1
|
Johnson G, Griffin LV, Qiu S, Rao SD. Differences in tissue-level properties as assessed by nano-scratching in patients with and without atypical femur fractures on long-term bisphosphonate therapy: a proof-of-concept pilot study. JBMR Plus 2024; 8:ziae097. [PMID: 39135632 PMCID: PMC11318351 DOI: 10.1093/jbmrpl/ziae097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 07/15/2024] [Accepted: 07/24/2024] [Indexed: 08/15/2024] Open
Abstract
Atypical femur fractures (AFFs) are a well-established complication of long-term bisphosphonate (BP) therapy, but their pathogenesis is not fully understood. Although many patients on long-term BP therapy have severe suppression of bone turnover (SSBT), not all such patients experience AFF, even though SSBT is a major contributor to AFF. Accordingly, we evaluated tissue level properties using nano-scratch testing of trans-iliac bone biopsy specimens in 12 women (6 with and 6 without AFF matched for age and race). Nano-scratch data were analyzed using a mixed-model ANOVA with volume-normalized scratch energy as a function of AFF (Yes or No), region (periosteal or endosteal), and a first-order interaction between region and AFF. Tukey post hoc analyses of the differences of least squared means of scratch energy were performed and reported as significant if p<.05. The volume-normalized scratch energy was 10.6% higher in AFF than in non-AFF patients (p=.003) and 17.9 % higher in the periosteal than in the endosteal region (p=.004). The differences in normalized scratch energy are suggestive of a higher hardness of the bone tissue after long-term BP therapy. The results of this study are consistent with other studies in the literature and demonstrate the efficacy of using Nano-Scratch technique to evaluate bone tissue that exhibits SSBT and AFF. Further studies using nano-scratch may help quantify and elucidate underlying mechanisms for the pathogenesis of AFF.
Collapse
Affiliation(s)
- Gabriel Johnson
- Department of Biomedical Engineering, California Polytechnic State University (Cal Poly), San Luis Obispo, CA, 93407-0365, United States
| | - Lanny V Griffin
- Department of Biomedical Engineering, California Polytechnic State University (Cal Poly), San Luis Obispo, CA, 93407-0365, United States
| | - Shijing Qiu
- Bone & Mineral Research Laboratory, Henry Ford Health/Wayne State University Integrative Biosciences (IBio) Research Facility, Detroit, MI, 48202, United States
- Division of Endocrinology, Diabetes, and Bone & Mineral Disorders, Henry Ford Health, Detroit, MI, 48202, United States
| | - Sudhaker D Rao
- Bone & Mineral Research Laboratory, Henry Ford Health/Wayne State University Integrative Biosciences (IBio) Research Facility, Detroit, MI, 48202, United States
- Division of Endocrinology, Diabetes, and Bone & Mineral Disorders, Henry Ford Health, Detroit, MI, 48202, United States
| |
Collapse
|
2
|
Leungsuwan DS, Chandran M. Bone Fragility in Diabetes and its Management: A Narrative Review. Drugs 2024:10.1007/s40265-024-02078-5. [PMID: 39103693 DOI: 10.1007/s40265-024-02078-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2024] [Indexed: 08/07/2024]
Abstract
Bone fragility is a serious yet under-recognised complication of diabetes mellitus (DM) that is associated with significant morbidity and mortality. Multiple complex pathophysiological mechanisms mediating bone fragility amongst DM patients have been proposed and identified. Fracture risk in both type 1 diabetes (T1D) and type 2 diabetes (T2D) continues to be understated and underestimated by conventional risk assessment tools, posing an additional challenge to the identification of at-risk patients who may benefit from earlier intervention or preventive strategies. Over the years, an increasing body of evidence has demonstrated the efficacy of osteo-pharmacological agents in managing skeletal fragility in DM. This review seeks to elaborate on the risk of bone fragility in DM, the underlying pathogenesis and skeletal alterations, the approach to fracture risk assessment in DM, management strategies and therapeutic options.
Collapse
Affiliation(s)
| | - Manju Chandran
- Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, 20 College Road, ACADEMIA, Singapore, 169856, Singapore.
- DUKE NUS Medical School, Singapore, Singapore.
| |
Collapse
|
3
|
Cunha-Santos F, Augusto D, Pinto AS, Dinis SP, Madeira N, Vaz C, Ferreira JF. Predictors of atypical femoral fractures: experience of a Portuguese Fracture Liaison Service. Osteoporos Int 2024; 35:931-932. [PMID: 38285186 DOI: 10.1007/s00198-024-07033-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/19/2024] [Indexed: 01/30/2024]
Affiliation(s)
- F Cunha-Santos
- Rheumatology Department, Local Health Unit of Guarda, Guarda, Portugal.
| | - D Augusto
- Rheumatology Department, Local Health Unit of Guarda, Guarda, Portugal
| | - A S Pinto
- Rheumatology Department, Local Health Unit of Guarda, Guarda, Portugal
| | - S P Dinis
- Rheumatology Department, Local Health Unit of Guarda, Guarda, Portugal
| | - N Madeira
- Rheumatology Department, Local Health Unit of Guarda, Guarda, Portugal
| | - C Vaz
- Rheumatology Department, Local Health Unit of Guarda, Guarda, Portugal
- Faculty of Health Sciences, Beira Interior University, Covilhã, Portugal
| | - J F Ferreira
- Rheumatology Department, Local Health Unit of Guarda, Guarda, Portugal
- Faculty of Health Sciences, Beira Interior University, Covilhã, Portugal
| |
Collapse
|
4
|
Oliveira D, Garcia S, Pereira L, Magalhães J, Costa L, Frazão J, Vaz C. Effects of teriparatide on histomorphological features in a patient with an atypical femoral fracture and chronic kidney disease. Porto Biomed J 2024; 9:253. [PMID: 38898920 PMCID: PMC11185972 DOI: 10.1097/j.pbj.0000000000000253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/08/2024] [Accepted: 04/14/2024] [Indexed: 06/21/2024] Open
Affiliation(s)
- Daniela Oliveira
- Rheumatology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Salomé Garcia
- Rheumatology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Medicine of Faculty of Medicine, University of Porto, Porto, Portugal
| | - Luciano Pereira
- Department of Medicine of Faculty of Medicine, University of Porto, Porto, Portugal
- Institute of Investigation and Innovation in Health, University of Porto, Porto, Portugal
- INEB—National Institute of Biomedical Engineering, University of Porto, Porto, Portugal
| | - Juliana Magalhães
- Department of Medicine of Faculty of Medicine, University of Porto, Porto, Portugal
- INEB—National Institute of Biomedical Engineering, University of Porto, Porto, Portugal
- USF BarcelSaúde do ACeS Cávado III Barcelos/Esposende, Barcelos, Portugal
| | - Lúcia Costa
- Rheumatology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - João Frazão
- Department of Medicine of Faculty of Medicine, University of Porto, Porto, Portugal
- Institute of Investigation and Innovation in Health, University of Porto, Porto, Portugal
- INEB—National Institute of Biomedical Engineering, University of Porto, Porto, Portugal
- USF BarcelSaúde do ACeS Cávado III Barcelos/Esposende, Barcelos, Portugal
| | - Carlos Vaz
- Rheumatology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Medicine of Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
5
|
Wang Y, Wang H, Xu J, Wang J, You L, Bai Y, Guo J. Exploration of the Clinical Effect of Different Autotransfusion Methods on Patients With Femoral Shaft Fracture Surgery. J Clin Lab Anal 2024; 38:e25018. [PMID: 38468395 PMCID: PMC10959180 DOI: 10.1002/jcla.25018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/30/2023] [Accepted: 02/02/2024] [Indexed: 03/13/2024] Open
Abstract
OBJECTIVE To explore the clinical effect of predeposit, salvage, and hemodilution autotransfusion on patients with femoral shaft fracture (FSF) surgery. METHODS Selected patients with FSF were randomly divided into three groups: intraoperative blood salvage autotransfusion, preoperative hemodilution autohemotransfusion, and predeposit autotransfusion. Five days after the operation, the body temperature, heart rate, blood platelet (PLT), and hemoglobin (Hb) of patients were determined. The concentrations of EPO and GM-CSF in the three groups were calculated by ELISA. The content of CD14+ monocytes was calculated by FCM assay. The growth time and condition of the patient's callus were determined at the 30th, 45th, and 60th day after operation. Cox regression analysis was used to analyze the correlation between EPO, GM-CSF, CD14+ mononuclear content, callus growth, and autotransfusion methods. RESULTS There were no statistically significant differences in body temperature and heart rate between the three groups (p > 0.05). PLT and Hb in the Predeposit group were markedly increased compared with that in the Salvage and Hemodilution groups. The concentrations of EPO and GM-CSF in the Predeposit group were markedly increased compared with that in the Salvage and Hemodilution groups. The content of CD14+ monocytes in the Predeposit group was significantly higher than that in the Salvage and Hemodilution groups. Predeposit autotransfusion promotes callus growth more quickly. CONCLUSION Predeposit autotransfusion promoted the recovery of patients with FSF after the operation more quickly than salvage autotransfusion and hemodilution autotransfusion.
Collapse
Affiliation(s)
- Yujia Wang
- School of Gongli Hospital Medical TechnologyUniversity of Shanghai for Science and TechnologyShanghaiChina
| | - Huan Wang
- Department of Anesthesiology, Shanghai Gongli HospitalNaval Military Medical UniversityShanghaiChina
| | - Jiaming Xu
- Department of Anesthesiology, Shanghai Gongli HospitalNaval Military Medical UniversityShanghaiChina
| | - Jinhuo Wang
- Department of Anesthesiology, Shanghai Gongli HospitalNaval Military Medical UniversityShanghaiChina
| | - Laiwei You
- Department of Anesthesiology, Shanghai Gongli HospitalNaval Military Medical UniversityShanghaiChina
| | - Yu Bai
- Department of Anesthesiology, Shanghai Gongli HospitalNaval Military Medical UniversityShanghaiChina
| | - Jianrong Guo
- Department of Anesthesiology, Shanghai Gongli HospitalNaval Military Medical UniversityShanghaiChina
| |
Collapse
|
6
|
Peng Y, Langermann S, Kothari P, Liu L, Zhao W, Hu Y, Chen Z, Moraes de Lima Perini M, Li J, Cao J, Guo XE, Chen L, Bauman WA, Qin W. Anti-Siglec-15 Antibody Prevents Marked Bone Loss after Acute Spinal Cord Injury-Induced Immobilization in Rats. JBMR Plus 2023; 7:e10825. [PMID: 38130761 PMCID: PMC10731123 DOI: 10.1002/jbm4.10825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/23/2023] [Accepted: 09/11/2023] [Indexed: 12/23/2023] Open
Abstract
Rapid and extensive sublesional bone loss after spinal cord injury (SCI) is a difficult medical problem that has been refractory to available interventions except the antiresorptive agent denosumab (DMAB). While DMAB has shown some efficacy in inhibiting bone loss, its concurrent inhibition of bone formation limits its use. Sialic acid-binding immunoglobulin-like lectin (Siglec)-15 is expressed on the cell surface of mature osteoclasts. Anti-Siglec-15 antibody (Ab) has been shown to inhibit osteoclast maturation and bone resorption while maintaining osteoblast activity, which is distinct from current antiresorptive agents that inhibit the activity of both osteoclasts and osteoblasts. The goal of the present study is to test a Siglec-15 Ab (NP159) as a new treatment option to prevent bone loss in an acute SCI model. To this end, 4-month-old male Wistar rats underwent complete spinal cord transection and were treated with either vehicle or NP159 at 20 mg/kg once every 2 weeks for 8 weeks. SCI results in significant decreases in bone mineral density (BMD, -18.7%), trabecular bone volume (-43.1%), trabecular connectivity (-59.7%), and bone stiffness (-76.3%) at the distal femur. Treatment with NP159 almost completely prevents the aforementioned deterioration of bone after SCI. Blood and histomorphometric analyses revealed that NP159 is able to greatly inhibit bone resorption while maintaining bone formation after acute SCI. In ex vivo cultures of bone marrow cells, NP159 reduces osteoclastogenesis while increasing osteoblastogenesis. In summary, treatment with NP159 almost fully prevents sublesional loss of BMD and metaphysis trabecular bone volume and preserves bone strength in a rat model of acute SCI. Because of its unique ability to reduce osteoclastogenesis and bone resorption while promoting osteoblastogenesis to maintain bone formation, Siglec-15 Ab may hold greater promise as a therapeutic agent, compared with the exclusively antiresorptive or anabolic agents that are currently used, in mitigating the striking bone loss that occurs after SCI or other conditions associated with severe immobilization. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.
Collapse
Affiliation(s)
- Yuanzhen Peng
- Spinal Cord Damage Research Center, James J. Peters Veteran Affairs Medical CenterBronxNew YorkUSA
| | | | | | | | - Wei Zhao
- Spinal Cord Damage Research Center, James J. Peters Veteran Affairs Medical CenterBronxNew YorkUSA
| | - Yizhong Hu
- Department of Biomedical EngineeringColumbia UniversityNew YorkNew YorkUSA
| | - Zihao Chen
- Department of BiotechnologyBrown UniversityProvidenceRhode IslandUSA
| | | | - Jiliang Li
- School of Science, Indiana University Purdue UniversityIndianapolisIndianaUSA
| | - Jay Cao
- USDA‐ARS Grand Forks Human Nutrition Research CenterGrand ForksNorth DakotaUSA
| | - X. Edward Guo
- Department of Biomedical EngineeringColumbia UniversityNew YorkNew YorkUSA
| | - Lieping Chen
- NextCure, IncBeltsvilleMarylandUSA
- Cancer Research, Immunobiology and Medicine, The Yale University School of MedicineNew HavenConnecticutUSA
| | - William A. Bauman
- Spinal Cord Damage Research Center, James J. Peters Veteran Affairs Medical CenterBronxNew YorkUSA
- Departments of MedicineRehabilitation and Human Performance, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Rehabilitation and Human Performance, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Weiping Qin
- Spinal Cord Damage Research Center, James J. Peters Veteran Affairs Medical CenterBronxNew YorkUSA
- Departments of MedicineRehabilitation and Human Performance, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| |
Collapse
|
7
|
Kujala MA, Hongisto MT, Luukkaala T, Stenholm S, Nuotio MS. Pertrochanteric hip fracture is associated with mobility decline and poorer physical performance 4 to 6 months post-hip fracture. BMC Geriatr 2023; 23:722. [PMID: 37940840 PMCID: PMC10631110 DOI: 10.1186/s12877-023-04415-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 10/17/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND To study the effect of hip fracture type on physical performance, functional ability and change in mobility four to six months after the injury. METHODS A total of 1331 patients out of consecutive 2052 patients aged ≥ 65 years who underwent hip fracture surgery were included in the study. Patient information was collected on admission, during hospitalization, by phone interview and at the geriatric outpatient clinic 4 to 6 months after the fracture. Of the 1331 eligible patients, Grip strength, Timed Up and Go -test (TUG), Elderly Mobility Scale (EMS), mobility change compared to pre-fracture mobility level, Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL) were used to determine physical performance and functional ability. Logistic regression was used for the analyses which was adjusted for gender, age, American Society of Anesthesiologists score, diagnosis of cognitive disorder, pre-fracture living arrangements, mobility and need of mobility aid. RESULTS Patients with pertrochanteric hip fracture had an EMS lower than 14 (Odds Ratio (OR) 1.38, 95% confidence intervals (CI) 1.00-1.90), TUG time ≥ 20 s (OR 1.69, 95% CI 1.22-2.33) and they had declined in mobility (OR 1.58, 95% CI 1.20-2.09) compared to femoral neck fracture patients 4 to 6 months post-hip fracture in multivariable-adjusted logistic regression analyses. Grip strength and functional ability (IADL, BADL) 4 to 6 months after hip fracture did not differ between fracture types. There were no statistically significant differences in physical performance in patients with a subtrochanteric fracture compared to patients with a femoral neck fracture. CONCLUSIONS Pertrochanteric hip fracture independently associated with poorer physical performance 4 to 6 months post hip fracture compared to other hip fracture types. Pertrochanteric hip fracture patients should be given special attention in terms of regaining their previous level of mobility.
