201
|
Dejaco C, Singh YP, Perel P, Hutchings A, Camellino D, Mackie S, Abril A, Bachta A, Balint P, Barraclough K, Bianconi L, Buttgereit F, Carsons S, Ching D, Cid M, Cimmino M, Diamantopoulos A, Docken W, Duftner C, Fashanu B, Gilbert K, Hildreth P, Hollywood J, Jayne D, Lima M, Maharaj A, Mallen C, Martinez-Taboada V, Maz M, Merry S, Miller J, Mori S, Neill L, Nordborg E, Nott J, Padbury H, Pease C, Salvarani C, Schirmer M, Schmidt W, Spiera R, Tronnier D, Wagner A, Whitlock M, Matteson EL, Dasgupta B. 2015 recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Arthritis Rheumatol 2016; 67:2569-80. [PMID: 26352874 DOI: 10.1002/art.39333] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 07/13/2015] [Indexed: 12/12/2022]
Abstract
Therapy for polymyalgia rheumatica (PMR) varies widely in clinical practice as international recommendations for PMR treatment are not currently available. In this paper, we report the 2015 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) recommendations for the management of PMR. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology as a framework for the project. Accordingly, the direction and strength of the recommendations are based on the quality of evidence, the balance between desirable and undesirable effects, patients' and clinicians' values and preferences, and resource use. Eight overarching principles and nine specific recommendations were developed covering several aspects of PMR, including basic and follow-up investigations of patients under treatment, risk factor assessment, medical access for patients and specialist referral, treatment strategies such as initial glucocorticoid (GC) doses and subsequent tapering regimens, use of intramuscular GCs and disease modifying anti-rheumatic drugs (DMARDs), as well as the roles of non-steroidal anti-rheumatic drugs and non-pharmacological interventions. These recommendations will inform primary, secondary and tertiary care physicians about an international consensus on the management of PMR. These recommendations should serve to inform clinicians about best practices in the care of patients with PMR.
Collapse
Affiliation(s)
- Christian Dejaco
- Medical University Graz, Department of Rheumatology, Graz, Austria, and Southend University Hospital, Department of Rheumatology, Essex, UK
| | - Yogesh P Singh
- Southend University Hospital, Department of Rheumatology, Essex, UK
| | - Pablo Perel
- London School of Hygiene and Tropical Medicine, Epidemiology and Population Health Faculty, London, UK
| | - Andrew Hutchings
- London School of Hygiene and Tropical Medicine, Department of Health Services Research and Policy, London, UK
| | - Dario Camellino
- University of Genoa, Department of Internal Medicine, Research Laboratory and Academic Division of Clinical Rheumatology, Genoa, Italy
| | - Sarah Mackie
- University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
| | - Andy Abril
- Mayo Clinic, Department of Rheumatology, Jacksonville, Florida
| | - Artur Bachta
- Military Institute of Medicine, Department of Internal Medicine and Rheumatology, Warsaw, Poland
| | - Peter Balint
- National Institute of Rheumatology and Physiotherapy, 3rd Rheumatology Department, Budapest, Hungary
| | | | | | - Frank Buttgereit
- Charité University Medicine, Department of Rheumatology, Berlin, Germany
| | - Steven Carsons
- Stony Brook University School of Medicine, Division of Rheumatology, Allergy and Immunology, Winthrop-University Hospital Campus, Mineola, New York
| | - Daniel Ching
- Timaru Hospital, Department of Rheumatology, Timaru, New Zealand
| | - Maria Cid
- University of Barcelona Hospital Clinic, Department of Systemic Autoimmune Diseases, Barcelona, Spain
| | - Marco Cimmino
- University of Genoa, Department of Internal Medicine, Research Laboratory and Academic Division of Clinical Rheumatology, Genoa, Italy
| | | | - William Docken
- Brigham and Women's Hospital, Division of Rheumatology, Boston, Massachusetts
| | - Christina Duftner
- Medical University of Innsbruck, Department of Internal Medicine-Clinic VI, Innsbruck, Austria
| | - Billy Fashanu
- Southend University Hospital, Department of Rheumatology, Essex, UK
| | - Kate Gilbert
- patient representatives from Polymyalgia Rheumatica and Giant Cell Arteritis UK, London, UK
| | - Pamela Hildreth
- patient representatives from Polymyalgia Rheumatica and Giant Cell Arteritis UK, London, UK
| | - Jane Hollywood
- Southend University Hospital, Department of Rheumatology, Essex, UK
| | - David Jayne
- University of Cambridge, Department of Medicine, Cambridge, UK
| | - Manuella Lima
- Hospital Universitário Pedro Ernesto, Department of Rheumatology, Rio de Janeiro, Brazil
| | - Ajesh Maharaj
- University of Kwa Zulu Natal, Prince Mshiyeni Memorial Hospital, Nelson R. Mandela School of Medicine, Department of Internal Medicine, Durban, South Africa
| | - Christian Mallen
- Keele University, Arthritis Research UK Primary Care Centre, Keele, UK
| | - Victor Martinez-Taboada
- Universidad de Cantabria, Hospital Universitario Marqués de Valdecilla, Facultad de Medicina, Servicio de Reumatología, Santander, Spain
| | - Mehrdad Maz
- University of Kansas Medical Center, Department of Medicine, Division of Allergy, Clinical Immunology, and Rheumatology, Kansas City
| | - Steven Merry
- Mayo Clinic, Department of Family Medicine, Rochester, Minnesota
| | - Jean Miller
- patient representatives from Polymyalgia Rheumatica and Giant Cell Arteritis UK, London, UK
| | - Shunsuke Mori
- NHO Kumamoto Saishunsou National Hospital, Department of Rheumatology, Clinical Research Center for Rheumatic Diseases, Kohshi, Kumamoto, Japan
| | - Lorna Neill
- patient representatives from Polymyalgia Rheumatica and Giant Cell Arteritis UK, London, UK
| | - Elisabeth Nordborg
- Sahlgren University Hospital, Department of Rheumatology, Göteborg, Sweden
| | - Jennifer Nott
- patient representatives from Polymyalgia Rheumatica and Giant Cell Arteritis UK, London, UK
| | - Hannah Padbury
- patient representatives from Polymyalgia Rheumatica and Giant Cell Arteritis UK, London, UK
| | - Colin Pease
- University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
| | - Carlo Salvarani
- Azienda Ospedaliera-IRCCS di Reggio Emilia, Department of Internal Medicine, Division of Rheumatology, Reggio Emilia, Italy
| | - Michael Schirmer
- Medical University of Innsbruck, Department of Internal Medicine-Clinic VI, Innsbruck, Austria
| | - Wolfgang Schmidt
- Immanuel Krankenhaus Berlin and Medical Center for Rheumatology Berlin-Buch, Berlin, Germany
| | - Robert Spiera
- Hospital for Special Surgery, Department of Medicine, New York, New York
| | - David Tronnier
- patient representative from the Mayo Clinic, Rochester, Minnesota
| | - Alexandre Wagner
- Universidade Federal de São Paulo, Department of Internal Medicine, São Paulo, Brazil
| | | | - Eric L Matteson
- Mayo Clinic College of Medicine, Department of Health Sciences Research, Division of Rheumatology, Rochester, Minnesota
| | - Bhaskar Dasgupta
- Southend University Hospital, Department of Rheumatology, Essex, UK
| | | | | |
Collapse
|
202
|
Prevention and Treatment of Bone Disease in Systemic Lupus Erythematosus. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2016. [DOI: 10.1007/s40674-016-0034-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
203
|
Balancing benefits and risks of glucocorticoids in rheumatic diseases and other inflammatory joint disorders: new insights from emerging data. An expert consensus paper from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Aging Clin Exp Res 2016; 28:1-16. [PMID: 26746234 DOI: 10.1007/s40520-015-0522-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 12/22/2015] [Indexed: 12/26/2022]
Abstract
PURPOSE This consensus review article considers the question of whether glucocorticoid (GC) therapy is still relevant in the treatment of rheumatic diseases, with a particular focus on rheumatoid arthritis (RA), and whether its side effects can be adequately managed. Recent basic and clinical research on the molecular, cellular and clinical effects of GCs have considerably advanced our knowledge in this field. An overview of the subject seems appropriate. METHODS This review is the result of a multidisciplinary expert working group, organised by European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis. The recent literature was surveyed and the salient evidence synthetized. RESULTS The pathophysiological basis of RA (and other inflammatory rheumatic diseases) now strongly implicates the adaptive immune system in addition to innate mechanisms. The molecular effect of GCs and differential GC sensitivity is better understood, although exploiting this knowledge is still in its infancy. The newer treatment strategies of early and aggressive control of RA have gr eatly improved clinical outcomes, but improvements are still possible. Newer targeted anti-inflammatory drugs have made an important impact, yet they too are associated with numerous side effects. DISCUSSION Short durations of moderate doses of GCs are generally well tolerated and have a positive benefit/risk ratio. Patients should be assessed for fracture risk and bone preserving agents and be prescribed calcium and vitamin D supplementation. CONCLUSIONS Within a strategy of a disease modifying approach to inflammatory disease, combination therapy including a GC is effective approach.
Collapse
|
204
|
Tada M, Inui K, Sugioka Y, Mamoto K, Okano T, Koike T, Nakamura H. Reducing glucocorticoid dosage improves serum osteocalcin in patients with rheumatoid arthritis-results from the TOMORROW study. Osteoporos Int 2016; 27:729-35. [PMID: 26294294 DOI: 10.1007/s00198-015-3291-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 08/11/2015] [Indexed: 01/30/2023]
Abstract
UNLABELLED Decreasing the daily dose of glucocorticoids improved bone metabolic marker levels in patients with rheumatoid arthritis. However, changes in disease activity did not influence bone metabolism. Bone metabolism might thus remain uncontrolled even if disease activity is under good control. Decreasing glucocorticoid dosage appears important for improving bone metabolism. INTRODUCTION Patients with rheumatoid arthritis (RA) develop osteoporosis more frequently than healthy individuals. Bone resorption is increased and bone formation is inhibited in patients with RA, and glucocorticoid negatively affects bone metabolism. We aimed to investigate factors influencing bone metabolic markers in patients with RA. METHODS We started the 10-year prospective cohort Total Management of Risk Factors in Rheumatoid Arthritis Patients to Lower Morbidity and Mortality (TOMORROW) study in 2010. We compared changes in urinary cross-linked N-telopeptide of type I collagen (uNTx) and serum osteocalcin (OC), as markers of bone resorption and formation, respectively, in 202 RA patients and age- and sex-matched volunteers between 2010 and 2011. We also investigated factors influencing ΔuNTx and ΔOC in the RA group using multivariate analysis. RESULTS Values of ΔuNTx were significantly lower in patients with RA than in healthy controls (-0.51 vs. 7.41 nmol bone collagen equivalents (BCE)/mmol creatinine (Cr); p = 0.0013), whereas ΔOC values were significantly higher in RA patients (0.94 vs. 0.37 ng/ml; p = 0.0065). Changes in prednisolone dosage correlated negatively with ΔOC (β = -0.229, p = 0.001), whereas changes in disease activity score, bisphosphonate therapy, and period of biologics therapy did not correlate significantly with ΔOC. No significant correlation was seen between ΔuNTx and change in prednisolone dosage. CONCLUSIONS Decreased glucocorticoid dosage improved bone metabolic markers in RA, but disease activity, bisphosphonate therapy, and period of biologics therapy did not influence levels of bone metabolic markers. Decreasing glucocorticoid dosage appears important for improving bone metabolic marker profiles in patients with RA.
Collapse
Affiliation(s)
- M Tada
- Department of Orthopaedic Surgery, Osaka City University Medical School, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - K Inui
- Department of Rheumatosurgery, Osaka City University Medical School, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Y Sugioka
- Center for Senile Degenerative Disorders, Osaka City University Medical School, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - K Mamoto
- Department of Orthopaedic Surgery, Osaka City University Medical School, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - T Okano
- Department of Orthopaedic Surgery, Osaka City University Medical School, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - T Koike
- Center for Senile Degenerative Disorders, Osaka City University Medical School, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
- Search Institute for Bone and Arthritis Disease, Shirahama Foundation for Health and Welfare, Nishimurogun Shirahamacho 1447, Wakayama, 649-2211, Japan.
| | - H Nakamura
- Department of Orthopaedic Surgery, Osaka City University Medical School, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| |
Collapse
|
205
|
|
206
|
Abstract
UNLABELLED Osteoporosis treatment rates within 2 years following an index event (fragility fracture, osteoporotic bone mineral density (BMD) T-score, or osteoporosis ICD-9 codes) were determined from 2005 to 2011. Most patients were not treated. Fracture patients had the lowest treatment rate. Low treatment rates also occurred in patients that were male, black, or had non-commercial insurance. INTRODUCTION Clinical recognition of osteoporosis (osteoporotic BMD, assignment of an ICD-9 code, or the occurrence of fragility fractures) provides opportunities to treat patients at risk for future fracture. METHODS A cohort of 36,965 patients was identified from 2005 to 2011 in the Indiana Health Information Exchange, with index events after age 50 of either non-traumatic fractures, an osteoporosis ICD-9 code, or a BMD T-score ≤ -2.5. Patients with osteoporosis treatment in the preceding year were excluded. Medication records during the ensuing 2 years were extracted to identify osteoporosis treatments, demographics, comorbidities, and co-medications. Predictors of treatment were evaluated in a multivariable logistic regression model. RESULTS The cohort was 78 % female, 11 % black, 91 % urban-dwelling, and 53 % commercially insured. The index events were as follows: osteoporosis diagnosis (47 % of patients), fragility fracture (44 %), and osteoporotic T-scores (9 %). Within 2 years after the index event, 23.3 % received osteoporosis medications (of which, 82.2 % were oral bisphosphonates). Treatment rates were higher after osteoporosis diagnosis codes (29.3 %) or osteoporotic T-score (53.9 %) than after fracture index events (10.5 %) (p < 0.001). Age had an inverted U-shaped effect for women with highest odds around 60-65 years. Women (OR 1.86) and non-black patients (OR 1.52) were more likely to be treated (p < 0.001). Patients with public (versus commercial) insurance (OR 0.86, p < 0.001) or chronic comorbidities (ORs about 0.7-0.9, p < 0.001) were less likely to be treated. CONCLUSION Most osteoporosis treatment candidates remained untreated. Men, black patients, and patients with fracture or chronic comorbidities were less likely to receive treatment, representing disparity in the recognition and treatment of osteoporosis.
