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[Sequential treatment of osteoporosis with anti-sclerostin.].
Inoue, D
Clinical calcium. 2019;(3):363-369
Abstract
Romosozumab is a humanized anti-sclerostin monoclonal antibody that has just been approved for the treatment of osteoporosis in Japan. Romosozumab causes both transient stimulation of bone formation and continuous suppression of resorption, thereby increasing bone mineral density and decreasing fracture incidence. Because the effect of romosozumab is reversible, sequential therapy with anti-resorptives after romosozumab will be necessary. This overview summarizes the results of ARCH study demonstrating superior efficacy of romosozumab compared to alendronate and effect of sequential therapy with alendronate. Possible adverse effect of romosozumab on cardiovascular diseases will also be discussed.
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2.
[Idiopathic hypercalciuria. Diagnosis and treatment].
Olefir, YV, Yavorskii, AN, Butnaru, DV, Shatalova, OV, Gorbatenko, VS, Gerasimenko, AS
Urologiia (Moscow, Russia : 1999). 2017;(6):112-119
Abstract
Most patients with idiopathic hypercalciuria and calcium nephrolithiasis have a family history of the disease. Idiopathic hypercalciuria is a metabolic abnormality with various causes and developmental pathways. The systematic review describes specific mutations associated with idiopathic hypercalciuria and nephrolithiasis. Detection of these mutations may provide a better understanding of the pathogenesis of this heterogeneous disease and personalize patient management depending on the detected polymorphisms. A promising treatment option for a mutation in the vitamin D receptor gene is thiazide diuretics in combination with bisphosphonates. Among bisphosphonates, the drug of choice which has been most strongly supported by research evidence is alendronate.
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3.
Fractures related to bone fragility: prevention First-choice treatments.
Prescrire international. 2017;(181):103-106
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Important aspects concerning alendronate-related osteonecrosis of the jaws: a literature review.
Iglesias, JE, Salum, FG, Figueiredo, MA, Cherubini, K
Gerodontology. 2015;(3):169-78
Abstract
OBJECTIVE To conduct a literature review on sodium alendronate, focusing on osteonecrosis of the jaws, a serious potential side effect. BACKGROUND Sodium alendronate is a bisphosphonate that is widely used for the treatment of osteopenia, osteoporosis and Paget's disease. Like other bisphosphonates, it inhibits bone resorption by inactivating osteoclasts. Alendronate has evident benefits in the treatment of these diseases, but it is associated with jaw osteonecrosis, although less frequently compared with intravenous bisphosphonates. Therefore, some preventive measures should be taken to avoid this side effect. MATERIAL AND METHODS We reviewed the literature regarding the pharmacological aspects, mechanism of action, indications of use and side effects of sodium alendronate, as well as the management of patients under this therapy. CONCLUSION The benefits of sodium alendronate are scientifically proven, but a serious adverse effect is osteonecrosis. Therefore, it is crucial to prepare the oral cavity before bisphosphonate therapy, providing a careful dental evaluation and all needed dental treatment.
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5.
[Anabolic therapy of induced osteoporosis in beta-thalassaemia major: case report and literature review].
Trotta, A, Corrado, A, Cantatore, FP
Reumatismo. 2010;(2):119-26
Abstract
Transfusion program and chelating therapy treatment has extended the life expectancy of thalassaemic patient; osteoporosis is considered an important cause of morbidity in adult patients who display increased fracture risk. This is a case report is about a thalassaemic young female with multiple spine fractures (D11, D12 e L2) and lumbar spine DEXA - T score = -3,1 and femoral = -3,4. This was in spite of therapy with alendronate 70 mg/week from January 2006 to September 2007. The patient was subsequentently treated for 18 months with 1-34 recombinant human parathyroid hormone and colecalciferol (100.000 U/monthly). After 4 months of therapy, the patient showed a decrease in spinal pain (Roland and Morris Disability Questionnaire) and an improvement of quality of life (Qualeffo) with normalization of osteocalcin and 25-OHcolecalciferol haematic levels after 6 months. Lumbar spine and femoral DEXA - Tscore, at 18 months, rose respectively to -2,5 and -2,4. Thalassaemia-induced osteoporosis is multifactorial and its management is very difficult. Bone marrow expansion, endocrine dysfunction, iron overload and genetic factors all seem to play important roles in the development of low bone mass in these patients. Bisphosfonates have been used in the management of thalassemia induced osteoporosis but there is no data about fracture risk. Anabolic therapy for thalassemic patients requests additional study on a large scale.
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6.
[Effects of SERMs on bone health. Combination therapy with raloxifene].
Gorai, I, Hori, H
Clinical calcium. 2010;(3):408-12
Abstract
It is generally considered that drugs with different pharmacological actions are prescribed when combination therapy is undertaken. Vitamin D insufficiency or deficiency is prevalent in osteopenic and osteoporotic postmenopausal women. Combination therapy of raloxifene with other agents including vitamin D has been reported and its effect on fracture prevention remains to be elucidated.
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[Bisphosphonates and other new therapeutic agents for the treatmednt of osteogenesis imperfecta].
Yamashita, S
Clinical calcium. 2009;(2):253-7
Abstract
Osteogenesis imperfecta (OI) is a genetic disorder characterized by fragile bone and reduced bone mineral density. Cyclic intravenous pamidronate is now the standard treatment for moderate to severe forms of OI, however clinical studies are not yet sufficient to conclude appropriate annual doze and ideal duration of therapy at present time. Oral alendronate is also effective in milder forms of OI. Zoledronic acid has undergone international multicentric clinical trials to examine efficiency and long-term side effects including osteonecrosis of the jaw. Teriparatide (rhPTH1-34) and denosumab (monoclonal antibody against RANK ligand) have the potential for management of OI. Stem cell and gene therapy are currently being actively investigated and may become clinically applicable in the near future.
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8.
Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women.
Wells, GA, Cranney, A, Peterson, J, Boucher, M, Shea, B, Robinson, V, Coyle, D, Tugwell, P
The Cochrane database of systematic reviews. 2008;(1):CD001155
Abstract
BACKGROUND Osteoporosis is an abnormal reduction in bone mass and bone deterioration leading to increased fracture risk. Alendronate belongs to the bisphosphonate class of drugs, which act to inhibit bone resorption by interfering with the activity of osteoclasts. OBJECTIVES To assess the efficacy of alendronate in the primary and secondary prevention of osteoporotic fractures in postmenopausal women. SEARCH STRATEGY We searched CENTRAL, MEDLINE and EMBASE for relevant randomized controlled trials published between 1966 to 2007. SELECTION CRITERIA Women receiving at least one year of alendronate, for postmenopausal osteoporosis, were compared to those receiving placebo and/or concurrent calcium/vitamin D. The outcome was fracture incidence. DATA COLLECTION AND ANALYSIS We undertook study selection and data abstraction in duplicate. We performed meta-analysis of fracture outcomes using relative risks and a > 15% relative change was considered clinically important. We assessed study quality through reporting of allocation concealment, blinding and withdrawals. MAIN RESULTS Eleven trials representing 12,068 women were included in the review. Relative (RRR) and absolute (ARR) risk reductions for the 10 mg dose were as follows. For vertebral fractures, a significant 45% RRR was found (RR 0.55, 95% CI 0.45 to 0.67). This was significant for both primary prevention, with 45% RRR (RR 0.55, 95% CI 0.38 to 0.80) and 2% ARR, and secondary prevention with 45% RRR (RR 0.55, 95% CI 0.43 to 0.69) and 6% ARR. For non-vertebral fractures, a significant 16% RRR was found (RR 0.84, 95% CI 0.74 to 0.94). This was significant for secondary prevention, with 23% RRR (RR 0.77, 95% CI 0.64 to 0.92) and 2% ARR, but not for primary prevention (RR 0.89, 95% CI 0.76 to 1.04). There was a significant 40% RRR in hip fractures (RR 0.60, 95% CI 0.40 to 0.92), but only secondary prevention was significant with 53% RRR (RR 0.47, 95% CI 0.26 to 0.85) and 1% ARR. The only significance found for wrist was in secondary prevention, with a 50% RRR (RR 0.50 95% CI 0.34 to 0.73) and 2% ARR. For adverse events, we found no statistically significant differences in any included study. However, observational data raise concerns regarding potential risk for upper gastrointestinal injury and, less commonly, osteonecrosis of the jaw. AUTHORS' CONCLUSIONS At 10 mg per day, both clinically important and statistically significant reductions in vertebral, non-vertebral, hip and wrist fractures were observed for secondary prevention ('gold' level evidence, www.cochranemsk.org). We found no statistically significant results for primary prevention, with the exception of vertebral fractures, for which the reduction was clinically important ('gold' level evidence).
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9.
[Alendronate].
Okazaki, R
Clinical calcium. 2008;(10):1410-6
Abstract
Alendronate is one of a few pharmaceutical agents that have evidence to protect both vertebral and non-vertebral fracture. Here I review its effects on fracture prevention, as well as on surrogate markers such as bone mineral density, height loss, metabolic bone markers. Its effects on activities of daily living and quality of life will also be touched upon.
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10.
[Alendronate and vitamin D (Fosavance): persistence, adherence and importance of vitamin D].
Grazio, S, Morović-Vergles, J
Reumatizam. 2007;(2):89-92
Abstract
Persistence and adherence are major determinants of optimal results in the treatment of osteoporosis. In order to improve the efficacy of antiresorptive drugs, fewer demands on patients and better adherence were obtained with less frequent dosing schedule. Once-weekly and once-monthly oral bisphophonates showed equivalency with once daily medications. Comparison of persistence and adherence between weekly and monthly bisphosphonate regimens revealed conflicting results. In Croatia, persistence and adherence of weekly alendronate seem to be better than in other countries. In the light of compliance problems there is a need to assure adequate intake of vitamin D, because it is essential for prevention and treatment of osteoporosis and osteoporotic fractures. Vitamin D has other beneficial effects, particularly on neuromuscular performances. A high prevalence of vitamin D inadequacy was seen across all geographic regions. Weekly alendronate and vitamin D in one tablet provides proven fracture prevention at the spine and hip, and assure that patients receive a weekly dose of vitamin D.