Teriparatide, the anabolic agent, has received a boost in status as a preferentially effective treatment for glucocorticoid-induced osteoporosis in the form of a second, confirmatory, randomized double-blind trial.

The trial demonstrated that the drug achieves substantially greater increases in bone mineral density compared to a bisphosphonate.

From Familypracticenews.com:

“Based upon the pathogenesis of glucocorticoid-induced osteoporosis [(GIOP)], we think that an anabolic agent makes some sense. It may be beneficial to stimulate osteoblasts to promote new bone formation,” said Dr. Saag, professor of medicine and epidemiology at the University of Alabama at Birmingham.

Steroids are known to have apoptosis-mediated deleterious effects on both osteocytes and osteoblasts that lead to decline in bone function and an abrupt increase in fracture risk independent of bone mineral density (BMD). Osteoclasts are also unfavorably impacted due to crosstalk and the indirect effects of sex steroids, insulin-like growth factor, and a modest effect of secondary hyperparathyroidism mediated through altered calcium absorption. In addition, higher-dose steroids have adverse effects upon muscle that can independently lead to a higher fracture rate, the rheumatologist explained.

These positive study findings are bolstered by a biologically plausible mechanism of benefit, according to the observations of Dr. Kenneth G. Saag at the annual meeting of the American Society for Bone and Mineral Research.

Tags: bone-mineral density, osteoporosis, steroids, teriparatide

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Chemotherapy for lymphoma should be recognized as a risk factor for the development of osteoporosis, according to Dr. Bhaskar Dasgupta in a poster session at the annual meeting of the British Society for Rheumatology.

Dr. Dasgupta, director of rheumatology, Southend Hospital NHS Trust, Westcliff on Sea, England, said patients with lymphoma have greatly improved survival rates because of advances in treatment, but their quality of life may be compromised by long-term complications of chemotherapy.

From Internalmedicinenews.com:

Height loss as a surrogate marker for vertebral osteoporosis was evaluated in a study of patients attending a lymphoma clinic. A total of 25 patients, 8 with Hodgkin’s and 17 with non-Hodgkin’s lymphoma, were enrolled. Mean age was 57.6 years, and 13 of the patients were female, reported Dr. Dasgupta. Exclusion criteria included a previous osteoporosis diagnosis, lymphoma with spinal involvement, and previous corticosteroid treatment.

When baseline height was compared with height 24 months or more after chemotherapy, the mean loss was found to be 22.8 mm, according to Dr. Dasgupta.

The degree of height loss increased with age—every 10-year increase in age was associated with a 5.2-mm decrease in height, he reported. No association was seen between height loss and gender, and none of the patients had other risk factors for osteoporosis.

No height loss association was found with either cumulative steroid dose or the type of chemotherapy received.

Osteoporosis is a complication that can result from treatment with alkylating agents and the steroids that are usually given with chemotherapy.

Tags: chemotherapy, corticosteroid, osteoporosis, steroid dose, steroids

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Children afflicted with nephrotic syndrome and who have been administered with steroid drugs do not have to face the risk of bone loss, which is one of the common side effects of treatment based on steroids for adults.

Childhood nephrotic syndrome, which is believed to affect 3 out of 100,000 children, leads to weakening of ability of the body to remove water and salt from the blood and cause swelling in the belly, legs, and around the eyes.

From News-Medical.Net:

“Unlike other childhood diseases treated with steroid drugs, such as inflammatory bowel disease or juvenile rheumatoid arthritis, nephrotic syndrome resolves quickly when treated,” said pediatric nephrologist Mary B. Leonard, M.D., of The Children’s Hospital of Philadelphia, lead author of the study. “We specifically chose steroid-sensitive nephrotic syndrome because we are able to isolate the drug’s effects on bones, without having an underlying systemic disease simultaneously affecting the bones.”

The team led by Dr. Leonard compared 60 children and adolescents with steroid-sensitive nephrotic syndrome to 195 healthy children. Specialized X- ray measurements showed no signs of osteoporosis, a loss in bone mass, among the nephrotic syndrome patients. The study appeared in the August 26 New England Journal of Medicine.

