Redefining osteoporosis treatment: who to treat and how long to treat

Lewiecki, E. Michael; Silverman, Stuart L.

doi:10.1590/s0004-27302006000400015

Cited by 16 publications

(16 citation statements)

References 45 publications

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“…Secondarily, it may be due to prolonged corticosteroid therapy, nutritional changes such as poor calcium intake, vitamin D deficiency, alcoholism, and smoking. [9][10][11][12] In our study, we observed that, in women with IBD, fracture cases were more frequent among smokers, a factor already pointed out in another study, 9 which associated smoking with reduction of BMD and with increased risk of fractures. Souza et al described that the number of patients with low BMD between the two groups of IBD is equivalent.…”

Section: Discussionmentioning

confidence: 52%

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Alert for bone alterations and low serum concentrations of vitamin D in patients with intestinal inflammatory disease

Kotze

Costa

Cavassani

et al. 2017

Rev. Assoc. Med. Bras.

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Background: Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), are characterized by chronic inflammation of the intestine that can reduce the absorption of nutrients such as vitamin D and calcium. Objective: To investigate bone alterations and serum levels of vitamin D in patients with IBD. Method: This was a cross-sectional study based on a review of medical records of patients from a private office in Curitiba, PR, Brazil. Serum levels of vitamin D and bone densitometry were measured at diagnosis of IBD. A total of 105 patients were included; 38 (58.4%) with CD; 27 (41.6%) with UC and 40 with irritable bowel syndrome (IBS) as comparison group. Results: When compared to patients with UC, CD patients showed a higher prevalence of bone alterations, being 15.8% with osteoporosis and 36.8% with osteopenia. In UC, bone alterations occurred in 29.6% of cases, 3.7% with osteoporosis and 25.9% with osteopenia. As for vitamin D levels, among CD patients, 10.5% had vitamin deficiency, 65.8% insufficiency and 23.7% were sufficient. In UC, 7.4% of cases had deficiency, 74.1% insufficiency and 18.5% had sufficient serum levels of vitamin D. In the group with IBS, deficiency was observed in 17.5% of cases, insufficiency in 55% and sufficiency in 27.5% of them. There was no significant difference between groups. Conclusion: IBD patients have a high prevalence of bone changes, especially those with CD. Serum levels of vitamin D are below the recommended in all the evaluated groups.

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Section: Discussionmentioning

confidence: 52%

“…1,12,15 Two of the female patients with CD with a history of fracture were perimenopausal, another contributing factor to bone loss. 9,10 Among the patients with UC, only one was menopaused and presented normal BMD.…”

Section: Discussionmentioning

confidence: 99%

Alert for bone alterations and low serum concentrations of vitamin D in patients with intestinal inflammatory disease

Kotze

Costa

Cavassani

et al. 2017

Rev. Assoc. Med. Bras.

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“…While several dosing schedules are available, oral bisphosphonates require a complex dosing regimen, which has been shown to have a negative impact on patient compliance with therapy [30]. The dosing regimen for oral bisphosphonates requires a 30-min post-dose fast for alendronate and risedronate (including the monthly dosing regimen) and a 60-min post-dose fast for ibandronate [31]. Because esophageal irritation is common, bisphosphonates must be taken with water, and the patient must sit upright for at least 30 min after ingestion [32].…”

Section: Conveniencementioning

confidence: 99%

Individualizing osteoporosis therapy

Silverman

Christiansen

2012

Osteoporos Int

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Guidelines for osteoporosis treatment are available; however, these guidelines suggest when to treat patients, without specific recommendations on what drugs to prescribe in various situations. Choice of osteoporosis therapy should be individualized based on consideration of the efficacy, safety, cost, convenience (i.e., dosing regimen and delivery), and other non-osteoporosis-related benefits associated with each agent. Bisphosphonates, administered orally or intravenously, should be considered first-line therapy, particularly in older patients, owing to their efficacy across multiple skeletal sites; however, there are potential short- and long-term safety concerns. Selective estrogen receptor modulators should be considered for younger postmenopausal women at greater risk for vertebral than hip fractures or as second-line therapy in women who cannot tolerate first-line therapies. Low-dose hormone therapy may be appropriate as prevention in women with menopausal symptoms at lower fracture risk. Calcitonin, with its relatively benign safety profile, may be appropriate for elderly women who may have difficulty following the complex dosing schedules of oral bisphosphonates. Anabolic therapies such as teriparatide should be considered for high-risk patients. Strontium ranelate (approved outside of North America), with both anabolic and antiresorptive properties, may be appropriate for women who cannot tolerate or are unable to take bisphosphonates. Denosumab is a monoclonal antibody appropriate for women at high fracture risk or who have failed other osteoporosis therapies, and may be considered in patients with renal insufficiency. It will be important to incorporate newer agents (e.g., bazedoxifene, tissue selective estrogen complex) into this individualized treatment paradigm to optimize clinical outcomes in patients with osteoporosis.

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“…Osteoporosis is a common public health problem, growing in both developed and developing countries [1,2] . Fractures in hip and spine are known to be the most important complication of the disease which leads mortality and serious morbidity [3] .…”

Section: Introductionmentioning

confidence: 99%

“…Fractures in hip and spine are known to be the most important complication of the disease which leads mortality and serious morbidity [3] . Osteoporosis is a systemic skeletal disease characterized by low bone mass and deterioration of bone tissue with consequent increase in bone fragility and susceptibility to fractures (1). Bone mineral density (BMD) is a significant determinant of fracture risk [4 -6] .…”

Section: Introductionmentioning

confidence: 99%

Untitled

2018

Int. J. Orthop. Sci.

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There is no data or very limited data available about the relation between anthropometric measurements like weight and height, and bone mineral density based on sex and age of South Indian population. Identifying persons at risk of sustaining osteoporotic fractures is crucial for the prevention of fracture. Therefore the present was undertaken for the identification, prevention and timely treatment of osteoporosis. The study population consisted of 350 patients (both male and female patients). The study was conducted during the period of January 2016 to November 2017. Patients with risk factors for osteoporosis as per WHO criteria were included for the study. Patients with Osteomyelitis, fracture, tumor pathology or trauma in bone were excluded from the study. Out of 350 patients, 110 were male subjects (31.5%) and 240 females (72.2%). Correlation analysis was used to investigate the continuous variables related with bone mineral density (BMD). Data were analyzed by means of SPSS version 16.0 using t-test and one way ANOVA. There is high prevalence of osteoporosis among men and women of this population. It can be concluded that certain anthropometric parameters (BMI and weight) can considerably affect one's risk of developing osteoporosis. Therefore, weight and BMI can be used as to screen those at risk of developing osteoporosis and its related complication.

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Redefining osteoporosis treatment: who to treat and how long to treat

Cited by 16 publications

References 45 publications

Alert for bone alterations and low serum concentrations of vitamin D in patients with intestinal inflammatory disease

Alert for bone alterations and low serum concentrations of vitamin D in patients with intestinal inflammatory disease

Individualizing osteoporosis therapy

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