Modifiable Risk Factor For Osteoporosis Research Articles

Does the association of therapeutic exercise and supplementation with sucrosomial magnesium improve posture and balance and prevent the risk of new falls?

BackgroundFracture of the proximal femur is the most feared complication of osteoporosis. Given the numerous physiological functions that magnesium performs in our body, in the literature there is a correlation between osteoporosis and low serum levels of magnesium.AimEvaluate the incidence of hypomagnesemia in patients with lateral fragility fracture of the proximal femur, the possible correlation between serum magnesium levels and fractures, and the effectiveness of supplementing Sucrosomial® magnesium associated with therapeutic exercise on the outcome of these patients.MethodsWe divided the study into two parts. In the first part, we assessed the preoperative incidence of hypomagnesemia in patients using a blood test. In the second part, patients with hypomagnesemia were divided, in the post-operative period, into two groups, who received, respectively, only therapeutic exercise or oral supplementation with sucrosomial magnesium associated with therapeutic exercise.ResultsHalf of the patients with fragility femoral fracture had hypomagnesemia, with a higher incidence of the subclinical form. From the comparison between the two groups, the T1 treatment group showed a significant improvement in blood levels of magnesium (2.11 ± 0.15 vs. 1.94 ± 0.11; p < 0.05), on the NRS scale (5.7 ± 0.81 vs. 6.6 ± 1.18; p < 0.05), the Tinetti scale (17.3 ± 1.15 vs. 15.2 ± 2.98; p < 0.05) and the SarQoL questionnaire (47.3 ± 5.21 vs. 44.9 ± 5.54; p < 0.05).ConclusionsMore attention would be needed in the diagnosis and correction of subclinical hypomagnesemia and not just the simple and clinically evident one, including hypomagnesemia among the modifiable risk factors for osteoporosis.

Osteoporosis - risk factors, pharmaceutical and non-pharmaceutical treatment.

Osteoporosis is a metabolic disease of the skeletal system which currently affects over 200 million patients worldwide. The WHO criteria define osteoporosis as low bone mineral density, with a T-score ≤ -2.5 found in the spine, the neck of the femur, or during a full hip examination. Osteoporosis considerably reduces a patient's quality of life. QoL should be carefully evaluated before fractures occur to enable the development of an appropriate treatment plan. The progression of osteoporosis may be significantly inhibited by following a proper diet, leading a healthy lifestyle, taking dietary supplements, and receiving appropriate treatment. Education and the prevention of the disease play a major role. Potentially modifiable risk factors for osteoporosis are vitamin D deficiency, smoking, alcohol consumption, low calcium intake, low or excessive phosphorus intake, protein deficiency or a high-protein diet, excessive consumption of coffee, a sedentary lifestyle or lack of mobility, and insufficient exposure to the sun. Pharmaceutical treatment for osteoporosis involves bisphosphonates, calcium and vitamin D3, denosumab, teriparatide, raloxifene, and strontium ranelate. Data indicates that 30%-50% of patients do not take their medication correctly. Other methods of treatment include exercise, kinesitherapy, treatment at a health resort, physical therapy, and diet.

Activité physique chez l’adulte en consultation de l’ostéoporose

Physical activity is a modifiable risk factor for osteoporosis. Studies on physical activity and bone health have mainly targeted postmenopausal women. Observational studies with fracture outcomes of physical activity interventions in adults older than 40 years found 11-40 % reduced risk of any fracture. There is no randomised controlled trials of exercise with fracture as a primary outcome. However, there is evidence that exercise can reduce fall-related fractures, particularly exercise that includes functional strength and balance training. Exercise recommendations to optimize bone health emphasize moderate-intensity or high-intensity progressive resistance training (PRT), and impact (weight-bearing activities) and balance training in order to reduce falls and improve bone mineral density. Indeed, multicomponent programmes that combine impact exercise with sufficiently dosed, moderate-intensity or high-intensity PRT and that are progressive in nature are the most effective. Professionals should avoid restricting physical activity and exercise unnecessarily according to age. People with osteoporosis should be encouraged to do more rather than less. Important themes for osteoporosis are: strong, steady and straight!

