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1.
Medicine (Baltimore) ; 100(7): e24839, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607854

RESUMO

BACKGROUND: To systematically evaluate the efficacy of teriparatide and bisphosphonates in preventing fractures in postmenopausal women with osteoporosis. MATERIALS AND METHODS: We performed a systematic search of PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) that compared teriparatide and bisphosphonates for osteoporosis treatment. Searches were performed without language restrictions and included studies from beginning of time to March 2019. Two authors independently screened and extracted the selected article. The quality of the included studies was evaluated using the Cochrane system evaluation method. Data were extracted and analysed using RevMan 5.2 software. RESULTS: Nine RCTs were included for a total of 2990 postmenopausal women with osteoporosis. Of these, 1515 patients were treated with teriparatide and 1475 were treated with bisphosphonates. After pooling the data of 9 studies, there were significant differences between teriparatide and bisphosphonates [relative risk (RR): 0.61, 95% confidence interval (CI) (0.51, 0.74)] in the prevention of fractures according to different follow-up durations (P < .05), whatever alendronate [RR: 0.51, 95% CI (0.27, 0.95)] and other bisphosphonates [RR: 0.63, 95% CI (0.51, 0.77)]. In addition, we found significant differences between teriparatide and bisphosphonates in the prevention of vertebral fractures [RR: 0.47, 95% CI (0.35, 0.64)] and non-vertebral fractures [RR: 0.76, 95% CI (0.58,0.99)]. There were no significant differences in adverse effects between teriparatide and bisphosphonates [RR: 0.89, 95% CI (0.76, 1.03)]. CONCLUSIONS: Based on the results of our meta-analysis, teriparatide was better than bisphosphonates in preventing fractures in postmenopausal women with osteoporosis both in the short-term and long-term follow-up periods. Teriparatide was superior to bisphosphonates in preventing vertebral and non-vertebral fractures. These drugs did not differ in terms of their adverse effects. More high-quality studies are needed to compare other factors such as costs and adverse reactions.


Assuntos
Difosfonatos/uso terapêutico , Fraturas Ósseas/prevenção & controle , Osteoporose Pós-Menopausa/tratamento farmacológico , Teriparatida/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Alendronato/uso terapêutico , Conservadores da Densidade Óssea/efeitos adversos , Conservadores da Densidade Óssea/uso terapêutico , Estudos de Casos e Controles , Difosfonatos/efeitos adversos , Feminino , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/etiologia , Humanos , Incidência , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/complicações , Ensaios Clínicos Controlados Aleatórios como Assunto , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/prevenção & controle , Teriparatida/efeitos adversos , Resultado do Tratamento
2.
Instr Course Lect ; 70: 465-474, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33438928

RESUMO

This chapter is largely drawn from the recently published (2019) clinical practice guideline on the treatment of metastatic carcinoma and myeloma of the femur jointly produced by the Musculoskeletal Tumor Society, American Society for Radiation Oncology, and American Society of Clinical Oncology. Previous clinical practice guidelines on this topic broadly addressed the potential benefits of bone-targeted agents (eg, diphosphonates) on skeletal-related events, a broad term that encompasses pathologic fractures of any bone, need for surgery or radiation, and hypercalcemia. Guidelines on the use of palliative radiation therapy primarily focused on short-term pain control and long-term radiation-induced adverse effects. The starting goals of this guideline were twofold-focus on the femur, as fractures of the femur almost always require surgery and, when about the hip, dramatically alter patients' quality of life and, potentially, survival; and to address this topic in a multidisciplinary fashion that includes the insights of orthopaedic surgeons, along with radiation oncologists and medical oncologists. For many important clinical topics, there is a dearth of evidence, which will hopefully prompt researchers and funding agencies to help fill these evidentiary gaps.


