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2.
Arch Osteoporos ; 17(1): 11, 2022 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-34981246

RESUMO

Decisions on whether to use pharmacologic osteoporosis therapy in skilled nursing facility residents are complex and require shared decision-making. Residents, proxies, and staff desire individualized fracture risk estimates that consider advanced age, dementia, and mobility. They want options for reducing administration burden, monitoring instructions, and periodic reassessment of risk vs. benefit. PURPOSE: Decisions about pharmacologic osteoporosis treatment in nursing home (NH) residents with advanced age and multimorbidity are complex and should occur using shared decision-making. Our objective was to identify processes and tools to improve shared decision-making about pharmacologic osteoporosis treatment in NHs. METHODS: Qualitative analysis of data collected in three NHs from residents at high fracture risk, their proxies, nursing assistants, nurses, and one nurse practitioner (n = 28). Interviews explored participants' stories, attitudes, and experiences with oral osteoporosis medication management. Framework analysis was used to identify barriers to shared decision-making regarding osteoporosis treatment in this setting. RESULTS: Participants wanted individualized fracture risk estimates that consider immobility, advanced age, and comorbid dementia. Residents and proxies expected nursing staff to be involved in the decision-making; nursing staff wished to be informed on the relative risks vs. benefits of medications and given monitoring instructions. Two important competing demands to address during the shared decision-making process were burdensome administration requirements and polypharmacy. Participants wanted to reassess pharmacologic treatment appropriateness over time as clinical status or goals of care change. CONCLUSIONS: Shared decision-making using strategies and tools identified in this analysis may move osteoporosis pharmacologic treatment in NHs and for other older adults with multimorbidity from inappropriate inertia to appropriate prescribing or appropriate inaction.


Assuntos
Demência , Osteoporose , Idoso , Demência/tratamento farmacológico , Demência/epidemiologia , Humanos , Casas de Saúde , Osteoporose/tratamento farmacológico , Osteoporose/epidemiologia
3.
Phytomedicine ; 94: 153810, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34798519

RESUMO

BACKGROUND: Osteoporosis affects more than half the patients with type 2 diabetes mellitus (T2DM). Up to data, there is no effective clinical practice in managing type 2 diabetes osteoporosis (T2DOP) because of its complex pathogenesis. Gegen Qinlian Decoction (GQD) has been used for the long-term management of T2DM. However, the underlying mechanism of GQD in the treatment of T2DOP remains unknown. PURPOSE: To reveal the role of GQD in T2DOP and its potential therapeutic targets in the management of T2DOP. STUDY DESIGN: The effect of GQD on T2DOP was observed in db/db mice in four groups: model group, GQD low-dose group (GQD-L), GQD high-dose group (GQD-H), and metformin (positive control) group. C57BL/6J mice were used as the negative control group. METHODS: Quantitative phytochemical analysis of GQD was performed using high-performance liquid chromatography (HPLC). Micro-CT and hematoxylin-eosin (H&E) staining were used to evaluate bone histomorphometry. To screen for candidate targets of GQD, a cytokine antibody array was used, followed by bioinformatics analysis. Quantitative real-time PCR (qRT-PCR) and western blotting (WB) were used to determine expression levels. RESULTS: The major active components of GQD were confirmed by HPLC. Micro-CT and H&E staining showed that bone mass was significantly increased in the GQD-H group compared with the model group. Antibody arrays revealed that the expression of insulin-like growth factor binding protein 3 (IGFBP3) was elevated in the GQD-H group. The MAPK pathway was identified using bioinformatics analysis. Additionally, the levels of osteoclastogenesis-related genes, including cathepsin K (Ctsk), acid phosphatase 5 (Acp5), matrix metallopeptidase 9 (Mmp9), and ATPase H+ transporting V0 subunit D2 (Atp6v0d2) were significantly decreased in the GQD-H group. Compared with the model group, high-dosage GQD inhibited phosphorylation of extracellular signal-regulated kinases (ERKs) and P38 mitogen-activated protein kinase (MAPK) and the expression of c-Fos and nuclear factor of activated T cells 1 (NFATc1). CONCLUSION: GQD plays a protective role in T2DOP by upregulating IGFBP3 expression and downregulating the IGFBP3/MAPK/NFATc1 signaling pathway. IGFBP3 in serum may also be a novel biomarker in the treatment of T2DOP. Our current findings not only expand the application of GQD, but also provide a theoretical basis and guidance for T2DOP.


