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Jørgensen EB, Overgaard LK, Folkestad L, Damkier P, Hallas J, Henriksen DP. The risk of fragility fractures following initiation of gabapentin and pregabalin-A Danish, nationwide, high-dimensional propensity score-matched cohort study. Basic Clin Pharmacol Toxicol 2022; 132:384-391. [PMID: 36526604 DOI: 10.1111/bcpt.13825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
Gabapentin and pregabalin have been associated with an increased risk of fragility fractures. Due to differences in pharmacokinetics, we aimed to assess the fracture-risk difference between the two medicines. We performed a Danish nationwide new user, high-dimensional propensity score-matched cohort study to assess the 90-day risk of fragility fractures among adults, from January 1996 to December 2018. We applied a high-dimensional propensity score to match new users of gabapentin with new users of pregabalin in a 1:1 intention-to-treat approach. Hazard ratios (HRs), incidence rates (IRs) and incidence rate difference (IRD) were obtained. We identified 388 236 eligible patients of which 294 223 and 98 869 initiated gabapentin and pregabalin, respectively. We included 48 272 matched pairs for further analysis. The mean age was 56 (IQR 44-69) years, and the average follow-up was approximately 11 500 person-years (PY). The IRs of fragility fractures were 23.7 (95%CI 21.0-26.7) and 23.2 (95%CI 20.5-26.2) per 1000 PY for gabapentin and pregabalin-exposed patients, respectively. This yielded an HR of 1.02 (95%CI 0.86-1.21) when using gabapentin as the intervention drug and pregabalin as the reference drug. The IRD was estimated to 0.5 PY (95%CI -3.5-4.5). In conclusion, short-term risk of fragility fractures among gabapentin initiators was not different compared to those initiating pregabalin.
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Affiliation(s)
| | | | - Lars Folkestad
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Per Damkier
- Department of Clinical Pharmacology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jesper Hallas
- Department of Clinical Pharmacology, Odense University Hospital, Odense, Denmark.,Clinical Pharmacology, Pharmacy, and Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Daniel Pilsgaard Henriksen
- Department of Clinical Pharmacology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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2
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McGrath C, Little-Letsinger SE, Sankaran JS, Sen B, Xie Z, Styner MA, Zong X, Chen W, Rubin J, Klett EL, Coleman RA, Styner M. Exercise Increases Bone in SEIPIN Deficient Lipodystrophy, Despite Low Marrow Adiposity. Front Endocrinol (Lausanne) 2021; 12:782194. [PMID: 35145475 PMCID: PMC8822583 DOI: 10.3389/fendo.2021.782194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/20/2021] [Indexed: 01/12/2023] Open
Abstract
Exercise, typically beneficial for skeletal health, has not yet been studied in lipodystrophy, a condition characterized by paucity of white adipose tissue, with eventual diabetes, and steatosis. We applied a mouse model of global deficiency of Bscl2 (SEIPIN), required for lipid droplet formation. Male twelve-week-old B6 knockouts (KO) and wild type (WT) littermates were assigned six-weeks of voluntary, running exercise (E) versus non-exercise (N=5-8). KO weighed 14% less than WT (p=0.01) and exhibited an absence of epididymal adipose tissue; KO liver Plin1 via qPCR was 9-fold that of WT (p=0.04), consistent with steatosis. Bone marrow adipose tissue (BMAT), unlike white adipose, was measurable, although 40.5% lower in KO vs WT (p=0.0003) via 9.4T MRI/advanced image analysis. SEIPIN ablation's most notable effect marrow adiposity was in the proximal femoral diaphysis (-56% KO vs WT, p=0.005), with relative preservation in KO-distal-femur. Bone via μCT was preserved in SEIPIN KO, though some quality parameters were attenuated. Running distance, speed, and time were comparable in KO and WT. Exercise reduced weight (-24% WT-E vs WT p<0.001) but not in KO. Notably, exercise increased trabecular BV/TV in both (+31%, KO-E vs KO, p=0.004; +14%, WT-E vs WT, p=0.006). The presence and distribution of BMAT in SEIPIN KO, though lower than WT, is unexpected and points to a uniqueness of this depot. That trabecular bone increases were achievable in both KO and WT, despite a difference in BMAT quantity/distribution, points to potential metabolic flexibility during exercise-induced skeletal anabolism.