Research Article Incidence rate and modifiable risk factors for osteoporosis in Vietnam

Research Article Incidence rate and modifiable risk factors for osteoporosis in Vietnam

PREVALENCE OF RISK FACTORS FOR OSTEOPOROSIS AMONG FEMALES AGED 35 YEARS AND ABOVE IN SAUDI ARABIA

Osteoporosis is a common public health challenge globally but the relative contribution of variousrisk factors for osteoporosis in Saudi Arabia is not well established. We conducted this study to determine the prevalence of risk factors for osteoporosis among females aged 35 years and above in Saudi Arabia. We performed a descriptive cross-sectional study with a sample size of 2070 and determined the prevalence of risk factors as percentages of the total sample size. We foundthat vitamin D deficiency is the major modifiable risk factor for osteoporosis in Saudi Arabia followed by cigarette smoking. Autoimmune and endocrine diseases were also not uncommon. Our results therefore suggest for the strengthening of measures to prevent vitamin D deficiency, reduce corticosteroid-related osteoporosis and curb cigarette smoking.

Enjoyability And Acceptability Of Bone Targeted Exercise For Young Adult Women: The OPTIMA-Ex Trial

PURPOSE: While physical activity participation is recognized as an effective modifiable risk factor for osteoporosis, adherence and compliance present significant challenges. We aimed to explore the experiences related to a bone-targeted exercise intervention, determine enjoyment and acceptability of each exercise mode, and identify barriers and facilitators to osteogenic exercise for young adult women with low bone mass. METHODS: A mixed-methods study was conducted within the OPTIMA-Ex trial, a three-arm RCT comparing musculoskeletal outcomes from high-intensity impact training (IT), high-intensity resistance training (RT), and a home-based low-intensity exercise control (CON). All 32 participants (IT=10, RT=12, CON=10) who finished the trial completed questionnaires on physical activity enjoyment (PACES-8, Kruskal-Wallis and Friedman’s test), quality of life (AQoL-6D, repeated measures ANOVA), and semi-structured interviews to facilitate qualitative analysis (Leximancer v4.50) of participant experiences. RESULTS: At follow-up, RT had the highest total score for PACES-8 (48.6±4.7), while only the IT group experienced an increase in total score over the 10 months (34.8±4.1 to 41.4±6.9, p<0.05). Only CON experienced an improvement in total AQoL-6D score. For the sub-domains, all groups experienced clinically significant improvements (>0.06 points) for ‘mental health’, while IT improved for ‘senses’ and CON improved for ‘coping’ (p<0.05). The qualitative analysis revealed that overall trial exercises were viewed positively by all groups, yet the two high-intensity groups had the ‘richest’ exercise experiences, developing a more positive attitude to exercise. Barriers to exercise related to time, convenience, accessibility, and cost. Both IT and CON groups experienced a 41% drop out compared to 29% in the RT group. Compliance did not differ between CON (78.8±4.1%), IT (61.4±15.1%), or RT (66.4±11.2%) (p=0.085). CONCLUSIONS: While IT and RT provide enjoyable bone-targeted exercise experiences for young adult women, on balance RT appears most favorable. It seems prudent, that bone-targeted exercise interventions for this demographic address perceptions of time demands and environmental barriers to participation in order to maximize compliance and adherence.

