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1.
Medicina (B.Aires) ; 81(5): 749-753, oct. 2021. graf
Article in English | LILACS | ID: biblio-1351046

ABSTRACT

Abstract Anabolic drugs are the treatment of choice for osteoporotic patients with very high risk of fractures. Post anabolic treatment with an antiresorptive drug maintains the bone mineral density (BMD) gained. The recommendations regarding the ideal antiresorptive drug are not precise. The aim of this paper is to compare the usefulness of zoledronate and denosumab in a group of 28 women with very high risk of fractures. All of them completed at least one year of treatment with teripatide and latter 14 received zolendronate and 14 denosumab for another year. We retrospectively review their biochemical and densitometric changes. Both treat ment groups experienced a reduction in bone turnover markers of the same magnitude at the end of the second year. In Lumbar Spine BMD increase of 3.96 ± 8.56% Median (Me) 2.54 p = 0.21 in zolendronate group and 3.55 ± 5.36% (Me 5.14) p = 0.07 in denosumab group. Femoral Neck BMD changed -0.09 ± 6.50% (Me 0.29) p = 0.85 in zolendronate group, and - 3.41 ± 5.08% (Me 5.35) p = 0.59 in denosumab group, with no difference between both groups. In Total Hip BMD an increase of 0.55 ± 4.20% (Me 0.43) p = 0.70 in zoledronate group, and 4.53 ± 5.13% (Me 0.64) p = 0.04 with denosumab. We conclude that both antiresortive treatments have a similar effect in biochemical markers after one year of treatment. BMD increase significantly in total hip and changed with a trend toward in lumbar spine with denosumab, but without differences between both groups of treatment.


Resumen Los anabólicos son el tratamiento de elección en la osteoporosis con muy alto riesgo de fracturas. Después del tratamiento anabólico un fármaco antirresortivo mantiene la densidad mineral ósea (DMO) ganada. Las reco mendaciones sobre el fármaco antirresortivo ideal no son precisas. El objetivo de este trabajo es comparar la utilidad de zoledronato y denosumab en un grupo de 28 mujeres con muy alto riesgo de fracturas. Todas ellas completaron al menos un año de tratamiento con teripatide y luego 14 recibieron zolendronato y 14 denosumab durante un año. Revisamos retrospectivamente sus cambios bioquímicos y densitométricos. Ambos grupos de tratamiento experimentaron una reducción de los marcadores de recambio óseo de la misma magnitud al final del segundo año. En columna lumbar la DMO aumentó 3.96 ± 8.56% Mediana (Me) 2.54, p = 0.21 en el grupo zolendronato y 3.55 ± 5.36% (Me 5.14) p = 0.07 en el grupo denosumab. La DMO del cuello femoral cambió -0.09 ± 6.50% (Me 0.29) p = 0.85 en el grupo zolendronato y - 3.41 ± 5.08% (Me 5.35) p = 0.59 en el grupo de denosumab, sin diferencias entre ambos grupos. En la Cadera Total la DMO aumentó 0.55 ± 4.20% (Me 0.43) p = 0.70 con zoledronato y 4.53 ± 5.13% (Me 0.64) p = 0.04 con denosumab. Concluimos que ambos tratamien tos antiresortivos tuvieron un efecto similar en los marcadores bioquímicos después de un año de tratamiento. La DMO aumentó significativamente en la cadera total y mostró una tendencia similar en columna lumbar con denosumab, sin diferencias entre ambos tratamientos.


Subject(s)
Humans , Female , Teriparatide/therapeutic use , Bone Density Conservation Agents/therapeutic use , Bone Density , Retrospective Studies , Denosumab/therapeutic use
2.
Article in Portuguese | LILACS, ColecionaSUS, CONASS, SES-GO | ID: biblio-1151190

ABSTRACT

Tecnologia: Teriparatida, comparada a bifosfonados orais ou Raloxifeno. Indicação: prevenção de fraturas em pessoas com osteoporose. Pergunta: A Teriparatida é mais eficaz e segura que os bifosfonados orais ou o Raloxifeno para tratamento da osteoporose e prevenção de fraturas secundárias à osteoporose? Métodos: Levantamento bibliográfico foi realizado na base de dados PUBMED, seguindo estratégias de buscas predefinidas. Foi feita avaliação da qualidade metodológica das revisões sistemáticas com a ferramenta Assessing the Methodological Quality of Systematic Reviews version 2 (AMSTAR-2). Resultados: Foram selecionadas 2 revisões sistemáticas, que atendiam aos critérios de inclusão. Conclusão: Para a população em geral com osteoporose, a Teriparatida evita mais fraturas vertebrais que o Alendronato de sódio ou Risedronato de sódio, mas efeito similar para fraturas não vertebrais. Teriparatida previne mais fraturas vertebrais e não vertebrais que Raloxifeno. Teriparatida tem maior efeito sobre a massa óssea corporal que o Risedronato de sódio e o Raloxifeno, mas tem efeito similar ao Alendronato de sódio. Na população masculina com osteoporose, a terapia com bifosfonados orais é mais eficaz que suplementação nutricional ou placebo para prevenir fraturas. Já o tratamento com Teriparatida não é mais eficaz que a suplementação nutricional ou placebo


Teriparatide compared to oral bisphosphonates or Raloxifene. Indication: prevention of fractures in people with osteoporosis. Question: Is Teriparatide more effective and safer than oral bisphosphonates or Raloxifene for treating osteoporosis and preventing fractures secondary to osteoporosis? Methods: Bibliographic survey was carried out in the PUBMED database, following predefined search strategies. Evaluation of the methodological quality of systematic reviews was carried out using the tool Assessing the Methodological Quality of Systematic Reviews version 2 (AMSTAR-2). Results: Two systematic reviews were selected, which met the inclusion criteria. Conclusion: For the general population with osteoporosis, Teriparatide prevents more vertebral fractures than Alendronate or Risedronate sodium, but has similar effect for non-vertebral fractures. Teriparatide prevents more vertebral and non-vertebral fractures than Raloxifene. Teriparatide has a greater effect on body bone mass than Risedronate sodium and Raloxifene, but it has a similar effect to Alendronate sodium. In the male population with osteoporosis, oral bisphosphonates is more effective than nutritional supplementation or placebo to prevent fractures. Treatment with teriparatide is no more effective than nutritional supplementation or placebo


Subject(s)
Humans , Teriparatide/therapeutic use , Raloxifene Hydrochloride/therapeutic use , Diphosphonates/therapeutic use , Osteoporotic Fractures/drug therapy , Efficacy , Spinal Fractures/drug therapy , Alendronate/therapeutic use , Evidence-Based Medicine , Risedronic Acid/therapeutic use , Denosumab/therapeutic use , Hip Fractures/drug therapy
3.
Actual. osteol ; 15(2): 94-102, mayo - ago. 2019. tab.
Article in Spanish | LILACS | ID: biblio-1048478