Collapse
Affiliation(s)
- Minna A Kujala
- Department of Geriatric Medicine, Seinäjoki Central Hospital, Wellbeing Services County of South Ostrobothnia, Seinäjoki, Finland.
- Department of Geriatric Medicine, University of Turku, Turku, Finland.
| | - Markus T Hongisto
- Division of Orthopaedics and Traumatology, Seinäjoki Central Hospital, Wellbeing Services County of South Ostrobothnia, Seinäjoki, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Tiina Luukkaala
- Research and Innovation Centre, Tampere University Hospital, Tampere, Finland
- Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Sari Stenholm
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Research Services, Turku University Hospital and University of Turku, Turku, Finland
| | - Maria S Nuotio
- Department of Geriatric Medicine, Seinäjoki Central Hospital, Wellbeing Services County of South Ostrobothnia, Seinäjoki, Finland
- Department of Geriatric Medicine, University of Turku and Turku University Hospital, Turku, Finland
| |
Collapse
|
8
|
Ferreira P, Bates P, Daoub A, Dass D. Is bisphosphonate use a risk factor for atypical periprosthetic/peri-implant fractures? - A metanalysis of retrospective cohort studies and systematic review of the current evidence. Orthop Traumatol Surg Res 2023; 109:103475. [PMID: 36347461 DOI: 10.1016/j.otsr.2022.103475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 07/05/2022] [Accepted: 07/18/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Atypical periprosthetic/peri-implant fractures are not recognised in any widely used classification and therefore little focus is given to them. Multiple case reports and case series demonstrate these fractures exist and are related to bisphosphonate (BP) use. HYPOTHESIS Are patients taking long-term BPs at an increased risk of developing an atypical periprosthetic/peri-implant fracture? Is a particular BP drug causing an increased risk of fracture? Is there a correlation between the time of BP use and the incidence of fractures? Do vitamin D analogues or parathyroid hormones reduce the time to union? MATERIAL AND METHODS Systematic review of all available evidence on the existence of periprosthetic/peri-implant atypical fractures in patients taking long-term BPs and metanalysis of available retrospective cohort studies. Selected 1 systematic review, 7 retrospective cohort studies (5 used for metanalysis) and 32 case reports. RESULTS Metanalysis reported a risk ratio of 14.1, p=0.25, suggesting bisphosphonates are a risk factor in the development of periprosthetic/peri-implant atypical fractures. The secondary outcomes couldn't be reliably identified due to the small size of available studies and risk of significant bias. DISCUSSION Atypical periprosthetic/peri-implant fractures are an entity and seem to be associated with the use of bisphosphonates. The benefits of bisphosphonates use outweigh the risks, but clinicians should be aware of atypical fractures and actively search for them when patients on long-term bisphosphonates attend with non-specific pain close to the implant/prosthesis or reduced mobility. LEVEL OF EVIDENCE II, Systematic review and metanalysis.
Collapse
Affiliation(s)
- Pedro Ferreira
- Queen Mary University of London and Oswestry/Stoke Trauma and Orthopaedic Training Programme, Mile End Rd, Bethnal Green, London E1 4NS, United Kingdom.
| | - Peter Bates
- Orthopaedic Trauma Sciences - Queen Mary University of London, Lead for orthopaedic trauma, Barts Health, Mile End Rd, Bethnal Green, London E1 4NS, United Kingdom
| | - Ahmed Daoub
- Oswestry/Stoke Trauma and Orthopaedic Training Programme - Robert Jones and Agnes Hunt Hospital, Gobowen, Oswestry SY10 7AG, United Kingdom
| | - Debashis Dass
- Oswestry/Stoke Trauma and Orthopaedic Training Programme - Robert Jones and Agnes Hunt Hospital, Gobowen, Oswestry SY10 7AG, United Kingdom
| |
Collapse
|
9
|
Ayers C, Kansagara D, Lazur B, Fu R, Kwon A, Harrod C. Effectiveness and Safety of Treatments to Prevent Fractures in People With Low Bone Mass or Primary Osteoporosis: A Living Systematic Review and Network Meta-analysis for the American College of Physicians. Ann Intern Med 2023; 176:182-195. [PMID: 36592455 DOI: 10.7326/m22-0684] [Citation(s) in RCA: 46] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The prevalence of osteoporosis is increasing in the United States. PURPOSE To evaluate low bone mass and osteoporosis treatments to prevent fractures. DATA SOURCES Ovid MEDLINE ALL, Ovid Evidence Based Medicine Reviews: Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov from 2014 through February 2022. STUDY SELECTION Adults receiving eligible interventions for low bone mass or osteoporosis. Randomized controlled trials (RCTs) for fracture outcomes, and RCTs and large observational studies (n ≥1000) for harms. DATA EXTRACTION Abstracted by 1 reviewer and verified by a second. Independent, dual assessments of risk of bias and certainty of evidence (CoE). DATA SYNTHESIS We included 34 RCTs (in 100 publications) and 36 observational studies. Bisphosphonates and denosumab reduced hip, clinical and radiographic vertebral, and other clinical fractures in postmenopausal females with osteoporosis (moderate to high CoE). Bisphosphonates for 36 months or more may increase the risk for atypical femoral fractures (AFFs) and osteonecrosis of the jaw (ONJ), but the absolute risks were low. Abaloparatide and teriparatide reduced clinical and radiographic vertebral fractures but increased the risk for withdrawals due to adverse events (WAEs; moderate to high CoE). Raloxifene and bazedoxifene for 36 months or more reduced radiographic vertebral but not clinical fractures (low to moderate CoE). Abaloparatide, teriparatide, and sequential romosozumab, then alendronate, may be more effective than bisphosphonates in reducing clinical fractures for 17 to 24 months in older postmenopausal females at very high fracture risk (low to moderate CoE). Bisphosphonates may reduce clinical fractures in older females with low bone mass (low CoE) and radiographic vertebral fractures in males with osteoporosis (low to moderate CoE). LIMITATION Few studies examined participants with low bone mass, males, or Black-identifying persons, sequential therapy, or treatment beyond 3 years. CONCLUSION Bisphosphonates, denosumab, abaloparatide, teriparatide, and romosozumab, followed by alendronate, reduce clinical fractures in postmenopausal females with osteoporosis. Abaloparatide and teriparatide increased WAEs; longer duration bisphosphonate use may increase AFF and ONJ risk though these events were rare. PRIMARY FUNDING SOURCE American College of Physicians. (PROSPERO: CRD42021236220).
Collapse
Affiliation(s)
- Chelsea Ayers
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon (C.A.)
| | - Devan Kansagara
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, and Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, Oregon (D.K.)
| | - Brittany Lazur
- Center for Evidence-based Policy, Oregon Health & Science University, Portland, Oregon (B.L.)
| | - Rongwei Fu
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon (R.F.)
| | - Amy Kwon
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, Oregon (A.K.)
| | - Curtis Harrod
- Division of General Internal Medicine & Geriatrics, Department of Medicine, and Center for Evidence-based Policy, Oregon Health & Science University, Portland, Oregon (C.H.)
| |
Collapse
|
10
|
Gao J, Liu X, Wu X, Li X, Liu J, Li M. A brief review and clinical evidences of teriparatide therapy for atypical femoral fractures associated with long-term bisphosphonate treatment. Front Surg 2023; 9:1063170. [PMID: 36684309 PMCID: PMC9852062 DOI: 10.3389/fsurg.2022.1063170] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/07/2022] [Indexed: 01/07/2023] Open
Abstract
The risk of bisphosphonate (BP)-associated atypical femur fracture (AFF) has markedly increased over recent decades due to suppression of bone turnover, accumulation of structural micro-damage and reduction of bone remodeling consequent to long-term BP treatment. These medications further delay bone union and result in challenging clinical management. Teriparatide (TPTD), a synthetic human parathyroid hormone, exhibits unique anabolic effects and can increase bone remodeling and improve bone microarchitecture, further promoting fracture healing and reducing the rate of bone non-union. In this study, we briefly define AFF as well as the effects of BPs on AFFs, detailed the role of TPTD in AFF management and the latest clinical therapeutic findings. We have confirmed that TPTD positively promotes the healing of AFFs by reducing the time to bone union and likelihood of non-union. Thus, teriparatide therapy could be considered as an alternative treatment for AFFs, however, further research is required for the establishment of effective clinical guidelines of TPTD use in the management of AFF.
Collapse
Affiliation(s)
- Jianpeng Gao
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Xiao Liu
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Xiaoyong Wu
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, China
| | - Xiaoya Li
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, China
| | - Jianheng Liu
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China,Correspondence: Ming Li Jianheng Liu
| | - Ming Li
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China,Correspondence: Ming Li Jianheng Liu
| |
Collapse
|
11
|
Konstantelos N, Rzepka AM, Burden AM, Cheung AM, Kim S, Grootendorst P, Cadarette SM. Fracture definitions in observational osteoporosis drug effects studies that leverage healthcare administrative (claims) data: a scoping review. Osteoporos Int 2022; 33:1837-1844. [PMID: 35578134 PMCID: PMC9463274 DOI: 10.1007/s00198-022-06395-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/30/2022] [Indexed: 11/27/2022]
Abstract
UNLABELLED Healthcare administrative (claims) data are commonly utilized to estimate drug effects. We identified considerable heterogeneity in fracture outcome definitions in a scoping review of 57 studies that estimated osteoporosis drug effects on fracture risk. Better understanding of the impact of different fracture definitions on study results is needed. PURPOSE Healthcare administrative (claims) data are frequently used to estimate the real-world effects of drugs. Fracture incidence is a common outcome of osteoporosis drug studies. We aimed to describe how fractures are defined in studies that use claims data. METHODS We searched MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), and gray literature for studies published in English between 2000 and 2020 that estimated fracture effectiveness (hip, humerus, radius/ulna, vertebra) or safety (atypical fracture of the femur, AFF) of osteoporosis drugs using claims data in Canada and the USA. Literature searches, screening and data abstraction were completed independently by two reviewers. RESULTS We identified 57 eligible studies (52 effectiveness, 3 safety, 2 both). Hip fracture was the most common fracture site studied (93%), followed by humerus (66%), radius/ulna (59%), vertebra (61%), and AFF (9%). Half (n = 29) of the studies did not indicate specific data sources, codes, or cite a validation paper. Of the papers with sufficient detail, heterogeneity in fracture definitions was common. The most common definition within each fracture site was used by less than half of the studies that examined effectiveness (12 definitions in 29 hip fracture papers, 8 definitions in 17 humerus papers, 8 definitions in 13 radius/ulna papers, 9 definitions in 15 vertebra papers), and 3 definitions among 4 AFF papers. CONCLUSION There is ambiguity and heterogeneity in fracture outcome definitions in studies that leverage claims data. Better transparency in outcome reporting is needed. Future exploration of how fracture definitions impact study results is warranted.
Collapse
Affiliation(s)
- N Konstantelos
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.
| | - A M Rzepka
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - A M Burden
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- ETH Zurich, Zurich, Switzerland
| | - A M Cheung
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Medicine, University Health Network, University of Toronto, Toronto, Canada
| | - S Kim
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- Women's College Hospital, Toronto, Canada
| | - P Grootendorst
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- WHO Collaborating Centre for Governance, Accountability and Transparency in the Pharmaceutical Sector, Toronto, Canada
| | - S M Cadarette
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- WHO Collaborating Centre for Governance, Accountability and Transparency in the Pharmaceutical Sector, Toronto, Canada
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, USA
| |
Collapse
|
12
|
Murphy B, Francis SL, Rhee I, Babazadeh S, Stoney J, Stevens J. Atypical femur fractures associated with bisphosphonate therapy: post-operative outcomes. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03314-y. [PMID: 35904634 DOI: 10.1007/s00590-022-03314-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/06/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Bisphosphonates are commonly used medication for the treatment of osteoporosis, and a well-established complication of this medication is bisphosphonate-associated atypical femur fractures (BAAFFs). The aim of this study was to assess the post-operative functional and radiographic outcomes of surgically treated BAAFFs. METHODS An analysis of patients treated at a university-affiliated institution was performed. Patients who had undergone surgical fixation for a subtrochanteric or shaft of femur fracture which had been classified as atypical and treated with bisphosphonate therapy at the time of fracture were included. The outcome measures assessed included post-operative complications, length of stay, discharge destination, post-operative function, independence in activities of daily living (ADLs) and fracture union. RESULTS Twenty patients were included in this study with a mean age of 75.2 years. The cohort was predominantly female. The average duration of bisphosphonate therapy was 7.35 years. Nine patients had contralateral bisphosphonate-related stress reactions at the time of their initial fracture and underwent prophylactic surgical intervention. The majority of patients received cephalomedullary nail fixation (95%) with more than half (65.0%) of the cohort experiencing one or more post-operative complications. The median length of stay was 6.5 days and 50% of the cohort required inpatient rehabilitation. At final review, independent mobilisation was recorded in only 10.0% of patients, and 70% of patients were dependent with their ADLs at their latest follow-up. Average follow-up was 8 months, and only six cases demonstrated union at the six-month review, with delayed union between 9 and 12 months being common. CONCLUSION Patients with BAAFFs experience high rates of complications, record poor post-operative functional outcomes, and demonstrate a delayed time to union. Nearly half of our cohort had radiographic evidence of bilateral pathology.
Collapse
Affiliation(s)
- Benjamin Murphy
- Department of Orthopaedics, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Sam L Francis
- Department of Orthopaedics, St Vincent's Hospital, Melbourne, VIC, Australia
- Department of Surgery, The University of Melbourne, Melbourne, VIC, Australia
| | - Isaac Rhee
- Department of Orthopaedics, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Sina Babazadeh
- Department of Orthopaedics, St Vincent's Hospital, Melbourne, VIC, Australia
- Department of Surgery, The University of Melbourne, Melbourne, VIC, Australia
| | - James Stoney
- Department of Orthopaedics, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Jarrad Stevens
- Department of Orthopaedics, St Vincent's Hospital, Melbourne, VIC, Australia.
