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1.
Acta Biomed ; 93(S1): e2022257, 2022 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-36129726

RESUMO

BACKGROUND AND AIM: Number of hip prosthesis implants in arthritis, number of patients treated with bisphosphonates to prevent fragility fractures and, together, number of atypical femoral fracture's cases are increasing. CASE SERIES: This article describes two cases of hip arthritis, treated with hip replacement, in patients using bisphosphonates for a long time; in both cases an incomplete atypical femoral fracture was misdiagnosed before the surgery. Authors describe the importance to carry out a complete osteometabolic and radiographic pre-operative examination of patients in treatment with bisphosphonates going to hip replacement, to check the possible presence of incomplete atypical femoral fracture and to optimize surgical and pharmacological treatment. CONCLUSIONS: In hip prosthesis surgery, prior diagnosis of incomplete atypical femoral fractures can indicate the choice of a different kind of prosthesis stem to optimize surgical results. This can also positively impact to rehabilitation in term of duration and daily activities recovery.


Assuntos
Artrite , Artroplastia de Quadril , Fraturas do Fêmur , Fraturas do Quadril , Prótese de Quadril , Artrite/induzido quimicamente , Artrite/tratamento farmacológico , Artrite/cirurgia , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Difosfonatos/efeitos adversos , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/etiologia , Fraturas do Fêmur/cirurgia , Fraturas do Quadril/cirurgia , Prótese de Quadril/efeitos adversos , Humanos , Estudos Retrospectivos
2.
An. pediatr. (2003. Ed. impr.) ; 97(3): 190-198, Sept. 2022. tab, ilus
Artigo em Inglês, Espanhol | IBECS | ID: ibc-207805

RESUMO

Introducción: Los estudios sobre efectividad y seguridad de los bisfosfonatos en osteoporosis infantil secundaria (OIS) son escasos. El objetivo fue analizar efectividad y seguridad de los bisfosfonatos en OIS. Pacientes y métodos: Estudio multicéntrico retrospectivo en <18 años afectos de OIS tratados con bisfosfonatos. Se recogieron variables clínicas. Se valoró densidad mineral ósea mediante el Z-score de densidad mineral ósea en columna lumbar (ZDMOcl) medido por absorciometría de rayos X de doble energía (DXA). Valoramos efectividad en función del cambio del ZDMOcl al año y a los dos años de su inicio y del descenso del número de fracturas/año. Los eventos adversos reportados fueron recogidos. Se realizó análisis descriptivo y bivariante. Resultados: Se reclutaron 32 pacientes. El ZDMOcl se incrementó al año del inicio del tratamiento ([-2,46±0,96] vs. [-1,54±1,38]; p<0,001). El número de fracturas/año disminuyó significativamente (1 [1-2] vs. 0 [0-0,61]; p<0,001). El cambio en el ZDMOcl fue mayor en los pacientes deambulantes (1,88+/- 0,72 vs. 0,55+/-0,82; p=0,07) y se correlacionó positivamente con el percentil del IMC (rho:0,564; p<0,001). El descenso del número de fracturas/año fue mayor en los pacientes con menor tasa inicial de fracturas (rho:-0,47; p=0,006) y cuanto mayor era el Z-score inicial (rho:-0,47; p=0,07). Se reportaron 10 eventos adversos leves en 7 pacientes (22%), todos con bisfosfonatos intravenosos. No se halló relación entre eventos adversos y las variables estudiadas. Conclusiones: Los bisfosfonatos son efectivos en OIS. La respuesta parece ser mejor en pacientes deambulantes, bien nutridos y en estadios precoces de la enfermedad. Resultan seguros, siendo los efectos adversos leves, aunque frecuentes. (AU)


Introduction: There are few studies on effectiveness and safety of bisphosphonate therapy in secondary osteoporosis in children. The aim of this research was to analyse effectiveness and safety of bisphosphonates in secondary osteoporosis in children. Patients and methods: Multicentre retrospective study in patients younger than 18 suffering from secondary osteoporosis and who had received bisphosphonates. Clinical data were recorded. Bone mineral density was assessed in terms of bone mineral density Z-score in lumbar spine (ZBMDls) measured by dual-energy X-ray absorptiometry (DXA). Effectiveness was valued at changes in ZBMDls one and two years after the onset of bisphosphonates and at the decrease in the number of fractures a year. Adverse events reported were recorded. Descriptive and bivariant analysis were performed. Results: 32 patients were recruited. ZBMDls increased one year after the onset of treatment ([−2.46±0.96] vs. [−1.54±1.38]; p<.001). Fractures a year decreased significantly (1 [1–2] vs. 0 [0–0.61]; p<,001). ZBMDls increase was higher in patients who were able to walk (1.88±0.72 vs. 0.55±0.82; p=.07) and correlated positively with body mass index (BMI) for age percentile (rho: 0.564; p<.001). The decrease in the number of fractures a year was higher in patients with lower initial fracture rate (rho: −0.47; p=.006) and with higher initial ZBMDls (rho: −0.47; p=.07). 10 adverse events were reported in 7 patients (22%), all of them intravenous bisphosphonates related. No association was found between adverse events and studied variables. Conclusions: Bisphosphonates are effective in secondary osteoporosis in children. Response seems to be better in patients who are able to walk, well-nourished and in the early stages of the disease. Adverse events were frequent but mild. (AU)


Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Difosfonatos , Osteoporose/tratamento farmacológico , Resultado do Tratamento , Estudos Longitudinais , Estudos Retrospectivos , Epidemiologia Descritiva
3.
Med Eng Phys ; 107: 103859, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36068034

RESUMO

The increased life expectancy has boomed the demand of dental implants in the elderly. As a consequence, considering the effect of poorer bone quality, due to aging or associated diseases such as osteoporosis, on the success of dental restoration is becoming increasingly important. Bisphosphonates are one of the most used drugs to overcome the effect of osteoporosis as they increase bone density. Bisphosphonates modify the physiological bone remodeling process by adhering to the bone surface, reducing the activity of osteoclasts. This study aims at comparing the effect on bone remodeling of two drug delivery methods of Bisphosphonates: local delivery by coating the implant surface and systemic delivery. A chemo-mechano-biological bone remodeling model validated in a previous paper was used here. The two drug delivery schemes were modeled by means of a finite element approach. In the systemic drug delivery case, the amount of drug that reaches the bone compartment was calculated using a pharmacokinetic model while in the local drug delivery system, the dose was calculated using Fickean diffusion. In particular, the effect of Zoledronate is studied here. The two drug delivery approaches are compared between them and with a control case with no drug. The results show that the use of Bisphosphonates increases the mechanical strength of bone, thus improving the implant fixation along time. Systemic drug delivery affects the entire skeleton, while local drug delivery only affects the area around the dental implant, which reduces the side effects of Bisphosphonates, such as increasing the mineral content, which may promote bone brittleness and microdamage far from the implant. These results support the conclusion that dental implants coated with Bisphosphonates can be a good solution for osteoporotic or low bone density patients without the long-term side effects of systemic drug delivery.


Assuntos
Implantes Dentários , Osteoporose , Idoso , Implantação Dentária , Difosfonatos/farmacologia , Difosfonatos/uso terapêutico , Sistemas de Liberação de Medicamentos , Humanos , Imidazóis/farmacologia , Imidazóis/uso terapêutico , Osseointegração , Osteoporose/tratamento farmacológico
4.
BMJ Case Rep ; 15(9)2022 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-36127032

RESUMO

Paget disease often presents as a rare asymptomatic lesion of the bone until it progresses into the advanced stages. A senile man was diagnosed with Paget disease of bone on routine dental radiographic analysis. His history of fractures, periodical ill-fitting dentures and frequent pain in the long bones were contributing to the diagnosis. The patient was referred to a general physician where whole body radiographs were taken, which showed several of the classic features of Paget disease. Biochemical analysis was also done in which serum alkaline phosphatase was elevated with all other values within normal limits, confirming the diagnosis. The patient was treated with single-infusion bisphosphonate followed by other required dental procedures. Early diagnosis and prompt management gave a good prognosis, preventing the potential complications.


Assuntos
Adenocarcinoma , Osteíte Deformante , Adenocarcinoma/complicações , Fosfatase Alcalina , Osso e Ossos/patologia , Difosfonatos/uso terapêutico , Humanos , Masculino , Osteíte Deformante/diagnóstico , Radiografia
5.
Front Endocrinol (Lausanne) ; 13: 964578, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36120447

RESUMO

Background: New vertebral compression fracture (VCF) may occur in patients who underwent percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF). However, the risk factors of new VCF remain controversial. The research aimed to analyze the risk factors of new VCF after PVP or PKP. Methods: From August 2019 to March 2021, we retrospectively analyzed the patients who underwent PVP or PKP for OVCF at our institution. Age, gender, body mass index (BMI), smoking, drinking, hypertension, diabetes, fracture location, surgical method, Hounsfield unit (HU) value, preoperative degree of anterior vertebral compression (DAVC), bisphosphonates, bone cement volume, bone cement leakage, and cement distribution were collected. The risk factors were obtained by univariate and multivariate analysis of the data. Results: A total of 247 patients were included in the study. There were 23 patients (9.3%) with new VCF after PVP or PKP. Univariate analysis showed that age (p < 0.001), BMI (p = 0.002), fracture location (p = 0.030), and a low HU value (p < 0.001) were significantly associated with new VCF after PVP or PKP. A low HU value was an independent risk factor for new VCF after PVP or PKP obtained by multivariate regression analysis (OR = 0.963; 95% CI, 0.943-0.984, p = 0.001). Conclusions: In this study, a low HU value was an independent risk factor of new VCF after PVP or PKP.


