Osteoporosis management in the new millennium

Effect of Bisphosphonates on Bone Health in Adult Renal Transplant Patients: Beyond the First Year Posttransplant-A Systematic Review and Meta-Analysis

Background:

Bone mineral density (BMD) decreases postrenal transplantation. Evidence demonstrating the effects of bisphosphonates on BMD and fracture risk beyond 1-year posttransplant is sparse in existing literature, but remains essential to enhance clinical outcomes in this population.

Objective:

Our study aimed to systematically review and meta-analyze the current literature on the use of any bisphosphonate in the adult renal transplant population beyond the first year of renal transplant to determine its effect on BMD and fracture incidence.

Design:

We conducted a systematic review and meta-analysis of primary research literature that included full-text, English-language, original randomized clinical trials (RCTs) and observational studies.

Setting:

Patient data were primarily captured in an outpatient setting across various studies.

Patients:

Our population of interest was patients older than 18 years who received deceased/living donor kidney transplantation and any bisphosphonate with a follow-up greater than 12 months posttransplantation.

Measurements:

The primary outcome was change in BMD from baseline. Secondary outcomes were the incidence of fractures and effects of other confounders on bone health.

Methods:

We included RCTs and observational studies that satisfied our inclusion criteria. Each study was analyzed for risk of bias and data were extrapolated to analyze for overall statistical significance accounting for heterogeneity of studies.

Results:

Sixteen studies (N = 1762) were analyzed. The follow-up ranged from 12 to 98 months. There was a nonsignificant improvement in BMD with bisphosphonate treatment persisting into the second and third years posttransplant at the lumbar spine. The calculated standardized mean BMD difference was −0.29 (−0.75 to 0.17), P = .22. Only 5 studies reported a total of 43 new fractures. Prednisone (P < .01), low body weight (P < .001), low body mass index (P < .01), and male gender (P < .05) correlated with reduced lumbar and femoral BMD.

Limitations:

Limitations of this review include the use of BMD as a surrogate outcome, the bias of the included studies, and the incomplete reporting data in numerous analyzed studies.

Conclusions:

We demonstrate no statistically significant benefit of bisphosphonate treatment on BMD beyond the first year postrenal transplantation. Despite heterogeneity of treatment, a differential nonsignificant improvement in lumbar spine BMD was consistent and may be clinically relevant.

Trial Registration:

PROSPERO CRD42019125593

Bioactive Molecules Released in Food by Lactic Acid Bacteria: Encrypted Peptides and Biogenic Amines

Lactic acid bacteria (LAB) can produce a huge amount of bioactive compounds. Since their elective habitat is food, especially dairy but also vegetal food, it is frequent to find bioactive molecules in fermented products. Sometimes these compounds can have adverse effects on human health such as biogenic amines (tyramine and histamine), causing allergies, hypertensive crises, and headache. However, some LAB products also display benefits for the consumers. In the present review article, the main nitrogen compounds produced by LAB are considered. Besides biogenic amines derived from the amino acids tyrosine, histidine, phenylalanine, lysine, ornithine, and glutamate by decarboxylation, interesting peptides can be decrypted by the proteolytic activity of LAB. LAB proteolytic system is very efficient in releasing encrypted molecules from several proteins present in different food matrices. Alpha and beta-caseins, albumin and globulin from milk and dairy products, rubisco from spinach, beta-conglycinin from soy and gluten from cereals constitute a good source of important bioactive compounds. These encrypted peptides are able to control nutrition (mineral absorption and oxidative stress protection), metabolism (blood glucose and cholesterol lowering) cardiovascular function (antithrombotic and hypotensive action), infection (microbial inhibition and immunomodulation) and gut-brain axis (opioids and anti-opioids controlling mood and food intake). Very recent results underline the role of food-encrypted peptides in protein folding (chaperone-like molecules) as well as in cell cycle and apoptosis control, suggesting new and positive aspects of fermented food, still unexplored. In this context, the detailed (transcriptomic, proteomic, and metabolomic) characterization of LAB of food interest (as starters, biocontrol agents, nutraceuticals, and probiotics) can supply a solid evidence-based science to support beneficial effects and it is a promising approach as well to obtain functional food. The detailed knowledge of the modulation of human physiology, exploiting the health-promoting properties of fermented food, is an open field of investigation that will constitute the next challenge.

Trends in pathological vertebral fractures in the United States: 1993 to 2004

OBJECT

Pathological vertebral fractures (PVFs) are an increasingly important cause of disability and have many clinical and economic implications. The authors examined trends in epidemiology and surgical management of pathological vertebral fractures in the US between 1993 and 2004.

METHODS

The Nationwide Inpatient Sample database was used to analyze data collected from 1993 through 2004 to determine general trends in PVFs. Patients with PVFs were identified using the appropriate International Classification of Diseases, 9th Revision (ICD-9) diagnostic code (ICD-9 733.13). Trends in vertebral augmentation procedures and spinal fusions as well as comparison with incidences of other major pathological fractures, such as hip and upper limb, were also examined.

RESULTS

In 2004, there were more than 55,000 inpatient admissions for PVFs. The majority of patients admitted were women (78%) in the 65 to 84 year-age group (60%). Medicare accounted for greater than 80% of insurance, and nearly 50% of all patients were admitted from the emergency department. The mean duration of hospitalization has continued to decrease, from 8.1 days in 1993 to 5.4 days in 2004. The mortality rate has remained relatively constant at approximately 1.5%. The discharge disposition has continued to change with an increasing number of patients being discharged to other institutions such as nursing homes and rehabilitation facilities. There was a staggering increase in the number of vertebral augmentation procedures performed between 1993 and 2004. The "national bill" for inpatient hospitalizations for PVFs totaled $1.3 billion in 2004.

CONCLUSIONS

With the continued aging of the population, PVFs represent an important cause of disability and a significant source of healthcare resource utilization.

Hormone replacement therapy in women with spinal cord injury – a survey with literature review

STUDY DESIGN

Postal questionnaire survey.

OBJECTIVE

To examine the current use of hormone replacement therapy (HRT) in a sample of menopausal women with spinal cord injury (SCI).

SETTING

National Spinal Injuries Centre (NSIC), Stoke Mandeville Hospital, Aylesbury, UK.

METHOD

A postal questionnaire was sent to 94 women from the NSIC patient database who met the study inclusion criteria (wheelchair dependent, aged 49 years and above, last seen or heard from within the last 3 years).

RESULTS

A total of 59 valid questionnaires were analysed. At the time of the survey, 50 women were menopausal and 11 of them were using HRT, six for menopausal symptoms and five for osteoporosis prevention. Another 11 had used HRT, eight for menopausal symptoms and three for osteoporosis prevention, but had discontinued it. The main reasons for stopping HRT were side effects. Of the 28 women who had never been on HRT, 20 had either enquired about it, or had been offered HRT, but decided against it. Of the nine women who were still premenopausal at the time of the survey, four would consider using HRT.

CONCLUSIONS

Results show that 44% of the menopausal women in our sample have used HRT at some point and 22% still do, mostly for treatment of menopausal symptoms and for osteoporosis prevention. In view of the latest literature findings in able-bodied women, use of HRT for osteoporosis prevention in women with SCI may have to be reconsidered.