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Ma HY, Chen S, Lu LL, Gong W, Zhang AH. Raloxifene in the Treatment of Osteoporosis in Postmenopausal Women with End-Stage Renal Disease: A Systematic Review and Meta-Analysis. Horm Metab Res 2021; 53:730-737. [PMID: 34740274 DOI: 10.1055/a-1655-4362] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
As a selective estrogen receptor modulator (SERM), raloxifene is used in healthy postmenopausal women to prevent bone loss and reduce fractures. However, the benefit of raloxifene is uncertain in the treatment of osteoporosis among patients with end-stage renal disease (ESRD) or those who require maintenance dialysis. We assessed the safety and efficacy of raloxifene in this particular population. Studies were selected from PubMed, Springer, CNKI (Chinese National Knowledge Infrastructure) and Wanfang Database. Randomized controlled trials (RCTs) and prospective studies with control/placebo groups were included. Five studies were included with a total of 244 participants (121 patients in the raloxifene group and 123 patients in the placebo/control group). The median duration of treatment was 12 months. The incidence rate of side effects of raloxifene was 0/121 (0%). There was a significant improvement of lumbar spine bone mineral density (BMD) levels in the raloxifene group compared with the placebo group (MD: 33.88, 95% CI: 10.93, 56.84, p=0.004). There was no significant difference concerning the improvement of femoral neck BMD (MD: 8.42, 95% CI: -10.21, 27.04, p=0.38), intact parathyroid hormone (iPTH) (MD: -12.62, 95% CI: -35.36, 10.13, p=0.28), calcium (MD: -0.08, 95% CI: -0.61, 0.44, p=0.76), phosphorus (MD: 0.18, 95% CI: -0.12, 0.48, p=0.23) or bone alkaline phosphatase (BAP) (MD: -4.33, 95% CI: -14.44, 5.79, p=0.40). Raloxifene seems to be effective in improving the lumbar spine BMD in postmenopausal women with ESRD. More large RCTs are necessary to evaluate the long-term safety of raloxifene in uremic patients.
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Affiliation(s)
- Hao-Yang Ma
- Department of Geriatrics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Shuang Chen
- Jiangsu Key Laboratory of Pediatrics, Nanjing Medical University, Nanjing, China
- Nanjing Key Laboratory of Pediatrics, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Ling-Ling Lu
- Jiangsu Key Laboratory of Pediatrics, Nanjing Medical University, Nanjing, China
- Nanjing Key Laboratory of Pediatrics, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Gong
- Jiangsu Key Laboratory of Pediatrics, Nanjing Medical University, Nanjing, China
- Nanjing Key Laboratory of Pediatrics, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Ai-Hua Zhang
- Jiangsu Key Laboratory of Pediatrics, Nanjing Medical University, Nanjing, China
- Nanjing Key Laboratory of Pediatrics, Children's Hospital of Nanjing Medical University, Nanjing, China
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Hara T, Hijikata Y, Matsubara Y, Watanabe N. Pharmacological interventions versus placebo, no treatment or usual care for osteoporosis in people with chronic kidney disease stages 3-5D. Cochrane Database Syst Rev 2021; 7:CD013424. [PMID: 34231877 PMCID: PMC8262129 DOI: 10.1002/14651858.cd013424.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) is an independent risk factor for osteoporosis and is more prevalent among people with CKD than among people who do not have CKD. Although several drugs have been used to effectively treat osteoporosis in the general population, it is unclear whether they are also effective and safe for people with CKD, who have altered systemic mineral and bone metabolism. OBJECTIVES To assess the efficacy and safety of pharmacological interventions for osteoporosis in patients with CKD stages 3-5, and those undergoing dialysis (5D). SEARCH METHODS We searched the Cochrane Kidney and Transplant Register of Studies up to 25 January 2021 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA Randomised controlled trials comparing any anti-osteoporotic drugs with a placebo, no treatment or usual care in patients with osteoporosis and CKD stages 3 to 5D were included. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, assessed their quality using the risk of bias tool, and extracted data. The main outcomes were the incidence of fracture at any sites; mean change in the bone mineral density (BMD; measured using dual-energy radiographic absorptiometry (DXA)) of the femoral neck, total hip, lumbar spine, and distal radius; death from all causes; incidence of adverse events; and quality of life (QoL). Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for dichotomous outcomes, and mean difference (MD) for continuous outcomes. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. MAIN RESULTS Seven studies involving 9164 randomised participants with osteoporosis and CKD stages 3 to 5D met the inclusion criteria; all participants were postmenopausal women. Five studies included patients with CKD stages 3-4, and two studies included patients with CKD stages 5 or 5D. Five pharmacological interventions were identified (abaloparatide, alendronate, denosumab, raloxifene, and teriparatide). All studies were judged to be at an overall high risk of bias. Among patients with CKD stages 3-4, anti-osteoporotic drugs may reduce the risk of vertebral fracture (RR 0.52, 95% CI 0.39 to 0.69; low certainty evidence). Anti-osteoporotic drugs probably makes little or no difference to the risk of clinical fracture (RR 0.91, 95% CI 0.79 to 1.05; moderate certainty evidence) and adverse events (RR 0.99, 95% CI 0.98 to 1.00; moderate certainty evidence). We were unable to incorporate studies into the meta-analyses for BMD at the femoral neck, lumbar spine and total hip as they only reported the percentage change in the BMD in the intervention group. Among patients with severe CKD stages 5 or 5D, it is uncertain whether anti-osteoporotic drug reduces the risk of clinical fracture (RR 0.33, 95% CI 0.01 to 7.87; very low certainty evidence). It is uncertain whether anti-osteoporotic drug improves the BMD at the femoral neck because the certainty of this evidence is very low (MD 0.01, 95% CI 0.00 to 0.02). Anti-osteoporotic drug may slightly improve the BMD at the lumbar spine (MD 0.03, 95% CI 0.03 to 0.04, low certainty evidence). No adverse events were reported in the included studies. It is uncertain whether anti-osteoporotic drug reduces the risk of death (RR 1.00, 95% CI 0.22 to 4.56; very low certainty evidence). AUTHORS' CONCLUSIONS Among patients with CKD stages 3-4, anti-osteoporotic drugs may reduce the risk of vertebral fracture in low certainty evidence. Anti-osteoporotic drugs make little or no difference to the risk of clinical fracture and adverse events in moderate certainty evidence. Among patients with CKD stages 5 and 5D, it is uncertain whether anti-osteoporotic drug reduces the risk of clinical fracture and death because the certainty of this evidence is very low. Anti-osteoporotic drug may slightly improve the BMD at the lumbar spine in low certainty evidence. It is uncertain whether anti-osteoporotic drug improves the BMD at the femoral neck because the certainty of this evidence is very low. Larger studies including men, paediatric patients or individuals with unstable CKD-mineral and bone disorder are required to assess the effect of each anti-osteoporotic drug at each stage of CKD.