Assuntos
Fraturas Ósseas , Fraturas Espontâneas , Difosfonatos/uso terapêutico , Fêmur , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/prevenção & controle , Humanos , Qualidade de Vida
3.
Instr Course Lect ; 70: 527-536, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33438933

RESUMO

Osteoporosis is a skeletal condition characterized by decreased bone mineral density and poor bone quality with resultant greater fracture risk. There has been a focus on bone mineral density deficiency, which is easily measured with dual-energy x-ray absorptiometry and managed with pharmaceutic medications. More recently, impaired bone quality independent of bone mineral density has been recognized as a potential cause of fragility fracture and poor bone healing. Many conditions lead to poor bone quality; the most common is vitamin D deficiency and others are genetic causes and other nutritional deficits. In addition, the cellular and molecular changes associated with osteoporosis are being investigated and are potential targets for treatment. Treatment of patients with poor bone health include nutritional supplementation with vitamin D and calcium, weight-bearing exercises, and antiosteoporotic medications when warranted. Antiosteoporotic medications include antiresorptive drugs such as diphosphonate and denosumab that inhibit osteoclastic bone resorption. Anabolic agents such as teriparatide, abaloparatide, and romosozumab stimulate osteoblastic differentiation and bone formation. All these agents are effective in reducing fracture risk.


Assuntos
Conservadores da Densidade Óssea , Osteoporose , Fraturas por Osteoporose , Densidade Óssea , Conservadores da Densidade Óssea/uso terapêutico , Difosfonatos , Humanos , Osteoporose/tratamento farmacológico
4.
Ann Intern Med ; 174(1): JC9, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33395342

RESUMO

SOURCE CITATION: Black DM, Geiger EJ, Eastell R, et al. Atypical femur fracture risk versus fragility fracture prevention with bisphosphonates. N Engl J Med. 2020;383:743-53. 32813950.


Assuntos
Fraturas do Fêmur , Fraturas por Osteoporose , Difosfonatos/efeitos adversos , Feminino , Fraturas do Fêmur/induzido quimicamente , Fraturas do Fêmur/epidemiologia , Fêmur , Humanos , Fraturas por Osteoporose/induzido quimicamente , Fraturas por Osteoporose/epidemiologia
5.
Arch Osteoporos ; 16(1): 8, 2021 01 06.
Artigo em Inglês | MEDLINE | ID: mdl-33409668

RESUMO

Treatment rates for osteoporosis after a major osteoporotic fracture are unacceptably low. We evaluate the effectiveness of an ortho-geriatric team (OGT) in initiating pharmacologic therapy for osteoporosis post-hip fracture. The OGT was able to achieve a higher treatment rate for patients post-hip fracture in comparison to usual care provided by the primary care hospitalist. Potential reasons for delaying or not proceeding with drug therapy include patient concern regarding potential rare side effects of antiresorptive therapy including osteonecrosis of the jaw and atypical femoral fracture. These events however are rare, and in this study, only 3% of hip fractures were atypical femoral fractures. INTRODUCTION: Currently, a significant care gap for osteoporosis therapy exists post-hip fracture despite advances in pharmacologic therapy. We evaluate the effectiveness of the OGT at the Oakville Trafalgar Memorial Hospital (OTMH), Ontario, Canada, in reducing the care gap and initiating pharmacologic therapy in hip fracture patients prior to hospital discharge. We also evaluated the incidence of atypical femoral fracture (AFF) separately. METHODS: A retrospective chart review of patients 59 years and older with a hip fracture admitted to OTMH from January 1, 2016, to February 1, 2017, was conducted. The primary outcome was the proportion of hip fracture patients discharged from the hospital with appropriate treatment for their underlying osteoporosis. A sub-analysis was completed reporting the incidence of AFF among older adults. RESULTS: A total of 197 patients with a hip fracture were identified, 134/197 (68%) patients were seen by the OGT, 98/134 (73%) of these patients were started on pharmacologic therapy prior to discharge, and 120/134 (89%) of patients seen by the OGT were on treatment within 3 months of discharge following assessment in the complex osteoporosis clinic. Sixty-three patients of the 197 (63/197) (32%) of the hip fracture patients were seen by a hospitalist, and treatment rates prior to discharge were 5%. Only 6/197 patients had experienced an AFF during the study period, and all patients with an atypical femoral fracture had been on long-term bisphosphonate therapy. All of the patients with an AFF had thigh or groin pain for several weeks to months prior to the development of the atypical femoral fracture, providing an opportunity to stop therapy and possibly prevent the development of a complete AFF. CONCLUSION: The OGT was able to initiate anti-osteoporosis therapy in significantly more patients in comparison to usual care, and higher treatment rates are possible with an OGT.


