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1.
Yakugaku Zasshi ; 140(1): 63-79, 2020.
Artículo en Japonés | MEDLINE | ID: mdl-31902887

RESUMEN

Since the first report in 2003, bisphosphonate-related osteonecrosis of the jaw (BRONJ) has been increasing, without effective clinical strategies. Osteoporosis is common in elderly women, and bisphosphonates (BPs) are typical and widely used anti-osteoporotic or anti-bone-resorptive drugs. BRONJ is now a serious concern in dentistry. As BPs are pyrophosphate analogues and bind strongly to bone hydroxyapatite, and the P-C-P structure of BPs is non-hydrolysable, they accumulate in bones upon repeated administration. During bone-resorption, BPs are taken into osteoclasts and exhibit cytotoxicity, producing a long-lasting anti-bone-resorptive effect. BPs are divided into nitrogen-containing BPs (N-BPs) and non-nitrogen-containing BPs (non-N-BPs). N-BPs have far stronger anti-bone-resorptive effects than non-N-BPs, and BRONJ is caused by N-BPs. Our murine experiments have revealed the following. N-BPs, but not non-N-BPs, exhibit direct and potent inflammatory/necrotic effects on soft-tissues. These effects are augmented by lipopolysaccharide (the inflammatory component of bacterial cell-walls) and the accumulation of N-BPs in jawbones is augmented by inflammation. N-BPs are taken into soft-tissue cells via phosphate-transporters, while the non-N-BPs etidronate and clodronate inhibit this transportation. Etidronate, but not clodronate, has the effect of expelling N-BPs that have accumulated in bones. Moreover, etidronate and clodronate each have an analgesic effect, while clodronate has an anti-inflammatory effect via inhibition of phosphate-transporters. These findings suggest that BRONJ may be induced by phosphate-transporter-mediated and infection-promoted mechanisms, and that etidronate and clodronate may be useful for preventing and treating BRONJ. Our clinical trials support etidronate being useful for treating BRONJ, although additional clinical trials of etidronate and clodronate are needed.


Asunto(s)
Osteonecrosis de los Maxilares Asociada a Difosfonatos/etiología , Osteonecrosis de los Maxilares Asociada a Difosfonatos/prevención & control , Conservadores de la Densidad Ósea/efectos adversos , Difosfonatos/efectos adversos , Animales , Osteonecrosis de los Maxilares Asociada a Difosfonatos/tratamiento farmacológico , Conservadores de la Densidad Ósea/metabolismo , Conservadores de la Densidad Ósea/uso terapéutico , Ensayos Clínicos como Asunto , Ácido Clodrónico/química , Ácido Clodrónico/metabolismo , Ácido Clodrónico/farmacología , Ácido Clodrónico/uso terapéutico , Difosfonatos/química , Difosfonatos/metabolismo , Difosfonatos/uso terapéutico , Ácido Etidrónico/química , Ácido Etidrónico/metabolismo , Ácido Etidrónico/farmacología , Ácido Etidrónico/uso terapéutico , Humanos , Inflamación , Maxilares/metabolismo , Ratones , Nitrógeno , Proteínas de Transporte de Fosfato/antagonistas & inhibidores , Ratas
2.
Dentomaxillofac Radiol ; 49(2): 20190155, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31670576

RESUMEN

OBJECTIVES: To verify quantitative differences of the mandibular cortical and trabecular bone between patients with multiple myeloma (MM) under bisphosphonate (BP) therapy and a control group never exposed to BP. METHODS: Clinical and demographic characteristics were collected through medical records and interviews. Mandibular cortical thickness (MCT) and fractal dimension (FD) were measured on cone beam computed tomography (CBCT) images, on the molar region, in both groups. Additionally, FD was measured on periapical digital intraoral radiography and results were compared to CBCT measurements. RESULTS: There were 33 patients with MM under BP therapy and 28 controls, with no significant differences in gender and age between groups. Pamidronate was used by all MM patients, either associated or not to other types of BP. The median MCT was higher in MM group exposed to BP (5.20 mm) than in controls (3.50 mm, p < 0.001). There were no significant differences in the median FD between patients in the MM group and controls, on CBCT (0.95 vs 0.90, p = 0.814) and periapical digital intraoral radiography (0.98 vs 0.96, p = 0.963), respectively, even when more than one type of BP was used. CONCLUSIONS: The MCT represents an useful tool in the detection of bone dimensional changes caused by BP, in patients with MM. Additional studies are necessary to improve the knowledge on the quantitative evaluation of trabecular jaw bone, in individuals with MM, under BP therapy.


