bluuebunny/crossref_metadata_2025_split huggingface dataset:
7635 Severe Osteoporosis in a Patient with Heterotopic Calcification: A Case Report
Authors: Bacha D Salih , Khan L Z 
Published: October 2024

Abstract
Disclosure: D. Salih Bacha: None. L.Z. Khan: None.
Background: While osteoporosis and heterotopic ossification (HO) are distinct conditions affecting bone health, their coexistence poses intriguing clinical challenges. Osteoporosis, characterized by increased bone fragility, typically results from various factors such as aging, steroid use, or malabsorption. HO is a condition where bone forms abnormally in soft tissues. Risk factors that predispose to HO include male sex, spinal cord injury, trauma, surgery, and genetic factors. Treatment of HO is typically surgical resection and NSAIDs. Initial evidence supported the use of bisphosphonates for preventing ectopic bone formation post-trauma, but recent data failed to show significant benefit in HO prevention. This case presents a patient with unique challenges of both HO and bone fragility with multiple severe vertebral fractures. Case: A 44-year-old male patient had a major motor vehicle accident necessitating multiple recurrent abdominal surgeries. During one exploratory laparotomy, diffuse mesenteric calcifications were noted, indicative of HO. A baseline Dual X-ray Absorptiometry (DXA) scan revealed bone density of 1.003 g/cm2 and 0.788 g/cm2 at the spine and femoral neck, respectively, concerning for osteopenia. He was started on zoledronic acid in preparation for upcoming intestinal transplant. Few months after the transplant, he was started on daily tacrolimus and hydrocortisone for immunosuppression. Within months, he experienced sudden back pain while riding an elevator, and was found to have acute fractures in T8 and T9 vertebrae. A repeat DXA scan showed a further decline in bone density to 0.909 g/cm2 and 0.748 g/cm2 at the spine and femoral neck, respectively. Within a year, additional fractures occurred in the thoracic and lumbar spine (T10, T11, T12, L1, L2, L3, and L4), requiring multiple kyphoplasty interventions. Over time, worsening kyphosis, back pain, and height loss occurred, significantly affecting the patient's quality of life. He continued receiving yearly zoledronic acid infusions and underwent regular DXA scans, which revealed mild improvement in his bone density. Currently, there are no established guidelines specifying the optimal duration for bisphosphonate treatment in such cases. Therefore, our individualized treatment plan involves a tentative 10-year course of bisphosphonate treatment with yearly assessment of bone mineral density. Conclusion: Although the patient had some risk factors for osteoporosis, including daily steroid and tacrolimus use, the severity and frequency of his fractures suggested a potential synergy between osteoporosis and HO, where the formation of heterotopic calcifications may have been exacerbating his bone loss. The coexistence of osteoporosis and HO in this patient underscores the need for individualized care and establishment of treatment guidelines in patients with multiple bone disorders.
Presentation: 6/3/2024
6970 Severe Symptomatic Hypophosphatemia After Intravenous Iron Therapy: An Under-recognized Adverse Reaction
Authors: Morvant A , Olajide O 
Published: October 2024

Abstract
Disclosure: A. Morvant: None. O. Olajide: None.
