scholarly journals Statin Use and Its Effects on Skeletal Related Events in Patients with Multiple Myeloma

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5774-5774 ◽  
Author(s):  
Fernando M Vargas Madueno ◽  
Amin Benyounes ◽  
Gentry King ◽  
Kuan-Hsiang Gary Huang ◽  
Gabor Varadi
Keyword(s):  
Multiple Myeloma ◽  
Vitamin D ◽  
Alcohol Abuse ◽  
Statin Therapy ◽  
Paget’S Disease ◽  
Paget's Disease ◽  
Exact Test ◽  
History Of ◽  
Skeletal Related Events ◽  
Statin Use

Abstract Introduction: Skeletal related events (SRE) in multiple myeloma (MM) patients are associated with significant morbidity and mortality. Studies assessing the anti myeloma effect of statins in conjunction with chemotherapy have shown conflicting results with regards to overall survival or disease response. To our knowledge there have been no studies evaluating the effect of statins on SRE. Here we sought to assess the relationship between statin use and the presence of SRE. Methods: We retrospectively reviewed 101 patients seen at our institution between the years 2007-2012 who had a diagnosis of MM separating them in 2 groups, patients on statin therapy (n=50) and those without statin therapy (n=51). Statin use was considered if present prior to the occurrence of a SRE. SRE were defined as pathologic fractures, necessity for orthopedic intervention, radiation therapy or spinal cord compression. MM stage as per the International Staging System (ISS), as well as history of osteoporosis, malignancy, hypothyroidism, Paget's disease of the bone, alcohol abuse, smoking status, calcium-vitamin D, and bisphosphonate use were also recorded. Results: In our cohorts the prevalence of SRE was significantly lower in patients on statin medication when compared to statin naive patients, (36% vs. 58.8% respectively, p = 0.029, Fisher's exact test, Figure 1). No significant differences were noted between statin treated group and statin naive group in the following variable subgroups (Fisher's exact test): the history of smoking or alcohol abuse, the documented diagnosis of osteoporosis, coexistent malignancy, hypothyroidism, or Paget's disease of the bone, and the use of other medications including bisphosphonates or calcium - vitamin D supplementation. There were no significant differences in distribution of cancer staging (according to ISS) when we compared between statin use status (chi-square test for trend). Conclusion: The use of statins was associated with a decrease in the prevalence of SRE in patients with MM. This was found independent of disease stage, history of osteoporosis or second malignancy, and bisphosphonate use. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

scholarly journals AB0622 WHEN OSTEOPOROSIS, COELIAC DISEASE AND MULTIPLE MYELOMA CO-EXIST

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1345.1-1345
Author(s):  
S. Khalid ◽  
R. Smith
Keyword(s):  
Bone Mineral Density ◽  
Multiple Myeloma ◽  
Vitamin D ◽  
Coeliac Disease ◽  
Secondary Osteoporosis ◽  
Gluten Free ◽  
Z Score ◽  
Mineral Density ◽  
History Of ◽  
Secondary Causes

