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[PMID]:29384970
[Au] Autor:Lou S; Wang L; Wang Y; Jiang Y; Liu J; Wang Y
[Ad] Endereço:Department of Spine Surgery.
[Ti] Título:Combination therapy of anabolic and nonbisphosphonates antiresorptive agents for the treatment of osteoporosis: A meta-analysis.
[So] Source:Medicine (Baltimore);96(52):e9534, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: According to the mechanisms of action, combination therapy of anabolic and antiresorptive agents may produce more effect for the treatment of osteoporosis. However, the combination therapy of anabolic agents and bisphosphonates reports no benefit and even reduced the anabolic effects of anabolic agents. This study aims to assess the effect of combination therapy of anabolic and nonbisphosphonates antiresorptive agents in adults with osteoporosis. METHODS: Medline, EMBASE, and Cochrane Library were searched from January 1, 1980 to November 1, 2017 for randomized controlled trials (RCTs) of adults with osteoporosis treated in combination therapy of anabolic and nonbisphosphonates antiresorptive agents compared with monotherapy of either agent alone. The primary outcome was the incidence of fractures. The secondary outcomes were the bone mineral density (BMD) changes at lumbar spine and total hip. Continuous outcomes were expressed as standardized mean difference (SMD) and 95% confidence interval (CI), while dichotomous outcomes were expressed as risk ratio (RR) and 95% CI. The meta-analysis was performed using a random-effects model. I statistic (I > 50% as a threshold indicates significant heterogeneity) was used to assess the heterogeneity. RESULTS: A total of 10 trials with a total of 1042 patients were included. The pooled results showed that the combination therapy demonstrated a significant advantage over a monotherapy in the BMD improvement at the lumbar spine (SMD 1.18; 95% CI, 0.63 to 1.72; I = 93%) and the total hip (SMD 0.89; 95% CI, 0.48 to 1.29; I = 88%) and further reduce the fracture risk (RR, 0.45; 95%CI, 0.21 to 0.94; I = 0%). CONCLUSIONS: Low-to-moderate-quality evidence shows that the combination therapy of anabolic and nonbisphosphonates antiresorptive agents is superior to monotherapy in improving the BMD and reducing the fracture risk. However, further high methodological quality studies are needed to determine the antifracture efficacy, cost-effectiveness and safety of this strategy of combination therapy.
[Mh] Termos MeSH primário: Conservadores da Densidade Óssea/uso terapêutico
Fraturas Ósseas/prevenção & controle
Osteoporose/tratamento farmacológico
[Mh] Termos MeSH secundário: Densidade Óssea/efeitos dos fármacos
Conservadores da Densidade Óssea/administração & dosagem
Difosfonatos/uso terapêutico
Quimioterapia Combinada
Seres Humanos
Hormônio Paratireóideo/uso terapêutico
Ensaios Clínicos Controlados Aleatórios como Assunto
Teriparatida/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS
[Nm] Nome de substância:
0 (Bone Density Conservation Agents); 0 (Diphosphonates); 0 (Parathyroid Hormone); 10T9CSU89I (Teriparatide)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009534


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[PMID]:29020057
[Au] Autor:Nishitani K; Mietus Z; Beck CA; Ito H; Matsuda S; Awad HA; Ehrhart N; Schwarz EM
[Ad] Endereço:Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States of America.
[Ti] Título:High dose teriparatide (rPTH1-34) therapy increases callus volume and enhances radiographic healing at 8-weeks in a massive canine femoral allograft model.
