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3.
Rev. esp. patol ; 56(2): 119-123, Abr-Jun 2023. ilus
Artigo em Espanhol | IBECS | ID: ibc-219166

RESUMO

El tumor de células gigantes óseo (TCGO) representa el 4-5% de los tumores óseos primarios, se localiza en la epífisis de huesos largos, cuerpos vertebrales y huesos planos, y es más frecuente en el sexo femenino entre los 20 y 45 años. Presentamos el caso de una mujer de 31 años con dolor torácico de un mes de evolución. En la exploración física se palpó un nódulo en mama derecha y semiología de derrame pleural ipsilateral. El estudio mediante TAC torácica evidenció una masa infiltrante. La lesión fue biopsiada, permitiendo el diagnóstico de TCGO. Debido a la localización y a la morfología, se planteó un amplio diagnóstico diferencial. Adicionalmente, se detectó la mutación del gen de la histona H3F3A, reforzando el diagnóstico. Recibió tratamiento neoadyuvante con denosumab, haciendo posible la posterior resección quirúrgica de la lesión. En la pieza quirúrgica se observaron cambios histológicos, fuente de pitfalls diagnósticos.(AU)


Giant cell tumour of bone (GCTOB) accounts for 4-5% of all primary bone tumours and occurs most frequently in females between 20 and 45 years old. It is found in the epiphyses of the long bones, vertebral bodies and flat bones.We report the case of a 31-year-old woman who presented with a one month history of thoracic pain. On examination, a mass was found in the right breast with signs of an ipsilateral pleural effusion. A thoracic CAT scan revealed an infiltrating mass which was subsequently biopsied and a GCTOB was diagnosed. Due to the localization and the morphology, a wide range of differential diagnoses were considered. Genetic studies detected a mutation of the gene H3F3A, supporting the original diagnosis. The patient underwent treatment with denosumab followed by surgical resection of the mass. The histopathology of the tumour revealed various histological changes which were a source of diagnostic pitfalls.(AU)


Assuntos
Humanos , Feminino , Adulto , Pacientes Internados , Exame Físico , Tumor de Células Gigantes do Osso , Caixa Torácica , Denosumab , Tomografia Computadorizada por Raios X , Dor no Peito
4.
Med. clín (Ed. impr.) ; 160(2): 51-59, enero 2023. tab
Artigo em Espanhol | IBECS | ID: ibc-214919

RESUMO

Objetivos: Evaluar aspectos del metabolismo óseo basal en pacientes con cáncer de próstata y el efecto, en práctica clínica habitual, de diferentes esquemas de tratamiento (intermitente o continuo) con agonistas de la hormona liberadora de hormona luteinizante (LH-RH) y del denosumab en la evolución de la densidad mineral ósea (DMO).MétodosEstudio observacional retrospectivo de una cohorte de pacientes con cáncer de próstata en tratamiento con agonistas LH-RH, valorados en el servicio de reumatología de un hospital de tercer nivel. Se recogieron datos demográficos, índice de FRAX, esquema de tratamiento LH-RH, tratamiento de osteoporosis, datos de laboratorio y de DMO. Se usaron modelos de regresión lineal de efecto mixto analizando la interacción de los esquemas de tratamiento LH-RH, denosumab y la evolución de DMO.ResultadosSe incluyeron 83 pacientes (73±8años). Evaluación basal: el 16% de los pacientes presentaron osteoporosis densitométrica y además un 27% un riesgo elevado de fractura (FRAX). El 80% tenían niveles de vitaminaD <30ng/l. La pauta intermitente de agonistas LH-RH y los niveles elevados de vitaminaD se asociaron a mejor DMO basal. No se detectó asociación entre la evolución de la DMO y las pautas de tratamiento de agonistas LH-RH, pero sí se encontró una correlación positiva con denosumab.ConclusionesUna elevada proporción de pacientes presentaban un alto riesgo de fractura o niveles insuficientes de vitaminaD no detectados previamente. El estudio tanto del metabolismo óseo como del riesgo de fractura son convenientes en estos pacientes. En práctica clínica habitual el efecto sobre la DMO del denosumab se detecta a corto plazo, mientras que el del esquema intermitente con agonistas LH-RH es menos evidente. (AU)