The researchers made adjustments for body mass index, an important consideration, since 38 percent of the children in the nephrotic syndrome sample were obese (in contrast, only 16 percent of the control subjects were obese, a proportion consistent with the general pediatric population). The disproportionate obesity among children with nephrotic syndrome disappears after the patients discontinue steroid treatments.

“While steroids tend to make children shorter and heavier than healthy children, increased weight is associated with an increase in bone mass,” said co-author Babette Zemel, Ph.D., of the Nutrition Center at Children’s Hospital. Specifically, whole-body measurements of bone mineral content were higher in children with nephrotic syndrome than in healthy children.

It was remarked by Dr. Leonard that these report findings could be helpful in assuring parents and physicians about steroid-based treatment in order to offer help to children with nephrotic syndrome as steroids do not enhance their risk of osteoporosis.

Tags: bone loss, Nephrotic syndrome, osteoporosis, steroid, steroids

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Low level of testosterone is a cause of concern for approximately 15 million men in the United States alone. The worrying fact is that a big majority of this population remains undiagnosed and untreated.

Dr. Ronald Tamler, the director of the Men’s Health Program at Mount Sinai Medical Center, said that testosterone has a significant influence on sexual desire and testosterone is effective against osteoporosis and helps in preserving lean body mass.

From NYdailynews.com:

SIGNS AND SYMPTOMS

The classic symptoms of hypogonadism are decreased libido, erectile dysfunction, fatigue, loss of muscle mass and depression. “So many men have come to me not because of erectile dysfunction, but because they’re feeling low energy,” says Tamler. “Their significant others say, ‘This has been going on too long,’ and chase them into my office.”

Other warning signs of low testosterone include brittle bones and poor focus. “Many patients report that they feel like they have brain fog,” says Tamler. “Often, that fog lifts once I treat them.”

Studies have shown that sex steroids have a cognitive effect on the brain. “If you feel low-energy all the time, it’s going to be difficult to do well on the job,” notes Tamler.

TRADITIONAL TREATMENT

Now that doctors know that lower testosterone is predictive of higher mortality, it’s all the more important to seek out treatment.

Tamler remarked that men with low testosterone levels are prone to higher risk of diabetes, heart disease, and early mortality.

Tags: erectile dysfunction, lean body mass, osteoporosis, testosterone

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Children afflicted with severe asthma should be taking an over-the-counter calcium supplement and a multi-vitamin every day for preventing loss of bone associated with osteoporosis, as per an article published in the Journal of Allergy and Clinical Immunology.

Joseph Spahn, M.D., an author of the article and a pediatric asthma specialist at National Jewish Medical and Research Center, said that a child does not have to be dependent on steroids to get osteoporosis.

From Sciencedaily.com:

Researchers did not find a connection between high usage of inhaled and oral steroids, and osteoporosis. Osteoporosis causes brittle bones and can lead to bone fractures, especially in active children. Nearly 5 million children in the United States have asthma.

Researchers also found that in the 1990s children had fewer growth problems than their counter-parts in the mid-1960s.

National Jewish looked at the side effects of steroids on adrenal gland suppression, cataracts, cushionoid disease and hypertension, making National Jewish’s study the most comprehensive ever published focusing on steroid side effects in children. The last time medical researchers performed a similar study was more than 35 years ago.

Because asthma is better controlled today—in the ’60s inhaled steroids didn’t exist as an asthma treatment—the disease has less of an impact of growth. Even though inhaled steroids can cause limited, short-term growth suppression—and children do catch up to the height of their peers as they get older—control of asthma is so much improved in the past three decades that the trade-off is a positive one for young patients. In addition, asthma itself can limit growth.

It is worth noting here that inhaled corticosteroids reduce and prevent swelling of the airways and oral (pills or syrup) corticosteroids relax tight muscles around the airways.

