No abstract available.
Arthritis, Rheumatoid/*drug therapy ; Bone Density Conservation Agents/*therapeutic use ; *Decision Support Techniques ; Female ; Glucocorticoids/*adverse effects ; Humans ; Osteoporosis/*chemically induced/*prevention & control

BACKGROUND/AIMS: We investigated differences in identifying candidates for antiosteoporotic treatment in rheumatoid arthritis (RA) patients according to two available clinical guidelines. METHODS: We prospectively enrolled 100 female patients aged 50 years or older with RA who visited Hanyang University Hospital for periodic examinations between April 2011 and August 2011. We applied the glucocorticoid-induced osteoporosis (GIOP) recommendations and the National Osteoporosis Foundation (NOF) guidelines to RA patients and examined agreement between the guidelines for identifying candidates for antiosteoporotic treatment. We also analyzed the impact of screening vertebral fractures (VFs) in determining the treatment of osteoporosis in RA patients. RESULTS: The 57 patients taking glucocorticoids were classified into high-risk (n = 23), medium-risk (n = 16), and low-risk (n = 18) groups according to the GIOP recommendations. Based on the NOF guidelines, 36 of 57 patients were candidates for antiosteoporotic treatment and the agreement between two guidelines was high (kappa = 0.76). Two of the 18 patients in the low-risk group and 19 of 43 patients not eligible per the GIOP recommendations were classified as candidates for antiosteoporotic treatment by the NOF guidelines. CONCLUSIONS: In determining antiosteoporotic treatment for RA patients, using only the GIOP recommendations is insufficient. Application of the NOF guidelines in patients not eligible for or classified into the low-risk group per the GIOP recommendations and screening for VFs may be helpful in deciding on antiosteoporotic treatment in RA patients.
Aged ; Arthritis, Rheumatoid/diagnosis/*drug therapy ; Bone Density Conservation Agents/*therapeutic use ; *Decision Support Techniques ; Female ; Glucocorticoids/*adverse effects ; Hospitals, University ; Humans ; Middle Aged ; Osteoporosis/*chemically induced/diagnosis/*prevention & control ; Osteoporotic Fractures/chemically induced/prevention & control ; Patient Selection ; Practice Guidelines as Topic ; Predictive Value of Tests ; Prospective Studies ; Republic of Korea ; Risk Assessment ; Risk Factors ; Spinal Fractures/chemically induced/prevention & control

Osteoporosis is a major, growing healthcare issue. This is especially of concern in an ageing population like that of Singapore. Osteoporotic patients are at risk of fractures, which can result in increased morbidity and mortality. The use of antiresorptive therapy with bisphosphonates or denosumab has been proven to reduce fracture risk. However, the use of these medications has rarely been associated with the development of osteonecrosis of the jaw, a potentially debilitating condition affecting one or both jaws. Appropriate understanding of the patient's antiresorptive therapy regime, as well as early institution of preventive dental measures, can play an important role in preventing medication-related osteonecrosis of the jaw (MRONJ). Regular monitoring and prompt referral to specialist care is warranted for patients with established MRONJ.
Aged ; Bone Density Conservation Agents ; adverse effects ; therapeutic use ; Denosumab ; adverse effects ; therapeutic use ; Diphosphonates ; adverse effects ; therapeutic use ; Humans ; Jaw Diseases ; chemically induced ; prevention & control ; Osteonecrosis ; chemically induced ; prevention & control ; Osteoporosis ; complications ; drug therapy ; Osteoporotic Fractures ; complications ; drug therapy ; Risk Factors ; Singapore ; Treatment Outcome

OBJECTIVETo observe the prevention and therapeutic effects of tanshitone (TAN) on retinoic acid induced osteoporosis in mice.

METHODThe mice osteoporosis was induced by given retinoic acid intragastrically for two weeks. The histomorphological features of bone were observed and biochemical indexes in serum (Ca, P, ALP, TRAP, E2, BGP) were determined after the mice were given TAN at the dose of 40, 80, 160 mg x kg(-1) respectly.

RESULTTanshinone can induce high conversion of osteoporosis. The levels of P, ALP, TRAP and BGP in the TAN groups were lower than the model group, while the E2 level was higher than the model group.

CONCLUSIONTanshitone can prevent the loss bone in the experimental mice. The mechanism may be that it improves the level of estrogenic hormone and inhibits the high bone turnover.