Asunto(s)
Conservadores de la Densidad Ósea , Difosfonatos , Mandíbula , Mieloma Múltiple , Conservadores de la Densidad Ósea/uso terapéutico , Tomografía Computarizada de Haz Cónico , Difosfonatos/uso terapéutico , Humanos , Maxilares/diagnóstico por imagen , Maxilares/efectos de los fármacos , Mandíbula/diagnóstico por imagen , Mandíbula/efectos de los fármacos , Mieloma Múltiple/complicaciones , Radiografía Dental Digital
3.
J Craniomaxillofac Surg ; 47(12): 1922-1928, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31810841

RESUMEN

Non-surgical therapy has proved to be effective in chronic diffuse sclerosing osteomyelitis (DSO) of the mandible in children. Therefore we aimed to investigate the effect of non-surgical therapy in adult DSO patients. We included consecutive patients with DSO who received non-surgical therapy in our center. They all received occlusal splint therapy, counselling about the disease, and/or physiotherapy by a specialised team. The use of analgesics, preferably nonsteroidal anti-inflammatory drugs, was advised for symptomatic control during periods of exacerbation. Sixteen patients (11/5 female/male) aged 39.9 ± 15.0 years with DSO of the mandible were included. The mean duration of symptoms was 39.7 ± 26.3 months before referral to our center. Patients were treated with a broad range of treatments before referral. All patients underwent non-surgical treatment. In 12 patients this led to remission. Four patients still had complaints after 12 months of non-surgical therapy and started with intravenous bisphosphonate therapy. In our center, DSO of the mandible was successfully treated with non-surgical therapy, despite a long duration before referral and extensive pre-treatment. Considering this high success rate, we recommend this non-surgical approach as the first treatment option for DSO of the mandible. In case of persistence, alternative treatments such as bisphosphonates should be explored.


Asunto(s)
Conservadores de la Densidad Ósea/uso terapéutico , Tratamiento Conservador/métodos , Difosfonatos/uso terapéutico , Enfermedades Mandibulares/terapia , Ferulas Oclusales , Osteomielitis/terapia , Dolor/tratamiento farmacológico , Periostitis/terapia , Adulto , Niño , Enfermedad Crónica , Femenino , Humanos , Masculino , Mandíbula/patología , Enfermedades Mandibulares/complicaciones , Persona de Mediana Edad , Osteomielitis/complicaciones , Dolor/etiología , Periostitis/complicaciones , Resultado del Tratamiento , Adulto Joven
4.
Ulus Travma Acil Cerrahi Derg ; 25(6): 603-610, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31701502

RESUMEN

BACKGROUND: Atypical femur fracture is a rare complication of bisphosphonate treatment, which is widely used for the prevention of osteoporotic fractures. This study aims to report clinical and radiological features and outcomes of surgically treated atypical femur fractures related to bisphosphonates. METHODS: We retrospectively reviewed patients with the diagnosis of atypical femur fracture who were under bisphosphonate treatment and who were surgically treated in our clinic between January 2009 and December 2017. Patients who met the atypical femur fracture criteria defined by the American Society for Bone and Mineral Research were included in this study. Radiological features of the fractures, bisphosphonate treatment and duration, prodromal clinical and radiological findings were evaluated. Outcome measures included perioperative results, clinical and radiological outcomes and mobilization status. RESULTS: In this study, 19 patients were enrolled. Mean age of the patients was 69.6 years (range: 60.8-85.1) and the mean follow-up was 33.8 months (range: 13-104). Mean bisphosphonate use duration was 8.65 years (range: 3-18). Four patients had bilateral fractures. Eight of 23 fractures were subtrochanteric and 15 were diaphyseal. Twenty-one fractures were treated with an intramedullary nail, one fracture with a locked compression plate and one fracture with cephalomedullary nail. Union was observed in 15 fractures within the first six months. There was a delayed union in four fractures and non-union in four fractures. Mean union time was 5.1 months (range: 2-9). While seven patients preserved their preoperative mobilization status, 12 patients showed regression after the fracture. CONCLUSION: This study suggests that atypical femur fractures may have prodromal signs and that their management is complex due to high complication and nonunion rates.


