Bruce Adams

Publications (2)2.88 Total impact

• Article: Osteoporosis in men: are we referring enough for DXA and how?

  Haider Al Attia, Bruce Adams
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  ABSTRACT: The aim of the study is to determine the pattern of male referrals to an osteodensitometry unit in a tertiary hospital in UAE. In this study, we reviewed the records of male patients referred for dual X-ray absorptiometry over 9 months since the establishment of the unit. Indications for scanning were categorized into high and medium risk and infrequent causes of osteopenia/osteoporosis. They were ranked according to frequency. The outcome was documented by category and patients were considered normal when they have bone mineral densities (BMD) over 0.82 g/cm(2), osteopenia between 0.60 and 0.82 g/cm(2), and osteoporosis below 0.60 g/cm(2) for hips and lumbar spine. The site with the lowest value was taken as representative of the patient's BMD status. The ages of the patients ranged from 16 to 91 years (mean of 55.2 years). Male referrals made up 8.8% (71/805) over the 9-month period. The number of indications was 83 accounting for 1.16 per patient. Most common reasons were patients on corticosteroid therapy (20.5%), bone rarefaction on radiographs (13%), and fragility fractures (12%). Others included back pain, general aches and pains, querying osteoporosis, and miscellaneous causes that made up 8.5% each. These were followed by immobilization, (6%) arthropathies (6%), excess alcohol intake (3.5%), aging, (2.5%), and hepatorenal disorders (2.5%). A positive family history of osteoporosis, treatment for neoplasia, smoking, and chronic obstructive airway disease (1% each) were the least common reasons for referral. Thirty-five patients (49%) had osteopenia, 16 (22.5%) had osteoporosis, and 20 (28%) were normal. The low referral rate and relatively high normal outcome among men suggest that osteoporosis is still viewed as a disease of females. This aberrant referral pattern, when viewing the majority of indications, reflects an inability to prioritize the reasons for referral. It is prudent, therefore, to instill an awareness of the increasing importance of osteoporosis in men in the minds of the referring clinicians.
  Clinical Rheumatology 08/2007; 26(7):1123-6. · 2.00 Impact Factor
• Article: Successful management of a widespread osteosarcoma. A case report.

  Pentti Grohn, Ashok Uttamchandani, Zuhair Al-Haider, Bruce Adams
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  ABSTRACT: To report the case of a 23-year-old woman with widespread osteosarcoma including skeletal, pulmonary and pleural metastases, who had a remarkable response to combined chemo- and radiotherapy. A 23-year-old Indonesian woman presented in October 1999 with a swelling of the right thigh, severe generalized pain and progressive left hemiparesis. Radiological examination revealed osteolytic lesions in the cervical spine. CT scan of the chest showed multiple pulmonary metastases and a huge left pleural effusion. Bone scan with technetium-99m hydroxymethylene diphosphonate showed intense uptake of the radiopharmaceutical in the distal right femur, generalized deposits throughout the skeleton and in the right hemithorax corresponding to the lung findings. Bone marrow and kidney function tests as well as serum calcium level were normal. Alkaline phosphatase was markedly elevated, 8,000 IU/l (normal <250 IU/l). Histopathology from the femoral tumor showed osteosarcoma. Treatment was started with radiotherapy to the cervical spine followed immediately by a combination chemotherapy with ifosfamide, cisplatin, etoposide and mesna rescue. In addition, the patient received bisphosphonates regularly. Eleven cycles of chemotherapy were given with a remarkable response. The patient was successfully treated with a combination of radio- and chemotherapy. She recovered fully and is in almost complete remission. The disease remained stable 24 months after the discontinuation of the treatment.
  Medical Principles and Practice 13(1):54-6. · 0.89 Impact Factor