Objectives: To evaluate the aspects of the basal bone health status in prostate cancer patients. Furthermore, to evaluate in a real-world setting the effect of different schemes (intermittent or continuous) of androgen deprivation therapy (ADT) and the effect of denosumab in bone mass density (BMD).MethodsObservational, retrospective study of a cohort of prostate cancer patients in treatment with luteinizing hormone-releasing hormone (LH-RH) agonists, evaluated in the rheumatology department of a tertiary center. Demographics, FRAX score, LH-RH treatment scheme, osteoporosis treatment, laboratory data and BMD were collected. Mixed effect regression models to analyze the interaction between LH-RH treatment scheme, denosumab and BMD evolution were used.ResultsEighty-three patients (mean age 71±8years) were included. At the basal evaluation, 16% of patients presented densitometric osteoporosis and 27% of patients presented high fracture risk. Eighty percent of patients had inadequate vitaminD levels. VitaminD >30ng/mL was correlated with higher T-scores. There was no association between LH-RH treatment scheme and BMD evolution, however there was a positive association with denosumab.ConclusionA high proportion of patients presented elevated fracture risk or inadequate vitaminD levels, not previously recognized. Bone health assessment and fracture risk evaluation are convenient in these patients. In a real-world setting, the effect of denosumab in BMD is detected, however the effect of intermittent LH-RH schema treatment is less evident. (AU)


Assuntos
Humanos , Antagonistas de Androgênios/efeitos adversos , Androgênios , Densidade Óssea , Denosumab/farmacologia , Denosumab/uso terapêutico , Osteoporose/induzido quimicamente , Neoplasias da Próstata/tratamento farmacológico , Fraturas Ósseas , Hormônio Liberador de Gonadotropina
5.
Med. clín (Ed. impr.) ; 159(7): 336-343, octubre 2022. tab
Artigo em Espanhol | IBECS | ID: ibc-212209

RESUMO

Aminobisphosphonates are widely used in the treatment of osteoporosis. They have a high affinity for hydroxyapatite, binding primarily to resorbing surfaces, but also to forming surfaces and to some extent to resting surfaces. They inhibit osteoclasts, thereby decreasing remodelling units. Consequently, they increase bone mass and reduce stress risers. This decreases the risk of fractures. If this decrease is sufficient, they can be temporarily withdrawn (drug holidays), which prevents serious complications (atypical femoral fracture). They probably reduce mortality. Virtually all patients with osteoporosis can benefit from them at some point in the course of their disease (at the beginning of treatment or after the administration of anabolics, selective estrogen receptor modulators or denosumab). If well tolerated orally, alendronate and risedronate are preferable. Otherwise, zoledronate is preferred. Their efficacy vs. cost-safety-convenience ratio makes aminobisphosphonates reference drugs in the field of osteoporosis. (AU)


Los aminobisfosfonatos se utilizan ampliamente en el tratamiento de la osteoporosis. Tienen gran afinidad por la hidroxiapatita, uniéndose fundamentalmente a las superficies en resorción, pero también a las superficies en formación y, en cierta medida, a las superficies en reposo. Inhiben a los osteoclastos, con lo que disminuyen las unidades de remodelación. En consecuencia, aumentan la masa ósea y reducen los concentradores de tensión. Ello disminuye el riesgo de fracturas. Si esta disminución es suficiente, pueden retirarse transitoriamente (vacaciones terapéuticas), lo que previene complicaciones graves (fractura atípica de fémur). Probablemente disminuyen la mortalidad. Pueden beneficiarse de ellos prácticamente todos los enfermos con osteoporosis en algún momento de su evolución (al comienzo del tratamiento o tras la administración de anabólicos, moduladores selectivos de los receptores estrogénicos o denosumab). Con buena tolerancia oral son preferibles el alendronato y el risedronato. En caso contrario, lo es el zoledronato. Su relación eficacia frente a coste-seguridad-comodidad los convierte en fármacos de referencia en el campo de la osteoporosis. (AU)


Assuntos
Humanos , Alendronato/uso terapêutico , Denosumab/uso terapêutico , Difosfonatos/uso terapêutico , Hidroxiapatitas/uso terapêutico , Osteoporose/tratamento farmacológico , Osteoporose/etiologia , Osteoporose Pós-Menopausa/tratamento farmacológico , Ácido Risedrônico/uso terapêutico , Ácido Zoledrônico/uso terapêutico
6.
Rev. osteoporos. metab. miner. (Internet) ; 14(2): 88-92, julio 2022. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-210544