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Affiliation(s)
- Takashi Hara
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Yasukazu Hijikata
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Yukiko Matsubara
- Department of Nephrology, Hiroshima University Hospital, Hiroshima, Japan
| | - Norio Watanabe
- Department of Psychiatry, Soseikai General Hospital, Kyoto, Japan
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Bar M, Ott SM, Lewiecki EM, Sarafoglou K, Wu JY, Thompson MJ, Vaux JJ, Dean DR, Saag KG, Hashmi SK, Inamoto Y, Dholaria BR, Kharfan-Dabaja MA, Nagler A, Rodriguez C, Hamilton BK, Shah N, Flowers MED, Savani BN, Carpenter PA. Bone Health Management After Hematopoietic Cell Transplantation: An Expert Panel Opinion from the American Society for Transplantation and Cellular Therapy. Biol Blood Marrow Transplant 2020; 26:1784-1802. [PMID: 32653624 DOI: 10.1016/j.bbmt.2020.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/05/2020] [Indexed: 12/14/2022]
Abstract
Bone health disturbances commonly occur after hematopoietic cell transplantation (HCT) with loss of bone mineral density (BMD) and avascular necrosis (AVN) foremost among them. BMD loss is related to pretransplantation chemotherapy and radiation exposure and immunosuppressive therapy for graft-versus-host-disease (GVHD) and results from deficiencies in growth or gonadal hormones, disturbances in calcium and vitamin D homeostasis, as well as osteoblast and osteoclast dysfunction. Although the pathophysiology of AVN remains unclear, high-dose glucocorticoid exposure is the most frequent association. Various societal treatment guidelines for osteoporosis exist, but the focus is mainly on menopausal-associated osteoporosis. HCT survivors comprise a distinct population with unique comorbidities, making general approaches to bone health management inappropriate in some cases. To address a core set of 16 frequently asked questions (FAQs) relevant to bone health in HCT, the American Society of Transplant and Cellular Therapy Committee on Practice Guidelines convened a panel of experts in HCT, adult and pediatric endocrinology, orthopedics, and oral medicine. Owing to a lack of relevant prospective controlled clinical trials that specifically address bone health in HCT, the answers to the FAQs rely on evidence derived from retrospective HCT studies, results extrapolated from prospective studies in non-HCT settings, relevant societal guidelines, and expert panel opinion. Given the heterogenous comorbidities and needs of individual HCT recipients, answers to FAQs in this article should be considered general recommendations, with good medical practice and judgment ultimately dictating care of individual patients. Readers are referred to the Supplementary Material for answers to additional FAQs that did not make the core set.
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Affiliation(s)
- Merav Bar
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington.
| | - Susan M Ott
- Department of Medicine, University of Washington, Seattle, Washington
| | - E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, New Mexico; Bone Health TeleECHO, UNM Health Sciences Center, Albuquerque, New Mexico
| | - Kyriakie Sarafoglou
- Department of Pediatrics, Divisions of Endocrinology and Genetics & Metabolism, University of Minnesota Medical School, Minneapolis, Minnesota; Department of Experimental & Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, Minnesota
| | - Joy Y Wu
- Division of Endocrinology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Matthew J Thompson
- Department of Orthopedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Jonathan J Vaux
- Department of Orthopedics and Sports Medicine, University of Washington, Seattle, Washington
| | - David R Dean
- Department of Oral Medicine, University of Washington School of Dentistry, Seattle, Washington
| | - Kenneth G Saag
- Department of Medicine, Division of Clinical Immunology and Rheumatology, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Shahrukh K Hashmi
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Yoshihiro Inamoto
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Bhagirathbhai R Dholaria
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology and Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, Florida
| | - Arnon Nagler
- Bone Marrow Transplantation Department, Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Cesar Rodriguez
- Department of Internal Medicine Hematology and Oncology, Wake Forest University Health Sciences, Winston-Salem, North Carolina
| | - Betty K Hamilton
- Blood and Marrow Transplant Program, Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Nina Shah
- Division of Hematology-Oncology, University of California, San Francisco, California
| | - Mary E D Flowers
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Bipin N Savani
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Paul A Carpenter
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
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Lin YC, Lee TC, Chen CY, Lin SJ, Hwang SJ, Lin MY. Effectiveness of antiresorptive medications in women on long-term dialysis after hip fracture: A population-based cohort study. PLoS One 2020; 15:e0238248. [PMID: 32877436 PMCID: PMC7467303 DOI: 10.1371/journal.pone.0238248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 08/12/2020] [Indexed: 11/30/2022] Open
