Top

BMC Musculoskeletal Disorders

Published in:

Open Access 01-12-2018 | Research article

Identification of vitamin D and other bone metabolism parameters as risk factors for primary bone marrow oedema syndrome

Authors: Nicola Oehler, Haider Mussawy, Tobias Schmidt, Tim Rolvien, Florian Barvencik

Published in: BMC Musculoskeletal Disorders | Issue 1/2018

Abstract

Background

The aetiology and pathogenesis of primary bone marrow oedema syndrome (BMES) remain unclear. This retrospective cross-sectional study in a large cohort of patients with BMES was performed to characterise the overall skeletal status and turnover in patients with BMES, with the aim of identifying risk factors for this disease.

Methods

Patients who were diagnosed with BMES on the basis of clinical and radiological (magnetic resonance imaging) findings in our outpatient clinic were identified retrospectively. Patient history, co-existing metabolic disorders, bone metabolism parameters (serum calcium, phosphate, 25-OH-D₃, bone-specific alkaline phosphatase, parathyroid hormone, and osteocalcin, and urinary deoxypyridinoline) and bone mineral density (as measured by dual-energy X-ray absorptiometry) were extracted from the medical records. Patients with secondary causes for BMES were excluded from the study.

Results

Of the 171 patients, 65 were identified without secondary cause for BMES. Of the 65 patients, 61.5% were female. The mean age was 49.5 ± 16.7 years, and age-related BMES prevalence showed two peaks, one in adolescence (11–20 years) and one at an older age (51–70 years). BMES predominantly affected the weight-bearing joints, namely, the ankle/foot (55.1%), knee (22.4%) and proximal femur (16.3%). Thyroid disorders and secondary hyperparathyroidism were highly prevalent (21.5 and 21.4%, respectively). On average, the cohort had elevated deoxypyridinoline levels and low 25-OH-D₃ levels (19.0 ± 7.5 μg/l in patients without vitamin D supplementation). Osteopenia and osteoporosis were diagnosed in 47.4 and 17.5% of patients, respectively.

Conclusions

BMES is associated with high bone turnover. Patients who are diagnosed with BMES should be screened carefully for bone metabolism disorders and their potential risk factors.

Available only for authorised users

Bonadio MB, Filho AGO, Helito CP, Stump XM, Demange MK. Bone marrow lesion: image, clinical presentation, and treatment. Magn Reson Insights. 2017;10:1178623X17703382. https://doi.org/10.1177/1178623X17703382 PubMed PMID: 28579795; PubMed Central PMCID: PMCPMC5428162.CrossRefPubMedPubMedCentral

Starr AM, Wessely MA, Albastaki U, Pierre-Jerome C, Kettner NW. Bone marrow edema: pathophysiology, differential diagnosis, and imaging. Acta Radiol. 2008;49(7):771–86. https://doi.org/10.1080/02841850802161023 PubMed PMID: 18608031.CrossRefPubMed

Patel S. Primary bone marrow oedema syndromes. Rheumatology (Oxford). 2014;53(5):785–92. https://doi.org/10.1093/rheumatology/ket324 PubMed PMID: 24080251.CrossRef

Trevisan C, Klumpp R, Compagnoni R. Risk factors in transient osteoporosis: a retrospective study on 23 cases. Clin Rheumatol. 2016;35(10):2517–22. https://doi.org/10.1007/s10067-016-3228-7 PubMed PMID: 26979746.CrossRefPubMed

Korompilias AV, Karantanas AH, Lykissas MG, Beris AE. Bone marrow edema syndrome. Skelet Radiol. 2009;38(5):425–36. https://doi.org/10.1007/s00256-008-0529-1 PubMed PMID: 18629460.CrossRef

Singh D, Ferrero A, Rose B, Goldberg A, Cullen N. Bone marrow edema syndrome of the foot and ankle: mid- to long-term follow-up in 18 patients. Foot Ankle Spec. 2016;9(3):218–26. https://doi.org/10.1177/1938640015609986 PubMed PMID: 26459365.CrossRefPubMed