[So] Source:PLoS One;12(10):e0185446, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Small animal studies have demonstrated significant high-dose recombinant parathyroid hormone1-34 (rPTH1-34) effects on intercalary allograft healing. Towards a human adjuvant therapy to decrease non-unions, we evaluated rPTH1-34 safety and efficacy in a clinically relevant canine femoral allograft model. Adult female mongrel hounds (n = 20) received a 5cm mid-diaphyseal osteotomy reconstructed with a plated allograft, and were randomized to: 1) Placebo (n = 5; daily saline), 2) Continuous rPTH1-34 (n = 7; 5 µg/kg/day s.c. from day 1-55 post-op), or 3) Delayed rPTH1-34 (n = 8; 5 µg/kg/day s.c. from day 14-28 post-op). Safety was assessed by physical behavior and blood calcium monitoring. Cone beam CT (CB-CT) was performed on days 14, 28 and 56 post-op to assess 2D cortical healing, 3D bone volume, and Union Ratio. Biomechanical testing and dynamic histomorphometry were also performed. The high drug dose was poorly tolerated, as most dogs receiving rPTH1-34 had to be given intravenous saline, and one dog died from hypercalcemia. Continuous rPTH1-34 significantly increased 2D healing and callus volumes at 4-weeks versus Placebo, and sustained the significant increase in cortical union at 8-week (p<0.05). These rPTH1-34 effects were confirmed by histomorphometry, revealing significant increases in mineral apposition rates (MAR) on host bone and graft-host junctions (p<0.05). Delayed rPTH1-34 significantly increased callus volume and MAR at 8 weeks (p<0.05). Although no biomechanical differences were observed, as expected for early healing, the results demonstrated that 2D RUST scoring significantly correlated with torsional biomechanics (p<0.01). In conclusion, 8-weeks of intermittent high-dose rPTH1-34 treatment significantly increases callus formation and accelerates bony union of intercalary massive allografts in a clinically relevant canine model, but with serious side-effects from hypercalcemia.
[Mh] Termos MeSH primário: Calo Ósseo/diagnóstico por imagem
Calo Ósseo/patologia
Fêmur/transplante
Teriparatida/administração & dosagem
Teriparatida/uso terapêutico
Cicatrização
[Mh] Termos MeSH secundário: Aloenxertos/efeitos dos fármacos
Animais
Fenômenos Biomecânicos/efeitos dos fármacos
Calo Ósseo/efeitos dos fármacos
Tomografia Computadorizada de Feixe Cônico
Modelos Animais de Doenças
Cães
Relação Dose-Resposta a Droga
Fêmur/fisiopatologia
Fêmur/cirurgia
Fluorescência
Minerais/metabolismo
Cuidados Pós-Operatórios
Teriparatida/farmacologia
Cicatrização/efeitos dos fármacos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Minerals); 10T9CSU89I (Teriparatide)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171031
[Lr] Data última revisão:
171031
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171012
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0185446


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[PMID]:28836858
[Au] Autor:Dede AD; Makras P; Anastasilakis AD
[Ad] Endereço:a Department of Endocrinology and Diabetes , Chelsea and Westminster Hospital , London , UK.
[Ti] Título:Investigational anabolic agents for the treatment of osteoporosis: an update on recent developments.
[So] Source:Expert Opin Investig Drugs;26(10):1137-1144, 2017 Oct.
[Is] ISSN:1744-7658
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Teriparatide, a PTH analogue, was the first anabolic agent to be approved for the treatment of osteoporosis in 2002. Abaloparatide was also recently approved by the FDA. The need for other anabolic agents is still unmet. Areas covered: In this review, we discuss target molecules and recent advances in the field of anabolic therapy for osteoporosis. PTH and PTHrP analogues binding to the PTH receptor and different routes of administration of teriparatide to avoid the burden of daily subcutaneous injections are discussed. We also review antibodies targeting suppressors of the Wnt pathway such as sclerostin and Dickopff-1. Expert opinion: The development of alternative ways of administering PTH receptor ligands is a promising field, especially via the transdermal route. Other more promising molecules are still at very early stages of development. FDA recently requested more data on Romosozumab.
