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Query: UMLS:C0005940 (bone disease)
 7,459 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Renal and extra-renal clearance of 18F and 99mTc-EHDP were compared in the same individuals. The 18F space is twice that of 99mTc-EHDP, as is its renal clearance. 99mTc undergoes glomerular filtration, 18F is excreted by glomerular filtration and tubular secretion. Extraction rate was determined indirectly by a comparison with extra-renal clearance, and for patients without bone disease it was four times as high for 18F as it was for 99mTc-EHDP. In patients with secondary hyperparathyroidism extra-renal clearance is greatly increased. This is explained by an increased extraction rate, which may be different for the two substances.
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PMID:[A comparison of osteotropic radiopharmaceuticals. II. Plasma clearance of 18F and 99mTc-EHDP (author's transl)]. 12 88

Experiences in sue of skeletal scintimaging, primarily with 99mTc EHDP, is reported in 108 patients with Paget's disease. The results are compared with other reports and suggest that the mean age of this sample at the time of initial diagnosis and study is somewhat younger than patients in series reported in the literature. In correlation of scintimaging with skeletal radiography only approximately 67% of lesions are seen with the latter. Lesions seen only on scintimaging primarily are associated with early symptomatic lesions and lesions seen only on radiography with older sclerotic "burned out" type lesions. Scintimaging reveals a relatively low incidence of monostotic distribution of lesions, and is superior to skeletal radiography for diagnosis of metastatic bone disease. Qualitative skeletal scintimaging is valuable for objective assessments of therapeutic management by new modes of therapy while clinical radiography is not.
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PMID:Skeletal scintimaging and radiography in the diagnosis and management of Paget's disease. 41 May 75

The limited role of bone scanning in the diagnosis of metabolic bone disease might be considerably improved by accurate quantification of skeletal uptake of the radiopharmaceutical. Using a standard shadow-shield whole-body monitor, we have measured whole-body retention (WBR) of Tc-99m HEDP up to 24 hr in 11 patients with renal osteodystrophy (mean WBR 88.6% at 24 hr); in ten patients with Paget's disease (mean 56.9%); in seven patients with osteomalacia (mean 40.7%); in five patients with primary hyperparathyroidism (mean 50.7%); in four patients with osteoporosis (mean 21.2%); and in 12 normals (mean 19.2%). The osteoporotic group could not be differentiated from the normal group, but the other groups were significantly different from the normal group at 24 hr (p less than 0.002), and each individual rest for the 24-hr WBR of Tc-99m HEDP in these groups lay outside our normal range. This test may, therefore, provide a sensitive means of detecting conditions with increased bone turnover. We obtained measurements of plasma activity of Tc-99m HEDP in these patients up to 24 hr, and 4-hr bone to soft-tissue ratios from bonescan images, but little additional information resulted.
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PMID:The use of whole-body retention of Tc-99m diphosphonate in the diagnosis of metabolic bone disease. 56 41

Bisphosphonates are nonbiodegradable pyrophosphate analogs that are capable of inhibiting bone resorption in vivo and in vitro. For this reason they have been used as effective therapeutic agents in several conditions characterized by increased bone turnover, including Paget's disease, hypercalcemia of malignancy, and metastatic bone disease. More recently, bisphosphonates have been proposed for the treatment and prevention of bone loss in several forms of osteoporosis. Etidronate, the first bisphosphonate to be used in clinical trials, has been found to increase vertebral bone mineral mass in osteoporotic patients. However, the gain in bone mass reaches a plateau after 1-2 years of treatment, with no further increase thereafter. No positive effect on osteoporotic fracture rate has been clearly demonstrated. Moreover, etidronate has been shown to impair bone formation and mineralization at therapeutic doses. Newer, more potent bisphosphonates selectively inhibit bone resorption without impairing bone histology and mechanical strength. Pamidronate has been shown to increase vertebral bone mass in patients with steroid-induced osteoporosis and involutional osteoporosis. In the latter group, this increase did not plateau and was found to be sustained for at least 4 years. However, pamidronate use is associated with relatively poor gastrointestinal tolerability. The use of another agent, clodronate, has been limited by the possible link with the onset of hematologic malignancies. Alendronate is another agent which in studies to date has been found to increase vertebral bone mass in postmenopausal patients. Alendronate also seems to be more potent and better tolerated than pamidronate.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Clinical trials with bisphosphonates. 129 94

