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Hitler L, Eze JF, Nwagu AD, Edet HO, Unimuke TO, Eno EA, Osabor VN, Adeyinka AS. Computational Study of the Interaction of C
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Nanocages with Alendronate Drug Molecule. ChemistrySelect 2023. [DOI: 10.1002/slct.202203607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Louis Hitler
- Computational and Bio-Simulation Research Group University of Calabar Calabar Nigeria
| | - John F. Eze
- Computational and Bio-Simulation Research Group University of Calabar Calabar Nigeria
| | - Adanna D. Nwagu
- Computational and Bio-Simulation Research Group University of Calabar Calabar Nigeria
| | - Henry O. Edet
- Computational and Bio-Simulation Research Group University of Calabar Calabar Nigeria
| | - Tomsmith O. Unimuke
- Computational and Bio-Simulation Research Group University of Calabar Calabar Nigeria
| | - Ededet A. Eno
- Computational and Bio-Simulation Research Group University of Calabar Calabar Nigeria
- Department of Pure and Applied Chemistry Faculty of Physical Sciences University of Calabar Calabar Nigeria
| | - Vincent N. Osabor
- Department of Pure and Applied Chemistry Faculty of Physical Sciences University of Calabar Calabar Nigeria
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Kang T, Park SY, Lee SH, Park JH, Suh SW. Comparison of Denosumab and Zoledronic Acid in Postmenopausal Women With Osteoporosis: Bone Mineral Density (BMD) and Trabecular Bone Score (TBS). J Korean Med Sci 2022; 37:e68. [PMID: 35380023 PMCID: PMC8980365 DOI: 10.3346/jkms.2022.37.e68] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 01/25/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Denosumab (DEN) and zoledronic acid (ZOL) currently represent the most potent antiresorptive agents for the treatment of osteoporosis. Despite similar effects on bone resorption, these agents have distinct mechanisms of action. The objective of this study was to compare the effect of DEN and ZOL after two-year administration on bone mineral density (BMD), trabecular bone score (TBS), bone turnover markers, and persistence. METHODS A total of 585 postmenopausal women with osteoporosis who did not use osteoporosis medications were retrospectively reviewed. 290 patients were administered 60 mg DEN subcutaneously every 6 months from 2017 to 2018, and 295 patients were treated with 5 mg ZOL intravenously yearly from 2015 to 2017. BMD, TBS, and C-terminal cross-linking telopeptide of type 1 collagen (CTX) measurements were obtained at baseline and two-year after DEN injection or ZOL infusion. RESULTS After two-year follow-up, 188 patients in the DEN group and 183 patients in the ZOL group were compared. BMD change from baseline at two years was significantly greater in the DEN group compared with the ZOL group (P < 0.001). The changes of TBS in the DEN group were statistically significant compared with baseline (P < 0.001) and the ZOL group (P < 0.001). The DEN group led to significantly greater reduction of CTX compared with ZOL group (P = 0.041). CONCLUSION In postmenopausal women with osteoporosis, DEN was associated with greater BMD increase at all measured skeletal sites, greater increase of TBS, and greater inhibition of bone remodeling compared with ZOL.
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Affiliation(s)
- Taewook Kang
- Department of Orthopedics, Anam Hospital, Korea University School of Medicine, Seoul, Korea
| | - Si Young Park
- Department of Orthopedics, Anam Hospital, Korea University School of Medicine, Seoul, Korea.
| | - Soon Hyuck Lee
- Department of Orthopedics, Anam Hospital, Korea University School of Medicine, Seoul, Korea
| | - Jong Hoon Park
- Department of Orthopedics, Anam Hospital, Korea University School of Medicine, Seoul, Korea
| | - Seung Woo Suh
- Department of Orthopedics, Anam Hospital, Korea University School of Medicine, Seoul, Korea
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Shanas N, Querido W, Oswald J, Jepsen K, Carter E, Raggio C, Pleshko N. Infrared Spectroscopy-Determined Bone Compositional Changes Associated with Anti-Resorptive Treatment of the oim/oim Mouse Model of Osteogenesis Imperfecta. APPLIED SPECTROSCOPY 2022; 76:416-427. [PMID: 34643134 DOI: 10.1177/00037028211055477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Applications of vibrational spectroscopy to assess bone disease and therapeutic interventions are continually advancing, with tissue mineral and protein composition frequently investigated. Here, we used two spectroscopic approaches for determining bone composition in a mouse model (oim) of the brittle bone disease osteogenesis imperfecta (OI) with and without antiresorptive agent treatment (alendronate, or ALN, and RANK-Fc). Near-infrared (NIR) spectral analysis using a fiber optic probe and attenuated total reflection Fourier transform infrared spectroscopy (ATR FTIR) mode were applied to investigate bone composition, including water, mineral, and protein content. Spectral parameters revealed differences among the control wildtype (WT) and OIM groups. NIR spectral analysis of protein and water showed that OIM mouse humerii had ∼50% lower protein and ∼50% higher overall water content compared to WT bone. Moreover, some OIM-treated groups showed a reduction in bone water compared to OIM controls, approximating values observed in WT bone. Differences in bone quality based on increased mineral content and reduced carbonate content were also found between some groups of treated OIM and WT bone, but crystallinity did not differ among all groups. The spectroscopically determined parameters were evaluated for correlations with gold-standard mechanical testing values to gain insight into how composition influenced bone strength. As expected, bone mechanical strength parameters were consistently up to threefold greater in WT mice compared to OIM groups, except for stiffness in the ALN-treated OIM groups. Furthermore, bone stiffness, maximum load, and post-yield displacement showed the strongest correlations with NIR-determined protein content (positive correlations) and bound-water content (negative correlations). These results demonstrate that in this study, NIR spectral parameters were more sensitive to bone composition differences than ATR parameters, highlighting the potential of this nondestructive approach for screening of bone diseases and therapeutic efficacy in pre-clinical models.
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Affiliation(s)
- No'ad Shanas
- Department of Bioengineering, Temple University, Philadelphia, PA, USA
| | - William Querido
- Department of Bioengineering, Temple University, Philadelphia, PA, USA
| | - Jack Oswald
- Department of Bioengineering, Temple University, Philadelphia, PA, USA
| | - Karl Jepsen
- Department of Orthopaedic Surgery and Bioengineering. University of Michigan, Ann Arbor, MI, USA
| | - Erin Carter
- Kathryn O. and Alan C. Greenberg Center for Skeletal Dysplasias, 25062Hospital for Special Surgery, New York City, NY, USA
| | - Cathleen Raggio
- Kathryn O. and Alan C. Greenberg Center for Skeletal Dysplasias, 25062Hospital for Special Surgery, New York City, NY, USA
| | - Nancy Pleshko
- Department of Bioengineering, Temple University, Philadelphia, PA, USA
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Wang H, Zhao WS, Xu L. Bisphosphonate of Zoledronate Has Antiapoptotic Effect on Hypoxia/Reoxygenation Injury in Human Embryonic Stem Cell-Derived Cardiomyocytes Through Trk Signaling Pathway. Cell Biochem Biophys 2022; 80:435-442. [PMID: 35226248 DOI: 10.1007/s12013-021-01031-7] [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: 04/16/2021] [Accepted: 08/04/2021] [Indexed: 11/29/2022]
Abstract
In this work, we investigated the in vitro and in vivo functions of bisphosphonate of zoledronate (Zd) in hypoxia/reoxygenation (H/R) injured human embryonic stem cell-derived cardiomyocytes (hES-CMs). In the in vitro setting, the effects of Zd on hES-CM survival and differentiation were examined. We found that low and medium concentrations (<2 µm) of Zd did not induce cell death of hES-CMs. 0.5 µm Zd protected H/R-induced hES-CM apoptosis but did not affect key differentiation proteins, including hcTnl, PECM-1 Cnx43 and Pan-Cadherin. In addition, Zd-induced TrkA/B phosphorylation and promoted VEGF to counter the apoptotic effect of H/R injury. In the in vivo animal model of myocardial infarction, Zd treatment promoted the survival of hES-CMs by inducing PECAM1 and hcTnl. Thus, we concluded that Zd protected H/R-induced hES-CM apoptosis in vitro and promoted hES-CM survival in vivo. These data may facilitate the development of human embryonic stem cells into clinical applications for patients with ischemic heart disease.
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Affiliation(s)
- Hua Wang
- Heart Center and Beijing Key Laboratory of Hypertension Research, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Wen-Shu Zhao
- Heart Center and Beijing Key Laboratory of Hypertension Research, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Lin Xu
- Heart Center and Beijing Key Laboratory of Hypertension Research, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China.
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Ouyang Y, Chen S, Wan T, Zheng G, Sun G. The effects of teriparatide and bisphosphonates on new fractures in postmenopausal women with osteoporosis: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e24839. [PMID: 33607854 PMCID: PMC7899820 DOI: 10.1097/md.0000000000024839] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 12/22/2020] [Accepted: 01/26/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To systematically evaluate the efficacy of teriparatide and bisphosphonates in preventing fractures in postmenopausal women with osteoporosis. MATERIALS AND METHODS We performed a systematic search of PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) that compared teriparatide and bisphosphonates for osteoporosis treatment. Searches were performed without language restrictions and included studies from beginning of time to March 2019. Two authors independently screened and extracted the selected article. The quality of the included studies was evaluated using the Cochrane system evaluation method. Data were extracted and analysed using RevMan 5.2 software. RESULTS Nine RCTs were included for a total of 2990 postmenopausal women with osteoporosis. Of these, 1515 patients were treated with teriparatide and 1475 were treated with bisphosphonates. After pooling the data of 9 studies, there were significant differences between teriparatide and bisphosphonates [relative risk (RR): 0.61, 95% confidence interval (CI) (0.51, 0.74)] in the prevention of fractures according to different follow-up durations (P < .05), whatever alendronate [RR: 0.51, 95% CI (0.27, 0.95)] and other bisphosphonates [RR: 0.63, 95% CI (0.51, 0.77)]. In addition, we found significant differences between teriparatide and bisphosphonates in the prevention of vertebral fractures [RR: 0.47, 95% CI (0.35, 0.64)] and non-vertebral fractures [RR: 0.76, 95% CI (0.58,0.99)]. There were no significant differences in adverse effects between teriparatide and bisphosphonates [RR: 0.89, 95% CI (0.76, 1.03)]. CONCLUSIONS Based on the results of our meta-analysis, teriparatide was better than bisphosphonates in preventing fractures in postmenopausal women with osteoporosis both in the short-term and long-term follow-up periods. Teriparatide was superior to bisphosphonates in preventing vertebral and non-vertebral fractures. These drugs did not differ in terms of their adverse effects. More high-quality studies are needed to compare other factors such as costs and adverse reactions.