Assuntos
Fraturas por Compressão , Cifoplastia , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Vertebroplastia , Cimentos Ósseos/efeitos adversos , Difosfonatos , Fraturas por Compressão/complicações , Fraturas por Compressão/cirurgia , Humanos , Cifoplastia/efeitos adversos , Cifoplastia/métodos , Fraturas por Osteoporose/etiologia , Fraturas por Osteoporose/cirurgia , Estudos Retrospectivos , Fatores de Risco , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento , Vertebroplastia/efeitos adversos , Vertebroplastia/métodos
6.
J Coll Physicians Surg Pak ; 32(9): 1165-1169, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36089714

RESUMO

OBJECTIVE: To evaluate the efficacy and safety of zoledronic acid in children with osteogenesis imperfecta (OI). STUDY DESIGN: Descriptive Study. PLACE AND DURATION OF STUDY: National Institute of Child Health, Department of Endocrine and Diabetes, Karachi, Pakistan, from January 2011 to December 2020. METHODOLOGY: Children, with OI registered for the treatment, were included. Zoledronic acid was given to them by intravenous infusion over 30 minutes with a dose of 0.05 mg/Kg/day for a median duration of 60 (24-96) months. To ensure safety, patients were kept for 24 hours after dose administration to monitor any short-term side effects. The patients were assessed after every 3-6 months for frequency of fracture, bone pain, and BMD. RESULT: Out of 82 children [40 females (48.8%) and 42 males (51.2%)], 11 patients (13.4%) had fever and 2 patients (2.4%) had flu-like illness. No other side effects were observed. The annual fracture rate decreased overall from 2.8±1.5 to 0.2±0.5 (˂0.001) in both males (2.6±1.3 to 0.1±0.4) and females (3.1±1.7 to 0.2±0.6). Z-score on DEXA scan showed improvement in BMD overall (-3.9±2.0 to 2.2 ±1.7), in males (-3.7±1.9 to -2.1±1.7) and in females (4.1±2.1 to -2.3±1.8). There were no other long-term side effects like ocular problems, osteonecrosis of the jaw, and delayed healing of the fractures. CONCLUSION: Zoledronate use in children is associated with minimal short-term and long-term side effects with a significant improvement in BMD and decline in fracture rate. KEY WORDS: Osteogenesis imperfecta (OI), Bisphosphonates (BPs), DEXA scan, Bone mineral density (BMD).


Assuntos
Conservadores da Densidade Óssea , Fraturas Ósseas , Osteogênese Imperfeita , Conservadores da Densidade Óssea/efeitos adversos , Criança , Difosfonatos/efeitos adversos , Feminino , Humanos , Masculino , Osteogênese Imperfeita/complicações , Osteogênese Imperfeita/tratamento farmacológico , Resultado do Tratamento , Ácido Zoledrônico/uso terapêutico
7.
J Allied Health ; 51(3): 163-171, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36100711

RESUMO

Interprofessional collaborative practice (IPCP) can be achieved through purposeful interprofessional education of healthcare students within a clinical environment. The purpose of this study was to examine the relationship between past participation of students in IPCP with interprofessional attitudes of students, as measured by the Interprofessional Attitudes Scale (IPAS). It further examined differences in IPAS based on profession. A Pearson correlation examined association of IPCP experience with IPAS scores. An analysis of covariance evaluated group differences, with post-hoc tests examining pairwise differences. Participants (n=170) consisted of students from medicine, physical therapy, social work, nursing, and pharmacy. A positive relationship existed for IPAS scores and IPCP experiences for medical students and pharmacy students, but no other profession. Medical students scored lower on interprofessional attitudes when compared with other professions. Further, when controlling for IPCP experience, IPAS scores differed between medical students and all other professions for total score as well as the teamwork, roles and responsibilities subdomain. Results indicate that the volume of IPCP experience may have a relationship with interprofessional attitudes among health professional students. Evidence supports the need for continued strategic curricular design to cultivate interprofessional behaviors in students through implementation of greater amounts of IPCP experiences for students.


