Strontium ranelate (SR) is a novel antiosteoporotic agent, electively concentrated in positions of active bone formation, and especially onto the crystal surface that allows permanent exchanges with extracellular fluid. Although the mechanism(s) of action is still under rigorous research, SR appears to reduce bone resorption by decreasing osteoclast differentiation and activity and to stimulate bone formation by increasing replication of preosteoblast cells, leading to increased matrix synthesis. In the placebo-controlled, phase III trial spinal osteoporosis therapeutic intervention (SOTI) (no=1442; mean age 69 years), there was a 41% decrease over 3 years in the number of patients with new vertebral fractures in the SR (2 g/day) group versus placebo (P<0.001), already detected after 12 months (49% lower risk, P<0.001). The phase III treatment of peripheral osteoporosis (TROPOS) study assessed the efficacy of SR (2 g/day) in preventing nonvertebral fractures in postmenopausal osteoporosis (no=4932; mean age 77 years). SR reduced nonvertebral fracture risk by 16% versus placebo (P=0.04) and hip fracture risk by 36% (P=0.031) in osteoporotic patients older than 74 years. Thus SR is an effective and safe treatment for vertebral and hip osteoporosis with a unique mode of action.

Background Ankle sprains are common injuries that may recur as chronic conditions. We aim to describe a treatment algorithm for chronic lateral ankle instability based on the arthroscopic findings of the calcaneofibular ligament (CFL). Methods We assessed 67 highly active patients with chronic lateral ankle instability. They were recreational athletes or active military personnel. After clinical examination, they were all investigated further with MRI scans and stress views. Diagnostic arthroscopy followed, where the integrity of the CFL was assessed. Patients with an intact CFL were placed in group A while those with CFL tears in group B. Concomitant intra-articular pathologies, if present, were treated arthroscopically. CFL tears mandated that modified Broström-Gould reconstruction would follow. The American Orthopaedic Foot and Ankle Society (AOFAS) and Tegner scores were noted post-injury and during the 24-month follow-up. Results A total of 37 patients were put in group A and 30 in group B. The posterior talofibular ligament was intact in both groups. Synovitis and scar tissue were more common in group A (p = 0.01) compared to group B. Overall, no postoperative ankle instability or relapsing ankle sprain was documented. Both groups demonstrated significant improvement in their Tegner (p = 0.009) and AOFAS scores (p = 0.001) during their 24 months follow-up. Inter-rater reliability for CFL tears was moderate on clinical examination (k = 0.514) and fair on MRI, in conjunction with ankle arthroscopy (k = 0.357). Conclusion Our proposed algorithm offered a reliable pathway for accurate evaluation and successful treatment of chronic lateral ankle instability in high-demand groups.

Development of secondary or even tertiary hyperparathyroidism following phosphate administration is an established complication in patients with X-linked hypophosphatemic rickets. However, in tumor-induced osteomalacia (TIO) there are very few documented cases of hyperparathyroidism persisting even after excision of the tumor (tertiary hyperparathyroidism). The development of hyperparathyroidism in TIO is related to long-term phosphate administration, which represents the main treatment option in cases of unlocalized or nonexcisable tumors. Furthermore, low or inappropriately normal calcitriol levels either systemically or at the level of parathyroid cell are probably implicated in parathyroid tumorigenesis. We present a case of a 68year-old female patient with TIO who received long-term phosphate treatment prior to localization and excision of the tumor and afterward developed autonomous hyperparathyroidism. Learning Objectives• List the clinical and laboratory abnormalities characteristic of tumor-induced osteomalacia (TIO) as exemplified by the present patient.• Compare and contrast suggested mechanisms of hyperparathyroidism in patients with TIO. • Outline those therapeutic and follow-up strategies for patients with TIO that are most likely to prevent or minimize autonomous hyperparathyroidism.

Osteoid osteomas of the talus are rarely seen. They can easily be misdiagnosed. In this case report, we present a 21-year-old man with an osteoid osteoma in the talar neck whose pain onset coincided with an ankle injury. The latter was deemed a misleading factor when making a diagnosis. Eventually, the patient was treated with surgical excision of the osteoid osteoma. The gap that resulted after the excision was filled with an autologous bone graft. A year after his operation, the patient returned to his daily activities and remained pain-free. A high index of suspicion and an appropriate imaging examination are mandated for the early diagnosis of such entities.

The incidence of falls is increasing proportionally with age and is related with high rates of disability and frailty. Falls are considered the leading cause of death in the elderly and are often multifactorial in origin. They are also linked with older adults losing their confidence and independency. Furthermore they are associated with increased funding spent for hospital extended stays, carer time and absence from work. Taking into account that the population is ageing, thus the number of people older than 65 will increase considerably in the near future, it is easy to understand that costs are really likely to increase further. It is therefore important to address that problem and instead of focusing especially on treatment to concentrate on prevention as well.