Assuntos
Conservadores da Densidade Óssea , Fraturas do Fêmur , Fraturas do Quadril , Osteoporose , Fraturas por Osteoporose , Idoso , Conservadores da Densidade Óssea/efeitos adversos , Difosfonatos , Fraturas do Quadril/epidemiologia , Hospitais Comunitários , Humanos , Ontário , Osteoporose/tratamento farmacológico , Osteoporose/epidemiologia , Fraturas por Osteoporose/epidemiologia , Estudos Retrospectivos
7.
Quintessence Int ; 0(0): 2-7, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33491398

RESUMO

Raloxifene is a selective estrogen receptor modulator (SERM) that is used to manage osteoporosis in women. Because of its tissue selectivity, raloxifene has fewer side effects than estrogen therapy; however, raloxifene-associated osteonecrosis of the jaw (ONJ) has recently been reported. While most of the reported cases were treated with antiresorptive therapy in addition to raloxifene, ONJ can also occur with the isolated use of raloxifene. This report presents a case where there was no prior exposure to bisphosphonates, in which the patient incidentally had florid cemento-osseous dysplasia (FCOD). Raloxifene-associated ONJ has never been reported before in a patient with FCOD. It is unclear whether the presence of FCOD increases the risk of ONJ. Case report: Clinical and radiographic findings regarding an African-American patient with FCOD and raloxifene-induced ONJ are described. The patient underwent a battery of investigations and surgical debridement of the area in question. She has remained disease free in the 2 years following the treatment. Conclusions: The aim of this report is to shed some light on a serious complication of raloxifene, a medication that is increasingly encountered in dental practices. Dental practitioners should use this knowledge to increase their awareness of possible ONJ development after the use of raloxifene. Brief recommendations and guidance in general dental practice for management of patients on raloxifene are also presented.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Conservadores da Densidade Óssea , Osteonecrose , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/diagnóstico por imagem , Conservadores da Densidade Óssea/efeitos adversos , Odontólogos , Difosfonatos , Feminino , Humanos , Papel Profissional , Cloridrato de Raloxifeno/efeitos adversos
8.
Medicine (Baltimore) ; 100(1): e22839, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429726

RESUMO

ABSTRACT: The association between the use of bisphosphonates (BPs) and the risk of lung cancer has been concerned recently. There is no explicit study indicating that whether the use of BPs would affect the risk of lung cancer. So, we conducted a meta-analysis to figure out the relationship between BPs and lung cancer.We searched the databases of PubMed and Embase. The random effects were used to calculate the pooled odds ratios (ORs) and 95% confidence interval (CIs) for the risk of lung cancer in BPs users compared with non-users. The stability of our results was evaluated by the sensitivity analysis. The publication bias was assessed in our study. The data in our study comes from the public database, therefore ethical approval is not necessary. Also, our study did not involve patient consent.Four studies met our inclusion criteria. All the included studies are cohort studies. Our analysis indicated that there was no significant association between the use of BPs and the risk of lung cancer (OR 1.02, 95%CI 0.85- 1.24, I2 71%). In our secondary analysis, the use of alendronate may increase the risk of lung cancer. The pooled OR of 3 studies is (OR 1.10, 95%CI 0.84-1.45, I2 77%), but when we performed a sensitivity analysis, 1 of the OR is (OR 1.23, 95%CI 1.02-1.49, I2 4.1%).This is the most detailed meta-analysis on this topic. And there was no significant association between the use of BPs and lung cancer. However, exposure to alendronate may increase the risk of lung cancer. More studies are needed to confirm our findings.


Assuntos
Protocolos Clínicos , Difosfonatos/efeitos adversos , Neoplasias Pulmonares/etiologia , Alendronato , Conservadores da Densidade Óssea/efeitos adversos , Conservadores da Densidade Óssea/farmacologia , Conservadores da Densidade Óssea/uso terapêutico , Difosfonatos/farmacocinética , Difosfonatos/uso terapêutico , Humanos , Metanálise como Assunto , Razão de Chances , Revisões Sistemáticas como Assunto
10.
Maturitas ; 143: 184-189, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33308627

