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Park HY, Choi HR, Kim YB, Oh SK, Kim T, Yang HS, In J. Chronic exposure to dexamethasone may not affect sugammadex reversal of rocuronium-induced neuromuscular blockade: an in vivo study on rats. Anesth Pain Med (Seoul) 2023; 18:275-283. [PMID: 37468197 PMCID: PMC10410550 DOI: 10.17085/apm.23021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/14/2023] [Accepted: 05/22/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Chronic glucocorticoid exposure is associated with resistance to nondepolarizing neuromuscular blocking agents. Therefore, we hypothesized that sugammadex-induced recovery would occur more rapidly in subjects exposed to chronic dexamethasone compared to those who were not exposed. This study evaluated the sugammadex-induced recovery profile after neuromuscular blockade (NMB) in rats exposed to chronic dexamethasone. METHODS Sprague-Dawley rats were allocated to three groups (dexamethasone, control, and pair-fed group) for the in vivo study. The mice received daily intraperitoneal dexamethasone injections (500 μg/kg) or 0.9% saline for 15 days. To achieve complete NMB, 3.5 mg/kg rocuronium was administered on the sixteenth day. The recovery time to a train-of-four ratio ≥ 0.9 was measured to evaluate the complete recovery following the sugammadex injection. RESULTS Among the groups, no significant differences were observed in the recovery time to a train-of-four ratio ≥ 0.9 following sugammadex administration (P = 0.531). The time to the second twitch of the train-of-four recovery following rocuronium administration indicated that the duration of NMB was significantly shorter in Group D than that in Groups C and P (P = 0.001). CONCLUSIONS Chronic exposure to dexamethasone did not shorten the recovery time of sugammadex-induced NMB reversal. However, the findings of this study indicated that no adjustments to sugammadex dosage or route of administration is required, even in patients undergoing long-term steroid treatment.
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Affiliation(s)
| | - Hey Ran Choi
- Department of Anesthesiology and Pain Medicine, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Yong Beom Kim
- Department of Anesthesia and Pain Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Seok Kyeong Oh
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Taehoon Kim
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Hong Seuk Yang
- Department of Anesthesiology and Pain Medicine, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Junyong In
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
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Kim YH, Lee HJ, Cho KA, Woo SY, Ryu KH. Conditioned medium from human tonsil-derived mesenchymal stem cells inhibits glucocorticoid-induced adipocyte differentiation. PLoS One 2022; 17:e0266857. [PMID: 35648740 PMCID: PMC9159628 DOI: 10.1371/journal.pone.0266857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/28/2022] [Indexed: 11/18/2022] Open
Abstract
Obesity, which has become a major global health problem, involves a constitutive increase in adipocyte differentiation signaling. Previous studies show that mesenchymal stem cells (MSCs) induce weight loss and glycemic control. However, the mechanisms by which MSCs regulate adipocyte differentiation are not yet known. In this study, we investigated the effects of conditioned medium obtained from human tonsil-derived MSCs (T-MSC CM) on adipocyte differentiation. We found that T-MSC CM attenuated adipocyte differentiation from early stages via inhibiting glucocorticoid signaling. T-MSC CM also increased the phosphorylation of p38 mitogen-activated protein kinase and glucocorticoid receptors and decreased the subsequent nucleus translocation of glucocorticoid receptors. Chronic treatment of mice with synthetic glucocorticoids induced visceral and bone marrow adipose tissue expansion, but these effects were not observed in mice injected with T-MSC CM. Furthermore, T-MSC CM injection protected against reductions in blood platelet counts induced by chronic glucocorticoid treatment, and enhanced megakaryocyte differentiation was also observed. Collectively, these results demonstrate that T-MSC CM exerts inhibitory effects on adipocyte differentiation by regulating glucocorticoid signal transduction. These findings suggest that the therapeutic application of T-MSC CM could reduce obesity by preventing adipose tissue expansion.
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Affiliation(s)
- Yu-Hee Kim
- Department of Microbiology, Ewha Womans University College of Medicine, Gangseo-Gu, Seoul, South Korea
- Advanced Biomedical Research Institute, Ewha Womans University Seoul Hospital, Gangseo-Gu, Seoul, South Korea
| | - Hyun-Ji Lee
- Department of Microbiology, Ewha Womans University College of Medicine, Gangseo-Gu, Seoul, South Korea
| | - Kyung-Ah Cho
- Department of Microbiology, Ewha Womans University College of Medicine, Gangseo-Gu, Seoul, South Korea
| | - So-Youn Woo
- Department of Microbiology, Ewha Womans University College of Medicine, Gangseo-Gu, Seoul, South Korea
| | - Kyung-Ha Ryu
- Department of Pediatrics, Ewha Womans University College of Medicine, Gangseo-Gu, Seoul, South Korea
- * E-mail:
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Quan L, Zhang Y, Dusad A, Ren K, Purdue PE, Goldring SR, Wang D. The Evaluation of the Therapeutic Efficacy and Side Effects of a Macromolecular Dexamethasone Prodrug in the Collagen-Induced Arthritis Mouse Model. Pharm Res 2015; 33:186-93. [PMID: 26286188 DOI: 10.1007/s11095-015-1776-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 08/10/2015] [Indexed: 12/19/2022]
Abstract
PURPOSE To investigate the efficacy and safety of N-(2-hydroxypropyl) methacrylamide (HPMA) copolymer-dexamethasone conjugate (P-Dex) in the collagen-induced arthritis (CIA) mouse model. METHODS HPMA copolymer labeled with a near infrared fluorescence (NIRF) dye was administered to mice with CIA to validate its passive targeting to inflamed joints and utility as a drug carrier system. The CIA mice were treated with P-Dex, dexamethasone (Dex) or saline and the therapeutic efficacy and skeletal toxicity evaluated using clinical scoring and micro-computed tomography (μ-CT). RESULTS The NIRF signal of the HPMA copolymer localized to arthritic joints consistent with its passive targeting to sites of inflammation. While the CIA mice responded more rapidly to P-Dex compared to Dex, the final clinical score and endpoint μ-CT analyses of localized bone erosions indicated that both single dose P-Dex and dose equivalent daily Dex led to comparable clinical efficacy after 30 days. μ-CT analysis of the proximal tibial metaphyses showed that P-Dex treatment was associated with significantly higher BMD and BV/TV compared to Dex and the saline control, consistent with reduced glucocorticoid (GC) skeletal toxicity. CONCLUSION These results validate the therapeutic efficacy of P-Dex in the CIA mouse model. P-Dex treatment averted the adverse effects of GC's on systemic bone loss, supporting its utility in clinical development for the management of rheumatoid arthritis.
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Affiliation(s)
- Lingdong Quan
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, 986025 Nebraska Medical Center, COP 3026, Omaha, Nebraska, 68198-6025, USA
| | - Yijia Zhang
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, 986025 Nebraska Medical Center, COP 3026, Omaha, Nebraska, 68198-6025, USA
| | - Anand Dusad
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, 986025 Nebraska Medical Center, COP 3026, Omaha, Nebraska, 68198-6025, USA
| | - Ke Ren
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, 986025 Nebraska Medical Center, COP 3026, Omaha, Nebraska, 68198-6025, USA
| | - P Edward Purdue
- Hospital for Special Surgery, New York, New York, 10021, USA
| | | | - Dong Wang
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, 986025 Nebraska Medical Center, COP 3026, Omaha, Nebraska, 68198-6025, USA.
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Laryea G, Muglia L, Arnett M, Muglia LJ. Dissection of glucocorticoid receptor-mediated inhibition of the hypothalamic-pituitary-adrenal axis by gene targeting in mice. Front Neuroendocrinol 2015; 36:150-64. [PMID: 25256348 PMCID: PMC4342273 DOI: 10.1016/j.yfrne.2014.09.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 08/05/2014] [Accepted: 09/11/2014] [Indexed: 12/17/2022]
Abstract
Negative feedback regulation of glucocorticoid (GC) synthesis and secretion occurs through the function of glucocorticoid receptor (GR) at sites in the hypothalamic-pituitary-adrenal (HPA) axis, as well as in brain regions such as the hippocampus, prefrontal cortex, and sympathetic nervous system. This function of GRs in negative feedback coordinates basal glucocorticoid secretion and stress-induced increases in secretion that integrate GC production with the magnitude and duration of the stressor. This review describes the effects of GR loss along major sites of negative feedback including the entire brain, the paraventricular nucleus of the hypothalamus (PVN), and the pituitary. In genetic mouse models, we evaluate circadian regulation of the HPA axis, stress-stimulated neuroendocrine response and behavioral activity, as well as the integrated response of organism metabolism. Our analysis provides information on contributions of region-specific GR-mediated negative feedback to provide insight in understanding HPA axis dysregulation and the pathogenesis of psychiatric and metabolic disorders.