[Mh] Termos MeSH primário: Anabolizantes/uso terapêutico
Drogas em Investigação/uso terapêutico
Osteoporose/tratamento farmacológico
[Mh] Termos MeSH secundário: Anabolizantes/administração & dosagem
Anabolizantes/farmacologia
Animais
Desenho de Drogas
Drogas em Investigação/administração & dosagem
Drogas em Investigação/farmacologia
Seres Humanos
Terapia de Alvo Molecular
Osteoporose/fisiopatologia
Proteína Relacionada ao Hormônio Paratireóideo/administração & dosagem
Proteína Relacionada ao Hormônio Paratireóideo/uso terapêutico
Receptores de Hormônios Paratireóideos/metabolismo
Teriparatida/administração & dosagem
Teriparatida/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Anabolic Agents); 0 (Drugs, Investigational); 0 (Parathyroid Hormone-Related Protein); 0 (Receptors, Parathyroid Hormone); 10T9CSU89I (Teriparatide); AVK0I6HY2U (abaloparatide)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170922
[Lr] Data última revisão:
170922
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170825
[St] Status:MEDLINE
[do] DOI:10.1080/13543784.2017.1371136


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[PMID]:28758904
[Au] Autor:Balani DH; Ono N; Kronenberg HM
[Ad] Endereço:Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
[Ti] Título:Parathyroid hormone regulates fates of murine osteoblast precursors in vivo.
[So] Source:J Clin Invest;127(9):3327-3338, 2017 Sep 01.
[Is] ISSN:1558-8238
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Teriparatide, a recombinant form of parathyroid hormone (PTH), is the only approved treatment for osteoporosis that increases the rate of bone formation. Teriparatide increases osteoblast numbers by suppressing osteoblast apoptosis and activating bone-lining cells. No direct evidence for teriparatide's actions on early cells of the osteoblast lineage has been demonstrated. Here, we have employed a lineage-tracing strategy that uses a tamoxifen-dependent, promoter-driven cre to mark early cells of the osteoblast lineage in adult mice. We show that teriparatide increases the numbers of osteoblast precursors and drives their differentiation into mature osteoblasts. Unexpectedly, following withdrawal of teriparatide therapy, bone marrow adipocytes increased dramatically in number. Some of these adipocytes derived from cells marked by Sox9-cre expression weeks earlier. Continued therapy with teriparatide prevented the appearance of adipocytes. Selective, inducible deletion of the PTH receptor in Sox9-cre cells demonstrated that PTH receptor expression is required for teriparatide-mediated increases in early osteoblast precursors. The increase in early precursors after teriparatide administration was associated with robust suppression of precursor apoptosis without affecting their rate of proliferation. Thus, teriparatide increases the numbers of early cells of the osteoblast lineage, hastens their differentiation into osteoblasts, and suppresses their differentiation into adipocytes in vivo.
[Mh] Termos MeSH primário: Linhagem da Célula
Osteoblastos/citologia
Hormônio Paratireóideo/metabolismo
[Mh] Termos MeSH secundário: Adipócitos/citologia
Adipócitos/metabolismo
Animais
Apoptose
Diferenciação Celular
Proliferação Celular
Genes Reporter
Proteínas de Fluorescência Verde/genética
Camundongos
Camundongos Transgênicos
Nestina/genética
Osteoblastos/metabolismo
Osteócitos/citologia
Osteócitos/metabolismo
Osteogênese
Osteoporose/metabolismo
Reação em Cadeia da Polimerase Via Transcriptase Reversa
Fatores de Transcrição SOX9/genética
Teriparatida/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Nes protein, mouse); 0 (Nestin); 0 (Parathyroid Hormone); 0 (SOX9 Transcription Factor); 0 (Sox9 protein, mouse); 10T9CSU89I (Teriparatide); 147336-22-9 (Green Fluorescent Proteins)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171024
[Lr] Data última revisão:
171024
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170801
[St] Status:MEDLINE


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[PMID]:28585373
[Au] Autor:Buckley L; Guyatt G; Fink HA; Cannon M; Grossman J; Hansen KE; Humphrey MB; Lane NE; Magrey M; Miller M; Morrison L; Rao M; Robinson AB; Saha S; Wolver S; Bannuru RR; Vaysbrot E; Osani M; Turgunbaev M; Miller AS; McAlindon T
[Ad] Endereço:Yale University, New Haven, Connecticut.
[Ti] Título:2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis.
[So] Source:Arthritis Rheumatol;69(8):1521-1537, 2017 Aug.
