scholarly journals Cranial Bone Growth in Isolated Sagittal Craniosynostosis Compared to Normal Growth in the First Six Months of Age

2019 ◽  
Author(s):  
Ezgi Mercan ◽  
Richard A. Hopper ◽  
A. Murat Maga
Keyword(s):  
Growth Model ◽  
Surgical Outcome ◽  
Bone Growth ◽  
Bone Fractures ◽  
Ct Images ◽  
Growth Patterns ◽  
Cranial Bone ◽  
Control Group ◽  
Anatomical Landmarks ◽  
Sagittal Craniosynostosis

AbstractBackgroundSagittal craniosynostosis (SCS), the most common type of premature perinatal cranial suture fusion, results in abnormal head shape that requires extensive surgery to correct. It is important to find objective and repeatable measures of severity and surgical outcome to examine the effect of timing and technique on different SCS surgeries. The purpose of this study was to develop statistical models of infant (0-6 months old) skull growth in both normative and SCS subjects (prior to surgery). Our goal was to apply these models to the assessment of differences between these two groups in overall post-natal growth patterns and sutural growth rates as a first step to develop methods for predictive models of surgical outcome.Methods and Findings:We identified 81 patients with isolated, non-syndromic SCS from Seattle Children’s Craniofacial Center patient database who had a pre-operative CT exam before the age of six months. As a control group, we identified 117 CT exams without any craniofacial abnormalities or bone fractures in the same age group. We first created population-level templates from the CT images of the SCS and normal groups. All CT images from both groups, as well as the canonical templates of both cohorts were annotated with anatomical landmarks, which were used in a growth model that predicted the locations of these landmarks at a given age based on each population. Using the template images and the landmark positions predicted by the growth models, we created 3D meshes for each week of age up to six months for both populations. To analyze the growth patterns at the suture sites, we annotated both templates with additional semi-landmarks equally spaced along the metopic, coronal, sagittal and lambdoidal cranial sutures. By transferring these semi-landmarks to meshes produced from the growth model, we measured the displacement of the bone borders and suture closure rates. We found that the growth at the metopic and coronal sutures were more rapid in the SCS cohort compared to the normal cohort. The antero-posterior displacement of the semi-landmarks indicated a more rapid growth in the sagittal plane in the SCS model compared to the normal model as well.Conclusions:Statistical templates and geometric morphometrics are promising tools for understanding the growth patterns in normal and synostotic populations and to produce objective and reproducible measurements of severity and outcome. Our study is the first of its kind to quantify the bone growth for the first six months of life in both normal and sagittal synostosis patients.

Marine spongin incorporation into Biosilicate® for tissue engineering applications: An in vivo study

2020 ◽  
Vol 35 (2) ◽  
pp. 205-214 ◽  
Author(s):  
Julia Risso Parisi ◽  
Kelly Rossetti Fernandes ◽  
Giovanna Caroline Aparecida do Vale ◽  
Alan de França Santana ◽  
Matheus de Almeida Cruz ◽  
...  
Keyword(s):  
Bone Defect ◽  
Bone Structure ◽  
Bone Fractures ◽  
Biological Effects ◽  
Bone Grafts ◽  
Tissue Growth ◽  
Cranial Bone ◽  
Control Group ◽  
Positive Effects ◽  
Post Surgery

Biomaterials and bone grafts, with the ability of stimulating tissue growth and bone consolidation, have been emerging as very promising strategies to treat bone fractures. Despite its well-known positive effects of biosilicate (BS) on osteogenesis, its use as bone grafts in critical situations such as bone defects of high dimensions or in non-consolidated fractures may not be sufficient to stimulate tissue repair. Consequently, several approaches have been explored to improve the bioactivity of BS. A promising strategy to reach this aim is the inclusion of an organic part, such as collagen, in order to mimic bone structure. Thus, the present study investigated the biological effects of marine spongin (SPG)-enriched BS composites on the process of healing, using a critical experimental model of cranial bone defect in rats. Histopathological and immunohistochemistry analyzes were performed after two and six weeks of implantation to investigate the effects of the material on bone repair (supplemental material-graphical abstract). Histological analysis demonstrated that for both BS and BS/SPG, similar findings were observed, with signs of material degradation, the presence of granulation tissue along the defect area and newly formed bone into the area of the defect. Additionally, histomorphometry showed that the control group presented higher values for Ob.S/BS (%) and for N.Ob/T.Ar (mm2) (six weeks post-surgery) compared to BS/SPG and higher values of N.Ob/T.Ar (mm2) compared to BS (two weeks post-surgery). Moreover, BS showed higher values for OV/TV (%) compared to BS/SPG (six weeks post-surgery). Also, VEGF immunohistochemistry was increased for BS (two weeks post-surgery) and for BS/SPG (six weeks) compared to CG. TGFb immunostaining was higher for BS compared to CG. The results of this study demonstrated that the BS and BS/SPG scaffolds were biocompatible and able to support bone formation in a critical bone defect in rats. Moreover, an increased VEGF immunostaining was observed in BS/SPG.

