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da Costa Pereira JP, Diniz ADS, de Lemos MCC, Pinho Ramiro CPS, Cabral PC. Frailty but not low muscle quality nor sarcopenia is independently associated with mortality among previously hospitalized older adults: A prospective study. Geriatr Gerontol Int 2023; 23:736-743. [PMID: 37691481 DOI: 10.1111/ggi.14660] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/12/2023]
Abstract
AIM There are few studies comparing the effects of geriatric syndromes and abnormalities in nutritional status and body composition on outcomes among older individuals who have been previously hospitalized. Our study aimed to evaluate the frequency and diagnosis of geriatric syndromes, low muscle quality, and nutritional status in hospitalized older individuals, and to examine their impact on both short- and long-term outcomes. METHODS This was a prospective study involving older adults (≥60 years). We assessed nutritional status, muscle quality, sarcopenia, and frailty. The outcomes were functional dependence, length of hospital stay, transfer to the Intensive Care Unit, number of readmissions, and mortality. Multivariate analysis was conducted to identify independent risk factors. RESULTS Even after adjustment for age and sex, increased risk of death was associated with possible undernourishment, sarcopenia, low muscle quality, and frailty (P < 0.05), but not the length of hospital stay (P > 0.05). Our multivariate analysis showed that frailty was independently associated with mortality and functional dependence. Low muscle quality was independently associated with functional dependence. CONCLUSIONS Geriatric syndromes, abnormalities in body composition, and the overall nutritional status of older patients are important risk factors for adverse outcomes, including functional dependence and mortality. These findings emphasize the need for interventions to improve muscle quality, prevent and treat malnutrition and sarcopenia, and address frailty in hospitalized patients. Geriatr Gerontol Int 2023; 23: 736-743.
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Keshavarz P, Lane G, Pahwa P, Lieffers J, Shafiee M, Finkas K, Desmarais M, Vatanparast H. Dietary Patterns of Off-Reserve Indigenous Peoples in Canada and Their Association with Chronic Conditions. Nutrients 2023; 15:nu15061485. [PMID: 36986215 PMCID: PMC10053984 DOI: 10.3390/nu15061485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/15/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
Nationally representative nutrition surveys (Canadian Community Health Survey (CCHS) Cycle 2.2, Nutrition 2004 and 2015) were used to examine dietary patterns and their association with socioeconomic/sociodemographic factors and chronic conditions in off-reserve Indigenous population in Canada. A cluster analysis was used to identify dietary patterns (DPs), and the Nutrient Rich Food Index (NRF 9.3) was used as the diet quality score and stratified by age/gender groups. In 2004 (n = 1528), the dominant DPs among Indigenous adults (age = 41 ± 2.3) were "Mixed" (mean NRF = 450 ± 12) and "Unhealthy" among men (mean NRF = 426 ± 18), "Fruits" among women (mean NRF = 526 ± 29), and "High-Fat/High-Sugar" among children (age = 10.2 ± 0.5) (mean NRF = 457 ± 12). In 2015 (n = 950), the dominant DPs were "Unhealthy" (mean NRF = 466 ± 6), "Mixed" (mean NRF = 485 ± 21), Healthy-Like (mean NRF = 568 ± 37), and "Mixed" (mean NRF = 510 ± 9) among adults (age = 45.6 ± 2.2), men, women, and children (age = 10.9 ± 0.3) respectively. The majority of Indigenous peoples had the "Unhealthy" DP with a low diet quality, which may contribute to a high prevalence of obesity and chronic diseases. The income level and smoking status among adults and physical inactivity among children were recognized as important factors that may be associated with the dietary intake of off-reserve Indigenous population.
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Affiliation(s)
- Pardis Keshavarz
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada
| | - Ginny Lane
- Margaret Ritchie School of Family and Consumer Sciences, University of Idaho, Moscow, ID 83844, USA
| | - Punam Pahwa
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK S0G 5L0, Canada
| | - Jessica Lieffers
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada
| | - Mojtaba Shafiee
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada
| | - Kelly Finkas
- Health and Social Development, Cowessess First Nation, Cowessess, SK S0G 5L0, Canada
| | - Marisa Desmarais
- Health and Social Development Department, Community Dietitian, Cowessess First Nation, Cowessess, SK S0G 5L0, Canada
| | - Hassan Vatanparast
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada
- School of Public Health, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada
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3
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Aypak C, Bircan MA, Özdemir A. Anti-osteoporotic Drug Utilization Rates for Secondary Prevention Among Patients with Osteoporotic Fractures. Rambam Maimonides Med J 2022; 13:RMMJ.10473. [PMID: 35701156 PMCID: PMC9345764 DOI: 10.5041/rmmj.10473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Anti-osteoporotic drugs (AOD) are essential for secondary prevention of osteoporotic fracture (OF) in patients with established osteoporosis. However, data about AOD utilization rates are scarce among patients with OF. This study was therefore aimed at determining the AOD utilization rates among those particularly vulnerable patients. MATERIALS AND METHODS This cross-sectional study followed the medical records of patients with OF starting from their first OF diagnosis date. Each patient's preventive osteoporosis treatments (vitamin D, calcium+vitamin D) and AOD utilization rate were recorded for a 12-month period following OF diagnosis. RESULTS A total of 210 patients (168 females, mean age: 67.8±11.9 years; 42 males, mean age 62.4±16.1 years) were enrolled in the study. Of these, 65.7% (n=138) did not use any medication for primary protection against osteoporosis before OF diagnosis. The ratio of patients not using any type of medication for secondary prevention after OF increased from 26.5% to 51% during a 12-month period. In addition, by one year following diagnosis, AOD usage rate had decreased from 62.3% to 41.3%. CONCLUSION The AOD usage rates for secondary prevention of OF were insufficient, and cessation rates were high. Identification of factors associated with decreased AOD utility rates will provide important information for guiding patient follow-up in order to reduce the occurrence of OF.
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Affiliation(s)
- Cenk Aypak
- To whom correspondence should be addressed. E-mail:
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Jota-Baptista C, Faustino-Rocha AI, Fardilha M, Ferreira R, Oliveira PA, Regueiro-Purriños M, Rodriguez-Altonaga JA, Gonzalo-Orden JM, Ginja M. Effects of testosterone and exercise training on bone microstructure of rats. Vet World 2022; 15:627-633. [PMID: 35497966 PMCID: PMC9047140 DOI: 10.14202/vetworld.2022.627-633] [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] [Received: 10/07/2021] [Accepted: 02/08/2022] [Indexed: 11/24/2022] Open
Abstract
Background and Aim: Male hypogonadism results from failure to produce physiological levels of testosterone. Testosterone in men is essential in masculine development, sperm production, and adult man’s health. Osteoporosis is one of the consequences of hypogonadism. Regular physical exercise and exogenous testosterone administration are frequently used to prevent or treat this condition. This study aimed to understand the effects of lifelong exercise training and testosterone levels (isolated and together) in the main bone structure parameters. Materials and Methods: A total of 24 rats were used and randomly divided into four groups: Control group (CG; n=6), exercised group (EG, n=6), testosterone group (TG, n=6), and testosterone EG (TEG, n=6). A micro-computed tomography equipment was used to evaluate 15 bone parameters. Results: Both factors (exercise training and testosterone) seem to improve the bone resistance and microstructure, although in different bone characteristics. Testosterone influenced trabecular structure parameters, namely, connectivity density, trabecular number, and trabecular space. The exercise promoted alterations in bone structure as well, although, in most cases, in different bone structure parameters as bone mineral density and medullar mineral density. Conclusion: Overall, exercise and testosterone therapy seems to have a synergistic contribution to the general bone structure and resistance. Further studies are warranted, comparing different individual factors, as gender, lifestyle, or testosterone protocols, to constantly improve the medical management of hypogonadism (and osteoporosis).
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Affiliation(s)
- Catarina Jota-Baptista
- Department of Veterinary Medicine, Surgery and Anatomy, Institute of Biomedicine (IBIOMED), University of León, Léon, Spain; Centre for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), Inov4Agro, Vila Real, Portugal
| | - Ana I. Faustino-Rocha
- Centre for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), Inov4Agro, Vila Real, Portugal; Department of Zootechnics, School of Sciences and Technology, Évora, Portugal; Comprehensive Health Research Center (CHRC), Évora, Portugal
| | - Margarida Fardilha
- iBIMED, Department of Medical Sciences, University of Aveiro (UA), Aveiro, Portugal
| | - Rita Ferreira
- LAQV-Associated Laboratory for Green Chemistry (REQUIMTE), Department of Chemistry, UA, Aveiro, Portugal
| | - Paula A. Oliveira
- Centre for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), Inov4Agro, Vila Real, Portugal; Department of Veterinary Sciences, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
| | - Marta Regueiro-Purriños
- Department of Veterinary Medicine, Surgery and Anatomy, Institute of Biomedicine (IBIOMED), University of León, Léon, Spain
| | - José A. Rodriguez-Altonaga
- Department of Veterinary Medicine, Surgery and Anatomy, Institute of Biomedicine (IBIOMED), University of León, Léon, Spain
| | - José M. Gonzalo-Orden
- Department of Veterinary Medicine, Surgery and Anatomy, Institute of Biomedicine (IBIOMED), University of León, Léon, Spain
| | - Mário Ginja
- Department of Veterinary Sciences, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal; Animal and Veterinary Research Center (CECAV), Vila Real, Portugal
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Elaborate the Mechanism of Ancient Classic Prescriptions (Erzhi Formula) in Reversing GIOP by Network Pharmacology Coupled with Zebrafish Verification. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:7019792. [PMID: 35047047 PMCID: PMC8763506 DOI: 10.1155/2022/7019792] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 11/16/2021] [Accepted: 12/23/2021] [Indexed: 11/17/2022]
Abstract
Osteoporosis is a degenerative disease that endangers human health. At present, chemical drugs used for osteoporosis have serious side effects. Therefore, it is valuable to search herbs with high safety and good curative effect in antiosteoporosis. Erzhi formula (EZF), an ancient classic compound, has been reported to have a beneficial effect in antiosteoporosis, but its mechanism is unclear. In this paper, the active compounds of EZF were found in Systems Pharmacology Database, and gene targets related to osteoporosis were obtained in GeneCards. The GO functional and KEGG pathway enrichment analysis were performed by Metascape. The network of “components-targets-signal pathway” was constructed by Cytoscape. Next, molecular docking between the active components and hub genes related to the PI3K-Akt signaling pathway was conducted by Autodock. In the verification experiment, the zebrafish induced by prednisolone (PNSL) was used to reproduce glucocorticoid-induced osteoporosis (GIOP) model, and then the reversal effects of EZF were systematically evaluated according to the behavior, skull staining area, bone mineralization area (BMA), average optical density (AOD), and cumulative optical density (COD). Finally, it was shown that 24 components in EZF could regulate 39 common gene targets to exert antiosteoporosis effect. Besides, the main regulatory mechanisms of EZF were 4 signaling pathways: PI3K-Akt, JAK-STAT, AGE-RAGE, and cancer pathway. In PI3K-Akt signaling pathway, wedelolactone, dimethyl wedelolactone, specnuezhenide, ursolic acid, acacetin, beta-sitosterol, apigenin, and kaempferol can bind tightly with EGF, IL-2, and IL-4 genes. Compared with the model group, the moving distance, swimming speed, and cumulative swimming time of zebrafish in EZF group were significantly increased (P < 0.05). Meanwhile, the BMA and COD of zebrafish were significantly improved after the intervention of EZF (P < 0.05). In summary, the 24 components of EZF exert their antiosteoporosis effects by regulating 39 related gene targets, among which the PI3K signaling pathway is crucial. EZF can promote bone formation and reversed GIOP through “multicomponent/multitarget/multipathway” and the medium dose of EZF may be the most suitable concentration for the treatment of GIOP in zebrafish model.