RESUMO

Introducción: El desarrollo de osteoporosis es una complicación frecuente tras una lesión medular (LM), especialmente bajo el nivel de la lesión. Sin embargo, su abordaje terapéutico continúa siendo incierto.Objetivo: Analizar la evolución de la densidad mineral ósea (DMO) y de los marcadores de remodelado óseo (MRO) en individuos con una LM reciente y osteoporosis asociada tratados con denosumab durante 24 meses.Métodos: Estudio prospectivo en el que se incluyeron pacientes con LM reciente y osteoporosis que recibieron tratamiento con denosumab durante 24 meses. A todos ellos se les realizó una analítica con determinación de MRO (PINP, CTX y FA ósea), 25-OH- vitamina D y una densitometría ósea en columna lumbar y fémur proximal basal y a los 12 y 24 meses.Resultados: Se incluyeron 13 pacientes (media de edad de 39±15 años) con LM reciente (con un tiempo medio de evolución de 15 meses) y osteoporosis. Todos los pacientes recibieron tratamiento con denosumab durante 24 meses. A los 12 meses de tratamiento con denosumab se observó un aumento significativo de la DMO en columna lumbar y fémur proximal, con un incremento adicional de los valores de DMO tras 24 meses de tratamiento, que fue del orden del 9,1% en columna lumbar, 4,4% en cuello de fémur y 5,3% en fémur total. Asimismo, los valores de los MRO disminuyeron de forma significativa durante los 24 meses de tratamiento. Ningún paciente presentó fracturas por fragilidad y no se observaron acontecimientos adversos relacionados con el tratamiento.Conclusiones: El tratamiento con denosumab durante 24 meses aumenta la DMO lumbar y femoral y disminuye los MRO en pacientes con LM reciente con osteoporosis. Denosumab parece ser una opción terapéutica prometedora en esta condición clínica. (AU)


Assuntos
Humanos , Denosumab , Osteoporose , Densidade Óssea , Ferimentos e Lesões , Pacientes , Remodelação Óssea , Terapêutica , Estudos Prospectivos
7.
Rev. osteoporos. metab. miner. (Internet) ; 14(1): 55-63, marzo 2022. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-210539

RESUMO

Introducción: La osteonecrosis de los maxilares es una reacción adversa severa poco frecuente, asociado a la administración de medicamentos utilizados para el tratamiento de la osteoporosis y cáncer, como los bisfosfonatos y el denosumab. Sin embargo, muchos profesionales suspenden estos medicamentos, o difieren los procedimientos hasta tener aval del médico tratante. El presente estudio evalúa los conocimientos y actitudes de un grupo de odontólogos colombianos, con respecto al riesgo de desarrollar osteonecrosis de maxilar con el uso de bisfosfonatos y denosumab.Métodos: Se diseñó una encuesta a partir de un grupo focal que fue avalada por expertos. Se obtuvo una herramienta de 30 preguntas, la cual fue enviada a un grupo de odontólogos, cirujanos maxilofaciales, periodoncistas y rehabilitadores orales afiliados a las sociedades odontológicas a través del software Survey Monkey.Resultados: Se analizaron las respuestas de 187 odontólogos (42,6% con estudios de posgrado). El 50,3% de los odontólogos consideraron equivocadamente, que el uso de bisfosfonatos es una contraindicación absoluta para procedimientos odontológicos mayores, y el 51,3% lo consideraron para el uso de denosumab. El 74,6% de los profesionales solicitarían innecesariamente aval del médico tratante para programar procedimientos en pacientes que reciben bisfosfonatos, y el 43,8% para pacientes con denosumab. Los hallazgos fueron similares independientemente de los años de experiencia o el nivel de educativo.Conclusión: Los resultados de nuestro estudio sugieren que hay bajo conocimiento, en relación al riesgo de desarrollar osteonecrosis de maxilar con el uso de medicamentos para el manejo de la osteoporosis. (AU)


Assuntos
Humanos , Osteonecrose , Difosfonatos , Denosumab , Osteoporose , Odontólogos , Preparações Farmacêuticas , Colômbia
9.
Med. oral patol. oral cir. bucal (Internet) ; 26(6): e684-e690, Nov. 2021. tab
Artigo em Inglês | IBECS | ID: ibc-224671