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Affiliation(s)
- Gloria Laryea
- Neuroscience Graduate Program, School of Medicine, Vanderbilt University, Nashville, TN, United States; Center for Preterm Birth Research, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 7009, Cincinnati, OH 45229, United States.
| | - Lisa Muglia
- Center for Preterm Birth Research, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 7009, Cincinnati, OH 45229, United States.
| | - Melinda Arnett
- Center for Preterm Birth Research, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 7009, Cincinnati, OH 45229, United States.
| | - Louis J Muglia
- Center for Preterm Birth Research, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 7009, Cincinnati, OH 45229, United States; Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Avenue, ML 7009, Cincinnati, OH 45229, United States.
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Kuan YC, How SH, Azian AA, Liam CK, Ng TH, Fauzi AR. Bone mineral density in asthmatic patients on inhaled corticosteroids in a developing country. Ann Thorac Med 2012; 7:69-73. [PMID: 22558010 PMCID: PMC3339206 DOI: 10.4103/1817-1737.94522] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Accepted: 12/10/2011] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION: Prolonged use of oral corticosteroids is a risk factor for osteoporosis. However, the effect of inhaled corticosteroids (ICS) on bone mineral density (BMD) of asthmatic patients remains controversial. OBJECTIVES: We aimed to determine the prevalence of osteopenia and osteoporosis in our patients with asthma receiving ICSs for more than one year compared with patients who did not have asthma and to determine the risk factors for osteopenia and osteoporosis among the asthmatic patients. METHODS: This was a cross-sectional study conducted from August 2007 to July 2009. Asthmatic patients aged 18 years and older who had been on ICS for at least one year and a control group of subjects not on ICS were included. BMD was measured using DEXA (dual energy X-ray absorptiometry) scan. The WHO classification of T-scores for osteopenia and osteoporosis were used. RESULTS: A total of 143 subjects were recruited (69 asthmatics and 74 control subjects). T-scores of the spine, femur, and hip of the asthmatics vs the control subjects were mean, −0.72 vs −0.57 (P=0.98); median, −0.60 vs −0.80 (P=0.474); and mean, 0.19 vs 0.06 (P=0.275); respectively. T-scores of the spine, femur, and hip showed significant negative correlation with age and significant positive correlation with body mass index (BMI). CONCLUSION: The risk factors for osteoporosis and osteopenia among asthmatic patients were older age and lower BMI, but not the cumulative dose of ICS. Asthmatic patients on ICS have no added risk of osteoporosis or osteopenia as compared with non-asthmatic subjects.
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Affiliation(s)
- Yeh Chunn Kuan
- Department of Internal Medicine, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
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Abstract
PURPOSE OF REVIEW Several large epidemiologic studies have shown an association between chronic obstructive pulmonary disease (COPD) and osteoporosis. Recent studies have further implied an emphysema-specific association with low bone mineral density independent of obstruction severity. RECENT FINDINGS This review will outline the studies demonstrating an independent association between radiographic emphysema and decreased bone mineral density and will discuss potential disease mechanisms, including systemic inflammation and immune-mediated factors, linking these disease processes. SUMMARY Radiographic emphysema should be considered an independent risk factor in studies examining the mechanisms underlying COPD-related bone loss. Future research focused on the relationship between emphysema and low bone mineral density could provide mechanistic insight and result in the development of targeted therapies designed to halt progression of both disease processes.
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Adamczyk P, Pluskiewicz W, Halaba Z, Nowakowski M, Madaj A, Drozdzowska B. Assessment of skeletal status by quantitative ultrasound at the hand phalanges in children with bronchial asthma--a pilot study. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:1802-1807. [PMID: 21924820 DOI: 10.1016/j.ultrasmedbio.2011.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 06/30/2011] [Accepted: 07/28/2011] [Indexed: 05/31/2023]
Abstract
The aim of the study was to assess the skeletal status by quantitative ultrasound measurement at hand phalanges in asthmatic children treated with inhaled corticosteroids. Sixty-nine (69) children with a mean age of 10.9 ± 2.6 y and 251 controls matched for age and body size were enrolled into the study. The mean value of amplitude-dependent speed of sound in asthmatic children was 1953.8 ± 60.2 m/s and the mean Z-score was -0.05 ± 1.02; the corresponding values in the controls were 1951.0 ± 53.9 m/s and -0.26 ± 1.05, respectively. The results did not differ between the asthmatic and the healthy (control) children. A cumulative dose of inhaled steroids was identified in a stepwise regression analysis as a factor with potentially negative influence on bone status. In conclusion, the skeletal status in asthmatic children, assessed by quantitative ultrasound, shows no difference in comparison with healthy children. Nonetheless, special caution is necessary in case of long-term corticosteroid therapy, in which a slightly negative influence of treatment on the skeleton cannot be excluded.
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Affiliation(s)
- Piotr Adamczyk
- Department and Clinic of Pediatrics in Zabrze, Medical University of Silesia, Katowice, Poland.
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Baccaro LF, Boin IFSF, Pedro AO, Costa-Paiva L, Leal ALG, Ramos CD, Pinto-Neto AM. Decrease in bone mass in women after liver transplantation: associated factors. Transplant Proc 2011; 43:1351-6. [PMID: 21620127 DOI: 10.1016/j.transproceed.2011.02.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND In the future, an increasing number of female liver transplant recipients will reach the climacteric with osteoporosis as a common complication. We evaluated the factors associated with decreased bone mass among women after liver transplantation. METHODS A prospective, cross-sectional study of 23 outpatient transplant recipients followed from February 2009 to March 2010 included women of age ≥35 years after liver transplantations ≥1 year prior. We recorded patient histories, liver enzyme levels, as well as bone mineral densities measured at the lumbar spine and femur. Statistical analysis used Fisher's exact test, simple odds ratio (OR), and Spearman's rank correlation coefficient. RESULTS The mean patient age was 52.5 ± 11 years with 30.4% premenopausal, and 69.6% perimenopausal or postmenopausal. Approximately 21% showed osteoporosis and 35%, a low bone mass. Postmenopausal women: OR 69.0 (95% CI 2.89-1647.18; P<.0001), aged ≥49 years: OR 13.33 (95% CI 1.78-100.15; P=.0123) and receiving a transplant after 44 years of age: OR 49.50 (95% CI 3.84-638.43; P<.0001) were associated with a lower bone mass. Having undergone transplantation for more than 5.8 years lowered the risk of bone mass change: OR 0.11 (95% CI 0.02-0.78; P=.0361). Clinical and laboratory variables, including corticosteroid use, were not associated with decreased bone mass. CONCLUSION Understanding the prevalence and factors associated with osteoporosis among female liver transplant recipients is important to enhance the strategies to diagnose and treat these women, seeking to improve their quality of life.
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Affiliation(s)
- L F Baccaro
- Department of Gynecology, State University of Campinas, Campinas, Brazil.
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Mitra R. Adverse effects of corticosteroids on bone metabolism: a review. PM R 2011; 3:466-71; quiz 471. [PMID: 21570035 DOI: 10.1016/j.pmrj.2011.02.017] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 02/01/2011] [Accepted: 02/07/2011] [Indexed: 12/29/2022]
Abstract
Glucocorticoid (GC) exposure is the most common etiology of drug-induced (secondary) osteoporosis. Twenty percent of all cases of osteoporosis have been attributed to GC exposure. Significant risk factors for the development of fractures after GC exposure include age older than 65 years, prolonged GC exposure (>3 months), positive family history of osteoporosis, and low calcium intake. GCs are known to inhibit bone remodeling and to increase fracture risk. GC exposure alters the fragile balance between osteoclast and osteoblast activity in bone metabolism. GC stimulates osteoclast-mediated bone resorption and reduces osteoblast-mediated bone formation, which results in increased overall net bone resorption. Specifically, the 2 main effects of GCs on bone metabolism are (1) inducing apoptosis in osteoblasts and osteocytes, thereby decreasing bone formation, and (2) prolonging the lifespan of osteoclasts and increasing bone resorption. The risk of fracture decreases 3 months after cessation of GC therapy; thus, a 3-month period may be ideal between GC exposures in patients at high risk for the development of osteoporosis. Patients managed with GCs who are at high risk for the development of secondary osteoporosis should have appropriate diagnostic testing; pre-GC exposure medication management (ie, use of bisphosphonates, human parathyroid hormone); and a limitation of GC therapy, with a wait period of 3 months between GC exposures if possible.
