Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 60
Filter
2.
Braz. j. med. biol. res ; 52(12): e8754, 2019. tab, graf
Article in English | LILACS | ID: biblio-1055467

ABSTRACT

Cuscuta chinensis Lam. (Convolvulaceae) is an important herbal medicine widely used to improve sexual function, treat osteoporosis, and prevent aging, and has been reported to exhibit anti-osteoporotic effects in vitro. However, the activity of Cuscuta chinensis Lam. on glucocorticoid-induced osteoporosis still remains unclear. The present study aimed to assess the protective effect and the underlying mechanism of action of Cuscuta chinensis extract (CCE) against glucocorticoid-induced osteoporosis in vivo. Sprague-Dawley rats were randomly divided into four groups as follows: control group, osteoporosis group, and 2 CCE-treated osteoporosis groups (100 mg·kg-1·day-1). Blood samples and femur bones were collected for immunohistochemistry, biochemical, mRNA expression, and western blot analysis. HPLC analysis revealed that chlorogenic acid, quercetin, and hyperin were the major constituents of CCE. The results indicated that CCE increased bone length, bone weight, and bone mineral density and suppressed dexamethasone (DEX)-induced reduction in body weight. In addition, TRAP staining indicated that CCE reduced osteoclasts in DEX-induced osteoporosis rats. Mechanistically, CCE treatment alleviated the increase of bone resorption markers and the decline of osteogenic markers, which might be partially mediated by regulation of RANKL/OPG and RunX2 pathways. These results suggest that CCE showed promising effects in the protection against glucocorticoid-induced osteoporosis through protecting osteoblasts and suppressing osteoclastogenesis.


Subject(s)
Animals , Rats , Osteoporosis/prevention & control , Dexamethasone/pharmacology , Plant Extracts/pharmacology , Cuscuta/chemistry , Osteoprotegerin/metabolism , Glucocorticoids/pharmacology , Osteoporosis/chemically induced , RNA, Messenger , Immunohistochemistry , Bone Density/drug effects , Blotting, Western , Chromatography, High Pressure Liquid , Rats, Sprague-Dawley , RANK Ligand/drug effects , RANK Ligand/metabolism , Osteoprotegerin/drug effects
3.
An. acad. bras. ciênc ; 89(4): 2833-2841, Oct.-Dec. 2017. graf
Article in English | LILACS | ID: biblio-886830

ABSTRACT

ABSTRACT Evaluate the effect of the extract of Ginkgo biloba in the bone alkaline phosphatase, bone mineral density, in the mechanical properties of the tibia in rats with glucocorticoid-induced-osteoporosis. After osteoporosis induction, the rats were divided into five groups: Osteoporosis; EGb1 (28 mg/Kg); EGb2 (56 mg/Kg); alendronate (0.2 mg/animal) and control. The animals were treated during 20 and 30 days. The control group was compared with the osteoporosis's (Student's t-test), while the other were analyzed by ANOVA test followed by Tukey/Dunnett'T3 (p<0.05). In the osteoporosis group the bone alkaline phosphatase, bone mineral density, the bone stiffness, the maximum load and the resilience were reduced. The bone alkaline phosphatase values increased in the EGb1 and EGb2 groups (30 days). In addition, in the EGb2 and alendronate groups (20 and 30 days) the bone mineral density increased. The extract of Ginkgo biloba restored bone alkaline phosphatase and bone mineral density using dual-energy x-ray absorptiometry.


Subject(s)
Animals , Female , Rats , Osteoporosis/drug therapy , Plant Extracts/pharmacology , Bone Density/drug effects , Osteoblasts , Osteoporosis/chemically induced , Tibia , Rats, Wistar , Disease Models, Animal , Alkaline Phosphatase/metabolism , Glucocorticoids
4.
Rev. interdisciplin. estud. exp. anim. hum. (impr.) ; 9(único): 21-28, outubro 2017. graf
Article in Portuguese | LILACS | ID: biblio-964837

ABSTRACT

Introdução: Além da indução da osteoporose, os glicocorticoides ocasionam aumento da resistência à insulina e gliconeogênese hepática, tendo como consequência a hiperglicemia. Objetivo: Avaliar comparativamente os efeitos do alendronato de sódio e da atorvastatina cálcica nos níveis séricos de glicose e insulina na osteoporose induzida com dexametasona. Métodos: A indução da osteoporose consistiu na administração de dexametasona na dose de 7,5 mg/kg de peso corporal, uma vez por semana durante 4 semanas, à exceção dos animais do grupo controle (G1). Os animais foram distribuídos nos seguintes grupos: G1 (grupo controle sem osteoporose), G2 (controle com osteoporose sem tratamento), G3 (com osteoporose tratado com alendronato de sódio 0,2 mg/kg) e G4 (com osteoporose tratado com atorvastatina cálcica 1,2 mg/kg). No período de 30 e 60 após o início do tratamento, foram coletadas amostras de sangue para as dosagens dos níveis séricos de glicose e insulina. Resultados: Os grupos G2 e G3, quando comparados com o grupo normal G1, apresentaram aumento da glicemia e insulinemia durante todo o período experimental. O grupo G4 apresentou, com 30 dias, aumento da glicemia e insulinemia e, com 60 dias, aumento da glicemia e queda da insulinemia. Conclusão: Os resultados demonstraram o quadro de hiperglicemia consequente do aumento da resistência à insulina, presentes na indução da osteoporose pela dexametasona. O alendronato de sódio não ocasionou nenhuma melhora da glicemia e insulinemia. A atorvastatina cálcica ocasionou agravamento da hiperglicemia e hiperinsulinemia, potencializando o quadro de resistência à insulina e levando a uma insuficiência relativa de insulina característica do diabetes mellitus tipo 2.


