Avaliação do efeito sinérgico entre risedronato sistêmico e genisteína local sobre o reparo peri-implantar em ratas com deficiência de estrógeno e síndrome metabólica / Evaluation of the synergistic effect between systemic Risedronate and local Genistein on peri-implant repair in strogen deficient rats and metabolic syndrome

O objetivo deste estudo foi investigar a ação sinérgica do risedronato de sódio sistêmico e da genisteína administrada localmente, através da funcionalização de implantes, de ratas submetidas a ovariectomia e com hábitos de mimetizam a síndrome metabólica. A parte in vitro deste estudo foi executado em 2 etapas. Na primeira etapa, foi realizada a funcionalização da superfície de discos/implantes com genistína na concentração de 100 µM pela técnica layer by layer (lbl). Na segunda etapa foram feitos testes biológicos em culturas de células, para avaliar as propriedades da superfície funcionalizada, quanto às respostas osteogênicas. Para a cultura de células foram utilizadas células mesenquimais diferenciadas em osteoblastos, isoladas de fêmures de ratos. Após a validação pelos testes executados nas superfícies funcionalizadas, foi realizado estudo in vivo (3ª etapa). Para tanto, no dia 0, as ratas Wistar adultas jovens, fêmeas (n=64) foram divididas em 4 grupos: 1- SHAM (n= 16), animais foram submetidos à ovariectomia (OVX) fictícia e dieta balanceada. 2- SHAM Síndrome Metabólica (SM) (n=16), animais foram submetidos à ovariectomia fictícia e dieta de cafeteria. 3- OVX SM (n=16), animais foram submetidos à ovariectomia bilateral e dieta de cafeteria. 4- OVX SM Risedronato (RIS) (n=16), animais foram submetidos à ovariectomia bilateral, dieta de cafeteria e tratadas com risedronato de sódio. Em cada grupo há 2 subgrupos: A- implantes convencionais e B- implantes funcionalizados com genisteína. No dia 30, foi iniciado o tratamento medicamentoso com risedronato de sódio, na concentração de 0,35mg/kg, ou apenas solução salina, via gavagem, 1 vez por semana. Passados 60 dias da medicação (dia 90), todos os animais foram submetidos à cirurgia para exodontia dos 1os molares superiores bilateralmente e, imediatamente, no alvéolo da raiz mesial, foi instalado os implantes com superfície convencional ou funcionalizada. Os animais foram eutanasiados aos 28 dias (dia 118) após a instalação dos implantes para mensuração do torque de falha na interface osso implante em N/cm. Os dados foram submetidos ao teste de homocedasticidade (Shapiro Wilk). Houve a confirmação de distribuição normal dos dados amostrais e na sequência, foi realizado o teste paramétrico ANOVA One Way or Two Way, seguido do pós teste de Tukey, com o nível de significância de 5% (p< 0,05). Concluiu-se que, a concentração de 100 µM da genisteína manteve a viabilidade celular e resultados favoráveis quanto a genotoxicidade. A dieta de cafeteria e a ovariectomia bilateral mimetizam a síndrome metabólica e a predisposição para osteoporose por deficiência de esteroides gonadais. E, a ação sinérgica entre fármaco sistêmico (risedronato de sódio) e genisteína local foi promissora para a melhora no processo de reparo periimplantar, principalmente no grupo SHAM e OVX SM RIS(AU)

The aim of this study was to investigate the synergistic action of systemic risedronate sodium and locally administered genistein, through implant functionalization, of rats submitted to ovariectomy and with habits mimicking the metabolic syndrome. The in vitro part of this study was performed in 2 steps. In the first step, the surface functionalization of discs/implants was performed with genistein at a concentration of 100 µM by the layer by layer (lbl) technique. In the second step biological tests were performed in cell cultures to evaluate the properties of the functionalized surface for osteogenic responses. For the cell culture, mesenchymal cells differentiated into osteoblasts, isolated from rat femurs, were used. After validation by tests performed on the functionalized surfaces, the in vivo study (third test) was performed. For this purpose, on day 0, young adult female Wistar rats (n=64) were divided into 4 groups: 1- SHAM (n=16), animals were submitted to sham ovariectomy (OVX) and balanced diet. 2- SHAM Metabolic Syndrome (MS) (n=16), animals were submitted to sham ovariectomy and cafeteria diet. 3- OVX SM (n=16), animals underwent bilateral ovariectomy and cafeteria diet. 4- OVX SM Risedronate (RIS) (n=16), animals underwent bilateral ovariectomy, cafeteria diet and treated with risedronate sodium. In each group there are 2 subgroups: A- conventional implants and B- implants functionalized with genistein. On day 30, drug treatment was started with risedronate sodium, at a concentration of 0.35 mg/kg, or just saline solution, via gavage, once a week. After 60 days of medication (day 90), all animals underwent surgery to extract the 1st upper molars bilaterally, and implants with conventional or functionalized surfaces were immediately installed in the mesial root alveolus. The animals were euthanized at 28 days (day 118) after implant installation to measure the failure torque at the implant-bone interface in N/cm. The data were submitted to the homoscedasticity test (Shapiro Wilk). The normal distribution of the sample data was confirmed and then the parametric One Way or Two Way ANOVA test was performed, followed by Tukey's post-test, with a significance level of 5% (p< 0.05). It was concluded that, the concentration of 100 µM of genistein maintained cell viability and favorable results regarding genotoxicity. The cafeteria diet and bilateral ovariectomy mimic the metabolic syndrome and predisposition to osteoporosis by gonadal steroid deficiency. And, the synergistic action between systemic drug (risedronate sodium) and local genistein was promising for the improvement in the periimplant repair process, especially in the SHAM and OVX SM RIS groups(AU)

