Role of zoledronic acid in treatment of osteoporosis and prevention of fractures

Introduction. One of the causes of primary disability and high mortality, among patients with osteoporosis, are fractures that occur with minimal trauma, as a rule, it is a fall from the height of one’s own height. The final link in the chain of preventive measures to reduce the frequency of osteoporosis and fractures on its background is the introduction of pharmacological correction of bone deficiency into the practical activity of an orthopedic traumatologist. Currently, there are several drugs that can change the disturbed metabolism. For example, the use of zoledronic acid significantly reduces the risk of fractures.Aim: to study the effect of zoledronic acid on bone mineral density in patients with osteoporosis complicated by a fracture of proximal end of the femur.Materials and methods. In a prospective cohort study, 14 patients received zoledronic acid for 2 years.Results. When comparing BMD L2-L4, it was revealed that a year after the start of treatment, its increase relative to the baseline value was 4.6%, but was statistically insignificant (0.86 ± 0.078 g/cm2 versus 0.90 ± 0.08 g/cm2, p > 0.05). After 2 years of treatment, the BMD of this segment increased, relative to the baseline values, by 12% and the differences became statistically significant (0.86 ± 0.078 g/cm2 compared to 0.97 ± 0.076 g/cm2, p < 0.05). The increase in BMD for the second year of treatment by 6% was statistically significantly different from the increase for the first year of treatment (0.90 ± 0.08 g/cm2 compared to 0.97 ± 0.076 g/cm2, p < 0.05).A comparative analysis of the basic units of the IPC hip after 1 and 2 years of treatment did not reveal significant differences: 0.7075 ± 0.046 g/cm2 compared to 0.7079 ± 0.034 g/cm2 and 0.70751 ± 0.046 g/cm2 compared to 0.6630 ± 0.97 g/cm2, p > 0.05. In any case, for 2 years not marked new vertebral body fractures. Only one patient had a fracture of the radius in the distal third. The quality of life, after 2 years, significantly improved on the scale of “habitual daily activities” (p = 0.007), decreased indicators on the scale of “anxiety” and “depression” (p > 0.05).Discussion. The study confirmed that even in the presence of pronounced bone loss, pharmacological correction of impaired remodeling reduces the risk of new fractures and improves the quality of life.Conclusion. Pharmacotherapy with zoledronic acid, in our study, confirmed its effectiveness in the treatment of osteoporosis.

Three Staged Revision Arthroplasty Using Structural Allograft in Chronic Periprosthetic Joint Infection Accompanied by Fracture: A Case Report

Revision arthroplasty for chronic periprosthetic joint infection is complex and determined by many variables. Generally, two-staged revision arthroplasty is the standard treatment for the management of chronic periprosthetic joint infection. However, it is difficult to resolve chronic infection accompanied by large bone deficiency due to pathologic fracture. I report a case of successful three-staged revision arthroplasty using frozen structural allograft in chronic periprosthetic knee joint infection accompanied by extensive bone defect due to fracture.

Sagittal expansion of the maxilla in an adult. A clinical case

Relevance. Skeletal Class III malocclusion is one of the most difficult to correct. Genetics, environmental factors, and postembryonic development influence its etiology. Sagittal expansion of the upper jaw will ensure the correct position of the lower jaw, which in turn will improve the patient's aesthetic parameters and health. The study examines a treatment method using the Fixed anterior growth guidance appliance (FAGGA).Materials and methods. This clinical case presents a 21-year-old male with skeletal class III due to maxillary bone deficiency. The patient refused surgery to increase the size of the upper jaw and opted for orthodontic treatment. The latter was performed using a Fixed anterior growth guidance appliance (FAGGA), followed by a rapid palatal (maxillary) expansion (RME) and brackets. We removed the FAGGA after eight months. The profile and occlusion improved.Results. The change in the inclination and protrusion of the maxillary incisors improved the profile. We received 2mm of space behind the upper right canine and 1.5mm of space behind the left one and the SNA angle increased by 2 degrees. The treatment continues with RME and brackets.Conclusions. An increase in inclination and protrusion of the maxillary incisors and a slight skeletal change improved the aesthetic parameters of the facial area.

Rehabilitation of severely atrophic mandible: A 3-year Follow Up Protocol.

Severe bone atrophies are considered a challenge in the rehabilitation process. In clinical situations involving excessive vertical bone deficiency in edentulous mandibles, there is risk of fracture and frequently the need for an approach that involves highly complex procedures. In this context, simultaneous three-dimensional bone reconstruction associated with rigid fixation is a viable alternative to optimize longevity and avoid failures in these cases. This clinical case report presents a technique for reconstruction of severely atrophic mandibles in an elderly female patient to allow the implant-supported prosthesis protocol. The placement of immediate implants was possible by using an intraoral approach for fixation of a titanium plate, followed by guided bone regeneration in association with rhBMP-2, deproteinized bovine bone mineral and titanium mesh in a one-stage surgical procedure. There are no reports in the literature with this approach for treating of severely atrophic mandibles. These association of techniques was shown to be predictable after three years of follow-up. Therefore, this protocol provides safe supported-implant prosthesis rehabilitation for patients with severely atrophic mandible.