Progressive bone disease in multiple myeloma frequently leads to osteolysis, bone resorption, pathologic fractures, vertebral compression, and hypercalcemia. We conducted a double-blind study in 173 newly diagnosed multiple myeloma patients of etidronate disodium (EHDP), a diphosphonate compound that reduces bone resorption by inhibiting osteoclastic activity. The patients were randomly assigned to receive oral EHDP 5 mg/kg/d or placebo until death or discontinuation due to intolerance or refusal. The extent of vertebral deformity was measured by a vertebral index as well as height. The frequency of pathologic fractures, hypercalcemia, and bone pain was regularly assessed, as well as size and number of osteolytic lesions. All patients received melphalan and prednisone daily for 4 days every 4 weeks as the primary chemotherapy for their disease. Although the repeated measures analysis showed a significant height loss, there was no difference between treatment arms (P = .98). There was no significant difference in bone pain, episodes of hypercalcemia, or development of pathologic fractures. Patients on EHDP showed less deterioration in their vertebral index, but this difference only approached statistical significance (P = .07). We conclude that EHDP therapy used in this dosage schedule does not have a clinically significant impact in multiple myeloma.
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PMID:Effect of daily etidronate on the osteolysis of multiple myeloma. 171 35

99mTc-HEDP bone scan was carried out on 12 long-time haemodialysed patients, suffering from bone pains. X-ray examinations of the bone and laboratory tests (serum calcium, -phosphor, -alkaline phosphatase, -parathormone, -aluminium, -ferritin) were also performed. The scintigrams were evaluated by two semiquantitative scores. Based on diffuse, increased radiopharmacon uptake of the bones and more than five points in the Fogelman score 5 patients most likely had serious and 3 had moderate hyperparathyroidism. In two patients osteomalacy was presumed based on decreased radiopharmacon uptake of the bones, increased uptake of the soft tissues and zero Fogelman score. Mixed or other bone disease was suggested in two other patients. Good correlation was found between the results of bone scans, the parathormone values and the results of histology obtained after parathyreoidectomy of 4 patients and autopsy of two others. This non-invasive examination (ie. bone scan) is helpful in differential diagnosis of uraemic osteodystrophy and its wide use is proposed in domestic nephrological practice.
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PMID:[Bone scintigraphy in uremic osteodystrophy]. 260 56

The pathogenesis, clinical features, indications for therapy, and current pharamacologic management of Paget's disease are reviewed. Paget's disease is a bone disorder of unknown etiology primarily affecting the elderly. Overactive bone resorption leads to the accelerated formation of disorganized, weak bone. Pain and fractures are common clinical features. Neurologic, cardiovascular, metabolic, and neoplastic complications are also reported. Because most patients are asymptomatic, the disease is often detected during routine roentgenography or laboratory tests. Primary indications for pharmacologic intervention include bone pain, neural compression, immobilization hypercalcemia or hypercalciuria, cardiac failure, and orthopedic surgery. Recurrent or non-healing fractures and rapidly progressing complications are additional indications. Drugs used in the management of Paget's disease include calcitonin, etidronate disodium, and plicamycin. Although these agents are efficacious, each has disadvantages. Clinical resistance to animal calcitonins may develop, and the cost of therapy may be prohibitive. Etidronate may induce ostemalacia. The use of plicamycin is limited by potentially severe toxicities. Dichloromethylene and aminohydroxypropylidene are promising diphosphonate compounds but are still investigational In those patients who are unresponsive to single-agent regimens, combination therapy may prove effective. Although many patients with Paget's disease do not require pharmacologic therapy, calcitonin and etidronate are the agents of choice when it is indicated.
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PMID:Pharmacologic management of Paget's disease. 266 12