Introduction: In addition to the induction of osteoporosis, glucocorticoids cause increased insulin resistance and hepatic gluconeogenesis resulting in hyperglycemia. Objective: Evaluate the effects of sodium alendronate and atorvastatin calcium on serum glucose and insulin levels in osteoporosis induced by dexamethasone. Methods: The induction of osteoporosis consisted of the administration of dexamethasone at a dose of 7.5 mg / kg body weight, once a week for 4 weeks, except for the control animals (G1). The animals were divided into the following groups: G1 (control group without osteoporosis), G2 (control with untreated osteoporosis), G3 (with osteoporosis treated with sodium alendronate 0.2 mg / kg) and G4 (with osteoporosis treated with atorvastatin calcium 1,2 mg / kg). In the 30 and 60 period after the start of the treatment blood samples were collected for dosages of serum glucose and insulin levels. Results: The G2 and G3 groups, when compared with the normal group G1, presented increased glycemia and insulinemia throughout the experimental period. The G4 group presented a 30-day increase in glycemia and insulinemia and at 60 days increased glycemia and decreased insulinemia. Conclusion: The results demonstrated the hyperglycaemia associated with the increase in insulin resistance present in the induction of osteoporosis by dexamethasone. Sodium alendronate did not cause any improvement in glycemia and insulinemia. Atorvastatin calcium caused worsening of hyperglycemia and hyperinsulinemia enhancing insulin resistance, leading to a relative insufficiency of insulin characteristic of type 2 diabetes mellitus.


Subject(s)
Animals , Rats , Osteoporosis/chemically induced , Dexamethasone/adverse effects , Alendronate/pharmacology , Atorvastatin/pharmacology , Glucose/analysis , Insulin/analysis , Rats, Wistar , Cushing Syndrome , Diabetes Mellitus
5.
Actual. osteol ; 13(2): 125-133, Mayo - Ago. 2017. graf, tab
Article in Spanish | LILACS | ID: biblio-1118076

ABSTRACT

La osteoporosis es un trastorno común en las mujeres posmenopáusicas; sin embargo, también puede afectar a hombres y mujeres jóvenes premenopáusicas. El objetivo del presente trabajo fue evaluar la prevalencia de causas secundarias de baja masa ósea en un grupo de mujeres premenopáusicas que consultaron en una Institución especializada en Osteología. Material y métodos: se realizó un estudio retrospectivo, de corte transversal, descriptivo y observacional. Se analizaron las historias clínicas de 88 pacientes que consultaron por baja masa ósea durante un período de 19 meses, con la finalidad de encontrar posibles causas secundarias. A su vez, se definió como pacientes con diagnóstico de baja masa ósea idiopática aquellas en las cuales no se encontró ninguna causa secundaria de pérdida ósea. Resultados: de las 88 mujeres evaluadas, el 48,9% presentaba al menos una causa secundaria para baja masa ósea (amenorrea secundaria, hipercalciuria, tratamiento con glucorticoides, hipovitaminosis D y enfermedad celíaca) y el 51,1% fueron consideradas idiopáticas. Conclusiones: es esencial evaluar exhaustivamente a las mujeres premenopáusicas con baja masa ósea a fin de descartar posibles causas secundarias y tomar las medidas preventivas necesarias para mejorar esa condición. (AU)


Objective: osteoporosis is a common disorder in postmenopausal women, however it can also affect men and premenopausal young women. The purpose of this study was to evaluate the prevalence of secondary causes of low bone mass in premenopausal women that consulted physicians in an institution specialized in osteology for a period of 19 months. Material and methods: this is a retrospective, transversal, descriptive and observational study. The clinical history of 88 patients who consulted a physician due to low bone mass for a period of 19 months in an institution specialized in osteology. Were analyzed the patient's clinical history in order to find secondary causes. We define as suffering Low Bone Mass those patients who did not have secondary causes. Results: of the 88 women tested, 48,9% had one or more secondary causes or risks factors for low bone mass (secondary amenorrea, hypercalciuria, treatment with glucocorticoids, hypovitamiosis D and celiac disease) and 51,1% patients were considered idiopathic. Conclusions: we conclude that it is essential to exhaustively search for secondary causes of low bone mass in premenopausal women, due to the high prevalence of secondary osteoporosis in this population. (AU)


Subject(s)
Humans , Female , Adult , Young Adult , Osteoporosis/chemically induced , Bone Diseases, Metabolic/complications , Premenopause/metabolism , Osteoporosis/physiopathology , Osteoporosis/prevention & control , Avitaminosis/complications , Bone and Bones/metabolism , Bone Diseases, Metabolic/etiology , Bone Diseases, Metabolic/blood , Fractures, Stress/prevention & control , Celiac Disease/complications , Prevalence , Retrospective Studies , Risk Factors , Cohort Studies , Densitometry , Hypercalciuria/complications , Osteoporotic Fractures/prevention & control , Amenorrhea/complications , Glucocorticoids/adverse effects
6.
Rev. paul. pediatr ; 35(2): 207-215, abr.-jun. 2017. graf
Article in Portuguese | LILACS | ID: biblio-902839

ABSTRACT

RESUMO Objetivo: Descrever os mecanismos pelos quais os glicocorticoides provocam osteoporose, com risco consequente de fraturas, integrando esse conhecimento a uma possível mudança de conduta dos profissionais de saúde. Fontes de dados: Foi realizada pesquisa aprofundada nas bases de dados (SciELO, PubMed, Medline e Scopus), buscando consensos, artigos de revisão, incluindo revisões sistemáticas e meta-análises, publicados em inglês, entre 2000 e 2016. As palavras-chaves utilizadas na busca foram glicocorticoides, esteroides, fraturas, osteoporose, saúde óssea, crianças e adolescentes. Síntese dos dados: A revisão foi dividida em quatro tópicos principais: 1) introdução, com breve enfoque nas fraturas em pediatria; 2) osteoporose em crianças e adolescentes, destacando-a como causa silenciosa de fraturas; 3) glicocorticoides e doença óssea secundária, com a descrição dos mecanismos deletérios desse grupo de esteroides na estrutura óssea; 4) efeitos moleculares do excesso de glicocorticoides no osso, com o detalhamento dos mecanismos nocivos a nível molecular do tecido ósseo. Conclusões: Os glicocorticoides em excesso determinam doença óssea precoce, favorecendo a ocorrência de fraturas. Dessa forma, uma criança ou adolescente que requer corticoterapia, sobretudo crônica e sistêmica, mas também em ciclos repetidos com doses cumulativas altas, necessita de cuidados e orientações relacionados à saúde óssea logo ao início do tratamento. Por outro lado, aqueles com fratura, mesmo entrelaçada a um trauma, podem sinalizar fragilidade óssea subjacente e desconhecida, incluindo a secundária ao uso de glicocorticoides e à deficiência de vitamina D.


