Bisphosphonate therapy for chronic recurrent multifocal osteomyelitis

Handly, Brian; Moore, Michael J.; Creutzberg, Gina; Groh, Brandt; Mosher, Timothy J.

doi:10.1007/s00256-013-1613-8

Cited by 15 publications

(8 citation statements)

References 8 publications

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“…DXA may be particularly useful in children with chronic systemic disease requiring long-term systemic steroid treatment and frequent DXA evaluation, for example in children with inflammatory bowel disease in which an association with CRMO has been described [12,13]. The incidental finding of a focal sclerotic bone lesion on DXA, for example, may prompt the suggestion of CRMO as a potential differential diagnosis in the appropriate clinical context.…”

Section: Discussionmentioning

confidence: 99%

“…DXA in children with CRMO undergoing cyclical bisphosphonate treatment may also have the added benefit of identifying dense metaphyseal bands which are typically associated with prolonged bisphosphonate treatment and correspond to alternating areas of increased and normal bone mineralization. Since dense metaphyseal bands have been implicated in increasing fracture risk by creating mechanical stressrises [13], their visualization on a DXA scan in a patient with CRMO Table 1: Patient demographics and DXA derived BMD/BMC Z-scores. Bone mineral density (BMD) and bone mineral content (BMC) Z-scores obtained from the total body less head (TBLH) before and after removing the CRMO lesion from the analysis.…”

Section: Discussionmentioning

confidence: 99%

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Influence of Chronic Recurrent Multifocal Osteomyelitis (CRMO) On Densitometry Measurements Obtained by Dual X-Ray Absorptiometry

Costantini¹,

Marie²,

Kohli³

et al. 2017

J Mol Biomark Diagn

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The incidence of detecting focal chronic recurrent multifocal osteomyelitis (CRMO) lesions on dual-energy x-ray absorptiometry (DXA), and the effect of these lesions on DXA bone mineral density (BMD), bone mineral content (BMC), and their associated Z-scores were retrospectively reviewed. Materials and Methods. The study included 22 patients (14 females, 8 males; median age of 13 years) with CRMO and in whom a total body less head (TBLH) and lumbar spine DXA scan had been obtained. Whole-body bone scintigraphy and MRI were used as the reference standards. Sites involved with CRMO were subsequently detected and DXA measurements were re-measured after removing the sclerotic lesions from the analysis. Results. In total, sclerotic CRMO lesions were detected in 15 of the 22 patients (68%) by DXA, although the number of lesions detected (on a per-lesion analysis) was much less (i.e. 29 of 129 lesions; 19.4%) when compared to MRI and/or bone scintigraphy. Larger lesions had a greater impact on the derived BMD/BMC measurements, and changed the diagnosis in one patient from having normal to abnormal DXA results based on the final Z-score. Discussion. CRMO lesions detected on DXA examinations should be regarded as a potential source of error. Careful inspection and re-quantification of the BMD, BMC and associated Z-score after applying an appropriate correction should be considered in patients with large CRMO lesions identified on DXA examinations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Influence of Chronic Recurrent Multifocal Osteomyelitis (CRMO) On Densitometry Measurements Obtained by Dual X-Ray Absorptiometry

Costantini¹,

Marie²,

Kohli³

et al. 2017

J Mol Biomark Diagn

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“…22 A similar phenomenon of metaphyseal sclerotic bands can be seen in pediatric patients undergoing bisphosphonate therapy for conditions such as osteogenesis imperfecta or chronic recurrent multifocal osteomyelitis. 27,29 Bisphosphonates have a profound inhibitory effect on osteoclastic activity and bone turnover. This cyclical inhibition gives rise to dense metaphyseal bands that migrate longitudinally into the diaphysis 29 (►Fig.…”

Section: Salter-harris Fracturesmentioning

confidence: 99%

“…27,29 Bisphosphonates have a profound inhibitory effect on osteoclastic activity and bone turnover. This cyclical inhibition gives rise to dense metaphyseal bands that migrate longitudinally into the diaphysis 29 (►Fig. 12).…”

Section: Salter-harris Fracturesmentioning

confidence: 99%

The Primary Physis

Brian

Choi

Moore

2018

Semin Musculoskelet Radiol

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The primary physis is responsible for long bone growth in children and adolescents. Injury and physiologic or metabolic stress to the primary physis present unique radiologic findings that are important for radiologists to recognize and diagnose. Appreciation of the anatomy and histology of the primary physis forms the basis for understanding the imaging findings associated with pathologic conditions affecting the primary physis. Salter-Harris injuries, physeal bars, growth arrest lines, rickets, and focal periphyseal edema zones are common conditions with recognizable radiologic presentations. Proper diagnosis of these primary physeal conditions will aid in the treatment of affected pediatric patients.

