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Heydorn A, Bertelsen B, Nolsöe RLM, Eiken P, Kristensen PL. Thyrotoxic periodic paralysis in a Caucasian man without identifiable genetic predisposition: a case report. Thyroid Res 2023; 16:10. [PMID: 37122018 PMCID: PMC10150465 DOI: 10.1186/s13044-023-00152-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/04/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Thyrotoxic periodic paralysis (TPP) is a rare condition characterized by muscle paralysis, thyrotoxicosis, and hypokalemia. It presents with paralysis of both proximal and distal musculature in upper and lower limbs and may affect respiratory musculature and the cardiac conduction system. Early diagnosis is essential, as the condition is potentially reversible by oral or intravenous potassium treatment, leading to rapid resolution without lasting weakness. Overlooking the diagnosis may result in respiratory failure and cardiac arrhythmias including QT prolongation, Torsades de points, and ventricular arrhythmias. CASE PRESENTATION A 19-year-old Caucasian man was admitted acutely with paralysis in upper and lower limbs and tachycardia. Over several months, he had experienced anxiousness, sweating more than usual, had daily palpitations, shortness of breath on exertion, and loose stools, and had lost 21 kg over the last year. Initial blood gas showed very low potassium of 1.4 mM, and blood tests showed decreased Thyroid-stimulating hormone (TSH) < 0.01 × 10- 3 IU/L, elevated free thyroxine (fT4) of 63.5 pM (reference interval (RI): 12.0-22.0 pM), and elevated total triiodothyronine (T3) of 8.2 nM (RI: 1.0-2.6 nM). He was diagnosed with TPP and treated with liquid oral potassium chloride (30 mmol every 30 minutes) and propylthiouracil (initial dose of 400 mg followed by 200 mg three times daily). TSH-receptor antibodies (TRAB) and thyroid-peroxidase antibodies (TPO-ab) were highly elevated. Thyroid ultrasound showed a normal-sized gland and color Doppler sonography showed increased vascularity throughout the gland, compatible with Graves' disease. He was discharged on day 4 with a normal potassium level and followed in the outpatient clinic where he received standard care for Graves' disease. Genetic testing using whole-genome sequencing found no genetic variants in genes previously associated with TPP. CONCLUSION TPP is very rare in Caucasians but more often affects young men in East Asian populations. The case presents a Caucasian man with TPP where genetic testing of CACNA1S, KCNJ18, SCN4A, KCNJ2, KCNE3, and ABCC8 shows no pathogenic variants in genes previously associated with TPP.
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Affiliation(s)
- Arne Heydorn
- Department of Endocrinology and Nephrology, Nordsjællands Hospital, Dyrehavevej 29, DK-3400, Hillerød, Denmark.
| | - Birgitte Bertelsen
- Center for Genomic Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Pia Eiken
- Department of Endocrinology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Peter Lommer Kristensen
- Department of Endocrinology and Nephrology, Nordsjællands Hospital, Dyrehavevej 29, DK-3400, Hillerød, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Bønløkke SE, Rand MS, Haddock B, Arup S, Smith CD, Jensen JEB, Schwarz P, Hovind P, Oturai PS, Jensen LT, Møller S, Eiken P, Rubin KH, Hitz MF, Abrahamsen B, Jørgensen NR. Baseline bone turnover marker levels can predict change in bone mineral density during antiresorptive treatment in osteoporotic patients: the Copenhagen bone turnover marker study. Osteoporos Int 2022; 33:2155-2164. [PMID: 35729342 DOI: 10.1007/s00198-022-06457-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/31/2022] [Indexed: 11/25/2022]
Abstract
UNLABELLED Anti-resorptive osteoporosis treatment might be more effective in patients with high bone turnover. In this registry study including clinical data, high pre-treatment bone turnover measured with biochemical markers was correlated with higher bone mineral density increases. Bone turnover markers may be useful tools to identify patients benefitting most from anti-resorptive treatment. INTRODUCTION In randomized, controlled trials of bisphosphonates, high pre-treatment levels of bone turnover markers (BTM) were associated with a larger increase in bone mineral density (BMD). The purpose of this study was to examine this correlation in a real-world setting. METHODS In this registry-based cohort study of osteoporosis patients (n = 158) receiving antiresorptive therapy, the association between pre-treatment levels of plasma C-telopeptide of type I Collagen (CTX) and/or N-terminal propeptide of type I procollagen (PINP) and change in bone mineral density (BMD) at lumbar spine, total hip, and femoral neck upon treatment was examined. Patients were grouped according to their pre-treatment BTM levels, defined as values above and below the geometric mean for premenopausal women. RESULTS Pre-treatment CTX correlated with annual increase in total hip BMD, where patients with CTX above the geometric mean experienced a larger annual increase in BMD (p = 0.008) than patients with CTX below the geometric mean. The numerical pre-treatment level of CTX showed a similar correlation at all three skeletal sites (total hip (p = 0.03), femoral neck (p = 0.04), and lumbar spine (p = 0.0003)). A similar association was found for PINP where pre-treatment levels of PINP above the geometric mean correlated with a larger annual increase in BMD for total hip (p = 0.02) and lumbar spine (p = 0.006). CONCLUSION Measurement of pre-treatment BTM levels predicts osteoporosis patients' response to antiresorptive treatment. Patients with high pre-treatment levels of CTX and/or PINP benefit more from antiresorptive treatment with larger increases in BMD than patients with lower pre-treatment levels.
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Affiliation(s)
- S E Bønløkke
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - M S Rand
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - B Haddock
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - S Arup
- Medical Department, National Research Center for Bone Health, Zealand University Hospital Køge, Køge, Denmark
| | - C D Smith
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - J E B Jensen
- Department of Endocrinology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - P Schwarz
- Department of Endocrinology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - P Hovind
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - P S Oturai
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - L T Jensen
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - S Møller
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - P Eiken
- Department of Endocrinology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - K H Rubin
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN - Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - M F Hitz
- Medical Department, National Research Center for Bone Health, Zealand University Hospital Køge, Køge, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - B Abrahamsen
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Medicine, Holbæk Hospital, Holbæk, Denmark
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - N R Jørgensen
- Department of Clinical Biochemistry, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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Matzen J, Bislev LS, Sikjær T, Rolighed L, Hitz MF, Eiken P, Hermann AP, Jensen JEB, Abrahamsen B, Rejnmark L. The effect of parathyroidectomy compared to non-surgical surveillance on kidney function in primary hyperparathyroidism: a nationwide historic cohort study. BMC Endocr Disord 2022; 22:14. [PMID: 34991581 PMCID: PMC8734053 DOI: 10.1186/s12902-021-00918-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 12/14/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Patients with primary hyperparathyroidism (pHPT) and impaired kidney function (estimated glomerular filtration rate (eGFR) < 60 mL/min) are offered parathyroidectomy (PTX) to protect them from further complications. Surprisingly, two recent uncontrolled cohort studies have suggested a further decrease in kidney function following PTX. We aimed to examine the effects of PTX compared to non-surgical surveillance on kidney function in pHPT patients. METHODS Historic cohort study. From the Danish National Patient Registry (NPR) and major medical biochemistry laboratories in Denmark, we identified 3585 patients with biochemically confirmed pHPT among whom n = 1977 (55%) were treated with PTX (PTX-group) whereas n = 1608 (45%) were followed without surgery (non-PTX group). Baseline was defined as time of diagnosis and kidney function was re-assessed 9-15 months after PTX (PTX group) or 9-15 months after diagnosis (non-PTX group). RESULTS At follow-up, eGFR had decreased significantly in the PTX- compared to the non-PTX-group (median - 4% vs. - 1%, p < 0.01). Stratification by baseline eGFR showed that the decrease was significant for those with a baseline eGFR value of 80-89 and > 90 mL/min, but not for those with lower eGFR values. Findings did not differ between patients with mild compared to moderate/severe hypercalcemia. However, after mutual adjustments, we identified baseline levels of calcium, PTH, and eGFR as well as age and treatment (PTX vs. no-PTX) as independent predictors for changes in kidney function. CONCLUSION Compared to non-surgical surveillance, PTX is associated with a small but significant decrease in kidney function in pHPT patients with an initial normal kidney function.
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Affiliation(s)
- Josephine Matzen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lise Sofie Bislev
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Tanja Sikjær
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Rolighed
- Department of Otorhinolaryngology, Aarhus University Hospital, Aarhus, Denmark
| | - Mette Friberg Hitz
- Department of Medical Endocrinology, Zealand University Hospital Køge, Køge, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Pia Eiken
- Department of Endocrinology, Bispebjerg, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Jens-Erik Beck Jensen
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Endocrinology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Bo Abrahamsen
- Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense C, Denmark
- Holbæk Hospital, Department of Medicine, Holbæk, Denmark
| | - Lars Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Nordklint AK, Almdal TP, Vestergaard P, Lundby-Christensen L, Boesgaard TW, Breum L, Gade-Rasmussen B, Sneppen SB, Gluud C, Hemmingsen B, Perrild H, Madsbad S, Mathiesen ER, Tarnow L, Thorsteinsson B, Vestergaard H, Lund SS, Eiken P. Effect of metformin and insulin vs. placebo and insulin on whole body composition in overweight patients with type 2 diabetes: a randomized placebo-controlled trial. Osteoporos Int 2021; 32:1837-1848. [PMID: 33594488 DOI: 10.1007/s00198-021-05870-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 02/01/2021] [Indexed: 12/12/2022]
Abstract
UNLABELLED Some studies indicate potential beneficial effects of metformin on body composition and bone. This trial compared metformin + insulin vs placebo + insulin. Metformin treatment had a small but positive effect on bone quality in the peripheral skeleton, reduced weight gain, and resulted in a more beneficial body composition compared with placebo in insulin-treated patients with type 2 diabetes. INTRODUCTION Glucose-lowering medications affect body composition. We assessed the long-term effects of metformin compared with placebo on whole body bone and body composition measures in patients with type 2 diabetes mellitus. METHODS This was a sub-study of the Copenhagen Insulin and Metformin Therapy trial, which was a double-blinded randomized placebo-controlled trial assessing 18-month treatment with metformin compared with placebo, in combination with different insulin regimens in patients with type 2 diabetes mellitus (T2DM). The sub-study evaluates the effects on bone mineral content (BMC), density (BMD), and body composition from whole body dual-energy X-ray absorptiometry (DXA) scans which were assessed at baseline and after 18 months. RESULTS Metformin had a small, but positive, (p < 0.05) effect on subtotal, appendicular, and legs BMC and BMD compared with placebo. After adjustment for sex, age, vitamin D, smoking, BMI, T2DM duration, HbA1c, and insulin dose, the effects on appendicular BMC and BMD persisted (p < 0.05 for both). The changes in appendicular BMC and BMD corresponded approximately to a 0.7% and 0.5% increase in the metformin group and 0.4% and 0.4% decrease in the placebo group, respectively. These effects were mostly driven by an increase in BMC and BMD in the legs and a loss of BMC and BMD in the arms. During 18 months, all participants increased in weight, fat mass (FM), FM%, and lean mass (LM), but decreased in LM%. The metformin group increased less in weight (subtotal weight (weight-head) - 2.4 [- 3.5, - 1.4] kg, p value < 0.001) and FM (- 1.5 [- 2.3, - 0.8] kg, p value < 0.001) and decreased less in LM% (0.6 [0.2, 1.1] %, p value < 0.001) compared with the placebo group. CONCLUSION Metformin treatment had a small positive effect on BMC and BMD in the peripheral skeleton and reduced weight gain compared with placebo in insulin-treated patients with T2DM.
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Affiliation(s)
- A K Nordklint
- Department of Nephrology and Endocrinology, Nordsjællands University Hospital, Hillerod, Denmark.
- Department of Ophthalmology, Rigshopitalet - Glostrup, Copenhagen, Denmark.
| | - T P Almdal
- Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - P Vestergaard
- Departments of Clinical Medicine and Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Jutland, Aalborg, Denmark
| | | | | | - L Breum
- Department of Medicine, Zealand University Hospital, Koge, Denmark
| | - B Gade-Rasmussen
- Department of Endocrinology, Copenhagen University Hospital, Hvidovre, Denmark
| | - S B Sneppen
- Department of Medicine, Gentofte, Copenhagen University Hospital, Hellerup, Denmark
| | - C Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - B Hemmingsen
- Department of Nephrology and Endocrinology, Nordsjællands University Hospital, Hillerod, Denmark
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - H Perrild
- Department of Endocrinology, Bispebjerg, Copenhagen University Hospital, Copenhagen, Denmark
| | - S Madsbad
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Endocrinology, Copenhagen University Hospital, Hvidovre, Denmark
| | - E R Mathiesen
- Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - L Tarnow
- Steno Diabetes Center Zealand, Holbak, Denmark
| | - B Thorsteinsson
- Department of Nephrology and Endocrinology, Nordsjællands University Hospital, Hillerod, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - H Vestergaard
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Medicine, Bornholms Hospital, Ronne, Denmark
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark
| | - S S Lund
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - P Eiken
- Department of Nephrology and Endocrinology, Nordsjællands University Hospital, Hillerod, Denmark
- Department of Endocrinology, Bispebjerg, Copenhagen University Hospital, Copenhagen, Denmark
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Abildgaard J, Ploug T, Pedersen AT, Eiken P, Pedersen BK, Holst JJ, Hartmann B, Lindegaard B. Preserved postprandial suppression of bone turnover markers, despite increased fasting levels, in postmenopausal women. Bone 2021; 143:115612. [PMID: 32853851 DOI: 10.1016/j.bone.2020.115612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/12/2020] [Accepted: 08/21/2020] [Indexed: 02/06/2023]
Abstract
CONTEXT Menopause leads to an increased bone turnover associated with a high risk of fractures. Bone turnover is inhibited by meal intake, to some extent mediated by gut hormones, and interventions based on these endocrine changes may have potential in future prevention of osteoporosis. OBJECTIVE To investigate whether postmenopausal women exhibit postprandial suppression of bone turnover markers to the same extent as premenopausal women, despite higher fasting levels. Furthermore, to assess whether menopausal differences in bone turnover markers are related to postmenopausal changes in plasma gut hormone levels. METHODS A cross-sectional study of 21 premenopausal, 9 perimenopausal, and 24 postmenopausal women between 45 and 60 years of age. Serum/plasma levels of bone turnover markers and gut hormones were investigated during a 120 min oral glucose tolerance test. Bone turnover markers included N-terminal propeptide of type-I procollagen (PINP, bone formation marker) and carboxyterminal collagen I crosslinks (CTX-I, bone resorption marker). Gut hormone secretion was evaluated from responses of glucagon-like peptide-1 (GLP-1), glucagon-like peptide-2 (GLP-2) and glucose-dependent insulinotropic polypeptide (GIP). RESULTS Fasting levels of s-CTX-I were increased in peri- and postmenopausal women compared to premenopausal women (p = 0.001). Despite higher fasting levels, the relative postprandial s-CTX-I suppression was comparable across menopausal status (p = 0.14). Fasting levels of s-PINP were also increased in postmenopausal women compared to premenopausal women (p < 0.001) with comparable and modest s-PINP suppression over menopause (p = 0.13). Postprandial plasma GLP-1 (p = 0.006) and GLP-2 (p = 0.01) were significantly increased in postmenopausal women compared to premenopausal women while GIP responses were slightly increased in the perimenopausal group (p = 0.02) but comparable between pre- and postmenopausal women. None of the postprandial gut hormone increases predicted postprandial bone turnover suppression in these women. CONCLUSIONS Glucose-induced suppression of bone turnover markers is preserved in postmenopausal women, despite significantly higher fasting values, indicating that CTX-I lowering treatments based on these postprandial mechanisms might be a feasible strategy to prevent postmenopausal osteoporosis.