RESUMO

OBJECTIVE: To prevent osteoporotic fractures in nursing home residents a combination of bisphosphonates, calcium and vitamin D is recommended. This study assessed the prevalence of pharmacological osteoporosis prevention in nursing home residents from eight countries, and assessed its association with patient characteristics. DESIGN: Cross-sectional analyses of the SHELTER study data. We assessed the overall prevalence of osteoporosis medication (OM) use (vitamin D, calcium and bisphosphonates) in residents stratified for falls and fractures over last 30 days, health instability with high mortality risk, cognitive impairment, and dependence in walking. SETTING AND PARTICIPANTS: Nursing home residents in the Czech Republic, England, Finland, France, Germany, Italy, The Netherlands and Israel. RESULTS: Of 3832 eligible residents, vitamin D, calcium and bisphosphonates were used by 16.2%, 10.4%, and 4.5% respectively. All 3 classes of OM together were used by 1.5% of all residents. Of residents with a recent fracture, 9.5% used a bisphosphonate (2.7% all 3 OMs). In patients with recent falls, 20.8% used vitamin D and 15.3% calcium. In residents with severe cognitive impairment, 15.5% used vitamin D and 9.3% used calcium. Of the bisphosphonate users, 33.7% also used both vitamin D and calcium, 25.8% used only calcium in addition and 17.4% only vitamin D in addition. The use of any OM varied widely across countries, from 66.8% in Finland to 3.0% in Israel. CONCLUSIONS AND IMPLICATIONS: We found substantial pharmacological under-treatment of prevention of osteoporosis in residents with recent falls, fractures and dependence in walking. Only two-thirds of bisphosphonate users also took a vitamin D-calcium combination, despite guideline recommendations. On the other hand, possible over-treatment was found in residents with high mortality risk in whom preventive pharmacotherapy might not have still been appropriate. The prevalence of pharmacological prevention of osteoporosis differed substantially between countries. Efforts are needed to improve pharmacotherapy in residents.


Assuntos
Casas de Saúde/estatística & dados numéricos , Osteoporose/tratamento farmacológico , Acidentes por Quedas , Idoso , Idoso de 80 Anos ou mais , Cálcio na Dieta/uso terapêutico , Difosfonatos/uso terapêutico , Uso de Medicamentos/estatística & dados numéricos , Europa (Continente) , Feminino , Humanos , Israel , Masculino , Osteoporose/prevenção & controle , Fraturas por Osteoporose/prevenção & controle , Vitamina D/uso terapêutico , Vitaminas/uso terapêutico
11.
N Z Med J ; 133(1527): 83-94, 2020 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-33332330

RESUMO

AIM: Drug-induced ocular inflammation is rare and may be overlooked as a cause of uveitis. The main objective was to describe the causes of drug-induced ocular inflammation. Secondary objectives included uveitis complications and drug rechallenge reactions. METHODS: A retrospective chart review at Auckland District Health Board's tertiary uveitis clinic (Auckland, New Zealand) was performed. Participants were identified using the uveitis database, which consists of 2,750 subjects. Fifty eyes of 35 subjects had drug-induced inflammation. RESULTS: Drug-induced inflammation occurred in 1.3% of subjects with uveitis. Mean age was 66.8±15.6 years, and 25 subjects (71.4%) were female. Drugs responsible were bisphosphonates (24 subjects, 68.6%), brimonidine (one subject, 2.9%), etanercept (three subjects, 8.6%), immune checkpoint inhibitors (two subjects, 5.7%), BRAF inhibitors (three subjects, 8.6%), EGFR inhibitors (one subject, 2.9%) and allopurinol/perindopril (one subject, 2.9%). In subjects with bisphosphonate inflammation, anterior uveitis occurred in 22 (91.7%) and scleritis in two (8.3%). A positive rechallenge reaction occurred in two subjects with zoledronate and one with alendronate. Uveitis occurred in six subjects (17.1%) treated with cancer drugs including immune checkpoint inhibitors, BRAF inhibitors and EGFR protein kinase inhibitors. Subjects with cancer-drug-induced uveitis were managed with corticosteroids and five subjects were able to continue therapy; in one subject uveitis was uncontrollable and required drug cessation. CONCLUSIONS: Ocular inflammation caused by bisphosphonates is usually mild and resolves on medication withdrawal. Uveitis seen in association with newer cancer medications can be more severe, but in most cases it can be managed without medication cessation.