Primary Osteoporosis Management by the Marche Region Health Care System

Osteoporosis is an illness that affects the skeleton and is characterized by progressive loss of bone mass as well asby micro architectural deterioration of bone tissue of the same. This condition exposes the person to fracture risk, aparticularly feared event not only in terms of individual health but even in terms of economic burden. The fractures,in fact, are accompanied by autonomy loss, institutionalization risk, comorbidity and mortality. On an economic level,the reduction of the same absorbs many more resources than anti-osteoporosis drug therapies even in the event thatall patients are reached with ascertained osteoporosis and with 100% adherence to medication. In the elderly, in addition to incurring in loss of bone density risk there is an increase of fall risk. Both of these factors add up causing anincrease of fracture risk. Due to the demographic increase and life expectancy, osteoporosis and fracturing events willtend to increase, causing an increase in costs. Today, the data collected in Italy regarding osteoporosis prevalenceand fragility fractures incidences are not entirely exhaustive. Concerning fractures, data is reliably collected usingthe “Diagnosis Related Group Classification” and refers to those of the femur.Detect and describe the pathway that the patient with primary osteoporosis follows in the Marche Region.Through the regional Single Booking Center (CUP) and the websites of the Italian League of Osteoporosis (LIOS)and the Italian Society of Osteoporosis, Mineral Metabolism and Skeleton Diseases (SIOMMMS), eleven serviceshave been identified, belonging to the four health care companies of the Marche Region (Asur, Inrca-Irccs, AO Ospedali Riuniti Marche Nord, AOU Ospedali Riuniti Ancona), which can be contacted for an osteoporosis checkup. Aquestionnaire was therefore prepared based on the recommendations contained in the SIOMMMS (2012), SIMFERand SIGN (2015) guidelines and sent to the above-mentioned services. The questionnaires are seven, duly completedand used for processing data.In the Marche Region, the medical specialties that deal with osteoporosis are various, demonstrating the fact that thisis a “border illness”. Concerning the interception of the patient, his sending to a specialized service, the diagnosticapproach and the use of risk-scoring tools, there is a substantial homogeneity throughout the regional territory. Thepatient is sent to the specialized center by the general practitioner (GP) or other specialist, based on the presence ofrisk factors for osteoporosis alone or on the basis of their presence in association with BMD measurement (body massdensity measurement) already known. For the purposes of diagnosis, the investigations required are the dual-energyx-ray absorptiometry (DXA) and the blood test while the use of risk-scoring tools are mainly dictated by the need todefine the threshold of pharmacological intervention and give the patient perception of its own fracture risk. The mostused algorithm is DeFRA. During the evaluation of the patient, all services detect pain and fall risk.The approach to osteoporosis and fall risk is purely pharmacological. From a non-pharmacological point of view,attention is paid in informing the patient about the modifiable risk factors for osteoporosis and falls. Only some services carry out interventions aimed at promoting adherence to treatment, resorting to different actions. In conclusion,the main critical issues relating to taking care of a fracture risk patient are: accessibility to information, early andexhaustive interception of the population at risk, detection of the fracture risk in relation to bone demineralizationand fall risk, adherence to therapy

Primary Osteoporosis Management by the Marche Region Health Care System

Osteoporosis is an illness that affects the skeleton and is characterized by progressive loss of bone mass as well as by micro architectural deterioration of bone tissue of the same. This condition exposes the person to fracture risk, a particularly feared event not only in terms of individual health but even in terms of economic burden. The fractures, in fact, are accompanied by autonomy loss, institutionalization risk, comorbidity and mortality. On an economic level, the reduction of the same absorbs many more resources than anti-osteoporosis drug therapies even in the event that all patients are reached with ascertained osteoporosis and with 100% adherence to medication. In the elderly, in addition to incurring in loss of bone density risk there is an increase of fall risk. Both of these factors add up causing an increase of fracture risk. Due to the demographic increase and life expectancy, osteoporosis and fracturing events will tend to increase, causing an increase in costs. Today, the data collected in Italy regarding osteoporosis prevalence and fragility fractures incidences are not entirely exhaustive. Concerning fractures, data is reliably collected using the "Diagnosis Related Group Classification" and refers to those of the femur. Detect and describe the pathway that the patient with primary osteoporosis follows in the Marche Region. Through the regional Single Booking Center (CUP) and the websites of the Italian League of Osteoporosis (LIOS) and the Italian Society of Osteoporosis, Mineral Metabolism and Skeleton Diseases (SIOMMMS), eleven services have been identified, belonging to the four health care companies of the Marche Region (Asur, Inrca-Irccs, AO Ospedali Riuniti Marche Nord, AOU Ospedali Riuniti Ancona), which can be contacted for an osteoporosis checkup. A questionnaire was therefore prepared based on the recommendations contained in the SIOMMMS (2012), SIMFER and SIGN (2015) guidelines and sent to the above-mentioned services. The questionnaires are seven, duly completed and used for processing data. In the Marche Region, the medical specialties that deal with osteoporosis are various, demonstrating the fact that this is a "border illness". Concerning the interception of the patient, his sending to a specialized service, the diagnostic approach and the use of risk-scoring tools, there is a substantial homogeneity throughout the regional territory. The patient is sent to the specialized center by the general practitioner (GP) or other specialist, based on the presence of risk factors for osteoporosis alone or on the basis of their presence in association with BMD measurement (body mass density measurement) already known. For the purposes of diagnosis, the investigations required are the dual-energy x-ray absorptiometry (DXA) and the blood test while the use of risk-scoring tools are mainly dictated by the need to define the threshold of pharmacological intervention and give the patient perception of its own fracture risk. The most used algorithm is DeFRA. During the evaluation of the patient, all services detect pain and fall risk. The approach to osteoporosis and fall risk is purely pharmacological. From a non-pharmacological point of view, attention is paid in informing the patient about the modifiable risk factors for osteoporosis and falls. Only some services carry out interventions aimed at promoting adherence to treatment, resorting to different actions. In conclusion, the main critical issues relating to taking care of a fracture risk patient are: accessibility to information, early and exhaustive interception of the population at risk, detection of the fracture risk in relation to bone demineralization and fall risk, adherence to therapy.