scholarly journals 3505 Fracture Targeted Parathyroid Hormone Agonist As An Effective Pharmaceutical For Bone Repair in Mouse and Canine Models

2019 ◽  
Vol 3 (s1) ◽  
pp. 105-106
Author(s):  
Jeffery Jay Howard Nielsen ◽  
Stewart A. Low ◽  
Philip S. Low
Keyword(s):  
Parathyroid Hormone ◽  
Bone Fracture ◽  
Bone Growth ◽  
Bone Fractures ◽  
Healing Process ◽  
Fracture Site ◽  
Fracture Repair ◽  
Control Group ◽  
Fracture Callus

OBJECTIVES/SPECIFIC AIMS: The primary objective of this study was to evaluate the performance of a bone fracture targeted systemically administrable bone anabolic as a potential therapeutic for bone fracture repair. Currently all bone fracture repair therapeutic require local administration during surgery. However, the population that need the most assistance in repair bone fractures are not eligible for surgery. So, it was our goal to design an inject-able therapeutic to assist in bone fracture repair to reduce the invasiveness. The injectable nature of it allows for repair administration of the bone anabolic and for therapeutic effect throughout the entire bone fracture healing process. Targeting it to the bone fracture site reduces the toxicity and increases the efficacy. METHODS/STUDY POPULATION: METHODS To achieve the above objective, a bone mineral-(hydroxyapatite-) targeting oligopeptide was conjugated to the non-signaling end of an engineered parathyroid hormone related protein fragment 1-46 with substitutions at Glu22,25, Leu23,28,31, Aib29, Lys26,30 (ePTHrP). The negatively charged oligopeptide has been shown to target raw hydroxyapatite with remarkable specificity, while the attached PTHrP has been demonstrated to induce sustained and accelerated bone growth under control of endogenous morphogenic regulatory factors. The conjugate’s specificity arises from the fact that raw hydroxyapatite is only exposed whenever a bone is fractured, surgically cut, grafted, or induced to undergo accelerated remodeling. The hydroxyapatite-targeted conjugate can therefore be administered systemically (i.e. without invasive surgery or localized injection) and still accumulate on the exposed hydroxyapatite at the fracture site where it accelerates the healing process Murine in vivo experiments were conducted on female Swiss Webster mice (10 per group). Femoral fractures were induced with a 3-point bending device and stabilized. Mice were dosed with 3 nmol/kg/d of targeted-ePTHrP, non-conjugated (free) ePTHrP, or saline. Following a 4-week study, fracture callus densities were measured using microCT. Canine in vivo experiments were conducted on 1-year-old male beagles. Beagles underwent a 10 mm bilateral ulnar ostectomy. Two dogs in the treatment group and Three dogs in the control group were dosed daily with either targeted-ePTHrP 0.5nmol/kg/d or saline respectively. Dogs were x-rayed weekly for the first 6 weeks and then every other week thereafter. One tailed ANOVA followed by Dunnett’s post-hoc test was used to establish significance. All animal experiments were conducted as described in approved IACUC protocols. P<0.05 was considered significant. RESULTS/ANTICIPATED RESULTS: RESULTS SECTION: In the murine studies we observed a marked increase in fracture callus size and a 2-fold increase in bone deposition was observed in the targeted-ePTHrP group over the saline group (P<0.01). A significant doubling in bone density was also observed. Targeted-ePTHrP group fractured femurs were able to achieve their pre-fracture strength as early as 3 weeks compared to 9 weeks in the saline mice representing a 66% reduction in healing time. In the canine studies, we observe a significantly higher closure of the ostectomy gap than saline controls (P<0.05). In addition, no significant differences in weight are observed in the treatment vs. saline controls. No significant difference between the control group and treatment groups was found in a histological investigation of the organs. DISCUSSION/SIGNIFICANCE OF IMPACT: DISCUSSION: Although attempts have been made in developing a systemically administered fracture therapeutic for fracture repair, i.e. teriparatide, to date, no such anabolics have been approved for this use. In these studies there is evidence that anabolic activity was occurring at the fracture site, but at a level that did not meet FDA required end-points.2 It is plausible that if sufficient drug were to be delivered to a fracture site then improved fracture repair would be possible. In previous studies, we demonstrated fracture specific accumulation bone anabolics can be achieved by modifying the drug with acidic oligopeptides.3 Here, by modifying a safe, clinically proven, parathyroid hormone receptor agonist with an acidic oligopeptide we observe improved bone deposition and strength in mice. Furthermore, when administered to canine critical sized defect ostectomies, a more relevant and difficult model, we observe improved ostectomy closure. CLINICAL RELEVANCE:: The ability to accelerate bone fracture repair is a fundamental need that has not been addressed by conventional methods. By targeting bone anabolic agents to bone fractures, we can deliver sufficient concentrations of anabolic agent to the fracture site to accelerate healing, thus avoiding surgery and any ectopic bone growth associated with locally-applied bone anabolic agents.

