Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.130
Filtrar
1.
Bone Joint J ; 101-B(11): 1402-1407, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31674239

RESUMO

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.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Fraturas do Quadril/cirurgia , Idoso , Cálcio/uso terapêutico , Estudos de Coortes , Denosumab/uso terapêutico , Difosfonatos/uso terapêutico , Humanos , Hidroxicolecalciferóis/uso terapêutico , Adesão à Medicação , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Teriparatida/uso terapêutico , Reino Unido , Vitamina D/uso terapêutico
2.
JAMA ; 320(22): 2325-2334, 2018 12 11.
Artigo em Inglês | MEDLINE | ID: mdl-30535217

RESUMO

Importance: Patients with chronic kidney disease have impaired vitamin D activation and elevated cardiovascular risk. Observational studies in patients treated with hemodialysis showed that the use of active vitamin D sterols was associated with lower risk of all-cause mortality, regardless of parathyroid hormone levels. Objective: To determine whether vitamin D receptor activators reduce cardiovascular events and mortality in patients without secondary hyperparathyroidism undergoing hemodialysis. Design, Setting, and Participants: Randomized, open-label, blinded end point multicenter study of 1289 patients in 207 dialysis centers in Japan. The study included 976 patients receiving maintenance hemodialysis with serum intact parathyroid hormone levels less than or equal to 180 pg/mL. The first and last participants were enrolled on August 18, 2008, and January 26, 2011, respectively. The final date of follow-up was April 4, 2015. Interventions: Treatment with 0.5 µg of oral alfacalcidol per day (intervention group; n = 495) vs treatment without vitamin D receptor activators (control group; n = 481). Main Outcomes and Measures: The primary outcome was a composite measure of fatal and nonfatal cardiovascular events, including myocardial infarctions, hospitalizations for congestive heart failure, stroke, aortic dissection/rupture, amputation of lower limb due to ischemia, and cardiac sudden death; coronary revascularization; and leg artery revascularization during 48 months of follow-up. The secondary outcome was all-cause death. Results: Among 976 patients who were randomized from 108 dialysis centers, 964 patients were included in the intention-to-treat analysis (median age, 65 years; 386 women [40.0%]), and 944 (97.9%) completed the trial. During follow-up (median, 4.0 years), the primary composite outcome of cardiovascular events occurred in 103 of 488 patients (21.1%) in the intervention group and 85 of 476 patients (17.9%) in the control group (absolute difference, 3.25% [95% CI, -1.75% to 8.24%]; hazard ratio, 1.25 [95% CI, 0.94-1.67]; P = .13). There was no significant difference in the secondary outcome of all-cause mortality between the groups (18.2% vs 16.8%, respectively; hazard ratio, 1.12 [95% CI, 0.83-1.52]; P = .46). Of the 488 participants in the intervention group, 199 (40.8%) experienced serious adverse events that were classified as cardiovascular, 64 (13.1%) experienced adverse events classified as infection, and 22 (4.5%) experienced malignancy-related serious adverse events. Of 476 participants in the control group, 191 (40.1%) experienced cardiovascular-related serious adverse events, 63 (13.2%) experienced infection-related serious adverse events, and 21 (4.4%) experienced malignancy-related adverse events. Conclusions and Relevance: Among patients without secondary hyperparathyroidism undergoing maintenance hemodialysis, oral alfacalcidol compared with usual care did not reduce the risk of a composite measure of select cardiovascular events. These findings do not support the use of vitamin D receptor activators for patients such as these. Trial Registration: UMIN-CTR Identifier: UMIN000001194.


Assuntos
Hidroxicolecalciferóis/uso terapêutico , Diálise Renal , Insuficiência Renal Crônica/tratamento farmacológico , Administração Oral , Idoso , Conservadores da Densidade Óssea/farmacologia , Conservadores da Densidade Óssea/uso terapêutico , Doenças Cardiovasculares/prevenção & controle , Morte Súbita Cardíaca/prevenção & controle , Feminino , Humanos , Hidroxicolecalciferóis/farmacologia , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Receptores de Calcitriol/efeitos dos fármacos , Receptores de Calcitriol/metabolismo , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/terapia , Método Simples-Cego
3.
Medicine (Baltimore) ; 97(47): e13159, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30461612

RESUMO

This study aimed to explore the therapeutic efficacy and safety of alfacalcidol among Chinese postmenopausal women (age >65 years) with osteoporosis or osteopenia.A total of 62 postmenopausal women with osteoporosis or osteopenia (>65 years) were recruited from urban residential community of Beijing. The patients daily took oral calcium and alfacalcidol (Alpha D3, 1 µg) for 9 months. Safety and efficacy assessments were performed at baseline and regular intervals. Alfacalcidol was adjusted to a daily dose of 0.5 µg in case of hypercalcemia or hypercalciuria.A significant improvement in "timed up and go test" and "chair rising test" was achieved 3 months after treatment. Significant decreases in bone turnover markers were observed 3 months after the treatment and lasted throughout the study. Nineteen patients discontinued due to adverse events (17 hypercalciuria, 1 hydronephrosis, and 1 stomach ache), while alfacalcidol was adjusted to a daily dose of 0.5 µg in 18 patients (29.0%). Increased serum creatinine was observed when compared to baseline (P <.001), but all the values were in normal range.The treatment with 1 µg alfacalcidol can significantly improve muscle function and bone metabolism. Regular monitoring of urine calcium and timely dosage-adjustments are very important to guarantee the safety of alfacalcidol treatment in Chinese menopausal women.