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Affiliation(s)
- Raj Mitra
- Stanford University School of Medicine, 450 Broadway St, Mailcode 6342, Redwood City, CA 94063, USA.
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Duckers JM, Evans BAJ, Fraser WD, Stone MD, Bolton CE, Shale DJ. Low bone mineral density in men with chronic obstructive pulmonary disease. Respir Res 2011; 12:101. [PMID: 21812978 PMCID: PMC3161864 DOI: 10.1186/1465-9921-12-101] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 08/03/2011] [Indexed: 01/28/2023] Open
Abstract
Background Osteoporosis is common in patients with COPD but the likely multi-factorial causes contributing to this condition (e.g. sex, age, smoking, therapy) mask the potential contribution from elements related to COPD. In order to study osteoporosis and bone mineral density (BMD) related to COPD, we studied a well-defined group of patients and controls. Methods BMD, forced expiratory volume in one second (FEV1), circulating bone biomarkers and biochemistry were determined in 30 clinically stable male ex-smokers with confirmed COPD and 15 age matched "ex-smoker" male controls. None of the patients were on inhaled corticosteroids or received more than one short course of steroids. Results Mean (SD) FEV1% predicted of patients was 64(6)%, the majority having Global Initiative for Chronic Obstructive Lung Disease (GOLD) II airflow obstruction. There were 5/30 patients and 1/15 controls who were osteoporotic, while a further 17 patients and 5 controls were osteopenic. The BMD at the hip was lower in patients than controls, but not at the lumbar spine. Mean values of procollagen type 1 amino-terminal propeptide and osteocalcin, both markers of bone formation, and Type 1 collagen β C-telopeptide, a marker of bone resorption, were similar between patients and controls. However, all bone biomarkers were inversely related to hip BMD in patients (r = -0.51, r = -0.67, r = -0.57, p < 0.05) but did not relate to lumbar spine BMD. 25-OH Vitamin D was lower in patients. Conclusions Men with COPD had a greater prevalence of osteoporosis and osteopenia than age matched male controls, with a marked difference in BMD at the hip. Bone biomarkers suggest increased bone turnover.
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Affiliation(s)
- James M Duckers
- Section of Respiratory Medicine, Wales Heart Research Institute, School of Medicine, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK.
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Nazrun A, Norazlina M, Norliza M, Nirwana SI. Tocotrienols as an Anti-Osteoporotic Agent: The Progress So Far. ACTA ACUST UNITED AC 2010. [DOI: 10.3923/ijom.2011.1.14] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Graat-Verboom L, Spruit MA, van den Borne BEEM, Smeenk FWJM, Martens EJ, Lunde R, Wouters EFM. Correlates of osteoporosis in chronic obstructive pulmonary disease: An underestimated systemic component. Respir Med 2010; 103:1143-51. [PMID: 19304474 DOI: 10.1016/j.rmed.2009.02.014] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 02/10/2009] [Accepted: 02/22/2009] [Indexed: 01/10/2023]
Abstract
RATIONALE Chronic obstructive pulmonary disease (COPD) patients are at increased risk of osteoporosis. Osteoporosis is under diagnosed and under treated in these patients and the underlying mechanisms remain unclear. To date, screening recommendations for osteoporosis in COPD patients are not available. OBJECTIVES To examine the prevalence of drug treatment of bone abnormalities as well as the clinical determinants of osteoporosis in COPD. METHODS COPD patients (n=554) consecutively entering pulmonary rehabilitation were included in this cross-sectional study. Medical history, current medication use, smoking status, lung function, bone mineral density, body composition and other clinical characteristics were assessed before entering pulmonary rehabilitation. Univariate- and multivariate multinomial logistic regression analyses were used to determine correlates of osteoporosis. MAIN RESULTS Twenty-one percent of patients had osteoporosis and 41% had osteopenia. Osteoporosis was pharmacologically under treated (82% of osteoporotic patients were not receiving bone medication). Independent predictors of osteoporosis were cachexia (OR: 12.1; 95%CI: 4.5-32.7; p<0.001), age between 55 and 65 years (OR: 6.0; 95%CI: 2.2-16.3; p<0.001) and over 65 years (OR: 11.7; 95%CI: 4.1-33.1; p=<0.001). Overweight (OR: 0.1; 95%CI: 0.05-0.4; p=0.001) and obesity (OR: 0.78; 95%CI: 0.02-0.4; p=0.002) showed a substantial protective effect. CONCLUSIONS The majority of COPD patients with osteoporosis entering pulmonary rehabilitation did not receive pharmacological treatment for osteoporosis. Cachectic COPD patients should be screened for osteoporosis, especially when over 55 years of age.
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Affiliation(s)
- Lidwien Graat-Verboom
- Department of Respiratory Medicine, University Medical Centre Maastricht, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.
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Santangelo A, Testaì M, Mamazza G, Zuccaro C, Albani S, Pavano S, Cappello A, Sambataro D, Atteritano M, Maugeri D. The bone mass (BM) and chronic cardiac decompensation (CCD) in an elderly population. Arch Gerontol Geriatr 2010; 53:51-4. [PMID: 20537414 DOI: 10.1016/j.archger.2010.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 05/02/2010] [Accepted: 05/03/2010] [Indexed: 11/18/2022]
Abstract
This study intended to evaluate the existing correlation between the cardiac compensation and the bone mass, investigating the bone mineral density (BMD) in a population suffering from CCD or chronic heart disease (CHD). We enrolled 171 patients, all over the age of 70, being in the functional N.Y.H.A. Class II (Population A: 85 patients) and in Class III (Population B: 86 patients). All patients underwent an analysis of their cardiac functions using a Doppler echo-cardiographic method measuring the ventricular ejection fraction (VEF), as well as the BMD by means of a computerized bone mineralometric DEXA method, performed in vertebral and femoral measurement sites. Both populations proved to be osteopenic, displaying reduced values of BMD. Higher bone mineral losses were measured in the patients who had more severe cardiac insufficiency. The present data revealed a significant reduction of BMD in the N.Y.H.A. Class III patients, in correlation with the VEF (p<0.001), both in the lumbar vertebral area (p<0.01) and even more in the femoral sites (p<0.001), where a direct correlation exists between BMD and the VEF. On the basis of these findings one can suggest that the actual VEF level has an influence on the bone turnover, reducing the mineral content through various mechanisms of action.
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Affiliation(s)
- Antonino Santangelo
- Scuola di Specializzazione di Geriatria, Università di Catania, c/o P.O. Cannizzaro Hospital, Via Messina 829, I-95129 Catania, Italy.
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Franco CB, Paz-Filho G, Gomes PE, Nascimento VB, Kulak CAM, Boguszewski CL, Borba VZC. Chronic obstructive pulmonary disease is associated with osteoporosis and low levels of vitamin D. Osteoporos Int 2009; 20:1881-7. [PMID: 19300892 DOI: 10.1007/s00198-009-0890-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Accepted: 01/21/2009] [Indexed: 10/21/2022]
Abstract
UNLABELLED We did a cross-sectional analysis of chronic pulmonary obstructive disease (COPD) patients without chronic use of systemic glucocorticoids (CUG). Osteoporosis was found in 51% and bone mineral density (BMD) was correlated with severity of disease. Low levels of vitamin D were found in 94%. All COPD patients may benefit from vitamin D supplementation and screening for low BMD. INTRODUCTION Patients with chronic pulmonary obstructive disease have low bone mineral density, caused by chronic use of systemic glucocorticoids and hypovitaminosis D. However, patients without CUG may also have low BMD. METHODS We performed a cross-sectional analysis in 49 patients (21 men, 28 postmenopausal women), with COPD without CUG, from Brazil (25 degrees 25' S). Several markers of bone metabolism were measured, plus BMD. Osteoporosis risk factors and history of fractures were investigated. Respiratory function was assessed by venous gasometry, spirometry, and oximetry. BMD results were compared to those of 40 healthy non-smokers controls. RESULTS COPD patients had lower BMD at all sites (p < 0.01). Osteoporosis was observed in 51%. BMD independently correlated with stage of disease (lumbar spine, R = 0.38, p = 0.01; total femur, R = 0.36, p = 0.01; femoral neck, R = 0.40, p < 0.01). Ninety-four percent had low levels of vitamin D (<30 ng/mL) and 67% had secondary hyperparathyroidism. Vitamin D was correlated with oxygen saturation (R = 0.36, p = 0.01), with lower levels in those with saturation <88% (p = 0.01). CONCLUSION Patients with COPD without CUG have increased risk for osteoporosis. Such patients have hypovitaminosis D, which is correlated with the severity of disease. Screening for low BMD and vitamin D supplementation may be warranted to all COPD patients.