Osteoporosis Knowledge and Health Beliefs Among Female Community Leaders in Peru.

Background: Osteoporosis presents an increasing problem globally, primarily affecting older adults and postmenopausal women. Among important modifiable risk factors for osteoporosis, physical activity and calcium intake help reduce bone mineral loss and decrease the prevalence of osteoporosis. Although osteoporosis knowledge and health beliefs are associated with adopting preventive behavior and screening rates, few studies have evaluated them in Latin American populations.Materials and Methods: We conducted a cross-sectional study among female community leaders in a Peruvian periurban setting. A total of 60 women participated in the study, with a mean age of 43.7 ± 8.3 years, mean body mass index of 30.4 ± 5.3 kg/m2, 88% being overweight or obese, and 58.3% having completed high school education or beyond. Participants completed translated and culturally adapted Osteoporosis Knowledge Test and Osteoporosis Health Belief Scale via semistructured interviews.Results: Most participants reported high knowledge regarding osteoporosis, perceived benefits to exercise and calcium intake, and health motivation. The level of osteoporosis knowledge was highly associated with the level of education, and we found a trend for the association between level of knowledge and perceived benefits of exercise and barriers to calcium intake among participants.Conclusions: Female community leaders with high health motivation and community engagement can contribute enormously to osteoporosis prevention programs in local communities in the future.

S219. RISK FACTORS FOR LOW BONE MINERAL DENSITY IN PATIENTS TAKING ANTIPSYCHOTICS

BackgroundThe aim of this study is to explore potentially modifiable risk factors for low bone mineral density (BMD) in adults with psychotic disorders. Furthermore, we sought to identify gender-specific risk factors.MethodsThe study included 285 community-dwelling patients with psychotic disorders. Dual-energy x-ray absorptiometry was used to measure BMD. Laboratory examinations included vitamin D and prolactin levels. Low BMD was defined as<1 standard deviation below the mean for young adults. Clinical characteristics associated with low BMD were identified with logistic regression analysis in total population and each gender.ResultsFifty-eight (20.4%) subjects had low BMD. Low BMD was more common in men and in patients with low body mass indices (BMIs), as well as in those with shorter treatment durations, those on Medicaid, and patients using serotonergic antidepressants. Logistic regression analysis revealed that low BMD was negatively associated with BMI and treatment duration and positively with gender (male) and serotonergic antidepressants use in the overall population. In men, low BMD was associated with treatment duration and BMI; in women, low BMD was associated with BMI, prolactin level, vitamin D, and serotonergic antidepressant use.DiscussionLow BMI was risk factor for reduced BMD in both genders. Shorter treatment duration was associated with low BMD in men, whereas higher prolactin levels, lower vitamin D, and the use of serotonergic antidepressants were associated with low BMD in women. Psychotropic agents should be prescribed mindful of their effects on bone, as use of these medications is a modifiable risk factor for osteoporosis in women with psychotic disorders.

Gender-specific risk factors for low bone mineral density in patients taking antipsychotics for psychosis.

This study examined clinical and gender-specific risk factors for low bone mineral density (BMD) in adult patients with psychotic disorders. The study included 285 community-dwelling patients with psychotic disorders. Dual-energy X-ray absorptiometry was used to measure BMD. Clinical characteristics associated with low BMD were identified with logistic regression analysis in total population and each gender. Fifty-eight (20.4%) subjects had low BMD. Low BMD was more common in men and in patients with low body mass indices (BMIs), as well as in those with shorter treatment durations, those on Medicaid, and patients using serotonergic antidepressants. Logistic regression analysis revealed that low BMD was negatively associated with BMI and treatment duration and positively with gender (male) and serotonergic antidepressants use in the overall population. In men, low BMD was associated with treatment duration and BMI; in women, low BMD was associated with BMI, prolactin level, vitamin D, and serotonergic antidepressant use. Managing the risk factors associated with low BMD among patients with psychotic disorder should be done gender-specifically. Psychotropic agents should be prescribed mindful of their effects on bone, as use of these medications is a modifiable risk factor for osteoporosis in women with psychotic disorders.

