OBJECTIVE: Glucocorticoid-induced osteoporosis (GIOP) requires aggressive intervention. Generally, the first-choice drug for GIOP is a bisphosphonate (BPH); however, denosumab (dMAB) has recently become an alternative for BPH. Therefore, the aim of this study was to evaluate the effectiveness of dMAB in controlling bone mineral density (BMD) in GIOP treatment compared to that of BPH.

METHODS: Patients who met the indication criteria for GIOP, as provided in the Guidelines on the Management and Treatment of Glucocorticoid-induced Osteoporosis of the Japanese Society for Bone and Mineral Research: 2014 update, were enrolled in this study. Patients’ BMD at glucocorticoid steroid (GC) administration, 6 months after initial treatment, if the drug was changed, and 6 months after the second treatment were measured for the lumbar spine (LS), femoral neck (FN), and greater trochanter (GT) using dual-energy X-ray absorptiometry (DEXA). Patients were classified as follows based on drugs used for initial treatment and second drug, if administered: patients who had been administered no drug (N), BPH as treatment-naïve and maintained the regimen (BB), BPH as treatment-naïve and then switched to dMAB (BD), dMAB as treatment-naïve and maintained the regimen (DD), and dMAB as treatment-naïve and then switched to BPH (DB). Patients’ BMD and the associated gain at each measurement were compared statistically.

RESULTS: We recruited 149 patients (48, 24, 22, 21, and 34, in the N, BB, BD, DD, and DB groups, respectively). All groups with drug interventions but the BD group showed significant increases in BMD of the LS from baseline to the 6-month measurement. The BMD of the FN increased 6 months after the drug switch for the BD group.

DISCUSSION: dMAB demonstrated a similar effect on BMD gain as BPH.

CONCLUSION: dMAB could be chosen as an initial drug for GIOP treatment.

BACKGROUND: We hypothesized that the greater tubercle stump of a rotator cuff tear would regress with ultrasound-guided steroid injection because Achilles’ tendon necrosis occurs following steroid injection.

MATERIALS and METHODS: We injected 3ml of 1% lidocaine hydrochloride and 2.5mg of betamethasone acetate suspension into the greater tubercle stump of a rotator cuff tear or the subacromial bursa with a 24-G needle under ultrasound guidance in patients with complete tears. We assessed the Japanese Orthopaedic Association (JOA) shoulder joint score before the injection and 2 weeks later. The stump injection group included 18 men and 14 women aged 54-89 years. The subacromial injection group included 15 men and 13 women aged 66-89 years.

RESULTS: The percent improvement in the JOA score was significantly greater in the stump injection group than in the subacromial injection group.

DISCUSSION: Inflammation of the rotator cuff was relieved following steroid injection into the greater tubercle stump. The stump regressed by inducing necrosis of the tissues of the rotator cuff, thereby relieving pain.

CONCLUSION: Following a complete rotator cuff tear, steroid injection into the greater tubercle stump is more useful than injection into the subacromial bursa.

OBJECTIVE: This study aimed to determine the pathology underlying diabetic tendinopathy using the Spontaneously Diabetic Torii Lepr^fa (SDT fatty) rat, a model of diabetes mellitus (DM).

MATERIALS and METHODS: Eight SDT fatty rats (age 6 weeks) were used and 8 age-matched Sprague Dawley^® (SD) rats were used as controls. At age 24 weeks, blood examination was performed, followed by supraspinatus tendon harvesting. Frozen sagittal sections were stained with antibodies for advanced glycation endproducts (AGEs), pentosidine, and receptors for AGEs (RAGEs).

RESULTS: Blood hemoglobin A1c (HbA1c), serum ketone body, triglyceride, and total cholesterol levels were significantly higher but serum insulin level was significantly lower in SDT fatty rats than those in control rats. Histologically, expression of AGEs was qualitatively similar in both groups but expression of pentosidine was qualitatively increased in SDT fatty rats compared to that in controls. The number of RAGE-positive cells in SDT fatty rats was significantly increased compared with that in controls.

DISCUSSION: Based on the results of blood examination, SDT fatty rats mimicked human type 2 DM with regard to the promotion of anaerobic metabolism, and disordered lipid metabolism was observed. Accumulation of pentosidine and enhancement of RAGE expression were observed in SDT fatty rats. These findings suggested that AGEs including pentosidine may play a key role in detrimental tendon alterations in patients with DM.

CONCLUSION: Accumulation of pentosidine and enhancement of RAGE expression may be key factors in detrimental tendon alterations in type 2 DM patients.