Assuntos
Difosfonatos/efeitos adversos , Uveíte Anterior/induzido quimicamente , Ácido Zoledrônico/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Alendronato/efeitos adversos , Alopurinol/efeitos adversos , Anti-Inflamatórios não Esteroides/efeitos adversos , Anticorpos Monoclonais Humanizados/efeitos adversos , Anti-Hipertensivos/efeitos adversos , Tartarato de Brimonidina/efeitos adversos , Receptores ErbB/antagonistas & inibidores , Cloridrato de Erlotinib/efeitos adversos , Etanercepte/efeitos adversos , Feminino , Humanos , Imidazóis/efeitos adversos , Masculino , Pessoa de Meia-Idade , Nivolumabe/efeitos adversos , Oximas/efeitos adversos , Inibidores de Proteínas Quinases/efeitos adversos , Proteínas Proto-Oncogênicas B-raf/antagonistas & inibidores , Estudos Retrospectivos , Esclerite/induzido quimicamente , Vemurafenib/efeitos adversos
12.
Artigo em Inglês | MEDLINE | ID: mdl-33353034

RESUMO

The purpose of the present study was to estimate the prevalence of cyclin-dependent kinase (CDK) 4/6 inhibitors use among cancer patients from the medication-related osteonecrosis of the jaw (MRONJ) cohort of the University of Messina. We retrospectively reviewed the records of all patients with either intravenous bisphosphonates or denosumab-related MRONJ reported in the electronic health records of the Unit of Oral Surgery, School of Dentistry, University of Messina between the first quarter of 2018 and the first quarter 2020 to identify eligible patients. We observed six cases of MRONJ associated with CDK4/6 inhibitors concomitantly with intravenous bisphosphonates and/or denosumab in breast cancer patients. The CDK4/6 inhibitors registered were palbociclib (n = 5) and abemaciclib (n = 1). Data of cancer patients diagnosed with MRONJ in the same period (n = 10) were extracted for comparison. The comparative assessment with this group of patients showed a similar distribution of MRONJ stage ranged and clinical course after treatment. The degree of risk for osteonecrosis in patients taking these new classes of drugs is uncertain but warrants awareness and close monitoring. The role of premedication dental evaluation as a prevention strategy has been acknowledged for cancer patients about to initiate intravenous bisphosphonates and/or denosumab for treatment of bone metastasis, but additional attention should be paid to whom are assuming CDK4/6 inhibitors because of their oral adverse events.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/metabolismo , Quinase 4 Dependente de Ciclina/metabolismo , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/epidemiologia , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/etiologia , Conservadores da Densidade Óssea/efeitos adversos , Difosfonatos/efeitos adversos , Feminino , Humanos , Arcada Osseodentária , Masculino , Estudos Retrospectivos
13.
BMJ Case Rep ; 13(12)2020 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-33318265

RESUMO

We present a 9-year-old male child having history of fractures on trivial trauma with a family history of the same. He was treated for osteogenesis imperfecta (OI; zolendronate, calcium and vitamin D) and showed clinical improvement. On evaluating his bone health using dual energy X-ray absorptiometry and peripheral quantitative CT, we found that the child had bone density within the reference range but a smaller bone mass for his height, low muscle mass and thin bones with a lower strength strain index in comparison with healthy children. Our case suggests that treatment with bisphosphonates results in increase in bone density; however, bones remain thin and the lean body mass in these children may also be low. Controlled physical activity to improve muscle health and newer approaches to improve bone geometry would result in better bone health in children with OI.


Assuntos
Absorciometria de Fóton , Densidade Óssea , Osteogênese Imperfeita/diagnóstico por imagem , Osteogênese Imperfeita/fisiopatologia , Tomografia Computadorizada por Raios X , Conservadores da Densidade Óssea/uso terapêutico , Cálcio/uso terapêutico , Criança , Difosfonatos/uso terapêutico , Fraturas Ósseas/etiologia , Fraturas Ósseas/prevenção & controle , Humanos , Masculino , Osteogênese Imperfeita/tratamento farmacológico , Tomografia Computadorizada por Raios X/métodos , Vitamina D/uso terapêutico , Ácido Zoledrônico/uso terapêutico
14.
Georgian Med News ; (306): 41-46, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33130644