Abstract
There is no clear evidence how effective the antiresorptive (AR) drugs alendronate and raloxifene are at reducing risk of second hip fracture and mortality in dialysis populations. The purpose of this study was to compare the risk of hospitalization for second hip fracture and risk of mortality between AR user and non-user groups in Taiwanese women on long-term dialysis with hip fractures. We conducted a retrospective cohort study using Taiwan National Health Insurance Research Datasets. Long-term dialysis women older than 50 years with newly diagnosed hip fractures and new to AR therapy from 2005 to 2011 were recruited. The patients were divided into AR users and non-users and matched by propensity score. We used Cox Proportional Hazards models to assess association of AR with risks of second hip fracture and mortality. Totally, 1,079 dialysis patients were included, and after matching, we were left with 74 AR users and 74 non-users. AR users did not show a significant reduction in the incidence of second hip fracture compared with non-users (adjusted Hazard Ratio (HR): 0.91, 95% CI: 0.30-2.76), and alendronate users exhibited higher risk of second hip fracture compared with raloxifene users (adjusted HR: 2.80, 95% CI: 0.42-18.79). In addition, AR users were found to have significantly lower 1- and 2-year mortality rates than the non-users (1- year: adjusted HR 0.25, 95% CI, 0.07-0.90; 2-year: 0.35, 95%CI: 0.17-0.72). AR treatment did not significantly improve the risk of second hip fracture but significantly reduce mortality in older women on dialysis. Further clinical trials on effectiveness of AR medications for dialysis populations should be warranted.
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Affiliation(s)
- Yu-Ciou Lin
- Graduate Institute of Clinical Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tien-Ching Lee
- Orthopaedic Research Center, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Yu Chen
- School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shun-Jin Lin
- Graduate Institute of Clinical Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shang-Jyh Hwang
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Ming-Yen Lin
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Master of Public Health Degree Program, College of Public Health, National Taiwan University, Taipei, Taiwan
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Aleksova J, Rodriguez AJ, McLachlan R, Kerr P, Milat F, Ebeling PR. Gonadal Hormones in the Pathogenesis and Treatment of Bone Health in Patients with Chronic Kidney Disease: a Systematic Review and Meta-Analysis. Curr Osteoporos Rep 2018; 16:674-692. [PMID: 30328552 DOI: 10.1007/s11914-018-0483-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Patients with chronic kidney disease (CKD) have a greatly increased fracture risk compared with the general population. Gonadal hormones have an important influence on bone mineral density (BMD) and fracture risk, and hormone therapies can significantly improve these outcomes. Gonadal dysfunction is a frequent finding in patients with CKD; yet, little is known about the impact of gonadal hormones in the pathogenesis and treatment of bone health in patients with CKD. This systematic review and meta-analysis aimed to examine the effects of gonadal hormones and hormone therapies on bone outcomes in men and women with CKD. METHODS EMBASE, MEDLINE, SCOPUS, and clinical trial registries were systematically searched from inception to February 14, 2018 for studies that assessed gonadal hormones or hormone treatments with bone outcomes in patients with CKD stage 3-5D. Two independent reviewers screened the titles and abstracts of search results according to inclusion criteria and assessed study quality and risk of bias using validated assessment tools. RECENT FINDINGS Thirteen studies met the inclusion criteria. Six moderate-to-high quality observational studies showed inconsistent association between any gonadal hormone and bone outcomes, limited by significant study heterogeneity. Five moderate-high risk of bias interventional studies examined treatment with selective oestrogen receptor modulators in post-menopausal women (four using raloxifene and one bazedoxifene) and demonstrated variable effects on BMD and fracture outcomes. Meta-analysis of raloxifene treatment in post-menopausal women demonstrated improvement in lumbar spine (SMD 3.30; 95% CI 3.21-3.38) and femoral neck (SMD 3.29; 95% CI 3.21-3.36) BMD compared with placebo. Transdermal oestradiol/norethisterone in pre-menopausal women receiving dialysis (n = 1 study), demonstrated BMD improvement over 12 months. Testosterone treatment for 6 months in dialysis-dependant men (n = 1 study) did not improve BMD. There is evidence that raloxifene treatment may be beneficial in improving BMD in post-menopausal women with CKD. There is insufficient evidence for other hormone treatments in men or women. Despite high fracture rates and frequent gonadal dysfunction in patients with CKD, significant evidence gaps exist, and well-designed studies are required to specifically assess the impact of gonadal status in the pathogenesis of CKD-related bone fragility and its treatment.