[Is] ISSN:2326-5205
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To develop recommendations for prevention and treatment of glucocorticoid-induced osteoporosis (GIOP). METHODS: We conducted a systematic review to synthesize the evidence for the benefits and harms of GIOP prevention and treatment options. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of evidence. We used a group consensus process to determine the final recommendations and grade their strength. The guideline addresses initial assessment and reassessment in patients beginning or continuing long-term (≥3 months) glucocorticoid (GC) treatment, as well as the relative benefits and harms of lifestyle modification and of calcium, vitamin D, bisphosphonate, raloxifene, teriparatide, and denosumab treatment in the general adult population receiving long-term GC treatment, as well as in special populations of long-term GC users. RESULTS: Because of limited evidence regarding the benefits and harms of interventions in GC users, most recommendations in this guideline are conditional (uncertain balance between benefits and harms). Recommendations include treating only with calcium and vitamin D in adults at low fracture risk, treating with calcium and vitamin D plus an additional osteoporosis medication (oral bisphosphonate preferred) in adults at moderate-to-high fracture risk, continuing calcium plus vitamin D but switching from an oral bisphosphonate to another antifracture medication in adults in whom oral bisphosphonate treatment is not appropriate, and continuing oral bisphosphonate treatment or switching to another antifracture medication in adults who complete a planned oral bisphosphonate regimen but continue to receive GC treatment. Recommendations for special populations, including children, people with organ transplants, women of childbearing potential, and people receiving very high-dose GC treatment, are also made. CONCLUSION: This guideline provides direction for clinicians and patients making treatment decisions. Clinicians and patients should use a shared decision-making process that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.
[Mh] Termos MeSH primário: Conservadores da Densidade Óssea/uso terapêutico
Glucocorticoides/efeitos adversos
Osteoporose/prevenção & controle
Fraturas por Osteoporose/prevenção & controle
Doenças Reumáticas/tratamento farmacológico
[Mh] Termos MeSH secundário: Cálcio na Dieta/uso terapêutico
Consenso
Denosumab/uso terapêutico
Difosfonatos/uso terapêutico
Seres Humanos
Osteoporose/induzido quimicamente
Osteoporose/tratamento farmacológico
Fraturas por Osteoporose/induzido quimicamente
Fraturas por Osteoporose/tratamento farmacológico
Cloridrato de Raloxifeno/uso terapêutico
Reumatologia
Sociedades Médicas
Teriparatida/uso terapêutico
Estados Unidos
Vitamina D/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE; PRACTICE GUIDELINE; REVIEW
[Nm] Nome de substância:
0 (Bone Density Conservation Agents); 0 (Calcium, Dietary); 0 (Diphosphonates); 0 (Glucocorticoids); 10T9CSU89I (Teriparatide); 1406-16-2 (Vitamin D); 4EQZ6YO2HI (Denosumab); 4F86W47BR6 (Raloxifene Hydrochloride)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171027
[Lr] Data última revisão:
171027
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170607
[St] Status:MEDLINE
[do] DOI:10.1002/art.40137


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[PMID]:28544807
[Au] Autor:Solomon DH; Kay J; Duryea J; Lu B; Bolster MB; Yood RA; Han R; Ball S; Coleman C; Lo E; Wohlfahrt A; Sury M; Yin M; Yu Z; Zak A; Gravallese EM
[Ad] Endereço:Brigham and Women's Hospital, Boston, Massachusetts.
[Ti] Título:Effects of Teriparatide on Joint Erosions in Rheumatoid Arthritis: A Randomized Controlled Trial.
[So] Source:Arthritis Rheumatol;69(9):1741-1750, 2017 Sep.