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Affiliation(s)
- C B Franco
- Serviço de Endocrinologia e Metabologia do Hospital de Clínicas da Universidade Federal do Paraná (SEMPR), Curitiba, Brazil, CEP: 80030-110
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van Brussel MS, Bultink IEM, Lems WF. Prevention of glucocorticoid-induced osteoporosis. Expert Opin Pharmacother 2009; 10:997-1005. [PMID: 19351276 DOI: 10.1517/14656560902868225] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Glucocorticoid-induced osteoporosis is the most common cause of secondary osteoporosis. The role of the Wnt signaling pathway in bone formation and the ratio of receptor activator for NF-kappaB ligand versus osteoprotegerin in bone resorption are exciting new insights. The absolute fracture risk helps both clinicians and patients to interpret the results of bone density measurement, which may have a positive influence on adherence to therapy. The bisphosphonates alendronate and risedronate are the first-line treatment in the prevention of glucocorticoid-induced osteoporosis, because both increase the bone mineral density of the spine and hips and reduce the vertebral fracture rate. Treatment with the anabolic agent parathyroid hormone (1 - 34) strongly stimulates bone turnover, and seems to be superior to treatment with alendronate. It might be attractive for glucocorticoid-treated patients with new vertebral fractures during treatment with bisphosphonates, and/or with severe fracture risk.
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Affiliation(s)
- M S van Brussel
- VU University Medical Center, Department of Rheumatology, Amsterdam, The Netherlands.
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16
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Chotirmall SH, Watts M, Branagan P, Donegan CF, Moore A, McElvaney NG. Diagnosis and management of asthma in older adults. J Am Geriatr Soc 2009; 57:901-9. [PMID: 19484848 DOI: 10.1111/j.1532-5415.2009.02216.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite comprehensive guidelines established by the European Global Initiative for Asthma and the U.S. National Asthma Education and Prevention Program on the diagnosis and management of asthma, its mortality in older adults continues to rise. Diagnostic and therapeutic problems contribute to older patients being inadequately treated. The diagnosis of asthma rests on the history and characteristic pulmonary function testing (PFT) with the demonstration of reversible airway obstruction, but there are unique problems in performing this test in older patients and in its interpretation. This review aims to address the difficulties in performing and interpreting PFT in older patients because of the effects of age-related changes in lung function on respiratory physiology. The concept of "airway remodeling" resulting in "fixed obstructive" PFT and the relevance of atopy in older people with asthma are assessed. There are certain therapeutic issues unique to older patients with asthma, including the increased probability of adverse effects in the setting of multiple comorbidities and issues surrounding effective drug delivery. The use of beta 2-agonist, anticholinergic, corticosteroid, and anti-immunoglobulin E treatments are discussed in the context of these therapeutic issues.
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Affiliation(s)
- Sanjay Haresh Chotirmall
- Department of Medicine, Respiratory Research Division, Education & Research Centre, Beaumont Hospital, Dublin 9, Republic of Ireland.
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17
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Mori H, Tanaka H, Ohno Y, Ito F, Funaguchi N, Endo J, La BLB, Minatoguchi S. Effect of intermittent systemic corticosteroid on bone metabolism in bronchial asthma patients. J Asthma 2009; 46:142-6. [PMID: 19253119 DOI: 10.1080/02770900802492095] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The purpose of this study was to assess the effect on bone mineral density (BMD) of systemic corticosteroid (SCS) intermittently administered for rescue from asthmatic exacerbation. Through digital image processing and calculation of four other indices, BMD was compared in groups of asthmatic patients receiving inhaled corticosteroid (ICS) alone or ICS plus intermittent SCS. We defined SCS as intermittent administration of the equivalent of 1 mg/day prednisolone in the management of asthma exacerbations during the previous 1 year. Serum NTX, a bone resorption marker, was significantly higher (p = 0.02) in the SCS group than the ICS group. SCS had no effect on BMD, although the frequency of patients at "high-risk" for osteoporosis according to the Female Osteoporosis Self-assessment Tool for Asia (FOSTA) tended to be higher in the SCS group (35%) than in the ICS (28%) or control (10%) group. Because patients in the ICS group already had impaired respiratory function due to repeated asthma exacerbations, it was difficult to determine whether it was asthma itself or SCS that is the risk factor for osteoporosis. In addition, the response of biochemical markers of bone turnover to intermittent SCS remains unclear and likely differs from that elicited by high-dose, short-term, or continuous SCS. That said, relatively low-dose intermittent administration of SCS raised levels of bone resorption markers, which likely reflects altered bone metabolism. Taken together, these findings suggest that, without consideration of its effects on bone, SCS administration should be avoided.
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Affiliation(s)
- Hidenori Mori
- Second Department of Internal Medicine Gifu University Graduate School of Medicine, Yanagido, Gifu, Japan
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18
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Li L, Brennan KJ, Gaughan JP, Ciccolella DE, Kuzma AM, Criner GJ. African Americans and men with severe COPD have a high prevalence of osteoporosis. COPD 2009; 5:291-7. [PMID: 18972277 DOI: 10.1080/15412550802363329] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Osteoporosis is a non-pulmonary manifestation whose true prevalence is uncertain in severe chronic obstructive pulmonary disease (COPD). We describe the prevalence and risk factors for osteoporosis in a large, well characterized COPD cohort. Dual energy x-ray absorptiometry of the lumbar spine and hip, full pulmonary function testing, cardiopulmonary exercise test, 6 minute walk distance and demographics were performed in 179 non-selected COPD patients. Patients were 59 +/- 7 years old, smoked 53 +/- 32 pack years, FEV(1) 26% +/- 9.8, and 45% were currently taking prednisone. Bone mineral density measurements were abnormal in 97%; 66% had dual energy X-ray absorptiometry defined osteoporosis, while 31% had osteopenia. The prevalence of osteoporosis in males versus females was 70% versus 62% (p = 0.33); both groups had similar fracture rates. The prevalence of osteoporosis in African Americans versus Caucasians was 69% versus 65% (p = 0.78). Caucasians had a significantly lower Ward's Triangle T score than African Americans (-2.52 +/- -0.96 vs. -2.16 +/- -0.91, p = 0.04). Those with bone fractures took higher doses of prednisone than those without fractures. Univariate analysis identified BMI and FVC% as predictors for osteoporosis (p = 0.03 OR 0.934 p = 0.006 OR 0.974). Multivariate analysis revealed only FVC% as a significant predictor (p = 0.006, OR 0.974). Osteoporosis is highly prevalent in severe COPD, and affects males and African Americans to a similar degree as females and Whites. Osteoporosis should be considered in severe COPD regardless of race or gender.
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Affiliation(s)
- Lihua Li
- Division of Pulmonary and Critical Care, Temple University School of Medicine, Philadelphia, Pennsylvania 19140, USA.
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19
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Fertl A, Menzel M, Hofer TPJ, Morresi-Hauf A, Ziegler-Heitbrock L, Frankenberger M. Monitoring of glucocorticoid therapy by assessment of CD14(+)CD16(+) monocytes: a case report. Immunobiology 2008; 213:909-16. [PMID: 18926305 DOI: 10.1016/j.imbio.2008.07.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Accepted: 07/23/2008] [Indexed: 01/15/2023]
Abstract
Bronchiolitis obliterans with organizing pneumonia (BOOP) is a disease affecting small airways and alveoli. It is characterized by interstitial inflammation rich in foamy macrophages and by fibroblastic connective tissue expanding into the airway and alveolar lumen. We report herein on a 54-year-old male BOOP patient who was treated with glucocorticoids (GCs) and who over a 5-year period had three relapses. At diagnosis the patient showed elevated CD14(+)CD16(+) monocyte numbers (85 cells/microl) and increased serum C-reactive protein (CRP) levels (29.4 mg/l). With GC therapy both parameters decreased within a few days. Diagnosis of relapse was preceded by a rise in CD14(+)CD16(+) monocyte numbers and in CRP levels which again responded to GC treatment. We conclude that determination of CD14(+)CD16(+) monocytes is a useful marker for monitoring of BOOP diagnosis and GC therapy.