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Affiliation(s)
- Jasna Aleksova
- Department of Endocrinology, Monash Health, 246 Clayton Rd. Clayton, Melbourne, Victoria, 3168, Australia.
- Hudson Institute of Medical Reearch, Clayton, Melbourne, Australia.
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia.
| | - Alexander J Rodriguez
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
- Bone & Muscle Health Research Group, Department of Medicine, Monash University, Melbourne, Australia
| | - Robert McLachlan
- Department of Endocrinology, Monash Health, 246 Clayton Rd. Clayton, Melbourne, Victoria, 3168, Australia
- Hudson Institute of Medical Reearch, Clayton, Melbourne, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Peter Kerr
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
- Department of Nephrology, Monash Health, Melbourne, Australia
| | - Frances Milat
- Department of Endocrinology, Monash Health, 246 Clayton Rd. Clayton, Melbourne, Victoria, 3168, Australia
- Hudson Institute of Medical Reearch, Clayton, Melbourne, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Peter R Ebeling
- Department of Endocrinology, Monash Health, 246 Clayton Rd. Clayton, Melbourne, Victoria, 3168, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
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Abstract
The World Health Organization estimates that diabetes mellitus occurs in more than 415 million people; this number could double by the year 2040. Epidemiologic data have shown that the skeletal system may be a target of diabetes-mediated damage, leading to the development of diabetes-induced osteoporosis. T1D and T2D have been associated with an increased risk of fracture. Bone mineral density and fracture risk prediction tools developed for the general population capture some of the risk associated with diabetes. Recent adaptations to these tools have improved their efficacy in patients with diabetes.
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Affiliation(s)
- G Isanne Schacter
- Department of Medicine, University of Manitoba, GF-335, 820 Sherbrook Street, Winnipeg, Manitoba R3A 1R9, Canada
| | - William D Leslie
- Department of Medicine, University of Manitoba, C5121, 409 Tache Avenue, Winnipeg, Manitoba R2H 2A6, Canada.
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Schwartz AV. Efficacy of Osteoporosis Therapies in Diabetic Patients. Calcif Tissue Int 2017; 100:165-173. [PMID: 27461216 DOI: 10.1007/s00223-016-0177-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 07/12/2016] [Indexed: 12/30/2022]
Abstract
Diabetes is characterized by increased fracture risk and by reduced bone strength for a given density. Contributing factors may include lower bone turnover and accumulation of advanced glycation endproducts. There are concerns that the pharmacological therapies for osteoporosis, particularly anti-resorptive therapies that suppress bone turnover, may not be as effective in the setting of diabetes. This review considers clinical trials and observational studies that have assessed the efficacy of anti-resorptive and anabolic therapies in diabetic patients. Post hoc analyses of randomized trials indicate that raloxifene has similar efficacy for prevention of vertebral fractures in diabetic compared with non-diabetic patients. Evidence from randomized clinical trials is lacking for anti-fracture efficacy of other osteoporosis therapies in diabetes. However, observational studies suggest that bisphosphonates are effective in preventing fractures in diabetic patients. The great majority of diabetic patients in studies to date have been type 2, and efficacy of osteoporosis therapies in type 1 diabetic patients remains to be addressed. Further evaluation of the efficacy of osteoporosis therapies in the setting of diabetes is needed to provide optimal fracture prevention for this population.
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Affiliation(s)
- Ann V Schwartz
- Department of Epidemiology and Biostatistics, University of California San Francisco, Box 0560, San Francisco, CA, 94143, USA.
