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Seemann LL, Hanos CT, Pujalte GGA. Metabolic Bone Disease. Prim Care 2024; 51:445-454. [PMID: 39067970 DOI: 10.1016/j.pop.2024.04.005] [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] [Indexed: 07/30/2024]
Abstract
Metabolic bone diseases encompass a group of disorders characterized by abnormalities in bone metabolism, structure, or mineralization. These disorders negatively impact overall health and quality of life and place individuals at high risk for fracture, which may increase morbidity and mortality. Clinicians should understand who is at risk for these disorders, select individuals who warrant further workup, determine appropriate laboratory and imaging evaluation, interpret results in a clinical context, and choose an optimal management strategy based on the individual patient.
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Affiliation(s)
- LaRae L Seemann
- Department of Family Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Christina T Hanos
- Department of Family Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - George G A Pujalte
- Department of Family Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA; Department of Orthopedic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
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Jeong S, Kim IK, Moon H, Kim H, Song BW, Choi JW, Kim SW, Lee S, Chae DS, Lim S. A 70% Ethanol Neorhodomela munita Extract Attenuates RANKL-Induced Osteoclast Activation and H 2O 2-Induced Osteoblast Apoptosis In Vitro. Molecules 2024; 29:1741. [PMID: 38675559 PMCID: PMC11052068 DOI: 10.3390/molecules29081741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
The rapid aging of the population worldwide presents a significant social and economic challenge, particularly due to osteoporotic fractures, primarily resulting from an imbalance between osteoclast-mediated bone resorption and osteoblast-mediated bone formation. While conventional therapies offer benefits, they also present limitations and a range of adverse effects. This study explores the protective impact of Neorhodomela munita ethanol extract (EN) on osteoporosis by modulating critical pathways in osteoclastogenesis and apoptosis. Raw264.7 cells and Saos-2 cells were used for in vitro osteoclast and osteoblast models, respectively. By utilizing various in vitro methods to detect osteoclast differentiation/activation and osteoblast death, it was demonstrated that the EN's potential to inhibit RANKL induced osteoclast formation and activation by targeting the MAPKs-NFATc1/c-Fos pathway and reducing H2O2-induced cell death through the downregulation of apoptotic signals. This study highlights the potential benefits of EN for osteoporosis and suggests that EN is a promising natural alternative to traditional treatments.
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Affiliation(s)
- Seongtae Jeong
- The Interdisciplinary Graduate Program in Integrative Biotechnology, Yonsei University, Seoul 03722, Republic of Korea;
| | - Il-Kwon Kim
- Department of Convergence Science, College of Medicine, Catholic Kwandong University, International St. Mary’s Hospital, Incheon 22711, Republic of Korea;
| | - Hanbyeol Moon
- Department of Integrated Omics for Biomedical Sciences, Graduate School, Yonsei University, Seoul 03722, Republic of Korea;
| | - Hojin Kim
- Department for Medical Science, College of Medicine, Catholic Kwandong University, Gangneung-si 25601, Republic of Korea;
| | - Byeong-Wook Song
- Department of Convergence Science, College of Medicine, Catholic Kwandong University, Gangneung-si 25601, Republic of Korea; (B.-W.S.); (S.W.K.); (S.L.)
| | - Jung-Won Choi
- Medical Science Research Institute, College of Medicine, Catholic Kwandong University, Incheon Metropolitan City 22711, Republic of Korea;
| | - Sang Woo Kim
- Department of Convergence Science, College of Medicine, Catholic Kwandong University, Gangneung-si 25601, Republic of Korea; (B.-W.S.); (S.W.K.); (S.L.)
| | - Seahyoung Lee
- Department of Convergence Science, College of Medicine, Catholic Kwandong University, Gangneung-si 25601, Republic of Korea; (B.-W.S.); (S.W.K.); (S.L.)
| | - Dong-Sik Chae
- Department of Orthopedic Surgery, International St. Mary’s Hospital, Catholic Kwandong University, Gangneung-si 25601, Republic of Korea
| | - Soyeon Lim
- Department of Convergence Science, College of Medicine, Catholic Kwandong University, Gangneung-si 25601, Republic of Korea; (B.-W.S.); (S.W.K.); (S.L.)
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Zhu Y, Liu Y, Wang Q, Niu S, Wang L, Cheng C, Chen X, Liu J, Zhao S. Using machine learning to identify patients at high risk of developing low bone density or osteoporosis after gastrectomy: a 10-year multicenter retrospective analysis. J Cancer Res Clin Oncol 2023; 149:17479-17493. [PMID: 37897658 DOI: 10.1007/s00432-023-05472-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/10/2023] [Indexed: 10/30/2023]
Abstract
INTRODUCTION Osteoporosis that emerges subsequent to gastrectomy poses a significant threat to the long-term health of patients. The primary objective of this investigation was to formulate a machine learning algorithm capable of identifying substantial preoperative, intraoperative, and postoperative risk factors. This algorithm, in turn, would enable the anticipation of osteoporosis occurrence after gastrectomy. METHODS This research encompassed a cohort of 1125 patients diagnosed with gastric cancer, including 108 individuals with low bone density or osteoporosis. A total of 40 distinct variables were collected, comprising patient demographics, pertinent medical history, medication records, preoperative examination attributes, surgical procedure specifics, and intraoperative details. Four distinct machine learning algorithms-extreme gradient boosting (XGBoost), random forest (RF), support vector machine (SVM), and k-nearest neighbor algorithm (KNN)-were employed to establish the predictive model. Evaluation of the models involved receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Shapley additive explanation (SHAP) was employed for visualization and analysis. RESULTS Among the four prediction models employed, the XGBoost algorithm demonstrated exceptional performance. The ROC analysis yielded excellent predictive accuracy, showcasing area under the curve (AUC) values of 0.957 and 0.896 for training and validation sets, respectively. The calibration curve further confirmed the robust predictive capacity of the XGBoost model. The DCA demonstrated a notably higher benefit rate for patients undergoing intervention based on the XGBoost model. Moreover, the AUC value of 0.73 for the external validation set indicated favorable extrapolation of the XGBoost prediction model. SHAP analysis outcomes unveiled numerous high-risk factors for osteoporosis development after gastrectomy, including a history of chronic obstructive pulmonary disease (COPD), inflammatory bowel disease (IBD), hypoproteinemia, postoperative neutrophil-to-lymphocyte ratio (NLR) exceeding 3, steroid usage history, advanced age, and absence of calcitonin use. CONCLUSION The osteoporosis prediction model derived through the XGBoost machine learning algorithm in this study displays remarkable predictive precision and carries significant clinical applicability.
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Affiliation(s)
- Yanfei Zhu
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China
| | - Yuan Liu
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China
| | - Qi Wang
- Department of Gastroenterology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Sen Niu
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China
| | - Lanyu Wang
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China
| | - Chao Cheng
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China
| | - Xujin Chen
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China
| | - Jinhui Liu
- Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| | - Songyun Zhao
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China.
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Inoue BKN, Paludetto LV, Monteiro NG, Batista FRDS, Kitagawa IL, da Silva RS, Antoniali C, Lisboa Filho PN, Okamoto R. Synergic Action of Systemic Risedronate and Local Rutherpy in Peri-implantar Repair of Ovariectomized Rats: Biomechanical and Molecular Analysis. Int J Mol Sci 2023; 24:16153. [PMID: 38003342 PMCID: PMC10671386 DOI: 10.3390/ijms242216153] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Postmenopausal osteoporosis and poor dietary habits can lead to overweightness and obesity. Bisphosphonates are the first-line treatment for osteoporosis. However, some studies show that they may increase the risk of osteonecrosis of the jaw. Considering the antimicrobial, angiogenic and vasodilatory potential of nitric oxide, this study aims to evaluate the local activity of this substance during the placement of surface-treated implants. Seventy-two Wistar rats were divided into three groups: SHAM (SHAM surgery), OVX + HD (ovariectomy + cafeteria diet), and OVX + HD + RIS (ovariectomy + cafeteria diet + sodium risedronate treatment), which were further subdivided according to the surface treatment of the future implant: CONV (conventional), TE10, or TE100 (TERPY at 10 or 100 μM concentration); n = 8 per subgroup. The animals underwent surgery for implant installation in the proximal tibia metaphysis and were euthanized after 28 days. Data obtained from removal torque and RT-PCR (OPG, RANKL, ALP, IBSP and VEGF expression) were subjected to statistical analysis at 5% significance level. For biomechanical analysis, TE10 produced better results in the OVX + HD group (7.4 N/cm, SD = 0.6819). Molecular analysis showed: (1) significant increase in OPG gene expression in OVX groups with TE10; (2) decreased RANKL expression in OVX + HD + RIS compared to OVX + HD; (3) significantly increased expressions of IBSP and VEGF for OVX + HD + RIS TE10. At its lowest concentration, TERPY has the potential to improve peri-implant conditions.
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Affiliation(s)
- Bruna Kaori Namba Inoue
- Department of Basic Sciences, Araçatuba Dental School, São Paulo State University Júlio de Mesquita Filho—UNESP, Aracatuba 16015-050, SP, Brazil; (B.K.N.I.); (L.V.P.); (N.G.M.); (F.R.d.S.B.); (C.A.)
| | - Laura Vidoto Paludetto
- Department of Basic Sciences, Araçatuba Dental School, São Paulo State University Júlio de Mesquita Filho—UNESP, Aracatuba 16015-050, SP, Brazil; (B.K.N.I.); (L.V.P.); (N.G.M.); (F.R.d.S.B.); (C.A.)
| | - Naara Gabriela Monteiro
- Department of Basic Sciences, Araçatuba Dental School, São Paulo State University Júlio de Mesquita Filho—UNESP, Aracatuba 16015-050, SP, Brazil; (B.K.N.I.); (L.V.P.); (N.G.M.); (F.R.d.S.B.); (C.A.)
| | - Fábio Roberto de Souza Batista
- Department of Basic Sciences, Araçatuba Dental School, São Paulo State University Júlio de Mesquita Filho—UNESP, Aracatuba 16015-050, SP, Brazil; (B.K.N.I.); (L.V.P.); (N.G.M.); (F.R.d.S.B.); (C.A.)
| | - Igor Lebedenco Kitagawa
- Federal Institute of Education, Science and Technology of São Paulo (IFSP), Birigui 16201-407, SP, Brazil;
| | - Roberto Santana da Silva
- Department of Biomolecular Sciences, Faculty of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo—USP, Ribeirão Preto 14040-403, SP, Brazil;
| | - Cristina Antoniali
- Department of Basic Sciences, Araçatuba Dental School, São Paulo State University Júlio de Mesquita Filho—UNESP, Aracatuba 16015-050, SP, Brazil; (B.K.N.I.); (L.V.P.); (N.G.M.); (F.R.d.S.B.); (C.A.)
| | - Paulo Noronha Lisboa Filho
- Department of Physics and Meteorology, Bauru Sciences School, São Paulo State University Júlio de Mesquita Filho—UNESP, Bauru 17033-360, SP, Brazil;
| | - Roberta Okamoto
- Department of Basic Sciences, Araçatuba Dental School, São Paulo State University Júlio de Mesquita Filho—UNESP, Aracatuba 16015-050, SP, Brazil; (B.K.N.I.); (L.V.P.); (N.G.M.); (F.R.d.S.B.); (C.A.)