Assuntos
Conservadores da Densidade Óssea/efeitos adversos , Conservadores da Densidade Óssea/uso terapêutico , Doenças Ósseas Metabólicas/tratamento farmacológico , Hidroxicolecalciferóis/efeitos adversos , Hidroxicolecalciferóis/uso terapêutico , Osteoporose Pós-Menopausa/tratamento farmacológico , Idoso , Grupo com Ancestrais do Continente Asiático , Pequim , Densidade Óssea , Doenças Ósseas Metabólicas/etnologia , Doenças Ósseas Metabólicas/fisiopatologia , Remodelação Óssea , Cálcio na Dieta/sangue , Cálcio na Dieta/uso terapêutico , Cálcio na Dieta/urina , Creatinina/sangue , Feminino , Humanos , Testes de Função Renal , Testes de Função Hepática , Músculo Esquelético/fisiologia , Osteoporose Pós-Menopausa/etnologia , Osteoporose Pós-Menopausa/fisiopatologia , Vigilância de Produtos Comercializados
4.
Acta Med Indones ; 50(3): 215-221, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30333271

RESUMO

BACKGROUND: Alphacalcidol, a vitamin D analog, shows immune regulatory potency as it works on the macrophage and T cell to control inflammation and T cell dysregulation in elderly. None has been known about its effect on elderly with various states of frailty syndrome, which have different level of chronic low grade inflammation. This study aimed to determine the effect of alphacalcidol on inflammatory cytokines (IL-6, IL-10, g-IFN ) and T cell subsets (CD4/CD8 ratio and CD8+ CD28-) of elderly with various stages of frailty syndrome. METHODS: from January to July 2017, a double blind randomized controlled trial (RCT) with allocation concealment, involving 110 elderly subjects from Geriatric Outpatient Clinic Cipto Mangunkusumo Hospital Jakarta, was conducted to measure the effect of 0.5 mcg alphacalcidol administration for 90 days to inflammatory cytokines (IL-6, IL-10, g-IFN) from PBMC culture supernatant, as well as CD4/CD8 and CD8+CD28- percentage using flow cytometry. Statistical analysis using SPSS version 20 was performed with t-test to measure mean difference. RESULTS: of 110 subjects involved in the RCT consisting of 27 fit, 27 pre-frail  and 56 frail elderly, 25(OH)D serum level was found to be as low as 25.59 (12.2) ng/ml in alphacalcidol group and 28.27 (10.4) ng/ml in placebo group. Alphacalcidol did not decrease IL-6 (p=0.4) and g- IFN (p=0.001), but it increased IL-10 (p=0,005) and decreased IL6/IL10 ratio (p=0.008). Alphacalcidol increased CD4/CD8 ratio from 2.68 (SD 2.45) to 3.2 (SD 2.9); p=0.001 and decreased CD8+ CD28- percentage from 5.1 (SD 3.96) to 2.5 (1.5); p<0.001. Sub group analysis showed similar patterns in all frailty states. CONCLUSION: Alphacalcidol improves immune senescence by acting as anti-inflammatory agent through increased IL-10 and decreased IL6/IL-10 ratio and also improves cellular immunity through increased CD4/CD8 ratio and decreased CD8+ CD28- subset in elderly. This effect is not influenced by frailty state.


Assuntos
Idoso Fragilizado , Fragilidade/tratamento farmacológico , Hidroxicolecalciferóis/uso terapêutico , Inflamação/tratamento farmacológico , Subpopulações de Linfócitos T/efeitos dos fármacos , Idoso , Biomarcadores/metabolismo , Método Duplo-Cego , Feminino , Citometria de Fluxo , Humanos , Hidroxicolecalciferóis/administração & dosagem , Interleucina-10/metabolismo , Interleucina-6/metabolismo , Leucócitos Mononucleares/efeitos dos fármacos , Masculino
5.
Pediatr Rheumatol Online J ; 16(1): 49, 2018 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-30053822

