Skeletal disease

NO is recognized as a mediator of bone cell metabolism, where it regulates osteoblast and osteoclast activity [141-143]. Osteoporosis, which frequently occurs in postmenopausal women, is a systemic skeletal disease associated with abnormal bone resorption. Addition of NO or NO donors to osteoclasts in vitro results in a reduction in bone resorption, whereas NO synthase inhibitors increase bone resorption, both in vitro and in vivo. Further research has shown that NO reduces bone resorption, via inhibition of the cysteine protease cathepsin K, which is believed to be a key protease in bone resorption. Most of the NO donors, i.e., nitroglycerin, 3-... 

The definition of osteoporosis is (NIH 2000) A systemic skeletal disease characterized by low bone mass and micro architectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture . 

E. Even-Sapir, U. Metser, G. Flusser, L. Zuriel, Y. Kollender, H. Lerman, G. Lievshitz, I. Ron, E. Mishani, Assessment of malignant skeletal disease Initial experience with F-fluoride PET/CT and comparison between F-fluoride PET and F-fluoride PET/CT, J. Nucl. Med. 45(2) (2004) 272-278. 

In their methodological concept, Mueller et al. (2003) discern between free and peptide-bound collagen crosslinks from urine samples of patients displaying different skeletal diseases, and argue that this discrimination might further characterize the underlying disorder. 

One female and one male patient had hyperparathyroidism with elevated serum alkaline phosphatase activities and extensive bone changes characteristic of generalized osteitis fibrosa cystica. In both instances, the serum acid phosphatase activity of the serum fell to normal values after removal of the parathyroid adenoma despite transitorily increased serum alkaline phosphatase activity. The fifth patient was a female with osteopetrosis involving the major part of the skeleton. The serum acid phosphatase was 8.7 K.A. units, the highest in the control series— yet the serum alkaline phosphatase was within normal limits. It would appear, therefore, that some patients with skeletal disease may have a slight but definitely elevated serum acid phosphatase activity, at least as determined by the Gutman method (GIO, G14), which cannot be explained by concurrent prostatic carcinoma or by a spillover of alkaline phosphatase activity to a pH of 5.0. 

Lipton A, Zheng M, Seaman J. Zoledronic acid delays the onset of skeletal-related events and progression of skeletal disease in patients with advanced renal cell carcinoma. Cancer 2003 98 962-969. 

Deftos LJ. Bone protein and peptide assays in the diagnosis and management of skeletal disease. Clin Chem 1991 37 1143-8. 

Demers LM. Bone markers in the management of patients with skeletal disease. Cancer 2003 97 ... 

An estimated 75 million people are affected by osteoporosis to some degree in the United States, Europe, and Japan. Osteoporosis is a systematic skeletal disease characterized by bone mass and microarchitectural deterioration with a consequent increase in bone fragility and susceptibility to fracture. Operationally, osteoporosis can be defined as a certain level of bone mineral density. The definition of osteoporosis is somewhat arbitrary and is based on epidemiological data relating fracture incidence to bone mass. Uncertainty also is introduced due to variability in bone densitometry measurements. Other clinical measures to assess the skeleton include collagen cross-links (measure of bone resorption) and levels of bone-specific alkaline phosphatase and osteocalcin (bone formation). A list of biochemical markers of bone remodeling is provided in Table 37-3. Measurement of total serum alkaline phosphatase level and urinary hydroxyproline or calcium levels is of limited value. 

Jeffers (T2) did electrophoretic studies on serum alkaline phosphatase in hepatobiliary and skeletal disease (Fig. 1). They found eight separate zones of alkaline phosphatase activity arranged in three distinct patterns, and suggested the use of the starch-gel zymogram in the differentiation between obstructive, metastatic, or infiltrative hepatobiliary disease, parenchymal hepatic disease, and osteoblastic disorders. 

The prevalence of skeletal disease among patients with nonterminal renal failure is not known. The majority of such patients do not complain of skeletal symptoms and their serum alkaline phosphatase activities are not markedly elevated. The mean for all patients in one study (15) was 1.5 times the upper reference limit for adults. In some patients with nonterminal renal failure, systemic acidosis is out of proportion to the degree of nitrogenous retention, and it currently seems that acidotic patients are more liable to develop skeletal abnormalities. Mean serum alkaline phosphatase in a group of such patients was 3.5 times the upper reference limit, with individual values of almost 10 times the upper reference limit (15). The rise in total serum alkaline phosphatase, which is largely due to increases in the bone isoenzyme (15, P15), shows a significant positive correlation with the severity of parathyroid osteopathy, irrespective of the presence or absence of concurrent osteomalacia (P15). 

Skeletal disease is common in patients with renal failure treated by chronic dialysis. The majority of these patients have histologically demonstrable bone disease, even in the absence of clinical symptoms (B21). However, serum alkaline phosphatase activities are either within reference limits or only moderately elevated (B21), with spectacular elevations occurring only rarely in both adults (B21, KIO) and children (P34). High serum alkaline phosphatase values have been described in patients on chronic dialysis with severe hypophosphatemic osteomalacia (M3). 