Introduction: Iron deficiency is a common condition that is often treated with intravenous preparations of iron supplementation. It has been documented in the literature that ferric carboxymaltose is the form of intravenous iron supplementation that is associated with the highest incidence of hypophosphatemia, when compared to other formulations of intravenous iron therapy. This case highlights a severe case of hypophosphatemia after ferric carboxymaltose therapy that led to multiple hospitalizations and required several months of oral and intravenous phosphorus repletion. Clinical Case A 36-year-old woman presented to the ED with severe diffuse arthralgias, generalized muscle weakness, and fatigue. Laboratory analysis revealed the following: phosphorus 1.2 mg/dL (2.3-4.7 mg/dL), 25-hydroxyvitamin D 13 ng/mL (25-80 ng/mL), parathyroid hormone 220 pg/mL (16-77 pg/mL), and calcium 8.5 mg/dL (8.4-10.5 mg/dL). She was admitted and started on intravenous and oral phosphorus repletion as well as oral ergocalciferol. She was subsequently discharged home on oral phosphorus and ergocalciferol supplementation, with a phosphorus level of 1.8 mg/dL. She was readmitted one day later with persistent arthralgias, myalgias, and severe fatigue, and found to have a phosphorus level of 1.1 mg/dL. Additional laboratory studies revealed the following: FGF23 41 pg/mL (&lt;59 pg/mL) and 24-hour urine phosphorus 2191 mg/24hr (400-1300 mg/24hr). The patient notably had a history of chronic severe iron deficiency anemia due to menorrhagia and had been treated with intravenous iron sucrose infusions 7 months prior to her presentation. Due to adverse reactions to iron sucrose, this was switched to ferric carboxymaltose, and she had received two doses; one month and two weeks prior to her initial presentation. She was treated again with intravenous and oral phosphorus repletion and ergocalciferol and discharged after two weeks on oral phosphorus and ergocalciferol as well as thrice-weekly intravenous phosphorus infusions in the outpatient setting. She continued intravenous phosphorus infusions for about three months, and this was subsequently discontinued without recurrent hypophosphatemia. She is currently on low doses of oral phosphorus with normophosphatemia. Conclusion: Intravenous ferric carboxymaltose therapy can lead to severe and long-lasting, treatment-resistant hypophosphatemia due to increased urinary phosphate excretion. An increased awareness about this is needed by clinicians in treating patients who receive ferric carboxymaltose and monitoring phosphorous levels is crucial. References: (1) Schaefer, Benedikt et al. “Hypophosphatemia after intravenous iron therapy: Comprehensive review of clinical findings and recommendations for management.” Bone vol. 154 (2022): 116202. doi:10.1016/j.bone.2021.116202
Presentation: 6/1/2024
6721 Short-Term Responses of Serum 25-Hydroxyvitamin D to Weekly Calcifediol or Cholecalciferol in Healthy Subjects
Authors: Caldeira R B , Nunes A S , Cazzetta F Z , Medeiros M S , Oliveira L B , Bandeira M P , Bandeira F F 
Published: October 2024

Abstract
Disclosure: R.B. Caldeira: None. A.S. Nunes: None. F.Z. Cazzetta: None. M.S. Medeiros: None. L.B. Oliveira: None. M.P. Bandeira: None. F.F. Bandeira: None.
Introduction: Recent studies have shown that oral calcifediol (CAL) induces faster serum 25-hydroxyvitamin D (25OHD) increases than cholecalciferol (CHO) as demonstrated in some studies on SARS-Cov2 infection. It is hypothesized that this rapid elevation is due to the unique mode of intestinal absorption of CAL to the portal vein system in comparison with CHO which is absorbed mainly by the lymphatic route. Data on weekly administration of calcifediol are still scarce. The aim of the present study was to compare serum 25OHD responses in the short term (30 days) to weekly doses of CAL or CHO in healthy subjects. Methods and Results: We studied 35 subjects (34% men, mean age 24.6 ± 4.6 years, BMI 22.9 ± 2.9 kg/m², waist circumference 74.7 ± 6.5 cm, SBP 111.1 ± 12.7 mmHg, and DBP 73.1 ± 9.1 mmHg) who were randomized to receive weekly oral CAL 70 mcg (18 subjects) or CHO 350 mcg (14,000 IU, 17 subjects). Doses were chosen based on the 2000 IU/day potency equivalence. Patients were matched for age, gender, BMI, and BP. They were contacted weekly to confirm medication adherence. Serum 25OHD concentrations were measured before administration of both agents and 24 hours after the last dose, using an immunochemiluminescent assay (Abbott Diagnostics, Lake Forest, IL, USA) with a detection range from 4.9 to 151.3 ng/ml. At baseline serum 25OHD was 32.1 ±8.8 vs 33.1 ± 6.6 in CAL and CHO groups respectively (p=0.691). In CAL group 8 subjects had serum 25 OHD &lt; 30 ng/mL (1 subject had 14.7 ng/mL) and in the CHO none had serum 25OHD below 20 ng/mL and 5 subjects had levels between 20 and 30 ng/mL. After 1 month, serum 25OHD levels rose significantly 3.3 times more with CAL than with CHO (+29.61 ± 7.39 ng/mL vs. 9.00 ± 3.50 ng/mL; p &lt; 0.001). In CHO group one subject remained with 25OHD below 30 ng/mL after the intervention. Conclusion: We found a rapid and robust elevation of serum 25OHD levels with CAL compared to CHO at similar potency doses. This may have clinical implications for conditions in which there is a need for immediate availability of 25OHD to peripheral tissues.
