Treatment Of Osteoporosis In Adults Research Articles

The Indian Society forBone and Mineral Research (ISBMR) position statement for the diagnosis and treatment of osteoporosis in adults.

In India, osteoporosis is a major public health problem. However, in the absence of any robust regional guidelines, the screening, treatment, and follow-up of patients with osteoporosis are lagging behind in the country. The Indian Society forBone and Mineral Research (ISBMR), which is a multidisciplinary group of physicians, researchers, dietitians, and epidemiologists and who study bone and related tissues, in their annual meeting, drafted the guidelines for the diagnosis and management of osteoporosis that would be appropriate in a resource constraint setting like India. Diagnosis of osteoporosis can be made in a patient with minimal trauma fracture without the aid of any other diagnostic tools. In others, bone mineral density measured by dual-energy X-ray absorptiometry remains the modality of choice. Data indicates that osteoporotic fractures occur at an earlier age in Indians than in the West; hence, screening for osteoporosis should begin at an earlier age. FRAX can be used for fracture risk estimation; however, it may underestimate the risk of future fractures in our population and still needs validation. Maintaining optimum serum 25-hydroxyvitamin D levels is essential, which, in most cases, would require regular vitamin D supplementation. Pharmacotherapy should be guided by the presence/absence of vertebral/hip fractures or the severity of risk based on clinical factors, although bisphosphonates remain the first choice in most cases. Regular follow-up is essential to ensure adherence and response to therapy. Implementation of the position statement in clinical practice is expected to improve theoverall care of patients with osteoporosis in India.

S3 Guideline Was Not Mentioned

In the study reported by Mpotsaris et al., osteoporosis was the cause of the vertebral fractures treated with vertebroplasty in three out of four cases. The authors even conclude that the “socioeconomically most important group of patients with vertebral body fractures, namely, those whose fractures are due to osteoporosis” experienced clinical improvement potentially for up to six months. The authors do not mention the written consensus of the German governing body for osteology (Dachverband Osteologie, DVO) on the prophylaxis, diagnostic evaluation, and treatment of osteoporosis in adults, in the form of the S3 guideline (www.dv-osteologie.org/dvo_leitlinien/dvo-leitlinie-2009), published first in 2006 and updated in 2009. In this guideline, vertebroplasty and kyphoplasty are discussed and it is recommended that interdisciplinary discussion of the individual case and a documented attempt at conservative treatment should precede the intervention, as should excluding degenerative changes as the cause of the existing pain. In the present article, the authors “retrospectively” conclude that the selection of suitable patients is an important criterion for achieving good results during follow-up. The authors must have been unfamiliar with the cited S3 guideline as such a selection should already be routine standard these days. Maybe this is also why readers do not learn what is used to provide the osteoporosis patients with osteoprotective treatment, although this may influence the degree of pain and constitutes the actual treatment for osteoporosis, which particularly needs to be taken into consideration in this group of patients. Furthermore I wish to point out that the authors acknowledge in their article the limitation of the lacking control group, but do not deal with the possible distortion of results owing to the “placebo effect” of the intervention. Publications on this topic can also be found at www.dv-osteologie.org.

Osteoporosis in Adults with Intellectual Disabilities

The medical care of adults with intellectual disabilities (ID) originates in primary care physicians' offices. With the move toward the deinstitutionalization of these individuals in the 1970s and 1980s and the increasing longevity of this population, more adults with disabilities are living in the community. Primary care providers need to be comfortable with treating the conditions of these individuals with special needs. Individuals with ID are at higher than average risk for many chronic conditions. One condition that is often overlooked or underdiagnosed is osteoporosis. Much research regarding osteoporosis has been conducted in postmenopausal women and other high-risk groups; however, gaps remain in our understanding of the evaluation and treatment of osteoporosis in adults with ID.

Moderate Strontium Loading Induces Rickets in Rats with Mild Chronic Renal Failure

Background/Aims: Renal osteodystrophy and eventually osteoporosis are serious long-term complications in children with end-stage renal disease before and after renal transplantation. Strontium (Sr) salts are used for treatment of osteoporosis in adults. Methods: To evaluate the time-dependent effects of Sr on growth plate morphology and their reversibility, chronic renal failure (CRF) rats received either normal or Sr-loaded drinking water (2 g/l; ±200 mg/kg/day) for periods of 2, 6 and 12 weeks with or without subsequent washout periods of 0, 2, 4 or 8 weeks. Results: While weight gain was not affected by Sr loading, a significant enlargement of the entire growth plate, mainly due to expansion of the hypertrophic zone, was already present after 2 weeks. Sr-loaded animals showed increased osteoid areas and reduced bone formation rates at 2, 6 and 12 weeks compared to controls. This was accompanied by reduced PTH levels and increased serum bone alkaline phosphatase activity. After the washout periods these effects were reversed. In general, the height of the hypertrophic zone was positively correlated with osteoid area and negatively correlated with bone formation rate. Conclusion: Moderate Sr loading in CRF rats results in rapid development of rickets, which is reversible after washout.

