Understanding Patients' Perspectives and Educational Needs by Type of Osteoporosis in Men and Women and People with Glucocorticosteroid-Induced Osteoporosis: A Qualitative Study to Improve Disease Management.

The aim of the study was to investigate similarities and differences in health beliefs, experiences and educational needs by type of osteoporosis (OP), particularly in people with glucocorticoid-induced OP (GIOP) and men. A qualitative study was conducted via focus groups involving post-menopausal women with or without osteoporotic fractures, osteoporotic men and people with GIOP. Fifty-three participants were included in eight groups. A wide range of health beliefs was found for all types of OP. Osteoporosis was considered a natural consequence of ageing except in men or conversely a serious disease associated with risk of new fractures and disability. GIOP patients had heterogeneous knowledge of OP and reported fewer prevention behaviours, and their quality of life was affected by the causal illness. Men had difficulties coping with the loss of their functional abilities and felt that OP was a "women's" disease. Beliefs about treatments ranged from confidence to fear of adverse effects or doubt about efficacy in all types of OP. Participants were interested in physical activity, fall prevention and diet, and preferred group sessions. GIOP patients and men had an interest in face-to-face education. Men were also interested in brief information including via the Internet. Patients' beliefs about OP differed by type of OP. Specific populations such as men or people with GIOP need particular care owing to experiences and needs. Offering group sessions in educational interventions is of interest to allow for sharing experiences and also face-to-face education for men and GIOP patients or the Internet for men.

French law: what about a reasoned reimbursement of serum vitamin D assays?

The number of serum 25-hydroxyvitamin D (25OHD) assays has increased tenfold in France in less than 10 years, sometimes for invalidated reasons. In 2013, the French National Authority for Health (Haute autorité de santé, or HAS) limited the indications for serum 25OHD measurements to rickets/osteomalacia, older adults with recurrent falls, monitoring of kidney transplant in adults, and surgical treatment of obesity in adults. Our aim here was to note that other indications for serum 25OHD measurements are supported by previous literature and by a number of national and international recommendations, in particular the following: any situation of bone fragility, any chronic renal failure <45 mL/min/1.73m2, any situation of malabsorption, clinical signs consistent with vitamin D deficiency or vitamin D overload, and calcium phosphorus evaluation. We suggest that the measurement of serum 25OHD concentration should remain reimbursed as part of these extended indications.

[The importance of taking care of osteoporosis]. / De l'importance de prendre en charge l'ostéoporose.

Consequences in terms of mortality and morbidity of osteoporotic fractures are serious and recent data show that mortality of osteoporosis is often a witness of poor health. Prevalent fracture is one of the most important risk factors for incident fracture. The risk of subsequent fractures is highest immediately after initial fractures. It is essential to treat postmenopausal osteoporotic women who had experienced a fragility fracture. Efforts to raise awareness of osteoporosis among the general public and medical profession are essential because only a minority of women is taken care and treated after a typical osteoporotic fracture. We have effective treatments, varied and adapted to all situations encountered in clinical practice for the management of osteoporosis. All available treatments showed an effect on vertebral fractures and some demonstrated an effect on nonvertebral fractures or hip fractures. The lack of adherence is perfectly demonstrated in osteoporosis. As for all patients affected by a chronic disease, patient education should become part of the global care of patients with osteoporosis.

Use of infliximab to treat psoriatic arthritis in HIV-positive patients.

Psoriatic arthritis in HIV-positive patients is not only severe, but also raises specific treatment challenges, as immunosuppressant and immunomodulating agents may adversely affect both the course of the HIV infection and the risk of opportunistic infections. TNFalpha antagonists have not been evaluated in patients with HIV infection, which is therefore considered to contraindicate their use. Two HIV-positive patients with psoriatic arthritis unresponsive to methotrexate alone were treated with infliximab (5 and 2 mg/kg, respectively), methotrexate, and antiretroviral drugs. Dramatic improvements in the skin and joint manifestations occurred in both patients. Tolerance was good, after follow-ups of 24 and 50 months, respectively. No opportunistic infections occurred. Viral load remained well controlled and CD4+T-cell counts stable, although both patients required adjustments in their antiretroviral regimens based on close monitoring of these two parameters. HIV infection classically contraindicates the use of TNFalpha antagonists to treat refractory inflammatory joint disease. However, exceptions to this rule can be made in carefully selected patients who have exhausted all other treatment options for their joint disease and who respond well to antiretroviral therapy. Potential long-term effects such as opportunistic infections, malignancies, and loss of HIV control need to be evaluated.

[Paget's disease and its therapeutic management]. / Maladie de Paget, prise en charge thérapeutique.

Bisphosphonates, potent anti-osteoclastic agents, are nowadays the first-line therapy for Paget's disease of bone. Solid evidence about efficacy and the risk/benefit ratio favor tiludronate and risedronate for oral administration and pamidronate for intravenous administration. Treatment is always intermittent, with the frequency of therapeutic sequences depending on the specific drug and the quality and duration of response. Treatment response is assessed by the extent of the reduction of biochemical markers of bone turnover, especially plasma total alkaline phosphatase. The goal of the treatment is to induce full remission, that is, normal levels of alkaline phosphatase. Bisphosphonates should be used in all patients with bone involvement that might create long-term articular (arthropathy) or neurologic (compression) complications. This aggressive strategy is the most likely to provide effective prevention of complications in the long term.

Paget's disease of bone.

Paget's disease of bone is characterized by an anarchic bone remodelling, associated with morphological and functional abnormalities of osteoclasts. Its prevalence and incidence rates decreased gradually over the past two decades; the reason for this remains unclear. The aetiology of the disease is still obscure, the paramyxoviral theory being very controversial. Recent advances in understanding of the disease come from genetic studies, with the identification of specific mutations in the p62-sequestosome gene, which could be involved in pathogenetic mechanisms leading to increased osteoclast activity. The disease affects one or several bone pieces, leading to bone pain, deformities, characteristic imaging features, and increased markers of bone remodelling. The long-lasting disease activity leads to complications, including arthropathies, neurological compressions, fissures or fractures and, rarely, osteosarcomatous transformation of a pagetic lesion. Potent bisphosphonates have proven their efficacy in reducing symptoms and disease activity. They are currently used as the first-line treatment with the goal of normalizing bone remodelling and, hopefully, preventing late complications.