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Jiang T, Xia T, Qiao F, Wang N, Jiang Y, Xin H. Role and Regulation of Transcription Factors in Osteoclastogenesis. Int J Mol Sci 2023; 24:16175. [PMID: 38003376 PMCID: PMC10671247 DOI: 10.3390/ijms242216175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/01/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
Bones serve mechanical and defensive functions, as well as regulating the balance of calcium ions and housing bone marrow.. The qualities of bones do not remain constant. Instead, they fluctuate throughout life, with functions increasing in some situations while deteriorating in others. The synchronization of osteoblast-mediated bone formation and osteoclast-mediated bone resorption is critical for maintaining bone mass and microstructure integrity in a steady state. This equilibrium, however, can be disrupted by a variety of bone pathologies. Excessive osteoclast differentiation can result in osteoporosis, Paget's disease, osteolytic bone metastases, and rheumatoid arthritis, all of which can adversely affect people's health. Osteoclast differentiation is regulated by transcription factors NFATc1, MITF, C/EBPα, PU.1, NF-κB, and c-Fos. The transcriptional activity of osteoclasts is largely influenced by developmental and environmental signals with the involvement of co-factors, RNAs, epigenetics, systemic factors, and the microenvironment. In this paper, we review these themes in regard to transcriptional regulation in osteoclastogenesis.
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Affiliation(s)
- Tao Jiang
- School of Pharmacy, Naval Medical University, Shanghai 200433, China; (T.J.); (T.X.); (F.Q.)
- School of Pharmacy, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
| | - Tianshuang Xia
- School of Pharmacy, Naval Medical University, Shanghai 200433, China; (T.J.); (T.X.); (F.Q.)
| | - Fangliang Qiao
- School of Pharmacy, Naval Medical University, Shanghai 200433, China; (T.J.); (T.X.); (F.Q.)
| | - Nani Wang
- Department of Medicine, Zhejiang Academy of Traditional Chinese Medicine, Hangzhou 310007, China;
| | - Yiping Jiang
- School of Pharmacy, Naval Medical University, Shanghai 200433, China; (T.J.); (T.X.); (F.Q.)
| | - Hailiang Xin
- School of Pharmacy, Naval Medical University, Shanghai 200433, China; (T.J.); (T.X.); (F.Q.)
- School of Pharmacy, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
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Dong A, Fei X, Huang Y, Huang Y. Efficacy of anti-osteoporosis treatment for men with osteoporosis: a meta-analysis. J Bone Miner Metab 2023; 41:258-267. [PMID: 36847867 DOI: 10.1007/s00774-023-01407-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/29/2023] [Indexed: 03/01/2023]
Abstract
INTRODUCTION Osteoporosis and fracture are important healthcare problems for men worldwide, which are relevant to severe disability and mortality. This meta-analysis aimed to assess the effectiveness of pharmacological therapy in men with osteoporosis, and to provide evidence-based hints for clinical practice. MATERIALS AND METHODS PubMed, Embase, Web of Science were searched from inception to July 31, 2022. Pooled standardized mean difference (SMD) and relative risk (RR) were calculated. Heterogeneity between included studies and publication bias were detected. RESULTS Twenty clinical studies were enrolled in this meta-analysis. The pooled SMD for mean percentage differences of change from baseline in lumbar spine BMD between the treatment group and the control group was 4.95 (95% CI 2.48, 7.42, I2 = 99%, p < 0.0001). For mean percentage differences of change in femoral neck BMD, the overall SMD was 3.08 (95% CI 0.95, 5.20, I2 = 99%, p = 0.0045). For a change in total hip BMD, the overall SMD was 1.06 (95% CI 0.50, 1.63, I2 = 82%, p = 0.0002). The overall RR for incident vertebral fractures was 0.50 (95% CI 0.37, 0.68, I2 = 5%, p = 0.3971). The pooled RR for nonvertebral fractures and clinical fracture were 0.74 (95% CI 0.41, 1.33, I2 = 28%, p = 0.3139) and 0.81 (95% CI 0.54, 1.21, I2 = 0%, p = 0.2992). CONCLUSION Findings in this meta-analysis indicate that pharmacological treatment increases lumbar spine, femoral neck, total hip BMD, and decreases incident vertebral fractures in men with osteoporosis.
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Affiliation(s)
- Aimei Dong
- Department of Endocrinology, Peking University First Hospital, Beijing, 100034, China.
| | - Xiuwen Fei
- Department of Emergency Department, Peking University First Hospital, Beijing, 100034, China
| | - Yucheng Huang
- Department of General Practice, Peking University First Hospital, Beijing, 100034, China
| | - Youyuan Huang
- Department of Endocrinology, Peking University First Hospital, Beijing, 100034, China
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He H, Zhang Y, Sun Y, Zhang Y, Xu J, Yang Y, Chen J. Folic Acid Attenuates High-Fat Diet-Induced Osteoporosis Through the AMPK Signaling Pathway. Front Cell Dev Biol 2022; 9:791880. [PMID: 35047504 PMCID: PMC8762056 DOI: 10.3389/fcell.2021.791880] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/03/2021] [Indexed: 12/30/2022] Open
Abstract
Objective: Obesity caused by a high-fat diet (HFD) will expand adipose tissue and cause chronic low-grade systemic inflammation, leading to osteoporosis. Folic acid (FA) is a water-soluble vitamin that plays an essential role in regulating blood lipids and antioxidants. However, the effects and underlying mechanisms of FA in osteoporosis induced by an HFD remain poorly understood. This study aimed to investigate the effect of FA on bone health by using HFD-induced osteoporosis mice. Materials and Methods: Mice were fed a normal diet, HFD or an HFD supplemented with FA (20 μg/ml in drinking water) for 16 weeks. Throughout the 16 weeks study period, the rats were weighed once every week. GTT, ITT and lipid indexes were detected to evaluate the effects of FA on lipid metabolism in the HFD-fed mice. Morphological and structural changes of the femur and tibial bone were observed using micro-CT, HE staining and bone conversion parameters. The expression of MDA, SOD and inflammatory factors were detected to evaluate the effects of FA on oxidative stress and inflammatory response in the HFD-fed mice. Quantitative real-time PCR and Western blot (WB) were used to investigate the AMPK signaling pathway. Results: After the intervention of FA, the body fat rate of obese mice was reduced, and related metabolic disorders such as insulin resistance, hyperlipidemia, and systemic inflammation were alleviated. In correlation with those modifications, FA attenuated bone loss and improved bone microarchitecture, accompanied the number of osteoclasts and adipocytes decreased. Furthermore, FA promoted the phosphorylation of AMPK, thereby promoting the expression of Carnitine palmitoyltransferase 1 (CPT1), nuclear factor erythroid-2 related factor 2 (Nrf2) and antioxidant enzymes. Conclusion: These findings suggest that FA may modulate lipid metabolism and oxidative stress responses activating the AMPK signaling pathway, thereby alleviating HFD-induced osteoporosis. The results from our study provide experimental evidence to prevent HFD-induced osteoporosis.
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Affiliation(s)
- Haiting He
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yaxi Zhang
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yue Sun
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yanwei Zhang
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, Changsha, China
| | - Jingjing Xu
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yuzhen Yang
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, Changsha, China
| | - Jihua Chen
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, Changsha, China
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The Effects of Osteoporotic and Non-osteoporotic Medications on Fracture Risk and Bone Mineral Density. Drugs 2021; 81:1831-1858. [PMID: 34724173 PMCID: PMC8578161 DOI: 10.1007/s40265-021-01625-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2021] [Indexed: 12/26/2022]
Abstract
Osteoporosis is a highly prevalent bone disease affecting more than 37.5 million individuals in the European Union (EU) and the United States of America (USA). It is characterized by low bone mineral density (BMD), impaired bone quality, and loss of structural and biomechanical properties, resulting in reduced bone strength. An increase in morbidity and mortality is seen in patients with osteoporosis, caused by the approximately 3.5 million new osteoporotic fractures occurring every year in the EU. Currently, different medications are available for the treatment of osteoporosis, including anti-resorptive and osteoanabolic medications. Bisphosphonates, which belong to the anti-resorptive medications, are the standard treatment for osteoporosis based on their positive effects on bone, long-term experience, and low costs. However, not only medications used for the treatment of osteoporosis can affect bone: several other medications are suggested to have an effect on bone as well, especially on fracture risk and BMD. Knowledge about the positive and negative effects of different medications on both fracture risk and BMD is important, as it can contribute to an improvement in osteoporosis prevention and treatment in general, and, even more importantly, to the individual's health. In this review, we therefore discuss the effects of both osteoporotic and non-osteoporotic medications on fracture risk and BMD. In addition, we discuss the underlying mechanisms of action.
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Roy A, Thulasiraman S, Panneerselvam E, Thulasi Doss G, Selvaraj MN, Ganesh SK, Raja KVB, Kangusamy B. Evaluation of the efficacy of salmon calcitonin nasal spray on bone healing following open reduction and internal fixation of mandibular fractures - A randomized controlled trial. J Craniomaxillofac Surg 2021; 49:1151-1157. [PMID: 34593298 DOI: 10.1016/j.jcms.2021.08.002] [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: 06/02/2020] [Revised: 08/04/2021] [Accepted: 08/28/2021] [Indexed: 01/17/2023] Open
Abstract
The objective of this study was to assess the efficacy of calcitonin spray on bone healing following open reduction internal fixation (ORIF) of mandibular fractures. Fourteen patients were subdivided into a study group and a control group. A standardized surgical protocol for ORIF was followed. Postoperatively, salmon calcitonin nasal spray was administered to only the study group. The outcome parameters assessed were serum osteocalcin, pain, and radiographic bone healing. Serum osteocalcin was assessed pre- and postoperatively. Postoperative pain was documented using a visual analogue scale (VAS) on the 7th, 14th, 23rd, and 30th days. An orthopantomogram was used to score fracture healing at four time intervals, as follows: 1 - absence of callus; 2 - presence of minimal callus; 3 - considerable callus; and 4 - complete fusion of fracture. Pain scores were lower for the study group, with no pain from the fifth day, while the control group produced a mean score for day 5 of 2.43 ± 0.98 (p = 0.001). Mean postoperative serum osteocalcin levels were higher for the study group (67.82 ± 8.89) compared with the control group (57.69 ± 6.22; p = 0.029). Bone healing at 12 weeks postoperatively was level 4 for 28.6% of patients in the study group and level 3 for 71.4%. In comparison, 85.7% in the control group demonstrated level 3 healing, while 14.3% remained at level 2 (p = 0.462). Within the limitations of the study, it can be concluded that intranasal salmon calcitonin spray reduces postoperative pain and facilitates fracture healing, although its economic efficiency is still to be proven.