[Is] ISSN:2326-5205
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Articular erosions correlate with disability in rheumatoid arthritis (RA). Biologic agents reduce erosion progression in RA, but erosion healing occurs infrequently. This study was undertaken to assess the effects of the anabolic agent teriparatide on joint erosion volume in RA patients treated with a tumor necrosis factor inhibitor (TNFi). METHODS: We conducted a randomized controlled trial in 24 patients with erosive RA, osteopenia, and disease activity controlled by TNFi treatment for at least 3 months. Half were randomized to receive teriparatide for 1 year and the others constituted a wait-list control group. Subjects and primary rheumatologists were not blinded with regard to treatment assignment, but all outcomes were assessed in a blinded manner. The primary outcome measure was change in erosion volume determined by computed tomography at 6 anatomic sites. Significance within each hand and anatomic site was based on a 2-tailed test, with P values less than 0.05 considered significant. RESULTS: Baseline characteristics of the treatment groups were well balanced. After 52 weeks, the median change in erosion volume in the teriparatide group was -0.4 mm (interquartile range [IQR] -34.5, 29.6) and did not differ significantly from that in controls (median change +9.1 mm [IQR -29.6, 26.4]) (P = 0.28). No significant difference in change in erosion volume was noted at the radius, ulna, or metacarpophalangeal joints. Bone mineral density improved at the femoral neck and lumbar spine in the teriparatide group. CONCLUSION: Our findings indicate that teriparatide treatment for 1 year does not significantly reduce erosion volume in the hands or wrists of patients with established RA with disease activity controlled by TNFi treatment.
[Mh] Termos MeSH primário: Artrite Reumatoide/tratamento farmacológico
Conservadores da Densidade Óssea/administração & dosagem
Densidade Óssea/efeitos dos fármacos
Doenças Ósseas Metabólicas/tratamento farmacológico
Teriparatida/administração & dosagem
[Mh] Termos MeSH secundário: Idoso
Antirreumáticos/uso terapêutico
Artrite Reumatoide/complicações
Artrite Reumatoide/diagnóstico por imagem
Doenças Ósseas Metabólicas/diagnóstico por imagem
Doenças Ósseas Metabólicas/etiologia
Feminino
Seres Humanos
Masculino
Articulação Metacarpofalângica/diagnóstico por imagem
Articulação Metacarpofalângica/efeitos dos fármacos
Meia-Idade
Rádio (Anatomia)/diagnóstico por imagem
Rádio (Anatomia)/efeitos dos fármacos
Índice de Gravidade de Doença
Tomografia Computadorizada por Raios X
Resultado do Tratamento
Fator de Necrose Tumoral alfa/antagonistas & inibidores
Ulna/diagnóstico por imagem
Ulna/efeitos dos fármacos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Antirheumatic Agents); 0 (Bone Density Conservation Agents); 0 (Tumor Necrosis Factor-alpha); 10T9CSU89I (Teriparatide)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170921
[Lr] Data última revisão:
170921
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170526
[St] Status:MEDLINE
[do] DOI:10.1002/art.40156


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[PMID]:28492856
[Au] Autor:Qaseem A; Forciea MA; McLean RM; Denberg TD; Clinical Guidelines Committee of the American College of Physicians
[Ad] Endereço:From the American College of Physicians and University of Pennsylvania Health System, Philadelphia, Pennsylvania, and Yale School of Medicine, New Haven, Connecticut.
[Ti] Título:Treatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and Women: A Clinical Practice Guideline Update From the American College of Physicians.
[So] Source:Ann Intern Med;166(11):818-839, 2017 Jun 06.
