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Pivonka P, Calvo-Gallego JL, Schmidt S, Martínez-Reina J. Advances in mechanobiological pharmacokinetic-pharmacodynamic models of osteoporosis treatment - Pathways to optimise and exploit existing therapies. Bone 2024; 186:117140. [PMID: 38838799 DOI: 10.1016/j.bone.2024.117140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/17/2024] [Accepted: 05/29/2024] [Indexed: 06/07/2024]
Abstract
Osteoporosis (OP) is a chronic progressive bone disease which is characterized by reduction of bone matrix volume and changes in the bone matrix properties which can ultimately lead to bone fracture. The two major forms of OP are related to aging and/or menopause. With the worldwide increase of the elderly population, particularly age-related OP poses a serious health issue which puts large pressure on health care systems. A major challenge for development of new drug treatments for OP and comparison of drug efficacy with existing treatments is due to current regulatory requirements which demand testing of drugs based on bone mineral density (BMD) in phase 2 trials and fracture risk in phase 3 trials. This requires large clinical trials to be conducted and to be run for long time periods, which is very costly. This, together with the fact that there are already many drugs available for treatment of OP, makes the development of new drugs inhibitive. Furthermore, an increased trend of the use of different sequential drug therapies has been observed in OP management, such as sequential anabolic-anticatabolic drug treatment or switching from one anticatabolic drug to another. Running clinical trials for concurrent and sequential therapies is neither feasible nor practical due to large number of combinatorial possibilities. In silico mechanobiological pharmacokinetic-pharmacodynamic (PK-PD) models of OP treatments allow predictions beyond BMD, i.e. bone microdamage and degree of mineralisation can also be monitored. This will help to inform clinical drug usage and development by identifying the most promising scenarios to be tested clinically (confirmatory trials rather than exploratory only trials), optimise trial design and identify subgroups of the population that show benefit-risk profiles (both good and bad) that are different from the average patient. In this review, we provide examples of the predictive capabilities of mechanobiological PK-PD models. These include simulation results of PMO treatment with denosumab, implications of denosumab drug holidays and coupling of bone remodelling models with calcium and phosphate systems models that allows to investigate the effects of co-morbidities such as hyperparathyroidism and chronic kidney disease together with calcium and vitamin D status on drug efficacy.
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Affiliation(s)
- Peter Pivonka
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, QLD 4000, Australia.
| | - José Luis Calvo-Gallego
- Departmento de Ingeniería Mecánica y Fabricación, Universidad de Sevilla, Seville 41092, Spain
| | - Stephan Schmidt
- Center for Pharmacometrics and Systems Pharmacology, Department of Pharmaceutics, College of Pharmacy, University of Florida, Orlando, FL 32827, USA
| | - Javier Martínez-Reina
- Departmento de Ingeniería Mecánica y Fabricación, Universidad de Sevilla, Seville 41092, Spain
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Rizi MM, Salari A, Salesi M, Rasooli L, Karimifar M. Comparison of bone mineral density of osteoporotic and osteopenia menopausal women treated with oral bisphosphonates before stopping the treatment and 1 year after drug holiday period. Clin Rheumatol 2024; 43:1375-1379. [PMID: 38347325 DOI: 10.1007/s10067-024-06906-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Osteoporosis is a skeletal and bone disorder characterized by bone fractures and decreased bone mineral density (BMD). Bisphosphonates have a great tendency to bind to minerals, and their long-term use can increase the risk of bone fragility in patients. Stopping bisphosphonates after a period of time is called a drug holiday (DH). Recent evidence has shown that patients' BMD may decrease again during DH. However, few studies have been done in this regard. In the present study, we compared the BMD of postmenopausal women during bisphosphonates treatment and 1 year after DH. MATERIAL AND METHODS A total of 202 patients were selected with osteopenia (n = 95) and osteoporosis (n = 107); they had been treated with alendronate for 5 years (a rheumatologist confirmed the diagnosis of osteopenia and osteoporosis) and had undergone DH for 1 year. At the arrival of all patients, BMD was checked with the DXA (dual-energy X-ray absorptiometry) method using the 2007 American Explorer model Hologic device based on the Caucasian race. One year later, patients were reassessed for BMD by the same device. RESULT The analysis of femoral neck (FN) and lumbar spine (LS) T-score indices in the osteopenia and the osteoporosis groups showed reduction after DH, and the difference was statistically significant in both groups (p = 0.001). After 1 year of stopping bisphosphonate treatment, the average of FN and LS BMD decreased in both groups (p = 0.001). CONCLUSION In general, it can be said that DH can reduce FN and LS T-scores. The results indicated a significant reduction in BMD after the DH period for both the osteoporosis and osteopenia groups in the early months. Also, the effect of DH in osteoporosis patients was more compared to the osteopenia individuals, which could have implications for their treatment approach, and also its effect on bone health. Key Points • The DH can reduce FN and LS T-scores • The BMD reduced after the DH period for both the osteoporosis and osteopenia groups • After 1 year of stopping bisphosphonate treatment, the average of FN and LS BMD decreased in both groups.
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Affiliation(s)
- Marzieh Moradi Rizi
- Department of Rheumatology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amirhossein Salari
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mansour Salesi
- Department of Rheumatology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Laa'ya Rasooli
- Department of Rheumatology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mansoor Karimifar
- Department of Rheumatology, Isfahan University of Medical Sciences, Isfahan, Iran.
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Karimi SM, Bayat M, Rahimi R. Plant-derived natural medicines for the management of osteoporosis: A comprehensive review of clinical trials. J Tradit Complement Med 2024; 14:1-18. [PMID: 38223808 PMCID: PMC10785263 DOI: 10.1016/j.jtcme.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 01/16/2024] Open
Abstract
Background Osteoporosis is a chronic and systemic skeletal disease that is defined by low bone mineral density (BMD) along with an increase in bone fragility and susceptibility to fracture. This study aimed to overview clinical evidence on the use of herbal medicine for management of osteoporosis. Methods Electronic databases including Pubmed, Medline, Cochrane library, and Scopus were searched until November 2022 for any clinical studies on the efficacy and/or safety of plant-derived medicines in the management of osteoporosis. Results The search yielded 57 results: 19 on single herbs, 16 on multi-component herbal preparations, and 22 on plant-derived secondary metabolites. Risk of fracture, bone alkaline phosphatase, BMD, and specific bone biomarkers are investigated outcomes in these studies. Medicinal plants including Acanthopanax senticosus, Actaea racemosa, Allium cepa, Asparagus racemosus, Camellia sinensis, Cissus quadrangularis, Cornus mas, Nigella sativa, Olea europaea, Opuntia ficus-indica, Pinus pinaster, Trifolium pretense and phytochemicals including isoflavones, ginsenoside, Epimedium prenyl flavonoids, tocotrienols are among plant-derived medicines clinically investigated on osteoporosis. It seems that multi-component herbal preparations were more effective than single-component ones; because of the synergistic effects of their constituents. The investigated herbal medicines demonstrated their promising results in osteoporosis via targeting different pathways in bone metabolism, including balancing osteoblasts and osteoclasts, anti-inflammatory, immunomodulatory, antioxidant, and estrogen-like functions. Conclusion It seems that plant-derived medicines have beneficial effects on bone and may manage osteoporosis by affecting different targets and pathways involved in osteoporosis; However, Future studies are needed to confirm the effectiveness and safety of these preparations.
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Affiliation(s)
- Seyedeh Mahnaz Karimi
- Department of Traditional Pharmacy, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Bayat
- Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Roja Rahimi
- Department of Traditional Pharmacy, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Gronskaya S, Belaya Z, Rozhinskaya L, Mamedova E, Vorontsova M, Solodovnikov A, Golounina O, Melnichenko G. Denosumab for osteoporosis in patients with primary hyperparathyroidism and mild-to-moderate renal insufficiency. Endocrine 2023:10.1007/s12020-023-03381-z. [PMID: 37133642 DOI: 10.1007/s12020-023-03381-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 04/18/2023] [Indexed: 05/04/2023]
Abstract
PURPOSE We aimed to assess the efficacy and safety of denosumab in postmenopausal women with primary hyperparathyroidism (PHPT)-related osteoporosis and chronic kidney disease (CKD). METHODS Women over 50 years of age with PHPT or postmenopausal osteoporosis (PMO) were retrospectively recruited into this longitudinal study. These PHPT and PMO groups were further categorized into subgroups based on the presence of CKD (Glomerular filtration rate (GFR) < 60 mL/min/1.73 m2). All patients were given denosumab over 24 months due to verified osteoporosis. The primary outcomes were changes in bone mineral density (BMD) and serum calcium levels. RESULTS 145 postmenopausal women median age 69 [63;77] were recruited and assigned to one of the subgroups: PHPT patients with CKD (n = 22), PHPT patients without CKD (n = 38), PMO patients with CKD (n = 17) and PMO patients without CKD (n = 68). Denosumab treatment significantly increased BMD in patients with PHPT-related osteoporosis and CKD: median T-score L1-L4 from -2.0 to -1.35 (p < 0.001), femur neck from -2.4 to -2.1 (p = 0.012), radius 33% from -3.2 to -3 (p < 0.05)) at 24 months. Changes in BMD were similar in all four studied groups compared to baseline. A marked decline in calcium was noted in the primary study group of PHPT with CKD (median ΔCa = -0.24 mmol/L p < 0.001), compared to PHPT without CKD (median ΔCa = -0.08 mmol/L p < 0.001) and PMO with or without CKD. Denosumab treatment was well-tolerated with no serious adverse events. CONCLUSION Denosumab treatment was similarly effective at increasing BMD in patients with PHPT and PMO with and without renal insufficiency. The calcium lowering effects of denosumab were most significant in patients with PHPT and CKD. The safety of denosumab did not differ among participants with and without CKD.
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Affiliation(s)
- Sofia Gronskaya
- Endocrinology Research Centre, Department of Neuroendocrinology and Bone Disease, Moscow, Russia
| | - Zhanna Belaya
- Endocrinology Research Centre, Department of Neuroendocrinology and Bone Disease, Moscow, Russia.
| | - Liudmila Rozhinskaya
- Endocrinology Research Centre, Department of Neuroendocrinology and Bone Disease, Moscow, Russia
| | - Elizaveta Mamedova
- Endocrinology Research Centre, Department of Neuroendocrinology and Bone Disease, Moscow, Russia
| | - Maria Vorontsova
- Endocrinology Research Centre, Department of Neuroendocrinology and Bone Disease, Moscow, Russia
- Lomonosov Moscow State University, Laboratory for Molecular Endocrinology, Moscow, Russia
| | | | - Olga Golounina
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - Galina Melnichenko
- Endocrinology Research Centre, Department of Neuroendocrinology and Bone Disease, Moscow, Russia
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Belaya Z, Rozhinskaya L, Dedov I, Drapkina O, Fadeev V, Golounina O, Lesnyak O, Mamedova E, Melnichenko G, Petraikin A, Rodionova S, Skripnikova I, Tkacheva O, Toroptsova N, Yureneva S, Kanis JA. A summary of the Russian clinical guidelines on the diagnosis and treatment of osteoporosis. Osteoporos Int 2023; 34:429-447. [PMID: 36651943 DOI: 10.1007/s00198-022-06667-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/29/2022] [Indexed: 01/19/2023]
Abstract
UNLABELLED Key statements of the Russian clinical guidelines on the diagnosis and treatment of osteoporosis are summarized. They were developed by a task force representing the key Russian professional associations involved in the management of osteoporosis and approved by the Russian Ministry of Health. PURPOSE To summarize key statements of the Russian clinical practice guidelines for the diagnosis and treatment of osteoporosis. METHODS The Russian clinical guidelines on the diagnosis and treatment of osteoporosis were developed by a task force representing the key Russian professional associations involved in the management of osteoporosis: These comprised the Russian Association of Endocrinologists, the Russian Association for Osteoporosis, the Association of Rheumatologists of Russia, the Association of Orthopedic surgeons and Traumatologists of Russia, the Russian Association of Gynecologists-Endocrinologists, and the Russian Association of Gerontologists and Geriatrics. The guidelines are based on a systematic literature review and principles of evidence-based medicine and were compiled in accordance with the requirements for clinical recommendations developed by the Ministry of Health of the Russian Federation. RESULTS Key statements included in the Russian guidelines of osteoporosis approved by the Russian Ministry of Health in 2021 are summarized. The statements are graded based on levels of evidence and supported by short comments. The guidelines are focused on the current approach to screening, diagnosis, differential diagnosis, and treatment of osteoporosis. CONCLUSION These guidelines are a practical tool for general practitioners, as well as medical specialists, primarily endocrinologists, rheumatologists, orthopedic surgeons, and other physicians who are involved in the management of patients with osteoporosis.
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Affiliation(s)
- Zhanna Belaya
- Neuroendocrinology and Bone Diseases, Endocrinology Research Centre, Moscow, Russia.
| | - Liudmila Rozhinskaya
- Neuroendocrinology and Bone Diseases, Endocrinology Research Centre, Moscow, Russia
| | - Ivan Dedov
- Neuroendocrinology and Bone Diseases, Endocrinology Research Centre, Moscow, Russia
| | - Oksana Drapkina
- National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia
| | - Valentin Fadeev
- Department of Endocrinology, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Olga Golounina
- Department of Endocrinology, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Olga Lesnyak
- Family Medicine Department-Western State Medical University Named After I.I. Mechnikov, St. Petersburg, Russia
| | - Elizaveta Mamedova
- Neuroendocrinology and Bone Diseases, Endocrinology Research Centre, Moscow, Russia
| | - Galina Melnichenko
- Neuroendocrinology and Bone Diseases, Endocrinology Research Centre, Moscow, Russia
| | - Alexey Petraikin
- Department of Radiation Diagnostics, Research and Practical Clinical Center for Diagnostics, Telemedicine Technologies of Moscow Health Care Department, Moscow, Russia
| | - Svetlana Rodionova
- National Medical Research Center of Traumatology and Orthopedics named after. N.N. Priorov, Moscow, Russia
| | - Irina Skripnikova
- National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia
| | - Olga Tkacheva
- Russian National Research Medical University Named After N.I. Pirogov, Moscow, Russia
| | | | - Svetlana Yureneva
- Department of Gynecological Endocrinology, National Medical Research Center for Obstetrics, Gynecology and Perinatology Named After V.I. Kulakov, Moscow, Russia
| | - John A Kanis
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Center for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
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Significance of medication discontinuation on bisphosphonate-related jaw osteonecrosis in a rat model. Sci Rep 2022; 12:21449. [PMID: 36509781 PMCID: PMC9744902 DOI: 10.1038/s41598-022-25347-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022] Open
Abstract
Bisphosphonate (BP) discontinuation has been advised as a measure to prevent the incidence of bisphosphonate-related osteonecrosis of the jaw (BRONJ), however, its efficacy remains controversial. This study aimed to analyze the efficacy of BP discontinuation in reducing BRONJ severity following tooth extraction in a rat model. Thirty-four male Sprague-Dawley rats were divided into two BRONJ model categories: oral administration (PO) of alendronate (1 mg/kg) for 3 and 8 weeks and intraperitoneal (IP) injection of pamidronate (3 mg/kg) and dexamethasone (1 mg/kg) for 20 days. The PO model was divided into five groups (a control group without BPs and four experimental groups with 1-week discontinuation). The IP model was divided into two groups consisting of group I (without discontinuation) and group II (1-week discontinuation). One molar from both sides of the mandible was extracted. After extraction, the PO models were sacrificed at 3 and 5 weeks, and the IP models were sacrificed either immediately or at 2, 4, 6, and 8 weeks. Micro-CT showed non-significant differences among PO groups but significant differences were observed between IP groups. Most bone remodeling parameters within group I of the IP model differed significantly (p-value < 0.05). Histologically, group I showed a significantly higher percentage of necrotic bone than group II (51.93 ± 12.75%, p < 0.05) and a higher number of detached osteoclasts in TRAP staining. With discontinuation of medication for at least 1 week in rats, the effects of BPs on alveolar bone are suppressed and bone turnover and osteoclast functions are restored.