Collapse
Affiliation(s)
- Z Liu
- Department of Biostatistics, Indiana University Schools of Medicine and Public Health, Health Information and Translational Sciences Building, 410 W 10th Street, Suite 3000, Indianapolis, IN, 46202-5111, USA.
| | - J Weaver
- Merck & Co, Whitehouse Station, New Jersey, NJ, 08889, USA
| | - A de Papp
- Merck & Co, Whitehouse Station, New Jersey, NJ, 08889, USA
| | - Z Li
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - J Martin
- Regenstrief Institute, Indianapolis, IN, USA
| | - K Allen
- Regenstrief Institute, Indianapolis, IN, USA
| | - S Hui
- Regenstrief Institute, Indianapolis, IN, USA
| | - E A Imel
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| |
Collapse
|
207
|
Jayasena A, Atapattu N, Lekamwasam S. Treatment of glucocorticoid-induced low bone mineral density in children: a systematic review. Int J Rheum Dis 2016; 18:287-93. [PMID: 25923606 DOI: 10.1111/1756-185x.12560] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
AIMS The aim of this systematic review was to evaluate, critically, the treatment options used in the management of bone loss associated with glucocorticoid (GC) use among children. METHODS We performed a systematic search using PubMed, Cochrane clinical trial registry, Clinicaltiral.gov and Ovid databases (1 March, 2013). The search resulted in 34 eligible retrievals. Of them, seven clinical trials that fulfilled the inclusion and exclusion criteria were selected by two authors. RESULTS Four studies have compared the effectiveness of bisphosphonates in the treatment of GC-induced low bone mineral density (BMD) in children. Remaining studies were on menatretenone + alfacacidol versus alfacalcidol alone, calcium + vitamin D versus placebo and alfacalcidol versus menatetrenone. In the four studies, bisphosphonates have shown the ability either to improve BMD or prevent bone loss associated with GC use in children. However, alendronate either in oral or intravenous routes and oral pamidronate were the only bisphosphnates that have been studied in children. Vitamin K2 (menatetrenone) combined with alfacalcidol has also preserved BMD in children on long-term GC therapy. Calcium combined with alfacalcidol has also prevented bone loss, greater than menatetrenone. Calcitriol together with Calcium in conventional doses has retarded bone loss, although the combination could not completely prevent the process. CONCLUSIONS Vitamin D derivatives such as calcitriol or alfacalcidol together with adequate calcium can be considered suitable treatment options to be started simultaneously when long-term GC therapy is needed in children. For children who have been on GCs or have already lost BMD, either oral pamidronate or alendronate in oral/intravenous routes can be considered based on the availability.
Collapse
Affiliation(s)
- Arundathi Jayasena
- Paediatric Endocrinology, Lady Ridgeway Hospital for Children, Colombo, Sri Lanka
| | | | | |
Collapse
|
208
|
Anastácio LR, Davisson Correia MIT. Nutrition therapy: Integral part of liver transplant care. World J Gastroenterol 2016; 22:1513-1522. [PMID: 26819518 PMCID: PMC4721984 DOI: 10.3748/wjg.v22.i4.1513] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/08/2015] [Accepted: 11/19/2015] [Indexed: 02/06/2023] Open
Abstract
Managing malnutrition before liver transplantation (LTx) while on the waiting list and, excessive weight gain/metabolic disturbances in post-surgery are still a challenge in LTx care. The aim of this review is to support an interdisciplinary nutrition approach of these patients. Cirrhotic patients are frequently malnourished before LTx and this is associated with a poor prognosis. Although the relation between nutritional status versus survival, successful operation and recovery after LTx is well established, prevalence of malnutrition before the operation is still very high. Emerging research has also demonstrated that sarcopenia pre and post-transplant is highly prevalent, despite the weight gain in the postoperative period. The diagnosis of the nutritional status is the first step to address the adequate nutritional therapy. Nutritional recommendations and therapy to manage the nutritional status of LTx patients are discussed in this review, regarding counseling on adequate diets and findings of the latest research on using certain immunonutrients in these patients (branched chain amino-acids, pre and probiotics). Nutrition associated complications observed after transplantation is also described. They are commonly related to the adverse effects of immunosuppressive drugs, leading to hyperkalemia, hyperglycemia and weight gain. Excessive weight gain and post-transplant metabolic disorders have long been described in post-LTx and should be addressed in order to reduce associated morbidity and mortality.
Collapse
|
209
|
The prediction and monitoring of toxicity associated with long-term systemic glucocorticoid therapy. Curr Rheumatol Rep 2016; 17:513. [PMID: 25903665 DOI: 10.1007/s11926-015-0513-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Glucocorticoids are often required for adequate control of inflammation in many serious inflammatory diseases; common indications for long-term treatment include polymyalgia rheumatica, giant cell arteritis, asthma and chronic obstructive pulmonary disease. Long-term glucocorticoid therapy is, however, associated with many adverse effects involving skin, gastro-intestinal, eye, skeletal muscle, bone, adrenal, cardio-metabolic and neuropsychiatric systems. This balance between benefits and risks of glucocorticoids is important for clinical practice and glucocorticoid-related adverse effects can significantly impair health-related quality of life. Understanding the nature and mechanisms of glucocorticoid-related adverse effects may inform how patients are monitored for toxicity and identify those groups, such as older people, that may need closer monitoring. For clinical trials in diseases commonly treated with glucocorticoids, standardised measurement of glucocorticoid-related adverse effects would facilitate future evidence synthesis and meta-analysis.
Collapse
|
210
|
Carli L, Tani C, Spera V, Vagelli R, Vagnani S, Mazzantini M, Di Munno O, Mosca M. Risk factors for osteoporosis and fragility fractures in patients with systemic lupus erythematosus. Lupus Sci Med 2016; 3:e000098. [PMID: 26848397 PMCID: PMC4731833 DOI: 10.1136/lupus-2015-000098] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 09/11/2015] [Accepted: 09/13/2015] [Indexed: 01/17/2023]
Abstract
Osteoporosis (OP) and fragility fractures (FFx) are a known comorbidity in patients with systemic lupus erythematosus (SLE). This work aimed at evaluating (1) the prevalence of OP and FFx in a cohort of SLE and (2) the risk factors associated with both OP and FFx. The following data were collected from clinical charts: age, sex, menopausal status (MP), body mass index, smoking habits, disease duration, daily dose and cumulative glucocorticoids (GCs), type of organ involvement, comorbidities and medications. Data on bone metabolism, calcium and vitamin D supplementation and treatment with bisphosphonates, teriparatide or denosumab were collected, together with bone mineral density (BMD) values (measured by dual-energy X-ray absorptiometry (DXA)) and history of FFx (occurred after the onset of SLE and unrelated to trauma). OP and reduced BMD were defined according to the WHO. 186 patients were included (women 175, men 11; mean age 46.4±13 years, mean disease duration 14.9±9 years). At their last visit, 97 patients (52.2%) had a reduced BMD and 52 (27.9%) had OP. 22 patients (11.8%), all women, had at least one FFx; six patients (27.3%) were pre-menopausal. On univariate analysis, age, cumulative dose of GC, MP, therapy with antiepileptics and chronic renal failure (CRF) were correlated with OP (p<0.03); age, total amount of GC, MP, CRF, anticoagulants (AC) and antiepileptic therapy were correlated with FFx (p<0.05). The multivariate logistic model confirmed a direct association of OP and age, MP and antiepileptic therapy (p≤0.01) and of FFx and age, chronic therapy with AC and antiepileptics (p<0.03). In conclusion, low BMD is frequently observed in SLE, and FFx are observed also in premenopausal patients. Together with traditional risk factors (age, MP and GC), CRF and chronic treatments with AC or antiepileptics seem to be associated with a higher risk profile for OP and FFx occurrence.
Collapse
Affiliation(s)
- L Carli
- Department of Genetic Oncology and Clinical Medicine (GenOMeC) PhD, University of Siena, Siena, Italy; Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - C Tani
- Rheumatology Unit, Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - V Spera
- Rheumatology Unit, Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - R Vagelli
- Rheumatology Unit, Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - S Vagnani
- Rheumatology Unit, Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - M Mazzantini
- Rheumatology Unit, Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - O Di Munno
- Rheumatology Unit, Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - M Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| |
Collapse
|
211
|
Naylor KL, Zou G, Leslie WD, McArthur E, Lam NN, Knoll GA, Kim SJ, Fraser LA, Adachi JD, Hodsman AB, Garg AX. Frequency of bone mineral density testing in adult kidney transplant recipients from Ontario, Canada: a population-based cohort study. Can J Kidney Health Dis 2016; 3:2. [PMID: 26779343 PMCID: PMC4715326 DOI: 10.1186/s40697-016-0092-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 11/17/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND We lack consensus on the clinical value, frequency, and timing of bone mineral density (BMD) testing in kidney transplant recipients. This study sought to determine practice patterns in BMD testing across kidney transplant centres in Ontario, Canada, and to compare the frequency of testing in kidney transplant recipients to non-transplant reference groups. METHODS Using healthcare databases from Ontario, Canada we conducted a population-based cohort study of adult kidney transplant recipients who received a transplant from 1994-2009. We used logistic regression to determine if there was a statistically significant difference across transplant centres in the decision to perform at least one BMD test after transplantation, adjusting for covariates that may influence a physician's decision to order a BMD test. We used the McNemar's test to compare the number of recipients who had at least one BMD test to non-transplant reference groups (matching on age, sex, and date of cohort entry). RESULTS In the first 3 years after transplant, 4821 kidney transplant recipients underwent 4802 BMD tests (median 1 test per recipient, range 0 to 6 tests), costing $600,000 (2014 CAD equivalent dollars). Across the six centres, the proportion of recipients receiving at least one BMD test varied widely (ranging from 15.6 to 92.1 %; P < 0.001). Over half (58 %) of the recipients received at least one BMD test post-transplant, a value higher than two non-transplant reference groups (general population with a previous non-vertebral fracture [hip, forearm, proximal humerus], 13.8 %; general population with no previous non-vertebral fracture, 8.5 %; P value <0.001 for each of the comparisons). CONCLUSIONS There is substantial practice variability in BMD testing after transplant. New high-quality information is needed to inform the utility, optimal timing, and frequency of BMD testing in kidney transplant recipients.