Assuntos
Diabetes Mellitus Tipo 2 , Osteoporose , Animais , Citocinas , Diabetes Mellitus Tipo 2/tratamento farmacológico , Medicamentos de Ervas Chinesas , Humanos , Proteína 3 de Ligação a Fator de Crescimento Semelhante à Insulina , Camundongos , Camundongos Endogâmicos C57BL , Fatores de Transcrição NFATC , Osteoporose/tratamento farmacológico , Proteínas Quinases , Transdução de Sinais
4.
Clin Imaging ; 81: 54-59, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34598006

RESUMO

BACKGROUND: Osteoporosis is an underdiagnosed and undertreated disease worldwide. Recent studies have highlighted the use of simple vertebral trabecular attenuation values for opportunistic osteoporosis screening. Meanwhile, machine learning has been used to accurately segment large parts of the human skeleton. PURPOSE: To evaluate a fully automated deep learning-based method for lumbar vertebral segmentation and measurement of vertebral volumetric trabecular attenuation values. MATERIAL AND METHODS: A deep learning-based method for automated segmentation of bones was retrospectively applied to non-contrast CT scans of 1008 patients (mean age 57 years, 472 female, 536 male). Each vertebral segmentation was automatically reduced by 7 mm in all directions in order to avoid cortical bone. The mean and median volumetric attenuation values from Th12 to L4 were obtained and plotted against patient age and sex. L1 values were further analyzed to facilitate comparison with previous studies. RESULTS: The mean L1 attenuation values decreased linearly with age by -2.2 HU per year (age > 30, 95% CI: -2.4, -2.0, R2 = 0.3544). The mean L1 attenuation value of the entire population cohort was 140 HU ± 54. CONCLUSIONS: With results closely matching those of previous studies, we believe that our fully automated deep learning-based method can be used to obtain lumbar volumetric trabecular attenuation values which can be used for opportunistic screening of osteoporosis in patients undergoing CT scans for other reasons.


Assuntos
Aprendizado Profundo , Osteoporose , Absorciometria de Fóton , Densidade Óssea , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Osteoporose/diagnóstico por imagem , Dor , Estudos Retrospectivos
5.
Oral Maxillofac Surg Clin North Am ; 34(1): 115-126, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34711466

RESUMO

Corticosteroids have been the cornerstone for treatment of many inflammatory and immune disorders with these beneficial effects well recognized by the medical community. It also possesses many undesirable clinical adverse effects that can occur within 2 weeks of use. Moreover, in the past decade, chronic users of corticosteroids have been linked to skeletal (vertebral and hip) osteoporosis/osteonecrosis with some patients requiring adjunctive antiresprotive medications to counteract fracture prevention. Additionally, two case reports have implicated daily prednisone user to cause osteonecrosis of the mandible. This chapter highlights current adrenal suppression classifications, pathophysiology, drug interactions, and perioperative surgical and anesthesia management.


Assuntos
Osteonecrose , Osteoporose , Cirurgia Bucal , Corticosteroides/efeitos adversos , Humanos , Mandíbula , Osteoporose/tratamento farmacológico
6.
Spine (Phila Pa 1976) ; 47(2): 128-135, 2022 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-34690329

RESUMO

STUDY DESIGN: Expert consensus study. OBJECTIVE: This expert panel was created to establish best practice guidelines to identify and treat patients with poor bone health prior to elective spinal reconstruction. SUMMARY OF BACKGROUND DATA: Currently, no guidelines exist for the management of osteoporosis and osteopenia in patients undergoing spinal reconstructive surgery. Untreated osteoporosis in spine reconstruction surgery is associated with higher complications and worse outcomes. METHODS: A multidisciplinary panel with 18 experts was assembled including orthopedic and neurological surgeons, endocrinologists, and rheumatologists. Surveys and discussions regarding the current literature were held according to Delphi method until a final set of guidelines was created with over 70% consensus. RESULTS: Panelists agreed that bone health should be considered in every patient prior to elective spinal reconstruction. All patients above 65 and those under 65 with particular risk factors (chronic glucocorticoid use, high fracture risk or previous fracture, limited mobility, and eight other key factors) should have a formal bone health evaluation prior to undergoing surgery. DXA scans of the hip are preferable due to their wide availability. Opportunistic CT Hounsfield Units of the vertebrae can be useful in identifying poor bone health. In the absence of contraindications, anabolic agents are considered first line therapy due to their bone building properties as compared with antiresorptive medications. Medications should be administered preoperatively for at least 2 months and postoperatively for minimum 8 months. CONCLUSION: Based on the consensus of a multidisciplinary panel of experts, we propose best practice guidelines for assessment and treatment of poor bone health prior to elective spinal reconstructive surgery. Patients above age 65 and those with particular risk factors under 65 should undergo formal bone health evaluation. We also established guidelines on perioperative optimization, utility of various diagnostic modalities, and the optimal medical management of bone health in this population.Level of Evidence: 5.


