Conventional imaging poorly captures bone disorganization, a pathological feature of hypophosphatasia (HPP). This single-patient case report applied ALIGNOGRAM to previously published open-access distal radius radiographs from a 16-year-old with severe HPP before and after six months of asfotase alfa. It detected overt, subtle, and covert lesions and quantified reduced lesion burden post-treatment. Residual disorganization persisted. These findings support preliminary technical feasibility, with independent validation in larger prospective cohorts required to establish diagnostic and treatment-response validity.
Atypical femoral fractures (AFFs) are rare but serious complications of prolonged antiresorptive therapy. While bisphosphonate-associated AFF is well documented, the risk associated with sequential teriparatide and antiresorptive therapy remains poorly characterized. This case demonstrates that contralateral impending AFF can develop after a single dose of denosumab in a bisphosphonate-pretreated patient, despite confirmed radiological normality at the time of the index fracture. Negative contralateral imaging should not provide reassurance in high-risk patients, and vigilance is warranted when considering antiresorptive therapy transitions following incomplete anabolic treatment.
Background Like many other chronic conditions, osteoporosis has been proposed to follow a social gradient where socio-economic disadvantage is associated with a higher diagnosis and fracture risk. While evidence for this association has come from biomedical research, and independent observations from studies on ancient human remains, the relationship between measured socioeconomic status (SES) and various parameters of ‘bone health’ appears inconsistent across different populations, methods, and timeframes. In this review article, we apply a comprehensive social and evolutionary framework to assess the spatial and temporal variation of SES on bone health. Methods A systematic review of the current biomedical and archaeological literature examined the association between SES and bone health. Peer reviewed articles were obtained through Google Scholar and PubMed. Four quantitative indicators of bone health were considered: bone mineral density (BMD), cortical index, osteoporotic fractures, and histomorphometry. Results Forty articles were identified, of which 30 reported a significant association between low SES and low BMD and/or high fracture risk. The earliest evidence for socially patterned osteoporosis was possibly in Ancient Egypt (2687–2191 BCE). Conclusion The examined literature generally supported the association between social disadvantage and poor bone health outcomes, following the social gradient. However, we found that research on both modern and archaeological skeletal samples does not always account for intraskeletal variability or use comparable methods when assigning SES, creating between-study inconsistencies. We highlight the contributions of archaeological studies on social conditions and bone fragility, emphasising that socially patterned osteoporosis is not a solely modern-day occurrence.
We present a rare case of type I GD with frequent bone complications. After multiple fractures the patient received 5 mg zoledronic acid hydrate, which improved TRACP-5b and P1NP levels. After 1 year, TRACP-5b levels increased significantly, and the patient received SRT therapy complemented with eldecalcitol for vitamin D deficiency. One year later, bone density had improved and bone metabolism markers remained within normal levels.Osteoporosis treatment is a potential strategy for GD-related bone symptoms.
Background Youth with Duchenne muscular dystrophy (DMD) are at high risk of osteoporosis due to progressive muscle weakness and chronic glucocorticoid (GC) therapy. Current guidelines recommend routine vertebral fracture screening leading to earlier antiresorptive initiation. Medication-related osteonecrosis of the jaw (MRONJ) is a well-established complication of antiresorptives in adults but is exceedingly rare in youth, with no reported cases in children or adolescents with DMD. Methods We describe two adolescents with DMD who developed MRONJ following dental extraction during antiresorptive therapy for GC-induced osteoporosis. Results Case 1: A 15-year-old on long-term deflazacort began zoledronic acid at age 11.8 years for a vertebral fracture. MRONJ developed at age 15 post dental extraction, seven months after their last infusion. Case 2: An 18-year-old receiving bisphosphonates from age 8 years, was switched to denosumab at age 18 years. MRONJ occurred six months later, following tooth extraction. In both cases, antiresorptives were suspended and conservative management led to complete healing of MRONJ. Antiresorptives were later resumed for pain and fracture prevention, with no recurrence after one year. Review of more than 1000 pediatric patients treated with bisphosphonates or denosumab identified no prior reports of MRONJ in children or adolescents with DMD. Conclusions To our knowledge, these are the two youngest reported cases of MRONJ in patients with DMD. They highlight a potential vulnerability related to prolonged GC exposure combined with long-term antiresorptive therapy. Although pediatric MRONJ risk remains extremely low, clinicians should be aware of this complication, particularly when invasive dental procedures are planned.