Analysis of Famous TCM Doctor Zan Qiang’s Experience in the Treatment of Perimenopausal Osteoporosis

The purpose of this study was to analyze the clinical experience of Zan Qiang, a famous doctor of Traditional Chinese Medicine in Shaanxi province, in the treatment of perimenopausal osteoporosis. Zan believed that the main etiology and pathogenesis of perimenopausal osteoporosis were "deficiency of kidney essence, decreased marrow and bone", "deficiency of liver and kidney" and "stasis caused by deficiency". Although it is a chronic physiological disease, and the pathological process is irreversible, the treatment groups of "tonifying kidney and filling essence", "tonifying liver and tonifying kidney" and "tonifying deficiency and promoting blood circulation" can significantly improve the symptoms of patients, slow down the progress of the disease and improve the quality of life of patients.

A Case of Cementless Impaction Bone Graft in a Revision Total Hip Arthroplasty Requiring Calcar Reconstruction

Introduction. In cases of bone deficiency or osteoporosis, and especially in revision cases, there were only two options for treatment until the impaction bone graft procedure was proposed. These were cemented or cementless femoral prosthesis. In the early 1990s, the use of impaction bone graft with a cemented mantle had gained popularity and had proven to be clinically effective. In Germany, a cementless impaction bone graft procedure using Corail® (DePuy Synthes) stems was devised, and functional scores were similar to conventional cemented Impaction bone grafts. Case presentation. A 48-year-old man presented with femur loosening of a reamed bipolar arthroplasty performed in 1990. The patient was treated with a cementless impaction bone graft using a Corail® (DePuy Synthes) stem in the femur in revision THA surgery, and the calcar was reconstructed by allograft. Results. At five years, the calcar allograft united with the host bone, and the femoral component showed no subsidence. Conclusion. Calcar reconstruction with a strut allograft, aimed at preventing sinking of the stem was key in this operation. Surgical indication for femoral cementless impaction bone graft should be for loosened femoral prosthesis in a type II Paprosky classification, where only the cortical bone of the isthmus is partially affected, cortical thinning does not exist, and it is mechanically strong enough for the allograft tip impaction. The procedure was safely feasible through the direct anterior approach.

IMMEDIATE IMPLANTATION AND AESTHETIC COMPONENT AS A RESULT OF SUCCESSFUL FORECAST TREATMENT

The aim: Improving the method of immediate implantation in the aesthetic zone in case of bone deficiency to obtain the highest aesthetic and predictable treatment result. Materials and methods: Under clinical observation were 32 patients with different clinical diagnoses in the anterior part of the upper jaw aged 30 to 55 years. In the course of recent advances, the following methods have been used: clinical protocol of immediate implantation with passive exceptional loads by temporary orthopedic constructions, X-ray method using cone-beam computed tomography, statistical analysis. Results: After surgical treatment of patients 1 year after surgery, the distribution of biotypes was as follows: in group 1 – thick biotype 12.87%, medium – 87.13%; in group 2 – thick biotype 27.04%, medium – 72.96%, with p <0.05. According to the results of CT, the distance between the implant and the vestibular in the first group was after 6 months – 1.67 ± 0.04 mm (p <0.05); in the second group of the study we obtained the following results after 6 months – 1.59 ± 0.06 mm (p <0.05). Conclusions: The advanced method of immediate implantation in the anterior part of the upper jaw allows to change the biotype of soft tissues, improve the color spectrum of the gums, increase the thickness of soft tissues with connective tissue autograft, and increase gum density and fixation of osteoplastic material in the presence of defect ), as well as reduce the risk of recession.

Split Hand/Foot Malformation with Long Bone Deficiency: A Report of Two Female Siblings

Spilt Hand/Foot Malformation with Long-bone Deficiency (SHFMLD) is a rare heterogeneous group of limb malformations characterised by absence/hypoplasia and/or median cleft of hands and/or feet associated with long bone abnormalities, most frequently tibia. This case report described two sisters with congenital limb defects born to healthy consanguineous parents. The six-year-old girl did not had both radii and the left fibula. There was a cleft in the left hand and the right foot. She had one digit in her right upper limb, but did not have the left foot. The four-year-old girl had short four limbs, bilateral tibial aplasia with single digit in all limbs. Both parents were normal, and no other similar cases was reported in the family. According to the authors' best knowledge, these two cases are the first published cases in Yemen with the SHFMLD, but they need a genetic study to determine their genetic profile.