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Affiliation(s)
- Aritra Roy
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram Campus, Ramapuram, Chennai, India
| | - Selvakumar Thulasiraman
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram Campus, Ramapuram, Chennai, India
| | - Elavenil Panneerselvam
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram Campus, Ramapuram, Chennai, India.
| | - Guruprasad Thulasi Doss
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram Campus, Ramapuram, Chennai, India
| | - Mary Nancy Selvaraj
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram Campus, Ramapuram, Chennai, India
| | - Sriraam Kasi Ganesh
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram Campus, Ramapuram, Chennai, India
| | - Krishnakumar V B Raja
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram Campus, Ramapuram, Chennai, India
| | - Boopathi Kangusamy
- Indian Council of Medical Research - National Institute of Epidemiology, Chennai, India
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Molecular Mechanisms and Emerging Therapeutics for Osteoporosis. Int J Mol Sci 2020; 21:ijms21207623. [PMID: 33076329 PMCID: PMC7589419 DOI: 10.3390/ijms21207623] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/09/2020] [Accepted: 10/11/2020] [Indexed: 12/15/2022] Open
Abstract
Osteoporosis is the most common chronic metabolic bone disease. It has been estimated that more than 10 million people in the United States and 200 million men and women worldwide have osteoporosis. Given that the aging population is rapidly increasing in many countries, osteoporosis could become a global challenge with an impact on the quality of life of the affected individuals. Osteoporosis can be defined as a condition characterized by low bone density and increased risk of fractures due to the deterioration of the bone architecture. Thus, the major goal of treatment is to reduce the risk for fractures. There are several treatment options, mostly medications that can control disease progression in risk groups, such as postmenopausal women and elderly men. Recent studies on the basic molecular mechanisms and clinical implications of osteoporosis have identified novel therapeutic targets. Emerging therapies targeting novel disease mechanisms could provide powerful approaches for osteoporosis management in the future. Here, we review the etiology of osteoporosis and the molecular mechanism of bone remodeling, present current pharmacological options, and discuss emerging therapies targeting novel mechanisms, investigational treatments, and new promising therapeutic approaches.
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Zeng LF, Pan BQ, Liang GH, Luo MH, Cao Y, Guo D, Chen HY, Pan JK, Huang HT, Liu Q, Guan ZT, Han YH, Zhao D, Zhao JL, Hou SR, Wu M, Lin JT, Li JH, Liang WX, Ou AH, Wang Q, Yang WY, Liu J. Does Routine Anti-Osteoporosis Medication Lower the Risk of Fractures in Male Subjects? An Updated Systematic Review With Meta-Analysis of Clinical Trials. Front Pharmacol 2019; 10:882. [PMID: 31447677 PMCID: PMC6695469 DOI: 10.3389/fphar.2019.00882] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 07/15/2019] [Indexed: 12/14/2022] Open
Abstract
Background: Several epidemiological articles have reported the correlations between anti-osteoporosis medication and the risks of fractures in male and female subjects, but the specific efficacy of anti-osteoporosis medication for male subjects remains largely unexplored. Objective: The aim of this study was to evaluate the correlation between anti-osteoporosis medication and the risk of fracture in relation to low bone mass [including outcomes of osteoporosis, fracture, and bone mineral density (BMD) loss] in male subjects analyzed in studies within the updated literature. Methods: Randomized controlled trials (RCTs) that analyzed the effectiveness of a treating prescription for male subjects with osteoporosis (or low BMD) and that focused on the outcomes of fracture were included. Relevant studies from Embase, Web of Science, PubMed, and Chinese database of CNKI were retrieved from inception to January 30th, 2019. Two staff members carried out the eligibility assessment and data extraction. The discrepancies were settled by consultation with another researcher. We calculated the pooled relative risks (RRs) based on 95% confidence intervals (CIs). Results: Twenty-seven documents (28 studies) with 5,678 subjects were identified. For the category of bisphosphonates, significant results were observed in pooled analyses for decreased risk of the vertebral fracture domain (RR, 0.44 [95% CI, 0.31-0.62]), nonvertebral fracture domain (RR, 0.63 [95% CI, 0.46-0.87]), and clinical fracture domain (RR, 0.59 [95% CI, 0.48-0.72]) compared with those of controls. Participants with bisphosphonates had a 56% (95% CI = 38-69%) lower risk of vertebral fractures, 37% (95% CI = 13-54%) lower risk of nonvertebral fractures, and 41% (95% CI = 28-52%) lower risk of clinical fractures. Furthermore, meta-analyses also demonstrated a decreased risk of the vertebral fracture domain via treatment with risedronate (RR, 0.45 [95% CI, 0.28-0.72]) and alendronate (RR, 0.41 [95% CI, 0.23-0.74]), but not with calcitriol, calcitonin, denosumab, ibandronate, monofluorophosphate, strontium ranelate, teriparatide, or zoledronic acid, compared with that of controls. Conclusions: This systematic review confirms that bisphosphonates were connected with a decreased risk of vertebral fractures, nonvertebral fractures, and clinical fractures for male subjects with osteoporosis. Future research is needed to further elucidate the role of nonbisphosphonates in treating fractures of osteoporosis subjects.
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Affiliation(s)
- Ling-Feng Zeng
- The 2nd Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China.,Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China.,The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Bi-Qi Pan
- Department of Traditional Chinese Medicine, Guangdong Women and Children Hospital, Guangzhou, China
| | - Gui-Hong Liang
- The 2nd Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China.,Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Ming-Hui Luo
- The 2nd Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Ye Cao
- Department of Clinical Research/National Clinical Trials Institute, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Da Guo
- The 2nd Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Hong-Yun Chen
- The 2nd Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Jian-Ke Pan
- The 2nd Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - He-Tao Huang
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qiang Liu
- World Federation of Chinese Medicine Societies, Beijing, China
| | - Zi-Tong Guan
- World Federation of Chinese Medicine Societies, Beijing, China
| | - Yan-Hong Han
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Di Zhao
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jin-Long Zhao
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Sen-Rong Hou
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ming Wu
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiong-Tong Lin
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jia-Hui Li
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wei-Xiong Liang
- The 2nd Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Ai-Hua Ou
- The 2nd Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Qi Wang
- The 2nd Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Wei-Yi Yang
- The 2nd Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Jun Liu
- The 2nd Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China.,Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China.,The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
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12
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Preparation and characterization of solid lipid nanoparticles loaded with salmon calcitonin phospholipid complex. J Drug Deliv Sci Technol 2019. [DOI: 10.1016/j.jddst.2019.05.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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13
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Filipović B, Šošić‐Jurjević B, Ajdžanović V, Živanović J, Ristić N, Trifunović S, Milošević V. Response of trabecular bone, thyroid C and follicular cells to synthetic salmon calcitonin in middle-aged orchidectomized male rats. J Anat 2017; 230:787-795. [PMID: 28220476 PMCID: PMC5442141 DOI: 10.1111/joa.12600] [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] [Accepted: 01/16/2017] [Indexed: 11/29/2022] Open
Abstract
In contrast to studies in women, male osteoporosis is poorly understood and strictly related to advancing age. Among the first antiresorptive substances used in the prevention and treatment of osteoporosis is calcitonin (CT), a hypocalcemic hormone that potently inhibits osteoclastic bone resorption. Natural CT is produced and secreted by thyroid C-cells. The other endocrine population of thyroid cells produces thyroid hormones (TH), which also affect bone turnover. The aim of this study was to evaluate the influence of salmon CT on trabecular bone microarchitecture with special reference to effects on the structure and function of both CT- and TH-producing thyroid cells in orchidectomized (Orx) middle-aged rats. Twenty-four male Wistar rats aged 15 months were randomly divided into Orx and sham-operated (SO) groups. One group of Orx animals received (s.c.) synthetic salmon CT (Orx + CT; 100 IU kg-1 b.w.) subcutaneously every second day for 6 weeks. The second Orx group and SO rats were given the same volume of vehicle alone by the same schedule. Trabecular bone histomorphometrical parameters were: cancellous bone area (B.Ar), trabecular thickness (Tb.Th), trabecular number (Tb.N) and trabecular separation (Tb.Sp) were obtained with an ImageJ public-domain image-processing program. The peroxidase-antiperoxidase method was applied for localization of CT in C-cells. Anti-human CT antisera served as the primary antibodies. For immunohistochemical characterization of vascular endothelial growth factor (VEGF) in thyroid tissue, rabbit antisera against human VEGF, served as primary antibodies. CT-immunopositive thyroid C-cells, thyroid follicular epithelium, interstitium and colloid were evaluated morphometrically. Blood serum samples were analyzed for CT, osteocalcin (OC), and thyroxine (T4 ), and calcium (Ca2+ ) concentration was determined in urine samples. Salmon CT application significantly increased B.Ar, TbTh and TbN, but markedly decreased Tb.Sp. Administration of exogenous CT significantly decreased mean volume (Vc) and relative volume density (Vv) of thyroid C-cells in relation to both SO and Orx groups. The Vv of the colloid was higher, whereas the VV of the follicular epithelium was lower after CT treatment compared with Orx alone. CT treatment markedly elevated serum CT, whereas serum OC, T4 and urinary Ca2+ concentrations were lower than in the Orx group. These results indicate that salmon CT stimulates trabecular bone microarchitecture, strongly inhibits thyroid C-cells and changes the structure of the thyroid gland, indicating hypoactivity.