RESUMO

BACKGROUND: Chronic recurrent multifocal osteomyelitis (CRMO) is a rare auto-inflammatory bone disorder that primarily affects young girls, with a mean age of 10 years at onset. Generally, it is a self-limited disease. However, recent data indicate that more than 50% of patients have a chronic persistent disease and about 20% a recurring course of this condition. Also, there are more cases reported with associated auto-inflammatory and autoimmune diseases. In this case report, we present a rare case of sporadic CRMO in which the patient eventually developed C-ANCA (cytoplasmic anti-neutrophil cytoplasmic antibodies)-associated renal vasculitis and hyperparathyroidism. CASE PRESENTATION: A 14 year old female patient was brought to the emergency department with a sudden onset of left leg pain and oedema. After physical evaluation and initial investigation, she was diagnosed with femoral and pelvic deep vein thrombosis. While searching for possible thrombosis causes, osteomyelitis of the left leg was identified. Additional CT and MRI scans hinted at the CRMO diagnosis. Due to the multifocal lesions of CRMO, endocrinological evaluation of calcium metabolism was done. The results showed signs of hyperparathyroidism with severe hypocalcaemia. Moreover, when kidney damage occurred and progressed, a kidney biopsy was performed, revealing a C-ANCA associated renal vasculitis. Treatment was started with cyclophosphamide and prednisolone according to the renal vasculitis management protocol. Severe metabolic disturbances and hyperparathyroidism were treated with alfacalcidol, calcium and magnesium supplements. Secondary glomerulonephritis (GN) associated hypertension was treated with ACE (angiotenzine converting enzyme) inhibitors. Anticoagulants were prescribed for deep vein thrombosis. After 1.5 years of treatment, the patient is free of complaints. All microelement and parathormone levels are within normal range. Kidney function is now normal. To date, there are no clinical or diagnostic signs of deep vein thrombosis. CONCLUSIONS: This case report presents a complex immunodysregulatory disorder with both auto-inflammatory and autoimmune processes. We hypothesize that the long lasting active inflammation of CRMO may induce an autoimmune response and result in concomitant diseases like C-ANCA-associated vasculitis in our patient. Any potential specific pathogenic relationships between these two rare pathologies may need to be further studied. Furthermore, there is a lack of specific biomarkers for CRMO and more studies are necessary to identify CRMO's characteristic patterns and how to best monitor disease progression.


Assuntos
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/etiologia , Glomerulonefrite/etiologia , Hiperparatireoidismo/etiologia , Osteomielite/complicações , Osteomielite/diagnóstico , Adolescente , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/diagnóstico , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/tratamento farmacológico , Anticorpos Anticitoplasma de Neutrófilos/metabolismo , Conservadores da Densidade Óssea/uso terapêutico , Ciclofosfamida/uso terapêutico , Diagnóstico Diferencial , Feminino , Glomerulonefrite/diagnóstico , Glomerulonefrite/tratamento farmacológico , Glucocorticoides/uso terapêutico , Humanos , Hidroxicolecalciferóis/uso terapêutico , Hiperparatireoidismo/diagnóstico , Hiperparatireoidismo/tratamento farmacológico , Imunossupressores/uso terapêutico , Rim/patologia , Imagem por Ressonância Magnética , Osteomielite/tratamento farmacológico , Prednisolona/uso terapêutico , Tomografia Computadorizada por Raios X
6.
BJU Int ; 122(4): 667-672, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29745000

RESUMO

OBJECTIVES: To evaluate the impact of serum vitamin D level on male lower urinary tract symptoms (LUTS). PATIENTS AND METHODS: Men with LUTS who visited the outpatient clinic of the urology department at one of two hospitals between March 2014 and April 2017 were eligible for inclusion in the study. The impact of vitamin D on LUTS was evaluated using multivariate analysis to adjust for age, body mass index, prostate-specific antigen, testosterone, glycated haemoglobin, physical activity and prostate volume. To exclude the effect of seasons, we also analysed the impact during each season. RESULTS: Vitamin D level was lowest in winter. According to the International Prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS), the severity of LUTS peaked in winter. There were no seasonal differences between prostate volume, maximum urinary flow rate (Qmax ) and post-void residual urine volume (PVR). For all patients, multivariate analysis showed that lower vitamin D level was significantly associated with higher total OABSS, whereas it was not associated with prostate volume, Qmax , PVR or total IPSS. In winter, lower vitamin D level was significantly associated with higher total OABSS based on multivariate analysis, whereas it was not during other seasons. In patients with vitamin D deficiency, the total OABSS significantly decreased after vitamin D replacement. The greatest improvement in total OABSS was associated with lower pre-treatment total OABSS and higher post-treatment vitamin D level. CONCLUSIONS: Vitamin D deficiency in men with LUTS may play a role in aggravated overactive bladder (OAB) symptoms, especially in winter. Increasing vitamin D level in patients with vitamin D deficiency appears to alleviate OAB symptoms.