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Affiliation(s)
- Andreas Fertl
- Asklepios Fachkliniken München-Gauting, Gauting, Germany
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20
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Ruf KM, Johnson NK, Clifford T, Smith KM. Risk factors, prevention, and treatment of corticosteroid-induced osteoporosis in adults. Orthopedics 2008; 31:768-72. [PMID: 18714771 DOI: 10.3928/01477447-20080801-29] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
An orthopedist can play a critical role in corticosteroid induced osteoporosis management by identifying at-risk patients and selecting appropriate prophylactic measures. This article is part two in a two-part series on osteoporosis. Part one appeared in the July 2008 issue of ORTHOPEDICS.
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Affiliation(s)
- Kathryn M Ruf
- University of Kentucky, College of Pharmacy, Lexington 40536-0293, USA
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21
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Hetsroni I, Markushevitz M, Nyska M. Bilateral femoral neck fractures in long-term steroid use for systemic lupus erythematosus and chronic lung disease. Orthopedics 2008; 31:180. [PMID: 19292188 DOI: 10.3928/01477447-20080201-12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Bilateral femoral neck fractures present a rare injury. Only one report to our knowledge was not related to an acute severe traumatic event, and developed years after pelvic irradiation. Chronic steroid use may severely decrease bone strength, thus increasing the risk for such an injury. Patients with chronic lung disease and chronic inflammatory conditions are frequently treated with steroids such as prednisone at doses that may exceed 2.5 mg a day for long durations. Fractures at vulnerable sites such as the femoral neck may then follow without any severe trauma. Awareness of the detrimental effect of chronic steroid consumption on bone morphology, and familiarity with treatment alternatives to improve bone mass is important to prevent such a severe injury. We describe two cases of bilateral femoral neck fractures in women who were treated for years with orally administered prednisone. The rarity of such an injury of bilateral hip fractures and the fact that neither of the patients sustained major trauma, strongly suggests that both cases were related to impaired bone metabolism due to the effect of prolonged steroid consumption. The biological effects of different roots of steroid administration on bone turnover, as well as several strategies that can be implemented by clinicians to treat and prevent steroid induced osteoporosis and fractures, are further clarified in this article.
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Affiliation(s)
- I Hetsroni
- Department of Orthopedics, Meir Hospital, Sapir Medical Center, Tsharnichovski, Kfar Saba, Israel
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22
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Fardet L, Kassar A, Cabane J, Flahault A. Corticosteroid-induced adverse events in adults: frequency, screening and prevention. Drug Saf 2007; 30:861-81. [PMID: 17867724 DOI: 10.2165/00002018-200730100-00005] [Citation(s) in RCA: 157] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Corticosteroids represent the most important and frequently used class of anti-inflammatory drugs and are the reference therapy for numerous neoplastic, immunological and allergic diseases. However, their substantial efficacy is often counter-balanced by multiple adverse events. These corticosteroid-induced adverse events represent a broad clinical and biological spectrum from mild irritability to severe and life-threatening adrenal insufficiency or cardiovascular events. The purpose of this article is to provide an overview of the available data regarding the frequency, screening and prevention of the adverse events observed in adults during systemic corticosteroid therapy (topically administered corticosteroids are outside the remit of this review). These include clinical (i.e. adipose tissue redistribution, hypertension, cardiovascular risk, osteoporosis, myopathy, peptic ulcer, adrenal insufficiency, infections, mood disorders, ophthalmological disorders, skin disorders, menstrual disorders, aseptic necrosis, pancreatitis) and biological (i.e. electrolytes homeostasis, diabetogenesis, dyslipidaemia) events. Lastly, data about the prescription of corticosteroids during pregnancy are provided. This review underscores the absence of data on many of these adverse events (e.g. lipodystrophy, dyslipidaemia). Our intent is to present to practitioners data that can be used in a practical way to both screen and prevent most of the adverse events observed during systemic corticosteroid therapy.
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Affiliation(s)
- Laurence Fardet
- Department of Internal Medicine, Hôpital Saint Antoine, Paris, France.
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23
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Fardet L, Flahault A, Kettaneh A, Tiev KP, Généreau T, Tolédano C, Lebbé C, Cabane J. Corticosteroid-induced clinical adverse events: frequency, risk factors and patient's opinion. Br J Dermatol 2007; 157:142-8. [PMID: 17501951 DOI: 10.1111/j.1365-2133.2007.07950.x] [Citation(s) in RCA: 171] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND More than 50 years after the introduction of corticosteroids, few studies have focused on corticosteroid-induced adverse events after long-term systemic therapy. OBJECTIVES To assess the frequency, risk factors and patient's opinion regarding clinical adverse events occurring early during prednisone therapy. PATIENTS AND METHODS We conducted a cohort study in two French centres. All consecutive patients starting long-term (> oir = 3 months), high dosage (> or = 20 mg day(-1)) prednisone therapy were enrolled. The main clinical adverse events attributable to corticosteroids were assessed after 3 months of therapy, by comparison with baseline status. The patient's opinion regarding the disability induced by these adverse events was recorded. Risk factors of frequently observed adverse effects were identified by using logistic regression. RESULTS Eighty-eight patients were enrolled and 80 were monitored for at least 3 months (women 76%; mean age 59.1 +/- 18.7 years; giant cell arteritis 39%; mean baseline prednisone dosage 54 +/- 17 mg day(-1)). Lipodystrophy was the most frequent adverse event [63.0% (51.0-73.1)], was considered the most distressing by the patients and was most frequent in women and young patients. Neuropsychiatric disorders occurred in 42 patients [52.5% (41.0-63.8)], necessitating hospitalization in five cases. Skin disorders were noted by 37 patients [46.2% (35.0-57.7)] and were more frequent in women. Muscle cramp and proximal muscle weakness were reported by 32.5% (22.5-43.9) and 15% (8.0-24.7) of patients, respectively. Newly developed hypertension occurred in 8.7% (2.9-20.3) of patients. Lastly, 39% (19.7-61.4) of the premenopausal women reported menstrual disorders. CONCLUSIONS Lipodystrophy and neuropsychiatric disorders are common adverse events of long-term prednisone therapy and are particularly distressing for the patients concerned. The impact of these adverse events on adherence to corticosteroid therapy is not known.
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Affiliation(s)
- L Fardet
- Department of Internal Medicine, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571 Paris Cedex 12, France.
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24
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Kjensli A, Mowinckel P, Ryg MS, Falch JA. Low bone mineral density is related to severity of chronic obstructive pulmonary disease. Bone 2007; 40:493-7. [PMID: 17049326 DOI: 10.1016/j.bone.2006.09.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2006] [Revised: 08/24/2006] [Accepted: 09/06/2006] [Indexed: 11/26/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) appears to be associated with low bone mineral density (BMD). BMD loss can be accelerated by a number of factors associated with COPD, but it is not known whether COPD itself has a direct effect. Our aim was to investigate in a cross-sectional study whether COPD patients have lower BMD than healthy individuals, and whether the severity of the disease affects BMD. Eighty-eight COPD patients attending a rehabilitation program were classified into stages II, III and IV using GOLD criteria. BMD was measured by dual X-ray absorptiometry in lumbar spine (L2-4), femoral neck (FN) and total body (TB). Values were converted to Z-scores (adjusted for age and sex). Associations between Z-scores and steroid use, body mass index, pack-years and six-min walking distance were analyzed. The Z-scores (mean and (CI)) for all patients were for L2-4: -0.6 (-0.9, -0.3), FN: -0.8 (-1.0, -0.5) and TB: -0.5 (-0.8, -0.2). All scores were significantly different from those of a control population (p<0.001). For all three variables (ZL2-4, ZFN, ZTB) there were significant differences between the stages. The difference for ZL2-4 was still significant after adjustment for risk factors. We conclude that BMD is low in COPD patients and decreases with increasing severity of the disease. Low BMD may to some extent be a disease-specific effect.
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Affiliation(s)
- A Kjensli
- Glittreklinikken, Pb 104 Aaneby, 1485 Hakadal, Norway.