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Newman CL, Creecy A, Granke M, Nyman JS, Tian N, Hammond MA, Wallace JM, Brown DM, Chen N, Moe SM, Allen MR. Raloxifene improves skeletal properties in an animal model of cystic chronic kidney disease. Kidney Int 2016; 89:95-104. [PMID: 26489025 PMCID: PMC4840093 DOI: 10.1038/ki.2015.315] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 08/19/2015] [Accepted: 08/20/2015] [Indexed: 12/13/2022]
Abstract
Patients with chronic kidney disease (CKD) have an increased risk of fracture. Raloxifene is a mild antiresorptive agent that reduces fracture risk in the general population. Here we assessed the impact of raloxifene on the skeletal properties of animals with progressive CKD. Male Cy/+ rats that develop autosomal dominant cystic kidney disease were treated with either vehicle or raloxifene for five weeks. They were assessed for changes in mineral metabolism and skeletal parameters (microCT, histology, whole-bone mechanics, and material properties). Their normal littermates served as controls. Animals with CKD had significantly higher parathyroid hormone levels compared with normal controls, as well as inferior structural and mechanical skeletal properties. Raloxifene treatment resulted in lower bone remodeling rates and higher cancellous bone volume in the rats with CKD. Although it had little effect on cortical bone geometry, it resulted in higher energy to fracture and modulus of toughness values than vehicle-treated rats with CKD, achieving levels equivalent to normal controls. Animals treated with raloxifene had superior tissue-level mechanical properties as assessed by nanoindentation, and higher collagen D-periodic spacing as assessed by atomic force microscopy. Thus, raloxifene can positively impact whole-bone mechanical properties in CKD through its impact on skeletal material properties.
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Affiliation(s)
- Christopher L Newman
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Amy Creecy
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Mathilde Granke
- Department of Orthopaedic Surgery and Rehabilitation and Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Jeffry S Nyman
- Department of Orthopaedic Surgery and Rehabilitation and Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Nannan Tian
- Materials Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Max A Hammond
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Joseph M Wallace
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA; Department of Biomedical Engineering, Indiana University-Purdue University, Indianapolis, Indiana, USA
| | - Drew M Brown
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Neal Chen
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sharon M Moe
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA; Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Matthew R Allen
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana, USA; Department of Biomedical Engineering, Indiana University-Purdue University, Indianapolis, Indiana, USA; Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
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9
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Gonnelli S, Caffarelli C, Giordano N, Nuti R. The prevention of fragility fractures in diabetic patients. Aging Clin Exp Res 2015; 27:115-24. [PMID: 25059454 DOI: 10.1007/s40520-014-0258-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 07/01/2014] [Indexed: 01/10/2023]
Abstract
Patients with diabetes mellitus (DM) are at greater risk of fractures mostly due to not only extraskeletal factors, such as propensity to falls, but also to bone quality alteration, which reduces bone strength. In people with DM, insulin deficit and hyperglycemia seem to play a role in determining bone formation alteration by AGE accumulation which directly influences osteoblast activity. Although there are conflicting data in the literature, adequate glycemic control with hypoglycemic treatment may be an important element in preventing bone tissue alterations in both type 1 and type 2 DM. Diabetes status is a predictive of future hip and major osteoporosis fractures independently of BMD and FRAX probability. Attention should be paid to the use of thiazolidinediones, especially in older women, because the direct negative effect on bone could exceed the positive effect of glycemic control. Systematic screening for complications and fall prevention efforts, along with calcium and vitamin D repletion and adequate physical activity, represents the mainstay of fracture prevention in DM patients. All anticatabolic drugs (raloxifene, bisphosphonates, denosumab) seem to be effective in DM patients. On the basis of pathophysiological evidence that suggests low bone formation in DM patients, osteoanabolic therapies such as teriparatide might represent an important therapeutic option for DM patients with severe osteoporosis and/or multiple fractures. The search for better methods for the identification of fragility fracture risk in the growing population of adult and elderly subjects with DM might be considered a clinical priority which could improve the prevention of fracture in DM patients.
