A unified consensus statement on medication-related osteonecrosis of the jaw (MRONJ) has not yet been established among the Asian member countries or regions of the Asian Federation of Osteoporosis Societies (AFOS). This study aimed to develop a consensus on MRONJ in patients with osteoporosis across these countries and regions. In this study, the term “Asia-Pacific” refers specifically to the Asian member countries and regions of AFOS. A structured survey consisting of nine MRONJ-related questions was distributed across 10 countries and regions to assess the level of agreement and summarize regional perspectives. In addition, a manual literature review and voting were conducted to evaluate the current evidence on MRONJ. The key aspects of MRONJ, including definition, staging, diagnosis, pathogenesis, risk factors, management, and prevention, were generally consistent among the AFOS countries and regions. The annual incidence and incidence rate of MRONJ associated with low-dose antiresorptive therapy in patients with osteoporosis ranged from 0.025% to 0.136% and 21 to 283 cases per 100,000 person-years, respectively. However, evidence regarding the benefits of drug discontinuation before dental surgery, such as tooth extraction, remains insufficient. Large-scale, multinational studies across AFOS countries and regions are warranted to determine the incidence of MRONJ better and evaluate the impact of antiresorptive drug discontinuation before dental procedures. These findings may contribute to the devel opment of effective evidence-based strategies for preventing MRONJ in patients with osteoporosis.

Objective: A diabetes prevention program is being proposed in the rural agricultural town of San Juan, Batangas, Philippines. This study aims to determine the prevailing level of food intake, physical activity, and health beliefs prior to any intervention. Methodology: Adults were recruited via random sampling with proportional allocation. Interviews were done to determine food intake and physical activity. Small group discussions were held to determine prevailing health beliefs. Results: The average energy intake (1,547 kcal/d) is only 72% of the recommended values for Filipinos. Only 12% of the respondents achieved the recommended energy intake. Carbohydrates comprise a large part (71%) of calorie intake. A majority (91%) already have moderate to high levels of physical activity. There are prevailing health beliefs that need to be considered when dietary modifications and physical activity interventions are to be done. Conclusion Internationally recommended diabetes prevention interventions such as reducing calorie intake and increasing physical activity may not be directly applicable here. We recommend that the features of a diabetes prevention program for this locale must include the following: 1) introduction of affordable plant sources of proteins; 2) decreasing the proportion of rice as a source of carbohydrates in the diet; 3) maintaining the level of physical activity; and 4) being sensitive to the prevailing health beliefs.
Culture ; Diet ; Life Style ; Prediabetic State ; Rural Population

Objectives: To compare Predictive Index for Osteoporosis (PIO) with Osteoporosis Self-Assessment Tool for Asians (OSTA) as a clinical tool for identifying the risk of osteoporosis in Filipino men 50e69 and Filipino women 50e65 years of age. Methods: This was an analytic study that employed a cross sectional approach that included Filipino men and women seen at the Outpatient Charity Department or at the private clinics and who underwent dual energy X-ray absorptiometry. All subjects completed a structured questionnaire and their weight and height were obtained, from which their PIO and OSTA scores were computed. Results: A total of 81 patients were included in the study. OSTA has an area under the curve of 0.712 which turns out to be significant (P ¼ 0.0004), with a calculated likelihood ratio of 1.64. The receiver operating characteristic (ROC) curve of PIO showed that the optimal cut off is > 0.962 and the calculated likelihood ratio that this patient may have osteoporosis is 1.38. Comparing the sensitivity and specificity, the resulting P value of 0.2728 denotes that the area under the curve of the 2 tools is not significantly different. Conclusions The optimal cut-off point of OSTA and PIO to discriminate high-risk and low-risk patients for osteoporosis were 0.712 and 0.686, respectively, based on ROC analysis. The performance measures of OSTA and PIO did not vary significantly in predicting the risk for osteoporosis in Filipino adults.

Introduction: Diabetes mellitus (DM) has been associated with increase in incidence of fracture irrespective of bone mineral density (BMD). There is a paucity of local studies on the relationship of DM, osteoporosis, and fracture. This study aims to compare the osteoporosis risk factors of patients with and without DM admitted for fragility fracture. Methods: This is a retrospective cross-sectional analysis of patients 40 years and above admitted for fragility fracture in Makati Medical Center from January 1, 2015 to December 31, 2017. Results: A total of 132 (32%) patients with DM and 285 patients without DM (non-DM) was reviewed. Mean BMI of DM patients was significantly higher (25.16 kg/m2) compared to non-DM patients (23.27 kg/m2) (P=0.0003). Likewise, presence of comorbidity, specifically hypertension, was significantly higher among DM patients (79.55%) as compared to only 61.75% among non-DM patients (P=0.0003). There was no significant difference found between the two groups in terms of age, gender, proportion of multiple fractures, smoking status, alcohol use, history of fracture and average BMD. Fracture sites were the same for the two groups except in fracture involving finger/toe which was significantly higher in DM patients (P=0.0113). Association between BMI and BMD among DM patients indicate a positive linear relationship (Pearson r of 0.4262) where a higher BMI will likely result to a higher BMD. (P=0.0237). The correlation of HbA1C of DM group patients was noted to have a negative linear relationship with BMD with Pearson r=0.4126 (P= 0.0451). Conclusion Among patients admitted for fragility fracture in Makati Medical Center from 2015 to 2017, clinical profile were similar whether in the DM group or non-DM group except for an increase mean BMI and presence of comorbidity among the DM group. There is also a significant difference in the fracture site according to BMI among both groups. A higher BMI was associated with higher BMD only in patients with DM. Poor glycemic control was associated with lower BMD.
Diabetes Mellitus ; Osteoporosis

Among the serious complications associated with radioiodine therapy (RAI) for thyroid cancer, cerebral edema is uncommon and has been reported previously in cases of swelling of brain metastases. This case is of a patient with papillary thyroid carcinoma who complained of nausea and vomiting after RAI and was then found unconscious the next day. Laboratory results showed electrolyte imbalances including hyponatremia and cranial imaging only revealed cerebral edema, and she regained consciousness after sodium correction. The etiology of the cerebral edema here is likely multifactorial - due to hyponatremia from hypothyroidism, aggravated by vomiting, copious water intake and a low sodium diet.

Human ; Female ; Adult ; Brain ; Brain Edema ; Carcinoma ; Consciousness ; Diet, Sodium-restricted ; Electrolytes ; Hyponatremia ; Hypothyroidism ; Iodine Radioisotopes ; Nausea ; Sodium ; Thyroid Neoplasms ; Vomiting