Medications For Treatment Of Osteoporosis Research Articles

Management of Osteoporosis Medication after Osteoporotic Fracture.

The aim of this study was to provide helpful information for use in selection of an appropriate medication after osteoporotic fractures through conduct of a literature review. In addition, a review of the recommendations of several societies for prevention of subsequent fractures was performed and the appropriate choice of medication for treatment of atypical femur fractures was examined. Clinical perspective was obtained and an updated search of literature was conducted across PubMed and MEDLINE and relevant articles were selected. The articles were selected manually according to relevance, and the references for identified articles and reviews were also evaluated for relevance. The following areas are reviewed: Commonly prescribed osteoporosis medications: BPs (bisphosphonates), denosumab, and SERMs (selective estrogen receptor modulators) in antiresorptive medications and recombinant human parathyroid hormone teriparatide, recently approved Romosuzumab in anabolic agents, clinical practice guidelines for the management of osteoporosis, osteoporotic fracture, and atypical femur fracture. Most medications for treatment of osteoporosis do not delay fracture healing and the positive effect of teriparatide on fracture healing has been confirmed. In cases where an osteoporotic fracture is diagnosed, risk assessment should be performed for selection of very high-risk patients in order to prevent subsequent fractures, and administration of anabolic agents is recommended.

Russian federal clinical guidelines on the diagnostics, treatment, and prevention of osteoporosis

Screening using the Fracture Risk Assessment Tool (FRAX) is recommended in all postmenopausal woman and mеn over 50 (A1) in order to identify individuals with high probability of fractures. It is recommended to diagnose osteoporosis and start treatment in patients with fragility fracture of large bones of the skeleton and/or high individual probability of major fragility fractures (FRAX) and/or detected decrease in bone mineral density (BMD) up to –2.5 T-score as assessed by DXA in the femoral neck and/or lumbar vertebrae (A1). Patients with back pain, lifetime height loss of 4 cm or height loss of 2 cm since a previous medical examination, those who receive glucocorticoids, patients with long lasting decompensated type 2 diabetes mellitus, or those receiving insulin therapy, as well as patients who were previously diagnosed with fragility fractures at the other sites are advised to underwent standard lateral X-ray imaging of the spine (Th4—L5) in order to verify the presence of compression vertebral fractures (B1).
 Dual-energy X-ray absorptiometry (DXA) is recommended for individuals whose 10-year probability of major osteoporotic fracture (FRAX) falls within the medium risk group (B1). It is recommended to include the trabecular bone score (TBS) the FRAX algorithm in order to improve the sensitivity of this method (B1).
 Laboratory testing is recommended for the differential diagnosis with other causes of increased skeletal fragility in all patients with newly diagnosed osteoporosis and when previously prescribed antiosteoporostic treatment was ineffective (B1).
 Bisphosphonates (BPs), antibodies to receptor activator of nuclear factor kappa-beta ligand (RANKL) (denosumab), or parathyroid hormone analogue (teriparatide) are equally recommended to prevent fragility fractures and increase BMD in patients with osteoporosis (A1). Denosumab is also recommended to prevent BMD loss and fractures in females receiving aromatase inhibitors therapy for breast cancer and males with prostate cancer receiving hormone-deprivation therapy and having no bone metastases (A1). Since teriparatide has the anabolic effect, it is recommended as the first line treatment in patients with severe osteoporosis having history of vertebral fractures, in the individuals with very high risk of fragility fractures, or in the cases when antiresorptive treatment was ineffective (B1). All medications for treatment of osteoporosis are recommended in combination with calcium and vitamin D supplements (A1).

Definition of Italian Specific DXA References for Diagnosis of Osteoporosis: Preliminary Data from the Osteoporosis Registry of Magenta Rheumatology School (OSTEOREMA)

Background : Osteoporosis is the most common metabolic bone disease and dual energy X ray absorptiometry (DXA) scans is the gold standard to evaluate individuals at risk of osteoporosis. Up to date, studies focused on population specific DXA values among general population are lacking. Primary aim of this study was to obtain lumbar and femoral DXA values of Italy adult females based on a nationally representative sample aged 20 years and older, attempting to obtain a national specific normative bone mineral density (BMD) levels curve. Methods : demographic and anthropometric data of females aged 20 years and older that performed their first DXA (QDR 9000 Hologic, Waltham, Mass.) in our Hospital between 2006 and 2015 were extracted from our local registry using a random sampling technique. Criteria for patient choice were: absence of known risk factors of Osteoporosis (e.g. smoke, alcohol), metabolic disease that affects bone (e.g. diabetes), a normal BMI between 18.5 to 24.5, previous fractures, any medication for treatment of osteoporosis or corticosteroids, spondylosis radiologically relevant. Our database was compared to Caucasian normal values incorporated into Hologic’s scan analysis software, that we proven were comparable in terms of BMI, gender and age. Results : DXA scan of 15335 women were extracted and analysed. Mean age was 64.2 ± 12.8 years (range 20.8 to 90). Mean BMI was 22.4± 5.1 (range 20.1 to 24.3). Mean menopause age was 41.3±5 (range 31-54). Mean menarche age was 16.3±5 (range 11-17). The lumbar and femoral BMD were substantially constant between 25 and 35 years (test for trend using ANOVA: P =0.31); these data collected in premenopausal women (mean 1.043± 0.12 g/cm 2 for lumbar spine and 0.97± 0.136 g/cm 2 for femoral neck) were thus defined as the reference peak bone mass values, significantly lower compared to the Hologic reference values (mean 1.079±0.11 g/cm 2 , p<0.05). The frequency of osteopenia and osteoporosis were so significantly different depending on whether you use the manufacturer criteria rather than those derived from collected data (X square p=0,01). Conclusions : our data suggest that the reference curves for the lumbar spine and femoral neck are significantly different from the current normative data reported by the manufacturer for the Italian population.