- Department of Surgery, The University of Melbourne, Melbourne, VIC, Australia.
| |
Collapse
|
13
|
Bisphosphonate Drug Holiday and Fracture Risk: Reviewing the Evidence. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2022. [DOI: 10.1007/s40674-022-00191-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
14
|
OKAMOTO M, KASHII M, ABE S. Development of Atypical Ulnar Fracture is Associated with Bisphosphonate Therapy and Severe Spinal Deformity: A Case Report. J Hand Surg Asian Pac Vol 2022; 27:553-559. [DOI: 10.1142/s2424835522720225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Atypical ulna fracture (AUF) is relatively rare and is known to be associated with prolonged bisphosphonate (BP) use. The developmental mechanism remains unclear. We report a patient with an AUF associated with BP and severe spinal deformity. The patient was an 85-year-old woman receiving oral alendronate for 8 years without vitamin D supplementation. During regular kitchen work, she needed left upper limb support. She presented with atraumatic pain over the ulna. Radiographs revealed a transverse fracture in the proximal ulna and ulna bowing deformity. Whole-spine standing radiographs showed severe degenerative kyphoscoliosis. The skin induration with pigmentation on her left elbow that suggested prolonged overload and during standing work, coincided exactly with fracture location. This report suggests that ‘direct stress’, with persistent local overload on the proximal ulna, is one of the developmental mechanisms of AUF, in addition to persistent suppression of bone remodelling by prolonged BP use and vitamin D deficiency. Level of Evidence: Level V (Therapeutic)
Collapse
Affiliation(s)
- Michio OKAMOTO
- Department of Orthopedic Surgery, Yao Municipal Hospital, Yao, Osaka, Japan
| | - Masafumi KASHII
- Department of Orthopedic Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | - Shingo ABE
- Department of Orthopedic Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| |
Collapse
|
15
|
Chalitsios CV, Shaw DE, McKeever TM. Risk of subtrochanteric and femoral shaft fractures due to bisphosphonate therapy in asthma: a population-based nested case-control study. Osteoporos Int 2022; 33:931-935. [PMID: 34635953 DOI: 10.1007/s00198-021-06197-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/05/2021] [Indexed: 11/24/2022]
Abstract
UNLABELLED Concerns have been raised over the association between bisphosphonates and atypical fractures in subtrochanteric and femoral shaft regions, but the potential risk of these fractures due to bisphosphonate use in asthma has not been examined. INTRODUCTION Bisphosphonates are used as first-line treatment for osteoporosis; however, concerns have been raised over their association with atypical subtrochanteric (ST) and femoral shaft (FS) fractures. The potential risk of atypical ST/FS fractures from bisphosphonate use in asthma has not been examined. METHODS A nested case-control study was conducted using linked data from the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) databases. Using an asthma cohort, we identified patients with atypical ST/FS fractures and sex, age, and practice-matched controls. Conditional logistic regression was used to determine the association between bisphosphonate exposure and atypical ST/FS fractures. RESULTS From a cohort of 69,074 people with asthma, 67 patients with atypical ST/FS fractures and 260 matched control subjects were identified. Of the case patients, 40.3% had received bisphosphonates as compared with 14.2% of the controls corresponding to an adjusted odds ratio (aOR) of 4.42 (95%CI, 2.98 to 8.53). The duration of use influenced the risk with long-term users to be at a greater risk (> 5 years vs no exposure; aOR = 7.67; 95%CI, 1.75 to 33.91). Drug withdrawal was associated with diminished odds of atypical ST/FS fractures. CONCLUSION Regular review of bisphosphonates should occur in patients with asthma. The risks and benefits of bisphosphonate therapy should be carefully considered in consultation with the patient. To improve AFF prevention, early signs which may warrant imaging, such as prodromal thigh pain, should be discussed.
Collapse
Affiliation(s)
- C V Chalitsios
- Division of Respiratory Medicine, Clinical Science Building, School of Medicine, University of Nottingham, Nottingham, UK.
- Division of Epidemiology and Public Health, Clinical Science Building, School of Medicine, University of Nottingham, Nottingham, UK.
| | - D E Shaw
- Division of Respiratory Medicine, Clinical Science Building, School of Medicine, University of Nottingham, Nottingham, UK
| | - T M McKeever
- Division of Epidemiology and Public Health, Clinical Science Building, School of Medicine, University of Nottingham, Nottingham, UK
| |
Collapse
|
16
|
Sakuda T, Omoto O, Hamasaki T, Okimoto N, Adachi N. Incomplete Atypical Femoral Fracture Treated by Prophylactic Intramedullary Nail Fixation: A Case Series. Cureus 2022; 14:e22725. [PMID: 35386143 PMCID: PMC8968090 DOI: 10.7759/cureus.22725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 11/15/2022] Open
Abstract
Long-term bisphosphonate use may be associated with atypical femoral fractures. In this report, we describe three cases of bisphosphonate-associated incomplete atypical femoral fracture, treated by prophylactic intramedullary nail fixation. Patients with long-term intake of bisphosphonates must be carefully monitored; atypical femoral fracture should be suspected in the presence of symptoms such as thigh pain. Its early identification is important to avoid a complete fracture and invasive surgery, and prophylactic fixation is recommended for incomplete atypical femoral fractures.
Collapse
|
17
|
Tsuda E, Fukuda C, Okada A, Karibe T, Hiruma Y, Takagi N, Isumi Y, Yamamoto T, Hasegawa T, Uehara S, Koide M, Udagawa N, Amizuka N, Kumakura S. Characterization, pharmacokinetics, and pharmacodynamics of anti-Siglec-15 antibody and its potency for treating osteoporosis and as follow-up treatment after parathyroid hormone use. Bone 2022; 155:116241. [PMID: 34715394 DOI: 10.1016/j.bone.2021.116241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 10/21/2021] [Accepted: 10/21/2021] [Indexed: 11/15/2022]
Abstract
Recent studies have established the idea that Siglec-15 is involved in osteoclast differentiation and/or function, and it is anticipated that therapies suppressing Siglec-15 function can be used to treat bone diseases such as osteoporosis. We have produced rat monoclonal anti-Siglec-15 antibody (32A1) and successively generated humanized monoclonal anti-Siglec-15 antibody (DS-1501a) from 32A1. Studies on the biological properties of DS-1501a showed its specific binding affinity to Siglec-15 and strong activity to inhibit osteoclastogenesis. 32A1 inhibited multinucleation of osteoclasts and bone resorption (pit formation) in cultured mouse bone marrow cells. 32A1 also inhibited pit formation in cultured human osteoclast precursor cells. Maximum serum concentration and serum exposure of DS-1501a in rats were increased in a dose-dependent manner after single subcutaneous or intravenous administration. Furthermore, single administration of DS-1501a significantly suppressed bone resorption markers with minimal effects on bone formation markers and suppressed the decrease in bone mineral density (BMD) of the lumbar vertebrae in ovariectomized (OVX) rats. In histological analysis, the osteoclasts distant from the chondro-osseous junction of the tibia tended to be flattened, shrunken, and functionally impaired in 32A1-treated rats, while alkaline phosphatase-positive osteoblasts were observed throughout the metaphyseal trabeculae. In addition, we compared the efficacy of 32A1 with that of alendronate (ALN) as follow-up medicine after treatment with parathyroid hormone (PTH) using mature established osteoporosis rats. The beneficial effect of PTH on bone turnover disappeared 8 weeks after discontinuing the treatment. The administration of 32A1 once every 4 weeks for 8 weeks suppressed bone resorption and bone formation when the treatment was switched from PTH to 32A1, leading to the maintenance of BMD and bone strength. Unlike with ALN, the onset of suppression of bone resorption with 32A1 was rapid, while the suppression of bone formation was mild. The improvement of bone mass, beneficial bone turnover balance, and suppression of osteoclast differentiation/multinucleation achieved by 32A1 were supported by histomorphometry. Notably, the effects of 32A1 on bone strength, not only structural (extrinsic) but also material (intrinsic) properties, were significantly greater than those of ALN. Since the effect of 32A1 on BMD was moderate, its effect on bone strength could not be fully explained by the increase in BMD. The beneficial balance of bone turnover caused by 32A1 might, at least in part, be responsible for the improvement in bone quality. This is the first report describing the effects of anti-Siglec-15 antibody in OVX rats; the findings suggest that this antibody could be an excellent candidate for treating osteoporosis, especially in continuation therapy after PTH treatment, due to its rapid action and unprecedented beneficial effects on bone quality.
Collapse
Affiliation(s)
- Eisuke Tsuda
- Specialty Medicine Research Laboratories I, Daiichi Sankyo Co., Ltd., 1-2-58 Hiromachi, Shinagawa-ku, Tokyo 140-8710, Japan
| | - Chie Fukuda
- Specialty Medicine Research Laboratories I, Daiichi Sankyo Co., Ltd., 1-2-58 Hiromachi, Shinagawa-ku, Tokyo 140-8710, Japan.
| | - Akiko Okada
- Biological Research Laboratories, Daiichi Sankyo Co., Ltd., 1-2-58 Hiromachi, Shinagawa-ku, Tokyo 140-8710, Japan
| | - Tsuyoshi Karibe
- Drug Metabolism and Pharmacokinetics Research Laboratories, Daiichi Sankyo Co., Ltd., 1-2-58 Hiromachi, Shinagawa-ku, Tokyo 140-8710, Japan
| | - Yoshiharu Hiruma
- Pharmacovigilance Department, Daiichi Sankyo Co., Ltd., 3-5-1 Nihonbashi-Honcho, Chuo-ku, Tokyo 103-8426, Japan
| | - Nana Takagi
- Pharmacovigilance Department, Daiichi Sankyo Co., Ltd., 3-5-1 Nihonbashi-Honcho, Chuo-ku, Tokyo 103-8426, Japan
| | - Yoshitaka Isumi
- Oncology Research Laboratories I, Daiichi Sankyo Co., Ltd., 1-2-58 Hiromachi, Shinagawa-ku, Tokyo 140-8710, Japan
| | - Tomomaya Yamamoto
- Developmental Biology of Hard Tissue, Faculty of Dental Medicine, Nishi 7 Chome, Kita 13 Jo, Kita-ku, Sapporo, Hokkaido University, Hokkaido 060-8586, Japan
| | - Tomoka Hasegawa
- Developmental Biology of Hard Tissue, Faculty of Dental Medicine, Nishi 7 Chome, Kita 13 Jo, Kita-ku, Sapporo, Hokkaido University, Hokkaido 060-8586, Japan
| | - Shunsuke Uehara
- Department of Oral Biochemistry, Matsumoto Dental University, 1780 Gobara Hirooka, Shiojiri, Nagano 399-0781, Japan
| | - Masanori Koide
- Division of Hard Tissue Research, Institute for Oral Science, Matsumoto Dental University, 1780 Gobara Hirooka, Shiojiri, Nagano 399-0781, Japan
| | - Nobuyuki Udagawa
- Department of Oral Biochemistry, Matsumoto Dental University, 1780 Gobara Hirooka, Shiojiri, Nagano 399-0781, Japan; Division of Hard Tissue Research, Institute for Oral Science, Matsumoto Dental University, 1780 Gobara Hirooka, Shiojiri, Nagano 399-0781, Japan
| | - Norio Amizuka
- Developmental Biology of Hard Tissue, Faculty of Dental Medicine, Nishi 7 Chome, Kita 13 Jo, Kita-ku, Sapporo, Hokkaido University, Hokkaido 060-8586, Japan
| | - Seiichiro Kumakura
- Translational Medicine Function, Daiichi Sankyo Co., Ltd., 1-2-58 Hiromachi, Shinagawa-ku, Tokyo 140-8710, Japan
| |
Collapse
|
18
|
Kobayashi T, Ishikawa T, Katsuragi J, Sasaki Y, Ohtori S. Open Reduction and Internal Fixation of Simultaneous, Bilateral, Atypical Femoral Shaft Fractures After Nine Years of Bisphosphonate Treatment. Cureus 2021; 13:e19177. [PMID: 34873519 PMCID: PMC8636182 DOI: 10.7759/cureus.19177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2021] [Indexed: 11/05/2022] Open
Abstract
Bisphosphonates are generally used to treat osteoporosis and decrease the risk of femoral neck and vertebral fractures in patients with osteoporosis. Recently, it has been suggested that long-term bisphosphonate use can lead to decreased bone remodeling and an increased risk of atypical fractures. Atypical fractures often occur in the femur. The purpose of the present report is to describe a rare case of simultaneous, bilateral, atypical femoral fractures. An 80-year-old female was walking when she sustained bilateral femoral fractures that were diagnosed as atypical. The patient had received bisphosphonate treatment over the prior nine years.
Collapse
Affiliation(s)
| | | | - Joe Katsuragi
- Orthopedic Surgery, Sanmu Medical Center, Chiba, JPN
| | | | - Seiji Ohtori
- Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| |
Collapse
|
19
|
Kim B, Cho YJ, Lim W. Osteoporosis therapies and their mechanisms of action (Review). Exp Ther Med 2021; 22:1379. [PMID: 34650627 PMCID: PMC8506919 DOI: 10.3892/etm.2021.10815] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/04/2021] [Indexed: 12/15/2022] Open
Abstract
Osteoporosis is a common disease that affects millions of patients worldwide and is most common in menopausal women. The main characteristics of osteoporosis are low bone density and increased risk of fractures due to deterioration of the bone architecture. Osteoporosis is a chronic disease that is difficult to treat; thus, investigations into novel effective therapeutic methods are required. A number of studies have focused on determining the most effective treatment options for this disease. There are several treatment options for osteoporosis that differ depending on the characteristics of the disease, and these include both well-established and newly developed drugs. The present review focuses on the various drugs available for osteoporosis, the associated mechanisms of action and the methods of administration.
Collapse
Affiliation(s)
- Beomchang Kim
- Laboratory of Orthopaedic Research, School of Medicine, Chosun University, Gwangju 61452, Republic of Korea
| | - Yong Jin Cho
- Department of Orthopaedic Surgery, College of Medicine, Chosun University, Gwangju 61452, Republic of Korea
| | - Wonbong Lim
- Laboratory of Orthopaedic Research, School of Medicine, Chosun University, Gwangju 61452, Republic of Korea
- Department of Orthopaedic Surgery, College of Medicine, Chosun University, Gwangju 61452, Republic of Korea
- Department of Premedical Sciences, College of Medicine, Chosun University, Gwangju 61452, Republic of Korea
| |
Collapse
|
20
|
Cha SM, Shin HD, Ahn BK. Revision osteosynthesis after primary treatment of atypical ulnar fractures associated with bisphosphonate usage - Nonunion after ordinary open reduction and internal fixation. Arch Orthop Trauma Surg 2021; 141:1855-1862. [PMID: 32797295 DOI: 10.1007/s00402-020-03567-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 08/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND We performed revision surgeries to treat nonunion of bisphosphonate-associated ulnar fractures that had originally been treated, after misdiagnosis, using the typical open reduction/internal fixation (ORIF). METHODS Of nine cases of ulnar nonunion initially treated at other institutions, we performed revision surgeries on four that met our inclusion/exclusion criteria. All previous implants were removed; the areas of nonunion were resected, and strut bone grafts were inserted and fixed with locking plates. Radiological assessments were performed monthly for 3 months after surgery and then every 3 months for 1 year. RESULTS All patients were female, with a mean age of 71.8 years. All patients had been taking bisphosphonate for a mean of 7.2 years. The primary fixation methods used at other institutions were intra-medullary nailing (n = 1) and placement of 3.5-mm locking plates (n = 3). In one patient (patient 1), the contralateral (right) ulna developed a new fracture at 1 month after revision surgery on the left ulna. Another patient (patient 3) exhibited an incomplete fracture in the contralateral (right) ulna. All four patients exhibited hip fractures (bilateral in three). All revisions resulted in final union at a mean of 4.8 months postoperatively. CONCLUSION Atypical ulnar fractures should be suspected in elderly women on long-term bisphosphonate treatment. Union will fail with standard ORIF for atypical ulnar fractures, because the fracture occurred due to compromised normal bone metabolism as reflected in the bone resorption, remodeling, and healing processes. Revision osteosynthesis using a locking plate with callus resection and strut/cancellous bone graft provided satisfactory results. LEVEL OF EVIDENCE Therapeutic level IV.