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Affiliation(s)
- Julie Abildgaard
- Centre of Inflammation and Metabolism and Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Denmark; Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, Denmark.
| | - Thorkil Ploug
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Anette Tønnes Pedersen
- Department of Gynaecology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Pia Eiken
- Department of Nephrology and Endocrinology, Nordsjællands Hospital, Hillerød, Denmark
| | - Bente Klarlund Pedersen
- Centre of Inflammation and Metabolism and Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Denmark
| | - Jens Juul Holst
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; NNF Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Bolette Hartmann
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; NNF Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Birgitte Lindegaard
- Centre of Inflammation and Metabolism and Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Denmark; Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, Hillerød, Denmark.
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Lendorf ME, Boisen MK, Kristensen PL, Løkkegaard ECL, Krog SM, Brandi L, Brinth LS, Nolsöe RLM, Ryrsø C, Eiken P, Bestle MH, Jørgensen IM, Pedersen-Bjergaard U, Lindegaard B, Christensen TB, Fischer TK. Characteristics and early outcomes of patients hospitalised for COVID-19 in North Zealand, Denmark. Dan Med J 2020; 67:A06200428. [PMID: 32800073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) is an ongoing pandemic associated with significant morbidity and mortality worldwide. Limited data are available describing the clinical presentation and outcomes of hospitalised COVID-19 patients in Europe. METHODS This was a single-centre retrospective chart review of all patients with COVID-19 admitted to the North Zealand Hospital in Denmark between 1 March and 4 May 2020. Main outcomes include major therapeutic interventions during hospitalisation, such as invasive mechanical ventilation, as well as death. RESULTS A total of 115 patients were included, including four infants. The median age of adults was 68 years and 40% were female. At admission, 55 (50%) patients had a fever, 29 (26%) had a respiratory rate exceeding 24 breaths/minute, and 78 (70%) received supplemental oxygen. The prevalence of co-infection was 13%. Twenty patients (18%) (median age: 64 years; 15% female) were treated in the intensive care unit. Twelve (10.4%) received invasive mechanical ventilation and three (2.6%) renal replacement therapy. Nine patients (8%) developed pulmonary embolism. Sixteen patients (14%) died. Among patients requiring mechanical ventilation (n = 12), seven (6.1%) were discharged alive, four (3.4%) died and one (0.9%) was still hospitalised. CONCLUSION In this cohort of hospitalised COVID-19 patients, mortality was lower than in other Danish and European case series. FUNDING none. TRIAL REGISTRATION not relevant.
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Nordklint AK, Almdal TP, Vestergaard P, Lundby-Christensen L, Jørgensen NR, Boesgaard TW, Breum L, Gade-Rasmussen B, Sneppen SB, Gluud C, Hemmingsen B, Krarup T, Madsbad S, Mathiesen ER, Perrild H, Tarnow L, Thorsteinsson B, Vestergaard H, Lund SS, Eiken P. Effect of Metformin vs. Placebo in Combination with Insulin Analogues on Bone Markers P1NP and CTX in Patients with Type 2 Diabetes Mellitus. Calcif Tissue Int 2020; 107:160-169. [PMID: 32468187 DOI: 10.1007/s00223-020-00711-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/21/2020] [Indexed: 01/20/2023]
Abstract
Preclinical studies have shown a potential osteoanabolic effect of metformin but human studies of how metformin affects bone turnover are few. A post hoc sub-study analysis of an 18-month multicenter, placebo-controlled, double-blinded trial in type 2 diabetes mellitus (T2DM), randomizing participants to metformin versus placebo both in combination with different insulin analogue regimens (Metformin + Insulin vs. Placebo + Insulin). Patients were not treatment naive at baseline, 83% had received metformin, 69% had received insulin, 57.5% had received the combination of metformin and insulin before entering the study. Bone formation and resorption were assessed by measuring, N-terminal propeptide of type I procollagen (P1NP) and C-terminal telopeptide of type I collagen (CTX) at baseline and end of study. The influence of gender, age, smoking, body mass index (BMI), T2DM duration, glycosylated hemoglobin A1c (HbA1c), c-reactive protein (CRP) and insulin dosage was also included in the analyses. The levels of bone formation marker P1NP and bone resorption marker CTX increased significantly in both groups during the trial. P1NP increased less in the Metformin + Insulin compared to the placebo + insulin group (p = 0.001) (between group difference change), while the increases in CTX levels (p = 0.11) were not different. CRP was inversely associated (p = 0.012) and insulin dosage (p = 0.011) was positively related with change in P1NP levels. BMI (p = 0.002) and HbA1C (p = 0.037) were inversely associated with change in CTX levels. During 18 months of treatment with metformin or placebo, both in combination with insulin, bone turnover increased in both groups. But the pattern was different as the bone formation marker (P1NP) increased less during Metformin + Insulin treatment, while change in bone resorption (CTX) was not significantly different between the two groups.
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Affiliation(s)
- Azra Karahasanovic Nordklint
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.
- Department of Nephrology and Endocrinology, Nordsjællands University Hospital, Hillerød, Denmark.
| | - Thomas Peter Almdal
- Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology, Herlev, Copenhagen University Hospital, Herlev, Denmark
| | - Peter Vestergaard
- Departments of Clinical Medicine and Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Jutland, Aalborg, Denmark
| | | | - Niklas Rye Jørgensen
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Leif Breum
- Department of Medicine, Zealand University Hospital, Køge, Denmark
| | | | - Simone B Sneppen
- Department of Medicine, Gentofte, Copenhagen University Hospital, Hellerup, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Bianca Hemmingsen
- Department of Nephrology and Endocrinology, Nordsjællands University Hospital, Hillerød, Denmark
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Thure Krarup
- Department of Endocrinology, Bispebjerg, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sten Madsbad
- Department of Endocrinology, Copenhagen University Hospital, Hvidovre, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth R Mathiesen
- Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hans Perrild
- Department of Endocrinology, Bispebjerg, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lise Tarnow
- Steno Diabetes Center Zealand, Holbæk, Denmark
| | - Birger Thorsteinsson
- Department of Nephrology and Endocrinology, Nordsjællands University Hospital, Hillerød, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Vestergaard
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Endocrinology, Herlev, Copenhagen University Hospital, Herlev, Denmark
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark
| | - Søren S Lund
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - Pia Eiken
- Department of Nephrology and Endocrinology, Nordsjællands University Hospital, Hillerød, Denmark
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Diemar SS, Jørgensen NR, Eiken P, Suetta C, Andersen NB, Sejling AS. The effect of normalization of sodium on bone turnover markers in patients with epilepsy. A randomized single-blinded placebo-controlled trial. Contemp Clin Trials Commun 2020; 19:100587. [PMID: 32566796 PMCID: PMC7298402 DOI: 10.1016/j.conctc.2020.100587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 05/22/2020] [Accepted: 06/07/2020] [Indexed: 11/04/2022] Open
Abstract
Hyponatremia [p[Na]<136 mmol/L] is an independent risk factor for decreased bone mineral density (BMD). However, whether hyponatremia represents a surrogate marker, or a direct causal relationship to bone loss remains unknown. The aim of the study was to investigate the effect of salt replacement therapy on bone turnover markers (BTM) and BMD in patients with epilepsy and chronic hyponatremia. This prospective single-blinded randomized trial investigated serum BTM and BMD, evaluated by Dual Energy X-ray Absorptiometry (DXA), in 21 patients at baseline and following three months of salt replacement therapy. Patients with two consecutive measurements of hyponatremia prior to baseline and no known osteoporosis were included from the epilepsy out-patient clinic at Rigshospitalet, Denmark. Seven patients were randomized to placebo and 14 to salt intervention. The baseline p[Na] was 134 (130.5–140) mmol/L (median (IQR)). All patients had BTM within age-specific reference ranges at baseline. Following 3 months of intervention with 3–9 g of salt daily there was no difference in levels of procollagen type 1 N-terminal propeptide (P1NP) or C-terminal cross-linking telopeptide of type 1 collagen (CTX) between placebo and intervention. Nor was there any difference in BMD evaluated at the lumbar spine (L1-L4) or at the femoral neck or total hip. In our study, salt replacement did neither affect BTM nor BMD. However, due to the small size of the study, more studies are needed to further investigate this. Patients with epilepsy and hyponatremia have low bone turnover. Defining chronic hyponatremia in patients with epilepsy is challenging. Bone turnover markers are not affected by salt supplements.
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Affiliation(s)
- Sarah Seberg Diemar
- Department of Neurology, Rigshospitalet Glostrup, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark.,OPEN, Open Patient Data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000, Odense C, Denmark
| | - Niklas Rye Jørgensen
- OPEN, Open Patient Data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000, Odense C, Denmark.,Department of Clinical Biochemistry, Rigshospitalet Glostrup, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark
| | - Pia Eiken
- Department of Endocrinology and Nephrology, Nordsjællands Hospital, Dyrehavevej 29, 3400, Hillerød, Denmark
| | - Charlotte Suetta
- Geriatric Research Unit, Department of Internal Medicine, Herlev-Gentofte Hospital, Herlev Ringvej 75, 2720, Herlev, Denmark.,Geriatric Department, Bispebjerg-Frederiksberg Hospital, Nielsine Nielsensvej 7, 2400, Copenhagen, Denmark.,Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet Glostrup, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | - Noémi Becser Andersen
- Department of Neurology, Rigshospitalet Glostrup, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark
| | - Anne-Sophie Sejling
- Department of Endocrinology and Nephrology, Nordsjællands Hospital, Dyrehavevej 29, 3400, Hillerød, Denmark
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Hadad Z, Tjelum L, Eiken P, Trolle W, Haupter I, Afzelius P. Multiple Brown Tumors Caused by Primary Hyperparathyroidism as a Differential Diagnosis to Multiple Osteolytic Bone Metastases: A Case Report. J Endocrinol Metab 2020. [DOI: 10.14740/jem637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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10
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Kanstrup C, Teilum D, Rejnmark L, Bigaard JV, Eiken P, Kroman N, Tjønneland A, Mejdahl MK. 25-Hydroxyvitamin D at time of breast cancer diagnosis and breast cancer survival. Breast Cancer Res Treat 2019; 179:699-708. [PMID: 31707511 DOI: 10.1007/s10549-019-05486-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/28/2019] [Indexed: 01/24/2023]
Abstract
PURPOSE Previous studies have shown that low levels of 25-hydroxyvitamin D (25(OH)D) are associated with a poorer breast cancer survival. The relationship between vitamin D status and breast cancer outcomes is however still debated. The aim of the present study was to investigate the association between 25(OH)D blood levels measured at time of diagnosis and event-free survival (EFS) and overall survival (OS) in a large cohort of patients with early-stage primary invasive breast cancer. METHODS From April 2008 to April 2013, 25(OH)D status was measured at time of diagnosis in all women operated for early stage primary invasive breast cancer at Rigshospitalet, Copenhagen, Denmark. Associations between 25(OH)D and EFS and OS were investigated using a Cox Proportional hazards model, adjusting for age, disease characteristics, time period, and BMI. Differences in survival were evaluated by hazard ratios (HR). RESULTS In the present study, 2510 women with primary invasive breast cancer were included. Women with the lowest 25(OH)D levels (≤ 52 nmol/L) had an inferior EFS with a HR of 1.63 (95% CI 1.21-2.19) compared to women in the third quartile (76-99 nmol/L). Women with the highest 25(OH)D levels (≥ 99 nmol/L) also had an inferior EFS with a HR of 1.37 (95% CI 1.02-1.83). Plotting 25(OH)D status against EFS, the association was inversely J-shaped. For OS, a similar association with 25(OH)D status was observed. CONCLUSION We confirmed previous findings suggesting that a low 25(OH)D status is associated with an inferior breast cancer survival, but unlike previous findings, we found an indication of poorer breast cancer survival also among women with high 25(OH)D levels.
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Affiliation(s)
- Charlotte Kanstrup
- Department of Breast Surgery, Copenhagen University Hospital Herlev, Herlev Ringvej 75, 2730, Herlev, Denmark
| | - Dorthe Teilum
- Department of Breast Surgery, Copenhagen University Hospital Herlev, Herlev Ringvej 75, 2730, Herlev, Denmark
| | - Lars Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Pia Eiken
- Department of Endocrinology and Nephrology, Nordsjaellands Hospital, Hilleroed, Denmark
| | - Niels Kroman
- Department of Breast Surgery, Copenhagen University Hospital Herlev, Herlev Ringvej 75, 2730, Herlev, Denmark.,Danish Cancer Society, Copenhagen, Denmark
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mathias Kvist Mejdahl
- Department of Breast Surgery, Copenhagen University Hospital Herlev, Herlev Ringvej 75, 2730, Herlev, Denmark. .,Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
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11
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Diemar SS, Sejling AS, Eiken P, Andersen NB, Jørgensen NR. An explorative literature review of the multifactorial causes of osteoporosis in epilepsy. Epilepsy Behav 2019; 100:106511. [PMID: 31522076 DOI: 10.1016/j.yebeh.2019.106511] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/20/2019] [Accepted: 08/20/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE Patients with epilepsy have a greatly increased risk of osteoporosis and fractures. The literature is diverse and contradictory when dealing with the underlying pathophysiological mechanisms. Consequently, the purpose of this review was to shed light on the multifactorial causes behind the increased occurrence of metabolic bone disease in patients with epilepsy and to identify areas for future research. METHODS A review of the literature was performed searching PubMed with relevant Medical Subject Headings MeSH terms. The results of the search were evaluated for relevance to the review based on the title and abstract of the publication. Publications in language other than English and publications pertaining only pediatric patients were excluded. For all studies, included reference lists were evaluated for further relevant publications. In total, 96 publications were included in this explorative review. RESULTS The high occurrence of metabolic bone disease in patients with epilepsy is multifactorial. The causes are the socioeconomic consequences of having a chronic neurological disease but also adverse effects to antiepileptic drug treatment ranging from interference with calcium and vitamin D metabolism to hyponatremia-induced osteoporosis. CONCLUSION The literature supports the need for awareness of bone health in patients with epilepsy. The pathophysiological mechanisms are many and various wanting for further research in the less well-characterized areas. Furthermore, great responsibility rests on the healthcare professionals in implementing comprehensive patient care and in assuring bone protective measures in clinical practice to prevent bone loss in patients with epilepsy.