Asunto(s)
Conservadores de la Densidad Ósea/efectos adversos , Difosfonatos/efectos adversos , Fracturas del Fémur , Anciano , Anciano de 80 o más Años , Conservadores de la Densidad Ósea/uso terapéutico , Difosfonatos/uso terapéutico , Fracturas del Fémur/inducido químicamente , Fracturas del Fémur/diagnóstico por imagen , Fracturas del Fémur/cirugía , Fémur/diagnóstico por imagen , Fémur/cirugía , Fracturas por Estrés , Humanos , Persona de Mediana Edad , Osteoporosis/tratamiento farmacológico , Estudios Retrospectivos
5.
Bone Joint J ; 101-B(11): 1402-1407, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31674239

RESUMEN

AIMS: Bone health assessment and the prescription of medication for secondary fracture prevention have become an integral part of the acute management of patients with hip fracture. However, there is little evidence regarding compliance with prescription guidelines and subsequent adherence to medication in this patient group. PATIENTS AND METHODS: The World Hip Trauma Evaluation (WHiTE) is a multicentre, prospective cohort of hip fracture patients in NHS hospitals in England and Wales. Patients aged 60 years and older who received operative treatment for a hip fracture were eligible for inclusion in WHiTE. The prescription of bone protection medications was recorded from participants' discharge summaries, and participant-reported use of bone protection medications was recorded at 120 days following surgery. RESULTS: Of 5456 recruited patients with baseline data, 2853 patients (52%) were prescribed bone protection medication at discharge, of which oral bisphosphonates were the most common, 4109 patients (75%) were prescribed vitamin D or calcium, and 606 patients (11%) were not prescribed anything. Of those prescribed a bone protection medication, only 932 patients (33%) reported still taking their medication 120 days later. CONCLUSION: These data provide a reference for current prescription and adherence rates. Adherence with oral medication remains poor in patients with hip fracture. Cite this article: Bone Joint J 2019;101-B:1402-1407.


Asunto(s)
Conservadores de la Densidad Ósea/uso terapéutico , Fracturas de Cadera/cirugía , Anciano , Calcio/uso terapéutico , Estudios de Cohortes , Denosumab/uso terapéutico , Difosfonatos/uso terapéutico , Humanos , Hidroxicolecalciferoles/uso terapéutico , Cumplimiento de la Medicación , Persona de Mediana Edad , Cuidados Posoperatorios/métodos , Complicaciones Posoperatorias/prevención & control , Estudios Prospectivos , Teriparatido/uso terapéutico , Reino Unido , Vitamina D/uso terapéutico
6.
BMC Oral Health ; 19(1): 260, 2019 11 27.
Artículo en Inglés | MEDLINE | ID: mdl-31775719

RESUMEN

BACKGROUND: Although several studies assessed the effect of bisphosphonate (BIS) administration on alveolar bone loss, this relationship has not been fully investigated using longitudinal analysis. The aim of the this article is to predict annual alveolar bone loss in a subpopulation of older adults patients who were taking oral bisphosphonate (BIS), adjusting for systemic diseases and associated risk factors. METHODS: This is a retrospective cohort study. We identified all subjects who reported receiving oral bisphosphonate from 2008 to 2015 (N = 30) using the electronic health records of each patient to identify suitable radiographs for analysis. For the longitudinal data analysis, 26 subjects were eligible for inclusion, having at least two exposures of the complete mouth set or repeated bitewing radiographs at least a one-year interval; they were then matched on age and sex to another 26 patients who did not report receiving bisphosphonate at any point of their life. RESULTS: Mild periodontitis was higher in the BIS group compared to the no BIS group; however, moderate periodontitis was higher in the no BIS group. For those who did not take oral BIS, change over time was not significant after the two-year period. However, the BIS group had experienced 0.088 mm more bone loss compared to the no BIS group (95% CI: 0.001, 0.176. P-value = 0.048), adjusting for all other variables included in the model. CONCLUSION: The group that reported receiving oral bisphosphonates showed no improvement in maintaining alveolar bone level, and the use of oral BIS may not be effective in reducing annual alveolar bone loss; however, emerging evidence is promising for the use of bisphosphonate as an adjunctive local delivery medication for the management of periodontal diseases.


Asunto(s)
Pérdida de Hueso Alveolar , Conservadores de la Densidad Ósea , Periodontitis , Anciano , Pérdida de Hueso Alveolar/tratamiento farmacológico , Conservadores de la Densidad Ósea/efectos adversos , Difosfonatos/uso terapéutico , Femenino , Humanos , Masculino , Periodontitis/tratamiento farmacológico , Estudios Retrospectivos
7.
J Biol Regul Homeost Agents ; 33(5): 1315-1320, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31591875