Assuntos
Hidroxicolecalciferóis/sangue , Hidroxicolecalciferóis/uso terapêutico , Sintomas do Trato Urinário Inferior/sangue , Sintomas do Trato Urinário Inferior/dietoterapia , Bexiga Urinária Hiperativa/sangue , Bexiga Urinária Hiperativa/dietoterapia , Deficiência de Vitamina D/patologia , Idoso , Estudos de Coortes , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/patologia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Valor Preditivo dos Testes , Próstata/efeitos dos fármacos , Próstata/patologia , Antígeno Prostático Específico/sangue , Hiperplasia Prostática/dietoterapia , Hiperplasia Prostática/patologia , Testosterona/sangue , Bexiga Urinária Hiperativa/etiologia , Bexiga Urinária Hiperativa/patologia , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/complicações , Vitaminas/sangue , Vitaminas/uso terapêutico
8.
Osteoporos Int ; 29(5): 1203-1209, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29492624

RESUMO

Evaluation of bone is of great importance in chronic kidney disease patients, as these patients are at an increased risk for fractures. We treated a hemodialysis patient suffering from hyperparathyroid bone disease with cinacalcet hydrochloride and concurrent administration of maxacalcitol and alfacalcidol for a year. Hyperparathyroid bone disease is characterized by cortical thinning, increased cortical porosity, reduced trabecular bone volume, and increased hypomineralized matrix volume, and there is little information to date about the effects of treatment with cinacalcet hydrochloride on the bone fragility in patients with hyperparathyroid bone disease. In the present study, histological and backscattered electron microscopic evaluation of this combination treatment revealed an excellent improvement of both bone volume and bone morphology. This treatment improved cortical thinning, cortical porosity, and trabecular thinning. Furthermore, the treatment also reduced hypomineralized matrix volume, indicative of improved mineralization by osteocytes. We speculate that the intermittent maxacalcitol administration may have effectively stimulated the vitamin D receptors expressed on osteocytes and osteoblasts, resulting in increased mineralization. Our approach for evaluating the bone in patients with chronic kidney disease by backscattered electron microscopy is novel.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Distúrbio Mineral e Ósseo na Doença Renal Crônica/tratamento farmacológico , Hiperparatireoidismo Secundário/complicações , Ílio/ultraestrutura , Biópsia , Calcitriol/análogos & derivados , Calcitriol/uso terapêutico , Distúrbio Mineral e Ósseo na Doença Renal Crônica/patologia , Cinacalcete/uso terapêutico , Humanos , Hidroxicolecalciferóis/uso terapêutico , Hiperparatireoidismo Secundário/patologia , Ílio/patologia , Microscopia Eletrônica , Pessoa de Meia-Idade
9.
Nephrol Ther ; 14(4): 189-200, 2018 Jun.
Artigo em Francês | MEDLINE | ID: mdl-29545131

RESUMO

Secondary hyperparathyroidism (SHPT) is one of the most frequent and deleterious complication of chronic kidney disease (CKD). SHPT is also one of the principal components of the now called CKD-mineral and bone disorders (MBD) syndrome. It is usually prevented and treated by vitamin D derivatives. However, the rationale for the prescription of vitamin D sterols in those patients is still a matter of hotly debates, mainly because of unsatisfactory results from numerous observational and not well-controlled studies. Scanty clinical data on head-to-head comparisons between the multiple vitamin D sterols are currently available. Moreover, there is crescent expectations on nutritional vitamin D, as well as vitamin D receptor activators (VDRA), regarding their putative pleiotropic effects even in CKD patients, and the promising effects of VDRA against proteinuria and myocardial hypertrophy in diabetic CKD cohorts. Nevertheless, additional randomized controlled trials (RCT) are needed to answer to many open questions and incertitude considering the effect of nutritional vitamin D and VDRA on hard end points including the risk of skeletal fractures and of mortality in CKD patients. RCT comparing VDRA to calcimimetics in the control of SHPT are also needed in dialysis patients. The present review will visit these open questions that nephrologists should ask before starting a treatment by nutritional vitamin D or VDRA.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Distúrbio Mineral e Ósseo na Doença Renal Crônica/tratamento farmacológico , Hidroxicolecalciferóis/uso terapêutico , Hiperparatireoidismo Secundário/tratamento farmacológico , Insuficiência Renal Crônica/complicações , Densidade Óssea/efeitos dos fármacos , Humanos , Hiperparatireoidismo Secundário/etiologia , Insuficiência Renal Crônica/tratamento farmacológico , Vitamina D/uso terapêutico
10.
Geriatr Gerontol Int ; 18(3): 434-440, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29143428

RESUMO

AIM: To determine the effect of alfacalcidol on muscle strength and functional mobility in Indonesian older women whose handgrip strength was low. METHODS: A randomized, double-blind controlled trial was carried out among 95 older women whose handgrip strength was ≤22 kg. Participants were randomized into two groups: 47 participants received alfacalcidol 0.5 µg/day and 48 participants received a placebo. Each participant in both groups was given calcium 500 mg/day. Handgrip strength as well as the Timed-Up and Go test were measured before and after 90 days of intervention. Per protocol analysis after intervention between two groups was carried out. RESULTS: There was a significant improvement of handgrip strength in the group that received alfacalcidol compared with the placebo group (15.50 vs 13.75; P = 0.003). The median time for the Timed-Up and Go test in the alfacalcidol group also improved significantly compared with the placebo group (9.01 vs 10.07, P = 0.028). CONCLUSIONS: Alfacalcidol with daily doses of 0.5 µg significantly improved muscle strength and functional mobility in Indonesian older women. Geriatr Gerontol Int 2018; 18: 434-440.