Collapse
Affiliation(s)
- Kyla L Naylor
- Institute for Clinical Evaluative Sciences (ICES), London, Ontario Canada ; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario Canada ; Institute for Clinical Evaluative Sciences, Room ELL-111, Westminster, London Health Sciences Centre, 800 Commissioners Road East,London, Ontario, N6A 4G5 Canada
| | - Guangyong Zou
- Department of Epidemiology & Biostatistics, Western University, London, Ontario Canada
| | - William D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba Canada
| | - Eric McArthur
- Institute for Clinical Evaluative Sciences (ICES), London, Ontario Canada
| | - Ngan N Lam
- Division of Nephrology, University of Alberta, Edmonton, AB Canada
| | - Gregory A Knoll
- Division of Nephrology, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario Canada
| | - S Joseph Kim
- Institute for Clinical Evaluative Sciences (ICES), London, Ontario Canada ; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario Canada ; Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario Canada
| | - Lisa-Ann Fraser
- Division of Endocrinology, Western University, London, Ontario Canada
| | - Jonathan D Adachi
- Division of Rheumatology, McMaster University, Hamilton, Ontario Canada
| | | | - Amit X Garg
- Institute for Clinical Evaluative Sciences (ICES), London, Ontario Canada ; Department of Epidemiology & Biostatistics, Western University, London, Ontario Canada ; Division of Nephrology, Western University, London, Ontario Canada
| |
Collapse
|
212
|
Adler RA, El-Hajj Fuleihan G, Bauer DC, Camacho PM, Clarke BL, Clines GA, Compston JE, Drake MT, Edwards BJ, Favus MJ, Greenspan SL, McKinney R, Pignolo RJ, Sellmeyer DE. Managing Osteoporosis in Patients on Long-Term Bisphosphonate Treatment: Report of a Task Force of the American Society for Bone and Mineral Research. J Bone Miner Res 2016; 31:16-35. [PMID: 26350171 PMCID: PMC4906542 DOI: 10.1002/jbmr.2708] [Citation(s) in RCA: 365] [Impact Index Per Article: 45.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 09/04/2015] [Accepted: 09/07/2015] [Indexed: 12/19/2022]
Abstract
Bisphosphonates (BPs) are the most commonly used medications for osteoporosis. This ASBMR report provides guidance on BP therapy duration with a risk-benefit perspective. Two trials provided evidence for long-term BP use. In the Fracture Intervention Trial Long-term Extension (FLEX), postmenopausal women receiving alendronate for 10 years had fewer clinical vertebral fractures than those switched to placebo after 5 years. In the HORIZON extension, women who received 6 annual infusions of zoledronic acid had fewer morphometric vertebral fractures compared with those switched to placebo after 3 years. Low hip T-score, between -2 and -2.5 in FLEX and below -2.5 in HORIZON extension, predicted a beneficial response to continued therapy. Hence, the Task Force suggests that after 5 years of oral BP or 3 years of intravenous BP, reassessment of risk should be considered. In women at high risk, for example, older women, those with a low hip T-score or high fracture risk score, those with previous major osteoporotic fracture, or who fracture on therapy, continuation of treatment for up to 10 years (oral) or 6 years (intravenous), with periodic evaluation, should be considered. The risk of atypical femoral fracture, but not osteonecrosis of the jaw, clearly increases with BP therapy duration, but such rare events are outweighed by vertebral fracture risk reduction in high-risk patients. For women not at high fracture risk after 3 to 5 years of BP treatment, a drug holiday of 2 to 3 years can be considered. The suggested approach for long-term BP use is based on limited evidence, only for vertebral fracture reduction, in mostly white postmenopausal women, and does not replace the need for clinical judgment. It may be applicable to men and patients with glucocorticoid-induced osteoporosis, with some adaptations. It is unlikely that future trials will provide data for formulating definitive recommendations. © 2015 American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Robert A Adler
- McGuire Veterans Affairs Medical Center and Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | | | - Douglas C Bauer
- University of California, San Francisco, San Francisco, CA, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
213
|
Albaum JM, Lévesque LE, Gershon AS, Liu G, Cadarette SM. Glucocorticoid-induced osteoporosis management among seniors, by year, sex, and indication, 1996-2012. Osteoporos Int 2015; 26:2845-52. [PMID: 26138581 DOI: 10.1007/s00198-015-3200-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 06/05/2015] [Indexed: 01/30/2023]
Abstract
UNLABELLED We identified that glucocorticoid-induced osteoporosis management (bone mineral density testing or osteoporosis treatment) among seniors improved among men (2 to 23 %) and women (10 to 48 %) between 1996 and 2007, and then remained relatively stable through to 2012. Differences were also noted by indication (from a low of 21 % for respiratory conditions to a high of 41 % for rheumatic conditions). PURPOSE The aim of our study was to describe the proportion of chronic oral glucocorticoid (GC) users that receive osteoporosis management (bone mineral density test or osteoporosis treatment) by sex and over time. METHODS We identified community-dwelling older adults initiating chronic oral GC therapy in Ontario using pharmacy data from 1996 to 2012. Chronic GC use was defined as greater than or equal to two oral GC prescriptions dispensed and ≥450 mg prednisone equivalent over a 6-month period. Osteoporosis management within 6 months of starting chronic GC therapy was examined by sex, year, indication for therapy, and osteoporosis management history. Results were summarized using descriptive statistics. RESULTS We identified 72,099 men and 95,975 women starting chronic oral GC therapy (mean age = 74.9 years, SD = 6.5). Approximately two thirds of patients (65 %) received ≥900 mg within the 6-month chronic use window. GC-induced osteoporosis management increased from 2 to 23 % (men) and 10 to 48 % (women) between 1996 and 2007, and then remained relatively stable through to 2012. A higher proportion of patients with prior osteoporosis management were managed within 6 months (56 % men, 67 % women) of chronic GC use, compared to patients without prior management (12 % men, 23 % women). Patients with rheumatic disease were managed most commonly (41 %), and patients with respiratory conditions were managed least commonly (21 %). CONCLUSIONS GC-induced osteoporosis management improved significantly over time for both sexes yet remains low. Significant care gaps by sex and between clinical areas represent a missed opportunity for fracture prevention among patients requiring chronic GC therapy.
Collapse
Affiliation(s)
- J M Albaum
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada
| | - L E Lévesque
- Queen's University, Kingston, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - A S Gershon
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - G Liu
- Queen's University, Kingston, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - S M Cadarette
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada.
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
| |
Collapse
|
214
|
Abstract
PURPOSE OF REVIEW This manuscript will provide a review of recent publications, examining the correlation of systemic lupus erythematosus (SLE) with changes in bone health and associated osteoporosis, highlighting prevalence, etiology, diagnosis, and treatment. RECENT FINDINGS Studies suggest that bone loss and fractures are associated with SLE, related not only to the disease itself, but also with low vitamin D and treatment side-effects. Understanding the mechanisms of glucocorticoids on bone and the immunologic relationship of vitamin D, as well as recognizing the role of chronic inflammation on bone, allows for better understanding of skeletal side-effects. Further awareness of the association of poor bone health has led to an increased need for prevention and treatment. New imaging and treatment are emerging, although not recommended currently. SUMMARY Loss of bone density culminating in osteoporosis and fracture is a frequent comorbidity in SLE patients at any age and is multifactorial in etiology. Awareness and diagnosis is crucial because of its prevalence and morbidity. Prevention is safe and effective in this high-risk population where diagnostic measures and interventions are underutilized and guidelines are lacking.
Collapse
Affiliation(s)
- Cuoghi Edens
- aDepartment of Pediatrics, Division of Pediatric Infectious Diseases and Rheumatology, Rainbow Babies and Children's Hospital bDepartment of Internal Medicine, Division of Rheumatology, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | | |
Collapse
|
215
|
Abstract
Patients with rheumatoid arthritis are predisposed to systemic bone loss, and they are at an increased risk of fractures. Although there are similarities in the patient demographics between rheumatoid arthritis patients and the general population of osteoporosis patients, there are factors, particularly the use of glucocorticoids, which are specific to rheumatoid arthritis. These factors can lead to an increased risk of bone loss and fracture. Given that fractures are often very debilitating, especially in elderly patients, it is of paramount importance for the practicing rheumatologist to be aware of ways to reduce the risk of fracture in patients with rheumatoid arthritis. This review discusses currently available modalities for fracture risk assessment as well as pharmacologic and lifestyle interventions available to treat and prevent bone loss in rheumatoid arthritis patients.
Collapse
|
216
|
Kim D, Cho SK, Kim JY, Choi YY, Sung YK. Association between trabecular bone score and risk factors for fractures in Korean female patients with rheumatoid arthritis. Mod Rheumatol 2015; 26:540-5. [PMID: 26418481 DOI: 10.3109/14397595.2015.1101212] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To identify the association between trabecular bone score (TBS) and other known risk factors for fractures in rheumatoid arthritis (RA) patients. METHODS One hundred female RA patients aged ≥50 years were enrolled. The following risk factors for fracture were selected: prevalent vertebral fracture (VF), bone mineral density (BMD), TBS, and 10-year probability of major osteoporotic fracture by FRAX® (MOF-FRAX scores). The associations between risk factors were identified, and accuracy of TBS, BMD, and FRAX scores to detect the prevalent VF, the strongest risk factor for future fracture, were assessed. RESULTS Twenty-six patients were revealed to have moderate to severe VFs. There was a modest negative correlation between MOF-FRAX score and TBS (r = -0.367, p < 0.01), while there was no correlation between MOF-FRAX score and L-spine BMD (r = -0.050, p = 0.62). The areas under curves (AUCs) were 0.818, 0.683, and 0.518 for the MOF-FRAX score, TBS, and L-spine BMD, respectively. Among patients with glucocorticoids (GC) use (n = 57), AUCs were 0.762, 0.758, and 0.448 for their MOF-FRAX score, TBS, and L-spine BMD, respectively. CONCLUSIONS TBS showed better correlation with MOF-FRAX score than BMD, and it was superior to BMD in identifying prevalent VFs in RA patients, especially who are in use of GCs.
Collapse
Affiliation(s)
- Dam Kim
- a Department of Rheumatology , Hanyang University Hospital for Rheumatic Diseases , Seoul , Republic of Korea .,b Clinical Research Center for Rheumatoid Arthritis (CRCRA) , Seoul , Republic of Korea , and
| | - Soo-Kyung Cho
- a Department of Rheumatology , Hanyang University Hospital for Rheumatic Diseases , Seoul , Republic of Korea .,b Clinical Research Center for Rheumatoid Arthritis (CRCRA) , Seoul , Republic of Korea , and
| | - Ji Young Kim
- c Department of Nuclear Medicine , Hanyang University Hospital , Seoul , Republic of Korea
| | - Yun Young Choi
- c Department of Nuclear Medicine , Hanyang University Hospital , Seoul , Republic of Korea
| | - Yoon-Kyoung Sung
- a Department of Rheumatology , Hanyang University Hospital for Rheumatic Diseases , Seoul , Republic of Korea .,b Clinical Research Center for Rheumatoid Arthritis (CRCRA) , Seoul , Republic of Korea , and
| |
Collapse
|
217
|
Hayashi T, Joki N, Tanaka Y, Iwasaki M, Kubo S, Asakawa T, Matsukane A, Takahashi Y, Imamura Y, Hirahata K, Hase H. The FRAX ® as a predictor of mortality in Japanese incident hemodialysis patients: an observational, follow-up study. J Bone Miner Metab 2015; 33:674-83. [PMID: 25691284 DOI: 10.1007/s00774-014-0631-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 09/02/2014] [Indexed: 10/24/2022]
Abstract
The World Health Organization Fracture Risk Assessment Tool (FRAX(®)) was recently developed to estimate the 10-year absolute risk of osteoporotic fracture among the general population. However, the evidence for its use in chronic kidney disease patients has been lacking, and the association between the FRAX(®) and mortality is unknown. Therefore, a hospital-based, prospective, cohort study was conducted to evaluate the predictive ability of the FRAX(®) for mortality in hemodialysis patients. A total of 252 patients who had been started on maintenance hemodialysis, 171 men and 81 women, with a mean age of 67 ± 14 years, was studied. The endpoint was defined as all-cause death. The Cox proportional hazards model was used to calculate hazard ratios and 95 % confidence intervals. During the mean follow-up period of 3.4 ± 2.7 years, 61 deaths occurred. The median (interquartile range) of the FRAX(®) for major osteoporotic fracture was 6.9 (4.6-12.0) % in men and 19.0 (7.6-33.0) % in women. Cumulative survival rates at 5 years after starting dialysis, with the FRAX(®) levels above and below the median, were 51.9 and 87.9 %, respectively, in men and 67.4 and 83.7 %, respectively, in women. Overall, in men, the multivariate Cox regression analyses revealed that the log-transformed FRAX(®) remained an independent predictor of death after adjusting by confounding variables. However, in women, the significant association between the FRAX(®) value and the outcome was eliminated if age was put into these models. Among Japanese hemodialysis patients, the FRAX(®) seems to be useful for predicting death, especially in men.