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25
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Cruse LM, Valeriano J, Vasey FB, Carter JD. Prevalence of evaluation and treatment of glucocorticoid-induced osteoporosis in men. J Clin Rheumatol 2007; 12:221-5. [PMID: 17023807 DOI: 10.1097/01.rhu.0000242778.65766.22] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Screening and treatment of glucocorticoid- induced osteoporosis in male patients is less than recommended despite available screening and therapies. OBJECTIVES We determined if men treated with long-term oral glucocorticoid therapy for any reason receive assessment and therapy for the prevention and treatment of glucocorticoid-induced osteoporosis. METHODS A retrospective computer-generated chart review was performed involving all men given prednisone from January 2002 through July 2002. There were 370 patients evaluated from the James A. Haley Veterans Affairs Hospital, Tampa, Florida, a large teaching hospital for the University of South Florida College of Medicine. Charts were reviewed for bone mineral density testing; dose, duration, and indication of glucocorticoid therapy; age of the patients as of January 2002;continuous or intermittent dosing; history of fracture; bone loss prevention medication use, including bisphosphonate, calcitonin, testosterone replacement therapy, calcium, and vitamin D; and the steroid-prescribing and screening practitioner's specialty and sex. RESULTS Of the 370 men, 258 used 7.5 mg prednisone or more daily and 295 used glucocorticoids for more than 3 months. Of the 370 men, 163 had a bone mineral density test; 87 were treated with a bisphosphonate. Calcium and vitamin D were given to half of the patients. Of the patients with a normal T-score, 13 of 55 were treated with a bisphosphonate (24%) compared with 24 of 40 (60%) with an osteopenic score and 14 of 21 (67%) with osteoporosis. Of the 46 patients with no score available but indication that it had been ordered or otherwise addressed, 23 patients were treated empirically with a bisphosphonate. Rheumatology screened 75% of their patients, whereas primary care screened 30% of their patients. CONCLUSIONS Bone mineral density testing was performed or ordered for less than half of the glucocorticoid-treated patients and less than one third were taking bisphosphonate therapy. Further intervention is needed to increase prevention of glucocorticoid-induced osteoporosis and subsequent risk of fracture.
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Affiliation(s)
- Laura M Cruse
- University of South Florida College of Medicine, Department of Rheumatology, Tampa, Florida 33612, USA.
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26
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Jørgensen NR, Schwarz P, Holme I, Henriksen BM, Petersen LJ, Backer V. The prevalence of osteoporosis in patients with chronic obstructive pulmonary disease: a cross sectional study. Respir Med 2006; 101:177-85. [PMID: 16677808 DOI: 10.1016/j.rmed.2006.03.029] [Citation(s) in RCA: 142] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2005] [Revised: 03/24/2006] [Accepted: 03/25/2006] [Indexed: 11/22/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a complex disease, where the initial symptoms are often cough as a result of excessive mucus production and dyspnea. With disease progression several other symptoms may develop, and patients with moderate to severe COPD have often multiorganic disease with severely impaired respiratory dysfunction, decreased physical activity, right ventricular failure of the heart, and a decreased quality of life. In addition osteoporosis might develop possibly due to a number of factors related to the disease. We wanted to investigate the prevalence of osteoporosis in a population of patients with severe COPD as well as to correlate the use of glucocorticoid treatment to the occurrence of osteoporosis in this population. Outpatients from the respiratory unit with COPD, a history of forced expiratory volume in 1s (FEV1) less than 1.3 L, with FEV1% pred. ranging from 17.3% to 45.3% (mean 31.4%, standard deviation (sd) 7.3%). Patients between 50 and 70 years were included. Other causes of osteoporosis were excluded before inclusion. At study entry spirometry, X-ray of the spine (to evaluate presence of vertebral fractures), and bone mineral density of lumbar spine and hip were performed. Of 181 patients invited by mail, 62 patients were included (46 females and 16 males). All had symptoms of COPD such as exertional dyspnea, productive cough, limitations in physical activity etc. The mean FEV1 was 0.90 L (sd: 0.43 L) and the mean FEV1% pred. of 32.6% (sd: 14.1%). All had sufficient daily intake of calcium and vitamin D. In 15 patients, X-ray revealed compression fractures previously not diagnosed. Bone density measurements showed osteoporosis in 22 patients and osteopenia in 16. In total, 26 of the COPD patients were osteoporotic as evaluated from both X-ray and bone density determinations. Thus 68% of the participants had osteoporosis or osteopenia, but glucocorticoid use alone could not explain the increased prevalence of osteoporosis. A large fraction of these needed treatment for severe osteoporosis in order to prevent further bone loss and to reduce future risk of osteoporotic fractures. Thus, there is a significant need to screen patients with COPD to select the individuals in risk of fracture and to initiate prophylaxis or treatment for the disease.
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Affiliation(s)
- N R Jørgensen
- Department of Clinical Biochemistry, Copenhagen University Hospital Hvidovre, DK-2650 Hvidovre, Denmark.
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27
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Antonelli-Incalzi R, Pedone C. Treatment of chronic obstructive pulmonary disease in older adults. ACTA ACUST UNITED AC 2006. [DOI: 10.2217/1745509x.2.2.277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This article summarizes some distinctive features of chronic obstructive pulmonary disease in the elderly and the ensuing diagnostic and therapeutic needs. It focuses on atypical presentation, systemic effects of the disease and comorbid conditions. The role of nonpharmacological measures, such as rehabilitation, physical exercise and nutritional support, is discussed. Finally, the author emphasizes that a comprehensive geriatric approach should guide the planning of therapy and monitoring of its efficacy.
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Affiliation(s)
- Raffaele Antonelli-Incalzi
- Department of Geriatrics, University Campus Bio-Medico, Rome, Via dei Compositori, 130,00128 Roma, Italy
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Abstract
Osteoporosis affects more than 75 million people in the United States, Asia, and Europe. Osteoporosis results from a combination of genetic and environmental factors that contribute to peak bone mass and the rate of bone loss. These factors include medications, diet, race, sex, lifestyle, and physical activity. The management of osteoporosis can be complicated by simultaneous treatment of other diseases. For dermatologists, the use of long-term oral corticosteroids for the management of immunobullous and blistering diseases is of particular importance. Although these treatment modalities are potentially lifesaving for patients, the side effects can be dangerous. This article examines the pathophysiology, clinical course, and treatments for osteoporosis and the special considerations that arise when managing patients using corticosteroids.
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Affiliation(s)
- Angela Lamb
- Albert Einstein Medical Center, 1300 Morris Park Avenue, Belfer Room 205, Bronx, NY 10461, and Department of Dermatology, University of Pennsylvania, Philadelphia 19104, USA
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29
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Mineo TC, Ambrogi V, Mineo D, Fabbri A, Fabbrini E, Massoud R. Bone Mineral Density Improvement After Lung Volume Reduction Surgery for Severe Emphysema. Chest 2005; 127:1960-6. [PMID: 15947308 DOI: 10.1378/chest.127.6.1960] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND In patients with severe emphysema, bone mineral density (BMD) is reduced and the risk of osteoporosis is increased. STUDY OBJECTIVES To identify the impact of lung volume reduction surgery on BMD. DESIGN Prospective cohort study. SETTING University hospital. PATIENTS AND INTERVENTIONS Forty emphysematous patients, all receiving oral steroid therapy, underwent bilateral lung volume reduction surgery. Thirty similar patients, who refused the operation, followed a standard respiratory rehabilitation program. MEASUREMENTS All subjects were evaluated pretreatment and 12 months posttreatment for respiratory function, nutritional status, and bone-related biochemical parameters. BMD was assessed by dual-energy radiograph absorptiometry. RESULTS After surgery, we observed significant improvements in respiratory function (FEV1, + 18.8% [p < 0.01]; residual volume [RV], -29.6% [p < 0.001]; diffusing capacity of the lung for carbon monoxide [Dlco], + 21.6% [p < 0.01]) nutritional parameters (fat-free mass, + 6.0% [p < 0.01]), levels of bone-related hormones (free-testosterone, + 20.5% [p < 0.01]; parathormone, -11.2% [p < 0.01]), bone turnover markers (osteocalcin, -12.7% [p < 0.05]; bone-alkaline-phosphatase, -14.0% [p < 0.05]; beta-crosslaps, -33.6% [p < 0.001]), BMD (lumbar, + 8.8% [p < 0.01]; femoral, + 5.5% [p < 0.01]), and T-score (lumbar, + 21.0% [p < 0.01]; femoral, + 12.4% [p < 0.01]) with reduction in osteoporosis rate (50 to 25%). Nineteen patients who had undergone surgery were able to discontinue treatment with oral steroids. These subjects showed a more significant improvement in BMD (lumbar, + 9.6%; femoral, + 6.8%; p < 0.001) and T-score (lumbar, + 27.3%; femoral, + 14.3%; p < 0.001). The remaining 21 patients who had undergone surgery experienced significant improvement compared to respiratory rehabilitation subjects despite continued therapy with oral steroids (BMD: lumbar, + 4.5% vs -0.7%, respectively [p < 0.01]; femoral, + 2.7% vs -1.1%, respectively [p < 0.05]; T-score: lumbar, + 14 vs -2.1, respectively [p < 0.01]; femoral, + 7.4 vs -2.7, respectively [p < 0.01]). The increase in lumbar BMD was correlated with the surgical reduction of RV (p = 0.02) and with the increase in Dlco (p = 0.01) and fat-free mass (p = 0.01). CONCLUSIONS Lung volume reduction surgery significantly improves BMD compared to respiratory rehabilitation therapy, even in patients requiring oral steroids. The increase in BMD correlates with RV, Dlco, and fat-free mass, suggesting that the restoration of respiratory dynamics, gas exchange, and nutritional status induces improvement in bone metabolism and mineral content.
