Bone metabolism in complex regional pain syndrome
Abstract. Introduction:. Patients with complex regional pain syndrome (CRPS) often show disturbed bone metabolism, assessed using three-phase bone scintigraphy (TPBS). However, current methods lack automation and standardisation. Bone serum markers have been proposed as biomarkers, but their utility...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2024-12-01
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| Series: | PAIN Reports |
| Online Access: | http://journals.lww.com/painrpts/fulltext/10.1097/PR9.0000000000001217 |
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| author | Michael A. Harnik Annemarie Sodmann Beate Hartmannsberger Gudrun Kindl Juliane Becker Ann-Kristin Reinhold Eva Herrmann Andreas K. Buck Ulrich Dischinger Frank Birklein Alexander Brack Abdelrahman Sawalma Heike L. Rittner |
| author_facet | Michael A. Harnik Annemarie Sodmann Beate Hartmannsberger Gudrun Kindl Juliane Becker Ann-Kristin Reinhold Eva Herrmann Andreas K. Buck Ulrich Dischinger Frank Birklein Alexander Brack Abdelrahman Sawalma Heike L. Rittner |
| author_sort | Michael A. Harnik |
| collection | DOAJ |
| description | Abstract. Introduction:. Patients with complex regional pain syndrome (CRPS) often show disturbed bone metabolism, assessed using three-phase bone scintigraphy (TPBS). However, current methods lack automation and standardisation. Bone serum markers have been proposed as biomarkers, but their utility is unclear.
Objectives:. This study aimed to evaluate bone metabolism in CRPS using TPBS and bone serum markers.
Methods:. A deep learning model for automated segmentation quantified tracer enhancement in TPBS images. Serum markers analysed included alkaline phosphatase (AP), 25-OH vitamin D, osteoprotegerin, procollagen type I N-terminal propeptide (PINP), and β-C-terminal telopeptide, compared to 48 healthy controls (HC). The study included 114 patients with CRPS, 41 of whom underwent TPBS.
Results:. Of the 41 patients with CRPS with TPBS, 39 (95.1%) displayed radiotracer enhancement in the bone phase across CRPS subtypes. Serum markers of 114 patients did not significantly differ between patients and HC, nor did they correlate with TPBS enhancement, except in warm CRPS. In these patients, TPBS accumulation in the metacarpophalangeal region correlated with PINP (Spearman ρ = 0.63, P = 0.038), and AP levels were elevated at 78 U/L (interquartile range 64–88) compared to cold CRPS at 66 U/L (51–77; P = 0.003) and HC at 60 U/L (53–69; P < 0.001).
Conclusion:. Automated TPBS quantification revealed widespread bone metabolism alterations, common in CRPS and detectable beyond qualitative assessment. Although most serum markers remained unchanged, patients with warm CRPS exhibited unique features, suggesting distinct pathophysiological profiles. Integrating novel image analysis with other biomarkers may enhance diagnostic precision and patient stratification for targeted therapies. |
| format | Article |
| id | doaj-art-030b3c0267224a04a3d20f12edae625d |
| institution | OA Journals |
| issn | 2471-2531 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | PAIN Reports |
| spelling | doaj-art-030b3c0267224a04a3d20f12edae625d2025-08-20T02:27:18ZengWolters KluwerPAIN Reports2471-25312024-12-0196e121710.1097/PR9.0000000000001217PR90000000000001217Bone metabolism in complex regional pain syndromeMichael A. Harnik0Annemarie Sodmann1Beate Hartmannsberger2Gudrun Kindl3Juliane Becker4Ann-Kristin Reinhold5Eva Herrmann6Andreas K. Buck7Ulrich Dischinger8Frank Birklein9Alexander Brack10Abdelrahman Sawalma11Heike L. Rittner12a Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Centre for Interdisciplinary Pain Medicine, University Hospital Würzburg, Würzburg, Germanyc Departments of Neurology anda Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Centre for Interdisciplinary Pain Medicine, University Hospital Würzburg, Würzburg, Germanya Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Centre for Interdisciplinary Pain Medicine, University Hospital Würzburg, Würzburg, Germanya Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Centre for Interdisciplinary Pain Medicine, University Hospital Würzburg, Würzburg, Germanya Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Centre for Interdisciplinary Pain Medicine, University Hospital Würzburg, Würzburg, Germanya Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Centre for Interdisciplinary Pain Medicine, University Hospital Würzburg, Würzburg, Germanyd Nuclear Medicine, University Hospital Würzburg, Würzburg, Germanye Division of Endocrinology and Diabetes, Department of Internal Medicine, University Hospital Würzburg, Würzburg, Germanyf Department of Neurology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germanya Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Centre for Interdisciplinary Pain Medicine, University Hospital Würzburg, Würzburg, Germanya Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Centre for Interdisciplinary Pain Medicine, University Hospital Würzburg, Würzburg, Germanya Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Centre for Interdisciplinary Pain Medicine, University Hospital Würzburg, Würzburg, GermanyAbstract. Introduction:. Patients with complex regional pain syndrome (CRPS) often show disturbed bone metabolism, assessed using three-phase bone scintigraphy (TPBS). However, current methods lack automation and standardisation. Bone serum markers have been proposed as biomarkers, but their utility is unclear. Objectives:. This study aimed to evaluate bone metabolism in CRPS using TPBS and bone serum markers. Methods:. A deep learning model for automated segmentation quantified tracer enhancement in TPBS images. Serum markers analysed included alkaline phosphatase (AP), 25-OH vitamin D, osteoprotegerin, procollagen type I N-terminal propeptide (PINP), and β-C-terminal telopeptide, compared to 48 healthy controls (HC). The study included 114 patients with CRPS, 41 of whom underwent TPBS. Results:. Of the 41 patients with CRPS with TPBS, 39 (95.1%) displayed radiotracer enhancement in the bone phase across CRPS subtypes. Serum markers of 114 patients did not significantly differ between patients and HC, nor did they correlate with TPBS enhancement, except in warm CRPS. In these patients, TPBS accumulation in the metacarpophalangeal region correlated with PINP (Spearman ρ = 0.63, P = 0.038), and AP levels were elevated at 78 U/L (interquartile range 64–88) compared to cold CRPS at 66 U/L (51–77; P = 0.003) and HC at 60 U/L (53–69; P < 0.001). Conclusion:. Automated TPBS quantification revealed widespread bone metabolism alterations, common in CRPS and detectable beyond qualitative assessment. Although most serum markers remained unchanged, patients with warm CRPS exhibited unique features, suggesting distinct pathophysiological profiles. Integrating novel image analysis with other biomarkers may enhance diagnostic precision and patient stratification for targeted therapies.http://journals.lww.com/painrpts/fulltext/10.1097/PR9.0000000000001217 |
| spellingShingle | Michael A. Harnik Annemarie Sodmann Beate Hartmannsberger Gudrun Kindl Juliane Becker Ann-Kristin Reinhold Eva Herrmann Andreas K. Buck Ulrich Dischinger Frank Birklein Alexander Brack Abdelrahman Sawalma Heike L. Rittner Bone metabolism in complex regional pain syndrome PAIN Reports |
| title | Bone metabolism in complex regional pain syndrome |
| title_full | Bone metabolism in complex regional pain syndrome |
| title_fullStr | Bone metabolism in complex regional pain syndrome |
| title_full_unstemmed | Bone metabolism in complex regional pain syndrome |
| title_short | Bone metabolism in complex regional pain syndrome |
| title_sort | bone metabolism in complex regional pain syndrome |
| url | http://journals.lww.com/painrpts/fulltext/10.1097/PR9.0000000000001217 |
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