ANABOLIC BONE WINDOW WITH WEEKLY TERIPARATIDE THERAPY IN POSTMENOPAUSAL OSTEOPOROSIS: A PILOT STUDY.

OBJECTIVE: Osteoporosis is a major public health problem that reduces bone strength and increases fracture risk. Teriparatide is an established and the only currently available anabolic therapy for the treatment of postmenopausal osteoporosis (PMO) with a recommended daily dose of 20 µg given subcutaneously. However, there are limited data regarding the long-term effect of once-weekly teriparatide therapy on bone mineral density (BMD), bone turnover markers (BTMs), and anabolic bone window. METHODS: In this prospective observational study, 26 patients with PMO were treated with weekly teriparatide therapy (60 µg) for 2 years. BMD was measured at baseline, 12 months, and 24 months. The bone formation marker type 1 collagen C-terminal propeptide (P1NP) and the bone resorption marker C-terminal telopeptide of type 1 collagen (CTx) were measured at baseline; 6 weeks; and 6, 12, 18, and 24 months. RESULTS: BMDs at the lumbar spine increased by 3.1% and 10.8% after 1 and 2 years of weekly teriparatide therapy, respectively. The T-score increased significantly at the lumbar spine compared to baseline after 2 years of therapy (P = .015). Serum P1NP levels increased significantly at 6 months (P = .024), peaked at 1 year, and remained above the baseline even after 2 years. Serum CTx levels decreased significantly at 6 months (P = .025) and remained below baseline after 2 years of teriparatide therapy. CONCLUSION: Weekly teriparatide therapy (60 µg) appears to be as effective as daily teriparatide for the treatment of PMO by extending the anabolic bone window. ABBREVIATIONS: AE = adverse event; BMD = bone mineral density; BTM = bone turnover marker; CTx = C-terminal telopeptide of type 1 collagen; DXA = dual-energy X-ray absorptiometry; iPTH = intact parathyroid hormone; P1NP = type 1 collagen C-terminal propeptide; PMO = postmenopausal osteoporosis.

An invisible student population: Accommodating and serving college students with lupus.

BACKGROUND: Systemic Lupus Erythematosus (SLE), or lupus, is a chronic autoimmune disorder. Individuals with lupus face unique psychosocial and emotional challenges such as living with the unpredictability of the disease, symptoms such as fatigue, pain and depression, anxiety, cognitive problems, and coping with stress. OBJECTIVE: This article attempts to shed light on the role that lupus plays in the lives of college students in their academics and other unique psychosocial needs. METHOD: The author uses a single case study method based on the lived experience of a student with lupus. The method adopted is used as a means to provide anecdotal information about specific areas to consider when providing services to students living with this condition. RESULTS: Findings from this one case study identified some of the accommodations available to help students in higher education that may even vary for two students with same diagnosis of lupus. CONCLUSIONS: The paper presents some of the innovative strategies that can be used by practitioners while working with these students in higher education. These strategies can provide helpful support for students with lupus with the recommended academic accommodations.

Burden of lupus on work: Issues in the employment of individuals with lupus.

BACKGROUND: Systemic lupus erythematosus (SLE) or Lupus is one of the leading causes of work disability in the United States, accounting for about 20% of the more than estimated 1.5 million Americans with a work disability. The symptoms of lupus can have a profound impact on the person's employment. Impacts of lupus are more pronounced among young and middle-adulthood. Studies have shown that loss in work hours cost the nation nearly $13 billion annually. The loss also impacts the individual's work, quality of life, self-management, and self-efficacy. OBJECTIVE: In this article, the author describes the financial burden of lupus. The article also describes the substantial impact of lupus on employment outcomes for individuals living with the condition. The author also reviews major signs and symptoms of disease and their impact on employment. RESULTS: Findings from this research can be used to identify various accommodations and strategies for individuals to prevent flare-ups. CONCLUSIONS: The paper presents innovative strategies that include early interventions and how employers andco-workers can provide helpful support that includes job accommodations to individuals with lupus.

Management of Pseudohypoparathyroidism Type 1a during Pregnancy and Labor: A Case Report.

Pseudohypoparathyroidism is rare during pregnancy and poses multiple challenges related to its diagnosis and management during pregnancy. We hereby report a case of a young woman who was diagnosed to have type 1a pseudohypoparathyroidism. She was managed by multidisciplinary team and had good maternal and perinatal outcome. Management-related issues are discussed here in detail.

Kyphoscoliosis complicating pregnancy: maternal and neonatal outcome.

OBJECTIVE: To assess the outcome of pregnancies complicated by kyphoscoliosis in modern obstetric and orthopedic care. METHODS: A total of 22 kyphoscoliotic patients with 34 pregnancies were identified from 46,828 pregnancies between 1998 and 2009. Their obstetric records and associated orthopedic problem were studied. RESULTS: The incidence of kyphoscoliosis complicating pregnancy was 0.072%. The mean age of the patients in their index pregnancy was 28.4 years (range 23-35), mean height 130 cm (range 125-138). The cause of kyphoscoliosis included idiopathic (majority), poliomyelitis and traumatic injury. Only 1 of the patient had previous spinal surgery. The cesarean rate was very high and none had any significant cardiorespiratory problem during anesthesia. There was no maternal or perinatal mortality. CONCLUSIONS: The high maternal and perinatal risks associated with kyphoscoliosis reported earlier no longer exist.