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Osteoporosis management review

Matthew T Morris, Sandip P Tarpada, Vafa Tabatabaie, Woojin Cho
PURPOSE: In patients undergoing lumbar fusion, osteoporosis has been shown to lead to poorer outcomes and greater incidence of fusion-related complications. Given the undesirable effect of osteoporosis on lumbar fusion surgery, a number of medications have been proposed for use in the peri- and postoperative period to mitigate risks and enhance outcomes. The purpose of this review was to summarize and synthesize the current literature regarding medical management of osteoporosis in the context of lumbar fusion surgery...
March 14, 2018: Archives of Osteoporosis
Carmelo Messina, Gabriele Maffi, Jacopo Antonino Vitale, Fabio Massimo Ulivieri, Giuseppe Guglielmi, Luca Maria Sconfienza
Osteoporosis and sarcopenia represent two major health problems with an increasing prevalence in the elderly population. The correlation between these diseases has been widely reported, leading to the development of the term "osteosarcopenia" to diagnose those patients suffering from both diseases. Several imaging methods for the diagnosis and management of osteoporosis exist, with dual-energy X-ray absorptiometry (DXA) being the most commonly used for measuring bone mineral density (BMD). Imaging technique other than DXA is represented by conventional radiography, computed tomography (CT) and ultrasound (US)...
February 2018: Quantitative Imaging in Medicine and Surgery
Mariela Varsavsky, Manuel Romero Muñoz, Verónica Ávila Rubio, Antonio Becerra, Antonia García Martín, Guillermo Martínez Díaz-Guerra, Pedro Rozas Moreno, Esteban Jódar Gimeno, Manuel Muñoz Torres
OBJECTIVE: To provide practical recommendations to assess and treat osteoporosis in males. PARTICIPANTS: Members of the Bone Metabolism Working Group of the Spanish Society of Endocrinology. METHODS: Recommendations were formulated using the GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation) to describe both the strength of recommendations and the quality of evidence. A systematic search was made in Medline (PubMed) using the following associated terms: «osteoporosis», «men», «fractures», «bone mineral density», «treatment», «hypogonadism», and «prostate cancer»...
March 9, 2018: Endocrinología, Diabetes y Nutrición
Patrick Martineau, William D Leslie
PURPOSE OF REVIEW: Trabecular bone score (TBS) is a texture index derived from the lumbar spine dual-energy X-ray absorptiometry which can assess skeletal quality and provide information about fracture risk independent of bone mineral density (BMD). TBS is useful in assessing osteoporotic fracture risk, with lower TBS values associated with increased fracture risk. In this article, we review the current state of TBS, including its utility and limitations in the assessment and management of osteoporosis, with particular emphasis on the recent literature...
March 9, 2018: Current Opinion in Rheumatology
Kelsey H Collins, Walter Herzog, Graham Z MacDonald, Raylene A Reimer, Jaqueline L Rios, Ian C Smith, Ronald F Zernicke, David A Hart
Inflammation can arise in response to a variety of stimuli, including infectious agents, tissue injury, autoimmune diseases, and obesity. Some of these responses are acute and resolve, while others become chronic and exert a sustained impact on the host, systemically, or locally. Obesity is now recognized as a chronic low-grade, systemic inflammatory state that predisposes to other chronic conditions including metabolic syndrome (MetS). Although obesity has received considerable attention regarding its pathophysiological link to chronic cardiovascular conditions and type 2 diabetes, the musculoskeletal (MSK) complications (i...
2018: Frontiers in Physiology
Elliot M Silver, William Ochoa
BACKGROUND Chronic intake of high-dose corticosteroids is associated with multiple adverse clinical effects, including hypertension, insulin resistance, impaired wound healing, immunosuppression, myopathy, and osteoporosis. In cases of autoimmune disease, use of steroid-sparing treatment modalities is preferred over chronic steroid therapy to limit these side effects. Glucocorticoid-induced myopathy is a less common side effect of chronic steroid use in patients treated with <10 mg/day of prednisone. However, doses exceeding 40-60 mg/day can induce clinically significant myopathy and weakness...
March 11, 2018: American Journal of Case Reports
V A Levin, X Jiang, R Kagan
Menopause predisposes women to osteoporosis due to declining estrogen levels. This results in a decrease in bone mineral density (BMD) and an increase in fractures. Osteoporotic fractures lead to substantial morbidity and mortality, and are considered one of the largest public health priorities by the World Health Organization (WHO). It is therefore essential for menopausal women to receive appropriate guidance for the prevention and management of osteoporosis. The Women's Health Initiative (WHI) randomized controlled trial first proved hormonal therapy (HT) reduces the incidence of all osteoporosis-related fractures in postmenopausal women...
