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2018 ; 13
(1
): 47
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Bisphosphonate therapy for spinal osteoporosis in Hajdu-Cheney syndrome - new
data and literature review
#MMPMID29618366
Pittaway JFH
; Harrison C
; Rhee Y
; Holder-Espinasse M
; Fryer AE
; Cundy T
; Drake WM
; Irving MD
Orphanet J Rare Dis
2018[Apr]; 13
(1
): 47
PMID29618366
show ga
BACKGROUND: Hajdu-Cheney syndrome (HCS) (#OMIM 102500) is a rare, autosomal
dominant condition that presents in early childhood. It is caused by mutations in
the terminal exon of NOTCH2, which encodes the transmembrane NOTCH2 receptor.
This pathway is involved in the coupled processes of bone formation and
resorption. The skeletal features of HCS include acro-osteolysis of the digits
and osteoporosis commonly affecting vertebrae and long bones. Fractures are a
prominent feature and are associated with significant morbidity. There is no
specific treatment, but with both acro-osteolysis and generalized osteoporosis,
it is possible that anti-resorptive treatment might be of benefit. However, to
date only a few case reports have evaluated the effectiveness of bisphosphonate
treatment. METHODS: We describe the clinical features, treatment regimens and
response to bisphosphonate treatment in 7 newly described patients aged 6-39 with
HCS, and pooled the data with that from 8 previously published cases (a total of
17 courses of treatment in 15 individuals). RESULTS: The mean lumbar spine bone
mineral density (BMD) z-score before treatment was -?2.9 (SD 1.2). In 14 courses
of treatment (82%), there was an increase in BMD with bisphosphonate treatment,
but the impact (in terms of change in spinal BMD z-score) appeared to be less
with advancing age (p?=?0.01). There was no evidence that acro-osteolysis was
prevented. CONCLUSIONS: Although individual response is variable and age-related,
the data support a role for bisphosphonates in preventing or treating spinal
osteoporosis in HCS, but bone loss from the lumbar spine may be rapid after
cessation.