Background:Secondary causes of bone loss are sometimes overlooked in patients who are diagnosed as having osteoporosis. This is especially true if more than one risk factor for secondary osteoporosis is present, with clinicians focusing on the more common cause. Here we present a case of secondary osteoporosis caused by coeliac disease and multiple myeloma.Objectives:Secondary osteoporosis should be suspected in patients with very low bone mineral density and those with no obvious risk factors. Comprehensive examination and investigations must be done to look for all secondary causes because sometimes, as seen in our patient, you may find more than one.Methods:A 74 year old gentleman presented to the rheumatology clinic for assessment of osteoporosis. He had been recently diagnosed with coeliac disease. DXA scan showed a T score of -3.5 at the lumbar spine, -2.5 at the left hip and a low Z score of -2.9. He had not sustained any fractures in the past. There was no history of corticosteroid exposure and no parental history of hip fracture or osteoporosis. He drank up to 21 units of alcohol a week and was an ex-smoker. He was managing a gluten-free diet. His testosterone and vitamin D levels were normal. Serum electrophoresis, done as part of the osteoporosis workup, revealed a diagnosis of multiple myeloma. He then developed back pain and given his new diagnosis of myeloma, prompt investigations were carried out. A skeletal survey showed T7 fracture and a subsequent MRI scan showed impending cord compression, which were treated successfully with radiotherapy. He underwent chemotherapy and autologous stem cell transplantation for his myeloma.He recently had an OGD following one week post gluten rechallenge after an established gluten free diet. His biopsy shows no evidence of coeliac disease. Interestingly, the stem cell transplantation did not only treat our patient’s myeloma, but also his coeliac disease.Results:Z-score is a useful indicator of possible secondary osteoporosis. A score of −2.0 or less is below the expected range for age and should prompt careful scrutiny for an underlying cause.Coeliac disease is a gluten-sensitive enteropathy and a known cause for secondary osteoporosis. It likely causes bone loss by secondary hyperparathyroidism from vitamin D deficiency. Multiple myeloma is a disease of aging adults resulting in osteolytic and/or osteoporotic bone disease through increased bone resorption and decreased bone formation from pro-inflammatory cytokines. While coeliac disease patients are at increased risk of all malignancies, association with multiple myeloma is rare, but has been described.Conclusion:This case highlights the importance of evaluating for secondary causes for low bone mineral density and often, one may find more than one contributory factor. It also shows that a Z-score of −2.0 could help identify patients with a secondary cause for osteoporosis and those who would especially benefit from a thorough history and examination.References:[1]Sahin, Idris & Demir, Cengiz & Alay, Murat & Eminbeyli, Lokman. (2011). The Patient Presenting with Renal Failure Due to Multiple Myeloma Associated with Celiac Disease: Case Report. UHOD - Uluslararasi Hematoloji-Onkoloji Dergisi. 21. 10.4999/uhod.09087.[2]İpek, Belkiz & Aksungar, Fehime & Tiftikci, Arzu & Coskun, Abdurrahman & Serteser, Mustafa & Unsal, Ibrahim. (2016). A rare association: celiac disease and multiple myeloma in an asymptomatic young patient. Turkish Journal of Biochemistry. 41. 10.1515/tjb-2016-0053.[3]Swaminathan K, Flynn R, Garton M, Paterson C, Leese G. Search for secondary osteoporosis: are Z scores useful predictors? Postgrad Med J. 2009 Jan;85(999):38-9. doi: 10.1136/pgmj.2007.065748. PMID: 19240287.Disclosure of Interests:None declared.

scholarly journals A rare case of Paget’s disease affecting the cervical spine

2019 ◽  
Vol 101 (2) ◽  
pp. e38-e42
Author(s):  
J Holton ◽  
M Jones ◽  
Z Klezl ◽  
M Czyz ◽  
M Grainger ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Independent Living ◽  
Paget’S Disease ◽  
Posterior Part ◽  
Cord Compression ◽  
Bone Cell ◽  
Paget's Disease ◽  
History Of ◽  
Posterior Instrumented Fusion ◽  
Degenerative Cervical Spine

We present the case of a 75-year-old man with a rapidly progressive cervical myelopathy on a background of a 3-year history of neck pain and a severely degenerative cervical spine. The patient developed progressive myelopathy over a six-month period and suffered from worsening kyphosis. Suspicion of an underlying oncological process prompted transfer to our tertiary referral unit. Biopsy was consistent for Paget’s disease, an extremely rare diagnosis of the cervical spine. Magnetic resonance imaging revealed cord compression between C4 and C6 with associated cord signal change indicative of myelopathy. A three-level corpectomy and posterior instrumented fusion was performed. There was significant blood loss (3.5l) intraoperatively, consistent with a diagnosis of Paget’s disease of the bone. Cell salvage was used, as was neuromonitoring for both the anterior and posterior part of the procedure. Postoperatively, neurological function improved slightly and the patient required community neurorehabilitation to allow independent living.

scholarly journals Extramammary Paget's Disease: A Case Report

2020 ◽  
Vol 8 (1) ◽  
pp. 83-85
Author(s):  
Anita Shah ◽  
Yogesh Poudel ◽  
Anuj Poudel
Keyword(s):  
Paget’S Disease ◽  
Paget's Disease ◽  
Extramammary Paget’S Disease ◽  
Erythematous Plaque ◽  
Eosinophilic Cytoplasm ◽  
Topical Glucocorticoids ◽  
Atypical Cells ◽  
History Of ◽  
White Scale ◽  
Extramammary Paget's Disease

A 60- year-old man presented with four year history of a non- healing rash. The rash was pruritic and painless. He had previously been treated empirically with oral and topical antibiotics, topical antifungal agents, and topical glucocorticoids without improvement. The physical examination revealed an erythematous plaque with superficial white scale affecting the skin of the groin and scrotum. Skin biopsy and histopathology revealed epidermal infiltration by large atypical cells that had eosinophilic cytoplasm and prominent nucleoli, findings were consistent with Pagets disease. Extramammary Paget's disease (EMPD) is an intraepithelial adenocarcinoma that is sometimes misdiagnosed as dermatitis clinically. It most commonly involves the vulva and in perianal skin, scrotum, penis and axilla. The patient was kept on regular surveillance. The patient has increased intensity of itching and increase in size of lesion after six months of diagnosis.