Polyhedral Oligomeric Silsesquioxane /Platelets Rich Plasma/Gelrite-Based Hydrogel Scaffold for Bone Tissue Engineering

2020 ◽  
Vol 26 (26) ◽  
pp. 3147-3160
Author(s):  
Saeedeh Ahmadipour ◽  
Jaleh Varshosaz ◽  
Batool Hashemibeni ◽  
Leila Safaeian ◽  
Maziar Manshaei
Keyword(s):  
Bone Fractures ◽  
Compressive Strain ◽  
Gelation Time ◽  
Polyhedral Oligomeric Silsesquioxane ◽  
Local Drug Delivery ◽  
Gelling Agent ◽  
Control Group ◽  
Hydrogel Scaffold ◽  
Alizarin Red ◽  
Oligomeric Silsesquioxane

Background: Polyhedral oligomeric silsesquioxane (POSS) is a monomer with silicon structure and an internal nanometric cage. Objective: The purpose of this study was to provide an injectable hydrogel that could be easily located in open or closed bone fractures and injuries, and also to reduce the possible risks of infections caused by bone graft either as an allograft or an autograft. Methods: Various formulations of temperature sensitive hydrogels containing hydroxyapatite, Gelrite, POSS and platelets rich plasma (PRP), such as the co-gelling agent and cell growth enhancer, were prepared. The hydrogels were characterized for their injectability, gelation time, phase transition temperature and viscosity. Other physical properties of the optimized formulation including compressive stress, compressive strain and Young’s modulus as mechanical properties, as well as storage and loss modulus, swelling ratio, biodegradation behavior and cell toxicity as rheometrical parameters were studied on human osteoblast MG-63 cells. Alizarin red tests were conducted to study the qualitative and quantitative osteogenic capability of the designed scaffold, and the cell adhesion to the scaffold was visualized by scanning electron microscopy. Results: The results demonstrated that the hydrogel scaffold mechanical force and injectability were 3.34±0.44 Mpa and 12.57 N, respectively. Moreover, the scaffold showed higher calcium granules production in alizarin red staining compared to the control group. The proliferation of the cells in G4.5H1P0.03PRP10 formulation was significantly higher than in other formulations (p<0.05). Conclusion: The optimized Gelrite/Hydroxyapatite/POSS/PRP hydrogel scaffold has useful impacts on osteoblasts activity, and may be beneficial for local drug delivery in complications including a break or bone loss.