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Skuladottir SS, Ramel A, Eymundsdottir H, Hjaltadottir I, Launer LJ, Cotch MF, Siggeirsdottir K, Gudnason V, Sigurdsson G, Steingrimsdottir L, Halldorsson TI. Serum 25-Hydroxy-Vitamin D Status and Incident Hip Fractures in Elderly Adults: Looking Beyond Bone Mineral Density. J Bone Miner Res 2021; 36:2351-2360. [PMID: 34585782 DOI: 10.1002/jbmr.4450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 09/05/2021] [Accepted: 09/24/2021] [Indexed: 12/19/2022]
Abstract
Observational studies have consistently reported a higher risk of fractures among those with low levels of serum 25-hydroxyvitamin D (25(OH)D). Emerging evidence suggests that low serum 25(OH)D levels may increase the rate of falls through impaired physical function. Examine to what extent baseline measures of volumetric bone mineral density (vBMD), absolute bone mineral content (BMC), and markers of physical function may explain incident hip fractures in older adults with different serum levels of 25(OH)D. A prospective study of 4309 subjects (≥66 years) recruited between 2002 and 2006 into the Age, Gene/Environment Susceptibility-Reykjavik (AGES-Reykjavik) study. Hip fractures occurring until the end of 2012 were extracted from hospital records. Prevalence of serum 25(OH)D deficiency (<30 nmol/L), inadequacy (30-<50 nmol/L), and sufficiency (≥50 nmol/L) was 6%, 23%, and 71% for males; and 11%, 28%, and 53% for females, respectively. Female participants had ~30% lower absolute BMC compared to males. Serum 25(OH)D concentrations were positively associated with vBMD and BMC of the femoral neck and markers of physical function, including leg strength and balance. Those who had deficient compared to sufficient status at baseline had a higher age-adjusted risk of incidence hipfractures with hazard ratios (HRs) of 3.1 (95% confidence interval [CI], 1.9-5.2) and 1.8 (95% CI, 1.3-2.5) among males and females, respectively. When adjusting for vBMD and measures of physical function, the association was attenuated and became nonsignificant for males (1.3; 95% CI, 0.6-2.5) but remained significant for females (1.7; 95% CI, 1.1-2.4). Deficient compared to sufficient serum 25(OH)D status was associated with a higher risk of incident hip fractures. This association was explained by poorer vBMD and physical function for males but to a lesser extent for females. Lower absolute BMC among females due to smaller bone volume may account for these sex-specific differences. © 2021 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Sigrun S Skuladottir
- The Icelandic Gerontological Research Institute, Reykjavik, Iceland.,Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland.,School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Faculty of Nursing, University of Iceland, Reykjavik, Iceland
| | - Alfons Ramel
- The Icelandic Gerontological Research Institute, Reykjavik, Iceland.,Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
| | | | - Ingibjorg Hjaltadottir
- School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Faculty of Nursing, University of Iceland, Reykjavik, Iceland
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Baltimore, MD, USA
| | - Mary-Frances Cotch
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Vilmundur Gudnason
- Icelandic Heart Association Research Institute, Kopavogur, Iceland.,Faculty of Medicine, University of Iceland, University of Iceland, Reykjavik, Iceland
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7
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Ning H, Du Y, Zhao LJ, Tian Q, Feng H, Deng HW. The mediating effect of skeletal muscle index on the relationship between menarcheal age and bone mineral density in premenopausal women by race/ethnicity. Menopause 2021; 28:1143-1149. [PMID: 34313616 PMCID: PMC8514157 DOI: 10.1097/gme.0000000000001814] [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] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the contribution of skeletal mass index (SMI) as a mediator in the relationship between menarcheal age and hip/spine bone mineral density (BMD) in premenopausal women by race/ethnicity. METHODS The data of 4,329 participants (age ≥ 18; mean age=35.7 ± 9.5) of Whites (n = 2,543), African Americans (n = 1,236), and Asians (n = 550) enrolled from October 2011 to January 2019 from the Louisiana Osteoporosis Study were analyzed. After adjustment for physiological and behavioral factors, multivariable linear regression analyses were conducted to evaluate each component of the proposed mediation models, and mediation was verified by the bootstrapping resampling approach. RESULTS Premenopausal women with early menarcheal age tended to have higher SMI and BMD than women with normal menarcheal age among all races/ethnicities included. Women with late menarcheal age were, however, more likely to have a lower SMI than their counterparts with normal menarcheal age (r = -0.212, 95% CI = [-0.321 to -0.103] for White women; r = -0.181, 95% CI = [-0.410 to -0.008] for African-American women; r = -0.174, 95% CI = [-0.343 to -0.006] for Asian women). Similar results were found for both spine and hip BMD. SMI fully mediated the difference in BMD due to different menarcheal ages among Whites, African Americans, and Asian women with early menarcheal age; however, no mediating effects were observed for Asian women with late menarcheal age. CONCLUSIONS SMI, as a full mediator, affected the relationship between menarcheal age and BMD among premenopausal women, and the mediating effects varied by race/ethnicity. To prevent or slow down the loss of hip/spine BMD and the development of osteoporosis, measures aiming at minimizing the risk for muscle mass loss should be recommended, especially for White and African-American women with late menarcheal age.
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Affiliation(s)
- Hongting Ning
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Yan Du
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Lan-Juan Zhao
- Center for Bioinformatics and Genomics, Department of Biostatistics, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
| | - Qing Tian
- Center for Bioinformatics and Genomics, Department of Biostatistics, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
| | - Hui Feng
- Xiangya School of Nursing, Xiangya-Oceanwide Health Management Research Institute, Central South University, Changsha, Hunan, China
| | - Hong-Wen Deng
- School of Medicine, Tulane University, New Orleans, LA
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8
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Pilutin A, Misiakiewicz-Has K, Kolasa-Wołosiuk A, Trybek G, Urban F, Marchlewicz M, Leszczyński B, Wróbel A, Wiszniewska B. Morphology and serum and bone tissue calcium and magnesium concentrations in the bones of male rats chronically treated with letrozole, a nonsteroidal cytochrome P450 aromatase inhibitor. Connect Tissue Res 2021; 62:454-463. [PMID: 32419518 DOI: 10.1080/03008207.2020.1771329] [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] [Indexed: 02/03/2023]
Abstract
Purpose/Aim of the study: The role of estrogen (E) in the regulation of bone turnover in women is well established, though the contributions of E versus testosterone (T) in the control of bone turnover in men are poorly understood. The aim of this study was to examine the association between chronic treatment with letrozole, a nonsteroidal inhibitor blocking the aromatase activity and thus the conversion of androgens into estrogens, and cortical bone morphology in the femur and humerus of male adult rats.Materials and Methods: Adult male rats were treated with letrozole for 6 months and the body and femur weight, morphology, collagen structure, blood serum, and bone tissue concentrations of calcium and magnesium were examined.Results: Long-term aromatase inhibition resulted in a decrease in femur mass, a wavelike arrangement of bone and lamellae with an altered organization of collagen in compact bone, a increased concentration of calcium in blood serum, and no change in calcium bone tissue concentration, magnesium serum, or bone tissue concentration. MicroCT study of the humerus revealed significant decreases of whole bone tissue volume, cortical bone thickness, cortical bone volume, and external cortical bone thickness with letrozole treatment.Conclusion: Chronic treatment with letrozole affected cortical bone structure and produced histomorphological changes in male rat bone similar to that observed in the aging processes.
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Affiliation(s)
- Anna Pilutin
- Department of Histology and Embryology, Pomeranian Medical University, Szczecin, Poland
| | | | | | - Grzegorz Trybek
- Department of Dental Surgery, Pomeranian Medical University, Szczecin, Poland
| | - Fabian Urban
- Department of Histology and Embryology, Pomeranian Medical University, Szczecin, Poland
| | - Mariola Marchlewicz
- Department of Aesthetic Dermatology, Pomeranian Medical University, Szczecin, Poland
| | - Bartosz Leszczyński
- M. Smoluchowski Institute of Physics, Jagiellonian University, Krakow, Poland
| | - Andrzej Wróbel
- M. Smoluchowski Institute of Physics, Jagiellonian University, Krakow, Poland
| | - Barbara Wiszniewska
- Department of Histology and Embryology, Pomeranian Medical University, Szczecin, Poland
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9
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Carnovali M, Banfi G, Mariotti M. Age-dependent modulation of bone metabolism in zebrafish scales as new model of male osteoporosis in lower vertebrates. GeroScience 2020; 43:927-940. [PMID: 32997256 PMCID: PMC8110640 DOI: 10.1007/s11357-020-00267-0] [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] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/10/2020] [Indexed: 12/13/2022] Open
Abstract
After middle age, in human bone, the resorption usually exceeds formation resulting in bone loss and increased risk of fractures in the aged population. Only few in vivo models in higher vertebrates are available for pathogenic and therapeutic studies about bone aging. Among these, male Danio rerio (zebrafish) can be successfully used as low vertebrate model to study degenerative alterations that affect the skeleton during aging, reducing the role of sex hormones. In this paper, we investigated the early bone aging mechanisms in male zebrafish (3, 6, 9 months old) scales evaluating the physiological changes and the effects of prednisolone, a pro-osteoporotic drug. The results evidentiated an age-dependent reduction of the mineralization rate in the fish scales, as highlighted by growing circle measurements. Indeed, the osteoblastic ALP activity at the matrix deposition site was found progressively downregulated. The higher TRAP activity was found in 63% of 9-month-old fish scales associated with resorption lacunae along the scale border. Gene expression analysis evidentiated that an increase of the tnfrsf1b (homolog of human rank) in aging scales may be responsible for resorption stimulation. Interestingly, prednisolone inhibited the physiological growth of the scale and induced in aged scales a more significant bone resorption compared with untreated fish (3.8% vs 1.02%). Bone markers analysis shown a significant reduction of ALP/TRAP ratio due to a prednisolone-dependent stimulation of tnfsf11 (homolog of human rankl) in scales of older fish. The results evidentiated for the first time the presence of a senile male osteoporosis in lower vertebrate. This new model could be helpful to identify the early mechanisms of bone aging and new therapeutic strategies to prevent age-related bone alterations in humans.