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Affiliation(s)
- Sarah Seberg Diemar
- Department of Neurology, Rigshospitalet Glostrup, Valdemar Hansens vej 1-23, 2600 Glostrup, Denmark; OPEN, Odense Patient Data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, J. B. Winsløws vej 19, 5000 Odense C, Denmark.
| | - Anne-Sophie Sejling
- Department of Endocrinology and Nephrology, Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Pia Eiken
- Department of Endocrinology and Nephrology, Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Noémi Becser Andersen
- Department of Neurology, Rigshospitalet Glostrup, Valdemar Hansens vej 1-23, 2600 Glostrup, Denmark
| | - Niklas Rye Jørgensen
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, J. B. Winsløws vej 19, 5000 Odense C, Denmark; Department of Clinical Biochemistry, Rigshospitalet Glostrup, Valdemar Hansens vej 1-23, 2600 Glostrup, Denmark
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12
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Diemar SS, Sejling AS, Eiken P, Suetta C, Jørgensen NR, Andersen NB. Hyponatremia and metabolic bone disease in patients with epilepsy: A cross-sectional study. Bone 2019; 123:67-75. [PMID: 30905745 DOI: 10.1016/j.bone.2019.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 03/12/2019] [Accepted: 03/15/2019] [Indexed: 11/22/2022]
Abstract
AIM Patients with epilepsy frequently develop hyponatremia due to the treatment with antiepileptic drugs and have an increased risk of developing metabolic bone disease. Hyponatremia is known to be associated with osteoporosis. The aim of the study was to investigate the association between hyponatremia and osteoporosis in patients with epilepsy. METHOD AND MATERIAL This cross-sectional study included patients with epilepsy from a tertiary epilepsy out-patient clinic in Denmark, who had a Dual Energy X-ray Absorptiometry scan performed and an accompanying plasma sodium (p-Na) measured prior to or a maximum of 14 days after the scan. Information regarding the patients' health and medical conditions were obtained from their medical reports. RESULTS A total of 695 patients (females 53.8%, age 49 (34:63) years (median (quartiles)) were included. 10.4% had hyponatremia (p-Na ≤ 135 mmol/L). The hyponatremic patients had significantly lower T-scores in the lumbar spine, femoral neck and total femur (all p < 0.023) and the odds ratio of osteoporosis (T-score < -2.5) was significantly increased (2.91 (1.61-5.27) (95% confidence interval) (p = 0.001)). When adjusting for potential confounders the patients with moderate and severe hyponatremia (p-Na < 129 mmol/L) had a significantly lower mean T-score in the lumbar spine (p = 0.030). CONCLUSION We conclude that hyponatremia is common in patients with epilepsy and that moderate and severe hyponatremia is independently associated with decreased bone mineral density in the lumbar spine. Therefore, hyponatremia in a patient with epilepsy should warrant further examination of the patient for bone loss and osteoporosis.
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Affiliation(s)
- Sarah Seberg Diemar
- Department of Neurology, Rigshospitalet Glostrup, Valdemar Hansens vej 1-23, 2600 Glostrup, Denmark; OPEN, Odense Patient Data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, J. B. Winsløws vej 19, 5000 Odense, C, Denmark.
| | - Anne-Sophie Sejling
- Department of Endocrinology and Nephrology, Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Pia Eiken
- Department of Endocrinology and Nephrology, Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Charlotte Suetta
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark; Geriatric Research Unit, Department of Internal Medicine, Herlev-Gentofte Hospital, Herlev Ringvej 75, 2720 Herlev, Denmark; Geriatric Department, Bispebjerg-Frederiksberg Hospital, Nielsine Nielsensvej 7, 2400 Copenhagen, Denmark; Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet Glostrup, Valdemar Hansens vej 1-23, 2600 Glostrup, Denmark
| | - Niklas Rye Jørgensen
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, J. B. Winsløws vej 19, 5000 Odense, C, Denmark; Department of Clinical Biochemistry, Rigshospitalet Glostrup, Valdemar Hansens vej 1-23, 2600 Glostrup, Denmark
| | - Noémi Becser Andersen
- Department of Neurology, Rigshospitalet Glostrup, Valdemar Hansens vej 1-23, 2600 Glostrup, Denmark
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13
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Wang L, Dehm SM, Hillman DW, Sicotte H, Tan W, Gormley M, Bhargava V, Jimenez R, Xie F, Yin P, Qin S, Quevedo F, Costello BA, Pitot HC, Ho T, Bryce AH, Ye Z, Li Y, Eiken P, Vedell PT, Barman P, McMenomy BP, Atwell TD, Carlson RE, Ellingson M, Eckloff BW, Qin R, Ou F, Hart SN, Huang H, Jen J, Wieben ED, Kalari KR, Weinshilboum RM, Wang L, Kohli M. A prospective genome-wide study of prostate cancer metastases reveals association of wnt pathway activation and increased cell cycle proliferation with primary resistance to abiraterone acetate-prednisone. Ann Oncol 2019; 29:352-360. [PMID: 29069303 DOI: 10.1093/annonc/mdx689] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background Genomic aberrations have been identified in metastatic castration-resistant prostate cancer (mCRPC), but molecular predictors of resistance to abiraterone acetate/prednisone (AA/P) treatment are not known. Patients and methods In a prospective clinical trial, mCRPC patients underwent whole-exome sequencing (n = 82) and RNA sequencing (n = 75) of metastatic biopsies before initiating AA/P with the objective of identifying genomic alterations associated with resistance to AA/P. Primary resistance was determined at 12 weeks of treatment using criteria for progression that included serum prostate-specific antigen measurement, bone and computerized tomography imaging and symptom assessments. Acquired resistance was determined using the end point of time to treatment change (TTTC), defined as time from enrollment until change in treatment from progressive disease. Associations of genomic and transcriptomic alterations with primary resistance were determined using logistic regression, Fisher's exact test, single and multivariate analyses. Cox regression models were utilized for determining association of genomic and transcriptomic alterations with TTTC. Results At 12 weeks, 32 patients in the cohort had progressed (nonresponders). Median study follow-up was 32.1 months by which time 58 patients had switched treatments due to progression. Median TTTC was 10.1 months (interquartile range: 4.4-24.1). Genes in the Wnt/β-catenin pathway were more frequently mutated and negative regulators of Wnt/β-catenin signaling were more frequently deleted or displayed reduced mRNA expression in nonresponders. Additionally, mRNA expression of cell cycle regulatory genes was increased in nonresponders. In multivariate models, increased cell cycle proliferation scores (≥ 50) were associated with shorter TTTC (hazard ratio = 2.11, 95% confidence interval: 1.17-3.80; P = 0.01). Conclusions Wnt/β-catenin pathway activation and increased cell cycle progression scores can serve as molecular markers for predicting resistance to AA/P therapy.
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Affiliation(s)
- L Wang
- Division of Biomedical Statistics and Informatics, Department of Health Sciences, Rochester, USA; Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, USA
| | - S M Dehm
- Masonic Cancer Center, University of Minnesota, Minneapolis, USA; Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, USA; Department of Urology, University of Minnesota, Minneapolis, USA
| | - D W Hillman
- Division of Biomedical Statistics and Informatics, Department of Health Sciences, Rochester, USA
| | - H Sicotte
- Division of Biomedical Statistics and Informatics, Department of Health Sciences, Rochester, USA
| | - W Tan
- Department of Medicine, Mayo Clinic, Jacksonville, USA
| | - M Gormley
- Janssen Research and Development, Spring House, Philadelphia, USA
| | - V Bhargava
- Janssen Research and Development, Spring House, Philadelphia, USA
| | - R Jimenez
- Department of Pathology and Lab Medicine, Mayo Clinic, Rochester, USA
| | - F Xie
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, USA
| | - P Yin
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, USA
| | - S Qin
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, USA
| | - F Quevedo
- Department of Oncology, Mayo Clinic, Rochester, USA
| | - B A Costello
- Department of Oncology, Mayo Clinic, Rochester, USA
| | - H C Pitot
- Department of Oncology, Mayo Clinic, Rochester, USA
| | - T Ho
- Department of Medicine, Mayo Clinic, Scottsdale, USA
| | - A H Bryce
- Department of Medicine, Mayo Clinic, Scottsdale, USA
| | - Z Ye
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, USA
| | - Y Li
- Division of Biomedical Statistics and Informatics, Department of Health Sciences, Rochester, USA
| | - P Eiken
- Department of Radiology, Mayo Clinic, Rochester, USA
| | - P T Vedell
- Division of Biomedical Statistics and Informatics, Department of Health Sciences, Rochester, USA
| | - P Barman
- Division of Biomedical Statistics and Informatics, Department of Health Sciences, Rochester, USA
| | - B P McMenomy
- Department of Radiology, Mayo Clinic, Rochester, USA
| | - T D Atwell
- Department of Radiology, Mayo Clinic, Rochester, USA
| | - R E Carlson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences, Rochester, USA
| | - M Ellingson
- Medical Genetics, Mayo Clinic, Rochester, USA
| | - B W Eckloff
- Medical Genome Facility, Mayo Clinic, Rochester, USA
| | - R Qin
- Division of Biomedical Statistics and Informatics, Department of Health Sciences, Rochester, USA
| | - F Ou
- Division of Biomedical Statistics and Informatics, Department of Health Sciences, Rochester, USA
| | - S N Hart
- Division of Biomedical Statistics and Informatics, Department of Health Sciences, Rochester, USA
| | - H Huang
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, USA
| | - J Jen
- Medical Genome Facility, Mayo Clinic, Rochester, USA; Division of Experimental Pathology and Laboratory Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, USA
| | - E D Wieben
- Medical Genome Facility, Mayo Clinic, Rochester, USA
| | - K R Kalari
- Division of Biomedical Statistics and Informatics, Department of Health Sciences, Rochester, USA
| | - R M Weinshilboum
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, USA
| | - L Wang
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, USA.
| | - M Kohli
- Department of Oncology, Mayo Clinic, Rochester, USA.
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14
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Tjelum L, Eiken P. [Multiple vertebral fractures after denosumab discontinuation]. Ugeskr Laeger 2018; 180:V12170948. [PMID: 30404716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Recent reports imply, that denosumab discontinuation may lead to an increased risk of multiple vertebral fractures. This is a case report about two postmenopausal women, both with previous fragility fractures, who presented multiple vertebral fractures after denosumab discontinuation. One of the women also had symptomatic hypoparathyroid hypercalcaemia, six months after denosumab was discontinued. We recommend, that denosumab treatment should not be stopped without considering an alternative treatment.
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Nordklint AK, Almdal TP, Vestergaard P, Lundby-Christensen L, Boesgaard TW, Breum L, Gade-Rasmussen B, Sneppen SB, Gluud C, Hemmingsen B, Jensen T, Krarup T, Madsbad S, Mathiesen ER, Perrild H, Tarnow L, Thorsteinsson B, Vestergaard H, Lund SS, Eiken P. The effect of metformin versus placebo in combination with insulin analogues on bone mineral density and trabecular bone score in patients with type 2 diabetes mellitus: a randomized placebo-controlled trial. Osteoporos Int 2018; 29:2517-2526. [PMID: 30027438 DOI: 10.1007/s00198-018-4637-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 07/09/2018] [Indexed: 12/16/2022]
Abstract
UNLABELLED Some antihyperglycemic medications have been found to affect bone metabolism. We assessed the long-term effects of metformin compared with placebo on bone mineral density (BMD) and trabecular bone score (TBS) in patients with type 2 diabetes. Metformin had no significant effect on BMD in the spine and hip or TBS compared with a placebo. INTRODUCTION Patients with type 2 diabetes mellitus (T2DM) have an increased risk of fractures despite a high bone mass. Some antihyperglycemic medications have been found to affect bone metabolism. We assessed the long-term effects of metformin compared with placebo on bone mineral density (BMD) and trabecular bone score (TBS). METHODS This was a sub-study of a multicenter, randomized, 18-month placebo-controlled, double-blinded trial with metformin vs. placebo in combination with different insulin regimens (the Copenhagen Insulin and Metformin Therapy trial) in patients with T2DM. BMD in the spine and hip and TBS in the spine were assessed by dual-energy X-ray absorptiometry at baseline and after 18 months follow-up. RESULTS Four hundred seven patients were included in this sub-study. There were no between-group differences in BMD or TBS. From baseline to 18 months, TBS decreased significantly in both groups (metformin group, - 0.041 [- 0.055, - 0.027]; placebo group - 0.046 [- 0.058, - 0.034]; both p < 0.001). BMD in the spine and total hip did not change significantly from baseline to 18 months. After adjustments for gender, age, vitamin D, smoking, BMI, duration of T2DM, HbA1c, and insulin dose, the TBS between-group differences increased but remained non-significant. HbA1c was negatively associated with TBS (p = 0.009) as was longer duration of diabetes, with the femoral neck BMD (p = 0.003). Body mass index had a positive effect on the hip and femoral neck BMD (p < 0.001, p = 0.045, respectively). CONCLUSIONS Eighteen months of treatment with metformin had no significant effect on BMD in the spine and hip or TBS in patients with T2DM compared with a placebo. TBS decreased significantly in both groups. TRIAL REGISTRATION ClinicalTrials.gov (NCT00657943).
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Affiliation(s)
- A K Nordklint
- Department of Endocrinology and Nephrology, Nordsjællands University Hospital, Hillerød, Denmark.
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - T P Almdal
- Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
| | - P Vestergaard
- Department of Clinical Medicine and Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Jutland, Aalborg, Denmark
| | - L Lundby-Christensen
- Department of Paediatrics and Adolescent Medicine, Nordsjællands Hospital, Hillerød, Denmark
| | | | - L Breum
- Department of Medicine, Zealand University Hospital, Køge, Denmark
| | - B Gade-Rasmussen
- Department of Endocrinology, Copenhagen University Hospital, Hvidovre, Denmark
| | - S B Sneppen
- Department of Medicine, Gentofte, Copenhagen University Hospital, Hellerup, Denmark
| | - C Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - B Hemmingsen
- Department of Endocrinology and Nephrology, Nordsjællands University Hospital, Hillerød, Denmark
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - T Jensen
- Department of Endocrinology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - T Krarup
- Department of Endocrinology, Bispebjerg, Copenhagen University Hospital, Copenhagen, Denmark
| | - S Madsbad
- Department of Endocrinology, Copenhagen University Hospital, Hvidovre, Denmark
- Astra - Zeneca, Gothenburg, Sweden
| | - E R Mathiesen
- Department of Endocrinology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Astra - Zeneca, Gothenburg, Sweden
| | - H Perrild
- Department of Endocrinology, Bispebjerg, Copenhagen University Hospital, Copenhagen, Denmark
| | - L Tarnow
- Department of Endocrinology and Nephrology, Nordsjællands University Hospital, Hillerød, Denmark
- Steno Diabetes Center Sjælland, Holbæk, Denmark
| | - B Thorsteinsson
- Department of Endocrinology and Nephrology, Nordsjællands University Hospital, Hillerød, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - H Vestergaard
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Endocrinology, Herlev, Copenhagen University Hospital, Herlev, Denmark
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark
| | - S S Lund
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - P Eiken
- Department of Endocrinology and Nephrology, Nordsjællands University Hospital, Hillerød, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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16
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Napoli N, Langdahl BL, Ljunggren Ö, Lespessailles E, Kapetanos G, Kocjan T, Nikolic T, Eiken P, Petto H, Moll T, Lindh E, Marin F. Effects of Teriparatide in Patients with Osteoporosis in Clinical Practice: 42-Month Results During and After Discontinuation of Treatment from the European Extended Forsteo® Observational Study (ExFOS). Calcif Tissue Int 2018; 103:359-371. [PMID: 29909449 PMCID: PMC6153867 DOI: 10.1007/s00223-018-0437-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 05/25/2018] [Indexed: 02/05/2023]
Abstract
This study aimed to describe clinical outcomes in patients prescribed teriparatide and followed up for 18 months after stopping the drug in real-life conditions. The Extended Forsteo® Observational Study analysed incident clinical fractures in 6-month intervals using logistic regression with repeated measures. Changes in back pain (visual analogue scale) and health-related quality of life (HRQoL; EQ-5D questionnaire) were analysed using mixed models for repeated measures. Patients were analysed if they had a post-baseline visit, regardless of whether and for how long they took teriparatide. Of 1531 patients analysed (90.7% female, mean age: 70.3 years), 76 (5.0%) never took teriparatide. Median treatment duration was 23.6 months. The adjusted odds of clinical fracture decreased by 47% in the > 12- to 18-month treatment period (p = 0.013) compared with the first 6-month period, with no statistically significant reduction in the > 18- to 24-month interval. The clinical fracture rate remained stable during the 18 months' post-teriparatide, when approximately 98% of patients took osteoporosis medication (51% bisphosphonates). Clinical vertebral fractures were reduced at every time period compared with the first 6 months. Adjusted mean back pain scores decreased and EQ-5D scores increased significantly at each post-baseline observation. In a real-life clinical setting, the risk of clinical fractures declined during 24 months of teriparatide treatment. This reduction was maintained 18 months after stopping teriparatide. In parallel, patients reported significant improvements in back pain and HRQoL. The results should be interpreted in the context of the non-controlled design of this observational study.
