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양규현,민병우,하용찬 대한골대사학회 2015 대한골대사학회지 Vol.22 No.3
Bisphosphonate (BP) is a useful anti-resorptive agent which decreases the risk of osteoporotic fracture by about 50%. However, recent evidences have shown its strong correlation with the occurrence of atypical femoral fracture (AFF). The longer the patient takes BP, the higher the risk of AFF. Also, the higher the drug adherence, the higher the risk of AFF. It is necessary to ask the patients who are taking BP for more than 3 years about the prodromal symptoms such as dull thigh pain. Simple radiography, bone scan, and magnetic resonance imaging (MRI) are good tools for the diagnosis of AFF. The pre-fracture lesion depicted on the hip dual energy X-ray absorptiometry (DXA) images should not be missed. BP should be stopped immediately after AFF is diagnosed and calcium and vitamin D (1,000 to 2,000 IU) should be administered. The patient should be advised not to put full weight on the injured limb. Daily subcutaneous injection of recombinant human parathyroid hormone (PTH; 1-34) is recommended if the patient can afford it. Prophylactic femoral nailing is indicated when the dreaded black line is visible in the lateral femoral cortex, especially in the subtrochanteric area.
고령 환자 대퇴골 원위부 골절에서 가골 생성 촉진을 위한 부갑상선 호르몬의 간헐적 투여
양규현,오원택,송형근 대한골대사학회 2011 대한골대사학회지 Vol.18 No.2
Fracture healing is the ongoing process but it is often delayed in elderly patients. Because the fractures in elderly patients with osteoporosis are severely comminuted and their quality of bone is poor, the associated delay of fracture healing is likely to lead to surgical failure. Recently, as a way to promote healing fractures, intermittent systemic parathyroid hormone treatment has been actively researched. Although the effect of parathyroid hormone, which is demonstrated by animal experiments, is well known, there are not many clinical applications. The authors report 2 cases which had the time-shortened callus formation by intermittent parathyroid hormone (teriparatide) administration after surgical treatment, maximum preservation of periosteum as possible, in elderly patients who have supracondylar fracture on distal femur. [Korean Journal of Bone Metabolism, 18(2): 137-141, 2011 골절의 치유는 스스로 진행되는 과정이지만 고령의 환자에서는 골절 치유가 지연되는 경우가 많다. 골다공증이 동반된고령 환자가 골절상을 입은 경우에는 골절 분쇄상이 심하고 골질이 약하여 수술적 내고정력이 견고하지 못하기 때문에,이러한 골절 치유의 지연은 수술적 실패로 이어질 가능성이 높다. 최근에 골절 치유를 촉진시키는 방법으로 간헐적인 부갑상선 호르몬의 전신적 투여에 대한 연구가 활발히 진행되고 있다. 부갑상선 호르몬의 골절 치유 촉진 효과는 여러 동물실험을 통해 입증되어 잘 알려져 있음에도 불구하고 임상적인 투여 사례는 많지 않다. 저자들은 원위 대퇴골 과상부 골절이 있는 고령의 환자에서 골막을 최대한 보존한 수술적 치료 후, 부갑상선 호르몬 (teriparatide)을 간헐적으로 투여하여 가골 형성 시간이 단축된 2례를 경험하였기에 보고한다.
양규현,원정훈,윤한국,류종현,추교석,김재신 연세대학교의과대학 2007 Yonsei medical journal Vol.48 No.4
Purpose: Bisphosphonates have been used to treat osteoporosis for more than ten years. However, complications associated with long-term administration of bisphosphonates, such as nonunion after pelvic insufficiency fracture or osteonecrosis of the jaw, have been recently reported in the literature. We investigated the relationships among the mechanical properties of the intact rat femur as well as healing fracture calluses and the intraosseous concentration of pamidronate (ICP), after long-term administration of pamidronate in a rat osteoporosis model. Materials and Methods: We performed bilateral ovariectomy in 25 3-month-old female Sprague-Dawley rats. Beginning three months after ovariectomy, disodium pamidronate (0.5mg/kg) was injected every month. After the six-month administration period, the left femoral shaft was fractured using the closed fracture technique. Five weeks after fracture, 23 rats were euthanized and both femora were removed. We checked the mechanical properties of the intact (right) and fractured (left) femora using a three-point bending technique. Intraosseous concentration of pamidronate was checked by high-performance liquid chromatography. Results: The mean ICP was 61.8±15.7ng/mg of bone. High ICP decreased the ultimate load to failure, stiffness, and ultimate stress of the intact femora (p=0.015, 0.027, 0.039, respectively). There was a tendency to decrease the ultimate load to failure in the healing callus when the ICP increased (p= 0.183). High ICP decreased the bone mineral density of the femoral head (p=0.005). Conclusion: High concentrations of pamidronate in intact bone decreased the bone mineral density and weakened the mechanical strength of the rat femora. The mechanical strength of the early healing callus was not correlated with concentration of pamidronate in the bone.