Alkaline Phosphatase ; blood ; Animals ; Bone Density ; drug effects ; Disease Models, Animal ; Diterpenes, Abietane ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Humans ; Male ; Mice ; Osteoporosis ; blood ; chemically induced ; drug therapy ; prevention & control ; Phenanthrenes ; administration & dosage ; Tretinoin ; adverse effects

Aromatase Inhibitors ; adverse effects ; therapeutic use ; Bone Density ; drug effects ; Bone Density Conservation Agents ; therapeutic use ; Breast Neoplasms ; drug therapy ; Calcium ; therapeutic use ; Diphosphonates ; therapeutic use ; Female ; Fractures, Bone ; chemically induced ; prevention & control ; Humans ; Imidazoles ; therapeutic use ; Osteoporosis, Postmenopausal ; chemically induced ; diagnosis ; prevention & control ; Postmenopause ; Vitamin D ; therapeutic use

Osteoporosis is one of the most serious complications of corticosteroid treatment. Loss of bone mineral density (BMD) and fractures occur early in the course of corticosteroid treatment, and thus early recognition of fracture risk and effective intervention based on evidence-based-medicine (EBM) are needed. A study of meta-analysis representing the highest level in a hierarchy of evidence showed that when the outcome measure of interest was limited to changes in lumbar spine BMD, bisphosphonates were the most effective of the agents studied in comparison with no therapy or treatment with calcium, and were also more efficacious than either vitamin D or calcitonin; the efficacy of bisphosphonates was enhanced when used in combination with vitamin D. Randomized controlled trials (RCTs) representing the second level in a hierarchy of evidence showed that bisphosphonates stabilized BMD not only in the lumbar spine, but also in the hip, and that parathyroid hormone (PTH) markedly increased lumbar spine BMD. According to the EBM, bisphosphonates and possibly PTH are suggested to be the most efficacious for preserving BMD. The efficacy of these agents in reducing the incidence of vertebral fractures in patients exposed to corticosteroids remains to be established in meta-analysis studies, although some RCTs have demonstrated the anti-fracture effects of etidronate, alendronate, and risedronate in the spine. Further RCTs of fracture prevention conducted on a large number of patients and their meta-analysis are needed to confirm the efficacy of bisphosphonates, PTH, or other agents in preventing vertebral and nonvertebral fractures.
Adrenal Cortex Hormones/*adverse effects ; Bone Density ; Diphosphonates/therapeutic use ; Estrogens/therapeutic use ; Humans ; Osteoporosis/*chemically induced/*drug therapy/prevention & control ; Parathyroid Hormone/therapeutic use ; Vitamin K 2/therapeutic use

OBJECTIVETo study the effect of Shugan Jiangu Recipe (SJR) on bone mineral density (BMD) and serum bone metabolic biochemical markers in postmenopausal breast cancer patients with osteopenia.

METHODSTotally 38 patients of postmenopausal women with breast cancer, who received aromatase inhibitors (AIs), were assigned to the treatment group (21 cases) and the control group (17 cases) by using random digit table. All patients took Caltrate D Tablet (containing Ca 600 mg and Vit D3 125 IU), one tablet daily. Patients in the treatment group took SJR, 6 g each time, twice daily for 6 successive months. The bone mineral density (BMD) level was detected before treatment and at months 6 after treatment. Levels of bone alkaline phosphatase (BALP), bone gla protein (BGP), tartrate-resistant acid phosphatase (TRAP), and C-terminal telopeptide of type II collagen (CTX-II) were detected by enzyme linked immunosorbent assay (ELISA). The drug safety was also assessed.

RESULTSCompared with before treatment, BMD of L2-4 and femur neck obviously increased in the treatment group at month 6 after treatment (P < 0.01), serum BALP and TRAP decreased (P < 0.05). Compared with before treatment, BMD of L2-4 and femur neck obviously decreased in the control group at month 6 after treatment (P < 0.05), serum BALP and TRAP increased (P < 0.01). Compared with the control group, lumbar and femur neck BMD obviously increased, serum levels of BGP and BALP obviously decreased, and serum levels of CTX-II and TRAP obviously increased in the treatment group at month 6 after treatment (P < 0.01). No serious adverse event occurred during the treatment period. Bone fracture occurred in one case of the control group (5.8%).

CONCLUSIONSJR could attenuate bone loss of postmenopausal women with breast cancer who received AIs, increase BMD and improve abnormal bone metabolism.

Acid Phosphatase ; blood ; Aged ; Alkaline Phosphatase ; blood ; Aromatase Inhibitors ; adverse effects ; Bone Density ; drug effects ; Bone and Bones ; drug effects ; metabolism ; Breast Neoplasms ; drug therapy ; metabolism ; Collagen Type II ; blood ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Isoenzymes ; blood ; Middle Aged ; Osteocalcin ; blood ; Osteoporosis, Postmenopausal ; chemically induced ; prevention & control ; Peptide Fragments ; blood ; Tartrate-Resistant Acid Phosphatase