[Is] ISSN:1539-3704
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Description: This guideline updates the 2008 American College of Physicians (ACP) recommendations on treatment of low bone density and osteoporosis to prevent fractures in men and women. This guideline is endorsed by the American Academy of Family Physicians. Methods: The ACP Clinical Guidelines Committee based these recommendations on a systematic review of randomized controlled trials; systematic reviews; large observational studies (for adverse events); and case reports (for rare events) that were published between 2 January 2005 and 3 June 2011. The review was updated to July 2016 by using a machine-learning method, and a limited update to October 2016 was done. Clinical outcomes evaluated were fractures and adverse events. This guideline focuses on the comparative benefits and risks of short- and long-term pharmacologic treatments for low bone density, including pharmaceutical prescriptions, calcium, vitamin D, and estrogen. Evidence was graded according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. Target Audience and Patient Population: The target audience for this guideline includes all clinicians. The target patient population includes men and women with low bone density and osteoporosis. Recommendation 1: ACP recommends that clinicians offer pharmacologic treatment with alendronate, risedronate, zoledronic acid, or denosumab to reduce the risk for hip and vertebral fractures in women who have known osteoporosis. (Grade: strong recommendation; high-quality evidence). Recommendation 2: ACP recommends that clinicians treat osteoporotic women with pharmacologic therapy for 5 years. (Grade: weak recommendation; low-quality evidence). Recommendation 3: ACP recommends that clinicians offer pharmacologic treatment with bisphosphonates to reduce the risk for vertebral fracture in men who have clinically recognized osteoporosis. (Grade: weak recommendation; low-quality evidence). Recommendation 4: ACP recommends against bone density monitoring during the 5-year pharmacologic treatment period for osteoporosis in women. (Grade: weak recommendation; low-quality evidence). Recommendation 5: ACP recommends against using menopausal estrogen therapy or menopausal estrogen plus progestogen therapy or raloxifene for the treatment of osteoporosis in women. (Grade: strong recommendation; moderate-quality evidence). Recommendation 6: ACP recommends that clinicians should make the decision whether to treat osteopenic women 65 years of age or older who are at a high risk for fracture based on a discussion of patient preferences, fracture risk profile, and benefits, harms, and costs of medications. (Grade: weak recommendation; low-quality evidence).
[Mh] Termos MeSH primário: Doenças Ósseas Metabólicas/complicações
Doenças Ósseas Metabólicas/tratamento farmacológico
Fraturas Ósseas/prevenção & controle
Osteoporose/complicações
Osteoporose/tratamento farmacológico
[Mh] Termos MeSH secundário: Cálcio na Dieta/uso terapêutico
Denosumab/uso terapêutico
Difosfonatos/uso terapêutico
Terapia de Reposição de Estrogênios
Exercício
Feminino
Seres Humanos
Masculino
Osteoporose Pós-Menopausa/complicações
Osteoporose Pós-Menopausa/tratamento farmacológico
Cloridrato de Raloxifeno/uso terapêutico
Fatores de Risco
Teriparatida/uso terapêutico
Vitamina D/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE; PRACTICE GUIDELINE
[Nm] Nome de substância:
0 (Calcium, Dietary); 0 (Diphosphonates); 10T9CSU89I (Teriparatide); 1406-16-2 (Vitamin D); 4EQZ6YO2HI (Denosumab); 4F86W47BR6 (Raloxifene Hydrochloride)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170620
[Lr] Data última revisão:
170620
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170512
[St] Status:MEDLINE
[do] DOI:10.7326/M15-1361


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[PMID]:28422848
[Au] Autor:Xiaofeng L; Daxia X; Yunzhen C
[Ad] Endereço:Department of Orthopedics, Qilu Hospital of Shandong University, Ji'nan, Shandong Province, China.
[Ti] Título:Teriparatide as a nonoperative treatment for tibial and femoral fracture nonunion: A case report.
[So] Source:Medicine (Baltimore);96(16):e6571, 2017 Apr.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Fracture nonunion is a great challenge for orthopedic surgeons. Many surgical interventions are associated with significant pain and heavy economic burden. Therefore, our aim was to evaluate the outcomes of a new nonoperative treatment for fracture nonunion. PATIENT CONCERNS: A 44-year-old man suffered closed fractures of the right tibia and left femur. Eleven months after surgery, there was no radiographic healing between fracture fragments. DIAGNOSES: Fracture nonunion of the right tibia and left femur. INTERVENTIONS: The patient received systemic treatment with teriparatide (recombinant human Parathyroid Hormone 1-34) 20 µg/d for 8 months, with further observation at 4 months after discontinuation. During treatment, bone metabolic markers were measured to evaluate metabolic activity of osteoblasts and osteoclasts. The Ethics Committee of Qilu Hospital of Shandong University approved this study. OUTCOMES: Satisfactory healing of fracture nonunion was obtained without further intervention. LESSONS: Anabolic treatment with teriparatide showed a positive effect on healing of fracture nonunion. Evaluation of bone metabolic markers during treatment is necessary to observe the curative effect. In view of the positive effect of teriparatide on healing of fracture nonunion in numerous animal models and clinical studies, it may be a promising alternative treatment for fracture nonunion in patients who are not suitable for surgical intervention.