ABSTRACT

El propósito de la terapia en el desorden del metabolismo óseo mineral asociado a la enfermedad renal crónica (IRC) consiste en restaurar el balance mineral, y, en la osteoporosis, mantener o aumentar la masa ósea. Ambas terapias tratan de evitar la fractura ósea. La mayoría de los osteoactivos están contraindicados en la insuficiencia renal crónica avanzada (estadios 4 y 5), y las terapias son empíricas. Algunos autores opinan que sin anomalías bioquímicas del desorden del metabolismo óseo mineral asociado a la enfermedad renal crónica avanzada se podría intentar el tratamiento estándar para la osteoporosis. Antes de intentar la terapia osteoactiva se debe corregir el desorden mineral óseo que pudiera presentarse asociado a la IRC, y en la indicación del tipo de osteoactivo se sugiere seleccionar al paciente según su estado óseo. Se aconseja que la administración de los antirresortivos se realice a dosis menores con respecto a los que tienen mejor función renal junto con aportes adecuados de calcio y vitamina D, antes y durante el tratamiento para prevenir el riesgo de severas hipocalcemias y un efecto óseo excesivo. Se presenta el caso clínico de una mujer de 65 años, con diagnóstico de osteoporosis de etiología multifactorial, fractura de pelvis, múltiples fracturas vertebrales e insuficiencia renal crónica avanzada, entre otras comorbilidades, y probable enfermedad ósea adinámica. Recibió inicialmente terapia con teriparatide y luego con denosumab, complicándose con hipocalcemia asintomática. (AU)


The purpose of therapy for the bone mineral metabolism disorder associated with chronic kidney disease is to restore the mineral balance; and to maintain or increase bone mass in osteoporosis. The goal of both types of therapy is to avoid bone fractures. Most antiosteoporotic drugs are contraindicated in advanced chronic renal failure (CRF) stages 4 and 5, and the therapies are empirical. Some authors believe that without biochemical abnormalities of the mineral bone metabolism disorder associated with advanced chronic kidney disease, standard treatment for osteoporosis could be attempted. Before attempting antiosteoporotic therapy, the bone mineral disorder that may be associated with CRF must be corrected, and in the indication of the type drug it is suggested that the patient be selected according to their bone status. It is advised that the administration of anti-resorptives be performed at lower doses in individuals with poor renal function compared to those with better renal function together with adequate calcium and vitamin D, before and during treatment to prevent the risk of severe hypocalcemia, and an excessive bone effect. We present the clinical case of a 65-year-old woman with a diagnosis of osteoporosis of multifactorial etiology, pelvic fracture, multiple vertebral fractures and advanced chronic renal failure, among other comorbidities and probable adynamic bone disease. The patient received initial therapy with teriparatide and followed by denosumab administration and exhibited asymptomatic hypocalcemia. (AU)


Subject(s)
Humans , Female , Aged , Chronic Kidney Disease-Mineral and Bone Disorder/drug therapy , Fractures, Bone/prevention & control , Osteoporosis/therapy , Chronic Kidney Disease-Mineral and Bone Disorder/complications , Chronic Kidney Disease-Mineral and Bone Disorder/metabolism , Chronic Kidney Disease-Mineral and Bone Disorder/therapy , Vitamin D/administration & dosage , Vitamin D/therapeutic use , Calcium/administration & dosage , Calcium/therapeutic use , Alendronate/therapeutic use , Teriparatide/administration & dosage , Teriparatide/adverse effects , Teriparatide/therapeutic use , Diphosphonates/administration & dosage , Diphosphonates/adverse effects , Diphosphonates/therapeutic use , Cinacalcet/therapeutic use , Risedronic Acid/therapeutic use , Denosumab/administration & dosage , Denosumab/adverse effects , Denosumab/therapeutic use , Hypocalcemia/prevention & control
4.
s.l; RedARETS; ago. 2019. tab.
Non-conventional in Spanish | LILACS, BRISA | ID: biblio-1095359

ABSTRACT

CONTEXTO: La osteoporosis es un trastorno esquelético caracterizado por resistencia óssea comprometida, predisposición pacientes a un mayor riesgo de fractura. La prevalência aumenta del 6% de las mujeres de edad 50 a 59 años a más del 40% de las mujeres de edad 80 años y mayores.1 Consecuencias de mantener una fractura puede ser grave e incluir un aumento riesgo de fracturas posteriores, hospitalización o institucionalización, disminución de la calidad de vida, y mortalidad prematura, con una carga relacionada com el sistema de salud. DESCRIPCIÓN DE LA TECNOLOGÍA: El denosumab es un anticuerpo monoclonal que inhibe la resorción ósea producida por los osteoclastos. Fue comercializado en 2010 para el tratamiento de la osteoporosis. En estos años se han identificado varios efectos adversos potencialmente graves: predisposición a infecciones, cáncer, reacciones de hipersensibilidad, transtornos autoinmunes, e incremento de la incidencia de múltiples fracturas vertebrales espontáneas al suspender el tratamiento. En este número revisamos estas novedades. TECNOLOGÍAS ALTERNATIVAS: Los agentes antirresortivos como los bifosfonatos orales son el estándar tratamiento para la osteoporosis posmenopáusica, en conjunto con medidas no farmacológicas y sobre todo el énfasis en la prevención de las caídas. Otras opciones de tratamiento incluyen un bisfosfonatos intravenoso (ácido zoledrónico), un agente formador de hueso (teriparatida) y un modulador selectivo del receptor de estrógeno (raloxifeno). MÉTODOS: Se realizó una búsqueda bibliográfica utilizando las siguientes bases de datos bibliográficas: MEDLINE, EMBASE, The Cochrane Library, y PubMed. Aplicaron filtros metodológicos para evaluaciones de tecnología sanitaria, estudios económicos, revisiones sistemáticas, metanálisis, y ensayos controlados aleatorios (ECA). La búsqueda también se limitó a Idioma en Inglés y humanos. Se excluyeron los resúmenes de congresos en los resultados de búsqueda. Se identificó la literatura gris (literatura que no se publica comercialmente) fue identificado mediante la búsqueda de secciones relevantes de la Lista de verificación de Grey Matters (http://www.cadth.ca/en/resources/grey-matters). Google y otros motores de búsqueda de internet fueron se utiliza para buscar en la web adicional materiales Estas búsquedas se complementaron con revisar las bibliografías de documentos clave y a través de contactos con expertos apropiados. ESTRATEGIA DE BÚSQUEDA: Se realizó una búsqueda con última fecha 26/08/2019 en diversas bases de datos, incluidas PubMed y Embase, así como la biblioteca Cochrane, ClinicalTrials.gov y bases de datos de revisiones sistematicas Epistemonikos. La búsqueda sólo incluyó documentos escrito en ingles y espanol. RESULTADOS: Denosumab comparado con placebo para pacientes con osteoporosis. El riesgo en el grupo de intervención (y su intervalo de confianza del 95%) se basa en el riesgo asumido en el grupo de comparación y en el efecto relativo de la intervención (y su intervalo de confianza del 95%). Eficacia frente a bifosfonatos: comparaciones directas. Se evalúa el perfil de evidencia GRADE donde se evidencia el metaanálisis entre cuatro ECA 5-8 que comprendieron 2071 participantes con un rango de seguimiento de 12 a 24 meses y compararon el uso de Denosumab con bifosfonatos orales (Alendronato,Etidronato). Existe incertidumbre en el efecto de denosumab sobre el riesgo de fracturas en comparación con bifosfonatos. La certeza em la evidencia va desde BAJA A MUY BAJA considerando la presencia de imprecisión muy seria y el potencial riesgo de sesgo de publicación. Eficacia frente a bifosfonatos: comparaciones indirectas. No se han encontrado en la literatura comparaciones directas entre Denosumab y otros fármacos distintos. Esta recomendación de cobertura otorga más peso a la incertidumbre en la eficacia comparada con bifosfonatos, al potencial impacto presupuestario de su uso y la potencial reducción de la equidad; que a la preferencia de los pacientes respecto de la forma de administración de las drogas para osteoporosis.