Collapse
Affiliation(s)
- Soo Min Cha
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, 266 Munwha-ro, Jung-Gu, Daejeon, Korea
| | - Hyun Dae Shin
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, 266 Munwha-ro, Jung-Gu, Daejeon, Korea.
| | - Byung Kuk Ahn
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, 266 Munwha-ro, Jung-Gu, Daejeon, Korea
| |
Collapse
|
21
|
Tsukazaki H, Kikuta J, Ao T, Morimoto A, Fukuda C, Tsuda E, Minoshima M, Kikuchi K, Kaito T, Ishii M. Anti-Siglec-15 antibody suppresses bone resorption by inhibiting osteoclast multinucleation without attenuating bone formation. Bone 2021; 152:116095. [PMID: 34216837 DOI: 10.1016/j.bone.2021.116095] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/06/2021] [Accepted: 06/27/2021] [Indexed: 02/06/2023]
Abstract
Anti-resorptive drugs are widely used for the treatment of osteoporosis, but excessive inhibition of osteoclastogenesis can suppress bone turnover and cause the deterioration of bone quality. Sialic acid-binding immunoglobulin-like lectin 15 (Siglec-15) is a transmembrane protein expressed on osteoclast precursor cells and mature osteoclasts. Siglec-15 regulates proteins containing immunoreceptor tyrosine-based activation motif (ITAM) domains, which then induce nuclear factor of activated T-cells 1 (NFATc1), a master transcription factor of osteoclast differentiation. Anti-Siglec-15 antibody modulates ITAM signaling in osteoclast precursors and inhibits the maturation of osteoclasts in vitro. However, in situ pharmacological effects, particularly during postmenopausal osteoporosis, remain unclear. Here, we demonstrated that anti-Siglec-15 antibody treatment protected against ovariectomy-induced bone loss by specifically inhibiting the generation of multinucleated osteoclasts in vivo. Moreover, treatment with anti-Siglec-15 antibody maintained bone formation to a greater extent than with risedronate, the first-line treatment for osteoporosis. Intravital imaging revealed that anti-Siglec-15 antibody treatment did not cause a reduction in osteoclast motility, whereas osteoclast motility declined following risedronate treatment. We evaluated osteoclast activity using a pH-sensing probe and found that the bone resorptive ability of osteoclasts was lower following anti-Siglec-15 antibody treatment compared to after risedronate treatment. Our findings suggest that anti-Siglec-15 treatment may have potential as an anti-resorptive therapy for osteoporosis, which substantially inhibits the activity of osteoclasts while maintaining physiological bone coupling.
Collapse
Affiliation(s)
- Hiroyuki Tsukazaki
- Department of Immunology and Cell Biology, Graduate School of Medicine & Frontier Biosciences, Osaka University, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan; Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - Junichi Kikuta
- Department of Immunology and Cell Biology, Graduate School of Medicine & Frontier Biosciences, Osaka University, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan; WPI-Immunology Frontier Research Center, Osaka University, Osaka, Japan; Laboratory of Bioimaging and Drug Discovery, National Institutes of Biomedical Innovation, Health and Nutrition, 7-6-8 Saito-Asagi, Ibaraki, Osaka 567-0085, Japan.
| | - Tomoka Ao
- Department of Immunology and Cell Biology, Graduate School of Medicine & Frontier Biosciences, Osaka University, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan; Laboratory of Bioimaging and Drug Discovery, National Institutes of Biomedical Innovation, Health and Nutrition, 7-6-8 Saito-Asagi, Ibaraki, Osaka 567-0085, Japan
| | - Akito Morimoto
- Department of Immunology and Cell Biology, Graduate School of Medicine & Frontier Biosciences, Osaka University, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - Chie Fukuda
- Specialty Medicine Research Laboratories I, Daiichi Sankyo Co., Ltd., 1-2-58 Hiromachi, Shinagawa-ku, Tokyo 140-8710, Japan
| | - Eisuke Tsuda
- Specialty Medicine Research Laboratories I, Daiichi Sankyo Co., Ltd., 1-2-58 Hiromachi, Shinagawa-ku, Tokyo 140-8710, Japan
| | - Masafumi Minoshima
- Department of Material and Life Sciences, Graduate School of Engineering, Osaka University, 2-1 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - Kazuya Kikuchi
- WPI-Immunology Frontier Research Center, Osaka University, Osaka, Japan; Department of Material and Life Sciences, Graduate School of Engineering, Osaka University, 2-1 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - Takashi Kaito
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - Masaru Ishii
- Department of Immunology and Cell Biology, Graduate School of Medicine & Frontier Biosciences, Osaka University, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan; WPI-Immunology Frontier Research Center, Osaka University, Osaka, Japan; Laboratory of Bioimaging and Drug Discovery, National Institutes of Biomedical Innovation, Health and Nutrition, 7-6-8 Saito-Asagi, Ibaraki, Osaka 567-0085, Japan.
| |
Collapse
|
22
|
Ke CH, Li HY, Yang D, Ying H, Xu J, Wang J, Zhu HW, Wang L. Dynamic Effects of the Third Generation Bisphosphonate of Risedronate on Rat Osteoporotic Fractures for Clinical Usage Guidance. Orthop Surg 2021; 13:2433-2441. [PMID: 34676672 PMCID: PMC8654647 DOI: 10.1111/os.13158] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To better understand the risks of bisphosphonates in order to develop guidance for appropriate clinical usage, to compared femoral fracture healing at different time points and to explore the effects of Residronate on fracture healing. METHODS Osteoporosis model was achieved by ovariectomy surgery, followed by surgical incision of left femoral shaft 4 weeks after ovariectomy surgery. Three days after fracture surgery, risedronateor saline was fed by intragastric administration. X ray examination was used to check the callus formation, Bone Mineral Density (BMD), Bone Mineral Content (BMC), biomechanical, imaging and micromorphological of bone tissue as well as the trabecular bone parameters were all examined. The femoral pathology tissue of each rat was used to analyze trabecular bone parameters, including trabecular bone volume/tissue volume (Tb. BV/TV), bone surface to tissue volume ratio (BS/TV), trabecular bone mineral density (Tb. BMD), trabecular bone number (Tb. N), trabecular bone thickness (Tb. Th) and small bone Trabecular bone space (Tb. Sp). RESULTS Via X-ray and pathologically, risedronate treatment promoted the callus forming at the fracture site during the following 6 weeks after osteoporotic fracture by X-ray (P < 0.01), increased the local bone mineral density (P < 0.01), and accelerated the fracture healing during the first 3 weeks (P <0.01), but delayed facture healing in the later 3 weeks (P < 0.01). Risedronate increased the bone continuity of fracture at 7th week, but this phenomenon was not found at the 10th week (P < 0.01). Delayed fracture healing occurred locally at the fracture site. At 7th week, Risedronate may promote cartilage cells proliferating at fracture site, increase the dense of bone trabeculae and the connection of bone trabeculae, thicken the bone cortex showing better fracture healing than OPF-Saline groups (P < 0.01). However, these parameter did not continue during the 7th and 10th weeks. Comparing the first and the later 3 weeks, the rats in group Osteoporotic Fracture-Risedronate (OPF-RD) accelerated the local fracture healing in the first 3 weeks but not in the last 3 weeks, which is consistent for the BMD and BMC among each group (P < 0.05). Through evaluation of bone mineral density and bone mineral content, risedronate dramatically increased the BMD at the fracture site and resulted in reduction of BMC by risedronate at the fracture site (P < 0.05) among each group still exist, indicating dramatic (P < 0.05). Through load testing, Risedronate increased the structural strength and mechanical indexes of the new callus (P < 0.01). CONCLUSION Risedronate can improve the structural strength and mechanical index of newborn callus. Longer than 7 weeks usage of third generation bisphosphonate of risedronate does not contribute to osteoporotic fracture.
Collapse
Affiliation(s)
- Cheng-Hui Ke
- Department of Orthopaedics, Children's Hospital of Shanghai, Shanghai, China
| | - Hong-Yun Li
- Department of Anesthesiology, Children's Hospital of Shanghai, Shanghai, China
| | - Dan Yang
- Department of Orthopaedics, Children's Hospital of Shanghai, Shanghai, China
| | - Hao Ying
- Department of Orthopaedics, Children's Hospital of Shanghai, Shanghai, China
| | - Jun Xu
- Tongji University School of Medicine, Shanghai, China
| | - Jian Wang
- Tongji University School of Medicine, Shanghai, China
| | - Hong-Wen Zhu
- Tianjin Hospital, Tianjin Academy of Integrative Medicine, Tianjin, China
| | - Lin Wang
- Department of Orthopaedics, Children's Hospital of Shanghai, Shanghai, China
| |
Collapse
|
23
|
Konstantelos N, Rzepka AM, Cadarette SM. Fracture outcome definitions in observational osteoporosis drug effects studies: a scoping review protocol. JBI Evid Synth 2021; 20:907-916. [PMID: 34636342 DOI: 10.11124/jbies-20-00509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review is to describe fracture outcome definitions in observational osteoporosis drug effects studies from Canada and the United States of America. INTRODUCTION Health care administrative data are commonly utilized in pharmacoepidemiologic studies. These data are used to define outcomes, such as fractures, and are critical to determining real-world safety and effectiveness of medications. However, there is no current standard for fracture outcome definitions in observational studies. As a result, fractures are inconsistently defined. To inform future research, a synthesis of how fractures are defined in observational studies using health care administrative claims data is needed. Providing clarity on how fractures are defined will provide guidance for future research. INCLUSION CRITERIA We will include observational studies from the United States and Canada published in English from 2000 to the present that consider the impact of osteoporosis pharmacotherapies on fracture risk and leverage health care administrative data. METHODS This review will follow the three-step JBI methodology for scoping reviews. We will search MEDLINE (Ovid), Embase (Ovid), and CINAHL (EBSCO). Following de-duplication, titles and abstracts will be screened independently by two reviewers. We will then conduct full-text screening for eligible studies. In addition, Canadian and American government pharmacovigilance websites will be searched to identify gray literature. Data extraction will be completed by two reviewers. Results will be presented in figures and tabular form.
Collapse
Affiliation(s)
- Natalia Konstantelos
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada ICES, Toronto, ON, Canada Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA WHO Collaborating Center for Governance, Accountability and Transparency in the Pharmaceutical Sector, University of Toronto, Toronto, ON, Canada
| | | | | |
Collapse
|
24
|
Back J, Nguyen MN, Li L, Lee S, Lee I, Chen F, Gillinov L, Chung YH, Alder KD, Kwon HK, Yu KE, Dussik CM, Hao Z, Flores MJ, Kim Y, Ibe IK, Munger AM, Seo SW, Lee FY. Inflammatory conversion of quiescent osteoblasts by metastatic breast cancer cells through pERK1/2 aggravates cancer-induced bone destruction. Bone Res 2021; 9:43. [PMID: 34588427 PMCID: PMC8481290 DOI: 10.1038/s41413-021-00158-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 03/09/2021] [Accepted: 03/28/2021] [Indexed: 02/08/2023] Open
Abstract
Disruption of bone homeostasis caused by metastatic osteolytic breast cancer cells increases inflammatory osteolysis and decreases bone formation, thereby predisposing patients to pathological fracture and cancer growth. Alteration of osteoblast function induces skeletal diseases due to the disruption of bone homeostasis. We observed increased activation of pERK1/2 in osteolytic breast cancer cells and osteoblasts in human pathological specimens with aggressive osteolytic breast cancer metastases. We confirmed that osteolytic breast cancers with high expression of pERK1/2 disrupt bone homeostasis via osteoblastic ERK1/2 activation at the bone-breast cancer interface. The process of inflammatory osteolysis modulates ERK1/2 activation in osteoblasts and breast cancer cells through dominant-negative MEK1 expression and constitutively active MEK1 expression to promote cancer growth within bone. Trametinib, an FDA-approved MEK inhibitor, not only reduced breast cancer-induced bone destruction but also dramatically reduced cancer growth in bone by inhibiting the inflammatory skeletal microenvironment. Taken together, these findings suggest that ERK1/2 activation in both breast cancer cells and osteoblasts is required for osteolytic breast cancer-induced inflammatory osteolysis and that ERK1/2 pathway inhibitors may represent a promising adjuvant therapy for patients with aggressive osteolytic breast cancers by altering the shared cancer and bone microenvironment.