RESUMO

Background: Medication-related osteonecrosis of the jaws (MRONJ) is a well-known complication associatedwith antiresorptive and antiangiogenic therapies. The purpose of this study was to analyse if there is any predic-tive factor of recurrence after local debridement plus platelet rich plasma (PRP) placement in MRONJ patients.Material and Methods: Seventy MRONJ patients treated at the department of Oral and Maxillofacial Surgery inLa Paz Hospital (Madrid, Spain) were included in this retrospective study. All of them were treated surgicallyby local debridement and PRP placement. The observation period was between January 2012 and January 2019.Information regarding use, type, administration, and duration of therapy with BP/denosumab was recorded. Thefollow-up period ranged from 2-52 months. A descriptive analysis, a bivariate and a multivariate study were per-formed.Results: Most of the patients were women (82.9%) between 50-70 years old (64.3%), with a stage II disease(74.3%). The therapy lasted more than 12 months in 54.8% of them. Zoledronic acid was the main antiresorptiveused (44.3%), followed by oral administered BPs (29 patients, 41.4%) and denosumab (10 patients, 14.3%). Oste-oporosis (48.6%), breast cancer (30%) and multiple myeloma (11.4%) were the main diseases because the patientswere taking antirresorptives. 13 patients (18.6%) experienced recurrence. We found that breast cancer patients(p>0.0001), smokers (p>0.016), and administration of zoledronic acid (p>0.0001) were related to recurrence.After performing the multivariate model, we found that the only factor related to recurrence was smoking habit(Wald 3.837, p=0.05, OR 6.12). Conclusions: recurrence after local debridement plus PRP placement in our MRONJ series affected to 18.6% ofpatients. It seems to be more frequent in breast cancer patients, smokers, and after zoledronic acid administration.Smoking habit was the only independent factor related to recurrence in our series.(AU)


Assuntos
Humanos , Masculino , Feminino , Idoso , Densidade Óssea , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Plasma Rico em Plaquetas , Mieloma Múltiplo , Ácido Zoledrônico , Denosumab , Estudos Retrospectivos , Espanha , Fatores de Risco
10.
Rev. Soc. Esp. Dolor ; 28(4): 211-218, Juli-Agos. 2021. tab, graf
Artigo em Inglês | IBECS | ID: ibc-227834

RESUMO

Introduction: The word osteonecrosis (ONC) means "dead bone"; it is a bone disease secondary to the loss of blood supply to the bone, causing its collapse and subsequent death. It can occur in any bone in the body, including those of the maxillofacial region, it is more common in the jaw. In recent years, the relationship of ONC with drugs such as bisphosphonates, antiresorptive, steroids for prolonged use, angiogenesis inhibitor agents, among others, has been found. However, despite the studies carried out by various authors, ONC continues to be an underdiagnosed entity with variable management and treatment, which is why the inte­rest of this research arises with the main objective of reporting the cases of patients diagnosed with Pharmacological ONC. Material and method: A descriptive, retrospective, cross-sectional, observational study was carried out for approximately 6 years (January 1, 2013 - December 31, 2019), in the Maxillofacial Surgery service of the Specialty Hospital, of National Medical Center, "Siglo XXI", IMSS. Making a review of clinical records, collecting clinical and image controls, reporting the number of cases and the management of patients with ONC, as well as the number of cases of ONC that were related to drugs. Of 9 patients with a diagnosis of osteonecrosis (ONC), only 4 patients were Pharmacological ONC, from the Maxillofacial Surgery service. Results: From a universe of 9 patients with ONC, 4 representative cases of patients with pharmacological ONC were presented, with management based on the protocol used in the Maxillofacial Surgery service of the National Medical Center "Siglo XXI", IMSS; Likewise, the signs and symptoms with which the treatment was staged and determined are shown.(AU)