Subject(s)
Humans , Female , Osteoporosis, Postmenopausal/drug therapy , Teriparatide/therapeutic use , Raloxifene Hydrochloride/therapeutic use , Diphosphonates/therapeutic use , Osteoporotic Fractures/drug therapy , Denosumab/therapeutic use , Zoledronic Acid/therapeutic use , Technology Assessment, Biomedical , Cost-Benefit Analysis/economics
5.
J. bras. nefrol ; 41(2): 304-305, Apr.-June 2019. graf
Article in English | LILACS | ID: biblio-1012531

ABSTRACT

Abstract Mineral bone disorder is a common feature of chronic kidney disease. Lion face syndrome is rare complication of severe hyperparathyroidism in end-stage renal disease patients, which has been less commonly reported due to dialysis and medical treatment advances in the last decade. The early recognition of the characteristic facial deformity is crucial to prompt management and prevent severe disfigurement. The authors present a rare case of severe hyperparathyroidism presenting with lion face syndrome and bone fractures.


Resumo O distúrbio mineral e ósseo é uma característica comum da doença renal crônica. A síndrome da face leonina é uma complicação rara do hiperparatireoidismo grave em pacientes com doença renal terminal, que tem sido menos relatada devido aos avanços na diálise e tratamento médico na última década. O reconhecimento precoce da deformidade facial característica é crucial para estimular o tratamento precoce e prevenir a desfiguração severa. Os autores apresentam um caso raro de hiperparatireoidismo grave, apresentando síndrome da face leonina e fraturas ósseas.


Subject(s)
Humans , Female , Adult , Chronic Kidney Disease-Mineral and Bone Disorder/complications , Hyperostosis Frontalis Interna/diagnosis , Hyperostosis Frontalis Interna/etiology , Kidney Failure, Chronic/complications , Postoperative Complications/drug therapy , Bone Density , Hyperostosis Frontalis Interna/surgery , Ergocalciferols/therapeutic use , Calcium/therapeutic use , Parathyroidectomy/adverse effects , Renal Dialysis , Treatment Outcome , Teriparatide/therapeutic use , Fractures, Bone/diagnosis , Bone Density Conservation Agents/therapeutic use , Hypocalcemia/etiology , Hypocalcemia/drug therapy
7.
Actual. osteol ; 13(1): 9-16, Ene - Abr. 2017. tab
Article in Spanish | LILACS | ID: biblio-1118618

ABSTRACT

Tanto el ranelato de estroncio (RSr) como el denosumab (Dmab) son eficaces en el tratamiento de la osteoporosis (OP) posmenopáusica (PM). El efecto de cada fármaco por separado sobre la densidad mineral ósea (DMO) ha sido estudiado recientemente. Con ambas drogas se observó, al año de tratamiento, un aumento significativo de la DMO en columna lumbar (CL), cuello femoral (CF) y cadera total (CT). En este trabajo comparamos la respuesta densitométrica al año de tratamiento con una y otra droga. Utilizamos los registros de 425 pacientes PMOP tratadas con Dmab y 441 tratadas con RSr. En cada paciente analizamos el porcentaje de cambio; se clasificaron como respondedoras aquellas que mostraron un cambio ≥3%. Adicionalmente se comparó la respuesta en pacientes no previamente tratadas con bifosfonatos (BF-naïve) en comparación con pacientes que habían recibido previamente un BF. Al analizar el grupo completo para Dmab, el porcentaje de pacientes respondedoras fue de 68,4% en CL, 63,3% en CF y 49,3% en CT. Por otro lado, en el grupo de pacientes tratadas con RSr, el porcentaje de respondedoras (53,8% en CL, 40,0% en CF y 35,6% en CT) fue estadísticamente menor. Cuando comparamos la respuesta entre las pacientes BF-naïve que recibieron RSr o Dmab, el Dmab indujo mayor respuesta en CL y CF que el grupo RSr, sin diferencias en CT. Cuando se analizaron los subgrupos BF-previo, las tratadas con Dmab mostraron mayor respuesta en todas las regiones. Conclusión: en pacientes con OP-PM, el tratamiento con Dmab produjo mayores incrementos densitométricos que el RSr, siendo el porcentaje de pacientes respondedoras mayor con Dmab que con RSr. (AU)


Both strontium ranelate (SrR) and denosumab (Dmab) are effective in the treatment of postmenopausal osteoporosis (PMOP). The effect of each drug on bone mineral density (BMD) has been studied separately by us. With both treatments, there was a significant increase after one year of treatment at the lumbar spine (LS) and hip. In this paper we compared the densitometric response after one year of treatment with both drugs used separately. We used the clinical records of 425 PM patients treated with Dmab and 441 treated with SrR. For each patient we analyzed the percentage of change; those who showed a change ≥3% were classified as responders. Additionally, the response was compared in patients not previously treated with bisphosphonates (BP-naïve) compared to patients who had previously received a BP. When analyzing the complete group for Dmab, the percentage of "responders" was 65.2% at the LS, 62.9% at the femoral neck (FN) and 47.4% at the total hip (TH). On the other hand, in the group of patients treated with SrR the percentage of responders (53.8% at the LS, 40.0% at the FN and 35.6% at the TH) was statistically lower. When comparing the response between in BF-naïve patients receiving RSr or Dmab, Dmab induced a greater response at the LS and FN than the RSr group, with no statistical differences at the TH. When the subgroups with prior BP treatment were analyzed, those treated with Dmab showed greater response in all regions. Conclusion: in patients with PMOP treatment with Dmab produced greater densitometric increments than SrR, and the percentage of responders was higher with Dmab than with SrR. (AU)


