Bone turnover markers in Paget’s disease of the bone: A Systematic review and meta-analysis

Nofal, Alaa Al; Altayar, Osama; Benkhadra, Khalid; Agha, Osama Qasim; Asi, Noor; Nabhan, Mohammed; Prokop, Larry J.; Tebben, Peter J.; Murad, M. Hassan

doi:10.1007/s00198-015-3095-0

Cited by 70 publications

(27 citation statements)

References 37 publications

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“…(82) The role of biochemical markers in predicting disease extent was evaluated in a systematic review by Al-Nofal and colleagues. (83) This study synthesized data from 17 observational studies and 1 randomized trial in patients with PDB. The markers included were serum total ALP, BSALP, uNTX, ubCTX, sbCTX, and PINP.…”

Section: Recommendationmentioning

confidence: 99%

“…(66) Predicting the response of bone lesions Al Nofal and colleagues conducted a systematic review and meta-analysis of studies that compared changes in marker concentrations after bisphosphonate therapy with disease extent as assessed by quantitative radionuclide scintigraphy. (83) Decreases in bone ALP concentrations after treatment have been observed after treatment with various bisphosphonates. However, in a meta-analysis, bone ALP was a weak predictor of scintigraphic indices of disease extent after treatment (r ¼ 0.24, 95% CI 0.004-0.457).…”

Section: Costs and Use Of Resourcesmentioning

confidence: 99%

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Diagnosis and Management of Paget's Disease of Bone in Adults: A Clinical Guideline

Ralston

Corral‐Gudino

Cooper

et al. 2019

Journal of Bone and Mineral Research

117

137

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An evidence based clinical guideline for the diagnosis and management of Paget’s disease of Bone (PDB) was developed using GRADE methodology, by a Guideline Development Group (GDG) led by the Paget’s Association (UK). A systematic review of diagnostic tests, pharmacological and non-pharmacological treatment options was conducted which sought to address several key questions of clinical relevance. Twelve recommendations and five conditional recommendations were made but there was insufficient evidence to address eight of the questions posed. The following recommendations were identified as the most important. Radionuclide bone scans, in addition to targeted radiographs, are recommended as a means of fully and accurately defining the extent of the metabolically active disease in patients with PDB.Serum total alkaline phosphatase (ALP) is recommended as a first line biochemical screening test in combination with liver function tests in screening for the presence of metabolically active PDB.Bisphosphonates are recommended for the treatment of bone pain associated with Paget’s disease. Zoledronic acid is recommended as the bisphosphonate most likely to give a favourable pain response.Treatment aimed at improving symptoms is recommended over a treat-to-target strategy aimed at normalising total ALP in PDB.Total hip or knee replacements are recommended for patients with PDB who develop osteoarthritis in whom medical treatment is inadequate. There is insufficient information to recommend one type of surgical approach over another. The guideline was endorsed by the European Calcified Tissues Society, the International Osteoporosis Foundation, the American Society of Bone and Mineral Research, the Bone research Society (UK) and the British Geriatric Society. The GDG noted that there had been a lack of research on patient-focused clinical outcomes in PDB and identified several areas where further research was needed.

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Section: Recommendationmentioning

confidence: 99%

Section: Costs and Use Of Resourcesmentioning

confidence: 99%

Diagnosis and Management of Paget's Disease of Bone in Adults: A Clinical Guideline

Ralston

Corral‐Gudino

Cooper

et al. 2019

Journal of Bone and Mineral Research

117

137

View full text Add to dashboard Cite

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“…Both Paget disease and the group of rare Paget-like skeletal disorders including expansile skeletal hyperphosphatasia, familial expansile osteolysis, juvenile Paget disease, and fibrous dysplasia are characterized by a substantial increase in nearly every BTM measured (92 ). Furthermore, BTM concentrations, particularly PINP concentrations, have been shown to correlate with bone scintigraphy measures of disease activity and to respond to treatment with antiresorptives; thus BTMs have both diagnostic and disease monitoring applications for Paget disease of bone (93 ).…”