Cost-effectiveness of Pharmaceutical Interventions to Prevent Osteoporotic Fractures in Postmenopausal Women with Osteopenia

BACKGROUND: To assess the cost-effectiveness of drug therapy to prevent osteoporotic fractures in postmenopausal women with osteopenia in Korea. METHODS: A Markov cohort simulation was conducted for lifetime with a hypothetical cohort of postmenopausal women with osteopenia and without prior fractures. They were assumed to receive calcium/vitamin D supplements only or drug therapy (i.e., raloxifene or risedronate) along with calcium/vitamin D for 5 years. The Markov model includes fracture-specific and non-fracture specific health states (i.e. breast cancer and venous thromboembolism), and all-cause death. Published literature was used to determine the model parameters. Local data were used to estimate the baseline incidence rates of fracture in those with osteopenia and the costs associated with each health state. RESULTS: From a societal perspective, the estimated incremental cost-effectiveness ratios (ICERs) for the base cases that had T-scores between -2.0 and -2.4 and began drug therapy at the age of 55, 60, or 65 years were $16,472, $6,741, and -$13,982 per quality-adjusted life year (QALY) gained, respectively. Sensitivity analyses for medication compliance, risk of death following vertebral fracture, and relaxing definition of osteopenia resulted in ICERs reached to $24,227 per QALY gained. CONCLUSIONS: ICERs for the base case and sensitivity analyses remained within the World Health Organization's willingness-to-pay threshold, which is less than per-capita gross domestic product in Korea (about $25,700). Thus, we conclude that drug therapy for osteopenia would be a cost-effective intervention, and we recommend that the Korean National Health Insurance expand its coverage to include drug therapy for osteopenia.

Determination method of related substances in risedronate sodium tablets / 药学实践杂志

Objective To establish a HPLC method for determination of related substances of risedronate sodium tab‐lets .Methods The C18 column ,5 μm ,150 mm × 4 .6 mm ,the buffer solution (3 .22 g tetrabutyl ammonium bromide was added to a buffer solution of 1 000 ml 0 .05 mol/L ammonium chloride ,then adjusted pH to 7 .8 ± 0 .05 by ammonia)‐methanol‐aceto‐nitrile =250:50:25 as mobile phase ,column temperature:room temperature ,flow rate:1 .0 ml/min ,detection length:254 nm . Results Determined by HPLC at high temperature ,acid ,alkali degradation ,the main peak and the impurity peaks were separa‐ted well ,and the peaks had a linear relationship ,Y=1 .28 × 107 X-1 .62 × 105 (r=0 .999 9) .Conclusion The method was rap‐id ,simple ,accurate and sensitive ,and suitable for determination of risedronate sodium tablets related substances .

Therapeutic effect of proximal femoral nail antirotation treatment combined with risedronate sodium on intertrochanteric fractures in elderly patients / 中华老年医学杂志