Subject(s)
Humans , Female , Middle Aged , Aged , Aged, 80 and over , Strontium/therapeutic use , Osteoporosis, Postmenopausal/drug therapy , Denosumab/therapeutic use , Phosphates/blood , Strontium/administration & dosage , Strontium/chemistry , Vitamin D/administration & dosage , Biomarkers , Bone Density/drug effects , Fractures, Stress/prevention & control , Osteocalcin/blood , Osteoporosis, Postmenopausal/blood , Calcium/administration & dosage , Calcium/blood , Retrospective Studies , Teriparatide/therapeutic use , Densitometry , Diphosphonates/therapeutic use , Alkaline Phosphatase/blood , Bone Density Conservation Agents/therapeutic use , Femur Neck/drug effects , Denosumab/administration & dosage , Treatment Adherence and Compliance , Hip , Lumbosacral Region
9.
Clinics ; 69(6): 438-446, 6/2014. tab, graf
Article in English | LILACS | ID: lil-712695

ABSTRACT

Osteogenesis and bone remodeling are complex biological processes that are essential for the formation of new bone tissue and its correct functioning. When the balance between bone resorption and formation is disrupted, bone diseases and disorders such as Paget's disease, fibrous dysplasia, osteoporosis and fragility fractures may result. Recent advances in bone cell biology have revealed new specific targets for the treatment of bone loss that are based on the inhibition of bone resorption by osteoclasts or the stimulation of bone formation by osteoblasts. Bisphosphonates, antiresorptive agents that reduce bone resorption, are usually recommended as first-line therapy in women with postmenopausal osteoporosis. Numerous studies have shown that bisphosphonates are able to significantly reduce the risk of femoral and vertebral fractures. Other antiresorptive agents indicated for the treatment of osteoporosis include selective estrogen receptor modulators, such as raloxifene. Denosumab, a human monoclonal antibody, is another antiresorptive agent that has been approved in Europe and the USA. This agent blocks the RANK/RANKL/OPG system, which is responsible for osteoclastic activation, thus reducing bone resorption. Other approved agents include bone anabolic agents, such as teriparatide, a recombinant parathyroid hormone that improves bone microarchitecture and strength, and strontium ranelate, considered to be a dual-action drug that acts by both osteoclastic inhibition and osteoblastic stimulation. Currently, anti-catabolic drugs that act through the Wnt-β catenin signaling pathway, serving as Dickkopf-related protein 1 inhibitors and sclerostin antagonists, are also in development. This concise review provides an overview of the drugs most commonly used for the control of osteogenesis in bone diseases.


Subject(s)
Female , Humans , Male , Bone Diseases/drug therapy , Osteogenesis/drug effects , Antibodies, Monoclonal, Humanized/therapeutic use , Bone Density Conservation Agents/therapeutic use , Diphosphonates/therapeutic use , Selective Estrogen Receptor Modulators/therapeutic use , Teriparatide/therapeutic use , Thiophenes/therapeutic use
10.
Coluna/Columna ; 13(1): 20-22, Jan-Mar/2014. graf
Article in English | LILACS | ID: lil-709632

ABSTRACT

OBJECTIVE: The objective was to assess the improvement of chronic low back pain in osteoporotic patients treated with teriparatide (TPTD). METHODS: This was an observational study with a convenience sample of 21 patients with osteoporosis using TPTD, 20 mcg/day, between 2006 and 2010, with chronic low back pain (more than three months). Dorsolumbar radiographs and bone densitometry (DXA) were performed before and after treatment. For pain measurement the VAS pain scale was used. Data were entered in Excel and processed in STATA/SE 8.0 with Chi2 square or Fisher (p < 0.05). RESULTS: twenty-one patients aged 40-90 (mean 70 years), eight (40%) had senile osteoporosis and thirteen (60%) had osteoporosis secondary to medications. Seventeen (80%) had previous dorsolumbar fractures. Ten (47.5%) used TPTD for 24 months, six (27.5 %) used the medication for 18 months, four (20%) for 12 months and one (5%) for six months. Eight patients (40%) received previous anti-reabsortive therapy. Thirteen patients (60%) exhibited bone mass gain between 0% and 9% while eight (40%), between 10% and 15%. The final average VAS was 2.6 representing an improvement of 4.7 (p< 0.05). CONCLUSION: There was a significant reduction in the severity of low back pain with the use of TPTD (initial mean VAS: 7.3, final VAS: 2.6, improvement: 4.7). .


OBJETIVO: Avaliar a melhora da lombalgia crônica nos pacientes osteoporóticos em tratamento com teriparatida (TPTD). MÉTODOS: Trata-se de um estudo observacional, com amostra por conveniência de 21 pacientes com osteoporose em uso de TPTD, 20 mcg/dia, entre 2006 e 2010, portadores de lombalgia crônica (mais de três meses). Foram realizadas radiografias dorso-lombares e densitometria óssea (DXA), antes e após o tratamento e, para a mensuração da dor, foi usada a Escala EVA. Os dados foram aplicados no Excel e as análises processadas no STATA / SE 8.0, com Qui2 ou Fisher (p < 0,05). RESULTADOS: De vinte e um pacientes, com idade entre 40 e 90 anos (média 70 anos), oito deles (40%) apresentavam osteoporose senil e treze (60%) osteoporose secundária a medicações. Dezessete (80%) tinham fraturas dorso-lombares prévias. Dez (47,5%) utilizaram TPTD por 24 meses, seis (27,5%) por 18, quatro (20%) por 12 e um (5%) por seis. Oito (40%) usaram previamente antirreabsortivos. Treze pacientes (60%) apresentaram ganho de massa óssea entre 0% e 9% e oito (40%), entre 10% e 15%. A média final da EVA foi de 2,6, correspondendo a uma melhora de 4,7 (p< 0,05). CONCLUSÃO: Ocorreu uma redução significativa na severidade da lombalgia com uso de TPTD (EVA inicial média: 7,3; final: 2,6; melhora: 4,7). .