Collapse
Affiliation(s)
- Toshihide Hayashi
- Division of Nephrology, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-Ku, Tokyo, 153-8515, Japan.
| | - Nobuhiko Joki
- Division of Nephrology, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-Ku, Tokyo, 153-8515, Japan.
| | - Yuri Tanaka
- Division of Nephrology, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-Ku, Tokyo, 153-8515, Japan
| | - Masaki Iwasaki
- Division of Nephrology, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-Ku, Tokyo, 153-8515, Japan
| | - Shun Kubo
- Division of Nephrology, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-Ku, Tokyo, 153-8515, Japan
| | - Takasuke Asakawa
- Division of Nephrology, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-Ku, Tokyo, 153-8515, Japan
| | - Ai Matsukane
- Division of Nephrology, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-Ku, Tokyo, 153-8515, Japan
| | - Yasunori Takahashi
- Division of Nephrology, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-Ku, Tokyo, 153-8515, Japan
| | | | | | - Hiroki Hase
- Division of Nephrology, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-Ku, Tokyo, 153-8515, Japan
| |
Collapse
|
218
|
Frenkel B, White W, Tuckermann J. Glucocorticoid-Induced Osteoporosis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015. [PMID: 26215995 DOI: 10.1007/978-1-4939-2895-8_8] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Osteoporosis is among the most devastating side effects of glucocorticoid (GC) therapy for the management of inflammatory and auto-immune diseases. Evidence from both humans and mice indicate deleterious skeletal effects within weeks of pharmacological GC administration, both related and unrelated to a decrease in bone mineral density (BMD). Osteoclast numbers and bone resorption are also rapidly increased, and together with osteoblast inactivation and decreased bone formation, these changes lead the fastest loss in BMD during the initial disease phase. Bone resorption then decreases to sub-physiological levels, but persistent and severe inhibition of bone formation leads to further bone loss and progressively increased fracture risk, up to an order of magnitude higher than that observed in untreated individuals. Bone forming osteoblasts are thus considered the main culprits in GC-induced osteoporosis (GIO). Accordingly, we focus this review primarily on deleterious effects on osteoblasts: inhibition of cell replication and function and acceleration of apoptosis. Mediating these adverse effects, GCs target pivotal regulatory mechanisms that govern osteoblast growth, differentiation and survival. Specifically, GCs inhibit growth factor pathways, including Insulin Growth Factors, Growth Hormone, Hepatocyte Growth/Scatter Factor and IL6-type cytokines. They also inhibit downstream kinases, including PI3-kinase and the MAP kinase ERK, the latter attributable in part to direct transcriptional stimulation of MAP kinase phosphatase 1. Most importantly, however, GCs inhibit the Wnt signaling pathway, which plays a pivotal role in osteoblast replication, function and survival. They transcriptionally stimulate expression of Wnt inhibitors of both the Dkk and Sfrp families, and they induce reactive oxygen species (ROS), which result in loss of ß-catenin to ROS-activated FoxO transcription factors. Identification of dissociated GCs, which would suppress the immune system without causing osteoporosis, is proving more challenging than initially thought, and GIO is currently managed by co-treatment with bisphosphonates or PTH. These drugs, however, are not ideally suited for GIO. Future therapeutic approaches may aim at GC targets such as those mentioned above, or newly identified targets including the Notch pathway, the AP-1/Il11 axis and the osteoblast master regulator RUNX2.
Collapse
Affiliation(s)
- Baruch Frenkel
- Department of Orthopaedic Surgery, Keck School of Medicine, Institute for Genetic Medicine, University of Southern California, 2250 Alcazar Street, CSC-240, Los Angeles, CA, 90033, USA,
| | | | | |
Collapse
|
219
|
Level of Adherence to Prophylactic Osteoporosis Medication amongst Patients with Polymyalgia Rheumatica and Giant Cell Arteritis: A Cross-Sectional Study. Int J Rheumatol 2015; 2015:783709. [PMID: 26491449 PMCID: PMC4603323 DOI: 10.1155/2015/783709] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 09/13/2015] [Indexed: 01/01/2023] Open
Abstract
Objective. To estimate level of adherence to oral calcium and vitamin D supplementation as well as bisphosphonate amongst patients with PMR and GCA treated with glucocorticoids. Method. A total of 138 patients with the diagnosis of PMR and/or GCA registered in our department in December 2013. In this cross-sectional study we interviewed all the patients to measure level of adherence to calcium and vitamin D, as well as bisphosphonates. Results. Out of the 118 included patients, 88.9% of them were adherent to their prescription. Only 2 patients (1.7%) did not take calcium and vitamin D at all and 10 patients (8.5%) took their medication infrequently, 9 and 1 out of 10 patients took the medication 50-100% of the time and less than 50% of the prescribed dose, respectively. Sixty-one patients received additional treatment with bisphosphonate and 96.6% were adherent to this therapy. The remaining 3.4% of the patients did not take the medication at all. Forgetfulness, adverse side effects, and lack of understanding of treatment benefits were the most significant causes for nonadherence to calcium and vitamin D. Conclusions. Contrary to what we expected this study found that adherence to osteoporosis preventive medication in patients with PMR and GCA was high.
Collapse
|
220
|
Kanis JA, Harvey NC, Johansson H, Odén A, Leslie WD, McCloskey EV. FRAX and fracture prediction without bone mineral density. Climacteric 2015; 18 Suppl 2:2-9. [PMID: 26489076 DOI: 10.3109/13697137.2015.1092342] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The major application of FRAX in osteoporosis is to direct pharmacological interventions to those at high risk of fracture. Whereas the efficacy of osteoporosis treatment, with the possible exception of alendronate, is largely independent of baseline bone mineral density (BMD), it remains a widely held perception that osteoporosis therapies are only effective in the presence of low BMD. Thus, the use of FRAX in the absence of BMD to identify individuals requiring therapy remains the subject of some debate and is the focus of this review. The clinical risk factors used in FRAX have high evidence-based validity to identify a risk responsive to intervention. The selection of high-risk individuals with FRAX, without knowledge of BMD, preferentially selects for low BMD and thus identifies a risk that is responsive to pharmacological intervention. The prediction of fractures with the use of clinical risk factors alone in FRAX is comparable to the use of BMD alone to predict fractures and is suitable, therefore, in the many countries where facilities for BMD testing are sparse. In countries where access to BMD is greater, FRAX can be used without BMD in the majority of cases and BMD tests reserved for those close to a probability-based intervention threshold. Thus concerns surrounding the use of FRAX in clinical practice without information on BMD are largely misplaced.
Collapse
Affiliation(s)
- J A Kanis
- a Centre for Metabolic Bone Diseases, University of Sheffield Medical School , UK
| | - N C Harvey
- b MRC Lifecourse Epidemiology Unit, University of Southampton , Southampton , UK
| | - H Johansson
- a Centre for Metabolic Bone Diseases, University of Sheffield Medical School , UK ;,c Centre for Bone and Arthritis Research, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden
| | - A Odén
- a Centre for Metabolic Bone Diseases, University of Sheffield Medical School , UK
| | - W D Leslie
- d University of Manitoba , Winnipeg , Canada
| | - E V McCloskey
- a Centre for Metabolic Bone Diseases, University of Sheffield Medical School , UK
| |
Collapse
|
221
|
Byreddy DV, Bouchonville MF, Lewiecki EM. Drug-induced osteoporosis: from Fuller Albright to aromatase inhibitors. Climacteric 2015; 18 Suppl 2:39-46. [PMID: 26488130 DOI: 10.3109/13697137.2015.1103615] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Many commonly prescribed medications, such as selective serotonin reuptake inhibitors, proton pump inhibitors, thiazolidinediones, aromatase inhibitors, and androgen deprivation therapy, have been associated with adverse skeletal effects. The levels of evidence in support of a causal relationship between drug use and the development of bone loss and fractures are variable. For some drugs, a causal relationship is suspected (but not proven) based on observational studies, while in others causality is firmly established with randomized, controlled clinical trials. The mechanism of action for skeletal damage is poorly understood for some drugs and well known for others. Guidelines for managing bone health in patients taking some medications with potential skeletal toxicity have been developed using the best available evidence and expert opinion. This is a review of selected medications that have been associated with bone loss and fractures, with recommendations for clinical care.
Collapse
Affiliation(s)
- D V Byreddy
- a Division of Endocrinology and Metabolism, Department of Internal Medicine , University of New Mexico , Albuquerque, Albuquerque , New Mexico
| | - M F Bouchonville
- a Division of Endocrinology and Metabolism, Department of Internal Medicine , University of New Mexico , Albuquerque, Albuquerque , New Mexico
| | - E M Lewiecki
- b New Mexico Clinical Research & Osteoporosis Center , University of New Mexico School of Medicine , Albuquerque , New Mexico , USA
| |
Collapse
|
222
|
Drampalos E, Nikolopoulos K, Baltas C, Balanika A, Galanos A, Papaioannou N, Pneumaticos S. Vertebral fracture assessment: Current research status and application in patients with kyphoplasty. World J Orthop 2015; 6:680-687. [PMID: 26495245 PMCID: PMC4610910 DOI: 10.5312/wjo.v6.i9.680] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 07/15/2015] [Accepted: 08/11/2015] [Indexed: 02/06/2023] Open
Abstract
Imaging of the spine is of paramount importance for the recognition of osteoporotic vertebral fractures (VFs), and standard radiography (SR) of the spine is the suggested diagnostic method but is not routinely used because of the cost and radiation exposure considerations. VF assessment (VFA) is an efficient, low radiation method for identifying VFs at the time of bone mineral density (BMD) measurement. Prediction models used to indicate the need for VFA may have little predictive power in subspecialty referral populations such as rheumatologic patients or patients who underwent kyphoplasty. Rheumatologic patients are frequently at increased risk for VFs, and VFA should be performed on an individual basis, also taking in account the guidelines for the general population. Kyphoplasty is a new minimal invasive procedure for the treatment of VFs and is being performed with increasing frequency. Following kyphoplasty, there may be a risk of new VFs in adjacent vertebrae. The assessment and follow-up of patients who underwent kyphoplasty requires repetitive X-ray imaging with the known limitations of SR. Thus, VFA may facilitate the evaluation of VFs in these patients because most of the kyphoplasty patients would fulfill the criteria. In a pilot study, we measured the BMD and performed VFA in 28 patients treated with kyphoplasty. Ratios of anterior to posterior (A/P) and middle to posterior (M/P) height were measured, and Genant’s method was used to classify vertebrae accordingly. Intraobserver and interobserver reliability for A/P, M/P and the Genant’s method were determined. Only 1 patient did not meet the criteria for VFA. Of the 364 available vertebrae, 295 could be analyzed. Most missing data (concerning 69 vertebrae) occurred in the upper thoracic region. Three of the 69 non-eligible vertebrae were lumbar vertebrae with cement leakage from the kyphoplasty procedure. In our hands, VFA was highly reproducible, demonstrating very good agreement in terms of intraobserver and interobserver reliability. Agreement was very good on the vertebral level, “vertebrae with kyphoplasty” level and “2 above and 1 below the kyphoplasty vertebrae” level. The application of Genant’s method to these patients also resulted in perfect agreement. We believe that the potential value of VFA in patients treated with kyphoplasty requires further evaluation, particularly comparing VFA with SR and performing a longitudinal follow-up. More research will help to adopt care processes that determine which patients require VFA and how often VFA should be performed, while also considering the impact of this technique on the cost of healthcare organizations.
Collapse
|
223
|
Ren H, Liang D, Jiang X, Tang J, Cui J, Wei Q, Zhang S, Yao Z, Shen G, Lin S. Variance of spinal osteoporosis induced by dexamethasone and methylprednisolone and its associated mechanism. Steroids 2015. [PMID: 26216207 DOI: 10.1016/j.steroids.2015.07.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Glucocorticoid (GC) administration is the most common cause of secondary osteoporosis. Previous studies investigated GCs dose and frequency correlated positively with the side effects of glucocorticoid on bone health, however the impaired effect of various types of GCs on bone has not yet been reported. PURPOSE The aim is to compare the effect of long-acting (dexamethasone) and relatively short-acting glucocorticoid (methylprednisolone) on rat lumbar spine and try to explore the associated mechanism. METHOD Sprague Dawley rats (N=48) were randomly divided into four groups: baseline group (BL), control group (CON), methylprednisolone group (MP) and dexamethasone group (DEXA). BL rats were euthanized to remain as baseline (M0) at the beginning of experiment. CON group were injected daily with vehicle, while the other groups were given a daily subcutaneous injection of 1mg/kg methylprednisolone and were given a subcutaneous injection of 0.6mg/kg dexamethasone per 3days, respectively. CON, MP and DEXA groups were monitored at 4th week (M1), 8th week (M2) and 12th week (M3) after intervention. Dual-energy X-ray, micro-computed tomography, compressive test, enzyme-linked immunosorbent assay have been used for bone mineral density, microarchitecture, biomechanical property of vertebrae and levels of estrogen, PINP and β-CTX, respectively. mRNA expression analysis of Biglycan, Col1a1, MMP9, Cathepsin K, Runx2, OPG, LRP5, Sclerostin were performed. RESULT We found that the bone mineral density (BMD) was significantly lower in DEXA rats at M3 compared with MP rats. The relative surface and trabecular number were significantly lower in DEXA group than that in MP group at M2, while trabecular separation was significantly higher in DEXA group than that in MP group at the same point. The compressive strength was significantly lower in L4 of DEXA than that in MP rats at M2 and M3. The levels of both PINP and estradiol in DEXA group were lower than MP group at M3, even though without statistical significance. The expression of bone formation marker Runx2 was significantly down-regulated at M3 in DEXA group compared with MP, CON and BL groups, while the expression of Col1a1 was significantly up-regulated and biglycan, LRP-5, OPG were significantly down-regulated in GCs intervention groups compared with CON and BL groups. There were no statistical differences in MMP9, Cathepsin K, Sclerostin among CON, MP and DEXA groups. CONCLUSION These results indicate that dexamethasone, the long-acting glucocorticoid, generates more serious osteoporosis of rat lumbar spine than methylprednisolone, which is relatively short-acting glucocorticoid. The discrepancy between the two GCs inducing osteoporosis may be mainly caused by a decrease in bone formation. RUNX2 and Col1a1 may be the two of critical genes inducing the discrepant impairment.