Presentation: 6/2/2024
12555 Stress Fractures In A Military Population Across Different Career Stages
Authors: Joseph Spiro Andrew , Shakir Mohamed K M , Duc Hoang Thanh 
Published: October 2024

Abstract
Disclosure: A.J. Spiro: None. M.K. Shakir: None. T.D. Hoang: None.
Stress fractures are overuse injuries that occur in people with normal bones in the absence of an acute injury. They tend to occur in individuals who are beginning new or more intense physical activity and affect military personnel at higher rates than the general population. These injuries negatively impact force readiness and may lead to serious injury or discharge from military service. Much of the existing literature has focused on basic training recruits, as this population is known to be susceptible to stress fractures. Few studies have examined military populations with many years of service to evaluate how fracture trends may change after the initial basic-training period. We aimed to characterize stress fracture patterns in military personnel over the full spectrum of career stages, from new recruit through late career, and identify whether stress fracture locations varied by career length. We performed a retrospective chart of review covering a 3-year period (from Jan 1, 2017 to Dec 31, 2019) of military patients in the National Capital Region who were diagnosed with a new stress fracture. Career length was defined at the time of diagnosis as: new recruit (&lt;12 months’ time-in-service), early-career (1 to &lt;5 years’ time-in-service), mid-career (5 to &lt;14 years’ time-in-service), and late-career (≥14 years’ time-in-service). Stress fracture locations were defined as: tibia, fibula, foot, femoral neck, femoral shaft, and pelvis. Frequencies of fracture types and presence of multiple fractures were described and compared by career length group using Chi-square tests. Femoral neck (11.1% vs 3.6%), femoral shaft (8.1% vs 1.8%), and pelvis fractures (3.8% vs 0.7%) were more frequent in new recruits vs other career length groups (p≤0.03 for each). Foot fractures were less frequent (19.2% vs 34.3%) in new recruits vs other career length groups (p&lt;0.001). The presence of multiple fractures (23.7% vs 10.1%) was more frequent in new recruits vs others (p=0.01). Frequencies of each fracture type and of presence of multiple fractures were qualitatively similar among early-career, mid-career, and late-career groups. In our military population, new recruits had higher frequency of femoral neck, femoral shaft, and pelvic fractures, but lower frequency of foot fractures when compared to other patient groups. New recruits also had multiple fractures more often than other patients groups at the time of presentation.
Presentation: 6/1/2024
12366 The Association Between Obstructive Sleep Apnea And Bone Health: A Systematic Review And Meta-analysis
Authors: Boon Teo Chong , Hoe Chan Yong , Tay Joshua K , SJ Cheong Crystal 
Published: October 2024

Abstract
Disclosure: C. Teo: None. Y. Chan: None. J. Tay: None. C. Cheong: None.
