Osteoporosis: Chen JF

Chan SP, Chen JF, Chu LW, Van DP, Hosking D, Ip TP, Koh L, Kung A, Lai NS, Lau E, Lee JK, Leewattana R, Min YK, Nghia ND, Boonsong O, Park HM, Ringe J, Setyohadi B, Shin CS, Soontrapa S, Taechakraichana N, Tanjung F, Tobing D, Tsai KS, Woo J, Yang RS. · c/o Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, People's Republic of China. · Public Health Nutr. · Pubmed #18647434 No free full text.

Abstract: BACKGROUND: Vitamin D is essential for Ca absorption, prevention of falls and fracture, and maintenance of muscle strength and balance. Lack of awareness of the importance of vitamin D in bone health is common in Asia. OBJECTIVE: To define key statements, objectives and actions for improving osteoporosis management and vitamin D inadequacy in Asia. RESULTS AND CONCLUSION: This declaration was jointly produced by specialists at the Asia Metaforum on the Role of Vitamin D and the Management of Osteoporosis, held in September 2006 in Hong Kong, to define actions to prevent vitamin D insufficiency in Asia. Although developed specifically for Asia, some or all of these statements may be applicable to other regions of the world.

Lee ST, Chen JF. · Department of Neurosurgery, Chang Gung University & Chang Gung Memorial Hospital, Taoyuan, Taiwan, Republic of China. · J Neurosurg. · Pubmed #15070152 No free full text.

Abstract: The purpose of this study was to determine the efficacy and feasibility of closed reduction vertebroplasty for the treatment of osteoporotic vertebral compression fractures. Two hundred consecutive patients (183 women and 17 men) with single-level osteoporotic vertebral compression fracture were included in this study. After induction of general anesthesia, the patient was placed prone on an operating table. Closed reduction of the fractured and kyphotic spine was achieved by extending the table to restore the kyphotic angle and vertebral body (VB) height. Percutaneous vertebroplasty was then performed to treat the fractured vertebra. The results were quantitatively evaluated, according to the concept of estimated VB height. The anterior, middle, and posterior VB heights of the fractured vertebra were measured preoperatively and immediately after surgery by studying plain standing lateral radiographs. In 162 (81%) of the compression fractures the anterior VB height was restored (57.1 +/- 24.8% of lost anterior VB height); in 152 (76%) of the compression fractures the middle VB height was restored (61.4 +/- 20.6% of lost middle VB height); and in 52 (26%) of the compression fractures the posterior VB height was restored (51.3 +/- 23.1% of lost posterior VB height). In 141 (71.5%) of the compression fractures kyphosis was corrected by 12.5 +/- 3.8 degrees [mean 61.6 +/- 23.7%]). Closed reduction vertebroplasty is an efficacious and simple method in the treatment of osteoporotic vertebral compression fracture and was able to restore the VB height and kyphotic angle in postions of fractured vertebrae. Its associated, long-term effects on treated vertebrae, however, need further evaluation.

Hwang JS, Chen JF, Yang TS, Wu DJ, Tsai KS, Ho C, Wu CH, Su SL, Wang CJ, Tu ST. · Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Chlayi, Kaohsiung, Taiwan, ROC. · Calcif Tissue Int. · Pubmed #18843436 No free full text.

Abstract: The aim of this study was to assess the efficacy and safety of strontium ranelate in the treatment of postmenopausal women with osteoporosis in Taiwan. In this 12-month multicenter, randomized, double-blind, placebo-controlled study, 125 women with osteoporosis were randomly given either strontium ranelate 2 g daily or placebo. Lumbar spine, femoral neck, and total-hip bone mineral density (BMD) and biochemical markers of bone turnover were measured; adverse events and tolerability were recorded and assessed. Subjects treated with strontium ranelate showed significant increases in BMD of 5.9% at the lumbar spine, 2.6% at the femoral neck, and 2.7% at the total hip, while the placebo group exhibited no significant change at 12 months. Serum level of a formation marker (bone-specific alkaline phosphatase) was also significantly increased at 6 and 12 months. Thus, although the sample size and the treatment duration of this study could not show its effect of reducing osteoprotic fractures, strontium ranelate showed bone protection effects by increasing BMD and concentrations of a bone formation marker. Safety assessment revealed adverse events were mild and not significantly different from placebo.

Hwang JS, Tu ST, Yang TS, Chen JF, Wang CJ, Tsai KS. · Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taiwan, Republic of China. · Osteoporos Int. · Pubmed #16421647 No free full text.