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Affiliation(s)
| | - Giuseppe Banfi
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Mariotti
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy. .,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
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Fugiel J, Ignasiak Z, Skrzek A, Sławińska T. Evaluation of Relationships between Menopause Onset Age and Bone Mineral Density and Muscle Strength in Women from South-Western Poland. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5410253. [PMID: 32596326 PMCID: PMC7303744 DOI: 10.1155/2020/5410253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/02/2020] [Accepted: 05/25/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The onset of the menopause entails numerous changes, both physical and mental, in the functioning of the bodies of women. Moreover, the early menopause increases the risk of occurrence of many civilization-related diseases. Major factors contributing to health deficits include lowered bone mineral density and sarcopenia, which can result in serious functional limitations and the acceleration of ageing processes in the body. The aim of this study was to determine how the menopause onset age is linked with bone mineral density and the strength of selected muscles of the limbs and the trunk. Material and Methods. 756 women aged 50-80 years were subjected to tests. The subjects were divided into three groups: (I) from 50 to 59 years, (II) from 60 to 69 years, and (III) from 70 to 79 years. Each of the women specified the age when her final menstrual period occurred. On this basis, groups of women with (1) the early menopause-before the 50th year of life-and (2) with the late menopause-after the 50th year of life-were distinguished. Bone mineral density (BMD), dominant hand grip strength, knee extensor and flexor strength, and functional upper and lower body muscle strength were determined in each of the women. RESULTS The test results indicate differences in levels of muscle strength and BMD between the 50-year-old early- and late-menopausal women. The late-menopausal women score better motor ability test results and higher BMD values. The differences decrease in the groups of 60-year-old women, whereas the 70-year-old early- and late-menopausal women score similar results. CONCLUSIONS A higher percentage of women with a lowered bone mass and a lower strength level was found in the group of early-menopausal subjects. The rate of decline in hand grip strength, the functional efficiency of the upper and lower limbs, and BMD is faster in the late-menopausal women, whereby the two groups of 70-year-old women score similar test results.
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Affiliation(s)
- Jarosław Fugiel
- Department of Biostructure, University School of Physical Education in Wroclaw, Wroclaw, Poland
| | - Zofia Ignasiak
- Department of Biostructure, University School of Physical Education in Wroclaw, Wroclaw, Poland
| | - Anna Skrzek
- Department of Physiotherapy in Motor Organ Dysfunctions, University School of Physical Education in Wroclaw, Wroclaw, Poland
| | - Teresa Sławińska
- Department of Biostructure, University School of Physical Education in Wroclaw, Wroclaw, Poland
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Casula M, Olmastroni E, Galimberti F, Tragni E, Corrao G, Scotti L, Catapano AL. Association between the cumulative exposure to bisphosphonates and hospitalization for atherosclerotic cardiovascular events: A population-based study. Atherosclerosis 2020; 301:1-7. [PMID: 32289617 DOI: 10.1016/j.atherosclerosis.2020.03.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/21/2020] [Accepted: 03/26/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND AIMS Although bisphosphonates have been suggested to protect against atherosclerotic cardiovascular (CV) events, evidence is still conflicting. We aimed at investigating the effect of bisphosphonates on hospitalizations for atherosclerotic CV events. METHODS We carried out a retrospective cohort study selecting subjects aged>40 years, incident users of bisphosphonates. Exposure to bisphosphonates was characterized based on cumulative doses (proportion of days covered, PDC). Treatment's adherence was classified as low (PDC≤40%), intermediate (PDC 41%-80%), or high (PDC>80%). A multivariate Cox model was fitted to estimate the association between cumulative time-dependent exposure to bisphosphonates and hospitalization for atherosclerotic CV events (hazard ratio [HR] and 95% confidence interval). RESULTS Among 82,704 new bisphosphonates users (females 87.0%, mean age 70.7 ± 10.6 years), 16.1% had a CV hospitalization during a mean follow-up of 6.5 + 2.6 years. Compared with individuals with PDC ≤40%, those exposed for 41-80% or more than 80% showed HRs of CV hospitalization of 0.95 [0.91-0.99] and 0.75 [0.71-0.81], respectively. In the sub-analysis by type of event, a PDC >80% was associated with a reduced incidence for both coronary and cerebrovascular events (HRs 0.75 [0.68-0.83] and 0.76 [0.70-0.83], respectively). The protective effect was confirmed in stratified analyses by sex and age classes, and in those performed at 1 and 3 years of follow-up. CONCLUSIONS Strict adherence to bisphosphonate treatment was associated with a better CV outcome. Although further studies to investigate possible mechanisms are warranted, bisphosphonates could be considered as having a potential CV benefit beyond the effect on bones.
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Affiliation(s)
- Manuela Casula
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy; IRCCS MultiMedica, Sesto S. Giovanni (Milan), Italy.
| | - Elena Olmastroni
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Federica Galimberti
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Elena Tragni
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Giovanni Corrao
- National Centre for Healthcare Research & Pharmacoepidemiology, Milan, Italy; Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Lorenza Scotti
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Alberico L Catapano
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy; IRCCS MultiMedica, Sesto S. Giovanni (Milan), Italy
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Keramidaki K, Tsagari A, Hiona M, Risvas G. Osteosarcopenic obesity, the coexistence of osteoporosis, sarcopenia and obesity and consequences in the quality of life in older adults ≥65 years-old in Greece. J Frailty Sarcopenia Falls 2019; 4:91-101. [PMID: 32300723 PMCID: PMC7155308 DOI: 10.22540/jfsf-04-091] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE We investigated the coexistence of sarcopenia and obesity in older adults≥65 years diagnosed with osteoporosis and the association with Quality of Life (QoL). METHODS A Cross-sectional survey has been performed on a randomized sample of 50 diagnosed osteoporotic elderly people from both sexes (Men=16; Women=34). MEASUREMENTS Quantitative ultrasound was conducted to identify osteoporosis and defined with a T score ≤2.5. Validated anthropometric equations were used in order to estimate body fat percentage and skeletal muscle mass so as to detect the reallocation of body fat and lean muscle. 10m gait speed and hand grip strength was measured in order to diagnose sarcopenia according to European Society for Clinical Nutrition and Metabolism (ESPEN) algorithm. The evaluation of QoL was conducted using a QoL questionnaire specific to osteoporosis. The data were analyzed with descriptive statistics and a chi-square test was performed to examine if Osteosarcopenic Obesity (OSO) is sex related and the correlation between OSO and QoL. RESULTS From the 50 participants, 40%(n=19) were classified as people with OSO and 60%(n=31) without OSO. From n=19 people that experienced OSO women represent 20% (n=9) and men 18% (n=9); with the latter had a greater decline in muscle mass than women, while women had lower BMD than men according to the z score. OSO is not related with sex (p>.05) and there is no significant association between OSO and QoL (p> .05 for all the domains of QoL questionnaire). CONCLUSION Osteoporosis in the elderly often coexists with reduced muscle mass and muscle strength as well as an increase in adiposity and was independently associated with QoL. People that experience OSO presenting lower functionality that increases the risk for falls and bone fractures originated from the decline in bone and muscle mass, and increased adiposity. Increased awareness of OSO may help develop efficient interventions and public health policies for healthier and more active elderly people.
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Affiliation(s)
- Konstantia Keramidaki
- Outpatient Οbesity Clinic, EASO accredited Center for Obesity Management (COM), 1 Propaedeutic Internal Medicine Department, University Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
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13
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Efficacy, safety, and compliance of ibandronate treatment for 3 years in postmenopausal Japanese women with primary osteoporosis. Osteoporos Sarcopenia 2019; 4:69-72. [PMID: 30775545 PMCID: PMC6362971 DOI: 10.1016/j.afos.2018.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 03/17/2018] [Accepted: 04/15/2018] [Indexed: 12/05/2022] Open
Abstract
Objectives The aim of this study was to examine the efficacy, safety, and adherence of ibandronate (IBN) treatment with or without vitamin D supplementation for 3 years in Japanese women with postmenopausal osteoporosis. Methods This prospective investigation included 27 patients treated with IBN alone (monotherapy group) and 29 patients receiving IBN and alfacalcidol (ALF) (combination group). Bone metabolism and bone mineral density (BMD) were measured before and at 18, 24, 30, and 36 months of therapy. Treatment discontinuation and fracture occurrence were assessed as well. Results Lumbar 1–4 BMD (L-BMD) was significantly increased in the monotherapy and combination groups by 3.9% and 7.2%, respectively, at 36 months, with significant gains in total hip BMD (H-BMD) of 3.7% and 4.9%, respectively. There were significant differences in L-BMD improvement between the groups at 18, 24, and 30 months (P < 0.05) and at 36 months (P < 0.01). Compared with pretreatment levels, the percentage changes of L-BMD and H-BMD were significant at all time points in the combination group and at all points apart from L-BMD at 36 months in the monotherapy group. In the monotherapy group, 14 patients dropped out during 3 years and 2 vertebral fractures occurred during the first year. In the combination group, 16 cases dropped out during 3 years and 1 nonvertebral fracture was noted during the first year. Conclusions Our findings suggest that combination therapy of IBN and vitamin D is superior to monotherapy with regard to L-BMD improvements for 3 years, with both groups showing comparable safety and adherence to treatment.
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14
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Jeng YT, Lin SY, Hu HY, Lee OK, Kuo LL. Osteoporosis and dry eye syndrome: A previously unappreciated association that may alert active prevention of fall. PLoS One 2018; 13:e0207008. [PMID: 30395639 PMCID: PMC6218084 DOI: 10.1371/journal.pone.0207008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 10/23/2018] [Indexed: 01/13/2023] Open
Abstract
Objective Osteoporosis is a multifactorial disease associated with inflammation and hormone imbalance. It is noteworthy that dry eye syndrome shares a similar pathophysiology with osteoporosis. Both diseases are more prevalent among the elderly and females. Dry eye syndrome can result in impaired vision, which increases the risk of fall and fracture when osteoporosis exists. In this study, we investigated whether osteoporosis is associated with an increased risk of developing dry eye syndrome. Methods Claims data from the National Health Insurance Research Database (NHIRD) of Taiwan were used to conduct a retrospective population-based cohort study covering the period from January 1, 2000, to December 31, 2011. Multiple logistic regression was used to determine whether osteoporosis is an independent factor in the risk of developing dry eye syndrome, with risk estimates presented in the form of odds ratios (ORs). Results The exclusion of patients with specific autoimmune diseases and those younger than 50 years old resulted in 42,365 patients in the osteoporosis group and 147,460 patients in the comparison group during the study period. The number of patients newly diagnosed with dry eye syndrome was 6,478 (15.29%) in the osteoporosis group and 15,396 (10.44%) in the comparison group. The crude OR of patients with osteoporosis developing dry eye syndrome was 1.55 and the 95% confidence interval (95% CI) was 1.50–1.60. After adjusting for patients’ age, sex, and underlying comorbidities, the adjusted OR was 1.26 and the 95% CI was 1.22–1.30. Subgroup analysis revealed this association in each age group and among females but not among males. Conclusions Our results demonstrate that osteoporosis is a risk factor for the subsequent development of dry eye syndrome. Clinicians should be aware of the early symptoms of dry eye syndrome in osteoporotic patients in order to prevent further complications.
