Multidisciplinary team approach for CKD-associated osteoporosis.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: D.H. reports research grant from Vifor Pharma and Gedeon Richter and consultancy fees and lecture fees from UCB Nordic, GSK and AstraZeneca. A.C.F. reports lecture fees from Vifor and AstraZeneca. R.J. received fees as site PI in a pharmacy-initiated study (SHP634-401) of Takeda. S.K. reports consultancy fees from Vifor Pharma, GSK and Bayer, and lecture fees from AstraZeneca. M.H.L.-P. reports research grant from Kiowa Kirin. K.E.S.P. educational fora lecture fees and honoraria from UCB and Amgen, with all fees donated to charity via waiver before undertaking the work. P.E. reports research grant from Vifor Pharma, and consultancy fees and lecture fees from UCB and Vifor Pharma. M.H. advisory board Resverlogix and employee at Diaverum AB. H.S.J., T.L.A., A.F., H.K., L.M., and X.T. report no conflicts of interest. 13. EFORT Open Rev. 2017 Mar 13;1(5):136-145. doi: 10.1302/2058-5241.1.000008. eCollection 2016 May. Treatment of pathological fractures of the long bones. Willeumier JJ(1), van der Linden YM(1), van de Sande MAJ(1), Dijkstra PDS(1). Author information: (1)Department of Orthopaedics, Leiden University Medical Centre, The Netherlands. Bone metastases of the long bones often lead to pain and pathological fractures. Local treatment consists of radiotherapy or surgery. Treatment strategies are strongly based on the risk of the fracture and expected survival.Diagnostic work-up consists of CT and biopsy for diagnosis of the primary tumour, bone scan or PET-CT for dissemination status, patient history and blood test for evaluation of general health, and biplanar radiograph or CT for evaluation of the involved bone.A bone lesion with an axial cortical involvement of >30 mm has a high risk of fracturing and should be stabilised surgically.Expected survival should be based on primary tumour type, performance score, and presence of visceral and cerebral metastases.Radiotherapy is the primary treatment for symptomatic lesions without risk of fracturing. The role of post-operative radiotherapy remains unclear.Main surgical treatment options consist of plate fixation, intramedullary nails and (endo) prosthesis. The choice of modality depends on the localisation, extent of involved bone, and expected survival. Adjuvant cement should be considered in large lesions for better stabilisation. Cite this article: Willeumier JJ, van der Linden YM, van de Sande MAJ, Dijkstra PDS. Treatment of pathological fractures of the long bones. EFORT Open Rev 2016;1:136-145. DOI: 10.1302/2058-5241.1.000008. DOI: 10.1302/2058-5241.1.000008 PMCID: PMC5367617