RESUMO

The goal of the study is assessing the population structure of lymphocytes and the subpopulation composition of NK cells in the peripheral blood of humans in the case of drug-induced osteonecrosis of the jaw for improving the quality of diagnosis, treatment, and prevention of osteonecrosis of the jaw. Thirty patients were examined, including 15 patients with drug-induced osteonecrosis of the jaw (ONJ), 10 healthy individuals, and five patients with pyoinflammatory diseases of the maxillofacial region, aged 49 to 77. Every four weeks, the patients had been receiving 4 mg intravenous injections of bisphosphonates (the Zometa preparation (zoledronic acid)) for 1.5 - 3 years. The study was performed on a FACS Canto II flow cytometer manufactured by Becton Dickinson (BD), USA. In the patients with ONJ, an imbalance of the NK cell subtypes was observed. As to the common NK cells, the level of subtypes of cytolytic NK cells (CD3-CD16+(or hight)56dim) was elevated, and the level of cytokine-producing cells (СD3-CD16-(or low) 56bright) was reduced, compared to the healthy individuals (p<0.05). In the patients with ONJ, after the surgical treatment, the relative and absolute levels of lymphocytes and the total level of NK cells (CD3-CD16+/56+) normalized on the seventh day. The level of NK cells subtypes did not change after the treatment. This pathology is characterized by a low level of innate protection factors, as evidenced by the reduction of the total population of NK cells, and the imbalance of NK cells subtypes. The imbalance of NK cells (the natural killer cells) was an indicator of unfavorable prognosis for osteonecrosis treatment.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Conservadores da Densidade Óssea , Doenças Maxilomandibulares , Células Matadoras Naturais , Linfócitos , Idoso , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/imunologia , Difosfonatos/efeitos adversos , Humanos , Pessoa de Meia-Idade
15.
Arch Osteoporos ; 15(1): 158, 2020 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-33030619

RESUMO

PURPOSE: Osteoporosis is one of the most common conditions among adults worldwide. It also presents a challenge among patients undergoing spinal surgery. Use of Teriparatide and bisphosphonates in such patients has been shown to improve outcomes after fusion surgery, including successful fusion, decreased risk of instrumentation failure, and patient-reported outcomes. Herein, we performed a systematic review and indirect meta-analysis of available literature on outcomes of fusion surgery after use of bisphosphonates or Teriparatide. METHODS: We conducted a comprehensive search of all databases (Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus) to identify studies assessing outcomes of spinal fusion among osteoporotic patients after use of Teriparatide or bisphosphonate. Four authors independently screened electronic search results, and all four authors independently performed study selection. Two authors performed independent data extraction and assessed the studies' risk of bias assessment using standardized forms of Revised Cochrane risk-of-bias tool for randomized trials (RoB 2) and Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I). RESULTS: Nineteen studies were included in the final analysis. A total of 13 studies evaluated the difference in fusion rate between bisphosphonates and Teriparatide or control group. Fusion rate was higher for bisphosphonates (effect size (ES) 83%, 95% CI 77-89%) compared with Teriparatide (ES 71%, 95% CI 57-85%), with the p value for heterogeneity between groups without statistical significance (p = 0.123). Five studies assessed the impact of using bisphosphonate or Teriparatide on screw loosening. The rate of screw loosening was higher for bisphosphonates (ES 19%, 95% CI 13-25%) compared with Teriparatide (ES 13%, 95% CI 9-16%) without statistical significance (p = 0.52). CONCLUSION: Our results indicate that while both agents may be associated with positive outcomes, bisphosphonates may be associated with a higher fusion rate, while Teriparatide may be associated with lower screw loosening. The decision to treat with either agent should be tailored individually for each patient keeping in consideration the adverse effect and pharmacokinetic profiles.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Difosfonatos/uso terapêutico , Osteoporose/tratamento farmacológico , Teriparatida/uso terapêutico , Conservadores da Densidade Óssea/efeitos adversos , Difosfonatos/efeitos adversos , Humanos , Doenças da Coluna Vertebral/tratamento farmacológico , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/efeitos adversos , Teriparatida/efeitos adversos , Vértebras Torácicas/efeitos dos fármacos , Vértebras Torácicas/cirurgia , Resultado do Tratamento
16.
J Oral Implantol ; 46(4): 431-437, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-33031547

RESUMO

Osteonecrosis of the jaw is a possible oral complication resulting from antiresorptive therapies, such as bisphosphonates (Bfs). Although the etiology is not entirely clear, it has been shown to be dependent on several factors, with the traumatic stimulation caused by the placement of teeth implants indicated as one of the predisposing factors to this pathology. The indications and preventive methods for performing these procedures have been questioned, making it essential to determine the proper protocols. Thus, the present study aims to discuss the risks of the development of osteonecrosis in patients undergoing dental implant surgery who use Bfs as well as to discuss related local and systemic factors and possible methods for preventing this side effect. The study also aims to present a clinical case of an osteopenic patient who used Bfs and underwent rehabilitation through implants according to specific protocols, which resulted in successful treatment.