Response to acute and chronic administration of calcitonin and calcium and of biphosphonates (EHDP) was evaluated in 14 patients with Paget's bone disease who were grouped on the basis of homogeneous disease activity, as appraised by bone involvement and alkaline phosphatase and hydroxyproline levels. At first, 100 MRC U of calcitonin followed 4 hours later by 500 mg of elemental calcium were given for 10 days; a significant (p less than 0.001; paired and unpaired Student t test) reduction in alkaline phosphatase (-25%) and hydroproline (-55%) was observed. Subsequently, 5 mg/kg/day of EHDP was given for 20 days. Both parameters increased to levels similar to basal values. These increases were significant (p less than 0.001 for the paired and unpaired Student test) compared with those obtained after calcitonin administration; alkaline phosphatase rose +27% and hydroxproline +135%. After this, patients were divided into 2 groups (A and B). Group A was treated with calcitonin and calcium, at the dosage indicated above, for 10 days a month during 6 months. Group B continued with the same protocol with the addition of EHDP for the 20 days during which calcitonin and calcium were not given. The results of 6 months of treatment showed that calcitonin was more active and suggested that EHDP diminishes hormonal effects. These results also demonstrate a short-term absence of EHDP activity.
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PMID:Biochemical assessment of acute and chronic treatment of Paget's bone disease with calcitonin and calcium with and without biphosphonate. 313 91

Fifty-four patients with Paget's bone disease have been treated with the bisphosphonate APD. Twenty-six patients had not previously received treatment for Paget's disease; and 28 had been treated before with EHDP alone or in combination with calcitonin. APD was given orally in a mean dose of 500 mg daily (congruent to 6.8 mg/kg of body weight) for 4 to 12 months. Bone pain diminished or disappeared in 34 of 39 patients with symptoms. A very significant diminution of the biochemical indices of bone turnover was observed in all patients, but the responses were faster in patients who had not previously received treatment for Paget's disease. After 4 months of treatment the serum levels of alkaline phosphatase of previously untreated patients diminished from 58.8 +/- 8.0 to 20.0 +/- 3.9 KA units (P less than 0.001) and urinary excretion of hydroxyproline diminished from 108.6 +/- 16.9 to 42.4 +/- 8.3 mg/24 h (P less than 0.001). In 23 of 26 previously untreated patients the biochemical indices decreased to the normal range (complete response). A reduction of 50% or more without reaching the normal range was observed in the other 3 patients (partial response). Actuarial analysis of the duration of the effect 12 months after stopping APD disclosed that 63% of patients who had achieved a complete response but only 23% of those with a partial response were in biochemical remission. A second course of APD was administered to 11 patients. The results were as effective during the second as the first course in 9 patients, whereas 2 patients had no response to retreatment.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Efficacy of the bisphosphonate APD in the control of Paget's bone disease. 409 79

Diphosphonates have been used in the management of Paget's disease of bone because of their experimentally demonstrated antiosteoclastic activity. Light microscopic examination of bone tissue from 13 patients with Paget's bone disease who were receiving (EHDP) treatment showed considerably reduced osteoclastic resorption accompanied by gradual replacement of irregular woven bone by lamellar tissue. Electron microscopic examination confirmed that pagetoid osteoclasts are morphologically abnormal cells and degenerate after EHDP treatment. EHDP does not affect the measles nucleocapsid-like inclusions in the osteoclast nuclei. Immunocytologic analysis showed that during EHDP treatment viral antigens of the measles type persist in the cytoplasm and nuclei of osteoclasts even when these cells are greatly altered. These findings support the hypothesis of a viral etiology in Paget's disease of bone.
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PMID:Bone tissue in Paget's disease treated by ethane-1, hydroxy-1, 1 diphosphonate (EHDP). Structure, ultrastructure, and immunocytology. 642 33


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