Assuntos
Relações Interprofissionais , Estudantes de Farmácia , Atitude do Pessoal de Saúde , Comportamento Cooperativo , Difosfonatos , Ocupações em Saúde/educação , Humanos
8.
Korean J Intern Med ; 37(5): 1011-1020, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36068717

RESUMO

BACKGROUND/AIMS: Despite the prominence of denosumab as the number one prescribed anti-osteoporosis drug in Korea, the effects of denosumab in male osteoporosis patients were not researched sufficiently. Moreover, concerns on rebound vertebral fractures associated with poor denosumab adherence exist. METHODS: We retrospectively evaluated 147 Korean male osteoporosis patients treated with denosumab. After 12 months of treatment, 60 patients were lost during follow-up, and eight were excluded due to missing data. Out of the initial 147 patients, 79 were considered eligible for the analysis of the efficacy of denosumab. 54 patients were initially drug-naïve, and 25 had previously received bisphosphonate therapy. RESULTS: In 54 drug-naïve patients, significant increases in bone mineral density (BMD) were observed in all measurement sites: 5.2% ± 3.7% in the lumbar spine, 2.3% ± 2.8% in the femoral neck, and 1.9% ± 2.8% in the total hip (p < 0.01, respectively). Trabecular bone score showed an increase of 0.5% ± 5.8% in drug-naïve patients. Likewise, in 25 patients with previous bisphosphonate treatment, increase in BMD were observed as well: 4.8% ± 3.5% in the lumbar spine, 1.4% ± 3.6% in the femoral neck, and 0.8% ± 2.1% in the total hip (p < 0.01, p = 0.06, p = 0.06, respectively). Significant declines of -55.1% ± 31.8% in C-terminal telopeptide of type 1 collagen (CTX), and -62.9% ± 21.3% in total procollagen 1 N-terminal propeptide (P1NP), in drug-naïve patients; and -37.7% ± 41.5%, in CTX and -55.4% ± 30.1%, in P1NP in patients with previous bisphosphonate treatment were exhibited after 12 months of treatment. The adherence rates of the second and third dosing schedules were 79.9% and 56.8%, respectively. CONCLUSION: Our study indicates that denosumab is effective in increasing BMD in Korean osteoporosis males regardless of prior bisphosphonate treatment.


Assuntos
Conservadores da Densidade Óssea , Osteoporose Pós-Menopausa , Osteoporose , Densidade Óssea , Conservadores da Densidade Óssea/efeitos adversos , Denosumab/efeitos adversos , Difosfonatos/farmacologia , Difosfonatos/uso terapêutico , Feminino , Humanos , Masculino , Osteoporose/complicações , Osteoporose/tratamento farmacológico , Estudos Retrospectivos
9.
Artigo em Inglês | MEDLINE | ID: mdl-36078614

RESUMO

In patients with osteoporosis receiving antiresorptive agents (ARs), it has been widely practiced to withdraw ARs for several months before tooth extraction and during treatment if medication-related osteonecrosis of the jaw (MRONJ) develops. This study examined the effects of drug holidays on recovery from osteoclast suppression and the treatment outcomes. The relationship between the period of the drug holidays and treatment outcomes was examined retrospectively in 166 osteoporosis patients with MRONJ who received ARs. Histological examinations using hematoxylin and eosin staining and cathepsin K stains were performed to observe the recovery from osteoclast suppression in 43 patients in whom living bone was observed in the resection margins of the surgical specimens. Three-month AR drug holidays were not significantly correlated with the treatment outcomes of the 139 patients who underwent surgical treatment and the 27 who underwent conservative treatment. Of the 43 patients who underwent histological investigations, 16 had drug holidays from 7 to 678 days. Osteoclast suppression was observed in almost all patients, except in one without a drug holiday and one with a 261-day drug holiday. These findings suggest that AR drug holidays for approximately 3 months neither recover osteoclast suppression nor affect treatment outcomes.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Conservadores da Densidade Óssea , Osteoporose , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/tratamento farmacológico , Conservadores da Densidade Óssea/uso terapêutico , Difosfonatos/efeitos adversos , Humanos , Osteoclastos , Osteoporose/tratamento farmacológico , Estudos Retrospectivos , Resultado do Tratamento
10.
Acta Chir Orthop Traumatol Cech ; 89(4): 312-314, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36055673

RESUMO

Bisphosphonates are commonly used in the treatment of osteoporosis. Long-term use without drug holiday causes the risk of atypical fractures. Subtrochanteric and femoral stress fractures are among the frequently described complications. In our case report; a stress fracture of the scapular spine, a previously undescribed adverse effect of bisphosphonates, is presented. Key words: bisphosphonates, scapular spine, stress fracture, drug holiday.