Assuntos
Conservadores da Densidade Óssea , Fraturas Ósseas , Osteoporose , Absorciometria de Fóton , Adulto , Idoso , Densidade Óssea , Humanos , Osteoporose/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/cirurgia
7.
Dentomaxillofac Radiol ; 51(1): 20210175, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34324394

RESUMO

OBJECTIVES: The purpose of this study was to evaluate rater agreement and the accuracy of a semi-automated software and its fully automated tool for osteoporosis risk assessment in intraoral radiographs. METHODS: A total of 567 intraoral radiographs was selected retrospectively from women aged 75-80 years participating in a large population-based study (SUPERB) based in Gothenburg, Sweden. Five raters assessed participants' risk of osteoporosis in the intraoral radiographs using a semi-automated software. Assessments were repeated after 4 weeks on 121 radiographs (20%) randomly selected from the original 567. Radiographs were also assessed by the softwares' fully automated tool for analysis. RESULTS: Overall interrater agreement for the five raters was 0.37 (95% CI 0.32-0.41), and for the five raters with the fully automated tool included as 'sixth rater' the overall Kappa was 0.34 (0.30-0.38). Intrarater agreement varied from moderate to substantial according to the Landis and Koch interpretation scale. Diagnostic accuracy was calculated in relation to reference standard for osteoporosis diagnosis which is T-score values for spine, total hip and femoral neck and presented in form of sensitivities, specificities, predictive values, likelihood ratios and odds ratios. All raters' mean sensitivity, including the fully automated tool, was 40,4% (range 14,3%-57,6%). Corresponding values for specificity was 69,5% (range 59,7%-90,4%). The diagnostic odds ratios ranged between 1 and 2.7. CONCLUSION: The low diagnostic odds ratio and agreement between raters in osteoporosis risk assessment using the software for analysis of the trabecular pattern in intraoral radiographs shows that more work needs to be done to optimise the automation of trabecular pattern analysis in intraoral radiographs.


Assuntos
Osteoporose , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Osteoporose/diagnóstico por imagem , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Software
8.
Environ Res ; 203: 111772, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34324851

RESUMO

Neonicotinoids (NEOs) are extensively applied in global agricultural production for pest control but have adverse effects on human health. In this study, the concentrations of six NEOs and three characteristic metabolites were investigated by collecting 200 serum samples from an elderly population in China. Results showed that the NEOs and their metabolites were widely detected (89%-98 %) in the serum samples from the osteoporosis (OP) (n = 120) and non-OP (n = 80) population, and their median concentrations ranged from 0.04 ng/mL to 5.99 ng/mL and 0.01 ng/mL to 2.02 ng/mL, respectively. N-desmethyl-acetamiprid (ACE-dm) was the most abundant NEOs in the serum samples. Gender-related differences were found in concentrations of most NEOs and their metabolites in serum, with males having higher target analytes than females. Significantly (p < 0.05) positive correlations were observed among most NEO concentrations, suggesting that exposure source of these substances is common or related. However, associations between the concentrations of characteristic metabolites and their corresponding NEOs were insignificant, probably because the exogenous intake are the primary sources of metabolites of NEOs instead of the internal biotransformation. The associations between NEO concentrations (i.e., ACE-dm, dinotefuran, and olefin-imidacloprid) and OP (OR = 2.33-6.92, 95 % CI = 0.37-16.9, p-trend < 0.05) indicate that NEO exposure is correlated with increased odds of prevalent OP. This study is the first to document the profiles of NEOs and their metabolites in serum samples collected from an elderly population in South China and examine the relationships between NEO exposure and OP.