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Affiliation(s)
- Branko Filipović
- Department of CytologyInstitute for Biological Research ‘Siniša Stanković’ University of BelgradeBelgradeSerbia
| | - Branka Šošić‐Jurjević
- Department of CytologyInstitute for Biological Research ‘Siniša Stanković’ University of BelgradeBelgradeSerbia
| | - Vladimir Ajdžanović
- Department of CytologyInstitute for Biological Research ‘Siniša Stanković’ University of BelgradeBelgradeSerbia
| | - Jasmina Živanović
- Department of CytologyInstitute for Biological Research ‘Siniša Stanković’ University of BelgradeBelgradeSerbia
| | - Nataša Ristić
- Department of CytologyInstitute for Biological Research ‘Siniša Stanković’ University of BelgradeBelgradeSerbia
| | - Svetlana Trifunović
- Department of CytologyInstitute for Biological Research ‘Siniša Stanković’ University of BelgradeBelgradeSerbia
| | - Verica Milošević
- Department of CytologyInstitute for Biological Research ‘Siniša Stanković’ University of BelgradeBelgradeSerbia
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Nayak S, Greenspan SL. Osteoporosis Treatment Efficacy for Men: A Systematic Review and Meta-Analysis. J Am Geriatr Soc 2016; 65:490-495. [PMID: 28304090 DOI: 10.1111/jgs.14668] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To evaluate the efficacy of treatment options to reduce osteoporotic fracture risk in men. DESIGN Systematic review and meta-analysis. SETTING Randomized clinical trials that evaluated the efficacy of a treatment for osteoporosis or low bone mineral density for adult men and reported fracture outcomes. PARTICIPANTS Men. MEASUREMENTS PubMed, Embase, and the Cochrane Library databases were searched for relevant studies. Information was extracted from included studies on participant sociodemographic characteristics, number of male participants, treatment evaluated, comparator for evaluated treatment, study duration, and fracture outcomes. Risk of bias of individual studies was assessed using measures recommended by the Cochrane Collaboration. RESULTS Twenty-four articles reporting results for 22 studies (including 4,868 male participants) met strict inclusion criteria. Fixed-effects meta-analyses using the Mantel-Haenszel method demonstrated significantly lower risk of vertebral fractures with alendronate (relative risk (RR) = 0.328, 95% confidence interval (CI) = 0.155-0.692) and risedronate (RR = 0.428, 95% CI = 0.245-0.746) but not with calcitonin (RR = 0.272, 95% CI = 0.046-1.608) or denosumab (RR = 0.256, 95% CI = 0.029-2.238) than in controls. For bisphosphonates as a treatment category, meta-analyses demonstrated significantly lower risk of vertebral fractures (RR = 0.368, 95% CI = 0.252-0.537) and nonvertebral fractures (RR = 0.604, 95% CI = 0.404-0.904) than in controls. The meta-analysis finding that bisphosphonates significantly reduce nonvertebral fracture risk was not robust to sensitivity analysis. CONCLUSION Bisphosphonates reduce the risk of vertebral and possibly nonvertebral fractures for men with osteoporosis. Further studies are needed to evaluate the efficacy of bisphosphonates for reducing nonvertebral fracture risk and the efficacy of nonbisphosphonates for reducing vertebral and nonvertebral fracture risk in men with osteoporosis.
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Affiliation(s)
- Smita Nayak
- Swedish Center for Research and Innovation, Swedish Health Services, Swedish Medical Center, Seattle, Washington
| | - Susan L Greenspan
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Shohrati M, Bayat N, Saburi A, Abbasi Z. Effect of Nasal Calcitonin on the Health-Related Quality of Life in Postmenopause Women Affected With Low Bone Density. IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 17:e6613. [PMID: 26421180 PMCID: PMC4584075 DOI: 10.5812/ircmj.17(5)2015.6613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 12/05/2014] [Accepted: 03/06/2015] [Indexed: 12/05/2022]
Abstract
Background: Physical activity and mental health could be affected by osteoporosis and various therapeutic options such as calcitonin may influence Quality Of Life (QOL) of these patients with Low Bone Density (LBD). Objectives: This study aimed to evaluate the effect of nasal calcitonin on QOL in post menopause women with LBD. Patients and Methods: This clinical trial study was performed on one hundred and fifteen menopause women with LBD less than 1 SD in Bone Mineral Densitometry (BMD) referred to Baqiyatallah Hospital in Tehran, Iran, during 2009 - 2010. They were assigned to receive 200 IU calcitonin nasal spray along with calcium (1000 mg) and vitamin D (400 IU) for 6 months. Quality of life was assessed by Short-Form 36 (SF-36) questionnaire (Persian-validated version). Results: The mean age (± SD) of the participants was 58.75 ± 8.15 years. Intranasal spray of calcitonin increased QOL scores significantly (88.05 ± 15.63 vs. 92.15 ± 13.22, P value = 0.000). Bone mineral density of spine was increased from 0.834 ± 0.11 to 0.12 ± 0.852 and this difference in BMD of lumbar spine was statistically significant (P value: 0.003) but not significant in femur’s BMD (P value = 0.061). In comparison with BMD indexes, The QOL scores especially Mental Health domain changes had only a significant correlation with the changes of total T score in BMD (P = 0.031, Coefficient Correlation = 0.248). Conclusions: It seems that nasal spray of calcitonin can effectively improve QOL of women with LBD and QOL changes were not influenced by clinical or para-clinical alteration. Mental health domain must be more considered in further studies as a predicting domain for Health-Related Quality of Life (HR-QOL) changes.
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Affiliation(s)
- Majid Shohrati
- Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Noushin Bayat
- Internal Diseases Department, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Noushin Bayat, Internal Diseases Department, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, IR Iran. Tel: +98-2188600067, E-mail:
| | - Amin Saburi
- Radiology Department, Birjand Atherosclerosis and Coronary Artery Research Center, Birjand University of Medical Sciences, Birjand, IR Iran
| | - Zahra Abbasi
- Pharmaceutical Sciences Branch, Islamic Azad University (IAUPS), Tehran, IR Iran
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Nakamura T, Shiraki M, Fukunaga M, Tomomitsu T, Santora AC, Tsai R, Fujimoto G, Nakagomi M, Tsubouchi H, Rosenberg E, Uchida S. Effect of the cathepsin K inhibitor odanacatib administered once weekly on bone mineral density in Japanese patients with osteoporosis--a double-blind, randomized, dose-finding study. Osteoporos Int 2014; 25:367-76. [PMID: 23716037 DOI: 10.1007/s00198-013-2398-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 05/06/2013] [Indexed: 10/26/2022]
Abstract
UNLABELLED The efficacy and safety of oral placebo or odanacatib 10, 25, or 50 mg once weekly for 52 weeks were evaluated in a double-blind, randomized, multi-center study in Japanese female and male patients with osteoporosis. INTRODUCTION Odanacatib is a selective and reversible cathepsin K inhibitor that decreases bone resorption and increases bone mineral density (BMD). METHODS The primary efficacy endpoint was percent change from baseline to week 52 in lumbar spine BMD. Secondary endpoints included percent change in total hip, femoral neck, and trochanter BMD and in bone biomarkers after treatment for 52 weeks. RESULTS In this study, 286 patients [94% female, mean age (SD) 68.2 (7.1) years] were included in the analysis. The least-squares mean percent changes from baseline to week 52 in the groups receiving placebo, 10, 25 and 50 mg of odanacatib for lumbar spine (L1~L4) BMD were 0.5, 4.1, 5.7, and 5.9% and for total hip BMD were -0.4, 1.3, 1.8, and 2.7%, respectively. The changes in femoral neck and trochanter BMD were similar to those at the total hip. Bone turnover markers were reduced in a dose-dependent manner. However, the effects of odanacatib on bone formation markers were less compared with the effects on bone resorption markers. Tolerability and safety profiles were similar among all treatment groups with no dose-related trends in any adverse events. CONCLUSIONS Weekly odanacatib treatment for 52 weeks increased BMD at the lumbar spine and at all hip sites in a dose-dependent manner and was well tolerated in Japanese patients with osteoporosis.
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Affiliation(s)
- T Nakamura
- National Center for Global Health and Medicine, Shinjuku-ku Tokyo, 162-8655, Japan,
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Banu J. Causes, consequences, and treatment of osteoporosis in men. DRUG DESIGN DEVELOPMENT AND THERAPY 2013; 7:849-60. [PMID: 24009413 PMCID: PMC3758213 DOI: 10.2147/dddt.s46101] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Men undergo gradual bone loss with aging, resulting in fragile bones. It is estimated that one in five men will suffer an osteoporotic fracture during their lifetime. The prognosis for men after a hip fracture is very grim. A major cause is reduction of free testosterone. Many other factors result in secondary osteoporosis, including treatment for other diseases such as cancer and diabetes. Patients should be screened not only for bone density but also assessed for their nutritional status, physical activity, and drug intake. Therapy should be chosen based on the type of osteoporosis. Available therapies include testosterone replacement, bisphosphonates, and nutritional supplementation with calcium, vitamin D, fatty acids, and isoflavones, as well as certain specific antibodies, like denosumab and odanacatib, and inhibitors of certain proteins.
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Affiliation(s)
- Jameela Banu
- Coordinated Program in Dietetics, College of Health Sciences and Human Services and Department of Biology, College of Science and Mathematics, University of Texas-Pan American, Edinburg, TX 78539, USA.
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18
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Mosekilde L, Vestergaard P, Rejnmark L. The pathogenesis, treatment and prevention of osteoporosis in men. Drugs 2013; 73:15-29. [PMID: 23329464 DOI: 10.1007/s40265-012-0003-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Testosterone stimulates longitudinal and appositional growth during childhood, whereas estrogen induces epiphysial closure. During adulthood, testosterone continues to stimulate periosteal growth, whereas estrogen is important for the maintenance of trabecular bone mass and structure. In males, testosterone is aromatized to estradiol. Both free and bioavailable plasma levels of testosterone and estradiol decrease with age in males, and fracture risk is associated with low estradiol levels. Testosterone may increase muscle mass and prevent fractures related to falls. Younger hypogonadal males should be treated with testosterone to attain peak bone mass and increase bone mineral density (BMD). Older hypogonadal males should be treated in cases of osteoporosis, reduced muscle strength and increased risk of falling. Secondary hyperparathyroidism caused by calcium and vitamin D insufficiency may reduce bone mass and strength and increase fracture risk and should be avoided. Since calcium supplementation has been associated with an increased risk of cardiovascular complications and renal stones, the dose should be tailored to the habitual daily calcium intake. Lifestyle-related risk factors (smoking, alcohol consumption, lack of physical activity and low body weight) should be addressed. The antifracture efficacy of antiresorptive and anabolic treatment for osteoporosis has not been documented in larger randomized controlled studies. However, changes in BMD and bone markers suggest similar effects in males and females of bisphosphonates (alendronate, risedronate, ibandronate, zoledronic acid), nasal calcitonin, denosumab and teriparatide (parathyroid hormone [1-34]). The antiresorptive drugs should be used in males with BMD T-score less than -2.5 and one or more risk factors, or with hip and vertebral fractures. It seems appropriate to recommend a higher cut-off T-score (e.g. less than -1.0 standard deviation [SD]) in glucocorticoid-induced osteoporosis and in patients receiving androgen deprivation therapy because of the fast initial bone loss. Anabolic treatment should be used in more severe spinal fracture cases, including glucocorticoid-induced osteoporosis.
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The number of pharmacological options for the treatment of osteoporosis in men has broadened, but more studies needed. DRUGS & THERAPY PERSPECTIVES 2013. [DOI: 10.1007/s40267-013-0042-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Martínez Díaz-Guerra G, Guadalix Iglesias S, Hawkins Carranza F. [Etiopathogenesis and treatment of osteoporosis and fractures in adult males]. Med Clin (Barc) 2011; 137:656-62. [PMID: 21420694 DOI: 10.1016/j.medcli.2011.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 01/20/2011] [Accepted: 01/25/2011] [Indexed: 10/18/2022]
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22
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Schwarz P, Jorgensen NR, Mosekilde L, Vestergaard P. The evidence for efficacy of osteoporosis treatment in men with primary osteoporosis: a systematic review and meta-analysis of antiresorptive and anabolic treatment in men. J Osteoporos 2011; 2011:259818. [PMID: 21776371 PMCID: PMC3138068 DOI: 10.4061/2011/259818] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 03/31/2011] [Indexed: 11/20/2022] Open
Abstract
Purpose. Fragility fractures in men constitute a major worldwide public health problem with a life-time risk of 13%. It cannot be directly inferred that antiosteoporotic drugs effective in women have the same effect in men. Our aim was to appraise the existing evidence for efficacy of osteoporosis treatment in men. Methods. This study was a systematic review of the published literature on the clinical efficacy of medical osteoporosis therapy in the reduction of fracture risk in men (age > 50 years). Studies included were randomised, placebo-controlled trials of men. Results. Five BMD studies of antiresorptive treatment were included. All studies showed an increase in BMD, but there was only a nonsignificant trend in the reduction of clinical fractures. Three BMD studies of anabolic treatment with teriparatide were also included. These showed a significant mean increase in spine BMD and for vertebral fractures a non-significant trend towards a reduction was seen. Conclusion. The evidence of medical osteoporosis treatment in men is scant and inconclusive due to the lack of prospective RCT studies with fracture prevention as primary end point. So far, all evidence is based on BMD increases in small RCT studies showing BMD increases comparable to those reported in postmenopausal women.