Collapse
Affiliation(s)
- Hui Ren
- The First School of Clinic Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510405, China.
| | - De Liang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Laboratory Affiliated to National Key Discipline of Orthopaedic and Traumatology of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510405, China.
| | - Xiaobing Jiang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Laboratory Affiliated to National Key Discipline of Orthopaedic and Traumatology of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510405, China.
| | - Jingjing Tang
- The First School of Clinic Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Jianchao Cui
- The First School of Clinic Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Qiushi Wei
- Laboratory Affiliated to National Key Discipline of Orthopaedic and Traumatology of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Postdoctoral Programme, General Hospital of Guangzhou Military Command of Chinese PLA, Guangzhou 510010, China
| | - Shuncong Zhang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Zhensong Yao
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Gengyang Shen
- The First School of Clinic Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Shunxin Lin
- The First School of Clinic Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| |
Collapse
|
224
|
Abstract
The principles of systemic glucocorticoid (GC) therapy in dermatology are reviewed. As a basis for an efficient GC therapy with few side effects the pharmacology, endogenous regulation as well as the mechanisms and side effects of GCs as well as their management are introduced. Modern therapeutic approaches such as circadian application and low-dose therapy are discussed as well as principles of tapering dosages and the most important indications for systemic GCs in dermatology.
Collapse
|
225
|
Ochi K, Furuya T, Ishibashi M, Watanabe M, Ikari K, Taniguchi A, Yamanaka H, Momohara S. Risk factors associated with the occurrence of proximal humerus fractures in patients with rheumatoid arthritis: a custom strategy for preventing proximal humerus fractures. Rheumatol Int 2015; 36:213-9. [DOI: 10.1007/s00296-015-3371-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 09/22/2015] [Indexed: 01/23/2023]
|
226
|
Abstract
PURPOSE OF REVIEW Many patients with psoriatic arthritis (PsA) have additional medical problems that can have an impact on morbidity and mortality. The goal of this review is to summarize the available evidence to date on the association of medical comorbidities with PsA and the implications these comorbidities have on prognosis, therapy selection and treatment response. RECENT FINDINGS Cardiovascular disease, metabolic syndrome, obesity, diabetes, fatty liver disease Crohn's disease, ophthalmic disease, depression and anxiety are common comorbidities associated with PsA. Additional comorbidities may include an elevated risk for malignancy and osteoporosis; however, fewer studies have addressed these issues and the data available are sometimes conflicting. SUMMARY All clinicians caring for patients with PsA should be aware of the relevant comorbidities affecting patients with PsA and should have an understanding of how these comorbidities affect management.
Collapse
|
227
|
D'Oronzo S, Stucci S, Tucci M, Silvestris F. Cancer treatment-induced bone loss (CTIBL): pathogenesis and clinical implications. Cancer Treat Rev 2015; 41:798-808. [PMID: 26410578 DOI: 10.1016/j.ctrv.2015.09.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 09/07/2015] [Accepted: 09/09/2015] [Indexed: 12/20/2022]
Abstract
Osteopenia and osteoporosis are often long-term complications of anti-neoplastic treatments, defined as "cancer treatment-induced bone loss" (CTIBL). This pathological condition in oncologic patients results in a higher fracture risk than in the general population, and so has a significant negative impact on their quality of life. Hormone treatment is the main actor in this scenario, but not the only one. In fact, chemotherapies, radiotherapy and tyrosine kinase inhibitors may contribute to deregulate bone remodeling via different mechanisms. Thus, the identification of cancer patients at risk for CTIBL is essential for early diagnosis and appropriate intervention, that includes both lifestyle modifications and pharmacological approaches to prevent bone metabolism failure during anti-tumor treatments.
Collapse
Affiliation(s)
- S D'Oronzo
- University of Bari "Aldo Moro", Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, Piazza Giulio Cesare, 11, 70124 Bari, Italy.
| | - S Stucci
- University of Bari "Aldo Moro", Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, Piazza Giulio Cesare, 11, 70124 Bari, Italy.
| | - M Tucci
- University of Bari "Aldo Moro", Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, Piazza Giulio Cesare, 11, 70124 Bari, Italy.
| | - F Silvestris
- University of Bari "Aldo Moro", Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, Piazza Giulio Cesare, 11, 70124 Bari, Italy.
| |
Collapse
|
228
|
Weinerman S, Usera GL. Indications and Outcomes of Osteoporosis and Bone Modulation Therapies. Oral Maxillofac Surg Clin North Am 2015; 27:567-71. [PMID: 26363939 DOI: 10.1016/j.coms.2015.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Osteoporosis is a disorder of bone strength that leads to an increased risk of fractures. It is most commonly seen in patients aged 50 or older, although it can sometimes occur at a younger age if there are other comorbidities present. The most common cause of osteoporosis by far is menopause, although it also occurs in men, usually with higher morbidity rates than those seen in women. There are many treatment options available, such as anabolics and antiresorptives, with many more currently being developed. However, osteoporosis remains grossly unrecognized and untreated, resulting in a significant strain on the American economy.
Collapse
Affiliation(s)
- Stuart Weinerman
- Division of Endocrinology, Diabetes and Metabolism, Hofstra North Shore-LIJ School of Medicine, 865 Northern Boulevard, Suite 203, Great Neck, NY 11021, USA.
| | - Gianina L Usera
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Hofstra North Shore-LIJ School of Medicine, 865 Northern Boulevard, Suite 203, Great Neck, NY 11021, USA
| |
Collapse
|
229
|
Lahousse L, Ziere G, Verlinden VJA, Zillikens MC, Uitterlinden AG, Rivadeneira F, Tiemeier H, Joos GF, Hofman A, Ikram MA, Franco OH, Brusselle GG, Stricker BH. Risk of Frailty in Elderly With COPD: A Population-Based Study. J Gerontol A Biol Sci Med Sci 2015; 71:689-95. [PMID: 26355016 DOI: 10.1093/gerona/glv154] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 08/12/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Despite frailty being an important geriatric syndrome, its prevalence and associated mortality risk in older patients with chronic obstructive pulmonary disease (COPD) are unknown. METHODS We examined the relationship between COPD confirmed by spirometry, COPD severity, and frailty defined by the Fried criteria within 2,142 participants (aged 74.7 ± 5.6 years) of the Rotterdam Study, a prospective population-based cohort study. RESULTS The frailty prevalence was significantly higher (p < .001) in participants with COPD (10.2%, 95% CI: 7.6%-13.5%) compared with participants without COPD (3.4%, 95% CI: 2.6%-4.4%). Adjusted for age, sex, smoking, corticosteroids, and other confounders, participants with COPD had a more than twofold increased prevalence of frailty (odds ratio 2.2, 95% CI: 1.34-3.54, p = .002). The prevalence was highest when severe airflow limitation, dyspnea, and frequent exacerbations were present. Participants with mild airflow limitation were more frequently prefrail. COPD elderly who were frail had significant worse survival. CONCLUSIONS This population-based cohort study in elderly demonstrates that COPD is associated with frailty even after adjusting for shared risk factors. Our findings suggest that frailty-in addition to COPD severity and comorbidities-identifies those COPD participants at high risk of mortality.
Collapse
Affiliation(s)
- Lies Lahousse
- Department of Respiratory Medicine, Ghent University and Ghent University Hospital, De Pintelaan, Belgium. Departments of Epidemiology
| | | | | | - M Carola Zillikens
- Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands. Netherlands Consortium on Healthy Aging (NCHA), Leiden, The Netherlands
| | - André G Uitterlinden
- Departments of Epidemiology, Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands. Netherlands Consortium on Healthy Aging (NCHA), Leiden, The Netherlands
| | - Fernando Rivadeneira
- Departments of Epidemiology, Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands. Netherlands Consortium on Healthy Aging (NCHA), Leiden, The Netherlands
| | - Henning Tiemeier
- Departments of Epidemiology, Netherlands Consortium on Healthy Aging (NCHA), Leiden, The Netherlands
| | - Guy F Joos
- Department of Respiratory Medicine, Ghent University and Ghent University Hospital, De Pintelaan, Belgium
| | - Albert Hofman
- Departments of Epidemiology, Netherlands Consortium on Healthy Aging (NCHA), Leiden, The Netherlands
| | - M Arfan Ikram
- Departments of Epidemiology, Radiology, and Netherlands Consortium on Healthy Aging (NCHA), Leiden, The Netherlands. Departments of Neurology and
| | - Oscar H Franco
- Departments of Epidemiology, Netherlands Consortium on Healthy Aging (NCHA), Leiden, The Netherlands
| | - Guy G Brusselle
- Department of Respiratory Medicine, Ghent University and Ghent University Hospital, De Pintelaan, Belgium. Departments of Epidemiology, Respiratory Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bruno H Stricker
- Departments of Epidemiology, Netherlands Consortium on Healthy Aging (NCHA), Leiden, The Netherlands. Inspectorate of Healthcare, The Hague, The Netherlands.
| |
Collapse
|
230
|
Dejaco C, Singh YP, Perel P, Hutchings A, Camellino D, Mackie S, Abril A, Bachta A, Balint P, Barraclough K, Bianconi L, Buttgereit F, Carsons S, Ching D, Cid M, Cimmino M, Diamantopoulos A, Docken W, Duftner C, Fashanu B, Gilbert K, Hildreth P, Hollywood J, Jayne D, Lima M, Maharaj A, Mallen C, Martinez-Taboada V, Maz M, Merry S, Miller J, Mori S, Neill L, Nordborg E, Nott J, Padbury H, Pease C, Salvarani C, Schirmer M, Schmidt W, Spiera R, Tronnier D, Wagner A, Whitlock M, Matteson EL, Dasgupta B. 2015 Recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Ann Rheum Dis 2015; 74:1799-807. [DOI: 10.1136/annrheumdis-2015-207492] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
231
|
Abstract
Epidemiologic studies have shown that, in patients with psoriatic arthritis (PsA), associated comorbidities may occur more frequently than expected. This article discusses related comorbidities in patients with PsA. Identifying these comorbidities may affect the management and treatment decisions for these patients to ensure an optimal clinical outcome. All health care providers caring for patients with PsA should be aware of the relevant comorbidities and should have an understanding of how these comorbidities affect management. The common comorbidities include cardiovascular disease, metabolic syndrome, obesity, diabetes, fatty liver disease, inflammatory bowel disease, ophthalmic disease, kidney disease, osteoporosis, depression, and anxiety.
Collapse
|
232
|
Mirza F, Canalis E. Management of endocrine disease: Secondary osteoporosis: pathophysiology and management. Eur J Endocrinol 2015; 173:R131-51. [PMID: 25971649 PMCID: PMC4534332 DOI: 10.1530/eje-15-0118] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 05/12/2015] [Indexed: 12/14/2022]
Abstract
Osteoporosis is a skeletal disorder characterized by decreased mass and compromised bone strength predisposing to an increased risk of fractures. Although idiopathic osteoporosis is the most common form of osteoporosis, secondary factors may contribute to the bone loss and increased fracture risk in patients presenting with fragility fractures or osteoporosis. Several medical conditions and medications significantly increase the risk for bone loss and skeletal fragility. This review focuses on some of the common causes of osteoporosis, addressing the underlying mechanisms, diagnostic approach and treatment of low bone mass in the presence of these conditions.
Collapse
Affiliation(s)
- Faryal Mirza
- Division of Endocrinology and MetabolismDepartments of MedicineOrthopaedic SurgeryUConn Musculoskeletal Institute, UConn Health, 263 Farmington Avenue, Farmington, Connecticut 06030-5456, USA
| | - Ernesto Canalis
- Division of Endocrinology and MetabolismDepartments of MedicineOrthopaedic SurgeryUConn Musculoskeletal Institute, UConn Health, 263 Farmington Avenue, Farmington, Connecticut 06030-5456, USA Division of Endocrinology and MetabolismDepartments of MedicineOrthopaedic SurgeryUConn Musculoskeletal Institute, UConn Health, 263 Farmington Avenue, Farmington, Connecticut 06030-5456, USA
| |
Collapse
|
233
|
Abstract
This article examines the current knowledge of the effects of both exogenous and endogenous glucocorticoids on bone and muscle. It demonstrates the similarity of effects of supraphysiologic loads of glucocorticoids regardless of whether they enter the body in the form of medication or are manufactured by the body in response to stimuli such as inflammation. The effects of endogenous glucocorticoids and the systemic inflammatory response resulting from pediatric burn injury are compared and the difficulty in sorting out which of the two factors is responsible for the ultimate effects on bone and muscle is pointed out. The focus then switches to the body's response to the influence of both glucocorticoids and inflammatory cytokines and evidence supporting a common pathway of response to oxidative damage caused by both is discussed. Current recommended medical management of glucocorticoid-induced bone and muscle loss is discussed and the failure to reconcile current management with known mechanisms is highlighted.