Assuntos
Inseticidas , Osteoporose , Idoso , China , Coleta de Dados , Feminino , Humanos , Inseticidas/análise , Masculino , Neonicotinoides , Osteoporose/epidemiologia
9.
Nutrition ; 93: 111428, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34474186

RESUMO

OBJECTIVES: Skeletal muscle loss and osteoporosis are major medical and socioeconomic concerns as the global population ages. Studies have reported that skeletal muscle mass correlates to bone mineral density (BMD). The psoas muscle index (PMI), measured as the L3 cross-sectional areas of the right and left psoas divided by the square of height, has a positive correlation with the total volume of skeletal muscle in the body. This study aimed to evaluate relationships between PMI and BMD and fracture risk estimated by the Fracture Risk Assessment Tool (FRAX). METHODS: Preoperatively acquired, plain computed tomography images at the L3 level were used to measure PMI in 87 people with degenerative spinal diseases. We evaluated the correlation between PMI and BMD and fracture risk estimated by FRAX. RESULTS: PMI was significantly correlated with BMD in the entire lumbar spine and femoral neck (r = 0.413 and 0.525, both P < 0.001). People with osteoporosis showed significantly lower PMI than those without (P < 0.05). PMI was also significantly correlated with FRAX score (r = -0.545, P < 0.001). Furthermore, based on the recommendation of osteoporosis treatment, participants were divided into two groups: FRAX ≥15% (R group) and FRAX <15% (C group). The R group showed significantly lower PMI than the C group (P < 0.001). Receiver operating characteristic curve analysis revealed that PMI has moderate accuracy in diagnosing osteoporosis and FRAX ≥15%. CONCLUSIONS: PMI was significantly associated with BMD and fracture risk. PMI measurement is straightforward and may increase the diagnosis rate of osteoporosis and fracture risk.


Assuntos
Osteoporose , Fraturas por Osteoporose , Doenças da Coluna Vertebral , Absorciometria de Fóton , Densidade Óssea , Humanos , Osteoporose/diagnóstico por imagem , Osteoporose/epidemiologia , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/etiologia , Músculos Psoas/diagnóstico por imagem , Medição de Risco , Fatores de Risco
10.
Biol Trace Elem Res ; 200(1): 298-307, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33594527

RESUMO

The incidence of type 2 diabetic osteoporosis (T2DOP), which seriously threatens elderly people's health, is rapidly increasing in recent years. However, the specific mechanism of the T2DOP is still unclear. Studies have shown the relationship between iron overload and T2DOP. Mitochondrial ferritin (FtMt) is a protein that stores iron ions and intercepts toxic ferrous ions in cells mitochondria. Ferroptosis, an iron-dependent cell injured way, may be related to the pathogenesis of T2DOP. In this study, we intend to elucidate the effect of FtMt on ferroptosis in osteoblasts and explain the possible mechanism. We first detected the occurrence of ferroptosis in bone tissue and the expression of FtMt after inducing T2DOP rat model. Then we used hFOB1.19 cells to study the influence of high glucose on FtMt, ferroptosis, and osteogenic function of osteoblasts. Then we observed the effect of FtMt on ferroptosis and osteoblast function by lentiviral silencing and overexpression of FtMt. We found ferroptosis in T2DOP rats bone. Overexpression of FtMt reduced osteoblastic ferroptosis under high glucose condition while silent FtMt induced mitophagy through ROS / PINK1/Parkin pathway. Then we found increased ferroptosis in osteoblasts after activating mitophagy by carbonyl cyanide-m-chlorophenyl-hydrazine (CCCP, a mitophagy agonist). Our study demonstrated that FtMt inhibited the occurrence of ferroptosis in osteoblasts by reducing oxidative stress caused by excess ferrous ions, and FtMt deficiency induced mitophagy in the pathogenesis of T2DOP. This study suggested that FtMt might serve as a potential target for T2DOP therapy.


Assuntos
Diabetes Mellitus Tipo 2 , Ferritinas/metabolismo , Ferroptose , Proteínas Mitocondriais/metabolismo , Osteoporose , Animais , Ferritinas/genética , Proteínas Mitocondriais/genética , Mitofagia , Ratos , Espécies Reativas de Oxigênio/metabolismo , Ubiquitina-Proteína Ligases
11.
Biol Trace Elem Res ; 200(1): 183-196, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33715074