Collapse
Affiliation(s)
- Jungho Back
- grid.47100.320000000419368710Department of Orthopædics & Rehabilitation, Yale University, School of Medicine, New Haven, CT USA
| | - Minh Nam Nguyen
- grid.47100.320000000419368710Department of Orthopædics & Rehabilitation, Yale University, School of Medicine, New Haven, CT USA ,grid.444808.40000 0001 2037 434XResearch Center for Genetics and Reproductive Health, School of Medicine, Vietnam National University Ho Chi Minh City, Linh Trung Ward, Thu Duc District, Ho Chi Minh City, Vietnam
| | - Lu Li
- grid.47100.320000000419368710Department of Orthopædics & Rehabilitation, Yale University, School of Medicine, New Haven, CT USA ,grid.415869.7Department of Rehabilitation Medicine, Renji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Saelim Lee
- grid.47100.320000000419368710Department of Orthopædics & Rehabilitation, Yale University, School of Medicine, New Haven, CT USA ,grid.411982.70000 0001 0705 4288College of Medicine, Dankook University, Cheonan, Republic of Korea
| | - Inkyu Lee
- grid.47100.320000000419368710Department of Orthopædics & Rehabilitation, Yale University, School of Medicine, New Haven, CT USA ,grid.254224.70000 0001 0789 9563Department of Life Science, Chung-Ang University, Seoul, Republic of Korea
| | - Fancheng Chen
- grid.47100.320000000419368710Department of Orthopædics & Rehabilitation, Yale University, School of Medicine, New Haven, CT USA ,grid.11841.3d0000 0004 0619 8943Shanghai Medical College, Fudan University, Shanghai City, China
| | - Lauren Gillinov
- grid.47100.320000000419368710Department of Orthopædics & Rehabilitation, Yale University, School of Medicine, New Haven, CT USA
| | - Yeon-Ho Chung
- grid.47100.320000000419368710Department of Orthopædics & Rehabilitation, Yale University, School of Medicine, New Haven, CT USA
| | - Kareme D. Alder
- grid.47100.320000000419368710Department of Orthopædics & Rehabilitation, Yale University, School of Medicine, New Haven, CT USA
| | - Hyuk-Kwon Kwon
- grid.47100.320000000419368710Department of Orthopædics & Rehabilitation, Yale University, School of Medicine, New Haven, CT USA
| | - Kristin E. Yu
- grid.47100.320000000419368710Department of Orthopædics & Rehabilitation, Yale University, School of Medicine, New Haven, CT USA
| | - Christopher M. Dussik
- grid.47100.320000000419368710Department of Orthopædics & Rehabilitation, Yale University, School of Medicine, New Haven, CT USA
| | - Zichen Hao
- grid.47100.320000000419368710Department of Orthopædics & Rehabilitation, Yale University, School of Medicine, New Haven, CT USA ,grid.411525.60000 0004 0369 1599Department of Emergency & Trauma, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Michael J. Flores
- grid.47100.320000000419368710Department of Orthopædics & Rehabilitation, Yale University, School of Medicine, New Haven, CT USA
| | - Yoseph Kim
- grid.21107.350000 0001 2171 9311Biomedical Engineering, Johns Hopkins University, Baltimore, MD USA
| | - Izuchukwu K. Ibe
- grid.47100.320000000419368710Department of Orthopædics & Rehabilitation, Yale University, School of Medicine, New Haven, CT USA
| | - Alana M. Munger
- grid.47100.320000000419368710Department of Orthopædics & Rehabilitation, Yale University, School of Medicine, New Haven, CT USA
| | - Sung Wook Seo
- grid.414964.a0000 0001 0640 5613Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Gangnam-gu Republic of Korea
| | - Francis Y. Lee
- grid.47100.320000000419368710Department of Orthopædics & Rehabilitation, Yale University, School of Medicine, New Haven, CT USA
| |
Collapse
|
25
|
Griffin LV, Warner E, Palnitkar S, Qiu S, Honasoge M, Griffin SG, Divine G, Rao SD. Bone Nanomechanical Properties and Relationship to Bone Turnover and Architecture in Patients With Atypical Femur Fractures: A Prospective Nested Case-Control Study. JBMR Plus 2021; 5:e10523. [PMID: 34532612 PMCID: PMC8441274 DOI: 10.1002/jbm4.10523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/18/2021] [Accepted: 06/02/2021] [Indexed: 11/20/2022] Open
Abstract
Atypical femur fractures (AFFs) are well‐established serious complication of long‐term bisphosphonate and denosumab therapy in patients with osteopenia or osteoporosis. To elucidate underlying mechanism(s) for the development of AFF, we performed a nested case‐control study to investigate bone tissue nanomechanical properties and prevailing bone microstructure and tissue‐level remodeling status as assessed by bone histomorphometry. We hypothesized that there would be differences in nanomechanical properties between patients with and without AFF and that bone microstructure and remodeling would be related to nanomechanical properties. Thirty‐two full‐thickness transiliac bone biopsies were obtained from age‐ and sex‐matched patients on long‐term bisphosphonate therapy with (n = 16) and without an AFF (n = 16). Standard histomorphometric measurements were made in each sample on three different bone envelopes (cancellous, intracortical, and endosteal). Iliac bone wall thickness was significantly lower on all three bone surfaces in patients with AFF than in those without AFF. Surface‐based bone formation rate was suppressed similarly in both groups in comparison to healthy premenopausal and postmenopausal women, with no significant difference between the two groups. Nanoindentation was used to assess material properties of cortical and cancellous bone separately. Elastic modulus was higher in cortical than in cancellous bone in patients with AFF as well as compared to the elastic modulus of cortical bone from non‐AFF patients. However, the elastic modulus of the cancellous bone was not different between AFF and non‐AFF groups or between cortical and cancellous bone of non‐AFF patients. Resistance to plastic deformation was decreased in cortical bone in both AFF and non‐AFF groups compared to cancellous bone, but to a greater extent in AFF patients. We conclude that long‐term bisphosphonate therapy is associated with prolonged suppression of bone turnover resulting in altered cortical remodeling and tissue nanomechanical properties leading to AFF. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Lanny V Griffin
- California Polytechnic State University (Cal Poly) San Luis Obispo CA USA
| | - Elizabeth Warner
- Bone & Mineral Research Laboratory Henry Ford Health System/Wayne State University Integrative Biosciences (IBio) Research Facility Detroit MI USA
| | - Saroj Palnitkar
- Bone & Mineral Research Laboratory Henry Ford Health System/Wayne State University Integrative Biosciences (IBio) Research Facility Detroit MI USA
| | - Shijing Qiu
- Bone & Mineral Research Laboratory Henry Ford Health System/Wayne State University Integrative Biosciences (IBio) Research Facility Detroit MI USA
| | - Mahalakshmi Honasoge
- Division of Endocrinology, Diabetes, and Bone & Mineral Disorders Henry Ford Health System Detroit MI USA
| | - Shawna G Griffin
- California Polytechnic State University (Cal Poly) San Luis Obispo CA USA
| | - George Divine
- Department of Public Health Sciences Henry Ford Health System Detroit MI USA
| | - Sudhaker D Rao
- Bone & Mineral Research Laboratory Henry Ford Health System/Wayne State University Integrative Biosciences (IBio) Research Facility Detroit MI USA.,Division of Endocrinology, Diabetes, and Bone & Mineral Disorders Henry Ford Health System Detroit MI USA
| |
Collapse
|
26
|
Lamarre M, Marcotte M, Laurin D, Furrer D, Vedel I, Tourigny A, Giguère A, Carmichael PH, Martines R, Morais J, Kröger E. Discontinuation of bisphosphonates in seniors: a systematic review on health outcomes. Arch Osteoporos 2021; 16:133. [PMID: 34524561 DOI: 10.1007/s11657-021-01000-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 09/05/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Bisphosphonates are used to treat osteoporosis. Despite their benefits on bone mineral density (BMD) and fractures, they have shown adverse effects, sometimes severe, during chronic use. Taken for several years, they achieve long-term bone retention, making deprescribing feasible. This review aimed to synthesize evidence on the success and health outcomes of deprescribing of bisphosphonates in seniors, aged over 60 years. METHODS The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, including articles in English, French, or German published before July 2020. Eligible studies included seniors having discontinued bisphosphonates and reported on health outcomes; some allowed meta-analyses on fracture risk. RESULTS The review included 9 RCTs and 9 cohort studies of moderate quality. Bisphosphonates were discontinued after 2 to 7 years of use, and BMD or fractures were assessed during follow-up of 0.5 to 5 years. A significant reduction in BMD after discontinuation was observed in 9 of 10 studies. Results on fracture risk after discontinuation are mitigated: 6 RCT extensions showed no increase in the risk of any osteoporotic fractures after discontinuation. Meta-analyses including 4 RCTs showed an increased odds ratio of vertebral fractures of 2.04 (95% CI, 1.39-2.99) among discontinuers. Results from 2 large cohort studies showed no increased risks of any osteoporotic or vertebral fractures, while 2 studies found increased fracture risks. CONCLUSION Bisphosphonates have successfully been discontinued low overall fracture risk after at least 3 years of use, but a risk for decreased BMD and increased vertebral fractures remained.
Collapse
Affiliation(s)
- Marianne Lamarre
- Faculté de médecine, Université Laval, Quebec City, Quebec, Canada
| | - Martine Marcotte
- Centre d'excellence sur le vieillissement de Québec, CIUSSS Capitale Nationale, Quebec City, Quebec, Canada
| | - Danielle Laurin
- Centre d'excellence sur le vieillissement de Québec, CIUSSS Capitale Nationale, Quebec City, Quebec, Canada.,Faculté de pharmacie, Université Laval, Quebec City, Quebec, Canada.,Institut sur le vieillissement et la participation sociale des aînés de l, Université Laval, Quebec City, Quebec, Canada.,Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec, Canada.,VITAM Centre de recherche sur la santé durable, Quebec City, Quebec, Canada
| | - Daniela Furrer
- Centre d'excellence sur le vieillissement de Québec, CIUSSS Capitale Nationale, Quebec City, Quebec, Canada
| | - Isabelle Vedel
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - André Tourigny
- Faculté de médecine, Université Laval, Quebec City, Quebec, Canada.,Centre d'excellence sur le vieillissement de Québec, CIUSSS Capitale Nationale, Quebec City, Quebec, Canada.,Institut sur le vieillissement et la participation sociale des aînés de l, Université Laval, Quebec City, Quebec, Canada.,Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec, Canada.,VITAM Centre de recherche sur la santé durable, Quebec City, Quebec, Canada
| | - Anik Giguère
- Faculté de médecine, Université Laval, Quebec City, Quebec, Canada.,Centre d'excellence sur le vieillissement de Québec, CIUSSS Capitale Nationale, Quebec City, Quebec, Canada.,Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec, Canada.,VITAM Centre de recherche sur la santé durable, Quebec City, Quebec, Canada
| | - Pierre-Hugues Carmichael
- Centre d'excellence sur le vieillissement de Québec, CIUSSS Capitale Nationale, Quebec City, Quebec, Canada.,VITAM Centre de recherche sur la santé durable, Quebec City, Quebec, Canada
| | - Rosa Martines
- Centre d'excellence sur le vieillissement de Québec, CIUSSS Capitale Nationale, Quebec City, Quebec, Canada
| | - José Morais
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Edeltraut Kröger
- Centre d'excellence sur le vieillissement de Québec, CIUSSS Capitale Nationale, Quebec City, Quebec, Canada. .,Faculté de pharmacie, Université Laval, Quebec City, Quebec, Canada. .,Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec, Canada. .,VITAM Centre de recherche sur la santé durable, Quebec City, Quebec, Canada. .,Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
| |
Collapse
|
27
|
Kim K, Won YY, Lee SW, Seo KD. The Effect of Teriparatide on the Hip: A Literature Review. Hip Pelvis 2021; 33:45-52. [PMID: 34141690 PMCID: PMC8190496 DOI: 10.5371/hp.2021.33.2.45] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/09/2020] [Accepted: 12/14/2020] [Indexed: 12/04/2022] Open
Abstract
Teriparatide (TPTD) is a bone-forming agent used to treat postmenopausal osteoporosis. Since hip fractures are related to higher morbidity and mortality rates than other fractures, efficacious osteoporosis drugs for the hip are critical. We reviewed research articles reporting the efficacy of TPTD in terms of bone mineral density (BMD), fractures prevention, changes in the outer diameter, cortical thickness and porosity, post-operative periprosthetic BMD loss, and healing of typical and atypical fractures of the hip. Data meta-analyses indicated that TPTD not only increased the BMD of the proximal femur but also decreased the risk of hip fractures. Even though TPTD increases the cortical bone porosity of the proximal femur, the bone strength does not decrease as the majority of the porosity is located at the endocortex; further, it increases the outer diameter and thickens the cortical bone. TPTD stimulates bone remodeling and facilitates callus maturity and fracture healing. There have been many reports on improving the effect of TPTD on the healing of atypical fractures; therefore it is advisable to use TPTD considering the increase benefit compared to the risk.
Collapse
Affiliation(s)
- Kwangkyoun Kim
- Department of Orthopaedic Surgery, Konyang University College of Medicine, Daejeon, Korea
| | - Ye-Yeon Won
- Department of Orthopedic Surgery, Ajou University College of Medicine, Suwon, Korea
| | - Seok-Won Lee
- Department of Orthopaedic Surgery, Konyang University College of Medicine, Daejeon, Korea
| | - Kyung-Deok Seo
- Department of Orthopaedic Surgery, Konyang University College of Medicine, Daejeon, Korea
| |
Collapse
|
28
|
Wang B, Tang J, Weng S, Chen L, Wu Z, Xie Z, Yang L. Is vitamin K 2 a treatment choice for atypical femoral fractures in patients with secondary osteoporosis? J Int Med Res 2021; 49:3000605211001643. [PMID: 33845598 PMCID: PMC8047822 DOI: 10.1177/03000605211001643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
An atypical femoral fracture (AFF) is a rare complication associated with excessive inhibition of osteoclast expression during treatment of osteoporosis. We herein describe a patient who had been treated with alendronate for more than 10 years and subsequently developed an AFF that healed after treatment with vitamin K2 (VK2). We also discuss the potential beneficial effects of VK2 on the healing of AFFs. A 48-year-old Asian man with secondary osteoporosis was treated with alendronate for more than 10 years. The patient underwent surgical treatment for a complete AFF of the right femur. Six months postoperatively, he complained of pain in his left thigh. X-ray examination revealed an incomplete AFF of the left femoral shaft. He was then treated with VK2. After 4 months of VK2 treatment, the patient reported that the pain in his left thigh had decreased, and follow-up X-ray examination demonstrated healing of the left AFF line. This case report indicates that VK2 may be a potential direction for pharmacological treatment of AFFs in future research.
Collapse
Affiliation(s)
- Bingzhang Wang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China
| | - Jiahao Tang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China
| | - Sheji Weng
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China
| | - Liang Chen
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China
| | - Zongyi Wu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China
| | - Zhongjie Xie
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China
| | - Lei Yang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China
| |
Collapse
|
29
|
Duration of Bisphosphonate Drug Holidays in Osteoporosis Patients: A Narrative Review of the Evidence and Considerations for Decision-Making. J Clin Med 2021; 10:jcm10051140. [PMID: 33803095 PMCID: PMC7963175 DOI: 10.3390/jcm10051140] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/23/2021] [Accepted: 03/04/2021] [Indexed: 12/21/2022] Open
Abstract
Bisphosphonates are first-line therapy for osteoporosis, with alendronate, risedronate, and zoledronate as the main treatments used globally. After one year of therapy, bisphosphonates are retained in bone for extended periods with extended anti-fracture effects after discontinuation. Due to this continued fracture protection and the potential for rare adverse events associated with long-term use (atypical femoral fractures and osteonecrosis of the jaw), a drug holiday of two to three years is recommended for most patients after long-term bisphosphonate therapy. The recommendation for a drug holiday up to three years is derived primarily from extensions of pivotal trials with alendronate and zoledronate and select surrogate marker studies. However, certain factors may modify the duration of bisphosphonate effects on a drug holiday and warrant consideration when determining an appropriate time off-therapy. In this narrative review, we recall what is currently known about drug holidays and discuss what we believe to be the primary considerations and areas for future research regarding drug holiday duration: total bisphosphonate exposure, type of bisphosphonate used, bone mineral density and falls risk, and patient sex and body weight.
Collapse
|
30
|
Chen J, Yue C, He P, Huang Z, Li L, Zhang X, Fan Y, Liu Y. Comparison of clinical outcomes with hip replacement versus PFNA in the treatment of intertrochanteric fractures in the elderly: A systematic review and meta-analysis (PRISMA). Medicine (Baltimore) 2021; 100:e24166. [PMID: 33655910 PMCID: PMC7939162 DOI: 10.1097/md.0000000000024166] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 12/10/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The purpose of this meta-analysis was to evaluate the clinical efficacy and safety of HR and PFNA in the treatment of intertrochanteric fractures in the elderly. METHODS We carried out this review according to the principle of preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline. The clinical randomized controlled trials (RCTs), prospective cohort studies, retrospective cohort studies (RCSs), and case-control studies involving HR and PFNA in the treatment of intertrochanteric fractures in the elderly from 2000 to 2020 were compared by searching Web of Science, Pubmed, the Cochrane Library, and Embase. The quality of the included cohort study (CS) lines was evaluated using the Newcastle-Ottawa Scale (NOS). The quality of the included RCT lines was evaluated using Jadad. Forest plots were drawn by RevMan5.4 software based on the results and the data were analyzed. RESULTS After screening, a total of 9 articles were included, of which one was a clinical RCT and eight were RCSs with 1374 patients. The operative time of the PFNA group was shorter [WMD = 15.20; 95% CI (13.17, 17.23), P < .05] and the intraoperative blood loss was less [WMD = 178.81; 95% CI (97.24, 260.38), P < .05] than the HR group, while the first weight-bearing time of the HR group was shorter [WMD = -7.70; 95% CI (-10.54, -4.86), P < .05] than the PFNA group. There was no significant difference in the length of hospital stay, HHS, postoperative orthopedic complications, and postoperative medical complications between the 2 groups. CONCLUSION With the development of HR technology and minimally invasive technology, the trauma caused by surgery is decreasing. Under the premise of improving perioperative management, such as optimizing the preoperative preparation and postoperative management, shortening the operative time, reducing intraoperative blood loss, and actively managing co-existing diseases, HR has more advantages than PFNA in the treatment of senile intertrochanteric fractures.