OBJETIVO: Evaluar la mejoría del dolor lumbar crónico en pacientes con osteoporosis tratados con teriparatida (TPTD). MÉTODOS: Se realizó un estudio observacional, con una muestra de conveniencia de 21 pacientes con osteoporosis en uso de TPTD, 20 mcg/día, entre 2006 y 2010, portadores de dolor lumbar crónico (más de tres meses). Se realizaron radiografías dorsolumbares y densitometría ósea (DXA) antes y después del tratamiento y, para la mensuración del dolor, se utilizó la Escala EVA. Los datos fueron exportados al Excel y el análisis procesado en STATA/SE 8.0, con Qui² o Fisher (p < 0,05). RESULTADO: De veintiún pacientes, con edad entre 40 y 90 años (media 70 años), ocho (40%) presentaban osteoporosis senil y trece (60%) osteoporosis secundaria a medicaciones. Diecisiete (80%) tuvieron fracturas dorsolumbares previas. Diez (47,5%) utilizaron TPTD por 24 meses, seis (27,5%) por 18, cuatro (20%) por 12 y uno (5%) por seis meses. Ocho (40%) usaron previamente antirreabsortivos. Trece pacientes (60%) presentaron aumento de masa ósea entre 0% y 9 % y ocho (40%), entre 10% y 15%. La media final del EVA fue de 2,6, correspondiendo a una mejora de 4,7 (p< 0,05). CONCLUSIÓN: Una reducción significativa en la gravedad del dolor lumbar se produjo con el uso de TPTD (EVA inicial media: 7,3; final: 2,6; mejora: 4,7). .


Subject(s)
Humans , Low Back Pain/drug therapy , Osteoporosis , Teriparatide/therapeutic use , Chronic Pain
11.
Bogotá; IETS; oct. 2013.
Monography in Spanish | LILACS, BRISA | ID: biblio-847424

ABSTRACT

Antecedentes: Descripción de la condición de salud de interés: La osteoporosis es un problema sanitario global cuya importancia va en aumento con el envejecimiento de la población. Se define como un trastorno esquelético sistémico caracterizado por masa ósea baja y deterioro de la microarquitectura del tejido óseo, con el consecuente incremento de la fragilidad ósea y una mayor susceptibilidad a las fracturas (1). La resistencia ósea refleja fundamentalmente la unión de densidad y calidad óseas. A su vez, el concepto de calidad pretende integrar todos aquellos factores ajenos a la masa ósea que condicionan la fragilidad del hueso, e incluye la microarquitectura, el grado de recambio, acumulo de lesiones o micro fracturas y el grado de mineralización. Descripción de la tecnología: Teriparatide (TE) es el fragmento activo de la hormona paratiroidea humana (PTH) obtenido mediante ADN recombinante que actúa estimulando la formación ósea, su uso ha sido aprobado en el tratamiento de la osteoporosis posmenopáusica. Además de este fármaco, también ocupan un lugar en la terapéutica de la osteoporosis los bifosfonatos (alendronato, risendronato, entre otros), el raloxifeno y la calcitonina. Evaluación de efectividad y seguridad: Pregunta de investigación: ¿Cuál es la efectividad y seguridad de teriparatide comparado con alendronato, ácido zoledrónico o denosumab como tratamiento de primera línea para reducir la frecuencia de fracturas vertebrales y no vertebrales en adultos con riesgo de fractura por osteoporosis? La pregunta de investigación fue desarrollada teniendo en cuenta las siguientes fuentes de información: registro sanitario INVIMA, Acuerdo 029 de 2011, guías de práctica clínica, reportes de evaluación de tecnologías, revisiones sistemática y narrativas, estudios de prevalencia/incidencia y carga de enfermedad, libros de texto, consulta con expertos temáticos, sociedades científicas y otros actores clave. Población: Estudios cuya población de estudio fueran adultos con riesgo de fractura causado por osteoporosis. Tecnología de interés: Teriparatide. Metodología: Búsqueda de literatura, Búsqueda en bases de datos electrónicas. Conclusiones: -Efectividad: los resultados de comparaciones directas muestran que teriparatide es más efectivo que el placebo para el desenlace de frecuencia de fracturas vertebrales y no vertebrales en adultos con riesgo elevado de fractura por osteoporosis; -Las comparaciones indirectas de teriparatide contra alendronato, ácido zoledrónico o denosumab no muestran diferencias significativas entre ellos para el desenlace de reducción de fracturas vertebrales y no vertebrales en adultos con riesgo elevado de fractura por osteoporosis; -Teriparatide, bifosfonatos (alendronato, ácido zoledrónico) y denosumab, comparados entre ellos, tienen una efectividad similar en la reducción del riesgo de fracturas vertebrales y no vertebrales; -Seguridad: la evidencia muestra que teriparatide es seguro en evaluaciones realizadas con terapia hasta 18 meses. La seguridad de teriparatide no ha sido evaluada por un periodo superior a 2 años, actualmente se desconocen los efectos posteriores.


Subject(s)
Humans , Osteoporosis/etiology , Osteoporosis/therapy , Bone Density/drug effects , Fractures, Bone/complications , Technology Assessment, Biomedical , Teriparatide/therapeutic use , Treatment Outcome
12.
Medicina (B.Aires) ; 73(5): 428-432, oct. 2013. graf, tab
Article in Spanish | LILACS | ID: lil-708529

ABSTRACT

El objetivo de este trabajo retrospectivo fue evaluar el tratamiento de la osteoporosis grave con teriparatide (PTH) y comparar nuestros resultados con los publicados en la literatura médica. Se incluyeron cuarenta y seis pacientes, cuarenta y dos mujeres y cuatro varones, edad: 69.15 ± 9.43 años. Seis eran vírgenes de tratamiento y cuarenta tratados previamente con bisfosfonatos. Treinta y dos pacientes habían tenido 93 fracturas de las cuales 86 vertebrales. Cuarenta y seis recibieron PTH 6 meses, 29 pacientes durante 12 meses y 20 completaron los 18 meses sugeridos. La densidad mineral ósea (DMO) de columna lumbar aumentó significativamente desde el primer control a los 6 meses (p < 0.0001). La DMO de cuello de fémur alcanzó un incremento significativo al final del tratamiento (p = 0.002). La osteocalcina aumentó significativamente al mes, seguido por el ß crosslaps (beta-CTx, prueba en suero) al tercer mes y la fosfatasa alcalina ósea, regresando los marcadores de recambio óseo a niveles basales a los 18 meses. Las calcemias y las calciurias no se modificaron significativamente, pero 8 pacientes tuvieron hipercalcemias leves y tres hipercalciurias asintomáticas. El tratamiento fue bien tolerado y no se registraron efectos adversos graves que requirieran suspender el tratamiento. En conclusión, la PTH es una alternativa útil y segura para el tratamiento de la osteoporosis grave. Nuestros resultados concuerdan con los previamente publicados en la literatura médica.