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Affiliation(s)
| | - ShuiLin Chen
- The Fourth Affiliated Hospital of Nanchang University
| | | | | | - GuiCai Sun
- The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
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Zeng H, Zhao X, Wang L, Tang C, Li Z, Xie N, Wang F. Effects of Drynaria Total Flavonoid on the Microstructure of the Mandible in Ovariectomized Rats. Med Sci Monit 2020; 26:e926171. [PMID: 33128539 PMCID: PMC7640376 DOI: 10.12659/msm.926171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background The aim of this study is to investigate the effects of Drynaria total flavonoids (DTF) on mandible microarchitecture, serum estrogen (E2), osteoprotegerin (OPG), and receptor activator of nuclear factor kappa-B ligand (RANKL) levels in an ovariectomy-induced osteoporosis rat model. Material/Methods Thirty female Sprague-Dawley rats were divided into 5 groups (n=6 per group): sham surgery, ovariectomy (OVX), and low-dose, middle-dose, and high-dose DTF. Mandibular osteoporosis was induced by ovariectomy; an equal amount of ovary-sized fat tissue was removed from the sham group. The DTF-treated groups were given DTF gavage at different doses for 12 weeks; the sham and OVX groups were given saline. After the treatment phase, the effects of DTF on the microarchitecture of the mandible were evaluated by measuring bone density, maximum load, morphometric parameters, and histopathological alterations. Serum E2, OPG, and RANKL levels were measured. Results The OVX group showed obvious osteoporosis in the mandible and decreased serum E2 levels and OPG/RANKL ratio. The low-dose group did not show significant improvement in mandibular microstructure. The middle-dose group showed significantly ameliorated osteoporosis. The high-dose group had further improvement in bone microstructures and increase of OPG/RANKL over the middle-dose group. Furthermore, ovariectomy significantly decreased serum E2, but DTF treatment failed to restore serum E2 levels. Conclusions Ovariectomy can cause significant bone loss in the rat mandible and a decrease in serum E2 and OPG/RANKL. DTF significantly improved the mandibular microstructure and restored OPG/RANKL balance, but it did not restore the decreased serum E2 concentration following ovariectomy.
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Affiliation(s)
- Hui Zeng
- School of Stomatology, Xi'an Medical College, Xi'an, Shaanxi, China (mainland)
| | - Xubing Zhao
- Department of Emergency, Affiliated Stomatology Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Lin Wang
- School of Stomatology, Xi'an Medical College, Xi'an, Shaanxi, China (mainland)
| | - Chengfang Tang
- School of Stomatology, Xi'an Medical College, Xi'an, Shaanxi, China (mainland)
| | - Zixia Li
- School of Stomatology, Xi'an Medical College, Xi'an, Shaanxi, China (mainland)
| | - Na Xie
- School of Stomatology, Xi'an Medical College, Xi'an, Shaanxi, China (mainland)
| | - Feng Wang
- School of Stomatology, Xi'an Medical College, Xi'an, Shaanxi, China (mainland)
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Gupta S, Mathur S, Kapoor A, Vijay S, Khatri RK, Srivastava R. Clinical efficacy of amino bisphosphonate on periodontal disease status in postmenopausal women: Randomized double-blind placebo-controlled trial. J Family Med Prim Care 2020; 9:4919-4924. [PMID: 33209822 PMCID: PMC7652136 DOI: 10.4103/jfmpc.jfmpc_724_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/11/2020] [Accepted: 07/03/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives: Osteoporosis is a common skeletal disorder affecting postmenopausal women. Data suggest that postmenopausal women are at increased risk of periodontal diseases. Amino bisphosphonates are potent inhibitors of bone resorption and effectively used in the treatment of osteoporosis. Preliminary data indicate that there is a potential role for bisphosphonates in the management of periodontitis. Hence, this randomized placebo-controlled trial was designed to investigate the clinical efficacy of amino bisphosphonate on periodontal disease status among postmenopausal women. Materials and Methods: Thirty patients were randomly allocated to two treatment groups: Group A, which received scaling and root debridement and 70 mg weekly single oral dose of alendronate drug, and Group B, which received scaling and root debridement and placebo drug for 6 months. Clinical periodontal measurements were carried out for all patients at the baseline and 6 months later. Mandibular bone mineral density (BMD) was measured using a dual energy X-ray absorptiometer at the beginning of the study and the end of 6 months. Results: A weekly single oral dose of 70 mg alendronate was well-tolerated. The intragroup comparison showed significant improvement in periodontal parameters in both groups. The intergroup comparison showed a significant increase in BMD after 6 months in Group A when compared with Group B (P = 0.0179). Conclusion: Single oral dose of 70 mg alendronate per week is well-tolerable, gastro-intestinally safe, and improves the clinical outcome of nonsurgical periodontal therapy.
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Affiliation(s)
- Shikha Gupta
- Department of Periodontics, RUHS College of Dental Sciences, Jaipur, Rajasthan, India
| | - Setu Mathur
- Department of Periodontics, RUHS College of Dental Sciences, Jaipur, Rajasthan, India
| | - Anjali Kapoor
- Department of Periodontics, RUHS College of Dental Sciences, Jaipur, Rajasthan, India
| | - Sharmistha Vijay
- Department of Periodontics, RUHS College of Dental Sciences, Jaipur, Rajasthan, India
| | - Rohit K Khatri
- Department of Conservative Dentistry and Endodontics, RUHS College of Dental Sciences, Jaipur, Rajasthan, India
| | - Rashi Srivastava
- Department of Oral Pathology, Rajasthan Dental College, Jaipur, Rajasthan, India
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Soen S, Kishimoto H, Hagino H, Sone T, Ohishi H, Fujimoto T, Sasaki E, Tanaka S, Sugimoto T. Phase II/III, randomized, double-blind, parallel-group study of monthly delayed-release versus daily immediate-release risedronate tablets in Japanese patients with involutional osteoporosis. J Bone Miner Metab 2020; 38:86-98. [PMID: 31420748 DOI: 10.1007/s00774-019-01031-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 06/26/2019] [Indexed: 10/26/2022]
Abstract
Absorption of oral immediate-release (IR) risedronate tablets is reduced by food intake, thus a delayed-release (DR) tablet has been developed to overcome the necessity of taking IR tablets under fasting conditions. This randomized, double-blind, phase II/III study compared efficacy and safety of risedronate IR once-daily (QD) and DR once-monthly (QM) tablets in Japanese patients with involutional osteoporosis. Patients received 2.5 mg IR on awakening QD, or 25 or 37.5 mg DR on awakening, following breakfast, or 30 min after breakfast, QM for 12 months. Primary endpoint was non-inferiority in mean percent change from baseline to end of study (month 12, last observation carried forward [M12, LOCF]) in mean lumbar spine (L2-L4) bone mineral density (BMD) between risedronate IR on awakening and DR following breakfast. Mean percent changes in (L2-L4) BMD at M12, LOCF were 5.07% (IR at awakening, n = 190), 3.36% (25 mg DR following breakfast, n = 194), and 4.11% (37.5 mg DR following breakfast, n = 181). Mean percent change in (L2-L4) BMD was numerically lower in the DR following breakfast groups versus the respective on awakening and 30 min after breakfast DR groups. Overall incidences of treatment-emergent adverse events (TEAEs) were comparable between groups. In the DR groups, 1.5-4.0% of patients reported TEAEs potentially associated with acute-phase reactions versus 0% in the IR group. In this study, non-inferiority could not be declared for 37.5 or 25 mg DR following breakfast QM (p = 0.1346 or p = 0.6711, respectively) versus 2.5 mg IR on awakening QD.
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Affiliation(s)
- Satoshi Soen
- Department of Orthopedic Surgery and Rheumatology, Kindai University Nara Hospital, 1248-1 Otodacho, Ikoma, Nara, 630-0293, Japan.
| | | | - Hiroshi Hagino
- School of Health Science and Rehabilitation Division, Tottori University, Yonago, Tottori, Japan
| | - Teruki Sone
- Department of Nuclear Medicine, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | | | | | - Emma Sasaki
- Takeda Pharmaceutical Company Ltd., Chuo-ku, Osaka, Japan
| | - Sakae Tanaka
- Orthopedic Surgery, Sensory and Motor System Medicine, Surgical Sciences, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Toshitsugu Sugimoto
- Internal Medicine 1, Shimane University, Faculty of Medicine, Izumo, Shimane, Japan
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Kolb AD, Bussard KM. The Bone Extracellular Matrix as an Ideal Milieu for Cancer Cell Metastases. Cancers (Basel) 2019; 11:cancers11071020. [PMID: 31330786 PMCID: PMC6678871 DOI: 10.3390/cancers11071020] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/01/2019] [Accepted: 07/18/2019] [Indexed: 12/12/2022] Open
Abstract
Bone is a preferential site for cancer metastases, including multiple myeloma, prostate, and breast cancers.The composition of bone, especially the extracellular matrix (ECM), make it an attractive site for cancer cell colonization and survival. The bone ECM is composed of living cells embedded within a matrix composed of both organic and inorganic components. Among the organic components, type I collagen provides the tensile strength of bone. Inorganic components, including hydroxyapatite crystals, are an integral component of bone and provide bone with its rigidity. Under normal circumstances, two of the main cell types in bone, the osteoblasts and osteoclasts, help to maintain bone homeostasis and remodeling through cellular communication and response to biophysical signals from the ECM. However, under pathological conditions, including osteoporosis and cancer, bone remodeling is dysregulated. Once in the bone matrix, disseminated tumor cells utilize normal products of bone remodeling, such as collagen type I, to fuel cancer cell proliferation and lesion outgrowth. Models to study the complex interactions between the bone matrix and metastatic cancer cells are limited. Advances in understanding the interactions between the bone ECM and bone metastatic cancer cells are necessary in order to both regulate and prevent metastatic cancer cell growth in bone.
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Affiliation(s)
- Alexus D Kolb
- Department of Cancer Biology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Karen M Bussard
- Department of Cancer Biology, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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Yang YL, Xiang ZJ, Yang JH, Wang WJ, Xiang RL. The incidence and relative risk of adverse events in patients treated with bisphosphonate therapy for breast cancer: a systematic review and meta-analysis. Ther Adv Med Oncol 2019; 11:1758835919855235. [PMID: 31217825 PMCID: PMC6558551 DOI: 10.1177/1758835919855235] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 05/08/2019] [Indexed: 12/18/2022] Open
Abstract
Background: Adjuvant bisphosphonates reduce the rate of breast cancer recurrence in the
bone and improve breast cancer survival. However, the risk of adverse events
associated with bisphosphonate therapy for breast cancer remains poorly
defined. Methods: A literature search was conducted using the PubMed, EMBASE, Cochrane and Web
of Science libraries. Risk ratio (RR) was calculated to evaluate the adverse
events of the meta-analytic results. Osteonecrosis of the jaw (ONJ)
incidence was calculated using the random effect model (D+L pooled) for
meta-analysis. Results: A total of 47 studies comprising 20,607 patients were included; 23 randomized
controlled studies (RCTs) provided data of adverse events for bisphosphonate
therapy versus without bisphosphonates. Bisphosphonates
were significantly associated with influenza-like illness (RR = 4.52),
fatigue (RR = 1.08), fever (RR = 1.82), dyspepsia (RR = 1.25), anorexia
(RR = 1.29), and urinary tract infection (RR = 1.32). No differences were
observed in other adverse events. We combined the incidence of ONJ in 24
retrospective studies to analyze the incidence of ONJ using bisphosphonates.
The pooled probability of ONJ toxicity in the bisphosphonates group was
2%. Conclusions: Bisphosphonates were significantly associated with influenza-like illness,
fatigue, fever, dyspepsia, anorexia, and urinary tract infection.
Furthermore, bisphosphonates increase the risk of ONJ toxicity.