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Liang B, Burley G, Lin S, Shi YC. Osteoporosis pathogenesis and treatment: existing and emerging avenues. Cell Mol Biol Lett 2022; 27:72. [PMID: 36058940 PMCID: PMC9441049 DOI: 10.1186/s11658-022-00371-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022] Open
Abstract
AbstractOsteoporotic fractures lead to increased disability and mortality in the elderly population. With the rapid increase in the aging population around the globe, more effective treatments for osteoporosis and osteoporotic fractures are urgently required. The underlying molecular mechanisms of osteoporosis are believed to be due to the increased activity of osteoclasts, decreased activity of osteoblasts, or both, which leads to an imbalance in the bone remodeling process with accelerated bone resorption and attenuated bone formation. Currently, the available clinical treatments for osteoporosis have mostly focused on factors influencing bone remodeling; however, they have their own limitations and side effects. Recently, cytokine immunotherapy, gene therapy, and stem cell therapy have become new approaches for the treatment of various diseases. This article reviews the latest research on bone remodeling mechanisms, as well as how this underpins current and potential novel treatments for osteoporosis.
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Okawa H, Kondo T, Hokugo A, Cherian P, Campagna JJ, Lentini NA, Sung EC, Chiang S, Lin YL, Ebetino FH, John V, Sun S, McKenna CE, Nishimura I. Mechanism of bisphosphonate-related osteonecrosis of the jaw (BRONJ) revealed by targeted removal of legacy bisphosphonate from jawbone using competing inert hydroxymethylene diphosphonate. eLife 2022; 11:e76207. [PMID: 36017995 PMCID: PMC9489207 DOI: 10.7554/elife.76207] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
Bisphosphonate-related osteonecrosis of the jaw (BRONJ) presents as a morbid jawbone lesion in patients exposed to a nitrogen-containing bisphosphonate (N-BP). Although it is rare, BRONJ has caused apprehension among patients and healthcare providers and decreased acceptance of this antiresorptive drug class to treat osteoporosis and metastatic osteolysis. We report here a novel method to elucidate the pathological mechanism of BRONJ by the selective removal of legacy N-BP from the jawbone using an intra-oral application of hydroxymethylene diphosphonate (HMDP) formulated in liposome-based deformable nanoscale vesicles (DNV). After maxillary tooth extraction, zoledronate-treated mice developed delayed gingival wound closure, delayed tooth extraction socket healing and increased jawbone osteonecrosis consistent with human BRONJ lesions. Single cell RNA sequencing of mouse gingival cells revealed oral barrier immune dysregulation and unresolved proinflammatory reaction. HMDP-DNV topical applications to nascent mouse BRONJ lesions resulted in accelerated gingival wound closure and bone socket healing as well as attenuation of osteonecrosis development. The gingival single cell RNA sequencing demonstrated resolution of chronic inflammation by increased anti-inflammatory signature gene expression of lymphocytes and myeloid-derived suppressor cells. This study suggests that BRONJ pathology is related to N-BP levels in jawbones and demonstrates the potential of HMDP-DNV as an effective BRONJ therapy.
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Affiliation(s)
- Hiroko Okawa
- Weintraub Center for Reconstructive Biotechnology, Division of Regenerative & Reconstructive Sciences, University of California, Los Angeles School of DentistryLos AngelesUnited States
- Division of Molecular & Regenerative Prosthodontics, Tohoku University Graduate School of DentistrySendaiJapan
| | - Takeru Kondo
- Weintraub Center for Reconstructive Biotechnology, Division of Regenerative & Reconstructive Sciences, University of California, Los Angeles School of DentistryLos AngelesUnited States
- Division of Molecular & Regenerative Prosthodontics, Tohoku University Graduate School of DentistrySendaiJapan
| | - Akishige Hokugo
- Weintraub Center for Reconstructive Biotechnology, Division of Regenerative & Reconstructive Sciences, University of California, Los Angeles School of DentistryLos AngelesUnited States
- Regenerative Bioengineering and Repair Laboratory, Division of Plastic and Reconstructive Surgery, Department of Surgery, David Geffen School of Medicine at University of California, Los AngelesLos AngelesUnited States
| | | | - Jesus J Campagna
- Department of Neurology, David Geffen School of Medicine at University of California, Los AngelesLos AngelesUnited States
| | - Nicholas A Lentini
- Department of Chemistry, University of Southern CaliforniaLos AngelesUnited States
| | - Eric C Sung
- Weintraub Center for Reconstructive Biotechnology, Division of Regenerative & Reconstructive Sciences, University of California, Los Angeles School of DentistryLos AngelesUnited States
| | - Samantha Chiang
- Division of Oral & Systemic Health Sciences, University of California, Los Angeles School of DentistryLos AngelesUnited States
| | - Yi-Ling Lin
- Section of Oral & Maxillofacial Pathology, University of California, Los Angeles School of DentistryLos AngelesUnited States
| | | | - Varghese John
- Department of Neurology, David Geffen School of Medicine at University of California, Los AngelesLos AngelesUnited States
| | - Shuting Sun
- Weintraub Center for Reconstructive Biotechnology, Division of Regenerative & Reconstructive Sciences, University of California, Los Angeles School of DentistryLos AngelesUnited States
- BioVinc, LLCPasadenaUnited States
| | - Charles E McKenna
- Department of Chemistry, University of Southern CaliforniaLos AngelesUnited States
| | - Ichiro Nishimura
- Weintraub Center for Reconstructive Biotechnology, Division of Regenerative & Reconstructive Sciences, University of California, Los Angeles School of DentistryLos AngelesUnited States
- Division of Oral & Systemic Health Sciences, University of California, Los Angeles School of DentistryLos AngelesUnited States
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Wang B, Zhan Y, Yan L, Hao D. How zoledronic acid improves osteoporosis by acting on osteoclasts. Front Pharmacol 2022; 13:961941. [PMID: 36091799 PMCID: PMC9452720 DOI: 10.3389/fphar.2022.961941] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 07/22/2022] [Indexed: 11/23/2022] Open
Abstract
Osteoporosis is called a silent disease, because it is difficult to detect until comprehensive examinations for osteoporosis are performed or osteoporotic fractures occur. Zoledronic acid is currently the first-line anti-osteoporotic drug, with good efficacy and treatment compliance. A major advantage of zoledronic acid is that intravenous zoledronic acid often guarantees a therapeutic effect for up to 1 year after infusion. The reasons why zoledronic acid is effective in improving osteoporosis are that it can inhibit osteoclast differentiation and induce osteoclast apoptosis, thus suppressing bone resorption and increasing bone density. The story between zoledronic acid and osteoclasts has been written long time ago. Both the canonical receptor activator of the receptor activator of nuclear factor-κB ligand (RANKL) pathway and the non-canonical Wnt pathway are the main pathways by which zoledronic acid inhibits osteoclast differentiation. Farnesyl pyrophosphate synthase (FPPS), reactive oxygen species (ROS), and ferroptosis that was first proposed in 2012, are all considered to be closely associated with zoledronic acid-induced osteoclast apoptosis. Here, we provide a brief review of the recent progress on the study of zoledronic acid and osteoclasts, and hope to elaborate how zoledronic acid improves osteoporosis by acting on osteoclasts.
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Affiliation(s)
- Biao Wang
- Spine Surgery, Honghui Hospital Affiliated to Xi’an Jiaotong University, Xi’an, China
| | - Yi Zhan
- Spine Surgery, Honghui Hospital Affiliated to Xi’an Jiaotong University, Xi’an, China
- The Sceond Clinical Medical College of Shaanxi University of Chinese Medicine, Xi’an, China
| | - Liang Yan
- Spine Surgery, Honghui Hospital Affiliated to Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Dingjun Hao, ; Liang Yan,
| | - Dingjun Hao
- Spine Surgery, Honghui Hospital Affiliated to Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Dingjun Hao, ; Liang Yan,
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10
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Nasca V, Frezza AM, Morosi C, Buonomenna C, Parafioriti A, Zappalà G, Bini F, Casali PG, Loppini M, Stacchiotti S. Rechallenge of denosumab in advanced giant cell tumor of the bone after atypical femur fracture: A case report and review of literature. Front Oncol 2022; 12:953149. [PMID: 35928864 PMCID: PMC9343706 DOI: 10.3389/fonc.2022.953149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/27/2022] [Indexed: 12/27/2022] Open
Abstract
Giant cell tumor of the bone (GCTB) is a locally aggressive neoplasm where surgery is often curative. However, it can rarely give rise to distant metastases. Currently, the only available active therapeutic option for unresectable GCTB is denosumab, an anti-RANKL monoclonal antibody that dampens the aggressive osteolysis typically seen in this disease. For advanced/metastatic GCTB, denosumab should be continued lifelong, and although it is usually well tolerated, important questions may arise about the long-term safety of this drug. In fact, uncommon but severe toxicities can occur and eventually lead to denosumab discontinuation, such as atypical fracture of the femur (AFF). The optimal management of treatment-related AFF is a matter of debate, and to date, it is unknown whether reintroduction of denosumab at disease progression is a clinically feasible option, as no reports have been provided so far. Hereinafter, we present a case of a patient with metastatic GCTB who suffered from AFF after several years of denosumab; we describe the clinical features, orthopedic treatment, and oncological outcomes, finally providing the first evidence that denosumab rechallenge after AFF occurrence may be a safe and viable option at GCTB progression.
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Affiliation(s)
- Vincenzo Nasca
- Department of Medical Oncology, Fondazione Instituti Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milano, Italy
| | - Anna Maria Frezza
- Department of Medical Oncology, Fondazione Instituti Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milano, Italy
| | - Carlo Morosi
- Department of Radiology, Fondazione Instituti Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milano, Italy
| | - Ciriaco Buonomenna
- Department of Radiology, Fondazione Instituti Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milano, Italy
| | - Antonina Parafioriti
- Department of Pathology, Aziende Socio Sanitarie Territoriali (ASST) Pini – Centri Traumatologici Ortopedici (CTO), Milano, Italy
| | - Giorgio Zappalà
- Department of Orthopaedic Surgery, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Federica Bini
- Department of Medical Oncology, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Paolo Giovanni Casali
- Department of Medical Oncology, Fondazione Instituti Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milano, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milano, Italy
| | - Mattia Loppini
- Department of Biomedical Sciences, Humanitas University, Milano, Italy
- Department of Orthopaedic Surgery, Instituti Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milano, Italy
| | - Silvia Stacchiotti
- Department of Medical Oncology, Fondazione Instituti Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milano, Italy
- *Correspondence: Silvia Stacchiotti,
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Bisphosphonate Drug Holiday and Fracture Risk: Reviewing the Evidence. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2022. [DOI: 10.1007/s40674-022-00191-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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12
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Ishii T, Ruiz-Torruella M, Yamamoto K, Yamaguchi T, Heidari A, Pierrelus R, Leon E, Shindo S, Rawas-Qalaji M, Pastore MR, Ikeda A, Nakamura S, Mawardi H, Kandalam U, Hardigan P, Witek L, Coelho PG, Kawai T. Locally Secreted Semaphorin 4D Is Engaged in Both Pathogenic Bone Resorption and Retarded Bone Regeneration in a Ligature-Induced Mouse Model of Periodontitis. Int J Mol Sci 2022; 23:ijms23105630. [PMID: 35628440 PMCID: PMC9148012 DOI: 10.3390/ijms23105630] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 02/04/2023] Open
Abstract
It is well known that Semaphorin 4D (Sema4D) inhibits IGF-1-mediated osteogenesis by binding with PlexinB1 expressed on osteoblasts. However, its elevated level in the gingival crevice fluid of periodontitis patients and the broader scope of its activities in the context of potential upregulation of osteoclast-mediated periodontal bone-resorption suggest the need for further investigation of this multifaceted molecule. In short, the pathophysiological role of Sema4D in periodontitis requires further study. Accordingly, attachment of the ligature to the maxillary molar of mice for 7 days induced alveolar bone-resorption accompanied by locally elevated, soluble Sema4D (sSema4D), TNF-α and RANKL. Removal of the ligature induced spontaneous bone regeneration during the following 14 days, which was significantly promoted by anti-Sema4D-mAb administration. Anti-Sema4D-mAb was also suppressed in vitro osteoclastogenesis and pit formation by RANKL-stimulated BMMCs. While anti-Sema4D-mAb downmodulated the bone-resorption induced in mouse periodontitis, it neither affected local production of TNF-α and RANKL nor systemic skeletal bone remodeling. RANKL-induced osteoclastogenesis and resorptive activity were also suppressed by blocking of CD72, but not Plexin B2, suggesting that sSema4D released by osteoclasts promotes osteoclastogenesis via ligation to CD72 receptor. Overall, our data indicated that ssSema4D released by osteoclasts may play a dual function by decreasing bone formation, while upregulating bone-resorption.
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Affiliation(s)
- Takenobu Ishii
- Department of Orthodontics, Tokyo Dental College, Tokyo 101-0061, Japan;
| | | | - Kenta Yamamoto
- Department of Dental Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan;
| | - Tsuguno Yamaguchi
- Research and Development, LION Corporation, Odawara 256-0811, Japan;
| | - Alireza Heidari
- Department of Oral Science and Translational Research, College of Dental Medicine, Nova Southeastern University, 3200 South University Drive, Davie, Fort Lauderdale, FL 33328, USA; (A.H.); (R.P.); (E.L.); (S.S.); (M.R.-Q.); (M.R.P.); (S.N.)
| | - Roodelyne Pierrelus
- Department of Oral Science and Translational Research, College of Dental Medicine, Nova Southeastern University, 3200 South University Drive, Davie, Fort Lauderdale, FL 33328, USA; (A.H.); (R.P.); (E.L.); (S.S.); (M.R.-Q.); (M.R.P.); (S.N.)
| | - Elizabeth Leon
- Department of Oral Science and Translational Research, College of Dental Medicine, Nova Southeastern University, 3200 South University Drive, Davie, Fort Lauderdale, FL 33328, USA; (A.H.); (R.P.); (E.L.); (S.S.); (M.R.-Q.); (M.R.P.); (S.N.)
| | - Satoru Shindo
- Department of Oral Science and Translational Research, College of Dental Medicine, Nova Southeastern University, 3200 South University Drive, Davie, Fort Lauderdale, FL 33328, USA; (A.H.); (R.P.); (E.L.); (S.S.); (M.R.-Q.); (M.R.P.); (S.N.)
| | - Mohamad Rawas-Qalaji
- Department of Oral Science and Translational Research, College of Dental Medicine, Nova Southeastern University, 3200 South University Drive, Davie, Fort Lauderdale, FL 33328, USA; (A.H.); (R.P.); (E.L.); (S.S.); (M.R.-Q.); (M.R.P.); (S.N.)
| | - Maria Rita Pastore
- Department of Oral Science and Translational Research, College of Dental Medicine, Nova Southeastern University, 3200 South University Drive, Davie, Fort Lauderdale, FL 33328, USA; (A.H.); (R.P.); (E.L.); (S.S.); (M.R.-Q.); (M.R.P.); (S.N.)
| | - Atsushi Ikeda
- Department of Periodontics and Endodontics, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8525, Japan;
| | - Shin Nakamura
- Department of Oral Science and Translational Research, College of Dental Medicine, Nova Southeastern University, 3200 South University Drive, Davie, Fort Lauderdale, FL 33328, USA; (A.H.); (R.P.); (E.L.); (S.S.); (M.R.-Q.); (M.R.P.); (S.N.)
| | - Hani Mawardi
- Department of Oral Diagnostic Sciences, Faculty of Dentistry, King Abdul-Aziz University, Jeddah 21589, Saudi Arabia;
| | - Umadevi Kandalam
- Woody L. Hunt School of Dental Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA;
| | - Patrick Hardigan
- Patel College of Allopathic Medicine, Nova Southeastern University, 3200 South University Drive, Davie, Fort Lauderdale, FL 33328, USA;
| | - Lukasz Witek
- Division of Biomaterials, NYU College of Dentistry, New York, NY 10010, USA; (L.W.); (P.G.C.)
| | - Paulo G. Coelho
- Division of Biomaterials, NYU College of Dentistry, New York, NY 10010, USA; (L.W.); (P.G.C.)
| | - Toshihisa Kawai
- Department of Oral Science and Translational Research, College of Dental Medicine, Nova Southeastern University, 3200 South University Drive, Davie, Fort Lauderdale, FL 33328, USA; (A.H.); (R.P.); (E.L.); (S.S.); (M.R.-Q.); (M.R.P.); (S.N.)