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Affiliation(s)
- Nicola Napoli
- Division of Endocrinology and Diabetes, University Campus Bio-Medico, Alvaro del Portillo 21, 00128, Rome, Italy.
| | | | - Östen Ljunggren
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Eric Lespessailles
- University Orléans, Orléans, France
- Regional Hospital of Orléans, Orléans, France
| | | | | | | | - Pia Eiken
- Department of Cardiology, Nephrology and Endocrinology, Hillerød Hospital, Hillerød, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Kruse C, Goemaere S, De Buyser S, Lapauw B, Eiken P, Vestergaard P. Predicting mortality and incident immobility in older Belgian men by characteristics related to sarcopenia and frailty. Osteoporos Int 2018; 29:1437-1445. [PMID: 29569152 DOI: 10.1007/s00198-018-4467-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 02/25/2018] [Indexed: 11/24/2022]
Abstract
UNLABELLED There is an increasing awareness of sarcopenia in older people. We applied machine learning principles to predict mortality and incident immobility in older Belgian men through sarcopenia and frailty characteristics. Mortality could be predicted with good accuracy. Serum 25-hydroxyvitamin D and bone mineral density scores were the most important predictors. INTRODUCTION Machine learning principles were used to predict 5-year mortality and 3-year incident severe immobility in a population of older men by frailty and sarcopenia characteristics. METHODS Using prospective data from 1997 on 264 older Belgian men (n = 152 predictors), 29 statistical models were developed and tuned on 75% of data points then validated on the remaining 25%. The model with the highest test area under the curve (AUC) was chosen as the best. From these, ranked predictor importance was extracted. RESULTS Five-year mortality could be predicted with good accuracy (test AUC of .85 [.73; .97], sensitivity 78%, specificity 89% at a probability cut-off of 22.3%) using a Bayesian generalized linear model. Three-year incident severe immobility could be predicted with fair accuracy (test AUC .74 [.57; .91], sensitivity 67%, specificity 78% at a probability cut-off of 14.2%) using a multivariate adaptive regression splines model. Serum 25-hydroxyvitamin D levels and hip bone mineral density scores were the most important predictors of mortality, while biochemical androgen markers and Short-Form 36 Physical Domain questions were the most important predictors of immobility. Sarcopenia assessed by lean mass estimates was relevant to mortality prediction but not immobility prediction. CONCLUSIONS Using advanced statistical models and a machine learning approach 5-year mortality can be predicted with good accuracy using a Bayesian generalized linear model and 3-year incident severe immobility with fair accuracy using a multivariate adaptive regression splines model.
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Affiliation(s)
- C Kruse
- Steno Diabetes Center North Jutland (SDCN), Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark.
- Department of Endocrinology, Aalborg University Hospital, Hobrovej 19, 9100, Aalborg, Denmark.
| | - S Goemaere
- Unit for Osteoporosis and Metabolic Bone Diseases, Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - S De Buyser
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
| | - B Lapauw
- Unit for Osteoporosis and Metabolic Bone Diseases, Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - P Eiken
- Department of Cardiology, Nephrology, and Endocrinology, Nordsjaellands Hospital, Hilleroed, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - P Vestergaard
- Steno Diabetes Center North Jutland (SDCN), Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
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18
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Thorsteinsson AL, Hansen L, Vestergaard P, Eiken P. Long-term benefits and risks of parathyroid hormone treatment in compliant osteoporotic patients. A Danish national register based cohort study. Arch Osteoporos 2018; 13:50. [PMID: 29717390 DOI: 10.1007/s11657-018-0444-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 03/06/2018] [Indexed: 02/03/2023]
Abstract
PURPOSE Medical treatment of osteoporosis should preferably be both effective and have minimal side effects. The aim of the present study was to examine long-term benefits and risks of parathyroid hormone (PTH) treatment in compliant patients. METHODS This is a nationwide retrospective cohort study based on national registers in which we identified 1739 patients treated with PTH (2003-2010) (index cases) for at least 18 months and with a medication possession rate of > 0.8. For comparison, patients treated with bisphosphonate (BP) (n = 13,131) and anti-osteoporotic treatment-naïve controls (n = 12,721) were selected. Incidence of fractures, drug consumption, and comorbidity were compared between the three cohorts. Mean follow-up of the PTH-treated patients was 4.3 years (range 1.8-8.7 years). RESULTS Before initiation of treatment, PTH patients had a significantly higher Charlson comorbidity index score and more osteoporotic fractures than both BP patients and controls. No difference was detected in the incidence of fractures during PTH treatment or years after between PTH patients and BP patients. No significant difference in the use of drugs was seen between PTH and BP patients, except for PPI intake which was higher in PTH patients. No significant increases were found in the incidence of cancers or other ICD-10 diagnoses among PTH-treated patients in comparison with both BP and controls. CONCLUSION Overall, PTH treatment is effective and safe. Following PTH treatment in compliant patients, neither fracture incidence nor drug consumption differed between PTH-treated and BP-treated patients, despite the fact that PTH-treated patients had more severe osteoporosis. No increased incidence of malignant diseases or other diseases was detected.
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Affiliation(s)
- Anne-Luise Thorsteinsson
- Department of Cardiology, Nephrology and Endocrinology, Nordsjællands Hospital, Dyrehavevej 29, 3400, Hillerød, Denmark. .,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Louise Hansen
- Danish Center for Healthcare Improvements, Department of Business and Management, Aalborg University, Aalborg, Denmark
| | - Peter Vestergaard
- Departments of Clinical Medicine and Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Pia Eiken
- Department of Cardiology, Nephrology and Endocrinology, Nordsjællands Hospital, Dyrehavevej 29, 3400, Hillerød, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Abstract
Apply machine learning principles to predict hip fractures and estimate predictor importance in Dual-energy X-ray absorptiometry (DXA)-scanned men and women. Dual-energy X-ray absorptiometry data from two Danish regions between 1996 and 2006 were combined with national Danish patient data to comprise 4722 women and 717 men with 5 years of follow-up time (original cohort n = 6606 men and women). Twenty-four statistical models were built on 75% of data points through k-5, 5-repeat cross-validation, and then validated on the remaining 25% of data points to calculate area under the curve (AUC) and calibrate probability estimates. The best models were retrained with restricted predictor subsets to estimate the best subsets. For women, bootstrap aggregated flexible discriminant analysis ("bagFDA") performed best with a test AUC of 0.92 [0.89; 0.94] and well-calibrated probabilities following Naïve Bayes adjustments. A "bagFDA" model limited to 11 predictors (among them bone mineral densities (BMD), biochemical glucose measurements, general practitioner and dentist use) achieved a test AUC of 0.91 [0.88; 0.93]. For men, eXtreme Gradient Boosting ("xgbTree") performed best with a test AUC of 0.89 [0.82; 0.95], but with poor calibration in higher probabilities. A ten predictor subset (BMD, biochemical cholesterol and liver function tests, penicillin use and osteoarthritis diagnoses) achieved a test AUC of 0.86 [0.78; 0.94] using an "xgbTree" model. Machine learning can improve hip fracture prediction beyond logistic regression using ensemble models. Compiling data from international cohorts of longer follow-up and performing similar machine learning procedures has the potential to further improve discrimination and calibration.
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Affiliation(s)
- Christian Kruse
- Department of Endocrinology, Aalborg University Hospital, Moelleparkvej 4, 9000, Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000, Aalborg, Denmark.
- Department of Endocrinology, Aalborg University Hospital, Hobrovej 19, 9100, Aalborg, Denmark.
| | - Pia Eiken
- Department of Cardiology, Nephrology and Endocrinology, Nordsjaellands Hospital, Dyrehavevej 29, 3400, Hilleroed, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Peter Vestergaard
- Department of Endocrinology, Aalborg University Hospital, Moelleparkvej 4, 9000, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000, Aalborg, Denmark
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20
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Abstract
UNLABELLED Clustering analysis can identify subgroups of patients based on similarities of traits. From data on 10,775 subjects, we document nine patient clusters of different fracture risks. Differences emerged after age 60 and treatment compliance differed by hip and lumbar spine bone mineral density profiles. INTRODUCTION The purposes of this study were to establish and quantify patient clusters of high, average and low fracture risk using an unsupervised machine learning algorithm. METHODS Regional and national Danish patient data on dual-energy X-ray absorptiometry (DXA) scans, medication reimbursement, primary healthcare sector use and comorbidity of female subjects were combined. Standardized variable means, Euclidean distances and Ward's D2 method of hierarchical agglomerative clustering (HAC), were used to form the clustering object. K number of clusters was selected with the lowest cluster containing less than 250 subjects. Clusters were identified as high, average or low fracture risk based on bone mineral density (BMD) characteristics. Cluster-based descriptive statistics and relative Z-scores for variable means were computed. RESULTS Ten thousand seven hundred seventy-five women were included in this study. Nine (k = 9) clusters were identified. Four clusters (n = 2886) were identified based on low to very low BMD with differences in comorbidity, anthropometrics and future bisphosphonate compliance. Two clusters of younger subjects (n = 1058, mean ages 30 and 51 years) were identified as low fracture risk with high to very high BMD. A mean age of 60 years was the earliest that allowed for separation of high-risk clusters. DXA scan results could identify high-risk subjects with different antiresorptive treatment compliance levels based on similarities and differences in lumbar spine and hip region BMD. CONCLUSIONS Unsupervised HAC presents a novel technology to improve patient characteristics in bone disease beyond traditional T-score-based diagnosis. Technological and validation limitations need to be overcome to improve its use in internal medicine. Current DXA scan indication guidelines could be further improved by clustering algorithms.
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Affiliation(s)
- C Kruse
- Department of Endocrinology, Aalborg University Hospital, Hobrovej 19, 9100, Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark.
| | - P Eiken
- Department of Cardiology, Nephrology and Endocrinology, Nordsjaellands Hospital, Hilleroed, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - P Vestergaard
- Department of Endocrinology, Aalborg University Hospital, Hobrovej 19, 9100, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
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21
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Karahasanovic A, Thorsteinsson AL, Bjarnason NH, Eiken P. Long-term leukopenia in a lung transplanted patient with cystic fibrosis treated with zoledronic acid: a case report. Osteoporos Int 2016; 27:2621-5. [PMID: 27080707 DOI: 10.1007/s00198-016-3559-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 03/01/2016] [Indexed: 10/22/2022]
Abstract
Cystic fibrosis (CF) is a serious autosomal recessive genetic disorder associated with chronic lung disease, malabsorption, malnutrition, pancreatic insufficiency and premature respiratory failure. Recent advances in medical science and technology have increased the lifespan of patients with CF, albeit with long-term consequences of the disease, such as osteoporosis, becoming of increasing significance. The medical treatment of osteoporosis in patients with CF or after organ transplantation is still being explored, and no clear guidelines regarding the best choice of bisphosphonate exist. We report a case of a young woman with CF, lung transplantation and low bone mass developing long-term leukopenia after treatment with zoledronic acid. The leukopenia, with a strong affection of the neutrocytes, lasted for 4 months and the condition only went into remission after granulocyte-colony stimulating factor (G-CSF) treatment. It is important to be aware of symptomatic leukopenia in immunosuppressive patients after treatment with zoledronic acid.
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Affiliation(s)
- A Karahasanovic
- Department of Cardiology, Nephrology and Endocrinology, Nordsjaellands Hospital-Hillerød, Dyrehavevej 29, DK-3400, Hilleroed, Denmark.
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - A-L Thorsteinsson
- Department of Cardiology, Nephrology and Endocrinology, Nordsjaellands Hospital-Hillerød, Dyrehavevej 29, DK-3400, Hilleroed, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - N H Bjarnason
- Department Respiratory Medicine, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark
- Department Lung Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - P Eiken
- Department of Cardiology, Nephrology and Endocrinology, Nordsjaellands Hospital-Hillerød, Dyrehavevej 29, DK-3400, Hilleroed, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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22
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Abrahamsen B, Eiken P, Prieto-Alhambra D, Eastell R. Risk of hip, subtrochanteric, and femoral shaft fractures among mid and long term users of alendronate: nationwide cohort and nested case-control study. BMJ 2016; 353:i3365. [PMID: 27353596 PMCID: PMC4924596 DOI: 10.1136/bmj.i3365] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To determine the skeletal safety and efficacy of long term (≥10 years) alendronate use in patients with osteoporosis. DESIGN Open register based cohort study containing two nested case control studies. SETTING Nationwide study of population of Denmark. PARTICIPANTS 61 990 men and women aged 50-94 at the start of treatment, who had not previously taken alendronate, 1996-2007. INTERVENTIONS Treatment with alendronate. MAIN OUTCOME MEASURES Incident fracture of the subtrochanteric femur or femoral shaft (ST/FS) or the hip. Non-fracture controls from the cohort were matched to fracture cases by sex, year of birth, and year of initiation of alendronate treatment. Conditional logistic regression models were fitted to calculate odds ratios with and without adjustment for comorbidity and comedications. Sensitivity analyses investigated subsequent treatment with other drugs for osteoporosis. RESULTS 1428 participants sustained a ST/FS (incidence rate 3.4/1000 person years, 95% confidence interval 3.2 to 3.6), and 6784 sustained a hip fracture (16.2/1000 person years, 15.8 to 16.6). The risk of ST/FS was lower with high adherence to treatment with alendronate (medication possession ratio (MPR, a proxy for compliance) >80%) compared with poor adherence (MPR <50%; odds ratio 0.88, 0.77 to 0.99; P=0.05). Multivariable adjustment attenuated this association (adjusted odds ratio 0.88, 0.77 to 1.01; P=0.08). The risk was no higher in long term users (≥10 dose years; 0.70, 0.44 to 1.11; P=0.13) or in current compared with past users (0.91, 0.79 to 1.06; P=0.22). Similarly, MPR >80% was associated with a decreased risk of hip fracture (0.73, 0.68 to 0.78; P<0.001) as was longer term cumulative use for 5-10 dose years (0.74, 0.67 to 0.83; P<0.001) or ≥10 dose years (0.74, 0.56 to 0.97; P=0.03). CONCLUSIONS These findings support an acceptable balance between benefit and risk with treatment with alendronate in terms of fracture outcomes, even for over 10 years of continuous use.