Tags: calcium supplement, corticosteroids, Oral Steroids, osteoporosis, steroid side effects, steroids, supplement

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A recent study has determined that Teriparatide, a synthetic form of the human parathyroid hormone, could be used to effectively treat steroid-induced osteoporosis.

It was found by the involved researchers that osteoporosis patients when treated with teriparatide for a period of 36 months had a greater increase in BMD (bone mineral density) and fewer new vertebral fractures than those treated with alendronate.

From Sciencedaily.com:

Results show at 36 months the BMD for lumbar spine was 11% higher than baseline in the teriparatide group compared with 5.3% in the alendronate group. The BMD (teriparatide versus alendronate) for total hip was 5.2% versus 2.7% and 6.3% versus 3.4% for femoral neck. Researchers also observed fewer vertebral fractures in subjects taking teriparatide (1.7%) than those administered alendronate (7.7%). Higher levels of calcium concentrations were noted in the teriparatide group (21%) than in the alendronate group (7%).

“There is a significant number of individuals who are regularly treated with steroids to control inflammation which puts them at risk for developing osteoporosis. A need for therapies that mitigate this side-effect of steroid use and substantially improves bone mass is vital,” commented Dr. Saag. The ACR estimates that diseases commonly treated with (cortico) steroids may affect more than 30 million Americans. “Our research shows that teriparatide is a safe and effective treatment for patients with steroid-induced OA and should be considered as a therapeutic option for those at high risk of bone fracture,” recommended Dr. Saag.

The findings of this study were published in an issue of Arthritis & Rheumatism, a journal of the American College of Rheumatology (ACR).

Tags: alendronate, BMD, osteoporosis, steroids, teriparatide

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Terming as a serious international public health concern, results from the Global Longitudinal Study of Osteoporosis in Women (GLOW) have shown that there is a failure in perceiving the implications of important risk factors among women even though the fairer sex is at an increased risk for osteoporosis-associated fractures. This latest study from GLOW, which is based at the Center for Outcomes Research at the University of Massachusetts Medical School, was published in the journal Osteoporosis International and evaluated more than 60,000 postmenopausal women in 10 countries.

From Sciencedaily.com:

Improved education of both physicians and postmenopausal women about osteoporosis risk factors is urgently needed, according to the study authors. Osteoporosis causes bones to become fragile and therefore more likely to break. If left untreated, the disease can progress painlessly until a fracture occurs. Several risk factors for fractures have been identified and should be considered by physicians treating women age 55 and over:

* older age

* low weight

* parental hip fracture

* personal history of fracture (clavicle, arm, wrist, spine, rib, hip, pelvis, upper leg, lower leg, ankle) since age 45

* two or more falls in the past year

* current use of cortisone or prednisone (steroids often prescribed for a number of medical conditions)

* rheumatoid arthritis

* cigarette smoking

* consumption of three or more alcoholic beverages daily.

Lead author of the paper, Ethel Siris, MD, GLOW investigator and Director of the Toni Stabile Osteoporosis Center of the Columbia University Medical Center, New York-Presbyterian Hospital, said most women are not making the association between their risk factors and the serious consequences of fractures.

Tags: osteoporosis, Prednisone, steroids

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A serious international public health concern was recently raised by researchers after results from the Global Longitudinal Study of Osteoporosis in Women (GLOW) showed that women are at an increased risk for osteoporosis-associated fractures.

It was also suggested by the study that there is a complete failure among women to perceive the implications of having important risk factors.

From Sciencedaily.com:

Improved education of both physicians and postmenopausal women about osteoporosis risk factors is urgently needed, according to the study authors. Osteoporosis causes bones to become fragile and therefore more likely to break. If left untreated, the disease can progress painlessly until a fracture occurs. Several risk factors for fractures have been identified and should be considered by physicians treating women age 55 and over:

* older age

* low weight

* parental hip fracture

* personal history of fracture (clavicle, arm, wrist, spine, rib, hip, pelvis, upper leg, lower leg, ankle) since age 45

* two or more falls in the past year

* current use of cortisone or prednisone (steroids often prescribed for a number of medical conditions)

* rheumatoid arthritis

* cigarette smoking

* consumption of three or more alcoholic beverages daily.