An overview on the clinical application of radionuclide imaging in skeletal disease provides methodological detail (McAfee 1987). 

McAfee JG (1987) Radionuclide imaging in metabolic and systemic skeletal diseases. Semin Nucl Med 17 334-349... 

Osteoporosis is a skeletal disease that is characterized by loss of bone mass as well as microarchitectural deterioration of the bone tissue. This disease is associated with increased bone fragility and susceptibility to fracture. It is a condition that is characterized not by inadequate bone formation but, rather, by a deficiency in the production of well-mineralized bone mass. Whereas no medical cause typically is evident in primary osteoporosis (3), secondary osteoporosis classically stems from medical illness or medication use. There are two types of primary adult osteoporosis, type I, or postmenopausal, and type II, or senile (Table 35.1). In type I osteoporosis, there is an accelerated rate of bone loss via enhanced resorption at the onset of menopause. In this form of the disease, the loss of trabecular bone is threefold greater than the loss of cortical bone. This disproportionate loss of bone mass is the primary cause of the vertebral crush fractures and the wrist and ankle fractures experienced by postmenopausal women. In type II osteoporosis, which is associated with aging, the degree of bone loss is similar in both trabecular and cortical bone (5) and is caused by decreased bone formation by the osteoblasts. 

Putz-Anderson, V. (1988), Cumulative Trauma Disorders A Manual for Musculo-Skeletal Diseases... 

In many countries, OCD ranks first among all notified occupational diseases and constitutes up to 30% of all occupational diseases for which compensation is payable. In some countries, this proportion has declined in recent years because other diseases (in particular musculo-skeletal diseases) have been recognized as occupational diseases. This caused an increase in the total number of notified occupational diseases and a decrease of the proportion of skin diseases, while the IRs remained about the same. To follow trends in incidence of work-related dermatoses recent data are needed. 

Even-Sapir E, Metser U, Flusser G, Zuriel L, Kollender Y, Lerman H, Lievshitz G, Ron I, Mishani E. Assessment of malignant skeletal disease initial experience with 18F-fluoride PET/CT and comparison between 18F-fluoride PET and 18F-Huoride PET/CT. J Nucl Med 2004 45 272-278. 

Hypophosphatasia mainly affects bone and teeth involvement of muscle tissue has been suggested but is probably subclinical in most cases. The clinical spectrum of hypophosphatasia is broad (MIM 241500, 241510, 146300) and includes a perinatally lethal, generalized skeletal mineralization defect ( the boneless fetus ), infantile and juvenile forms with rickets-like skeletal disease, and an exclusively dental form ( odontohypophosphatasia ). The incidence of the condition in its various forms is not known precisely. 

National Institutes of Health National Institute of Dental and Craniofacial Research Craniofacial and Skeletal Diseases Branch... 

Gerber B, Guggenberger R, Fasler D, Nair G, Manz MG, Stussi G, et al. Reversible skeletal disease and high fluoride serum levels in hematologic patients receiving voriconazole. Blood 2012 120(12) 2390-4. 

Markstrom A, Sundell K, Lysdahl M, et al. Quality of life evaluation of patients with neuromuscular and skeletal diseases treated with non-invasive home mechanical ventilation. Chest... 

Simonds AK, Ward S, Heather S, et al. Outcome of paediatric domiciliary mask ventilation in neuromuscular and skeletal disease. Eur Respir J 2000 16 476-481. 

Osteoporosis is a major public problem, it is a skeletal disease characterized by low bone mass and microarchitec-tural deterioration. Osteoporotic patient occur fragility fracture frequently, and the common positions were vertebral, hip, wrist. There was 1.66million hip fracture in worldwide [1], 1,197,000 in women and 463,000 in men. Dynamic hip screw was the standard treatment in stable femoral proximal fracture. But in unstable fracture, it has high failure rate. Unstable fracture has the weak structure, it cause that the force loads on femoral head. Then the cut-out complication will happen, especially on osteoporotic patient. The hip biomechanics can help us to design new device and develop new technique to solve the clinical problem. From the diagram of the lines of stress in the upper femur, the lesser trochanter supply the compression... 

The wrist joint is involved in virtually every human functional activity and as such, are exposed to high number of traumatic injuries, primary osteoarthritis and secondary degenerative disease [1], One of the most common skeletal disease that is always associated with the wrist joint is Rheumatoid Arthritis [2], The disease affects mostly synovial joints, resulting in considerable pain, loss of function and eventual deformity. It is a life-long condition, and the disease activity might change over time. Even though other joints such as the hip and knee can also be affected with Rheumatoid Arthritis, the most commonly affected joint is the wrist [3]. 

Osteoporosis is a skeletal disease causing loss of bone mass and micro-architectural deteriorations. The current gold standard for the assessment of osteoporosis is the dualenergy X-ray absorptiometry (DXA). DXA enables the measurement of bone mineral density (BMD). DXA has, however, several problems, for example, high cost, ionizing radiation and unsuitable for group screening. 

Zelzer, E. and Olsen, B.R. 2003. The genetic basis for skeletal diseases. Nature 423 343-348. 

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