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Heidari B, Hajian-Tilaki K, Babaei M. Effectiveness and safety of routine calcium supplementation in postmenopausal women. A narrative review. Diabetes Metab Syndr 2020; 14:435-442. [PMID: 32371186 DOI: 10.1016/j.dsx.2020.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 04/12/2020] [Accepted: 04/12/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND To determine whether routine administration of calcium supplementation is useful in postmenopausal women, while it is associated with an increased risk of cardiovascular complications. METHODS A literature search was performed using Medline/PubMed, Scopus and Google Scholar by using relevant keywords. RESULTS Calcium supplement exerts a small protective effect against bone loss which disappears after cessation. Antifracture effect of supplemental calcium is limited to older frail women or community-dwelling residents who are vitamin D deficient and have inadequate dietary calcium intake. The results of studies on the association between calcium supplementation and cardiovascular complications are contradictory and do not lead to a decisive conclusion CONCLUSION: Current data do not support routine calcium supplementation to all postmenopausal women for prevention of bone loss or bone fracture.
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Affiliation(s)
- Behzad Heidari
- Mobility Impairment Research Center, Babol University of Medical Sciences, Babol, Iran; Clinical Research Developmemt Unit, Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran.
| | | | - Mansour Babaei
- Clinical Research Developmemt Unit, Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran; Department of Medicine Division of Rheumatology, Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
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2
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Espinosa R, Clark P, Denova-Gutiérrez E, de Los Ángeles Aguilera-Barreiro M, Flores M, Diez P, Jasqui S, Del Pilar De la Peña M, Cisneros-Dreinhofer F, Lavielle P, Mercado V. Prevention of low bone mass to achieve high bone density in Mexico: position of the Mexican Association for Bone and Mineral Metabolism. Arch Osteoporos 2018; 13:105. [PMID: 30306345 DOI: 10.1007/s11657-018-0520-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 09/18/2018] [Indexed: 02/03/2023]
Abstract
UNLABELLED In Mexico, osteoporosis is a public health problem. In this document, the Mexican Association for Bone and Mineral Metabolism defines its position on calcium, vitamin D supplement use, and physical activity as an effective, safe, and cost-effective initiatives to prevent low bone mass. INTRODUCTION In Mexico, osteoporosis is a public health problem that is expected to increase in the decades ahead. Generally, modifiable risk factors for bone health are related with lifestyles, especially nutrition and physical activity. METHODS In this position paper, the Mexican Association for Bone and Mineral Metabolism (AMMOM, by its acronym in Spanish), which is a multidisciplinary group of researchers, dietitians, epidemiologists, nurses, and physicians who study bone and related tissues and communicate the best strategies for diagnosis, treatment, and prevention of bone problems, aims to analyze the association between nutrition and bone health, risk behaviors for low bone mass, and the economic impact that prevention of low bone mass represents for the health care system. RESULTS Addressing therapeutic management with pharmacological and non-pharmacological approaches, we emphasize the important role the patient plays in the doctor-patient relationship, both in the consulting room and in daily life. Furthermore, the AMMOM defines its position on calcium and vitamin D supplement use as an effective, safe, and cost-effective initiative to prevent low bone mass. CONCLUSIONS In summary, most research and clinical practice related to osteoporosis have focused on diagnosis and treatment, but general measures for primary prevention based on addressing modifiable risk factors as a public health priority to delay the onset of loss of bone mass have not been considered by Mexican authorities. Consequently, the AMMOM task force also seeks to provide information on concrete actions to prevent low bone mass.
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Affiliation(s)
- Rolando Espinosa
- Departamento de Reumatología, Instituto Nacional de Rehabilitación, Ciudad de México, Mexico
| | - Patricia Clark
- Unidad de Investigación en Epidemiología Clínica, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico.,Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Edgar Denova-Gutiérrez
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Universidad No. 655, Colonia Santa María Ahuacatitlán, C.P. 62100, Cuernavaca, Mexico.
| | | | - Mario Flores
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Universidad No. 655, Colonia Santa María Ahuacatitlán, C.P. 62100, Cuernavaca, Mexico
| | - Pilar Diez
- Instituto Nacional de Rehabilitación, Ciudad de México, Mexico.,Sanatorio San José Satélite, Naucalpan, Mexico
| | - Salomón Jasqui
- Servicio de Ortopedia y Traumatología, Hospital Angeles de las Lomas, Ciudad de México, Mexico.,Facultad de Medicina, Universidad Anáhuac, Ciudad de México, Mexico
| | | | | | - Pilar Lavielle
- Unidad de Investigación en Epidemiologia Clínica, Instituto Mexicano del Seguro Social, Ciudad de México, Mexico
| | - Víctor Mercado
- Clínica Integral de Menopausia, Centro Medico Dalinde, Ciudad de México, Mexico
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3
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Eremenko NN, Shikh EV, Serebrova SY. Complex method for calculating total serum calcium concentration. Drug Metab Pers Ther 2018; 33:135-139. [PMID: 30145579 DOI: 10.1515/dmpt-2018-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 08/06/2018] [Indexed: 06/08/2023]
Abstract
Abstract
Background
Calcium drugs are analogs of endogenous substances. The baseline concentration of endogenous substances in the body and homeostasis mechanisms of regulation make the bioavailability and bioequivalence (BE) evaluation of these drugs very difficult. The aim of the study was to assess the pharmacokinetic parameters of calcium in the studies of comparative bioavailability combined with the assessment of homeostatic regulation mechanisms.
Methods
The study included 42 healthy male volunteers. We studied the composition of 1000 and 1200 mg of calcium, and 800 and 1000 IU of cholecalciferol. Blood sampling was carried out at 8 a.m. and 0.5, 1, 2, 3, 4, 6, 8 h after administering the drugs. Calcium pharmacokinetic parameters were measured: the area under the curve (AUC) “concentration-time”, and maximum concentration (Cmax) in volunteers. The excretion of calcium in urine in terms of creatinine clearance and parathyroid hormone (PTH) levels was assessed. The maximum excretion of calcium was converted to creatinine (calcium/creatinine). Enzyme-linked immunosorbent assay (ELISA) was used to determine the PTH and the o-cresolphthalein method to quantitatively measure the total calcium serum and urine.
Results
Results indicated that both the AUC and the excretion of calcium are comparable, and the differences are not statistically significant, p>0.05 (the ratio of calcium and creatinine in the urine maintained within physiological levels). The comparable dynamics of PTH concentration is an indirect measure of the amount of absorbed calcium.
Conclusions
The study demonstrates that, along with the standard way of calculating the area under the curve “concentration-time” (total calcium in serum), it is important to assess the calcium excretion in urine in terms of creatinine excretion, as well as focusing on the changes in the PTH levels in volunteers, which could be considered as a marker of the calcium level in the blood.
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Affiliation(s)
- Natalia N Eremenko
- Sechenov First Moscow State Medical University, Trubetskaya 8/2, Moscow 119991, Russia
- Scientific Centre for Expert Evaluation of Medicinal Products, Ministry of Public Health of the Russian Federation, Petrovsky bul. 8/2, Moscow 127051, Russia
| | - Eugenia V Shikh
- Sechenov First Moscow State Medical University, Moscow, Russia
- Scientific Centre for Expert Evaluation of Medicinal Products, Ministry of Public Health of the Russian Federation, Moscow, Russia
| | - Svetlana Y Serebrova
- Sechenov First Moscow State Medical University, Moscow, Russia
- Scientific Centre for Expert Evaluation of Medicinal Products, Ministry of Public Health of the Russian Federation, Moscow, Russia
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Sànchez-Riera L, Wilson N. Fragility Fractures & Their Impact on Older People. Best Pract Res Clin Rheumatol 2017; 31:169-191. [PMID: 29224695 DOI: 10.1016/j.berh.2017.10.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/05/2017] [Accepted: 09/14/2017] [Indexed: 01/31/2023]
Abstract
Osteoporotic fractures, in particular hip and vertebral, are a major health burden worldwide. The majority of these fractures occur in the elderly population, resulting in one of the most important causes of mortality and disability in older ages. Their cost for societies is enormous and is forecast to steadily increase over the coming decades globally. Low bone mineral density (BMD) remains a key preventable risk factor for fractures. Screening and treatment of individuals with high risk of fracture is cost-effective. Predictive tools including clinical risk factors, minimisation of falls risk and public authorities' support to create Fracture Liaison Services are paramount strategies.