The primary objective of this retrospective study was to evaluate the treatment of severe osteoporosis with teriparatide (PTH) and to compare our results with those published in the literature. We included 46 patients, 42 women and four men, mean age: 69.15 ± 9.43 years. Six patients were treatment naive and forty previously treated with bisphosphonates. Thirty-two patients had had 93 fractures of which 86 vertebral. Forty-six received PTH for 6 months, twenty-nine for 12 months and twenty completed the 18 months suggested. Bone mineral density (BMD) of the lumbar spine increased significantly at the first control performed at six months of treatment (p < 0.0001), and the femoral neck BMD reached a significant increase at the end of treatment (p = 0.002). Serum osteocalcin values significantly increased from the first month of treatment, followed by ß crosslaps (beta-CTx, serum test) and bone-specific alkaline phosphatase, returning all the markers of bone turnover to baseline levels at 18 months. Serum and urinary calcium did not change significantly at any time, but 8 (17.9%) patients developed mild hypercalcemia and 3 (6.5%) asymptomatic hypercalciuria. The treatment was well tolerated and there were no serious adverse events requiring discontinuation. In conclusion, PTH is a safe and useful alternative for the treatment of primary severe osteoporosis. Our results agree with those previously reported in the literature.


Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Bone Density Conservation Agents/therapeutic use , Osteoporosis/drug therapy , Teriparatide/therapeutic use , Alkaline Phosphatase/blood , Bone Density , Calcium/blood , Calcium/urine , Diphosphonates/therapeutic use , Osteocalcin/blood , Osteoporosis/blood , Retrospective Studies , Severity of Illness Index , Statistics, Nonparametric , Time Factors , Treatment Outcome
13.
J. bras. med ; 101(02): 13-18, mar.-abr. 2013. tab
Article in Portuguese | LILACS | ID: lil-686288

ABSTRACT

As fraturas atípicas do fêmur são raras, mas sua crescente descrição na literatura e sua provável associação com os bifosfonatos trouxeram à tona uma série de aspectos ainda nebulosos no tocante ao uso contínuo dessas drogas. O protocolo mais sugerido atualmente, embora ainda não totalmente estabelecido, orienta a retirada da medicação após três a cinco anos de uso contínuo dos bifosfonatos, retornando cerca de três anos depois, quando houver necessidade


Atypical femur fractures are rare but a growing concern, as they are more common in patients who use long-term bisphosphonates. This brought to light a number of issues still unknown regarding the continued use of these drugs. Nowadays the most suggested protocol, although not yet fully esbablished, considers not more than three to five years of bisphosphonate treatment for osteoporotic patients, returning about three years later, when the need arises


Subject(s)
Humans , Male , Female , Diphosphonates/administration & dosage , Diphosphonates/therapeutic use , Femoral Fractures/etiology , Diaphyses , Diphosphonates/adverse effects , Diphosphonates/pharmacology , Fracture Fixation, Intramedullary , Hip Fractures , Osteoporosis/physiopathology , Osteoporosis/drug therapy , Teriparatide/therapeutic use
14.
Arq. bras. endocrinol. metab ; 57(2): 153-156, Mar. 2013. ilus
Article in English | LILACS | ID: lil-668754

ABSTRACT

Satisfactory healing of the osteoporotic fracture is critically important to functional recovery, morbidity, and quality of life. Some therapies for osteoporosis may affect the processes associated with bone repair. For example, bisphosphonates in experimental models are associated with increased callus size and mineralization, reduced callus remodeling, and improved mechanical strength. Local and systemic bisphosphonate treatment may improve implant fixation. No negative impact on fracture healing has been observed, even after major surgery or when administered immediately after fracture. For the osteoanabolic agent teriparatide, case reports and a randomized trial have produced mixed results, but they are consistent with a positive impact of teriparatide on fracture healing. Some of the agents currently being developed for osteoporosis, notably sclerostin and DKK1 antibodies have shown a beneficial effect on fracture healing. At this point, therefore, there is no evidence that osteoporosis therapies are detrimental to fracture healing with some promising experimental evidence for positive effects on healing, notably for those agents whose actions are primarily anabolic.


A consolidação adequada da fratura osteoporótica é essencial para recuperação funcional, morbidade e qualidade de vida. Alguns tratamentos para osteoporose podem afetar os processos associados ao reparo ósseo. Por exemplo, os bisfosfonatos, em modelos experimentais, estão associados com aumento do tamanho do calo e a mineralização, reduzindo o remodelamento do calo e melhorando a força mecânica. Tratamento com bisfosfonato, local ou sistêmico, pode melhorar a fixação de implantes. Não foi observado impacto negativo na consolidação da fratura, mesmo após uma cirurgia maior ou quando administrado imediatamente após a fratura. Relatos e um estudo randomizado com o osteoanabólico teriparatida produziram resultados mistos, mas que são consistentes com o impacto positivo da teriparatida na consolidação da fratura. Algumas das drogas que estão sendo desenvolvidas no momento para osteoporose, como anticorpos para esclerotina e DKK1, têm mostrado efeito benéfico na consolidação da fratura. No estágio atual, portanto, não há evidência de que terapias para osteoporose impeçam a consolidação da fratura, mas existem algumas evidências experimentais promissoras de efeito positivo na consolidação, especialmente daqueles agentes cuja ação é primariamente anabólica.


Subject(s)
Aged, 80 and over , Female , Humans , Bone Density Conservation Agents/therapeutic use , Femoral Neck Fractures/drug therapy , Fracture Healing/drug effects , Osteoporotic Fractures/drug therapy , Teriparatide/therapeutic use , Bone Density , Randomized Controlled Trials as Topic , Treatment Outcome
15.
Arq. bras. endocrinol. metab ; 54(2): 213-219, Mar. 2010. ilus, graf
Article in English | LILACS | ID: lil-546265

ABSTRACT

Anabolic drugs have recently widened therapeutic options in osteoporosis treatment, as they influence processes associated with bone formation to a greater extent and earlier than bone reabsortion. They positively affect a number of skeletal properties besides bone density, as intermittent administration of parathyroid hormone (PTH) results in an increase in the number and activity of osteoblasts leading to an increase in bone mass and improvement in skeletal architecture at both the trabecular and cortical bone. Human recombinant parathyroid hormone (hrPTH 1-84) and human recombinant PTH peptide 1-34 (teriparatide) belong to this group. The objective of this paper is to review PTH actions, benefits and adverse effects, action on biochemical markers, combination therapy with antiresorptive agents, impact of antiresorptive therapy prior to anabolic treatment, sequential treatment, and effect on glucocorticoid-induced osteoporosis.