Importance: Obstructive sleep apnea (OSA) is a globally prevalent yet underdiagnosed sleep disorder with well-known metabolic consequences. However, the relationship between OSA and bone health, especially osteoporosis, remains poorly understood. Given that both OSA and osteoporosis are highly prevalent chronic conditions with significant public health indications, elucidating the relationship between these conditions is important. Objective: To investigate the association of OSA with bone health, specifically if individuals with OSA had a higher risk of developing osteoporosis, and discuss its clinical implications. Data Sources: A systematic search of MEDLINE (via PubMed), Embase and Cochrane Library from inception to 22 November 2023. Keywords related to obstructive sleep apnea, osteoporosis and bone density were included. Study Selection: Studies that reported on the association between OSA and osteoporosis in adults aged 18 years and above were included. Outcomes of interest included any markers of osteoporosis or bone mineral density. Data Extraction and Synthesis: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and data extracted independently by two observers. Meta-analysis across studies was pooled using a random-effects model. Main Outcome(s) and Measure(s): Correlation of OSA with bone mineral density, as well as the mean difference in bone density scores and the risk of developing osteoporosis among between individuals with OSA and without OSA. Results: We identified 15 studies comprising 158,273 individuals. All studies had low or moderate risk of bias. The presence of OSA was negatively correlated with bone mineral density on meta-analysis (pooled correlation = -0.30; 95% CI -0.42 – -0.17; N = 8). Individuals with OSA also had poorer bone mineral density scores (mean difference = -0.58, 95% CI, -1.15 – 0.01; N = 8), and had significantly higher risk of developing osteoporosis (adjusted odds ratio = 2.18; 95% CI, 1.14–4.136; N = 4). Notably, both body mass index (BMI) and age were not significant effect modulators in the correlation of OSA and bone density. Conclusions and Relevance: OSA is associated with diminished bone health and a significant risk in developing osteoporosis. Further studies are required to determine if treatment of OSA may have the potential to mitigate these risks.
Presentation: 6/3/2024
8250 The Impact of Inflammatory bowel disease on Outcomes for Osteoporotic fractures (OF) hospitalization Using the National Inpatient Sample Database
Authors: Khan Shahryar , Zia Laila , Alam Khan Mashal , Kashif Amin Muhammad , Atif Khan Muhammad , Sattar Farhan 
Published: October 2024

Abstract
Disclosure: S. Khan: None. L. Zia: None. M. Khan: None. M. Amin: None. M. Khan: None. F. Sattar: None.
Background: Osteoporosis has a significant implication on healthcare system with increasing hospitalizations for fractures, disabilities, and causing individual financial burden. Patients with Inflammatory bowel disease (IBD) are at higher risk of developing osteopenia and osteoporosis than the general population. We aimed to investigate the effects of sociodemographic of patients and outcomes for OF admissions with or without IBD. Methods: Data were obtained from the National Inpatient Sample, 2020, provided by the Healthcare Cost and Utilization project. This data represents 20% of admissions in the USA, weighted to represent the entire country. Our primary outcome was inpatient mortality, while the secondary outcomes were hospital length of stay (LOS), and total hospitalization charges (THC). We conducted the analysis using STATA software version 18.0, multivariate regression analysis was used to adjust for potential confounders. Results: Among 32 million hospitalizations, we found 60,890 admissions with a principal diagnosis of OF, 730 (1.2%) had concomitant IBD. Our study indicated that patients admitted with IBD were younger (72.63 Vs 78.35 P ≤ 0.05), more likely to be white (91.7% Vs 85.6%) and had higher Chronic steroid use (8.8% Vs 4.3, P = 0.02). The number of patients died during hospitalization for OF were 1455, 2.3% in non-IBD and 4% with IBD. There was no significant difference in inpatient mortality of patients admitted for OF with or without IBD, Crude Odds ratio of Mortality 1.75 (95% CI 0.77-3.98) and adjusted odds ratio of Mortality 2.03 (95% CI 0.86-4.82). Multivariable analysis revealed that Age (OR= 1.02; 95% CI 1.009-1.03), female (OR= 0.58; 95% CI 0.45-0.75), Charlson Comorbidity Index (OR= 1.22; 95% CI 1.18-1.1.27) were predictors of Mortality. Among secondary outcomes, there was no significant difference in LOS (Adjusted Mean difference 0.69, P= 0.27), THC (Adjusted Mean difference 5331, P=0.430). Mean LOS in hospital for OF was 6.16 days and Mean THC was 77652 USD. Conclusion: National admissions data indicates that hospitalizations for Osteoporotic fractures with or without IBD showed no significant difference in inpatient mortality, Length of stay in the hospital and total hospitalization charges. Despite lack of statistical difference, clinical relevance is important given greater mortality in OF with IBD. As physicians, it is important to screen the appropriate population for osteoporosis which can help with earlier diagnosis, guiding for preventive and treatment strategies.
