Osteoporosis in China Wang, Y; Tao, Y; Hyman, M. E ...
Osteoporosis international,
10/2009, Letnik:
20, Številka:
10
Journal Article
Recenzirano
Summary Based on related studies published between 1980 and May 2008, we examine the prevalence of osteoporoses in mainland China, Hong Kong, and Taiwan. Overall, the prevalence of osteoporosis among ...these Chinese populations remains low compared to other Caucasian populations; in the mainland, it was approximately 13%. Introduction Osteoporosis is a significant public health problem and has received great attention in industrialized countries. However, limited is known in many developing countries including China, where aging and changing lifestyles likely contribute to increased osteoporosis. The objectives of the study is to examine the disease burden (prevalence) and time trends of osteoporosis in mainland China, Hong Kong, and Taiwan. Methods Related studies published in English and Chinese between January 1980 and May 2008 were reviewed and analyzed. Results The prevalence increased with age and varied dramatically based on local versus international diagnosis criteria. In the mainland, reported overall prevalence of osteoporosis based on nationwide surveys ranged from 6.6% to 19.3% (average = 13.0%). The prevalence varied considerably across studies, and by regions, gender, and bone sites, but the urban to rural difference was small. In Hong Kong, the prevalence among women >=50 years ranged from 34.1-37% in the spine; was 7% in the same aged men. In Taiwan, among those aged >=50 years, average prevalence of osteoporosis was 11.4% in women and 1.6% in men. Conclusions Future national programs need to monitor the burden of osteoporosis in China though available data indicate that the prevalence of osteoporosis remains low compared to that of other Caucasian populations.
The Clinician’s Guide to Prevention and Treatment of Osteoporosis was developed by an expert committee of the National Osteoporosis Foundation (NOF) in collaboration with a multispecialty council of ...medical experts in the field of bone health convened by NOF. Readers are urged to consult current prescribing information on any drug, device, or procedure discussed in this publication.
Summary
Guidance is provided in an international setting on the assessment and specific treatment of postmenopausal women at low, high and very high risk of fragility fractures.
Introduction
The ...International Osteoporosis Foundation and European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis published guidance for the diagnosis and management of osteoporosis in 2019. This manuscript seeks to apply this in an international setting, taking additional account of further categorisation of increased risk of fracture, which may inform choice of therapeutic approach.
Methods
Clinical perspective and updated literature search.
Results
The following areas are reviewed: categorisation of fracture risk and general pharmacological management of osteoporosis.
Conclusions
A platform is provided on which specific guidelines can be developed for national use to characterise fracture risk and direct interventions.
Abstract
Purpose
The efficacy and safety of abaloparatide, a parathyroid hormone-related protein analog for the treatment of osteoporosis in postmenopausal women at high fracture risk, is reviewed.
...Summary
A MEDLINE search was conducted for full text English-language articles, using the terms abaloparatide, parathyroid hormone, and osteoporosis. Published articles pertinent to the short- and long-term efficacy and safety of abaloparatide among postmenopausal women with osteoporosis were reviewed and summarized. Based on randomized, placebo-controlled and active-comparator studies, abaloparatide can reduce the risk of new vertebral and nonvertebral fractures in postmenopausal women with osteoporosis. Abaloparatide can also significantly increase bone mineral density (BMD) at the total hip, femoral neck, and lumbar spine. Patients receiving abaloparatide experience faster and more robust changes in BMD compared to those receiving teriparatide. Overall, abaloparatide is well tolerated with a mild adverse effect profile, including dizziness, headache, nausea, and palpitations. Additionally, there is a lower incidence of hypercalcemia with abaloparatide than with teriparatide. At this time, the differences demonstrated between abaloparatide and teriparatide would not be considered clinically significant. Larger and more robust studies are needed to determine future clinical significance of abaloparatide compared with other agents for use in the postmenopausal osteoporotic population.
Conclusion
Abaloparatide is an effective anabolic agent to improve bone formation and resorption amongst postmenopausal women with osteoporosis. Based on its clinical evidence, abaloparatide can result in greater BMD increases and less hypercalcemia compared with the only current marketed anabolic agent, teriparatide. Adverse events associated with abaloparatide are generally mild in nature and include nausea, dizziness, headache, and palpitations.