Horas K, Fraissler L, Maier G, Jakob F, Seefried L, Konrads C, et al. High prevalence of vitamin D deficiency in patients with bone marrow edema syndrome of the foot and ankle. Foot Ankle Int. 2017;38(7):760–6. https://doi.org/10.1177/1071100717697427 PubMed PMID: 28340550.CrossRefPubMed

Sprinchorn AE, O'Sullivan R, Beischer AD. Transient bone marrow edema of the foot and ankle and its association with reduced systemic bone mineral density. Foot Ankle Int. 2011;32(5):S508–12. https://doi.org/10.3113/FAI.2011.0508 PubMed PMID: 21733459.CrossRefPubMed

Berger CE, Kroner AH, Minai-Pour MB, Ogris E, Engel A. Biochemical markers of bone metabolism in bone marrow edema syndrome of the hip. Bone. 2003;33(3):346–51 PubMed PMID: 13678776.CrossRefPubMed

10.

Thiryayi WA, Thiryayi SA, Freemont AJ. Histopathological perspective on bone marrow oedema, reactive bone change and haemorrhage. Eur J Radiol. 2008;67(1):62–7. https://doi.org/10.1016/j.ejrad.2008.01.056 PubMed PMID: 18337044.CrossRefPubMed

11.

Stoker GE, Buchowski JM, Bridwell KH, Lenke LG, Riew KD, Zebala LP. Preoperative vitamin D status of adults undergoing surgical spinal fusion. Spine (Phila Pa 1976). 2013;38(6):507–15. https://doi.org/10.1097/BRS.0b013e3182739ad1 PubMed PMID: 22986835.CrossRef

12.

Milovanovic P, Adamu U, Simon MJ, Rolvien T, Djuric M, Amling M, et al. Age- and sex-specific bone structure patterns portend bone fragility in radii and tibiae in relation to Osteodensitometry: a high-resolution peripheral quantitative computed tomography study in 385 individuals. J Gerontol A Biol Sci Med Sci. 2015;70(10):1269–75. https://doi.org/10.1093/gerona/glv052 PubMed PMID: 25934995.CrossRefPubMed

13.

Burt LA, Liang Z, Sajobi TT, Hanley DA, Boyd SK. Sex- and site-specific normative data curves for HR-pQCT. J Bone Miner Res. 2016;31(11):2041–7. https://doi.org/10.1002/jbmr.2873 PubMed PMID: 27192388.CrossRefPubMed

14.

Priemel M, von Domarus C, Klatte TO, Kessler S, Schlie J, Meier S, et al. Bone mineralization defects and vitamin D deficiency: histomorphometric analysis of iliac crest bone biopsies and circulating 25-hydroxyvitamin D in 675 patients. J Bone Miner Res. 2010;25(2):305–12. https://doi.org/10.1359/jbmr.090728 PubMed PMID: 19594303.CrossRefPubMed

15.

Klontzas ME, Vassalou EE, Zibis AH, Bintoudi AS, Karantanas AH. MR imaging of transient osteoporosis of the hip: an update on 155 hip joints. Eur J Radiol. 2015;84(3):431–6. https://doi.org/10.1016/j.ejrad.2014.11.022 PubMed PMID: 25533717.CrossRefPubMed

16.

Karantanas AH, Drakonaki E, Karachalios T, Korompilias AV, Malizos K. Acute non-traumatic marrow edema syndrome in the knee: MRI findings at presentation, correlation with spinal DEXA and outcome. Eur J Radiol. 2008;67(1):22–33. https://doi.org/10.1016/j.ejrad.2008.01.053 PubMed PMID: 18342472.CrossRefPubMed

17.

Cahir JG, Toms AP. Regional migratory osteoporosis. Eur J Radiol. 2008;67(1):2–10. https://doi.org/10.1016/j.ejrad.2008.01.051 PubMed PMID: 18355999.CrossRefPubMed

18.