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“…Los bisfosfonatos, como medicamentos que inhiben la resorción ósea, han demostrado ser efectivos en el tratamiento de la CRMO, especialmente indicados en pacientes con marcada esclerosis ósea, niños con compromiso de columna vertebral, mandíbula o incremento de captación en las últimas fases de la gamagrafía 43 . Pamidronato ha sido el más frecuentemente usado en diferentes regímenes reportados en la literatura, en infusiones semanales (días 1, 7, 14, 28 y 56) o infusiones de 60 mg durante tres días consecutivos y luego cada tres meses 44,45 .…”

Section: Tratamientounclassified

Osteomielitis crónica multifocal recurrente: estado del arte

Eusse

Velásquez-Franco

Navas

2016

MedUPB

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RESUMENLa osteomielitis crónica multifocal recurrente es una enfermedad autoinflamatoria que se caracteriza por focos estériles de inflamación ósea que producen dolor recurrente. Es una entidad poco frecuente que tiene como manifestaciones cardinales la presencia de lesiones óseas inflamatorias en las regiones metaepifisiarias de los huesos largos que predomina en miembros inferiores. Esta enfermedad, con frecuencia asociada con sínto-mas sistémicos y lesiones en piel, hace parte del grupo de enfermedades que conforma el síndrome: artritis-dermatitis. Los hallazgos radiológicos más comunes son las áreas de osteolisis rodeadas de un halo esclerótico delgado, sin reacción perióstica asociada o la formación de secuestros óseos. La resonancia nuclear magnética permite hacer una detección precoz de la entidad y facilita su diagnóstico diferencial, principalmente, con infecciones y tumores óseos. El tratamiento está basado en la información obtenida mediante reportes de caso y series de pacientes y consiste en el uso de antiinflamatorios no esteroideos y en casos refractarios, bisfosfonatos y antagonistas del factor de necrosis tumoral alfa. El pronóstico de esta enfermedad, en general, es bueno, con un curso clínico benigno y autolimitado, en la mayoría de los casos. Palabras clave: osteomielitis; inflamación; hiperostosis. ABSTRACTChronic recurrent multifocal osteomyelitis is a sterile autoinflammatory disease characterized by foci of sterile inflammation in the bone that generate recurrent pain. It is a rare entity in which the cardinal clinical manifestation is the presence of inflammatory bone lesions in metaepiphyseal regions of long bones, predominating in lower limbs. The disease is often associated with systemic symptoms and skin involvement making it part of the arthritis-dermatitis syndrome. The most common radiographic finding is osteolysis surrounded by a thin sclerotic halo, without periosteal reaction associated with bone formation or bone sequestrum. Magnetic resonance imaging allows early detection and facilitates the differential diagnosis between osteomyelitis and infections or bone tumors. Treatment is supported mainly by case reports and series of patients and consists of the use of nonsteroidal anti-inflammatory drugs and the use of bisphosphonates or tumor necrosis factor alpha antagonists in refractory cases. The prognosis of this disease is generally good, with a benign and self-limited clinical course in most cases.

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Bisphosphonate therapy for chronic recurrent multifocal osteomyelitis

Cited by 15 publications

References 8 publications

Influence of Chronic Recurrent Multifocal Osteomyelitis (CRMO) On Densitometry Measurements Obtained by Dual X-Ray Absorptiometry

Influence of Chronic Recurrent Multifocal Osteomyelitis (CRMO) On Densitometry Measurements Obtained by Dual X-Ray Absorptiometry

The Primary Physis

Osteomielitis crónica multifocal recurrente: estado del arte

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