ABSTRACT Objective: To describe mechanisms by which glucocorticoids cause osteoporosis, with fracture risk, combining this learning with a possible professional behavior change. Data sources: A systematic search on SciELO, PubMed, Scopus, and Medline databases was carried out for consensus, review articles, including systematic reviews and meta-analysis, which were published in English, between 2000 and 2016. Keywords used on the search were the following: glucocorticoids, fractures, osteoporosis, bone health, vitamin D, children, and adolescents. Data synthesis: The review was divided into four topics: 1) introduction, with a brief focus on pediatric fractures; 2) osteoporosis in children and adolescents, highlighting it as a silent cause of fractures; 3) glucocorticoids and secondary bone disease, describing deleterious mechanisms of this steroids group on bone structure; 4) molecular effects of glucocorticoids excess on bone, with details about the harmful mechanisms on bone molecular level. Conclusions: Glucocorticoids excess determines early bone disease, favoring the occurrence of fractures. Thus, a child or an adolescent who uses glucocorticoids, especially systemically and chronically, but also repeats cycles at high cumulative doses of the medication, needs care and guidance related to bone health at the onset of treatment. On the other hand, the presence of fractures, even if related to trauma, can be a sign of underlying and unknown bone fragility, which may be secondary to the use of glucocorticoids and/or vitamin D deficiency.


Subject(s)
Humans , Child , Adolescent , Osteoporosis/chemically induced , Glucocorticoids/adverse effects , Bone Diseases/chemically induced , Fractures, Spontaneous/chemically induced
7.
Actual. osteol ; 12(2): 107-125, 2016. tab
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1372377

ABSTRACT

La osteoporosis inducida por glucocorticoides (OIC) es la causa más común de osteoporosis secundaria. La pérdida ósea se produce en forma temprana, en los primeros meses siguientes a la introducción de los glucocorticoides (GC), dependiendo de la dosis diaria. La patogénesis es multifactorial y el principal efecto deletéreo es la inhibición de la formación ósea. Los GC inducen fracturas por fragilidad ósea, especialmente en la columna vertebral, y esto genera incapacidad funcional. En los últimos años se han publicado algunas guías internacionales elaboradas por consenso para la prevención y el tratamiento de la OIC. La Sociedad Argentina de Osteoporosis designó a un grupo de trabajo para elaborar una guía propia y actualizada para el diagnóstico, la prevención y el tratamiento de la OIC (GE-OIC-SAO). (AU)


Glucocorticoid-induced osteoporosis (GIO) is the most common cause of secondary osteoporosis. It occurs early, with rapid bone loss in the first few weeks after the initiation of the treatment, with a rate that is dependent mainly on the daily dose. While the pathogenesis is multifactorial, the highest inhibitory effect occurs on bone formation. Glucocorticoids induce fragility fractures, especially in spine, generating functional disability. In recent years, there have been some international guidelines developed by consensus for the prevention and treatment of GIO. The Argentinean Osteoporosis Society appointed a working group to prepare a national guide updating the diagnosis, prevention and treatment of GIO. (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Osteoporosis/diagnosis , Osteoporosis/chemically induced , Osteoporosis/prevention & control , Osteoporosis/drug therapy , Osteoporosis/therapy , Glucocorticoids/adverse effects , Osteogenesis Imperfecta/chemically induced , Osteoporosis/physiopathology , Osteoporosis/epidemiology , Vitamin D/administration & dosage , Calcium/administration & dosage , Practice Guidelines as Topic , Teriparatide/administration & dosage , Densitometry , Diphosphonates/administration & dosage , Vertebroplasty , Osteoporotic Fractures/chemically induced , Glucocorticoids/administration & dosage
8.
Braz. oral res. (Online) ; 29(1): 1-9, 2015. tab, ilus
Article in English | LILACS | ID: lil-777204

ABSTRACT

Patients with bisphosphonate-related osteonecrosis of the jaws (BRONJ) who received intravenous or oral bisphosphonates (BP) were selected for determination of their bone microarchitecture as a risk predictor of BRONJ development. The diagnosis of BRONJ was made based on clinical and radiographic findings. The control group consisted of healthy patients. All patients underwent quantitative and qualitative ultrasound measurements of bone at the hand phalanges carried out using the DBM Sonic BP. Ultrasound bone profile index (UBPI), amplitude-dependent speed of sound (AD-SoS), bone biophysics profile (BBP), and bone transmission time (BTT) were measured. The BRONJ group consisted of 17 patients (62 ± 4.24; range: 45-82); 10 (58.8%) were male and seven (41.1%) were female, of whom 11 (64.7%) suffered from multiple myeloma, three (17.6%) from osteoporosis, one (5.8%) from prostate cancer, one (5.8%) from kidney cancer, and one (5.8%) from leukemia. Fourteen (82.3%) of them received intravenous BP whereas three (17.6%) received oral BP. Nine (9/17; 52.9%) patients developed bone exposure: two in the maxilla and seven in the mandible. Regarding quantitative parameters, Ad-SoS was low in the BRONJ group, but not significant. The UBPI score was significantly reduced in BRONJ patients with exposed bone when compared to controls (0.47 ± 0.12 vs. 0.70 ± 0.15; p = 0.004). The present study demonstrated that quantitative ultrasound was able to show bone microarchitecture alterations in BRONJ patients, and suggests that these analyses may be an important tool for early detection of bone degeneration associated with BRONJ.


Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Bisphosphonate-Associated Osteonecrosis of the Jaw , Finger Phalanges , Analysis of Variance , Bone Density , Bisphosphonate-Associated Osteonecrosis of the Jaw/pathology , Bisphosphonate-Associated Osteonecrosis of the Jaw/physiopathology , Bone Remodeling/physiology , Case-Control Studies , Cross-Sectional Studies , Finger Phalanges/pathology , Finger Phalanges/physiopathology , Hand , Jaw/pathology , Jaw , Multiple Myeloma/pathology , Osteoporosis/chemically induced , Reproducibility of Results , Risk Factors , Time Factors
9.
Indian J Exp Biol ; 2014 Feb; 52(2): 153-158
Article in English | IMSEAR | ID: sea-150344

ABSTRACT

Administration of aqueous extract of T. aestivum (200 and 400 mg/kg/day, po, for 30 days) and risedronate (20 mg/kg, sc, five times a week for 30 days) following methyl prednisolone sodium succinate (10 mg/kg, sc, thrice a week for 4 weeks) induced osteoporosis in Wistar rats showed an increase in the serum levels of bone mineral content markers, decrease in the serum and urinary levels of bone resorption markers. An incline in strength of femur and tibia was seen particularly with 400 mg/kg of T. aestivum. Maintenance of calcium homeostasis, formation of collagen and scavenging of free radicals can plausibly be the mode of action of aqueous extract of T. aestivum thereby combating osteoporosis induced by glucocorticoids.


Subject(s)
Animals , Bone Density/drug effects , Bone Resorption/drug therapy , Bone Resorption/metabolism , Collagen/biosynthesis , Etidronic Acid/administration & dosage , Etidronic Acid/analogs & derivatives , Femur/drug effects , Femur/metabolism , Free Radical Scavengers/administration & dosage , Glucocorticoids/toxicity , Male , Osteoporosis/chemically induced , Osteoporosis/drug therapy , Osteoporosis/pathology , Plant Extracts/administration & dosage , Plant Extracts/chemistry , Prednisolone/administration & dosage , Rats , Tibia/drug effects , Tibia/metabolism , Triticum/chemistry
10.
Araçatuba; s.n; 2014. 126 p. tab, ilus.
Thesis in Portuguese | LILACS, BBO | ID: biblio-870070

ABSTRACT

O objetivo deste estudo foi avaliar o reparo ósseo na interface osso/implante em ratas com osteoporose induzida. As ratas submetidas à ovariectomia bilateral foram alimentadas com uma dieta pobre em cálcio. Dois grupos receberam tratamento medicamentoso (raloxifeno [OVX RAL] ou alendronato [OVX ALE]) e outro grupo não recebeu nenhuma medicação (OVX ST). O grupo controle foi submetido à cirurgia fictícia e foi alimentado com uma dieta normal (SHAM DN). Cada animal recebeu um implante em cada tíbia. Os animais foram eutanasiados após 14 ou 42 dias. Foram realizadas as análises biomecânica (torque reverso), extensão linear de contato osso/implante (ELCOI) e dinâmica óssea periimplantar pela proporção dos fluorocromos calceína/alizarina, aplicando-se a análise de variância ANOVA e o pós-teste de Tukey (p<0,05). A imunoistoquímica marcou a precipitação de osteoprotegerina (OPG), RANKL, TRAP e osteocalcina (OC). O medicamento RAL melhorou o reparo ósseo periimplantar, em que o grupo ALE foi semelhante ao grupo OVX ST. Não houve diferenças estatisticamente significativas no torque reverso (p = 0,861), na precipitação dos fluorocromos (calceína/alizarina) e na ELCOI entre os grupos OVX RAL e grupo controle - SHAM DN (p > 0,05). As imunomarcações de OPG e RANKL foram similares para os grupos RAL e SHAM; houve moderada expressão de OC aos 14 dias. A TRAP foi marcada intensamente aos 42 dias para o grupo OVX. Portanto, o raloxifeno melhorou o reparo ósseo periimplantar de ratas osteoporóticas, sugerindo a sua indicação no tratamento da osteoporose.


The aim of this study was to evaluate the bone healing in bone/implant interface in rats with induced osteoporosis. The rats underwent bilateral ovariectomy were fed a diet low in calcium. Two groups received drug treatment (raloxifene [OVX RAL] or alendronate [OVX ALE]) and the other group received no medication (OVX NT). The control group underwent sham surgery and was fed a normal diet (SHAM ND). Each animal received an implant on the tibia. The animals were euthanized after 14 or 42 days. The biomechanical analysis (reverse torque), linear extension contact bone / implant (BIC) and bone dynamics periimplantar by the proportion of fluorochrome calcein/alizarin, applying the ANOVA and Tukey’s post-test (p<0.05). Immunohistochemistry marked precipitation of osteoprotegerin (OPG), RANKL, TRAP and osteocalcin (OC). The RAL improved drug peri-implant bone repair, wherein the ALE OVX group was similar to the ST group. There were no statistically significant differences in reverse torque (p = 0.861), precipitation of fluorochromes (calcein/alizarin) and BIC between OVX RAL and control groups - SHAM ND (p> 0.05). The immunostaining of OPG and RANKL were similar to RAL and SHAM groups; there was moderate OC expression at 14 days. TRAP was marked intensely at 42 days for the OVX group. Therefore, raloxifene improved peri-implant bone repair of osteoporotic rats, suggesting its indication in the treatment of osteoporosis.


Subject(s)
Animals , Rats , Alendronate/therapeutic use , Raloxifene Hydrochloride/therapeutic use , Bone Density Conservation Agents/therapeutic use , Dental Implants , Microscopy , Osteoporosis/chemically induced , Biomechanical Phenomena/physiology , Ovariectomy/rehabilitation , Rats, Wistar
12.
Article in English | WPRIM | ID: wpr-116726

ABSTRACT

BACKGROUND/AIMS: We investigated differences in identifying candidates for antiosteoporotic treatment in rheumatoid arthritis (RA) patients according to two available clinical guidelines. METHODS: We prospectively enrolled 100 female patients aged 50 years or older with RA who visited Hanyang University Hospital for periodic examinations between April 2011 and August 2011. We applied the glucocorticoid-induced osteoporosis (GIOP) recommendations and the National Osteoporosis Foundation (NOF) guidelines to RA patients and examined agreement between the guidelines for identifying candidates for antiosteoporotic treatment. We also analyzed the impact of screening vertebral fractures (VFs) in determining the treatment of osteoporosis in RA patients. RESULTS: The 57 patients taking glucocorticoids were classified into high-risk (n = 23), medium-risk (n = 16), and low-risk (n = 18) groups according to the GIOP recommendations. Based on the NOF guidelines, 36 of 57 patients were candidates for antiosteoporotic treatment and the agreement between two guidelines was high (kappa = 0.76). Two of the 18 patients in the low-risk group and 19 of 43 patients not eligible per the GIOP recommendations were classified as candidates for antiosteoporotic treatment by the NOF guidelines. CONCLUSIONS: In determining antiosteoporotic treatment for RA patients, using only the GIOP recommendations is insufficient. Application of the NOF guidelines in patients not eligible for or classified into the low-risk group per the GIOP recommendations and screening for VFs may be helpful in deciding on antiosteoporotic treatment in RA patients.