- Cell Therapy Institute, Center for Collaborative Research, Nova Southeastern University, 3200 South University Drive, Fort Lauderdale, FL 33328, USA
- Correspondence: ; Tel.: +1-954-262-1282
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13
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Ishizu H, Shimizu H, Shimizu T, Ebata T, Ogawa Y, Miyano M, Arita K, Ohashi Y, Iwasaki N. Rheumatoid Arthritis is a Risk Factor for Refracture in Patients with Fragility Fractures. Mod Rheumatol 2021; 32:1017-1022. [PMID: 34865103 DOI: 10.1093/mr/roab109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/09/2021] [Accepted: 11/06/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To determine whether patients with rheumatoid arthritis (RA) who have had fragility fractures are at an increased risk of refractures. METHODS Patients with fragility fractures who were treated surgically at ten hospitals from 2008 to 2017 and who underwent follow-up for more than 24 months were either categorized into a group comprising patients with RA or a group comprising patients without RA (controls). The groups were matched 1:1 by propensity score matching. Accordingly, 240 matched participants were included in this study. The primary outcome was the refracture rate in patients with RA as compared to in the controls. Multivariable analyses were also conducted on patients with RA to evaluate the odds ratios (ORs) for the refracture rates. RESULTS Patients with RA were significantly associated with increased rates of refractures during the first 24 months (OR: 2.714, 95% confidence interval [95% CI]: 1.015-7.255; P = 0.040). Multivariable analyses revealed a significant association between increased refracture rates and long-term RA (OR: 6.308, 95% CI: 1.195-33.292; P=0.030). CONCLUSIONS Patients with RA who have experienced fragility fractures are at an increased risk of refractures. Long-term RA is a substantial risk factor for refractures.
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Affiliation(s)
- Hotaka Ishizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Hirokazu Shimizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Tomohiro Shimizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Taku Ebata
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Yuki Ogawa
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Masahiro Miyano
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Kosuke Arita
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Yusuke Ohashi
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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14
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Anagnostis P, Paschou SA, Gonzalez-Rodriguez E, Potoupnis M, Tsiridis E, Lamy O, Goulis DG. Spontaneous Vertebral Fractures in Males with Osteoporosis After Denosumab Discontinuation: A Report of Two Cases. J Clin Rheumatol 2021; 27:S581-S584. [PMID: 30614889 DOI: 10.1097/rhu.0000000000000979] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Accidental Extrusion of Sodium Hypochlorite in a Patient Taking Alendronate: A Case Report With an 8-Year Follow-up. J Endod 2021; 47:1947-1952. [PMID: 34626612 DOI: 10.1016/j.joen.2021.09.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 12/22/2022]
Abstract
Extrusion of sodium hypochlorite (NaOCl) is a very rare accident with the most common complications including pain, swelling, and hematoma. It can occur even if procedural guidelines, predisposing conditions, and risk factors are taken into consideration. A 59-year-old female patient was admitted to the endodontics department to treat a left maxillary first premolar (World Dental Federation tooth 24). The medical history included osteoporosis and systemic medication with alendronate. Initially, the diagnosis was "symptomatic irreversible pulpitis" with "normal apical tissues." During instrumentation of the buccal canal, accidental extrusion of 2.5% NaOCl occurred into the periapical tissues, resulting from misinterpretation of the working length, and caused severe pain and bleeding. The canal was immediately flushed using copious irrigation with saline solution. An analgesic and corticosteroid were prescribed. At 3 and 7 days, ecchymosis and slight hematoma were observed extraorally in the area of the affected tooth and an intraoral ulceration at the apex of the affected tooth. At 15 days, minimal signs of ecchymosis were observed, and the treatment was resumed. At 30 days after the accident, there was complete remission of the sequelae. The clinical, radiographic, and tomographic assessment after 1 month, 1 year, and 8 years showed favorable case evolution. During the 8-year follow-up, the patient maintained the systemic use of alendronate. It can be concluded that NaOCl extrusion is an accident that causes patients and clinicians to experience an unpleasant consequence. The radiographic working length should always be determined carefully. A successful outcome can be achieved in patients who take alendronate.
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16
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Yong EL, Cheong WF, Huang Z, Thu WPP, Cazenave-Gassiot A, Seng KY, Logan S. Randomized, double-blind, placebo-controlled trial to examine the safety, pharmacokinetics and effects of Epimedium prenylflavonoids, on bone specific alkaline phosphatase and the osteoclast adaptor protein TRAF6 in post-menopausal women. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2021; 91:153680. [PMID: 34352588 DOI: 10.1016/j.phymed.2021.153680] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/04/2021] [Accepted: 07/15/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Fragility fractures due to menopausal osteoporosis are a major cause of morbidity and mortality. Osteoporotic medications have substantial side effects that limit long term use. HYPOTHESES Ingestion of a purified extract of Epimedium spp. (EP) is safe, can increase serum levels of prenylflavonoid metabolites, exert positive changes in bone specific alkaline phosphatase (BSAP), suppress of tumor necrosis factor receptor associated factor 6 (TRAF6) protein in osteoclast-precursor monocytes in peripheral blood and therefore have the potential to reduce post-menopausal bone loss. STUDY DESIGN & METHODS Healthy postmenopausal women were randomized in a double-blind fashion to consume either EP prenylflavonoid extract (740 mg daily) or placebo daily for 6 weeks. The main outcome measures were safety and pharmacokinetics of EP flavonoids. Fasting blood was collected at 3- and 6-weeks, and two weeks after stopping medication for safety evaluations and measurement of BSAP. Peripheral blood monocytes were harvested for measurement of TRAF6 levels. Serum levels of the EP metabolites icariin, icariside I & II, icaritin and desmethylicaritin were measured using tandem mass spectrometry, and non-compartmental pharmacokinetic analyses performed using WinNonlin software. RESULTS Between October 2018 and Jun 2020, 58 postmenopausal women, aged 57.9 ± 8.9 years, were randomized and completed the study. Consumption of EP prenylflavonoids was not associated with any significant adverse symptoms, with no changes in hepatic, hematological, and renal parameters observed. The main metabolites detected in sera after ingestion of EP prenylflavonoid capsules were desmethylicaritin, icaritin and icariside II. Icariin and icariside I were below detection levels. Ingestion of EP prenylflavonoids induced a median Cmax and AUC0→∞ for desmethylicaritin of 60.9 nM, and 157.9 nM ×day, respectively; and were associated with higher levels of BSAP (p < 0.05) and a trend (p = 0.068) towards lower levels of TRAF6 in peripheral blood monocytes eight weeks after commencing prenylflavonoid ingestion. Prenylflavonoid metabolites were not detected in the sera of placebo participants. CONCLUSIONS Despite the widespread consumption of EP extracts, the safety, mechanisms of action of their bioactive compounds, and therapeutic indications in humans are unknown. Daily consumption of EP prenylflavonoids for six weeks was safe. The predominant metabolite in sera was desmethylicaritin. Rise in prenylflavonoid metabolites was associated with higher levels of the bone anabolic marker BSAP, suggesting potential therapeutic value for post-menopausal osteoporosis.
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Affiliation(s)
- Eu-Leong Yong
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore.
| | - Wei Fun Cheong
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore
| | - Zhongwei Huang
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Institute of Molecular and Cell Biology, Agency of Science, Technology and Research, 138673 Singapore
| | - Win Pa Pa Thu
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore
| | - Amaury Cazenave-Gassiot
- Singapore Lipidomics Incubator, Life Sciences Institute, National University of Singapore, 117456 Singapore; Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, 117596 Singapore
| | - Kok Yong Seng
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, 117600 Singapore
| | - Susan Logan
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore
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17
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Rudran B, Super J, Jandoo R, Babu V, Nathan S, Ibrahim E, Wiik AV. Current concepts in the management of bisphosphonate associated atypical femoral fractures. World J Orthop 2021; 12:660-671. [PMID: 34631450 PMCID: PMC8472443 DOI: 10.5312/wjo.v12.i9.660] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/21/2021] [Accepted: 08/05/2021] [Indexed: 02/06/2023] Open
Abstract
Bisphosphonates are a class of drugs used as the mainstay of treatment for osteoporosis. Bisphosphonates function by binding to hydroxyapatite, and subsequently targeting osteoclasts by altering their ability to resorb and remodel bone. Whilst aiming to reduce the risk of fragility fractures, bisphosphonates have been associated with atypical insufficiency fractures, specifically in the femur. Atypical femoral fractures occur distal to the lesser trochanter, until the supracondylar flare. There are a number of the differing clinical and radiological features between atypical femoral fractures and osteoporotic femoral fractures, indicating that there is a distinct difference in the respective underlying pathophysiology. At the point of presentation of an atypical femoral fracture, bisphosphonate should be discontinued. This is due to the proposed inhibition of osteoclasts and apoptosis, resulting in impaired callus healing. Conservative management consists primarily of cessation of bisphosphonate therapy and partial weightbearing activity. Nutritional deficiencies should be investigated and appropriately corrected, most notably dietary calcium and vitamin D. Currently there is no established treatment guidelines for either complete or incomplete fractures. There is agreement in the literature that nonoperative management of bisphosphonate-associated femoral fractures conveys poor outcomes. Currently, the favoured methods of surgical fixation are cephalomedullary nailing and plate fixation. Newer techniques advocate the use of both modalities as it gives the plate advantage of best reducing the fracture and compressing the lateral cortex, with the support of the intramedullary nail to stabilise an atypical fracture with increased ability to load-share, and a reduced bending moment across the fracture site. The evidence suggests that cephalomedullary nailing of the fracture has lower revision rates. However, it is important to appreciate that the anatomical location and patient factors may not always allow for this. Although causation between bisphosphonates and atypical fractures is yet to be demonstrated, there is a growing evidence base to suggest a higher incidence to atypical femoral fractures in patients who take bisphosphonates. As we encounter a growing co-morbid elderly population, the prevalence of this fracture-type will likely increase. Therefore, it is imperative clinicians continue to be attentive of atypical femoral fractures and treat them effectively.
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Affiliation(s)
- Branavan Rudran
- Department of Orthopaedic Surgery, Chelsea and Westminster NHS Trust, London TW7 6AF, United Kingdom
- The MSk Lab, Imperial College London, London W12 0BZ, United Kingdom
| | - Jonathan Super
- The MSk Lab, Imperial College London, London W12 0BZ, United Kingdom
| | - Rajan Jandoo
- Department of Orthopaedic Surgery, Chelsea and Westminster NHS Trust, London TW7 6AF, United Kingdom
| | - Victor Babu
- Department of Orthopaedic Surgery, Chelsea and Westminster NHS Trust, London TW7 6AF, United Kingdom
| | - Soosai Nathan
- Department of Orthopaedic Surgery, Chelsea and Westminster NHS Trust, London TW7 6AF, United Kingdom
| | - Edward Ibrahim
- Department of Orthopaedic Surgery, Chelsea and Westminster NHS Trust, London TW7 6AF, United Kingdom
| | - Anatole Vilhelm Wiik
- Department of Orthopaedic Surgery, Chelsea and Westminster NHS Trust, London TW7 6AF, United Kingdom
- Department of Surgery and Cancer, Charing Cross Hospital, London W6 8RF, United Kingdom
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18
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Lamarre M, Marcotte M, Laurin D, Furrer D, Vedel I, Tourigny A, Giguère A, Carmichael PH, Martines R, Morais J, Kröger E. Discontinuation of bisphosphonates in seniors: a systematic review on health outcomes. Arch Osteoporos 2021; 16:133. [PMID: 34524561 DOI: 10.1007/s11657-021-01000-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 09/05/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Bisphosphonates are used to treat osteoporosis. Despite their benefits on bone mineral density (BMD) and fractures, they have shown adverse effects, sometimes severe, during chronic use. Taken for several years, they achieve long-term bone retention, making deprescribing feasible. This review aimed to synthesize evidence on the success and health outcomes of deprescribing of bisphosphonates in seniors, aged over 60 years. METHODS The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, including articles in English, French, or German published before July 2020. Eligible studies included seniors having discontinued bisphosphonates and reported on health outcomes; some allowed meta-analyses on fracture risk. RESULTS The review included 9 RCTs and 9 cohort studies of moderate quality. Bisphosphonates were discontinued after 2 to 7 years of use, and BMD or fractures were assessed during follow-up of 0.5 to 5 years. A significant reduction in BMD after discontinuation was observed in 9 of 10 studies. Results on fracture risk after discontinuation are mitigated: 6 RCT extensions showed no increase in the risk of any osteoporotic fractures after discontinuation. Meta-analyses including 4 RCTs showed an increased odds ratio of vertebral fractures of 2.04 (95% CI, 1.39-2.99) among discontinuers. Results from 2 large cohort studies showed no increased risks of any osteoporotic or vertebral fractures, while 2 studies found increased fracture risks. CONCLUSION Bisphosphonates have successfully been discontinued low overall fracture risk after at least 3 years of use, but a risk for decreased BMD and increased vertebral fractures remained.