Assuntos
Cálcio/uso terapêutico , Força da Mão , Hidroxicolecalciferóis/uso terapêutico , Desempenho Físico Funcional , Idoso , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Humanos , Indonésia , Resultado do Tratamento
11.
Clin Endocrinol (Oxf) ; 88(3): 380-387, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29266368

RESUMO

OBJECTIVE: Glucocorticoids (GCs) are the first-line treatment for myasthenia gravis (MG) and act as long-term immunosuppressants. However, GCs can induce osteoporosis and bone fractures. In this study, we evaluate the effects of oral alendronate and alfacalcidol, or alfacalcidol alone on the bone of Chinese patients with MG who will initiate treatment with GCs. DESIGN AND METHODS: A total of 75 patients were included in this 12-month prospective, open-label, single-centre study. Patients with bone mineral density (BMD) T-score less than -1.0 at baseline were treated with 70 mg of alendronate per week. Patients with BMD T-score greater than -1.0 at baseline were included in the alfacalcidol-alone group. Patients in two groups were treated with 0.25 µg of alfacalcidol every other day and 600 mg of calcium daily. RESULTS: After 12 months of treatment, the mean BMD of lumbar spine, femoral neck and total hip increased by 3.4% (P = .002), 1.8% (P = .21) and 2.6% (P = .02), respectively, in alendronate group. In alfacalcidol-alone group, the mean BMD of lumbar spine, femoral neck and total hip decreased by 6.1%, 3.2% and 3.3%, respectively (all P < .001 vs baseline). CONCLUSIONS: We demonstrated for the first time that treatment with alendronate combined with alfacalcidol significantly increased BMD, decreased bone turnover biomarker levels and reduced the occurrence of hypercalciuria in a large cohort of Chinese patients with MG who initiated treatment with glucocorticoids. However, treatment with alfacalcidol alone failed to prevent bone loss in patients with MG receiving glucocorticoid therapy.


Assuntos
Alendronato/farmacologia , Quimioterapia Combinada , Glucocorticoides/uso terapêutico , Hidroxicolecalciferóis/farmacologia , Miastenia Gravis/tratamento farmacológico , Idoso , Alendronato/uso terapêutico , Grupo com Ancestrais do Continente Asiático , Densidade Óssea , Remodelação Óssea/efeitos dos fármacos , Osso e Ossos/efeitos dos fármacos , Feminino , Fraturas Ósseas/induzido quimicamente , Humanos , Hidroxicolecalciferóis/uso terapêutico , Masculino , Pessoa de Meia-Idade , Osteoporose/induzido quimicamente , Osteoporose/prevenção & controle , Estudos Prospectivos
13.
Clin Oral Investig ; 22(2): 745-755, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28608052

RESUMO

ᅟOBJECTIVES: Vitamin-D-dependent rickets type 1A (VDDR1A) is a rare inherited disease caused by defective activation of vitamin D. The aim of the study was to describe the craniofacial characteristics and the dental phenotype of patients with genetically confirmed VDDR1A. The VDDR1A findings were compared to findings in patients with X-linked hypophosphatemia (XLH) and healthy controls. MATERIAL AND METHODS: Ten patients with VDDR1A were identified. The reference group for the comparison of cephalometric findings was 49 adults without chronic disease. The reference group for the comparison of dental findings was 30 adults with XLH. Clinical examination, clinical photos, and radiographs were obtained. Cephalometric analysis was performed. Photos and radiographs were visually evaluated. RESULTS: The depth of the posterior cranial fossa (d-p and d-s-iop) in VDDR1A adults was reduced compared to the reference group (p < 0.05). Five (83%) of six adults with VDDR1A and one (4%) of 25 adults with XLH had enamel hypoplasia on several incisors and/or canines (p < 0.001). Three (75%) of four adults with VDDR1A and none of 16 adults with XLH had several first molars with enamel hypoplasia (p = 0.004). Five of 7 (71%) adults with VDDR1A and 24 of 30 (80%) adults with XLH had endodontically affected teeth. CONCLUSIONS: The dental aberration of VDDR1A is more in line with the dental aberration of nutritional rickets than with the dental aberrations in XLH, suggesting the combination of low availability of both calcium and phosphate to be critical in periods of enamel formation. CLINICAL RELEVANCE: Knowledge on craniofacial and dental aberration in patients with rare diseases, e.g., inherited rickets, is of importance to the dental practitioner, especially during diagnostics and treatment in special care units.