Quantitative Analysis of Deltoid Ligament Degradation in Patients With Chronic Ankle Instability Using Computed Tomographic Images

2021 ◽  
pp. 107110072199707
Author(s):  
Yasunari Ikuta ◽  
Tomoyuki Nakasa ◽  
Junichi Sumii ◽  
Akinori Nekomoto ◽  
Nobuo Adachi
Keyword(s):  
Ankle Instability ◽  
Ct Images ◽  
Chronic Ankle Instability ◽  
Control Group ◽  
Deltoid Ligament ◽  
Anterior Talofibular Ligament ◽  
Mri Findings ◽  
Calcaneofibular Ligament ◽  
Level Of Evidence ◽  
Strong Negative Correlation

Background: Rotational ankle instability (RAI) is associated with the faster onset of severe ankle osteoarthritis via dysfunction of the anterior talofibular ligament, calcaneofibular ligament, and deltoid ligament. No specific clinical examination is available for RAI, and diagnostic imaging has limitations in evaluating ligament degradation. This study investigated the deltoid ligament degeneration using Hounsfield unit (HU) values on computed tomography (CT) images. Methods: Patients were enrolled in this retrospective analysis if they had undergone magnetic resonance imaging (MRI) and CT scans of the ankle. The chronic ankle instability (CAI) group comprised 20 ankles with CAI (9 men, 11 women; mean age, 28.7 years) and the control group comprised 28 ankles (16 men, 12 women, mean age, 41.3 years). The average HU values of the deep posterior tibiotalar ligament (dPTL) that constitutes the deltoid ligament were measured on coronal CT images, and MRI results were used as a reference. All patients were subdivided based on the MRI findings of dPTL injury such as fascicular disruption, irregularity, and the loss of striation. Results: A strong negative correlation was identified between age and HU values for all patients (Spearman ρ = −0.63; P < .001). The mean HU values of the dPTL for participants aged <60 years were 81.0 HU for the control group (21 ankles) and 69.5 HU for the CAI group ( P = .0075). No significant differences in the HU values were observed for the dPTL among the MRI subgroups. Conclusion: In addition to the conventional imaging examination such as stress radiographs and MRI, HU measurements of CT images could be useful for quantitatively and noninvasively evaluating degenerative changes in the deltoid ligament for CAI patients to assist the diagnosis of RAI. Level of Evidence: Level III. case-control study.

scholarly journals The Bone Buttress Theory: The Effect of the Mechanical Loading of Bone on the Osseointegration of Dental Implants

Biology ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. 12
Author(s):  
David Chavarri-Prado ◽  
Aritza Brizuela-Velasco ◽  
Ángel Álvarez-Arenal ◽  
Markel Dieguez-Pereira ◽  
Esteban Pérez-Pevida ◽  
...  
Keyword(s):  
Dental Implants ◽  
Mechanical Loading ◽  
Bone Growth ◽  
Bone Matrix ◽  
Test Group ◽  
Control Group ◽  
Group A ◽  
Bone To Implant Contact ◽  
The Stability ◽  
Group B

Objectives: To determine the effect of mechanical loading of bone on the stability and histomorphometric variables of the osseointegration of dental implants using an experimental test in an animal model. Materials and Methods: A total of 4 human implants were placed in both tibiae of 10 New Zealand rabbits (n = 40). A 6-week osseointegration was considered, and the rabbits were randomly assigned to two groups: Group A (Test group) included 5 rabbits that ran on a treadmill for 20 min daily during the osseointegration period; Group B (Controls) included the other 5 that were housed conventionally. The monitored variables were related to the primary and secondary stability of the dental implants (implant stability quotient—ISQ), vertical bone growth, bone to implant contact (BIC), area of regenerated bone and the percentage of immature matrix. Results: The results of the study show a greater vertical bone growth (Group A 1.26 ± 0.48 mm, Group B 0.32 ± 0.47 mm, p < 0.001), higher ISQ values (Group A 11.25 ± 6.10 ISQ, 15.73%; Group B 5.80 ± 5.97 ISQ, 7.99%, p = 0.006) and a higher BIC (Group A 19.37%, Group B 23.60%, p = 0.0058) for implants in the test group, with statistically significant differences. A higher percentage of immature bone matrix was observed for implants in the control group (20.68 ± 9.53) than those in the test group (15.38 ± 8.84) (p = 0.108). A larger area of regenerated bone was also observed for the test implants (Group A 280.50 ± 125.40 mm2, Group B 228.00 ± 141.40 mm2), but it was not statistically significant (p = 0.121). Conclusions: The mechanical loading of bone improves the stability and the histomorphometric variables of the osseointegration of dental implants.