Collapse
|
234
|
Abstract
Obstructive lung disease includes asthma and chronic obstructive pulmonary disease (COPD). Because a previous issue of Medical Clinics of North America (2012;96[4]) was devoted to COPD, this article focuses on asthma in adults, and addresses some topics about COPD not addressed previously. Asthma is a heterogeneous disease marked by variable airflow obstruction and bronchial hyperreactivity. Onset is most common in early childhood, although many people develop asthma later in life. Adult-onset asthma presents a particular challenge in the primary care clinic because of incomplete understanding of the disorder, underreporting of symptoms, underdiagnosis, inadequate treatment, and high rate of comorbidity.
Collapse
Affiliation(s)
- Michael J Lenaeus
- Department of General Internal Medicine, University of Washington Medical Center, 1959 Northeast Pacific Street, Box 356429, Seattle, WA 98195-6429, USA.
| | - Jan Hirschmann
- Department of General Internal Medicine, Puget Sound VA Medical Center, University of Washington School of Medicine, 1660 South Columbian Way, Seattle, WA 98108, USA
| |
Collapse
|
235
|
Goldilocks, vitamin D and sarcoidosis. Arthritis Res Ther 2015; 16:111. [PMID: 25166268 PMCID: PMC4060200 DOI: 10.1186/ar4568] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 05/14/2014] [Indexed: 01/30/2023] Open
Abstract
While low levels of vitamin D can increase the risk for osteoporosis, excessive amounts of vitamin D may also be problematic. Hypercalcemia and hypercalcuria due to increased vitamin D activity occur in a significant proportion of sarcoidosis patients. Saidenberg-Kermanac’h and colleagues compared vitamin D levels with bone fragility fractures in their sarcoidosis clinic. They found that a 25-(OH) vitamin D level between 10 and 20 ng/ml was associated with the lowest risk of bone fractures and paradoxically higher levels increased the risk of bone fractures. Using less vitamin D supplementation may simultaneously lower the risk for bone fracture and hypercalcemia in sarcoidosis.
Collapse
|
236
|
Jiang Y, Fu Y, Xing XP, Li M, Wang O, Xia WB, Meng XW. Zoledronic acid-induced hepatotoxicity relieved after subsequent infusions in a Chinese woman with glucocorticoid-induced osteoporosis. Eur J Med Res 2015; 20:68. [PMID: 26297149 PMCID: PMC4546306 DOI: 10.1186/s40001-015-0161-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 08/11/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Zoledronic acid (ZOL) is widely used for treatment of glucocorticoid-induced osteoporosis. The most common adverse effects of ZOL treatment are post-dose symptoms. ZOL-induced hepatotoxicity has very rarely been reported. CASE REPORT Here, we described a 50-year-old Chinese woman who had vertebral fractures and severe back pain after glucocorticoid therapy for Behcet disease for 13 years. Three days after ZOL 5 mg infusion in April 2012, serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyltransferase (GGT) levels increased by 7.7, 4.9 and 3.0 times, respectively, compared with pre-treatment values. Liver protective agents were administered per os. Her hepatic enzyme levels returned to nearly normal range 9 days post-infusion. In the subsequent ZOL infusion with 1 year interval, serum ALT, AST and GGT levels increased slightly after the second infusion and were sustained to be normal after the third infusion. Her post-dose symptoms alleviated in the meantime. CONCLUSIONS Hepatotoxicity due to ZOL therapy is a rare, but possible adverse effect which may be relieved after subsequent infusions.
Collapse
Affiliation(s)
- Yan Jiang
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 100730, Beijing, China
| | - Yong Fu
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 100730, Beijing, China
| | - Xiao-ping Xing
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 100730, Beijing, China
| | - Mei Li
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 100730, Beijing, China
| | - Ou Wang
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 100730, Beijing, China
| | - Wei-bo Xia
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 100730, Beijing, China.
| | - Xun-wu Meng
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 100730, Beijing, China
| |
Collapse
|
237
|
Mérida S, Palacios E, Navea A, Bosch-Morell F. New Immunosuppressive Therapies in Uveitis Treatment. Int J Mol Sci 2015; 16:18778-95. [PMID: 26270662 PMCID: PMC4581271 DOI: 10.3390/ijms160818778] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/03/2015] [Accepted: 08/06/2015] [Indexed: 12/14/2022] Open
Abstract
Uveitis is an inflammatory process that initially starts in the uvea, but can also affect other adjacent eye structures, and is currently the fourth cause of blindness in developed countries. Corticoids are probably the most widespread treatment, but resorting to other immunosuppressive treatments is a frequent practice. Since the implication of different cytokines in uveitis has been well demonstrated, the majority of recent treatments for this disease include inhibitors or antibodies against these. Nevertheless, adequate treatment for each uveitis type entails a difficult therapeutic decision as no clear recommendations are found in the literature, despite the few protocolized clinical assays and many case-control studies done. This review aims to present, in order, the mechanisms and main indications of the most modern immunosuppressive drugs against cytokines.
Collapse
Affiliation(s)
- Salvador Mérida
- Instituto de Ciencias Biomédicas, Universidad CEU Cardenal Herrera, Valencia 46113, Spain.
| | - Elena Palacios
- Oftalmología Médica, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, Valencia 46020, Spain.
| | - Amparo Navea
- Instituto de Ciencias Biomédicas, Universidad CEU Cardenal Herrera, Valencia 46113, Spain.
- Oftalmología Médica, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, Valencia 46020, Spain.
| | - Francisco Bosch-Morell
- Instituto de Ciencias Biomédicas, Universidad CEU Cardenal Herrera, Valencia 46113, Spain.
- Oftalmología Médica, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, Valencia 46020, Spain.
| |
Collapse
|
238
|
Wen L, Kang JH, Yim YR, Lee JW, Lee KE, Park DJ, Kim TJ, Park YW, Lee SS. Risk factors for treatment failure in osteoporotic patients with rheumatoid arthritis. Mod Rheumatol 2015; 26:194-9. [PMID: 26140470 DOI: 10.3109/14397595.2015.1069444] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Lihui Wen
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Ji-Hyoun Kang
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Yi-Rang Yim
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Jeong-Won Lee
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Kyung-Eun Lee
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Dong-Jin Park
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Tae-Jong Kim
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Yong-Wook Park
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Shin-Seok Lee
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| |
Collapse
|
239
|
Rossini M, Orsolini G, Viapiana O, Adami S, Gatti D. Bisphosphonates in the treatment of glucocorticoid-induced osteoporosis: pros. Endocrine 2015; 49:620-7. [PMID: 25649760 DOI: 10.1007/s12020-014-0506-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 12/05/2014] [Indexed: 12/12/2022]
Abstract
In glucocorticoid-induced osteoporosis (GIO), both bone formation and resorption are altered, however, with a relative prevalence of resorption, consistent with the positive results that have been reported with bisphosphonate treatment. Many studies have investigated the effect of bisphosphonates (BPs), a widely used class of anti-resorptive drugs, showing a positive effect on bone mineral density and fracture risk. Also in case of postmenopausal osteoporosis, the safety and cost-effectiveness profile of BPs in GIO appears good. Currently, the use of BPs is recommended at the earliest by all major scientific societies in postmenopausal women and men ≥50 years at high risk of fracture receiving glucocorticoid therapy. BPs are the most commonly used anti-osteoporotic agents and they remain the current standard of care for GIO.
Collapse
Affiliation(s)
- Maurizio Rossini
- Rheumatology Section, Department of Medicine, University of Verona, Verona, Italy,
| | | | | | | | | |
Collapse
|
240
|
Lin CW, Chen YY, Chen YJ, Liang CY, Lin MS, Chen W. Prevalence, risk factors, and health-related quality of life of osteoporosis in patients with COPD at a community hospital in Taiwan. Int J Chron Obstruct Pulmon Dis 2015; 10:1493-500. [PMID: 26251589 PMCID: PMC4524376 DOI: 10.2147/copd.s85432] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Data regarding osteoporosis in COPD patients in Taiwan remain limited. The primary end point of this study was to evaluate the prevalence and risk factors of osteoporosis in COPD patients in Taiwan. The secondary end point was to examine the association between osteoporosis and health-related quality of life (HRQL) in COPD patients. Materials and methods This prospective cross-sectional study enrolled 125 COPD patients (mean age 73.6 years, forced expiratory volume in 1 second [FEV1] 1.19±0.43 L) who had bone mineral-density measurements performed consecutively. Demographic data, lung function, and HRQL including modified Medical Research Council dyspnea scale, St George’s Respiratory Questionnaire, oxygen-cost diagram, Center for Epidemiologic Studies – depression scale, and COPD Assessment Test scores were recorded. Results A total of 50 (40%) participants were diagnosed as having osteoporosis. In a multivariate logistic regression model including age, smoking amount (pack-year), body mass index (BMI), and FEV1, only BMI (odds ratio 0.824, 95% confidence interval 0.73–0.93; P=0.002) and FEV1 (odds ratio 0.360, 95% confidence interval 0.13–0.98; P=0.046) were negatively associated with an increased risk of osteoporosis in COPD patients. In addition, COPD patients with osteoporosis had significantly higher modified Medical Research Council dyspnea scale scores (1.7±0.8 vs 1.4±0.8, P=0.046), St George’s Respiratory Questionnaire scores (36.6 vs 28.0, P=0.01), and COPD Assessment Test scores (14.7±8 vs 11.5±7, P=0.019), and lower oxygen-cost diagram score (4.8±1.8 vs 5.4±1.6, P=0.045) than patients without osteoporosis. Conclusion The prevalence of osteoporosis in COPD patients was high at a community hospital in Taiwan. BMI and FEV1 were the independent risk factors for osteoporosis in COPD. In addition, COPD patients with osteoporosis had worse HRQL than those without osteoporosis.
Collapse
Affiliation(s)
- Chun-Wei Lin
- Division of Pulmonary and Critical Care Medicine, Chia-Yi Christian Hospital, Chia-Yim, Taiwan ; Division of Chest, Division of Pulmonary Medicine, Kuang Tien General Hospital, Taichung, Taiwan
| | - Yih-Yuan Chen
- Department of Internal Medicine, Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Yi-Jen Chen
- Division of Pulmonary and Critical Care Medicine, Chia-Yi Christian Hospital, Chia-Yim, Taiwan ; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Chi-Yen Liang
- Division of Pulmonary and Critical Care Medicine, Chia-Yi Christian Hospital, Chia-Yim, Taiwan
| | - Ming-Shian Lin
- Division of Pulmonary and Critical Care Medicine, Chia-Yi Christian Hospital, Chia-Yim, Taiwan ; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Wei Chen
- Division of Pulmonary and Critical Care Medicine, Chia-Yi Christian Hospital, Chia-Yim, Taiwan ; College of Nursing, Dayeh University, Taichung, Taiwan ; Department of Respiratory Therapy, China Medical University, Taichung, Taiwan
| |
Collapse
|
241
|
Abstract
BACKGROUND Alterations in bone mineral metabolism occur when kidney function declines and often continue after transplantation. We investigated long-term changes in bone mineral density (BMD) among kidney transplant recipients undergoing routine clinical BMD monitoring and management. METHODS We identified adults receiving a kidney transplant in the province of Manitoba, Canada (1996-2011) who had greater than or equal to 2 posttransplant dual energy X-ray absorptiometry examinations. Bone mineral density was expressed as Z scores (standard deviation above/below sex-matched and age-matched reference data). The main outcome was the change in BMD. RESULTS A total of 326 kidney transplant recipients were included (mean age, 45 years; 61% men). Recipients were followed up for an average of 8.2 years (766 follow-up dual energy X-ray absorptiometry measurements). At baseline (first scan; median, 0.5 years after transplantation), bone density was slightly below average for age and sex (mean Z scores: lumbar spine, -0.4 ± 1.6; femoral neck, -0.7 ± 1.1; total hip, -0.7 ± 1.1). At the second scan (mean, 2.7 years after first scan), mean bone density Z scores have increased (lumbar spine, -0.2 ± 1.6; femoral neck, -0.6 ± 1; total hip, -0.6 ± 1.1; matched, P < 0.01 at all sites). The only factor associated with a significant BMD change at all sites was osteoporosis treatment (BMD increase). Even after restricting the analysis to recipients who had not received osteoporosis treatment, final mean bone density (mean, 8.2 years after first scan) was average for age and sex (lumbar spine, +0.7 ± 1.6; femoral neck, -0.1 ± 1.1; total hip, 0.0 ± 1.1). CONCLUSION With routine BMD monitoring and management, posttransplant bone density typically remains stable or improves with mean values that are average for age and sex.