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Affiliation(s)
- Lídia Sànchez-Riera
- University Hospital Bristol NHS Foundation Trust, Bristol, UK; Institute of Bone and Joint Research, The Kolling Institute, Sydney Medical School, St Leonards, NSW, Australia.
| | - Nicholas Wilson
- Institute of Bone and Joint Research, The Kolling Institute, Sydney Medical School, St Leonards, NSW, Australia
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Hyassat D, Alyan T, Jaddou H, Ajlouni KM. Prevalence and Risk Factors of Osteoporosis Among Jordanian Postmenopausal Women Attending the National Center for Diabetes, Endocrinology and Genetics in Jordan. Biores Open Access 2017; 6:85-93. [PMID: 28736691 PMCID: PMC5515108 DOI: 10.1089/biores.2016.0045] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
To assess the prevalence of osteoporosis and osteopenia among Jordanian postmenopausal women attending the National Center for Diabetes, Endocrinology, and Genetics (NCDEG), and to determine the potential associated risk factors. A cross-sectional study was conducted at (NCDEG) in Amman, Jordan. A total of 1079 Jordanian postmenopausal women aged between 45 and 84 years were included in this study that was conducted during the period between April 2013 and December 2014. All patients underwent bone mineral density measurement through dual-energy X-ray absorptiometry (DEXA) scan. DEXA scan was interpreted in terms of T score as per World Health Organization guidelines. The overall prevalence of osteoporosis and osteopenia was 37.5% and 44.6%, respectively. The maximum prevalence of osteoporosis was observed at the lumbar spine (32.4%) followed by the left femoral neck (14.4%), while the maximum prevalence of osteopenia was observed at the left femoral neck (56.1%) followed by the lumbar spine (41.3%). Patients with longer menopausal duration, normal or overweight body mass index, high parity, physical inactivity, positive family history of osteoporosis, inadequate sun exposure, high daily caffeine intake, low daily calcium intake, and delay in the age of menarche were all positively associated with osteoporosis. On the other hand, women with type 2 diabetes mellitus had lower risk of osteoporosis. There is a high prevalence of osteoporosis and osteopenia among Jordanian postmenopausal women. Necessary steps are needed for more public education and a wider dissemination of information about osteoporosis and its prevention.
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Affiliation(s)
- Dana Hyassat
- Department of Endocrinology, The National Center (Institute) for Diabetes, Endocrinology and Genetics (NCDEG)/The University of Jordan, Amman, Jordan
| | - Taghreed Alyan
- Department of Endocrinology, The National Center (Institute) for Diabetes, Endocrinology and Genetics (NCDEG)/The University of Jordan, Amman, Jordan
| | - Hashem Jaddou
- Department of Epidemiology and Public Health, The Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Kamel M. Ajlouni
- Department of Endocrinology, The National Center (Institute) for Diabetes, Endocrinology and Genetics (NCDEG)/The University of Jordan, Amman, Jordan
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Méndez-Sánchez L, López Casimiro K, Winzenberg TM, Tugwell P, Clark P. Calcium and vitamin D for increasing bone mineral density in premenopausal women. Hippokratia 2017. [DOI: 10.1002/14651858.cd012664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Lucía Méndez-Sánchez
- Children's Hospital of Mexico Federico Gomez; Clinical Epidemiology Unit; Dr. Márquez 162. Col. Doctores Mexico City Distrito Federal Mexico 06720
| | - Karen López Casimiro
- Children's Hospital of Mexico Federico Gomez; Clinical Epidemiology Unit; Dr. Márquez 162. Col. Doctores Mexico City Distrito Federal Mexico 06720
| | - Tania M Winzenberg
- University of Tasmania; Menzies Institute for Medical Research and Faculty of Health; Private Bag 23 Hobart Tasmania Australia 7000
| | - Peter Tugwell
- Faculty of Medicine, University of Ottawa; Department of Medicine; Ottawa ON Canada K1H 8M5
| | - Patricia Clark
- Children's Hospital of Mexico Federico Gomez; Clinical Epidemiology Unit; Dr. Márquez 162. Col. Doctores Mexico City Distrito Federal Mexico 06720
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Strumińska-Parulska DI. Determination of (210)Po in calcium supplements and the possible related dose assessment to the consumers. JOURNAL OF ENVIRONMENTAL RADIOACTIVITY 2015; 150:121-5. [PMID: 26318774 DOI: 10.1016/j.jenvrad.2015.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 07/31/2015] [Accepted: 08/15/2015] [Indexed: 05/23/2023]
Abstract
The aim of this pioneer study was to investigate the most popular calcium supplements as a potential additional source of polonium (210)Po in human diet. The analyzed calcium pharmaceutics contained organic or inorganic calcium compounds; some from natural sources as mussels' shells, fish extracts, or sedimentary rocks. The objectives of this research were to investigate the naturally occurring (210)Po activity concentrations in calcium supplements, find the correlations between (210)Po concentration in medicament and calcium chemical form, and calculate the effective radiation dose connected to analyzed calcium supplement consumption. As results showed, (210)Po concentrations in natural origin calcium supplements (especially sedimentary rocks) were higher than the other analyzed. Also the results of (210)Po analysis obtained for inorganic forms of calcium supplements were higher. The highest (210)Po activity concentrations were determined in mineral tablets made from sedimentary rocks: dolomite and chalk - 3.88 ± 0.22 and 3.36 ± 0.10 mBq g(-1) respectively; while the lowest in organic calcium compounds: calcium lactate and calcium gluconate - 0.07 ± 0.02 and 0.17 ± 0.01 mBq g(-1). The annual effective radiation doses from supplements intake were estimated as well. The highest annual radiation dose from (210)Po taken with 1 tablet of calcium supplement per day was connected to sample made from chalk - 2.5 ± 0.07 μSv year(-1), while the highest annual radiation dose from (210)Po taken with 1 g of pure calcium per day was connected to dolomite - 12.7 ± 0.70 μSv year(-1).
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Affiliation(s)
- Dagmara I Strumińska-Parulska
- University of Gdańsk, Faculty of Chemistry, Environmental Chemistry and Radiochemistry Chair, Wita Stwosza 63, 80-308 Gdańsk, Poland.
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8
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Breitling LP. Calcium intake and bone mineral density as an example of non-linearity and threshold analysis. Osteoporos Int 2015; 26:1271-81. [PMID: 25637058 DOI: 10.1007/s00198-014-2996-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 12/08/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED Non-linearity is a likely phenomenon in bone metabolism, but is often ignored in pertinent epidemiological studies. Using NHANES III data on calcium intake and bone mineral density, the most important non-linear methods are introduced and discussed. The results should motivate researchers to consider non-linearity in this field more frequently. INTRODUCTION Many relationships in bone metabolism and homeostasis are likely to follow non-linear patterns. Detailed dose-response analyses allowing for non-linear associations nonetheless remain scarce in this field. METHODS A detailed analysis of NHANES III data on dietary calcium intake and bone mineral density was used to demonstrate the application and some of the challenges of the most important dose-response methods, including LOESS, categorical analysis, fractional polynomials, restricted cubic splines, and segmented regression. RESULTS The spline estimate suggested increasing bone mineral density up to a calcium intake of about 1 g/day and a plateau thereafter. In segmented regression, the break-point marking the beginning of the plateau was placed at an intake of 0.58 (95 % confidence interval, 0.33 to 0.82) g/day. Sensitivity analyses suggested a less curved dose-response in women. CONCLUSIONS Knowing about the possibilities and limitations of non-linear dose-response approaches should encourage researchers to consider these methods more frequently in studies on bone health and disease. The example analysis suggested bone mineral density to reach a plateau slightly below current calcium intake recommendations, with fairly pronounced differences of the dose-response shape by sex and menopausal status.
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Affiliation(s)
- L P Breitling
- German Cancer Research Center, Division C070 Clinical Epidemiology and Aging Research, PO Box 101949, 69009, Heidelberg, Germany,
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9
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Abstract
The association between calcium supplementation and adverse cardiovascular events has recently become a topic of debate due to the publication of two epidemiological studies and one meta-analysis of randomized controlled clinical trials. The reports indicate that there is a significant increase in adverse cardiovascular events following supplementation with calcium; however, a number of experts have raised several issues with these reports such as inconsistencies in attempts to reproduce the findings in other populations and questions concerning the validity of the data due to low compliance, biases in case ascertainment, and/or a lack of adjustment. Additionally, the Auckland Calcium Study, the Women's Health Initiative, and many other studies included in the meta-analysis obtained data from calcium-replete subjects and it is not clear whether the same risk profile would be observed in populations with low calcium intakes. Dietary calcium intake varies widely throughout the world and it is especially low in East Asia, although the risk of cardiovascular events is less prominent in this region. Therefore, clarification is necessary regarding the occurrence of adverse cardiovascular events following calcium supplementation and whether this relationship can be generalized to populations with low calcium intakes. Additionally, the skeletal benefits from calcium supplementation are greater in subjects with low calcium intakes and, therefore, the risk-benefit ratio of calcium supplementation is likely to differ based on the dietary calcium intake and risks of osteoporosis and cardiovascular diseases of various populations. Further studies investigating the risk-benefit profiles of calcium supplementation in various populations are required to develop population-specific guidelines for individuals of different genders, ages, ethnicities, and risk profiles around the world.