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Affiliation(s)
- Cody McGrath
- Department of Medicine, Division of Endocrinology & Metabolism, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Sarah E. Little-Letsinger
- Department of Medicine, Division of Endocrinology & Metabolism, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jeyantt Srinivas Sankaran
- Department of Medicine, Division of Endocrinology & Metabolism, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Buer Sen
- Department of Medicine, Division of Endocrinology & Metabolism, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Zhihui Xie
- Department of Medicine, Division of Endocrinology & Metabolism, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Martin A. Styner
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Xiaopeng Zong
- Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Weiqin Chen
- Department of Physiology, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Janet Rubin
- Department of Medicine, Division of Endocrinology & Metabolism, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- North Carolina Diabetes Research Center (NCDRC), Chapel Hill, NC, United States
| | - Eric L. Klett
- Department of Medicine, Division of Endocrinology & Metabolism, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- North Carolina Diabetes Research Center (NCDRC), Chapel Hill, NC, United States
- Department of Nutrition, Gillings School of Global Public Health, UNC, Chapel Hill, NC, United States
| | - Rosalind A. Coleman
- Department of Nutrition, Gillings School of Global Public Health, UNC, Chapel Hill, NC, United States
| | - Maya Styner
- Department of Medicine, Division of Endocrinology & Metabolism, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- North Carolina Diabetes Research Center (NCDRC), Chapel Hill, NC, United States
- *Correspondence: Maya Styner,
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3
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Affiliation(s)
- Neil Shah
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania
| | - Srinath Adusumalli
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania.,Penn Medicine Nudge Unit, Penn Medicine Center for Healthcare Innovation.,Office of the Chief Medical Information Officer, University of Pennsylvania Health System
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Abstract
The development of the anterior pituitary gland occurs in distinct sequential developmental steps, leading to the formation of a complex organ containing five different cell types secreting six different hormones. During this process, the temporal and spatial expression of a cascade of signaling molecules and transcription factors plays a crucial role in organ commitment, cell proliferation, patterning, and terminal differentiation. The morphogenesis of the gland and the emergence of distinct cell types from a common primordium are governed by complex regulatory networks involving transcription factors and signaling molecules that may be either intrinsic to the developing pituitary or extrinsic, originating from the ventral diencephalon, the oral ectoderm, and the surrounding mesenchyme. Endocrine cells of the pituitary gland are organized into structural and functional networks that contribute to the coordinated response of endocrine cells to stimuli; these cellular networks are formed during embryonic development and are maintained or may be modified in adulthood, contributing to the plasticity of the gland. Abnormalities in any of the steps of pituitary development may lead to congenital hypopituitarism that includes a spectrum of disorders from isolated to combined hormone deficiencies including syndromic disorders such as septo-optic dysplasia. Over the past decade, the acceleration of next-generation sequencing has allowed for rapid analysis of the patient genome to identify novel mutations and novel candidate genes associated with hypothalmo-pituitary development. Subsequent functional analysis using patient fibroblast cells, and the generation of stem cells derived from patient cells, is fast replacing the need for animal models while providing a more physiologically relevant characterization of novel mutations. Furthermore, CRISPR-Cas9 as the method for gene editing is replacing previous laborious and time-consuming gene editing methods that were commonly used, thus yielding knockout cell lines in a fraction of the time. © 2020 American Physiological Society. Compr Physiol 10:389-413, 2020.