Collapse
|
242
|
2014 update of recommendations on the prevention and treatment of glucocorticoid-induced osteoporosis. Joint Bone Spine 2015; 81:493-501. [PMID: 25455041 DOI: 10.1016/j.jbspin.2014.10.001] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2014] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To update the recommendations on the prevention and treatment of glucocorticoid-induced osteoporosis issued in 2003 by the French National Authority for Health (HAS). This update was performed under the aegis of the Bone Section of the French Society for Rheumatology (SFR) and Osteoporosis Research and Information Group (GRIO), in collaboration with four French learned societies (primary-care, gastroenterology, internal medicine, and nephrology). METHODS A task force composed of members of the medical specialties involved in managing patients with glucocorticoid-induced osteoporosis conducted a systematic literature review according to the method developed by the HAS then used the results to develop updated recommendations. RESULTS These recommendations are intended for all physicians involved in the management of patients who are scheduled to start, or are taking, long-term glucocorticoid therapy (≥ 3 months) in any dose and for any reason. In postmenopausal women and men older than 50 years of age, treatment is warranted in the presence of any of the following risk factors for fracture: history of bone frailty fracture after 50 years of age, bone mineral density T-score ≤ −2.5 at one or more sites, age ≥ 70 years, and dosage ≥ 7.5 mg/d prednisone-equivalent for longer than 3 months. Bisphosphonates can be used in all these situations; teriparatide can be given as first-line therapy in patients at high fracture risk but is reimbursed by the French statutory health insurance system only in patients having two or more prevalent vertebral fractures. The fracture risk is lower in non-menopausal women and in men younger than 50 years of age,in whom treatment decisions should rest on a case-by-case evaluation. CONCLUSION These recommendations are intended to clarify the pharmacological management of glucocorticoid-induced osteoporosis.
Collapse
|
243
|
Warriner AH, Outman RC, Allison JJ, Curtis JR, Markward NJ, Redden DT, Safford MM, Stanek EJ, Steinkellner AR, Saag KG. An Internet-based Controlled Trial Aimed to Improve Osteoporosis Prevention among Chronic Glucocorticoid Users. J Rheumatol 2015; 42:1478-83. [PMID: 26136484 DOI: 10.3899/jrheum.141238] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2015] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To address the low prevention and treatment rates for those at risk of glucocorticoid-induced osteoporosis (GIOP), we evaluated the influence of a direct-to-patient, Internet-based educational video intervention using "storytelling" on rates of antiosteoporosis medication use among chronic glucocorticoid users who were members of an online pharmacy refill service. METHODS We identified members who refilled ≥ 5 mg/day of prednisone (or equivalent) for 90 contiguous days and had no GIOP therapy for ≥ 12 months. Using patient stories, we developed an online video addressing risk factors and treatment options, and delivered it to members refilling a glucocorticoid prescription. The intervention consisted of two 45-day "Video ON" periods, during which the video automatically appeared at the time of refill, and two 45-day "Video OFF" periods, during which there was no video. Members could also "self-initiate" watching the video by going to the video link. We used an interrupted time series design to evaluate the effectiveness of this intervention on GIOP prescription therapies over 6 months. RESULTS Among 3017 members (64.8%) exposed to the intervention, 59% had measurable video viewing time, of which 3% "self-initiated" the video. The GIOP prescription rate in the "Video ON" group was 2.9% versus 2.7% for the "Video OFF" group. There was a nonsignificant trend toward greater GIOP prescription in members who self-initiated the video versus automated viewing (5.7% vs 2.9%, p = 0.1). CONCLUSION Among adults at high risk of GIOP, prescription rates were not significantly affected by an online educational video presented at the time of glucocorticoid refill. ClinicalTrials.gov Identifier: NCT01378689.
Collapse
Affiliation(s)
- Amy H Warriner
- From the Division of Endocrinology, Diabetes and Metabolism, and Division of Clinical Immunology and Rheumatology, and Department of Biostatistics, and Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Express Scripts, St. Louis, Missouri; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Real Endpoints LLC, Westport, Connecticut, USA.A.H. Warriner, MD, Division of Endocrinology, Diabetes and Metabolism; R.C. Outman, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; J.J. Allison, MD, MS, Department of Quantitative Health Sciences, University of Massachusetts Medical School; J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; N.J. Markward, PhD, Express Scripts; D.T. Redden, PhD, Department of Biostatistics; M.M. Safford, MD, Division of Preventive Medicine, University of Alabama at Birmingham; E.J. Stanek, PharmD, Novartis Pharmaceuticals Corporation; A.R. Steinkellner, PharmD, Express Scripts* and Real Endpoints LLC; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham
| | - Ryan C Outman
- From the Division of Endocrinology, Diabetes and Metabolism, and Division of Clinical Immunology and Rheumatology, and Department of Biostatistics, and Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Express Scripts, St. Louis, Missouri; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Real Endpoints LLC, Westport, Connecticut, USA.A.H. Warriner, MD, Division of Endocrinology, Diabetes and Metabolism; R.C. Outman, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; J.J. Allison, MD, MS, Department of Quantitative Health Sciences, University of Massachusetts Medical School; J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; N.J. Markward, PhD, Express Scripts; D.T. Redden, PhD, Department of Biostatistics; M.M. Safford, MD, Division of Preventive Medicine, University of Alabama at Birmingham; E.J. Stanek, PharmD, Novartis Pharmaceuticals Corporation; A.R. Steinkellner, PharmD, Express Scripts* and Real Endpoints LLC; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham
| | - Jeroan J Allison
- From the Division of Endocrinology, Diabetes and Metabolism, and Division of Clinical Immunology and Rheumatology, and Department of Biostatistics, and Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Express Scripts, St. Louis, Missouri; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Real Endpoints LLC, Westport, Connecticut, USA.A.H. Warriner, MD, Division of Endocrinology, Diabetes and Metabolism; R.C. Outman, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; J.J. Allison, MD, MS, Department of Quantitative Health Sciences, University of Massachusetts Medical School; J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; N.J. Markward, PhD, Express Scripts; D.T. Redden, PhD, Department of Biostatistics; M.M. Safford, MD, Division of Preventive Medicine, University of Alabama at Birmingham; E.J. Stanek, PharmD, Novartis Pharmaceuticals Corporation; A.R. Steinkellner, PharmD, Express Scripts* and Real Endpoints LLC; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham
| | - Jeffrey R Curtis
- From the Division of Endocrinology, Diabetes and Metabolism, and Division of Clinical Immunology and Rheumatology, and Department of Biostatistics, and Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Express Scripts, St. Louis, Missouri; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Real Endpoints LLC, Westport, Connecticut, USA.A.H. Warriner, MD, Division of Endocrinology, Diabetes and Metabolism; R.C. Outman, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; J.J. Allison, MD, MS, Department of Quantitative Health Sciences, University of Massachusetts Medical School; J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; N.J. Markward, PhD, Express Scripts; D.T. Redden, PhD, Department of Biostatistics; M.M. Safford, MD, Division of Preventive Medicine, University of Alabama at Birmingham; E.J. Stanek, PharmD, Novartis Pharmaceuticals Corporation; A.R. Steinkellner, PharmD, Express Scripts* and Real Endpoints LLC; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham
| | - Nathan J Markward
- From the Division of Endocrinology, Diabetes and Metabolism, and Division of Clinical Immunology and Rheumatology, and Department of Biostatistics, and Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Express Scripts, St. Louis, Missouri; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Real Endpoints LLC, Westport, Connecticut, USA.A.H. Warriner, MD, Division of Endocrinology, Diabetes and Metabolism; R.C. Outman, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; J.J. Allison, MD, MS, Department of Quantitative Health Sciences, University of Massachusetts Medical School; J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; N.J. Markward, PhD, Express Scripts; D.T. Redden, PhD, Department of Biostatistics; M.M. Safford, MD, Division of Preventive Medicine, University of Alabama at Birmingham; E.J. Stanek, PharmD, Novartis Pharmaceuticals Corporation; A.R. Steinkellner, PharmD, Express Scripts* and Real Endpoints LLC; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham
| | - David T Redden
- From the Division of Endocrinology, Diabetes and Metabolism, and Division of Clinical Immunology and Rheumatology, and Department of Biostatistics, and Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Express Scripts, St. Louis, Missouri; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Real Endpoints LLC, Westport, Connecticut, USA.A.H. Warriner, MD, Division of Endocrinology, Diabetes and Metabolism; R.C. Outman, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; J.J. Allison, MD, MS, Department of Quantitative Health Sciences, University of Massachusetts Medical School; J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; N.J. Markward, PhD, Express Scripts; D.T. Redden, PhD, Department of Biostatistics; M.M. Safford, MD, Division of Preventive Medicine, University of Alabama at Birmingham; E.J. Stanek, PharmD, Novartis Pharmaceuticals Corporation; A.R. Steinkellner, PharmD, Express Scripts* and Real Endpoints LLC; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham
| | - Monika M Safford
- From the Division of Endocrinology, Diabetes and Metabolism, and Division of Clinical Immunology and Rheumatology, and Department of Biostatistics, and Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Express Scripts, St. Louis, Missouri; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Real Endpoints LLC, Westport, Connecticut, USA.A.H. Warriner, MD, Division of Endocrinology, Diabetes and Metabolism; R.C. Outman, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; J.J. Allison, MD, MS, Department of Quantitative Health Sciences, University of Massachusetts Medical School; J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; N.J. Markward, PhD, Express Scripts; D.T. Redden, PhD, Department of Biostatistics; M.M. Safford, MD, Division of Preventive Medicine, University of Alabama at Birmingham; E.J. Stanek, PharmD, Novartis Pharmaceuticals Corporation; A.R. Steinkellner, PharmD, Express Scripts* and Real Endpoints LLC; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham
| | - Eric J Stanek
- From the Division of Endocrinology, Diabetes and Metabolism, and Division of Clinical Immunology and Rheumatology, and Department of Biostatistics, and Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Express Scripts, St. Louis, Missouri; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Real Endpoints LLC, Westport, Connecticut, USA.A.H. Warriner, MD, Division of Endocrinology, Diabetes and Metabolism; R.C. Outman, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; J.J. Allison, MD, MS, Department of Quantitative Health Sciences, University of Massachusetts Medical School; J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; N.J. Markward, PhD, Express Scripts; D.T. Redden, PhD, Department of Biostatistics; M.M. Safford, MD, Division of Preventive Medicine, University of Alabama at Birmingham; E.J. Stanek, PharmD, Novartis Pharmaceuticals Corporation; A.R. Steinkellner, PharmD, Express Scripts* and Real Endpoints LLC; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham
| | - Amy R Steinkellner
- From the Division of Endocrinology, Diabetes and Metabolism, and Division of Clinical Immunology and Rheumatology, and Department of Biostatistics, and Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Express Scripts, St. Louis, Missouri; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Real Endpoints LLC, Westport, Connecticut, USA.A.H. Warriner, MD, Division of Endocrinology, Diabetes and Metabolism; R.C. Outman, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; J.J. Allison, MD, MS, Department of Quantitative Health Sciences, University of Massachusetts Medical School; J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; N.J. Markward, PhD, Express Scripts; D.T. Redden, PhD, Department of Biostatistics; M.M. Safford, MD, Division of Preventive Medicine, University of Alabama at Birmingham; E.J. Stanek, PharmD, Novartis Pharmaceuticals Corporation; A.R. Steinkellner, PharmD, Express Scripts* and Real Endpoints LLC; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham
| | - Kenneth G Saag
- From the Division of Endocrinology, Diabetes and Metabolism, and Division of Clinical Immunology and Rheumatology, and Department of Biostatistics, and Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Express Scripts, St. Louis, Missouri; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Real Endpoints LLC, Westport, Connecticut, USA.A.H. Warriner, MD, Division of Endocrinology, Diabetes and Metabolism; R.C. Outman, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; J.J. Allison, MD, MS, Department of Quantitative Health Sciences, University of Massachusetts Medical School; J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; N.J. Markward, PhD, Express Scripts; D.T. Redden, PhD, Department of Biostatistics; M.M. Safford, MD, Division of Preventive Medicine, University of Alabama at Birmingham; E.J. Stanek, PharmD, Novartis Pharmaceuticals Corporation; A.R. Steinkellner, PharmD, Express Scripts* and Real Endpoints LLC; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham.
| |
Collapse
|
244
|
Polat SB, Evranos B, Aydin C, Cuhaci N, Ersoy R, Cakir B. Effective treatment of severe pregnancy and lactation-related osteoporosis with teriparatide: case report and review of the literature. Gynecol Endocrinol 2015; 31:522-5. [PMID: 25893268 DOI: 10.3109/09513590.2015.1014787] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Pregnancy or lactation-related osteoporosis (PLO) is a very rare and debilitating condition which is usually diagnosed during the last trimester of the pregnancy or early postpartum period. Herein, we report a case with severe PLO and multiple vertebral compression fractures that were successfully treated with teriparatide. Twenty-three-year-old female patient was admitted to our clinic two months after her first spontaneous vaginal delivery with the complaint of severe back pain. Bone mineral density was measured using dual energy X-ray absorptiometry (DEXA), and low T- and Z-scores were observed in lumbar vertebrae. In vertebral MRI, severe height loss was detected in thoracic (T) 5,7,10,11,12 vertebrae. After exclusion of the other possible causes of OP, she was diagnosed to have PLO and the lactation was stopped. She was treated with calcium 1000 mg/day, cholecalciferol 800 mg/day and teriparatide 20 µg/day. At the 12th and 18th month of therapy, BMD was increased by 8% and 27%, respectively, at the lumbar spine and pain was completely relieved in few months. There are pharmacological therapy modalities that can be used in PLO. Bisphosphonates are effective, but there are some concerns that they accumulate in bone and may expose fetus in subsequent pregnancies. Teriparatide is a strong candidate to be the optimal medical therapy in severe cases since it is effective and safe.