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Affiliation(s)
- Yan-Li Yang
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | | | | | - Ruo-Lan Xiang
- Department of Physiology and Pathophysiology, Peking University School of Basic Medical Sciences, Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, and Beijing Key Laboratory of Cardiovascular Receptors Research, China
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von Moos R, Costa L, Gonzalez-Suarez E, Terpos E, Niepel D, Body JJ. Management of bone health in solid tumours: From bisphosphonates to a monoclonal antibody. Cancer Treat Rev 2019; 76:57-67. [PMID: 31136850 DOI: 10.1016/j.ctrv.2019.05.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/23/2019] [Accepted: 05/13/2019] [Indexed: 02/06/2023]
Abstract
Patients with solid tumours are at risk of impaired bone health from metastases and cancer therapy-induced bone loss (CTIBL). We review medical management of bone health in patients with solid tumours over the past 30 years, from first-generation bisphosphonates to the receptor activator of nuclear factor κB ligand (RANKL)-targeted monoclonal antibody, denosumab. In the 1980s, first-generation bisphosphonates were shown to reduce the incidence of skeletal-related events (SREs) in patients with breast cancer. Subsequently, more potent second- and third-generation bisphosphonates were developed, particularly zoledronic acid (ZA). Head-to-head studies showed that ZA was significantly more effective than pamidronate for reducing SREs in patients with breast and castrate-resistant prostate cancer (CRPC), becoming the standard of care for more than a decade. The RANKL inhibitor denosumab was licensed in 2010, and head-to-head studies and integrated analyses confirmed its superiority to ZA for preventing SREs, particularly in breast cancer and CRPC. Bisphosphonates and denosumab have also been investigated for prevention of CTIBL in patients receiving hormonal therapy for breast and prostate cancer, and denosumab is licensed in this indication. Despite advances in management of bone health, several issues remain, notably the optimal time to initiate therapy, duration of therapy, and dosing frequency, and how to avoid toxicity, particularly with long-term treatment. In summary, introduction of ZA and denosumab has protected patients with bone metastasis from serious bone complications and improved their quality of life. Ongoing research will hopefully guide the optimal use of these agents to help maintain bone health in patients with solid tumours.
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Affiliation(s)
- Roger von Moos
- Kantonsspital Graubünden, Loëstrasse 170, Chur, Graubünden, Switzerland.
| | - Luis Costa
- Hospital de Santa Maria, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Avenida Professor Egas Moniz, Lisboa, Portugal
| | - Eva Gonzalez-Suarez
- Cancer Epigenetics and Biology Program (PEBC), Bellvitge Biomedical Research Institute, (IDIBELL) Avinguda Gran Via de l'Hospitalet, Barcelona, Spain
| | - Evangelos Terpos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | | | - Jean-Jacques Body
- Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Brussels, Belgium
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Cheng L, Zhang K, Zhang Z. Effectiveness of thiazides on serum and urinary calcium levels and bone mineral density in patients with osteoporosis: a systematic review and meta-analysis. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:3929-3935. [PMID: 30532521 PMCID: PMC6241760 DOI: 10.2147/dddt.s179568] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective Osteoporosis is the most common metabolic bone disease and a major public health problem worldwide. Thiazides are widely used as antihypertensive agents with good tolerability and efficacy. Furthermore, thiazides have long been regarded as candidates for the prevention of postmenopausal bone loss. However, there is insufficient evidence that thiazides have a sustained beneficial effect on preserving bone mass and preventing osteoporosis to date. Materials and methods We searched the PubMed, the Cochrane Library, and Embase in June 2018 for randomized controlled trials on the use of thiazides to treat osteoporosis. Continuous outcomes are presented as the standardized mean difference (SMD) and 95% CI. Furthermore, P-values <0.05 were considered significant. Results Five trials with 756 patients were randomly assigned in the five trials included in this meta-analysis. Serum calcium level was higher in the thiazide group than in the control group (SMD 0.33, 95% CI [0.16, 0.50]), and urinary calcium level was significantly lower in the thiazide group (SMD −0.35, 95% CI [−0.52, −0.17]). There was no significant difference in bone mineral density between the two groups (SMD 0.19, 95% CI [−0.16, 0.54]). Conclusion Thiazides might play a role in preserving bone mass and be effective in the prevention and treatment of osteoporosis. Future high-quality trials are needed to confirm our findings in the future.
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Affiliation(s)
- Lei Cheng
- Department of Thyroid Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Keyan Zhang
- Department of Thyroid Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Zhenyong Zhang
- The Second Department of Clinical Oncology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China,
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13
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Lüftner D, Niepel D, Steger GG. Therapeutic approaches for protecting bone health in patients with breast cancer. Breast 2018; 37:28-35. [DOI: 10.1016/j.breast.2017.10.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 02/07/2023] Open
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Khajuria DK, Zahra SF, Razdan R. Effect of locally administered novel biodegradable chitosan based risedronate/zinc-hydroxyapatite intra-pocket dental film on alveolar bone density in rat model of periodontitis. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2017; 29:74-91. [PMID: 29088987 DOI: 10.1080/09205063.2017.1400145] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The aim of this study was to develop a chitosan-based risedronate/zinc-hydroxyapatite intrapocket dental film (CRZHDF) for applications in the treatment of alveolar bone loss in an animal model of periodontitis. The physical characteristics (folding endurance, pH, mucoadhesive strength, risedronate content and release) of CRZHDF, exhibited results within the limit. X-ray diffraction analysis indicates reduced or disappeared crystallinity of risedronate and zinc-hydroxyapatite in presence of chitosan. Further, FTIR studies revealed stability of CRZHDF and compatibility between risedronate, zinc-hydroxyapatite and chitosan. Periodontitis was induced by Porphyromonas gingivalis-lipopolysaccharide injections around the mandibular first molar. We divided rats into 5 groups (12 rats/group): healthy, untreated periodontitis; periodontitis plus CRZHDF-A, periodontitis plus CRZHDF-B, and periodontitis plus chitosan film. After four weeks, blood samples and mandibles were obtained for biochemical, radiographic and histological analysis. Bone specific alkaline phosphatise activity and tartrate resistant acid phosphatase 5b was statistically lower in CRZHDF-A and CRZHDF-B groups as compared to the untreated periodontitis group (p < 0.0001). The expression of osteocalcin was statistically higher in CRZHDF-A and CRZHDF-B groups as compared to the untreated periodontitis group (p < 0.0001). Alveolar bone was intact in the healthy group. Local administration of CRZHDF resulted in significant improvements in the mesial and distal periodontal bone support (MPBS and DPBS, respectively) proportions (%), bone mineral density, and also reversed alveolar bone resorption when compared to the untreated periodontitis group (p < 0.001). The study reported here reveals that novel CRZHDF treatment effectively reduced alveolar bone destruction and contributes to periodontal healing in a rat model of experimental periodontitis.
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Affiliation(s)
- Deepak Kumar Khajuria
- a Department of Pharmacology , Al-Ameen College of Pharmacy , Bangalore , India.,b The Musculoskeletal Genetics Laboratory, Faculty of Medicine in the Galilee , Bar-Ilan University , Safed , Israel
| | | | - Rema Razdan
- a Department of Pharmacology , Al-Ameen College of Pharmacy , Bangalore , India
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Hadji P, Aapro MS, Body JJ, Gnant M, Brandi ML, Reginster JY, Zillikens MC, Glüer CC, de Villiers T, Baber R, Roodman GD, Cooper C, Langdahl B, Palacios S, Kanis J, Al-Daghri N, Nogues X, Eriksen EF, Kurth A, Rizzoli R, Coleman RE. Management of Aromatase Inhibitor-Associated Bone Loss (AIBL) in postmenopausal women with hormone sensitive breast cancer: Joint position statement of the IOF, CABS, ECTS, IEG, ESCEO IMS, and SIOG. J Bone Oncol 2017; 7:1-12. [PMID: 28413771 PMCID: PMC5384888 DOI: 10.1016/j.jbo.2017.03.001] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 03/10/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Several guidelines have been reported for bone-directed treatment in women with early breast cancer (EBC) for averting fractures, particularly during aromatase inhibitor (AI) therapy. Recently, a number of studies on additional fracture related risk factors, new treatment options as well as real world studies demonstrating a much higher fracture rate than suggested by randomized clinical controlled trials (RCTs). Therefore, this updated algorithm was developed to better assess fracture risk and direct treatment as a position statement of several interdisciplinary cancer and bone societies involved in the management of AI-associated bone loss (AIBL). PATIENTS AND METHODS A systematic literature review identified recent advances in the management of AIBL. Results with individual agents were assessed based on trial design, size, follow-up, and safety. RESULTS Several fracture related risk factors in patients with EBC were identified. Although, the FRAX algorithm includes fracture risk factors (RF) in addition to BMD, it does not seem to adequately address the effects of AIBL. Several antiresorptive agents can prevent and treat AIBL. However, concerns regarding compliance and long-term safety remain. Overall, the evidence for fracture prevention is strongest for denosumab 60 mg s.c. every 6 months. Additionally, recent studies as well as an individual patient data meta-analysis of all available randomized trial data support additional anticancer benefits from adjuvant bisphosphonate treatment in postmenopausal women with a 34% relative risk reduction in bone metastasis and 17% relative risk decrease in breast cancer mortality that needs to be taken into account when advising on management of AIBL. CONCLUSIONS In all patients initiating AI treatment, fracture risk should be assessed and recommendation with regard to exercise and calcium/vitamin D supplementation given. Bone-directed therapy should be given to all patients with a T-score<-2.0 or with a T-score of <-1.5 SD with one additional RF, or with ≥2 risk factors (without BMD) for the duration of AI treatment. Patients with T-score>-1.5 SD and no risk factors should be managed based on BMD loss during the first year and the local guidelines for postmenopausal osteoporosis. Compliance should be regularly assessed as well as BMD on treatment after 12 - 24 months. Furthermore, because of the decreased incidence of bone recurrence and breast cancer specific mortality, adjuvant bisphosphonates are recommended for all postmenopausal women at significant risk of disease recurrence.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - John Kanis
- Catholic University of Australia, Melbourne, Australia and University of Sheffield, UK
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16
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Kjellberg J, Jorgensen AD, Vestergaard P, Ibsen R, Gerstoft F, Modi A. Cost and health care resource use associated with noncompliance with oral bisphosphonate therapy: an analysis using Danish health registries. Osteoporos Int 2016; 27:3535-3541. [PMID: 27394414 DOI: 10.1007/s00198-016-3683-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 06/20/2016] [Indexed: 01/22/2023]
Abstract
UNLABELLED We estimated the rate of compliance with oral bisphosphonates among Danish women and examined its association with health care resource use and cost. Approximately 30 % of Danish females aged >55 who take bisphosphonates are noncompliant, and noncompliance is significantly associated with increased health care resource use and cost. INTRODUCTION Two objectives of this study were to estimate the rate of oral bisphosphonate compliance among Danish women and to examine the association of noncompliance with health care resource use and cost. METHODS Women ≥55 with an index prescription claim for an oral bisphosphonate were identified from Danish national health registries between 2003 and 2008. Compliance was measured as the medication possession ratio (MPR) during the first 12 months post-index. Cost and health care resource use were collected for the following 12 months. RESULTS Among the 38,234 women meeting the study inclusion criteria, 29.9 % were noncompliant (MPR <70 %). Younger age was associated with higher odds of compliance (OR [95 % CI] 1.22 [1.15-1.29] for ages 55-64 and 1.18 [1.12-1.24] for ages 65-74; reference age group ≥75 years). Rates of all-cause health care resource use were significantly higher in noncompliant subjects: 28.9 versus 23.0 % had inpatient admissions, 16.5 versus 13.0 % had emergency room visits, and 48.7 versus 43.3 % used outpatient services (P < 0.001 for all comparisons). The total mean (SD) all-cause cost per patient (excluding office visits) was €626 (2344) and €4178 (7854), respectively. The mean (SD) osteoporosis-related cost per patient (excluding office visits) was €572 (2085) and €754 (2857) for compliant and non-compliant subjects, respectively. The compliant subjects accrued significantly lower all-cause and OP-related cost than noncompliant subjects, regardless of whether the total cost or medical cost only was considered. CONCLUSIONS Approximately 30 % of Danish females aged 55 or older who take bisphosphonates are noncompliant. Noncompliance is significantly associated with increased health care resource use and cost.
