Effect of neridronate on axial involvement in patients with spondyloarthritis when biologics are not possible. Results of a monocentric study.

Introduction: This study aims to examine the potential effectiveness of intravenous neridronate (IVNer) on axial involvement in patients with spondyloarthritis (SpA) refractory to non-steroidal anti-inflammatory drugs (NSAIDs) but not eligible for biological disease-modifying antirheumatic drugs (bDMARDs). Method: Patients with active SpA (BASDAI score ≥ 4) and active sacroiliitis (SI) on MRI (according to ASAS MRI definition), who were NSAID-insufficient responder/intolerant but not eligible for bDMARDs, were retrospectively recruited in a tertiary rheumatology centre between September 2015 and December 2021. IVNer (100 mg) was administered to the patients on days 1, 4, 7, and 10. Responses were evaluated 60 days after the last infusion as the median changes from the baseline of BASDAI and Visual Analogue Scale (VAS) pain and there are improvements on MRI signs. Results: A total of 38 patients (26 axial SpA, 3 enteropathic arthritis, and 9 axial psoriatic arthritis) were included [66% women, mean age ± SD: 38.0 ± 14.1 years, mean disease duration: 30.5 ± 49.5 months (range 1.0-298), 47% HLAB27+]. The reason for bDMARD ineligibility was concurrent solid tumors (n = 6) or hematological (n = 1) malignancy, comorbidities (n = 11), or patient preference (n = 20). Both median BASDAI [5.83 (4.2-8.33) versus 3.66 (1.1-6.85), p < 0.001] and VAS pain [7 (5.75-8.0) versus 3 (1.0-7.0), p < 0.0001] significantly decreased after IVNer. Of 28 available MRI at follow-up, we observed a complete (36%) or partial (39%) resolution of sacroiliitis or a persistent activity (25%). Discussion: IVNer was effective in improving axial involvement in patients with SpA refractory to NSAIDs but not eligible for bDMARDs. IVNer can be considered as a potential alternative therapeutic option in selected settings.

Estimating the Incidence and Key Risk Factors of Cardiovascular Disease in Patients at High Risk of Imminent Fracture Using Routinely Collected Real-World Data From the UK.

The objective of this work was to estimate the incidence rate of cardiovascular disease (CVD) events (myocardial infarction, stroke, or CVD death) at 1 year among three cohorts of patients at high risk of fracture (osteoporosis, previous fracture, and anti-osteoporosis medication) and to identify the key risk factors of CVD events in these three cohorts. To do so, this prospective cohort study used data from the Clinical Practice Research Datalink, a primary care database from United Kingdom. Major adverse cardiovascular events (MACE, a composite outcome for the occurrence of either myocardial infarction [MI], stroke, or CVD death) were identified in patients aged 50 years or older at high or imminent fracture risk identified in three different cohorts (not mutually exclusive): recently diagnosed with osteoporosis (OST, n = 65,295), incident fragility fracture (IFX, n = 67,065), and starting oral bisphosphonates (OBP, n = 145,959). About 1.90%, 4.39%, and 2.38% of the participants in OST, IFX, and OBP cohorts, respectively, experienced MACE events. IFX was the cohort with the higher risk: MACE incidence rates (cases/1000 person-years) were 19.63 (18.54-20.73) in OST, 52.64 (50.7-54.5) in IFX, and 26.26 (25.41-27.12) in OBP cohorts. Risk of MACE events at 1 year was predicted in the three cohorts. Models using a set of general, CVD, and fracture candidates selected by lasso regression had a good discrimination (≥70%) and internal validity and generally outperformed the models using only the CVD risk factors of general population listed in QRISK tool. Main risk factors common in all MACE models were sex, age, smoking, alcohol, atrial fibrillation, antihypertensive medication, prior MI/stroke, established CVD, glomerular filtration rate, systolic blood pressure, cholesterol levels, and number of concomitant medicines. Identified key risk factors highlight the differences of patients at high risk of fracture versus general population. Proposed models could improve prediction of CVD events in patients with osteoporosis in primary care settings. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Implicaciones de la osteoporosis sobre los movimientos ortodóncicos: revisión de literatura / Osteoporosis implications upon orthodontic movements: a literature review

En la actualidad se muestra un incremento en la demanda de servicios ortodóncicos en pacientes adultos, los cuales están propensos a sufrir enfermedades metabólicas que afectan el componente óseo, entre ellas la osteoporosis definida como un desorden metabólico óseo que altera la densidad ósea. Su aparición se da en cualquier etapa de la vida, tiene múltiples factores de riesgo asociados y su manejo puede ser o no de tipo farmacológico. Es necesario para el ortodoncista identificar si su paciente presenta o no osteoporésis debido a que es un factor clave en la respuesta del hueso alveolar a los movimientos dentales. Los procedimientos de ortodoncia y ortopedia dentofacial involucran procesos de remodelación ósea que requiere de un conocimiento de esta patología y un manejo clínico muy cuidadoso. Diversos estudios sobre el uso de medicamentos como los anticonceptivos orales que contienen estrógeno y progesterona reportan que pueden disminuir o inhibir el movimiento dentario, así como los bifosfonatos que en ocasiones es empleado para reforzar el anclaje. La realización de una historia clínica completa indagando sobre aspectos médicos familiares, permitirá desarrollar un plan de tratamiento ortodoncico individualizado, con lo cual se podrá cumplir con los objetivos establecidos y se podrá evitar que los fenómenos biológicos que se presentan durante los movimientos dentales no repercutan en lesiones o alteraciones irreversibles que dañen o atrofien los tejidos periodontales y óseos.

Currently, there is an increase in demand for orthodontic treatment of adult patients who tend to suffer metabolic diseases that affect the bony structure such as osteoporosis which is defined as a metabolic disorder that affects bone density. It appears en any stage in life and has multiple associated risk factors and its management can pharmacological or non-pharmacological. It is important for the orthodontist to identify if the patient presents osteoporosis given that it is key factor in the alveolar bone response to dental movement. Orthodontic or orthopedic movements involve osseous remodeling processes that require a knowledge of this pathology and clinical management is very delicate. Different studies on the use of drugs such as contraceptives that contain estrogen and progesterone report that may decrease or inhibit dental movement such as bis-phonates that are used in some occasions to reinforce anchorage. A complete clinical history reviewing past medical background will alllow an individualized treatment plan that allows an achievement of established goals and avoid biological phenomena that occur during dental movements that result in irreversible alterations that damage periodontal and bony tissues.