Section: Btms In Paget Disease Of Bonementioning

confidence: 99%

Bone Turnover Markers in the Diagnosis and Monitoring of Metabolic Bone Disease

2017

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BACKGROUND Disorders of bone metabolism, most notably osteoporosis, are highly prevalent and predispose to fractures, causing high patient morbidity and mortality. Diagnosis and monitoring of bone metabolic defects can present a major challenge as these disorders are largely asymptomatic and radiographic measures of bone mass respond slowly to changes in bone physiology. CONTENT Bone turnover markers (BTMs) are a series of protein or protein derivative biomarkers released during bone remodeling by osteoblasts or osteoclasts. BTMs can offer prognostic information on fracture risk that supplements radiographic measures of bone mass, but testing using BTMs has to take into account the large number of preanalytic factors and comorbid clinical conditions influencing BTM levels. BTMs respond rapidly to changes in bone physiology, therefore, they have utility in determining patient response to and compliance with therapies for osteoporosis. SUMMARY BTMs are a useful adjunct for the diagnosis and therapeutic monitoring of bone metabolic disorders, but their use has to be tempered by the known limitations in their clinical utility and preanalytic variables complicating interpretation.

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“…Vários marcadores de formação e reabsorção existem e podem ser utilizados para avaliação do turnover ósseo. Entretanto, deve-se considerar a disponibilidade e o custo ao decidir o marcador ósseo a ser investigado (AL NOFAL et al, 2015). É importante salientar que pacientes que apresentam doenças do metabolismo ósseo apresentam marcadores ósseos alterados acompanhados de algum comprometimento do estado de saúde geral.…”

Section: Considerações Finaisunclassified

Bifosfonatos e Denosumabes: mecanismos de ação e algumas implicações para a implantodontia

Chaves

Órfão²,

Júnior³

et al. 2018

RBM

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Antirreabsortivos são potentes inibidores da reabsorção óssea empregados no tratamento da osteoporose e das alterações do metabolismo ósseo associadas ou não a neoplasias. Devido à sua eficácia, antirreabsortivos como bifosfonatos (BPs) e denosumabes (DMABs) são amplamente utilizados. Porém, esses medicamentos têm sido associados à ocorrência de osteonecrose dos maxilares (ONJ), denominada “medication-related osteonecrosis of jaw (MRONJ)”. Parece haver uma relação entre a MRONJ e cirurgias odontológicas em pacientes tratados com BPs e DMABs. Porém, a relação entre a ocorrência de MRONJ e a instalação de implantes dentários não é muito discutida. O objetivo deste artigo foi realizar uma revisão de literatura a respeito do uso de antirreabsortivos, descrevendo seus mecanismos de ação, bem como sua inter-relação no tratamento com implantes. Foram também discutas estratégias prévias à realização de implantes em pacientes que fazem ou fizeram uso recente dos mesmos. Com isso, foi possível concluir que BPs e DMABs inibem a reabsorção óssea por mecanismos distintos. Os BPs se ligam ao tecido ósseo e quando incorporados por osteoclastos induzem sua apoptose. Já os DMABs, atuam inibindo a formação osteoclastica. Com relação entre o uso de BPs ou DMABs, a instalação de implantes e a MRONJ, a literatura é controversa. Cabe ao cirurgião-dentista e ao o médico, avaliarem os riscos e benefícios da suspensão do tratamento, para cada indivíduo candidato à implantodontia. Na tomada de decisão da suspensão ou não da medicação deve-se considerar variáveis associadas ao medicamento e ao paciente, prezando sempre pela prevenção da ONJ.

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Bone turnover markers in Paget’s disease of the bone: A Systematic review and meta-analysis

Cited by 70 publications

References 37 publications

Diagnosis and Management of Paget's Disease of Bone in Adults: A Clinical Guideline

Diagnosis and Management of Paget's Disease of Bone in Adults: A Clinical Guideline

Bone Turnover Markers in the Diagnosis and Monitoring of Metabolic Bone Disease

Bifosfonatos e Denosumabes: mecanismos de ação e algumas implicações para a implantodontia

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