Mirghasemi SA, Trepman E, Sadeghi MS, Rahimi N, Rashidinia S. Bone marrow edema syndrome in the foot and ankle. Foot Ankle Int. 2016;37(12):1364–73. https://doi.org/10.1177/1071100716664783 PubMed PMID: 27587374.CrossRefPubMed

19.

Asadipooya K, Graves L, Greene LW. Transient osteoporosis of the hip: review of the literature. Osteoporos Int. 2017;28(6):1805–16. https://doi.org/10.1007/s00198-017-3952-0 PubMed PMID: 28314897.CrossRefPubMed

20.

Farr JN, Khosla S. Skeletal changes through the lifespan--from growth to senescence. Nat Rev Endocrinol. 2015;11(9):513–21. https://doi.org/10.1038/nrendo.2015.89. PubMed PMID: 26032105; PubMed Central PMCID: PMCPMC4822419.CrossRefPubMedPubMedCentral

21.

Bachrach LK. Acquisition of optimal bone mass in childhood and adolescence. Trends Endocrinol Metab. 2001;12(1):22–8 PubMed PMID: 11137037.CrossRefPubMed

22.

Mitra R. Adverse effects of corticosteroids on bone metabolism: a review. PM R. 2011;3(5):466–71. https://doi.org/10.1016/j.pmrj.2011.02.017 quiz 71. PubMed PMID: 21570035.CrossRefPubMed

23.

Khattak RM, Ittermann T, Nauck M, Below H, Volzke H. Monitoring the prevalence of thyroid disorders in the adult population of Northeast Germany. Popul Health Metr. 2016;14:39. https://doi.org/10.1186/s12963-016-0111-3 PubMed PMID: 27833458; PubMed Central PMCID: PMCPMC5101821.CrossRefPubMedPubMedCentral

24.

Garmendia Madariaga A, Santos Palacios S, Guillen-Grima F, Galofre JC. The incidence and prevalence of thyroid dysfunction in Europe: a meta-analysis. J Clin Endocrinol Metab. 2014;99(3):923–31. https://doi.org/10.1210/jc.2013-2409 PubMed PMID: 24423323.CrossRefPubMed

25.

Eastman CJ. Screening for thyroid disease and iodine deficiency. Pathology. 2012;44(2):153–9. https://doi.org/10.1097/PAT.0b013e32834e8e83 PubMed PMID: 22297907.CrossRefPubMed

26.

Wojcicka A, Bassett JH, Williams GR. Mechanisms of action of thyroid hormones in the skeleton. Biochim Biophys Acta. 2013;1830(7):3979–86. https://doi.org/10.1016/j.bbagen.2012.05.005 PubMed PMID: 22634735.CrossRefPubMed

27.

Saleh F, Jorde R, Sundsfjord J, Haug E, Figenschau Y. Causes of secondary hyperparathyroidism in a healthy population: the Tromso study. J Bone Miner Metab. 2006;24(1):58–64. https://doi.org/10.1007/s00774-005-0647-y PubMed PMID: 16369900.CrossRefPubMed

28.

Karlsson SL, Indridason OS, Franzson L, Sigurdsson G. Prevalence of secondary hyperparathyroidism (SHPT) and causal factors in adult population in Reykjavik area. Laeknabladid. 2005;91(2):161–9 PubMed PMID: 16155312.PubMed

29.

Ito T, Jensen RT. Association of long-term proton pump inhibitor therapy with bone fractures and effects on absorption of calcium, vitamin B12, iron, and magnesium. Curr Gastroenterol Rep. 2010;12(6):448–57. https://doi.org/10.1007/s11894-010-0141-0 PubMed PMID: 20882439; PubMed Central PMCID: PMCPMC2974811.CrossRefPubMedPubMedCentral

30.