Assuntos
Conservadores da Densidade Óssea , Fraturas do Fêmur , Fraturas de Estresse , Fraturas do Ombro , Fraturas da Coluna Vertebral , Conservadores da Densidade Óssea/efeitos adversos , Difosfonatos/efeitos adversos , Fraturas do Fêmur/induzido quimicamente , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/cirurgia , Fraturas de Estresse/induzido quimicamente , Fraturas de Estresse/diagnóstico por imagem , Humanos , Fraturas da Coluna Vertebral/induzido quimicamente , Fraturas da Coluna Vertebral/complicações
11.
Sci Rep ; 12(1): 14967, 2022 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-36056121

RESUMO

Glucocorticoids are widely used for a variety of diseases, but the prevention of glucocorticoid-induced osteoporosis is sometimes neglected. Therefore, the effectiveness of a computerized clinical decision support system (CDSS) to improve the performance rate of preventive care for glucocorticoid-induced osteoporosis was evaluated. We conducted a prospective cohort study of outpatients who used glucocorticoids for three months or longer and who met the indication for preventive care based on a guideline. The CDSS recommended bisphosphonate (BP) prescription and bone mineral density (BMD) testing based on the risk of osteoporosis. The observation period was one year (phase 1: October 2017-September 2018) before implementation and the following one year (phase 2: October 2018-September 2019) after implementation of the CDSS. Potential alerts were collected without displaying them during phase 1, and the alerts were displayed during phase 2. We measured BP prescriptions and BMD testing for long-term prescription of glucocorticoids. A total of 938 patients (phase 1, 457 patients; phase 2, 481 patients) were included, and the baseline characteristics were similar between the phases. The median age was 71 years, and men accounted for 51%. The primary disease for prescription of glucocorticoids was rheumatic disease (28%), followed by hematologic diseases (18%). The prevalence of patients who needed an alert for BP prescription (67% vs. 63%, P = 0.24) and the acceptance rate of BP prescription (16% vs. 19%, P = 0.33) were similar between the phases. The number of patients who had orders for BMD testing was significantly increased (4% vs. 24%, P < 0.001) after CDSS implementation. The number of patients who needed an alert for BMD testing was significantly decreased from 93% in phase 1 to 87% in phase 2 (P = 0.004). In conclusion, the CDSS significantly increased BMD testing in patients with a higher risk of glucocorticoid-induced osteoporosis, but did not increase BP prescription.


Assuntos
Conservadores da Densidade Óssea , Sistemas de Apoio a Decisões Clínicas , Osteoporose , Idoso , Densidade Óssea , Conservadores da Densidade Óssea/uso terapêutico , Difosfonatos/uso terapêutico , Glucocorticoides/efeitos adversos , Humanos , Masculino , Osteoporose/induzido quimicamente , Osteoporose/tratamento farmacológico , Osteoporose/prevenção & controle , Estudos Prospectivos
12.
Genesis ; 60(8-9): e23500, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36106755

RESUMO

Since the initial description of medication-related osteonecrosis of the jaw (MRONJ) almost two decades ago, the potential pathophysiology and risk factors have been elaborated on in many investigations and guidelines. However, the definitive pathophysiology based on scientific evidence remains lacking. Consequently, the optimal clinical treatment and prevention strategies for MRONJ have not been established. Despite their different mechanisms of action, many drugs, including bisphosphonates, denosumab, angiogenesis inhibitors, and other medications, have been reported to be associated with MRONJ lesions in cancer and osteoporosis patients. Importantly, MRONJ occurs predominantly in the jawbones and other craniofacial regions, but not in the appendicular skeleton. In this up-to-date review, the currently available information and theories regarding MRONJ are presented from both clinical and basic science perspectives. The definition and epidemiology of MRONJ, triggering medication, and histopathology are comprehensively summarized. The immunopathology and the potential pathophysiology based on immune cells such as neutrophils, T and B cells, macrophages, dendritic cells, and natural killer cells are also discussed. In addition, antiangiogenesis, soft tissue toxicity, necrotic bone, osteocyte death, and single-nucleotide polymorphisms are examined. Moreover, other possible mechanisms of MRONJ development are considered based on the unique embryological characteristics, different cell behaviors between jawbones and appendicular skeleton, unique anatomical structures, and sustained bacterial exposure in the oral cavity as a basis for MRONJ site specificity. Based on the literature review, it was concluded that multiple factors may contribute to the development of MRONJ, although which one is the key player triggering MRONJ in the craniofacial region remains unknown.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Conservadores da Densidade Óssea , Inibidores da Angiogênese/efeitos adversos , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/tratamento farmacológico , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/etiologia , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/prevenção & controle , Conservadores da Densidade Óssea/efeitos adversos , Denosumab/efeitos adversos , Difosfonatos/efeitos adversos , Humanos , Nucleotídeos
13.
Sr Care Pharm ; 37(9): 458-467, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-36038998