Subject(s)
Aged , Arthritis, Rheumatoid/diagnosis , Bone Density Conservation Agents/therapeutic use , Decision Support Techniques , Female , Glucocorticoids/adverse effects , Hospitals, University , Humans , Middle Aged , Osteoporosis/chemically induced , Osteoporotic Fractures/chemically induced , Patient Selection , Practice Guidelines as Topic , Predictive Value of Tests , Prospective Studies , Republic of Korea , Risk Assessment , Risk Factors , Spinal Fractures/chemically induced
13.
Article in English | WPRIM | ID: wpr-228626

ABSTRACT

Glucocorticosteroid-induced osteoporosis is the most frequent of all secondary types of osteoporosis, and can increase the risk of vertebral compression fractures (VCFs). There are promising additions to current medical treatment for appropriately selected osteoporotic patients. Few studies have reported on the efficiency of percutaneous vertebroplasty (PVP) or kyphoplasty for whole thoracic and lumbar glucocorticosteroid-induced osteoporotic vertebral compression fractures. We report a case of a 67-year-old man with intractable pain caused by successional VCFs treated by PVP.


Subject(s)
Aged , Arthritis, Rheumatoid/drug therapy , Fractures, Compression/diagnostic imaging , Glucocorticoids/adverse effects , Humans , Kyphoplasty , Lumbar Vertebrae/diagnostic imaging , Male , Osteoporosis/chemically induced , Pulmonary Fibrosis/drug therapy , Thoracic Vertebrae/diagnostic imaging , Vertebroplasty
14.
Rev. peru. med. exp. salud publica ; 30(1): 26-30, ene.-mar. 2013. ilus, graf, mapas, tab
Article in Spanish | LIPECS, LILACS, LIPECS | ID: lil-671686

ABSTRACT

Objetivos. Identificar la frecuencia de uso de medicamentos para prevención de osteoporosis inducida por corticoides (OIC) en pacientes que reciben corticoides por un periodo mayor a tres meses y que son afiliados al Sistema General de Seguridad Social en Salud de Colombia. Materiales y métodos. Estudio de tipo transversal. Se utilizó información sobre, las personas afiliadas al Sistema General de Seguridad Social en Salud de Colombia (3,7 millones). Se incluyeron en el trabajo los usuarios de todas las edades y sexos a los cuales se les indicó algún glucocorticoide entre el 1 de agosto y 30 de noviembre de 2011.Se identificaron variables sociodemográficas y las características de prescripción de glucocorticoides y medicamentos para profilaxis de OIC con dosis expresadas en dosis diarias definidas (DDD). Resultados. Se obtuvo una base de datos de 255 568 prescripciones de glucocorticoides, de los cuales 1837 pacientes recibían algún glucocorticoide de manera crónica. Predominaron pacientes de sexo femenino (60,2%), edad promedio de 55,2± 16,9 años distribuidos en 65 ciudades del país. El glucocorticoide más utilizado fue prednisolona en 1546 (84,1%), mientras que el medicamento para profilaxis más prescrito fue calcitriol (67,1%). Se encontraron 994 casos (54,2%) que no estaban recibiendo profilaxis para osteoporosis a pesar de requerirlo. Conclusiones. Existe un bajo empleo de profilaxis para OIC. Se recomienda implementar acciones de farmacovigilancia que permitan identificar problemas relacionados con medicamentos para prevenir eventos adversos y optimizar recursos, anticipándose a la aparición de complicaciones para el paciente.


Objective. To identify the frequency of drug use for the prevention of corticosteroid induced osteoporosis (CIO) among patients using corticosteroids for more than three months affiliated to the General Social Health Security System of Colombia. Materials and methods. Cross-sectional study. Information about people affiliated to the General Social Health Security System of Colombia (3.7 million) was used. This study included men and women of all ages having been prescribed any glucocorticoid from August 1 to November 30, 2011. Sociodemographic variables and the characteristics of of the glucocorticoid prescription and CIO prophylaxis drugs in a defined daily dose (DDD) were identified. Results. A database of 255,568 prescriptions of glucocorticoids was obtained, with a total of 1,837 patients receiving some glucocorticoid chronically. The majority of participants were females (60.2%), with an average age of 55.2± 16.9 years distributed in 65 cities of the country. Prednisolone was the most commonly used glucocorticoid (1,546 patients, 84.1%), whereas the most prescribed prophylaxis drug used was calcitriol (67.1%). Despite the need to receive prophylaxis, 994 cases (54.2%) were not receiving it. Conclusions. There is a poor utilization of CIO prophylaxis. The implementation of drug surveillance actions that allow the identification of problems related to these drugs in order to prevent adverse events and optimize resources is recommended, thus anticipating the emergence of complications in the patients.