Collapse
Affiliation(s)
- Sefika Burcak Polat
- a Department of Endocrinology and Metabolism, Faculty of Medicine, Ankara , Yildrim Beyazit University , Turkey
| | | | | | | | | | | |
Collapse
|
245
|
Makras P, Athanasakis K, Boubouchairopoulou N, Rizou S, Anastasilakis AD, Kyriopoulos J, Lyritis GP. Cost-effective osteoporosis treatment thresholds in Greece. Osteoporos Int 2015; 26:1949-57. [PMID: 25740208 DOI: 10.1007/s00198-015-3055-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 01/28/2015] [Indexed: 01/29/2023]
Abstract
UNLABELLED A Greek-specific cost-effectiveness analysis determined the FRAX-based intervention thresholds. Assuming a willingness to pay of 30,000 <euro>, osteoporosis treatment is cost-effective in subjects under the age of 75 with 10-year probabilities for hip and major osteoporotic fractures of 2.5 and 10 %, respectively, while for older patients, the same thresholds are raised to 5 and 15 %. INTRODUCTION The purpose of this study was to determine the FRAX calculated fracture probabilities at which therapeutic intervention can be considered as cost-effective in the Greek setting. METHODS A Markov cohort model was populated with Greek data, and quality-adjusted life years (QALYs) were used to calculate the cost-effective thresholds for an annual medication cost of 733.7 <euro> by gender and age. Average FRAX-based 10-year probabilities for both major osteoporotic and hip fractures were multiplied by the model-derived relative risk at which a cost of 30,000 <euro> for each QALY gained was observed for treatment versus to no intervention. RESULTS A biphasic intervention threshold model is supported by our findings. Osteoporosis treatment becomes cost-effective when absolute 10-year probabilities for hip and major osteoporotic fractures reach 2.5 and 10 %, respectively, among both men and women under the age of 75. For older subjects, the proposed intervention thresholds are raised to 5 and 15 % 10-year probability for hip and major osteoporotic fractures, respectively. CONCLUSIONS Cost-effective osteoporosis treatment may be facilitated in Greece if FRAX algorithm is used to identify subjects with 10-year probabilities for hip and major osteoporotic fractures of 2.5 and 10 %, under the age of 75, while for older patients, the relevant thresholds are 5 and 15 %, respectively.
Collapse
Affiliation(s)
- P Makras
- Department of Endocrinology and Diabetes, 251 Hellenic Air Force General Hospital, Athens, Greece,
| | | | | | | | | | | | | |
Collapse
|
246
|
Lin X, Xiong D, Peng YQ, Sheng ZF, Wu XY, Wu XP, Wu F, Yuan LQ, Liao EY. Epidemiology and management of osteoporosis in the People's Republic of China: current perspectives. Clin Interv Aging 2015; 10:1017-33. [PMID: 26150706 PMCID: PMC4485798 DOI: 10.2147/cia.s54613] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
With the progressive aging of the population, osteoporosis has gradually grown into a global health problem for men and women aged 50 years and older because of its consequences in terms of disabilities and fragility fractures. This is especially true in the People's Republic of China, which has the largest population and an increasing proportion of elderly people, as osteoporosis has become a serious challenge to the Chinese government, society, and family. Apart from the fact that all osteoporotic fractures can increase the patient's morbidity, they can also result in fractures of the hip and vertebrae, which are associated with a significantly higher mortality. The cost of osteoporotic fractures, moreover, is a heavy burden on families, society, and even the country, which is likely to increase in the future due, in part, to the improvement in average life expectancy. Therefore, understanding the epidemiology of osteoporosis is essential and is significant for developing strategies to help reduce this problem. In this review, we will summarize the epidemiology of osteoporosis in the People's Republic of China, including the epidemiology of osteoporotic fractures, focusing on preventive methods and the management of osteoporosis, which consist of basic measures and pharmacological treatments.
Collapse
Affiliation(s)
- Xiao Lin
- Institute of Metabolism and Endocrinology, Central South University, Changsha, Hunan, People's Republic of China
| | - Dan Xiong
- Institute of Metabolism and Endocrinology, Central South University, Changsha, Hunan, People's Republic of China
| | - Yi-Qun Peng
- Institute of Metabolism and Endocrinology, Central South University, Changsha, Hunan, People's Republic of China
| | - Zhi-Feng Sheng
- Institute of Metabolism and Endocrinology, Central South University, Changsha, Hunan, People's Republic of China
| | - Xi-Yu Wu
- Institute of Metabolism and Endocrinology, Central South University, Changsha, Hunan, People's Republic of China
| | - Xian-Ping Wu
- Institute of Metabolism and Endocrinology, Central South University, Changsha, Hunan, People's Republic of China
| | - Feng Wu
- Department of Pathology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Ling-Qing Yuan
- Institute of Metabolism and Endocrinology, Central South University, Changsha, Hunan, People's Republic of China
| | - Er-Yuan Liao
- Institute of Metabolism and Endocrinology, Central South University, Changsha, Hunan, People's Republic of China
| |
Collapse
|
247
|
Mok CC, Ho LY, Ma KM. Switching of oral bisphosphonates to denosumab in chronic glucocorticoid users: a 12-month randomized controlled trial. Bone 2015; 75:222-8. [PMID: 25761434 DOI: 10.1016/j.bone.2015.03.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 02/28/2015] [Accepted: 03/02/2015] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To evaluate the effect of switching from oral bisphosphonates to denosumab on bone mineral density (BMD) in long-term glucocorticoid users. METHODS Adult patients who were receiving long-term prednisolone (≥2.5 mg/day for ≥1 year) and oral bisphosphonates (≥2 years) were recruited. Participants were randomized to either continue oral bisphosphonates or switch to denosumab (60 mg subcutaneously every 6 months) for 12 months. Serial BMD (lumbar spine, hip) and bone turnover markers (serum osteocalcin, P1NP, β-CTX) were measured. RESULTS 42 women were recruited (age 54.7±12.9 years; 21 shifted to denosumab and 21 continued on bisphosphonates). The duration of prednisolone therapy was 101±66.3 months and the daily dose was 4.4±2.1 mg. Baseline demographic data, osteoporosis risk factors, and BMD at various sites were similar between the two groups of patients. At month 12, BMD of the spine and hip increased by +3.4±0.9% (p=0.002) and +1.4±0.6% (p=0.03), respectively, in the denosumab group; whereas the corresponding change was +1.5±0.4% (p=0.001) and +0.80±0.5% (p=0.12) in the bisphosphonate group. The spinal BMD at month 12 was significantly higher in the denosumab than bisphosphonate group after adjustment for baseline BMD and β-CTX values, and other confounding factors (p=0.01). Bone turnover markers (β-CTX and P1NP) were more strongly suppressed by denosumab than the bisphosphonates. Minor infections were more common in denosumab-treated patients while other adverse events occurred at similar frequencies between the two groups. CONCLUSIONS In patients receiving long-term glucocorticoids, switching from oral bisphosphonates to denosumab resulted in greater gain of the spinal BMD and suppression of bone turnover markers after 12 months of therapy. The results have to be confirmed by a larger clinical trial with fracture as endpoint.
Collapse
Affiliation(s)
- Chi Chiu Mok
- Department of Medicine, Tuen Mun Hospital, Hong Kong.
| | - Ling Yin Ho
- Department of Medicine, Tuen Mun Hospital, Hong Kong
| | - Kwok Man Ma
- Department of Nuclear Medicine, Tuen Mun Hospital, Hong Kong
| |
Collapse
|
248
|
Siu S, Haraoui B, Bissonnette R, Bessette L, Roubille C, Richer V, Starnino T, McCourt C, McFarlane A, Fleming P, Kraft J, Lynde C, Gulliver W, Keeling S, Dutz J, Pope JE. Meta-Analysis of Tumor Necrosis Factor Inhibitors and Glucocorticoids on Bone Density in Rheumatoid Arthritis and Ankylosing Spondylitis Trials. Arthritis Care Res (Hoboken) 2015; 67:754-64. [DOI: 10.1002/acr.22519] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 10/25/2014] [Accepted: 11/11/2014] [Indexed: 12/25/2022]
Affiliation(s)
| | - Boulos Haraoui
- Centre Hospitalier de l'Universite de Montreal and Institut de Rhumatologie de Montreal; Montreal Quebec Canada
| | | | - Louis Bessette
- Centre Hospitalier Universitaire de Quebec; Quebec City Quebec Canada
| | - Camille Roubille
- University of Montreal Hospital Research Center and Notre-Dame Hospital; Montreal Quebec Canada
| | | | - Tara Starnino
- Sacre-Coeur Hospital of Montreal and The University of Montreal; Montreal Quebec Canada
| | - Collette McCourt
- University of British Columbia; Vancouver British Columbia Canada
| | | | | | - John Kraft
- Lynde Dermatology; Markham Ontario Canada
| | | | | | | | - Jan Dutz
- University of British Columbia; Vancouver British Columbia Canada
| | | |
Collapse
|
249
|
Kenanidis E, Potoupnis ME, Kakoulidis P, Leonidou A, Sakellariou GT, Sayegh FE, Tsiridis E. Management of glucocorticoid-induced osteoporosis: clinical data in relation to disease demographics, bone mineral density and fracture risk. Expert Opin Drug Saf 2015; 14:1035-53. [PMID: 25952267 DOI: 10.1517/14740338.2015.1040387] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Glucocorticoid-induced osteoporosis (GIOP) is the most common type of secondary osteoporosis. Patient selection and the treatment choice remain to be controversial. None of the proposed management guidelines are widely accepted. We evaluate the available clinical data, the efficacy of current medication and we propose an overall algorithm for managing GIOP. AREAS COVERED This article provides a critical review of in vivo and clinical evidence regarding GIOP and developing evidence-based algorithm of treatment. Data base used includes MEDLINE® (1950 to May 2014). EXPERT OPINION Patient-specific treatment is the gold standard of care. Glucocorticoid (GC)-treated patients must comply with a healthy lifestyle and receive 1000 mg of calcium and at least 800 mg of Vitamin D daily. Bisphosphonate (BP) therapy is the current standard of care for prevention and treatment of GIOP. Most of bisphosphonates demonstrated benefit in lumbar bone mineral density (BMD) and some in hip BMD. Alendronate, risedronate and zoledronate showed vertebral anti-fracture efficacy in postmenopausal women and men. Scarce data however when compared head to head with BP efficacy. In post-menopausal women, early antiresorptive BP treatment appears to be efficient and safe. In premenopausal women and patients at high risk of fracture receiving long-term GC therapy however, teriparitide may be advised alternatively.
Collapse
Affiliation(s)
- Eustathios Kenanidis
- Aristotle University Medical School, Academic Orthopaedic Unit , Thessaloniki , Greece
| | | | | | | | | | | | | |
Collapse
|
250
|
Yang MG, Dhar TGM, Xiao Z, Xiao HY, Duan JJW, Jiang B, Galella MA, Cunningham M, Wang J, Habte S, Shuster D, McIntyre KW, Carman J, Holloway DA, Somerville JE, Nadler SG, Salter-Cid L, Barrish JC, Weinstein DS. Improving the Pharmacokinetic and CYP Inhibition Profiles of Azaxanthene-Based Glucocorticoid Receptor Modulators—Identification of (S)-5-(2-(9-Fluoro-2-(4-(2-hydroxypropan-2-yl)phenyl)-5H-chromeno[2,3-b]pyridin-5-yl)-2-methylpropanamido)-N-(tetrahydro-2H-pyran-4-yl)-1,3,4-thiadiazole-2-carboxamide (BMS-341). J Med Chem 2015; 58:4278-90. [DOI: 10.1021/acs.jmedchem.5b00257] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Michael G. Yang
- Research and Development, Bristol-Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - T. G. Murali Dhar
- Research and Development, Bristol-Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Zili Xiao
- Research and Development, Bristol-Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Hai-Yun Xiao
- Research and Development, Bristol-Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - James J.-W. Duan
- Research and Development, Bristol-Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Bin Jiang
- Research and Development, Bristol-Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Michael A. Galella
- Research and Development, Bristol-Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Mark Cunningham
- Research and Development, Bristol-Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Jinhong Wang
- Research and Development, Bristol-Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Sium Habte
- Research and Development, Bristol-Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - David Shuster
- Research and Development, Bristol-Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Kim W. McIntyre
- Research and Development, Bristol-Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Julie Carman
- Research and Development, Bristol-Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Deborah A. Holloway
- Research and Development, Bristol-Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - John E. Somerville
- Research and Development, Bristol-Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Steven G. Nadler
- Research and Development, Bristol-Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Luisa Salter-Cid
- Research and Development, Bristol-Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - Joel C. Barrish
- Research and Development, Bristol-Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| | - David S. Weinstein
- Research and Development, Bristol-Myers Squibb Company, Princeton, New Jersey 08543-4000, United States
| |
Collapse
|