RESUMO

Antiresorptive medications, including bisphosphonates and RANK-L inhibitors, are commonly used to treat various skeletal pathologies. One devastating complication associated with these drugs is medication-related osteonecrosis of the jaw (MRONJ). Patients who develop MRONJ suffer immensely from oral lesions that may persist, even with treatment, until their death. The jawbone is known to remodel 5 to 10 times faster than skeletal bone. Dentists are at the forefront in managing the severe maxillofacial repercussions of MRONJ. Because MRONJ risk is relatively low (reportedly 0.7% to 6.7%) it is underappreciated by many clinical specialties. The minimization of MRONJ is further compounded because it may take months or years to develop. To date, dental treatment protocols are based more on expert opinion than concrete scientific evidence. This iatrogenic, intractable illness is discouraging for both the patient and the treating dentist. To promote multidisciplinary understanding and cooperation, a single MRONJ case caused by intravenous pamidronate is presented, along with commentary from a dentist's perspective. The intent is that these data will increase awareness of MRONJ's stomatognathic consequences to the physician, who prescribed the causative agent, and the pharmacist, who dispensed it. Collaboration between the dentist, physician, and pharmacist has tremendous potential to improve treatment strategies and, ultimately, optimize patient care.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Conservadores da Densidade Óssea , Médicos , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/etiologia , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/prevenção & controle , Conservadores da Densidade Óssea/efeitos adversos , Odontólogos , Difosfonatos/efeitos adversos , Humanos
14.
Acta Orthop Belg ; 88(2): 255-262, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36001830

RESUMO

Osteogenesis imperfecta is a rare congenital disease of connective tissue characterized by recurrent fractures and progressive skeletal deformities which may impact on gait. The aims of this prospective study were to identify gait deviations in children with osteogenesis imperfecta compared to age-matched controls and establish relationships with clinical features. We evaluated 22 patients with different types of osteogenesis imperfecta using three-dimensional gait analysis. The incidence and location of frac- tures, fracture at birth, age at first fracture, use of intramedullary rodding and number of surgical in- terventions in the lower extremities, bone mineral density, hypermobility and number of injections of bisphosphonates were recorded for each patient. Step length was lower in the osteogenesis imperfecta group compared with the control group. Kinematics showed that sagittal pelvic and transversal hip range of motion were higher in the osteogenesis imperfecta group, whereas sagittal knee range of motion during swing phase was reduced. Regarding kinetics, hip flexion moment and hip negative power peak were significantly decreased in the osteogenesis imperfecta group. Mechanical and energetic parameters were considered as normal. The principal component analysis revealed that the bone mineral density was increased in children who had received more in- jections of bisphosphonates and these had also less deficit in kinematic parameters. Main modifications in gait parameters were observed in spatiotemporal, kinematic and kinetic data. More studies are necessary to allow stratification of severity of the osteogenesis imperfecta disease, help improve its challenging multidisciplinary treatment and ob- jectively assess treatment outcomes.


Assuntos
Osteogênese Imperfeita , Criança , Difosfonatos/uso terapêutico , Marcha , Análise da Marcha , Humanos , Recém-Nascido , Osteogênese Imperfeita/complicações , Estudos Prospectivos
16.
Arch Osteoporos ; 17(1): 110, 2022 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-35920939

