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1.
Surgical Considerations in Managing Osteoporosis, Osteopenia, and Vitamin D Deficiency During Arthroscopic Rotator Cuff Repair.
Entezari, V, Lazarus, M
The Orthopedic clinics of North America. 2019;(2):233-243
Abstract
Osteopenia and osteoporosis are common in older adults and are associated with increased risk of fragility fractures. Vitamin D deficiency caused by chronic disease, poor nutrition, and inadequate sun exposure affects bone quality. Chronic rotator cuff tears can deteriorate the bone mineral density of the greater tuberosity and have been linked to reduced anchor pullout strength and high re-tear rate after repair especially in older patients with larger tear size. This article summarizes the current evidence on rotator cuff tear and bone quality and provides treatment strategies for rotator cuff repair in patients with poor bone quality.
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2.
The next step after anti-osteoporotic drug discontinuation: an up-to-date review of sequential treatment.
Guañabens, N, Moro-Álvarez, MJ, Casado, E, Blanch-Rubió, J, Gómez-Alonso, C, Díaz-Guerra, GM, Del Pino-Montes, J, Valero Díaz de Lamadrid, C, Peris, P, Muñoz-Torres, M, et al
Endocrine. 2019;(3):441-455
Abstract
Several antiresorptive drugs, like bisphosphonates and denosumab, are currently available for the treatment of osteoporosis due to their evidenced efficacy in reducing fracture risk at mid-term. Osteoanabolic therapies, like teriparatide, whose treatment duration is limited to 2 years, have also shown efficacy in the reduction of fracture risk. However, depending on the severity of osteoporosis and the presence of other associated risk factors for fracture, some patients may require long-term treatment to preserve optimal bone strength and minimize bone fracture risk. Given the limited duration of some treatments, the fact that most of the antiresorptive drugs have not been assessed beyond 10 years, and the known long-term safety issues of these drugs, including atypical femoral fractures or osteonecrosis of the jaw, the long-term management of these patients may require an approach based on drug discontinuation and/or switching. In this regard, interest in sequential osteoporosis therapy, wherein drugs are initiated and discontinued over time, has grown in recent years, although the establishment of an optimal and individualized order of therapies remains controversial. This review reports the currently available clinical evidence on the discontinuation effects of different anti-osteoporotic drugs, as well as the clinical outcomes of the different sequential treatment regimens. The objective of this article is to present up-to-date practical knowledge on this area in order to provide guidance to the clinicians involved in the management of patients with osteoporosis.
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3.
Exercise for the prevention of osteoporosis in postmenopausal women: an evidence-based guide to the optimal prescription.
Daly, RM, Dalla Via, J, Duckham, RL, Fraser, SF, Helge, EW
Brazilian journal of physical therapy. 2019;(2):170-180
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Abstract
BACKGROUND Osteoporosis and related fragility fractures are a global public health problem in which pharmaceutical agents targeting bone mineral density (BMD) are the first line of treatment. However, pharmaceuticals have no effect on improving other key fracture risk factors, including low muscle strength, power and functional capacity, all of which are associated with an increased risk for falls and fracture, independent of BMD. Targeted exercise training is the only strategy that can simultaneously improve multiple skeletal and fall-related risk factors, but it must be appropriately prescribed and tailored to the desired outcome(s) and the specified target group. OBJECTIVES In this review, we provide an overview of the general principles of training and specific loading characteristics underlying current exercise guidelines for the prevention of osteoporosis, and an update on the latest scientific evidence with regard to the type and dose of exercise shown to positively influence bone mass, structure and strength and reduce fracture risk in postmenopausal women.
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Microbial osteoporosis: The interplay between the gut microbiota and bones via host metabolism and immunity.
Li, L, Rao, S, Cheng, Y, Zhuo, X, Deng, C, Xu, N, Zhang, H, Yang, L
MicrobiologyOpen. 2019;(8):e00810
Abstract
The complex relationship between intestinal microbiota and host is a novel field in recent years. A large number of studies are being conducted on the relationship between intestinal microbiota and bone metabolism. Bone metabolism consisted of bone absorption and formation exists in the whole process of human growth and development. The nutrient components, inflammatory factors, and hormone environment play important roles in bone metabolism. Recently, intestinal microbiota has been found to influence bone metabolism via influencing the host metabolism, immune function, and hormone secretion. Here, we searched relevant literature on Pubmed and reviewed the effect of intestinal microbiota on bone metabolism through the three aspects, which may provide new ideas and targets for the clinical treatment of osteoporosis.