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Affiliation(s)
- Bo Abrahamsen
- Odense Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 9 A, 3. Sal, DK-5000, Odense, Denmark Department of Medicine, Holbæk Hospital, Smedelundsgade 60, 4300 Holbæk, Denmark
| | - Pia Eiken
- Department of Cardiology, Nephrology and Endocrinology, Hillerød Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark, Pia Eiken Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark, Pia Eiken
| | - Daniel Prieto-Alhambra
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeltal Sciences (NDORMS), University of Oxford, Botnar Research Centre, Oxford OX3 7LD, UK Musculoskeletal Research Unit, IMIM-Parc de Salut Mar and RETICEF, Universitat Autònoma de Barcelona and Instituto Carlos III (FEDER Research Funds), Passeig Marítim 25-29, 08003 Barcelona, Spain,
| | - Richard Eastell
- Academic Unit of Bone Metabolism (AUBM), Northern General Hospital and University of Sheffield, Sheffield S5 7AU, UK
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23
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Kruse C, Eiken P, Vestergaard P. Optimal age of commencing and discontinuing thiazide therapy to protect against fractures. Osteoporos Int 2016; 27:1875-85. [PMID: 26659068 DOI: 10.1007/s00198-015-3451-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 12/02/2015] [Indexed: 11/28/2022]
Abstract
UNLABELLED A study of national Danish patient data with regard to thiazide diuretics vs. non-treatment. We find that after age 83 years, thiazides increase the 10-year risk of major fractures. We also find that thiazides can be stopped after 63 years old to possibly protect against fracture occurrence. INTRODUCTION The purpose of this study was to retrospectively examine the optimal age for commencing and discontinuing thiazide therapy to protect from osteoporotic fractures. METHODS A population-based, retrospective matched cohort study was done using national data of 2.93 million Danish subjects. Ten-year crude and adjusted age-grouped hazard ratios (HRs) of fracture occurrence were stratified by age of commencing thiazides compared to non-exposure. Separate analyses were done on Anatomical Therapeutic Chemical Classification System (ATC) codes C03AA and C03AA + C03AB compiled. Ten-year crude HRs of fracture occurrence for discontinuing vs. continuing thiazides were estimated and stratified by age for the two groups. RESULTS For C03AB alone (97.1 % of thiazide prescriptions), adjusted 10-year HRs of fracture occurrence were significantly increased for thiazide commencement after age 83 years and comparable to non-exposure for commencement between ages 50 and 83 years. For C03AA + C03AB, 10-year adjusted HRs of fracture occurrence were significantly increased from ages 73 years and upwards. Crude 10-year HRs of fracture occurrence were significantly decreased for discontinuing vs. continuing thiazides at or after age 63 years for C03AB and age 77 years for C03AA + C03AB. CONCLUSIONS No significantly protective effect of thiazides was found on fracture occurrence compared to non-users, but evidence that thiazides increase the 10-year adjusted HR risk of fractures if prescribed after the age of 83 years for C03AB and 73 years for C03AA + C03AB. Discontinuing thiazides at or after age 63 years for C03AB or 77 years for C03AA & C03AB significantly decreases the 10-year risk of fractures compared to continuing thiazides. Further prospective studies are warranted.
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Affiliation(s)
- C Kruse
- Department of Endocrinology, Aalborg University Hospital, Hobrovej 19, 9100, Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark.
| | - P Eiken
- Department of Cardiology, Nephrology and Endocrinology, Nordsjaellands Hospital, Hilleroed, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - P Vestergaard
- Department of Endocrinology, Aalborg University Hospital, Hobrovej 19, 9100, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
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24
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Kruse C, Eiken P, Verbalis J, Vestergaard P. The effect of chronic mild hyponatremia on bone mineral loss evaluated by retrospective national Danish patient data. Bone 2016; 84:9-14. [PMID: 26679436 DOI: 10.1016/j.bone.2015.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 11/23/2015] [Accepted: 12/01/2015] [Indexed: 01/05/2023]
Abstract
PURPOSE To evaluate the effect of chronic mild hyponatremia ([Na+]=130-137mmol/L) on bone mineral content (BMC) and bone mineral density (BMD) loss through multiple, serial dual-energy X-ray absorptiometry (DXA) scans. METHODS Utilizing biochemical and DXA scan data from two Danish regions between 2004 and 2011, supplemented with national Danish patient diagnosis and prescription reimbursement databases, a retrospective cohort study was performed. All subjects with more than one DXA scan were included, then stratified into "normonatremia" ([Na(+)]=[137.00-147.00] mmol/L) and "mild hyponatremia" ([Na(+)]=[130.00-137.00[mmol/L) based on mean and confidence interval (CI) values calculated from all plasma sodium measurements between each subject's first and last DXA scan. Baseline, follow-up and delta values for hip and lumbar spine BMC and BMD were estimated between groups, then adjusted for comorbidity and medication use. RESULTS Hip and lumbar spine groups had 884 and 1069 patients with "normonatremia" versus 58 and 58 patients with "mild hyponatremia", respectively. Mild hyponatremia was associated with lower BMC and BMD in nearly all regions of the hip, and with worse losses in the trochanteric, femoral neck and total hip regions. Mild hyponatremia had limited effect on the lumbar spine. CONCLUSIONS Chronic mild hyponatremia seems to greatly affect bone in the hip, while the effect is limited in the lumbar spine. We suggest further retrospective study of patients with moderate (P-Na=120-130mmol/L) to severe hyponatremia (P-Na<120mmol/L) and prospective studies to further examine the association.
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Affiliation(s)
- Christian Kruse
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark; Clinical Institute, Aalborg University Hospital, Aalborg, Denmark.
| | - Pia Eiken
- Department of Cardiology, Nephrology and Endocrinology, Nordsjællands Hospital Hilleroed, Hilleroed, Denmark; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Joseph Verbalis
- Georgetown University Medical Center, Georgetown University, Washington, DC, USA
| | - Peter Vestergaard
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark; Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
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Kruse C, Eiken P, Vestergaard P. Continuous and long-term treatment is more important than dosage for the protective effect of thiazide use on bone metabolism and fracture risk. J Intern Med 2016. [PMID: 26223424 DOI: 10.1111/joim.12397] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Data from observational studies have suggested that thiazide diuretics protect against fractures. Few studies have investigated time frames from initiation of treatment to fracture occurrence. OBJECTIVE To evaluate the time to spinal, hip, femur, wrist and upper extremity fracture occurrence before and after thiazide exposure. METHODS A matched retrospective cohort study of patient information from national Danish patient databases was conducted. Patients with reimbursed prescriptions for noncompounded thiazide diuretics with potassium supplementation (Anatomical Therapeutic Chemical classification system code C03AB) between 1996 and 2011 were matched with nonexposed control subjects by date of birth and gender. Weekly odds ratios (ORs) of fracture occurrence and total incidence rates (IRs) and incidence rate ratios (IRRs) of fracture risk were calculated for the periods before treatment initiation, weeks 1-42 and weeks 43-780. RESULTS A total of 1,602,141 'thiazide exposure periods' (46,8271 individuals) and 1,530,233 'nonexposure periods' (655,399 individuals) were included in the analysis. Thiazide use was associated with factors of increased de novo fracture risk. Weekly adjusted fracture risk between exposure and nonexposure was increased prior to commencing thiazide therapy, further increasing from weeks 1-42 weeks and then decreasing gradually from weeks 43-780. There was a decreasing trend in total age-adjusted risk during these periods: IRR [95% confidence interval 1.44 [1.42; 1.47], 1.27 [1.24; 1.29] and 1.14 [1.11; 1.18], respectively. Prescription patterns showed several treatment breaks amongst thiazide users. CONCLUSIONS It appears that thiazides reduce the background risk of fracture that is increased prior to commencing therapy. Long duration and continuity of thiazide exposure seems to be important to obtain this protective effect on fracture risk, but we have found in this study that this approach is not always used in clinical practice.
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Affiliation(s)
- C Kruse
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark.,Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
| | - P Eiken
- Department of Cardiology, Nephrology and Endocrinology, Nordsjaellands Hospital Hilleroed, Hilleroed, Denmark.,Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - P Vestergaard
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark.,Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
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Abstract
Alendronate (ALN) and risedronate (RIS) are ideal as first-choice therapy options in the treatment of postmenopausal osteoporosis. What to do for patients who do not respond adequately to bisphosphonates has not been conclusively determined, but transitioning to other therapies should be considered. The aim of this article is to describe potential alternatives for patients switching from ALN or RIS to other therapies for osteoporosis. A systematic search of PubMed was conducted to find papers that evaluate the effects of switching therapies on fractures, bone mineral density (BMD), or bone turnover markers. Results from 11 studies that prospectively assessed treatment after ALN or RIS in women with postmenopausal osteoporosis were reviewed. All studies are of short duration (all 24 months or less) and assess the topic of transitioning therapy from ALN or RIS. None of the studies had the statistical power to assess fracture-reduction efficacy. Transitioning from ALN to zoledronic acid maintains therapeutic effects for 12 months. Switching to strontium ranelate, denosumab, or teriparatide causes further increases in BMD. Specifically, transitioning to teriparatide could be used for a limited time for select patients but needs to be followed up with anti-resorptive treatment to prevent a loss of the bone gained. There are only few studies-of short duration-that assess the topic of transitioning therapy from ALN or RIS, although this is a very frequent occurrence in clinical practice. This is especially true if the patient has not reached his/her therapy goal. Further long-term studies are needed.
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Affiliation(s)
- P Eiken
- Department of Cardiology, Nephrology and Endocrinology, Nordsjaellands Hospital, Hilleroed, Denmark.
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - P Vestergaard
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
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Starup-Linde J, Karahasanovic A, Vestergaard P, Eiken P. [Diabetes increases the risk of fractures]. Ugeskr Laeger 2015; 177:V08150663. [PMID: 26651553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Diabetes is associated with an increased risk of fracture, however, neither bone mineral density, falls, diabetes complications nor other risk factors can explain why. Among patients with diabetes, hyperglycaemia may have detrimental effects on bone, but also use of anti-diabetic treatment may have an impact on fracture risk. In this article we assess the relationship between diabetes, bone and fracture and the effects of hyperglycaemia and anti-diabetic treatment on bone. Furthermore, fracture preventive measures in patients with diabetes are evaluated.
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Thorsteinsson AL, Vestergaard P, Eiken P. Compliance and persistence with treatment with parathyroid hormone for osteoporosis. A Danish national register-based cohort study. Arch Osteoporos 2015; 10:35. [PMID: 26427867 DOI: 10.1007/s11657-015-0237-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 09/16/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED Medical intervention is important in the treatment of osteoporosis, and compliance with medical treatment is essential for an optimal outcome. Based on Danish national registers, we found that compliance with parathyroid hormone (PTH) treatment is high and associated with marital status, working status, and type of PTH treatment. PURPOSE Compliance and persistence are essential for an optimal outcome during medical treatment of osteoporosis. We aimed to evaluate compliance and persistence with treatment with PTH in daily clinical practice in Danish patients and to describe factors affecting compliance. METHODS Register-based nationwide cohort study on all patients in Denmark initiates PTH or analogue treatment for osteoporosis in 2003-2010 (n = 4281). PTH drugs included were the PTH analogue teriparatide(1-34) and recombinant human PTH (rhPTH(1-84)). Compliance with treatment was calculated by using medication possession ratio (MPR). RESULTS In the study period, 3702 patients were exclusively treated with teriparatide and 579 were exclusively treated with rhPTH(1-84). We found that for patients persistent with therapy for at least 18 months and with MPR >0.8, 83 % of the patients in the teriparatide group were compliant versus 72 % in the recombinant PTH group (p < 0.01). Being married/cohabiting, still in the labor market, and taking teriparatide were significantly associated with higher compliance, whereas age, gender, level of education, income, alcoholism, and Charlson comorbidity index were not associated with compliance. CONCLUSION Compliance with PTH treatment overall is high, with teriparatide compliance higher than rhPTH(1-84), in patients persistent to therapy for 18 months. Compliance is associated with marital status, working status, and type of PTH treatment.
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Affiliation(s)
- Anne-Luise Thorsteinsson
- Department of Cardiology, Nephrology and Endocrinology, Nordsjællands Hospital, Dyrehavevej 29, DK-3400, Hillerød, Denmark.
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Peter Vestergaard
- Departments of Clinical Medicine and Endocrinology, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
| | - Pia Eiken
- Department of Cardiology, Nephrology and Endocrinology, Nordsjællands Hospital, Dyrehavevej 29, DK-3400, Hillerød, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Jimenez R, Sicotte H, Barman P, Sinnwell J, Eiken P, Atwell T, McMenomy B, Tan W, Wu K, Bryce A, Ho T, Pitot H, Quevedo J, Costello B, Dronca R, Moynihan T, Wang L, Qin R, Carlson R, Kohli M. 2523 Feasibility analysis of pathology and genetic yield from a prospective trial of tissue biopsies in metastatic castrate resistant prostate cancer. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31342-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kohli M, Tan W, Eiken P, McMenomy B, Atwell T, Carlson R, Campion M, Wang L, Costello B, Pitot H, Quevedo F, Ho T, Bryce A, Qin R, Paz-Fumagalli R, Moynihan T, Dronca R, Liu M. 2573 Impact of biopsy of metastases on circulating tumor cell (CTC) counts in castrate resistant prostate cancer (CRPC). Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31392-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
Bisphosphonates (BPs) are widely used as the main treatment for osteoporosis. In vitro and animal studies suggest that use of BPs may have a potential for colorectal cancer (CRC) prevention. Safety and efficacy in terms of osteoporosis prevention have only been evaluated in randomized controlled trials (RCTs) of relatively short duration (3-5 years), with smaller extension studies. The evidence for a benefit beyond 5 years is limited and intake of BPs has not shown any relationship with CRC in intervention studies. Observational studies and meta-analysis have shown unchanged or decreased risk of CRC. BPs used for treatment and prevention of osteoporosis should not be applied for prevention of CRC in clinical practice.
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Affiliation(s)
- Pia Eiken
- Department of Cardiology, Nephrology and Endocrinology, NOH Hillerød Hospital, Dyrehavevej 29, DK-3400 Hillerød, Denmark and Faculty of Health Sciences, University of Copenhagen, Denmark
| | - Peter Vestergaard
- Department of Endocrinology and Clinical Institute, Aalborg University Hospital, Aalborg, Denmark and Clinical Institute, Aalborg University Hospital, Denmark
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Winckler K, Tarnow L, Lundby-Christensen L, Almdal TP, Wiinberg N, Eiken P, Boesgaard TW. Vitamin D, carotid intima-media thickness and bone structure in patients with type 2 diabetes. Endocr Connect 2015; 4:128-35. [PMID: 25956908 PMCID: PMC4463474 DOI: 10.1530/ec-15-0034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 04/30/2015] [Indexed: 12/21/2022]
Abstract
Despite aggressive treatment of cardiovascular disease (CVD) risk factors individuals with type 2 diabetes (T2D) still have increased risk of cardiovascular morbidity and mortality. The primary aim of this study was to examine the cross-sectional association between total (25-hydroxy vitamin D (25(OH)D)) and risk of CVD in patients with T2D. Secondary objective was to examine the association between 25(OH)D and bone health. A Danish cohort of patients with T2D participating in a randomised clinical trial were analysed. In total 415 patients (68% men, age 60±9 years (mean±s.d.), duration of diabetes 12±6 years), including 294 patients (71%) treated with insulin. Carotid intima-media thickness (IMT) and arterial stiffness (carotid artery distensibility coefficient (DC) and Young's elastic modulus (YEM)) were measured by ultrasound scan as indicators of CVD. Bone health was assessed by bone mineral density and trabecular bone score measured by dual energy X-ray absorptiometry. In this cohort, 214 patients (52%) were vitamin D deficient (25(OH)D <50 nmol/l). Carotid IMT was 0.793±0.137 mm, DC was 0.0030±0.001 mmHg, YEM was 2354±1038 mmHg and 13 (3%) of the patients were diagnosed with osteoporosis. A 25(OH)D level was not associated with carotid IMT or arterial stiffness (P>0.3) or bone health (P>0.6) after adjustment for CVD risk factors. In conclusion, 25(OH)D status was not associated with carotid IMT, arterial stiffness or bone health in this cohort of patients with T2D. To explore these associations and the association with other biomarkers further, multicentre studies with large numbers of patients are required.
