von Ehrlich B, Kempten, Deutschland

Typical orthopedic/neurological connoted diseases with ectopic calcification in soft tissues are predominantly explained mechanical, traumatic, chronic exogenous exercise induced. The individual and social burden of these investigated diseases is high. Partially there is little literature of explaining pathogenesis. A biochemical association with magnesium depletion is hardly perceived – and not investigated in healthcare routine. Without magnesium the human organism would calcificate polytopic and premature. Coming from a case with excessive chronic pain induced by soft tissue calcification near osteosynthesis with documented long lasting magnesium-depletion we try a working hypothesis concerning wide spread pain caused by dystopic calcifications in general . Hypothesis: chronic systemic magnesium depletion favours – in context with other causes of chronic lokal mechanical or inflammatory stress the development of painful disease entities in part „bottleneck-syndromes“. Aim : „proof of concept“ . Methods: Retrospective cohort study selcting the diagnoses 1) impingement syndrome, shoulder arm syndrome (SAV), 2) posttraumatic soft tissue calcification (myositis ossificans traumatica) (PTV), 3)Calcification of plantar fascia – fasciitis plantaris (PLF) 4) lumbar spinal stenosis (SKS) 5) meningeal calcifications (MV) within a period of u to 15 years testing for association with documented magnesium depletion over 1 year. All patients where treated in primary care setting. Included where patients with the clinical diagnosis in PTV and MV each and in SAV and PLF only partially x ray. In second step each patient was checked for existing clinical and laboratory data of long lasting magnesium depletion. Chronic magnesium depletion (cMMS) was categorized if at least 2 laboratory values within minimum 1 year documented below cutoff Mgs < 0,85 mmol/l or Mg/Ca (mmol/mmol) ≤ 0,36 and clinical signs for cMMS existed. Results : Overall 98 patients with dystopic calcification syndromes were extracted. Resuls are given in Table 1. Besides a characteristic increase of the mean manifestation age of the different entities of calcification all sub-categories show a remarkable lowering oft the serum-magnesium trigger value (i.e. lowest measured serum magnesium and/of Mg/Ca usually before beginn of supplementation) and evenly impressive pathological Mg/Ca index. . 95% of spinal stenosis patients – 2/3 female where over a decade documented cMMS patientes , certainly supplementation reccomended from the time of detection. 20/21 of these patients where clinically identifyable as MMS patients. The majority was overweighted , 1 patient underweighted . We see a tendency that those patients with good supplementation compliance might have favourable outcome. Diskussion: Pub Med search reveals 66 publications to Magnesium and soft tissue calcifications, 62 human (28.9.2022). Until the early 90th sucessfull therapy with hybrid magnesium injected topically and oral is reported(1). Chinese group of Zeng reports a first epidemiological study with a great number (n=1626) reporting a dose dependet correlation between serum-magnesium and chondrocalcinosis of knee(2). Biochemical aspects of magnesium for biomineralisation are fucussed by Zhang(3). While detection of calcification has increased very much due to x ray and sonography the association with magnesium has yet come into the very periphery of interest lately. Regarding the high prevalence of magnesium-depletion under „western“ attributed lifestyle still as a black box phenomenon coincided by late-time increasing disease burden of dystopic calcifications discussion of early magnesium prevention justifies taking the association of magnesium depletion and dystopic calcifications into focus. This ist o our knowlege the first paper regarding this with long term magnesium data. - It might seem strange including the two cases with meningeal calcification into this project. This seems justified regarding physis and psyche of one case: In a patient with long lasting headache and migaine history and long documented magnesium depletion CT of cranium revealed a small calcificated suspected falx meningeoma. Due to literature 20-30% of such findings are benigne(4) not tumorous but etiologically unclear. Regarding the frequency of such situation due to steep increase of CT and MRI diagnostics the extraordinary psychological stress of these patients hat to be taken into account. It would be of high importance for these patients knowing a possible simple and treatable connection. An analysis of the association with magnesium depletion is not jet published (Pub med. 28.9.22) Only an animal report with bears in virginia reports a correlation of magnesium depletion with meningeal calcifications (5). Besides early optimizing Mg/Ca index the possibilty of parenteral magnesium therapy is suggested as a thinkable tool for symptomatic improve. We also discuss in patients with (frequent) posttraumatic osteosynthesis to optimize there Mg/Ca index to the aim 0,4.

Lit: 1) L. Steidl,R Ditmar Treatmen of soft tissue calcifications with magnesium , Acta Univ.Palacki Olomuc Fa Med 1991 ;130:273-87 2) Chao Zeng et al Dose-response relationship between lower serum magnesium level and higher prevalence of Knee chondrocalcinosis. Arthritis Research &Therapy 2017 19:236 3) J.Zhang et al Dual function of magnesium in bone biomineralisation Advanced Healthcare Materials 2019 1901030 1-12) 4) Nakasu S Nakasu Y Natural history of meningeomas: review with meta-analysis Neurol Med Chir (Tokyo) 2020 Mar 15;60(3):109-120 5) Hamir AN, Hanlon CA, Rupprecht CE Prevalence of psammoma bodies in meninges and chorioid plexuses of raccoons (Procon lotor) from Parramore island Virginia J.Vet Diagn Invest 2001 Jan;13(1):76-9