RESUMO

Osteoporosis is a systemic metabolic disease defined by a decreased bone mineral density, microarchitectural deterioration, and an increased incidence of fragility fractures that may lead to morbidity and mortality. Boron may stimulate new bone formation and regeneration, when combined with nano-hydroxyapatite. We questioned whether injecting boron-containing nano-hydroxyapatite composites with hyaluronan increased the bone mineral density and new bone formation in osteoporotic rabbit femurs. The regenerative effects of injectable boron-containing nano-hydroxyapatite composites from 6 to 12 weeks, which may prevent osteoporotic femoral fractures, were assessed. Boron-containing (10 µg/ml) nano-hydroxyapatite composites were injected into the intramedullary femoral cavity with hyaluronan. These significantly increased the histomorphometric new bone surface to the total bone surface ratio at 6 and 9 weeks. The micro-tomographic bone volume to the total volume ratio and bone mineral density in osteoporotic rabbit femurs increased when compared to the hyaluronan (p = 0.004, p = 0.004, p = 0.004, p = 0.01, respectively) and the sham-control (p = 0.01, p = 0.004, p = 0.01, p = 0.037, respectively) groups. The boron-containing group had a higher bone mineralization and new bone formation compared to the nano-hydroxyapatite group, although the difference was not statistically significant. These findings reveal that intramedullary injection of boron-containing nano-hydroxyapatite with hyaluronan increases new bone formation and mineralization in ovariectomized rabbit femurs. Boron-containing nano-hydroxyapatite composites are promising tissue engineering biomaterials that may have regenerative potential in preventing primary and/or secondary femoral fractures in osteoporosis patients.


Assuntos
Durapatita , Osteoporose , Animais , Regeneração Óssea , Boro/farmacologia , Fêmur , Humanos , Osteoporose/tratamento farmacológico , Coelhos
12.
Comput Methods Programs Biomed ; 213: 106499, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34763174

RESUMO

BACKGROUND AND OBJECTIVE: Adequate fixation is a requisite for hinged Total Knee Arthroplasty (TKA): consequently, several stem solutions are currently available. However, there are no evidence-based biomechanical guidelines for surgeons to determine the appropriate stem length and whether to use cemented or press-fit fixation. The objective of this study is therefore to compare, using a validated finite-element model, bone stresses and implant micromotions in different configurations. METHODS: The 3D bone geometries were obtained from CT-scans reconstruction and the 3D model components of an Endo-Model Rotating Hinge (WALDEMAR LINK GmbH & Co. KG, Hamburg, Germany) were generated from industrial designs provided by the manufacturer. Sixteen configurations were investigated considering four stem lengths (50, 95, 120, 160 mm), cemented and press-fit fixation and physiological and osteoporotic bone properties. A further configuration without stem was analyzed as control. Average Von-Mises stresses, risk of fracture and micromotions were extracted in several regions of interest at 0° and 90° of flexion, under physiological load conditions. RESULTS: Generally, longer stems guarantee better fixation compared to short ones; however, they induce higher stress-shielding effect in the distal region of the femur (even greater for press-fit stems, with values up to 38.5% greater than cemented ones). The cemented configurations, especially in case of 50 mm and 95 mm lengths, induce lower micromotions (down to 16% lower) compared to their respective press-fit configurations. The osteoporotic RF values were greater than the physiological ones (up to 20.5%), but always below the bone limit of fracture. CONCLUSIONS: According to this study, when surgeons need to select a femoral stem in a hinged TKA aiming to proper stability and bone stress, the preferable option would be short cemented stems.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoporose , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Desenho de Prótese
13.
Univ. salud ; 23(3): 248-254, sep.-dic. 2021. tab, graf
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-1341771

RESUMO

Resumen Introducción: Actualmente la vitamina D ha ganado importancia, por ser considerada una hormona y porque sus bajos niveles están asociados con diferentes patologías, especialmente alteraciones de la masa ósea. Objetivo: Determinar la prevalencia de bajos niveles de vitamina D en pacientes adultos con osteopenia y osteoporosis, atendidos en consulta externa de endocrinología en Popayán Cauca. Materiales y métodos: Estudio descriptivo y retrospectivo que incluyó pacientes con diagnóstico de osteopenia y osteoporosis realizado por densitometría ósea entre los años 2013 y 2016, que tenían reporte de niveles de vitamina D obtenidos por cualquier método. Se describieron características sociodemográficas, resultados de densitometría ósea, niveles vitamina D, hormona paratiroidea y calcio iónico. Resultados: Se incluyeron 300 pacientes con diagnóstico de osteopenia y osteoporosis de los cuales 211 tenían bajos niveles de vitamina D, para una prevalencia del 71,3%, el nivel promedio de 25 hidroxivitamina D fue de 24,35ng/ml. Conclusiones: La alta prevalencia de bajos niveles de vitamina D en pacientes con osteopenia y osteoporosis hace indispensable la medición de 25 hidroxivitamina D en esta población, esto con el fin de realizar una intervención terapéutica apropiada.