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Affiliation(s)
- Peter Schwarz
- Research Center of Aging and Osteoporosis, Department of Medicine, Glostrup Hospital, 2600 Glostrup, Denmark,Faculty of Health Science, Copenhagen University, Copenhagen, Denmark,*Peter Schwarz:
| | - Niklas Rye Jorgensen
- Research Center of Aging and Osteoporosis, Department of Medicine, Glostrup Hospital, 2600 Glostrup, Denmark,Department of Clinical Biochemistry, Glostrup Hospital, 2600 Glostrup, Denmark
| | - Leif Mosekilde
- Department of Endocrinology and Internal Medicine, MEA, THG, Aarhus University Hospital, Denmark
| | - Peter Vestergaard
- Department of Endocrinology and Internal Medicine, MEA, THG, Aarhus University Hospital, Denmark
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23
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Gates BJ, Das S. Management of osteoporosis in elderly men. Maturitas 2011; 69:113-9. [DOI: 10.1016/j.maturitas.2011.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 03/08/2011] [Accepted: 03/10/2011] [Indexed: 11/15/2022]
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Henriksen K, Bollerslev J, Everts V, Karsdal MA. Osteoclast activity and subtypes as a function of physiology and pathology--implications for future treatments of osteoporosis. Endocr Rev 2011; 32:31-63. [PMID: 20851921 DOI: 10.1210/er.2010-0006] [Citation(s) in RCA: 157] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Osteoclasts have traditionally been associated exclusively with catabolic functions that are a prerequisite for bone resorption. However, emerging data suggest that osteoclasts also carry out functions that are important for optimal bone formation and bone quality. Moreover, recent findings indicate that osteoclasts have different subtypes depending on their location, genotype, and possibly in response to drug intervention. The aim of the current review is to describe the subtypes of osteoclasts in four different settings: 1) physiological, in relation to turnover of different bone types; 2) pathological, as exemplified by monogenomic disorders; 3) pathological, as identified by different disorders; and 4) in drug-induced situations. The profiles of these subtypes strongly suggest that these osteoclasts belong to a heterogeneous cell population, namely, a diverse macrophage-associated cell type with bone catabolic and anabolic functions that are dependent on both local and systemic parameters. Further insight into these osteoclast subtypes may be important for understanding cell-cell communication in the bone microenvironment, treatment effects, and ultimately bone quality.
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Affiliation(s)
- K Henriksen
- Nordic Bioscience A/S, Herlev Hovedgade 207, DK-2730 Herlev, Denmark.
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Abstract
Osteoporosis and fragility fracture become common with advancing age in men. The incidence of osteoporosis-related fracture is similar to myocardial infarction and exceeds that of lung and prostate carcinoma combined. These fractures cause substantial morbidity, and the mortality following hip fracture is greater in men than in women. A decline in sex steroids and glucocorticoid and alcohol use, among other factors, contribute to bone loss and fracture risk. Approaches to reduce fracture risk in men are very similar to that in women - recognising and addressing muscle weakness/falls risk and optimising nutrition, with emphasis on calcium and vitamin D and medications when appropriate. Despite the high prevalence, osteoporosis remains largely undiagnosed and undertreated. Hopefully, increased recognition of male osteoporosis by health-care providers and the men themselves, in combination with recent consensus recommendations for treatment based on fracture-risk estimation, will reduce the burden of fragility fracture in men.
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Affiliation(s)
- Neil Binkley
- Osteoporosis Clinical Center and Research Program and Institute on Aging University of Wisconsin, Madison, WI, USA.
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Leeming DJ, Henriksen K, Byrjalsen I, Qvist P, Madsen SH, Garnero P, Karsdal MA. Is bone quality associated with collagen age? Osteoporos Int 2009; 20:1461-70. [PMID: 19330423 DOI: 10.1007/s00198-009-0904-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 02/27/2009] [Indexed: 12/27/2022]
Abstract
The World Health Organization defines osteoporosis as a systemic disease characterized by decreased bone tissue mass and microarchitectural deterioration, resulting in increased fracture risk. Since this statement, a significant amount of data has been generated showing that these two factors do not cover all risks for fracture. Other independent clinical factors, such as age, as well as aspects related to qualitative changes in bone tissue, are believed to play an important role. The term "bone quality" encompasses a variety of parameters, including the extent of mineralization, the number and distribution of microfractures, the extent of osteocyte apoptosis, and changes in collagen properties. The major mechanism controlling these qualitative factors is bone remodeling, which is tightly regulated by the osteoclast/osteoblast activity. We focus on the relationship between bone remodeling and changes in collagen properties, especially the extent of one posttranslational modification. In vivo, measurements of the ratio between native and isomerized C-telopeptides of type I collagen provides an index of bone matrix age. Current preclinical and clinical studies suggests that this urinary ratio provides information about bone strength and fracture risk independent of bone mineral density and that it responds differently according to the type of therapy regulating bone turnover.
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Affiliation(s)
- D J Leeming
- Nordic Bioscience, Herlev Hovedgade 207, 2730, Herlev, Denmark.
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28
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Abstract
Osteoporosis in the aging male remains an important yet under-recognized and undertreated disease. Current US estimates indicate that over 14 million men have osteoporosis or low bone mass, and men suffer approximately 500,000 osteoporotic fractures each year. Men experience fewer osteoporotic fractures than women but have higher mortality after fracture. Bisphosphonates are potent antiresorptive agents that inhibit osteoclast activity, suppress in vivo markers of bone turnover, increase bone mineral density, decrease fractures, and improve survival in men with osteoporosis. Intravenous zoledronic acid may be a preferable alternative to oral bisphosphonate therapy in patients with cognitive dysfunction, the inability to sit upright, or significant gastrointestinal pathology. Zoledronic acid (Reclast) is approved in the US as an annual 5 mg intravenous infusion to treat osteoporosis in men. The zoledronic acid (Zometa) 4 mg intravenous dose has been studied in the prevention of bone loss associated with androgen deprivation therapy.
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Affiliation(s)
- Paul K Piper
- Division of Endocrinology and Metabolism, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Ugis Gruntmanis
- Division of Endocrinology and Metabolism, University of Texas Southwestern Medical Center, Dallas, TX USA
- North Texas Veterans Affairs Medical Center, Dallas, TX USA
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Karsdal MA, Henriksen K, Arnold M, Christiansen C. Calcitonin: a drug of the past or for the future? Physiologic inhibition of bone resorption while sustaining osteoclast numbers improves bone quality. BioDrugs 2008; 22:137-44. [PMID: 18481897 DOI: 10.2165/00063030-200822030-00001] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Postmenopausal osteoporosis results from a continuous imbalance between bone resorption and bone formation, favoring bone resorption. An increasing number of treatments for osteoporosis are in development and on the market. A range of differences and similarities are found between these treatment options, and these need to be carefully evaluated before the initiation of treatment. This article summarizes data from in vitro and animal studies, as well as clinical trials, on the effect of calcitonin on bone turnover. Calcitonin was found to exert its antiresorptive effects via directly reducing osteoclastic resorption, and thus leads to an increase in bone mineral density and bone strength. Furthermore, calcitonin appears to mainly target the most active osteoclasts, and in contrast to most other antiresorptive agents it does not reduce the number of osteoclasts. Finally, in humans, while attenuating resorption, calcitonin treatment does not interfere markedly with bone formation, in contrast to other currently available antiresorptive agents. Thus, we speculate that calcitonin treatment will lead to a continuously positive bone balance in contrast with other antiresorptive agents currently on the market and thereby, in a physiologic manner, result in improved bone quality. Calcitonin is currently only available in injectable and nasal formulations. An oral formulation may, however, improve patient acceptance and compliance. Currently, several different routes are being pursued to identify an optimal oral formulation, of which the technology based on 5-CNAC is the most advanced. There are promising clinical data available for this formulation from both osteoarthritis and osteoporosis clinical trials, although the antifracture efficacy is not yet known.
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Affiliation(s)
- Morten A Karsdal
- Pharmacology Department, Nordic Bioscience A/S, Herlev, Denmark.
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30
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Abstract
With the aging of the population, there is a growing recognition that osteoporosis and fractures in men are a significant public health problem, and both hip and vertebral fractures are associated with increased morbidity and mortality in men. Osteoporosis in men is a heterogeneous clinical entity: whereas most men experience bone loss with aging, some men develop osteoporosis at a relatively young age, often for unexplained reasons (idiopathic osteoporosis). Declining sex steroid levels and other hormonal changes likely contribute to age-related bone loss, as do impairments in osteoblast number and/or activity. Secondary causes of osteoporosis also play a significant role in pathogenesis. Although there is ongoing controversy regarding whether osteoporosis in men should be diagnosed based on female- or male-specific reference ranges (because some evidence indicates that the risk of fracture is similar in women and men for a given level of bone mineral density), a diagnosis of osteoporosis in men is generally made based on male-specific reference ranges. Treatment consists both of nonpharmacological (lifestyle factors, calcium and vitamin D supplementation) and pharmacological (most commonly bisphosphonates or PTH) approaches, with efficacy similar to that seen in women. Increasing awareness of osteoporosis in men among physicians and the lay public is critical for the prevention of fractures in our aging male population.
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Affiliation(s)
- Sundeep Khosla
- Endocrine Research Unit, Guggenheim 7, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA.
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Sharma S, Fraser M, Lovell F, Reece A, McLellan AR. Characteristics of males over 50 years who present with a fracture: epidemiology and underlying risk factors. ACTA ACUST UNITED AC 2008; 90:72-7. [PMID: 18160503 DOI: 10.1302/0301-620x.90b1.18773] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Osteoporosis and fragility fractures in men constitute a considerable burden in healthcare. We have reviewed 2035 men aged over 50 years with 2142 fractures to clarify the epidemiology of these injuries and their underlying risk factors. The prevalence of osteoporosis ranged between 17.5% in fractures of the ankle and 57.8% in those of the hip. The main risk factors associated with osteoporosis were smoking (47.4%), alcohol excess (36.2%), body mass index < 21 (12.8%) and a family history of osteoporosis (8.4%). Immobility, smoking, self-reported alcohol excess, a low body mass index, age >/=72 and loss in height were significantly more common among men with fractures of the hip than in those with fractures elsewhere.