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Affiliation(s)
- Yu-Ting Jeng
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
| | - Shu-Yi Lin
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
| | - Hsiao-Yun Hu
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
- Institute of Public Health and Department of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Oscar K. Lee
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Li-Lin Kuo
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
- Zhongxiao Branch, Taipei City Hospital, Taipei, Taiwan
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- * E-mail:
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15
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Bahl A, Schafer S. Utility of Abdominal Computed Tomography in Geriatric Patients on Warfarin with a Fall from Standing. J Emerg Trauma Shock 2018; 11:88-91. [PMID: 29937636 PMCID: PMC5994848 DOI: 10.4103/jets.jets_52_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Context: Geriatric head trauma resulting from falls has been extensively studied both in the presence and absence of blood thinners. In this population, however, the prevalence and extent of abdominal injury resulting from falls are much less defined. Aim: We aim to evaluate the utility of abdominal computed tomography (CT) imaging in geriatric patients on Warfarin with a recent history of fall. Setting and Design: A retrospective analysis was completed of consecutive geriatric patients who presented to a Level 1 Trauma Center emergency department after fall from standing while taking Warfarin. Methods: Inclusion criteria included age 65 years or older and fall while taking Warfarin. Incomplete medical records were excluded from the study. Data collection included the type of anticoagulant medications, demographics, physical examination, laboratories, CT/X-ray findings if ordered, and final diagnosis on admission. Categorical variables were examined using Pearson's Chi-square where appropriate (expected frequency >5), or Fisher's Exact test. Continuous variables were examined using nonparametric Wilcoxon rank tests. Results: Eight hundred and sixty-three charts were reviewed. One hundred and thirty-one subjects met inclusion criteria. Mean age was 83 years. Nearly 39.6% of patients were male. A total of 48 patients had abdominal CT imaging. Seven of the 131 patients (5.3%) had an abdominal injury. Abdominal tenderness was predictive of injury, with 4 of 7 cases with abdominal injury demonstrating abdominal tenderness versus only 10 of 124 cases without abdominal injury demonstrating tenderness (P = 0.003). Abdominal CTs were ordered in 11 of 19 cases of patients that exhibited head trauma yet none of these patients were shown to have sustained abdominal trauma (P = 0.08). There was no association between international normalized ratio level and presence of abdominal injury (P = 0.99). Conclusions: A small percentage of elderly fall patients on Warfarin have a significant abdominal injury. Anticoagulated geriatric patients are sometimes subjected to abdominal scans liberally without supporting physical examination findings such as abdominal tenderness or presence of a distracting injury. Specifically, the utility of abdominal CT is questionable in isolated head injury patients. Further, taking Warfarin or other anticoagulant medications do not seem to increase the risk of intraabdominal injury.
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Affiliation(s)
- Amit Bahl
- Department of Emergency Medicine, Beaumont Hospital, Royal Oak, Michigan, USA
| | - Steven Schafer
- Department of Emergency Medicine, Beaumont Hospital, Royal Oak, Michigan, USA
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16
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Kaushal N, Vohora D, Jalali RK, Jha S. Prevalence of osteoporosis and osteopenia in an apparently healthy Indian population - a cross-sectional retrospective study. Osteoporos Sarcopenia 2018; 4:53-60. [PMID: 30775543 PMCID: PMC6362954 DOI: 10.1016/j.afos.2018.04.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 03/08/2018] [Accepted: 04/26/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES An understanding of bone mineral density (BMD) pattern in a population is crucial for prevention and diagnosis of osteoporosis and management of its complications in later life. This study aimed to screen the bone health status and factors associated with osteoporosis in an apparently healthy Indian population. METHODS A retrospective review of medical records was done in a tertiary-care hospital for the subjects who had undergone preventive health-check-ups that included BMD measurements at femur-neck, total-femur, and lumbar-spine. RESULTS We evaluated 524 subjects (age, 50.0 ± 12.4 years) including 41.2% female and 58.8% male subjects. Osteoporosis was present in 6.9% subjects (female, 11.1%; male, 4.2%) and osteopenia in 34% subjects (female, 40.3%; male, 29.9%). Absolute BMD was higher in male subjects (P < 0.001) compared to female subjects at all bone sites. Prevalence of osteoporosis increased with age in female subjects, but not in male subjects. Osteoporosis rates in the age-groups of 30-39, 40-49, 50-59, 60-69, and ≥70 years were 3%, 3.4%, 14.3%, 18.6%, and 36.4%, respectively in female subjects while prevalence in male subjects was 0%, 4%, 6.5%, 4.3%, and 5.6%, respectively, at lumbar spine. Height (r = 0.234-0.358), weight (r = 0.305-0.388), body mass index (r = 0.143-0.285) and physical activity (r = 0.136-0.153) were positively; and alkaline phosphatase (r = -0.133 to -0.203) was negatively correlated with BMD (all P < 0.01) at all sites. These parameters retained significant correlation after controlling for age and sex. No correlation of serum 25-hydroxy-vitamin-D and calcium was noted with BMD (P > 0.05) at any site. CONCLUSIONS Further data on absolute BMD, T scores, and prevalence rates of osteoporosis/osteopenia on multiple bone sites have been presented in this article.
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Affiliation(s)
- Neelam Kaushal
- Pharmaceutical Medicine, Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Divya Vohora
- Pharmaceutical Medicine, Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Rajinder K. Jalali
- Medical Affairs & Clinical Research, Sun Pharmaceutical Industries Limited, Gurgaon, India
| | - Sujeet Jha
- Institute of Endocrinology, Diabetes and Metabolism, Max Healthcare Inst. Ltd., New Delhi, India
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17
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Fatahi S, Namazi N, Larijani B, Azadbakht L. The Association of Dietary and Urinary Sodium With Bone Mineral Density and Risk of Osteoporosis: A Systematic Review and Meta-Analysis. J Am Coll Nutr 2018; 37:522-532. [DOI: 10.1080/07315724.2018.1431161] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Somaye Fatahi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazli Namazi
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Azadbakht
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
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18
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Hansen RA, Qian J, Berg RL, Linneman JG, Seoane-Vazquez E, Dutcher S, Raofi S, Page CD, Peissig PL. Comparison of Outcomes Following a Switch From a Brand to an Authorized Versus Independent Generic Drug. Clin Pharmacol Ther 2018; 103:310-317. [PMID: 27981563 PMCID: PMC5860648 DOI: 10.1002/cpt.591] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/08/2016] [Accepted: 12/05/2016] [Indexed: 11/07/2022]
Abstract
Authorized generics are identical in formulation to brand drugs, manufactured by the brand company but marketed as a generic. Generics, marketed by generic manufacturers, are required to demonstrate pharmaceutical and bioequivalence to the brand drug, but repetition of clinical trials is not required. This retrospective cohort study compared outcomes for generics and authorized generics, which serves as a generic vs. brand proxy that minimizes bias against generics. For the seven drugs studied between 1999 and 2014, 5,234 unique patients were on brand drugs prior to generic entry and 4,900 (93.6%) switched to a generic. During the 12 months following the brand-to-generic switch, patients using generics vs. authorized generics were similar in terms of outpatient visits, urgent care visits, hospitalizations, and medication discontinuation. The likelihood of emergency department (ED) visits was slightly higher for authorized generics compared with generics. These data suggest that generics were clinically no worse than their proxy brand comparators.
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Affiliation(s)
- Richard A. Hansen
- Auburn University, Harrison School of Pharmacy, Department of Health Outcomes Research and Policy, Auburn, AL
| | - Jingjing Qian
- Auburn University, Harrison School of Pharmacy, Department of Health Outcomes Research and Policy, Auburn, AL
| | - Richard L. Berg
- Marshfield Clinic Research Foundation, Biomedical Informatics Research Center, Marshfield, WI
| | - James G. Linneman
- Marshfield Clinic Research Foundation, Biomedical Informatics Research Center, Marshfield, WI
| | - Enrique Seoane-Vazquez
- Massachusetts College of Pharmacy and Health Sciences, International Center for Pharmaceutical Economics and Policy, Boston, MA
| | - Sarah Dutcher
- U.S. Food and Drug Administration, Office of Generic Drugs, Silver Spring, MD
| | - Saeid Raofi
- U.S. Food and Drug Administration, Office of Generic Drugs, Silver Spring, MD
| | - C. David Page
- University of Wisconsin, School of Medicine and Public Health, Department of Biostatistics and Medical Informatics, and Department of Computer Science, Madison, WI
| | - Peggy L. Peissig
- Marshfield Clinic Research Foundation, Biomedical Informatics Research Center, Marshfield, WI
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Gomez-Bruton A, Montero-Marín J, González-Agüero A, Gómez-Cabello A, García-Campayo J, Moreno LA, Casajús JA, Vicente-Rodríguez G. Swimming and peak bone mineral density: A systematic review and meta-analysis. J Sports Sci 2017; 36:365-377. [PMID: 28394711 DOI: 10.1080/02640414.2017.1307440] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This meta-analysis aims to determine the effects of regular swimming on bone mineral density (BMD) in young adults (18-30 years). A systematic search was performed in Pubmed, SPORTDiscus and the Cochrane Library from the earliest possible year to March 2016. Swimmers were compared to non-athletic controls (CG) and to high-impact athletes (HIGH). Effect sizes with the Hedges g in random effects models were developed. Fourteen studies met the inclusion criteria and were included in the meta-analyses. Swimmers presented similar BMD values to CG in whole-body (g = -0.20; P = 0.251), femoral neck (g = -0.05; P = 0.818) and lumbar spine (g = 0.18; P = 0.492); and lower BMD in the whole-body (g = -1.21; P < 0.001), femoral neck (g = -1.51; P < 0.001) and lumbar spine (g = -0.84; P = 0.017) than the HIGH. For the whole-body differences, the higher the latitude the smaller the differences between swimmers and HIGH (B = 0.10; P = 0.001). For the femoral neck differences, age also seemed to reduce the differences between groups (B = 0.19; P = 0.020). Young adult swimmers present similar BMD values than CG and lower values than HIGH.
