Calcitonin in the prevention and treatment of osteoporosis

Chestnut, Charles

doi:10.1007/bf01621908

Cited by 11 publications

(4 citation statements)

References 5 publications

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“…The Prevent Recurrence of Osteoporotic Fractures study demonstrated a 33% reduction in the risk of new vertebral fractures in postmenopausal women with osteoporosis given salmon calcitonin intranasally at 200 IU/day as compared with placebo 39. However, calcitonin is considered a second-line agent by the AGA and BSG because of cost and concerns for tachyphylaxis.…”

Section: Treatment Optionsmentioning

confidence: 99%

Osteoporosis in Inflammatory Bowel Disease

Ali

Lam

Bronze

et al. 2009

The American Journal of Medicine

225

183

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Osteoporosis commonly afflicts patients with inflammatory bowel disease, and many factors link the 2 states together. A literature review was conducted about the pathophysiology of osteoporosis in relation to inflammatory bowel disease. Screening guidelines for osteoporosis in general as well as those directed at patients with inflammatory bowel disease are reviewed, as are currently available treatment options. The purpose of this article is to increase physician awareness about osteopenia and osteoporosis occurring in patients with inflammatory bowel disease and to provide basic, clinically relevant information about the pathophysiology and guidelines to help them treat these patients in a cost-effective manner. KeywordsInflammatory bowel disease; Osteopenia; Osteoporosis Approximately 1.4 million people in the United States and 2.2 million people in Europe suffer from inflammatory bowel disease. 1 Patients with inflammatory bowel disease are at higher risk of developing osteoporosis and osteopenia than the general population, with relative risk of fracture 40% higher in patients with inflammatory bowel disease. 2 The prevalence of osteopenia and osteoporosis in patients with inflammatory bowel disease varies significantly depending on the study populations, location, and design, but ranges from 22%-77% and 17%-41%, respectively. 3,4 Because of the high prevalence, it is imperative that physicians recognize patients at risk for osteoporosis, screen appropriate patients, and prevent or treat accordingly. PATHOPHYSIOLOGY OF OSTEOPOROSIS IN INFLAMMATORY BOWEL DISEASEBone is a living tissue that undergoes constant remodeling by bone-forming cells (osteoblasts) and bone-resorbing cells (osteoclasts). Imbalances in bone formation and resorption lead to osteoporosis. Several gastrointestinal dis orders have been associated with osteoporosis and ROLE OF CORTICOSTEROIDSBecause glucocorticoids are a treatment mainstay for chronic inflammatory diseases, it is important to recognize the effects they have on bone remodeling. They have been shown to impair osteoblast function, induce osteoblast apoptosis, reduce intestinal calcium absorption, and increase renal excretion of calcium. 5,7 Patients on glucocorticoids are at increased risk for fracture, with the greatest bone loss occurring in the initial months of treatment. 8 Interestingly, studies show a decrease in fracture risk back toward baseline after stopping glucocorticoid therapy. 9 It is, however, difficult to distinguish how much impact glucocorticoid use has on bone compared with disease activity, as increased disease activity and higher degrees of inflammation are indications for steroid use. While prednisone, prednisolone, and methylprednisolone are systemically acting steroids and one of the major contributing factors in osteoporosis in inflammatory bowel disease, budesonide, a locally acting corticosteroid with low systemic bioavailability, has been increasingly used in the treatment of inflammatory bowel disease because of its lack of systemic effect...

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Section: Treatment Optionsmentioning

confidence: 99%

Osteoporosis in Inflammatory Bowel Disease

Ali

Lam

Bronze

et al. 2009

The American Journal of Medicine

225

183

View full text Add to dashboard Cite

show abstract

“…Skeletal response to mechanically induced strain is well substantiated Lanyon, 1984, 1985;Nordin and Frankel, 1989;Chestnut, 1993;Greendale et al, 1995;Hazelwood et al, 2001). Muscle and bone are inextricably linked; forces produced by muscle contractions dominate the skeleton's postnatal structural adaptation to loading (Daly et al, 2004;Rauch et al, 2004;Bitsakos et al, 2005).…”

Section: Discussionmentioning

confidence: 92%

Intraskeletal variability in bone mass

Peck

Stout

2006

American J Phys Anthropol

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For methodological or other reasons, a variety of skeletal elements are analyzed and subsequently used as a basis for describing general bone loss and mass. However, bone loss and mass may not be uniform within and among skeletal elements of the same individual because of biomechanical factors. We test the hypothesis that a homogeneity in bone mass exists among skeletal elements of the same individual. Measures indicative of bone mass were calculated from the midshafts of six skeletal elements from the same individuals (N = 41). The extent of intraskeletal variability in bone mass (relative cortical area) was then examined for the entire sample, according to age, sex, and pathological status. The results of the analysis showed that all measures reflect a heterogeneity in bone mass (P

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“…• Calcitonin may be an effective treatment in patients with bone disease who are receiving AEDs because studies have found decreased calcitonin associated with AED use. In a study of postmenopausal women not on AEDs, intranasal salmon calcitonin at a dosage of 200 IU per day reduced the rate of vertebral but not peripheral fracture [31]. Side effects include nasal irritation, backache, bloody nose, and headaches.…”

Section: Bone Healthmentioning

confidence: 97%

Effects of treatment on endocrine function in patients with epilepsy

Pack

2005

Curr Treat Options Neurol

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Antiepileptic drug (AED) treatment is associated with multiple short- and long-term side effects. Effects on endocrine function, including weight change, reproductive function, thyroid function, and bone health are examples of these side effects. Some AEDs affect weight, resulting in weight gain or loss. Levetiracetam and lamotrigine are weight-neutral agents, whereas valproate is associated with weight gain. Reproductive dysfunction is reported in women and men with epilepsy treated with AEDs. In women, the most common symptoms are hyperandrogenism, menstrual disorders with ovulatory failure, polycystic ovary-appearing ovaries or polycystic ovary syndrome, and hyperinsulinemia. These symptoms may be secondary to epilepsy or to AED treatment, particularly with valproate. In men, effects on sperm quality and motility, delayed sexual development, and small testicular size have been described in association with AED treatment. Carbamazepine reduces testosterone levels, whereas valproate increases androgen levels. Oxcarbazepine is not associated with changes in testosterone levels. Treatment with all of these agents can result in changes in sperm, including concentration, morphology, and motility. Enzyme-inducing AEDs are known to result in decreased thyroid hormones. Recent studies found reduced serum thyroid hormone concentrations in men and young girls treated with carbamazepine and oxcarbazepine. However, all patients were clinically euthyroid, and these changes were reversible after AED withdrawal. Persons with epilepsy treated with AEDs are at increased risk for fracture. Not only is this increased because of seizure activity, but also because of treatment with AEDs. AED treatment results in decreased bone mineral density, the most sensitive predictor of fracture and changes in biochemical indices of bone metabolism, including calcium, vitamin D, and markers of bone formation and resorption. Identifying each of these endocrine abnormalities is important because it may be necessary and beneficial to change AED treatment. In addition, multiple therapies exist for the treatment of polycystic ovary syndrome, infertility, and decreased bone mineral density.

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Calcitonin in the prevention and treatment of osteoporosis

Cited by 11 publications

References 5 publications

Osteoporosis in Inflammatory Bowel Disease

Osteoporosis in Inflammatory Bowel Disease

Intraskeletal variability in bone mass

Effects of treatment on endocrine function in patients with epilepsy

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