Introducción: La palabra osteonecrosis (ONC) significa "hueso muerto". Es una patología ósea secundaria a la pérdida de suministro de sangre al hueso, provocando su colapso y su posterior muerte. Puede presentarse en cualquier hueso del cuerpo, incluyendo los de la región maxilofacial; es más frecuente en la mandíbula. En los últimos años se ha encontrado la relación de la ONC con medicamentos tales como bifosfonatos, antirresortivos, esteroides por uso prolongado, agentes inhibidores de angiogénesis, entre otros. Sin embargo, pese a los estudios realizados por diversos autores, la ONC continúa siendo una entidad subdiagnosticada y con manejo y tratamiento variable; es por ello que surge el interés de esta investigación con el principal objetivo de reportar los casos de pacientes diagnosticados con ONC farmacológica. Material y método: Se realizó un estudio descriptivo, retrospectivo, transversal, observacional, durante aproximadamente 6 años (1 de enero de 2013- 31 de diciembre de 2019), en el servicio de Cirugía Maxilofacial del Hospital de Especialidades, del Centro Médico Nacional, Siglo XXI, IMSS. Haciendo una revisión de expedientes clínicos, recabando controles clínicos y de imagen, reportando el número de casos y el manejo de pacientes con ONC, así como el número de casos de ONC que estuvieron relacionados a fármacos. Se obtuvo una muestra de 9 pacientes con diagnóstico de osteonecrosis (ONC) en el Servicio de Cirugía Maxilofacial. Resultados: No se encontró predominio por algun género en específico, la edad promedio fue de 63,44 años, aproximadamente el 50 % de la muestra obtenida fueron pacientes diagnosticados con ONC farmacológica, de los cuales solo uno estuvo asociado a denosumab y 3 fueron ONC relacionada con bifosfonatos.(AU)


Assuntos
Humanos , Masculino , Feminino , Manejo da Dor/métodos , Osteonecrose/terapia , Cirurgia Bucal , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Denosumab/uso terapêutico , Manejo da Dor/tendências , Osteonecrose/diagnóstico , Osteonecrose/cirurgia , México , Estudos Transversais , Estudos Retrospectivos , Epidemiologia Descritiva
11.
Med. oral patol. oral cir. bucal (Internet) ; 26(4): e466-e473, Juli. 2021. tab, graf
Artigo em Inglês | IBECS | ID: ibc-224591

RESUMO

Background: Incidence of Medication-Related Osteonecrosis of the Jaw (MRONJ) related to cancer and myelomatreatments is undetermined, with scarce data varying from 2 to 7.8/million/year in limited investigated popula-tions. A 9-years [2009-2018] regional-wide survey was conducted, deploying the North-Western Italy Cancer Net-work (“Rete Oncologica Piemonte e Valle d’Aosta”), to assess number and main characteristics of MRONJ casesamong myeloma/cancer patients, within a population of 4.5 million inhabitants.Material and Methods: MRONJ cases were collected retrospectively from January 2009 to June 2015; from July2015 to December 2018, data were collected prospectively. Number of new MRONJ cases per year, underlyingdisorder, drug(s) administered, treatment duration, site and onset timing of MRONJ were detailed.Results: 459 MRONJ cases were identified. Primary diseases were breast cancer (46%), prostate cancer (21%),myeloma (19%), and other types of carcinoma (14%). Patients received antiresorptive treatment either alone (399;88.47%) or in combination with biological agents (52; 11.53%); 8 patients (1.7%) received only antiangiogenicdrugs. Zoledronic acid [388] and denosumab [59] were the most frequently administered drugs. Mandible was involved in 296 (64,5%) cases. Number of new MRONJ cases was stable from 2009 to 2015, with a mean of 51.3 casesper year (raw incidence: 11.6/million/year), declining in the 2016-2018 years to 33.3 cases per year (raw incidence:7.5/million/year).Conclusions: With such discrepancy of cases overtime being partially explicable, number of new MRONJ cases peryear are consistent with those observed in a previous study [2003-2008] in the same region, being instead higher thanthose reported in other populations.(AU)


Assuntos
Humanos , Masculino , Feminino , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Neoplasias , Inibidores da Angiogênese , Denosumab , Ácido Zoledrônico , Mieloma Múltiplo/tratamento farmacológico , Itália , Saúde Bucal , Medicina Bucal , Patologia Bucal , Cirurgia Bucal , Incidência , Estudos Retrospectivos
12.
Reumatol. clín. (Barc.) ; 17(2): 97-105, Feb 2021. ilus, tab
Artigo em Espanhol, Português | IBECS | ID: ibc-211807

