Zoledronic acid is a third-generation amino-containing BF that has been used to treat patients with osteoporosis for more than 15 years. Over the years, numerous experimental and clinical studies have proven the high efficacy of the drug in osteoporosis, both in women of various age groups, and in men, with primary and secondary osteoporosis, in patients with varying degrees of bone loss and risk of fractures. Intravenous infusions of zoledronic acid have been shown to result in a rapid gain of bone mass, a significant reduction in the risk of low-energy fractures of the vertebrae (spine), proximal femoral and nonvertebral fractures on the whole. However, in recent years, the use of the drug has significantly decreased, which is associated both with the lack of awareness of primary care physicians about the possibilities of this drug, and the fear of such complications of its use as atypical fractures and osteonecrosis of the jaw bones. The presented review aims to increase the knowledge of physicians regarding the mechanism of action of zoledronic acid, the regimens for prescribing the drug in various forms of osteoporosis and fractures against its background. The given clinical example shows the ability of zoledronic acid (osteostatics) to increase the mass of not only cancellous, but also the cortical bone of the proximal femur, which increases the role of zoledronic acid in the prevention of recurrent fractures. On top of that, the prolonged effect of the drug allows, when the desired therapeutic effect is achieved, to reduce the frequency of prescribing according to the ‘drug holiday’ principal, decreasing economic expenditures and medical and social burden.
Phosphaturic mesenchymal tumor inducing development of phosphopenic osteomalacia is manifested as deformations and multiple fractures of the bones which decreases patients’ quality of life and leads to disability. Insufficient awareness about this pathology among doctors and absence of symptoms allowing its diagnosis cause late diagnosis of the disease despite application of up-to-date high-tech diagnostic methods. The optimal treatment of phosphaturic mesenchymal tumors is radical resection. However, strong connection of the tumor with the surrounding tissues and, in many cases, absence of a capsule or sclerosis (if located in the bones) complicate surgery leading to high recurrence rate. Radical resection of phosphaturic mesenchymal tumors is especially complicated in cases of localization in complex anatomical areas of the lower limbs.The disease is characterized by long timespan between first clinical signs, diagnosis, and start of treatment (sometimes, several years). Diagnosis confirmation and visualization of the details of phosphaturic mesenchymal tumor requires magnetic resonance imaging. This method allows to examine connection between the tumor and surrounding tissues and the presence of a capsule. Magnetic resonance imaging also allows to accurately determine the area of surgical intervention. Radical tumor resection leads to normalization of blood and urine biochemistry in the span of several weeks. Restoration of bone density and muscle function requires 3–6 months after the operation.
In the treatment of bone tissue pathology associated with a violation of its metabolism, drugs belonging to the class of bisphosphonates have been increasingly used in the last decade. Bisphosphonates are synthetic analogs of pyrophosphoric acid containing, instead of the chemical bond [P-O-P], which undergoes rapid decay in the body, a non-hydrolyzable bond [P-C-P]. This prevents the drugs from breaking down when taken per os, but since they are chelators, it is recommended to take them on an empty stomach to prevent binding to divalent ions.
Long-term outcomes of reconstructive operations for substitution of post-resection defects of the articular ends of tubular bones that form the hip, knee and shoulder joints using home endoprosthesis were studied. The study included 344 patients who were treated at CITO department of bone pathology from 2004 to 2014. Substitution of the defect was performed in 236 and 108 cases for the knee, hip joints, respectively. Indications for surgical intervention were: bone tumors; previously performed arthroplasty failure; defects of the articular ends after failed traumatologic and orthopaedic operations; severe forms of knee arthroses. Functional results (MSTS scale), survival of constructions, inflammatory complications were analyzed and comparative evaluation with imported analogues was performed. General functional outcomes and rate of complications correspond to the data on application of new oncologic and modular endoprostheses presented in foreign literature.
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