Abstract: This study compared the clinical efficacy, safety, and tolerability of daily subcutaneous injections of teriparatide and salmon calcitonin in the treatment of postmenopausal women with established osteoporosis in Taiwan. This 6-month, multicenter, randomized, controlled study enrolled 63 women with established osteoporosis. They were randomized to receive either teriparatide 20 microg or calcitonin 100 IU daily in an open-label fashion. Lumber spine, femoral neck, total hip bone mineral density (BMD), and biochemical markers of bone turnover were measured, and adverse events and tolerability were recorded. The results at 6 months showed that patients using teriparatide had larger mean increases in spinal BMD than those who used calcitonin (4.5% vs. 0.1%), but the BMD changes in these two groups at the femoral neck and the total hip were not significant. There were also larger mean increases in bone markers in the teriparatide group than in the calcitonin group (bone specific alkaline phosphatase 142% vs. 37%; osteocalcin 154% vs. 23%). We conclude that teriparatide has more positive effects on bone formation than salmon calcitonin, as shown by the larger increments of lumbar spine BMD and bone formation markers, and caused only mild adverse events and no significant change in liver, kidney or hematological parameters. Compared with the published global results, teriparatide seems to be equally effective and safe to use in this Asian population.

Wu CT, Lee SC, Lee ST, Chen JF. · Department of Neurosurgery, Chang Gung University and Chang Gung Memorial Hospital, 5 Fu-Shing Street, 333, Kweishan, Taoyuan, Taiwan. · J Clin Neurosci. · Pubmed #16410195 No free full text.

Abstract: The pathophysiology of osteoporotic compression fractures is different from those occurring secondary to traumatic spinal injury, and currently, there is no classification suitable for symptomatic osteoporotic compression fractures treated by percutaneous vertebroplasty. We propose a new classification based on the radiological appearance in the subacute or chronic stage of the clinical presentation of these fractures. They are classified by the authors based on observations and measurements from preoperative and postoperative dynamic lateral radiographs. Compression fractures are divided into two types. Type I is a compression fracture involving the anterior column only. Type II is a fracture involving both the anterior and middle column. Each type is divided into two groups: fractures with union and those with non-union. Type II compression fractures have a higher incidence of non-union than type I (p<0.05). In both type I and II non-union groups, fractures achieve greater increase in vertebral body height after vertebroplasty than both type I and type II union group fractures (p<0.05). In both non-union groups, fractures achieved a greater reduction of kyphotic angle post-vertebroplasty than type I and II union group fractures (p<0.05). Further clinical follow-up of these patients will confirm and extend this classification.

Hung JW, Tsai MY, Yang BY, Chen JF. · Division of Rehabilitation Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan. · Arch Phys Med Rehabil. · Pubmed #15641005 No free full text.

Abstract: Tocolysis therapy with magnesium sulfate is known to affect calcium homeostasis. Prolonged infusion of magnesium sulfate (MgSO(4)) has been used for the treatment of refractory preterm labor, and has been reported to change maternal calcium homeostasis and possible mineralization. In this case report, we present a woman in her mid thirties who had undergone intravenous MgSO(4) tocolysis therapy, and developed osteoporosis leading to significant morbidity after delivery. The laboratory investigation, including the bone scan, magnetic resonance image, indices of bone turnover, and the results of 2 years of follow-up of bone mineral density, are also reported. This case report supports the existence of a possible association between prolonged intravenous magnesium tocolysis and maternal osteoporosis. To prevent osteoporosis, it is important to avoid a prolonged period of MgSO(4) tocolysis. In cases of prolonged MgSO(4) treatment and bedrest, physicians should be aware of the risk of osteoporosis. The recommended management is also discussed in this report.

Chen CH, Chen JF, Yang BY, Liu RT, Tung SC, Chien WY, Lu YC, Kuo MC, Hsieh CJ, Wang PW. · Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan. · J Formos Med Assoc. · Pubmed #15278189 No free full text.