Abstract Introduction: Vitamin D has gained interest because it is a hormone whose low levels are associated with different pathologies such as bone mass disorders. Objective: To determine the prevalence of low levels of vitamin D in adult patients with osteopenia and osteoporosis who received care at an outpatient endocrinology clinic in Popayan, Cauca. Materials and methods: A retrospective and descriptive study that included patients diagnosed with osteopenia and osteoporosis through bone densitometry between 2013 and 2016, who also had their vitamin D levels measured by means of any laboratory method. Sociodemographic characteristics, bone densitometry results as well as vitamin D, parathormone and ionic calcium levels were described. Results: A total of 300 patients with osteopenia and osteoporosis were included in the study, of which 211 had low levels of vitamin D, representing a prevalence of 71.3%. Finally, the average level of 25-hydroxyvitamin D was 24.35 ng/ml. Conclusion: The high prevalence of low levels of vitamin D in patients with osteopenia and osteoporosis highlights the importance to measure 25-hydroxyvitamin D levels in this population in order to carry out an appropriate therapeutic intervention.


Assuntos
Vitamina D , Doenças Ósseas Metabólicas , Osteoporose , Prevalência
14.
Biol Res ; 54(1): 42, 2021 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-34930472

RESUMO

Osteoporosis (OP), a common systemic metabolic bone disease, is characterized by low bone mass, increasing bone fragility and a high risk of fracture. At present, the clinical treatment of OP mainly involves anti-bone resorption drugs and anabolic agents for bone, but their long-term use can cause serious side effects. The development of stem cell therapy and regenerative medicine has provided a new approach to the clinical treatment of various diseases, even with a hope for cure. Recently, the therapeutic advantages of the therapy have been shown for a variety of orthopedic diseases. However, these stem cell-based researches are currently limited to animal models; the uncertainty regarding the post-transplantation fate of stem cells and their safety in recipients has largely restricted the development of human clinical trials. Nevertheless, the feasibility of mesenchymal stem cells to treat osteoporotic mice has drawn a growing amount of intriguing attention from clinicians to its potential of applying the stem cell-based therapy as a new therapeutic approach to OP in the future clinic. In the current review, therefore, we explored the potential use of mesenchymal stem cells in human OP treatment.


Assuntos
Reabsorção Óssea , Células-Tronco Mesenquimais , Osteoporose , Animais , Camundongos , Osteoporose/terapia
15.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(12): 1642-1649, 2021 Dec 15.
Artigo em Chinês | MEDLINE | ID: mdl-34913324

RESUMO

Objective: To review the research progress of exosomes (EXOs) derived from different cells in the treatment of osteoporosis (OP). Methods: Recent relevant literature about EXOs for OP therapy was extensively reviewed. And the related mechanism and clinical application prospect of EXOs derived from different cells in OP therapy were summarized and analyzed. Results: EXOs derived from various cells, including bone marrow mesenchymal stem cells, osteoblasts, osteoclasts, osteocytes, and endothelial cells, et al, can participate in many links in the process of bone remodeling, and their mechanisms involve the regulation of proliferation and differentiation of bone-related cells, the promotion of vascular regeneration and immune regulation, and the suppression of inflammatory reactions. A variety of bioactive substances contained in EXOs are the basis of regulating the process of bone remodeling, and the combination of genetic engineering technology and EXOs-based drug delivery can further improve the therapeutic effect of OP. Conclusion: EXOs derived from different cells have great therapeutic effects on OP, and have the advantages of low immunogenicity, high stability, strong targeting ability, and easy storage. EXOs has broad clinical application prospects and is expected to become a new strategy for OP treatment.