Objective To compare the clinical outcomes between proximal femoral nail antirotation (PFNA) combined with risedronate sodium and isolated PFNA for the treatment of intertrochanteric fractures in elderly patients.Methods Clinical data of 62 elderly patients with intertrochanteric fracture from January 2011 to April 2013 were prospectively studied.Patients were randomly divided into two treatment groups:risedronate sodium group (the combined PFNA and risedronate) and control group (isolated PFNA).According to AO classification,32 patients in risedronate sodium group (15 males and 17 females,with an average age of 78 years) were divided into type A1 (n=10),type A2 (n=18) and type A3 (n=4).30 patients in control group (13 males and 17 females,with an average age of 77.5 years) were divided into type A1 (n=9),type A2 (n=16) and type A3 (n=5).Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry before and 1 year after operation.The hip joint function was assessed by Harris hip score.Complications and subsequent fragility fractures were evaluated postoperatively.Results 60 patients (30 patients in risedronate sodium group and 30 patients in control group) were followed up for at least one year.All fractures were healed at 6 months after surgery.No significant difference was found between the two groups in BMD in contra-lateral hip before treatment [(-2.58±0.41)kg/m2 vs.(-2.56±0.36)kg/m2,P＞0.05].BMD in contra-lateral hip had significant difference between the risedronate sodium and control groups one year after surgery [(-0.66±0.37)kg/m2 vs.(-1.13 ±0.28)kg/m2,P=0.000].There was no significant difference between the two groups in Harris hip score (P=0.238).During the follow-up,no patient in risedronate group suffered from subsequent fragility fracture after surgery,while lumbar compression fracture occurred in 1 case,distal radius fracture occurred in 1 case,the contralateral hip fractures occurred in 2 cases,postoperatively.Conclusions PFNA treatment combined with risedronate sodium can effectively improve BMD and reduce the risk for refracture,and has a good effect on intertrochanteric fracture in elderly patients.

Estudo de biodisponibilidade relativa/bioequivalência de duas formulações de risedronato de sódio em voluntários sadios de ambos os sexos / Study of relative bioavailability/bioequivalence of two formulations of risendronate sodium in healthy volunteers of both sexes

O estudo foi realizado para comparar a biodisponibilidade de duas formulações de risedronato de sódio 35 mg comprimido revestido (risedronato de sódio do Aché Laboratórios Farmacêuticos S/A, formulação teste, e Actonel® da Sanofi-Aventis Farmacêutica Ltda., formulação referência, Brasil) em 80 voluntários de ambos os sexos. O estudo foi aberto, aleatorizado, 2-sequências, 2-períodos, cruzado, dose única com dois tratamentos, nos quais um grupo de voluntários recebeu a formulação teste e outro a formulação referência. As amostras de sangue foram obtidas ao longo de um intervalo de 96 horas. As concentrações de risedronato de sódio foram determinadas através de espectrometria de massa (UPLC-MS-MS), utilizando ácido risedrônico-D4 (risedronato deuterado) como padrão interno. A partir dos dados obtidos se calcularam os seguintes parâmetros farmacocinéticos: ASC0-t, ASC0-¥ e Cmax. A média geométrica de Risedronato de Sódio/Actonel® 35 mg foi de 101,90 % para ASC0-t, 97,95 % para ASC0-¥ e 100,70 % para Cmax. Os intervalos de confiança de 90% foram de 86,43%-120,14%, 83,04%-115,54% e 85,50%-118,61%, respectivamente. Uma vez que os intervalos de confiança de 90% para Cmax e ASC0-t estiveram dentro da faixa de 80%-125% proposta pelo FDA e pela ANVISA (Agência Nacional de Vigilância Sanitária do Brasil), conclui-se que o comprimido de risedronato de sódio de 35 mg foi bioequivalente ao comprimido de Actonel® de 35 mg e, dessa forma, o produto teste pode ser considerado intercambiável na prática médica.

Efficacy and Safety of Risedronate Sodium in Treatment of Postmenopausal Osteoporosis / 华中科技大学学报（医学）（英德文版）

To evaluate the efficacy and safety of risedronate sodium in treatment of postmenopausal osteoporosis, one-year randomized, double blind clinical trial was performed among 54 women with postmenopausal osteoporosis. The changes were compared in bone mineral density (BMD), bone metabolism markers and adverse events after 12 months oral administration of risedronate sodium.BMD was measured by dual energy X-ray absorptionmetry (DEXA) and bone turnover marker was detected. The results showed that there was a significant increase in BMD of the lumbar spine (3.29 % ± 1.18 %, 4. 51% ±1.64 % respectively) after 6 and 12 months in the risedronate treatment group versus placebo control group (-0.62 % ±0.24 %, 0.48 % ±0.18 % respectively).Bone turnover was decreased to a stable nadir over 6 and 12 months for resorption markers [N-Telopeptide (NTx), P＜0. 05] and over 12 months for formation marker (ALP, P＜0.05; BGP, P＜0.05). The safety profile of risedronate sodium was similar to that of placebo. There were no trends toward increased frequency of any adverse experience except for gastrointestinal symptoms (7.1%), rash (7.1%) and hematuria (3.6 %), which were usually mild, transient, and resolved with continued treatment. It was concluded that risedronate was an efficacious and safe drug in treatment of postmenopausal osteoporosis.