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Affiliation(s)
- Karoline Winckler
- Department of CardiologyNephrology and EndocrinologyDepartment of ResearchNordsjaellands Hospital, Nordsjællands University Hospital, Dyrehavevej 29, 3400 Hilleroed, DenmarkInstitute of Clinical StudiesUniversity of Aarhus, Aarhus, DenmarkClinical Research UnitSteno Diabetes Center, Gentofte, DenmarkDepartment of PaediatricsHvidovre Hospital, Copenhagen University Hospital, Hvidovre, DenmarkDepartment of MedicineCopenhagen University Hospital, Gentofte, DenmarkDepartment of Physiology and Nuclear MedicineFrederiksberg Hospital, Copenhagen University Hospital, Frederiksberg, DenmarkInstitute of Clinical MedicineUniversity of Copenhagen, Copenhagen, Denmark
| | - Lise Tarnow
- Department of CardiologyNephrology and EndocrinologyDepartment of ResearchNordsjaellands Hospital, Nordsjællands University Hospital, Dyrehavevej 29, 3400 Hilleroed, DenmarkInstitute of Clinical StudiesUniversity of Aarhus, Aarhus, DenmarkClinical Research UnitSteno Diabetes Center, Gentofte, DenmarkDepartment of PaediatricsHvidovre Hospital, Copenhagen University Hospital, Hvidovre, DenmarkDepartment of MedicineCopenhagen University Hospital, Gentofte, DenmarkDepartment of Physiology and Nuclear MedicineFrederiksberg Hospital, Copenhagen University Hospital, Frederiksberg, DenmarkInstitute of Clinical MedicineUniversity of Copenhagen, Copenhagen, Denmark Department of CardiologyNephrology and EndocrinologyDepartment of ResearchNordsjaellands Hospital, Nordsjællands University Hospital, Dyrehavevej 29, 3400 Hilleroed, DenmarkInstitute of Clinical StudiesUniversity of Aarhus, Aarhus, DenmarkClinical Research UnitSteno Diabetes Center, Gentofte, DenmarkDepartment of PaediatricsHvidovre Hospital, Copenhagen University Hospital, Hvidovre, DenmarkDepartment of MedicineCopenhagen University Hospital, Gentofte, DenmarkDepartment of Physiology and Nuclear MedicineFrederiksberg Hospital, Copenhagen University Hospital, Frederiksberg, DenmarkInstitute of Clinical MedicineUniversity of Copenhagen, Copenhagen, Denmark Department of CardiologyNephrology and EndocrinologyDepartment of ResearchNordsjaellands Hospital, Nordsjællands University Hospital, Dyrehavevej 29, 3400 Hilleroed, DenmarkInstitute of Clinical StudiesUniversity of Aarhus, Aarhus, DenmarkClinical Research UnitSteno Diabetes Center, Gentofte, DenmarkDepartment of PaediatricsHvidovre Hospital, Copenhagen University Hospital, Hvidovre, DenmarkDepartment of MedicineCopenhagen University Hospital, Gentofte, DenmarkDepartment of Physiology and Nuclear MedicineFrederiksberg Hospital, Copenhagen University Hospital, Frederiksberg, DenmarkInstitute of Clinical MedicineUniversity of Copenhagen, Copenhagen, Denmark
| | - Louise Lundby-Christensen
- Department of CardiologyNephrology and EndocrinologyDepartment of ResearchNordsjaellands Hospital, Nordsjællands University Hospital, Dyrehavevej 29, 3400 Hilleroed, DenmarkInstitute of Clinical StudiesUniversity of Aarhus, Aarhus, DenmarkClinical Research UnitSteno Diabetes Center, Gentofte, DenmarkDepartment of PaediatricsHvidovre Hospital, Copenhagen University Hospital, Hvidovre, DenmarkDepartment of MedicineCopenhagen University Hospital, Gentofte, DenmarkDepartment of Physiology and Nuclear MedicineFrederiksberg Hospital, Copenhagen University Hospital, Frederiksberg, DenmarkInstitute of Clinical MedicineUniversity of Copenhagen, Copenhagen, Denmark Department of CardiologyNephrology and EndocrinologyDepartment of ResearchNordsjaellands Hospital, Nordsjællands University Hospital, Dyrehavevej 29, 3400 Hilleroed, DenmarkInstitute of Clinical StudiesUniversity of Aarhus, Aarhus, DenmarkClinical Research UnitSteno Diabetes Center, Gentofte, DenmarkDepartment of PaediatricsHvidovre Hospital, Copenhagen University Hospital, Hvidovre, DenmarkDepartment of MedicineCopenhagen University Hospital, Gentofte, DenmarkDepartment of Physiology and Nuclear MedicineFrederiksberg Hospital, Copenhagen University Hospital, Frederiksberg, DenmarkInstitute of Clinical MedicineUniversity of Copenhagen, Copenhagen, Denmark
| | - Thomas P Almdal
- Department of CardiologyNephrology and EndocrinologyDepartment of ResearchNordsjaellands Hospital, Nordsjællands University Hospital, Dyrehavevej 29, 3400 Hilleroed, DenmarkInstitute of Clinical StudiesUniversity of Aarhus, Aarhus, DenmarkClinical Research UnitSteno Diabetes Center, Gentofte, DenmarkDepartment of PaediatricsHvidovre Hospital, Copenhagen University Hospital, Hvidovre, DenmarkDepartment of MedicineCopenhagen University Hospital, Gentofte, DenmarkDepartment of Physiology and Nuclear MedicineFrederiksberg Hospital, Copenhagen University Hospital, Frederiksberg, DenmarkInstitute of Clinical MedicineUniversity of Copenhagen, Copenhagen, Denmark Department of CardiologyNephrology and EndocrinologyDepartment of ResearchNordsjaellands Hospital, Nordsjællands University Hospital, Dyrehavevej 29, 3400 Hilleroed, DenmarkInstitute of Clinical StudiesUniversity of Aarhus, Aarhus, DenmarkClinical Research UnitSteno Diabetes Center, Gentofte, DenmarkDepartment of PaediatricsHvidovre Hospital, Copenhagen University Hospital, Hvidovre, DenmarkDepartment of MedicineCopenhagen University Hospital, Gentofte, DenmarkDepartment of Physiology and Nuclear MedicineFrederiksberg Hospital, Copenhagen University Hospital, Frederiksberg, DenmarkInstitute of Clinical MedicineUniversity of Copenhagen, Copenhagen, Denmark
| | - Niels Wiinberg
- Department of CardiologyNephrology and EndocrinologyDepartment of ResearchNordsjaellands Hospital, Nordsjællands University Hospital, Dyrehavevej 29, 3400 Hilleroed, DenmarkInstitute of Clinical StudiesUniversity of Aarhus, Aarhus, DenmarkClinical Research UnitSteno Diabetes Center, Gentofte, DenmarkDepartment of PaediatricsHvidovre Hospital, Copenhagen University Hospital, Hvidovre, DenmarkDepartment of MedicineCopenhagen University Hospital, Gentofte, DenmarkDepartment of Physiology and Nuclear MedicineFrederiksberg Hospital, Copenhagen University Hospital, Frederiksberg, DenmarkInstitute of Clinical MedicineUniversity of Copenhagen, Copenhagen, Denmark
| | - Pia Eiken
- Department of CardiologyNephrology and EndocrinologyDepartment of ResearchNordsjaellands Hospital, Nordsjællands University Hospital, Dyrehavevej 29, 3400 Hilleroed, DenmarkInstitute of Clinical StudiesUniversity of Aarhus, Aarhus, DenmarkClinical Research UnitSteno Diabetes Center, Gentofte, DenmarkDepartment of PaediatricsHvidovre Hospital, Copenhagen University Hospital, Hvidovre, DenmarkDepartment of MedicineCopenhagen University Hospital, Gentofte, DenmarkDepartment of Physiology and Nuclear MedicineFrederiksberg Hospital, Copenhagen University Hospital, Frederiksberg, DenmarkInstitute of Clinical MedicineUniversity of Copenhagen, Copenhagen, Denmark Department of CardiologyNephrology and EndocrinologyDepartment of ResearchNordsjaellands Hospital, Nordsjællands University Hospital, Dyrehavevej 29, 3400 Hilleroed, DenmarkInstitute of Clinical StudiesUniversity of Aarhus, Aarhus, DenmarkClinical Research UnitSteno Diabetes Center, Gentofte, DenmarkDepartment of PaediatricsHvidovre Hospital, Copenhagen University Hospital, Hvidovre, DenmarkDepartment of MedicineCopenhagen University Hospital, Gentofte, DenmarkDepartment of Physiology and Nuclear MedicineFrederiksberg Hospital, Copenhagen University Hospital, Frederiksberg, DenmarkInstitute of Clinical MedicineUniversity of Copenhagen, Copenhagen, Denmark
| | - Trine W Boesgaard
- Department of CardiologyNephrology and EndocrinologyDepartment of ResearchNordsjaellands Hospital, Nordsjællands University Hospital, Dyrehavevej 29, 3400 Hilleroed, DenmarkInstitute of Clinical StudiesUniversity of Aarhus, Aarhus, DenmarkClinical Research UnitSteno Diabetes Center, Gentofte, DenmarkDepartment of PaediatricsHvidovre Hospital, Copenhagen University Hospital, Hvidovre, DenmarkDepartment of MedicineCopenhagen University Hospital, Gentofte, DenmarkDepartment of Physiology and Nuclear MedicineFrederiksberg Hospital, Copenhagen University Hospital, Frederiksberg, DenmarkInstitute of Clinical MedicineUniversity of Copenhagen, Copenhagen, Denmark
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Abstract
UNLABELLED The association between hyponatremia and osteoporosis was evaluated in humans. A significant association was found between low sodium levels, lower bone mineralization in the hip, and with several common conditions. Hyponatremia could be used as a marker of osteoporosis and systemic disease. INTRODUCTION The objective of this study was to evaluate the association between hyponatremia and osteoporosis in humans through a cross-sectional study. METHODS Patient information was gathered from regional and national Danish patient databases, both in- and outpatient settings, from 2004 to 2011. Patients with dual-energy x-ray absorptiometry (DXA) scans performed within this time were included if accompanied [Na+] was measured within 14 days prior or past the scan date. A total of 1575 patients were included. RESULTS A total of 104 patients were hyponatremic (6.6 %). Total hip and lumbar spine bone mineral content (BMC) and densities (BMD) and T-scores were all significantly lower with hyponatremia. The odds ratio (OR) of osteoporosis significantly increased among hyponatremic patients at both total hip (unadjusted OR = 2.17, 95% CI = [1.40-3.34], p < .05) and lumbar spine (unadjusted OR = 1.83, 95% CI = [1.20-2.80], p < .05) regions. Dose-response found between increasing [Na+] and increasing total hip BMC (slope .174, adjusted p < .05), BMD (slope .004, adjusted p < .05), and T-score (slope .034, adjusted p < .05). Systemic disease was more prevalent in hyponatremia. CONCLUSION The presence of hyponatremia increases the risk of concurrent osteoporosis at both the total hip and lumbar spine in humans. Hyponatremia could be used a screening tool and marker of secondary osteoporosis.
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Affiliation(s)
- C Kruse
- Department of Endocrinology, Aalborg University Hospital, Hobrovej 18-22, 9100, Aalborg, Denmark,
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Abstract
INTRODUCTION Recent studies show an association between hyponatremia and osteoporosis. We have previously reported a case of severe male osteoporosis due to chronic syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Here, we provide a follow-up on this case after cure of the condition that further supports the causal relationship. THE CASE A 38-year-old man had been diagnosed with severe osteoporosis most likely due to chronic SIADH. The SIADH was believed to be idiopathic. A magnetic resonance imaging scan, however, revealed a tumor in the sinus, and biopsies showed an esthesioneuroblastoma, immunohistochemically positive for antidiuretic hormone (ADH). After the tumor was removed, ADH and sodium levels normalized. A dual-energy x-ray absorptiometry scan performed 7 months after the patient's last surgery showed a significant spontaneous improvement in bone mineral density in the lumbar vertebrae. CONCLUSION This case provides evidence for a causal relationship between SIADH and chronic hyponatremia and impaired bone metabolism that can lead to severe secondary osteoporosis. The effect on bone metabolism is at least partially reversible.
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Affiliation(s)
- Anne-Sophie Sejling
- Department of Cardiology, Nephrology, and Endocrinology (A.-S.S., A.-L.T., U.P.-B., P.E.), Nordsjællands Hospital, DK-3400 Hillerød, Denmark; Faculty of Health Sciences (A.-S.S.), University of Southern Denmark, DK-5000 Odense, Denmark; and Faculty of Health Sciences (U.P.-B., P.E.), University of Copenhagen, DK-2200 Copenhagen, Denmark
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Thorsteinsson AL, Vestergaard P, Eiken P. External auditory canal and middle ear cholesteatoma and osteonecrosis in bisphosphonate-treated osteoporosis patients: a Danish national register-based cohort study and literature review. Osteoporos Int 2014; 25:1937-44. [PMID: 24664275 DOI: 10.1007/s00198-014-2684-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 03/11/2014] [Indexed: 11/24/2022]
Abstract
UNLABELLED Long-term treatment with bisphosphonates against osteoporosis may cause atypical femur fractures and osteonecrosis of the jaw. Eight cases of bisphosphonate-associated osteonecrosis of the external auditory canal area are published. Based on Danish national registers, we report a time- and dose-dependent increased risk of cholesteatoma in osteoporosis patients treated with bisphosphonates. INTRODUCTION In the recent years, there has been a focus on possible rare side effects of bisphosphonates (BPs). Eight cases of BP-associated osteonecrosis of the external auditory canal have been reported in the world literature. Our aim was to describe the incidence of external auditory canal and middle ear diseases in Danish patients exposed to BPs in the treatment of osteoporosis. METHODS This register-based nationwide cohort study was conducted on the Danish population of approximately 5.6 million individuals. Patients who were prescribed BP for treatment of osteoporosis from 2003 to 2010 (n = 131,794) were included in the study and compared with the age- and gender-matched controls, unexposed to BP. RESULTS The overall incidence of cholesteatoma in the ear was low. Only 350 events were seen in 527,176 cases and controls over 2,826,120.73 observation years. Totally, 119 events of cholesteatoma in the ear were recorded after initiation of BP therapy, 34 in the external auditory canal and 85 in the middle ear. Cholesteatoma in the external auditory canal was more frequent in the exposed than in the unexposed group (p < 0.0001). We found a significant dose-event relationship between incidence of cholesteatoma and dose of alendronate (p < 0.0001) and etidronate (p < 0.0001). Furthermore, we found an association between duration of treatment with alendronate and etidronate and risk of cholesteatoma in the external auditory ear canal (log rank, p = 0.002). No cases of bone destruction were observed during the 7-year observation period in either group. CONCLUSION The use of oral BP is associated with an increased risk of cholesteatoma of the external auditory canal. The risk is small and associated with duration and dosage of BP.