Assuntos
Exossomos , Células-Tronco Mesenquimais , Osteoporose , Diferenciação Celular , Células Endoteliais , Humanos , Osteoporose/terapia
16.
Minerva Obstet Gynecol ; 73(6): 662-677, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34905874

RESUMO

Adolescence is a fundamental period for the formation of the skeleton, because is the stage in which bones grow more in both size and strength, laying a solid foundation for the future health of the skeleton. Any condition interfering with optimal peak bone mass accrual can increase fracture risk later in life. Up to 80% of peak bone mass is genetically determined while the remaining 20% is modulated by environmental factors that, if deleterious, may result in low bone mineral density (BMD) and an increased risk of fracture. The preferred test to assess bone health is dual-energy x-ray absorptiometry (spine or total body less head) using Z scores instead of T scores, even though in short stature or growth delay, should be used the height Z-score. The correction of risk factors is the first treatment for low BMD in children and adolescents. It's necessary having a correct lifestyle for preserving bone health: a proper nutrition, an adequate physical weight-bearing activity and avoidance of alcohol intake and tobacco smoke. Bisphosphonates could be used in children who sustained osteoporotic fractures, impairing quality of life, when spontaneous recovery is low for the persistence of osteoporosis risk factors. This clinical review discusses factors affecting bone health during childhood and adolescence and deals with diagnosis and treatment of low bone mass or osteoporosis in this age group.


Assuntos
Osteoporose , Fraturas por Osteoporose , Absorciometria de Fóton , Adolescente , Densidade Óssea , Humanos , Qualidade de Vida
17.
Minerva Obstet Gynecol ; 73(6): 730-743, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34905878

RESUMO

Osteoporosis is the most common of all metabolic bone disorders characterized by loss of bone strength, due to modifications in bone turnover. It leads to bone fragility and increased fracture risk. Because of the increasing aging of the world population, the number of people affected by osteoporosis is continuously increasing. The WHO operational definition of osteoporosis, based on a measurement of bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA), identifies patients at greatest risk of fracture. However, in the population overall a greater total number of fractures occurs in individuals with BMD values above threshold for osteoporosis diagnosis; for this reason, algorithms have been developed to improve the identification of individuals at high fracture risk, including clinical risk factors for fracture. The correct diagnosis of osteoporosis with an appropriate and accurate use of diagnostic imaging results in better management in terms of adequate treatment and follow-up. Moreover, screening strategies will improve identification of patients who are most likely to benefit from drug treatment to prevent fracture. All women after the age of 65 years previously untested and women after the age of 50 years with previous low trauma fractures should be screened by DXA. In fact, osteoporosis-related fractures cause a significant increase in morbidity and mortality, decreasing the quality of life, with an increasing social and economic burdens. For this reason, fracture risk assessment should be a high priority amongst health measures.


Assuntos
Osteoporose Pós-Menopausa , Osteoporose , Fraturas por Osteoporose , Absorciometria de Fóton , Idoso , Densidade Óssea , Feminino , Humanos , Pessoa de Meia-Idade , Osteoporose/diagnóstico , Osteoporose Pós-Menopausa/complicações , Qualidade de Vida
18.
Minerva Obstet Gynecol ; 73(6): 744-753, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34905879

RESUMO

INTRODUCTION: The prevalence of metabolic syndrome has been reported to extremely vary depending on the gender, age, and ethnicity studied. Approximately, 25% of the worldwide adult population is affected by metabolic syndrome, indicating it as a significantly important public health challenge. Likewise, fragility fracture represents an important public health issue too, and the lifetime residual risk of its occurrence has been established in 50% in women and 30% in men over 50 years of age, respectively. Dysmobility syndrome summarizes a cluster of co-existing conditions such as osteoporosis, sarcopenia, obesity. Currently, clinical research focuses essentially on the cardiovascular risks associated with metabolic syndrome. Today, it is conceivable to incorporate all these conditions under a generic "disorder of energy metabolism." EVIDENCE ACQUISITION: Animal and human studies suggest metabolic and dysmobility syndromes negatively impact on the risk for fragility fracture, contributing to increase the associated mortality rate. EVIDENCE SYNTHESIS: In recent years, strong correlation between type 2 diabetes, a frequent constitutive part of metabolic syndrome and fragility fracture risk has been reported, but the possible molecular mechanisms by which it can occur are still to be defined. CONCLUSIONS: Only very few human clinical studies faced these aspects, but they lack adequate endpoints for a good clinical practice in these subjects. Much more still needs to be done before appropriate therapeutic diagnostic pathways will be available for these patients at risk of bone and even generalized fragility. Suggestions for a future overall approach by generating global risk score for these conditions are given.