Abstract Background Postmenopausal osteoporosis results from bone loss and decreased bone strength mediated by an increased rate of bone remodeling secondary to reduced estrogen levels. Remodeling ...cycles are initiated by osteoclasts, the formation, function, and survival of which depend on RANK ligand (RANKL). RANKL inhibition therefore represents a novel strategy for reducing remodeling and its effects on fracture risk. Objectives The goal of this study was to review the preclinical and clinical evidence supporting the value of RANKL inhibition in conditions of bone loss and to provide the rationale for the use of the fully human antibody denosumab, a RANKL inhibitor, in such conditions. Methods We searched PubMed from January 2005 to May 2011 using the following terms: RANK Ligand , RANKL , denosumab , and NOT cancer, metastatic bone, or rheumatoid in the title. Results The search method retrieved 111 articles. Preclinical evidence from several bone disease models suggests that RANKL inhibition leads to increased bone volume, density, and strength. Denosumab prevents RANKL from binding to its receptor, decreasing osteoclast activity and thereby reducing bone resorption and increasing cortical and trabecular bone mass and strength. It has consistently been reported to reduce bone turnover, increase bone density, and reduce the risk of fracture in clinical studies of postmenopausal women. Phase III head-to-head trials comparing denosumab with the bisphosphonate alendronate reported that denosumab was associated with significantly greater increases in bone density. Eczema as an adverse event and cellulitis as a serious adverse event were more common with denosumab than with placebo. Conclusions Preclinical studies defined the role of RANKL in bone remodeling and provided evidence for the therapeutic potential of RANKL inhibition in conditions of bone loss. Clinical studies evaluating RANKL inhibition with denosumab in postmenopausal women have reported significant reductions in vertebral, nonvertebral, and hip fractures, providing evidence compatible with the use of denosumab in postmenopausal women with osteoporosis.
Postmenopausal Osteoporosis: Latest Guidelines Arceo-Mendoza, Rod Marianne; Camacho, Pauline M
Endocrinology and metabolism clinics of North America,
06/2021, Letnik:
50, Številka:
2
Journal Article
Recenzirano
Significant development has occurred in the treatment of postmenopausal osteoporosis. We review the most recent guidelines from the American Association of Clinical Endocrinologists/American College ...of Endocrinology, Endocrine Society, and the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis/International Osteoporosis Foundation Guidelines.
Periodontitis and osteoporosis are prevalent inflammation‐associated skeletal disorders that pose significant public health challenges to our aging population. Both periodontitis and osteoporosis are ...bone disorders closely associated with inflammation and aging. There has been consistent intrigue on whether a systemic skeletal disease such as osteoporosis will amplify the alveolar bone loss in periodontitis. A survey of the literature published in the past 25 years indicates that systemic low bone mineral density (BMD) is associated with alveolar bone loss, while recent evidence also suggests a correlation between clinical attachment loss and other parameters of periodontitis. Inflammation and its influence on bone remodeling play critical roles in the pathogenesis of both osteoporosis and periodontitis and could serve as the central mechanistic link between these disorders. Enhanced cytokine production and elevated inflammatory response exacerbate osteoclastic bone resorption while inhibiting osteoblastic bone formation, resulting in a net bone loss. With aging, accumulation of oxidative stress and cellular senescence drive the progression of osteoporosis and exacerbation of periodontitis. Vitamin D deficiency and smoking are shared risk factors and may mediate the connection between osteoporosis and periodontitis, through increasing oxidative stress and impairing host response to inflammation. With the connection between systemic and localized bone loss in mind, routine dental exams and intraoral radiographs may serve as a low‐cost screening tool for low systemic BMD and increased fracture risk. Conversely, patients with fracture risk beyond the intervention threshold are at greater risk for developing severe periodontitis and undergo tooth loss. Various Food and Drug Administration‐approved therapies for osteoporosis have shown promising results for treating periodontitis. Understanding the molecular mechanisms underlying their connection sheds light on potential therapeutic strategies that may facilitate co‐management of systemic and localized bone loss.