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Affiliation(s)
- Kyriaki S Alatzoglou
- Genetics and Genomic Medicine Programme, UCL Great Ormond Street Institute of Child Health, University College London (UCL), London, UK
| | - Louise C Gregory
- Genetics and Genomic Medicine Programme, UCL Great Ormond Street Institute of Child Health, University College London (UCL), London, UK
| | - Mehul T Dattani
- Genetics and Genomic Medicine Programme, UCL Great Ormond Street Institute of Child Health, University College London (UCL), London, UK
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5
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Fukuyama Y, Numata K, Yoshino K, Santanda T, Funakoshi H. Euglycemic diabetic ketoacidosis due to a strict low-carbohydrate diet during treatment with sodium-glucose cotransporter 2 inhibitors. Acute Med Surg 2020; 7:e480. [PMID: 31988792 PMCID: PMC6971428 DOI: 10.1002/ams2.480] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 10/23/2019] [Accepted: 12/01/2019] [Indexed: 12/22/2022] Open
Abstract
Background Euglycemic diabetic ketoacidosis is a critical clinical presentation that can occur during treatment with sodium-glucose cotransporter 2 inhibitors. However, little is known regarding how a low-carbohydrate diet in combination with this treatment can increase the risk for this condition. Here, we report a case of euglycemic diabetic ketoacidosis in a patient treated with sodium-glucose cotransporter 2 inhibitors after initiation of a low-carbohydrate diet. Case Presentation A 54-year-old woman who was taking canagliflozin was transferred to our hospital with severe dyspnea. She had been started on a strict low-carbohydrate diet for 6 days before admission. Laboratory evaluation revealed severe ketoacidosis and a blood glucose level of 196 mg/dL. After her symptoms improved, she was diagnosed with type 1 diabetes mellitus. Conclusion Although low-carbohydrate diets are recommended for patients with diabetes mellitus, physicians should exercise great caution in recommending low-carbohydrate diets to patients undergoing treatment with sodium-glucose cotransporter 2 inhibitors.
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Affiliation(s)
- Yuita Fukuyama
- Department of Emergency and Critical Care Medicine Tokyo Bay Urayasu Ichikawa Medical Center Chiba Japan
| | - Kenji Numata
- Department of Emergency and Critical Care Medicine Tokyo Bay Urayasu Ichikawa Medical Center Chiba Japan
| | - Kaede Yoshino
- Department of General Internal Medicine Tokyo Bay Urayasu Ichikawa Medical Center Chiba Japan
| | - Takushi Santanda
- Department of Emergency and Critical Care Medicine Tokyo Bay Urayasu Ichikawa Medical Center Chiba Japan
| | - Hiraku Funakoshi
- Department of Emergency and Critical Care Medicine Tokyo Bay Urayasu Ichikawa Medical Center Chiba Japan
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Eghbali-Zarch M, Tavakkoli-Moghaddam R, Esfahanian F, Azaron A, Sepehri MM. A Markov decision process for modeling adverse drug reactions in medication treatment of type 2 diabetes. Proc Inst Mech Eng H 2019; 233:793-811. [PMID: 31177917 DOI: 10.1177/0954411919853394] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Type 2 diabetes has an increasing prevalence and high cost of treatment. The goal of type 2 diabetes treatment is to control patients' blood glucose level by pharmacological interventions and to prevent adverse disease-related complications. Therefore, it is important to optimize the medication treatment plans for type 2 diabetes patients to enhance the quality of their lives and to decrease the economic burden of this chronic disease. Since the treatment of type 2 diabetes relies on medication, it is vital to consider adverse drug reactions. Adverse drug reaction is undesired harmful reactions that may result from some certain medications. Therefore, a Markov decision process is developed in this article to model the medication treatment of type 2 diabetes, considering the possibility of adverse drug reaction occurring adverse drug reaction. The optimal policy of the proposed Markov decision process model is compared with clinical guidelines and existing models in the literature. Moreover, a sensitivity analysis is conducted to address the manner in which model behavior depends on model parameterization and then therapeutic insights are obtained based on the results. The satisfying results show that the model has the capability to offer an optimal treatment policy with an acceptable expected quality of life by utilizing fewer medications and provide significant implications in endocrinology and metabolism applications.