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Affiliation(s)
- J Kjellberg
- KORA (National Institute for Municipalities' and Regions' Analysis and Research), Kobmagergade 22, 1150, Copenhagen, Denmark.
| | | | - P Vestergaard
- Clinical Institute, Aalborg University, Aalborg, Denmark
| | | | | | - A Modi
- Merck & Co., Inc., Kenilworth, NJ, USA
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Hsieh PC. Effectiveness and Safety of Zoledronic Acid in the Treatment of Osteoporosis. Orthopedics 2016; 39:e263-70. [PMID: 26881461 DOI: 10.3928/01477447-20160201-02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 07/08/2015] [Indexed: 02/03/2023]
Abstract
The effectiveness of current treatments for osteoporosis is limited by poor patient compliance. However, a favorable dosing regimen of zoledronic acid (ZA) has the potential to improve patient compliance and thus clinical outcomes. The author conducted a retrospective analysis to examine adherence to and the antiosteoporotic effects of a once-yearly infusion of 5 mg of ZA in Taiwanese patients with osteoporosis for up to 48 months. Five men and 149 postmenopausal women (mean age, 77.1 years) were included. Prior to ZA treatment, 66.2% of patients had fractures; most patients discontinued previous treatments due to compliance or convenience issues. Approximately 85% of patients received at least 2 infusions of ZA. Following ZA treatment, bone mineral density improved from baseline at 12 months (11% from baseline; P=.01) and 48 months (20.7% from baseline; P=.009). In addition there was a significant reduction in mean beta-C-telopeptide at all time points from 12 (P<.001) to 36 months (P=.010). New clinical fractures occurred in 16 (10.4%) patients, of which 12 patients experienced a single fracture. Zoledronic acid had an acceptable safety profile; no adverse events were considered to be drug related. Treatment with ZA improved bone health by enhancing bone mineral density and reducing bone turnover, even in high-risk patients. Low fracture rates and high adherence further elucidate the benefits of ZA in the treatment of osteoporosis.
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Choi HJ, Kim TH, Kim SA, Kim JM, Lee A, Song HJ, Park YJ. Cell Therapy Products in Menopausal Medicine. J Menopausal Med 2016; 22:71-5. [PMID: 27617240 PMCID: PMC5016506 DOI: 10.6118/jmm.2016.22.2.71] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/10/2016] [Accepted: 06/15/2016] [Indexed: 11/05/2022] Open
Abstract
The incidence of postmenopausal diseases increases with the age of women. In this review, we introduce cell therapy products, a new treatment for postmenopausal osteoporosis, which often occurs in postmenopausal women. We also figure out the trends of research on cell therapy products and emphasize the necessity and importance of this research for researchers and postmenopausal women. Finally, we suggest the direction for improvement of postmenopausal osteoporosis and research on cell therapy products. We investigated which medication have been used so far. We also examined the development and technical problems of technologies that are currently in use.
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Affiliation(s)
- Hye Ji Choi
- Department of Life Science and Biotechnology, Soonchunhyang University College of Natural Sciences, Asan, Korea
| | - Tae-Hee Kim
- Department of Obstetrics and Gynecology, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Soo Ah Kim
- Department of Obstetrics and Gynecology, School of Medicine, Chosun University, Gwangju, Korea
| | - Jun-Mo Kim
- Department of Urology, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Arum Lee
- Department of Interdisciplinary Program in Biomedical Science, Soonchunhyang University Graduate School, Asan, Korea.; Department of Medical (CRO), The Way Communications Corporation, Seoul, Korea
| | - Hyeon Jin Song
- Department of Life Science and Biotechnology, Soonchunhyang University College of Natural Sciences, Asan, Korea
| | - Yoo Jin Park
- Department of Interdisciplinary Program in Biomedical Science, Soonchunhyang University Graduate School, Asan, Korea.; Department of Health Administration and Management, Soonchunhyang University College of Medical Sciences, Asan, Korea
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de Molon RS, Hsu C, Bezouglaia O, Dry SM, Pirih FQ, Soundia A, Cunha FQ, Cirelli JA, Aghaloo TL, Tetradis S. Rheumatoid Arthritis Exacerbates the Severity of Osteonecrosis of the Jaws (ONJ) in Mice. A Randomized, Prospective, Controlled Animal Study. J Bone Miner Res 2016; 31:1596-607. [PMID: 26950411 PMCID: PMC4970902 DOI: 10.1002/jbmr.2827] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 03/01/2016] [Accepted: 03/02/2016] [Indexed: 12/14/2022]
Abstract
Rheumatoid arthritis (RA), an autoimmune inflammatory disorder, results in persistent synovitis with severe bone and cartilage destruction. Bisphosphonates (BPs) are often utilized in RA patients to reduce bone destruction and manage osteoporosis. However, BPs, especially at high doses, are associated with osteonecrosis of the jaw (ONJ). Here, utilizing previously published ONJ animal models, we are exploring interactions between RA and ONJ incidence and severity. DBA1/J mice were divided into four groups: control, zoledronic acid (ZA), collagen-induced arthritis (CIA), and CIA-ZA. Animals were pretreated with vehicle or ZA. Bovine collagen II emulsified in Freund's adjuvant was injected to induce arthritis (CIA) and the mandibular molar crowns were drilled to induce periapical disease. Vehicle or ZA treatment continued for 8 weeks. ONJ indices were measured by micro-CT (µCT) and histological examination of maxillae and mandibles. Arthritis development was assessed by visual scoring of paw swelling, and by µCT and histology of interphalangeal and knee joints. Maxillae and mandibles of control and CIA mice showed bone loss, periodontal ligament (PDL) space widening, lamina dura loss, and cortex thinning. ZA prevented these changes in both ZA and CIA-ZA groups. Epithelial to alveolar crest distance was increased in the control and CIA mice. This distance was preserved in ZA and CIA-ZA animals. Empty osteocytic lacunae and areas of osteonecrosis were present in ZA and CIA-ZA but more extensively in CIA-ZA animals, indicating more severe ONJ. CIA and CIA-ZA groups developed severe arthritis in the paws and knees. Interphalangeal and knee joints of CIA mice showed advanced bone destruction with cortical erosions and trabecular bone loss, and ZA treatment reduced these effects. Importantly, no osteonecrosis was noted adjacent to areas of articular inflammation in CIA-ZA mice. Our data suggest that ONJ burden was more pronounced in ZA treated CIA mice and that RA could be a risk factor for ONJ development. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- Rafael Scaf de Molon
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA 90095, USA
- Department of Diagnosis and Surgery, School of Dentistry at Araraquara, Sao Paulo State University, Araraquara 14801–903, Brazil
| | - Chingyun Hsu
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA 90095, USA
| | - Olga Bezouglaia
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA 90095, USA
| | - Sarah M. Dry
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Flavia Q. Pirih
- Division of Constitutive & Regenerative Sciences, UCLA School of Dentistry, Los Angeles, CA 90095, USA
| | - Akrivoula Soundia
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA 90095, USA
| | - Fernando Queiroz Cunha
- Department of Pharmacology, School of Medicine of Ribeirao Preto, Sao Paulo 14049, Brazil
| | - Joni Augusto Cirelli
- Department of Diagnosis and Surgery, School of Dentistry at Araraquara, Sao Paulo State University, Araraquara 14801–903, Brazil
| | - Tara L. Aghaloo
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA 90095, USA
| | - Sotirios Tetradis
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA 90095, USA
- Molecular Biology Institute, UCLA, Los Angeles, CA 90095, USA
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Ochiuz L, Grigoras C, Popa M, Stoleriu I, Munteanu C, Timofte D, Profire L, Grigoras AG. Alendronate-Loaded Modified Drug Delivery Lipid Particles Intended for Improved Oral and Topical Administration. Molecules 2016; 21:E858. [PMID: 27367664 PMCID: PMC6272979 DOI: 10.3390/molecules21070858] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 06/24/2016] [Accepted: 06/25/2016] [Indexed: 11/12/2022] Open
Abstract
The present paper focuses on solid lipid particles (SLPs), described in the literature as the most effective lipid drug delivery systems that have been introduced in the last decades, as they actually combine the advantages of polymeric particles, hydrophilic/lipophilic emulsions and liposomes. In the current study, we present our most recent advances in the preparation of alendronate (AL)-loaded SLPs prepared by hot homogenization and ultrasonication using various ratios of a self-emulsifying lipidic mixture of Compritol 888, Gelucire 44/14, and Cremophor A 25. The prepared AL-loaded SLPs were investigated for their physicochemical, morphological and structural characteristics by dynamic light scattering, differential scanning calorimetry, thermogravimetric and powder X-ray diffraction analysis, infrared spectroscopy, optical and scanning electron microscopy. Entrapment efficacy and actual drug content were assessed by a validated HPLC method. In vitro dissolution tests performed in simulated gastro-intestinal fluids and phosphate buffer solution pH 7.4 revealed a prolonged release of AL of 70 h. Additionally, release kinetics analysis showed that both in simulated gastrointestinal fluids and in phosphate buffer solution, AL is released from SLPs based on equal ratios of lipid excipients following zero-order kinetics, which characterizes prolonged-release drug systems.
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Affiliation(s)
- Lacramioara Ochiuz
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Grigore T. Popa University of Medicine and Pharmacy of Iasi, Universitatii Street, 16, Iasi 700115, Romania.
| | - Cristian Grigoras
- Petru Poni Institute of Macromolecular Chemistry, Aleea, Grigore Ghica Voda, 41A, Iasi 700487, Romania.
| | - Marcel Popa
- Department of Natural and Synthetic Polymers, Gheorghe Asachi Technical University of Iasi, Romania, Prof. Dr. Docent Dimitrie Mangeron Avenue, 73, Iasi 700050, Romania.
| | - Iulian Stoleriu
- Faculty of Mathematics, Alexandru I. Cuza University, 11 Bvd. Carol I, Iasi 700506, Romania.
| | - Corneliu Munteanu
- Faculty of Mechanical Engineering, Gheorghe Asachi Technical University of Iasi, Romania, Prof. Dr. Docent Dimitrie Mangeron Avenue, 73, Iasi 700050, Romania.
| | - Daniel Timofte
- Faculty of Medicine, Grigore T.Popa University of Medicine and Pharmacy Iasi, 16 Universitatii Street, Iasi 700115, Romania.
- Surgery Department, Sf. Spiridon Hospital, 1 Piata Independentei, Iasi 700111, Romania.
| | - Lenuta Profire
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Grigore T. Popa University of Medicine and Pharmacy of Iasi, Universitatii Street, 16, Iasi 700115, Romania.
| | - Anca Giorgiana Grigoras
- Petru Poni Institute of Macromolecular Chemistry, Aleea, Grigore Ghica Voda, 41A, Iasi 700487, Romania.
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The effect of vitamin D and bisphosphonate on fracture healing: An experimental study. J Clin Orthop Trauma 2016; 7:90-4. [PMID: 27182145 PMCID: PMC4857164 DOI: 10.1016/j.jcot.2016.01.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 01/14/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The aim of the study was to evaluate the effects of the using bisphosphonate, vitamin D, and a combination of bisphosphonate and vitamin D on fracture healing, by comparison of radiological and histological findings of the study groups and a control group. METHODS A total of 24 rats were randomly divided into 4 groups. A mid-third fracture was created in the femur of all rats. Saline was administered to Group A, bisphosphonate (Alendronate) to Group B, bisphosphonate (Alendronate) + vitamin D (Calcitriol) to Group C and vitamin D (Calcitriol) to Group D. All preparations were administered orally for 28 days. RESULTS No statistically significant difference was determined between the groups in respect of the effect on fracture healing according to radiological findings. The histological findings of fracture healing showed Groups B and C to be significantly more advanced than Group A (p = 0.017, p = 0.009). However no significant difference was found in Group D comparison with Group A (p = 0.224). CONCLUSION According to the histological findings, advanced fracture healing was seen in the groups administered with bisphosphonate or combined bisphosphonate and vitamin D compared to the use of vitamin D alone and the control group. It was concluded that bisphosphonate treatment combined with vitamin D can be used safely without any negative effect on fracture healing.