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Affiliation(s)
- Marianne Lamarre
- Faculté de médecine, Université Laval, Quebec City, Quebec, Canada
| | - Martine Marcotte
- Centre d'excellence sur le vieillissement de Québec, CIUSSS Capitale Nationale, Quebec City, Quebec, Canada
| | - Danielle Laurin
- Centre d'excellence sur le vieillissement de Québec, CIUSSS Capitale Nationale, Quebec City, Quebec, Canada.,Faculté de pharmacie, Université Laval, Quebec City, Quebec, Canada.,Institut sur le vieillissement et la participation sociale des aînés de l, Université Laval, Quebec City, Quebec, Canada.,Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec, Canada.,VITAM Centre de recherche sur la santé durable, Quebec City, Quebec, Canada
| | - Daniela Furrer
- Centre d'excellence sur le vieillissement de Québec, CIUSSS Capitale Nationale, Quebec City, Quebec, Canada
| | - Isabelle Vedel
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - André Tourigny
- Faculté de médecine, Université Laval, Quebec City, Quebec, Canada.,Centre d'excellence sur le vieillissement de Québec, CIUSSS Capitale Nationale, Quebec City, Quebec, Canada.,Institut sur le vieillissement et la participation sociale des aînés de l, Université Laval, Quebec City, Quebec, Canada.,Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec, Canada.,VITAM Centre de recherche sur la santé durable, Quebec City, Quebec, Canada
| | - Anik Giguère
- Faculté de médecine, Université Laval, Quebec City, Quebec, Canada.,Centre d'excellence sur le vieillissement de Québec, CIUSSS Capitale Nationale, Quebec City, Quebec, Canada.,Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec, Canada.,VITAM Centre de recherche sur la santé durable, Quebec City, Quebec, Canada
| | - Pierre-Hugues Carmichael
- Centre d'excellence sur le vieillissement de Québec, CIUSSS Capitale Nationale, Quebec City, Quebec, Canada.,VITAM Centre de recherche sur la santé durable, Quebec City, Quebec, Canada
| | - Rosa Martines
- Centre d'excellence sur le vieillissement de Québec, CIUSSS Capitale Nationale, Quebec City, Quebec, Canada
| | - José Morais
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Edeltraut Kröger
- Centre d'excellence sur le vieillissement de Québec, CIUSSS Capitale Nationale, Quebec City, Quebec, Canada. .,Faculté de pharmacie, Université Laval, Quebec City, Quebec, Canada. .,Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec, Canada. .,VITAM Centre de recherche sur la santé durable, Quebec City, Quebec, Canada. .,Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
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19
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Saag K, Cosman F, De Villiers T, Langdahl B, Scott BB, Denker AE, Pong A, Santora AC. Early changes in bone turnover and bone mineral density after discontinuation of long-term oral bisphosphonates: a post hoc analysis. Osteoporos Int 2021; 32:1879-1888. [PMID: 33606045 DOI: 10.1007/s00198-020-05785-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
UNLABELLED This post hoc analysis of a randomized, double-blind study of postmenopausal women with osteoporosis found that there were early increases in bone turnover markers and decreases in bone mineral density after discontinuation of long-term alendronate. These findings might help guide treatment decisions, including monitoring after alendronate withdrawal. INTRODUCTION The short-term effects of discontinuing long-term bisphosphonates are poorly characterized. This post hoc analysis investigated 1-12-month changes in bone mineral density (BMD) and bone turnover markers (BTM) after alendronate (ALN) discontinuation. METHODS Data were from a randomized, double-blind trial of MK-5442 (calcium-sensing receptor antagonist) following oral bisphosphonates, with placebo and continued ALN controls ( ClinicalTrials.gov NCT00996801). Postmenopausal women with osteoporosis had received oral bisphosphonate (≥ 3-4 preceding years; ALN for the 12 months pre-screening), continuing on ALN 70 mg/week (n = 87) or placebo (n = 88). RESULTS At 12 months, least-squares mean percent changes from baseline BMD (placebo vs. ALN) were lumbar spine (LS): - 0.36 vs. 1.29, total hip: - 1.44 vs. 0.46, and femoral neck (FN): - 1.26 vs. - 0.08 (all P < 0.05). BTM levels increased by 1-3 months, to 12 months, with placebo vs. ALN (P < 0.001). FN BMD decline was greater in the placebo subgroup with higher urinary N-terminal cross-linked telopeptides of type I collagen/creatinine [uNTx/Cr] (P < 0.01), and higher serum N-terminal pro-peptide of type 1 collagen [P1NP] levels (P < 0.05), at baseline. There was a trend toward greater FN BMD loss with higher BTM levels at 3 and/or 6 months. Younger age and higher LS BMD at baseline were associated with greater LS BMD loss at 12 months (P = 0.04 and < 0.01, respectively); higher baseline FN BMD predicted greater FN BMD loss (P = 0.04). CONCLUSION Early changes in BTM levels and BMD were observed after discontinuation of long-term ALN. Further characterization of factors associated with patients' risk of bone loss upon bisphosphonate discontinuation is warranted.
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Affiliation(s)
- K Saag
- University of Alabama, Birmingham, AL, USA.
| | - F Cosman
- Department of Medicine, Columbia University, New York, NY, USA
| | - T De Villiers
- Stellenbosch University and Mediclinic Panorama, Western Cape, South Africa
| | - B Langdahl
- Aarhus University Hospital, Aarhus, Denmark
| | - B B Scott
- Merck & Co., Inc, Kenilworth, NJ, USA
| | | | - A Pong
- Merck & Co., Inc, Kenilworth, NJ, USA
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Ishizu H, Arita K, Terkawi MA, Shimizu T, Iwasaki N. Risks vs. benefits of switching therapy in patients with postmenopausal osteoporosis. Expert Rev Endocrinol Metab 2021; 16:217-228. [PMID: 34310233 DOI: 10.1080/17446651.2021.1956902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/14/2021] [Indexed: 10/20/2022]
Abstract
Introduction: Osteoporosis is characterized by the fragility of bones, leading to fractures and, consequently, the deterioration of functional capacity and quality of life. Postmenopausal women, in particular, are prone to osteoporosis and often require anti-osteoporosis treatment. In the last few decades, various anti-osteoporosis drugs have been approved for clinical use. In an aging society, osteoporosis cannot be treated using a single agent; therefore, switching therapy is an important treatment strategy.Areas covered: This review covers switching therapy in patients with postmenopausal osteoporosis. It's extremely important to understand the characteristics of each drug including; limitations on the duration of use, side effects due to long-term use (such as atypical femur fracture and osteonecrosis of the jaw) or discontinuation (such as rebound phenomenon), compliance, and ability to prevent fractures. We review and summarize the risks and benefits of switching therapy.Expert opinion: When switching therapy, the order of drug administration is important. Routine monitoring should be continued after switching treatments. We recommend first using osteoanabolic agents in postmenopausal women with severe osteoporosis. In addition, identifying predictors of the efficacy and side effects of treatment may help prevent the inappropriate use of drugs for the treatment of osteoporosis.
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Affiliation(s)
- Hotaka Ishizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Kosuke Arita
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Mohamad Alaa Terkawi
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Tomohiro Shimizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, Japan
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21
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Miyashita H, Satoi S, Cruz C, Kim SM, Patel VG. Bone-modifying agents for bone loss in patients with prostate cancer receiving androgen deprivation therapy; insights from a network meta-analysis. Support Care Cancer 2021; 30:855-863. [PMID: 34392414 DOI: 10.1007/s00520-021-06490-5] [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: 02/20/2021] [Accepted: 08/07/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The data of head-to-head comparisons of the effect of bone-modifying agents (BMAs) in patients with androgen deprivation therapy (ADT) for prostate cancer without skeletal metastasis is limited. Thus, we conducted a network meta-analysis to compare each BMA for the efficacy of bone mineral densities (BMDs) and the risk of fracture. METHODS We performed a network meta-analysis to compare the change of BMDs and the risk of vertebral fracture in the studies included using a random-effect model. The primary outcomes are the change of BMD of the lumbar spine (LS) and the total hip (TH) from the baseline at 1 year from the initiation of the BMA and the risk of vertebral fracture. RESULTS We identified and included 15 studies in this analysis. All BMAs except risedronate showed a significant increase of BMD of the LS compared with groups without BMA, among which zoledronate showed the most BMD gain. At TH, bisphosphonates (alendronate, pamidronate, and zoledronate) and denosumab showed significant elevation compared with the no-BMA group. Denosumab was associated with the most BMD gain at the TH. Only denosumab reduced the risk of vertebral fracture (relative risk [95% confidence interval]: 0.40 [0.20-0.81]). Although zoledronate showed the highest BMD gain at the LS, it did not reduce the risk of vertebral fracture in this analysis. CONCLUSION Most bisphosphonates and denosumab significantly increased BMD at the LS and the TH in patients receiving ADT for prostate cancer without skeletal metastasis. In particular, zoledronate and denosumab were the most potent BMAs in terms of BMD increment at the LS and the TH, respectively. However, denosumab, not zoledronate, was the only BMA that showed a significant risk reduction of vertebral fracture. We need further studies to examine the change of bone quality and the effect on the risk of non-vertebral and hip fractures.
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Affiliation(s)
- Hirotaka Miyashita
- Department of Medicine, Icahn School of Medicine At Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA. .,Mount Sinai Bone Program, Icahn School of Medicine At Mount Sinai, New York, NY, USA.
| | - Sera Satoi
- Department of Medicine, Icahn School of Medicine At Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
| | - Christina Cruz
- Department of Medicine, Icahn School of Medicine At Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
| | - Se-Min Kim
- Department of Medicine, Icahn School of Medicine At Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA. .,Mount Sinai Bone Program, Icahn School of Medicine At Mount Sinai, New York, NY, USA.
| | - Vaibhav G Patel
- Tisch Cancer Institute, Icahn School of Medicine At Mount Sinai, New York, NY, USA
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22
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Kobza AO, Herman D, Papaioannou A, Lau AN, Adachi JD. Understanding and Managing Corticosteroid-Induced Osteoporosis. Open Access Rheumatol 2021; 13:177-190. [PMID: 34239333 PMCID: PMC8259736 DOI: 10.2147/oarrr.s282606] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/03/2021] [Indexed: 11/23/2022] Open
Abstract
Glucocorticoids are effective immunosuppressants used in a wide variety of diseases. Their use results in secondary osteoporosis in about 30–50% of chronic glucocorticoid users. Glucocorticoids cause a rapid decline in bone strength within the first 3–6 months mostly due to increased bone resorption by osteoclasts. This is followed by a more gradual loss of bone partly due to decreased osteoblastogenesis and osteoblast and osteocyte apoptosis. The loss of bone strength induced by glucocorticoids is not fully captured by bone mineral density measurements. Other tools such as the trabecular bone score and advanced imaging techniques give insight into bone quality; however, these are not used widely in clinical practice. Glucocorticoid-induced osteoporosis should be seen as a widely preventable disease. Currently, only about 15% of chronic glucocorticoid users are receiving optimal care. Glucocorticoids should be prescribed at the lowest dose and shortest duration. All patients should be counselled on lifestyle measures to maintain bone strength including nutrition and weight-bearing exercise. Pharmacological therapy should be considered for all patients at moderate to high risk of fracture as there is evidence for the prevention of bone loss and fractures with a favourable safety profile. Oral bisphosphonates are the current mainstay of therapy, whereas osteoanabolic agents may be considered for those at highest risk of fracture.
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Affiliation(s)
- Alexandra O Kobza
- Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Deena Herman
- Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Alexandra Papaioannou
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada
| | - Arthur N Lau
- Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jonathan D Adachi
- Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, ON, Canada
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23
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Inderjeeth CA, Inderjeeth KA. Osteoporosis in older people. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2021. [DOI: 10.1002/jppr.1743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Charles A. Inderjeeth
- School of Medicine & Pharmacology The University of Western Australia Crawley Australia
- Sir Charles Gairdner and Osborne Park Hospital Group Nedlands Australia
- Arthritis and Osteoporosis WA Perth Australia
| | - Keenan A. Inderjeeth
- Dental Esthetique Subiaco Australia
- Captain Stirling Compounding Pharmacy Nedlands Australia
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24
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Madeira M, Rocha AC, Moreira CA, Aguiar ÁMM, Maeda SS, Cardoso AS, de Moura Castro CH, D'Alva CB, Silva BCC, Ferraz-de-Souza B, Lazaretti-Castro M, Bandeira F, Torres SR. Prevention and treatment of oral adverse effects of antiresorptive medications for osteoporosis - A position paper of the Brazilian Society of Endocrinology and Metabolism (SBEM), Brazilian Society of Stomatology and Oral Pathology (Sobep), and Brazilian Association for Bone Evaluation and Osteometabolism (Abrasso). ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 64:664-672. [PMID: 34033275 PMCID: PMC10528626 DOI: 10.20945/2359-3997000000301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 07/13/2020] [Indexed: 11/23/2022]
Abstract
Antiresorptive therapy is the main form of prevention of osteoporotic or fragility fractures. Medication-related osteonecrosis of the jaw (MRONJ) is a relatively rare but severe adverse reaction to antiresorptive and antiangiogenic drugs. Physicians and dentists caring for patients taking these drugs and requiring invasive procedures face a difficult decision because of the potential risk of MRONJ. The aim of this study was to discuss the risk factors for the development of MRONJ and prevention of this complication in patients with osteoporosis taking antiresorptive drugs and requiring invasive dental treatment. For this goal, a task force with representatives from three professional associations was appointed to review the pertinent literature and discuss systemic and local risk factors, prevention of MRONJ in patients with osteoporosis, and management of established MRONJ. Although scarce evidence links the use of antiresorptive agents in the context of osteoporosis to the development of MRONJ, these agents are considered a risk factor for this complication. Despite the rare reports of MRONJ in patients with osteoporosis, the severity of symptoms and impact of MRONJ in the patients' quality of life make it imperative for health care professionals to consider this complication when planning invasive dental procedures.
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Affiliation(s)
- Miguel Madeira
- Divisão de Endocrinologia, Departamento de Clínica Médica, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil,
- Divisão de Endocrinologia, Departamento de Clínica Médica, Hospital Federal de Bonsucesso, Rio de Janeiro, RJ, Brasil
| | - André Caroli Rocha
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Carolina Aguiar Moreira
- Unidade de Endocrinologia e Metabologia (SEMPR), Universidade Federal do Paraná, Curitiba, PR, Brasil
| | - Águida Maria Menezes Aguiar
- Hospital Municipal Souza Aguiar, Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Sergio Setsuo Maeda
- Disciplina de Endocrinologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Abel Silveira Cardoso
- Departamento de Patologia e Diagnóstico Oral, Faculdade de Odontologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | | | | | - Barbara Campolina Carvalho Silva
- Faculdade de Medicina, Centro Universitário de Belo Horizonte, Belo Horizonte, MG, Brasil
- Divisão de Endocrinologia, Hospital Felício Rocho, Belo Horizonte, MG, Brasil
- Divisão de Endocrinologia, Santa Casa de Belo Horizonte, Belo Horizonte, MG, Brasil
| | - Bruno Ferraz-de-Souza
- Laboratório de Endocrinologia Celular e Molecular (LIM-25) e Unidade de Doenças Osteometabólicas, Divisão de Endocrinologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Marise Lazaretti-Castro
- Disciplina de Endocrinologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Francisco Bandeira
- Divisão de Endocrinologia e Diabetes, Faculdade de Medicina da Universidade de Pernambuco, Recife, PE, Brasil
| | - Sandra R Torres
- Departamento de Patologia e Diagnóstico Oral, Faculdade de Odontologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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25
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Zhao X, Patil S, Xu F, Lin X, Qian A. Role of Biomolecules in Osteoclasts and Their Therapeutic Potential for Osteoporosis. Biomolecules 2021; 11:747. [PMID: 34067783 PMCID: PMC8156890 DOI: 10.3390/biom11050747] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 02/06/2023] Open
Abstract
Osteoclasts (OCs) are important cells that are involved in the regulation of bone metabolism and are mainly responsible for coordinating bone resorption with bone formation to regulate bone remodeling. The imbalance between bone resorption and formation significantly affects bone metabolism. When the activity of osteoclasts exceeds the osteoblasts, it results in a condition called osteoporosis, which is characterized by reduced bone microarchitecture, decreased bone mass, and increased occurrences of fracture. Molecules, including transcription factors, proteins, hormones, nucleic acids, such as non-coding RNAs, play an important role in osteoclast proliferation, differentiation, and function. In this review, we have highlighted the role of these molecules in osteoclasts regulation and osteoporosis. The developed therapeutics targeting these molecules for the treatment of osteoporosis in recent years have also been discussed with challenges faced in clinical application.