March 8, 2018: Osteoporosis International
Pascale Khairallah, Thomas L Nickolas
CKD mineral and bone disease is a common complication of kidney disease, and it affects the majority of patients with moderate to severe CKD. Recently, prospective studies have shown that measurement of bone mineral density by dual energy x-ray absorptiometry predicts incident fracture, providing nephrologists the ability to risk classify patients for skeletal fragility and targeted antifracture strategies for the first time. Furthermore, an expanding body of literature and anecdotal evidence suggest that pharmacologic agents used to treat osteoporosis in the general population can be safely used in patients with CKD...
February 27, 2018: Clinical Journal of the American Society of Nephrology: CJASN
Ecaterina-Constanța Barbu, Cristina-Emilia Chițu-Tișu, Mihai Lazăr, Cristina Olariu, Mihai Bojincă, Răzvan Adrian Ionescu, Daniela Adriana Ion, Ioana Anca Bădărău
Hepatic osteodystrophy is a common and frequently untreated complication, manifested as osteoporosis or osteopenia, encountered in the evolution of chronic liver diseases. This article provides a narrative review of hepatic osteodystrophy. The aim is to revise the prevalence, pathophysiology, diagnosis and management of hepatic osteodystrophy. We searched medical literature via PubMed, Google Scholar, Wiley, Science Direct, and Springer Link using respective keywords to obtain data on low bone mineral density connected to chronic liver diseases...
September 2017: Acta Clinica Croatica
Julien Paccou, Guillaume Penel, Christophe Chauveau, Bernard Cortet, Pierre Hardouin
There is growing interest in the relationship between bone marrow fat (BMF) and skeletal health. Progress in clinical studies of BMF and skeletal health has been greatly enhanced by recent technical advances in our ability to measure BMF non-invasively. Magnetic resonance imagery (MRI) with or without spectroscopy is currently the standard technique for evaluating BMF content and composition in humans. This review focuses on clinical studies of marrow fat and its relationship with bone. The amount of marrow fat is associated with bone mineral density (BMD)...
February 27, 2018: Bone
Nathan K Wool, Shannon Wilson, Alexander Cm Chong, Bradley R Dart
Introduction: Metabolic bone disease is a malady that causes significant morbidity and mortality to a patient who has sustained a fragility fracture. There is currently no protocol to prevent secondary fragility fracture at our institution. The objective of this study was to create an appropriate protocol for implementing clinical pathways for physicians to diagnose and treat osteoporosis and fragility fractures by educating patients. Methods: A multidisciplinary team created an appropriate protocol that could be implemented in an inpatient setting...
August 2017: Kansas Journal of Medicine
Emma D Deeks
Denosumab (Prolia®; Pralia®) is a human monoclonal antibody targeting the key bone resorption mediator RANKL. The drug is administered via subcutaneous injection once every 6 months and is approved for various indications, including the treatment of postmenopausal (PM) women with osteoporosis at increased/high risk of fracture or failure/intolerance of other osteoporosis therapies (indications featured in this review). Denosumab showed benefit in several phase 3 or 4 studies in PM women with osteoporosis or low bone mineral density (BMD), including the pivotal 3-year double-blind FREEDOM trial and its 7-year open-label extension...
February 12, 2018: Drugs & Aging
S L Greenspan, A Singer, K Vujevich, B Marchand, D A Thompson, Y-J Hsu, D Vaidya, L S Stern, D Zeldow, D B Lee, S Karp, R Recker
PURPOSE: Although half of women and one-quarter of men aged 50 and older will sustain an acute low-trauma fracture, less than a quarter receive appropriate secondary fracture prevention. The goal of this quality improvement demonstration project was to implement a Fracture Liaison Service (FLS) focused on secondary prevention of an osteoporotic fracture in three open health care systems aided by a cloud-based tool. METHODS: The pre-post study design examined the proportion of men and women over age 50 who received appropriate assessment (bone mineral density, vitamin D levels) and treatment (calcium/vitamin D, pharmacologic therapy) in the six months following a recently diagnosed fracture...