GLOW is supported by a grant from The Alliance for Better Bone Health (formerly sanofi-aventis and P&G Pharmaceuticals, now sanofi-aventis and Warner Chilcott) and is being directed by The Center for Outcomes Research, University of Massachusetts Medical School.

Tags: cortisone, osteoporosis, Prednisone, public health, Rheumatoid arthritis, steroids

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The injectable form of Teriparatide, Forteo, is superior to oral Alendronate, Fosamax, in a head-to-head comparison when it comes to improving bone mineral density (BMD) by as much as twice.

Teriparatide promotes greater increases in bone-mineral density at the spine and hip, as per Kenneth Saag, M.D., of the University of Alabama at Birmingham and his colleagues.

From Medpagetoday.com:

“In our study, teriparatide was associated with greater increases in [BMD] at the spine and hip and with significantly fewer new vertebral fractures,” Dr. Saag’s group wrote. But the dropout rate for adverse effects was twice as high for those taking teriparatide.

Only one out of 171 evaluable patients receiving teriparatide had radiographic evidence of a vertebral fracture, while 10 of 165 evaluable patients on alendronate had such fractures (P=0.004).

Nonvertebral fractures occurred at similar rates with the two treatments (5.6% versus 3.7%, P=0.36). BMD in the total hip increased with both drugs, though less dramatically than in the lumbar spine. Teriparatide increased hip BMD by 3.8% while it rose 2.4% in the alendronate group. The advantage for teriparatide was significant (P<0.01). Significantly more patients in the teriparatide group had at least one elevated serum calcium measurement > 10.5 mg/dL (18% versus 5.7%, P<0.001) and there was a tendency toward more patients with at least one measurement > 11 mg/dL (3.8% versus 1%, P=0.06).

Teriparatide is a recombinant peptide drug, based on a portion of the parathyroid hormone protein. Earlier studies had indicated that it leads to increased BMD.

Philip N. Sambrook, M.D., of the University of Sydney, said that Saag’s findings suggest that teriparatide is a superior drug for treating steroid-induced Osteoporosis.

Tags: bone-mineral density, oral alendronate, osteoporosis, teriparatide

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The introduction of HAART (Highly Active Antiretroviral Therapy) may have improved the survival and quality of life for people infected with the human immunodeficiency virus (HIV-1) but this improved prognosis has also resulted in long term negative disorders, namely osteoporosis.

Osteoporosis is a multifactorial disease characterized by reductions in bone mass leading to an increased propensity to bone fractures.

A study published in the Spanish review Enfermedades Infecciosas y Microbiología Clínica [Infectious Diseases and Clinical Microbiology] revealed that the prevalence of osteoporosis in HIV-1 infected patients.

From News-Medical.Net:

As far as Olmos is concerned, “recognition that osteoporosis is one of the late consequences of HIV-1 infection compels us to give an early diagnosis of this disease in these patients, in order to take the necessary preventive and therapeutic measures.

For this reason the study emphasises the need to take a detailed clinical history from HIV-1 infected people, and this should include the classic risk factors for osteoporosis, paying particular attention to treatment that has been received (corticosteroid medicines, HAART, etc) and the pattern of the disease.

In addition to the routine laboratory tests, the authors maintain that in order to optimise the prognosis of the patients, “a bone densitometry scan must be performed wherever there are data relating to hypogonadism, treatment with steroids for chronic disease or a previous history of fractures caused by osteoporosis“.

There is also a scientific consensus as to the recommended preventive measures to take: physical exercise, sufficient ingestion of calcium and Vitamin D, and elimination of risk factors such as alcohol, tobacco and poor diet.

The authors said that clinical trial results are awaited with a hope to bring new evidence about the possible effectiveness of anti-osteoporotic treatment in these patients.

Tags: corticosteroid, osteoporosis, steroids

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