Assuntos
Raquitismo Hipofosfatêmico Familiar/patologia , Crânio/anormalidades , Anormalidades Dentárias/patologia , Conservadores da Densidade Óssea/uso terapêutico , Estudos de Casos e Controles , Cefalometria , Dinamarca , Raquitismo Hipofosfatêmico Familiar/tratamento farmacológico , Feminino , Humanos , Hidroxicolecalciferóis/uso terapêutico , Lactente , Masculino , Fenótipo , Sistema de Registros
14.
Endocrinol Metab Clin North Am ; 46(4): 983-1007, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29080646

RESUMO

Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are associated with abnormalities in bone and mineral metabolism, known as CKD-bone mineral disorder. CKD and ESRD cause skeletal abnormalities characterized by hyperparathyroidism, mixed uremic osteodystrophy, osteomalacia, adynamic bone disease, and frequently enhanced vascular and ectopic calcification. Hyperparathyroidism and mixed uremic osteodystrophy are the most common manifestations due to phosphate retention, reduced concentrations of 1,25-dihydroxyvitamin D, intestinal calcium absorption, and negative calcium balance. Treatment with 1-hydroxylated vitamin D analogues is useful.


Assuntos
Calcitriol/uso terapêutico , Ergocalciferóis/uso terapêutico , Hidroxicolecalciferóis/uso terapêutico , Hiperparatireoidismo/tratamento farmacológico , Falência Renal Crônica/complicações , Insuficiência Renal Crônica/complicações , Humanos , Hiperparatireoidismo/etiologia , Resultado do Tratamento
15.
Psychiatr Pol ; 51(3): 437-454, 2017 Jun 18.
Artigo em Inglês, Polonês | MEDLINE | ID: mdl-28866715

RESUMO

Traditional methods of depression treatment with the use of pharmacotherapy with antidepressants have limited effectiveness. Biological, psychological and environmental causes of depressive disorders are known, but pathophysiology of depression has not been fully explained. Many factors and mechanisms play role in the pathophysiology of depression, one of which may be vitamin D3 deficiency. Deficiency or border level of vitamin D3 is fairly common in the general population and may occur even in one billion people globally. Epidemiological studies show that vitamin D3 or its metabolites do not reach an optimal level in most adults. Even lower than the optimal level may cause clinical symptoms and be one of the risk factors for depression. In the population of patients suffering from depressive disorders deficiency or insufficiency of vitamin D3 occur more frequently than in the general population. The use of vitamin D3in patients with depression may have antidepressant effect. Continuous supplementation may also reduce the risk of recurrence. This article is a review of literature on the possible impact of vitamin D3 deficiency on the prevalence of depression and antidepressant effect of the supplementation. Selection of articles was made by searching the Medline and PubMed databases using specific keywords: depression, vitamin D3 deficiency. Previous studies on the use of vitamin D3 and its role in prevention and treatment of depressive disorders included too small number of people to clearly assess the effectiveness and safety of supplementation used as adjunctive therapy to antidepressants, as well as and dose range which should be used.


Assuntos
Colecalciferol/uso terapêutico , Transtorno Depressivo Maior/prevenção & controle , Suplementos Nutricionais , Hidroxicolecalciferóis/uso terapêutico , Deficiência de Vitamina D/prevenção & controle , Transtorno Depressivo Maior/etiologia , Feminino , Humanos , Masculino , Deficiência de Vitamina D/complicações
16.
Tohoku J Exp Med ; 241(4): 319-326, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28458336

RESUMO

Bisphosphonates (BPs) increase bone mineral density (BMD) through the inhibition of osteoclast activity. Among BPs, ibandronate (IBN) is a strong inhibitor of bone resorption. However, the effects of a vitamin D analogue, alfacalcidol (ALF), on IBN treatment for osteoporosis is unknown. Fifty-three treatment-naïve post-menopausal women with primary osteoporosis were recruited and divided into IBN-treatment group (IBN group) and IBN with ALF group (IBN/ALF group). IBN (1.0 mg) was intravenously injected once a month, with or without oral ALF (1.0 µg/day). Ultimately, 19 subjects in IBN group and 26 in IBN/ALF group were analyzed. Bone turnover markers were examined at 4, 6, 12, and 18 months, and BMD was measured at 6, 12, and 18 months. Compared with pre-treatment, bone turnover markers significantly decreased in both groups after 4 months. The levels of serum N-terminal propeptide of type-1 procollagen and tartrate-resistant acid phosphatase-5b, and urinary N-terminal telopeptide of type-I collagen were significantly lower in IBN/ALF group than those in IBN group at 12 months. Lumbar 1-4 (L)-BMD significantly increased from 6 months in IBN/ALF group and at 18 months in IBN group. L-BMD was significantly higher in IBN/ALF group (6.6% increase) than in IBN group (3.4%) at 18 months. Total hip (H)-BMD significantly increased from 6 months in IBN/ALF group and tended to improve in IBN group. H-BMD was significantly higher in IBN/ALF group (4.8%) than in IBN group (3.2%) at 18 months. In conclusion, treatment with ALF in combination with IBN improves BMD in post-menopausal women with osteoporosis.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Densidade Óssea/efeitos dos fármacos , Difosfonatos/uso terapêutico , Hidroxicolecalciferóis/uso terapêutico , Osteoporose/tratamento farmacológico , Absorciometria de Fóton , Administração Intravenosa , Administração Oral , Idoso , Grupo com Ancestrais do Continente Asiático , Sinergismo Farmacológico , Feminino , Quadril/diagnóstico por imagem , Humanos , Hidroxicolecalciferóis/efeitos adversos , Ácido Ibandrônico , Pós-Menopausa , Fosfatase Ácida Resistente a Tartarato/sangue
17.
Ann Allergy Asthma Immunol ; 118(5): 557-563, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28377173