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Qing GZ, Lu Y, Yi T, Zhang KQ, Tang ZH. The relationship of frequency of meat consumption and osteoporosis in Chinese postmenopausal women. Int J Clin Exp Med 2015; 8:21130-21137. [PMID: 26885045 PMCID: PMC4723890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 11/10/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND This study was aimed at evaluating the associations between frequency of meat food intake and osteoporosis (OP) in general Chinese postmenopausal women. METHODS We conducted a large-scale, community-based, cross-sectional study to investigate the associations by using self-report questionnaire to access frequency of meat food intake. The total of 1905 participants was available to data analysis in this study. Multiple regression models controlling for confounding factors to include frequency of meat food intake variable were performed to investigate the relationships for OP. RESULTS Positive correlations between frequency of meat food intake and T-score were reported (β = 0.12, P value < 0.001). Multiple regression analysis indicated that the frequency of meat food intake was significantly associated with OP (P < 0.1 for model 1 and model 2). The postmenopausal women with high frequency of meat food intake had a lower prevalence of OP. CONCLUSION The findings indicated that frequency of meat food intake was independently and significantly associated with OP. The prevalence of OP was less frequent in Chinese postmenopausal women preferring meat food habits.
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Affiliation(s)
- Guo-Zhong Qing
- Department of Emergence, The First Hospital Affiliated to South China UniversityHengyang, Hunan, China
| | - Yu Lu
- Department of Emergence, The First Hospital Affiliated to South China UniversityHengyang, Hunan, China
| | - Tao Yi
- Department of Emergence, The First Hospital Affiliated to South China UniversityHengyang, Hunan, China
| | - Ke-Qin Zhang
- Department of Endocrinology and Metabolism, Shanghai Tongji Hospital, School of Medicine, Tongji UniversityShanghai, China
| | - Zi-Hui Tang
- Department of Endocrinology and Metabolism, Shanghai Tongji Hospital, School of Medicine, Tongji UniversityShanghai, China
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Şalvarcı A, Altınay S. Mandibular osteonecrosis due to bisphosphonate use. Turk J Urol 2015; 41:43-7. [PMID: 26328198 DOI: 10.5152/tud.2015.90277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 06/23/2014] [Indexed: 11/22/2022]
Abstract
Due to their efficient osteoclastic inhibitor effect in bone metabolism and antiangiogenic activity, bisphosphonates are widely used in many cancer diseases particularly in prostate cancers with bone metastasis, lung cancer, breast cancer and multiple myeloma, as well as in systemic diseases such as osteoporosis, osteopenia, Paget disease and osteogenesis imperfect for the last 13 years. Prostate cancer is a common cancer in males and it is the leading cause of bone metastasis. Mandibular metastasis is rarely encountered during the course of prostate cancer. Mandibular osteonecrosis as well has begun to be observed along with the availability of more efficient and stronger formulations developed following the use of bisphosphonates. Zolendronic acid, which has been used also by our patient, has widely come into practice as a 3(rd) generation bisphosphonate. Because of prostate cancer and widespread bone metastases, our patient has been receiving zolendronic acid with maximum androgen blockage for 4 years. Tomography of the patient, who has undergone intensive treatment because of submandibular abscess, demonstrated extensive osteonecrosis in the fovea sublingual region of the mandible corpus. In large series, although, mandibular osteonecrosis was widely seen due to bisphosphonate use for the metastases of lung and breast cancers, this rate was between 9.6% and 11% for prostate cancer within the series. Although our patient had no mandibular metastasis before, mandibular necrosis was observed due to long-term bisphosphonate use. We are going to present our patient who had this rare complication with his clinical picture.
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Affiliation(s)
| | - Serdar Altınay
- Department of Pathology, Bağcılar Training and Research Hospital, İstanbul, Turkey
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Srividhya NB, Singh N, Goel N, Gambhir JK, Rathi V, Rajaram S. Comparison of antiresorptive effect of hormone therapy and ibandronate in postmenopausal osteoporotic women by assessing type I collagen C-telopeptide levels. Post Reprod Health 2015; 21:48-55. [PMID: 25792627 DOI: 10.1177/2053369115574613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The aim of this study is to compare the antiresorptive effect of hormone therapy and oral ibandronate in postmenopausal osteoporotic women by measuring bone mineral density (BMD) and degradation products of C-terminal telopeptide of type I collagen (CTX) using serum crosslaps ELISA. STUDY DESIGN The study is a randomized comparative trial. METHODS About 60 women with age > 40 years, having either surgical or medical menopause with T- or Z-score below -2.5 SD were included in the study. They were randomized into two groups of 30 each; one group received conventional hormone therapy (group I) and the other group received ibandronate monthly (group II). The treatment was given for 6 months. RESULTS The BMD increased from 0.894 g/cm(2) to 0.933 g/cm(2) (p < 0.01) in group I and from 0.865 g/cm(2) to 0.934 g/cm(2) (p < 0.01) in group II. The increase in BMD in group I (4.3%) was less than group II (7.9%) which was significant (p < 0.01). The serum CTX levels also showed significant reduction in both groups after 6 months of therapy; more reduction was seen in group II as compared to group I (41.5% vs. 4.6%, p < 0.01). CONCLUSION Ibandronate can be used as a substitute to hormone therapy in women presenting with osteoporosis. Long-term studies are needed to authenticate the observation.
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Affiliation(s)
- N B Srividhya
- Department of Obstetrics and Gynaecology, University College of Medical Sciences & Guru Tegh Bahadur Hospital, New Delhi, India
| | - Nilanchali Singh
- Department of Obstetrics and Gynaecology, University College of Medical Sciences & Guru Tegh Bahadur Hospital, New Delhi, India
| | - Neerja Goel
- Department of Obstetrics and Gynaecology, University College of Medical Sciences & Guru Tegh Bahadur Hospital, New Delhi, India
| | - J K Gambhir
- Department of Biochemistry, University College of Medical Sciences, New Delhi, India
| | - Vinita Rathi
- Department of Radiology, University College of Medical Sciences, New Delhi, India
| | - Shalini Rajaram
- Department of Obstetrics and Gynaecology, University College of Medical Sciences & Guru Tegh Bahadur Hospital, New Delhi, India
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Torres SR, Chen CSK, Leroux BG, Lee PP, Hollender LG, Lloid M, Drew SP, Schubert MM. Mandibular inferior cortical bone thickness on panoramic radiographs in patients using bisphosphonates. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119:584-92. [PMID: 25864820 PMCID: PMC4395858 DOI: 10.1016/j.oooo.2015.02.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 01/25/2015] [Accepted: 02/09/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The goal of this study was to detect dimensional changes in the mandibular cortical bone associated with bisphosphonate (BP) use and to correlate measurements of the cortical bone with the cumulative dose of BPs. STUDY DESIGN Mandibular inferior cortical bone thickness (MICBT) was measured under the mental foramen on panoramic radiographs of patients with and without bisphosphonate-related osteonecrosis of the jaws (BRONJ) taking BPs and controls. RESULTS Patients with BRONJ had the highest mean MICBT (6.81 ± 1.35 mm), compared with patients without BRONJ taking BPs (5.44 ± 1.09 mm) and controls (4.79 ± 0.85 mm) (P < .01). Mean MICBT of patients with BRONJ was significantly higher than that of patients without BRONJ taking BPs. There was a correlation between MICBT and cumulative dose of zolendronate. CONCLUSIONS Measurement of MICBT on panoramic radiographs is a potentially useful tool for the detection of dimensional changes associated with BP therapy.
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Affiliation(s)
- Sandra R. Torres
- Associate Professor, Department of Oral Pathology and Diagnosis of Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. Visiting Faculty at University of Washington, Seattle, US
| | - Curtis S. K. Chen
- Professor and Director of Oral Radiology Specialty Program, Department of Oral Medicine, School of Dentistry, University of Washington, Seattle, US
| | - Brian G. Leroux
- Professor, Dental Public Health Sciences and Biostatistics, School of Dentistry, University of Washington, Seattle, US
| | - Peggy P. Lee
- Assistant Professor, Department of Oral Medicine, School of Dentistry, University of Washington, Seattle, US
| | - Lars G. Hollender
- Professor, Department of Oral Medicine, School of Dentistry, University of Washington, Seattle, US
| | - Michelle Lloid
- Clinical Associate Professor, Department of Oral Medicine, University of Washington, Seattle, USA
| | | | - Mark M. Schubert
- Professor, Department of Oral Medicine, School of Dentistry, University of Washington, Director, Oral Medicine Service, Seattle Cancer Care Alliance, Seattle, US
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Patel S, Saberi N. External Cervical Resorption Associated with the Use of Bisphosphonates: A Case Series. J Endod 2015; 41:742-8. [DOI: 10.1016/j.joen.2015.01.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 01/22/2015] [Accepted: 01/31/2015] [Indexed: 10/23/2022]
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Li H, Chen B, Pang G, Chen J, Xie J, Huang H. Anti-osteoporotic activity of puerarin 6"-O-xyloside on ovariectomized mice and its potential mechanism. PHARMACEUTICAL BIOLOGY 2015; 54:111-117. [PMID: 25857587 DOI: 10.3109/13880209.2015.1017885] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
CONTEXT Osteoporosis is one of the most common bone diseases, and radix of Pueraria lobata (Willd.) Ohwi possesses an obvious therapeutical effect on postmenopausal osteoporosis. OBJECTIVE This study investigates the anti-osteoporotic activity of the puerarin 6"-O-xyloside (PXY) on ovariectomized mice and its related mechanism. MATERIALS AND METHODS Osteoporotic mice model was established by ovariectomy (OVX). A total of 50 mice were divided into five groups (n = 10): sham, OVX group, PXY treatment groups (20, 40, and 60 mg/kg/d, i.p.). After 12 weeks' treatment, body weights were recorded. Then, mice were sacrificed, and serum samples were collected to determine the blood calcium, blood phosphorus, alkaline phosphatase (ALP), and osteoprotegerin (OPG) concentrations and uterine index was assayed. The thigh-bones of mice were collected to evaluate histopathological changes. In the in vitro experiment, the effect of PXY on osteoblasts' proliferation was evaluated and western blotting was performed to determine expressions of OPG and the receptor activators of NF-κB ligand (RANKL), as well as the ratio of OPG/RANKL. RESULTS PXY (40 and 60 mg/kg/d, i.p.) obviously decreased body weights and increased uterine index of OVX (p < 0.05), and improved osteoporotic syndromes of OVX mice; PXY also significantly increased the concentrations of blood calcium, blood phosphorus, ALP, and OPG of OVX mice (p < 0.05); moreover, PXY obviously up-regulated the ratio of OPG/RANKL (p < 0.05). CONCLUSION Our results demonstrated that the puerarin 6"-O-xyloside possesses significant anti-osteoporotic activity on ovariectomy mice.