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Affiliation(s)
- Chan Soo Shin
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
| | - Kyoung Min Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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10
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Baccaro LF, Conde DM, Costa-Paiva L, Pinto-Neto AM. The epidemiology and management of postmenopausal osteoporosis: a viewpoint from Brazil. Clin Interv Aging 2015; 10:583-91. [PMID: 25848234 PMCID: PMC4374649 DOI: 10.2147/cia.s54614] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Brazil has an aging population, with an associated increase in the prevalence of chronic diseases. Postmenopausal osteoporosis is of particular concern because it leads to an increased risk of fractures, with subsequent negative impacts on health in older women. In recent years, efforts have been made to better understand the epidemiology of osteoporosis in Brazil, and to manage both direct and indirect costs to the Brazilian health care system. The reported prevalence of osteoporosis among postmenopausal women in Brazil varies from 15% to 33%, depending on the study methodology and the use of bone densitometry data or self-reporting by participants. A diagnosis of osteoporosis can be made on the basis of fractures occurring without significant trauma or on the basis of low bone mineral density measured by dual energy X-ray absorptiometry. To reduce the risk of osteoporosis, all postmenopausal women should be encouraged to maintain a healthy lifestyle, which includes physical activity and a balanced diet. Smoking and alcohol use should also be addressed. Special attention should be given to interventions to reduce the risk of falls, especially among older women. Calcium intake should be encouraged, preferably through diet. The decision to recommend calcium supplementation should be made individually because there is concern about a possible increased risk of cardiovascular disease associated with this treatment. Brazilian women obtain a minimal amount of vitamin D from their diet, and supplementation is warranted in women with little exposure to solar ultraviolet-B radiation. For women diagnosed with osteoporosis, some form of pharmacologic therapy should be initiated. Compliance with treatment should be monitored, and the treatment period should be individualized for each patient. The Brazilian government provides medication for osteoporosis through the public health system free of charge, but without proper epidemiological knowledge, the implementation of public health programs is impaired.
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Affiliation(s)
- Luiz Francisco Baccaro
- Department of Gynecology, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Délio Marques Conde
- Breast Clinic, Hospital for Maternal and Child Healthcare, Goiânia, Goiás, Brazil
| | - Lúcia Costa-Paiva
- Department of Gynecology, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Aarão Mendes Pinto-Neto
- Department of Gynecology, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
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Eysteinsdottir T, Halldorsson TI, Thorsdottir I, Sigurdsson G, Sigurðsson S, Harris T, Launer LJ, Gudnason V, Gunnarsdottir I, Steingrimsdottir L. Milk consumption throughout life and bone mineral content and density in elderly men and women. Osteoporos Int 2014; 25:663-72. [PMID: 23948877 PMCID: PMC4948942 DOI: 10.1007/s00198-013-2476-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 07/26/2013] [Indexed: 10/26/2022]
Abstract
UNLABELLED Association between bone mineral density and bone mineral content in old age and milk consumption in adolescence, midlife, and old age was assessed. The association was strongest for milk consumption in midlife: those drinking milk daily or more often had higher bone mineral density and content in old age than those drinking milk seldom or never. INTRODUCTION The role of lifelong milk consumption for bone mineral density (BMD) and bone mineral content (BMC) in old age is not clear. Here we assess the association between hip BMD and BMC in old age and milk consumption in adolescence, midlife, and current old age. METHODS Participants of the Age, Gene/Environment Susceptibility-Reykjavik Study, aged 66-96 years (N = 4,797), reported retrospective milk intake during adolescence and midlife as well as in current old age, using a validated food frequency questionnaire. BMC of femoral neck and trochanteric area was measured by volumetric quantitative computed tomography and BMD obtained. Association was assessed using linear regression models. Differences in BMC, bone volume, and BMD in relation to milk intake were portrayed as gender-specific Z-scores. RESULTS Men consuming milk ≥ once/day during midlife had 0.21 higher Z-scores for BMD and 0.18 for BMC in femoral neck (95 % confidence interval 0.05-0.39 and 0.01-0.35, respectively) compared with < once/week. Results were comparable for trochanter. For women the results were similar, with slightly lower differences according to midlife milk consumption. For current and adolescent milk consumption, differences in Z-scores were smaller and only reached statistical significance in the case of BMD for current consumption in men, while this association was less pronounced for BMC. CONCLUSIONS Our data suggest that regular milk consumption throughout life, from adolescence to old age, is associated with higher BMC and BMD in old age, with no differences seen in bone volume. The strongest associations are seen for midlife milk consumption in both genders.
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Affiliation(s)
- T. Eysteinsdottir
- Unit for Nutrition Research, University of Iceland and Landspitali, National University Hospital, Reykjavik, Iceland
| | - T. I. Halldorsson
- Unit for Nutrition Research, University of Iceland and Landspitali, National University Hospital, Reykjavik, Iceland
- Faculty of Food Science and Human Nutrition, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - I. Thorsdottir
- Unit for Nutrition Research, University of Iceland and Landspitali, National University Hospital, Reykjavik, Iceland
- Faculty of Food Science and Human Nutrition, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - G. Sigurdsson
- Icelandic Heart Association, Kopavogur, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland and Landspitali, National University Hospital, Reykjavik, Iceland
| | | | - T. Harris
- Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, MD, USA
| | - L. J. Launer
- Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, MD, USA
| | - V. Gudnason
- Faculty of Food Science and Human Nutrition, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Icelandic Heart Association, Kopavogur, Iceland
| | - I. Gunnarsdottir
- Unit for Nutrition Research, University of Iceland and Landspitali, National University Hospital, Reykjavik, Iceland
- Faculty of Food Science and Human Nutrition, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - L. Steingrimsdottir
- Unit for Nutrition Research, University of Iceland and Landspitali, National University Hospital, Reykjavik, Iceland
- Faculty of Food Science and Human Nutrition, School of Health Sciences, University of Iceland, Reykjavik, Iceland
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12
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D'Amelio P, Spertino E, Martino F, Isaia GC. Prevalence of postmenopausal osteoporosis in Italy and validation of decision rules for referring women for bone densitometry. Calcif Tissue Int 2013; 92:437-43. [PMID: 23334353 DOI: 10.1007/s00223-013-9699-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 12/07/2012] [Indexed: 10/27/2022]
Abstract
We report the prevalence of osteoporosis, osteopenia, and fractures in a cohort of Italian women randomly recruited among the general population and validate the use of clinical guidelines in referring women for bone density testing. We enrolled in the study 995 healthy women (age range 45-92 years). A bone density test at the lumbar spine and femur was performed and a questionnaire on osteoporosis risk factors completed for all patients. The prevalence of osteoporosis was 33.67 %, that of osteopenia was 46.63, and 19.7 % were normal at bone density testing. Osteoporotic women were generally older and thinner, with a shorter period of estrogen exposure. The prevalence of fractures was 21.9 %, and fractured women had a lower bone density, were older, and had a longer postmenopausal period. Clinical guidelines for referring women for bone density testing performed poorly (the best performance was 68 %). This is the first study providing data on the prevalence of osteoporosis/osteopenia and of fractures in a cohort of healthy postmenopausal women. Known risk factors influence bone density and risk of fractures. The role of screening in detecting women with postmenopausal osteoporosis is far from optimal.
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Affiliation(s)
- Patrizia D'Amelio
- Geriatrics and Bone Metabolic Unit, Department of Medical Science, University of Torino, Corso Bramante 88/90, 10126, Turin, Italy.
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13
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Lötters FJB, Lenoir-Wijnkoop I, Fardellone P, Rizzoli R, Rocher E, Poley MJ. Dairy foods and osteoporosis: an example of assessing the health-economic impact of food products. Osteoporos Int 2013; 24:139-50. [PMID: 22707061 PMCID: PMC3536961 DOI: 10.1007/s00198-012-1998-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Accepted: 04/03/2012] [Indexed: 12/16/2022]
Abstract
UNLABELLED Osteoporosis has become a major health concern, carrying a substantial burden in terms of health outcomes and costs. We constructed a model to quantify the potential effect of an additional intake of calcium from dairy foods on the risk of osteoporotic fracture, taking a health economics perspective. INTRODUCTION This study seeks, first, to estimate the impact of an increased dairy consumption on reducing the burden of osteoporosis in terms of health outcomes and costs, and, second, to contribute to a generic methodology for assessing the health-economic outcomes of food products. METHODS We constructed a model that generated the number of hip fractures that potentially can be prevented with dairy foods intakes, and then calculated costs avoided, considering the healthcare costs of hip fractures and the costs of additional dairy foods, as well as the number of disability-adjusted life years (DALYs) lost due to hip fractures associated with low nutritional calcium intake. Separate analyses were done for The Netherlands, France, and Sweden, three countries with different levels of dairy products consumption. RESULTS The number of hip fractures that may potentially be prevented each year with additional dairy products was highest in France (2,023), followed by Sweden (455) and The Netherlands (132). The yearly number of DALYs lost was 6,263 for France, 1,246 for Sweden, and 374 for The Netherlands. The corresponding total costs that might potentially be avoided are about 129 million, 34 million, and 6 million Euros, in these countries, respectively. CONCLUSIONS This study quantified the potential nutrition economic impact of increased dairy consumption on osteoporotic fractures, building connections between the fields of nutrition and health economics. Future research should further collect longitudinal population data for documenting the net benefits of increasing dairy consumption on bone health and on the related utilization of healthcare resources.