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Affiliation(s)
- S Sharma
- Department of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow G4 0SF, UK
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32
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González Macías J, Guañabens Gay N, Gómez Alonso C, del Río Barquero L, Muñoz Torres M, Delgado M, Pérez Edo L, Bernardino Díaz López J, Jódar Gimeno E, Hawkins Carranza F. Guías de práctica clínica en la osteoporosis posmenopáusica, glucocorticoidea y del varón. Sociedad Española de Investigación Ósea y del Metabolismo Mineral. Rev Clin Esp 2008. [DOI: 10.1016/s0014-2565(08)71780-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Chesnut CH, Azria M, Silverman S, Engelhardt M, Olson M, Mindeholm L. Salmon calcitonin: a review of current and future therapeutic indications. Osteoporos Int 2008; 19:479-91. [PMID: 18071651 DOI: 10.1007/s00198-007-0490-1] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2006] [Accepted: 07/31/2007] [Indexed: 02/07/2023]
Abstract
Salmon calcitonin, available as a therapeutic agent for more than 30 years, demonstrates clinical utility in the treatment of such metabolic bone diseases as osteoporosis and Paget's disease, and potentially in the treatment of osteoarthritis. This review considers the physiology and pharmacology of salmon calcitonin, the evidence based research demonstrating efficacy and safety of this medication in postmenopausal osteoporosis with potentially an effect on bone quality to explain its abilities to reduce the risk of spine fracture, the development of an oral salmon calcitonin preparation, and the therapeutic rationale for this preparation's chondroprotective effect in osteoarthritis.
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Affiliation(s)
- C H Chesnut
- Osteoporosis Research Group, University of Washington, Seattle, WA, USA.
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Guven Z, Karadag-Saygi E, Unlu-Ozkan F, Akyuz G. The effects of daily alendronate, daily calcitonin and alendronate every other day on bone mineral density in osteoporotic men. Aging Male 2007; 10:197-201. [PMID: 18033629 DOI: 10.1080/13685530701661051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES Biphosphonates have been widely used in the treatment of osteoporosis, but there is not enough data on their use in men. The aim of this study is to investigate the effects of twelve months' treatment with daily 10 mg alendronate, every other day 10 mg alendronate and daily 200 IU calcitonin on bone mineral density (BMD) in men with osteoporosis. MATERIALS AND METHODS 46 men with osteoporosis were randomly allocated to three groups: 15 patients in the first group received daily 10 mg alendronate and calcium (1000 mg/day), 14 patients in the second group used every other day 10 mg alendronate and calcium and 17 patients in the third group were given intranasal salmon calcitonin and calcium. At the baseline, sixth and twelfth months, BMD was measured at lumbar spine (L(2-4)), femoral neck and Ward's triangle zone by means of dual energy X-ray absorptiometry (LUNAR). RESULTS In daily and every other day alendronate and calcitonin groups there was a significant increase in BMD at lumbar spine (p = 0.004, p = 0.001, p = 0.04), but no difference at the femoral neck (p > 0.05) at the end of twelve months. When the groups were compared with each other, no significant differences in BMD levels at lumbar spine, femoral neck and Ward's triangle were found (p > 0.05).
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Affiliation(s)
- Zeynep Guven
- Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, Istanbul, Turkey
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35
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Szulc P, Kaufman JM, Delmas PD. Biochemical assessment of bone turnover and bone fragility in men. Osteoporos Int 2007; 18:1451-61. [PMID: 17566813 DOI: 10.1007/s00198-007-0407-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2007] [Accepted: 05/22/2007] [Indexed: 10/23/2022]
Abstract
UNLABELLED Osteoporosis in men is less studied than in women. Few data concern biochemical bone turnover markers (BTM) in men and their potential use. METHODOLOGY We evaluated papers concerning BTM in men cited on Medline. Selection of studies were based on the number of subjects, age range, group homogeneity, follow-up duration, number of BTM. RESULTS BTM levels are high in young men, then decrease with age. In elderly men, bone resorption increases with age more than bone formation. Variability of individual values is high and their significance is unclear. In elderly men, BTM levels correlate negatively with bone mineral density suggesting that accelerated bone turnover underlies age-related bone loss. Data on the prediction of accelerated bone loss and fractures by BTM in men are scant. Testosterone treatment induces a decrease in bone resorption followed by a decrease in bone formation. Bisphosphonates and calcitonin decrease BTM levels in osteoporotic men. Parathyroid hormone 1-34 and growth hormone induce a rapid increase in bone turnover followed by a progressive slowdown. CONCLUSIONS Few studies concern BTM in men. Currently available data are not sufficient to suggest guidelines for the practical use of BTM in the clinical management of the osteoporosis in elderly men.
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Affiliation(s)
- P Szulc
- INSERM Research Unit 831, University of Lyon, Lyon, France.
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36
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Griel AE, Kris-Etherton PM, Hilpert KF, Zhao G, West SG, Corwin RL. An increase in dietary n-3 fatty acids decreases a marker of bone resorption in humans. Nutr J 2007; 6:2. [PMID: 17227589 PMCID: PMC1784104 DOI: 10.1186/1475-2891-6-2] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2006] [Accepted: 01/16/2007] [Indexed: 12/20/2022] Open
Abstract
Human, animal, and in vitro research indicates a beneficial effect of appropriate amounts of omega-3 (n-3) polyunsaturated fatty acids (PUFA) on bone health. This is the first controlled feeding study in humans to evaluate the effect of dietary plant-derived n-3 PUFA on bone turnover, assessed by serum concentrations of N-telopeptides (NTx) and bone-specific alkaline phosphatase (BSAP). Subjects (n = 23) consumed each diet for 6 weeks in a randomized, 3-period crossover design: 1) Average American Diet (AAD; [34% total fat, 13% saturated fatty acids (SFA), 13% monounsaturated fatty acids (MUFA), 9% PUFA (7.7% LA, 0.8% ALA)]), 2) Linoleic Acid Diet (LA; [37% total fat, 9% SFA, 12% MUFA, 16% PUFA (12.6% LA, 3.6% ALA)]), and 3) alpha-Linolenic Acid Diet (ALA; [38% total fat, 8% SFA, 12% MUFA, 17% PUFA (10.5% LA, 6.5% ALA)]). Walnuts and flaxseed oil were the predominant sources of ALA. NTx levels were significantly lower following the ALA diet (13.20 +/- 1.21 nM BCE), relative to the AAD (15.59 +/- 1.21 nM BCE) (p < 0.05). Mean NTx level following the LA diet was 13.80 +/- 1.21 nM BCE. There was no change in levels of BSAP across the three diets. Concentrations of NTx were positively correlated with the pro-inflammatory cytokine TNFalpha for all three diets. The results indicate that plant sources of dietary n-3 PUFA may have a protective effect on bone metabolism via a decrease in bone resorption in the presence of consistent levels of bone formation.
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Affiliation(s)
- Amy E Griel
- Department of Nutritional Sciences, 126 S Henderson Bldg, The Pennsylvania State University, University Park, PA 16802, USA
- The Huck Institutes of the Life Sciences, 201 Life Sciences Bldg, The Pennsylvania State University, University Park, PA 16802, USA
| | - Penny M Kris-Etherton
- Department of Nutritional Sciences, 126 S Henderson Bldg, The Pennsylvania State University, University Park, PA 16802, USA
- The Huck Institutes of the Life Sciences, 201 Life Sciences Bldg, The Pennsylvania State University, University Park, PA 16802, USA
| | - Kirsten F Hilpert
- Department of Nutritional Sciences, 126 S Henderson Bldg, The Pennsylvania State University, University Park, PA 16802, USA
- The Huck Institutes of the Life Sciences, 201 Life Sciences Bldg, The Pennsylvania State University, University Park, PA 16802, USA
| | - Guixiang Zhao
- Department of Nutritional Sciences, 126 S Henderson Bldg, The Pennsylvania State University, University Park, PA 16802, USA
| | - Sheila G West
- Department of Biobehavioral Health, 315 Health & Human Development East, The Pennsylvania State University, University Park, PA 16802, USA
| | - Rebecca L Corwin
- Department of Nutritional Sciences, 126 S Henderson Bldg, The Pennsylvania State University, University Park, PA 16802, USA
- The Huck Institutes of the Life Sciences, 201 Life Sciences Bldg, The Pennsylvania State University, University Park, PA 16802, USA
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37
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Abstract
In elderly women, loss in bone mass and micro-architectural changes are generally attributed to the onset of menopause. Men do not experience menopause, they do, however, experience age-related acceleration in bone loss and micro-architecture deterioration. The incidence of osteoporotic fractures in elderly men, just as in aged women, increases exponen-tially with age; the rise in men, however, is some 5-10 years later than in women. Up to 50% of male osteoporotics have no identifiable etiology; however elderly males have much higher likelihood of having an identifiable secondary cause than younger men. Therefore, clinical and laboratory evaluation of aged male osteoporotics must be thorough and should be aimed at identifying lifestyle or conditions contributing to bone loss and fragility. It is essential to identify and treat secondary causes and ensure adequate vitamin D and calcium intake before embarking upon treatment with pharmacological agents. The evidence from a limited number of trials suggests that bisphosphonates, especially alendronate and risedronate, are effective in improving BMD, and seem to be the treatments of choice in aged men with osteoporosis. In cases where bisphosphonates are contra-indicated or ineffective, teriparatide or alternatives such as strontium should be considered.
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Affiliation(s)
- Stephen P Tuck
- Departments of Rheumatology, James Cook University Hospital, Marton Road, Middlesbrough, Cleveland, UK
| | - Harish K Datta
- School of Clinical and Laboratory Sciences, The Medical School, University of Newcastle, Newcastle upon Tyne, UK
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Sarikaya S, Ozdolap S, Mungan AG, Gümüştaş S, Koç U, Güven B, Beğendik F. Effect of underground working on vitamin D levels and bone mineral densities in coal miners: a controlled study. J Int Med Res 2006; 34:362-6. [PMID: 16989491 DOI: 10.1177/147323000603400404] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The aim of this study was to determine the effect of underground working on 25-hydroxyvitamin D (25-OHD) levels and bone mineral density (BMD) values in coal miners. Fifty coal miners working underground and 50 surface workers as controls, matched for age and body mass index, from Zonguldak, Turkey, were recruited to the study. Levels of 25-OHD, biochemical bone markers, and lumbar spine and femur BMD values were measured in all study participants. Lumbar spine and femur BMD values were significantly higher in underground workers compared with surface workers, but there was no significant difference in 25-OHD levels between the two groups. Duration of underground working, age, 25-OHD levels, cigarette consumption and dietary calcium intake were not correlated with BMD values. Underground physical working does not seem to be a significant risk factor for low 25-OHD levels or low BMD values.