Subject(s)
Female , Humans , Male , Middle Aged , Adrenal Cortex Hormones/adverse effects , Drug Prescriptions/statistics & numerical data , Osteoporosis/chemically induced , Osteoporosis/prevention & control , Colombia , Cross-Sectional Studies
15.
Article in English | WPRIM | ID: wpr-148465

ABSTRACT

The risk of osteoporosis or osteopenia is known to increase after childhood cancer treatment. The purpose of this study was to evaluate patterns of bone mineral density (BMD) and to identify factors related to the decreased BMD in childhood cancer survivors. We studied 78 patients (34 boys, 44 girls) treated for childhood cancer. Twenty (25.7%) patients had lumbar BMD (LBMD) standard deviation score (SDS) lower than -2. Nineteen (24.4%) patients had femur neck BMD (FNBMD) SDS lower than -2. The patients treated with hematopoietic stem cell transplantation had lower LBMD SDS (-1.17 +/- 1.39 vs -0.43 +/- 1.33, P = 0.025). The risk of having LBMD SDS < -2 was higher in the patients treated with glucocorticoid (GC) for graft-versus-host disease (GVHD) (36.6% vs 13.5%; odds ratio [OR], 3.7; P = 0.020). In multivariate logistic regression analysis, longer duration of GC treatment for GVHD (OR, 1.12; 95% confidence interval [CI], 1.05-1.20) and lower body mass index (BMI) SDS (OR, 0.59; 95% CI, 0.36-0.95) were associated with decreased LBMD SDS. These findings suggest that prolonged GC use and reduction in BMI are risk factors for decreased BMD in childhood cancer survivors. Anticipatory follow-up and appropriate treatment are necessary, especially for the patients with risk factors.


Subject(s)
Adolescent , Body Mass Index , Bone Density/drug effects , Bone Diseases, Metabolic/chemically induced , Child , Female , Glucocorticoids/adverse effects , Graft vs Host Disease/drug therapy , Hematopoietic Stem Cell Transplantation/adverse effects , Hormones/blood , Humans , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology , Leukemia, Myeloid, Acute/pathology , Male , Osteoporosis/chemically induced , Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology , Risk Factors , Survivors
16.
Arab Journal of Pharmaceutical Sciences. 2013; 4 (10): 47-64
in English, Arabic | IMEMR | ID: emr-139581

ABSTRACT

Long-term glucocorticoid [GC] therapy has been instrumental in decreasing morbidity and mortality in a variety of diseases. One of the most serious side effects of chronic glucocorticoid [GC] therapy is secondary osteoporosis. Recommendations stemmed from international guidelines concerning GC induced osteoporosis [GIOP] are currently inadequately implemented in underdeveloped health care systems. This study aimed at evaluating GC induced osteoporosis [GIOP] prevalence, and implementation of current guidelines in a cohort of Syrian patients undergoing long term systemic GC therapy. This cross-sectional study was conducted in Al Mouassat teaching hospital in Damascus. Patients on GC for over three months were interviewed and their medical records were thoroughly reviewed. Information comprised age, BMI [kg/m[2]], past medical history, underlying disease, smoking, dietary calcium intake, GC indication, past and current dose and duration of GC therapy. Implementation of guidelines was assessed based on bone mineral density [BMD] testing prior to this study, and practice of prevention and treatment of GIOP. BMD at lumbar spine [L2-L4] and femoral neck were prospectively measured using Dual energy X-ray Absorptiometry [DXA]. A total of 81 patients were evaluated [age 42.1 +/- 14.2 years; mean body mass index [BMI] 25.93 +/- 5.01 kg/m[2]; and 74.1% females]. Rheumatoid arthritis, Pemphigus Vulgaris, and Systemic Lupus Erythematous were the top indications for GC prescription. Average duration of GC was 48.0 +/- 14.2 months, and average daily dose was 18.0 +/- 21.07 mg equivalent of prednisolone. Only 33.3% of the patients underwent a previous BMD testing. Bisphosphonate was prescribed for 35.8% of the patients. Despite that 60% of the patients received calcium or vitamin D supplementation, only 2% had calcium intake of > 1000 mg, and 37% received Vit D dose according to guidelines [> 800 IU]. Moreover, prevalence of osteopenia/osteoporosis was as high as 87.7% and 61.7% at lumbar spine and femoral neck, respectively, osteoporosis/osteopenia was similarly prevalent in men and women; however it was higher in older patients [51-70]-year-old, patients with BMI <19 kg/m[2], and inpatients when compared with outpatients [p<0.05]. This study proves the high prevalence of osteoporosis/osteopenia in a cohort of Syrian patients on chronic systemic GC therapy, and reveals that GIOP is overlooked and undertreated. Enforcement of current guidelines is expected to improve GIOP management


Subject(s)
Humans , Male , Female , Glucocorticoids/adverse effects , Osteoporosis/chemically induced , Bone Diseases, Metabolic , Body Mass Index , Absorptiometry, Photon , Health Planning Guidelines , Cross-Sectional Studies , Disease Management
17.
Rev. bras. reumatol ; 52(4): 580-593, jul.-ago. 2012.
Article in Portuguese | LILACS | ID: lil-644630