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Affiliation(s)
- Alejandro Gomez-Bruton
- a Faculty of Health and Sport Science (FCSD), Department of Physiatry and Nursing , Universidad de Zaragoza , Huesca , Spain.,b GENUD (Growth, Exercise, Nutrition and Development) Research Group , Zaragoza , Spain.,c Centro de Investigación Biomédica en Red de Fisología de la Obesidad y Nutrición , Madrid , Spain
| | - Jesús Montero-Marín
- a Faculty of Health and Sport Science (FCSD), Department of Physiatry and Nursing , Universidad de Zaragoza , Huesca , Spain.,d redIAPP Reseach Network , Zaragoza , Spain
| | - Alejandro González-Agüero
- a Faculty of Health and Sport Science (FCSD), Department of Physiatry and Nursing , Universidad de Zaragoza , Huesca , Spain.,b GENUD (Growth, Exercise, Nutrition and Development) Research Group , Zaragoza , Spain.,c Centro de Investigación Biomédica en Red de Fisología de la Obesidad y Nutrición , Madrid , Spain
| | - Alba Gómez-Cabello
- b GENUD (Growth, Exercise, Nutrition and Development) Research Group , Zaragoza , Spain.,c Centro de Investigación Biomédica en Red de Fisología de la Obesidad y Nutrición , Madrid , Spain.,e Centro Universitario de la Defensa , Zaragoza , Spain
| | - Javier García-Campayo
- d redIAPP Reseach Network , Zaragoza , Spain.,f Miguel Servet University Hospital , Zaragoza , Spain
| | - Luis A Moreno
- b GENUD (Growth, Exercise, Nutrition and Development) Research Group , Zaragoza , Spain.,c Centro de Investigación Biomédica en Red de Fisología de la Obesidad y Nutrición , Madrid , Spain.,g Faculty of Health Science (FCS) , Universidad de Zaragoza , Zaragoza , Spain
| | - Jose A Casajús
- a Faculty of Health and Sport Science (FCSD), Department of Physiatry and Nursing , Universidad de Zaragoza , Huesca , Spain.,b GENUD (Growth, Exercise, Nutrition and Development) Research Group , Zaragoza , Spain.,c Centro de Investigación Biomédica en Red de Fisología de la Obesidad y Nutrición , Madrid , Spain
| | - Germán Vicente-Rodríguez
- a Faculty of Health and Sport Science (FCSD), Department of Physiatry and Nursing , Universidad de Zaragoza , Huesca , Spain.,b GENUD (Growth, Exercise, Nutrition and Development) Research Group , Zaragoza , Spain.,c Centro de Investigación Biomédica en Red de Fisología de la Obesidad y Nutrición , Madrid , Spain
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20
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Aslam MN, Jepsen KJ, Khoury B, Graf KH, Varani J. Bone structure and function in male C57BL/6 mice: Effects of a high-fat Western-style diet with or without trace minerals. Bone Rep 2016; 5:141-149. [PMID: 27350956 PMCID: PMC4920365 DOI: 10.1016/j.bonr.2016.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 04/21/2016] [Accepted: 05/11/2016] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Osteoporosis occurs in both women and men, but most of what we know about the condition comes from studies in females. The present study examined bone structure and function over an 18-month period in male C57BL/6 mice maintained on either a rodent chow diet (AIN76A) or a high-fat, Western-style diet (HFWD). Effects of mineral supplementation were assessed in both diets. METHODS Trabecular and cortical bone structure in femora and vertebrae were assessed by micro-CT analysis. Following this, bone stiffness and strength measurements were made. Finally, bone levels of several cationic trace elements were quantified, and serum biomarkers of bone metabolism evaluated. RESULTS Bone loss occurred over time in both diets but was more rapid and extensive in mice on the HFWD. Dietary mineral supplementation reduced bone loss in both diets and increased bone stiffness in the femora and bone stiffness and strength in the vertebrae. Bone content of strontium was increased in response to mineral supplementation in both diets. CONCLUSIONS Bone loss was more severe in mice on the HFWD and mineral supplementation mitigated the effects of the HFWD. In comparison to previous findings with female C57BL/6 mice, the present studies indicate that males are more sensitive to diet and benefited from a healthy diet (AIN76A), while females lost as much bone on the healthy diet as on the HFWD. Male mice benefited from mineral supplementation, just as females did in the previous study.
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Affiliation(s)
| | - Karl J. Jepsen
- Department of Orthopaedic Surgery, The University of Michigan, Ann Arbor, MI 48109, USA
| | - Basma Khoury
- Department of Orthopaedic Surgery, The University of Michigan, Ann Arbor, MI 48109, USA
| | - Kristin H. Graf
- Department of Orthopaedic Surgery, The University of Michigan, Ann Arbor, MI 48109, USA
| | - James Varani
- Department of Pathology, The University of Michigan, Ann Arbor, MI 48109, USA
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21
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Ma Z, Li Y, Zhou M, Huang K, Hu H, Liu X, Xu X. Predictors of Ibandronate Efficacy for the Management of Osteoporosis: A Meta-Regression Analysis. PLoS One 2016; 11:e0150203. [PMID: 26930292 PMCID: PMC4773099 DOI: 10.1371/journal.pone.0150203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 02/10/2016] [Indexed: 11/18/2022] Open
Abstract
Background Aim of the present study was to identify the predictors of ibandronate efficacy in subjects with osteoporosis or decreased bone mineral density (BMD). Method Several electronic databases were searched by using specific keywords for the acquisition of research articles reporting the efficacy of ibandronate in subjects with osteoporosis or decreased BMD. Metaregression analyses were carried out by using changes in the BMD of lumbar spine and total hip following ibandronate treatment as dependent (outcome) variables against several independent (explanatory) variables. Results Data were extracted from 34 studies (11,090 ibandronate treated subjects) which fulfilled eligibility criteria. A history of previous fracture/s was reported by 46% of these subjects. In overall population, longer treatment duration from 1 to 5 years, increasing age, history of previous fractures, lower baseline T score, and higher baseline levels of C-terminal telopeptide of type 1 collagen (CTX) predicted higher ibandronate efficacy in improving BMD of the lumbar spine as well as of the total hip. Lower baseline levels of vitamin D and higher baseline levels of bone specific alkaline phosphatase (BSAP) predicted higher efficacy of ibandronate for lumbar spine only. In postmenopausal women with osteoporosis or decreased BMD, in addition to above-mentioned predictors, better efficacy of ibandronate was also associated with increasing time since menopause for both lumbar spine and total hip and lower body weight for lumbar spine only. Conclusion Longer treatment duration from 1 to 5 years, increasing age, lower baseline T scores, and higher serum CTX levels are identified as the predictors of better efficacy of ibandronate in the study subjects with osteoporosis or decreased BMD.
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Affiliation(s)
- Zeren Ma
- Spinal and Joint Unit, Department of Orthopedics, Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang, Jiangxi 330006, China
- * E-mail:
| | - Yong Li
- Department of Orthopaedics, Shanxi Province People’s Hospital, Xi’an 710068, China
| | - Ming Zhou
- Spinal and Joint Unit, Department of Orthopedics, Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang, Jiangxi 330006, China
| | - Kedi Huang
- Spinal and Joint Unit, Department of Orthopedics, Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang, Jiangxi 330006, China
| | - Hejun Hu
- Spinal and Joint Unit, Department of Orthopedics, Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang, Jiangxi 330006, China
| | - Xiaoping Liu
- Spinal and Joint Unit, Department of Orthopedics, Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang, Jiangxi 330006, China
| | - Xiaosheng Xu
- Spinal and Joint Unit, Department of Orthopedics, Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang, Jiangxi 330006, China
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Eimar H, Alebrahim S, Manickam G, Al-Subaie A, Abu-Nada L, Murshed M, Tamimi F. Donepezil regulates energy metabolism and favors bone mass accrual. Bone 2016; 84:131-138. [PMID: 26719214 DOI: 10.1016/j.bone.2015.12.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 12/15/2015] [Accepted: 12/18/2015] [Indexed: 11/20/2022]
Abstract
The autonomous nervous system regulates bone mass through the sympathetic and parasympathetic arms. The sympathetic nervous system (SNS) favors bone loss whereas the parasympathetic nervous system (PNS) promotes bone mass accrual. Donepezil, a central-acting cholinergic agonist, has been shown to down-regulate SNS and up-regulate PNS signaling tones. Accordingly, we hypothesize that the use of donepezil could have beneficial effects in regulating bone mass. To test our hypothesis, two groups of healthy female mice were treated either with donepezil or saline. Differences in body metabolism and bone mass of the treated groups were compared. Body and visceral fat weights as well as serum leptin level were increased in donepezil-treated mice compared to control, suggesting that donepezil effects on SNS influenced metabolic activity. Donepezil-treated mice had better bone quality than controls due to a decrease in osteoclasts number. These results indicate that donepezil is able to affect whole body energy metabolism and favors bone mass in young female WT mice.
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Affiliation(s)
- Hazem Eimar
- Faculty of Dentistry, McGill University, Montreal, Quebec H3A 0C7, Canada
| | - Sharifa Alebrahim
- Faculty of Dentistry, McGill University, Montreal, Quebec H3A 0C7, Canada
| | - Garthiga Manickam
- Faculty of Dentistry, McGill University, Montreal, Quebec H3A 0C7, Canada
| | - Ahmed Al-Subaie
- Faculty of Dentistry, McGill University, Montreal, Quebec H3A 0C7, Canada
| | - Lina Abu-Nada
- Faculty of Dentistry, McGill University, Montreal, Quebec H3A 0C7, Canada
| | - Monzur Murshed
- Faculty of Dentistry, McGill University, Montreal, Quebec H3A 0C7, Canada; Faculty of Medicine, McGill University, Montreal, Quebec H3G 1Y6, Canada; Genetics Unit, Shriners Hospital for Children, Montreal, Quebec H3G 1A6, Canada.
| | - Faleh Tamimi
- Faculty of Dentistry, McGill University, Montreal, Quebec H3A 0C7, Canada.
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Urbaniak C, Reid G. The potential influence of the microbiota and probiotics on women during long spaceflights. ACTA ACUST UNITED AC 2016; 12:193-8. [PMID: 26901697 DOI: 10.2217/whe.15.101] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Humans have been exploring space for almost 55 years but space travel comes with many psychological and physiological changes that astronauts have to adapt to, both during and post flight missions. Now, with the reality of such missions lasting years, maintaining proper health of the flight crew is a high priority. While conditions such as nausea, bone loss, renal calculi and depression have been recognized, and approaches to medical and surgical care in space considered, the influence of the microbiota could be of added significance in maintaining astronaut health. While probiotics have long been part of the Russian cosmonaut diet, their use for specific health concerns of women has not been assessed. In this article, we explore the ways in which the microbiome may influence the health of female astronauts during long space flights, and present a rationale for the use of probiotics.
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Affiliation(s)
- Camilla Urbaniak
- Lawson Health Research Institute, London, ON, N6A 4V2, Canada.,Department of Microbiology & Immunology, Western University, London, ON, N6A 5C1, Canada
| | - Gregor Reid
- Lawson Health Research Institute, London, ON, N6A 4V2, Canada.,Department of Microbiology & Immunology, Western University, London, ON, N6A 5C1, Canada
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Doyard M, Chappard D, Leroyer P, Roth MP, Loréal O, Guggenbuhl P. Decreased Bone Formation Explains Osteoporosis in a Genetic Mouse Model of Hemochromatosiss. PLoS One 2016; 11:e0148292. [PMID: 26829642 PMCID: PMC4734777 DOI: 10.1371/journal.pone.0148292] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 01/15/2016] [Indexed: 01/19/2023] Open
Abstract
Osteoporosis may complicate iron overload diseases such as genetic hemochromatosis. However, molecular mechanisms involved in the iron-related osteoporosis remains poorly understood. Recent in vitro studies support a role of osteoblast impairment in iron-related osteoporosis. Our aim was to analyse the impact of excess iron in Hfe-/- mice on osteoblast activity and on bone microarchitecture. We studied the bone formation rate, a dynamic parameter reflecting osteoblast activity, and the bone phenotype of Hfe-/- male mice, a mouse model of human hemochromatosis, by using histomorphometry. Hfe-/- animals were sacrificed at 6 months and compared to controls. We found that bone contains excess iron associated with increased hepatic iron concentration in Hfe-/- mice. We have shown that animals with iron overload have decreased bone formation rate, suggesting a direct impact of iron excess on active osteoblasts number. For bone mass parameters, we showed that iron deposition was associated with bone loss by producing microarchitectural impairment with a decreased tendency in bone trabecular volume and trabecular number. A disorganization of trabecular network was found with marrow spaces increased, which was confirmed by enhanced trabecular separation and star volume of marrow spaces. These microarchitectural changes led to a loss of connectivity and complexity in the trabecular network, which was confirmed by decreased interconnectivity index and increased Minkowski's fractal dimension. Our results suggest for the first time in a genetic hemochromatosis mouse model, that iron overload decreases bone formation and leads to alterations in bone mass and microarchitecture. These observations support a negative effect of iron on osteoblast recruitment and/or function, which may contribute to iron-related osteoporosis.