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Affiliation(s)
- F. J. B. Lötters
- Institute of Health Policy and Management (iBMG), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - I. Lenoir-Wijnkoop
- Departement of Pharmaceutical Sciences, University of Utrecht, Sorbonnelaan 16, 3508TB Utrecht, The Netherlands
- Danone Research, Route Départementale 128, 91767 Palaiseau, France
| | - P. Fardellone
- Service de Rhumatologie, Centre Hospitalier Universitaire Amiens, INSERM ERI 12, Amiens, France
| | - R. Rizzoli
- University Hospital Geneva, Bone Diseases, Geneva, Switzerland
| | - E. Rocher
- Danone Research, Route Départementale 128, 91767 Palaiseau, France
| | - M. J. Poley
- Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands
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14
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Speer G, Szamosujvári P, Dombai P, Csóré K, Mikófalvi K, Steindl T, Streicher I, Tarsoly J, Zajzon G, Somogyi P, Szamosújvári P, Lakatos P. Dietary calcium intake and calcium supplementation in hungarian patients with osteoporosis. Int J Endocrinol 2013; 2013:754328. [PMID: 23737777 PMCID: PMC3662157 DOI: 10.1155/2013/754328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 02/22/2013] [Accepted: 03/13/2013] [Indexed: 11/25/2022] Open
Abstract
Purpose. Adequate calcium intake is the basis of osteoporosis therapy-when this proves insufficient, even specific antiosteoporotic agents cannot exert their actions properly. Methods. Our representative survey analyzed the dietary intake and supplementation of calcium in 8033 Hungarian female and male (mean age: 68 years) (68.01 (CI95: 67.81-68.21)) patients with osteoporosis. Results. Mean intake from dietary sources was 665 ± 7.9 mg (68.01 (CI95: 67.81-68.21)) daily. A significant positive relationship could be detected between total dietary calcium intake and lumbar spine BMD (P = 0.045), whereas such correlation could not be demonstrated with femoral T-score. Milk consumption positively correlated with femur (P = 0.041), but not with lumbar BMD. The ingestion of one liter of milk daily increased the T-score by 0.133. Average intake from supplementation was 558 ± 6.2 mg (68.01 (CI95: 67.81-68.21)) daily. The cumulative dose of calcium-from both dietary intake and supplementation-was significantly associated with lumbar (r = 0.024, P = 0.049), but not with femur BMD (r = 0.021, P = 0.107). The currently recommended 1000-1500 mg total daily calcium intake was achieved in 34.5% of patients only. It was lower than recommended in 47.8% of the cases and substantially higher in 17.7% of subjects. Conclusions. We conclude that calcium intake in Hungarian osteoporotic patients is much lower than the current recommendation, while routinely applied calcium supplementation will result in inappropriately high calcium intake in numerous patients.
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Affiliation(s)
- Gábor Speer
- Semmelweis University, 1st Department of Medicine, 1083 Budapest, Hungary
- Pálmai-Med Private Medical Praxis, Margit körút 44, 1027 Budapest, Hungary
- *Gábor Speer:
| | | | - Péter Dombai
- Soldra International Ltd, 1024 Budapest, Hungary
| | | | | | | | | | | | - Gergely Zajzon
- Semmelweis University, Institute of Health Informatics Development and Further Training, 1082 Budapest, Hungary
| | - Péter Somogyi
- National Institute for Sport Medicine, 1123 Budapest, Hungary
| | | | - Péter Lakatos
- Semmelweis University, 1st Department of Medicine, 1083 Budapest, Hungary
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15
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Comparison of the Effects of Ossein-Hydroxyapatite Complex and Calcium Carbonate on Bone Metabolism in Women with Senile Osteoporosis. Clin Drug Investig 2012; 31:817-24. [DOI: 10.1007/bf03256920] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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16
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Reginster JY, Hiligsmann M, Bruyere O. Strontium Ranelate: Long-Term Efficacy against Vertebral, Nonvertebral and Hip Fractures in Patients with Postmenopausal Osteoporosis. Ther Adv Musculoskelet Dis 2012; 2:133-43. [PMID: 22870443 DOI: 10.1177/1759720x10362824] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Osteoporosis treatments need to combine an unequivocally demonstrated reduction of fractures, at various skeletal sites, long-term safety, and a user-friendly profile, optimizing therapeutic adherence. Strontium ranelate is the first compound to simultaneously decrease bone resorption and stimulate bone formation. Its antifracture efficacy, at various skeletal sites, has been established up to 8 years, through studies of the highest methodological standards. Increases in bone mineral density, observed after 1 year of treatment, are predictive of the long-term fracture efficacy, hence suggesting, for the first time in osteoporosis, that bone densitometry can be used as a monitoring tool for both efficacy and compliance. Owing to a positive benefit/risk ratio, strontium ranelate may now be considered as a first-line treatment in the management of osteoporosis.
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Abstract
Osteoporosis, a condition associated with significant morbidity and mortality, is prevalent in the growing elderly population. Aging is associated with characteristic changes in the complex pathways of bone remodeling and in patterns of food intake. Whereas the traditional focus of nutritional supplementation for protection of bone health has centered around calcium and vitamin D, a multitude of nutrients have been identified with effects on bone, both individually and in combination. An integrative physiology approach can assist in formulating a deeper understanding of the complex interactions of nutrition and aging with bone, with the goal of identifying modifiable risk factors for the prevention of bone loss.
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Affiliation(s)
- Rifka C Schulman
- Division of Endocrinology, Diabetes, and Bone Disease, Mount Sinai School of Medicine, New York, NY 10128, USA
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18
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Ciria-Recasens M, Blanch-Rubió J, Coll-Batet M, Del Pilar Lisbona-Pérez M, Díez-Perez A, Carbonell-Abelló J, Manasanch J, Pérez-Edo L. Comparison of the effects of ossein-hydroxyapatite complex and calcium carbonate on bone metabolism in women with senile osteoporosis: a randomized, open-label, parallel-group, controlled, prospective study. Clin Drug Investig 2011. [PMID: 22035462 DOI: 10.2165/11592930-000000000-00000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND AND OBJECTIVE Calcium and vitamin D supplementation is recommended in patients with osteopenia and osteoporosis. One group that could benefit from this treatment is women with senile osteoporosis. Two sources of supplementary calcium are ossein-hydroxyapatite complex (OHC) and calcium carbonate, but, to date, their comparative effects on bone metabolism have not been studied in women with senile osteoporosis. The objective of this study was to compare the effects of OHC and calcium carbonate on bone metabolism in women with senile osteoporosis. METHODS This was a randomized, open-label, parallel-group, controlled, prospective study to compare the effects of OHC (treatment group) and calcium carbonate (control group) on bone metabolism. Patients were included between 2000 and 2004 and followed up for a maximum of 3 years. The study was carried out at the bone metabolism unit of two university hospitals in Barcelona, Spain. Subjects were women aged >65 years with densitometric osteoporosis of the lumbar spine or femoral neck. The treatment group received open-label OHC (Osteopor®) at a dose of two 830 mg tablets every 12 hours (712 mg elemental calcium per day). The control group received open-label calcium carbonate at a dose of 500 mg of elemental calcium every 12 hours (1000 mg elemental calcium per day). Both groups also received a vitamin D supplement (calcifediol 266 μg) at a dose of one vial orally every 15 days. Biochemical markers of bone remodelling (osteocalcin by electrochemiluminescence, tartrate-resistant acid phosphatase using colorimetry) were measured at baseline and annually for 3 years. Bone mineral density (BMD) at the lumbar spine and femoral neck was also measured. RESULTS One hundred and twenty women were included (55 in the OHC group and 65 in the calcium carbonate group), of whom 54 completed 3 years of follow-up. Levels of serum osteocalcin increased to a greater extent in the OHC group compared with the calcium carbonate group (by a mean ± SD of 0.84 ± 3.13 ng/mL at year 2 and 1.86 ± 2.22 ng/mL at year 3 in the OHC group compared with a mean ± SD decrease of 0.39 ± 1.39 ng/mL at year 2 and an increase of 0.31 ± 2.51 ng/mL at year 3 in the calcium carbonate group); the differences between treatment groups were statistically significant (p < 0.05) at both years. Changes over time in serum osteocalcin level were also statistically significant (p < 0.05) in the OHC group, but not in the calcium carbonate group. Changes in mean BMD at the lumbar spine and femoral neck between baseline and year 3 were -1.1% and 2.5% for OHC and -2.3% and 1.2% for calcium carbonate, respectively. CONCLUSION OHC had a greater anabolic effect on bone than calcium carbonate.
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Affiliation(s)
- Manel Ciria-Recasens
- Rheumatology Unit, Hospitales Universitarios del Mar y de la Esperana, Barcelona, Spain
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Li-Yu J, Perez EC, Cañete A, Bonifacio L, Llamado LQ, Martinez R, Lanzon A, Sison M. Consensus statements on osteoporosis diagnosis, prevention, and management in the Philippines. Int J Rheum Dis 2011; 14:223-38. [PMID: 21816018 DOI: 10.1111/j.1756-185x.2011.01626.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The consensus statements were developed to assist healthcare practitioners in providing optimal care to postmenopausal individuals at risk for osteoporosis and fragility fractures in the local setting. METHODOLOGY The Technical Review Committee formed by the Osteoporosis Society of the Philippines Foundation Inc. in cooperation with the Philippine Orthopedic Association drafted, retrieved available published evidence, and appraised important issues on osteoporosis and fragility fractures. The Appraisal of Guidelines Research and Evaluation instrument was used to appraise published guidelines while a systematic way of validating the quality of evidence and the level of recommendation was done using the GRADE system. A multidisciplinary panel of experts and stakeholders in an en banc meeting conferred and approved the recommendations. RESULTS AND CONCLUSION There were five key issues on preventive, seven on diagnostic, nine on therapeutic aspects of osteoporosis with four other surgical concerns on fragility fractures. All were approved by a panel of stakeholders through a majority vote. These statements will best inform the clinicians and the specialists including orthopedic surgeons and general care practitioners on issues of postmenopausal Filipino women at risk for osteoporosis and fragility fractures.