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Affiliation(s)
- Hai Li
- a Department of Histology and Embryology
| | | | - Guangfu Pang
- c Department of Laboratory Medicine , Youjiang Medical University for Nationalities , Baise , China
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Cole RE. Clinical Strategies to Address Patients' Concerns in Osteoporosis Management with Bisphosphonates. Postgrad Med 2015; 123:131-44. [DOI: 10.3810/pgm.2011.03.2271] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kinetic release studies of nitrogen-containing bisphosphonate from gum acacia crosslinked hydrogels. Int J Biol Macromol 2015; 73:115-23. [DOI: 10.1016/j.ijbiomac.2014.10.064] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 10/01/2014] [Accepted: 10/25/2014] [Indexed: 11/17/2022]
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Su G, Xiang Y, He G, Jiang C, Li C, Yan Z, Zhong Y. Bisphosphonates May Protect against Bone Loss in Postmenopausal Women with Early Breast Cancer Receiving Adjuvant Aromatase Inhibitor Therapy: Results from a Meta-analysis. Arch Med Res 2014; 45:570-9. [DOI: 10.1016/j.arcmed.2014.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 10/23/2014] [Indexed: 01/25/2023]
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Zhou Z, Chen C, Zhang J, Ji X, Liu L, Zhang G, Cao X, Wang P. Safety of denosumab in postmenopausal women with osteoporosis or low bone mineral density: a meta-analysis. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2014; 7:2113-2122. [PMID: 24966919 PMCID: PMC4069896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 04/10/2014] [Indexed: 06/03/2023]
Abstract
PURPOSE The aim of this meta-analysis was to assess the safety of denosumab in postmenopausal women with osteoporosis or low bone mineral density (BMD). METHODS Safety of denosumab was compared with placebo or bisphosphonates. A systematic literature search without language restriction was conducted up to January, 2014. The RevMan 5.1 software was used for statistical analysis. RESULTS A total of 11 English literatures were eventually identified. The pooled data in the overall analysis revealed that there was no significant difference when compared denosumab with placebo or bisphosphonates in any adverse events (AAE) (RR=0.99, 95% CI=0.98-1.01, p=0.29), serious adverse event (SAE) (RR=1.05, 95% CI=0.98-1.13, p=0.18), neoplasm/cancer (RR=1.14, 95% CI=0.95-1.37, p=0.16) and deaths (RR=0.77, 95% CI=0.57-1.04, p=0.09). However, significant differences were found when compared denosumab with placebo or bisphosphonates in SAE related to infection (RR=1.23, 95% CI=1.00-1.52, p=0.05) and non-vertebral fracture (RR=0.86, 95% CI=0.74-1.00, p=0.05). Subgroup analysis was performed by the type of drugs which was used in the control group. The results of subgroup analysis did not demonstrate the differences between denosumab and bisphosphonates in SAE related to infection (RR=1.13, 95% CI=0.63-2.03) and non-vertebral fracture (RR=1.31, 95% CI=0.87-1.98). CONCLUSIONS Compared to placebo, denosumab treatment significantly decreased the risk of non-vertebral fracture but increased the risk of SAE related to infection in the postmenopausal women with osteoporosis or low BMD. However, no difference between the safety of denosumab and bisphosphonates was found.
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Affiliation(s)
- Zhenyu Zhou
- Department of Orthopedic Surgery, Jinan Military General Hospital of PLAJinan 250031, Shandong Province, China
| | - Chen Chen
- Department of Orthopedic Surgery, Jinan Military General Hospital of PLAJinan 250031, Shandong Province, China
| | - Jun Zhang
- Department of Orthopedic Surgery, Jinan Military General Hospital of PLAJinan 250031, Shandong Province, China
| | - Xinran Ji
- Department of Orthopaedic, PLA General Hospital28 Fuxing Road, Beijing, 100000, PR China
| | - Lifeng Liu
- Department of Orthopedic Surgery, Jinan Military General Hospital of PLAJinan 250031, Shandong Province, China
| | - Guichun Zhang
- Department of Orthopedic Surgery, Jinan Military General Hospital of PLAJinan 250031, Shandong Province, China
| | - Xuecheng Cao
- Department of Orthopedic Surgery, Jinan Military General Hospital of PLAJinan 250031, Shandong Province, China
| | - Pingshan Wang
- Department of Orthopedic Surgery, Jinan Military General Hospital of PLAJinan 250031, Shandong Province, China
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Rajpal RK, Ross B, Rajpal SD, Hoang K. Bromfenac ophthalmic solution for the treatment of postoperative ocular pain and inflammation: safety, efficacy, and patient adherence. Patient Prefer Adherence 2014; 8:925-31. [PMID: 25028541 PMCID: PMC4077855 DOI: 10.2147/ppa.s46667] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Ophthalmic nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used by clinicians to manage ocular inflammation and pain following cataract surgery. Over the past decade, the US Food and Drug Administration has approved multiple topical NSAIDs for these purposes, including several reformulated products. One of these medications, bromfenac ophthalmic solution, has a long and extensive history, with proven efficacy and safety in patients following cataract surgery. The evolution of bromfenac ophthalmic solution over the years has involved either lowering the concentration of the active ingredient or extending the dosing interval to improve patient adherence/compliance. This review will focus on the history and progression of bromfenac ophthalmic solution and report the available patient preference and adherence data regarding this ocular NSAID throughout its evolution.
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Affiliation(s)
- Rajesh K Rajpal
- See Clearly Vision Group, McLean, VA, USA
- Correspondence: Rajesh Rajpal, See Clearly Vision Group, 8138 Watson St, McLean, VA 22102, USA, Email
| | - Bryan Ross
- See Clearly Vision Group, McLean, VA, USA
| | | | - Khoa Hoang
- See Clearly Vision Group, McLean, VA, USA
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Inotai A, Petrova G, Vitezic D, Kaló Z. Benefits of investment into modern medicines in Central–Eastern European countries. Expert Rev Pharmacoecon Outcomes Res 2013; 14:71-9. [DOI: 10.1586/14737167.2014.868314] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Tüzün Ş, Akyüz G, Eskiyurt N, Memiş A, Kuran B, İçağasıoğlu A, Sarpel T, Özdemir F, Özgirgin N, Günaydın R, Çakçı A, Yurtkuran M. Impact of the training on the compliance and persistence of weekly bisphosphonate treatment in postmenopausal osteoporosis: a randomized controlled study. Int J Med Sci 2013; 10:1880-7. [PMID: 24324365 PMCID: PMC3856379 DOI: 10.7150/ijms.5359] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 10/17/2013] [Indexed: 11/05/2022] Open
Abstract
Long-term patient adherence to osteoporosis treatment is poor despite proven efficacy. In this study, we aimed to assess the impact of active patient training on treatment compliance and persistence in patients with postmenopausal osteoporosis. In the present national, multicenter, randomized controlled study, postmenopausal osteoporosis patients (45-75 years) who were on weekly bisphosphonate treatment were randomized to active training (AT) and passive training (PT) groups and followed-up by 4 visits after the initial visit at 3 months interval during 12 months of the treatment. Both groups received a bisphosphonate usage guide and osteoporosis training booklets. Additionally, AT group received four phone calls (at 2(nd), 5(th), 8(th), and 11(th) months) and participated to four interactive social/training meetings held in groups of 10 patients (at 3(rd), 6(th), 9(th), and 12(th) months). The primary evaluation criteria were self-reported persistence and compliance to the treatment and the secondary evaluation criteria was quality life of the patients assessed by 41-item Quality of Life European Foundation for Osteoporosis (QUALEFFO-41) questionnaire. Of 448 patients (mean age 62.4±7.7 years), 226 were randomized to AT group and 222 were randomized to PT group. Among the study visits, the most common reason for not receiving treatment regularly was forgetfulness (54.9% for visit 2, 44.3% for visit 3, 51.6% for visit 4, and 43.8% for visit 5), the majority of the patients always used their drugs regularly on recommended days and dosages (63.8% for visit 2, 60.9% for visit 3, 72.1% for visit 4, and 70.8% for visit 5), and most of the patients were highly satisfied with the treatment (63.4% for visit 2, 68.9% for visit 3, 72.4% for visit 4, and 65.2% for visit 5) and wanted to continue to the treatment (96.5% for visit 2, 96.5% for visit 3, 96.9% for visit 4, and 94.4% for visit 5). QUALEFFO scores of the patients in visit 1 significantly improved in visit 5 (37.7±25.4 vs. 34.0±14.6, p<0.001); however, the difference was not significant between AT and PT groups both in visit 1 and visit 5. In conclusion, in addition to active training, passive training provided at the 1(st) visit did not improve the persistence and compliance of the patients for bisphosphonate treatment.
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Affiliation(s)
- Şansın Tüzün
- 1. Department of Physical Medicine and Rehabilitation, Istanbul University Cerrahpasa School of Medicine, Istanbul
| | - Gülseren Akyüz
- 2. Department of Physical Medicine and Rehabilitation, Marmara University Faculty of Medicine, Istanbul
| | - Nurten Eskiyurt
- 3. Department of Physical Medicine and Rehabilitation, Istanbul University Istanbul School of Medicine, Istanbul
| | - Asuman Memiş
- 4. Physical Medicine and Rehabilitation Clinic, Izmir Ataturk Training and Research Hospital, Izmir
| | - Banu Kuran
- 5. Physical Medicine and Rehabilitation Clinic, Sisli Etfal Training and Research Hospital, Istanbul
| | - Afitap İçağasıoğlu
- 6. Physical Medicine and Rehabilitation Clinic, Goztepe Training and Research Hospital, Istanbul
| | - Tunay Sarpel
- 7. Department of Physical Medicine and Rehabilitation, Cukurova University Faculty of Medicine, Adana
| | - Ferda Özdemir
- 8. Department of Physical Medicine and Rehabilitation, Trakya University Faculty of Medicine, Edirne
| | - Neşe Özgirgin
- 9. Physical Medicine and Rehabilitation Clinic, Ankara Physical Therapy Training and Research Hospital, Ankara
| | - Rezzan Günaydın
- 10. Physical Medicine and Rehabilitation Clinic, Izmir Training and Research Hospital, İzmir
| | - Aytül Çakçı
- 11. Physical Medicine and Rehabilitation Clinic, Diskapi Training and Research Hospital, Ankara
| | - Merih Yurtkuran
- 12. Department of Physical Medicine and Rehabilitation, Uludag University Faculty of Medicine, Bursa; Turkey
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Shehadeh-Sheeny A, Eilat-Tsanani S, Bishara E, Baron-Epel O. Knowledge and health literacy are not associated with osteoporotic medication adherence, however income is, in Arab postmenopausal women. PATIENT EDUCATION AND COUNSELING 2013; 93:282-288. [PMID: 23994007 DOI: 10.1016/j.pec.2013.06.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 05/30/2013] [Accepted: 06/23/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To investigate the association between adherence with oral bisphosphonate treatment, income, health literacy, knowledge, and receiving instructions from a pharmacist or doctor, among Arab postmenopausal women diagnosed with osteoporosis in Israel. METHODS Arab osteoporotic women treated with oral bisphosphonates were interviewed (303 women). The questionnaire included socio-demographic characteristics, knowledge about osteoporosis and health literacy. Adherence was measured by the Medication Possession Ratio (MPR) according to the number of prescription refills registered in the database of Clalit Health Services. RESULTS Forty-one percent of the women were adherent according to the MPR. The main predictor of adherence in a multivariate logistic regression was income. Health literacy and knowledge were not associated with adherence after adjustment for income. Neither was the health care provider's counseling regarding the medication. CONCLUSIONS Lower income seems to be a barrier to adherence with osteoporotic medication, over and above other known barriers. Policy makers should take into account that medication funding may be a barrier to treatment. Practical implications Income may be a major barrier to adherance with osteoporosis medication and calls for attention of practiciner.