RESUMO

Antecedentes: El presente artículo muestra la evidencia y recomendaciones de la eficacia y seguridad de las terapias hasta hoy aprobadas y disponibles en México para el tratamiento de la osteoporosis en su etapa severa o establecida, con la finalidad de establecer una postura terapéutica acerca de la eficacia y seguridad para esta etapa del padecimiento, de acuerdo con las cédulas descriptivas del Cuadro Básico y Catálogo de Medicamentos del Sector Salud en México. Métodos: Se realizó una revisión sistemática y narrativa de la evidencia de teriparatida y denosumab, desde su perfil farmacológico, efectividad y seguridad derivado de ensayos clínicos, además de un análisis de las recomendaciones generales de las principales guías de práctica clínica nacionales e internacionales. Resultados: La evidencia establece que teriparatida y denosumab pertenecen a clases terapéuticas distintas, con mecanismos de acción biológicamente opuestos e indicaciones de uso claramente diferenciadas en sus respectivas cédulas, por lo cual no son sustituibles ni intercambiables en la terapia de osteoporosis severa. Ambas representan la mejor opción disponible hasta el momento para esta etapa del padecimiento. Son similares en su eficacia de prevención de nuevas fracturas vertebrales por fragilidad, con un RR de 0,35 (IC 95%: 0,22-0,55) para teriparatida, y de 0,32 (IC 95%: 0,26-0,41) para denosumab. La reducción absoluta del riesgo es mayor con teriparatida 9,3% (21 meses) que con denosumab 4,8% (36 meses). Conclusiones: Nuestros resultados concuerdan con las recomendaciones disponibles en las principales guías de práctica clínica nacionales e internacionales, por lo que son propuestas ambas terapias como consecutivas y nunca como sustitutivas.(AU)


Background: This article presents evidence and recommendations regarding the efficacy and safety of the approved and available therapies in Mexico to treat severe or established osteoporosis with the aim of developing a position regarding therapeutics in this stage of the disease, according to the descriptive cards of the National Drug Formulary of the National General Health Council of Mexico. Methods: We performed a systematic and narrative review of the evidence of teriparatide and denosumab, from their pharmacological profile, effectiveness, and safety derived from clinical trials, as well as an analysis of the general recommendations of the national and international clinical practice guidelines. Results: The evidence establishes that teriparatide and denosumab belong to different therapeutic classes, with biologically opposed mechanisms of action and indications of use, which are clearly differentiated in their respective national codes, therefore these drugs cannot be substitutable or interchangeable in severe osteoporosis therapy. Both represent the best options currently available for this stage of the disease; being similar in their efficacy in preventing new vertebral fragility fractures, with an RR of .35 (CI 95%; .22-.55) for teriparatide, and .32 (CI 95%: .26-.41) for denosumab. The absolute risk reduction is higher with teriparatide 9.3% (21 months) compared with denosumab at 4.8% (36 months). Conclusions: Our results agree with the recommendations available in national and international clinical practice guidelines, with both therapies proposed as a sequential, but not a substitute, treatment.(AU)


Assuntos
Humanos , Osteoporose/tratamento farmacológico , Denosumab , Fraturas por Osteoporose , México , Reumatologia , Doenças Reumáticas
13.
Reumatol. clín. (Barc.) ; 16(6): 480-484, nov.-dic. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-201051

RESUMO

OBJETIVOS: Analizar las características clínicas y de metabolismo óseo de una serie de pacientes con fracturas vertebrales tras la suspensión de denosumab (DMab). MÉTODOS: Estudio observacional retrospectivo de 10 pacientes con fracturas vertebrales tras suspender DMab atendidas en el Servicio de Reumatología de un hospital español de tercer nivel entre 2015 y 2018. RESULTADOS: Se registraron un total de 49 fracturas espontáneas tras una media de 6 dosis de DMab y transcurridos 10,9 meses desde la suspensión del fármaco. El 90% había recibido tratamiento previo, 7 de 10 bisfosfonatos orales. Tras la suspensión, CTX y P1NP estaban elevados y la media de T-score en cuello femoral y columna lumbar fue menor que previo a DMab. Las vértebras más afectadas fueron L3, L5, D6, D7, D9 y D11. CONCLUSIÓN: La descripción de nuevos casos de fracturas vertebrales múltiples en los meses posteriores a la suspensión de DMab subraya la preocupación emergente en la comunidad científica siendo preciso apoyar en evidencias sólidas las nuevas recomendaciones sobre su manejo