RESUMEN

Osteoarthritis (OA) is a chronic rheumatic disease characterized by joint cartilage wear and loss of normal function. Clodronate (CLO) is a first-generation non-nitrogen-containing bisphosphonate that exerts anti-inflammatory and analgesic and modulatory effects on bone and cartilage metabolism. To date, few clinical studies have evaluated the effect of CLO in OA. Current evidence suggests that CLO may represent a new type of analgesic drug as it reduces pain in bone diseases characterized by edema such as Complex Regional Pain Syndrone type-1 and vertebral fractures. Thanks to its anti-inflammatory and analgesic effects, CLO has been shown to afford benefit in knee OA, erosive OA of the hand, painful knee hip prosthesis and veterinary practice. Transforming growth factor ß1 has also been found to play an important role in the pathogenesis of OA. The present review article examines recent evidence on the potential use of CLO in the treatment of OA.


Asunto(s)
Ácido Clodrónico/uso terapéutico , Difosfonatos/uso terapéutico , Osteoartritis/tratamiento farmacológico , Cartílago Articular/patología , Humanos
8.
Bone Joint J ; 101-B(10): 1285-1291, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31564154

RESUMEN

AIMS: Currently, periprosthetic fractures are excluded from the American Society for Bone and Mineral Research (ASBMR) definition of atypical femoral fracture (AFFs). This study aims to report on a series of periprosthetic femoral fractures (PFFs) that otherwise meet the criteria for AFFs. Secondary aims were to identify predictors of periprosthetic atypical femoral fractures (PAFFs) and quantify the complications of treatment. PATIENTS AND METHODS: This was a retrospective case control study of consecutive patients with periprosthetic femoral fractures between 2007 and 2017. Two observers identified 16 PAFF cases (mean age 73.9 years (44 to 88), 14 female patients) and 17 typical periprosthetic fractures in patients on bisphosphonate therapy as controls (mean age 80.7 years (60 to 86, 13 female patients). Univariate and multivariate analysis was performed to identify predictors of PAFF. Management and complications were recorded. RESULTS: Interobserver agreement for the PAFF classification was excellent (kappa = 0.944; p < 0.001). On univariate analysis compared with controls, patients with PAFFs had higher mean body mass indices (28.6 kg/m2 (sd 8.9) vs 21.5 kg/m2 (sd 3.3); p = 0.009), longer durations of bisphosphonate therapy (median 5.5 years (IQR 3.2 to 10.6) vs 2.4 years (IQR 1.0 to 6.4); p = 0.04), and were less likely to be on alendronate (50% vs 94%; p = 0.02) with an indication of secondary osteoporosis (19% vs 0%; p = 0.049). Duration of bisphosphonate therapy was an independent predictor of PAFF on multivariate analysis (R2 = 0.733; p = 0.05). Following primary fracture management, complication rates were higher in PAFFs (9/16, 56%) than controls (5/17, 29%; p = 0.178) with a relative risk of any complication following PAFF of 1.71 (95% confidence interval (CI) 0.77 to 3.8) and of reoperation 2.56 (95% CI 1.3 to 5.2). CONCLUSION: AFFs do occur in association with prostheses. Longer duration of bisphosphonate therapy is an independent predictor of PAFF. Complication rates are higher following PAFFs compared with typical PFFs, particularly of reoperation and infection. Cite this article: Bone Joint J 2019;101-B:1285-1291.


Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Difosfonatos/efectos adversos , Osteoporosis/tratamiento farmacológico , Fracturas Periprotésicas/inducido químicamente , Fracturas Periprotésicas/cirugía , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/métodos , Estudios de Casos y Controles , Intervalos de Confianza , Difosfonatos/uso terapéutico , Relación Dosis-Respuesta a Droga , Femenino , Fracturas del Fémur/inducido químicamente , Fracturas del Fémur/cirugía , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Análisis Multivariante , Variaciones Dependientes del Observador , Osteoporosis/complicaciones , Fracturas Periprotésicas/diagnóstico por imagen , Estudios Retrospectivos , Medición de Riesgo , Factores de Tiempo , Estados Unidos
9.
Lakartidningen ; 1162019 Sep 16.
Artículo en Sueco | MEDLINE | ID: mdl-31529420

RESUMEN

Atypical fracture of the femur is a well-documented adverse reaction to antiresorptive treatment with bisphosphonates. Although there has been significant gain of knowledge during the past decade, the pathogenesis of this type of fracture is still poorly understood. We present an update on the evidence in regard to epidemiology, pathophysiology, and management of atypical fractures.