Moderate hyperhomocysteinemia induced by short-term dietary methionine overload alters bone microarchitecture and collagen features during growth

AimsIn general, hyperhomocysteinemia is increasingly appreciated as a risk factor for various diseases, including osteoporosis. However, its effects in non-adults remain largely unknown. Our aim was to determine whether dietary-caused increased homocysteine levels have deleterious effects on bone structure during growth. Main methodsWe developed a model of moderate hyperhomocysteinemia caused by short-term methionine nutritional overload in growing rats. 30-days-old male Wistar albino rats were randomly assigned to either experimental group subject to a 30-days hypermethionine diet or control group. High-resolution 3D assessment of bone geometry and microarchitecture, as well as fluorescence spectroscopic analysis of bone matrix were performed. Key findingsShort-term moderate hyperhomocysteinemia (~30μmol/L) achieved in the study notably affected bone and cartilage characteristics. Parameters of the cortical bone geometry in the experimental group indicated peculiar reorganization of the bone cross-section. Trabecular bone microarchitecture was especially sensitive to hyperhomocysteinemia showing clearly negative bone balance in the experimental group (almost 30% reduced bone volume, mainly due to ~25% decrease in trabecular number as well as markedly reduced trabecular connections). Fluorescent spectroscopy of bone matrix revealed multiple alterations to collagen spectra due to homocysteine accumulation in bone, indicative of broken collagenous cross-links. SignificanceGiven that appropriate accrual of bone mass during growth has important effects on the risk of osteoporosis in adulthood, understanding the skeletal effects of dietary-induced hyperhomocysteinemia in non-adults is essential for interpreting its importance as a modifiable risk factor for osteoporosis and improving programs to preserve/re-establish bone health.

Bone Density and Fractures in HIV-infected Postmenopausal Women: A Systematic Review

With the development of effective antiretroviral therapy, HIV-infected women are living longer and transitioning through menopause. The purpose of our study was to systematically examine the evidence that menopause is an additional risk predictor for osteoporosis and fractures in HIV-infected women. Electronic databases were searched for studies of low bone density or fractures in HIV-infected postmenopausal women. Studies that met the inclusion criteria (n = 10) were appraised using a validated quality assessment tool. The majority of studies were rated as good quality and the remaining were fair. The prevalence of osteoporosis reported in these studies ranged from 7.3% to 84% and 0.7% to 23% in HIV-infected and uninfected postmenopausal women, respectively. In the two qualifying studies, postmenopausal status was not a predictor of fractures in HIV-infected women. Findings suggest that HIV care providers should accurately assess postmenopausal status and modifiable risk factors for osteoporosis in all older HIV-infected women.

Association between dietary fat intake and bone mineral density in Korean adults: data from Korea National Health and Nutrition Examination Survey IV (2008 ∼ 2009).

We determined the relation between dietary fat intake and bone mineral density, and our study showed that low- as well as high-fat diet was associated with the risk of osteoporosis. Our study provides significant evidence of the specific dietary components that may be important modifiable factors for the prevention of osteoporosis. Osteoporosis and osteoporosis-related fractures have become major public health problems. It is important to understand the various factors that influence bone health and to prevent osteoporosis by correcting modifiable risk factors for the disease. Previous studies suggested that dietary habits and body composition were potent factors associated with bone mineral density. The aim of this study was to determine the independent effect of dietary fat intake on bone mineral density while controlling for other possible confounders, including fat mass and lean body mass. This study was based on data obtained in the Fourth Korea National Health and Nutrition Examination Survey. After serial exclusion of subjects according to the selection criteria, 7,192 subjects were included in our analysis. We divided the study population into quintiles according to dietary fat calorie/total calorie intake and compared the adjusted means of bone mineral density between quintiles. The bone mineral density was higher in men and women with a medium fat energy intake compared to those with a low- and high-fat energy intake, but the finding was statistically significant only in women. The results were valid after controlling for body fat percentage and lean body mass. We found that dietary fat intake is an independent modifiable risk factor for osteoporosis, regardless of body fat or lean body mass, especially in women. However, further investigations with accurate analyses of food intake and nutritional consumption, in addition to long-term follow-up data, are necessary to recommend an osteoporosis-preventive diet in Koreans.