Objectives: The aim of this study is to define the frequency of vitamin D deficiency in postmenopausal women and to evaluate its implications on bone metabolism. Patients, who admitted to the Ankara ...University Faculty of Medicine Outpatient Clinics included to the study. Materials and Methods: The study was conducted as a cross-sectional study. Postmenopausal women were scanned with DEXA and divided into three groups as osteoporosis, osteopenia, and the control group according to the T scores. During medical visit, patients’ clothing habits, and daily sunlight exposure rates have been scored from 1 to 4 with a questionnaire. Vitamin D, Parathyroid hormone (PTH), osteocalcin, Dependent personality disorder (DPD), calcium, phosphorus, Alkaline phosphotase (ALP) levels were compared. Results: 29.8% of the women had osteoporosis, and 45.8% had osteopenia. Forty eight women (36.6%) were reported to have severe vitamin D deficiency (25-OH-D<10 ng/mL), 38 women (%29) moderate vitamin D deficiency (10≤25-OH-D<20 ng/mL), and 22 women (%16.8) mild vitamin D deficiency (20≤25-OH-D<30 ng/mL). Only 23 of the women (17.6%) had vitamin D levels higher than 30 ng/mL. It was observed that as the vitamin D levels dropped, PTH levels increased. The threshold for 25-OH-D level was estimated as 16.3 ng/mL. A negative relation was observed between vitamin D and osteocalcin and a positive relation was observed between ALP, osteocalcin and PTH. Conclusion: Since the research to find out preventive effects of vitamin D on chronic diseases such as cancer, hypertension, diabetes mellitus and it is already known that vitamin D reduces the risk of falls and fracture, closer follow-up of patients with vitamin D levels below 16.3 ng/mL with appropriate vitamin replacement may be important in reducing bone loss.
This review updates evidence since the 2002 U.S. Preventive Services Task Force recommendation on osteoporosis screening.
To determine the effectiveness and harms of osteoporosis screening in ...reducing fractures for men and postmenopausal women without known previous fractures; the performance of risk-assessment instruments and bone measurement tests in identifying persons with osteoporosis; optimal screening intervals; and the efficacy and harms of medications to reduce primary fractures.
Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (through the fourth quarter of 2009), MEDLINE (January 2001 to December 2009), reference lists, and Web of Science.
Randomized, controlled trials of screening or medications with fracture outcomes published in English; performance studies of validated risk-assessment instruments; and systematic reviews and population-based studies of bone measurement tests or medication harms.
Data on patient populations, study design, analysis, follow-up, and results were abstracted, and study quality was rated by using established criteria.
Risk-assessment instruments are modest predictors of low bone density (area under the curve, 0.13 to 0.87; 14 instruments) and fractures (area under the curve, 0.48 to 0.89; 11 instruments); simple and complex instruments perform similarly. Dual-energy x-ray absorptiometry predicts fractures similarly for men and women; calcaneal quantitative ultrasonography also predicts fractures, but correlation with dual-energy x-ray absorptiometry is low. For postmenopausal women, bisphosphonates, parathyroid hormone, raloxifene, and estrogen reduce primary vertebral fractures. Trials are lacking for men. Bisphosphonates are not consistently associated with serious adverse events; raloxifene and estrogen increase thromboembolic events; and estrogen causes additional adverse events.
Trials of screening with fracture outcomes, screening intervals, and medications to reduce primary fractures, particularly those enrolling men, are lacking.
Although methods to identify risk for osteoporotic fractures are available and medications to reduce fractures are effective, no trials directly evaluate screening effectiveness, harms, and intervals.
Agency for Healthcare Research and Quality.
A guidance on the assessment and treatment of postmenopausal women at risk from fractures due to osteoporosis was recently published in Osteoporosis International as a joint effort of the ...International Osteoporosis Foundation and European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (Kanis et al. in Osteoporos Int
https://doi.org/10.1007/s00198-018-4704-5
, 2018). This manuscript updates the previous guidelines document, published in 2013 (Kanis et al. in Osteoporos Int 24:23–57, 2013) and is written in a European perspective. The present article reports and summarizes the main recommendations included in this 2018 guidance document.
PDF