Asunto(s)
Conservadores de la Densidad Ósea/efectos adversos , Difosfonatos/efectos adversos , Fracturas del Fémur/inducido químicamente , Anciano , Difosfonatos/uso terapéutico , Medicina Basada en la Evidencia , Femenino , Fracturas del Fémur/diagnóstico por imagen , Fracturas del Fémur/fisiopatología , Fracturas del Fémur/prevención & control , Humanos , Masculino , Radiografía , Factores de Riesgo
11.
J Assoc Physicians India ; 67(9): 87-90, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31561698

RESUMEN

Pachydermoperiostosis is a rare genetic disorder which commonly presents with clubbing, bone pains and skin changes. The treatment is mostly unsatisfactory. We tried bisphosphonates in our case with encouraging results. We suggest that parenteral bisphosphonates should be tried early in treatment of Pachydermoperiostosis.


Asunto(s)
Difosfonatos/uso terapéutico , Osteoartropatía Hipertrófica Primaria/tratamiento farmacológico , Humanos , Piel
12.
J Biol Regul Homeost Agents ; 33(3 Suppl. 1): 43-50, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31538449

RESUMEN

Customization of post-and-cores using computer-aided-design and computer-aided-manufacturing (CAD-CAM) requires the scanning of a pattern and the subsequent digital design. This case report describes the production of a CAD-CAM customized post-and-core designed from an intraoral scan and milled from a metal block. The use of an intraoral scanner (IOS) for post-endodontic rehabilitation could lead to a faster and more efficient CAD-CAM customized post-and-core realization. The use of a high resistance material such as metal is paramount in cases with high loss of coronal structure. The patient has been treated with bisphosphonate (BP) for years. The risk of osteonecrosis of the jaw after extraction was high.


Asunto(s)
Diseño Asistido por Computador , Implantes Dentales , Flujo de Trabajo , Osteonecrosis de los Maxilares Asociada a Difosfonatos , Implantación Endodóntica Endoósea , Difosfonatos/efectos adversos , Difosfonatos/uso terapéutico , Humanos , Metales
13.
Acta Ortop Mex ; 33(2): 63-66, 2019.
Artículo en Español | MEDLINE | ID: mdl-31480105

RESUMEN

INTRODUCTION: Osteogenesis imperfeta (OI) is defined as a heterogeneous group of hereditary diseases, which present with the presence of bone fragility, frequent fractures, bone deformities and short stature. Treatment with biphosfonates in patients with diagnosis of OI has shown a decrease in the frecuency of fractures, as well as an improvement in vertebral bone density. There is little evidence on quality of life in patients diagnosed with OI treated with bisphosphonates, Therefore this study evaluated the quality of life of patients diagnosed with OI after treatment with bisphosphonates. MATERIAL AND METHODS: It is a prospective, deliberate intervention, self-controlled clinical trial. Nine patients with ages between two and thirteen ages and diagnosed with OI were treated with Zolendronic, a quality of life measurement was performed in the patients before and after the application. For measuring the quality of life in the patients we used the PedsQL 4.0 quality of life survey that was applied to both children and parents. RESULTS: In the quality of life survey performed on the parents, an increase was observed in the four dimensions evaluated. In the survey made on the children two dimensions showed a significant increase. The number of fractures decreased after the treatment. CONCLUSIONS: There is a correlation between the decrease in the number of fractures and the perception that both parents and children have in the quality of life after treatment with bisphosphonates.


Asunto(s)
Conservadores de la Densidad Ósea , Difosfonatos , Osteogénesis Imperfecta , Calidad de Vida , Adolescente , Conservadores de la Densidad Ósea/uso terapéutico , Niño , Preescolar , Difosfonatos/uso terapéutico , Humanos , Osteogénesis Imperfecta/complicaciones , Osteogénesis Imperfecta/tratamiento farmacológico , Estudios Prospectivos
14.
Evid. actual. práct. ambul ; 22(2): e001112, sept. 2019.
Artículo en Español | LILACS | ID: biblio-1046678

RESUMEN

La osteopenia, una disminución de la densidad mineral ósea de menor severidad que la osteoporosis, definida por valores de T-score entre -1,0 y -2,5 en la densitometría ósea , podría asociarse con un mayor riesgo de fracturas. Motivado por el pedido de una paciente con osteopenia que solicita a su médico algún medicamento que le ayude a disminuir su riesgo de fracturas, el autor se pregunta si los bifosfonatos podrían ser beneficiosos para las pacientes con este factor de riesgo. Luego de realizar una búsqueda bibliográfica y seleccionar la evidencia más reciente y de mejor calidad, se concluye que estos fármacos podrían ser útiles para prevenir fracturas en mujeres mayores de 65 años con elevado riesgo de fractura,independientemente del resultado de la densitometría. (AU)