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Affiliation(s)
- Julie Li-Yu
- Department of Medicine, University of Santo Tomas Hospital, Manila, Philippines.
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20
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Loza Santamaría E. [Are calcium and vitamin D supplements for everyone?: Cons]. ACTA ACUST UNITED AC 2011; 7 Suppl 2:S40-5. [PMID: 21924219 DOI: 10.1016/j.reuma.2011.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 06/24/2011] [Accepted: 06/29/2011] [Indexed: 11/16/2022]
Abstract
Calcium and vitamin D supplements are one of the most widely used treatments in the field of bone metabolism and, especially due to its frequency, in the case of the osteoporosis. Sometimes the use of these treatments can be easily justified because there is plenty of evidence or because prescription is mandatory. But other times, not only because of the possibility of adverse events, the indication of these therapies is more controversial. Furthermore, and particularly in the context of osteoporosis, it may be suggested that prescribing calcium and vitamin D supplements to the general population may reduce the impact of disease.
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21
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Schwarz P, Jorgensen NR, Mosekilde L, Vestergaard P. The evidence for efficacy of osteoporosis treatment in men with primary osteoporosis: a systematic review and meta-analysis of antiresorptive and anabolic treatment in men. J Osteoporos 2011; 2011:259818. [PMID: 21776371 PMCID: PMC3138068 DOI: 10.4061/2011/259818] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 03/31/2011] [Indexed: 11/20/2022] Open
Abstract
Purpose. Fragility fractures in men constitute a major worldwide public health problem with a life-time risk of 13%. It cannot be directly inferred that antiosteoporotic drugs effective in women have the same effect in men. Our aim was to appraise the existing evidence for efficacy of osteoporosis treatment in men. Methods. This study was a systematic review of the published literature on the clinical efficacy of medical osteoporosis therapy in the reduction of fracture risk in men (age > 50 years). Studies included were randomised, placebo-controlled trials of men. Results. Five BMD studies of antiresorptive treatment were included. All studies showed an increase in BMD, but there was only a nonsignificant trend in the reduction of clinical fractures. Three BMD studies of anabolic treatment with teriparatide were also included. These showed a significant mean increase in spine BMD and for vertebral fractures a non-significant trend towards a reduction was seen. Conclusion. The evidence of medical osteoporosis treatment in men is scant and inconclusive due to the lack of prospective RCT studies with fracture prevention as primary end point. So far, all evidence is based on BMD increases in small RCT studies showing BMD increases comparable to those reported in postmenopausal women.
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Affiliation(s)
- Peter Schwarz
- Research Center of Aging and Osteoporosis, Department of Medicine, Glostrup Hospital, 2600 Glostrup, Denmark,Faculty of Health Science, Copenhagen University, Copenhagen, Denmark,*Peter Schwarz:
| | - Niklas Rye Jorgensen
- Research Center of Aging and Osteoporosis, Department of Medicine, Glostrup Hospital, 2600 Glostrup, Denmark,Department of Clinical Biochemistry, Glostrup Hospital, 2600 Glostrup, Denmark
| | - Leif Mosekilde
- Department of Endocrinology and Internal Medicine, MEA, THG, Aarhus University Hospital, Denmark
| | - Peter Vestergaard
- Department of Endocrinology and Internal Medicine, MEA, THG, Aarhus University Hospital, Denmark
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22
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Shu L, Ji J, Zhu Q, Cao G, Karaplis A, Pollak MR, Brown E, Goltzman D, Miao D. The calcium-sensing receptor mediates bone turnover induced by dietary calcium and parathyroid hormone in neonates. J Bone Miner Res 2011; 26:1057-71. [PMID: 21542007 PMCID: PMC3179300 DOI: 10.1002/jbmr.300] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
We have investigated, in neonates, whether the calcium-sensing receptor (CaR) mediates the effects of dietary calcium on bone turnover and/or modulates parathyroid hormone (PTH)-induced bone turnover. Wild-type (WT) pups and pups with targeted deletion of the Pth (Pth(-/-)) gene or of both Pth and CaR (Pth(-/-)CaR(-/-)) genes were nursed by dams on a normal or high-calcium diet. Pups nursed by dams on a normal diet received daily injections of vehicle or of PTH(1-34) (80 µg/kg) for 2 weeks starting from 1 week of age. In pups receiving vehicle and fed by dams on a normal diet, trabecular bone volume, osteoblast number, type 1 collagen-positive area, and mineral apposition rate, as well as the expression of bone-formation-related genes, all were reduced significantly in Pth(-/-) pups compared with WT pups and were decreased even more dramatically in Pth(-/-)CaR(-/-) pups. These parameters were increased in WT and Pth(-/-) pups but not in Pth(-/-)CaR(-/-) pups fed by dams on a high-calcium diet compared with pups fed by dams on a normal diet. These parameters also were increased in WT, Pth(-/-), and Pth(-/-)CaR(-/-) pups following exogenous PTH treatment; however, the percentage increase was less in Pth(-/-)CaR(-/-) pups than in WT and Pth(-/-) pups. In vehicle-treated pups fed by dams on either the normal or high-calcium diet and in PTH-treated pups fed by dams on a normal diet, the number and surfaces of osteoclasts and the ratio of RANKL/OPG were reduced significantly in Pth(-/-) pups and less significantly in Pth(-/-)CaR(-/-) pups compared with WT pups. These parameters were further reduced significantly in WT and Pth(-/-) pups from dams fed a high-calcium diet but did not decrease significantly in similarly treated Pth(-/-)CaR(-/-) pups, and they increased significantly in PTH-treated pups compared with vehicle-treated, genotype-matched pups fed by dams on the normal diet. These results indicate that in neonates, the CaR mediates alterations in bone turnover in response to changes in dietary calcium and modulates PTH-stimulated bone turnover.
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Affiliation(s)
- Lei Shu
- Laboratory of Reproductive Medicine, Research Center for Bone and Stem Cells, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
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Cizza G. Major depressive disorder is a risk factor for low bone mass, central obesity, and other medical conditions. DIALOGUES IN CLINICAL NEUROSCIENCE 2011. [PMID: 21485748 PMCID: PMC3181971 DOI: 10.31887/dcns.2011.13.1/gcizza] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Major depressive disorder (MDD) is one of the most common psychiatric illnesses in the adult population. It is often associated with an increased risk of cardiovascular disease. Osteoporosis is also a major public health threat. Multiple studies have reported an association between depression and low bone mineral density, but a causal link between these two conditions is disputed. Here the most important findings of the POWER (Premenopausal, Osteoporosis Women, Alendronate, Depression) Study, a large prospective study of bone turnover in premenopausal women with major depression, are summarized. The endocrine and immune alterations secondary to depression that might affect bone mass, and the possible role of poor lifestyle in the etiology of osteoporosis in subjects with depression, are also reviewed, as is the potential effect of antidepressants on bone loss. It is proposed that depression induces bone loss and osteoporotic fractures, primarily via specific immune and endocrine mechanisms, with poor lifestyle habits as potential contributory factors.
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Affiliation(s)
- Giovanni Cizza
- Diabetes, Obesity, Endocrine Branch, NIDDK, NIH, DHHS, Department of Laboratory Medicine, Clinical Center, Bethesda, Maryland 20892-1613, USA.
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25
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Plawecki K, Chapman-Novakofski K. Bone health nutrition issues in aging. Nutrients 2010; 2:1086-105. [PMID: 22253999 PMCID: PMC3257623 DOI: 10.3390/nu2111086] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2010] [Revised: 10/29/2010] [Accepted: 11/02/2010] [Indexed: 11/16/2022] Open
Abstract
Bone health is an important issue in aging. Calcium and vitamin D currently have the most focus in published research on nutrition and bone health in aging, although evidence from published research is not conclusive. A systematic review was conducted to determine the impact of dietary and supplemental interventions focused on calcium and vitamin D over the past 10 years. Using key words to search, and search limits (aging population, English), 62 papers were found related to diet, nutrition, and bone; and 157 were found related to calcium and bone. Our review found a positive effect on bone health for supplements; food-based interventions; and educational strategies. Although there may be a publishing bias related to non-significant findings not being published, our results suggest the effectiveness of food based and educational interventions with less economic impact to the individual, as well as less risk of physiological side effects occurring.
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Affiliation(s)
- Karen Plawecki
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, 61801, USA.
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27
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Body JJ, Bergmann P, Boonen S, Boutsen Y, Devogelaer JP, Goemaere S, Kaufman JM, Rozenberg S, Reginster JY. Evidence-based guidelines for the pharmacological treatment of postmenopausal osteoporosis: a consensus document by the Belgian Bone Club. Osteoporos Int 2010; 21:1657-80. [PMID: 20480148 PMCID: PMC2931762 DOI: 10.1007/s00198-010-1223-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 02/22/2010] [Indexed: 12/27/2022]
Abstract
Several drugs are available for the management of postmenopausal osteoporosis. This may, in daily practice, confuse the clinician. This manuscript offers an evidence-based update of previous treatment guidelines, with a critical assessment of the currently available efficacy data on all new chemical entities which were granted a marketing authorization. Osteoporosis is widely recognized as a major public health concern. The availability of new therapeutic agents makes clinical decision-making in osteoporosis more complex. Nation-specific guidelines are needed to take into consideration the specificities of each and every health care environment. The present manuscript is the result of a National Consensus, based on a systematic review and a critical appraisal of the currently available literature. It offers an evidence-based update of previous treatment guidelines, with the aim of providing clinicians with an unbiased assessment of osteoporosis treatment effect.