OBJECTIVES: Analyse clinical and bone metabolism features in a case series of patients with multiple vertebral fractures after discontinuation of denosumab (DMab). METHODS: An observational descriptive study analysing data from ten patients with multiple vertebral fractures after DMab discontinuation that were admitted to our rheumatology department between 2015 and 2018. RESULTS: There were a total of 49 spontaneous fractures after an average of 6 DMab doses and 10.9 months from discontinuation. Ninety percent had already received treatment other than DMab 7 of 10 oral bisphosphonates. After discontinuation, CTX and P1NP remained elevated and mean T-score for femoral neck and lumbar spine was lower than before treatment. The most affected vertebrae were L3, L5, D6, D7, D9 and D11. CONCLUSION: This report of ten new cases suffering multiple vertebral fractures early after discontinuation of DMab highlights the emerging concern on the subject in the scientific community and the need to clarify its pathogenic mechanism, and to support by solid evidence the new recommendations on its management


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Denosumab/uso terapêutico , Fraturas Múltiplas/etiologia , Fraturas por Osteoporose/epidemiologia , Fraturas da Coluna Vertebral/epidemiologia , Conservadores da Densidade Óssea/uso terapêutico , Suspensão de Tratamento , Estudos Retrospectivos , Efeito Rebote , Anticorpos Monoclonais Humanizados/uso terapêutico , Densitometria/métodos
15.
Rev. ORL (Salamanca) ; 11(3): 361-368, jul.-sept. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-197904

RESUMO

El diagnóstico de hiperparatiroidismo primario en pacientes sin criterio quirúrgico es cada vez más frecuente. Aunque la evidencia de calidad es escasa en algunos casos, cada vez se dispone de más datos que nos permiten conocer el efecto de los distintos fármacos sobre la calcemia, la afectación ósea y renal en pacientes sometidos a ellos durante periodos prolongados de tiempo


The diagnosis of primary hyperparathyroidism in patients without surgical criteria is increasingly frequent. Although quality evidence is scarce in some cases, last years there are more data available that allow us to know the effect of different drugs on calcemia, bone and kidney involvement in patients undergoing them for prolonged periods of time


Assuntos
Humanos , Hiperparatireoidismo Primário/terapia , Hiperparatireoidismo Primário/diagnóstico , Difosfonatos/uso terapêutico , Colecalciferol/uso terapêutico , Denosumab/uso terapêutico , Estabilidade de Medicamentos , Hiperparatireoidismo Primário/prevenção & controle
18.
Med. clín (Ed. impr.) ; 154(9): 358-365, mayo 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-193217

RESUMO

La artritis reumatoide (AR) es una enfermedad inflamatoria crónica que puede ocasionar destrucción articular y marcada discapacidad. El tratamiento precoz con fármacos modificadores de la enfermedad, incluyendo la terapia biológica, constituye el principal tratamiento para prevenir el daño estructural asociado a esta entidad. Algunos estudios han indicado que el tratamiento concomitante con antirresortivos, como los bisfosfonatos o el denosumab, podría prevenir el desarrollo de lesiones erosivas en este proceso, e incluso se ha sugerido que el tratamiento con un osteoformador, como la teriparatida, podría revertir las lesiones erosivas previamente establecidas. En este artículo se revisa la evidencia disponible sobre la eficacia del tratamiento antirresortivo y osteoformador en la prevención o tratamiento de las erosiones óseas asociadas a la AR


Rheumatoid arthritis (RA) is a chronic inflammatory disease that can cause joint destruction and marked disability. Early treatment with disease-modifying drugs, including biological therapy, is the principal treatment to prevent the structural damage associated with this entity. Some studies have indicated that concomitant treatment with antiresorptives, such as bisphosphonates or denosumab, could prevent erosive lesions in this process, and it has even been suggested that treatment with a bone forming agent, such as teriparatide, could revert previously established erosive lesions. In this article we review the evidence available on the efficacy of treatment with antiresorptives and bone forming agents in the prevention and/or treatment of bone erosions associated with RA


Assuntos
Humanos , Artrite Reumatoide/terapia , Antirreumáticos/uso terapêutico , Remodelação Óssea/efeitos dos fármacos , Denosumab/uso terapêutico , Articulações/efeitos dos fármacos , Conservadores da Densidade Óssea/uso terapêutico , Autoimunidade , Articulações/fisiopatologia
19.
Med. oral patol. oral cir. bucal (Internet) ; 25(3): e326-e336, mayo 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-196318