Osteopenia, a minor decrease in bone mineral density, defined by T-score values between -1.0 and -2.5 in a bone densitometry, is associated with an increased risk of fractures. Moved by the request of a patient with osteopenia who asks her doctor for any medication that may help her reduce his risk of fractures, the author wonders if bisphosphonates could be beneficial for patients with this condition. After conducting a bibliographic search and selecting the most recent and best quality evidence, he concluded that these drugs could be useful to prevent fractures in women older than 65 years with ahigh risk of fracture, regardless of densitometry results. (AU)


Asunto(s)
Humanos , Femenino , Anciano , Osteoporosis/tratamiento farmacológico , Enfermedades Óseas Metabólicas/tratamiento farmacológico , Difosfonatos/uso terapéutico , Fracturas Osteoporóticas/prevención & control , Osteoporosis/etiología , Enfermedades Óseas Metabólicas/complicaciones , Enfermedades Óseas Metabólicas/etiología , Enfermedades Óseas Metabólicas/diagnóstico por imagen , Factores de Riesgo , Fracturas Osteoporóticas/fisiopatología , Fracturas Osteoporóticas/tratamiento farmacológico
15.
G Ital Nefrol ; 36(4)2019 Jul 24.
Artículo en Italiano | MEDLINE | ID: mdl-31373465

RESUMEN

Osteoporosis affects a segment of the population in which Chronic Kidney Disease is also greatly represented. Nephropathic patients may present peculiar biochemical abnormalities related to Chronic Kidney Disease, defining the Mineral and Bone Disorder. This kind of anomalies, in the worst scenarios, configure the typical histomorphology patterns of Renal Osteodystrophy. Scientific Societies of Endocrinology have established therapy guidelines for patients with osteoporosis only based on the glomerular filtration rate and recommend avoiding the use of some drugs for the more advanced classes of nephropathy. However, there is no clear therapeutic approach for patients with advanced nephropathy and bone abnormalities. In this paper we propose a systematic review of the literature and present our proposal for managing patients with advanced nephropathy, based on eGFR and on presence of Mineral and Bone Disorder.


Asunto(s)
Conservadores de la Densidad Ósea/uso terapéutico , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/tratamiento farmacológico , Difosfonatos/uso terapéutico , Osteoporosis/tratamiento farmacológico , Insuficiencia Renal Crónica/complicaciones , Anticuerpos Monoclonales/uso terapéutico , Conservadores de la Densidad Ósea/efectos adversos , Conservadores de la Densidad Ósea/química , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/etiología , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/fisiopatología , Contraindicaciones , Denosumab/uso terapéutico , Difosfonatos/efectos adversos , Difosfonatos/química , Femenino , Fracturas Espontáneas/tratamiento farmacológico , Fracturas Espontáneas/etiología , Fracturas Espontáneas/prevención & control , Tasa de Filtración Glomerular , Humanos , Masculino , Osteoporosis/complicaciones , Osteoporosis/diagnóstico , Proteína Relacionada con la Hormona Paratiroidea/uso terapéutico , Guías de Práctica Clínica como Asunto , Insuficiencia Renal Crónica/fisiopatología , Factores de Riesgo , Teriparatido/uso terapéutico
16.
Orthop Clin North Am ; 50(4): 433-443, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31466660

RESUMEN

This article serves to provide an overview of molecular and surgical interventions to minimize the progression of posttraumatic arthritis following high-energy intra-articular fractures. The roles of cartilage and the microcellular environment are discussed, as well as the response of the joint and cartilage to injury. Molecular therapies, such as glucocorticoids, mesenchymal stem cells, and bisphosphonates, are presented as potential treatments to prevent progression to posttraumatic arthritis. High-energy intra-articular fractures of the elbow, hip, knee, and ankle are discussed, with emphasis on restoring anatomic alignment, articular reduction, and stability of the joint.