RESUMO

BACKGROUND: Despite the use of alfacalcidol in the management of corticosteroid-induced osteoporosis, it has never been considered an adjunct treatment for asthma management. It can target vitamin D deficiency, a possible risk factor for asthma, and, hence, improve pulmonary function of patients with asthma. OBJECTIVE: To explore the effect of alfacalcidol administration on pulmonary function and study the pattern of vitamin D deficiency in adults with asthma in Egypt. METHODS: Serum 25-hydroxyvitamin D was measured in 115 adults: 33 healthy subjects and 82 patients with asthma. Then, patients with asthma were randomized to receive standard asthma treatment only (n = 39) or receive it in addition to 1 µg of alfacalcidol daily for 4 months (n = 43). Randomization was stratified by the stage of asthma severity. Spirometry and measurement of 25-hydroxyvitamin were performed at baseline and end of follow-up. RESULTS: Vitamin D deficiency was more common in patients with asthma (57.3%) than in healthy subjects (21.2%; P < .001). In patients with asthma, alfacalcidol significantly improved forced expiratory volume in the first second and forced vital capacity (P < .001 for the 2 tests). Moreover, more patients in the intervention arm showed improvement in asthma severity stage (P = .04). A nonsignificant difference was observed in improvement of forced expiratory volume in the first second between patients with vitamin D deficiency and those without deficiency in the intervention group (P > .05). CONCLUSION: Alfacalcidol supplementation improved the pulmonary function and severity stage of adult patients with asthma regardless of deficiency. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02747381.


Assuntos
Asma/complicações , Asma/fisiopatologia , Conservadores da Densidade Óssea/uso terapêutico , Hidroxicolecalciferóis/uso terapêutico , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/tratamento farmacológico , Corticosteroides/efeitos adversos , Corticosteroides/uso terapêutico , Adulto , Idoso , Antiasmáticos/efeitos adversos , Antiasmáticos/uso terapêutico , Asma/diagnóstico , Asma/tratamento farmacológico , Estudos de Casos e Controles , Egito , Feminino , Volume Expiratório Forçado/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Espirometria , Resultado do Tratamento , Vitamina D/análogos & derivados , Vitamina D/sangue , Deficiência de Vitamina D/diagnóstico , Adulto Jovem
18.
J Arthroplasty ; 32(7): 2176-2180, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28318867

RESUMO

BACKGROUND: Bone mineral density (BMD) loss around femoral implants, particularly in the proximal femur, is a common outcome after total hip arthroplasty. Previous studies reported the prevention of postsurgical decrease in BMD with the use of osteoporosis drug therapy. This randomized study evaluated the efficacy of alendronate and alfacalcidol for preserving BMD over a long-term follow-up. METHODS: Sixty consecutive patients with hip osteoarthritis who had undergone primary cementless total hip arthroplasty were randomly assigned to an alendronate (n = 20), alfacalcidol (n = 18), or control (n = 22) group. Periprosthetic BMD was measured using dual-energy X-ray absorptiometry at 1 week, 1 year, and the current follow-up (minimum 9 years after surgery). Changes in BMD are reported as mean percentages relative to the values at 1 week (baseline reference). RESULTS: All groups showed a significant decrease in the BMD of the calcar at the current follow-up compared to the values at both 1 week and 1 year postoperatively (P < .001). The BMD values were significantly higher in the alendronate group than in the alfacalcidol and control groups (P < .05). The BMD values at the current follow-up were 76% ± 30% (alendronate group), 64% ± 22% (alfacalcidol group), and 59% ± 22% (control group) of the baseline values. CONCLUSION: Our findings demonstrate the efficacy of early administration of alendronate for the prevention of bone loss in the calcar region.