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Affiliation(s)
- Mathilde Doyard
- INSERM UMR U991, F- 35033, Rennes, France
- Université de Rennes 1, IFR 140, F- 35043, Rennes, France
| | - Daniel Chappard
- GEROM Groupe Etude Remodelage Osseux et bioMatériaux LHEA, IRIS-IBM, Institut de biologie en santé, CHU, F- 49933, Angers, France
| | - Patricia Leroyer
- INSERM UMR U991, F- 35033, Rennes, France
- Université de Rennes 1, IFR 140, F- 35043, Rennes, France
| | | | - Olivier Loréal
- INSERM UMR U991, F- 35033, Rennes, France
- Université de Rennes 1, IFR 140, F- 35043, Rennes, France
- Service des Maladies du Foie, Hôpital Pontchaillou, CHU, F- 35033, Rennes, France
| | - Pascal Guggenbuhl
- INSERM UMR U991, F- 35033, Rennes, France
- Université de Rennes 1, IFR 140, F- 35043, Rennes, France
- Service de Rhumatologie, Hôpital Sud, CHU, F- 35033, Rennes, France
- * E-mail:
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Current Scenario of Prevalence of Vitamin D Deficiency in Ostensibly Healthy Indian Population: A Hospital Based Retrospective Study. Indian J Clin Biochem 2016; 31:452-7. [PMID: 27605743 DOI: 10.1007/s12291-016-0552-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 01/20/2016] [Indexed: 01/05/2023]
Abstract
25-hydroxy vitamin D [25(OH) vit D] deficiency is a serious public health problem, particularly in the Indian sub-continent. The objective of the present study was to study the prevalence of 25(OH) vit D in different age groups. The data of 25(OH) vit D assay of 26,346 ostensibly healthy individuals, enrolled under executive health checkup at Medanta The Medicity, Gurgaon, over a period of 3 years, were extracted from the hospital information system and reviewed extensively. 25(OH) vit D deficiency (VDD) was defined as 25(OH) vit D < 20 ng/ml, insufficiency (VDI) as 25(OH) vit D between 20 and 40 ng/ml and 25(OH) vit D sufficiency (VDS) as 25(OH) D > 40 ng/mL. 25(OH) vit D deficiency (VDD + VDI) was observed in 93 % of the subject population. Maximum number of the subjects belonged to the age group of 41-60 years. 59 % had frank 25(OH) vit D deficiency when cut off level was <20 ng/mL. Mean value of 25(OH) vit D in our subjects was 21.4 ± 14.4 ng/mL. Significant difference in 25(OH) vit D level was observed in between male and female subjects. Simultaneously 25(OH) vit D levels were significantly lower in the patient visited hospital in winter-spring season than the summer-autumn season (p > 0.001). Our study demonstrates a high prevalence of 25(OH) vit D deficiency in an ostensibly healthy Indian population. There is a need for redefining our reference ranges according to our population and extensively improving the status of vitamin D.
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Weng W, Hess BJ, Lynn LA, Lipner RS. Assessing the Quality of Osteoporosis Care in Practice. J Gen Intern Med 2015; 30:1681-7. [PMID: 25956825 PMCID: PMC4617929 DOI: 10.1007/s11606-015-3342-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 12/17/2014] [Accepted: 04/01/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with osteoporosis can sustain fractures following falls or other minimal trauma. This risk of fracture can be reduced through appropriate diagnostic testing, pharmacologic therapy, and other readily measured standards of care. OBJECTIVES Our aim was to develop a credible clinical performance assessment to measure physicians' quality of osteoporosis care, and determine reasonable performance standards for both competent and excellent care. DESIGN This was a retrospective cohort study. PARTICIPANTS Three hundred and eighty one general internists and subspecialists with time-limited board certification were included in the study. MAIN MEASURES Performance rates on eight evidence-based measures were obtained from the American Board of Internal Medicine (ABIM) Osteoporosis Practice Improvement Module® (PIM), a web-based tool that uses medical chart reviews to help physicians assess and improve care. We applied a patented methodology, using an adaptation of the Angoff standard-setting method and the Dunn-Rankin method, with an expert panel skilled in osteoporosis care to form a composite and establish standards for both competent and excellent care. Physician and practice characteristics, including a practice infrastructure score based on the Physician Practice Connections Readiness Survey (PPC-RS), were used to examine the validity of the inferences made from the composite scores. KEY RESULTS The mean composite score was 67.54 out of 100 maximum points with a reliability of 0.92. The standard for competent care was 46.87, and for excellent care it was 83.58. Both standards had high classification accuracies (0.95). Sixteen percent of physicians performed below the competent care standard, while 22 % met the excellent care standard. Specialists scored higher than generalists, and better practice infrastructure was associated with higher composite scores, providing some validity evidence. CONCLUSIONS We developed a rigorous methodology for assessing physicians' osteoporosis care. Clinical performance feedback relative to absolute standards of care provides physicians with a meaningful approach to self-evaluation to improve patient care.
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Affiliation(s)
- Weifeng Weng
- American Board of Internal Medicine, 510 Walnut Street, Suite 1700, Philadelphia, PA, 19106, USA.
| | | | - Lorna A Lynn
- American Board of Internal Medicine, 510 Walnut Street, Suite 1700, Philadelphia, PA, 19106, USA
| | - Rebecca S Lipner
- American Board of Internal Medicine, 510 Walnut Street, Suite 1700, Philadelphia, PA, 19106, USA
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27
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Assessing information needs on bone health in cancer survivors. J Cancer Surviv 2015; 10:480-8. [DOI: 10.1007/s11764-015-0491-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 10/10/2015] [Indexed: 12/13/2022]
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Hou Y, Gu K, Xu C, Ding H, Liu C, Tuoheti Y. Dose-Effectiveness Relationships Determining the Efficacy of Ibandronate for Management of Osteoporosis: A Meta-Analysis. Medicine (Baltimore) 2015; 94:e1007. [PMID: 26131800 PMCID: PMC4504649 DOI: 10.1097/md.0000000000001007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to perform a meta-analysis on the efficacy of ibandronate by evaluating the effect sizes of different dosing regimens.Major electronic databases were searched from 1985 to February 2015. A random effects meta-analysis was performed in STATA.Data from 34 studies (13,639 patients) were included in this meta-analysis. Ibandronate treatment significantly improved lumbar spine bone mineral density (BMD) as shown by the percent change from baseline (4.80%, P < 0.0001, 95% confidence interval [CI] [4.14, 5.45]). The respective effect sizes for oral intake and intravenous (IV) infusion were 4.57% and 5.22% (P < 0.0001, CIs [3.71, 5.42] and [4.37, 6.07]), respectively. All doses led to a significant increase in BMD except 2 oral dose regimens (1 mg/d: 4.65%, P = 0.285, 95% CI [-3.87, 13.18] and 0.5 mg/d: 3.60%, P = 0.38, 95% CI [-4.43, 11.64]. Ibandronate treatment (overall as well as dose wise) also significantly improved the total hip BMD-2.30% overall, 2.13% oral, and 2.63% IV (P < 0.0001, 95% CIs [1.96, 2.64], [1.70, 2.55], and [2.07, 3.20]), respectively. Ibandronate administration significantly decreased serum markers of bone resorption to -46.53% for C-terminal telopeptide of type 1 collagen, -24.03% for bone-specific alkaline phosphatase, and -50.17% for procollagen type I N-terminal propeptide (P < 0.0001, 95% CIs [-53.16, -39.91], [-31.28, -16.77], and [-64.13, -36.20]), respectively. Parathyroid hormone levels remained unaffected by ibandronate treatment (3.03%, P = 0.439, 95% CI [-5.06, 11.66]).There was no significant difference in the efficacy of ibandronate between oral or IV administration. Predominant dose regimens for IV administration were 1 to 3 mg/3 mo and 150 mg/mo oral and 2.5 mg/d for oral ibandronate treatment.
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Affiliation(s)
- Yanjie Hou
- From the Department of Orthopaedics (YH, CX, HD, YT), The Second Affiliated Hospital of Xinjiang Medical University, Urumchi; Department of Pain and Minimally Invasive (KG), The 316th Hospital of People's Liberation Army, Beijing; and Pain Center (CL), The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
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Korpi-Steiner N, Milhorn D, Hammett-Stabler C. Osteoporosis in men. Clin Biochem 2014; 47:950-9. [PMID: 24726494 DOI: 10.1016/j.clinbiochem.2014.03.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 03/24/2014] [Accepted: 03/29/2014] [Indexed: 12/11/2022]
Abstract
Osteoporosis in men causes significant morbidity and mortality. Bone health declines gradually, often insidiously; and in light of the advancing aging population poses a serious public health issue that is not well recognized. Studies of the past decade have expanded our understanding of the events within, as well as the regulation of, bone remodeling and provided better insight into the physiology and pathophysiology specific to the adult male skeleton. The clinical measurement of bone mineral density using dual-energy X-ray absorptiometry remains the gold standard for diagnosis of osteoporosis in males; and fracture risk assessment is now recognized as a preferred approach to guide treatment decisions. Utilizing surrogate end-points such as increasing bone mineral density and decreasing concentrations of bone resorption markers, clinical trials have demonstrated efficacy in pharmacological treatment of osteoporosis in the adult male. Unfortunately, few studies have evaluated the anti-fracture benefits in this population. Measurement of bone turnover markers may be an additional tool to monitor therapeutic responsiveness in addition to the measurement of bone mineral density.
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Affiliation(s)
- Nichole Korpi-Steiner
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Denise Milhorn
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Catherine Hammett-Stabler
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA.