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Affiliation(s)
- Stefano Gonnelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy,
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10
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Lasco A, Catalano A, Morabito N. Are physicians ready to prevent osteoporotic fractures in hemodialysis patients? Int J Endocrinol Metab 2012; 10:634-5. [PMID: 23843836 PMCID: PMC3693635 DOI: 10.5812/ijem.6239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Revised: 05/09/2012] [Accepted: 05/09/2012] [Indexed: 11/24/2022] Open
Affiliation(s)
- Antonino Lasco
- Department of Internal Medicine, University of Messina, Messina, Italy
- Corresponding author: Antonino Lasco, Department of Internal Medicine, A.O.U. Policlinico “G. Martino” Via C. Valeria, 98125 Messina, Italy. Tel.: +39-0902212391, Fax: +39-0902935162, E-mail:
| | - Antonino Catalano
- Department of Internal Medicine, University of Messina, Messina, Italy
| | - Nancy Morabito
- Department of Internal Medicine, University of Messina, Messina, Italy
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11
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Jacobsen D. Safety of raloxifene in hemodialysis patients. Int J Endocrinol Metab 2012; 10:638-9. [PMID: 23843838 PMCID: PMC3693647 DOI: 10.5812/ijem.6285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 05/09/2012] [Accepted: 05/12/2012] [Indexed: 11/16/2022] Open
Affiliation(s)
- Didy Jacobsen
- Geriatric Department, Radboud University Medical Center, Nijmegen, The Netherlands
- Corresponding author: Didy Jacobsen, Geriatric Department, Radboud University Medical Center, Nijmegen, The Netherlands. Tel.: +31-243616772, Fax: +31-243617408, E-mail:
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12
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Akgol G, Gulkesen A, Ozgocmen S. Oxidative stress and raloxifene. Int J Endocrinol Metab 2012; 10:577-8. [PMID: 23843825 PMCID: PMC3693630 DOI: 10.5812/ijem.5341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Revised: 04/30/2012] [Accepted: 04/30/2012] [Indexed: 11/16/2022] Open
Affiliation(s)
- Gurkan Akgol
- Bingol State Hospital, PMR Clinic, Bingol, Turkey
| | - Arif Gulkesen
- Firat University, Faculty of Medicine, Deptartment PMR, Elazig, Turkey
| | - Salih Ozgocmen
- Erciyes University, Faculty of Medicine, Deptartment PMR, Division of Rheumatology, Kayseri, Turkey
- Corresponding author: Salih Ozgocmen, Erciyes University, Faculty of Medicine, Department PMR, Division of Rheumatology, Kayseri, Turkey. Tel.: +90-5327645440, E-mail:
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13
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Iwamoto J. Effects of raloxifene on bone metabolism in hemodialysis patients. Int J Endocrinol Metab 2012; 10:573-5. [PMID: 23843823 PMCID: PMC3693629 DOI: 10.5812/ijem.5367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 05/01/2012] [Accepted: 05/02/2012] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jun Iwamoto
- Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan
- Corresponding author: Jun Iwamoto, Institute for Integrated Sports Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, 160-8582, Tokyo, Japan. Tel.: +81-333531211, Fax: +81-333529467, E-mail:
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14
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Keller F. Raloxifene in hemodialysis patients. Int J Endocrinol Metab 2012; 10:576. [PMID: 23843824 PMCID: PMC3693624 DOI: 10.5812/ijem.5457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Revised: 05/07/2012] [Accepted: 05/07/2012] [Indexed: 11/16/2022] Open
Affiliation(s)
- Frieder Keller
- Nephrology Department, University Hospital, Germany
- Corresponding author: Frieder Keller, Nephrology Department, University Hospital, Albert Einstein Allee 23, D-89070, Ulm, Germany. Tel.: +49-73150044561, Fax: +49-73150044567, E-mail:
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15
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Dane C, Dane B. Which Method is More Efficient in Determining Osteoporosis, QUS or DEXA? Int J Endocrinol Metab 2012; 10:642-3. [PMID: 23843840 PMCID: PMC3693636 DOI: 10.5812/ijem.5394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 05/10/2012] [Accepted: 05/14/2012] [Indexed: 11/25/2022] Open
Affiliation(s)
- Cem Dane
- Department of Gynecology and Obstetrics, Haseki Training and Research Hospital, Istanbul, Turkey
- Corresponding author: Cem Dane, Haseki Training and Research Hospital, Department of Gynecology and Obstetrics, Istanbul, Turkey. Tel.: +90-212 6217521, Fax: +90-2125896229, E-mail:
| | - Banu Dane
- Department of Gynecology and Obstetrics, Bezmialem University, Faculty of Medicine, Istanbul, Turkey
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16
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Worsley R, Gavrilidis E, Kulkarni J. Raloxifene may have further benefits in women on hemodialysis. Int J Endocrinol Metab 2012; 10:644-5. [PMID: 23843841 PMCID: PMC3693644 DOI: 10.5812/ijem.6580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 06/04/2012] [Accepted: 06/06/2012] [Indexed: 11/23/2022] Open
Affiliation(s)
- Roisin Worsley
- Monash Alfred Psychiatry Research Centre, Monash University, Australia
- Corresponding author: Roisin Worsley, Monash Alfred Psychiatry Research Centre, Monash University, Australia. Tel.: +44-39076 6294, Fax: +44-390768545, E-mail:
| | | | - Jayashri Kulkarni
- Monash Alfred Psychiatry Research Centre, Monash University, Australia
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17
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Ravn P. Significant effect of raloxifene on bone in hemodialysis patients. Int J Endocrinol Metab 2012; 10:636-7. [PMID: 23843837 PMCID: PMC3693645 DOI: 10.5812/ijem.6251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 05/10/2012] [Accepted: 05/12/2012] [Indexed: 11/26/2022] Open
Affiliation(s)
- Pernille Ravn
- Department of Gynecology and Obstetrics, Gynecologic Endocrinology Unit, Odense University Hospital, Odense C, Denmark
- Corresponding author: Pernille Ravn, Department of Gynecology and Obstetrics, Gynecologic-Endocrinology Unit, Odense University Hospital, Odense C, Denmark. Tel.: +45-65411260, Fax: +45-65412322, E-mail:
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18
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Gorai I. Effects of raloxifene on bone in patients with type 2 diabetes. Int J Endocrinol Metab 2012; 10:646-7. [PMID: 23843842 PMCID: PMC3693633 DOI: 10.5812/ijem.6558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Revised: 05/29/2012] [Accepted: 05/29/2012] [Indexed: 11/16/2022] Open
Affiliation(s)
- Itsuo Gorai
- Department of Obstetrics and Gynecology, Hori Hospital, Futatsubashi-Cho, Seya-ku, Yokohama, Japan
- Corresponding author: Itsuo Gorai, Department of Obstetrics and Gynecology, Hori Hospital, 292 Futatsubashi-cho, Seya-ku, Yokohama, 246-0021, Japan. E-mail:
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19
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Lewiecki EM. Preventing fractures in diabetic dialysis patients. Int J Endocrinol Metab 2012; 10:640-1. [PMID: 23843839 PMCID: PMC3693648 DOI: 10.5812/ijem.5384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 05/14/2012] [Accepted: 05/15/2012] [Indexed: 12/02/2022] Open
Affiliation(s)
- E. Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, New Mexico, USA
- Corresponding author: E. Michael Lewiecki, New Mexico Clinical Research & Osteoporosis Center, 300 Oak St. NE, Albuquerque, New Mexico, USA. Tel.: +505-8555525, Fax: +505-884-4006, E-mail:
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