ABSTRACT

Os glicocorticoides (GC) são prescritos por praticamente todas as especialidades médicas, e cerca de 0,5% da população geral do Reino Unido utiliza esses medicamentos. Com o aumento da sobrevida dos pacientes com doenças reumatológicas, a morbidade secundária ao uso dessa medicação representa um aspecto importante que deve ser considerado no manejo de nossos pacientes. As incidências de fraturas vertebrais e não vertebrais são elevadas, variando de 30%-50% em pessoas que usam GC por mais de três meses. Assim, a osteoporose e as fraturas por fragilidade devem ser prevenidas e tratadas em todos os pacientes que iniciarão ou que já estejam em uso desses esteroides. Diversas recomendações elaboradas por várias sociedades internacionais têm sido descritas na literatura, porém não há consenso entre elas. Recentemente, o Americam College of Rheumatology publicou novas recomendações, porém elas são fundamentadas na FRAX (WHO Fracture Risk Assessment Tool) para analisar o risco de cada indivíduo e, dessa maneira, não podem ser completamente utilizadas pela população brasileira. Dessa forma, a Comissão de Osteoporose e Doenças Osteometabólicas da Sociedade Brasileira de Reumatologia, em conjunto com a Associação Médica Brasileira e a Associação Brasileira de Medicina Física e Reabilitação, implementou as diretrizes brasileiras de osteoporose induzida por glicocorticoide (OPIG), baseando-se na melhor evidência científica disponível e/ou experiência de experts. DESCRIÇÃO DO MÉTODO DE COLETA DE EVIDÊNCIA: A revisão bibliográfica de artigos científicos desta diretriz foi realizada na base de dados MEDLINE. A busca de evidência partiu de cenários clínicos reais, e utilizou as seguintes palavras-chave (MeSH terms): Osteoporosis, Osteoporosis/chemically induced*= (Glucocorticoids= Adrenal Cortex Hormones, Steroids), Glucocorticoids, Glucocorticoids/administration and dosage, Glucocorticoids/therapeutic use, Glucocorticoids/adverse effects, Prednisone/adverse effects, Dose-Response Relationship, Drug, Bone Density/drug effects, Bone Density Conservation Agents/pharmacological action, Osteoporosis/ prevention&control, Calcium, Vitamin D, Vitamin D deficiency, Calcitriol, Receptors, Calcitriol; 1-hydroxycholecalciferol, Hydroxycholecalciferols, 25-Hydroxyvitamin D3 1-alpha-hydroxylase OR Steroid Hydroxylases, Prevention and Control, Spinal fractures/prevention & control, Fractures, Spontaneous, Lumbar Vertebrae/injuries, Lifestyle, Alcohol Drinking, Smoking OR tobacco use disorder, Movement, Resistance Training, Exercise Therapy, Bone density OR Bone and Bones, Dual-Energy X-Ray Absorptiometry OR Absorptiometry Photon OR DXA, Densitometry, Radiography, (Diphosphonates Alendronate OR Risedronate Pamidronate OR propanolamines OR Ibandronate OR Zoledronic acid, Teriparatide OR PTH 1-34, Men AND premenopause, pregnancy, pregnancy outcome maternal, fetus, lactation, breast-feeding, teratogens, Children (6-12 anos), adolescence (13-18 anos). GRAU DE RECOMENDAÇÃO E FORÇA DE EVIDÊNCIA: A) Estudos experimentais e observacionais de melhor consistência; B) Estudos experimentais e observacionais de menor consistência; C) Relatos de casos (estudos não controlados); D) Opinião desprovida de avaliação crítica, com base em consensos, estudos fisiológicos ou modelos animais. OBJETIVO: Estabelecer as diretrizes para a prevenção e o tratamento da OPIG.


Glucocorticoids (GC) are used in almost all medical specialties, and approximately 0.5% of the general population of the United Kingdom receives those medications. With the increased survival of patients with rheumatological diseases, morbidity secondary to the use of those medications represents an important aspect of the management of our patients. The incidences of vertebral and non-vertebral fractures are elevated, ranging from 30% to 50% of the individuals on GC for over three months. Thus, osteoporosis and frailty fractures should be prevented and treated in all patients initiating or already on GC. There are several recommendations on this topic elaborated by several international societies, but consensus still lacks. Recently, the American College of Rheumatology has published new recommendations, but they are based on the WHO Fracture Risk Assessment Tool (FRAX®) to evaluate the risk for each individual, and, thus, cannot be completely used for the Brazilian population. Thus, the Committee for Osteoporosis and Bone Metabolic Disorders of the Brazilian Society of Rheumatology, along with the Brazilian Medical Association and the Brazilian Association of Physical Medicine and Rehabilitation, has elaborated the Brazilian Guidelines for Glucocorticoid-Induced Osteoporosis (GIO), based on the better available scientific evidence and/or expert experience. METHOD OF EVIDENCE COLLECTION: The bibliographic review of scientific articles of this guideline was performed in the MEDLINE database. The search for evidence was based on real clinical scenarios, and used the following keywords (MeSH terms): Osteoporosis, Osteoporosis/ chemically induced*= (Glucocorticoids= Adrenal Cortex Hormones, Steroids), Glucocorticoids, Glucocorticoids/administration and dosage, Glucocorticoids/therapeutic use, Glucocorticoids/adverse effects, Prednisone/adverse effects, Dose-Response Relationship, Drug, Bone Density/drug effects, Bone Density Conservation Agents/pharmacological action, Osteoporosis/prevention & control, Calcium, Vitamin D, Vitamin D deficiency, Calcitriol, Receptors, Calcitriol; 1-hydroxycholecalciferol, Hydroxycholecalciferols, 25-Hydroxyvitamin D3 1-alpha-hydroxylase OR Steroid Hydroxylases, Prevention and Control, Spinal fractures/prevention & control, Fractures, Spontaneous, Lumbar Vertebrae/injuries, Lifestyle, Alcohol Drinking, Smoking OR tobacco use disorder, Movement, Resistance Training, Exercise Therapy, Bone density OR Bone and Bones, Dual-Energy X-Ray Absorptiometry OR Absorptiometry Photon OR DXA, Densitometry, Radiography, (Diphosphonates Alendronate OR Risedronate Pamidronate OR propanolamines OR Ibandronate OR Zoledronic acid, Teriparatide OR PTH 1-34, Men AND premenopause, pregnancy, pregnancy outcome maternal, fetus, lactation, breast-feeding, teratogens, Children (6-12 years), adolescence (13-18 years). GRADE OF RECOMMENDATION AND LEVEL OF EVIDENCE: A) Data derived from more consistent experimental and observational studies; B) Data derived from less consistent experimental and observational studies; C) Case reports (uncontrolled studies); D) Expert opinion without explicit critical appraisal, or based on consensus, physiological studies or animal models. OBJECTIVE: To establish guidelines for the prevention and treatment of GIO.


Subject(s)
Humans , Glucocorticoids/adverse effects , Osteoporosis/chemically induced , Osteoporosis/therapy , Osteoporosis/prevention & control
18.
Actual. osteol ; 8(2): 79-85, mayo-ago. 2012. ilus
Article in Spanish | LILACS | ID: lil-658656

ABSTRACT

En los últimos años ha crecido el conocimiento sobre el papel de la serotonina en el recambio óseo. Parece haber un efecto dual, con la serotonina cerebral ejerciendo un efecto anabólicosobre el hueso y la serotonina intestinalfrenando la función osteoblástica, pero han surgido controversias recientes al respecto.Los inhibidores selectivos de la recaptación de serotonina, ampliamente usados para tratar desórdenes afectivos, inducen osteopenia y aumentan el riesgo de fracturas. Se abre la posibilidad de intervenir farmacológicamente para modular la producción de serotonina intestinal como eventual tratamiento de la osteoporosis, pero falta todavía recorrer un largo camino para trasladar los hallazgos básicos a la clínica.