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Affiliation(s)
- Maryam Eghbali-Zarch
- 1 School of Industrial Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Reza Tavakkoli-Moghaddam
- 1 School of Industrial Engineering, College of Engineering, University of Tehran, Tehran, Iran.,2 LCFC, Arts et Métiers ParisTech, Metz, France
| | - Fatemeh Esfahanian
- 3 Department of Endocrinology & Metabolism, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Azaron
- 4 Beedie School of Business, Simon Fraser University, Vancouver, BC, Canada.,5 School of Business, Kwantlen Polytechnic University, Vancouver, BC, Canada
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7
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Cawthorn WP, Scheller EL. Editorial: Bone Marrow Adipose Tissue: Formation, Function, and Impact on Health and Disease. Front Endocrinol (Lausanne) 2017; 8:112. [PMID: 28611729 PMCID: PMC5447009 DOI: 10.3389/fendo.2017.00112] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/09/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- William P. Cawthorn
- University/British Heart Foundation Centre for Cardiovascular Science, The Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
- *Correspondence: William P. Cawthorn,
| | - Erica L. Scheller
- Division of Bone and Mineral Diseases, Department of Medicine, Washington University, Saint Louis, MO, United States
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8
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Arum O, Boparai RK, Saleh JK, Wang F, Dirks AL, Turner JG, Kopchick JJ, Liu J, Khardori RK, Bartke A. Specific suppression of insulin sensitivity in growth hormone receptor gene-disrupted (GHR-KO) mice attenuates phenotypic features of slow aging. Aging Cell 2014; 13:981-1000. [PMID: 25244225 PMCID: PMC4326932 DOI: 10.1111/acel.12262] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2014] [Indexed: 12/20/2022] Open
Abstract
In addition to their extended lifespans, slow-aging growth hormone receptor/binding protein gene-disrupted (knockout) (GHR-KO) mice are hypoinsulinemic and highly sensitive to the action of insulin. It has been proposed that this insulin sensitivity is important for their longevity and increased healthspan. We tested whether this insulin sensitivity of the GHR-KO mouse is necessary for its retarded aging by abrogating that sensitivity with a transgenic alteration that improves development and secretory function of pancreatic β-cells by expressing Igf-1 under the rat insulin promoter 1 (RIP::IGF-1). The RIP::IGF-1 transgene increased circulating insulin content in GHR-KO mice, and thusly fully normalized their insulin sensitivity, without affecting the proliferation of any non-β-cell cell types. Multiple (nonsurvivorship) longevity-associated physiological and endocrinological characteristics of these mice (namely beneficial blood glucose regulatory control, altered metabolism, and preservation of memory capabilities) were partially or completely normalized, thus supporting the causal role of insulin sensitivity for the decelerated senescence of GHR-KO mice. We conclude that a delayed onset and/or decreased pace of aging can be hormonally regulated.
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Affiliation(s)
- Oge Arum
- Department of Internal Medicine Southern Illinois University‐School of Medicine Springfield IL 62794USA
| | - Ravneet K. Boparai
- Department of Internal Medicine Southern Illinois University‐School of Medicine Springfield IL 62794USA
| | - Jamal K. Saleh
- Department of Internal Medicine Southern Illinois University‐School of Medicine Springfield IL 62794USA
| | - Feiya Wang
- Department of Internal Medicine Southern Illinois University‐School of Medicine Springfield IL 62794USA
| | - Angela L. Dirks
- Department of Internal Medicine Southern Illinois University‐School of Medicine Springfield IL 62794USA
| | - Jeremy G. Turner
- Division of ENT‐Otolaryngology Department of Surgery Southern Illinois University‐School of Medicine Springfield IL 62794USA
| | - John J. Kopchick
- Edison Biotechnology Institute and Department of Biomedical Sciences Heritage College of Osteopathic Medicine Ohio University Athens OH 45701USA
| | - Jun‐Li Liu
- Fraser Laboratories for Diabetes Research Department of Medicine McGill University Health Centre 687 Pine Avenue West Montreal QC H3A 1A1 Canada
| | - Romesh K. Khardori
- Division of Endocrinology & Metabolism Department of Internal Medicine Eastern Virginia Medical School 700 West Olney Road Norfolk VA 23507 USA
| | - Andrzej Bartke
- Department of Internal Medicine Southern Illinois University‐School of Medicine Springfield IL 62794USA
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