Abstract: BACKGROUND AND PURPOSE: Most patients with well-differentiated thyroid carcinoma have an excellent prognosis and are likely to live long enough to be subjected to osteoporosis. The purpose of this study was to investigate the consequences of treatment with a supraphysiological dose of levothyroxine (l-T4) on bone mineral density (BMD) in Taiwanese women with differentiated thyroid cancer. METHODS: A total of 69 (44 premenopausal, 25 postmenopausal) Taiwanese women with differentiated thyroid cancer were included in this retrospective study. These patients were free of disease recurrence after initial near-total thyroidectomy and I-131 radioablation, and had undergone regular l-T4 suppressive therapy for more than 3 years (mean, 7.3 +/- 3.0 years; range, 3 to 15 years). The degree of thyroid-stimulating hormone (TSH) suppression was determined based on the mean TSH score for each patient which was determined by analysis of all available follow-up TSH data, where 1 = undetectable TSH (< 0.2 mIU/mL); 2 = subnormal TSH (0.2 to 0.39 mIU/mL); 3 = normal TSH (0.4 to 4.0 mIU/mL); and 4 = elevated TSH (> 4.0 mIU/mL). The patients were divided into a full TSH suppression group with a mean TSH score in the range 1.0 to 1.99, and a partial TSH suppression group with a mean TSH score in the range 2.0 to 2.99. BMD was measured by dual-energy X-ray absorptiometry at the lumbar spine, femoral neck, Ward's triangle and total hip. Comparisons between subgroups of patients and controls were performed by unpaired t test. Correlation between BMD and other clinical variables was assessed by Pearson's correlation analysis. RESULTS: Postmenopausal patients (aged 57.7 +/- 6.9 years) had significantly higher serum calcium levels and decreased BMD at all sites of the spine and hip as compared with premenopausal patients (aged 38.6 +/- 6.7 years) with similar BMI and duration of TSH suppression. Comparison of BMD between postmenopausal patients and BMI- and age-matched controls revealed that the patient group had decreased BMD at all sites of measurement, although this difference was not significant. This phenomenon was not observed in the premenopausal patients. Furthermore, when BMD was compared between patients categorized as having full and partial suppression of TSH, only patients with full suppression in the postmenopausal group showed a tendency to lower BMD. There was a strong correlation of BMD with age, BMI and serum calcium level. However, no correlation was found between BMD and degree of TSH suppression or duration of l-T4 suppression therapy. CONCLUSION: Women with differentiated thyroid cancer who had long-term (mean, 7.3 +/- 3.0 years) l-T4 therapy and suppressed TSH levels had no evidence of lower BMD. However, patients with full suppression in the postmenopausal group showed a tendency towards lower BMD. Therefore, careful monitoring of BMD in postmenopausal women during suppression therapy is mandatory.

Chen JF, Lee ST, Lui TN, Wu CT, Liao CC. · Department of Neurosurgery, Chang Gung University and Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC. · Chang Gung Med J. · Pubmed #12141703 links to  free full text

Abstract: BACKGROUND: This report assesses the efficacy and safety of percutaneous vertebroplasty for osteoporotic vertebral compression fractures and reports on preliminary results of its use. METHODS: The technique was used on 50 patients with 86 painful vertebral fractures, all of which had failed to respond to earlier conservative medical treatment. The technique involves percutaneous puncture of the involved vertebra via a transpedical approach followed by injection of polymethyl methacrylate (PMMA) into the compressed vertebra. Patients were asked to quantity their degree of pain on Huskisson's visual analogue scale (VAS) to assess the clinical symptoms and surgical results. RESULTS: The procedures were technically successful in all patients, and no complications relating to either the anesthesia or the surgical procedure were reported. The quantity of PMMA injected per vertebral body varied from 2.5 to 12 ml according to both the position of the damaged vertebra(e) and the severity of the compression fracture. Pain, as assessed on the Huskisson's VAS, decreased from 82 +/- 15 mm at the baseline to 37 +/- 22 mm on the first postoperative day, and 32 +/- 19 mm at 1 month. Reductions in pain from the baseline to the first day and to 1 month were both statistically significant (p < 0.05). All patients were able to return to their previous activity and quality of life. CONCLUSION: Through the expertise and attention of experienced surgeons, percutaneous vertebroplasty appears to provide a very good surgical choice for patients with vertebral compression fractures, as this surgical procedure is able to eliminate the risk of major spinal surgery, and through prompt pain relief, may provide early mobilization and rehabilitation for elderly polymorbid patients.

Lin JD, Chen JF, Chang HY, Ho C. · Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, 5 Fu-Shin St., Kweishan County, Taoyuan Hsien, Taiwan, Republic of China. · Br J Radiol. · Pubmed #11509395 links to  free full text

Abstract: Caucasians and Asians are among those with the highest risk for involutional osteoporosis. To obtain accurate data about the prevalence of osteoporosis or osteopenia in different age groups, a large epidemiological study is necessary. Quantitative ultrasound (QUS) of bone is a promising technique in assessing bone microarchitecture in addition to bone mass. This study had two aims. The first was to establish bone mineral density (BMD) using QUS in subjects with no obvious disease undergoing routine health examination. The second was to determine risk factors for osteoporosis in Taiwan in order that better prevention and treatment measures may be provided for these patients. A prospective study of the risk factors for fracture was conducted in the health examination division of Chang Gung Medical Center in Linkou, Taiwan, from January 1996 to December 1997. Broadband ultrasound attenuation of the right heel was measured with an achilles bone densitometer (Lunar, Nauheim, Germany). A total of 16,862 subjects were examined, including 9,314 women (mean age 51.5+/-11.7 years) and 7,548 men (mean age 51.1+/-12.1 years). The incidence of osteoporosis in all subjects increased from 1.13% in the 21--30-year-old age group to 54.55% in those over 80 years of age. 12.02% of the subjects had osteoporosis and 34.45% had osteopenia. From multivariate analysis, bone density evaluated by QUS showed a relationship with age, gender, body mass index, waist/hip ratio, smoking and frequency of exercise. In conclusion, BMD evaluated by QUS is not found to be higher in Taiwan than elsewhere. The role of QUS in predicting fractures in Taiwan requires further investigation.