Tumor-induced osteomalacia: a case report

Background Tumor-induced osteomalacia is a rare, acquired paraneoplastic syndrome, including hypophosphatemia, high serum alkaline phosphatase, reduced active vitamin D, suboptimal bone mineral density, bone pain, fragility fractures, and muscle weakness. Case presentation We report a case of 74–year–old male of mixed ancestry with hypophosphatemia resistant to treatment despite optimal compliance, associated with profound reduction of bone mineral density and multiple nontraumatic fractures, including bilateral rib fractures, lower-thoracic (T11, T12) vertebrae, and two fractures involving the surgical and anatomical neck of the right humerus. We discuss an approach to identifying the underlying cause of hypophosphatemia associated with fragility fractures, and options for management of this rare condition. Conclusion Although rare, tumor-induced osteomalacia can be diagnosed if a logical stepwise approach is implemented. Surgery could be curative if the tumor is properly located and is resectable.

Influence of the Zinc and Fibre Addition in the Diet on Biomechanical Bone Properties in Weaned Piglets

The effects of the zinc and fibre source in piglets’ diet on the bone mineral content, density, and strength parameters of the femur were investigated using 24 piglets fed a diet supplemented with either lignocellulose (LC) or potato fibre (PF). Half of each group of piglets consumed a diet with ZnSO4 monohydrate or with zinc glycinate (ZnGly). The diets contained similar amounts of lysine, energy, and fibre. Bone mineral content and density were over 9% higher in pigs receiving diets with ZnGly than in animals fed diets with ZnSO4. Moreover, ZnGly strongly improved maximum and elastic strength (by 25.7 and 20.0%, respectively, p < 0.0001) and bone stiffness (by 29.4%, p < 0.0001). Only the mass of the femur was affected by the type of fibre in the diet, as the femurs of piglets fed diets with LC were over 7% (p < 0.0001) heavier than in piglets fed diets with PF. The intake of digestible zinc and the zinc content in the blood serum were positively correlated with the measured bone parameters and, depending on the parameter, “r” ranged from 0.749 to 0.866 and from 0.400 to 0.479, respectively. It can be concluded that bone parameters are affected more strongly by the organic than inorganic source of zinc.

Bone Mineral Density Compared to Trabecular Bone Score in Primary Hyperparathyroidism

Individuals with primary hyperparathyroidism (PHPT) have reduced bone mineral density (BMD) according to dual X-ray absorptiometry at cortical sites, with relative sparing of trabecular BMD. However, fracture risk is increased at all sites. Trabecular bone score (TBS) may more accurately describe their bone quality and fracture risk. This study compared how BMD and TBS describe bone quality in PHPT. We conducted a retrospective cross-sectional study with a longitudinal component, of adults with PHPT, admitted to a tertiary hospital in Australia over ten years. The primary outcome was the TBS at the lumbar spine, compared to BMD, to describe bone quality and predict fractures. Secondary outcomes compared changes in TBS after parathyroidectomy. Of 68 included individuals, the mean age was 65.3 years, and 79% were female. Mean ± SD T-scores were −1.51 ± 1.63 at lumbar spine and mean TBS was 1.19 ± 0.12. Only 20.6% of individuals had lumbar spine BMD indicative of osteoporosis, while 57.4% of TBS were ≤1.20, indicating degraded architecture. There was a trend towards improved fracture prediction using TBS compared to BMD which did not reach statistical significance. Comparison of 15 individuals following parathyroidectomy showed no improvement in TBS.

Possible relationships of selected food items to osteoporosis among a group of Iraqi women

Background: Osteoporosis is a global health problem which is estimated to affect more than 200 million people worldwide, especially postmenopausal women. It is characterized by decreased bone mineral density leading to fragility and increased risk of fractures. Objective: This study was conducted to explore the consumption of inappropriate foods related to osteoporosis among a group of Iraqi women. JFac Med Baghdad 2021; Vol.63, No. 4 Received: Sep., 2021 Accepted: Nov., 2021 Published: Jan., 2021 Patients and methods: A cross sectional study of 140 females aged ≥ 40 years attending polyclinics in Al-Dora sector in Baghdad city from 18th January to 24th April 2021. The bone mineral density was measured by portable quantitative calcaneal ultrasound machine (osteosystem) and the bone was assessed for osteoporosis by T-score. Food frequency questionnaire was used for collecting data related to food consumption. Results: Out of the total sample, 74 (52.9%) were found to be osteoporotic. There was a significant association with high salt and coffee consumption with the occurrence of osteoporosis (77.3% and 83.3%, respectively, p = 0.001), compared to those who did not consume caffeinated drinks. Participants with daily consumption of caffeinated drinks had a highly significant association with osteoporosis (21.8% vs 100%, p = 0.001). Conclusion: Excessive consumption of salty foods and caffeinated beverages appears to exert a negative effect on bone mineral density and the occurrence of osteoporosis among the studied group of Iraqi women.