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Affiliation(s)
- J.-J. Body
- Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - P. Bergmann
- Department of Radioisotopes, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - S. Boonen
- Center for Metabolic Bone Diseases, Katholieke University Leuven, Leuven, Belgium
| | - Y. Boutsen
- Department of Rheumatology, Mont-Godinne University Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - J.-P. Devogelaer
- Department of Rheumatology, Saint Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - S. Goemaere
- Department of Rheumatology and Endocrinology, State University of Gent, Ghent, Belgium
| | - J.-M. Kaufman
- Department of Endocrinology, State University of Gent, Ghent, Belgium
| | - S. Rozenberg
- Department of Gynaecology-Obstetrics, Université Libre de Bruxelles, Brussels, Belgium
| | - J.-Y. Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
- Bone and Cartilage Metabolism Research Unit, CHU Centre-Ville, Policliniques L. BRULL, Quai Godefroid Kurth 45, 4020 Liege, Belgium
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28
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Affiliation(s)
- Amar Patel
- Department of Orthopaedic Surgery, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, USA.
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Murota I, Baba T, Shimada M, Sato N. Safety Evaluation of Excessive Intake of Calcium-fortified Fish Sausage to Prevent Osteoporosis in Humans. J JPN SOC FOOD SCI 2010. [DOI: 10.3136/nskkk.57.163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Dimai HP, Pietschmann P, Resch H, Preisinger E, Fahrleitner-Pammer A, Dobnig H, Klaushofer K. [Austrian guidance for the pharmacological treatment of osteoporosis in postmenopausal women--update 2009]. Wien Med Wochenschr 2009:1-34. [PMID: 19484202 DOI: 10.1007/s10354-009-0656-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Accepted: 01/08/2009] [Indexed: 12/19/2022]
Abstract
Osteoporosis is a systemic skeletal disease characterized by diminished bone mass and deterioration of bone microarchitecture, leading to increased fragility and subsequent increased fracture risk. Therapeutic measures therefore aim at reducing individual fracture risk. In Austria, the following drugs, all of which have been proven to reduce fracture risk, are currently registered for the treatment of postmenopausal osteoporosis: alendronate, risedronate, etidronate, ibandronate, raloxifene, teriparatide (1-34 PTH), 1-84 PTH, strontium ranelate and salmon calcitonin. Fluorides are still available, but their role in daily practice has become negligible. Currently, there is no evidence that a combination of two or more of these drugs could improve anti-fracture potency. However, treatment with PTH should be followed by the treatment with an anticatabolic drug such as bisphosphonates. Calcium and vitamin D constitute an important adjunct to any osteoporosis treatment.
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Affiliation(s)
- Hans Peter Dimai
- Klinische Abteilung für Endokrinologie und Nuklearmedizin, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Austria.
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Reginster JY, Deroisy R, Neuprez A, Hiligsmann M, Zegels B, Bruyere O. Strontium ranelate: new data on fracture prevention and mechanisms of action. Curr Osteoporos Rep 2009; 7:96-102. [PMID: 19723468 DOI: 10.1007/s11914-009-0016-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Osteoporosis treatments need to combine an unequivocally demonstrated reduction of fractures, at various skeletal sites, long-term safety, and a user-friendly profile that optimizes therapeutic adherence. Strontium ranelate is the first compound to simultaneously decrease bone resorption and stimulate bone formation. Its anti-fracture efficacy at various skeletal sites has been established for as long as 5 years through studies of the highest methodological standards. Increases in bone mineral density observed after 1 year of treatment are predictive of the long-term fracture efficacy, suggesting for the first time in osteoporosis that bone densitometry can be used as a monitoring tool. Due to a positive risk/benefit ratio, strontium ranelate is now considered as a first-line treatment in the management of osteoporosis.
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Affiliation(s)
- Jean-Yves Reginster
- Bone and Cartilage Metabolism Research Unit, CHU Centre-Ville, Policliniques L. BRULL, 4020 Liege, Belgium.
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Abstract
Good nutrition is vital to overall health, and poor diet and a sedentary lifestyle are major causes of morbidity and mortality worldwide. Nutritional factors are implicated in many oral and systemic diseases and conditions, including obesity, hypertension, dyslipidemia, type II diabetes, cardiovascular disease, osteoporosis, dental caries and some cancers including oral cancers. This review focuses on the evidence for the relations between key nutritional factors and health. Energy intake is related to body weight and obesity, highlighting the importance of lower-energy diets and regular physical activity for body weight maintenance and for preventing obesity. Evidence is presented for the health benefits of high quality carbohydrates, such as whole grain products, and fruits and vegetables, in reducing the risk of cardiovascular disease and cancer. The adverse effects of sugar, sweetened beverages, and trans and saturated fats on several diseases including caries, diabetes and cardiovascular disease are described. The health benefits of unsaturated fats, antioxidants, B vitamins and vitamin D in cardiovascular disease, periodontitis, cancer, and other conditions are documented. Both benefits and harmful effects of dairy product intake on health are discussed. Based on the evidence, nutritional guidelines are provided, as well as key recommendations for preventing obesity. Dentists can play a critical role in motivating and enabling healthy food choices.
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Affiliation(s)
- C Palacios
- Nutrition Program, School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, PR.
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Bischoff-Ferrari HA, Kiel DP, Dawson-Hughes B, Orav JE, Li R, Spiegelman D, Dietrich T, Willett WC. Dietary calcium and serum 25-hydroxyvitamin D status in relation to BMD among U.S. adults. J Bone Miner Res 2009; 24:935-42. [PMID: 19113911 PMCID: PMC3312737 DOI: 10.1359/jbmr.081242] [Citation(s) in RCA: 172] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2008] [Revised: 08/27/2008] [Accepted: 12/22/2008] [Indexed: 01/20/2023]
Abstract
A higher calcium intake is still the primary recommendation for the prevention of osteoporosis, whereas vitamin D deficiency is often not addressed. To study the relative importance of dietary calcium intake and serum 25-hydroxyvitamin D [25(OH)D] status in regard to hip BMD, 4958 community-dwelling women and 5003 men >/=20 yr of age from the U.S. NHANES III population-based survey were studied. Calcium supplement users and individuals with a prior radius or hip fracture were excluded. We calculated standardized means for BMD by quartiles of sex-specific calcium intake for three 25(OH)D categories (<50, 50-74, and 75+ nM) among men and women, separately controlling for other important predictors of BMD. A higher calcium intake was significantly associated with higher BMD (p value for trend: p = 0.005) only for women with 25(OH)D status <50 nM, whereas calcium intake beyond the upper end of the lowest quartile (>566 mg/d) was not significantly associated with BMD at 25(OH)D concentrations >50 nM. Among men, there was no significant association between a higher calcium intake beyond the upper end of the lowest quartile (626 mg/d) and BMD within all 25(OH)D categories. Among both sexes, BMD increased stepwise and significantly with higher 25(OH)D concentrations (<50, 50-74, 75+ nM; p value for trend: women < 0.0001; men = 0.0001). Among men and women, 25(OH)D status seems to be the dominant predictor of BMD relative to calcium intake. Only women with 25(OH)D concentrations <50 nM seem to benefit from a higher calcium intake.
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Cao G, Gu Z, Ren Y, Shu L, Tao C, Karaplis A, Goltzman D, Miao D. Parathyroid hormone contributes to regulating milk calcium content and modulates neonatal bone formation cooperatively with calcium. Endocrinology 2009; 150:561-9. [PMID: 18832101 DOI: 10.1210/en.2008-0654] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
To determine whether PTH and calcium (Ca) interact in neonatal bone formation, female lactating mice either heterozygous (PTH(+/-)) or homozygous (PTH(-/-)) for targeted deletion of the pth gene were fed either a normal (1% Ca, 0.6% phosphate) or high-Ca diet (2% Ca and 0.4% phosphate). Dietary effects on milk Ca content and Ca-regulating hormones were determined in dams, and the effects of milk content were assessed on bone turnover in 3-wk-old pups. On the normal diet, milk Ca and 1,25-dihydroxyvitamin D(3) levels were lower, but milk PTH-related protein levels were higher in the PTH(-/-) dams compared with the PTH(+/-) dams. On the high-Ca diet, milk Ca levels were higher, but milk 1,25-dihydroxyvitamin D(3) and PTH-related protein levels were lower in both PTH(+/-) and PTH(-/-) dams. In pups fed by PTH(-/-) dams compared with pups fed by PTH(+/-) dams on normal diets, bone mineral density, trabecular bone volume relative to tissue volume, and the number of osteoblasts were reduced in both PTH(+/-) (32.5 +/- 1.2 vs. 39.6 +/- 1.5 mg/cm(2), P < 0.05; 23.3 +/- 1.6 vs. 29.2 +/- 2.8%, P < 0.01; and 94.2 +/- 8.2 vs. 123.5 +/- 3.5/mm(2), P < 0.01, respectively) and PTH(-/-) (20.4 +/- 0.9 vs. 27.0 +/- 1.2 mg/mm(2), P < 0.05; 16.8 +/- 1.9 vs. 19.3 +/- 2.1%, P < 0.05; and 48.6 +/- 7.9 vs. 90.5 +/- 8.6/mm(2), P < 0.01, respectively) pups but were lower in the PTH(-/-) pups compared with the PTH(+/-) pups. In contrast, in pups fed by either PTH(+/-) or PTH(-/-) dams on the high-Ca diet, bone mineral density, bone volume/tissue volume, and osteoblast numbers were significantly higher, in both PTH(+/-) (50.5 +/- 1.7 vs. 58.7 +/- 2.0 mg/mm(2), P < 0.05; 37.9 +/- 5.2 vs. 46.1 +/- 5.1, P < 0.05; and 120.5 +/- 9.2 vs. 159.3 +/- 14.7/mm(2), P < 0.01, respectively) and PTH(-/-) (33.0 +/- 1.2 vs. 47.5 +/- 2.2 mg/mm(2), P < 0.001; 23.8 +/- 3.1 vs. 35.9 +/- 2.0, P < 0.05; and 78.7 +/- 10.1 vs. 99.8 +/- 13.6/mm(2), P < 0.05, respectively), and were highest in the PTH(+/-) pups fed by the PTH(+/-) dams on the high-Ca diet. These results indicate that PTH can modulate Ca content of milk, and that PTH and Ca can each exert cooperative roles on osteoblastic bone formation in the neonate.