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Morales-Avalos R, Leyva-Villegas J, Sánchez-Mejorada G, Cárdenas-Serna M, Vílchez-Cavazos F, De León ÁMP, Elizondo-Riojas G, Martínez-García J, De La Garza-Castro O, Elizondo-Omaña R, Guzmán-López S. Age- and gender-related variations in morphometric characteristics of thoracic spine pedicle. Clin Anat 2013; 27:441-50. [DOI: 10.1002/ca.22359] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 11/11/2013] [Accepted: 11/15/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Rodolfo Morales-Avalos
- Department of Human Anatomy; Faculty of Medicine, Universidad Autónoma de Nuevo León; Monterrey Nuevo León México
| | - Jorge Leyva-Villegas
- Department of Human Anatomy; Faculty of Medicine, Universidad Autónoma de Nuevo León; Monterrey Nuevo León México
| | - Gabriela Sánchez-Mejorada
- Laboratory of Physical Anthropology, Department of Human Anatomy; Faculty of Medicine, Universidad Nacional Autónoma de México, D.F; México
| | - Marcela Cárdenas-Serna
- Department of Human Anatomy; Faculty of Medicine, Universidad Autónoma de Nuevo León; Monterrey Nuevo León México
| | - Félix Vílchez-Cavazos
- Orthopedics and Traumatology Service; University Hospital “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León; Monterrey Nuevo León México
| | - Ángel Martínez-Ponce De León
- Neurosurgery Service; University Hospital “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León; Monterrey Nuevo León México
| | - Guillermo Elizondo-Riojas
- Department of Radiology; University Hospital “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León; Monterrey Nuevo León México
| | - Jorge Martínez-García
- Department of Radiology; University Hospital “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León; Monterrey Nuevo León México
| | - Oscar De La Garza-Castro
- Department of Human Anatomy; Faculty of Medicine, Universidad Autónoma de Nuevo León; Monterrey Nuevo León México
| | - Rodrigo Elizondo-Omaña
- Department of Human Anatomy; Faculty of Medicine, Universidad Autónoma de Nuevo León; Monterrey Nuevo León México
| | - Santos Guzmán-López
- Department of Human Anatomy; Faculty of Medicine, Universidad Autónoma de Nuevo León; Monterrey Nuevo León México
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May A, Pettifor JM, Norris SA, Ramsay M, Lombard Z. Genetic factors influencing bone mineral content in a black South African population. J Bone Miner Metab 2013; 31:708-16. [PMID: 23475190 PMCID: PMC3825635 DOI: 10.1007/s00774-013-0431-3] [Citation(s) in RCA: 6] [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: 08/07/2012] [Accepted: 01/24/2013] [Indexed: 11/30/2022]
Abstract
Bone mass differs according to ethnic classification, with individuals of African ancestry attaining the highest measurements across numerous skeletal sites. Elevated bone mass is even maintained in those individuals exposed to adverse environmental factors, suggesting a prominent genetic effect that may have clinical or therapeutic value. Using a candidate gene approach, we investigated associations of six candidate genes (ESR1, TNFRSF11A, TNFRSF11B, TNFSF11, SOST and SPP1) with bone mass at the hip and lumbar spine amongst pre-pubertal black South African children (mean age 10.6 years) who formed part of the longitudinal Birth to Twenty cohort. 151 black children were genotyped at 366 polymorphic loci, including 112 previously associated and 254 tagging single nucleotide polymorphisms (SNPs). Linear regression was used to highlight significant associations whilst adjusting for height, weight, sex and bone area. Twenty-seven markers (8 previously associated and 19 tag SNPs; P < 0.05) were found to be associated with either femoral neck (18) or lumbar spine (9) bone mineral content. These signals were derived from three genes, namely ESR1 (17), TNFRSF11B (9) and SPP1 (1). One marker (rs2485209) maintained its association with the femoral neck after correction for multiple testing (P = 0.038). When compared to results amongst Caucasian adults, we detected differences with respect to associated skeletal sites. Allele frequencies and linkage disequilibrium patterns were also significantly different between populations. Hence, our results support the existence of a strong genetic effect acting at the femoral neck in black South African children, whilst simultaneously highlighting possible causes that account for inter-ethnic bone mass diversity.
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Affiliation(s)
- Andrew May
- />Division of Human Genetics, School of Pathology, Faculty of Health Sciences, National Health Laboratory Service, University of the Witwatersrand, Watkins-Pitchford Building, Room 109, Cnr Hospital and De Korte Street, Braamfontein, 2000 Johannesburg South Africa
| | - John M. Pettifor
- />MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2000 South Africa
| | - Shane A. Norris
- />MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2000 South Africa
| | - Michèle Ramsay
- />Division of Human Genetics, School of Pathology, Faculty of Health Sciences, National Health Laboratory Service, University of the Witwatersrand, Watkins-Pitchford Building, Room 109, Cnr Hospital and De Korte Street, Braamfontein, 2000 Johannesburg South Africa
| | - Zané Lombard
- />Division of Human Genetics, School of Pathology, Faculty of Health Sciences, National Health Laboratory Service, University of the Witwatersrand, Watkins-Pitchford Building, Room 109, Cnr Hospital and De Korte Street, Braamfontein, 2000 Johannesburg South Africa
- />Wits Bioinformatics, University of the Witwatersrand, Private Bag 3, Wits, 2050 Johannesburg South Africa
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Wang HL, Booth-LaForce C, Tang SM, Wu WR, Chen CH. Depressive symptoms in Taiwanese women during the peri- and post-menopause years: associations with demographic, health, and psychosocial characteristics. Maturitas 2013; 75:355-60. [PMID: 23726260 DOI: 10.1016/j.maturitas.2013.04.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 03/27/2013] [Accepted: 04/28/2013] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the prevalence of depressive symptoms in peri- and post-menopausal Taiwanese women, and to investigate the relation between depressive symptoms and demographic variables, chronic disease status, health habits, stress management, menopausal symptoms, and attitudes toward menopause and aging. STUDY DESIGN Cross-sectional study, using a purposive sample of 566 women between 45 and 60 years of age from a medical center and residential community in Southern Taiwan. MAIN OUTCOME MEASURES Demographic and health habits questionnaire, Women's Health Initiative Symptom Scale, Attitudes Toward Menopause and Aging Scale, and Center for Epidemiological Studies-Depression Scale (CES-D). RESULTS The prevalence of depressive symptoms (CES-D score≥16) was 38.7% in peri- and post-menopausal Taiwanese women. Bivariate correlations and analyses of variance indicated that higher CES-D scores were related to lower family income, younger age, smoking for a greater number of years, consuming more alcohol, having multiple chronic diseases, not exercising regularly, consulting with a specialist for stress management, having more severe menopausal symptoms, and more negative attitudes toward menopause and aging. A stepwise multiple regression analysis indicated that the key predictors, accounting for 33.7% of the variance, were menopausal symptoms, attitudes toward menopause and aging, family income, and chronic disease status. CONCLUSIONS Results highlight the importance of considering psychosocial factors, life style, and chronic disease management in providing health guidance for peri- and post-menopausal women to enhance their quality of life and reduce the risk of depressive symptoms.
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Affiliation(s)
- Hui-Ling Wang
- Institute of Allied Health Science, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Characterisation of Trabecular Bone Structure. STUDIES IN MECHANOBIOLOGY, TISSUE ENGINEERING AND BIOMATERIALS 2013. [DOI: 10.1007/8415_2011_113] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Minematsu A, Hazaki K, Harano A, Iki M, Fujita Y, Okamoto N, Kurumatani N. A screening model for low bone mass in elderly Japanese men using quantitative ultrasound measurements: Fujiwara-Kyo Study. J Clin Densitom 2012; 15:343-50. [PMID: 22677197 DOI: 10.1016/j.jocd.2012.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 02/06/2012] [Accepted: 02/07/2012] [Indexed: 11/24/2022]
Abstract
Screening for low bone mass is important to prevent fragility fractures in men as well as women, although men show a much lower prevalence of osteoporosis than women. The purpose of this study was to establish a screening model for low bone mineral density (BMD) using a quantitative ultrasound parameter and easily obtained objective indices for elderly Japanese men. We examined 1633 men (65-84 yr old) who were subjects of the Fujiwara-Kyo Study. Speed of sound (SOS) at the calcaneus was determined, and BMD was measured by dual-energy X-ray absorptiometry at the lumbar spine (LS), total hip (TH), and femoral neck (FN). Low BMD was defined as >1 standard deviation below the young adult mean, in accordance with World Health Organization criteria. We performed receiver operating characteristic (ROC) analysis to identify a better screening model incorporating SOS and determined the optimal cutoff value using Youden index. Prevalences of low BMD at the 3 skeletal sites were 27.8% (LS), 33.5% (TH), 48.6% (FN), and 43.3% at either LS or TH. The greatest area under the ROC curve (0.806, 95% confidence interval: 0.785-0.828) and smallest Akaike's information criterion were obtained in the multivariate model incorporating SOS, age, height, and weight for predicting low BMD at all skeletal sites. This model predicted low BMD at TH with the sensitivity of 0.726 and specificity of 0.739, whereas a similar model predicted low BMD at LS with much lower validity. We conclude that the multivariate model for TH could be used to screen for low BMD in elderly Japanese men.
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Affiliation(s)
- Akira Minematsu
- Department of Physical Therapy, Faculty of Health and Science, Kio University, Nara, Japan.
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Cortet B, Biver E, Borg S, Chopin F, Hoppé E, Laroche M, Morel G, Razjbaum G, Roux C, Thomas T, Legrand E. Management of male osteoporosis: lessons for clinical practice. Joint Bone Spine 2012; 78 Suppl 2:S208-10. [PMID: 22153672 DOI: 10.1016/s1297-319x(11)70006-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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38
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Hoppé E, Morel G, Biver E, Borg S, Chopin F, Legrand E. Male osteoporosis: do sex steroids really benefit bone health in men? Joint Bone Spine 2012; 78 Suppl 2:S191-6. [PMID: 22153669 DOI: 10.1016/s1297-319x(11)70003-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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39
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Osteoporosis prescribing trends in primary care: a population-based retrospective cohort study. Prim Health Care Res Dev 2012; 14:1-6. [DOI: 10.1017/s1463423612000114] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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40
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Borg S, Chopin F, Hoppé E, Morel G, Biver E, Laroche M. Why and how should we investigate men for osteoporosis? Joint Bone Spine 2011; 78 Suppl 2:S197-201. [DOI: 10.1016/s1297-319x(11)70004-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Biver E, Borg S, Chopin F, Hoppé E, Morel G, Cortet B. Male osteoporosis: Who should be treated and how? Joint Bone Spine 2011; 78 Suppl 2:S202-7. [DOI: 10.1016/s1297-319x(11)70005-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Solimeo SL. Living with a `women's disease': risk appraisal and management among men with osteoporosis. JOURNAL OF MEN'S HEALTH 2011; 8:185-191. [PMID: 22125585 PMCID: PMC3223980 DOI: 10.1016/j.jomh.2011.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND: There is clear evidence that men suffer from osteoporosis (OP) in increasing numbers, but that men commonly remain underdiagnosed, undertreated and experience poorer outcomes than do women. The widespread sociocultural association of OP with postmenopausal women reflects their greater risk for developing the disorder, but the sexing of OP as a women's disease disadvantages at-risk men. METHODS: This paper reports on qualitative data gathered from 23 community-residing men who have an OP diagnosis. RESULTS: Interviews with men reveal that the sexing of OP as a female disease may affect men's risk appraisal. Men clearly associate OP risk factors with women and accordingly may feel protected from the disorder. Subsequent to diagnosis, men's OP-related risk management strategies reveal that men's gender identity constrains their ability to enact risk-reducing behavior. CONCLUSIONS: Men may internalize the association of OP with women and incorporate it into a sense of perceived invulnerability to the condition, which, in turn, contributes to delayed diagnosis and treatment. Limited male-specific treatment and support options as well as social expectations of male gender performance play roles in men's health behavior.