As drogas anabólicas ampliaram recentemente as opções terapêuticas no tratamento da osteo-porose e influenciam em maior escala os processos relacionados com a formação óssea, que ocorrem antes do efeito na reabsorção. Essas drogas afetam um grande número de propriedades esqueléticas, além da densidade mineral óssea. A administração intermitente de PTH leva a um aumento do número e atividade dos osteoblastos, ocasionando aumento da massa óssea e melhora da arquitetura, tanto do osso trabecular quanto cortical. O paratormônio recombinante humano (hrPTH 1-84) e o peptídeo recombinante humano 1-34 (teriparatide) pertencem a esse grupo de agentes. O objetivo deste artigo é revisar as ações, os benefícios e os efeitos adversos do PTH, assim como sua ação nos marcadores bioquímicos do metabolismo ósseo, a terapia combinada com drogas antirreabsortivas, o impacto do uso dos antirreabsortivos antes do tratamento anabólico, o tratamento sequencial e o tratamento da osteoporose induzida por glicocorticoides.


Subject(s)
Humans , Anabolic Agents/therapeutic use , Bone Density Conservation Agents/therapeutic use , Osteoporosis/drug therapy , Parathyroid Hormone/therapeutic use , Teriparatide/therapeutic use , Anabolic Agents/adverse effects , Biomarkers/metabolism , Bone Density Conservation Agents/adverse effects , Bone Density/drug effects , Bone Resorption/metabolism , Lumbar Vertebrae/drug effects , Parathyroid Hormone/adverse effects , Spinal Fractures/prevention & control , Teriparatide/adverse effects
16.
Arq. bras. endocrinol. metab ; 54(2): 244-249, Mar. 2010. graf, tab
Article in English | LILACS | ID: lil-546270

ABSTRACT

OBJECTIVE: To evaluate the responses of serum β-CTX and osteocalcin in patients who were undergoing treatment with teriparatide or strontium ranelate (SR). SUBJECTS AND METHODS: We analyzed 14 patients (12 women and 2 men; mean age of 71 years) taking teriparatide, and 13 female patients (mean age of 70 years) taking SR; all the patients having previously been on bisphosphonates. Serum β-CTX and osteocalcin levels were determined before and after the first and third months of teriparatide treatment and up to the fourth month of treatment with SR. RESULTS: We observed an initial significant increase in osteocalcin levels during the first month (165 percent, p = 0.01) followed by a peak of β-CTX (180 percent, p = 0.02) after the third month of treatment with teriparatide. An increase in these markers was also observed with SR: 49 percent in osteocalcin (p = 0.002) and 80 percent in β-CTX (p = 0.008). CONCLUSION: SR had a predominantly short-term bone-forming effect in postmenopausal women with osteoporosis previously treated with bisphosphonates in a lesser degree than with teriparatide.


OBJETIVO: Avaliar as respostas do β-CTX e osteocalcina séricos em pacientes que foram submetidas a tratamento com teriparatida ou ranelato de estrôncio (RE). SUJEITOS E MÉTODOS: Analisaram-se 14 pacientes (12 mulheres e 2 homens; idade média 71 anos) tomando teriparatida, e 13 mulheres (idade média 70 anos) tomando RE; todos os pacientes haviam previamente tomado bisfosfonatos. Níveis séricos de β-CTX e osteocalcina foram determinados antes e após o primeiro e terceiro meses de tratamento com teriparatida e no quarto mês de tratamento com RE. RESULTADOS: Observou-se um aumento inicial significativo nos níveis de osteocalcina no primeiro mês (165 por cento, p = 0,01), seguido por um pico do β-CTX (180 por cento, p = 0,02) após o terceiro mês de tratamento com teriparatida. Aumento nesses marcadores também foi observado com RE: 49 por cento na osteocalcina (p = 0,002) e 80 por cento no β-CTX (p = 0,008). CONCLUSÃO: RE teve um efeito predominantemente na formação óssea a curto prazo em mulheres na pós-menopausa com osteoporose tratadas previamente com bisfosfonatos em menor grau que a teriparatida.


Subject(s)
Aged , Female , Humans , Male , Bone Density Conservation Agents/therapeutic use , Diphosphonates/therapeutic use , Organometallic Compounds/therapeutic use , Osteocalcin/blood , Osteoporosis/drug therapy , Teriparatide/therapeutic use , Thiophenes/therapeutic use , Bone Density , Biomarkers/blood , Osteoporosis/blood , Peptides/blood
17.
Säo Paulo med. j ; 126(5): 279-284, Sept. 2008. ilus, tab
Article in English | LILACS | ID: lil-500336

ABSTRACT

CONTEXT AND OBJECTIVE: Osteoporosis is defined as a disease characterized by low bone mass and deterioration of the bone tissue microarchitecture. Teriparatide stimulates the formation and action of osteoblasts, which are responsible for bone formation, thus promoting bone tissue increase. The aim was to assess the effectiveness and safety of teriparatide for treating postmenopausal osteoporosis. METHODS: A systematic review was conducted using the Cochrane Collaboration methodology. RESULTS: 1) Teriparatide 20 µg or 40 µg versus placebo: there was a benefit from teriparatide, considering the following outcomes: reduction in the number of new vertebral and non-vertebral fractures, and increased whole-body, lumbar and femoral bone mineral density. 2) Teriparatide 40 µg versus alendronate 10 mg/day for 14 months: there was no statistical difference regarding the incidence of new vertebral or non-vertebral fractures, although in the group that received teriparatide there was greater bone mineral density increase in the whole body, lumbar column and femur. 3) Estrogen plus teriparatide 25 µg versus estrogen: there was a benefit, considering the following outcomes: reduction in the number of new vertebral fractures, and increased whole-body, lumbar and femoral bone mineral density after three years. CONCLUSIONS: When teriparatide is intermittently administered in low doses, it reduces the incidence of vertebral fractures (67 percent) and non-vertebral fractures (38 percent) and increases bone mineral density in the lumbar column and femur. There is a need for studies with longer observation in order to allow conclusions regarding the safety and duration of the therapeutic effects.