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Affiliation(s)
- Xin Zhao
- School of Pharmacy, Shaanxi Institute of International Trade & Commerce, Xi’an 712046, China;
| | - Suryaji Patil
- Xi’an Key Laboratory of Special Medicine and Health Engineering, Key Lab for Space Biosciences and Biotechnology, Research Center for Special Medicine and Health Systems Engineering, NPU-UAB Joint Laboratory for Bone Metabolism, School of Life Sciences, Northwestern Polytechnical University, Xi’an 710072, China; (S.P.); (F.X.); (X.L.)
| | - Fang Xu
- Xi’an Key Laboratory of Special Medicine and Health Engineering, Key Lab for Space Biosciences and Biotechnology, Research Center for Special Medicine and Health Systems Engineering, NPU-UAB Joint Laboratory for Bone Metabolism, School of Life Sciences, Northwestern Polytechnical University, Xi’an 710072, China; (S.P.); (F.X.); (X.L.)
| | - Xiao Lin
- Xi’an Key Laboratory of Special Medicine and Health Engineering, Key Lab for Space Biosciences and Biotechnology, Research Center for Special Medicine and Health Systems Engineering, NPU-UAB Joint Laboratory for Bone Metabolism, School of Life Sciences, Northwestern Polytechnical University, Xi’an 710072, China; (S.P.); (F.X.); (X.L.)
| | - Airong Qian
- Xi’an Key Laboratory of Special Medicine and Health Engineering, Key Lab for Space Biosciences and Biotechnology, Research Center for Special Medicine and Health Systems Engineering, NPU-UAB Joint Laboratory for Bone Metabolism, School of Life Sciences, Northwestern Polytechnical University, Xi’an 710072, China; (S.P.); (F.X.); (X.L.)
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26
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Xu J, Li H, Qu Y, Zheng C, Wang B, Shen P, Xie Z, Wei K, Wang Y, Zhao J. Denosumab might prevent periprosthetic bone loss after total hip and knee arthroplasties: a review. ARTHROPLASTY 2021; 3:13. [PMID: 35236485 PMCID: PMC8796657 DOI: 10.1186/s42836-021-00068-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 01/18/2021] [Indexed: 11/21/2022] Open
Abstract
Total hip arthroplasty and total knee arthroplasty are extensively used for the treatment of the end-stage degenerative joint diseases. Currently, periprosthetic bone loss is still the major cause of aseptic loosening, resulting in implant failures. Previous literature introduced some widely accepted protocols for the prevention and treatment of periprosthetic bone loss, but no guideline has been proposed. Denosumab, a human monoclonal immunoglobulin G2 (IgG2) antibody, can inhibit bone resorption by binding to the receptor activator of nuclear factor kappa-B ligand (RANKL). This article reviews the present findings and evidence concerning the effect of denosumab on the periprosthetic bone loss after total hip arthroplasty and total knee arthroplasty. Overall, the current evidence suggests that denosumab is a promising agent for the treatment of periprosthetic bone loss.
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Affiliation(s)
- Jianda Xu
- Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Affiliated to Nanjing University of Traditional Chinese Medicine, 25 North Heping Road, Changzhou, 213000, Jiangsu, China
| | - Huan Li
- Department of Arthroplasty, The First People's Hospital of Changzhou, Changzhou, 213003, China
| | - Yuxing Qu
- Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Affiliated to Nanjing University of Traditional Chinese Medicine, 25 North Heping Road, Changzhou, 213000, Jiangsu, China.
| | - Chong Zheng
- Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Affiliated to Nanjing University of Traditional Chinese Medicine, 25 North Heping Road, Changzhou, 213000, Jiangsu, China
| | - Bin Wang
- Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Affiliated to Nanjing University of Traditional Chinese Medicine, 25 North Heping Road, Changzhou, 213000, Jiangsu, China
| | - Pengfei Shen
- Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Affiliated to Nanjing University of Traditional Chinese Medicine, 25 North Heping Road, Changzhou, 213000, Jiangsu, China
| | - Zikang Xie
- Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Affiliated to Nanjing University of Traditional Chinese Medicine, 25 North Heping Road, Changzhou, 213000, Jiangsu, China
| | - Kang Wei
- Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Affiliated to Nanjing University of Traditional Chinese Medicine, 25 North Heping Road, Changzhou, 213000, Jiangsu, China
| | - Yan Wang
- Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Affiliated to Nanjing University of Traditional Chinese Medicine, 25 North Heping Road, Changzhou, 213000, Jiangsu, China
| | - Jianning Zhao
- Department of Orthopaedics, Jinling Hospital, Nanjing, 210002, Jiangsu, China.
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27
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Bauer DC, Abrahamsen B. Bisphosphonate Drug Holidays in Primary Care: When and What to Do Next? Curr Osteoporos Rep 2021; 19:182-188. [PMID: 33528743 PMCID: PMC8744486 DOI: 10.1007/s11914-021-00660-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review describes the rational for bisphosphonate holidays, summaries key evidence to support the concept, and provides a roadmap to help clinicians initiate, monitor, and discontinue a bisphosphonate drug holiday. RECENT FINDINGS Randomized trials and data from large observational studies are available to determine the short and long-term bisphosphonate benefits (prevention of fracture) and harms (principally atypical femoral fractures and osteonecrosis of the jaw). Mounting evidence points towards a causal relationship between bisphosphonate use and AFF and ONJ, particularly with > 5 years of use. Multiple studies now confirm the risk of AFF falls rapidly after BPs are discontinued. Osteoporosis patients without previous hip, vertebral, or multiple non-spine fractures who are successfully treated with oral bisphosphonates for 5 years (3 years if intravenous), should be offered a 3-5 year drug holiday, particularly if hip BMD T-score is > - 2.5. Bisphosphonates should only be continued beyond 10 years (6 years if parenteral) in patients at very high risk of fracture.
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Affiliation(s)
- Douglas C Bauer
- University of California, San Francisco, 1545 Divisadero, 3rd floor, San Francisco, CA, 94143, USA.
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28
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Abstract
Screening for osteoporosis in women can be based on age and weight, using the Osteoporosis Screening Tool for Asians and assessment for other risk factors such as early menopause, Chinese ethnicity and other secondary factors. Based on the resulting risk profile, women can be triaged to dual-energy X-ray absorptiometry (DEXA) scanning for definite diagnosis of osteoporosis. Treatment should be considered in women with previous fragility fractures, DEXA-diagnosed osteoporosis and high risk of fracture. Exercise improves muscle function, can help prevent falls and has moderate effects on improvements in bone mass. Women should ensure adequate calcium intake and vitamin D. Menopausal hormone therapy (MHT) effectively prevents osteoporosis and fractures, and should be encouraged in those aged < 50 years. For women aged < 60 years, MHT or tibolone can be considered, especially if they have vasomotor or genitourinary symptoms. Risedronate or bisphosphonates may then be reserved for those aged over 60 years.
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Affiliation(s)
- Eu-Leong Yong
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Susan Logan
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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29
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The awareness and practice of dentists regarding medication-related osteonecrosis of the jaw and its prevention: a cross-sectional survey. BMC Oral Health 2021; 21:155. [PMID: 33761923 PMCID: PMC7992948 DOI: 10.1186/s12903-021-01475-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/28/2021] [Indexed: 11/25/2022] Open
Abstract
Background Accurate documentation of a patient’s prior medication use and awareness of side effects associated with anti-osteoporotic agents can assist dentists to prevent medication-related osteonecrosis of the jaw. I aimed to determine the awareness of Korean dentists regarding medication-related osteonecrosis of the jaw and the duration of drug holidays they prescribe to patients who need to undergo various dental procedures. Methods An online, questionnaire-based survey was conducted among 1000 dentists registered in an online community in Korea. The following were determined: general characteristics; type of practice; recordkeeping regarding patients’ use of bone-modifying agents; requirement of a doctor’s referral letter; advice given regarding drug holidays of bone-modifying agents before dental surgery procedures; and experience with medication-related osteonecrosis of the jaw. Differences between dentists with and without experience in treating patients with medication-related osteonecrosis of the jaw were evaluated using the χ2 test. Results Although a relatively high proportion (293/1000, 29.3%) of dentists had experienced cases of medication-related osteonecrosis of the jaw, only 650/1000 (65.0%) routinely documented the type of bone-modifying agent used by patients and the duration of its use. Moreover, only 591/1000 (59.1%) dentists routinely requested referral letters from doctors before performing dental surgery on patients. Although the recommended period for a drug holiday differs for each drug, 533/1000 (53.3%) dentists did not make such a distinction. There was a statistically significant difference in the level of detail documented in terms of anti-osteoporotic drug use between dentists who had no experience in medication-related osteonecrosis of the jaw (707/1000) and those who had such experience (P = 0.007). There was a statistically significant difference in the length of drug holidays prescribed between dentists with and without prior experience with the condition (P = 0.001). Conclusions These results suggest that dentists do not respond consistently to patients' drug history prior to performing dental procedures. This implies the need for increased cooperation between dentists and physicians, as well as the development of targeted educational interventions for the dental profession, to reduce the risk of medication-related osteonecrosis of the jaw. Trial registration Not applicable. Supplementary information The online version contains supplementary material available at 10.1186/s12903-021-01475-6.
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30
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Belaya ZE, Rozhinskaya LY, Grebennikova TA, Kanis JA, Pigarova EA, Rodionova SS, Toroptsova NV, Nikitinskaya OA, Skripnikova IA, Drapkina OМ, Ershova OV, Biryukova EV, Lesnyak OМ, Tsoriev TТ, Belova KY, Marchenkova LА, Dzeranova LK, Dreval’ AV, Mamedova EO, Tkacheva ON, Dudinskaya EN, Nikankina LV, Farba LY, Chernova TO, Yureneva SV, Yakushevskaya OV, Ilyukhina OB, Kryukova IV, Tarbaeva NV, Petryaykin AV, Zagorodniy NV, Mel’nichenko GА, Dedov II. Summary of the draft federal clinical guidelines for osteoporosis. ACTA ACUST UNITED AC 2021. [DOI: 10.14341/osteo12710] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A summary of the draft federal clinical guidelines on osteoporosis developed by members of the Russian Association of Endocrinologists, the Russian Association for Osteoporosis, the Association of Rheumatologists of Russia, the Association of Traumatologists and Orthopedists of Russia, the Russian Association for Menopause and the Russian Association of Gerontologists and Geriatrics is presented. The recommendations were developed from the perspective of evidence-based medicine, in accordance with the requirements for compiling clinical recommendations of the Ministry of Health of Russia published in 2019. A significant place is given to screening of primary osteoporosis in adults, differential diagnosis with other metabolic diseases of the skeleton, modern methods of diagnosing osteoporosis, principles of prescribing pathogenetic treatment, features of sequential and combination therapy, disease prevention and rehabilitation. Clinical recommendations will be useful both to general practitioners and physicians, as well as to narrow specialists, primarily endocrinologists, rheumatologists, orthopedic traumatologists, nephrologists, obstetrician-gynecologists and neurologists, since osteoporosis is a multifactorial and multidisciplinary disease.
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Affiliation(s)
| | | | | | - John A. Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield; Catholic University of Australia, Melbourne
| | | | | | | | | | | | | | | | - Elena V. Biryukova
- Moscow State University of Medicine and Dentistry named after A.I. Evdokimov
| | - Olga М. Lesnyak
- North-Western State Medical University named after I.I. Mechnikov
| | | | - Kseniya Y. Belova
- Yaroslavl State Medical University; Clinical emergency hospital named. N. V. Soloviev
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Alexey V. Petryaykin
- Scientific and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Department of Health
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31
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Androjna C, Yee CS, White CR, Waldorff EI, Ryaby JT, Zborowski M, Alliston T, Midura RJ. A comparison of alendronate to varying magnitude PEMF in mitigating bone loss and altering bone remodeling in skeletally mature osteoporotic rats. Bone 2021; 143:115761. [PMID: 33217628 DOI: 10.1016/j.bone.2020.115761] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 11/13/2020] [Accepted: 11/14/2020] [Indexed: 01/12/2023]
Abstract
Pulsed electromagnetic field (PEMF) treatments stimulate bone formation activities though further work is needed to optimize its therapeutic benefit. PEMF can generate local potential gradients and electric currents that have been suggested to mimic bone electrochemical responses to load. In line with this reasoning, a recent publication reported that PEMF application on isolated bone tissue induced detectable micro-vibrations (doi:https://doi.org/10.1109/TMAG.2016.2515069). To determine the ability of PEMF to intervene in a rat model of osteoporosis, we tested its effect on trabecular and cortical bone following ovariectomy. Four PEMF treatments, with increasing sinusoidal amplitude rise with time (3850 Hz pulse frequency and 15 Hz repetition rate at 10 tesla/sec (T/s), 30 T/s, 100 T/s, or 300 T/s), were compared to the efficacy of an osteoporosis drug, alendronate, in reducing levels of trabecular bone loss in the proximal tibia. Herein, the novel findings from our study are: (1) 30 T/s PEMF treatment approached the efficacy of alendronate in reducing trabecular bone loss, but differed from it by not reducing bone formation rates; and (2) 30 T/s and 100 T/s PEMF treatments imparted measurable alterations in lacunocanalicular features in cortical bone, consistent with osteocyte sensitivity to PEMF in vivo. The efficacy of specific PEMF doses may relate to their ability to modulate osteocyte function such that the 30 T/s, and to a lesser extent 100 T/s, doses preferentially antagonize trabecular bone resorption while stimulating bone formation. Thus, PEMF treatments of specific magnetic field magnitudes exert a range of measurable biological effects in trabecular and cortical bone tissue in osteoporotic rats.
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Affiliation(s)
- Caroline Androjna
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Cristal S Yee
- Department of Orthopaedic Surgery, Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, United States of America
| | - Carter R White
- Department of Orthopaedic Surgery, Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, United States of America
| | | | - James T Ryaby
- Orthofix, Inc., Lewisville, TX, United States of America
| | - Maciej Zborowski
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Tamara Alliston
- Department of Orthopaedic Surgery, Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, United States of America
| | - Ronald J Midura
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States of America.
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Park JH, Kwoen MJ, Lee JR, Kim KS, Lee HJ, Kim JW, Lee H. Gradual, but Not Sudden, Dose-Dependent Increase of ONJ Risk With Bisphosphonate Exposure: A Nationwide Cohort Study in Women With Osteoporosis. Front Endocrinol (Lausanne) 2021; 12:774820. [PMID: 34956086 PMCID: PMC8695600 DOI: 10.3389/fendo.2021.774820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/18/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND A causal relationship of bisphosphonate (BP) exposure with osteonecrosis of the jaw (ONJ) has been reported; however, a definite dose-dependent risk remains to be elucidated beyond current vague recommendations of 4-year oral BP for ONJ risk increase. OBJECTIVE To identify the effect of bisphosphonate cumulative dose on ONJ development in women with osteoporosis. METHODS A retrospective cohort study was designed using the National Health Insurance Service-National Health Screening database of Korea. Females over the age of 50 were diagnosed with osteoporosis based on the International Classification of Diseases 10th revision (ICD-10) codes (M80, M81, and M82) with bisphosphonate prescriptions. The cumulative dose of bisphosphonate was calculated using defined daily doses (DDD) to provide an accurate BP cumulative effect on ONJ occurrence. Osteonecrosis of the jaw was identified using both ICD-10 codes and related procedure codes. The incidence rates of ONJ and hazard ratios were estimated according to the bisphosphonate cumulative dose. RESULTS Among 74,491 included subjects, 190 cases of ONJ were identified. The incidence rate substantially increased after BP cumulative dose over 1 year (25.75 for DDD < 365, which increased to 53.43 for 365 ≤ DDD < 730). Compared to subjects with a cumulative dose of DDD < 365, subjects with a cumulative dose of 365 ≤ DDD < 730 had 2.36-fold hazard for developing ONJ (p < 0.001). CONCLUSION A bisphosphonate cumulative dose of more than 1 year had an increased risk of ONJ development. A gradual, but not sudden, dose-dependent increase in ONJ risk with BP exposure needs to be considered in providing the optimal BP treatment duration.