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Affiliation(s)
- Guofan Cao
- Laboratory of Reproductive Medicine, The Research Center for Bone and Stem Cells, Department of Anatomy, Histology and Embryology, Nanjing Medical University, Nanjing, Jiangsu, PR China
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Abstract
Women often consult for the first time after osteoporosis has already become established. Medications have therefore been developed which can stimulate bone formation, with the ultimate goal of restoring bone quantity and quality and reducing spinal and peripheral fractures to a greater extent than can be obtained with inhibitors of bone resorption. Peptides of the parathyroid hormone family, when given intermittently, increase the number and activity of osteoblasts, leading to an increase in bone mass and in an improvement in skeletal architecture. Teriparatide (1-34 parathyroid hormone, PTH) reduces vertebral and non-vertebral fractures at a dose of 20 microg/day given in subcutaneous daily injections. 1-84 PTH reduces vertebral fractures, but results on non-vertebral fractures are lacking. Strontium ranelate, suggested to uncouple bone formation from bone resorption, reduces vertebral, non-vertebral and hip fractures in osteoporotic patients aged >74 years. Reduction of a vertebral fracture has also been shown in osteopenic patients. Long-term (5-year) data are available on vertebral, non-vertebral, major non-vertebral and hip fractures in osteoporotic patients. Combination/sequential treatments using inhibitors of bone resorption and bone-forming agents have been assessed in a variety of regimens. Benefits from the use of bone-forming agents appear to be largely independent of previous treatment with inhibitors of bone resorption. After treatment with an anabolic agent, the use of anti-resorptive medications maintains the benefit of the former treatment. Concomitant use of an inhibitor of bone resorption and a stimulator of bone formation has not, so far, showed any additional benefit compared with each medication given alone.
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Affiliation(s)
- Audrey Neuprez
- Department of Public Health, Epidemiology and Health Economics, University of Liege, Liege, Belgium
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Targownik LE, Lix LM, Metge CJ, Prior HJ, Leung S, Leslie WD. Use of proton pump inhibitors and risk of osteoporosis-related fractures. CMAJ 2008; 179:319-26. [PMID: 18695179 DOI: 10.1503/cmaj.071330] [Citation(s) in RCA: 302] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The use of proton pump inhibitors has been associated with an increased risk of hip fracture. We sought to further explore the relation between duration of exposure to proton pump inhibitors and osteoporosis-related fractures. METHODS We used administrative claims data to identify patients with a fracture of the hip, vertebra or wrist between April 1996 and March 2004. Cases were each matched with 3 controls based on age, sex and comorbidities. We calculated adjusted odds ratios (OR) for the risk of hip fracture and all osteoporosis-related fractures for durations of proton pump inhibitor exposure ranging from 1 or more years to more than 7 years. RESULTS We matched 15 792 cases of osteoporosis-related fractures with 47 289 controls. We did not detect a significant association between the overall risk of an osteoportic fracture and the use of proton pump inhibitors for durations of 6 years or less. However, exposure of 7 or more years was associated with increased risk of an osteoporosis-related fracture (adjusted OR 1.92, 95% confidence interval [CI] 1.16-3.18, p = 0.011). We also found an increased risk of hip fracture after 5 or more years of exposure (adjusted OR 1.62, 95% CI 1.02-2.58, p = 0.04), with even higher risk after 7 or more years exposure (adjusted OR 4.55, 95% CI 1.68-12.29, p = 0.002). INTERPRETATION Use of proton pump inhibitors for 7 or more years is associated with a significantly increased risk of an osteoporosis-related fracture. There is an increased risk of hip fracture after 5 or more years exposure. Further study is required to determine the clinical importance of this finding and to determine the value of osteoprotective medications for patients with long-term use of proton pump inhibitors.
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Affiliation(s)
- Laura E Targownik
- Department of Gastroenterology, Division of Internal Medicine, University of Manitoba, Winnipeg, Man
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Abstract
Osteoporosis poses a significant public health issue, causing significant morbidity and mortality. Calcium and vitamin D utilization in the optimization of bone health is often overlooked by patients and health care providers. In addition, the optimal standard of care for osteoporosis should encompass adequate calcium and vitamin D intake. Dietary intake or supplementation with calcium and vitamin D will be reviewed, including recent recommendations for increased vitamin D intake. Compliance to calcium and vitamin D therapy is paramount for effective prevention of osteoporotic fractures. A recently released algorithm (FRAX) estimating absolute fracture risk allows the health care provider to decide when pharmacologic therapy is warranted in addition to calcium and vitamin D. When pharmacologic therapy is advised, continued use of calcium and vitamin D is recommended for optimal fracture risk reduction. A 'bricks and mortar' analogy is often helpful when counseling patients and this analogy will be explained. This manuscript reviews relevant data related to calcium and vitamin D use for patients at risk for fracture due to bone loss.
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Bischoff-Ferrari HA, Rees JR, Grau MV, Barry E, Gui J, Baron JA. Effect of calcium supplementation on fracture risk: a double-blind randomized controlled trial. Am J Clin Nutr 2008; 87:1945-51. [PMID: 18541589 PMCID: PMC3773875 DOI: 10.1093/ajcn/87.6.1945] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The effect of supplementation with calcium alone on risk fractures in a healthy population is not clear. OBJECTIVE The objective was to determine whether 4 y of calcium supplementation would reduce the fracture risk during treatment and subsequent follow-up in a randomized placebo-controlled trial. DESIGN The participants were aged <80 y at study entry (mean age: 61 y), were generally healthy, and had a recent diagnosis of colorectal adenoma. A total of 930 participants (72% men; mean age: 61 y) were randomly assigned to receive 4 y of treatment with 3 g CaCO(3) (1200 mg elemental Ca) daily or placebo and were followed for a mean of 10.8 y. The primary outcomes of this analysis were all fractures and minimal trauma fractures (caused by a fall from standing height or lower while sitting, standing, or walking). RESULTS There were 46 fractures (15 from minimal trauma) in 464 participants in the calcium group and 54 (29 from minimal trauma) in 466 participants in the placebo group. The overall risk of fracture differed significantly between groups during the treatment phase [hazard ratio (HR): 0.28; 95% CI: 0.09, 0.85], but not during the subsequent posttreatment follow-up (HR: 1.10; 95% CI: 0.71, 1.69). Minimal trauma fractures were also less frequent in the calcium group during treatment (HR: 0; 95% CI: 0, 0.50). CONCLUSION Calcium supplementation reduced the risk of all fractures and of minimal trauma fractures among healthy individuals. The benefit appeared to dissipate after treatment was stopped. This trial was registered at clinicaltrials.gov as NCT00153816.
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Affiliation(s)
- Heike A Bischoff-Ferrari
- Department of Rheumatology and Institute of Physical Medicine, University Hospital Zurich, Zurich, Switzerland.
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Grossman J, MacLean CH. Quality Indicators for the Care of Osteoporosis in Vulnerable Elders. J Am Geriatr Soc 2007; 55 Suppl 2:S392-402. [PMID: 17910562 DOI: 10.1111/j.1532-5415.2007.01347.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jennifer Grossman
- David Geffen School of Medicine, and Division of Rheumatology, University of California at Los Angeles, Los Angeles, CA 90095, USA.
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Lewiecki EM, Silverman SL. Redefining osteoporosis treatment: Who to treat and how long to treat. ACTA ACUST UNITED AC 2007; 50:694-704. [PMID: 17117295 DOI: 10.1590/s0004-27302006000400015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2006] [Accepted: 05/20/2006] [Indexed: 11/22/2022]
Abstract
Osteoporosis is a common disease that is associated with increased risk of fractures and serious clinical consequences. Bone mineral density (BMD) testing is used to diagnose osteoporosis, estimate the risk of fracture, and monitor changes in BMD over time. Combining clinical risk factors for fracture with BMD is a better predictor of fracture risk than BMD or clinical risk factors alone. Methodologies are being developed to use BMD and validated risk factors to estimate the 10-year probability of fracture, and then combine fracture probability with country-specific economic assumptions to determine cost-effective intervention thresholds. The decision to treat is based on factors that also include availability of therapy, patient preferences, and co-morbidities. All patients benefit from nonpharmacological lifestyle treatments such a weight-bearing exercise, adequate intake of calcium and vitamin D, fall prevention, avoidance of cigarette smoking and bone-toxic drugs, and moderation of alcohol intake. Patients at high risk for fracture should be considered for pharmacological therapy, which can reduce fracture risk by about 50%.