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Affiliation(s)
- Amal Shehadeh-Sheeny
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel; North District Health Office, Ministry of Health, Israel
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He M, Fan W, Zhang X. Adjuvant zoledronic acid therapy for patients with early stage breast cancer: an updated systematic review and meta-analysis. J Hematol Oncol 2013; 6:80. [PMID: 24283946 PMCID: PMC3874690 DOI: 10.1186/1756-8722-6-80] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 10/16/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Zoledronic acid is a potent inhibitor of osteoclast-mediated bone resorption and has been widely used in bone metastasis malignancies and postmenopausal osteoporosis as a preventive therapy against skeletal-related events. The purpose of this study was to evaluate the clinical outcome of zoledronic acid as an adjuvant therapy for patients with early stage breast cancer. PATIENTS AND METHODS Entries in the PubMed and EMBASE databases up to 12 July 2013 were systematically reviewed. Online abstracts from the proceedings of the Annual Meetings of the American Society of Clinical Oncology (ASCO) (1992-2013) and the San Antonio Breast Cancer Symposium (SABCS) (2004-2013) were also reviewed. Primary endpoints included overall survival (OS) and disease-free survival (DFS), while secondary endpoints included bone metastasis-free survival (BMFS), distant metastasis-free survival (DMFS), and fracture-free rate (FFR). RESULTS A total of eight studies including 3,866 subjects and 3,864 controls met our search criteria and were evaluated. The use of zoledronic acid was found to improve OS (relative risk (RR), 0.88; 95% confidence interval (CI), 0.77-1.01; p-value = 0.06) and DMFS (RR, 0.77; 95% CI, 0.60-1.00; p-value = 0.05). Furthermore, statistically significant benefits were associated with BMFS (RR, 0.81; 95% CI, 0.66-0.99; p-value = 0.04) and FFRs (RR, 0.75; 95% CI, 0.61-0.92; p-value = 0.007). In contrast, there was no significant difference in DFS with the application of zoledronic acid (RR, 0.88; 95% CI, 0.72-1.09; p-value = 0.24). Sensitivity analysis further identified the improvement of 5-year OS for the adjuvant zoledronic acid therapy in early stage breast cancer patients (RR, 0.86; 95% CI, 0.75-0.99; p-value = 0.03), while a borderline statistically significant benefit was observed for 5-year DFS (RR, 0.90; 95% CI, 0.81-1.00; p-value = 0.06). CONCLUSION Zoledronic acid as an adjuvant therapy appears to improve the 5-year OS rate for early stage breast cancer patients, and was associated with a protective effect for the bone metastases and fractures evaluated in more than 7,000 patients. However, further research is needed to confirm our findings, and sub-group analyses according to menopause status or hormone status may provide further insight.
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Affiliation(s)
| | | | - Xianquan Zhang
- Division of Oncology, the Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China.
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Oral adjuvant clodronate therapy could improve overall survival in early breast cancer: results from an updated systematic review and meta-analysis. Eur J Cancer 2013; 49:2086-92. [PMID: 23452992 DOI: 10.1016/j.ejca.2013.01.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 01/17/2013] [Accepted: 01/19/2013] [Indexed: 11/21/2022]
Abstract
OBJECT The aim of this study was to evaluate the effectiveness of clodronate in the adjuvant therapy of early breast cancer on patient survival. METHODS We performed a literature search to identify studies that investigated the effects of clodronate treatment on early breast cancer. Random and fixed-effect meta-analytical models were used where indicated and between-study heterogeneity was assessed. The primary study end-points were overall survival. Secondary end-points were bone metastasis-free survival and non-skeletal metastasis (mainly visceral metastases) free survival. RESULTS Four randomised controlled trials met the inclusion criteria. Risk ratio (95% confidence interval (CI)) of overall survival was 0.84 (0.56-1.26); risk ratio (95% CI) of bone metastasis-free survival was 0.77 (0.58-1.02); risk ratio (95% CI) of non-bone metastasis-free survival was 0.89 (0.61-1.30). Outcomes after sensitivity analysis were: risk ratio (95% CI) of overall survival was 0.71 (0.52-0.96); risk ratio (95% CI) of bone metastasis-free survival was 0.70 (0.56-0.86); risk ratio (95% CI) of non-bone metastasis-free survival was 0.76 (0.64-0.92). CONCLUSION Compared with the control arm, adjuvant treatment with clodronate may improve the overall survival, bone metastasis-free survival and non-bone metastasis-free (mainly visceral metastases) survival in patients with early breast cancer. However, further meta-analyses involving all known randomised trials with analysis of sub-groups by age or menopausal status, accessing original trial data, should be performed.
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Hazel-Fernandez L, Louder AM, Foster SA, Uribe CL, Burge RT. Association of teriparatide adherence and persistence with clinical and economic outcomes in Medicare Part D recipients: a retrospective cohort study. BMC Musculoskelet Disord 2013; 14:4. [PMID: 23281846 PMCID: PMC3599866 DOI: 10.1186/1471-2474-14-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 12/27/2012] [Indexed: 11/10/2022] Open
Abstract
Background Improper medication adherence is associated with increased morbidity, healthcare costs, and fracture risk among patients with osteoporosis. The objective of this study was to evaluate the healthcare utilization patterns of Medicare Part D beneficiaries newly initiating teriparatide, and to assess the association of medication adherence and persistence with bone fracture. Methods This retrospective cohort study assessed medical and pharmacy claims of 761 Medicare members initiating teriparatide in 2008 and 2009. Baseline characteristics, healthcare use, and healthcare costs 12 and 24 months after teriparatide initiation, were summarized. Adherence, measured by Proportion of Days Covered (PDC), was categorized as high (PDC ≥ 80%), moderate (50% ≥ PDC < 80%), and low (PDC < 50%). Non-persistence was measured as refill gaps in subsequent claims longer than 60 days plus the days of supply from the previous claim. Multivariate logistic regression evaluated the association of adherence and persistence with fracture rates at 12 months. Results Within 12 months of teriparatide initiation, 21% of the cohort was highly-adherent. Low-adherent or non-persistent patients visited the ER more frequently than did their highly-adherent or persistent counterparts (χ2 = 5.01, p < 0.05 and χ2 = 5.84, p < 0.05), and had significantly lower mean pharmacy costs ($4,361 versus $13,472 and $4,757 versus $13,187, p < 0.0001). Furthermore, non-persistent patients had significantly lower total healthcare costs. The healthcare costs of highly-adherent patients were largely pharmacy-related. Similar patterns were observed in the 222 patients who had fractures at 12 months, among whom 89% of fracture-related costs were pharmacy-related. The regression models demonstrated no significant association of adherence or persistence with 12-month fractures. Six months before initiating teriparatide, 50.7% of the cohort had experienced at least 1 fracture episode. At 12 months, these patients were nearly 3 times more likely to have a fracture (OR = 2.9, 95% C.I. 2.1-4.1 p < 0.0001). Conclusions Adherence to teriparatide therapy was suboptimal. Increased pharmacy costs seemed to drive greater costs among highly-adherent patients, whereas lower adherence correlated to greater ER utilization but not to greater costs. Having a fracture in the 6 months before teriparatide initiation increased fracture risk at follow-up.
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Hansen PJ, Knitschke M, Draenert FG, Irle S, Neff A. Incidence of bisphosphonate-related osteonecrosis of the jaws (BRONJ) in patients taking bisphosphonates for osteoporosis treatment—a grossly underestimated risk? Clin Oral Investig 2012; 17:1829-37. [DOI: 10.1007/s00784-012-0873-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 10/18/2012] [Indexed: 02/03/2023]
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Hadji P, Aapro M, Costa L, Gnant M. Antiresorptive treatment options and bone health in cancer patients—safety profiles and clinical considerations. Cancer Treat Rev 2012; 38:815-24. [DOI: 10.1016/j.ctrv.2012.03.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 03/02/2012] [Accepted: 03/07/2012] [Indexed: 11/29/2022]
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Abstract
Osteoporosis is a highly prevalent chronic disease in the US and worldwide. The most serious consequence of this disorder is fractures, which have a serious negative impact on quality of life and are often the trigger for accelerated deterioration, ultimately ending in death. Despite the availability of effective preventive treatments, osteoporosis is frequently underdiagnosed and/or undertreated, particularly among the elderly, who are also at greatest risk. In addition, the presence of co-morbid medical conditions may be both a barrier to osteoporosis care and a risk factor for falls; thus individuals with multiple co-morbid conditions may be a particularly high-risk group. The management of osteoporosis involves improving bone health via adequate nutrition, calcium and vitamin D supplements, and fall prevention strategies. Although these measures are important in the management of all patients, most elderly patients are likely to need additional pharmacological therapy to adequately reduce their fracture risk. Several pharmacological treatments have been shown to significantly reduce the risk of fracture, including bisphosphonates (e.g. alendronate, risedronate, ibandronate, zoledronic acid), denosumab, raloxifene, calcitonin and teriparatide. Despite recent advances in osteoporosis care, additional action is urgently needed to improve the quality of life of osteoporotic patients in general and of elderly patients in particular, since fracture outcomes are typically poorer in older than in younger patients. This article reviews the current status of osteoporosis management, emphasizing the need to improve osteoporosis care, with a particular focus on the US, by the use of quality-improvement measures and incentives, which might result in an increased awareness and improved treatment for this debilitating disease.
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Affiliation(s)
- Jeffrey R Curtis
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, AL 35294, USA.
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Hadji P, Ziller V, Gamerdinger D, Spieler W, Articus K, Baier M, Moericke R, Kann PH. Quality of life and health status with zoledronic acid and generic alendronate--a secondary analysis of the Rapid Onset and Sustained Efficacy (ROSE) study in postmenopausal women with low bone mass. Osteoporos Int 2012; 23:2043-51. [PMID: 22086310 DOI: 10.1007/s00198-011-1834-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Accepted: 08/19/2011] [Indexed: 10/15/2022]
Abstract
SUMMARY The ROSE study compared annual infusion with zoledronic acid and weekly generic alendronate. No significant differences in quality of life or health status between treatment groups were observed. Adherence to alendronate during the study was high, with 80.9% of patients achieving adequate adherence. INTRODUCTION A secondary analysis to evaluate quality of life, health status, adherence to alendronate and therapy preference in postmenopausal women with low bone mass who received treatment with zoledronic acid or alendronate was conducted. METHODS Postmenopausal women with low bone mass were randomised 2:1 to receive an annual infusion of zoledronic acid or weekly oral generic alendronate in this open-label, multicentre study. Changes in quality of life and health status were assessed using questionnaires at baseline and month 12. Adherence to alendronate was assessed by the investigator and/or study personnel, and subjective therapy preference was assessed using a questionnaire at month 12. RESULTS Patients were randomised to zoledronic acid (n = 408) and alendronate (n = 191). Overall, there were no significant differences in quality of life between zoledronic acid and alendronate. However, improvements in quality of life with zoledronic acid versus alendronate could be detected by posthoc analysis in patients with previous fractures. There were no significant differences in health status between patients receiving zoledronic acid or alendronate. Adherence to alendronate during the study was high, with 80.9% of patients achieving adequate adherence. A total of 81% of patients who had received zoledronic acid indicated that they would prefer to continue with that treatment, and 43% of the patients who received oral alendronate would like to switch to zoledronic acid. CONCLUSIONS There were no significant differences in quality of life between patients receiving zoledronic acid or alendronate.
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Affiliation(s)
- P Hadji
- Department of Gynaecological Endocrinology, Reproductive Medicine and Osteoporosis, Philipps University, Marburg, Germany.
