Safety and effectiveness of once-yearly zoledronic acid in Japanese osteoporosis patients: three-year post-marketing surveillance.

INTRODUCTION: Zoledronic acid (5 mg; ZOL), a once-yearly bisphosphonate, reduces osteoporotic fractures and increases bone mineral density (BMD). This 3-year post-marketing surveillance examined its real-world safety and effectiveness. MATERIALS AND METHODS: This prospective, observational study included patients who started ZOL for osteoporosis. Data were assessed at baseline, 12, 24, and 36 months for safety and effectiveness. Treatment persistence, potentially related factors, and persistence before and after the COVID-19 pandemic started were also investigated. RESULTS: The safety analysis and effectiveness analysis sets included 1406 and 1387 patients, respectively, with mean age of 76.5 years. Adverse reactions (ARs) occurred in 19.35% of patients, with an acute-phase reaction in 10.31, 1.01, and 0.55% after the first, second, and third ZOL infusions. Renal function-related ARs, hypocalcaemia, jaw osteonecrosis, and atypical femoral fracture occurred in 1.71, 0.43, 0.43, and 0.07% of patients, respectively. Three-year cumulative fracture incidences were 4.44% for vertebral, 5.64% for non-vertebral, and 9.56% for clinical fractures. BMD increased by 6.79, 3.14, and 1.78% at the lumbar spine, femoral neck, and total hip, respectively, after 3-year treatment. Bone turnover markers remained within reference ranges. Treatment persistence was 70.34% over 2 years and 51.71% over 3 years. Male, age ≥ 75 years, no previous medicines for osteoporosis, no concomitant medicines for osteoporosis, and inpatient at the first infusion were related to discontinuation. There was no significant difference in the persistence rate between before and after the COVID-19 pandemic (74.7% vs. 69.9%; p = 0.141). CONCLUSION: This 3-year post-marketing surveillance confirmed the real-world safety and effectiveness of ZOL.

Global flows of critical metals necessary for low-carbon technologies: the case of neodymium, cobalt, and platinum.

This study, encompassing 231 countries and regions, quantifies the global transfer of three critical metals (neodymium, cobalt, and platinum) considered vital for low-carbon technologies by means of material flow analysis (MFA), using trade data (BACI) and the metal contents of trade commodities, resolving the optimization problem to ensure the material balance of the metals within each country and region. The study shows that in 2005 international trade led to global flows of 18.6 kt of neodymium, 154 kt of cobalt, and 402 t of platinum and identifies the main commodities and top 50 bilateral trade links embodying these metals. To explore the issue of consumption efficiency, the flows were characterized according to the technological level of each country or region and divided into three types: green ("efficient use"), yellow ("moderately efficient use"), and red ("inefficient use"). On this basis, the shares of green, yellow, and red flows in the aggregate global flow of Nd were found to be 1.2%, 98%, and 1.2%, respectively. For Co, the respective figures are 53%, 28%, and 19%, and for Pt 15%, 84%, and 0.87%. Furthermore, a simple indicator focusing on the composition of the three colored flows for each commodity was developed to identify trade commodities that should be prioritized for urgent technical improvement to reduce wasteful use of the metals. Based on the indicator, we discuss logical, strategic identification of the responsibilities and roles of the countries involved in the global flows.

Characterization of economic requirements for a "carbon-debt-free country".

In recent years, greenhouse gas emission controls that incorporate the supply chains of products and services, thereby emphasizing the role of consumers rather than producers, have been drawing increasing attention. A country's consumption-based emissions, including those due to global supply chains, reflect the total emissions on which the national economy relies. To design effective emissions control strategies there is therefore an urgent need for countries to elucidate the structural relationship between their domestic economy and emissions occurring through global supply chains. Here we consider the structural characteristics of consumption-based emissions in Japan, which in 2005 totaled 1675 Mt CO(2)eq. Outside the country the Japanese economy generated global emissions of 541 Mt CO(2)eq, 35.7% of which were UNFCCC Annex I emissions and 64.3% were non-Annex I and other emissions. This figure of 64.3% reveals that Japan is actually relying to a considerable degree on emissions that are subject to no international obligations. We identify key economic contributors to consumption-based emissions at the commodity level and specify items of household expenditure that are effective options for both financial savings and emissions reduction. We then discuss the importance of emissions control for evolving toward a "carbon-debt-free country".

How has dematerialization contributed to reducing oil price pressure?: a qualitative input-output analysis for the Japanese economy during 1990-2000.

The evolution of crude oil use structure and its impacts on commodity prices are examined for Japanese economy between 1990 and 2000. We found that the out-degree of the production network, indicating the extent of the pressure on prices of downstream industries in response to higher crude oil prices, decreased in several sectors between 1990 and 2000. The results by sector showed that the decrease was greatest in the chemical product- and iron and steel manufacturing sectors, which both indirectly use crude oil. The decrease in out-degree is considered to have been caused by improved efficiency in the production of oil-related products and increase in energy savings by the manufacturing facilities in these sectors. In addition, many of the sectors having a high out-degree engage in intermediate product production. Conversely, the in-degree, which represents the extent of being pressured by other sectors with increased crude oil prices, also decreased during the period between 1990 and 2000. From the result of the in-degree, this study found that dematerialization and weight reduction of final products such as "cellular phones" and "personal computers" had a marked effect on decreasing in-degree. More importantly, for the top-ranked sectors with the high out-degree and in-degree, such as "aliphatic intermediates", "chemical fertilizers", "plastic products", "hot rolled steel", "yarn and fabric dyeing and finishing", the results suggest that the pressure due to rising crude oil prices can be more effectively eased by implementing measures targeted at upstream products and sectors, while current policy measures to alleviate oil-price induced inflation are mainly targeted at downstream products such as gasoline.