Effect of functional MRI–guided navigation on surgical outcomes: a prospective controlled trial in patients with arteriovenous malformations

2016 ◽  
Vol 126 (6) ◽  
pp. 1863-1872 ◽  
Author(s):  
Fuxin Lin ◽  
Yuming Jiao ◽  
Jun Wu ◽  
Bing Zhao ◽  
Xianzeng Tong ◽  
...  
Keyword(s):  
Brain Tissue ◽  
Surgical Outcome ◽  
Interim Analysis ◽  
Arteriovenous Malformations ◽  
Controlled Trial ◽  
Standard Procedure ◽  
Control Group ◽  
End Points ◽  
Experimental Group ◽  
Adjacent Brain

OBJECTIVEThe impact of functional MRI (fMRI)–guided navigation on the surgical outcome of patients with arteriovenous malformations (AVMs) is undetermined. This large, randomized controlled trial (RCT) was designed to determine the safety and efficacy of fMRI-guided microsurgery of AVMs. This paper reports the preliminary results of the interim analysis.METHODSBetween September 2012 and June 2015, eligible patients were randomized to the standard microsurgery group (control group) or the fMRI-guided surgery group (experimental group) in a 1:1 ratio. Patients in the control group underwent conventional digital subtraction angiography and MRI before surgery. The surgery was performed according to the standard procedure. However, patients in the experimental group underwent blood oxygen level–dependent (BOLD) fMRI and diffusion tensor imaging within 1 week before surgery. Moreover, preoperative eloquent brain tissue mapping and intraoperative fMRI navigation were performed in addition to the standard procedure. The preliminary end points were the total removal rate of AVMs and postoperative surgical complications. The primary end points were modified Rankin Scale (mRS) score (favorable: mRS Score 0–2; poor: mRS Score 3–6) and surgery-related permanent functional deficits (S-PFD) at the last clinic visit (≥ 6 months). Statistical analysis was performed using the statistical package from SPSS.RESULTSThe interim analysis included 184 participants (93 in the experimental group and 91 in the control group). Patients were equally distributed between the 2 groups. Neither the preliminary nor the primary end points, including postoperative complications (p = 0.781), residual AVM (p = 1.000), last mRS score (p = 0.654), and S-PFD (p = 0.944) showed any significant difference between the control and experimental group. According to the results of the univariate analysis, eloquent adjacent brain tissue (OR 0.14; 95% CI 0.06–0.32; p < 0.001), large size of the nidus (OR 1.05; 95% CI 1.02–1.08; p = 0.002), or diffuse nidus (OR 3.05; 95% CI 1.42–6.58; p = 0.004) were all significantly associated with S-PFD. Additionally, a high Spetzler-Martin score (OR 3.54; 95% CI 2.08–6.02; p < 0.001), no previous hemorrhage (OR 2.35; 95% CI 1.00–5.54; p = 0.05), or a low preoperative mRS score (OR 0.42; 95% CI 0.17–1.00; p = 0.049) were also significantly associated with S-PFD. Multivariate analysis revealed that independent factors correlated with S-PFD were eloquent adjacent brain tissue (OR 0.17; 95% CI 0.04–0.70; p = 0.014) and low preoperative mRS score (OR 0.22; 95% CI 0.07–0.69; p = 0.009).CONCLUSIONSThis preplanned interim analysis revealed no significant differences in the primary end points between the experimental and control group, prompting an early termination of this RCT. The preliminary data indicated that the additional intervention of fMRI navigation is not associated with a more favorable surgical outcome in patients with AVMs. The results indicated that eloquent adjacent brain tissue and a low preoperative mRS score are independent risk factors for S-PFD.Clinical trial registration no.: NCT01758211 (clinicaltrials.gov)

Prevalence of sarcopenia in patients with gastroesophageal and lung malignancies undergoing surgical resection and its impact on immediate postoperative outcomes: A prospective observational study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18617-e18617
Author(s):  
Sudhakar Gunasekar ◽  
SVS Deo ◽  
Sunil Kumar ◽  
Ekta Dhamija ◽  
Sandeep Kumar Bhoriwal
Keyword(s):  
Lung Cancer ◽  
Weight Loss ◽  
Grip Strength ◽  
Handgrip Strength ◽  
Ct Images ◽  
Control Group ◽  
Gastroesophageal Cancer ◽  
Combined Method ◽  
Skeletal Muscle Index ◽  
Strength Based