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Affiliation(s)
- Jung-Hyun Park
- Department of Oral and Maxillofacial Surgery, Research Institute for Intractable Osteonecrosis of the Jaw, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Min-Jeong Kwoen
- Department of Periodontology, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jae-Ryun Lee
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Keun-Suh Kim
- Department of Periodontology, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hyo-Jung Lee
- Department of Periodontology, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jin-Woo Kim
- Department of Oral and Maxillofacial Surgery, Research Institute for Intractable Osteonecrosis of the Jaw, College of Medicine, Ewha Womans University, Seoul, South Korea
- *Correspondence: Hyejin Lee, ; Jin-Woo Kim, ;
| | - Hyejin Lee
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- *Correspondence: Hyejin Lee, ; Jin-Woo Kim, ;
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33
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Persistence with oral bisphosphonates and denosumab among older adults in primary care in Ireland. Arch Osteoporos 2021; 16:71. [PMID: 33864529 PMCID: PMC8053179 DOI: 10.1007/s11657-021-00932-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/23/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Gaps in pharmacological treatment for osteoporosis can reduce effectiveness. Among older adults, we found about half of new users of oral bisphosphonate and denosumab persisted with their treatment at 2 years, with few switching to alternative therapy. Persistence is suboptimal and warrants evaluation of interventions to improve this. PURPOSE Gaps in pharmacological treatment for osteoporosis can reduce effectiveness. This study aimed to estimate persistence rates for oral bisphosphonates and denosumab in older primary care patients and identify factors associated with discontinuation. METHODS Older patients newly prescribed oral bisphosphonates or denosumab during 2012-2017 were identified from 44 general practices (GP) in Ireland. Persistence without a coverage gap of >90 days was calculated for both medications from therapy initiation. Factors associated with time to discontinuation were explored using Cox regression analysis. Exposures included age group, osteoporosis diagnosis, fracture history, calcium/vitamin D prescription, number of other medications, health cover, dosing frequency (bisphosphonates) and previous bone-health medication (denosumab). RESULTS Of 41,901 patients, n=1569 were newly initiated on oral bisphosphonates and n=1615 on denosumab. Two-year persistence was 49.4% for oral bisphosphonates and 53.8% for denosumab and <10% were switched to other medication. Having state-funded health cover was associated with a lower hazard of discontinuation for both oral bisphosphonates (HR=0.49, 95% CI=0.36-0.66, p<0.01) and denosumab (HR=0.71, 95% CI=0.57-0.89, p<0.01). Older age group, number of medications and calcium/vitamin D prescription were also associated with better bisphosphonate persistence, while having osteoporosis diagnosed was associated with better denosumab persistence. CONCLUSION Persistence for osteoporosis medications is suboptimal. Of concern, few patients are switched to other bone-health treatments when denosumab is stopped which could increase fracture risk. Free access to GP services and medications may have resulted in better medication persistence in this cohort. Future research should explore prescribing choices in primary care osteoporosis management and evaluate cost-effectiveness of interventions for improving persistence.
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34
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Lo JC, Neugebauer RS, Ettinger B, Chandra M, Hui RL, Ott SM, Grimsrud CD, Izano MA. Risk of complete atypical femur fracture with Oral bisphosphonate exposure beyond three years. BMC Musculoskelet Disord 2020; 21:801. [PMID: 33272248 PMCID: PMC7713036 DOI: 10.1186/s12891-020-03672-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 09/24/2020] [Indexed: 11/10/2022] Open
Abstract
Background Bisphosphonate (BP) therapy has been associated with atypical femur fracture (AFF). However, the threshold of treatment duration leading to increased AFF risk is unclear. In a retrospective cohort of older women initiating BP, we compared the AFF risk associated with treatment for at least three years to the risk associated with treatment less than three years. Methods We used observational data from a large population of female members of an integrated healthcare system who initiated oral BP during 2002–2014. Women were retrospectively followed for incident AFF confirmed by radiologic adjudication. Demographic data, pharmacologic exposures, comorbidity, bone density, and fracture history were ascertained from electronic health records. Inverse probability weighting was used to estimate risk differences comparing the cumulative incidence (risk) of AFF if women discontinued BP within three years to the cumulative incidence of AFF if women continued BP for three or more years, adjusting for potential time-dependent confounding by the aforementioned factors. Results Among 87,820 women age 45–84 years who initiated BP (mean age 68.6, median T-score − 2.6, 14% with prior major osteoporotic fracture), 16,180 continued BP for three or more years. Forty-six confirmed AFFs occurred during follow-up in the two groups. AFF-free survival was greater for BP treatment < 3 years compared to treatment ≥3 years (p = 0.004 comparing areas under survival curves). At five years, the risk of AFF was 27 per 100,000 (95% confidence interval, CI: 8–46) if women received BP treatment < 3 years and 120 per 100,000 (95% CI: 56–183) if women received BP treatment ≥3 years (risk difference 93 per 100,000, 95% CI: 30–160). By ten years, the risks were 27 (95% CI: 8–46) and 363 (95% CI: 132–593) per 100,000 for BP treatment < 3 and ≥ 3 years, respectively (risk difference 336 per 100,000, 95% CI: 110–570). Conclusions Bisphosphonate treatment for 3 or more years was associated with greater risk of AFF than treatment for less than 3 years. Although AFFs are uncommon among BP-treated women, this increased risk should be considered when counseling women about long-term BP use. Future studies should further characterize the dose-response relationship between BP duration and incident AFF and identify patients at highest risk.
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Affiliation(s)
- Joan C Lo
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA. .,The Permanente Medical Group, Oakland, CA, USA.
| | - Romain S Neugebauer
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.,The Permanente Medical Group, Oakland, CA, USA
| | - Bruce Ettinger
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Malini Chandra
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Rita L Hui
- Pharmacy Outcomes Research Group, Kaiser Permanente California, Oakland, CA, USA
| | - Susan M Ott
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Christopher D Grimsrud
- The Permanente Medical Group, Oakland, CA, USA.,Department of Orthopedic Surgery, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - Monika A Izano
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
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35
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Terpos E, Ntanasis-Stathopoulos I. Controversies in the use of new bone-modifying therapies in multiple myeloma. Br J Haematol 2020; 193:1034-1043. [PMID: 33249579 DOI: 10.1111/bjh.17256] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 12/22/2022]
Abstract
Bone-modifying therapies are essential in the treatment of patients with multiple myeloma. Zoledronic acid is preferred over other bisphosphonates due to its superiority in reducing the incidence of skeletal-related events and improving survival. The anti-receptor activator of nuclear factor-κΒ ligand (RANKL)-targeted agent denosumab has shown its non-inferiority compared to bisphosphonates in preventing skeletal-related events among newly diagnosed patients with myeloma bone disease. Denosumab may confer a survival benefit in patients eligible for autologous transplantation. Denosumab may present a safer profile for patients with renal impairment. Discontinuation of bone-directed therapies can be considered for patients with deep responses and after an adequate time period on treatment; however, a rebound effect may become evident especially in the case of denosumab. Three-monthly infusions of zoledronic acid or at-home denosumab administration should be considered during the coronavirus disease 2019 (COVID-19) pandemic. Measures to prevent hypocalcaemia, renal toxicity and osteonecrosis of the jaw are important for all bone-modifying agents.
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Affiliation(s)
- Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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36
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Martínez-Reina J, Calvo-Gallego JL, Pivonka P. Are drug holidays a safe option in treatment of osteoporosis? - Insights from an in silico mechanistic PK-PD model of denosumab treatment of postmenopausal osteoporosis. J Mech Behav Biomed Mater 2020; 113:104140. [PMID: 33080564 DOI: 10.1016/j.jmbbm.2020.104140] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 09/11/2020] [Accepted: 10/10/2020] [Indexed: 11/24/2022]
Abstract
Recent reviews by the clinical bone research community suggest caution with prescription of drug holidays for patients with postmenopausal osteoporosis (PMO) treated with denosumab for an extended period of time. Main reasons for this suggestion are based on the fact that discontinuation of denosumab treatment leads to a relapse of osteoclastic bone resorption and a loss of bone mineral density (BMD) to pre-treatment levels at only 12-28 months. The question remains what is the best treatment option for cases where it is required to discontinue and/or reduce the drug dose and what are the consequences on BMD and bone turnover markers (BTMs). The latter questions are difficult to be addressed using clinical trials alone given the large number of parameter combinations involved to answer this problem. In this paper, we apply a recently developed in silico mechanistic pharmacokinetic-pharmacodynamic (PK-PD) model of the effect of denosumab on bone remodelling in PMO. To address the above clinical relevant questions, we design a wide range of current and virtual treatment regimens to study the effect of drug holiday duration and therapy resumption on the evolution of BTMs, BMD and mineral content. Our numerical simulation results indicate the symptomatic effect of denosumab, which is lost once treatment is stopped. This effect is most clearly seen on rapid loss of BMD to pre-treatment levels 12 months after the last injection (8% and 3.6% per year in the lumbar spine and femoral neck, respectively). Also, we identify that independently of the duration of drug holiday (i.e. 12, 16 or 18 months) resuming treatment can restore BMD quite effectively. However, the latter result does not consider the possibility of potential fractures that can occur during the drug holiday. Finally, we identify a treatment case most promising for achieving maintenance of BMD and mineral content, while moderately increasing BTMs. The latter case uses no drug holiday, but reduces the most commonly prescribed denosumab dose (60 mg every 6 months) by half at same interval.
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Affiliation(s)
- Javier Martínez-Reina
- Departmento de Ingeniería Mecánica y Fabricación, Universidad de Sevilla, Seville 41092, Spain.
| | - José Luis Calvo-Gallego
- Departmento de Ingeniería Mecánica y Fabricación, Universidad de Sevilla, Seville 41092, Spain
| | - Peter Pivonka
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, QLD 4000, Australia
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37
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Bakr MM, Kelly WL, Brunt AR, Paterson BC, Massa HM, Morrison NA, Forwood MR. Intermittent Parathyroid Hormone Accelerates Stress Fracture Healing More Effectively Following Cessation of Bisphosphonate Treatment. JBMR Plus 2020; 4:e10387. [PMID: 32995690 PMCID: PMC7507447 DOI: 10.1002/jbm4.10387] [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] [Received: 06/10/2020] [Accepted: 06/28/2020] [Indexed: 11/08/2022] Open
Abstract
Parathyroid hormone (PTH) and bisphosphonates (BPs), including alendronate (ALN), have opposing effects on bone dynamics. The extent to which PTH remains effective in the treatment of stress fracture (SFx) in the presence of an ongoing BP treatment has not been tested. SFx was induced in 150 female Wistar rats, divided into five equal groups (n = 30). All rats were pretreated with ALN (1 μg/kg-1/day-1) for 14 days prior to SFx induction, followed by ALN cessation or continuation for the duration of the experiment; this was combined with daily PTH (8 μg/100 g-1/day-1) on SFx induction for 14 days, followed by cessation or continuation of ALN after SFx induction or an equivalent vehicle as a control. Ulnas were examined 2 weeks or 6 weeks following SFx. Two toluidine blue- and two tartrate-resistant acid phosphatase-stained sections were examined for histomorphometric analysis using Osteomeasure software. There was a significant interaction between the effects of time and treatment type on the woven bone width and apposition rate, as well as an improvement in the woven bone architecture. However, woven bone variables remained unaffected by the cessation or continuation of ALN. Cessation of ALN increased osteoclast number when compared with the ALN-PTH continuation group (p = 0.006), and vehicle (p = 0.024) after 2 weeks. There was a significant interaction between the effects of time and treatment type on the number of osteoclasts per unit BMU area and length. The number of osteoclasts per unit BMU area and length was significantly greater in ALN cessation groups. It was concluded that intermittent short-duration iPTH treatment effectively increased remodeling of SFx with a concurrent BP treatment, provided that BP was ceased at the time of SFx. Our results could help develop shorter iPTH treatment protocols for the clinical management of SFxs and guide clinical decision-making to cease BP treatment in cases of SFx. © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Mahmoud M Bakr
- School of Medical Sciences and Menzies Health Institute Queensland Griffith University Gold Coast Queensland Australia.,School of Dentistry and Oral Health Griffith University Gold Coast Queensland Australia
| | - Wendy L Kelly
- School of Medical Sciences and Menzies Health Institute Queensland Griffith University Gold Coast Queensland Australia
| | - Athena R Brunt
- School of Medical Sciences and Menzies Health Institute Queensland Griffith University Gold Coast Queensland Australia
| | - Bradley C Paterson
- School of Medical Sciences and Menzies Health Institute Queensland Griffith University Gold Coast Queensland Australia
| | - Helen M Massa
- School of Medical Sciences and Menzies Health Institute Queensland Griffith University Gold Coast Queensland Australia
| | - Nigel A Morrison
- School of Medical Sciences and Menzies Health Institute Queensland Griffith University Gold Coast Queensland Australia
| | - Mark R Forwood
- School of Medical Sciences and Menzies Health Institute Queensland Griffith University Gold Coast Queensland Australia
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38
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Dell'Aquila E, Armento G, Iuliani M, Simonetti S, D'Onofrio L, Zeppola T, Madaudo C, Russano M, Citarella F, Ribelli G, Pantano F, Vincenzi B, Tonini G, Santini D. Denosumab for cancer-related bone loss. Expert Opin Biol Ther 2020; 20:1261-1274. [PMID: 32835531 DOI: 10.1080/14712598.2020.1814731] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Prolonged use of anti-cancer treatments in breast and prostate tumors alters physiological bone turnover leading to adverse skeletal related events, such as osteoporosis, loss of bone mass, and increased risk of fractures. These complications known as cancer treatment-induced bone loss (CTIBL) should be managed with bone targeting agents such as the bisphosphonates and denosumab. The latter is a monoclonal antibody against the receptor activator of nuclear factor-kB ligand (RANKL) that suppresses osteoclasts function and survival increasing bone mass. AREAS COVERED This review will focus on the mechanisms associated with bone loss induced by cancer treatments and the most recent evidence about the use of denosumab as preventive and therapeutic strategy to protect bone health. Moreover, we will discuss several key aspects regarding the clinical practical use of denosumab to optimize the management of CTLIB in breast and prostate cancer. EXPERT OPINION Denosumab treatment strongly prevents cancer therapies-related skeletal issues in breast and prostate cancer with a good safety profile. Adjuvant six-monthly denosumab delays the time to first fracture onset in early stage breast cancer patients with normal or altered bone mineral density (BMD). Similarly, denosumab treatment is able to prevent fractures and BMD loss in nonmetastatic prostate cancer patients.