Collapse
Affiliation(s)
- Junming Chen
- Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fujian University of TCM), Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou
| | - Chen Yue
- Department of Orthopedic Surgery, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, China
| | - Peilin He
- Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fujian University of TCM), Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou
| | - Zeling Huang
- Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fujian University of TCM), Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou
| | - Li Li
- Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fujian University of TCM), Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou
| | - Xue Zhang
- Department of Orthopedic Surgery, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, China
| | - Yanan Fan
- Department of Orthopedic Surgery, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, China
| | - Youwen Liu
- Department of Orthopedic Surgery, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, China
| |
Collapse
|
31
|
Androjna C, Yee CS, White CR, Waldorff EI, Ryaby JT, Zborowski M, Alliston T, Midura RJ. A comparison of alendronate to varying magnitude PEMF in mitigating bone loss and altering bone remodeling in skeletally mature osteoporotic rats. Bone 2021; 143:115761. [PMID: 33217628 DOI: 10.1016/j.bone.2020.115761] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 11/13/2020] [Accepted: 11/14/2020] [Indexed: 01/12/2023]
Abstract
Pulsed electromagnetic field (PEMF) treatments stimulate bone formation activities though further work is needed to optimize its therapeutic benefit. PEMF can generate local potential gradients and electric currents that have been suggested to mimic bone electrochemical responses to load. In line with this reasoning, a recent publication reported that PEMF application on isolated bone tissue induced detectable micro-vibrations (doi:https://doi.org/10.1109/TMAG.2016.2515069). To determine the ability of PEMF to intervene in a rat model of osteoporosis, we tested its effect on trabecular and cortical bone following ovariectomy. Four PEMF treatments, with increasing sinusoidal amplitude rise with time (3850 Hz pulse frequency and 15 Hz repetition rate at 10 tesla/sec (T/s), 30 T/s, 100 T/s, or 300 T/s), were compared to the efficacy of an osteoporosis drug, alendronate, in reducing levels of trabecular bone loss in the proximal tibia. Herein, the novel findings from our study are: (1) 30 T/s PEMF treatment approached the efficacy of alendronate in reducing trabecular bone loss, but differed from it by not reducing bone formation rates; and (2) 30 T/s and 100 T/s PEMF treatments imparted measurable alterations in lacunocanalicular features in cortical bone, consistent with osteocyte sensitivity to PEMF in vivo. The efficacy of specific PEMF doses may relate to their ability to modulate osteocyte function such that the 30 T/s, and to a lesser extent 100 T/s, doses preferentially antagonize trabecular bone resorption while stimulating bone formation. Thus, PEMF treatments of specific magnetic field magnitudes exert a range of measurable biological effects in trabecular and cortical bone tissue in osteoporotic rats.
Collapse
Affiliation(s)
- Caroline Androjna
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Cristal S Yee
- Department of Orthopaedic Surgery, Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, United States of America
| | - Carter R White
- Department of Orthopaedic Surgery, Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, United States of America
| | | | - James T Ryaby
- Orthofix, Inc., Lewisville, TX, United States of America
| | - Maciej Zborowski
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Tamara Alliston
- Department of Orthopaedic Surgery, Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, United States of America
| | - Ronald J Midura
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States of America.
| |
Collapse
|
32
|
Aki T, Hashimoto K, Uozumi H, Saito M, Sugawara K, Suzuki M, Hamada S, Ito A, Itoi E. Morphological and Morphometrical Analyses of Fracture-Healing Sites of an Atypical Femoral Fracture in Patients with and without Long-Term Bisphosphonate Treatment for Osteoporosis: A Report of Two Cases. TOHOKU J EXP MED 2021; 253:261-267. [PMID: 33853993 DOI: 10.1620/tjem.253.261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Bisphosphonates have been the first drug of choice for osteoporosis in the recent years because of their known ability to suppress osteoclast activity. The adverse effect of long-term bisphosphonate administration in the fracture-healing process is controversial. The aim of our study was to observe not only morphology but also morphometry of the fracture site of atypical femoral fracture with and without long-term bisphosphonate administration, in a case study of two difficult-to-obtain human samples. The patients with insufficient healing of atypical femoral fracture were treated with valgus wedge osteotomy. Histomorphometrical analysis was performed in bone samples of fracture sites harvested during osteotomy. The thickness of the femoral cortex was measured in the fracture site and the adjacent, non-fracture site. A comparative analysis of the content of hypertrophic osteoclasts in fracture sites, shape and size of osteons, mass, and ratio of the woven bone to the total bone mass was performed, comparing bisphosphonate-treated and untreated samples. In bisphosphonate-treated samples, we observed femoral cortex thickening at the fracture site; the appearance of hypertrophic osteoclasts; decreased bone resorption surface, decreased osteoclast numbers on the bone resorption surface, and increased ratio of multinuclear osteoclasts; osteons were misshapen and thin; and the mass and ratio of the woven bone to the total bone mass were higher. This study demonstrated that long-term bisphosphonate administration can alter the morphological features of the fracture site compared to its physiological state.
Collapse
Affiliation(s)
- Takashi Aki
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine
| | - Ko Hashimoto
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine
| | | | | | | | - Manabu Suzuki
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine
| | - Soshi Hamada
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine
| | | | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine
| |
Collapse
|
33
|
Unim B, Minelli G, Da Cas R, Manno V, Trotta F, Palmieri L, Galluzzo L, Maggi S, Onder G. Trends in hip and distal femoral fracture rates in Italy from 2007 to 2017. Bone 2021; 142:115752. [PMID: 33188958 DOI: 10.1016/j.bone.2020.115752] [Citation(s) in RCA: 9] [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] [Received: 07/29/2020] [Revised: 10/20/2020] [Accepted: 11/09/2020] [Indexed: 02/08/2023]
Abstract
Osteoporosis-related fractures are a growing public health concern worldwide due to high societal and economic burden. The study aims to assess trends in incidence rates of hip and distal femoral fractures and in the use of anti-osteoporosis drugs in Italy between 2007 and 2017. Patients with hip and distal femoral fractures (ICD-9-CM codes 820.x and 821.x) were identified in the Italian National Hospital Discharge Database while anti-osteoporosis medication data were retrieved from the National Observatory on the Use of Medicines Database. A joinpoint regression analysis was performed to identify the years where the trends in incidence rates of hip and distal femoral fractures changed significantly; the average annual percentage change for the period of observation was estimated. Hospitalizations for femoral fractures were 991,059, of which 91.4% were hip fractures and 76.5% occurred in women. Age-standardized hip fractures rate per 100,000 person-years decreased both in women (-8.7%; from 789.9 in 2007 to 721.5 in 2017) and in men (-4.3%; from 423.9 to 405.6), while the rate of distal femoral fractures increased by 23.9% in women (from 67.78 to 83.95) and 22.7% in men (from 27.76 to 34.06). These changes were associated with an increment in the use of anti-osteoporosis drugs from 2007 to 2011 (from 9.1 to 12.4 DDD/1000 inhabitants/day), followed by a plateau in the period 2012-2017. The use of bisphosphonates increased progressively from 2007 to 2010 (from 8.2 to 10.5 DDD/1000 inhabitants/day), followed by a plateau and then decreased from 2015 onwards. The decreasing trend of hip fractures could be related to a major intake of anti-osteoporosis medications while the increment of distal femoral fractures might be due to population aging and to the use of bisphosphonates and denosumab. Further research is needed to identify and implement interventions to prevent hip and distal femoral fractures.
Collapse
Affiliation(s)
- Brigid Unim
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy.
| | - Giada Minelli
- Service of Statistics, Istituto Superiore di Sanità, Rome, Italy
| | - Roberto Da Cas
- National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Valerio Manno
- Service of Statistics, Istituto Superiore di Sanità, Rome, Italy
| | | | - Luigi Palmieri
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Lucia Galluzzo
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | | | - Graziano Onder
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| |
Collapse
|
34
|
Yuan S, Shen J. Bacteroides vulgatus diminishes colonic microbiota dysbiosis ameliorating lumbar bone loss in ovariectomized mice. Bone 2021; 142:115710. [PMID: 33148507 DOI: 10.1016/j.bone.2020.115710] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 12/29/2022]
Abstract
There is a need to discover additional kinds of intestinal microbiota to supplement the probiotic-treatment of postmenopausal osteoporosis. Increasing evidence has indicated that Bacteroides vulgatus has potential as a probiotic for ameliorating postmenopausal bone loss. In this study, ovariectomized female C57/BL6 mice were treated with B. vulgatus ATCC 8482 gavage to investigate the differences in colonic microbiota composition, inflammation signal pathways, inflammatory cytokines, bone turnover markers, and lumbar vertebrae microstructure compared with the control group. Our results show that B. vulgatus ATCC 8482 diminished microbiota dysbiosis and subsequently down-regulated the colonic lipopolysaccharide/TLR-4/p-NF-κB pathway leading to decreased serum TNF-α. This reduced TNF-α/RANKL expression and induced ALP and Runx-2 expression in the 5th lumbar vertebra, leading to amelioration of bone loss and microstructure destruction in the lumbar vertebra of ovariectomized mice. Taken together, these results indicate that B. vulgatus could be a probiotic for treatment of postmenopausal lumbar osteoporosis.
Collapse
Affiliation(s)
- Sijie Yuan
- Department of Endocrinology and Metabolic diseases, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong 510630, China
| | - Jie Shen
- Department of Endocrinology and Metabolic diseases, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong 510630, China.
| |
Collapse
|
35
|
Vannala V, Palaian S, Shankar PR. Therapeutic Dimensions of Bisphosphonates: A Clinical Update. Int J Prev Med 2020; 11:166. [PMID: 33312475 PMCID: PMC7716604 DOI: 10.4103/ijpvm.ijpvm_33_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 07/25/2019] [Indexed: 11/16/2022] Open
Abstract
Bisphosphonates (BPs) are a commonly used class of drugs for the treatment of bone disorders. An extensive review of BPs with their clinical efficacy and safety profile is unavailable. This study aimed to review the available literature on BPs, summarize their role in clinical therapy, and emphasize their safety profile. Authors reviewed the existing literature using the Google Scholar, PubMed, and Micromedex databases and analyzed the collected articles. BPs are the preferred medication for osteoporosis and other similar conditions owing to their efficient antiosteoclastic activity. Few of them are available in oral dosage forms; hence, they are patient-friendly. The mechanism of action, common adverse effects and their clinical applications, precautions and warnings pertaining to the route of administration, and safety profiles have been discussed in this manuscript. The common adverse effects are majorly related to the gastrointestinal, cardiovascular, and endocrine system. Upon chronic usage, patients may experience serious problems like osteonecrosis of the jaw and atypical bone fractures. Although BPs are effective and safe, they may cause GI adverse effects and rare cases of osteonecrosis. Patient counseling could prove beneficial in early identification and prevention of the adverse effects associated with BPs.
Collapse
Affiliation(s)
- Venkataramana Vannala
- Department of Orthodontics, College of Dentistry, Gulf Medical University, Ajman, UAE
| | - Subish Palaian
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, UAE
| | | |
Collapse
|
36
|
Ohara E, Bando Y, Yoshida T, Ohara M, Kirino Y, Iihara N. Fracture risk increased by concurrent use of central nervous system agents in older people: Nationwide case-crossover study. Res Social Adm Pharm 2020; 17:1181-1197. [PMID: 32980237 DOI: 10.1016/j.sapharm.2020.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/25/2020] [Accepted: 09/08/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Multiple medication use among older patients is reported to increase fracture risk. But this association is unclear in different subgroups and has not been confirmed by a case-crossover study, which can eliminate measurable and unmeasurable time-invariant confounders. OBJECTIVE To estimate the fragility fracture risk associated with concurrent use of multiple central nervous system (CNS) agents in older patients using a case-crossover design. METHODS This study targeted almost all patients aged ≥65 years in Japan who incurred fragility fractures from May 2013 to September 2014, based on the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB Japan). Conditional logistic regression analysis estimated the risk of fragility fracture associated with the daily number of CNS agents, including subgroup analyses stratified by sex, age, and fracture location. RESULTS For 446,101 patients, the adjusted odds ratios (ORs) of fragility fracture increased almost linearly with number of CNS agents; 0, 0-1, 1-2, 2-3, 3-4, 4-5, and >5: OR reference, 1.21 (95% confidence interval, 1.18-1.23), 1.40 (1.35-1.46), 1.58 (1.49-1.67), 1.89 (1.74-2.05), 1.80 (1.60-2.03), and 1.90 (1.61-2.23; trend p < 0.001), respectively. A similar trend was observed for several subgroups, especially in males and those aged ≥85 years, showing marked linearity. CONCLUSIONS The increased risk of fragility fracture associated with the use of multiple CNS agents was robust in older people in Japan.
Collapse
Affiliation(s)
- Eri Ohara
- Kagawa School of Pharmaceutical Sciences, Tokushima Bunri University, 1314-1 Shido, Sanuki-City, Kagawa, 769-2193, Japan.
| | - Yoshinori Bando
- Faculty of Health and Welfare, Tokushima Bunri University, 1314-1 Shido, Sanuki-City, Kagawa, 769-2193, Japan.
| | - Tomoji Yoshida
- Faculty of Health and Welfare, Tokushima Bunri University, 1314-1 Shido, Sanuki-City, Kagawa, 769-2193, Japan.
| | - Masaki Ohara
- Ayagawa National Health Insurance Sue Hospital, 1720-1 Ayagawa-cho, Ayauta-gun, Kagawa, 761-2103, Japan.
| | - Yutaka Kirino
- Kagawa School of Pharmaceutical Sciences, Tokushima Bunri University, 1314-1 Shido, Sanuki-City, Kagawa, 769-2193, Japan.
| | - Naomi Iihara
- Kagawa School of Pharmaceutical Sciences, Tokushima Bunri University, 1314-1 Shido, Sanuki-City, Kagawa, 769-2193, Japan.
| |
Collapse
|
37
|
Tile L, Cheung AM. Atypical femur fractures: current understanding and approach to management. Ther Adv Musculoskelet Dis 2020; 12:1759720X20916983. [PMID: 32913448 PMCID: PMC7443989 DOI: 10.1177/1759720x20916983] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 02/24/2020] [Indexed: 01/19/2023] Open
Abstract
Osteoporosis and resulting osteoporotic fractures are responsible for
significant morbidity, excess mortality, and health care costs in the
developed world. Medical therapy for osteoporosis has been shown in
multiple randomized controlled trials to reduce the risk of vertebral
and non-vertebral fractures and hip fractures, and in some studies
bisphosphonate medications have been associated with improved
survival. Although the overall benefit to risk ratio of osteoporosis
medications remains favorable, there have been concerns raised about
the long-term safety of these treatments. Atypical femur fracture,
which is a rare type of fracture that has been associated with the
long-term use of potent antiresorptive bone medications, is a
potentially devastating consequence of osteoporosis treatment. This
paper reviews our current understanding of atypical femur fractures,
their relationship to antiresorptive osteoporosis medications, and
proposed strategies for management, in order to inform clinical
decision making about the optimal use and duration of medical therapy
for the treatment of patients with osteoporosis or at high risk for
osteoporotic fractures.
Collapse
Affiliation(s)
- Lianne Tile
- EN7-222 Toronto General Hospital, 200 Elizabeth St, Toronto, Ontario, Canada M5G 2C4
| | - Angela M Cheung
- Divisions of General Internal Medicine and Endocrinology and Metabolism, Osteoporosis Program, Department of Medicine; Centre of Excellence in Skeletal Health Assessment, Joint Department of Medical Imaging; University Health Network and University of Toronto. Toronto, ON, Canada
| |
Collapse
|
38
|
Tsuda T, Hashimoto Y, Okamoto Y, Ando W, Ebina K. Meta-analysis for the efficacy of bisphosphonates on hip fracture prevention. J Bone Miner Metab 2020; 38:678-686. [PMID: 32236684 DOI: 10.1007/s00774-020-01096-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 02/23/2020] [Indexed: 01/22/2023]
Abstract
The aim of this study was to investigate the effect of bisphosphonates on preventing osteoporotic hip fracture in patients with or without prior major osteoporotic fracture. Randomized controlled trials (RCTs) and observational studies (OSs) based on electronic health records were used to assess bisphosphonate efficacy and were searched using PubMed, Scopus, and the Cochrane Library databases. Eight RCT studies and 14 OSs were extracted from the studies and quantitatively combined by random-effects meta-analysis. The odds ratio (OR) for all hip fractures in RCTs of 0.66, with a 95% confidence interval (CI) of 0.55-0.79, was lower than that in the OSs (OR 0.83; CI 0.74-0.94). The OR in patients with prior fracture was significantly reduced by bisphosphonates in both RCTs and OSs. Conversely, significant fracture reduction was not apparent in patients without prior fracture. A moderate relationship between prior major fracture rates and OR in hip fractures was defined. In patients with an average age of over 80 years, similar results were confirmed. In this meta-analysis, the efficacy of bisphosphonates was significant in patients with prior major fracture, recommending to prescribe for such patients. Their effect in patients without prior fracture, in contrast, remains unclear.