scholarly journals Molecular insights into an ancient form of Paget’s disease of bone

2019 ◽  
Vol 116 (21) ◽  
pp. 10463-10472 ◽  
Author(s):  
Barry Shaw ◽  
Carla L. Burrell ◽  
Darrell Green ◽  
Ana Navarro-Martinez ◽  
Daniel Scott ◽  
...  
Keyword(s):  
Direct Sequencing ◽  
Paget’S Disease ◽  
Paget's Disease ◽  
Paget’S Disease Of Bone ◽  
Paget's Disease Of Bone ◽  
North West ◽  
Sequestosome 1 ◽  
The North ◽  
History Of ◽  
Skeletal Samples

Paget’s disease of bone (PDB) is a chronic skeletal disorder that can affect one or several bones in individuals older than 55 y of age. PDB-like changes have been reported in archaeological remains as old as Roman, although accurate diagnosis and natural history of the disease is lacking. Six skeletons from a collection of 130 excavated at Norton Priory in the North West of England, which dates to medieval times, show atypical and extensive pathological changes resembling contemporary PDB affecting as many as 75% of individual skeletons. Disease prevalence in the remaining collection is high, at least 16% of adults, with age at death estimations as low as 35 y. Despite these atypical features, paleoproteomic analysis identified sequestosome 1 (SQSTM1) or p62, a protein central to the pathological milieu of PDB, as one of the few noncollagenous human sequences preserved in skeletal samples. Targeted proteomic analysis detected >60% of the ancient p62 primary sequence, with Western blotting indicating p62 abnormalities, including in dentition. Direct sequencing of ancient DNA excluded contemporary PDB-associated SQSTM1 mutations. Our observations indicate that the ancient p62 protein is likely modified within its C-terminal ubiquitin-associated domain. Ancient miRNAs were remarkably preserved in an osteosarcoma from a skeleton with extensive disease, with miR-16 expression consistent with that reported in contemporary PDB-associated bone tumors. Our work displays the use of proteomics to inform diagnosis of ancient diseases such as atypical PDB, which has unusual features presumably potentiated by yet-unidentified environmental or genetic factors.

scholarly journals Hydrocephalus and Headaches in Paget’s Disease of the Skull: Complete Relief by Ventriculo-Atrial Shunt

1984 ◽  
Vol 11 (1) ◽  
pp. 69-72 ◽  
Author(s):  
Chantal Hausser ◽  
Georges Elie Ouaknine ◽  
Jacques Sylvestre
Keyword(s):  
Paget’S Disease ◽  
Paget's Disease ◽  
Neurological Dysfunction ◽  
Complete Relief ◽  
Communicating Hydrocephalus ◽  
Intellectual Function ◽  
History Of ◽  
Atrial Shunt ◽  
First Time ◽  
Shunting Procedure

SUMMARYA 76 year old patient with a long history of headaches was found to have Paget’s disease and communicating hydrocephalus. There were (otherwise) no neurological or musculo-skeletal manifestations of Paget’s disease, but moderate impairment of intellectual function was present. Treatment with disphosphonates did not bring any significant improvement, but three days following a ventriculo-atrial shunting procedure, the patient became headache-free for the first time in several years.In the literature, patients with hydrocephalus have been shown to respond quite unevenly to atrio-ventricular shunting, but in most instances the descriptions concerned advanced cases with well-established symptoms of dementia, ataxia and incontinence. Our case is reported to stress the importance of early diagnosis and management of hydrocephalus in Paget’s disease for the prevention of widespread neurological dysfunction.

Medical uses of fluoride

1970 ◽  
Vol 8 (11) ◽  
pp. 41-43
Keyword(s):  
Multiple Myeloma ◽  
Dental Caries ◽  
Sodium Fluoride ◽  
Paget’S Disease ◽  
Paget's Disease ◽  
Treatment Of Osteoporosis ◽  
Overwhelming Evidence ◽  
Experimental Trials ◽  
Secondary Carcinoma

There is overwhelming evidence that sodium fluoride is effective in the prevention of dental caries, but other uses of it are much less well established. Nevertheless, experimental trials of fluoride in the treatment of osteoporosis, otosclerosis, Paget’s disease, multiple myeloma and secondary carcinoma have led to recommendations for their routine use in these conditions.1–3 So far no manufacturer has made a submission concerning such uses to the Safety of Drugs Committee, and no preparation is marketed for these purposes.

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