RESUMO

PURPOSE/INTRODUCTION: The objective of this study was to describe osteoporosis-related care patterns during the coronavirus disease 2019 (COVID-19) pandemic in Alberta, Canada, relative to the 3-year preceding. METHODS: A repeated cross-sectional study design encompassing 3-month periods of continuous administrative health data between March 15, 2017, and September 14, 2020, described osteoporosis-related healthcare resource utilization (HCRU) and treatment patterns. Outcomes included patients with osteoporosis-related healthcare encounters, physician visits, diagnostic and laboratory test volumes, and treatment initiations and disruptions. The percent change between outcomes was calculated, averaged across the control periods (2017-2019), relative to the COVID-19 periods (2020). RESULTS: Relative to the average control March to June period, all HCRU declined during the corresponding COVID-19 period. There was a reduction of 14% in patients with osteoporosis healthcare encounters, 13% in general practitioner visits, 9% in specialist practitioner visits, 47% in bone mineral density tests, and 13% in vitamin D tests. Treatment initiations declined 43%, 26%, and 35% for oral bisphosphonates, intravenous bisphosphonates, and denosumab, respectively. Slight increases were observed in the proportion of patients with treatment disruptions. In the subsequent June to September period, HCRU either returned to or surpassed pre-pandemic levels, when including telehealth visits accounting for 33-45% of healthcare encounters during the COVID periods. Oral bisphosphonate treatment initiations remained lower than pre-pandemic levels. CONCLUSIONS: This study demonstrates the COVID-19 pandemic and corresponding public health lockdowns further heightened the "crisis" around the known gap in osteoporosis care and altered the provision of care (e.g., use of telehealth and initiation of treatment). Osteoporosis has a known substantial care and management disparity, which has been classified as a crisis. The COVID-19 pandemic created additional burden on osteoporosis patient care with healthcare encounters, physician visits, diagnostic and laboratory tests, and treatment initiations all declining during the initial pandemic period, relative to previous years.


Assuntos
COVID-19 , Osteoporose , Alberta/epidemiologia , COVID-19/epidemiologia , COVID-19/terapia , Controle de Doenças Transmissíveis , Estudos Transversais , Difosfonatos/uso terapêutico , Humanos , Osteoporose/epidemiologia , Osteoporose/terapia , Pandemias
17.
Cells ; 11(15)2022 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-35954151

RESUMO

Multiple Myeloma (MM) is a hematologic malignancy characterized by the proliferation of monoclonal plasma cells localized within the bone marrow. Bone disease with associated osteolytic lesions is a hallmark of MM and develops in the majority of MM patients. Approximately half of patients with bone disease will experience skeletal-related events (SREs), such as spinal cord compression and pathologic fractures, which increase the risk of mortality by 20-40%. At the cellular level, bone disease results from a tumor-cell-driven imbalance between osteoclast bone resorption and osteoblast bone formation, thereby creating a favorable cellular environment for bone resorption. The use of osteoclast inhibitory therapies with bisphosphonates, such as zoledronic acid and the RANKL inhibitor denosumab, have been shown to delay and lower the risk of SREs, as well as the need for surgery or radiation therapy to treat severe bone complications. This review outlines our current understanding of the molecular underpinnings of bone disease, available therapeutic options, and highlights recent advances in the management of MM-related bone disease.


Assuntos
Produtos Biológicos , Neoplasias Ósseas , Reabsorção Óssea , Mieloma Múltiplo , Produtos Biológicos/uso terapêutico , Neoplasias Ósseas/tratamento farmacológico , Reabsorção Óssea/tratamento farmacológico , Difosfonatos/uso terapêutico , Humanos , Mieloma Múltiplo/complicações , Mieloma Múltiplo/tratamento farmacológico
18.
Eur J Endocrinol ; 187(4): R65-R80, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-35984345

RESUMO

Fractures occur in about half of older White women, and almost a third of older White men. However, 80% of the older individuals who have fractures do not meet the bone density definition of osteoporosis, suggesting that this definition is not an appropriate threshold for offering treatment. Fracture risk can be estimated based on clinical risk factors with or without bone density. A combination of calculated risk, fracture history, and bone density is used in treatment decisions. Medications available for reducing fracture risk act either to inhibit bone resorption or to promote bone formation. Romosozumab is unique in that it has both activities. Bisphosphonates are the most widely used interventions because of their efficacy, safety, and low cost. Continuous use of oral bisphosphonates for >5 years increases the risk of atypical femoral fractures, so is usually punctuated with drug holidays of 6-24 months. Denosumab is a further potent anti-resorptive agent given as 6-monthly s.c. injections. It is comparable to the bisphosphonates in efficacy and safety but has a rapid offset of effect after discontinuation so must be followed by an alternative drug, usually a bisphosphonate. Teriparatide stimulates both bone formation and resorption, substantially increases spine density, and reduces vertebral and non-vertebral fracture rates, though data for hip fractures are scant. Treatment is usually limited to 18-24 months, followed by the transition to an anti-resorptive. Romosozumab is given as monthly s.c. injections for 1 year, followed by an anti-resorptive. This sequence prevents more fractures than anti-resorptive therapy alone. Because of cost, anabolic drugs are usually reserved for those at very high fracture risk. 25-hydroxyvitamin D levels should be maintained above 30 nmol/L, using supplements if sunlight exposure is limited. Calcium intake has little effect on bone density and fracture risk but should be maintained above 500 mg/day using dietary sources.