Collapse
Affiliation(s)
- Takayuki Tsuda
- Department of Orthopaedic Surgery, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan.
| | - Yoshichika Hashimoto
- Department of Orthopaedic Surgery, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Yasunori Okamoto
- Department of Orthopaedic Surgery, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Wataru Ando
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Kosuke Ebina
- Department of Musculoskeletal Regenerative Medicine, Osaka University Graduate School of Medicine, Yamada-oka, Suita, Osaka, 565-0871, Japan
| |
Collapse
|
39
|
Pfeilschifter J, Steinebach I, Trampisch HJ, Rudolf H. Bisphosphonate drug holidays: Risk of fractures and mortality in a prospective cohort study. Bone 2020; 138:115431. [PMID: 32422299 DOI: 10.1016/j.bone.2020.115431] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 03/20/2020] [Accepted: 05/13/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE This study examined osteoporotic fractures and mortality in patients pretreated with bisphosphonates (BPs) during BP holidays and ongoing BP use. METHODS Interview-based prospective observational study in a cohort of 1973 patients with BP treatment for at least 80% of the total time of the preceding 4 years. Patients were recruited from 146 primarily endocrinological, orthopedic and rheumatological practices and clinics across Germany between May 2013 and June 2015. Outcomes were analyzed by Cox proportional hazards regression in relation to treatment status at the time of the first interview (model 1) or using time-dependent treatment variables (model 2). Temporal changes in fracture risk during BP holidays were evaluated by comparisons among 3 incremental levels of simple moving averages of BP treatment during the preceding 12 months (BP-SMA levels 0%, >0% to <50%, and ≥50%). RESULTS For an observation period of up to 25 months, the adjusted hazard ratios (HRs) in model 1 for BP holidays compared to ongoing BP use were 0.87 (95% confidence interval [CI] 0.59-1.28) for major osteoporotic fractures (MOFs), 0.95 (95% CI 0.70-1.28) for any clinical osteoporotic fracture, 0.96 (95% CI 0.55-1.68) for clinical vertebral fractures, and 0.86 (95% CI 0.50-1.48) for mortality. The risk of MOFs was higher for the BP-SMA level 0%, corresponding to a time >12 months since the start of a BP holiday, than for the BP-SMA level >0% to <50%, corresponding mainly to a time >6 to ≤12 months since the start of a BP holiday (adjusted HR 2.28, 95% CI 1.07-4.86). We found an interaction between prevalent vertebral fractures (PVFs) and BP-SMA-related time to first MOF for BP-SMA as a continuous variable (p for interaction 0.046 in the adjusted model). The adjusted HR for MOFs for the BP-SMA level 0% compared to the BP-SMA level >0% to <50% was 3.53 (95% CI 1.19-10.51) with a PVF but was 1.44 (95% CI 0.49-4.22) without a PVF. CONCLUSIONS Fracture risk and mortality in patients with preceding BP treatment did not significantly differ between BP holidays and ongoing BP use for an observation period up to 25 months when outcomes were analyzed in relation to treatment at the time of the first interview. However, in the presence of a PVF, the risk of MOFs was higher for a BP-SMA level corresponding to a time >12 months since the start of a BP holiday than for a BP-SMA level corresponding mainly to a time >6 to ≤12 months since the start of a BP holiday. The presence of a PVF may increase the relative risk of MOFs associated with a longer BP holiday.
Collapse
Affiliation(s)
- Johannes Pfeilschifter
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum, D-44780 Bochum, Germany.
| | - Inga Steinebach
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum, D-44780 Bochum, Germany
| | - Hans J Trampisch
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum, D-44780 Bochum, Germany
| | - Henrik Rudolf
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum, D-44780 Bochum, Germany
| |
Collapse
|
40
|
Won SH, Ahn S, Ji E, Park JW, Kim JK, Lee YK. Hip and Subtrochanteric or Femoral Shaft Fractures after Bisphosphonate Use in Korean Women, Using Korean National Sample Cohort. J Korean Med Sci 2020; 35:e193. [PMID: 32597040 PMCID: PMC7324261 DOI: 10.3346/jkms.2020.35.e193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/27/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Concern about bisphosphonate-associated subtrochanteric and femoral shaft (ST/FS) fractures has been raised. However, its real risk is still debatable, because there is no study to estimate risk and benefit of bisphosphonate. The objective of this study was to evaluate the risk of typical hip fractures and ST/FS fractures among bisphosphonate users using nationwide database. METHODS We performed a retrospective cohort study using National Health Insurance Service-National Sample Cohort. We evaluated occurrence of the ST/FS and femoral neck and intertrochanteric (FN/IT) fractures among female bisphosphonate new users. Incidence rate of ST/FS and FN/IT fractures were compared between long-term users (≥ 1 year) and short-term users (< 1 year). Number needed to harm (NNH) for ST/FS and number needed to treat (NNT) for typical hip fracture were analyzed. RESULTS Among 46,420 bisphosphonate users, we identified 14,689 long-term users and 21,840 short-term users. During the study period, 61 long-term users and 36 short-term users had ST/FS fractures, while 204 long-term users and 511 short-term users had FN/IT fractures. The long-term user showed higher incidence rate of ST/FS fractures (67.1/100,000 person-years; 95% confidence interval [CI], 50.3-83.9) comparing with 31.2/100,000 person-years (95% CI, 21.0-41.4) in the short-term users. The incidence rate of FN/IT fractures was 225.5/100,000 person-years (95% CI, 194.6-256.5) in the long-term users and 448.6/100,000 person-years (95% CI, 409.7-487.5) in the short-term users. The NNH for ST/FS was 400, while the NNT for typical hip fracture was 105. CONCLUSION Our study suggested that physicians keep the significant benefit of bisphosphonate to prevent typical hip fracture in mind, even the concerns about bisphosphonate-associated ST/FS fractures.
Collapse
Affiliation(s)
- Seok Hyung Won
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Soyeon Ahn
- Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eunjeong Ji
- Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung Wee Park
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin Kak Kim
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Kyun Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
| |
Collapse
|
41
|
Kanda J, Furukawa M, Izumo N, Shimakura T, Yamamoto N, Takahashi HE, Wakabayashi H. Effects of the combined administration of risedronate and menatetrenone on bone loss induced by tacrolimus in rats. Drug Discov Ther 2020; 14:77-83. [PMID: 32378649 DOI: 10.5582/ddt.2020.03012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Tacrolimus, a calcineurin inhibitor, affects bone metabolism and increases the risk of fracture due to marked bone loss. Bisphosphonates increase the bone mineral density (BMD) in osteoporosis patients. Menatetrenone has less positive effects on BMD but reduces the risk of fracture by improving bone quality. In this study, we investigated the effectiveness of the combined administration of risedronate and menatetrenone against bone loss induced by tacrolimus. Wistar rats were divided into four groups: [1] control, [2] tacrolimus at 1.5 mg/kg, [3] tacrolimus + risedronate at 1.0 mg/kg, and [4] tacrolimus + risedronate + menatetrenone at 20 mg/kg. After the drugs were administered for 4 weeks, bone histomorphometric analysis was performed and bone strength was evaluated using a three point bending method. BMD was measured using quantitative computed tomography. Tacrolimus significantly reduced the BMD and strength properties of the lower limb bones. These tacrolimusinduced decreases were suppressed by risedronate treatment. The combined administration of risedronate and menatetrenone more significantly improved bone strength properties than risedronate alone. Bone histomorphometric analysis revealed a significant increase in bone resorption with tacrolimus. Risedronate alone significantly suppressed the tacrolimus-induced increase in bone resorption but simultaneously reduced bone formation. On the other hand, the combined administration of risedronate and menatetrenone suppressed the tacrolimus-induced increase in bone resorption, in addition to the significant risedronate-induced decrease in bone formation. This study suggests that the combined administration of risedronate and menatetrenone improves bone strength in tacrolimus-treated rats by preventing and ameliorating the risedronate-induced suppression of bone formation.
Collapse
Affiliation(s)
- Junkichi Kanda
- Department of Clinical Pharmacotherapy, Faculty of Pharmaceutical Sciences, Niigata University of Pharmacy and Applied Life Sciences, Niigata, Japan
| | - Megumi Furukawa
- General Health Medical Center Yokohama University of Pharmacy, Yokohama, Japan
| | - Nobuo Izumo
- General Health Medical Center Yokohama University of Pharmacy, Yokohama, Japan
| | | | - Noriaki Yamamoto
- Niigata Bone Science Institute, Niigata, Japan.,Division of Orthopedic Surgery, Niigata Rehabilitation Hospital, Niigata, Japan
| | | | - Hiroyuki Wakabayashi
- Department of Clinical Pharmacotherapy, Faculty of Pharmaceutical Sciences, Niigata University of Pharmacy and Applied Life Sciences, Niigata, Japan
| |
Collapse
|
42
|
Chen L, Yao F, Wang T, Li G, Chen P, Bulsara M, Zheng JJY, Landao-Bassonga E, Firth M, Vasantharao P, Huang Y, Lorimer M, Graves S, Gao J, Carey-Smith R, Papadimitriou J, Zhang C, Wood D, Jones C, Zheng M. Horizontal fissuring at the osteochondral interface: a novel and unique pathological feature in patients with obesity-related osteoarthritis. Ann Rheum Dis 2020; 79:811-818. [PMID: 32269059 PMCID: PMC7286031 DOI: 10.1136/annrheumdis-2020-216942] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 01/05/2023]
Abstract
Objectives Obesity is a well-recognised risk factor for osteoarthritis (OA). Our aim is to characterise body mass index (BMI)-associated pathological changes in the osteochondral unit and determine if obesity is the major causal antecedent of early joint replacement in patients with OA. Methods We analysed the correlation between BMI and the age at which patients undergo total knee replacement (TKR) in 41 023 patients from the Australian Orthopaedic Association National Joint Replacement Registry. We then investigated the effect of BMI on pathological changes of the tibia plateau of knee joint in a representative subset of the registry. Results 57.58% of patients in Australia who had TKR were obese. Patients with overweight, obese class I & II or obese class III received a TKR 1.89, 4.48 and 8.08 years earlier than patients with normal weight, respectively. Microscopic examination revealed that horizontal fissuring at the osteochondral interface was the major pathological feature of obesity-related OA. The frequency of horizontal fissure was strongly associated with increased BMI in the predominant compartment. An increase in one unit of BMI (1 kg/m2) increased the odds of horizontal fissures by 14.7%. 84.4% of the horizontal fissures were attributable to obesity. Reduced cartilage degradation and alteration of subchondral bone microstructure were also associated with increased BMI. Conclusions The key pathological feature in OA patients with obesity is horizontal fissuring at the osteochondral unit interface. Obesity is strongly associated with a younger age of first TKR, which may be a result of horizontal fissures.
Collapse
Affiliation(s)
- Lianzhi Chen
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Felix Yao
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Tao Wang
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Guangyi Li
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia.,Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Peilin Chen
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Max Bulsara
- Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Jessica Jun Yi Zheng
- Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Euphemie Landao-Bassonga
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Marty Firth
- Centre for Applied Statistics, Department of Mathematics and Statistics, University of Western Australia, Perth, Western Australia, Australia
| | - Praveen Vasantharao
- Department of Orthopaedic Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Yigang Huang
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Michelle Lorimer
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Stephen Graves
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - Junjie Gao
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia.,Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia
| | - Richard Carey-Smith
- Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - John Papadimitriou
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia.,Pathwest Laboratories, Perth, Western Australia, Australia
| | - Changqing Zhang
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - David Wood
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Christopher Jones
- Medical School, Curtin University, Perth, Western Australia, Australia .,Department of Orthopaedic Surgery, Fiona Stanley Hospital Group, Perth, Western Australia, Australia
| | - Minghao Zheng
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia .,Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia
| |
Collapse
|
43
|
Rasmussen NH, Dal J, de Vries F, van den Bergh JP, Jensen MH, Vestergaard P. Diabetes and fractures: new evidence of atypical femoral fractures? Osteoporos Int 2020; 31:447-455. [PMID: 31838553 DOI: 10.1007/s00198-019-05224-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 11/05/2019] [Indexed: 12/12/2022]
Abstract
UNLABELLED Patients with diabetes have an increased risk of fractures. In this study, subtrochanteric and femoral shaft fractures were increased in patients with type 1 diabetes compared with the general population. In the light of this, more evidence points towards an association between diabetes and atypical femoral fractures. INTRODUCTION Patients with diabetes have an increased risk of femoral fractures, but little is known about the risk of atypical femoral fractures (AFFs). The aim of this study was to identify the risk of subtrochanteric and femoral shaft (ST/FS) fractures and estimate the risk of AFFs in patients with type 1 (T1D) and type 2 diabetes (T2D). METHODS From the nationwide Danish National Patient Register, we identified patients with T1D (n = 19,896), T2D (n = 312,188), and sex- and aged-matched controls without diabetes (n = 996,252) from the general population and all ST/FS fractures (n = 7509). Data were analyzed using a Cox proportional-hazards model and the incidence rate and rate ratio of ST/FS fractures were estimated. RESULTS The incidence rate of ST/FS fractures in T1D was 52.14 events per 100,000 person years and 73.21 per 100,000 person years in T2D. T1D was associated with an increased risk of ST/FS (HR 2.07 (95% CI 1.68-2.56)), whereas T2D was not (HR 0.99 (95% CI 0.94-1.10)). Previous ST/FS fractures were associated with an increased risk of subsequent ST/FS fractures (HR 6.95 (95% CI 6.00-8.05)) and the use of bisphosphonates with an increased risk of ST/FS fractures (HR 1.72 (95% CI 1.54-1.91)). CONCLUSION Patients with T1D have a higher risk of ST/FS fractures compared with sex- and age-matched controls. Since a proportion of ST/FS fractures are classified as AFFs, this could point towards the fact that AFFs also are increased in patients with T1D, but not T2D.