[Mh] Termos MeSH primário: Conservadores da Densidade Óssea/uso terapêutico
Fraturas do Fêmur/tratamento farmacológico
Fraturas não Consolidadas/tratamento farmacológico
Teriparatida/uso terapêutico
Fraturas da Tíbia/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Conservadores da Densidade Óssea/farmacologia
Consolidação da Fratura/efeitos dos fármacos
Fraturas não Consolidadas/cirurgia
Seres Humanos
Masculino
Osteoblastos/efeitos dos fármacos
Osteoclastos/efeitos dos fármacos
Teriparatida/farmacologia
Fraturas da Tíbia/cirurgia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Bone Density Conservation Agents); 10T9CSU89I (Teriparatide)
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170509
[Lr] Data última revisão:
170509
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170420
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000006571


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[PMID]:28401495
[Au] Autor:Martín-Merino E; Huerta-Álvarez C; Prieto-Alhambra D; Montero-Corominas D
[Ad] Endereço:Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency of Medicines and Medical Devices (AEMPS), Madrid, Spain. emartin_fcsai@bifap.aemps.es.
[Ti] Título:Cessation rate of anti-osteoporosis treatments and risk factors in Spanish primary care settings: a population-based cohort analysis.
[So] Source:Arch Osteoporos;12(1):39, 2017 Dec.
[Is] ISSN:1862-3514
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Among 95,057 patients ≥50 years with new anti-osteoporosis medications (AOM) (2001-2013) in primary care, 1-year cessation was 51% (28%-68%), higher in men, smokers, patients with missing lifestyle data, and out normal BMI, and lower in those aged 60-79, with recent fractures or other anti-osteoporotics, suggesting non-severe osteoporosis and less risk awareness. PURPOSE: Low compliance to anti-osteoporosis medications (AOM) has been previously reported. We aimed to estimate 1-year cessation rates of different AOMs as used in Spanish healthcare settings, and to identify associated risk factors. METHODS: A cohort study was performed using primary care records data (BIFAP). Patients entered the cohort when aged 50 years in 2001-2013, with ≥1 year of data available, and identified as incident users of AOM (1-year washout). Participants were divided into six cohorts: alendronate, other oral bisphosphonates, selective oestrogen receptor modulators, strontium ranelate, teriparatide, and denosumab. Patients were followed from therapy initiation to the earliest of cessation (90-day refill gap), switching (to alternative AOM), loss to follow-up, death, or end of 2013. One-year therapy cessation was estimated using life tables. Hazard ratios (of cessation) according to age, sex, lifestyle factors, morbidity, and co-medication were estimated after stepwise backwards selection. RESULTS: A total of 95,057 AOM users were identified (91% women; mean age 68). One-year cessation was 51% overall, highest for strontium ranelate (68%), and lowest for denosumab (28%). Cessation probability was higher in men (14% to 2.1-fold), smokers (>6%), and patients with missing BMI (19-28%) or smoking (6-20%) data, and overweight/obese/underweight (7% to 2.6-fold increase compared to normal weight). Patients aged 60-79 years, with a recent fracture or other drugs used for osteoporosis, had better persistence. CONCLUSIONS: Over half of the patients initiating AOM stopped therapy within the first year after initiation. The described risk factors for cessation could be proxies for non-severe osteoporosis, and/or disease/risk awareness, which could inform the targeting of high-risk patients for monitoring and/or interventions aimed at improving persistence.