Celiac disease and osteoporosis

The recently published “ASHP Therapeutic Position Statement on the Prevention and Treatment of Osteoporosis in Adults” is a well-written, comprehensive review of a very important disease.[1][1] I respectfully suggest that the document should have included a discussion of the important

ASHP Therapeutic Position Statement on the Prevention and Treatment of Osteoporosis in Adults

Osteoporosis is a devastating disease that may lead to significant morbidity and mortality from resultant fractures.[1][1]–[3][2] The efficacy of medications as one method to prevent and treat osteoporosis and avert future fractures, particularly vertebral fractures, is well documented in large

Bridging the gap between evidence and practice in osteoporosis

Osteoporosis is a devastating disease that can lead to significant morbidity and mortality. The ASHP Therapeutic Position Statement on the Prevention and Treatment of Osteoporosis in Adults that appears in this issue provides an overview of risk assessment, evaluation, and clinical data supporting

Bone mineral metabolism in pediatric inflammatory bowel disease

The development of reliable techniques to measure bone densitometry and evolving effective drug treatment have kindled great interest in the diagnosis and treatment of osteoporosis in adults with inflammatory bowel disease. A number of studies have examined the prevalence of abnormal bone mineral metabolism in children and adolescents. Studies, conducted over the past decade, indicate a greater likelihood of clinically significant problems in Crohn's disease than in ulcerative colitis. Corticosteroids have been proven to impair bone mineral status. It is increasingly clear that inflammation and other factors play a bigger role than malabsorbtion of minerals or vitamin D in most patients. As the use of the bisphonate class of drugs is limited in pediatric patients, there is a need to emphasize the role of diet and exercise in children and teenagers, particularly in those affected by inflammatory bowel disease.

Bisphosphonat-Therapie bei Kindern und Jugendlichen mit primären und sekundären osteoporotischen Erkrankungen

Bisphosphonates have a set place in the treatment of osteoporosis in adults. For the last 10 years they have also been used in pediatrics. Due to inhibition in differentiation and reduction in osteoclasts, both pamidronate and alendronate, the most commonly used preparations, cause an increase in bone density. Most experience comes from the i.v. treatment of forms with severe courses of osteogenesis imperfecta (OI). There is an increase in bone substance, a decrease in rate of fractures and a reduction in pain with higher mobility of those effected. In addition to the use of drugs, intramedullary nailing and physiotherapy are important therapeutic standards. Bisphosphonates are also used for other diseases involving bone remodeling, such as juvenile idiopathic osteoporosis or familial hyperphosphatemia. Acute side effects usually occur with the first infusion, involve "flu-like" symptoms and are self limiting. The question of long-term side effects cannot be answered with the currently available data.

Report of a Muscular Dystrophy Campaign funded workshop Birmingham, UK, January 16th 2004. Osteoporosis in Duchenne muscular dystrophy; its prevalence, treatment and prevention

A Muscular Dystrophy Campaign funded workshop to look into the potential problems of osteoporosis occurring in boys with DMD treated with steroids took place in Birmingham (UK) on the 16th January 2004. Fourteen participants met from varied backgrounds including, paediatric neuromuscular disease, neurology, paediatric and adult metabolic bone disease, paediatric rheumatology, genetics, physiotherapy and medical physics together with a representative from the Muscular Dystrophy Campaign. The aims of the workshop were to assess the evidence for the risk of osteoporosis in Duchenne muscular dystrophy (DMD), to assess the adverse effects of corticosteroid (steroid) treatment relating to bone mineral density and longitudinal growth and to assess the current evidence for the prevention and treatment of osteoporosis. Steroids are increasingly used in boys with DMD following the evidence from randomised controlled trials on their short-term benefit. However, the balance between long-term benefit and side effects has not been established. Long-term steroid use may be associated with significant side effects including weight gain, growth failure, cataracts and osteoporosis, so the development of strategies to prevent or treat these complications is important. We reviewed the literature to determine

The osteoporosis care gap in Canada.

BackgroundThe presence of a fragility fracture is a major risk factor for osteoporosis, and should be an indicator for osteoporosis diagnosis and therapy. However, the extent to which patients who fracture are assessed and treated for osteoporosis is not clear.MethodsWe performed a review of the literature to identify the practice patterns in the diagnosis and treatment of osteoporosis in adults over the age of 40 who experience a fragility fracture in Canada. Searches were performed in MEDLINE (1966 to January 2, 2003) and CINAHL (1982 to February 1, 2003) databases.ResultsThere is evidence of a care gap between the occurrence of a fragility fracture and the diagnosis and treatment of osteoporosis in Canada. The proportion of individuals with a fragility fracture who received an osteoporosis diagnostic test or physician diagnosis ranged from 1.7% to 50%. Therapies such as hormone replacement therapy, bisphosphonates or calcitonin were being prescribed to 5.2% to 37.5% of patients. Calcium and vitamin D supplement intake was variable, and ranged between 2.8% to 61.6% of patients.ConclusionMany Canadians who experience fragility fracture are not receiving osteoporosis management for the prevention of future fractures.

Bone mineral metabolism in pediatric inflammatory bowel disease.

The development of reliable techniques to measure bone densitometry and evolving effective drug treatment have kindled great interest in the diagnosis and treatment of osteoporosis in adults with inflammatory bowel disease. A number of studies have examined the prevalence of abnormal bone mineral metabolism in children and adolescents. Studies, conducted over the past decade, indicate a greater likelihood of clinically significant problems in Crohn's disease than in ulcerative colitis. Corticosteroids have been proven to impair bone mineral status. It is increasingly clear that inflammation and other factors play a bigger role than malabsorbtion of minerals or vitamin D in most patients. As the use of the bisphonate class of drugs is limited in pediatric patients, there is a need to emphasize the role of diet and exercise in children and teenagers, particularly in those affected by inflammatory bowel disease.