Assuntos
Conservadores da Densidade Óssea , Implantes Dentários , Osteonecrose , Conservadores da Densidade Óssea/efeitos adversos , Implantes Dentários/efeitos adversos , Difosfonatos , Humanos , Osteonecrose/induzido quimicamente , Osteonecrose/prevenção & controle
17.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 55(10): 783-788, 2020 Oct 09.
Artigo em Chinês | MEDLINE | ID: mdl-33045792

RESUMO

Bisphosphonate (BP), a group of anti-resorptive drugs, has been widely used for the treatments of osteoporosis and metastatic bone diseases. Medication-related osteonecrosis of the jaw (MRONJ), a serious well-recognized complication of patients receiving BP, adversely affects patients' oral health and quality of life. Its clinical signs include pain, bone exposure and necrosis of the jaws. Invasive oral treatments, which may affect the repair of jaws in patients using BP, could cause the occurrence of MRONJ. Therefore, it is important to avoid the risk factors of MRONJ and to standardize the operations in order to reduce the occurrence of MRONJ in oral treatments for patients receiving BP. After reviewing the related literature, this article aims to conclude the research progress on the standardized oral treatments of patients receiving BP and to provide clinical instructions for clinicians to treat these patients.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Osteoporose , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/etiologia , Difosfonatos/efeitos adversos , Humanos , Arcada Osseodentária , Osteoporose/tratamento farmacológico , Qualidade de Vida
18.
Medicine (Baltimore) ; 99(40): e22542, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019463

RESUMO

BACKGROUND: The goal of this study was to review relevant randomized controlled trials or case-control studies to determine the clinical efficacy of minodronate in the treatment of osteoporosis. METHOD: The relevant studies were identified on PubMed, Cochrane, and Embase databases using appropriate keywords. Pertinent sources in the literature were also reviewed, and all articles published through October 2019 were considered for inclusion. For each study, we assessed odds ratios, mean difference, and 95% confidence interval (95% CI) to evaluate and synthesize outcomes. RESULT: Thirteen studies comprising 3740 patients were included in this study. Compared with other drugs, minodronate significantly decreased N-telopeptide of type I collagen/creatinine (weighted mean difference [WMD]: -13.669, 95% confidence interval [CI]: -23.108 to -4.229), bone alkaline phosphatase (BAP) (WMD: -1.26, 95% CI: -2.04 to -0.47) and tartrate-resistant acid phosphatase 5b (WMD: -154.11, 95% CI: -277.85 to -30.37). Minodronate combined with other drugs would significantly decrease BAP (WMD: -3.10, 95% CI: -5.20 to -1.00) than minodronate. Minodronate-naïve would significantly decrease BAP (WMD: -3.00, 95% CI: -5.47 to 0.53) and tartrate-resistant acid phosphatase 5b (WMD: -128.20, 95% CI: -198.11 to -58.29) than minodronate-switch. The incidence of vertebral fracture was significantly decreased in the minodronate group than the other drugs (relative risk: 0.520, 95% CI: 0.363-0.744). CONCLUSION: Minodronate has better clinical efficacy in the treatment of osteoporosis than other drugs (alendronate, risedronate, raloxifene, or eldecalcitol).


Assuntos
Difosfonatos/uso terapêutico , Imidazóis/uso terapêutico , Osteoporose/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Alendronato/uso terapêutico , Fosfatase Alcalina/efeitos dos fármacos , Conservadores da Densidade Óssea/uso terapêutico , Estudos de Casos e Controles , Colágeno Tipo I/efeitos dos fármacos , Creatinina , Quimioterapia Combinada/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cloridrato de Raloxifeno/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Ácido Risedrônico/uso terapêutico , Fraturas da Coluna Vertebral/epidemiologia , Fosfatase Ácida Resistente a Tartarato/efeitos dos fármacos , Resultado do Tratamento , Vitamina D/análogos & derivados , Vitamina D/uso terapêutico
19.
J Craniomaxillofac Surg ; 48(11): 1080-1086, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32998853