February 10, 2018: Osteoporosis International
R W Jordan, A W P Chapman, D Buchanan, P Makrides
BACKGROUND: Ankle fractures are one of the most commonly occurring fractures in the elderly population. The overall incidence has been reported to be up to 184 fractures per 100,000 persons per year, of which 20-30% occur in the elderly. Medical co-morbidities, osteoporosis, suboptimal skin quality and poor toleration of non-weight bearing status all contribute to difficulties in managing these injuries in this population. Intramedullary implants are advantageous as they utilise smaller incisions, minimise soft tissue disruption and may allow early weight bearing...
February 2018: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
Maria Teresa Valenti, Luca Dalle Carbonare, Monica Mottes
MicroRNAs (miRNAs) are considered 'micro- managers of gene expression' and awareness of their fundamental role in the control of biological functions is constantly increasing. Bone formation and homeostasis are complex processes involving the differentiation and interaction of various cell types. Several miRNAs have been shown to be involved in different pathways and stages in the regulation of normal and abnormal bone formation and turnover. This present review focuses on the involvement of miRNAs in terms of their effect on the commitment of bone marrow mesenchymal stem cells towards osteogenesis, adipogenesis and chondrogenesis, respectively...
February 1, 2018: International Journal of Molecular Medicine
Kristie N Tu, Janette D Lie, Chew King Victoria Wan, Madison Cameron, Alaina G Austel, Jenny K Nguyen, Kevin Van, Diana Hyun
Approximately 10 million men and women in the U.S. have osteoporosis,1 a metabolic bone disease characterized by low bone density and deterioration of bone architecture that increase the risk of fractures.2 Osteoporosis-related fractures can increase pain, disability, nursing home placement, total health care costs, and mortality.3 The diagnosis of osteoporosis is primarily determined by measuring bone mineral density (BMD) using noninvasive dual-energy x-ray absorptiometry. Osteoporosis medications include bisphosphonates, receptor activator of nuclear factor kappa-B ligand inhibitors, estrogen agonists/antagonists, parathyroid hormone analogues, and calcitonin...
February 2018: P & T: a Peer-reviewed Journal for Formulary Management
Ennio Giulio Favalli, Martina Biggioggero, Chiara Crotti, Andrea Becciolini, Maria Gabriella Raimondo, Pier Luigi Meroni
Rheumatoid arthritis (RA) is a chronic and progressive autoimmune disease more common in women than men (3:1). Although sex-based differences may play a complex role in promoting an autoimmune dysfunction, to date the comprehensive knowledge of the link between sex and RA is still partially lacking. Furthermore, males and females have been demonstrated to differently deal with their chronic pathologies, modifying the perceived sex-based burden of disease. Gender medicine is a newly approach focusing on the impact of gender differences on human physiology, pathophysiology, and clinical features of diseases, analyzing the complex interrelation and integration of sex and psychological and cultural behavior...
January 26, 2018: Clinical Reviews in Allergy & Immunology
Julia S Kenkre, John H Bassett
The bone remodelling cycle replaces old and damaged bone and is a highly regulated, lifelong process essential for preserving bone integrity and maintaining mineral homeostasis. During the bone remodelling cycle osteoclastic resorption is tightly coupled to osteoblastic bone formation. The remodelling cycle occurs within the Basic Multicellular Unit and comprises five co-ordinated steps; activation, resorption, reversal, formation and termination. These steps occur simultaneously but asynchronously at multiple different locations within the skeleton...
January 1, 2018: Annals of Clinical Biochemistry
Maria Mattera, Alfonso Reginelli, Silvia Bartollino, Claudio Russo, Antonio Barile, Domenico Albano, Giovanni Mauri, Carmelo Messina, Salvatore Cappabianca, Giuseppe Guglielmi
Osteoporosis is the most important metabolic bone disease, with a wide distribution among the elderly. It is characterized by low bone mass and micro architectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk. Identify bone weakening with an appropriate and accurate use of diagnostic imaging is of critical importance in the diagnosis and follow-up of osteoporotic patients. The aim of this review is to evaluate the detection rates of the different imaging modalities in the evaluation of bone strength, in the assessment of fracture risk and in the management of fragility fractures...
January 19, 2018: Acta Bio-medica: Atenei Parmensis
Robert A Adler
Modern osteoporosis treatment began in the mid-1990s with the approval of amino-bisphosphonates, anti-resorptive agents that have been shown to decrease osteoporotic fracture risk by about half. In 2005, the first cases of atypical femoral fractures (AFF), occurring in the shaft of the femur, were reported. Since then, more cases have been found, leading to great concern among patients and a dramatic decrease in bisphosphonate prescribing. The pathogenesis and incidence of AFF are reviewed herein. Management and an approach to prevention or early detection of AFF are also provided...
March 2018: European Journal of Endocrinology
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