Assuntos
Conservadores da Densidade Óssea , Fraturas Ósseas , Osteoporose Pós-Menopausa , Osteoporose , Densidade Óssea , Denosumab/uso terapêutico , Difosfonatos/uso terapêutico , Feminino , Fraturas Ósseas/prevenção & controle , Humanos , Masculino , Osteoporose/induzido quimicamente , Osteoporose/tratamento farmacológico , Osteoporose Pós-Menopausa/tratamento farmacológico
19.
Hell J Nucl Med ; 25(2): 132-137, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35913859

RESUMO

OBJECTIVE: To investigate the correlation between the standardized uptake value (SUV) metrics derived from technetium-99m (99mTc) methylene diphosphonate (MDP) single photon emission computed tomography/computed tomography (SPECT/CT) and fluorine-18 (18F) sodium fluoride (NaF) positron emission tomography (PET)/CT. SUBJECTS AND METHODS: A total of 129 metastatic lesions from 14 patients who underwent both 99mTc-MDP SPECT/CT and 18F-NaF PET/CT within one month were included in the analyses. The lesions with markedly increased uptake were semi-automatically segmented into a volume of interest in both SPECT and PET images by taking the 42% of maximum uptake as a threshold. Maximum, average and minimum SUV (namely, SUVmax, SUVmean and SUVmin) were recorded for each lesion. The strength of correlation was evaluated with Pearson's correlation analysis. RESULTS: The correlation coefficitients for SUVmax, SUVmean and SUVmin derived SPECT and PET images were 0.652, 0.653 and 0.635, respectively (all P<0.001). Lesions with a volume of at least 5cm3 demonstrated a stronger correlation, increasing the correlation coefficients to 0.714, 0.724 and 0.686, respectively (all P<0.001). The strongest correlation was seen in the lesions of the appendicular skeleton, with coefficients for SUVmax, SUVmean and SUVmin being 0.769, 0.791 and 0.761, respectively (all P<0.001). CONCLUSION: The SUV metrics derived from 99mTc-MDP SPECT/CT strongly correlate with 18F-NaF PET, especially for relatively large lesions located in the appendicular skeleton. Technetium-99m-MDP SPECT/CT could potentially be used as an alternative method to 18F-NaF PET/CT for quantitative evaluation and objective follow-up of bone metastases.


Assuntos
Neoplasias Ósseas , Fluoreto de Sódio , Difosfonatos , Humanos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Tomografia por Emissão de Pósitrons , Tecnécio , Medronato de Tecnécio Tc 99m , Tomografia Computadorizada de Emissão de Fóton Único , Tomografia Computadorizada por Raios X
20.
Expert Rev Endocrinol Metab ; 17(5): 455-462, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35974686

RESUMO

BACKGROUND: The treatment of osteoporosis involves medications that reduce the risk of fractures, but some medications can decrease bone density. The aim was to identify the treatments, comorbidities, and prescriptions related to reducing bone mineral density in patients with osteoporosis. RESEARCH DESIGN AND METHODS: A cross-sectional study that identified patterns of anti-osteoporotic drug prescriptions for outpatient use and potentially inappropriate prescriptions for patients with osteoporosis based on the drug-dispensing database of 8.5 million people in Colombia. All patients ≥65 years with a diagnosis of osteoporosis were included. RESULTS: A total of 16,362 patients with osteoporosis were identified. They had a median age of 74.4 years, and 47.9% received anti-osteoporotic therapy, especially bisphosphonates (41.6%), and 86.5% received calcium and/or vitamin D supplement. 41.6% of those who had a history of bone fractures were prescribed anti-osteoporotic drugs. Potentially inappropriate prescriptions, especially corticosteroids at doses greater than 5mg prednisolone equivalent (4.4%), were found in 41.4% of cases and were more common in older patients and those with a history of fractures or with cardiovascular, digestive, neurological, psychiatric or neoplastic comorbidities. CONCLUSIONS: A significant proportion of patients had potentially inappropriate prescriptions, especially older patients, those with certain comorbidities, and those receiving comedication with antirheumatic drugs.


Assuntos
Conservadores da Densidade Óssea , Fraturas Ósseas , Osteoporose , Idoso , Conservadores da Densidade Óssea/uso terapêutico , Estudos Transversais , Difosfonatos/uso terapêutico , Fraturas Ósseas/prevenção & controle , Humanos , Prescrição Inadequada , Osteoporose/tratamento farmacológico
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