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Affiliation(s)
| | - Grazia Armento
- Medical Oncology Department, Campus Bio-Medico University of Rome , Rome, Itlay
| | - Michele Iuliani
- Medical Oncology Department, Campus Bio-Medico University of Rome , Rome, Itlay
| | - Sonia Simonetti
- Medical Oncology Department, Campus Bio-Medico University of Rome , Rome, Itlay
| | - Loretta D'Onofrio
- Medical Oncology Department, Campus Bio-Medico University of Rome , Rome, Itlay
| | - Tea Zeppola
- Medical Oncology Department, Campus Bio-Medico University of Rome , Rome, Itlay
| | - Cristina Madaudo
- Medical Oncology Department, Campus Bio-Medico University of Rome , Rome, Itlay
| | - Marco Russano
- Medical Oncology Department, Campus Bio-Medico University of Rome , Rome, Itlay
| | - Fabrizio Citarella
- Medical Oncology Department, Campus Bio-Medico University of Rome , Rome, Itlay
| | - Giulia Ribelli
- Medical Oncology Department, Campus Bio-Medico University of Rome , Rome, Itlay
| | - Francesco Pantano
- Medical Oncology Department, Campus Bio-Medico University of Rome , Rome, Itlay
| | - Bruno Vincenzi
- Medical Oncology Department, Campus Bio-Medico University of Rome , Rome, Itlay
| | - Giuseppe Tonini
- Medical Oncology Department, Campus Bio-Medico University of Rome , Rome, Itlay
| | - Daniele Santini
- Medical Oncology Department, Campus Bio-Medico University of Rome , Rome, Itlay
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Campisi G, Mauceri R, Bertoldo F, Bettini G, Biasotto M, Colella G, Consolo U, Di Fede O, Favia G, Fusco V, Gabriele M, Lo Casto A, Lo Muzio L, Marcianò A, Mascitti M, Meleti M, Mignogna MD, Oteri G, Panzarella V, Romeo U, Santarelli A, Vescovi P, Marchetti C, Bedogni A. Medication-Related Osteonecrosis of Jaws (MRONJ) Prevention and Diagnosis: Italian Consensus Update 2020. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5998. [PMID: 32824826 PMCID: PMC7460511 DOI: 10.3390/ijerph17165998] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 12/15/2022]
Abstract
The Medication-Related Osteonecrosis of Jaws (MRONJ) diagnosis process and its prevention play a role of great and rising importance, not only on the Quality of Life (QoL) of patients, but also on the decision-making process by the majority of dentists and oral surgeons involved in MRONJ prevention (primary and secondary). The present paper reports the update of the conclusions from the Consensus Conference-held at the Symposium of the Italian Society of Oral Pathology and Medicine (SIPMO) (20 October 2018, Ancona, Italy)-after the newest recommendations (2020) on MRONJ were published by two scientific societies (Italian Societies of Maxillofacial Surgery and Oral Pathology and Medicine, SICMF and SIPMO), written on the inputs of the experts of the Italian Allied Committee on ONJ (IAC-ONJ). The conference focused on the topic of MRONJ, and in particular on the common practices at risk of inappropriateness in MRONJ diagnosis and therapy, as well as on MRONJ prevention and the dental management of patients at risk of MRONJ. It is a matter of cancer and osteometabolic patients that are at risk since being exposed to several drugs with antiresorptive (i.e., bisphosphonates and denosumab) or, more recently, antiangiogenic activities. At the same time, the Conference traced for dentists and oral surgeons some easy applicable indications and procedures to reduce MRONJ onset risk and to diagnose it early. Continuous updating on these issues, so important for the patient community, is recommended.
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Affiliation(s)
- Giuseppina Campisi
- Department of Surgical, Oncological, and Oral Sciences, University of Palermo, 90127 Palermo, Italy; (G.C.); (O.D.F.); (A.L.C.); (V.P.)
- IAC-ONJ (Italian Allied Committee on ONJ), Temporary Chair at University of Palermo, 90100 Piazza Marina, Italy; (F.B.); (G.B.); (V.F.); (P.V.); (C.M.); (A.B.)
| | - Rodolfo Mauceri
- Department of Surgical, Oncological, and Oral Sciences, University of Palermo, 90127 Palermo, Italy; (G.C.); (O.D.F.); (A.L.C.); (V.P.)
- IAC-ONJ (Italian Allied Committee on ONJ), Temporary Chair at University of Palermo, 90100 Piazza Marina, Italy; (F.B.); (G.B.); (V.F.); (P.V.); (C.M.); (A.B.)
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98124 Messina, Italy; (A.M.); (G.O.)
| | - Francesco Bertoldo
- IAC-ONJ (Italian Allied Committee on ONJ), Temporary Chair at University of Palermo, 90100 Piazza Marina, Italy; (F.B.); (G.B.); (V.F.); (P.V.); (C.M.); (A.B.)
- Department of Medicine, University of Verona, 37134 Verona, Italy
| | - Giordana Bettini
- IAC-ONJ (Italian Allied Committee on ONJ), Temporary Chair at University of Palermo, 90100 Piazza Marina, Italy; (F.B.); (G.B.); (V.F.); (P.V.); (C.M.); (A.B.)
- Regional Center for Prevention, Diagnosis and Treatment of Medication and Radiation-Related Bone Diseases of the Head and Neck, University of Padova, 35128 Padova, Italy
| | - Matteo Biasotto
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34129 Trieste, Italy;
| | - Giuseppe Colella
- Department of Medical, Surgical and Dental Speciality, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Ugo Consolo
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Olga Di Fede
- Department of Surgical, Oncological, and Oral Sciences, University of Palermo, 90127 Palermo, Italy; (G.C.); (O.D.F.); (A.L.C.); (V.P.)
- IAC-ONJ (Italian Allied Committee on ONJ), Temporary Chair at University of Palermo, 90100 Piazza Marina, Italy; (F.B.); (G.B.); (V.F.); (P.V.); (C.M.); (A.B.)
| | - Gianfranco Favia
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy;
| | - Vittorio Fusco
- IAC-ONJ (Italian Allied Committee on ONJ), Temporary Chair at University of Palermo, 90100 Piazza Marina, Italy; (F.B.); (G.B.); (V.F.); (P.V.); (C.M.); (A.B.)
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Mario Gabriele
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy;
| | - Antonio Lo Casto
- Department of Surgical, Oncological, and Oral Sciences, University of Palermo, 90127 Palermo, Italy; (G.C.); (O.D.F.); (A.L.C.); (V.P.)
- IAC-ONJ (Italian Allied Committee on ONJ), Temporary Chair at University of Palermo, 90100 Piazza Marina, Italy; (F.B.); (G.B.); (V.F.); (P.V.); (C.M.); (A.B.)
| | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, University of Foggia, 71121 Foggia, Italy;
| | - Antonia Marcianò
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98124 Messina, Italy; (A.M.); (G.O.)
| | - Marco Mascitti
- Department of Clinical Specialistic and Dental Sciences, Marche Polytechnic University, 60126 Ancona, Italy; (M.M.); (A.S.)
| | - Marco Meleti
- Department of Medicine and Surgery, University of Parma, 43125 Parma, Italy;
| | - Michele D. Mignogna
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, 80131 Napoli, Italy;
| | - Giacomo Oteri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98124 Messina, Italy; (A.M.); (G.O.)
| | - Vera Panzarella
- Department of Surgical, Oncological, and Oral Sciences, University of Palermo, 90127 Palermo, Italy; (G.C.); (O.D.F.); (A.L.C.); (V.P.)
- IAC-ONJ (Italian Allied Committee on ONJ), Temporary Chair at University of Palermo, 90100 Piazza Marina, Italy; (F.B.); (G.B.); (V.F.); (P.V.); (C.M.); (A.B.)
| | - Umberto Romeo
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, 00161 Roma, Italy;
| | - Andrea Santarelli
- Department of Clinical Specialistic and Dental Sciences, Marche Polytechnic University, 60126 Ancona, Italy; (M.M.); (A.S.)
| | - Paolo Vescovi
- IAC-ONJ (Italian Allied Committee on ONJ), Temporary Chair at University of Palermo, 90100 Piazza Marina, Italy; (F.B.); (G.B.); (V.F.); (P.V.); (C.M.); (A.B.)
- Department of Medicine and Surgery, University of Parma, 43125 Parma, Italy;
| | - Claudio Marchetti
- IAC-ONJ (Italian Allied Committee on ONJ), Temporary Chair at University of Palermo, 90100 Piazza Marina, Italy; (F.B.); (G.B.); (V.F.); (P.V.); (C.M.); (A.B.)
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40125 Bologna, Italy
| | - Alberto Bedogni
- IAC-ONJ (Italian Allied Committee on ONJ), Temporary Chair at University of Palermo, 90100 Piazza Marina, Italy; (F.B.); (G.B.); (V.F.); (P.V.); (C.M.); (A.B.)
- Regional Center for Prevention, Diagnosis and Treatment of Medication and Radiation-Related Bone Diseases of the Head and Neck, University of Padova, 35128 Padova, Italy
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Cheung E, Borno HT. The limitations of today’s clinical guidance: Atypical femoral fracture and long-term bone-modifying agents in the oncology setting. J Oncol Pharm Pract 2020; 26:1180-1189. [DOI: 10.1177/1078155220907965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
While bone-modifying agents such as bisphosphonates and denosumab are crucial to preventing skeletal-related events in patients with bone metastases, the optimal duration remains undefined. Extended duration may be associated with adverse effects such as osteonecrosis of the jaw and atypical femoral fracture. Although uncommon, atypical femoral fracture represents a serious consequence of prolonged bone-modifying agent use and are characterized by a prodrome and distinct radiographic findings. The oncology setting encompasses a unique set of atypical femoral fracture risk factors and considerations, with hormonal therapy in early stage disease, bone metastases in the advanced setting, and new targeted agents that may affect bone homeostasis. As outcomes in cancer treatment continue to improve, the questions of risks versus benefits of long-term bone-modifying agents and how to mitigate atypical femoral fracture risk become increasingly pertinent.
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Affiliation(s)
- Edna Cheung
- Department of Clinical Pharmacy and School of Pharmacy, University of California San Francisco, San Francisco, USA
| | - Hala T Borno
- Division of Hematology/Oncology, School of Medicine, University of California San Francisco, San Francisco, USA
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Everts-Graber J, Reichenbach S, Ziswiler HR, Studer U, Lehmann T. A Single Infusion of Zoledronate in Postmenopausal Women Following Denosumab Discontinuation Results in Partial Conservation of Bone Mass Gains. J Bone Miner Res 2020; 35:1207-1215. [PMID: 31991007 DOI: 10.1002/jbmr.3962] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 01/10/2020] [Accepted: 01/19/2020] [Indexed: 12/19/2022]
Abstract
Discontinuation of denosumab is associated with a rapid return of bone mineral density (BMD) to baseline and an increased risk of multiple vertebral fractures. No subsequent treatment regimen has yet been established for preventing either loss of BMD or multiple vertebral fractures after denosumab discontinuation. The aim of this 8-year observational study was to investigate the effect of a single zoledronate infusion, administered 6 months after the last denosumab injection, on fracture occurrence and loss of BMD. We report on 120 women with postmenopausal osteoporosis who were treated with 60 mg denosumab every 6 months for 2 to 5 years (mean duration 3 years) and then 5 mg zoledronate 6 months after the last denosumab injection. All patients were evaluated clinically, by dual-energy X-ray absorptiometry (DXA) and vertebral fracture assessment (VFA), before the first and after the last denosumab injection and at 2.5 years (median) after denosumab discontinuation. During this off-treatment period, 3 vertebral fractures (1.1 per 100 patient-years) and 4 nonvertebral fractures (1.5 per 100 patient-years) occurred. No patients developed multiple vertebral fractures. Sixty-six percent (confidence interval [CI] 57% to 75%) of BMD gained with denosumab was retained at the lumbar spine and 49% (CI 31% to 67%) at the total hip. There was no significant difference in the decrease of BMD between patients with BMD gains of >9% versus <9% while treated with denosumab. Previous antiresorptive treatment or prevalent fractures had no impact on the decrease of BMD, and all bone loss occurred within the first 18 months after zoledronate infusion. In conclusion, a single infusion of 5 mg zoledronate after a 2- to 5-year denosumab treatment cycle retained more than half of the gained BMD and was not associated with multiple vertebral fractures, as reported in patients who discontinued denosumab without subsequent bisphosphonate treatment. © 2020 American Society for Bone and Mineral Research.
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Affiliation(s)
| | - Stephan Reichenbach
- Department of Rheumatology, Immunology and Allergology, University Hospital, Bern, Switzerland.,Institute for Social and Preventive Medicine, Bern, Switzerland
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Paschou SA, Anagnostis P, Pavlou DI, Vryonidou A, Goulis DG, Lambrinoudaki I. Diabetes in Menopause: Risks and Management. Curr Vasc Pharmacol 2020; 17:556-563. [PMID: 29938620 DOI: 10.2174/1570161116666180625124405] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 06/05/2018] [Accepted: 06/16/2018] [Indexed: 12/14/2022]
Abstract
The aim of this review is to present, critically appraise and qualitatively synthesize current evidence on the risk of type 2 diabetes mellitus (T2DM) development during menopause, the management of climacteric symptoms in women with T2DM and the management of T2DM in postmenopausal women. Menopause represents the end of reproductive life in women, as a result of ovarian aging. It is characterized by substantial decrease in the endogenous oestrogen concentrations and it is accompanied by alterations in body weight, adipose tissue distribution and energy expenditure, as well as insulin secretion, insulin sensitivity and activity that can predispose to the development of T2DM, independently of, and additively to, aging. Many women in midlife experience climacteric symptoms, including hot flushes and night sweats, resulting in an indication to receive Hormone Replacement Treatment (HRT). HRT has a favourable effect on glucose homeostasis both in women without and with T2DM. The latter was considered in the past as a cardiovascular disease (CVD) equivalent, which would suggest that women with the disease should not receive HRT. However, nowadays evidence exists to support an individualized approach of women based on their CVD risk, as some women with T2DM may be excellent candidates for HRT. Regarding T2DM management for women in menopause, lifestyle intervention, including diet and exercise, constitutes its cornerstone. However, most of these women will eventually require pharmacologic therapy. The most suitable agents should be selected according to their metabolic, cardiovascular and bone effects, taking into consideration the specific characteristics and comorbidities of each postmenopausal woman.
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Affiliation(s)
- Stavroula A Paschou
- Division of Endocrinology and Diabetes, "Aghia Sophia" Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Anagnostis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitra I Pavlou
- Forth Department of Internal Medicine, Hippokration Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andromachi Vryonidou
- Department of Endocrinology and Diabetes, Hellenic Red Cross Hospital, Athens, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Irene Lambrinoudaki
- Division of Endocrinology and Diabetes, Second Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Sanchez-Rodriguez D, Bergmann P, Body JJ, Cavalier E, Gielen E, Goemaere S, Lapauw B, Laurent MR, Rozenberg S, Honvo G, Beaudart C, Bruyère O. The Belgian Bone Club 2020 guidelines for the management of osteoporosis in postmenopausal women. Maturitas 2020; 139:69-89. [PMID: 32747044 DOI: 10.1016/j.maturitas.2020.05.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To provide updated evidence-based guidelines for the management of osteoporosis in postmenopausal women in Belgium. METHODS The Belgian Bone Club (BBC) gathered a guideline developer group. Nine "Population, Intervention, Comparator, Outcome" (PICO) questions covering screening, diagnosis, non-pharmacological and pharmacological treatments, and monitoring were formulated. A systematic search of MEDLINE, the Cochrane Database of Systematic Reviews, and Scopus was performed to find network meta-analyses, meta-analyses, systematic reviews, guidelines, and recommendations from scientific societies published in the last 10 years. Manual searches were also performed. Summaries of evidence were provided, and recommendations were further validated by the BBC board members and other national scientific societies' experts. RESULTS Of the 3840 references in the search, 333 full texts were assessed for eligibility, and 129 met the inclusion criteria. Osteoporosis screening using clinical risk factors should be considered. Patients with a recent (<2 years) major osteoporotic fracture were considered at very high and imminent risk of future fracture. The combination of bone mineral density measured by dual-energy X-ray absorptiometry and 10-year fracture risk was used to categorize patients as low or high risk. Patient education, the combination of weight-bearing and resistance training, and optimal calcium intake and vitamin D status were recommended. Antiresorptive and anabolic osteoporosis treatment should be considered for patients at high and very high fracture risk, respectively. Follow-up should focus on compliance, and patient-tailored monitoring should be considered. CONCLUSION BBC guidelines and 25 guideline recommendations bridge the gap between research and clinical practice for the screening, diagnosis, and management of osteoporosis.