Assuntos
Diabetes Mellitus Tipo 2 , Fraturas Ósseas , Síndrome Metabólica , Osteoporose , Sarcopenia , Feminino , Humanos , Masculino , Síndrome Metabólica/epidemiologia , Osteoporose/epidemiologia , Sarcopenia/epidemiologia
19.
Clin Interv Aging ; 16: 1789-1799, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34934310

RESUMO

Purpose: The research aimed to compare the therapeutic effect of teriparatide (TPTD) and zoledronic acid (ZOL) therapy on bone formation and spinal fusion in patients with osteoporosis (OP) who underwent transforaminal lumbar interbody fusion (TLIF). Methods: On the basis of different anti-OP treatment options, the TPTD group was treated daily with TPTD (20 µg. ih. qd) for at least 6 months, while the ZOL group was treated with a single dose of ZOL (5 mg. ivgtt. st) postoperatively. The visual analogue scale (VAS), Oswestry Disability Index (ODI), bone mineral density (BMD), and concentration of bone turnover markers before, 6, and 12 months after surgery were evaluated. X-ray and three-dimensional computed tomography scans were performed at 6 and 12 months postoperatively to assess interbody fusion. Results: The number of patients in the TPTD and ZOL groups was 29 and 38 patients, respectively. The VAS and ODI scores in both groups were significantly reduced at 6 and 12 months after TLIF. Compared with that of baseline, the lumbar spine BMD of TPTD patients increased significantly from 0.716±0.137 g/cm2 to 0.745±0.124 g/cm2 and 0.795±0.123 g/cm2 at 6 and 12 months, respectively, and was significantly higher than that of the ZOL group at 12 months (0.720±0.128 g/cm2). The bone formation marker, P1NP, in the TPTD group increased significantly (145.48±66.64 ng/mL and 119.55±88.27 ng/mL) compared with baseline (44.67±25.15 ng/mL) and in the ZOL group (28.82±19.76 ng/mL and 29.94±20.67 ng/mL) at 6 and 12 months, respectively. The fusion rates in the TPTD and ZOL groups were 57% and 45% at 6 months, without statistical significance. However, TPTD had a more statistically significant positive influence on fusion rate than ZOL at 12 months (86% vs 70%). Conclusion: TPTD was more efficient than ZOL in bone formation and spinal fusion in OP patients who underwent TLIF.


Assuntos
Conservadores da Densidade Óssea , Fusão Vertebral , Teriparatida , Ácido Zoledrônico , Conservadores da Densidade Óssea/administração & dosagem , Conservadores da Densidade Óssea/uso terapêutico , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Osteoporose , Estudos Retrospectivos , Teriparatida/administração & dosagem , Teriparatida/uso terapêutico , Resultado do Tratamento , Ácido Zoledrônico/administração & dosagem , Ácido Zoledrônico/uso terapêutico
20.
Acta Reumatol Port ; 46(4): 328-332, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34962247

RESUMO

INTRODUCTION: Fragility fractures cause significant mortality and morbidity. Even though there are multiple guidelines for the management of fragility fractures, european countries still report treatment rates of less than 30%. Implementation of fracture liaison services can increase this percentage by 21%. Our goal is to describe the management of osteoporosis, in patients with hip fragility fracture treated in a portuguese hospital with no internal protocols in place. METHODS: A retrospective study was conducted. Patients treated surgically for hip fragility fracture in our hospital, during 2017, were included. Data until May 2020 was collected on osteoporosis recognition and pharmacological treatment prescription. RESULTS: A total of 102 patients were included, 87% female, with a mean age of 79.9±9.9 years at the time of the fracture. Pharmacological anti-osteoporotic treatment after the hip fragility fracture was prescribed in 35%. From those, 53% did not include bisphosphonates. General practice doctors were responsible for 44% of anti-osteoporotic prescriptions and "Osteoporosis" ICD10 codification in primary care was present in 10.7%. DISCUSSION/CONCLUSION: We found a gap in osteoporosis treatment after a hip fragility fracture, similar to literature reports when no fracture liaison service is in place. We believe that the lack of such protocols, the low rate of "osteoporosis" or "fragility fracture" mentioning at hospital discharge, together with the under recognition at primary care level, contribute to this reality. The implementation of new measures is crucial to improve prevention and management of fragility fractures.


Assuntos
Conservadores da Densidade Óssea , Fraturas do Quadril , Osteoporose , Fraturas por Osteoporose , Idoso , Idoso de 80 Anos ou mais , Conservadores da Densidade Óssea/uso terapêutico , Feminino , Humanos , Masculino , Osteoporose/tratamento farmacológico , Fraturas por Osteoporose/prevenção & controle , Estudos Retrospectivos
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