[Mh] Termos MeSH primário: Conservadores da Densidade Óssea/uso terapêutico
Osteoporose/tratamento farmacológico
Atenção Primária à Saúde/estatística & dados numéricos
Suspensão de Tratamento/estatística & dados numéricos
[Mh] Termos MeSH secundário: Idoso
Alendronato/uso terapêutico
Estudos de Coortes
Denosumab/uso terapêutico
Feminino
Fraturas Ósseas/etiologia
Seres Humanos
Masculino
Meia-Idade
Fatores de Risco
Espanha
Teriparatida/uso terapêutico
Tiofenos/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Bone Density Conservation Agents); 0 (Thiophenes); 04NQ160FRU (strontium ranelate); 10T9CSU89I (Teriparatide); 4EQZ6YO2HI (Denosumab); X1J18R4W8P (Alendronate)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171003
[Lr] Data última revisão:
171003
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170413
[St] Status:MEDLINE
[do] DOI:10.1007/s11657-017-0331-6


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[PMID]:28395318
[Au] Autor:Wilson LM; Rebholz CM; Jirru E; Liu MC; Zhang A; Gayleard J; Chu Y; Robinson KA
[Ad] Endereço:From Johns Hopkins University Bloomberg School of Public Health and Johns Hopkins University School of Medicine, Baltimore, Maryland; Mount Sinai St. Luke's and Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, New York; and University of Vermont College of Medicine, Burlington, V
[Ti] Título:Benefits and Harms of Osteoporosis Medications in Patients With Chronic Kidney Disease: A Systematic Review and Meta-analysis.
[So] Source:Ann Intern Med;166(9):649-658, 2017 May 02.
[Is] ISSN:1539-3704
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Background: Complications of chronic kidney disease (CKD) include weak bones and increased fracture risk. Purpose: To review the benefits and harms of osteoporosis medications (bisphosphonates, teriparatide, raloxifene, and denosumab) compared with placebo, usual care, or active control in terms of bone mineral density (BMD), fractures, and safety in patients with CKD. Data Sources: PubMed and the Cochrane Central Register of Controlled Trials from December 2006 through December 2016. Study Selection: Paired reviewers independently screened abstracts and full-text articles for English-language, randomized, controlled trials that had at least 6 months of follow-up; evaluated osteoporosis medications among patients with CKD; and reported on BMD, fractures, or safety (mortality and adverse events). Data Extraction: Two reviewers serially abstracted data and independently assessed risk of bias and graded the strength of evidence (SOE). Data Synthesis: There were 13 trials (n = 9850) that included kidney transplant recipients (6 trials), patients who had stage 3 to 5 CKD or were receiving dialysis (3 trials), or postmenopausal women with CKD (4 trials). Evidence showed that bisphosphonates may slow loss of BMD among transplant recipients (moderate SOE), but their effects on fractures and safety in transplant recipients and others with CKD are unclear. Raloxifene may prevent vertebral fractures but may not improve BMD (low SOE). Effects of teriparatide and denosumab on BMD and fractures are unclear (very low SOE), and these medications may increase risk for some safety outcomes. Limitation: Unclear rigor of evidence, possible reporting biases, and scant evidence among patients with stage 3 to 5 CKD. Conclusion: Effects of osteoporosis medications on BMD, fracture risk, and safety among patients with CKD are not clearly established. Primary Funding Source: Kidney Disease: Improving Global Outcomes.
[Mh] Termos MeSH primário: Conservadores da Densidade Óssea/efeitos adversos
Conservadores da Densidade Óssea/uso terapêutico
Osteoporose/complicações
Osteoporose/tratamento farmacológico
Insuficiência Renal Crônica/complicações
[Mh] Termos MeSH secundário: Denosumab/efeitos adversos
Denosumab/uso terapêutico
Difosfonatos/efeitos adversos
Difosfonatos/uso terapêutico
Feminino
Seres Humanos
Cloridrato de Raloxifeno/efeitos adversos
Cloridrato de Raloxifeno/uso terapêutico
Teriparatida/efeitos adversos
Teriparatida/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Bone Density Conservation Agents); 0 (Diphosphonates); 10T9CSU89I (Teriparatide); 4EQZ6YO2HI (Denosumab); 4F86W47BR6 (Raloxifene Hydrochloride)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170620
[Lr] Data última revisão:
170620
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170411
[St] Status:MEDLINE
[do] DOI:10.7326/M16-2752



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