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Affiliation(s)
- A-L Thorsteinsson
- Department of Cardiology, Nephrology and Endocrinology, Nordsjællands Hospital-Hillerød, University of Copenhagen, Hillerød, Dyrehavevej 29, 3400, Hillerød, Denmark,
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Molsted S, Eiken P, Andersen JL, Eidemak I, Harrison AP. Interleukin-6 and vitamin D status during high-intensity resistance training in patients with chronic kidney disease. Biomed Res Int 2014; 2014:176190. [PMID: 24800209 PMCID: PMC3996980 DOI: 10.1155/2014/176190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 03/04/2014] [Accepted: 03/05/2014] [Indexed: 12/20/2022]
Abstract
Background. The aim of this study was to investigate IL-6 and 25-hydroxyvitamin D (25-OH D) associations with muscle size and muscle function in dialysis patients. Methods. Patients were included in a 16-week control period followed by 16 weeks of high-intensity resistance training thrice weekly. IL-6 and 25-OH D were analysed after an over-night fast. Muscle fibre size was analysed in biopsies from m. vastus lateralis. Muscle power was tested using a Leg Extensor Power Rig. Results. Patients (n = 36) with IL-6 ≥ 6.49 pg/ml (median) were older and had decreased muscle power and a reduced protein intake (P < 0.05) compared with patients with IL-6 < 6.49 pg/ml. IL-6 was not associated with muscle fibre size. Vitamin D deficiency (25-OH D < 50 nmol/l) was present in 51% of the patients and not associated with muscle power. IL-6 remained unchanged during the training period, whilst muscle power increased by 20-23% (P < 0.001). Conclusion. Elevated IL-6 values were associated with decreased muscle power but not with decreased muscle fibre size. Half of the patients were suffering from vitamin D deficiency, which was not associated with muscle power. IL-6 was unchanged by high-intensity resistance training in dialysis patients in this study.
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Affiliation(s)
- Stig Molsted
- Department of Cardiology, Nephrology & Endocrinology, Nordsjællands University Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Pia Eiken
- Department of Cardiology, Nephrology & Endocrinology, Nordsjællands University Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
- Faculty of Health and Medical Sciences, Copenhagen University, Blegdamsvej 3, 2200 Copenhagen N, Denmark
| | - Jesper L. Andersen
- Institute of Sports Medicine Copenhagen, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark
| | - Inge Eidemak
- Department of Nephrology P, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Adrian P. Harrison
- Department of Basic Animal and Veterinary Sciences, Faculty of Health and Medical Sciences, Copenhagen University, Grønnegårdsvej 15, 1870 Frederiksberg C, Denmark
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Torekov SS, Harsløf T, Rejnmark L, Eiken P, Jensen JB, Herman AP, Hansen T, Pedersen O, Holst JJ, Langdahl BL. A functional amino acid substitution in the glucose-dependent insulinotropic polypeptide receptor (GIPR) gene is associated with lower bone mineral density and increased fracture risk. J Clin Endocrinol Metab 2014; 99:E729-33. [PMID: 24446656 DOI: 10.1210/jc.2013-3766] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Food ingestion decreases bone resorption, and glucose-dependent insulinotropic polypeptide (GIP) may mediate this effect. Mice overexpressing GIP have increased osteoblast activity and are rescued from age-related bone loss, whereas GIPR knockout mice have decreased cortical bone mass and compromised bone quality. Carriers of the functional variant GIPR Glu354Gln (rs1800437) have higher plasma glucose 2 hours after glucose ingestion, suggesting that the variant encoding GIPR 354Gln decreases the effect of GIP. OBJECTIVE The objective of the study was to investigate the effect of GIPR Glu354Gln on bone mineral density (BMD) and fracture risk. DESIGN This was a prospective, comprehensive, cohort study (number NCT00252408). PARTICIPANTS A total of 1686 perimenopausal women were included. MAIN OUTCOME MEASURES Dual-energy X-ray absorptiometry was performed at baseline and after 10 years. Incident fractures were recorded during the follow-up and were obtained from the Danish National Patient Registry, giving a total follow-up time of a minimum 16 years. RESULTS After 10 years, women with the minor frequency C allele of rs1800437 (354Gln) had significantly lower BMD at the femoral neck compared with carriers of the major G-allele (CC: 0.755 ± 0.015 g/cm(2) vs CG: 747 ± 0.005 g/cm(2); GG: 0.766 ± 0.004 g/cm(2), P < .001). Correspondingly, total hip BMD was significantly lower among C allele carriers (CC: 0.881 ± 0.016 g/cm(2); CG: 0.884 ± 0.005 g/cm(2); and GG: 0.906 ± 0.004 g/cm(2), P < .001). Finally, women homozygous for the variant C allele had an increased risk (hazard ratio 1.6, confidence interval 1.0-2.6, P < .05) of nonvertebral fractures. CONCLUSION This study demonstrates an association between a functional GIPR polymorphism Glu354Gln (rs1800437) and BMD and fracture risk. These findings further establish GIP to be involved in the regulation of bone density.
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Affiliation(s)
- S S Torekov
- Department of Biomedical Sciences and NNF Center for Basic Metabolic Research (S.S.T., T.Han., O.P., J.J.H.), Faculty of Health and Medical Sciences (P.E.), University of Copenhagen, DK-2200 Copenhagen, Denmark; Department of Endocrinology and Metabolism (T.Har., L.R., B.L.L.), Aarhus University Hospital, DK-8000 C Aarhus, Denmark; Department of Cardiology, Nephrology, and Endocrinology (P.E.), Hillerød Hospital, DK-3400 Hillerød, Denmark; Department of Endocrinology (J.B.J.), Hvidovre University Hospital, DK-2650 Hvidovre, Denmark; and Department of Endocrinology M (A.P.H.), Odense University Hospital, DK-5000 Odense, Denmark
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Eiken P, Vestergaard P, Jensen JE. [Hormone replacement therapy as primary prevention?]. Ugeskr Laeger 2014; 176:V06130367. [PMID: 25096207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Benefits and risks from hormone replacement therapy are discussed if prescribed before the age of 60 years or within ten years after menopause.
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Affiliation(s)
- Pia Eiken
- Kardiologisk, Nefrologisk, Endokrinologisk Afdeling H, Hillerød Hospital, Dyrehavevej 29, 3400 Hillerød.
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Kamby C, Tarp S, Mellemgaard A, Christensen R, Cold S, Eiken P, Jakobsen EH, Langkilde NC, Langkjer ST, Laursen T, Ottesen SS, Pedersen AG, Stenbygaard LE, Vestlev PM. [Prevention of skeletal related events in patients with bone metastases from solid tumours]. Ugeskr Laeger 2014; 176:V08130525. [PMID: 25350304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This article is based on a systematic literature search and meta-analyses of clinical data regarding effects of bisphosphonates (BP) and denosumab (DS) on preventing skeletal related events (SRE) in patients with bone metastases from solid tumours. Although there are pharmacological differences between the different types of BP no major differences were observed between BP in preventing SRE or in adverse events. Treatment with DS has in three randomised trials showed a greater effect than BP in preventing SRE. The optimal choice of bone-anti-resorptive agent should depend on the patient's general condition, renal function and treatment logistics.
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Affiliation(s)
- Claus Kamby
- Onkologisk Klinik, Finsencenteret, Rigshospitalet.
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Brask-Lindemann D, Eiken P, Eskildsen P, Abrahamsen B. Time trends for alendronate prescription practices in women with chronic obstructive pulmonary disease and women exposed to systemic glucocorticoids. Osteoporos Int 2013; 24:1891-7. [PMID: 23152095 DOI: 10.1007/s00198-012-2220-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 10/30/2012] [Indexed: 01/30/2023]
Abstract
UNLABELLED Chronic obstructive pulmonary disease (COPD) and systemic glucocorticoid exposure are well-known risk factors of osteoporosis. We evaluated alendronate prescription practices related to COPD and exposure to systemic corticosteroids from 1996 to 2008 and showed an increasing targeting of alendronate treatment in patients with COPD and patients with systemic corticosteroid exposure. INTRODUCTION COPD and systemic glucocorticoid exposure are well-known risk factors of osteoporosis and fragility fracture, but osteoporosis is often underdiagnosed and undertreated in these patients. This study aims to evaluate alendronate prescription practices related to COPD and/or to exposure to systemic glucocorticoids among Danish women. METHODS A total of 388,314 female subjects >50 years old, 64,719 of whom initiated treatment with alendronate, and 323,595 age- and gender-matched controls were retrospectively identified between 1996 and 2008 from national health registers. Multivariate logistic regression was used for examining prescription practices, specifically if these risk factors (COPD or glucocorticoid exposure) increased or decreased the likelihood of beginning alendronate therapy. RESULTS A diagnosis of COPD was associated with an increased likelihood of using alendronate (odds ratio (OR) 1.4, 95 % confidence interval (CI) 1.4-1.5, p < 0.001). Further, a diagnosis of COPD was associated with an increasing tendency of initiating alendronate treatment in the study period (OR 1.3 (95 % CI 1.1-1.5, years 1996-1999) to 1.5 (95 % CI 1.4-1.6, years 2006-2008), p < 0.01). Exposure to systemic glucocorticoids was associated with a significantly increasing (OR 3.6, 95 % CI 3.3-3.9 to OR 5.5, 95 % CI 5.3-5.8) probability of receiving alendronate treatment in the same observation period. CONCLUSION This nationwide register-based study on alendronate prescription practices in Denmark shows an increasing targeting of alendronate treatment in patients with COPD and an even stronger trend for patients with systemic glucocorticoid exposure, perhaps indicating increased awareness of well-known and associated conditions.
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Affiliation(s)
- D Brask-Lindemann
- Department of Endocrinology, Copenhagen University Hospital Køge, Lykkebækvej 1, DK-4600 Køge, Denmark.
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Bondo L, Eiken P, Abrahamsen B. Analysis of the association between bisphosphonate treatment survival in Danish hip fracture patients-a nationwide register-based open cohort study. Osteoporos Int 2013; 24:245-52. [PMID: 22638712 DOI: 10.1007/s00198-012-2024-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 05/07/2012] [Indexed: 10/28/2022]
Abstract
UNLABELLED Bisphosphonate (BP) users have decreased mortality, but this could be due to channeling bias. National healthcare data on hip fracture showed lower mortality in patients who were treated prior to fracture or began treatment after fracture. Reduced mortality after only one prescription filled points to the importance of patient factors. INTRODUCTION Use of bisphosphonates has been found to be associated with decreased mortality even when adjusted for sex, frailty, bone mineral density and comorbidity, but BP may chiefly be initiated in patients with osteoporosis whose life expectancy is judged to be good. Our aim was to investigate the association between BP initiated before or after a hip fracture with mortality, and any modifying effects of comorbid conditions and recurrent fracture. METHODS This register-based cohort study used prescription and mortality information for Danish patients born ≤1945 experiencing a hip fracture between 1/Jan/1999 and 31/Dec/ 2002 (N = 42,076). Patients who began BP after hip fracture were compared with hip fracture patients who remained alive at the time when their matched index case began treatment. RESULTS Patients who used BP prior to their hip fracture (4.6 %) had significantly lower 3-month mortality (adjusted odds ratio, OR, 0.68; 0.59-0.77). Patients who began BP after the fracture (2.6 %) had significantly decreased mortality, both for patients who filled only one prescription (adjusted hazard ratio, HR 0.84; 0.73-0.95) and for patients who filled multiple prescriptions HR 0.73 (0.61-0.88). There was a significant interaction by gender with no significant risk reduction in men. CONCLUSION This national dataset shows significantly and substantially improved survival in women who receive BP before or after their hip fracture. However, the observation of a reduction in mortality in patients who filled only one prescription for a BP suggests that patient factors may account for a considerable part of the survival advantage observed with BPs.
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Affiliation(s)
- L Bondo
- Department of Medicine and Endocrinology F, Gentofte Hospital, 2900, Hellerup, Denmark
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Abstract
OBJECTIVE Recent studies indicate an association between hyponatremia and osteoporosis. We report a clinical case that supports this statement. CASE REPORT A 36-yr-old man was diagnosed with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) at the age of 22. In the years that followed, sodium levels in the blood remained low from 111-130 mmol/liter (137-144). At the age of 34, he was diagnosed with osteoporosis after a magnetic resonance imaging scan showed moderate compression fractures at Th9-11 and L2. A dual energy x-ray absorptiometry scan showed a Z-score of -3.9 at the lumbar spine (L3-L4) and a Z-score of -1.3 in the total hip. He had no other known risk factors for osteoporosis. Urinary excretion of calcium and sodium were elevated. Plasma vasopressin level was inappropriately elevated. One year after treatment with 5-mg zoledronic acid, there has been no significant change in the bone mineral density in the lumbar spine and a small increase in bone mineral density in the total hip. The symptoms from SIADH have not changed. CONCLUSION The case illustrates that severe idiopathic SIADH and chronic hyponatremia can have severe side effects on bone metabolism and can lead to secondary osteoporosis. We support the recommendation that patients with chronic SIADH should be screened for osteoporosis and suggest that early bone protective treatment should be considered to reduce or delay osteoporosis onset.
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Affiliation(s)
- Anne-Sophie Sejling
- Endocrine Section 0652, Department of Cardiology, Nephrology and Endocrinology, Hillerød Hospital, Dyrehavevej 29, DK-3400 Hillerød, Denmark.
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Schierbeck LL, Rejnmark L, Tofteng CL, Stilgren L, Eiken P, Mosekilde L, Køber L, Jensen JEB. Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial. BMJ 2012; 345:e6409. [PMID: 23048011 DOI: 10.1136/bmj.e6409] [Citation(s) in RCA: 412] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate the long term effect of hormone replacement therapy on cardiovascular outcomes in recently postmenopausal women. DESIGN Open label, randomised controlled trial. SETTING Denmark, 1990-93. PARTICIPANTS 1006 healthy women aged 45-58 who were recently postmenopausal or had perimenopausal symptoms in combination with recorded postmenopausal serum follicle stimulating hormone values. 502 women were randomly allocated to receive hormone replacement therapy and 504 to receive no treatment (control). Women who had undergone hysterectomy were included if they were aged 45-52 and had recorded values for postmenopausal serum follicle stimulating hormone. INTERVENTIONS In the treatment group, women with an intact uterus were treated with triphasic estradiol and norethisterone acetate and women who had undergone hysterectomy received 2 mg estradiol a day. Intervention was stopped after about 11 years owing to adverse reports from other trials, but participants were followed for death, cardiovascular disease, and cancer for up to 16 years. Sensitivity analyses were carried out on women who took more than 80% of the prescribed treatment for five years. MAIN OUTCOME MEASURE The primary endpoint was a composite of death, admission to hospital for heart failure, and myocardial infarction. RESULTS At inclusion the women on average were aged 50 and had been postmenopausal for seven months. After 10 years of intervention, 16 women in the treatment group experienced the primary composite endpoint compared with 33 in the control group (hazard ratio 0.48, 95% confidence interval 0.26 to 0.87; P=0.015) and 15 died compared with 26 (0.57, 0.30 to 1.08; P=0.084). The reduction in cardiovascular events was not associated with an increase in any cancer (36 in treated group v 39 in control group, 0.92, 0.58 to 1.45; P=0.71) or in breast cancer (10 in treated group v 17 in control group, 0.58, 0.27 to 1.27; P=0.17). The hazard ratio for deep vein thrombosis (2 in treated group v 1 in control group) was 2.01 (0.18 to 22.16) and for stroke (11 in treated group v 14 in control group) was 0.77 (0.35 to 1.70). After 16 years the reduction in the primary composite outcome was still present and not associated with an increase in any cancer. CONCLUSIONS After 10 years of randomised treatment, women receiving hormone replacement therapy early after menopause had a significantly reduced risk of mortality, heart failure, or myocardial infarction, without any apparent increase in risk of cancer, venous thromboembolism, or stroke. TRIAL REGISTRATION ClinicalTrials.gov NCT00252408.