Presentation: 6/3/2024
7090 The Largest Study on Asymptomatic Primary Hyperparathyroidism (APHPT) Conducted at the Tertiary Care Riga East Clinical University Hospital (RECUH)— Three Years of Data
Authors: Stūrīte Diāna , Rasa Ingvars 
Published: October 2024

Abstract
Disclosure: D. Stūrīte: None. I. Rasa: None.
Background: Primary hyperparathyroidism (PHPT) is the third most common endocrine disorder and a leading cause of hypercalcemia in the outpatient setting. The study aimed to assess the characteristics, management and outcomes of pts with APHPT. Methods: A retrospective analysis of data from 168 pts with APHPT, evaluated at RECUH from January 2021 to November 2023 was conducted. Information obtained included medical records, laboratory data, imaging results, surgical protocols, histopathology data. Statistical analysis was performed using IBM SPSS 29.0. Results: From the 168 pts (mean age: 63.7±11.8 years), 86.3% (n=145) were females. Predominantly, 67.3% (n=113) exhibited mild hypercalcemia (2.6-3.0mmol/L), while 22.6% (n=38) had moderate hypercalcemia (3.0-3.49mmol/L), and 4.8% (n=8) -severe hypercalcemia (≥3.5mmol/L). 5.3% (n=9) had normocalcaemic PHPT. The mean preoperative maximal calcium level was 2.9±0.3mmol/L, iPTH level - 247.6±224.9pg/mL, minimal phosphorus - 1.3±6.7mmol/L and 25-OH vitamin D level - 28.3±14.7ng/mL. The mean preoperative eGFR was 90.6±28.2 ml/min/1.73m2, creatinine - 72.5±23.9μmol/L. Parathyroid adenoma sizes ranged from 0.3x0.4cm to 5.3x3.7cm. Calcium levels positively correlated with adenoma cross-sectional area (ρ=0.187, p=0.029) and maximal adenoma dimension (ρ=0.215, p=0.011). Ultrasonography convincingly detected parathyroid adenomas in 63.9% (107/168), SPECT/CT - 68.4% (52/76), 99mTc-sestamibi scintigraphy - 65.6% (61/93), 3D-CT - 70.6% (24/34), contrast-enhanced ultrasonography - 84% (21/25) and MRI in - 40% (2/5) cases. 12.5% (n=21) pts had unlocated parathyroid adenoma. 34.5% (n=58) of pts had osteoporosis, 47.6% (n=80) osteopenia, 12.5% (n=21) had a history of osteoporotic fracture, 17.3% (n=29) had gallstones and 22.0% (n=37) - kidney stones. 80.4% (n=135) of pts had thyroid nodules, 48.2% (n=81) - nontoxic goitre, 24.4% (n=31) - autoimmune thyroiditis, 41.7% (n=70) - hypertension, 10.5% (n=18) - type 2 diabetes. 18.5% (n=31) pts were found to have a diagnosis of malignancy. 61.9% (n=104) of pts underwent parathyroidectomy. Histopathology and radiologic imaging revealed single parathyroid adenoma in 95.2% (n=99), double parathyroid adenomas in 1.9% (n=2), parathyroid hyperplasia in 2.9% (n=3) and parathyroid carcinoma in 1.9% (n=2) pts. The mean maximal postoperative calcium level (n=103) was 2.4±0.1mmol/L, iPTH (n=101) - 63.5±27.7pg/mL, 25-OH vitamin D - 41.5±13.3ng/mL, and the mean minimal phosphorus (n=56) - 1.1±0.2mmol/L. Conclusions: APHPT remains frequently encountered and often showcases bone manifestations. It's crucial to consider the diverse clinical manifestations and associated conditions in patients with APHPT.