e18617 Background: The study evaluated the prevalence & impact of sarcopenia in gastroesophageal cancer (GC) & lung cancer (LC) patients undergoing resection. Methods: An observational prospective study was conducted in department of surgical oncology, AIIMS, New Delhi. All patients aged under 65 years with resectable GC & LC were included. Skeletal muscle index (SMI) using cross-sectional CT images at the level of L3 & Hand grip strength (dynamometer) were used to assess sarcopenia. Random benign patients with CT images were used as control group. Patients were categorized into sarcopenic and non-sarcopenic and outcome parameters were compared. Results: In the study population (n = 66), GC & LC constituted 44 (66.67%) & 22(33.33%) respectively. Mean age was 53.4 years. The prevalence of sarcopenia based on the combined method (CT imaging & handgrip strength) was 57.58%, CT based sarcopenia was 33.34% & handgrip strength-based sarcopenia was 43.93%. Mild and moderate sarcopenia was seen in 37.88% (n = 25) & 19.7 % (n = 13) respectively. Among patients with GC, prevalence of sarcopenia was 59.09% by combined method, 36.36% and 43.18% by CT based method alone & handgrip strength-based method alone respectively. Among LC prevalence of sarcopenia was 54.54% by combined method, 27.27% and 45.45% by CT based & handgrip-based method. The concordance between CT muscle mass & grip strength was 62.12%. Most female patients had weak handgrip strength despite having normal SMI. In control group (n = 44) mean age was 54.5 years, the prevalence of CT based sarcopenia was 34.09%. Weight loss history & BMI correlated with the degree of sarcopenia. Out of 66 patients 13% (n = 9) patients were unresectable. Moderate sarcopenia group had more statistically significant (P -0.02) unresectable disease compared to mild and non-sarcopenic groups. In postoperative period, sarcopenic group (64.51% vs 38.36 %) had more grade 2 complications though statistically insignificant. There was no difference in hospital stay between the two groups. In patients with GC , postoperative respiratory complication occurred in 11.53% (n = 3) of sarcopenic patients and 5.5%(n = 1) of non-sarcopenic patients, anastomotic leak occurred in 7.69% (n = 2) of sarcopenic patients and 5.5% (n = 1) of nonsarcopenic patients. Conclusions: The prevalence of sarcopenia is higher in patients with gastroesophageal cancer compared to lung cancer. The important factors that affect the sarcopenia include age and body mass index and weight loss history. The study has showed a trend towards increased post-operative complications and increased unresectable cases in patients with mild to moderate sarcopenia. Further larger studies are required to validate if sarcopenia can be used as an adjunct to predict resectability and post-operative outcomes.

scholarly journals The effect of intravenous zoledronic acid on glucocorticoid-induced multiple vertebral fractures in juvenile systemic lupus erythematosus

2004 ◽  
Vol 59 (5) ◽  
pp. 302-305 ◽  
Author(s):  
Sonia Cristina de Magalhães Souza ◽  
Claudia Tereza Lobato Borges ◽  
Vanda Jorgetti ◽  
Rosa Maria Rodrigues Pereira
Keyword(s):  
Zoledronic Acid ◽  
Lupus Erythematosus ◽  
Bone Growth ◽  
Bone Fractures ◽  
Young Patients ◽  
Systemic Lupus ◽  
Treatment Of Osteoporosis ◽  
The Us ◽  
Us Fda ◽  
Intravenous Bisphosphonate

Glucocorticoids are widely used in the treatment of lupus patients, and adverse effects, which include osteoporosis and associated fractures, are frequent. Treatment of osteoporosis of young patients should be effective and not harmful to bone growth and remodeling. Bisphosphonates are drugs that decrease the incidence of bone fractures, but their use in juvenile patients is still controversial because of their possible side effects on the growing skeleton. However, recently published studies showed that linear growth continued normally after treatment with these drugs, and there was no excessive suppression of bone remodeling or mineralization defects. Zoledronic acid is a new intravenous bisphosphonate that has been approved by the US FDA for use with hypercalcemia of malignancies and might be an effective treatment for postmenopausal osteoporosis. The authors report a case of a young girl with systemic lupus who developed multiple vertebral collapses due to glucocorticoid therapy, and zoledronic acid was used producing significant clinical and densitometric improvement.

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