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Affiliation(s)
- Louise Lind Schierbeck
- Department of Endocrinology, Hvidovre Hospital, Kettegård alle 30, 2650 Hvidovre, Denmark.
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Schierbeck LL, Rejnmark L, Tofteng CL, Stilgren L, Eiken P, Mosekilde L, Køber L, Jensen JEB. Vitamin D deficiency in postmenopausal, healthy women predicts increased cardiovascular events: a 16-year follow-up study. Eur J Endocrinol 2012; 167:553-60. [PMID: 22875588 DOI: 10.1530/eje-12-0283] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To investigate the relationship between vitamin D status in healthy women and cardiovascular outcome. DESIGN AND METHODS Between 1990 and 1993, 2016 healthy, recently postmenopausal women were enrolled in the Danish Osteoporosis Prevention Study. Serum levels of 25-hydroxyvitamin D (25(OH)D, nmol/l) were measured at baseline. Participants were followed for 16 years. The primary end point was a combination of death, heart failure, myocardial infarction (MI) and stroke. Vitamin D deficiency was defined as serum 25(OH)D<50 nmol/l. The primary end point was adjusted for other risk factors of adverse cardiovascular events (age, smoking, blood pressure, hip-waist ratio, education and family history of MI). RESULTS At baseline, mean age was 50 years and BMI 25. Women with vitamin D deficiency (n=788) had more cardiovascular risk factors than vitamin D-replete women (n=1225). Compared with vitamin D-replete women, women with low 25(OH)D levels had significantly higher BMI and triglycerides, lower HDL and hip-waist ratio and less education. More were smokers among the vitamin D deficient (47 vs 38%). A primary end point was experienced by 118 (15%) with vitamin D deficiency and by 125 (10%) of the vitamin D replete. Hazard ratio (HR) was 1.49 (95% confidence interval: 1.16-1.92; P=0.002) in the vitamin D deficient. Adjusted HR was 1.32 (1.02-1.71; P=0.03). In total, 135 women died; of these, 65 (8%) were of the vitamin D deficient and 70 (6%) in the vitamin D-replete group; unadjusted HR was 1.44 (1.02-2.01; P=0.04) for vitamin D deficiency. CONCLUSION Healthy women with vitamin D deficiency have increased risk of adverse cardiovascular outcome.
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Affiliation(s)
- Louise Lind Schierbeck
- Department of Endocrinology, Hvidovre Hospital, afd. 541, Kettegård alle 30, 2650 Hvidovre, Denmark.
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Chen L, Sykes A, Jensen E, Eiken P, Yu L, Leng S, McCollough C. SU-D-217BCD-04: How Do We Know How Low Can We Go in Lung Cancer Screening CT? Med Phys 2012; 39:3619. [DOI: 10.1118/1.4734695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Vestergaard P, Hermann P, Jensen JEB, Eiken P, Mosekilde L. Effects of paracetamol, non-steroidal anti-inflammatory drugs, acetylsalicylic acid, and opioids on bone mineral density and risk of fracture: results of the Danish Osteoporosis Prevention Study (DOPS). Osteoporos Int 2012; 23:1255-65. [PMID: 21710339 DOI: 10.1007/s00198-011-1692-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 06/06/2011] [Indexed: 10/18/2022]
Abstract
UNLABELLED Pain medication has been associated with fractures. We found higher weight in paracetamol and non-steroidal anti-inflammatory drugs (NSAID) users and lower vitamin D levels in opioid and acetylsalicylic acid users. None of the pain medications influenced bone mineral density or loss. NSAID were associated with an increased fracture risk. INTRODUCTION To study the effects of use of paracetamol, non-steroidal anti-inflammatory drugs (NSAID), acetylsalicylic acid (ASA), and opioids on bone mineral density (BMD) and risk of fractures. METHODS Two-thousand sixteen perimenopausal women followed for 10 years as part of a partly randomised comprehensive cohort study on hormone therapy (HT). BMD was measured at baseline and after 10 years by DXA (Hologic). RESULTS Paracetamol users were heavier (70.4 ± 13.4 vs. 67.7 ± 11.9 kg, 2p < 0.01) than non-users. NSAID users were heavier (71.6 ± 15.6 vs. 67.8 ± 11.9 kg, 2p = 0.04) than non-users. ASA users had lower 25-hydroxy-vitamin D (25OHD) levels (21.9 ± 9.3 vs. 25.3 ± 12.4 ng/ml, 2p < 0.01) than non-users. Opioid users had lower 25OHD (21.4 ± 8.4 vs. 25.2 ± 12.3 ng/ml) and lower intake of vitamin D (2.2 ± 1.1 vs. 3.1 ± 3.0 μg/day, 2p < 0.01) than non-users. Despite these differences, no baseline differences were present in spine, hip, forearm or whole body BMD. Over 10 years, no differences were present in BMD alterations except a small trend towards a higher BMD gain in the spine in users of paracetamol, NSAID, ASA, and opioids compared to non-exposed. After adjustment, NSAID exposed sustained more fractures (HR = 1.44, 95% CI 1.07-1.93) than non-users. For users of paracetamol and opioids, a non-significant trend towards more fractures was present after adjustment. For ASA users, no excess risk of fractures was present. CONCLUSION Significant differences exist between subjects exposed to pain medications and non-users. Despite an absence of an effect over time on BMD, users of NSAID experienced more fractures than expected. The reasons for this have to be explored in further studies.
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MESH Headings
- Acetaminophen/administration & dosage
- Acetaminophen/adverse effects
- Acetaminophen/pharmacology
- Analgesics, Non-Narcotic/administration & dosage
- Analgesics, Non-Narcotic/adverse effects
- Analgesics, Non-Narcotic/pharmacology
- Analgesics, Opioid/administration & dosage
- Analgesics, Opioid/adverse effects
- Analgesics, Opioid/pharmacology
- Anthropometry/methods
- Anti-Inflammatory Agents, Non-Steroidal/administration & dosage
- Anti-Inflammatory Agents, Non-Steroidal/adverse effects
- Anti-Inflammatory Agents, Non-Steroidal/pharmacology
- Aspirin/administration & dosage
- Aspirin/adverse effects
- Aspirin/pharmacology
- Bone Density/drug effects
- Denmark/epidemiology
- Dose-Response Relationship, Drug
- Female
- Follow-Up Studies
- Humans
- Middle Aged
- Osteoporotic Fractures/chemically induced
- Osteoporotic Fractures/epidemiology
- Osteoporotic Fractures/physiopathology
- Risk Assessment/methods
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Affiliation(s)
- P Vestergaard
- Department of Endocrinology and Internal Medicine (MEA), Aarhus University Hospital, Aarhus, Denmark.
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Abstract
Recent studies have reached conflicting conclusions regarding the risk of esophageal cancer with oral bisphosphonates. Prior studies did not record the number of cancer deaths or endoscopy rates, which could be higher in bisphosphonate users and lead to more cancers being diagnosed at a stage when their esophageal or gastric location could be accurately distinguished. We conducted a register-based, open cohort study using national healthcare data for Denmark. Upper endoscopy frequency, cancer incidence and mortality was examined in 30,606 alendronate users (female, age 50+) and 122,424 matched controls. Primary outcomes were esophageal cancer incidence and death because of esophageal cancer. The analysis showed that alendronate users were more likely to have undergone recent upper endoscopy (4.1 versus 1.7%, p < 0.001). Alendronate users had a lower risk of incident gastric cancer [odds ratio (OR) 0.61; 95% confidence interval (CI): 0.39-0.97) and no increased risk of esophageal cancer (OR 0.71; 95% CI: 0.43-1.19). Risk reductions were greater in users with 10+ prescriptions. The risk of dying of esophageal cancer was significantly reduced in alendronate users after 3 years OR 0.45 (95% CI: 0.22-0.92) but not after 9 years (OR 1.01; 95% CI: 0.52-1.95). An additional comparison with etidronate users revealed no statistically significant difference in outcomes. In conclusion, we found no excess in esophageal cancer deaths or incidence. The early decrease in esophageal cancer rates may relate to the greater use of endoscopy before starting alendronate. Longer term observations also indicated no excess risk of esophageal cancer death and a significantly decreased risk of gastric cancer death.
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Affiliation(s)
- Bo Abrahamsen
- Department of Medicine F, Gentofte Hospital, Copenhagen, Denmark.
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Jørgensen NR, Husted LB, Skarratt KK, Stokes L, Tofteng CL, Kvist T, Jensen JEB, Eiken P, Brixen K, Fuller S, Clifton-Bligh R, Gartland A, Schwarz P, Langdahl BL, Wiley JS. Single-nucleotide polymorphisms in the P2X7 receptor gene are associated with post-menopausal bone loss and vertebral fractures. Eur J Hum Genet 2012; 20:675-81. [PMID: 22274585 DOI: 10.1038/ejhg.2011.253] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The purinergic P2X7 receptor has a major role in the regulation of osteoblast and osteoclast activity and changes in receptor function may therefore affect bone mass in vivo. The aim of this study was to determine the association of non-synonymous single-nucleotide polymorphisms in the P2RX7 gene to bone mass and fracture incidence in post-menopausal women. A total of 1694 women (aged 45-58) participating in the Danish Osteoporosis Prevention Study were genotyped for 12 functional P2X7 receptor variants. Bone mineral density was determined at baseline and after 10 years. In addition, vertebral fracture incidence was documented at 10 years. We found that the rate of bone loss was clearly associated with the Arg307Gln amino acid substitution such that individuals heterozygous for this polymorphism had a 40% increased rate of bone loss. Furthermore, individuals carrying the Ile568Asn variant allele had increased bone loss. In contrast, the Gln460Arg polymorphism was associated with protection against bone loss. The Ala348Thr polymorphism was associated with a lower vertebral fracture incidence 10 years after menopause. Finally, we developed a risk model, which integrated P2RX7 genotypes. Using this model, we found a clear association between the low-risk (high-P2X7 function) alleles and low rate of bone loss. Conversely, high-risk (reduced P2X7 function) alleles were associated with a high rate of bone loss. In conclusion, an association was demonstrated between variants that reduce P2X7 receptor function and increased rate of bone loss. These data support that the P2X7 receptor is important in regulation of bone mass.
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Affiliation(s)
- Niklas R Jørgensen
- Research Center for Ageing and Osteoporosis, Department of Clinical Biochemistry, Glostrup University Hospital, Glostrup, Denmark.
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Harsløf T, Tofteng CL, Husted LB, Nyegaard M, Børglum A, Carstens M, Stenkjær L, Brixen K, Eiken P, Jensen JEB, Mosekilde L, Rejnmark L, Langdahl BL. Polymorphisms of the peroxisome proliferator-activated receptor γ (PPARγ) gene are associated with osteoporosis. Osteoporos Int 2011; 22:2655-66. [PMID: 21104228 DOI: 10.1007/s00198-010-1491-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Accepted: 10/27/2010] [Indexed: 11/28/2022]
Abstract
UNLABELLED Stimulation of PPARγ turns mesenchymal stem cells into adipocytes instead of osteoblasts. We investigated the effect of polymorphisms in the PPARγ gene on BMD and fracture risk in two Danish cohorts and found opposing effects of certain SNPs and haplotypes in the two cohorts probably owing to environmental factors. INTRODUCTION Stimulation of PPARγ causes development of mesenchymal stem cells to adipocytes instead of osteoblasts leading to decreased osteoblast number and BMD. The aim of this study was to examine the effect of PPARG polymorphisms on BMD and fracture risk in two Danish cohorts: AROS, a case-control population comprising 809 individuals and DOPS, a population comprising 1,716 perimenopausal women allocated to hormone therapy or not at baseline and followed for 10 years. On the basis of linkage disequilibrium between SNPs throughout the gene and previous studies we chose 10 polymorphisms for investigation. METHODS In AROS, individuals heterozygous for the polymorphisms rs12497191, rs4135263, and rs1151999 had an increased risk of vertebral fractures (OR = 1.48-1.76, p = 0.005-0.04) compared with individuals homozygous for the common allele. In DOPS, individuals heterozygous for rs1151999 had an increased BMD at the hip sites (p ≤ 0.02). An interaction between rs1151999 and diet was found on BMD in both cohorts. RESULTS For the polymorphism rs1152003 there was an interaction with body weight on BMD at all sites in both cohorts (p ≤ 0.07). Stratified analyses revealed that in the high weight group in AROS individuals homozygous for the variant allele had a decreased BMD (p ≤ 0.02), whereas the same pattern was found in the low weight group in DOPS (p ≤ 0.03). A number of haplotype associations were found as well, the direction of which was opposite in the two cohorts. CONCLUSION Our study suggests an association SNPs in PPARG and haplotypes thereof and BMD and fracture risk. The effect however appears to be modifiable by environmental factors.
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Affiliation(s)
- T Harsløf
- Department of Endocrinology and Internal Medicine THG, Aarhus University Hospital, 8000, Århus C, Denmark.
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Harsløf T, Husted LB, Nyegaard M, Carstens M, Stenkjær L, Brixen K, Eiken P, Jensen JEB, Børglum AD, Mosekilde L, Rejnmark L, Langdahl BL. Polymorphisms in the ALOX12 gene and osteoporosis. Osteoporos Int 2011; 22:2249-59. [PMID: 21104233 DOI: 10.1007/s00198-010-1472-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 10/22/2010] [Indexed: 12/18/2022]
Abstract
UNLABELLED ALOX12 produces ligands for PPARγ thereby turning mesenchymal stem cells into adipocytes instead of osteoblasts. We investigated the effect of polymorphisms in the ALOX12 gene on BMD and fracture risk in two Danish cohorts and found four polymorphisms and a haplotype thereof to be associated with BMD and fracture risk. INTRODUCTION Stimulation of the PPARγ with ligands produced by the ALOX enzymes drives mesenchymal stem cells in an adipocyte direction at the expense of osteoblasts leading to decreased osteoblast number and BMD. Previously, polymorphisms in the ALOX12 gene have been associated with osteoporosis. METHODS We examined the effect of ALOX12 polymorphisms on BMD and the risk of fractures in two Danish cohorts: AROS, a case-control population comprising 809 individuals and DOPS, a population comprising 1,716 perimenopausal women allocated to hormone therapy or not at baseline and followed for up to 10 years. On the basis of linkage disequilibrium (LD) between SNPs throughout the gene and previous genetic association studies we chose ten polymorphisms for investigation. Genotyping was carried out using the Sequenom MassARRAY genotyping system and TaqMan assays. RESULTS In AROS, individuals heterozygous for the polymorphisms rs3840880, rs9897850, rs2292350 and rs1126667 had a 3.0-4.7% decreased lumbar spine BMD (p = 0.02-0.06) and an increased risk of vertebral fractures (p < 0.05) compared with individuals homozygous for either allele. In DOPS, none of the individual SNPs were associated with BMD or incident fractures. In both cohorts, the above-mentioned SNPs comprised an LD-block (pairwise D´ = 1.0, r (2) = 0.45-0.97). A haplotype comprising all the common alleles (frequency 9%) was associated with decreased bone loss at the hip (p < 0.05) and decreased incidence of osteoporotic fractures (p < 0.05) in DOPS and increased femoral neck BMD in AROS (p < 0.05). CONCLUSION Our study suggests that genetic variants in ALOX12 may influence BMD and fracture risk.
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Affiliation(s)
- T Harsløf
- Department of Endocrinology and Internal Medicine, THG, Aarhus University Hospital, 8000, Aarhus C, Denmark.
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