Asunto(s)
Cartílago Articular/lesiones , Fracturas Intraarticulares/complicaciones , Osteoartritis/terapia , Artroplastia , Difosfonatos/uso terapéutico , Progresión de la Enfermedad , Glucocorticoides/uso terapéutico , Humanos , Ácido Hialurónico/uso terapéutico , Trasplante de Células Madre Mesenquimatosas , Osteoartritis/etiología
17.
Actual. osteol ; 15(2): 94-102, mayo - ago. 2019. tab.
Artículo en Español | LILACS | ID: biblio-1048478

RESUMEN

El propósito de la terapia en el desorden del metabolismo óseo mineral asociado a la enfermedad renal crónica (IRC) consiste en restaurar el balance mineral, y, en la osteoporosis, mantener o aumentar la masa ósea. Ambas terapias tratan de evitar la fractura ósea. La mayoría de los osteoactivos están contraindicados en la insuficiencia renal crónica avanzada (estadios 4 y 5), y las terapias son empíricas. Algunos autores opinan que sin anomalías bioquímicas del desorden del metabolismo óseo mineral asociado a la enfermedad renal crónica avanzada se podría intentar el tratamiento estándar para la osteoporosis. Antes de intentar la terapia osteoactiva se debe corregir el desorden mineral óseo que pudiera presentarse asociado a la IRC, y en la indicación del tipo de osteoactivo se sugiere seleccionar al paciente según su estado óseo. Se aconseja que la administración de los antirresortivos se realice a dosis menores con respecto a los que tienen mejor función renal junto con aportes adecuados de calcio y vitamina D, antes y durante el tratamiento para prevenir el riesgo de severas hipocalcemias y un efecto óseo excesivo. Se presenta el caso clínico de una mujer de 65 años, con diagnóstico de osteoporosis de etiología multifactorial, fractura de pelvis, múltiples fracturas vertebrales e insuficiencia renal crónica avanzada, entre otras comorbilidades, y probable enfermedad ósea adinámica. Recibió inicialmente terapia con teriparatide y luego con denosumab, complicándose con hipocalcemia asintomática. (AU)


The purpose of therapy for the bone mineral metabolism disorder associated with chronic kidney disease is to restore the mineral balance; and to maintain or increase bone mass in osteoporosis. The goal of both types of therapy is to avoid bone fractures. Most antiosteoporotic drugs are contraindicated in advanced chronic renal failure (CRF) stages 4 and 5, and the therapies are empirical. Some authors believe that without biochemical abnormalities of the mineral bone metabolism disorder associated with advanced chronic kidney disease, standard treatment for osteoporosis could be attempted. Before attempting antiosteoporotic therapy, the bone mineral disorder that may be associated with CRF must be corrected, and in the indication of the type drug it is suggested that the patient be selected according to their bone status. It is advised that the administration of anti-resorptives be performed at lower doses in individuals with poor renal function compared to those with better renal function together with adequate calcium and vitamin D, before and during treatment to prevent the risk of severe hypocalcemia, and an excessive bone effect. We present the clinical case of a 65-year-old woman with a diagnosis of osteoporosis of multifactorial etiology, pelvic fracture, multiple vertebral fractures and advanced chronic renal failure, among other comorbidities and probable adynamic bone disease. The patient received initial therapy with teriparatide and followed by denosumab administration and exhibited asymptomatic hypocalcemia. (AU)


Asunto(s)
Humanos , Femenino , Anciano , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/tratamiento farmacológico , Fracturas Óseas/prevención & control , Osteoporosis/terapia , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/complicaciones , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/metabolismo , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/terapia , Vitamina D/administración & dosificación , Vitamina D/uso terapéutico , Calcio/administración & dosificación , Calcio/uso terapéutico , Alendronato/uso terapéutico , Teriparatido/administración & dosificación , Teriparatido/efectos adversos , Teriparatido/uso terapéutico , Difosfonatos/administración & dosificación , Difosfonatos/efectos adversos , Difosfonatos/uso terapéutico , Cinacalcet/uso terapéutico , Ácido Risedrónico/uso terapéutico , Denosumab/administración & dosificación , Denosumab/efectos adversos , Denosumab/uso terapéutico , Hipocalcemia/prevención & control
18.
Osteoporos Int ; 30(9): 1817-1825, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31263921