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5.
Polyphenol-Rich Foods and Osteoporosis.
Chisari, E, Shivappa, N, Vyas, S
Current pharmaceutical design. 2019;(22):2459-2466
Abstract
BACKGROUND Osteoporosis is a metabolic disease affecting the bone mineral density and thus compromise the strength of the bones. Disease prevention through diet is the objective of the study and discussion. Among the several nutrients investigated, the intake of phenols seems to influence bone mineral density by acting as free radical scavengers, preventing oxidation-induced damage to bone cells. In addition, the growing understanding of the bone remodelling process supports the theory that inflammation significantly contributes to the etiopathogenesis of osteoporosis. METHODS To provide an overview of current evidence on polyphenol-rich foods and osteoporosis prevention we made a comprehensive review of the literature focusing on the state of art of the topic. RESULTS Some polyphenol-rich foods, including olive oil, fruit and vegetable, tea and soy, seem to be beneficial for preventing osteoporosis disease and its progression. The mechanism is still partly unknown and may involve different pathways which include inflammation and other disease reactions. CONCLUSIONS However, further research is needed to better understand the mechanisms regulating the molecular interaction between osteoporosis incidence and progression and polyphenol-rich foods. The current evidence suggests that dietary intervention with polyphenol rich foods may be useful to prevent incidence and progression of this condition.
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[Differential diagnoses of osteoporosis].
Stumpf, U, Hesse, E, Böcker, W, Kammerlander, C, Neuerburg, C, Schmidmaier, R
Zeitschrift fur Gerontologie und Geriatrie. 2019;(5):414-420
Abstract
The differential diagnoses of osteoporosis in geriatric and trauma patients are very important as they may induce different therapies. On average approximately 20% of women and 50% of men have secondary causes of osteoporosis. The foundation of the diagnostics is a basic osteological laboratory investigation with which the most important secondary causes can be identified. From a geriatric and traumatological point of view vitamin D deficiency with secondary hyperparathyroidism, primary hyperparathyroidism, male hypogonadism, multiple myeloma and monoclonal gammopathy of unclear significance (MGUS) are of particular importance.
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The Prevention and Therapy of Osteoporosis: A Review on Emerging Trends from Hormonal Therapy to Synthetic Drugs to Plant-Based Bioactives.
Gupta, T, Das, N, Imran, S
Journal of dietary supplements. 2019;(6):699-713
Abstract
Osteoporosis is one of the major health problems worldwide. It is characterized by increased bone fragility and loss of bone matter due to the action of osteoclast cells, which are associated with modified hormone levels and factors such as aging. Bisphosphonates are the primary treatment for osteoporosis. Apart from bisphosphonates, hormone therapy, calcitonin treatment, selective estrogen receptor modulators (SERMs), and strontium ranelate (SR) are some of the other treatments available for osteoporosis. However, these treatments have some side effects, such as oily skin, fluid retention, nausea, long-term toxicity, and even prostate cancer in males, and thus natural therapies that incur fewer side effects are sought. Phytochemicals, antioxidants, and other plant-based bioactives are important in the human diet. They are abundant in fruits and help against various chronic diseases, including bone disorders. Other providers of these important compounds are the medicinal plant parts. In this article, we highlight the various species of plants and herbs that are useful for the treatment of osteoporosis. The prospect of using these plant-based bioactives in amelioration of osteoporosis as an alternative to hormonal and synthetic drug-based therapy is also discussed.
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8.
Tai chi for treating osteopenia and primary osteoporosis: a meta-analysis and trial sequential analysis.
Zhang, Y, Chai, Y, Pan, X, Shen, H, Wei, X, Xie, Y
Clinical interventions in aging. 2019;:91-104
Abstract
PURPOSE The aim of this meta-analysis was to evaluate the efficacy of Tai chi (TC) as an adjuvant treatment for osteopenia and primary osteoporosis. METHODS We went through eight databases to identify relevant randomized controlled trials that compared TC with a control group. The primary outcome was osteoporosis-related fractures (fracture incidence). Meta-analyses and trial sequential analyses (TSA) were conducted using RevMan 5.3 and TSA 0.9. RESULTS Fifteen randomized controlled trials involving a total of 857 patients were included in the analyses. No trials reported primary outcome; however, bone mineral density (BMD) values differed significantly in subgroup 1 (TC vs no treatment; weighted mean difference [WMD] =0.05 g/cm2, 95% CI 0.03 to 0.07; P<0.00001; P for heterogeneity =0.22, I 2=22%) and subgroup 2 (TC vs conventional treatments; WMD =0.16 g/cm2, 95% CI 0.11 to 0.21; P<0.00001; P for heterogeneity =0.008, I 2=75%). In addition, two trials compared TC with conventional treatments, which found a significant difference in bone gla protein (standardized mean difference =-1.18, 95% CI -1.66 to -0.70; P<0.00001; P for heterogeneity =0.58, I 2=75%). The results of the BMD were confirmed by TSA. Also, TC may have a certain effect on the relief of osteoporotic pain (WMD = -2.61, 95% CI -3.51 to -1.71; WMD = -1.39, 95% CI -2.01 to -0.77). However, it did not promote the quality of life, level of serum calcium, serum phosphorus, and also had no effect on bone turnover markers. CONCLUSION Although there is no study monitoring fracture incidence, TC may be beneficial for patients in improving BMD values, level of bone gla protein, and relieving osteoporotic pain. However, due to the low methodological quality, current evidence for treating osteopenia and primary osteoporosis through TC is insufficient.
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Treatment of Glucocorticoid-Induced Osteoporosis with Bisphosphonates Alone, Vitamin D Alone or a Combination Treatment in Eastern Asians: A Meta-Analysis.
Wang, J, Li, H
Current pharmaceutical design. 2019;(14):1653-1662
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Abstract
BACKGROUND Glucocorticoid (GC)-induced osteoporosis and fractures have become a serious problem for Eastern Asians. Bisphosphonates (BPs), vitamin D and a combination treatment are effective methods to prevent and treat GC-induced osteoporosis. OBJECTIVE The study aimed to compare the efficacy of BPs, vitamin D and a combination treatment for preventing and managing GC-induced osteoporosis in Eastern Asians. METHODS A comprehensive search in the PubMed, EMBASE, Web of Science and Cochrane CENTRAL databases was undertaken for randomized controlled trials (RCTs) on the effect of BPs, vitamin D and the combination treatment on GCs-induced osteoporosis in Eastern Asian populations. Primary outcome measures were the change in bone mineral density (BMD) and bone turnover markers. The final search was performed in March 2019. RESULTS Nine RCTs were included. A total of 545 patients met the inclusion criteria. Compared with vitamin D, BPs and the combination treatment significantly alleviated osteoporosis of the spine and femoral neck in Eastern Asians with GC-induced osteoporosis. At the same time, the change in serum bone-specific alkaline phosphatase (BAP) and serum C-telopeptide of type I collagen (CTX) levels was observed to be significantly less with BPs and the combination treatment with vitamin D alone. No significant difference was found between BPs and the combination treatment in the markers mentioned above. CONCLUSION Compared with vitamin D alone, BPs alone and the combination treatment were significantly effective on Eastern Asians with GC-induced osteoporosis. Compared with the combination treatment, BPs alone were observed to be effective enough to increase the BMDs of the spine and femoral neck on both sides and thus prevent GC-induced osteoporosis in Eastern Asians.
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10.
Anticoagulants and Osteoporosis.
Signorelli, SS, Scuto, S, Marino, E, Giusti, M, Xourafa, A, Gaudio, A
International journal of molecular sciences. 2019;(21)
Abstract
Anticoagulant agents are widely used in the treatment of thromboembolic events and in stroke prevention. Data about their effects on bone tissue are in some cases limited or inconsistent (oral anti-vitamin K agents), and in others are sufficiently strong (heparins) to suggest caution in their use in subjects at risk of osteoporosis. This review analyses the effects of this group of drugs on bone metabolism, on bone mineral density, and on fragility fractures. A literature search strategy was developed by an experienced team of specialists by consulting the MEDLINE platform, including published papers and reviews updated to March 2019. Literature supports a detrimental effect of heparin on bone, with an increase in fracture rate. Low molecular weight heparins (LMWHs) seem to be safer than heparin. Although anti-vitamin K agents (VKAs) have a significant impact on bone metabolism, and in particular, on osteocalcin, data on bone mineral density (BMD) and fractures are contrasting. To date, the new direct oral anticoagulants (DOACs) are found to safe for bone health.