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Miller PD, Recker RR, Reginster JY, Riis BJ, Czerwinski E, Masanauskaite D, Kenwright A, Lorenc R, Stakkestad JA, Lakatos P. Efficacy of monthly oral ibandronate is sustained over 5 years: the MOBILE long-term extension study. Osteoporos Int 2012; 23:1747-56. [PMID: 21953471 DOI: 10.1007/s00198-011-1773-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 08/24/2011] [Indexed: 10/17/2022]
Abstract
UNLABELLED The long-term efficacy and safety of once-monthly ibandronate were studied in this extension to the 2-year Monthly Oral Ibandronate in Ladies (MOBILE) trial. Over 5 years, lumbar spine bone mineral density (BMD) increased from baseline with monthly ibandronate 150 mg (8.4%). Long-term monthly ibandronate is effective and well tolerated for up to 5 years in women with postmenopausal osteoporosis. INTRODUCTION Once-monthly therapy with ibandronate has been studied for up to 5 years in a long-term extension (LTE) to the 2 year MOBILE trial. METHODS This multicenter, double-blind extension study of monthly ibandronate involved postmenopausal women who had completed 2 years of the MOBILE core study, with ≥75% adherence. Patients were reallocated, or were randomized from daily therapy, to ibandronate 100 mg monthly or 150 mg monthly for a further 3 years. RESULTS A pooled intent-to-treat (ITT) analysis of 344 patients receiving monthly ibandronate from the core MOBILE baseline showed increases over 5 years in lumbar spine BMD (8.2% with 100 mg and 8.4% with 150 mg). Three-year data relative to MOBILE LTE baseline in the full ITT population of all 698 patients randomized or reallocated from MOBILE (including those previously on daily treatment) showed, on average, maintenance of proximal femur BMD gains achieved in the core 2-year study, with further small gains in lumbar spine BMD. In general, maintenance of efficacy was also indicated by markers of bone metabolism. CONCLUSIONS There were no tolerability concerns or new safety signals. Monthly treatment with ibandronate 100 and 150 mg is effective and well tolerated for up to 5 years in women with postmenopausal osteoporosis.
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Affiliation(s)
- P D Miller
- Colorado Center for Bone Research, Lakewood, CO, USA.
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Harris KB, Nealy KL, Jackson DJ, Thornton PL. The clinical use of denosumab for the management of low bone mineral density in postmenopausal women. J Pharm Pract 2012; 25:310-8. [PMID: 22550161 DOI: 10.1177/0897190012442061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Osteoporosis is a leading cause of debility and declining quality of life in postmenopausal women worldwide. Treatment of osteoporosis has been ubiquitous throughout the developed world since the mid-1990s, most notably with the introduction of bisphosphonates in 1995. Nonetheless, the incidence of hip fractures increased by 25% between 1990 and 2000, despite advances in osteoporosis therapy. Studies indicate that bone density increases over the first 3 years of bisphosphonate therapy and then plateaus or perhaps even declines, placing these patients at greater risk of fracture. Since hip fractures are associated with increased morbidity, mortality, and increased cost of health care, improvements in treating osteoporosis are critical. Denosumab is a novel monoclonal antibody targeted against the receptor activator of nuclear factor-κB ligand (RANKL) that inhibits osteoclast activity. Initial data suggest that denosumab increases bone mineral density for greater than 3 years. Of greater importance, denosumab has been shown to decrease vertebral fractures by 68%, nonvertebral fractures by 19%, and hip fractures by 42% for at least 36 months. Data also indicate that the safety profile of denosumab is equivalent to other drugs used in osteoporosis management, but potential risks of immunosuppression and cancer have been hypothesized.
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Affiliation(s)
- Kira B Harris
- Wingate University School of Pharmacy, Wingate, NC, USA.
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Banu J, Varela E, Fernandes G. Alternative therapies for the prevention and treatment of osteoporosis. Nutr Rev 2012; 70:22-40. [PMID: 22221214 DOI: 10.1111/j.1753-4887.2011.00451.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Osteoporosis is a medical condition that affects millions of men and women. People with this condition have low bone mass, which places them at increased risk for bone fracture after minor trauma. The surgeries and treatments required to repair and heal bone fractures involve long recovery periods and can be expensive. Because osteoporosis occurs frequently in the elderly, the financial burden it places on society is likely to be large. In the United States, the Food and Drug Administration has approved several drugs for use in the prevention and treatment of osteoporosis. However, all of the currently available agents have severe side effects that limit their efficacy and underscore the urgent need for new treatment options. One promising approach is the development of alternative (nonpharmaceutical) strategies for bone maintenance, as well as for the prevention and treatment of osteoporosis. This review examines the currently available nonpharmaceutical alternatives that have been evaluated in in vitro and in vivo studies. Certain plants from the following families have shown the greatest benefits on bone: Alliceae, Asteraceae, Thecaceae, Fabaceae, Oleaceae, Rosaceae, Ranunculaceae, Vitaceae, Zingiberaceae. The present review discusses the most promising findings from studies of these plant families.
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Affiliation(s)
- Jameela Banu
- Division of Clinical Immunology and Rheumatology, Department of Medicine, San Antonio, Texas, USA.
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Efficacy of zoledronic acid in postmenopausal Japanese women with early breast cancer receiving adjuvant letrozole: 12-month results. Breast Cancer Res Treat 2012; 133:685-93. [PMID: 22307266 DOI: 10.1007/s10549-012-1973-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 01/19/2012] [Indexed: 10/14/2022]
Abstract
Aromatase inhibitor-associated bone loss has not been proved in the Japanese or Asian women. The aim of this study was to evaluate an upfront or delayed strategy of bone protection therapy with zoledronic acid administered at 4 mg every 6 months in postmenopausal Japanese women with early breast cancer to compare with results of the Z-FAST and ZO-FAST studies in western countries. Postmenopausal women with hormone receptor positive early breast cancer receiving adjuvant letrozole were randomly assigned to receive either upfront or delayed-start zoledronic acid (4 mg intravenously every 6 months). The delayed group received zoledronic acid when lumbar spine (L(2)-L(4)) bone mineral density (BMD) decreased to less than young adult mean -2.0SD or when a nontraumatic fracture occurred. The primary endpoint of this study was to compare the percent change in L(1)-L(4) BMD at 12 months between the groups. Secondary endpoints included percent changes in L(2)-L(4) and total hip (TH) BMD. The upfront and delayed groups included 94 and 95 patients, respectively. At 12 months, L(1)-L(4), L(2)-L(4), and TH BMD significantly decreased by 2.0, 2.4, and 2.4%, respectively, in the delayed group. L(1)-L(4) BMD was 4.9% higher in the upfront group than in the delayed group (95% CI 3.9-5.8%; p < 0.001). L(2)-L(4) BMD was 5.6% higher (95% CI 4.5-6.6%; p < 0.001), and TH BMD was 4.4% higher (95% CI 3.3-5.4%; p < 0.001). At 12 months, upfront zoledronic acid therapy prevented bone loss in postmenopausal Japanese women who were receiving adjuvant letrozole, confirming the Z-/ZO-FAST study results in western populations.
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Yan T, Yin W, Zhou Q, Zhou L, Jiang Y, Du Y, Shao Z, Lu J. The efficacy of zoledronic acid in breast cancer adjuvant therapy: A meta-analysis of randomised controlled trials. Eur J Cancer 2012; 48:187-95. [DOI: 10.1016/j.ejca.2011.10.021] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2011] [Revised: 08/30/2011] [Accepted: 10/17/2011] [Indexed: 11/28/2022]
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Abstract
One may consider that drug-drug interactions (DDIs) associated with antacids is an obsolete topic because they are prescribed less frequently by medical professionals due to the advent of drugs that more effectively suppress gastric acidity (i.e. histamine H(2)-receptor antagonists [H2RAs] and proton pump inhibitors [PPIs]). Nevertheless, the use of antacids by ambulant patients may be ever increasing, because they are freely available as over-the-counter (OTC) drugs. Antacids consisting of weak basic substances coupled with polyvalent cations may alter the rate and/or the extent of absorption of concomitantly administered drugs via different mechanisms. Polyvalent cations in antacid formulations may form insoluble chelate complexes with drugs and substantially reduce their bioavailability. Clinical studies demonstrated that two classes of antibacterials (tetracyclines and fluoroquinolones) are susceptible to clinically relevant DDIs with antacids through this mechanism. Countermeasures against this type of DDI include spacing out the dosing interval - taking antacid either 4 hours before or 2 hours after administration of these antibacterials. Bisphosphonates may be susceptible to DDIs with antacids by the same mechanism, as described in the prescription information of most bisphosphonates, but no quantitative data about the DDIs are available. For drugs with solubility critically dependent on pH, neutralization of gastric fluid by antacids may alter the dissolution of these drugs and the rate and/or extent of their absorption. However, the magnitude of DDIs elicited by antacids through this mechanism is less than that produced by H2RAs or PPIs; therefore, the clinical relevance of such DDIs is often obscure. Magnesium ions contained in some antacid formulas may increase gastric emptying, thereby accelerating the rate of absorption of some drugs. However, the clinical relevance of this is unclear in most cases because the difference in plasma drug concentration observed after dosing shortly disappears. Recent reports have indicated that some of the molecular-targeting agents such as the tyrosine kinase inhibitors dasatinib and imatinib, and the thrombopoietin receptor agonist eltrombopag may be susceptible to DDIs with antacids. Finally, the recent trend of developing OTC drugs as combination formulations of an antacid and an H2RA is a concern because these drugs will increase the risk of DDIs by dual mechanisms, i.e. a gastric pH-dependent mechanism by H2RAs and a cation-mediated chelation mechanism by antacids.
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Affiliation(s)
- Ryuichi Ogawa
- Department of Pharmacotherapy, Meiji Pharmaceutical University, Kiyose, Tokyo, Japan.
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Hadji P, Aapro M, Body J, Bundred N, Brufsky A, Coleman R, Gnant M, Guise T, Lipton A. Management of aromatase inhibitor-associated bone loss in postmenopausal women with breast cancer: practical guidance for prevention and treatment. Ann Oncol 2011; 22:2546-2555. [DOI: 10.1093/annonc/mdr017] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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Chitre M, Shechter D, Grauer A. Denosumab for treatment of postmenopausal osteoporosis. Am J Health Syst Pharm 2011; 68:1409-18. [PMID: 21785030 DOI: 10.2146/ajhp100493] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The pharmacologic properties, clinical efficacy, and safety profile of the injectable agent denosumab for the treatment of postmenopausal women with osteoporosis are reviewed. SUMMARY Denosumab, a human monoclonal antibody that targets a key protein mediator of bone resorption, was approved by the Food and Drug Administration in June 2010 for the treatment of postmenopausal women with osteoporosis who are at high risk for fracture, including "patients who have failed or are intolerant to other available osteoporosis therapy." Available in a 60-mg prefilled syringe, denosumab should be administered subcutaneously by a health care professional at six-month intervals. In Phase III clinical efficacy trials involving nearly 10,000 postmenopausal women, the use of denosumab was associated with a number of significant benefits: reduced bone resorption, increased bone mass, and reduced rates of vertebral, nonvertebral, and hip fractures. Results of two comparison studies indicated that denosumab therapy increased bone mineral density (BMD) at various skeletal sites to a significantly greater extent than alendronate therapy. In the largest clinical trial of the drug to date, adverse effects occurring significantly more often with denosumab versus placebo included eczema-related effects and cellulitis; long-term safety evaluations are ongoing. CONCLUSION Denosumab has been shown to decrease bone resorption; increase BMD at all skeletal sites measured; and significantly reduce rates of vertebral, nonvertebral, and hip fractures in postmenopausal women with osteoporosis. Denosumab appears to have a favorable risk:benefit profile and provides a new treatment option for many patients in this population.
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Affiliation(s)
- Mona Chitre
- Clinical Services, Strategy and Policy, Excellus BlueCross BlueShield, Rochester, NY 14647, USA.
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