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Dy CJ, LaMont LE, Ton QV, Lane JM. Sex and gender considerations in male patients with osteoporosis. Clin Orthop Relat Res 2011; 469:1906-12. [PMID: 21400003 PMCID: PMC3111783 DOI: 10.1007/s11999-011-1849-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Osteoporosis remains underrecognized and undertreated in both men and women, but men who sustain fragility fractures experience greater morbidity and mortality. While men exhibit advanced comorbidity at the time of hip fracture presentation, there are distinct sex- and gender-specific factors related to the pathophysiology and treatment of osteoporosis that further influence morbidity and mortality. QUESTIONS/PURPOSES With a selective review of the literature, we evaluated sex- and gender-based differences contributing to increased morbidity and mortality in men with osteoporosis. WHERE ARE WE NOW?: Sex-specific differences in bone biology and morphology may affect the pathophysiology of osteoporosis, choice of pharmacotherapy, and surgical implant selection. Additionally, estrogen metabolism may play a key role in both fracture prevention and healing. Gender-based differences in recommendations for screening and prevention between men and women may influence the severity at which osteoporosis is recognized. Primary, secondary, and tertiary prevention efforts in men lag behind those of women. This may be due to a lack of consensus regarding screening guidelines for osteoporosis in men but may be attributed to lack of awareness in the physician and patient about osteoporosis and its potentially debilitating consequences. WHERE DO WE NEED TO GO?: These disparities are a call to action for healthcare providers to raise awareness for early prevention and treatment of this potentially debilitating disease, particularly in men. HOW DO WE GET THERE?: Continued prospective research on the differences between men and women diagnosed with osteoporosis is needed, as well as sex-specific stratification of data in all studies on osteoporosis.
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Affiliation(s)
- Christopher J. Dy
- Department of Orthopaedic Surgery, Hospital for Special Surgery and Weill Cornell Medical College, 535 E 70th Street, New York, NY 10021 USA
| | - Lauren E. LaMont
- Department of Orthopaedic Surgery, Hospital for Special Surgery and Weill Cornell Medical College, 535 E 70th Street, New York, NY 10021 USA
| | - Quang V. Ton
- Department of Orthopaedic Surgery, Hospital for Special Surgery and Weill Cornell Medical College, 535 E 70th Street, New York, NY 10021 USA
| | - Joseph M. Lane
- Department of Orthopaedic Surgery, Hospital for Special Surgery and Weill Cornell Medical College, 535 E 70th Street, New York, NY 10021 USA
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Romagnoli E, Del Fiacco R, Russo S, Piemonte S, Fidanza F, Colapietro F, Diacinti D, Cipriani C, Minisola S. Secondary osteoporosis in men and women: clinical challenge of an unresolved issue. J Rheumatol 2011; 38:1671-9. [PMID: 21632675 DOI: 10.3899/jrheum.110030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To evaluate the clinical and etiological factors of osteoporosis. We also tested the FRAX algorithm to compare the assessment of fracture risk in patients with primary or secondary osteoporosis. METHODS A prospective study carried out in a large sample of 123 men and 246 women. All subjects had a biochemical, densitometric, and radiological examination of thoracic and lumbar spine. RESULTS The prevalence of primary (men 52.9% vs women 50%; p = nonsignificant) and secondary (men 21.1% vs women 17.5%; p = nonsignificant) osteoporosis did not differ between the sexes. In contrast, the prevalence of primary osteoporosis was significantly higher than secondary causes (p < 0.0001) in both men and women. While women came to our attention for prevention of osteoporosis, men sought help because of clinical symptoms or disease-related complications, such as fractures. As evaluated by the FRAX tool, patients with osteopenia do not need treatment, in agreement with Italian guidelines. The estimated risk of major osteoporotic and hip fractures was significantly higher in women with secondary osteoporosis compared to men and also compared to women with primary osteoporosis. CONCLUSION The prevalence of secondary osteoporosis in men is similar to that in women and it is less frequent than commonly reported. In patients with secondary osteoporosis, FRAX calculation may provide an estimate of a particularly high fracture risk in patients whose bone fragility is usually attributed to another disease.
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Affiliation(s)
- Elisabetta Romagnoli
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy.
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Rossi F, Bellini G, Luongo L, Torella M, Mancusi S, De Petrocellis L, Petrosino S, Siniscalco D, Orlando P, Scafuro M, Colacurci N, Perrotta S, Nobili B, Di Marzo V, Maione S. The endovanilloid/endocannabinoid system: a new potential target for osteoporosis therapy. Bone 2011; 48:997-1007. [PMID: 21237298 DOI: 10.1016/j.bone.2011.01.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 12/20/2010] [Accepted: 01/02/2011] [Indexed: 10/18/2022]
Abstract
Human osteoclasts express functional TRPV1 channels, CB1/CB2 cannabinoid receptors and endocannabinoid/endovanilloid synthetic/catabolic enzymes. Pharmacologic manipulation of this system can modulate osteoclast activity. Here, through multidisciplinary approaches, we demonstrate that enzymes and receptors of the endocannabinoid/endovanilloid system are differently expressed in osteoclasts from menopausal women without or with osteoporosis. We report that in osteoclasts from osteoporotic patients, TRPV1 channels are upregulated and, if persistently stimulated with resiniferatoxin, become clustered to the plasma membrane while inducing a massive over-expression of CB2 receptors. By providing new evidence for a critical functional cross-talk between CB2 and TRPV1 receptors in osteoporosis, we speculate that TRPV1 desensitization, or its enhanced trafficking, together with TRPV1 agonist-induced CB2 receptor overexpression, might be critical to minimize calcium entry in osteoclasts, which could be in turn responsible of cell over-activation and higher bone resorption. Our data pave the way to the use of TRPV1 agonist together with CB2 agonists or CB1 antagonists in osteoporosis.
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MESH Headings
- Acid Phosphatase/metabolism
- Amidohydrolases/antagonists & inhibitors
- Amidohydrolases/genetics
- Amidohydrolases/metabolism
- Bone and Bones/metabolism
- Calcium/metabolism
- Cannabinoid Receptor Modulators/metabolism
- Cell Count
- Cells, Cultured
- Endocannabinoids
- Female
- Gene Expression Regulation
- Gene Silencing
- Humans
- Immunohistochemistry
- Intracellular Space/metabolism
- Isoenzymes/metabolism
- Ligands
- Lipase/genetics
- Lipase/metabolism
- NF-kappa B/metabolism
- Osteoclasts/enzymology
- Osteoclasts/pathology
- Osteoporosis/pathology
- Osteoporosis/therapy
- Phospholipase D/genetics
- Phospholipase D/metabolism
- Polymorphism, Single Nucleotide/genetics
- Postmenopause/metabolism
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- Receptor, Cannabinoid, CB1/antagonists & inhibitors
- Receptor, Cannabinoid, CB1/genetics
- Receptor, Cannabinoid, CB1/metabolism
- Receptor, Cannabinoid, CB2/antagonists & inhibitors
- Receptor, Cannabinoid, CB2/genetics
- Receptor, Cannabinoid, CB2/metabolism
- TRPV Cation Channels/genetics
- TRPV Cation Channels/metabolism
- Tartrate-Resistant Acid Phosphatase
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Affiliation(s)
- Francesca Rossi
- Department of Pediatrics, Second University of Naples, Naples, Italy.
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Abstract
As people with cancer survive longer, and as the US population ages, skeletal effects of cancer treatment are becoming more pronounced. This is particularly true for breast and prostate cancer survivors because of the high average age of patients with these malignancies, the propensity of older adults in general toward the development of osteoporosis, and the wide use of therapeutic agents in these cancers that negatively impact bone health. Various therapies used in the treatment and prevention of cancer may cause decreases in bone mineral density and an increased risk of debilitating fracture, even in the absence of bone metastases. Aging is both a baseline risk factor in the development of osteoporosis and bony fracture, as well as a predictor of poor outcome after fracture. A variety of mechanisms may be responsible for the development of bone loss in patients with breast or prostate cancer. Cytotoxic chemotherapy may directly exert long-term toxic effects on bone. Chemotherapy and endocrine therapy can induce hypogonadism, leading to an increased rate of bone loss. The risk of skeletal events in older adults due to cancer therapy should be appreciated by all oncologists, geriatricians, and internists. The following review may serve as a guide to the skeletal side effects of cancer therapy in older adults with breast or prostate cancer, how to screen for treatment-related bone loss, and how to best prevent and/or treat skeletal events.
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Affiliation(s)
- Ari VanderWalde
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA.
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Abstract
Osteoporosis is classified as a public health problem by healthcare authorities because it is associated with an increased risk of potentially serious fractures. Osteoporotic fractures are known to generate a heavy burden of morbidity and financial cost [1]. However, recent data indicate that some osteoporotic fractures are also associated with excess mortality. These data have led to public health measures such as the addition by the World Health Organization of fracture prevention to the list of public health priorities [2] and the update on hip fractures issued recently by the statistics department of the French ministry of health (DREES [3]). Hip fractures constitute the most severe complication of osteoporosis because they can induce permanent physical disability, loss of self-sufficiency, institutionalization and, above all, an increased risk of death. Interestingly, two recent publications support the hypothesis that optimal osteoporosis management may affect the risk of death. Here, we will review the main data linking osteoporotic fractures overall (as opposed to hip fractures only) and mortality.
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Effect of parathyroid hormone on hypogonadism induced bone loss of proximal femur of orchiectomized rat. World J Urol 2011; 29:529-34. [PMID: 21298272 PMCID: PMC3143324 DOI: 10.1007/s00345-011-0652-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Accepted: 01/18/2011] [Indexed: 11/20/2022] Open
Abstract
Purpose Management of hypogonadism-induced osteoporosis in elderly men is still a challenge. We investigated the short-term effects of parathyroid hormone (PTH) treatments on strength, micro-architecture, and mineral density of trochanteric region of orchiectomized rat femur. Methods Eight-month-old male Sprague–Dawley rats (n = 44) were divided into two groups: (1) orchiectomized (ORX) and (2) sham group. Twelve weeks after orchiectomy, half of the orchiectomized animals were treated with daily subcutaneously injected PTH (0.040 mg/kg/BW) (ORX-PTH) for 5 weeks. The other half remained untreated (ORX). The sham-operated group was divided and treated in the same way (sham, sham-PTH). After 5 weeks, both femurs were excised for biomechanical and histomorphometric analysis, trabecular measurements, mineral content assessment, and immunofluorescence analysis. Results The femoral trochanteric strength after PTH treatment was enhanced in the breaking test (ORX-Fmax = 158.7 N vs. ORX + PTH-Fmax = 202 N). Stiffness of treated ORX animals reached nearly the levels observed in untreated sham rats. PTH therapy improved the trabecular connectivity, width, and area (ORX-Tb.Ar = 47.79% vs. ORX + PTH-Tb.Ar = 68.47%, P < 0.05) in the proximal femur. The treated rats showed significantly improved mineral content in ashed femurs (ORX-mineral content = 43.73% vs. ORX + PTH-mineral content = 49.49%) when compared to the untreated animals. A comparison of widths of fluorescence bands in cortical bone of the subtrochanteric cross-sections showed a significant increase in oppositions after the PTH therapy. Conclusions Our finding supports the hypothesis that PTH therapy seems to be a rational therapy in patients with hypogonadism induced bone loss and improves the bone strength of trochanteric region of rat femur.
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