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30
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McDonough RP, Doucette WR, Kumbera P, Klepser DG. An evaluation of managing and educating patients on the risk of glucocorticoid-induced osteoporosis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2005; 8:24-31. [PMID: 15841891 DOI: 10.1111/j.1524-4733.2005.04007.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To assess the impact of risk management activities on patient risk of glucocorticoid-induced osteoporosis. METHODS Ninety-six adult patients taking chronic glucocorticoid therapy in 15 community pharmacies. Patients in the control group received usual and customary care. Patients in the treatment pharmacies received education and an educational pamphlet about the risks of glucocorticoid-induced osteoporosis. In addition, the treatment group pharmacists monitored the patients' drug therapy, to identify and address drug-related problems. Data including the glucocorticoid taken by the patient, medications, and osteoporosis risk factors were collected at baseline and after 9 months of monitoring, via Web-based survey completed in the pharmacy. Using an intent to treat approach, the pre-post frequency changes were compared with contrasts for presence of bisphosphonate therapy, presence of estrogen therapy, presence of calcium supplement, discussion of glucocorticoid-induced osteoporosis risk, discussion of bone density test, presence of bone mineral density test, reported inactivity, and reported low calcium diet. RESULTS The contrast was significant in favor of the treatment pharmacies for the frequency of patients taking a calcium supplement (Control [-6.9%] vs. Treatment [17.1%], P < 0.05). No other contrast was significant. CONCLUSIONS Community pharmacists are capable of increasing calcium supplementation among patients at risk for glucocorticoid-induced osteoporosis. Pharmacists who educate at-risk patients can impact the self-care of these patients.
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Affiliation(s)
- Randy P McDonough
- The University of Iowa, College of Pharmacy, Iowa City, IA 52242, USA
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Goldhahn J, Jenet A, Schneider E, Lill CA, Christoph AL. Slow rebound of cancellous bone after mainly steroid-induced osteoporosis in ovariectomized sheep. J Orthop Trauma 2005; 19:23-8. [PMID: 15668580 DOI: 10.1097/00005131-200501000-00005] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES A sheep model of osteoporosis suitable for implant testing for osteoporotic fractures was evaluated with regard to normalization of hormonal status and possible rebound of bone mineral density subsequent to the termination of steroid application. DESIGN Osteoporosis was induced in 10 aged, female white alpine sheep. The sheep underwent ovariectomy, were kept in open, single-box husbandry, received a vitamin D(3) restricted diet, and a total dose of 2000 mg methylprednisolone (4 single doses of 500 mg at 3-week intervals). After 12 weeks, osteoporosis induction was discontinued, and bone mineral density was monitored for another 28 weeks. Eight healthy sheep served as controls for final measurements. MAIN OUTCOME MEASUREMENTS The bone mineral density of cancellous bone in both distal radii was monitored using peripheral quantitative computed tomography. Cortisone level was determined at 3-week intervals until week 21. Bone structural parameters were measured in biopsies of the lumbar vertebra 6 and the right iliac crest using micro CT. RESULTS The linear rate of bone loss during osteoporosis induction was 1.75% per week. Rebound of cancellous bone mineral density started between 6 and 11 weeks after the end of steroid treatment with a linear coefficient of 0.22% per week. Whereas structural changes in the iliac crest revealed significant differences at the end of the study, the values of L6 showed only slight changes. The level of basal cortisone dropped below detection limit during induction but recovered to physiological values 6 weeks after the end of steroid administration. In 2 animals, massive loss of weight and in 4 animals alopecia disseminata occurred. CONCLUSIONS Because the rebound of bone mineral density after the end of steroid administration is significantly slower than the initial decrease, this opens a sufficient time window for testing of implants for osteoporotic fractures. The significantly changed structural parameters at the end of the study also suggest osteoporosis like conditions during testing.
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Devillier P. [Limitations of drug prescriptions in patients with chronic obstructive pulmonary disease]. REVUE DE PNEUMOLOGIE CLINIQUE 2004; 60:203-208. [PMID: 15545948 DOI: 10.1016/s0761-8417(04)72100-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
National and international guidelines have described in detail the role of bronchodilators and inhaled corticosteroids for the management of patients with chronic obstructive lung disease (COPD). Such guidelines are identical to marketing approval documents in France. The French marketing approval, which limits use of bronchodilators to reversible COPD, is no longer coherent with recent evidence demonstrating the poor reproducibility of reversibility tests and the absence of correlation between reversibility and dyspnea relief. France has not delivered marketing authorization for any inhaled corticosteroid for the treatment of COPD. Clinical trials versus placebo have demonstrated that inhaled corticosteroids do not slow down the decline in ventilatory function but that they do diminish the risk of exacerbation. Decreased risk of exacerbation could be clinically pertinent in patients with severe COPD who often experience exacerbations requiring to specialist management. Inquiries concerning precriptions for COPD show that the majority of patients are treated by inhaled corticosteroids, demonstrating the gap between medical practice and national and international recommendations and marketing approval documents.
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Affiliation(s)
- Ph Devillier
- Service de Pharmacologie-Toxicologie, Hôpital Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims Cedex.
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Gluck O, Colice G. Recognizing and treating glucocorticoid-induced osteoporosis in patients with pulmonary diseases. Chest 2004; 125:1859-76. [PMID: 15136401 DOI: 10.1378/chest.125.5.1859] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Glucocorticoids are frequently used to treat patients with pulmonary diseases, but continuous long-term use of glucocorticoids may lead to significant bone loss and an increased risk of fragility fractures. Patients with certain lung diseases, regardless of pharmacotherapy-particularly COPD and cystic fibrosis-and patients waiting for lung transplantation are also at increased risk of osteoporosis. Fragility fractures, especially of the hip, will have substantial effects on the health and well-being of older patients. Vertebral collapse and kyphosis secondary to glucocorticoid-induced osteoporosis (GIO) may affect lung function. Identification of patients with osteopenia, osteoporosis, or fragility fractures related to osteoporosis is strongly recommended and should lead to appropriate treatment. Prevention of GIO in patients receiving continuous oral glucocorticoids is also recommended. In patients receiving either high-dose inhaled glucocorticoids or low- to medium-dose inhaled glucocorticoids with frequent courses of oral glucocorticoids, bone mineral density measurements should be performed to screen for osteopenia and osteoporosis. A bisphosphonate (risedronate or alendronate), calcium and vitamin D supplementation, and lifestyle modifications are recommended for the prevention and treatment of GIO.
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Affiliation(s)
- Oscar Gluck
- Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
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Boling EP. Secondary osteoporosis: underlying disease and the risk for glucocorticoid-induced osteoporosis. Clin Ther 2004; 26:1-14. [PMID: 14996513 DOI: 10.1016/s0149-2918(04)90001-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2003] [Indexed: 12/26/2022]
Abstract
BACKGROUND Chronic diseases of many organ systems require long-term (>or=1 year) treatment with glucocorticoids. Owing to the catabolic activity of glucocorticoid therapy, osteoporosis is a potential complication. OBJECTIVES This review discusses glucocorticoid-induced bone loss and the factors, including underlying disease, that increase the risk for osteoporosis. Therapeutic options for the prevention and treatment of glucocorticoid-induced osteoporosis (GIO) also are reviewed. METHODS A review of the English-language literature was conducted using the MEDLINE database and proceedings from scientific meetings. Search terms including glucocorticoid-induced osteoporosis, bone loss, and fracture were used to refine the search, and preference was given to studies published after 1990. RESULTS Long-term glucocorticoid treatment causes bone loss that is most precipitous in the first 6 months. Patients treated with glucocorticoids have additional risk factors for bone loss and osteoporosis that are associated with their primary disease. Chronic diseases can cause changes in bone metabolism, leading to bone loss in addition to that induced by glucocorticoids alone. Bone loss can be minimized through proper nutrition, weight-bearing exercise, calcium and vitamin D supplementation, and, where indicated, bisphosphonate treatment. The American College of Rheumatology Ad Hoc Committee on Glucocorticoid-Induced Osteoporosis guidelines recommend bisphosphonates for minimizing bone loss and fracture risk in patients at risk for GIO. Risedronate is indicated for the prevention and treatment of GIO, and alendronate is indicated for its treatment. Both risedronate and alendronate increase bone mineral density in patients at risk for GIO. Risedronate significantly reduces the incidence of vertebral fractures after 1 year of treatment (P<0.05). The effectiveness and tolerability of the bisphosphonates have not been established in pregnant women or pediatric patients. CONCLUSIONS Men and women initiating long-term glucocorticoid treatment and those with GIO should be concomitantly treated with effective osteoporosis therapy to reduce fracture risk and counseled on preventive lifestyle changes.
