Effectiveness of bisphosphonate combined with activated vitamin D in patients with aromatase inhibitor-induced osteoporosis after breast cancer operation

OBJECTIVES: We compared the effectiveness of bisphosphonates combined with activated vitamin D administered for therapy of aromatase inhibitor-induced osteoporosis after a breast cancer operation and primary postmenopausal osteoporosis through propensity score matching. METHODS: Forty-eight postmenopausal patients with estrogen receptor-positive early breast cancer, who had postoperative adjuvant treatment with aromatase inhibitors and whose T-score of bone mineral density (BMD) decreased below −2.5 (AI group), and 48 patients of primary postmenopausal osteoporosis (PO group) enrolled in this retrospective observational study. They were administered monthly risedronate or minodronate, and daily alfacalcitol or eldecalcitol were combined. Their BMD (L2–4, L-BMD), serum-corrected calcium, serum phosphate, tartrate-resistant acid phosphatase 5b (TRACP-5b), bone alkaline phosphatase (BAP), estimated glomerular filtration rate, urine calcium/creatinine ratio, intact-parathyroid hormone, and 25-hydroxy vitamin D were measured before treatment and until 24 months. RESULTS: L-BMD values increased with time compared with the baseline values in each group, and there was no significant difference in the groups. Percentage value of TRACP-5b decreased rapidly after 6 months and maintained low level until 24 months in both groups. Percentage value of BAP in the AI group decreased continuously until 24 months. In contrast, the percentage change in the PO group plateaued after 6 months. CONCLUSIONS: It is suggested that monthly oral bisphosphonate combined with activated Vitamin D is an effective therapy to increase BMD in the aromatase inhibitor-induced osteoporosis after breast cancer operation. Monitoring of kidney function and concentration of Ca in blood and urine may be necessary.

Comparison of effectiveness and safety of ibandronate and minodronate combined with eldecalcitol in primary osteoporosis of women: A 1-year follow-up study

OBJECTIVES: This is an open labeled and retrospective cohort study which compared the effectiveness and safety of ibandronate (IBN) and minodronate (MIN) combined with eldecalcitol (ELD) in primary osteoporosis of women. METHODS: One hundred and forty-eight primary osteoporotic women were classified into 3 groups; 1) intravenous IBN combined with oral ELD (IBN + ELD group, N = 50; 81.8 ± 6.2 years), 2) oral MIN combined with oral ELD (MIN + ELD group, N = 50; 77.2 ± 6.9 years) and 3) oral ELD alone (ELD group, N = 48; 75.0 ± 8.3 years). For statistical analysis, L-BMD, H-BMD, serum corrected Ca, serum iP, intact-PTH, TRACP-5b, BAP, serum Hcy, eGFR and urine Ca/Cr ratio were measured until 12 months after the start of therapy. RESULTS: L-BMD values increased significantly in both IBN + ELD and MIN + ELD group, however, H-BMD increased significantly in the IBN + ELD group only. TRACP-5b values decreased rapidly during the first 6 months in both IBN + ELD and MIN + ELD group. However, BAP value in the IBN + ELD group decreased more gradually compared with that in the MIN + ELD group. Both serum Ca value and urine Ca/Cr ratio tended to increase, and the eGFR value decreased significantly in each group. CONCLUSIONS: IBN combined with ELD administration can act more effectively to increase BMD compared with MIN combined with ELD administration. Differences of decreasing rate in TRACP-5b and BAP value may lead to differences of increased rate of BMD in the IBN + ELD and MIN + ELD group. Because many cases of osteoporosis are elderly persons associated with chronic kidney disease, monitoring of kidney function and concentration of Ca in blood and urine is essential.

The cause of failure to return to the pre-fracture place of residence and solution to continue medical treatment for osteoporosis following an operation for hip fracture - Periodic observation of single center

The purpose of this study was to investigate the causes of failure to return to the pre-fracture place of residence at hospital discharge following an operation for a hip fracture and to continue medical treatment for osteoporosis. Herein, we discuss methods for improving discharge protocols for these patients. We examined patients who sustained osteoporotic fractures and were operated on for a hip fracture between 2001 and 2003 (83 males and 386 females; 81.2 ± 9.0 years old) and between 2011 and 2013 (121 males and 462 females; 83.1 ± 9.3 years old). In a follow-up study, we examined patients who moved into our related rehabilitation institution over a 3-year period, from 2011 to 2013. The incidence of hip fractures had increased from 2001-2003 to 2011-2013 in both genders, and it tended to increase in patients greater than 80 years of age in male and 90 years of age in female. The most common destination residence after discharge from the rehabilitation institution was the pre-fracture place of residence. The Barthel Index at discharge from the rehabilitation institution was significantly lager in patients who returned to the pre-fracture place of residence compared to those who returned to nursing home and our hospital. These results suggest improved mobility and ADL level of patients enable them to return to the pre-fracture place of residence. We propose the construction of a feedback system that aids in a medical pass to increase the ambulant consultation rate for orthopedics and prevent fragile fractures.