RESUMO

BACKGROUND: The aim of the present study was to analyse the incidence, risk ratio (RR) and prognoses of two types of medication-related osteonecrosis of the jaws (MRONJ): denosumab-related osteonecrosis of the jaws (DRONJ) and Bisphosphonate-Related Osteonecrosis of the Jaws (BRONJ) in cancer patients under treatment with deno-sumab or zoledronic acid (ZA). MATERIAL AND METHODS: An electronic and manual search was conducted for randomized controlled trials (RCTs) until May 2019. Assessment of the identified studies, risk of bias and data extraction were performed independently by two reviewers. The incidence of DRONJ and BRONJ and the RR to develop MRONJ were calculated at 1 year, 2 years and 3 years of exposure. It was also calculated the odds ratio (OR) of their respective prognoses. They were calculated normalizing the values of the individual studies to 1 year, 2 years or 3 years when necessary through robust regression models using a statistical program. RESULTS: From 1.277 references identified, 8 RCTs were included, which comprised a total of 13.857 patients with a variety of neoplasms. The incidence of DRONJ in cancer patients under treatment with denosumab ranged from 0.5 to 2.1% after 1 year, 1.1 to 3.0% after 2 years, and 1.3 to 3.2% after 3 years of exposure. The incidence of BRONJ in cancer patients under treatment with ZA ranged from 0.4 to 1.6% after 1 year of exposure, 0.8 to 2.1% after 2 years, and 1.0 to 2.3% after 3 years of exposure. Statistically significant differences were found between de-nosumab and ZA in the risk of developing MRONJ after 1, 2 and 3 years of exposure. Nevertheless, there were no significant differences in terms of patient prognosis. CONCLUSIONS: Denosumab is associated with a significantly higher risk of developing MRONJ compared to ZA. Nevertheless, no differences were found in its prognoses


No disponible


Assuntos
Humanos , Masculino , Feminino , Osteonecrose/induzido quimicamente , Denosumab/efeitos adversos , Ácido Zoledrônico/efeitos adversos , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/etiologia , Doenças Maxilomandibulares/induzido quimicamente , Medição de Risco , Fatores de Risco , Ensaios Clínicos Controlados Aleatórios como Assunto , Neoplasias/tratamento farmacológico , Fatores de Tempo
20.
Med. oral patol. oral cir. bucal (Internet) ; 25(1): e71-e83, ene. 2020. tab, ilus
Artigo em Inglês | IBECS | ID: ibc-196198

RESUMO

BACKGROUND: Medication-related osteonecrosis of the jaw (MRONJ) is a rare, but serious adverse effect of certain drugs, of which bisphosphonates are the most widely known. This pathology is also associated with other medications such as the biologic antiresorptive agent, denosumab and some antiangiogenics such as sunitinib, bevacizumab or aflibercept. Very recently, new medications have also been associated with osteonecrosis of the jaw (ONJ). The objectives were to update the list of medications associated with ONJ, to analyze the fundamental aspects of this list and to describe the level of evidence available. MATERIAL AND METHODS: A narrative bibliographic review was made, using the PubMed-MedLine, DOAJ and SCI-ELO databases. Additional information was obtained through the online Medication Information Centre of the Spanish Agency of Medicines and Medical Devices (AEMPS - CIMA), the websites of the US Food & Drugs Administration (Drugs@FDA) and the European Medicines Agency (EMA). RESULTS: The latest drugs identified as potential facilitators of this pathology include a number of anti-VEGF based antiangiogenic drugs and anti-TKI and different types of immunomodulators. Neither the level of evidence in this association nor the risk are equal for all these drugs. On the other hand, over the coming years, new drugs will be marketed with similar action mechanisms to those that are recognized as having this adverse effect. CONCLUSIONS: No effective therapy is currently known for the treatment of ONJ. Therefore, in order to prevent new cases of MRONJ, it is essential for all oral healthcare professionals to be fully up-to-date with the etiopathogenic aspects of this pathology and to be aware of those drugs considered to be a risk


No disponible


Assuntos
Humanos , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/etiologia , Conservadores da Densidade Óssea/efeitos adversos , Inibidores da Angiogênese/efeitos adversos , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/prevenção & controle , Fatores de Risco , Denosumab/efeitos adversos , Bevacizumab/efeitos adversos , Sunitinibe/efeitos adversos
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