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Affiliation(s)
- S Sarikaya
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Zonguldak Karaelmas University, Zonguldak, Turkey.
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Shimon I, Eshed V, Doolman R, Sela BA, Karasik A, Vered I. Alendronate for osteoporosis in men with androgen-repleted hypogonadism. Osteoporos Int 2005; 16:1591-6. [PMID: 16362147 DOI: 10.1007/s00198-005-1879-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2004] [Accepted: 02/03/2005] [Indexed: 10/25/2022]
Abstract
Male hypogonadism is associated with low bone mineral density (BMD) and an increased risk of fractures. Testosterone replacement therapy improves BMD in young hypogonadal men. This effect is milder in older patients, who are at greater risk for fractures. We studied the effects of alendronate or placebo on BMD in 22 osteoporotic men, 29-69 years of age (mean, 50.2+/-11.2 years) with long-standing hypogonadism, receiving standard testosterone replacement treatment. Alendronate 10 mg daily (n=11) increased lumbar-spine BMD by 6.0 and 8.4% at 6 and 12 months, respectively, compared with -0.5% at 6 months and +3.3% at 12 months in the placebo group (n=11; P<0.005). Alendronate also increased mean femoral-neck BMD by 1.9% after 1 year, compared to a 1.4% decrease with placebo (P<0.005), and increased the total body bone mineral content by 4.4%, compared to a 0.6% decrease with placebo (P=0.07). After 6 months alendronate suppressed urinary deoxypyridinoline by 50% (P<0.005), compared to a 24% decrease in the placebo group. Both the alendronate and placebo groups continued with alendronate 70 mg once weekly for the following 2 years. Lumbar-spine BMD during this open-label study phase did not change significantly in the group originally treated with alendronate, but continued to increase in the placebo-alendronate group by 5.4, 6.5, and 6.2% after 18 (6 months of alendronate), 24 and 36 months, respectively (P<0.05). Femoral-neck BMD continued to increase in both groups receiving active therapy; in the alendronate-alendronate group by 3.7, 2.7, and 5.2% after 18, 24, and 36 months, respectively (P=0.01), and in the placebo-alendronate group by 0.7 and 1.9% at 24 (first 12 months of alendronate) and 36 months, respectively (P<0.05). Our results support the long-term administration of alendronate along with testosterone replacement to men with hypogonadism-induced osteoporosis.
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Affiliation(s)
- Ilan Shimon
- Institute of Endocrinology, Chaim Sheba Medical Center, 52621, Tel-Hashomer, Israel.
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40
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Hinchcliffe M, Jabbal-Gill I, Smith A. Effect of chitosan on the intranasal absorption of salmon calcitonin in sheep. J Pharm Pharmacol 2005; 57:681-7. [PMID: 15969922 DOI: 10.1211/0022357056073] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The effects of a chitosan-based delivery system on the pharmacokinetics of intranasally administered salmon calcitonin (sCT) were investigated in a sheep model. In particular, the feasibility of producing a formulation with a comparable or improved bioavailability and/or less variability than the currently marketed nasal product (Miacalcin nasal spray, Novartis Pharmaceuticals) was assessed. A comparator (control) formulation comprising sCT solution was also tested. Sheep (n=6) were dosed intranasally according to a randomized crossover design. The intranasal sCT dose was 1100 IU (equivalent to approximately 17 IU kg-1). After completion of the nasal dosing legs, five of the sheep received 300 IU sCT (equivalent to approximately 5 IU kg-1) by subcutaneous injection to estimate relative bioavailability. After intranasal or subcutaneous dosing, serial blood samples were taken and plasma separated by centrifugation before measuring sCT concentrations by ELISA. Pharmacokinetic (non-compartmental) and statistical (analysis of variance or non-parametric alternative) analyses were performed. No systemic or local adverse effects were observed following intranasal or subcutaneous administration of sCT. The mean relative bioavailability of sCT from the chitosan solution was improved twofold compared with Miacalcin nasal spray and threefold compared with sCT control solution. Inter-animal variability in sCT absorption appeared to be lower with use of the chitosan-based solution compared with the control solution or commercial product. Based on the reported sheep data, a chitosan delivery system could offer the potential to significantly improve the intranasal absorption of sCT and reduce the variability in absorption. In the clinical setting, this may allow relatively lower doses of the drug to be given intranasally and/or lead to improvements in the efficacy or quality of intranasal therapy.
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Affiliation(s)
- Michael Hinchcliffe
- Archimedes Development Ltd, Albert Einstein Centre, Nottingham Science & Technology Park, University Boulevard, Nottingham NG7 2TN, UK.
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&NA;. Osteoporosis in men: an increasingly recognised health problem usually best treated with bisphosphonates. DRUGS & THERAPY PERSPECTIVES 2005. [DOI: 10.2165/00042310-200521100-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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42
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Soung DY, Chung HY, Rhee SH, Park KY. Age-Related Male Osteoporosis, and Soy, Its Alternative Therapy - Review-. Prev Nutr Food Sci 2005. [DOI: 10.3746/jfn.2005.10.3.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Ofluoglu D, Karadag-Saygi E, Canbulat C, Gunduz OH, Kul-Panza E, Akyuz G. Early effect of nasal salmon calcitonin on the bone marker Crosslaps. Rheumatol Int 2005; 26:288-91. [PMID: 15875189 DOI: 10.1007/s00296-005-0591-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2004] [Accepted: 12/04/2004] [Indexed: 11/28/2022]
Abstract
The aim of this study was to investigate the early effect of nasal salmon calcitonin on a bone-resorption marker, "Crosslaps", in postmenopausal osteoporotic women. In this randomized, single-blind and placebo-controlled study we included 78 postmenopausal women with osteoporosis, between 45 and 65 years of age, with at least 5 years duration of menopause. Patients were randomly divided into two groups, the treatment and the placebo groups. Patients in the treatment group were given 100 IU day(-1) nasal salmon calcitonin, 1,000 mg day(-1) elemental calcium, and 400 IU day(-1) vitamin D. Patients in the placebo group took only 1,000 mg day(-1) elemental calcium, and 400 IU day(-1) vitamin D. The outcome measurements were urinary deoxypyridinoline, serum alkaline phosphatase, osteocalcin, and Crosslaps. The treatment group consisted of 39 patients whose mean age was 60.4 +/- 6 years and the placebo group included 39 patients with a mean age of 60.5 +/- 4.9 years. There was no significant difference between two groups in terms of demographic characteristics. The results of bone marker measurements were analyzed statistically. Crosslaps levels in the treatment group were significantly lower (P < 0.05) than in the placebo group. Other bone marker levels at the end of the study were not significantly lower (P > 0.05) than those at baseline in both treatment and placebo groups, however. Salmon calcitonin affects bone turnover within a few months and bone-resorption markers such as Crosslaps can be used to monitor the effect of nasal salmon calcitonin in the early phase of treatment for postmenopausal osteoporosis.
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Affiliation(s)
- Demet Ofluoglu
- Physical Medicine and Rehabilitation Department, Marmara University School of Medicine, No. 13/15, Altunizade, Istanbul, 34662, Turkey
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Abstract
Osteoporosis is a nationwide health care concern affecting millions of Americans. Health care dollars to prevent and treat osteoporosis are needed. Osteoporosis-related injuries and resulting disabilities, and consequent admissions to hospitals, nursing homes, and long-term care facilities is costing billions of dollars for care and treatment. Healthy lifestyle choices including vitamin and mineral therapy; safe home environments; a diet replete with calcium, vitamin D, and protein; weight-bearing and resistance exercises; and fall prevention programs for home-bound and hospitalized elders are needed to prevent osteoporosis-related fractures and injuries. Nurses must educate the public on osteoporosis and osteoporosis-prevention activities. Research in nursing, pharmacy, and allied health fields such as physical therapy and nutrition must expand to improve understanding of the risks associated with osteoporosis and to evaluate health-promotion and disease- prevention activities. Interdisciplinary partnerships should be established to study the issues, prevention, and treatment modalities of this "silent killer."
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Affiliation(s)
- Lynn C Parsons
- School of Nursing, Box 81, Middle Tennessee State University, Murfreesboro, TN 37132, USA.
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45
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Tóth E, Csupor E, Mészáros S, Ferencz V, Németh L, McCloskey EV, Horváth C. The effect of intranasal salmon calcitonin therapy on bone mineral density in idiopathic male osteoporosis without vertebral fractures--an open label study. Bone 2005; 36:47-51. [PMID: 15664001 DOI: 10.1016/j.bone.2004.09.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2004] [Revised: 09/02/2004] [Accepted: 09/12/2004] [Indexed: 10/26/2022]
Abstract
The aim of this study was to examine the effect of intranasal salmon calcitonin therapy on bone mineral density (BMD) in idiopathic male osteoporosis without vertebral fractures. We conducted a randomized, open label, controlled trial in 71 male patients (mean age 59 +/- 6 years) suffering from idiopathic osteoporosis (femoral neck T-score < -2.5) without vertebral deformity. Patients in the control group (n = 31) received 400 IU Vitamin D + 1000 mg elemental calcium daily while the treatment group (n = 40) received 400 IU Vitamin D, 1000 mg elemental calcium plus 200 IU calcitonin nasal spray daily during alternate months. The study period was 18 months. Compared to controls, nasal calcitonin was associated with significant increases in bone mineral density at the lumbar spine (+3.5 +/- (-4.3%) vs. +0.83 +/- 6.4%, P = 0.04) and the femoral neck (+3.2 +/- 3.9% vs. +0.68 +/- 5.7%, P = 0.004). No significant difference was observed at the radius between the treatment groups (+1.4 +/- 8.8% vs. +1.4 +/- 10.9%, P = 0.98). Treatment was well tolerated with no premature discontinuations or significant side effects compared to the control group. We conclude that 200 IU salmon calcitonin nasal spray used daily, intermittently proved to be an effective and safe therapy in male idiopathic osteoporosis.
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Affiliation(s)
- Edit Tóth
- Department of Rheumatology, Flór Ferenc Country Hospital, Kistarcsa, H-2143, Hungary.
