolendronic acid, raloxifen, teriparatide, denosumab). We followed these patients to develop cancer. All associated co-morbidities were recorded. Cox regression analysis were performed.ResultsThere were 1128 patients with acute vertebral fractures were enrolled, among them 693 patients accepted anti-osteoporotic therapy, 432 were not. The mean age of anti-osteoporotic therapy was 73.86±7.52, while the age of nonanti-osteoporotic therapy was 72.82±10.92 (p=0.059). 15 (2.2%) patients of anti-osteoporotic therapy developed cancer, while 24 (5.6%) patients of non-antiosteoporotic therapy developed cancer (p=0.004). After adjusting for potential confounders, patients with antiosteoporotic therapy still had a lower cancer risk (p=0.038; HR: 0.428, 95% CI: 0.192∼0.955). The cancer risk also increased among smokers (p=0.002; HR: 10.505; 95% CI: 2.375∼46.462).Table 1.Multivariable cox regression analysis of the hazard ratios for cancerRegression coefficientSEP valueHR (95.CI)Anti-osteoporosis-0.8480.4090.0380.428 (0.192–0.955)Gender-0.6930.5840.2360.500 (0.159–1.572)Age-0.0290.0160.0710.972 (0.942–1.002)Smmoking2.3520.7590.00210.505 (2.375–46.462)liver disease2.0120.4870.0017.477 (2.880–19.412)Kidney disease-0.3381.2240.7830.713 (0.065–7.859)Cardiovascular disease0.8560.6770.2062.355 (0.624–8.882)Pulmonary disease0.7710.5970.1972.162 (0.671–6.971)Abbreviations: HR, hazard ratio; SE, standard error.ConclusionsIn this study, anti-osteoporotic therapy decrease cancer risk. So we could safely use these drugs in osteoporotic management.References British Journal of Cancer (2013) 109, 795–806. AcknowledgementsWe thanked Kaohsiung Chang Gang Memorial hospital for data support.Disclosure of InterestNone declared
BackgroundHepatitis B virus (HBV) is a major cause of chronic liver diseases worldwide, particularly cirrhosis and hepatocellular carcinoma, and the most important liver disease in Taiwan. However, little is known the impact of hepatitis b on osteoporotic patients.ObjectivesThis study aimed to determine if hepatitis b can increase the risk of mortality in patients with osteoporotic vertebral fracture.MethodsThis retrospective study reviewed of cases of osteoporosis patients with acute vertebral fractures between 2001 and 2008. All associated co-morbidities were recorded. Kaplan-Meier and cox regression analysis were performed.ResultsThere were 432 patients with acute vertebral fractures. The mean age of 72.85±9.28. 31 (7.2%) patients had chronic hepatitis b. Using the Kaplan-Meier curve, hepatitis b had a significant effect on mortality (p<0.001, by log rank text). After adjusting for potential confounders, patients with hepatitis b still had a high mortality rate (p=0.019; HR: 2.436∼5.136) 2.137, 95% CI: 1.156∼5.136). The mortality rate also increased among smokers (p=0.026; HR: 3.6043.891; 95% CI: 1.056∼12.301).Table 1.Multivariable Cox regression analysis of the hazard ratios for adjacent fractureVariablesRegression coefficientP valueHR (95CI) Gender-0.1270.7640.88 (0.383–0.022)Age0.0040.7851.004 (0.976–1.032)Smoking1.2820.0413.604 (1.056–12.301)Alcohol consumption-0.7010.3960.496 (0.098–2.508)Body mass index (kg/m2)0.0240.4461.024 (0.964–1.088)Hepatitis B0.8910.0192.436 (1.156–5.136)Diabetes-0.1850.5380.831 (0.461–1.498)Hypertension-0.2710.310.762 (0.451–1.288)Stroke-0.6960.2480.499 (0.153–1.625)Kidney disease0.8090.1452.246 (0.758–6.656)Cardiovascular disease0.0370.9461.038 (0.351–3.069)Pulmonary disease-0.9710.3490.379 (0.050–2.883)Abbreviations: HR, hazard ratio; SE, standard error.ConclusionsIn this study, hepatitis b increase mortality in osteoporotic vertebral fracture patients. So we should pay attention to this group in osteoporotic management.References Chong-Shan Wang et al. Am. J. Trop. Med. Hyg., 66(4), 2002, pp. 389–393. AcknowledgementsWe thank Kaohsiung Chang Gang Memorial Hospital for data support.Disclosure of InterestNone declared
secondary osteoporosis was detected. Serum vitamin D concentration was <30 ng/ml in 5 patients, including 2 with concentration <10 ng/ml. Conclusions: Our study reveals that odontoid fractures mainly occur in elderly osteoporotic patients after a low energy impact. Although WHO osteoporosis definition excludes cervical fractures, odontoid fracture may be considered as an osteoporotic fracture. Further studies are required to confirm these results. References: [1] Watanabe M, et al. Analysis of predisposing factors in elderly people with type II odontoid fracture.
and hip fracture between those calculated with BMD and those without BMD measurements (P>0.05) respectively among female patients (n=32). Conclusions: A substantial gap exists between FRAX with BMD and without BMD in Korean patients with AS.
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