Subject(s)
Humans , Male , Female , Antidepressive Agents/adverse effects , Fractures, Bone/chemically induced , Serotonin Uptake Inhibitors/adverse effects , Osteoblasts , Osteoporosis/etiology , Osteoporosis/chemically induced , Risk Factors , Serotonin/adverse effects
19.
J. pediatr. (Rio J.) ; 87(1): 4-12, jan.-fev. 2011.
Article in Portuguese | LILACS | ID: lil-576122

ABSTRACT

OBJETIVO: Revisar os mecanismos de ações dos glicocorticoides e sua capacidade de induzir osteoporose e déficits de crescimento. FONTES DOS DADOS: A revisão bibliográfica de artigos científicos foi realizada na base de dados MEDLINE e utilizou as palavras-chave agrupadas nas sintaxes “glicocorticoides”, “mineralização óssea”, “crescimento” e “efeitos colaterais”, nos últimos 10 anos, e das referências destes nos reportamos para as publicações mais antigas, mas com os estudos fundamentais para a compreensão do assunto. SÍNTESE DOS DADOS: Destacam-se ações dos glicocorticoides sobre hormônios e citocinas responsáveis pelo crescimento longitudinal. Os efeitos finais dos glicocorticoides sobre o esqueleto são determinados por ações sistêmicas no metabolismo ósseo e por ações diretas desses esteroides nas células ósseas, levando a mudanças no número e função das mesmas e favorecendo a perda óssea. Discutem-se os mecanismos indutores da recuperação dos canais de crescimento e recuperação da massa óssea após a descontinuação dos glicocorticoides; os métodos diagnósticos do metabolismo e mineralização óssea; assim como medidas terapêuticas e preventivas das alterações óssea induzidas pelos glicocorticoides. CONCLUSÃO: A monitorização de cada paciente é essencial para identificação e potencial reversão dos danos associados ao uso crônico de glicocorticoides.


OBJECTIVE: To review the various mechanisms of glucocorticoid action and the ability of these agents to induce osteoporosis and growth deficits. SOURCES: A review of the scientific literature was conducted on the basis of a MEDLINE search using the keywords and descriptors “glucocorticoids,” “bone mineralization,” “growth,” and “side effects” and limited to articles published in the last decade. The references cited by these articles were used to identify relevant older publications, with an emphasis on landmark studies essential to an understanding of the topic. SUMMARY OF THE FINDINGS: Emphasis was placed on the actions of glucocorticoids on the hormones and cytokines that modulate linear growth. The end effects of glucocorticoids on the skeletal system are the result of systemic effects on bone metabolism and of direct actions on bone cells, which alter bone cell counts and predispose to bone loss. The mechanisms underlying catch-up growth and bone mass recovery after discontinuation of glucocorticoid treatment are discussed, followed by a review of diagnostic methods available for assessment of bone metabolism and mineralization and of measures for prevention and management of glucocorticoid-induced bone changes. CONCLUSION: Patient monitoring on a case-by-case basis plays an essential role in detection and, potentially, reversal of the damage associated with chronic glucocorticoid therapy.


Subject(s)
Adolescent , Adult , Female , Humans , Male , Bone Density/drug effects , Bone Development/drug effects , Glucocorticoids/adverse effects , Osteoporosis/chemically induced , Fractures, Bone/chemically induced , Fractures, Bone/metabolism , Osteoporosis/metabolism , Risk Factors
20.
Arq. bras. endocrinol. metab ; 54(2): 133-142, Mar. 2010. ilus, tab
Article in English | LILACS | ID: lil-546255

ABSTRACT

There is a high prevalence of osteoporosis in HIV-infected patients. Initially described in HIV-positive men, studies have also demonstrated a high prevalence of osteoporosis in HIV-infected women. It would appear that antiretroviral therapy (ART) plays an important role in the pathogenesis of osteoporosis in HIV-infected patients, although little is known about its importance in relation to osteoporosis and fractures in HIV-positive women. The aim of this systematic review was to evaluate the frequency of bone loss, bone mineral density (BMD) and fractures in HIV-positive women taking ART or protease inhibitors (PI). After screening 597 citations from the databases of PubMed, EMBASE and Lilacs, five studies were selected for the review. A difference was demonstrated of over 3 percent in the BMD at the femoral neck of HIV-positive women taking PI/ART. No difference was registered in the BMD at the lumbar spine between users and non-users of PI/ART. The lack of studies has made it impossible to reach any conclusion regarding the occurrence of fractures.


A prevalência de osteoporose é elevada em indivíduos infectados pelo HIV. Inicialmente descrita em homens HIV-positivos, estudos demonstraram alta prevalência de osteoporose também em mulheres HIV-positivas. A terapia antirretroviral parece exercer papel importante na patogênese da osteoporose dos indivíduos com HIV. Pouco se sabe sobre sua importância para a osteoporose e fraturas nas mulheres HIV-positivas. Esta revisão objetivou avaliar a frequência de perda de massa óssea, densidade mineral óssea (DMO) e fraturas em mulheres HIV-positivas em uso de terapia antirretroviral (TARV) ou inibidores de protease (IP). Após busca nos bancos de dados PubMed, EMBASE e Lilacs, de 597 citações, cinco estudos permaneceram na revisão. Demonstrou-se haver uma diferença superior a 3 por cento na DMO no colo do fêmur de mulheres HIV-positivas em uso de IP/TARV. Não se evidenciou diferença na DMO da coluna lombar entre usuárias e não usuárias de IP/TARV. A escassez de estudos impossibilitou qualquer conclusão sobre a ocorrência de fraturas.


Subject(s)
Humans , Male , Female , Anti-HIV Agents/adverse effects , Bone Density/drug effects , HIV Infections/drug therapy , Osteoporosis/chemically induced , Clinical Trials as Topic , Meta-Analysis as Topic
SELECTION OF CITATIONS
SEARCH DETAIL