Predictors of Immunosuppressive Regulatory T Lymphocytes in Healthy Women

Immunosuppressive regulatory T (Treg) cells play an important role in antitumor immunity, self-tolerance, transplantation tolerance, and attenuation of allergic response. Higher proportion of Treg cells has been observed in peripheral blood of cancer cases compared to controls. Little is known about potential epidemiological predictors of Treg cell levels in healthy individuals. We conducted a cross-sectional study including 75 healthy women, between 20 and 80 years of age, who participated in the Data Bank and BioRepository (DBBR) program at Roswell Park Cancer Institute (RPCI), Buffalo, NY, USA. Peripheral blood levels of CD4+CD25+FOXP3+ Treg cells were measured using flow cytometric analysis. A range of risk factors was evaluated using Wilcoxon Rank-Sum test, Kruskal-Wallis test, and linear regression. Age, smoking, medications for treatment of osteoporosis, postmenopausal status, body mass index (BMI), and hormone replacement therapy (HRT) were found to be significant positive predictors of Treg cell levels in peripheral blood (P ≤ 0.05). Higher education, exercise, age at first birth, oral contraceptives, and use of Ibuprofen were found be significant (P < 0.05) negative predictors of Treg levels. Thus, various epidemiological risk factors might explain interindividual variation in immune response to pathological conditions, including cancer.

Osteonecrosis associated with short-term oral administration of bisphosphonate

Orally administered bisphosphonates are generally considered a first-line medication for treatment of osteoporosis. As a side effect of bisphosphonates, osteonecrosis of the jaws (ONJ) has been reported worldwide. Most reports of osteonecrosis are attributed to the use of bisphosphonates administered intravenously for the treatment of bone disorders such as multiple myeloma. However, osteonecrosis has also been diagnosed in patients receiving oral bisphosphonates. The management of a patient with spontaneous removable partial denture prosthesis-related ONJ associated with short-term oral administration of bisphosphonate is described.

Treatment of Postmenopausal Osteoporosis

Osteoporosis is a skeletal disease characterized by low bone mass and microarchitectural deterioration with a resulting increase in bone fragility and hence susceptibility to fracture. Calcium and vitamin D are the most commonly used therapies for osteoporosis, although their efficacy in osteoporotic fracture prevention remains uncertain. Biphosphonates are the most frequently prescribed medication for treatment of osteoporosis and are often considered as first-line therapy for the treatment of osteoporosis. Currently, hormone replacement therapy is only approved by the Food and Drug Administration (FDA) for short-term treatment of severe postmenopausal symptoms with the lowest dose used for the shortest time. In view of its lack of effect on the prevention of nonvertebral fractures, the use of raloxifene should be limited to women with spinal osteoporosis. Most experts agree that it is preferable to treat osteoporosis with a more potent agent than calcitonin and manage the pain separately. Currently, the FDA recommends the use of parathyroid hormone for treatment of osteoporosis for a maximum of 2 years because of the concern of development of osteosarcoma.

Missed Opportunities in Patients with Osteoporosis and Distal Radius Fractures

Low-energy wrist (distal radius) fractures are hallmarks of osteoporosis. Prompt diagnosis and treatment of osteoporosis reduce refracture rates. We retrospectively determined the type and frequency of osteoporosis-related interventions rendered to patients 50 years and older in the year after a wrist fragility fracture. In addition, we compared the rates of intervention between men and women. Data were collected from the computerized medical record of one military healthcare system. We identified 111 patients who sustained wrist fragility fractures between July and December 2002. Endocrinology referrals, dual-energy xray absorptiometry scans, and osteoporosis medication prescriptions in the year after their fracture were recorded. Overall, 28 patients (25%) were referred to endocrinology, 22 patients (20%) had a dual-energy xray absorptiometry scan, 33 patients (30%) were prescribed an approved medication for treatment of osteoporosis, and 52 patients (47%) were prescribed one of these medications and/or vitamin D and calcium. Sixty percent of patients received at least one intervention. All diagnostic and medical interventions were more likely ordered for women than men. Orthopaedic surgeons continue to miss opportunities to initiate diagnostic and therapeutic interventions for patients, especially men, presenting with fragility fractures.

Parathyroid Hormone (1–84) and Treatment of Osteoporosis

To present the chemistry, pharmacology, and pharmacokinetics of parathyroid hormone (PTH) (1-84) and review the available clinical trials that evaluate its efficacy and safety; clinical applicability of this agent and its relationship to other Food and Drug Administration (FDA)-approved medications for treatment of osteoporosis are also discussed. A MEDLINE search (1996-December 2004) was completed, along with a review of information obtained from the manufacturer, NPS Pharmaceuticals. Key search terms included parathyroid hormone, PTH (1-84), and ALX 111. Studies were selected based on their relevance and availability. Pertinent information, including objectives, design, demographics, outcomes, adverse events, dosing strategies, and therapeutic controversies, was extracted. PTH (1-84) is being developed for treatment of osteoporosis. Recent studies have shown that, when administered intermittently as a subcutaneous injection, PTH (1-84) produces an increase in bone mineral density and prevents vertebral fractures. The fact that this agent contains the C-terminal region of PTH may differentiate it from PTH (1-34), teriparatide, which is approved by the FDA for treatment of osteoporosis. Further trials are necessary to determine the role of PTH (1-84) in combination with other treatments for osteoporosis and/or the order in which PTH (1-84) is given with these other agents. There are currently no comparative trials with other osteoporosis treatment modalities. PTH (1-84), when given intermittently as a subcutaneous injection, appears to be a safe and efficacious treatment option for osteoporosis. Further trials are needed to determine its specific place in therapy compared with other treatment options.