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Affiliation(s)
- Eugene P Boling
- Department of Medicine, Loma Linda University, Rancho Cucamonga, California, USA.
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Antonelli Incalzi R. Management of chronic obstructive pulmonary disease in the elderly. Aging Clin Exp Res 2004; 16:13-21. [PMID: 15132286 DOI: 10.1007/bf03324526] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chronic obstructive pulmonary disease (COPD), a leading cause of death and disability in the elderly, is frequently unrecognized or misinterpreted as heart disease. Comorbidity plays a primary role, both as a determinant of health status and as a prognostic marker in older populations with COPD. Multidimensional assessment tailored to the distinctive needs of respiratory patients and thus including selected respiratory function indexes, is mandatory for proper staging COPD and monitoring of its course and response to therapy. In stable COPD, a mix of pharmacological and non-pharmacological measures may improve health, but only by stopping smoking and, in the event of respiratory insufficiency, applying continuous oxygen therapy can the progression of the disease be delayed and life expectancy prolonged. In exacerbated COPD, age per se is a negative prognostic marker and, while many very old patients can successfully recover, they will experience some decline in personal independence. Thus, older patients with COPD should ideally be the object of a continuum of care throughout all the stages of their disease, in order to minimize the decline in personal independence and worsening health. In this perspective, COPD patients qualify as optimal candidates for dedicated programs of continuous geriatric care.
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Ryan JG, Morgan RK, Lavin PJ, Murray FE, O'Connell PG. Current management of corticosteroid-induced osteoporosis: variations in awareness and management. Ir J Med Sci 2004; 173:20-2. [PMID: 15732231 DOI: 10.1007/bf02914518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Guidelines for the prevention of corticosteroid-induced osteoporosis (CIO) have been widely published. There are no guidelines on the use of gastro-protectants with corticosteroids (CS). AIMS To determine whether patients receiving CS therapy are evaluated and treated for osteoporosis risk, how management varied by steroid dose and diagnosis, and how many patients received gastro-protection. METHODS A retrospective audit of 4,350 patients presenting to four medical specialities. RESULTS One hundred and fifty-one patients prescribed CS were identified. Indications for CS therapy included renal transplantation (32%) and asthma/respiratory diseases (23%), inflammatory arthritis/vasculitis (32%) and inflammatory bowel disease/auto-immune hepatitis/other (13%). Risk of osteoporosis was mentioned in 13% of charts. The prescription rates for bone protection agents varied from 69% to 4% according to the medical speciality attended. Gastro-protectants were prescribed for 44% of patients. CONCLUSION There are large variations among medical specialties both in the prescription of gastro-protectant agents and in the use of measures to prevent CIO. Simpler guidelines could facilitate rational prescribing in these patients.
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Affiliation(s)
- J G Ryan
- Department of Rheumatology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
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Shea JE, Miller SC, Poole DC, Mattson JP. Cortical bone dynamics, strength, and densitometry after induction of emphysema in hamsters. J Appl Physiol (1985) 2003; 95:631-4. [PMID: 12851418 DOI: 10.1152/japplphysiol.01049.2002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Recent evidence suggests that patients suffering from chronic obstructive pulmonary disease are also at an increased risk of developing osteoporosis. The pathophysiological mechanism(s) linking these progressive diseases is unknown. The goal of this investigation was to determine whether there were alterations in bone mineral density and content, cortical bone structure and strength, and indexes of bone formation and resorption in the elastase-induced emphysematous hamster. At 3 wk after induction of emphysema, the femoral bone mineral content was 8% less (P = 0.026) and the femoral fracture strength was 6% less (P = 0.032) in the emphysematous hamster than in controls. The cortical area was 8.4% less (P = 0.013) and the periosteal mineral appositional rate was 27% less (P = 0.05) than in controls. Additionally, the endocortical eroded surface in the emphysematous group was about twice that in the control group (P = 0.003). Differences in some indexes of bone formation and resorption, paralleled by differences in bone structure and strength, were observed 3 wk after induction of emphysema. These differences in skeletal metabolism and strength may help explain some of the skeletal changes associated with chronic obstructive pulmonary disease in humans.
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Affiliation(s)
- Jill E Shea
- Department of Radiology, University of Utah, Salt Lake City, UT 84112-0920, USA
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Sánchez-González R, Álvarez R, Peñasco P, Isabel Moreno A. ¿Nuestros pacientes con epoc reciben tratamiento broncodilatador adecuado? ACTA ACUST UNITED AC 2003. [DOI: 10.1016/s1134-282x(03)77655-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
PURPOSE Because patients with obstructive airways disease may be susceptible to osteoporosis, we sought to determine the association between airflow obstruction and osteoporosis. SUBJECTS AND METHODS We analyzed data from Caucasian participants (n = 9502) in the Third National Health and Nutrition Examination Survey, conducted in the United States between 1988 and 1994. We used data from dual-energy x-ray absorptiometry measurements of the total femur to determine whether a study participant had osteoporosis (defined as total bone mineral density values < or =2.5 SD below the corresponding mean values from young, healthy participants). We calculated the odds ratio (OR) for osteoporosis in four lung function categories: none, mild, moderate, and severe airflow obstruction. RESULTS Overall, airflow obstruction was associated with increased odds of osteoporosis compared with without airflow obstruction (OR = 1.9; 95% confidence interval [CI]: 1.4 to 2.5). Participants with severe airflow obstruction were at especially increased risk (OR = 2.4; 95% CI: 1.3 to 4.4). Moderate but not mild airflow obstruction was also associated with osteoporosis. CONCLUSION Airflow obstruction was an important risk factor for osteoporosis in the study population. These data highlight the importance of measuring bone mineral density in those with moderate-to-severe airflow obstruction for the detection and prevention of osteoporosis-related morbidity.
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Affiliation(s)
- Don D Sin
- Division of Pulmonary Medicine, University of Alberta, Edmonton, Alberta, Canada.
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Abstract
Osteoporosis, with resulting fractures, is a significant problem in patients with advanced COPD. The etiology for the bone loss is diverse but includes smoking, vitamin D deficiency, low body mass index, hypogonadism, sedentary lifestyle, and use of glucocorticoids. Effective strategies to prevent bone loss and/or to treat osteoporosis include calcium and vitamin D, hormone replacement when indicated, calcitonin, and bisphosphonate administration. However, many patients remain undiagnosed until their first fracture because of the lack of recognition of the disease. With an increased awareness by pulmonologists and the increased use of preventive strategies, the impact of osteoporosis on those patients with COPD should decrease.
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Affiliation(s)
- Diane M Biskobing
- Virginia Commonwealth University, Medical College of Virginia, Richmond, VA, USA.
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McEvoy CE, Niewoehner DE. Corticosteroids in chronic obstructive pulmonary disease. Clinical benefits and risks. Clin Chest Med 2000; 21:739-52. [PMID: 11194783 DOI: 10.1016/s0272-5231(05)70181-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The use of systemic and inhaled corticosteroids for COPD has increased appreciably over the past 20 years. Clearer indications for corticosteroid therapy in COPD are beginning to emerge as the results from large clinical trials become available. Systemic corticosteroids are only modestly effective for acute COPD exacerbations, increase the risk for hyperglycemia, and should be given for no more than 2 weeks. The efficacy of long-term systemic corticosteroid therapy has not been adequately evaluated in this patient population. If longer term use of systemic steroids in COPD should be found to be useful, this conclusion would have to be weighed against the risk for serious adverse effects. High doses of inhaled corticosteroids cause a small sustained increase of the FEV1 in patients with mild and moderately severe COPD, but they do not slow the rate of FEV1 decline. Based on analyses of secondary outcome, inhaled corticosteroids may improve the respiratory symptoms and decrease the number and severity of COPD exacerbations in patients with more advanced disease. Low doses of inhaled corticosteroids appear to be safe, but there is growing awareness that higher doses may not be so benign.
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Affiliation(s)
- C E McEvoy
- Pulmonary Critical Care Associates, 255 N. Smith Avenue, Suite 210, Saint Paul, MN 55102, USA
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