Stein EM, Silva BC, Boutroy S, Zhou B, Wang J, Udesky J, et al. Primary hyperparathyroidism is associated with abnormal cortical and trabecular microstructure and reduced bone stiffness in postmenopausal women. J Bone Miner Res. 2013;28(5):1029–40. https://doi.org/10.1002/jbmr.1841 PubMed PMID: 23225022; PubMed Central PMCID: PMCPMC3631282.CrossRefPubMed

31.

Simon MJ, Barvencik F, Luttke M, Amling M, Mueller-Wohlfahrt HW, Ueblacker P. Intravenous bisphosphonates and vitamin D in the treatment of bone marrow oedema in professional athletes. Injury. 2014;45(6):981–7. https://doi.org/10.1016/j.injury.2014.01.023 PubMed PMID: 24552768.CrossRefPubMed

32.

Rolvien T, Schmidt T, Butscheidt S, Amling M, Barvencik F. Denosumab is effective in the treatment of bone marrow oedema syndrome. Injury. 2017;48(4):874–9. https://doi.org/10.1016/j.injury.2017.02.020 PubMed PMID: 28242067.CrossRefPubMed

33.

Flores-Robles BJ, Sanz-Sanz J, Sanabria-Sanchinel AA, Huntley-Pascual D, Andreu Sanchez JL, Campos Esteban J, et al. Zoledronic acid treatment in primary bone marrow edema syndrome. J Pain Palliat Care Pharmacother. 2017;31(1):52–6. https://doi.org/10.1080/15360288.2016.1276993 PubMed PMID: 28287351.CrossRefPubMed

34.

Rabenberg M, Scheidt-Nave C, Busch MA, Rieckmann N, Hintzpeter B, Mensink GB. Vitamin D status among adults in Germany--results from the German health interview and examination survey for adults (DEGS1). BMC Public Health. 2015;15:641. https://doi.org/10.1186/s12889-015-2016-7 PubMed PMID: 26162848; PubMed Central PMCID: PMCPMC4499202.CrossRefPubMedPubMedCentral

35.

Wade SW, Strader C, Fitzpatrick LA, Anthony MS, O'Malley CD. Estimating prevalence of osteoporosis: examples from industrialized countries. Arch Osteoporos. 2014;9:182. https://doi.org/10.1007/s11657-014-0182-3 PubMed PMID: 24847682.CrossRefPubMed

36.

Hadji P, Klein S, Gothe H, Haussler B, Kless T, Schmidt T, et al. The epidemiology of osteoporosis--bone evaluation study (BEST): an analysis of routine health insurance data. Dtsch Arztebl Int. 2013;110(4):52–7. https://doi.org/10.3238/arztebl.2013.0052 PubMed PMID: 23413388; PubMed Central PMCID: PMCPMC3570954.CrossRefPubMedPubMedCentral

37.

Verna C. Regional acceleratory phenomenon. Front Oral Biol. 2016;18:28–35. https://doi.org/10.1159/000351897 PubMed PMID: 26599115.CrossRefPubMed

Title: Identification of vitamin D and other bone metabolism parameters as risk factors for primary bone marrow oedema syndrome
Authors: Nicola Oehler
Haider Mussawy
Tobias Schmidt
Tim Rolvien
Florian Barvencik
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Musculoskeletal Disorders / Issue 1/2018
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-018-2379-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Identification of vitamin D and other bone metabolism parameters as risk factors for primary bone marrow oedema syndrome

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2018

The risk of violating the posterior malleolar fracture when nailing the ipsilateral concomitant spiral distal tibial fracture

What do we know about managing Dupuytren’s disease cost-effectively?

Identifying individuals with chronic pain after knee replacement: a population-cohort, cluster-analysis of Oxford knee scores in 128,145 patients from the English National Health Service

A randomized, controlled study to evaluate the efficacy of intra-articular, autologous adipose tissue injections for the treatment of mild-to-moderate knee osteoarthritis compared to hyaluronic acid: a study protocol

Comparison between absorbable pins and mini-screw fixations for the treatment of radial head fractures Mason type II-III

Biologic plating of unstable distal radial fractures