Presentation: 6/2/2024
8251 The Silent Thief: Neurofibromatosis Type 1 (NF1) Leading to Severe Osteoporosis and Recurrent Bone Fractures
Authors: Hernan Sacoto Daniel , Madani Kulsum , Patel Dhara , De Rosairo Anne , Kiratt Rai Gur , Franco-Akel Alberto A , Belokovskaya Regina 
Published: October 2024

Abstract
Disclosure: D.H. Sacoto: None. K. Madani: None. D. Patel: None. A. De Rosairo: None. G. Rai: None. A.A. Franco-Akel: None. R. Belokovskaya: None.
Introduction: NF1 is an autosomal dominant disorder known to cause a remarkable reduction in bone mineral density (BMD) with almost a fivefold increase in fracture risk. Since fractures are associated with a high disability burden, early identification, prompt treatment, and consideration of prophylactic measures are important. We present a case of NF1 complicated with osteoporosis and recurrent bone fractures. Case presentation: An 85-year-old female with a history of NF1 complicated with a malignant left ankle Peripheral Nerve Sheet Tumor came in after a mechanical fall. Vital signs were stable. Examination demonstrated short stature, widespread cutaneous neurofibromas, and café au lait macules. Complain of generalized bone pain, in addition, to diffuse osseous demineralization on imaging and mild alkaline phosphatase elevation (141 U/L), led to further investigation, which revealed osteomalacia due to severe vitamin D deficiency (9.8 ng/mL) in the setting of malnutrition (albumin:3.4 mg/dL). Otherwise, normal renal function, phosphorus (3.7mg/dL) and calcium corrected for albumin (8.9 mg/dL). Previous records identified a right humerus close proximal fracture three years ago. At that time, a DEXA scan demonstrated severe osteoporosis with a lumbar T-score of -4.8 and dual femur of -3.7. She was started on Vitamin D supplementation, with questionable compliance. Bisphosphonates and denosumab were not prescribed due to the lack of guidelines on NF1 population. During the last two years, she experienced three more fractures, including a left femoral greater trochanteric, right 8th rib, and non-displaced pubic ramus fractures. One month ago, unfortunately, it expired due to septic shock. Discussion: Osteoporosis is found in 20–50% of NF1 patients, and it is associated with reduced serum 25-hydroxyvitamin D primarily due to a reduced expression of Vitamin D Receptor on neurofibromas in addition to reduced sun exposure and poor physical activity. At the molecular level, the loss of neurofibromin function causes a pathological increase in intracellular Ras activity, leading to an induction of osteoclastic activity and inhibition of osteoblastic differentiation. Currently, NF1 patients are resistant to bisphosphonate-induced apoptotic signals, and there are no guidelines for the use of denosumab in NF1 with osteoporosis. However, a recent clinical trial involving 141 NF1 adults identified that weight-bearing exercise, optimizing calcium and 25-hydroxyvitamin D intake and increased sun exposure can minimize BMD loss. However, guidelines for the management of bone abnormalities in NF1, including earlier screening and prophylactic therapy with vitamin D, are needed.
Presentation: 6/3/2024