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Bone microstructure is significantly altered in CRPS-affected distal tibiae as detected by HR-pQCT: a retrospective cross-sectional study

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Abstract

In the course of complex regional pain syndrome (CRPS), local osteopenia in the subchondral/subcortical areas of the affected limb represents a central manifestation. Mechanistic aspects of CRPS-associated pathologies remain unclear, and knowledge about bone morphology in CRPS-affected areas is rare. The aim of this study was to assess trabecular and cortical bone microstructure in patients with CRPS of the distal tibiae. We retrospectively analysed 14 women diagnosed with unilateral CRPS type I of the lower limb whose affected and unaffected distal tibiae were examined by high-resolution peripheral quantitative computed tomography (HR-pQCT). Laboratory tests included serum levels of calcium, phosphate, 25-hydroxyvitamin D, bone alkaline phosphatase, parathyroid hormone, osteocalcin and urinary levels of deoxypyridinoline (DPD). Bone mineral density was measured by dual-energy X-ray absorptiometry (DXA) at the lumbar spine and both proximal femurs. Average urinary DPD levels, a biochemical marker of bone resorption, were elevated in the examined patient cohort (7.1 ± 1.9 nmol/mmol, reference 3.0–7.0 nmol/mmol). According to HR-pQCT, CRPS-affected distal tibiae showed significantly lower values of cortical BMD and cortical thickness compared to the unaffected contralateral side. Also, bone volume relative to total volume was significantly lower. Trabecular number and trabecular thickness tended to be lower in the affected tibiae. CRPS is associated with significant alterations in bone microstructure of the affected tibiae. Increased bone resorption seems to play a crucial role within a multifactorial process of CRPS-mediated bone atrophy. HR-pQCT could possibly serve as a diagnostic tool in specific CRPS therapy.

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Acknowledgements

The authors thank Felix N. Schmidt for his excellent assistance with the HR-pQCT imaging.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

    Nicola Oehler, Tim Rolvien, Tobias Schmidt & Haider Mussawy

  2. Department of Osteology and Biomechanics, University Medical Centre Hamburg-Eppendorf, Lottestraße 59, 22529, Hamburg, Germany

    Sebastian Butscheidt, Ralf Oheim & Florian Barvencik

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  1. Nicola Oehler
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  2. Tim Rolvien
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  3. Tobias Schmidt
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  7. Haider Mussawy
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Correspondence to Nicola Oehler.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Oehler, N., Rolvien, T., Schmidt, T. et al. Bone microstructure is significantly altered in CRPS-affected distal tibiae as detected by HR-pQCT: a retrospective cross-sectional study. J Bone Miner Metab 37, 741–748 (2019). https://doi.org/10.1007/s00774-018-0976-2

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  • DOI: https://doi.org/10.1007/s00774-018-0976-2

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