Collapse
Affiliation(s)
- N H Rasmussen
- Steno Diabetes Center North, Aalborg University Hospital, Aalborg, Denmark.
| | - J Dal
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - F de Vries
- Department of Clinical Pharmacy & Toxicology, Maastricht UMC+, Maastricht, The Netherlands
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - J P van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands
- Department of Internal Medicine, Maastricht UMC+, Maastricht, The Netherlands
- Faculty of Medicine and Life Sciences, University Hasselt, Hasselt, Belgium
| | - M H Jensen
- Steno Diabetes Center North, Aalborg University Hospital, Aalborg, Denmark
| | - P Vestergaard
- Steno Diabetes Center North, Aalborg University Hospital, Aalborg, Denmark
| |
Collapse
|
44
|
Ruan L, Jiang N, Guo F, Xu H, Zhang J, Sun J. The antiresoptive effects of recombinant Lingzhi-8 protein against retinoic acid-induced osteopenia. Eur J Pharmacol 2019; 863:172669. [DOI: 10.1016/j.ejphar.2019.172669] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/03/2019] [Accepted: 09/18/2019] [Indexed: 01/18/2023]
|
45
|
Zhang HY, Weng HL, Li M, Zhang J. Different surgical outcomes in a patient with bilateral atypical femoral fracture related to bisphosphonate use with or without teriparatide treatment. Osteoporos Int 2019; 30:2349-2354. [PMID: 31428823 DOI: 10.1007/s00198-019-05131-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 08/14/2019] [Indexed: 12/14/2022]
Abstract
Bisphosphonates (BPs) are first-line drugs for the treatment of osteoporotic fractures, but long-term use of BP reduces bone turnover and is associated with atypical femur fractures (AFFs). Additionally, BP treatment may cause delayed fracture healing or nonunion, which makes AFF treatment difficult. The incidence of AFF is generally low. In fact, there are only a few clinical reports of AFF and there is no controlled study on AFF treatment. Herein, we report a case of multiple osteoporotic fractures. After 5 years of BP treatment, left and right AFFs occurred within 2 years. The fracture types and surgical operations were the same, but the level of bone metabolism and drug treatment were different. The right AFF healed well following teriparatide initiation compared with non-healed left AFF with BP continuation; thus, our case can be considered a self-controlled study. Furthermore, we have reviewed the diagnosis and treatment of this case in detail and analyzed and investigated the potential causes of the different outcomes of AFFs between the two sides to inform the clinical treatment of atypical fractures. Mini Abstract We report a case of bilateral AFFs. The surgical treatments were the same, but the final treatment outcomes were different with or without teriparatide treatment. We investigated the potential causes of the different outcomes of AFFs between the two sides to inform the clinical treatment of AFFs.
Collapse
Affiliation(s)
- H-Y Zhang
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, 100730, China
| | - H-L Weng
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, 100730, China
| | - M Li
- Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, 100730, China
| | - J Zhang
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, 100730, China.
| |
Collapse
|
46
|
Lu L, Lu L, Zhang J, Li J. Potential risks of rare serious adverse effects related to long-term use of bisphosphonates: An overview of systematic reviews. J Clin Pharm Ther 2019; 45:45-51. [PMID: 31608489 DOI: 10.1111/jcpt.13056] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 07/19/2019] [Accepted: 08/20/2019] [Indexed: 12/22/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE There have been concerns about a potential link between long-term use of bisphosphonates (BPs) for the treatment of osteoporosis and rare serious adverse effects, such as atypical femoral fractures. However, many reviews exist with conflicting conclusions about this issue. The aim of this overview of reviews was to systematically evaluate the risk of rare serious adverse effects of long-term use of BPs for the treatment of osteoporosis. METHODS We identified systematic reviews with meta-analyses of randomized controlled trials (RCTs) and (or) observational studies published in English or Chinese that evaluated the safety of BPs through to December 2018. The Cochrane library, PubMed, Web of Science and hand-searching of reference lists and clinical practice guidelines were electronically searched for data sources. Carcinogenicity, atypical fracture, osteonecrosis of jaw (ONJ) and fracture union time were specified as the primary outcomes. The methodological quality of each systematic review was assessed by two reviewers using the Assessment of Multiple Systematic Reviews (AMSTAR) tool, and the quality of evidence for key outcomes was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. RESULTS AND DISCUSSION In total, 1376 potentially relevant citations were identified, of which only 8 systematic reviews with meta-analyses met the eligibility criteria. All the included reviews were published between 2012 and 2015 and documented the pooled estimates of effect size (relative risk [RR], odds ratio [OR] or hazard ratio [HR] and their 95% confidence intervals [95% CI]) for the incidence of adverse events. All included systematic reviews were of moderate or high quality. The median AMSTAR score was 7.5 (interquartile range, 5-10). However, evidence of the key outcomes was mainly of very low or moderate quality. BP treatment only increased the risk of atypical fracture and ONJ, and prolonged union time compared with placebo or other anti-osteoporosis drugs (P < .05). WHAT IS NEW AND CONCLUSION This study indicated that long-term use of BPs could increase the risk of rare serious adverse effects, but the relationship between long-term use of BPs and carcinogenicity was often uncertain. Therefore, high-quality research and more complete inclusion criteria are needed.
Collapse
Affiliation(s)
- Liqing Lu
- General Hospital of Southern Theatre of PLA, Guangzhou, China
| | - Lifen Lu
- Guangxi Medical University, Nanning, Guangxi, China
| | | | - Jian Li
- General Hospital of Southern Theatre of PLA, Guangzhou, China
| |
Collapse
|
47
|
Fink HA, MacDonald R, Forte ML, Rosebush CE, Ensrud KE, Schousboe JT, Nelson VA, Ullman K, Butler M, Olson CM, Taylor BC, Brasure M, Wilt TJ. Long-Term Drug Therapy and Drug Discontinuations and Holidays for Osteoporosis Fracture Prevention: A Systematic Review. Ann Intern Med 2019; 171:37-50. [PMID: 31009947 DOI: 10.7326/m19-0533] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Optimal long-term osteoporosis drug treatment (ODT) is uncertain. PURPOSE To summarize the effects of long-term ODT and ODT discontinuation and holidays. DATA SOURCES Electronic bibliographic databases (January 1995 to October 2018) and systematic review bibliographies. STUDY SELECTION 48 studies that enrolled men or postmenopausal women aged 50 years or older who were being investigated or treated for fracture prevention, compared long-term ODT (>3 years) versus control or ODT continuation versus discontinuation, reported incident fractures (for trials) or harms (for trials and observational studies), and had low or medium risk of bias (ROB). DATA EXTRACTION Two reviewers independently rated ROB and strength of evidence (SOE). One extracted data; another verified accuracy. DATA SYNTHESIS Thirty-five trials (9 unique studies) and 13 observational studies (11 unique studies) had low or medium ROB. In women with osteoporosis, 4 years of alendronate reduced clinical fractures (hazard ratio [HR], 0.64 [95% CI, 0.50 to 0.82]) and radiographic vertebral fractures (both moderate SOE), whereas 4 years of raloxifene reduced vertebral but not nonvertebral fractures. In women with osteopenia or osteoporosis, 6 years of zoledronic acid reduced clinical fractures (HR, 0.73 [CI, 0.60 to 0.90]), including nonvertebral fractures (high SOE) and clinical vertebral fractures (moderate SOE). Long-term bisphosphonates increased risk for 2 rare harms: atypical femoral fractures (low SOE) and osteonecrosis of the jaw (mostly low SOE). In women with unspecified osteoporosis status, 5 to 7 years of hormone therapy reduced clinical fractures (high SOE), including hip fractures (moderate SOE), but increased serious harms. After 3 to 5 years of treatment, bisphosphonate continuation versus discontinuation reduced radiographic vertebral fractures (zoledronic acid; low SOE) and clinical vertebral fractures (alendronate; moderate SOE) but not nonvertebral fractures (low SOE). LIMITATION No trials studied men, clinical fracture data were sparse, methods for estimating harms were heterogeneous, and no trials compared sequential treatments or different durations of drug holidays. CONCLUSION Long-term alendronate and zoledronic acid therapies reduce fracture risk in women with osteoporosis. Long-term bisphosphonate treatment may increase risk for rare adverse events, and continuing treatment beyond 3 to 5 years may reduce risk for vertebral fractures. Long-term hormone therapy reduces hip fracture risks but has serious harms. PRIMARY FUNDING SOURCE National Institutes of Health and Agency for Healthcare Research and Quality. (PROSPERO: CRD42018087006).
Collapse
Affiliation(s)
- Howard A Fink
- University of Minnesota and Minneapolis VA Health Care System, Minneapolis, Minnesota (H.A.F., R.M., K.E.E., K.U., B.C.T., T.J.W.)
| | - Roderick MacDonald
- University of Minnesota and Minneapolis VA Health Care System, Minneapolis, Minnesota (H.A.F., R.M., K.E.E., K.U., B.C.T., T.J.W.)
| | - Mary L Forte
- University of Minnesota, Minneapolis, Minnesota (M.L.F., C.E.R., V.A.N., M.B., C.M.O., M.B.)
| | - Christina E Rosebush
- University of Minnesota, Minneapolis, Minnesota (M.L.F., C.E.R., V.A.N., M.B., C.M.O., M.B.)
| | - Kristine E Ensrud
- University of Minnesota and Minneapolis VA Health Care System, Minneapolis, Minnesota (H.A.F., R.M., K.E.E., K.U., B.C.T., T.J.W.)
| | - John T Schousboe
- University of Minnesota, Minneapolis, and HealthPartners, Bloomington, Minnesota (J.T.S.)
| | - Victoria A Nelson
- University of Minnesota, Minneapolis, Minnesota (M.L.F., C.E.R., V.A.N., M.B., C.M.O., M.B.)
| | - Kristen Ullman
- University of Minnesota and Minneapolis VA Health Care System, Minneapolis, Minnesota (H.A.F., R.M., K.E.E., K.U., B.C.T., T.J.W.)
| | - Mary Butler
- University of Minnesota, Minneapolis, Minnesota (M.L.F., C.E.R., V.A.N., M.B., C.M.O., M.B.)
| | - Carin M Olson
- University of Minnesota, Minneapolis, Minnesota (M.L.F., C.E.R., V.A.N., M.B., C.M.O., M.B.)
| | - Brent C Taylor
- University of Minnesota and Minneapolis VA Health Care System, Minneapolis, Minnesota (H.A.F., R.M., K.E.E., K.U., B.C.T., T.J.W.)
| | - Michelle Brasure
- University of Minnesota, Minneapolis, Minnesota (M.L.F., C.E.R., V.A.N., M.B., C.M.O., M.B.)
| | - Timothy J Wilt
- University of Minnesota and Minneapolis VA Health Care System, Minneapolis, Minnesota (H.A.F., R.M., K.E.E., K.U., B.C.T., T.J.W.)
| |
Collapse
|
48
|
Eastell R, Rosen CJ, Black DM, Cheung AM, Murad MH, Shoback D. Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society* Clinical Practice Guideline. J Clin Endocrinol Metab 2019; 104:1595-1622. [PMID: 30907953 DOI: 10.1210/jc.2019-00221] [Citation(s) in RCA: 405] [Impact Index Per Article: 81.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 01/28/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The objective is to formulate clinical practice guidelines for the pharmacological management of osteoporosis in postmenopausal women. CONCLUSIONS Evidence from clinical trials and insights from clinical experience with pharmacologic therapies for osteoporosis were critically evaluated in formulating this guideline for the management of postmenopausal osteoporosis. Patient preferences, data on adherence and persistence, and risks and benefits from the patient and provider perspectives were also considered in writing committee deliberations. A consensus by the Writing Committee members was achieved for four management principles: (i) The risk of future fractures in postmenopausal women should be determined using country-specific assessment tools to guide decision-making. (ii) Patient preferences should be incorporated into treatment planning. (iii) Nutritional and lifestyle interventions and fall prevention should accompany all pharmacologic regimens to reduce fracture risk. (iv) Multiple pharmacologic therapies are capable of reducing fracture rates in postmenopausal women at risk with acceptable risk-benefit and safety profiles.
Collapse
Affiliation(s)
| | | | - Dennis M Black
- University of California San Francisco, San Francisco, California
| | | | - M Hassan Murad
- Mayo Clinic Evidence-Based Practice Center, Rochester, Minnesota
| | - Dolores Shoback
- Endocrine Research Unit, San Francisco Veterans Affairs Medical Center, San Francisco, California
- Department of Medicine, University of California San Francisco, San Francisco, California
| |
Collapse
|
49
|
Melatonin Increases Bone Mass around the Prostheses of OVX Rats by Ameliorating Mitochondrial Oxidative Stress via the SIRT3/SOD2 Signaling Pathway. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:4019619. [PMID: 31110599 PMCID: PMC6487111 DOI: 10.1155/2019/4019619] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 02/05/2019] [Indexed: 12/11/2022]
Abstract
Bone mass loss around prostheses is a major cause of implant failure, especially in postmenopausal osteoporosis patients. In osteoporosis, excess oxidative stress largely contributed abnormal bone remodeling. Melatonin, which is synthesized from the pineal gland, promotes osteoblast differentiation and bone formation and has effectively been used to combat oxidative stress. Thus, we determined if melatonin can inhibit oxidative stress to promote osteogenesis and improve bone mass around prostheses in osteoporosis. In this study, we observed that received melatonin at 50 mg/kg body weight significantly increased periprosthetic bone mass as well as implant fixation intensity in ovariectomized (OVX) rats. Meanwhile, it decreased the expression of oxidative stress markers (NAPDH oxidase 2 and cytochrome c) and enhanced expressing level of the formation markers of bones (alkaline phosphatase, osteocalcin, and osterix) around prostheses compared to that in the control group. Additionally, melatonin decreased hydrogen peroxide- (H2O2-) induced oxidative stress and restored the osteogenesis potential of MC3T3-E1 cells. Mechanistically, melatonin clearly increased mitochondrial sirtuin 3 (SIRT3) expression and decreased the ratio of acetylated superoxide dismutase 2 (AC-SOD2)/SOD2 compared to the H2O2 group. SIRT3 inhibition counteracted the protective effects of melatonin on oxidative stress and bone formation. Together, the results showed that melatonin ameliorated oxidative stress in mitochondrial via the SIRT3/SOD2 signaling pathway, thereby promoting osteogenesis, improving bone mass around the prostheses, and increasing initial stability. Thus, melatonin might be a suitable candidate to decrease the rate of implant failure and lengthen the lifespan of prostheses after total joint arthroplasty.
Collapse
|
50
|
Black DM, Abrahamsen B, Bouxsein ML, Einhorn T, Napoli N. Atypical Femur Fractures: Review of Epidemiology, Relationship to Bisphosphonates, Prevention, and Clinical Management. Endocr Rev 2019; 40:333-368. [PMID: 30169557 DOI: 10.1210/er.2018-00001] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 05/08/2018] [Indexed: 12/18/2022]
Abstract
Bisphosphonates (BPs) are highly effective in treating osteoporosis and reducing hip, vertebral, and other fractures by as much as 50% to 70%. However, since 2006, atypical femur fractures (AFFs) emerged as potential side effects of BPs and other treatments. These fractures have unusual radiologic features and occur with little trauma. Public concern has led to a >50% decrease in BP usage. AFFs are rare: for each AFF, >1200 fractures, including 135 hip fractures, are prevented. Case definition criteria were updated by the American Society of Bone and Mineral Research in 2014. Many epidemiologic studies have been reported, and although methodologically challenging, generally support a BP-AFF association. However, the magnitude of the association between BPs and AFFs is uncertain: estimates of relative risk for AFFs among BP users vs nonusers range from 1 to 65 with a meta-analysis estimate of 1.7. Although mechanistic studies have proposed several hypotheses explaining how BPs might decrease bone strength, AFF pathogenesis remains uncertain and cannot explain the paradox of efficacy of reduction of common fractures while increasing risk for rare fractures at one site. There are several consistent risk factors, including Asian race (in North America), femoral bowing, and glucocorticoid use, whereas others remain unclear. Consensus is emerging about strategies to prevent AFFs in BP users (including drug holidays after 5 years' use in some patients). In conclusion, AFFs can be devastating, but even under the most pessimistic assumptions, the benefit/risk ratio is highly positive for BPs, particularly during 3 to 5 years of use. As understanding of AFFs increases, it is becoming increasingly possible to maximize BP benefits while minimizing AFF risk.
Collapse
Affiliation(s)
- Dennis M Black
- University of California, San Francisco, San Francisco, California
| | | | | | | | - Nicola Napoli
- Università Campus Bio-Medico di Roma, Rome, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| |
Collapse
|