Assuntos
Alendronato/uso terapêutico , Artroplastia de Quadril/efeitos adversos , Conservadores da Densidade Óssea/uso terapêutico , Reabsorção Óssea/prevenção & controle , Hidroxicolecalciferóis/uso terapêutico , Absorciometria de Fóton , Adulto , Idoso , Idoso de 80 Anos ou mais , Densidade Óssea , Reabsorção Óssea/etiologia , Feminino , Fêmur/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/cirurgia
19.
Sci Rep ; 7: 40370, 2017 01 11.
Artigo em Inglês | MEDLINE | ID: mdl-28074906

RESUMO

Early detection and surgery represent the mainstay of treatment for superficial melanoma, but for high risk lesions (Breslow's thickness >0.75 mm) an effective adjuvant therapy is lacking. Vitamin D insufficiency plays a relevant role in cancer biology. The biological effects of 1α hydroxycholecalciferol on experimental melanoma models were investigated. 105 melanoma patients were checked for 25-hydroxycholecalciferol (circulating vitamin D) serum levels. Human derived melanoma cell lines and in vivo xenografts were used for studying 1α-hydroxycholecalciferol-mediated biological effects on cell proliferation and tumor growth. 99 out of 105 (94%) melanoma patients had insufficient 25-hydroxycholecalciferol serum levels. Interestingly among the six with vitamin D in the normal range, five had a diagnosis of in situ/microinvasive melanoma. Treatment with 1α-hydroxycholecalciferol induced antiproliferative effects on melanoma cells in vitro and in vivo, modulating the expression of cell cycle key regulatory molecules. Cell cycle arrest in G1 or G2 phase was invariably observed in vitamin D treated melanoma cells. The antiproliferative activity induced by 1α-hydroxycholecalciferol in experimental melanoma models, together with the discovery of insufficient 25-hydroxycholecalciferol serum levels in melanoma patients, provide the rationale for using vitamin D in melanoma adjuvant therapy, alone or in association with other therapeutic options.


Assuntos
Hidroxicolecalciferóis/uso terapêutico , Melanoma/tratamento farmacológico , Melanoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinogênese/efeitos dos fármacos , Carcinogênese/patologia , Ciclo Celular/efeitos dos fármacos , Diferenciação Celular/efeitos dos fármacos , Linhagem Celular Tumoral , Proliferação de Células/efeitos dos fármacos , Forma Celular/efeitos dos fármacos , Ergocalciferóis/farmacologia , Ergocalciferóis/uso terapêutico , Feminino , Humanos , Hidroxicolecalciferóis/administração & dosagem , Hidroxicolecalciferóis/farmacologia , Masculino , Melanoma/sangue , Pessoa de Meia-Idade
20.
J Bone Miner Metab ; 35(2): 171-176, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26832388

RESUMO

We investigated whether eldecalcitol has further significant effects on bone metabolic markers and bone mineral density (BMD) in osteoporosis patients having undergone long-term bisphosphonate treatment. Eldecalcitol treatment was initiated in 48 postmenopausal osteoporosis patients who had undergone bisphosphonate treatment with or without alfacalcidol treatment for more than 2 years (average period 6.3 years). Age, height, weight, total muscle volume, total fat volume, estimated glomerular filtration rate, and BMD at the lumbar spine, total hip, and distal third of the radius were measured as background data for each patient. Serum alkaline phosphatase, tartrate-resistant acid phosphatase 5b, calcium, and phosphate levels were measured at the baseline and 3 and 12 months after the initiation of eldecalcitol treatment, and BMD was measured at the baseline and 12 months after the initiation of eldecalcitol treatment. Tartrate-resistant acid phosphatase 5b level was significantly decreased at 3 and 12 months after the initiation of eldecalcitol treatment in comparison with the baseline level. There were no significant changes in alkaline phosphatase, calcium, or phosphate levels in comparison with the baseline levels. In addition, the lumbar spine BMD at 12 months after the initiation of treatment was significantly increased in comparison with the baseline level, although no significant changes in BMD at the total hip and distal third of the radius were observed. Eldecalcitol demonstrated significant effects in additionally decreasing the level of the bone resorption marker tartrate-resistant acid phosphatase 5b and increasing BMD at the lumbar spine, even in osteoporosis patients having undergone long-term bisphosphonate treatment.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Densidade Óssea/efeitos dos fármacos , Difosfonatos/uso terapêutico , Osteoporose Pós-Menopausa/tratamento farmacológico , Vitamina D/análogos & derivados , Fosfatase Ácida/sangue , Idoso , Idoso de 80 Anos ou mais , Fosfatase Alcalina/sangue , Biomarcadores/sangue , Cálcio/sangue , Feminino , Humanos , Hidroxicolecalciferóis/uso terapêutico , Vértebras Lombares/efeitos dos fármacos , Pessoa de Meia-Idade , Fosfatos/sangue , Fosfatase Ácida Resistente a Tartarato/sangue , Vitamina D/uso terapêutico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA