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[The sequential therapy of romosozumab followed by denosumab for osteoporosis.].
Ono, K, Tanaka, S
Clinical calcium. 2019;(3):357-362
Abstract
Romosozumab is a bone-forming agent with a dual effect of increasing bone formation and decreasing bone resorption by inhibiting sclerostin. In the pivotal Fracture study in postmenopausal women with osteroposis(FRAME)and the extension trial, 12 months of romosozumab led to persistent fracture, especially new vertebral fracture, reduction benefit and ongoing BMD(bone mineral density)gains when follow 24 months of denosumab. The sequence therapy of romosozumab followed by denosumab may be a promising regimen for the treatment of osteoporosis.
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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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3.
Postmenopausal Osteoporosis: A Clinical Review.
Watts, NB
Journal of women's health (2002). 2018;(9):1093-1096
Abstract
In postmenopausal women, osteoporotic fractures are more common than stroke, myocardial infarction, and breast cancer combined, and fractures can be costly and result in disability or death. Because there are no signs or symptoms of osteoporosis other than fracture, risk assessment is necessary to identify those at higher risk for clinical events. For women, a clinical fracture risk assessment (FRAX) is appropriate at menopause. Bone mineral density (BMD) measurement is recommended for women at age 65, and earlier for those who have risk factors. Adequate calcium, vitamin D, and weight-bearing exercise are important for bone health at all ages, and those at high risk for fracture based on BMD or FRAX should be offered medical therapy to reduce fracture risk after an appropriate medical evaluation. Bisphosphonates can accumulate in bone, so after a period of treatment, lower risk patients may be offered a period off drug therapy. However, the effects of denosumab are not sustained when treatment is discontinued, so there is no "drug holiday" with denosumab. Anabolic therapy can be offered to those with higher risk for fracture. Although rare safety concerns regarding atypical femoral fracture and osteonecrosis of the jaw have received prominent attention, for patients who are appropriately treated according to National Osteoporosis Foundation guidelines, the benefit of hip fracture risk reduction far outweighs the risk of these uncommon side effects. Accurate information for patients and shared decision-making are important for acceptance and persistent with appropriate treatment.
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Oxidative stress as a possible pathogenic cofactor of post-menopausal osteoporosis: Existing evidence in support of the axis oestrogen deficiency-redox imbalance-bone loss.
Bonaccorsi, G, Piva, I, Greco, P, Cervellati, C
The Indian journal of medical research. 2018;(4):341-351
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Abstract
Post-menopausal osteoporosis (PO) is one of the major health issues associated with menopause-related oestrogen withdrawal. Despite the intense research and the relevant progress achieved in the last two decades, the pathogenic mechanism underlying PO is still poorly understood. As a consequence of this gap in the knowledge, such disorder and the related complications are still difficult to be effectively prevented. A wealth of experimental and epidemiological/clinical evidence suggests that the endocrine change associated to menopausal transition might lead to a derangement of redox homeostasis, that is, the prelude to the health-threaten condition of oxidative stress (OxS). In turn, this (bio)chemical stress has been widely hypothesized to contribute, most likely in synergy with inflammation, to the development of menopause-related diseases, including PO. The main aim of this review is to discuss the current literature evidence on the association between post-menopausal oestrogen withdrawal, OxS and PO. It is also aimed to provide a critical overview of the most significant epidemiological studies on the effects of dietary antioxidants on bone health and to devise a strategy to overcome the limitations emerged and controversial results.
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Abaloparatide for the treatment of postmenopausal osteoporosis.
Pietrogrande, L, Raimondo, E
Drugs of today (Barcelona, Spain : 1998). 2018;(5):293-303
Abstract
Abaloparatide is a synthetic 34-amino acid peptide analogue of the 1-34 portion of the human parathyroid hormone-related protein (PTHrP). It has been approved in the U.S. for the treatment of postmenopausal women with osteoporosis at a high risk for fracture. Abaloparatide is an anabolic agent and it seems to have a potent anabolic activity with reduced effects on bone resorption. It reduces the risk of vertebral and nonvertebral fractures, major osteoporotic fractures and clinical fractures, with a significant improvement in bone mineral density at femoral neck, total hip and lumbar spine. In this article we summarize the development of the abaloparatide molecule and preclinical and clinical studies published so far. Results from clinical trials indicate that abaloparatide may become an important option for the anabolic treatment of postmenopausal osteoporosis.
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Association between sleep duration and osteoporosis risk in middle-aged and elderly women: A systematic review and meta-analysis of observational studies.
Moradi, S, Shab-Bidar, S, Alizadeh, S, Djafarian, K
Metabolism: clinical and experimental. 2017;:199-206
Abstract
OBJECTIVE Increasing evidence has suggested an association between sleep duration and osteoporosis risk, although the results of previous studies have been inconsistent. To our knowledge, this is the first meta-analysis of the literature and quantitative estimates of the association between sleep duration and risk of osteoporosis in population-based studies of middle aged and elderly women. METHODS Pertinent studies were identified by searching PubMed and EMBASE databases up to February 2016. Five out of six included studies were cross-sectional and one was a prospective cohort study. They included 72,326 participants from three different countries. We extracted 31,625 individuals in these studies for our meta-analysis. RESULTS A pooled odds ratio analysis in women between 40 to 86years indicated that there is an inverse relationship between sleep duration and osteoporosis (overall OR =1.07 95% CI: 1.00-1.15). The negative association of long sleep duration (8h or more per day) with osteoporosis risk was observed in middle aged and elderly women (OR =1.22, 95% CI: 1.06-1.38) but not in women with short sleep duration (7h or less per day) (OR =0.98, 95% CI: 0.90-1.05). CONCLUSION This meta-analysis suggests that long sleep duration (8h or more per day) may be associated with a higher risk of osteoporosis in middle-aged and elderly. Further prospective cohort studies with longer follow-up periods, valid instruments for measurement of sleep duration and dynamic sleep quality are warranted to support the possible relationship between sleep duration and osteoporosis risk in women.
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Magnesium in the gynecological practice: a literature review.
Parazzini, F, Di Martino, M, Pellegrino, P
Magnesium research. 2017;(1):1-7
Abstract
A growing amount of evidence suggests that magnesium deficiency may play an important role in several clinical conditions concerning women health such as premenstrual syndrome, dysmenorrhea, and postmenopausal symptoms. A number of studies highlighted a positive correlation between magnesium administration and relief or prevention of these symptoms, thus suggesting that magnesium supplementation may represent a viable treatment for these conditions. Despite this amount of evidence describing the efficacy of magnesium, few and un-systematize data are available about the pharmacological mechanism of this ion for these conditions. Herein, we review and systematize the available evidence about the use of oral magnesium supplementation in several gynecological conditions and discuss the pharmacological mechanisms that characterize these interventions. The picture that emerges indicates that magnesium supplementation is effective in the prevention of dysmenorrhea, premenstrual syndrome, and menstrual migraine and in the prevention of climacteric symptoms.
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Clinical Inquiries: Does vitamin D without calcium reduce fracture risk?
Daly, S, Allison, C, Nashelsky, J
The Journal of family practice. 2016;(12):933-934
Abstract
Supplemental vitamin D without calcium--in doses averaging as much as 800 IU per day--doesn't reduce the risk of hip, vertebral, or nonvertebral fractures in postmenopausal women and older men.
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ENDOCRINE DILEMMA: Managing menopausal symptoms after breast cancer.
Eden, J
European journal of endocrinology. 2016;(3):R71-7
Abstract
Managing the symptoms of menopause after a diagnosis of breast cancer offers some unique clinical challenges. For some women, vasomotor symptoms can be severe and debilitating, and hormone therapy is at least relatively contraindicated. Non-oestrogen therapies for hot flushes include SSRIs, clonidine, gabapentin and perhaps black cohosh extracts. Vulvovaginal atrophy can usually be alleviated by simple moisturizers, although some may need specialized physiotherapy such as vaginal dilators. In a small number, topical oestrogens may be the only treatment that works. The CO2 laser may be a novel, non-oestrogen therapy to alleviate this unpleasant symptom. Bone loss can be accelerated in some patients on AIs or those who had early menopause induced by chemotherapy.
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Effects of tai chi exercise on bone health in perimenopausal and postmenopausal women: a systematic review and meta-analysis.
Sun, Z, Chen, H, Berger, MR, Zhang, L, Guo, H, Huang, Y
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2016;(10):2901-11
Abstract
Tai chi exercise may have positive effects on bone health in perimenopausal and postmenopausal women. This systematic review is the first to summarize evidence to clarify the efficacy of tai chi exercise in bone health. The benefits of tai chi exercise on bone health remain unclear; further studies are needed. Emerging randomized controlled trials (RCTs) exploring the efficacy of tai chi exercise on bone health among older women, but yielded inconclusive results. Our objective is to conduct a systematic review to evaluate evidence from RCTs to clarify the efficacy of tai chi exercise on bone mineral density (BMD), and bone turnover markers (BTM) in perimenopausal and postmenopausal women. Six electronic databases were searched, and reference lists of systematic reviews and identified studies from the search strategy were also screened. We included all RCTs that investigate tai chi exercise for bone health in perimenopausal and postmenopausal women. Data selection, extraction, and evaluation of risk of bias were performed independently by two reviewers. Ten trials detailed in 11 articles were included. Six of the 11 studies reported positive outcomes on bone health. Results of our meta-analysis showed a significant effect of tai chi exercise on BMD change at the spine compared with no treatment in perimenopausal and postmenopausal women. When tai chi exercise combined with a calcium supplement was compared with the calcium supplement alone, the result of BMD change at the spine showed no significant effect. Because the measurable effect observed was minimal, and due to the low quality of methodology of the studies, we conclude that the result is of limited reliability. Tai chi exercise may have benefits on bone health in perimenopausal and postmenopausal women, but the evidence is sometimes weak, poor, and inconsistent. Consequently, only limited conclusions can be drawn regarding the efficacy of tai chi exercise on bone health. Further well designed studies with low risk of bias are needed.