CONTEXTO E OBJETIVO: A osteoporose é definida como uma doença caracterizada por baixa massa óssea e deteriorização da microarquiquetura do tecido ósseo. O paratormônio estimula a formação e a ação dos osteoblastos responsáveis pela formação dos ossos, promovendo ganho de tecido ósseo. O objetivo foi determinar a efetividade e a segurança da teriparatida no tratamento da osteoporose pós-menopausa. MÉTODOS: Foi realizada uma revisão sistemática da literatura de acordo com a metodologia da Colaboração Cochrane. RESULTADOS: 1) Teriparatida 20 µg ou 40 µg versus placebo: benefício da teriparatida considerando os desfechos redução do número de novas fraturas vertebrais e não-vertebrais, aumento da densidade mineral óssea corporal total, lombar e do fêmur. 2) Teriparatida 40 µg versus alendronato 10 mg/dia por 14 meses: não houve diferença estatística em relação a incidência de novas fraturas vertebrais ou não-vertebrais, porém, no grupo que recebeu a teriparatida, houve maior ganho de densidade mineral óssea corporal total, na coluna lombar e no fêmur (região intertrocantérica e triângulo de Wards). 3) Estrogênio mais teriparatida 25 µg versus estrogênio: houve benefício do estrogênio associado a teriparatida considerando os desfechos redução do número de novas fraturas vertebrais, aumento da densidade mineral óssea corporal total, lombar e do fêmur ao final dos três anos do estudo. CONCLUSÕES: A teriparatida, quando administrada em baixas doses e de forma intermitente, reduz as fraturas vertebrais (67 por cento) e não vertebrais (38 por cento) e aumenta a densidade mineral óssea na coluna lombar e no fêmur. Há necessidade de estudos de maior tempo de observação para permitir conclusões sobre a segurança e a duração dos efeitos terapêuticos.


Subject(s)
Humans , Female , Middle Aged , Aged , Aged, 80 and over , Bone Density Conservation Agents/therapeutic use , Osteoporosis, Postmenopausal/drug therapy , Teriparatide/therapeutic use , Alendronate/therapeutic use , Estrogens/therapeutic use , Fertility Agents, Female/therapeutic use , Nafarelin/therapeutic use
18.
Arq. bras. endocrinol. metab ; 51(8): 1404-1412, nov. 2007.
Article in English | LILACS | ID: lil-471758

ABSTRACT

Glucocorticoid-induced osteoporosis (GIO) is the most common form of secondary osteoporosis. Fractures, which are often asymptomatic, may occur in as many as 30_50 percent of patients receiving chronic glucocorticoid therapy. Vertebral fractures occur early after exposure to glucocorticoids, at a time when bone mineral density (BMD) declines rapidly. Fractures tend to occur at higher BMD levels than in women with postmenopausal osteoporosis. Glucocorticoids have direct and indirect effects on the skeleton. They impair the replication, differentiation, and function of osteoblasts and induce the apoptosis of mature osteoblasts and osteocytes. These effects lead to a suppression of bone formation, a central feature in the pathogenesis of GIO. Glucocorticoids also favor osteoclastogenesis and as a consequence increase bone resorption. Bisphosphonates are the most effective of the various therapies that have been assessed for the management of GIO. Anabolic therapeutic strategies are under investigation. Teriparatide seems to be also efficacious for the treatment of patients with GIO.


A osteoporose induzida por glicocorticóides (OIG) é a forma mais comum de osteoporose secundária. Fraturas, que são freqüentemente assintomáticas, podem ocorrer em até 30_50 por cento dos pacientes recebendo terapia glicocorticóide crônica. Fraturas vertebrais ocorrem logo após exposição aos glicocorticóides, ocasião em que a densidade mineral óssea (DMO) diminui rapidamente. As fraturas tendem a ocorrer mais com níveis elevados de DMO do que em mulheres com osteoporose da pós-menopausa. Os glicocorticóides têm efeitos diretos e indiretos sobre o esqueleto: eles impedem a replicação, a diferenciação e a função dos osteoblastos e induzem apoptose dos osteoblastos maduros e osteócitos. Esses efeitos levam à supressão da formação óssea, uma manifestação central da patogênese da OIG. Os glicocorticóides também favorecem a osteoclastogênese e, como conseqüência, aumentam a reabsorção óssea. Os bisfosfonatos são a mais efetiva das várias terapias que têm sido avaliadas para o manuseio da OIG. Estratégias terapêuticas com anabolizantes estão sendo investigadas. O teriparatídeo parece também ser eficaz no tratamento de pacientes com OIG.


Subject(s)
Humans , Glucocorticoids/adverse effects , Osteoporosis/chemically induced , Bone Density Conservation Agents/therapeutic use , Bone Density/drug effects , Osteoporosis/diagnosis , Osteoporosis/drug therapy , Teriparatide/therapeutic use
19.
Arq. bras. endocrinol. metab ; 50(4): 745-754, ago. 2006. ilus, graf
Article in English, Portuguese | LILACS | ID: lil-437624

ABSTRACT

Antiresorptive agents for osteoporosis are a cornerstone of therapy, but anabolic drugs have recently widened our therapeutic options. By directly stimulating bone formation, anabolic agents reduce fracture incidence by improving bone qualities besides increasing bone mass. In this article, we review the role of anabolic treatment for osteoporosis. The only anabolic agent currently approved in the United States for osteoporosis, teriparatide [recombinant human parathyroid hormone(1-34)], has clearly emerged as a major approach to selected patients with osteoporosis. Teriparatide increases bone density and bone turnover, improves microarchitecture, and changes bone size. The incidence of vertebral and nonvertebral fractures is reduced. Teriparatide is approved for both postmenopausal women and men with osteoporosis who are at high risk for fracture. Other potential anabolic therapies for osteoporosis, including other forms of parathyroid hormone, strontium ranelate, growth hormone, and insulin-like growth factor-1, are also reviewed in this article.


Os agentes anti-reabsortivos são as drogas mais usadas no tratamento da osteoporose, porém os anabólicos recentemente ampliaram nossas opções terapêuticas. Por estimular diretamente a formação, os agentes anabólicos reduzem a incidência de fraturas por melhorar a qualidade óssea, além do aumento da massa óssea. Neste artigo, nós revisaremos o papel do tratamento anabólico para a osteoporose. O único agente anabólico, atualmente aprovado nos Estados Unidos, é o teriparatida (hormônio paratiroidiano recombinante humano), o qual tem sido considerado como a principal abordagem em pacientes selecionados. O teriparatida aumenta a densidade mineral óssea e o turnover ósseo, melhorando a microarquitetura, e altera o tamanho do osso. A incidência de fraturas vertebrais e não vertebrais é reduzida. O teriparatida é aprovado tanto para mulheres na pós-menopausa quanto para homens com osteoporose que apresentem alto risco para fraturas. Outras terapias anabólicas potenciais para a osteoporose incluem outras formas de hormônio da paratiróide, ranelato de estrôncio, hormônio de crescimento e IGF1 (insulin-like growth factor-1), e serão revisados neste artigo.


Subject(s)
Humans , Male , Female , Bone Density Conservation Agents/therapeutic use , Bone Density/drug effects , Osteoporosis/drug therapy , Teriparatide/therapeutic use , Bone Density Conservation Agents/pharmacology , Clinical Trials as Topic , Fractures, Bone/etiology , Fractures, Bone/prevention & control , Osteoporosis, Postmenopausal/complications , Osteoporosis, Postmenopausal/drug therapy , Risk Factors , Teriparatide/pharmacology
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