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Affiliation(s)
- E Michael Lewiecki
- New Mexico Clinical Research and Osteoporosis Center, Albuquerque, New Mexico 87106, USA.
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42
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Abstract
Undernutrition - of both macronutrients and micronutrients - is still a surprisingly common problem among older people in the UK. There is a variety of nutritional supplements that community nurses need to be aware of in managing their patients' nutritional requirements. Different supplements are taken for different disease states. This article looks at the various nutrient and energy requirements that relate directly to clients on the district nurse's caseload. Some of the negative consequences of malnutrition of the older adult are discussed, as are the NICE guidelines for nutrition. Factors affecting dietary intake in older people are considered.
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Vestergaard P, Jorgensen NR, Mosekilde L, Schwarz P. Effects of parathyroid hormone alone or in combination with antiresorptive therapy on bone mineral density and fracture risk--a meta-analysis. Osteoporos Int 2007; 18:45-57. [PMID: 16951908 DOI: 10.1007/s00198-006-0204-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2006] [Accepted: 07/05/2006] [Indexed: 11/27/2022]
Abstract
AIM The effects of parathyroid hormone (PTH) alone or in combination with antiresorptive therapy on changes in bone mineral density (BMD) and fracture risk were studied. MATERIALS AND METHODS Randomised placebo controlled trials were retrieved from the PubMed, Web of Science or Embase databases. RESULTS PTH alone or in combination with antiresorptive drugs reduced vertebral [relative risk (RR)=0.36, 95% confidence interval (CI): 0.28-0.47, 2p<0.01] and non-vertebral (RR=0.62, 95% CI: 0.48-0.82, 2p<0.01) fracture risk and increased spine BMD by 6.6% (95% CI: 5.2-8.1%, 2p<0.01) and hip BMD non-significantly by 1.0% (95% CI: -0.1 to 2.1%, 2p=0.08) during 11-36 months of follow-up (13 trials). The gain in spine and hip BMD tended to increase with the length of the PTH treatment. No significant effect of study duration on fracture risk could be demonstrated. The major adverse events were hypercalcaemia, nausea and discomfort at the injection sites. Only limited data are currently available on fracture risk reduction with PTH plus antiresorptive therapies. CONCLUSION Although the number of studies on non-vertebral fractures is limited, our pooled analysis revealed that PTH alone or in combination with antiresorptive drugs would appear to be able to reduce the risk of vertebral and non-vertebral fractures and to increase spine and perhaps hip BMD. However, these analyses were based on cross-sectional data--i.e. based on indirect comparisons--and further studies with a direct comparison of study duration are necessary. No studies comparing PTH, PTH plus antiresorptive drugs and antiresorptive drug versus placebo in a factorial design are available; consequently, we were unable to draw any conclusions on the superiority of PTH plus antiresorptive drug versus antiresorptive drug or PTH alone with respect to BMD or fractures.
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Affiliation(s)
- P Vestergaard
- The Osteoporosis Clinic, Department of Endocrinology, Aarhus University Hospital, Aarhus C, Denmark.
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44
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Plotnikoff GA. Osteoporosis. Integr Med (Encinitas) 2007. [DOI: 10.1016/b978-1-4160-2954-0.50042-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Winzenberg T, Shaw K, Fryer J, Jones G. Effects of calcium supplementation on bone density in healthy children: meta-analysis of randomised controlled trials. BMJ 2006; 333:775. [PMID: 16980314 PMCID: PMC1602024 DOI: 10.1136/bmj.38950.561400.55] [Citation(s) in RCA: 181] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess the effectiveness of calcium supplementation for improving bone mineral density in healthy children and to determine if any effect is modified by other factors and persists after supplementation stops. DESIGN Meta-analysis. DATA SOURCES Electronic bibliographic databases, hand searching of conference proceedings, and contacting authors for unpublished data. REVIEW METHODS We included randomised placebo controlled trials of calcium supplementation in healthy children that lasted at least three months and had bone outcomes measured after at least six months of follow-up. Two reviewers independently extracted data and assessed quality. Meta-analyses predominantly used fixed effects models with outcomes given as standardised mean differences. RESULTS We included 19 studies involving 2859 children. Calcium supplementation had no effect on bone mineral density at the femoral neck or lumbar spine. There was a small effect on total body bone mineral content (standardised mean difference 0.14, 95% confidence interval 0.01 to 0.27) and upper limb bone mineral density (0.14, 0.04 to 0.24). This effect persisted after the end of supplementation only at the upper limb (0.14, 0.01 to 0.28). There was no evidence that sex, baseline calcium intake, pubertal stage, ethnicity, or level of physical activity modified the effect. CONCLUSIONS The small effect of calcium supplementation on bone mineral density in the upper limb is unlikely to reduce the risk of fracture, either in childhood or later life, to a degree of major public health importance.
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Affiliation(s)
- Tania Winzenberg
- Menzies Research Institute, Private Bag 23, Hobart, Tas 7001, Australia.
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D'Amelio P, Tamone C, Pluviano F, Di Stefano M, Isaia G. Effects of lifestyle and risk factors on bone mineral density in a cohort of Italian women: suggestion for a new decision rule. Calcif Tissue Int 2005; 77:72-8. [PMID: 16059776 DOI: 10.1007/s00223-004-0253-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2004] [Accepted: 02/28/2005] [Indexed: 12/24/2022]
Abstract
In this study the authors analyzed the role of risk factors in postmenopausal osteoporosis in a cohort of Italian women and evaluated predictive values of decision rules for early identification of osteoporotic women. Furthermore, the authors investigated the prevalence of secondary osteoporosis in this population. Women who underwent bone densitometry were asked to answer a questionnaire about the common risk factors for osteoporosis. Patients were classified as nonosteoporotic, nonosteopenic, and osteoporotic. Risk factors were compared among the groups by use of analysis of variance (ANOVA). National Osteoporosis Foundation (NOF) recommendation, Osteoporosis Risk Assessment Instruments (ORAIs), Osteoporosis Self-Assessment Tools (OST) score, and weight criterion were applied to this population. The authors proposed a new decision rule based on a new score. A total of 525 women received the questionnaire: 47.4% women were osteoporotic, 32.2% were osteopenic, and 20.4% nonosteoporotic. Risk factors that differed significantly between these groups were: age, age at menarche, postmenopausal period, and body mass index (BMI); the aforementioned risk factors appear to be significant predictors of bone density (BMD) in linear regression model. The incidence of secondary osteoporosis was 13%. In conclusion, the authors (1) confirmed the role played by nonmodifiable risk factors in determining BMD; (2) showed that the use of NOF guidelines, ORAI, OST score, and weight criterion is not satisfactory in our cohort; (3) suggested a new score, based upon the features that were significantly different between patients and controls; and (4) demonstrated the relatively high prevalence of secondary osteoporosis and suggest a primary screening for secondary osteoporosis in all patients with low BMD.
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Affiliation(s)
- P D'Amelio
- Department of Internal Medicine, University of Torino, Corso Dogliotti 14, 10126-Torino, Italy.
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Mahakala A, Thoutreddy S, Kleerekoper M. Prevention and treatment of postmenopausal osteoporosis. Obstet Gynecol Clin North Am 2005; 35:301-15, ix. [PMID: 15981950 DOI: 10.1016/j.ogc.2008.03.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Osteoporosis is a systemic disease characterized by low bone mass and microarchitectural deterioration of the skeleton leading to enhanced bone fragility and an increased risk of fracture. Prior to fracture, diagnosis is established by documenting low bone mass. In the first section of this article we review the clinical use of bone mass measurements and biochemical markers of bone remodeling in selecting patients most in need of preventive therapy at menopause. Women with high bone turnover lose bone at menopause more rapidly than those with normal bone turnover and are more likely to derive benefit from the several preventive therapies available. The second section addresses the available technologies used to diagnose osteoporosis and/or establish fragility fracture risk using noninvasive bone mass measurement and biochemical markers of bone remodeling separately or in combination. In the third section we review the several treatment options available for patients with osteoporosis, including alendronate (alendronic acid), risendronate (risedronic acid), calcitonin, teriparatide, and raloxifene, and the approaches to monitoring the therapeutic response. The final section deals with fall protection--an often forgotten aspect of management of the patient at risk for sustaining and osteoporotic fragility fracture.
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Affiliation(s)
- Aparna Mahakala
- Division of Endocrinology and Metabolism, Wayne State University, Detroit, Michigan, USA
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Seeman E, Eisman JA. Treatment of osteoporosis: why, whom, when and how to treat. Med J Aust 2004. [DOI: 10.5694/j.1326-5377.2004.tb06283.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ego Seeman
- Austin Hospital, Studley Road, Heidelberg, VIC 3084
| | - John A Eisman
- and Director, Bone and Mineral Research Program, Garvan Institute of Medical Research, St Vincent's Hospital, Sydney, NSW
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