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Affiliation(s)
- D Sanchez-Rodriguez
- WHO Collaborating Center for Public Health aspects of musculo-skeletal health and ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium; Geriatrics Department, Rehabilitation Research Group, Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain.
| | - P Bergmann
- Department of Radioisotopes, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - J J Body
- Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - E Cavalier
- Department of Clinical Chemistry, UnilabLg, University of Liège, CHU de Liège, Liège, Belgium
| | - E Gielen
- Gerontology and Geriatrics Section, Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, University Hospitals, Leuven, Belgium
| | - S Goemaere
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium
| | - B Lapauw
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium
| | - M R Laurent
- Geriatrics Department, Imelda Hospital, Bonheiden, Belgium
| | - S Rozenberg
- Department of Gynaecology-Obstetrics, Université Libre de Bruxelles, Brussels, Belgium
| | - G Honvo
- WHO Collaborating Center for Public Health aspects of musculo-skeletal health and ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - C Beaudart
- WHO Collaborating Center for Public Health aspects of musculo-skeletal health and ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - O Bruyère
- WHO Collaborating Center for Public Health aspects of musculo-skeletal health and ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
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Zhang N, Zhang ZK, Yu Y, Zhuo Z, Zhang G, Zhang BT. Pros and Cons of Denosumab Treatment for Osteoporosis and Implication for RANKL Aptamer Therapy. Front Cell Dev Biol 2020; 8:325. [PMID: 32478071 PMCID: PMC7240042 DOI: 10.3389/fcell.2020.00325] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 04/16/2020] [Indexed: 12/26/2022] Open
Abstract
Osteoporosis is age-related deterioration in bone mass and micro-architecture. Denosumab is a novel human monoclonal antibody for osteoporosis. It is a receptor activator of nuclear factor-κB ligand (RANKL) inhibitor, which binds to and inhibits osteoblast-produced RANKL, in turn reduces the binding between RANKL and osteoclast receptor RANK, therefore decreases osteoclast-mediated bone resorption and turnover. However, adverse events have also been reported after denosumab treatment, including skin eczema, flatulence, cellulitis and osteonecrosis of the jaw (ONJ). Extensive researches on the mechanism of adverse reactions caused by denosumab have been conducted and may provide new insights into developing new RANKL inhibitors that achieve better specificity and safety. Aptamers are single-stranded oligonucleotides that can bind to target molecules with high specificity and affinity. They are screened from large single-stranded synthetic oligonucleotides and enriched by a technology named SELEX (systematic evolution of ligands by exponential enrichment). With extra advantages such as high stability, low immunogenicity and easy production over antibodies, aptamers are hypothesized to be promising candidates for therapeutic drugs targeting RANKL to counteract osteoporosis. In this review, we focus on the pros and cons of denosumab treatment in osteoporosis and the implication for novel aptamer treatment.
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Affiliation(s)
- Ning Zhang
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Zong-Kang Zhang
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Yuanyuan Yu
- Law Sau Fai Institute for Advancing Translational Medicine in Bone and Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China
| | - Zhenjian Zhuo
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Ge Zhang
- Law Sau Fai Institute for Advancing Translational Medicine in Bone and Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China
| | - Bao-Ting Zhang
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Abstract
BACKGROUND Discontinuation of bisphosphonates (BP) or a "drug holiday" after several years of treatment is increasingly common. However, the association of drug holiday duration with future fracture risk is unclear. OBJECTIVES We evaluated the rate of fracture in relation to various lengths of drug holidays among women receiving long-term BP therapy. RESEARCH DESIGN Observational cohort study using US Medicare data 2006-2016. Incidence rates (IRs) and Cox proportional hazards models were used to evaluate the rate and adjusted hazard ratios (aHRs) controlling for potential confounders. SUBJECTS Women aged 65 years and above enrolled in fee-for-service Medicare who had been adherent (≥80%) to alendronate, risedronate, or zoledronate for ≥3 years. MEASURES Hip, humerus, distal forearm, and clinical vertebral fracture. RESULTS Among 81,427 eligible women observed for a median (interquartile range) of 4.0 (2.5, 5.3) years, 28% of women underwent a drug holiday. In the alendronate cohort (73% overall), the IR of hip fracture among women who discontinued BP for >2 years was 13.2 per 1000 person-years. Risk was increased (aHR=1.3, 1.1-1.4) versus continuing therapy (IR=8.8, referent). Rates were elevated for humerus fracture with discontinuation >2 years (aHR=1.3, 1.1-1.66) and for clinical vertebral fracture with discontinuation >2 years (aHR=1.2, 1.1-1.4). Results were similar for risedronate, zoledronate, and ibandronate for hip and clinical vertebral fracture. CONCLUSION Discontinuing alendronate beyond 2 years was associated with increased risk of hip, humerus, and clinical vertebral fractures.
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Plum LA, Zella J, Clagett-Dame M, DeLuca HF. A New 1,25 Dihydroxy Vitamin D Analog with Strong Bone Anabolic Activity in OVX Rats with Little or no Bone Resorptive Activity. J Bone Miner Res 2020; 35:623-630. [PMID: 31369169 DOI: 10.1002/jbmr.3838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/18/2019] [Accepted: 07/12/2019] [Indexed: 12/20/2022]
Abstract
A new 1α,25-dihydroxy vitamin D3 analog (2-methylene-22(E)-(24R)-22-dehydro-1α,24,25-trihydroxy-19-norvitamin D3 or WT-51) has been tested as a possible therapeutic for osteoporosis. It is 1/10th as active as 1,25(OH)2 D3 in binding affinity for the vitamin D receptor but is at least 200 times more active than 1,25(OH)2 D3 and equal to that of 2MD (2-methylene-19-nor-(20S)-1α,25(OH)2 D3 , an analog previously tested in postmenopausal women), in supporting bone formation by isolated osteoblasts in culture. However, in contrast to 2MD, it is virtually inactive on bone resorption in vivo. WT-51 markedly increased bone mass (lumbar and femur) in ovariectomized (OVX) female rats. Further, bone strength tested by the three-point bending system is significantly increased by WT-51. Thus, WT-51 is an attractive candidate for the treatment of postmenopausal osteoporosis. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Lori A Plum
- Department of Biochemistry, University of Wisconsin-Madison, Madison, WI, USA
| | - Julia Zella
- Department of Biochemistry, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Hector F DeLuca
- Department of Biochemistry, University of Wisconsin-Madison, Madison, WI, USA
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Adami G, Jaleel A, Curtis JR, Delzell E, Chen R, Yun H, Daigle S, Arora T, Danila MI, Wright NC, Cadarette SM, Mudano A, Foster J, Saag KG. Temporal Trends and Factors Associated with Bisphosphonate Discontinuation and Restart. J Bone Miner Res 2020; 35:478-487. [PMID: 31714637 PMCID: PMC7401723 DOI: 10.1002/jbmr.3915] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/23/2019] [Accepted: 11/02/2019] [Indexed: 01/29/2023]
Abstract
Adverse events related to long-term use of bisphosphonates have raised interest in temporary drug discontinuation. Trends in bisphosphonate discontinuation and restart, as well factors associated with these decisions, are not fully understood at a population level. We investigated temporal trends of bisphosphonate discontinuation from 2010 to 2015 and identified factors associated with discontinuation and restart of osteoporosis therapy. Our cohort consisted of long-term bisphosphonate users identified from 2010 to 2015 Medicare data. We defined discontinuation as ≥12 months without bisphosphonate prescription claims. We used conditional logistic regression to compare factors associated with alendronate discontinuation or osteoporosis therapy restart in the 120-day period preceding discontinuation or restart referent to the 120-day preceding control periods. Among 73,800 long-term bisphosphonate users, 59,251 (80.3%) used alendronate, 6806 (9.2%) risedronate, and 7743 (10.5%) zoledronic acid, exclusively. Overall, 26,281 (35.6%) discontinued bisphosphonates for at least 12 months. Discontinuation of bisphosphonates increased from 1.7% in 2010, reaching a peak of 14% in 2012 with levels plateauing through 2015. The factors most strongly associated with discontinuation of alendronate were: benzodiazepine prescription (adjusted odds ratio [aOR] = 2.5; 95% confidence interval [CI] 2.1, 3.0), having a dual-energy X-ray absorptiometry (DXA) scan (aOR = 1.8; 95% CI 1.7, 2.0), and skilled nursing facility care utilization (aOR = 1.8; 95% CI 1.6, 2.1). The factors most strongly associated with restart of osteoporosis therapy were: having a DXA scan (aOR = 9.9; 95% CI 7.7, 12.6), sustaining a fragility fracture (aOR = 2.8; 95% CI 1.8, 4.5), and an osteoporosis or osteopenia diagnosis (aOR = 2.5; 95% CI 2.0, 3.1). Our national evaluation of bisphosphonate discontinuation showed that an increasing proportion of patients on long-term bisphosphonate therapy discontinue medications. The factors associated with discontinuation of alendronate were primarily related to worsening of overall health status, whereas traditional factors associated with worsening bone health were associated with restarting osteoporosis medication. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Giovanni Adami
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA.,Rheumatology Unit, University of Verona, Verona, Italy
| | - Ayesha Jaleel
- Health Primary & Specialty Care Network, Baptist Brookwood Hospital, Birmingham, AL, USA
| | - Jeffrey R Curtis
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth Delzell
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rui Chen
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Huifeng Yun
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shanette Daigle
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tarun Arora
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Maria I Danila
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nicole C Wright
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Suzanne M Cadarette
- Division of Pharmacoepidemiology and Pharmacoeconomics, University of Toronto, Toronto, Canada
| | - Amy Mudano
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeffrey Foster
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kenneth G Saag
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
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Kendler D, Chines A, Clark P, Ebeling PR, McClung M, Rhee Y, Huang S, Stad RK. Bone Mineral Density After Transitioning From Denosumab to Alendronate. J Clin Endocrinol Metab 2020; 105:5607536. [PMID: 31665314 PMCID: PMC7112973 DOI: 10.1210/clinem/dgz095] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 10/03/2019] [Indexed: 01/19/2023]
Abstract
CONTEXT There are few studies on patients transitioning from denosumab to bisphosphonates. OBJECTIVE To investigate patient characteristics and changes in bone mineral density (BMD) after transitioning from denosumab to alendronate. DESIGN Randomized, open-label, 2-year crossover Denosumab Adherence Preference Satisfaction (DAPS) study (NCT00518531). SETTING 25 study centers in the US and Canada. PATIENTS Treatment-naïve postmenopausal women with BMD T-scores from -2.0 to -4.0. INTERVENTIONS This post hoc analysis evaluated women randomized to subcutaneous denosumab 60 mg every 6 months in year 1 followed by once-weekly oral alendronate 70 mg in year 2. MAIN OUTCOME MEASURE A 3% BMD threshold identified participants who lost, maintained, or gained BMD in year 2 on alendronate. RESULTS Of 126 participants randomized to denosumab, 115 (91%) transitioned to alendronate in year 2. BMD increased by 3% to 6% with denosumab in year 1 and by 0% to 1% with alendronate in year 2. After transitioning to alendronate, most participants maintained or increased BMD; 15.9%, 7.6%, and 21.7% lost BMD at the lumbar spine, total hip, and femoral neck, respectively. Few participants fell below their pretreatment baseline BMD value; this occurred most often in those who lost BMD in year 2. Women who lost BMD with alendronate in year 2 also showed a greater percent change in BMD with denosumab in year 1. The BMD change in year 2 was similar regardless of baseline characteristics or adherence to oral alendronate. CONCLUSION Alendronate can effectively maintain the BMD gains accrued after 1 year of denosumab in most patients, regardless of baseline characteristics.
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Affiliation(s)
- David Kendler
- University of British Columbia, Vancouver, BC, Canada
- Correspondence: David Kendler, MD, 150-943 W. Broadway, Vancouver, BC, Canada V5Z 4E1. E-mail:
| | | | - Patricia Clark
- Hospital Infantil de Mexico Federico Gómez and National University of Mexico-UNAM, Mexico City, Mexico
| | | | - Michael McClung
- Oregon Osteoporosis Center, Portland, OR, US
- Australian Catholic University, Melbourne, VIC, Australia
| | - Yumie Rhee
- Yonsei University College of Medicine, Seoul, South Korea
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Abstract
Bisphosphonates have been safely used to treat osteoporosis, effectively reducing fracture risk after 3 to 5 years of treatment. Recent concerns about long-term safety coupled with posttreatment fracture risk reduction have increased support for drug holidays. The decision to start low-risk patients on drug holidays must be based on current fracture risk assessment.
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50
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Nyström A, Kiritopoulos D, Ullmark G, Sörensen J, Petrén-Mallmin M, Milbrink J, Hailer NP, Mallmin H. Denosumab Prevents Early Periprosthetic Bone Loss After Uncemented Total Hip Arthroplasty: Results from a Randomized Placebo-Controlled Clinical Trial. J Bone Miner Res 2020; 35:239-247. [PMID: 31589776 DOI: 10.1002/jbmr.3883] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 08/25/2019] [Accepted: 09/11/2019] [Indexed: 11/08/2022]
Abstract
Implant loosening is the most common indication for revision surgery after total hip arthroplasty (THA). Although bone resorption around the implants plays a pivotal role in the pathophysiology of loosening, it is unknown whether potent early inhibition of osteoclasts could mitigate this process and thus reduce the need for revision surgery. We performed a randomized, double-blind, placebo-controlled phase 2 trial in 64 patients aged 35 to 65 years with unilateral osteoarthritis of the hip. They underwent surgery with an uncemented THA and were randomized to either two subcutaneous doses of denosumab (n = 32) or placebo (n = 32) given 1 to 3 days and 6 months after surgery. Patients were followed for 24 months. Primary outcome was periprosthetic bone mineral density (BMD) of the hip at 12 months as measured by dual-energy X-ray absorptiometry (DXA). In addition, [18 F] sodium fluoride positron emission tomography/CT (F-PET) was performed in half of the patients for analysis of periprosthetic standardized uptake value (SUV). Analyses were made according to intention-to-treat principles. The trial was registered at ClinicalTrials.gov 2011-001481-18, NCT01630941. Denosumab potently inhibited early periprosthetic bone loss. After 12 months, BMD in the denosumab group was 32% (95% confidence interval [CI] 22-44) higher in Gruen zone 7 and 11% (95% CI 8-15) higher in zones 1 to 7. After 24 months, the difference in BMD between groups had decreased to 15% (95% CI 4-27) in zone 7 and 4% (95% CI 0-8) in zones 1 to 7. In both groups, SUV increased after surgery, but the increase was less pronounced in the denosumab group. Biochemical markers of bone metabolism decreased in the denosumab group in the first 12 months, but a rebound effect with marker concentrations above baseline was observed after 24 months. Denosumab potently prevents early periprosthetic bone loss after uncemented THA; however, the effect diminishes after discontinuation of treatment. Further research is needed to determine whether this bone loss will prove to be of clinical importance and, if so, whether the positive effect observed in this study could be preserved by either prolonged treatment with denosumab or additional antiresorptive treatment. © 2019 American Society for Bone and Mineral Research. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Andreas Nyström
- Department of Surgical Sciences, Section of Orthopedics, Uppsala University, Uppsala, Sweden
| | - Demostenis Kiritopoulos
- Department of Surgical Sciences, Section of Orthopedics, Uppsala University, Uppsala, Sweden
| | - Gösta Ullmark
- Department of Orthopedics, Gävle Hospital, Gävle, Sweden
| | - Jens Sörensen
- Department of Surgical Sciences, Section of Nuclear Medicine & PET, Uppsala University, Uppsala, Sweden
| | | | - Jan Milbrink
- Department of Surgical Sciences, Section of Orthopedics, Uppsala University, Uppsala, Sweden
| | - Nils P Hailer
- Department of Surgical Sciences, Section of Orthopedics, Uppsala University, Uppsala, Sweden
| | - Hans Mallmin
- Department of Surgical Sciences, Section of Orthopedics, Uppsala University, Uppsala, Sweden
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