A fruit, milk and whole grain dietary pattern is positively associated with bone mineral density in Korean healthy adults.

Osteoporosis is a major health problem that will grow in burden with ageing of the global population. Modifiable risk factors for osteoporosis, including diet, have significant implications for disease prevention. We examined associations between dietary patterns and bone mineral density (BMD) in a Korean adult population. In total, 1828 individuals from the Healthy Twin Cohort were included as subjects. Information on general characteristics, lifestyles and health status was obtained through a health examination, and BMD was assessed using DEXA. Dietary intake was assessed using a 3-day food record, and dietary patterns were examined by factor analysis. Associations between dietary patterns and BMD were examined using mixed linear regression, adjusting for family and twin structure as well as other potential risk factors for bone health. Four dietary patterns were identified (Rice and kimchi; eggs, meat and flour; Fruit, milk and whole grains; and Fast food and soda). The 'Fruit, milk and whole grains' pattern was associated with a reduced risk of having low BMD in men (odds ratio (OR)=0.38; 95% confidence interval (CI)=0.22-0.67) and women (OR=0.45; 95% CI=0.28-0.72) and was positively associated with BMD at multiple sites. The 'rice and kimchi' pattern had a positive association with only whole-arm BMD in men and women. Our results suggest that a dietary pattern with high intake of dairy products, fruits and whole grains may contribute positively to bone health in a Korean adult population, and dietary pattern-based strategies could have potential in promoting bone health.

The impact of educational interventions on modifiable risk factors for osteoporosis after a fragility fracture

The purpose of this study was to investigate the impact of two educational interventions on the intake of calcium and vitamin D supplements and modifiable risk factors for osteoporosis in women ≥50years with a fragility fracture (FF). Within 6-8months of fracture, women were randomized to one of three intervention groups: usual care (UC), written materials (WM), or videocassette and written materials (VC). The written materials for patients and their physician provided information on osteoporosis, FF, and available treatments; written materials for physician were provided through patients. The videocassette presented similar information as the written material, but in greater depth. Twelve months after randomization, the effectiveness of the interventions was assessed. The study cohort consisted of 1,175 women undiagnosed and untreated for osteoporosis. After 12months, the mean intake of Ca supplements increased by 33, 93, and 91mg/day for the UC, WM, and VC groups, respectively (p value, WM vs UC = 0.163; VC vs UC = 0.026); the corresponding mean increases for vitamin D were 58, 105, and 118IU/day (p value, WM vs UC = 0.214; VC vs UC = 0.012). The proportion of women who increased their Ca and vitamin D intake by supplements was similar in all three groups. The intervention had a greater impact in those not taking supplements at randomization and had no impact on modifiable risk factors. In women without diagnosis and treatment for osteoporosis, the interventions seem effective at increasing the amounts of Ca and vitamin D supplements, but not effective at inciting more women to increase their consumption. Therefore, the clinical significance of the impact of the intervention is difficult to evaluate.

남성의 골밀도 영향요인

Abstract Purpose: Osteoporosis is often considered as a women's disease, but men's osteoporosis is also increasingly recognized as an important public health problem. This study was carried out to identify the important modifiable risk factors for osteoporosis in men. Methods: Two hundred and fourteen men were selected among those who checked bone mineral density by dual energy x-ray absorptiometry in lumbar vertebrae from June to September, 2009 at 3 general hospitals in Busan. Self-administrated questionnaires and BMD results of lumbar vertebrae were used for data. Collected data were analyzed by using SPSS 14.0 program. Results: The sports activity level in 30's, body weight, and fracture history of mother were the most powerful influencing factors on the bone mineral density of lumbar vertebrae. Conclusion: These results highlight the need to participate vigorously in sports activity during 30s as a means of increasing peak bone mass in lumbar vertebrae in order to prevent osteoporosis and fracture in men.

