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SUBCLONES OF A RAT PARATHYROID CELL-LINE (PT-R) - REGULATION OF GROWTH AND PRODUCTION OF PARATHYROID HORMONE-RELATED PEPTIDE (PTHRP)
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Bazedoxifene: literature data and clinical evidence.
No full textA Multidisciplinary National Panel of Experts in the management of Menopause and Postmenopausal Osteoporosis was created to determine the specific positioning of Bazedoxifene acetate (BZA), a third-generation selective estrogen receptor modulator (SERM), in the field of available therapeutic options in prevention and treatment of postmenopausal osteoporosis.There are various therapeutic options in prevention and treatment for postmenopausal osteoporosis, but nevertheless the problem of osteoporosis and osteoporosis-related fractures is not yet resolved today.In view of this unmet medical need, to have new treatments with efficacy and safety profile so good to therapeutically manage even larger groups of population is the conceptual basis to reduce the devastating impact of this disease on individual's morbidity and mortality, and on public health expense.The Panel has, moreover, pointed up the need to increase the awareness about the issue "osteopenia" as a risk factor for fracture to consider in daily clinical practice and the opportunity to evaluate fracture risk using an adequate algorithm (for example, FRAX®, deFRA®), which integrates the result obtained by densitometry (Bone Mineral Density, BMD) (1, 2) and clinical risk factors, in order to consider threshold values for pharmacological intervention.As for prevention and treatment and different groups of age in women's life, it is evident as in the group ranging in age 50 to 65 years the reference Specialist may be the Gynecologist, as the Woman's doctor, even if other Specialists could be interested (Endocrinologist, Rheumatologist, Internist, General Practitioner, or other Specialist who is seeing a patient with osteopenia/osteoporosis). The involved Specialist, necessarily, has to make preventative and/or therapeutic strategies for osteopenia/osteoporosis.After the publication of the study Women's Health Initiative (WHI) in 2002 (3), there was a decrease in applying Hormonal Replacement Therapy (HRT) or Hormone Therapy (HT), that even if is prescribed for climacteric symptoms (hot flushes, night sweats, etc.) can prevent bone loss and reduce osteoporosis-related fracture risk. The lower use of HRT (HT) has increased and still increases the risk of developing, in postmenopausal women, osteopenia and osteoporosis, with increased fracture risk, as it is demonstrated by N.O.R.A. Study (National Osteoporosis Risk Assessment) published in 2004 (4).On the other hand, the different treatments available for osteoporosis therapy, significantly decrease the relative risk of osteoporosis, but the percentage of non-treated or under-treated patients remains high. Thus, it is still fundamental to have at disposal further treatments with proven efficacy in preventing and treating osteopenia and osteoporosis in everyday clinical practice
New perspectives on the definition and the management of severe osteoporosis: the patient with two or more fragility fractures
No full textOsteoporosis is the most common skeletal disorder in the elderly, being characterized by impaired bone strength and increased risk of fracture. Severe osteoporosis is currently defined by the threshold of bone density value below the -2.5 SDS of T-score, determined by dualenergy X-ray absorptiometry, and the presence of one or more fragility fractures. This definition does not entirely reflect the spectrum of severity of the disease that provides a variable increase in fracture risk
Appropriate use of anabolic treatment for severe osteoporosis.
No full textOsteoporotic fractures remain a major public health problem for their correlated morbidity and mortality. The primary aim of therapy must be the prevention of the first fragility fracture and avoiding subsequent fractures in patients who already have an existing fracture. There are evidences from randomized controlled trials (RCTs) about the efficacy of antiresorptives, such as bisphosphonates in reducing the risk of fracture, but none of these agents completely abolish the fracture risk. The reduction of RRR by different therapies in RCTs is relatively constant but it is important to note that the proportion of inadequate-responders (i.e.: patients fracturing despite adequate pharmacological treatment) is increasing with the severity of the disease: the higher the risk of fracture the higher the proportion of inadequate-responders. Thus, the proportion of non responders across different trials is directly related to the fracture incidence observed in the control group of RCTs which is the most proximate indicator of osteoporosis severity.Teriparatide (TPTD) demonstrate a real increases of both trabecular and cortical bone volume, which are associated with a true reduction of fracture risk, as many RCTs confirm. The beneficial effect of introducing a treatment with antiresorptives after the treatment course with TPTD has been clearly demonstrated with the prevention of the reabsorption of the new bone tissue built during TPTD therapy and rapidly lowers cortical porosity, which leads to further increases in BMD. For these results, the introduction of an anti-resorptive after the treatment course with TPTD is strongly recommended and taken into account.In Italy TPTD is fully reimbursed in patients incurring in a new vertebral or hip fracture while on chronic treatment with antiresorptive or in naive patients with 3 or more vertebral or hip fractures. In conclusion, since patients with severe osteoporosis are at very high risk of new fractures with worsening of quality of life and life expectancy, antiresorptives represent a sub-optimal treatment in these patients, werehas, since TPTD demonstrated real and substantial improvements in bone mass and reduction of fracture risk independently of initial risk, TPTD represents the only therapeutic option able to reverse at least in part this disabling disease
BIOELECTRICAL PHASE ANGLE ON HOSPITAL ADMISSION AS PREDICTOR OF SHORT- AND MIDDLE-TERM MORTALITY IN ELDERLY MEDICAL PATIENTS.
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