RESUMEN

Although Scandinavian countries have the highest incidence of hip fracture in the world, trends in anti-osteoporosis medication use have not been studied. We found less than one-third of Danish hip fracture patients had dispensing of anti-osteoporosis medication over a 10-year period using routinely collected data from population-based registries. INTRODUCTION: To examine trend in dispensing of anti-osteoporosis medication before and after hip fracture surgery in Denmark over a 10-year period using routinely collected data from population-based registries. METHODS: From the Danish Multidisciplinary Hip Fracture Registry, we included 65,011 patients aged 65 years or older with an incident hip fracture in 2005-2015. We calculated, for each calendar year of hip fracture diagnosis, the prevalence of use of anti-osteoporosis medication (at least one dispensing of bisphosphonates, strontium ranelate, denosumab, selective estrogen receptor modulators, or teriparatide) in the year before and in the year following hip fracture diagnosis. Among those without a dispensing in the year before hip fracture, we computed 1-year cumulative incidence of use following hip fracture. We treated death as a competing risk and stratified the analysis on sex, age, and comorbidity. RESULTS: The prevalence of use before hip fracture varied between 7 and 12%, increasing slightly from 2005 to 2015. The cumulative incidence of use following hip fracture decreased from 16% in 2005 to 13% in 2010, whereupon it increased to 20%. A similar pattern was seen with each stratum of sex, age groups, and comorbidity. The overall prevalence of use after hip fracture was below 22% in all calendar years. CONCLUSIONS: Less than one-third of hip fracture patients had dispensing of anti-osteoporosis medication up to 1 year after hip fracture. We observed only a slight increase in dispensing after hip fracture over the study period, irrespective of patient sex, age, and comorbidity at the time of hip fracture.


Asunto(s)
Conservadores de la Densidad Ósea/uso terapéutico , Fracturas de Cadera/prevención & control , Osteoporosis/tratamiento farmacológico , Fracturas Osteoporóticas/prevención & control , Factores de Edad , Anciano , Anciano de 80 o más Años , Comorbilidad , Dinamarca/epidemiología , Difosfonatos/uso terapéutico , Prescripciones de Medicamentos/estadística & datos numéricos , Utilización de Medicamentos/estadística & datos numéricos , Utilización de Medicamentos/tendencias , Femenino , Fracturas de Cadera/epidemiología , Fracturas de Cadera/cirugía , Humanos , Masculino , Osteoporosis/epidemiología , Fracturas Osteoporóticas/epidemiología , Fracturas Osteoporóticas/cirugía , Pautas de la Práctica en Medicina/estadística & datos numéricos , Pautas de la Práctica en Medicina/tendencias , Sistema de Registros , Prevención Secundaria/métodos , Prevención Secundaria/estadística & datos numéricos , Prevención Secundaria/tendencias , Factores Sexuales
20.
Orthop Surg ; 11(4): 569-577, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31322836

RESUMEN

OBJECTIVES: To investigate the knowledge and practices of Chinese doctors in the management of osteoporotic fractures after the Chinese osteoporotic fracture guidelines update and aseries of medical education in 2017. METHODS: This was a cross-sectional survey of doctors in 71 cities across Mainland China. Based on the 2017 Chinese guidelines for the diagnosis and treatment of osteoporotic fractures, a questionnaire was designed and pre-tested for reliability and validity. Doctors were surveyed with the questionnaire after scientific meetings during February 2017 to January 2018 through WeChat or conference digital platforms or in paper form. Descriptive statistics was used to analyze the responses to the questionnaire. RESULTS: Overall, 314 valid questionnaires were confirmed. Regarding diagnosis, 77% agreed that osteoporosis could be diagnosed once an osteoporotic fracture occurred; 83% believed that the bone mineral density criteria for osteoporosis diagnosis would be T ≤ -2.5 SD. For treatment, almost all (99.7%) agreed with anti-osteoporosis treatment being one of the basic principles of osteoporotic fracture treatment; 71.6% considered bisphosphonates as the most commonly used anti-osteoporosis drug; 97% believed that patients who have used anti-osteoporosis drugs should reassess osteoporosis after osteoporotic fractures instead of discontinue; 95% thought that the patients who did not use anti-osteoporosis medications before osteoporotic fracture should be treated with anti-osteoporosis drugs after fracture treatment as early as possible; 89% agreed that the standard use of bisphosphonates after osteoporotic fracture would not affect bone healing adversely; 59% believed the course of bisphosphonates treatment for osteoporosis would be 3-5 years, and 27% considered it to be 1-3 years. The patient follow-up rate was poor: 46% selected follow-up rate <30%; only 20% selected follow-up rate >50%. Only 31% of the hospitals had long-term management programs for osteoporotic fractures. CONCLUSIONS: Doctors generally adhered to the updated Chinese guidelines for osteoporotic fractures; frequent participation in medical education can help doctors to increase their awareness of osteoporosis as well as their acceptance and practice of the guidelines.


Asunto(s)
Competencia Clínica , Educación Médica Continua/estadística & datos numéricos , Adhesión a Directriz/estadística & datos numéricos , Fracturas Osteoporóticas/diagnóstico , Pautas de la Práctica en Medicina/estadística & datos numéricos , China , Estudios Transversales , Difosfonatos/uso terapéutico , Humanos , Fracturas Osteoporóticas/tratamiento farmacológico , Encuestas y Cuestionarios
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