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Srivastava AK, Libanati C, Hohmann O, Kriegman A, Baylink DJ. Acute effects of calcitonin nasal spray on serum C-telopeptide of type 1 collagen (CTx) levels in elderly osteopenic women with increased bone turnover. Calcif Tissue Int 2004; 75:477-81. [PMID: 15365658 DOI: 10.1007/s00223-004-0036-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2004] [Accepted: 04/19/2004] [Indexed: 12/01/2022]
Abstract
Salmon calcitonin is a potent inhibitor of osteoclastic activity. The effect of calcitonin in elderly women with high bone turnover at higher risk of developing osteoporosis has not been studied. To investigate acute effects of calcitonin treatment on bone resorption markers in elderly women, we conducted a randomized trial in women >65 years of age with high bone turnover assessed as urinary N-telopeptide of type-I collagen (NTx) levels 1 SD higher than mean premenopausal levels, which was irrespective of bone density. A total of 98 elderly women were randomly assigned to receive either 200 IU calcitonin nasal spray (n = 75) with calcium (500 mg) and vitamin D (200 IU) or calcium and vitamin D (n = 23) alone for 6 months. Blood and urine samples were collected at 0, 2, 4, and 6 months and analyzed for urinary NTx and serum C-telopeptide of type-1 collagen (CTx). At baseline, mean age was 72.1 +/- 4.7 (mean +/- SD) in the calcitonin group and 72.2 +/- 6 years in the control group. The spine and total hip BMD, serum PTH levels and urinary calcium/creatinine ratios were similar in both groups. Mean BMD was in the osteopenic range in both groups. Calcitonin treatment resulted in significant decreases in serum CTx levels, 2, 4 and 6 months after treatment as compared to baseline, and after 4 and 6 months as compared to controls. A maximum decrease from baseline of 33% was seen at 6 months. The urinary resorption marker, urine NTx, showed a significant decrease in the calcitonin group when compared to baseline only at the 6-month time point. Analysis of least significance change (LSC) showed that 70% of calcitonin patients were categorized as responders using serum CTx after 6 months of treatment. We conclude that 200 IU calcitonin effectively decreases bone resorption within 60 days of therapy, thus preventing further bone loss in elderly women who are at a high risk of developing osteoporosis.
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Affiliation(s)
- Apurva K Srivastava
- JLP VA Medical Center, Musculoskeletal Disease Center, Loma Linda, CA 92357, USA
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Tankó LB, Bagger YZ, Alexandersen P, Devogelaer JP, Reginster JY, Chick R, Olson M, Benmammar H, Mindeholm L, Azria M, Christiansen C. Safety and efficacy of a novel salmon calcitonin (sCT) technology-based oral formulation in healthy postmenopausal women: acute and 3-month effects on biomarkers of bone turnover. J Bone Miner Res 2004; 19:1531-8. [PMID: 15312255 DOI: 10.1359/jbmr.040715] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2004] [Revised: 04/19/2004] [Accepted: 05/03/2004] [Indexed: 11/18/2022]
Abstract
UNLABELLED Oral administration of calcitonin could improve compliance to long-term treatment. Efficacy and safety of a novel oral formulation was assessed on 277 postmenopausal women. The results show (1) effective enteral absorption, (2) marked inhibition of bone resorption with minimal alteration of formation, and (3) reproducibility of responses over 3 months. INTRODUCTION We have recently introduced an Eligen technology-based oral formulation of salmon calcitonin (sCT) that effectively delivers the hormone to the circulation. The efficacy and safety during longer-term administration, however, has not been investigated in the target population. MATERIALS AND METHODS This was a multicenter, randomized, double-blind, placebo-controlled, dose-ranging clinical trial including 277 healthy postmenopausal women 55-85 years of age. Women received treatment with either daily (0.15, 0.4, 1.0, or 2.5 mg) or intermittent doses (1.0 mg, every other day) of sCT combined with the delivery agent (8-[N-2-hydroxi-5-chloro-benzoyl]-amino-caprylic acid, 200 mg) or placebo for 3 months. All participants received 1,000 mg calcium plus 400 IU vitamin D daily throughout the study. Efficacy parameters were the acute and/or pre-dose changes in serum and urinary C-terminal telopeptide of type I collagen (CTx), N-mid osteocalcin (OC), bone-specific alkaline phosphatase (BSALP), calcium, and parathyroid hormone (PTH) measured by established immunoassays. RESULTS After the first dose, sCT evoked dose-dependent decreases in serum CTx (-60.8% to -81.8% from baseline) compared with placebo, reaching nadirs 2-3 h after drug intake, after which, gradual increases were observed. The simultaneous acute changes in OC were statistically nonsignificant. Area under the curve (AUC) of serum CTx responses at months 1 and 3 showed strong correlation with those at baseline (both r = 0.78, p < 0.001). At month 3, the placebo-corrected changes in the pre-dose value of serum and urinary CTx were significant only in the 1.0-mg dose group (-18.9% and -20.5%, respectively, p < 0.05). The placebo-corrected change in OC was -8.6 (p = 0.09), whereas the change in BSALP was -7.3 (p = 0.02). The oral formulation was well tolerated, with mild to moderate gastrointestinal and skin manifestations apparent mainly in the high-dose groups. CONCLUSION The results of this 3-month trial show that the novel Eligen technology-based oral formulation of sCT has potential to become a safe and effective treatment for postmenopausal bone loss. Future trials are needed to assess the impact of long-term administration on changes in BMD and fracture risk.
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Affiliation(s)
- László B Tankó
- Center for Clinical and Basic Research, Ballerup, Denmark.
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Olszynski WP, Shawn Davison K, Adachi JD, Brown JP, Cummings SR, Hanley DA, Harris SP, Hodsman AB, Kendler D, McClung MR, Miller PD, Yuen CK. Osteoporosis in men: epidemiology, diagnosis, prevention, and treatment. Clin Ther 2004; 26:15-28. [PMID: 14996514 DOI: 10.1016/s0149-2918(04)90002-1] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2003] [Indexed: 12/31/2022]
Abstract
BACKGROUND Osteoporosis and fragility fractures in men account for substantial health care expenditures and decreased quality of life. OBJECTIVE This article reviews the most current information about the epidemiology, diagnosis, prevention, and treatment of osteoporosis in men. METHODS Relevant literature was identified through a search of MEDLINE (1966-June 2003) limited to English-language studies in men. The search terms included fractures, bone density, or osteoporosis plus either epidemiology, diagnosis, prevention, control, or therapy. Additional search terms included specific subtopics (eg, bisphosphonates, calcium, exercise, parathyroid hormone). The authors contributed additional relevant publications. RESULTS Morbidity after fragility fracture is at least as high in men as in women, and the rate of fracture-related mortality 1 year hip fracture is approximately double in men compared with women. The bioavailable fraction of testosterone slowly declines into the ninth decade in men. There is evidence that the effect of estrogen on bone is greater than that of testosterone in men. Diagnosing osteoporosis in men is complicated by a lack of consensus on how it should be defined. Significant risk factors for osteoporosis or fracture include low bone mineral density, previous fragility fracture, maternal history of fracture, marked hypogonadism, smoking, heavy alcohol intake or alcoholism, low calcium intake, low body mass or body mass index, low physical activity, use of bone-resorbing medication such as glucocorticoids, and the presence of such conditions as hyperthyroidism, hyperparathyroidism, and hypercalciuria. Prevention is paramount and should begin in childhood. During adulthood, calcium (1000-1500 mg/d), vitamin D (400-800 IU/d), and adequate physical activity play crucial preventive roles. When treatment is indicated, the bisphosphonates are the first choice, whereas there is less support for the use of calcitonin or androgen therapy. Parathyroid hormone (1-34) is a promising anabolic therapy. There is also strong evidence for the use of bisphosphonates for the treatment of glucocorticoid-induced osteoporosis.
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Affiliation(s)
- Wojciech P Olszynski
- Department of Medicine, University of Saskatchewan, Saskatoon Osteoporosis Centre, Saskatoon, Saskatchewan, Canada.
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Francis RM, Baillie SP, Chuck AJ, Crook PR, Dunn N, Fordham JN, Kelly C, Rodgers A. Acute and long-term management of patients with vertebral fractures. QJM 2004; 97:63-74. [PMID: 14747620 DOI: 10.1093/qjmed/hch012] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Symptomatic vertebral fractures are associated with significant morbidity, excess mortality and health and social service expenditure. Up to 20% of patients with an incident vertebral fracture experience a further vertebral fracture within one year. It is therefore important that vertebral fractures are detected early, and treatment considered as soon as possible. Only a third of vertebral fractures come to medical attention, where they typically present with acute back pain, but other presentations include loss of height and increasing kyphosis. Spine X-rays should then be performed to confirm the diagnosis and exclude other pathology. Bone density measurements are not essential before starting treatment for osteoporosis in patients with low-trauma vertebral fractures, but may be useful to confirm osteoporosis when there is uncertainty about previous trauma. They may also aid in selecting the most appropriate therapy and monitoring response to treatment. Up to 30% of women and 55% of men with symptomatic vertebral crush fractures have underlying secondary osteoporosis, where treatment may lead to large increases in bone density. These conditions should therefore be sought by medical history, physical examination and appropriate investigations. The management of patients with acute vertebral fractures should include measures to reduce pain and improve mobility, as well as starting treatment for osteoporosis. Treatments have now been shown in randomized controlled trials to improve bone density and reduce the incidence of vertebral and non-vertebral fractures in patients with osteoporosis. Choice of treatment will depend on the underlying causes of bone loss, efficacy in any particular situation, cost, patient preference and the potential non-skeletal advantages and disadvantages.
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Affiliation(s)
- R M Francis
- Department of Medicine (Geriatrics), University of Newcastle upon Tyne, Newcastle upon Tyne, UK.
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50
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Abstract
Osteoporosis is being recognized increasingly in men, and represents a substantial public health problem. As the male population ages and lives longer, the incidence of osteoporotic fractures is expected to increase. The current lifetime risk for a fragility fracture is approximately 27% in men aged 50 years or more, and will increase further over the next 20 years. A major problem with osteoporosis in men is that it continues to be unrecognized, and the majority of men with fragility fractures due to osteoporosis are not being treated. A higher level of awareness is required amongst both general practitioners and the general public that osteoporosis is a treatable condition that can affect men. Secondary causes for osteoporosis are more common in men than in women, and require rigorous exclusion and treatment. Undiagnosed clinical hypogonadism is a common cause of osteoporosis in men, and is readily treatable. The cause of primary osteoporosis in men is unknown, but it results in an osteoblast defect. Genetic factors are likely to be important. In some but not all men, relative estrogen deficiency contributes to rapid rates of age-related bone loss and fractures. An adequate calcium intake, regular weight-bearing exercise, and normal vitamin D status are all very important, particularly with increasing age. The role of testosterone in treating eugonadal men with osteoporosis is currently unclear, and larger prospective studies will be required to carefully evaluate the benefits and risks of therapy. First-line treatment of osteoporosis in hypogonadal or eugonadal men is with bisphosphonates. Alendronate increases bone density and reduces vertebral fractures measured using a semiquantitative method in eugonadal or hypogonadal men with osteoporosis. In the near future, it is likely that subcutaneous human parathyroid hormone (1-34) or teriparatide will also be available as an important new anabolic treatment for men with osteoporosis. Teriparatide treatment also increases bone density in men. Selective estrogen receptor modulating drugs require further evaluation in men, but would appear to theoretically benefit men, especially those with low estradiol levels. In the future, selective androgen receptor modulating drugs may be useful in the prevention and treatment of osteoporosis, and in increasing lean body mass in men, without having adverse effects on prostate and breast tissue.
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Affiliation(s)
- Peter R Ebeling
- Department of Diabetes and Endocrinology, The University of Melbourne, The Royal Melbourne Hospital, Parkville, Victoria 3050, Australia.
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