RESUMO

PURPOSE: Medication-related osteonecrosis of the jaw (MRONJ) is a previously described debilitating condition in which patients experience progressive bone destruction in the maxilla and/or mandible after exposure to certain drugs. Clinical management of MRONJ remains controversial, with no established guidelines. The aim of our study was to conduct a literature review on the effectiveness of pentoxifylline (PTX) and tocopherol (PENTO protocol) on MRONJ. STUDY DESIGN: A literature review was conducted, using two different scientific databases, to evaluate the effects of PTX and tocopherol on MRONJ. DISCUSSION: PENTO protocol prescription to treat MRONJ was reported to be well tolerated, with minimal side-effects, and non-expensive when compared with other non-surgical treatment modalities. It was shown to relieve painful symptoms in all patients, and significant new bone formation was observed at final follow-up. CONCLUSION: Observational and case-series studies have demonstrated that pentoxifylline and tocopherol are potentially useful in the non-surgical management of MRONJ.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Conservadores da Densidade Óssea , Osteonecrose , Pentoxifilina , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/tratamento farmacológico , Difosfonatos , Humanos , Mandíbula , Osteonecrose/induzido quimicamente , Osteonecrose/tratamento farmacológico , Pentoxifilina/uso terapêutico , Tocoferóis/uso terapêutico
20.
Rev. bras. ortop ; 55(5): 543-550, Sept.-Oct. 2020. graf
Artigo em Inglês | LILACS | ID: biblio-1144202

RESUMO

Abstract Objective The aim of the present study was to determine the effect of combined zoledronic acid and alendronate therapy on bone edema and knee pain in cases of spontaneous osteonecrosis of the knee. We report our experience with this treatment. Methods A retrospective case series of 11 patients with spontaneous osteonecrosis of the knee confirmed by magnetic resonance image (MRI). The patients were treated with a single dose of 5 mg of intravenous zoledronic acid combined with 35 mg twice a week of oral alendronate, for 16 weeks. The visual analogue scale scores were noted before the beginning of the therapy, at 8 weeks, and at 16 weeks of follow-up. The size of the bone marrow edema adjacent to the lesion was measured on T2-weighted MRI coronal images at the beginning of the therapy and at 16 weeks. Results The average visual analogue scale score at 0 weeks was of 7.72, and of 0.81 at 16 weeks of therapy; the difference was statistically significant (p= 0.03). The mean bone marrow involvement at 0 weeks was of 80%, which reduced to 11.81% at 16 weeks of therapy. This change was statistically significant (p= 0.03). Conclusion Our data shows that the combination therapy causes early pain relief and reduction of the bone edema, and it is safe, effective and well-tolerated for a painful disease entity like spontaneous osteonecrosis of the knee.


Resumo Objetivo Determinar o efeito do tratamento combinado de ácido zoledrônico e alendronato no edema ósseo e na dor no joelho em casos de osteonecrose espontânea do joelho. A experiência dos autores com este tratamento é relatada. Métodos Série de casos retrospectiva, incluindo 11 pacientes com osteonecrose espontânea do joelho confirmada por ressonância magnética. Os pacientes foram tratados com uma dose intravenosa única de 5 mg de ácido zoledrônico combinada com 35 mg de alendronato oral, 2 vezes por semana, por 16 semanas. Os escores da escala visual analógica foram aferidos antes do começo do tratamento, em 8 semanas e em 16 semanas de acompanhamento. O tamanho do edema da medula óssea adjacente à lesão foi medido em imagens de ressonância magnética coronal ponderadas em T2 no início do tratamento e em 16 semanas. Resultados O escore médio da escala visual analógica em 0 semanas foi de 7,72, contra 0,81 em 16 semanas de tratamento, uma diferença estatisticamente significativa (p= 0,03). O envolvimento médio da medula óssea em 0 semanas foi de 80%, e foi reduzido para 11,81% em 16 semanas de tratamento, uma diferença também estatisticamente significativa (p= 0,03). Conclusão Os dados mostram que a terapia combinada proporciona alívio da dor inicial e redução do edema ósseo, sendo segura, eficaz e bem tolerada em uma enfermidade dolorosa como a osteonecrose espontânea do joelho.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Osteoartrite , Dor , Osso e Ossos , Medula Óssea , Espectroscopia de Ressonância Magnética , Terapia Combinada , Alendronato , Difosfonatos , Dosagem , Escala Visual Analógica , Ácido Zoledrônico , Articulação do Joelho , Necrose
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