Managing cancer treatment-induced bone loss and osteoporosis in patients with breast or prostate cancer

To discuss trends in breast and prostate cancer prevalence and survival; risk factors for bone loss, osteoporosis, and fractures and the approach to risk assessment in patients with these malignancies; established and investigational drug therapies for managing cancer treatment-induced bone loss and osteoporosis; and the role of health-system pharmacists in promoting bone health in patients with breast or prostate cancer. Breast cancer and prostate cancer are common, deadly diseases, but many survivors are alive today because of improvements in early detection and treatment over the past 10-15 years. Cancer chemotherapy, corticosteroids, hormone-ablation therapy, and other common risk factors place patients with breast or prostate cancer at high risk for bone loss, osteoporosis, and fractures. Most patients with breast or prostate cancer should undergo assessment of risk for bone loss and osteoporosis that involves a bone-related history and physical examination, dual-energy X-ray absorptiometry scanning, and the FRAX fracture risk assessment tool from the World Health Organization. A recent National Comprehensive Cancer Network task force report on bone health in cancer care provides recommendations for considering the use of pharmacologic therapy on the basis of the results of this assessment. Bisphosphonates are useful for slowing or preventing bone loss associated with hormone-ablation therapy in women with breast cancer and men with prostate cancer, although fracture data are limited in women and not available in men. The usefulness of other therapies (selective estrogen receptor modulators, teriparatide, calcitonin salmon, and estrogens) is limited by adverse effects, a lack of experience with the drugs in these patient populations, or both. Various drug therapies are in development for managing cancer treatment-induced bone loss and osteoporosis. The agent closest to approval by the Food and Drug Administration, denosumab, has been shown to improve bone mineral density in women and men receiving hormone-ablation therapy for breast or prostate cancer, but additional data are needed to dispel safety concerns that could limit the use of this drug in these patient populations. Health-system pharmacists play an important role in screening patients with a history of breast or prostate cancer for bone loss or osteoporosis, making drug therapy recommendations to address the problem, and counseling patients on modifiable risk factors for osteoporosis and proper use of drug therapies to improve bone health. Health-system pharmacists can improve the detection and management of cancer treatment-induced bone loss and osteoporosis in patients receiving systemic therapy for breast or prostate cancer.

A review of the association between osteoporosis and alveolar ridge augmentation

Because of increasing life expectancy and popularity of dental implants, surgeons face a larger number of osteoporotic patients who require bone augmentation. Relationship between low bone density/osteoporosis and bone graft success is still not clear. The purpose of this article is to review and summarize the literature regarding the success of alveolar bone augmentation in osteoporosis. The study design includes a literature review of relevant preclinical and clinical articles that address the association between osteoporosis and alveolar bone augmentation. Increased rate of complications such as resorption of bone graft, non-integration of bone graft, delayed healing time, and implant failure in augmented bone especially in the maxilla may be associated with compromised bone health. Despite the decreased success rate, osteoporosis is not an absolute contraindication for bone augmentation and dental implant placement. The modifiable risk factors for osteoporosis should be eliminated before surgery.

Homocysteine Enhances Bone Resorption by Stimulation of Osteoclast Formation and Activity Through Increased Intracellular ROS Generation

Hyperhomocystinemia is a modifiable risk factor for osteoporosis and fracture. Physiologic concentrations of Hcy directly activate osteoclast formation and activity through stimulation of p38 MAPK and integrin beta3. The effects of Hcy were mediated by generation of intracellular ROS. Hyperhomocysteinemia is a modifiable risk factor for osteoporosis and its related bone fractures. It has been reported that bone resorption and turnover rate were increased in hyperhomocystinemia. Using mouse bone marrow cells, we examined the direct effects of homocysteine (Hcy) on osteoclast formation and activity. Osteoclast formation was determined by TRACP staining and TRACP activity. Intracellular reactive oxygen species (ROS) generation was measured using a fluorescent probe, dichlorodihydrofluorescein diacetate. Intracellular signaling cascades of p38 mitogen-activated protein kinase (MAPK), extracellular signal-regulated kinase (ERK), c-Jun N-terminal kinase (JNK), and NF-kappaB were measured by Western blotting. Integrin beta3 mRNA levels were measured by RT-PCR. Actin ring formation and bone resorption assays were also performed. Physiologic concentrations of Hcy upregulated TRACP+ multinucleated cells and TRACP activity, stimulated actin ring formation, and increased the number of nuclei per cell and the level of expression of integrin beta3 mRNA. In addition, Hcy increased bone resorption and stimulated p38 MAPK activity and intracellular reactive oxygen species (ROS) generation. All of these Hcy-induced changes were blocked by pretreatment with the antioxidant, N-acetyl cysteine. Hcy directly activates osteoclast formation and activity through increased generation of intracellular ROS. These findings suggest that, in individuals with mild to moderate hyperhomocystinemia, increased bone resorption by osteoclasts may contribute to osteoporosis and that an antioxidant may attenuate bone loss in these individuals.