265,077 research outputs found
Diagnosis and treatment of subclinical hypercortisolism
No full textContext: Subclinical hypercortisolism (SH) is a condition of biochemical cortisol excess without the classical signsorsymptomsofoverthypercortisolism. It isthoughttobepresentinthe5-30%ofpatients with incidentally discovered adrenal mass (adrenal incidentalomas), which in turn are found in 4-7% of the adult population. Therefore, SH has been suggested to be present in 0.2-2.0% of the adult population. Some studies suggested that this condition is present in 1-10% of patients with diabetes or established osteoporosis. The present manuscript reviews the literature on diagnostic procedures and the metabolic effect of the recovery from SH. Evidence Acquisition: A PubMed search was used to identify the available studies. The most relevant studies from 1992 to November 2010 have been included in the review. Evidence Synthesis: The available data suggest that SH may be associated with chronic complications, such as hypertension, diabetes mellitus, overweight/obesity, and osteoporosis. The available intervention studies suggest that the recovery from SH may lead to the improvement of hypertension and diabetes mellitus. A retrospective study suggests that this beneficial effect could be predicted before surgery. Conclusions: SH is suggested to be associated with some chronic complications of overt cortisol excess. Recovery from this condition seems to improve these complications. However, a large, prospective, randomized study is needed to confirm this hypothesis and to establish the best diagnostic approach to identify patients with adrenal incidentalomas who can benefit from surgery
<i>Tips from a</i> ‘trip advisor’
No full text Jane Chiodini looks at delivering a travel health service in primary care </jats:p
<i>Have jabs</i>, will travel!
No full text Travel health specialist nurse Jane Chiodini goes globetrotting online to look at advice sources for those round-the-world vaccinations </jats:p
Falls, fractures and vitamin D: a never-ending story?
No full textComment on
Effects of vitamin D supplementation on musculoskeletal health: a systematic review, meta-analysis, and trial sequential analysis. [Lancet Diabetes Endocrinol. 2018]
Vitamin D is important for skeletal metabolism and calcium homeostasis, but conflicting evidence exists as to whether vitamin D supplementation has a protective effect on musculoskeletal outcomes. Do the results of a new meta-analysis bring clarity or increase confusion? © 2018, Springer Nature Limited
The effects of vegetarian diets on bone health: a literature review
No full textIn these recent years many people are adopting a vegetarian type diet due to the numerous positive health effects of this regimen such as the reduction of the incidence of many chronic disorders like diabetes, hypertension, obesity and cancer. However this diet is quite restrictive and so it could be possible to have a deficiency in some specific nutrients, increasing the risk of osteoporosis and fractures. Although there are conflicting results on the effects of the vegetarian diet on bone health and fracture incidence, it is always recommendable in vegetarian people to have an adequate intake of calcium and vitamin D, through an increased intake of supplements, natural and fortified foods, an adequate intake of protein, fruit, vegetables, as well as vitamin B12. The aim of this literature review is to revise the actual knowledge of the effect of some nutrients and vegetarian diets on bone health. Copyright © 2022 Falchetti, Cavati, Valenti, Mingiano, Cosso, Gennari, Chiodini and Merlotti
Efficacy and safety of abaloparatide for the treatment of post-menopausal osteoporosis
No full textOsteoporosis is a skeletal disorder characterized by loss of bone mass and strength affecting up to 30-50% of postmenopausal women worldwide. Current therapeutic options include antiresorptives such as aminobisphosphonates or denosumab and osteoanabolic compounds such as teriparatide. Areas covered: In this review, the authors summarize the clinical development, safety and efficacy profile of abaloparatide, a new osteoanabolic agent recently marketed in the US for the treatment of postmenopausal osteoporosis in women who are at high risk for fracture or who fail antiresorptive therapy. Expert opinion: Abaloparatide is a 1-34 PTH related peptide-like molecule that has been modified in order to potentiate the osteoanabolic effect. In its pivotal phase 3 trial in postmenopausal women with osteoporosis, subcutaneous abaloparatide 80 mcg/day reduced the risk of vertebral, nonvertebral, major osteoporotic, and clinical fractures compared with placebo and reduced the risk of major osteoporotic fractures compared with teriparatide. These results, together with a reduced prevalence of hypercalcemia and a lower cost of the marketed compound, point toward improved cost effectiveness with abaloparatide versus teriparatide. However, some concerns have been raised due to a somewhat higher occurrence of adverse effects (particularly with palpitations and increased heart rate) or the resultant discontinuation due to these adverse effects when compared to teriparatide
Interconnection of bone, glucose and cortisol, and clinical implications
No full textDati recenti della letteratura hanno posto in evidenza come un eccesso lieve di cortisolo di origine endogena (ipercortisolismo subclinico) possa incrementare il rischio di frattura riducendo la microarchitettura scheletrica più che la densità minerale ossea, inibendo l’azione osteoblastica. La riduzione dell’apposizione scheletrica e la conseguente riduzione dei livelli di osteocalcina da eccesso di cortisolo potrebbe peggiorare il compenso glicometabolico. Infatti, la condizione di ipercortisolismo subclinico determina anche un maggior rischio di diabete e malattia cardiovascolare. Il diabete stesso tuttavia riduce la microarchitettura scheletrica ed aumenta il rischio di frattura senza alterare la densità minerale ossea, per una serie di alterazioni tra le quali è stato recentemente dimostrato poter giocare un ruolo la secrezione di cortisolo e la sensibilità ai glucocorticoidi.
Queste interrelazioni tra cortisolo, diabete e metabolismo osseo rinforzano l’idea di un tessuto scheletrico come organo endocrino. La possibilità di modulare la secrezione di cortisolo potrebbe aver un ruolo contemporaneamente nel controllo della malattia diabetica e delle sue complicanze scheletrich
Treatment options for glucocorticoid-induced osteoporosis
No full textIntroduction: Glucocorticoid (GC) induced osteoporosis (GIOP) is the most common form of secondary osteoporosis. It develops in a dose and time dependent manner, due to a rapid and transient increase in bone resorption, followed by the inhibition of bone formation.Areas covered: In this review, the authors summarize the pathophysiology of GIOP and give discussion to the clinical management of patients taking GCs, focusing on the currently available drugs that have antiresorptive or anabolic activity on bone.Expert opinion: Despite the widespread use of GCs and their well-established detrimental skeletal effects, GIOP remains an under-diagnosed and under-treated condition. Indeed, the clinical management of GIOP is still debated, so that the recent guidelines differ in their indications for pharmacological intervention. Either bone mineral density (BMD) or algorithms such as FRAX do not completely account for the remarkable and rapid increase in fracture risk of most GC-treated patients. Moreover, while oral bisphosphonates remain the most used and cost-effective option, the potential increased benefits of more potent antiresorptive agents (e.g. denosumab and zoledronate) or anabolic compounds (e.g. teriparatide) warrant further investigation. Despite the above limitations, the assessment of fracture risk is recommended for all individuals committed to receiving oral GCs for 3 months or longer
Densitometry in glucocorticoid-induced osteoporosis
No full textThe technique of choice for the measurement of bone mineral density (BMD) in patients with glucocorticoid-induced osteoporosis (GIOP) is dual X-ray absorptiometry (DXA), which has been demonstrated to be reliable in diagnosing osteoporosis and monitoring bone mass variations over time in GIOP. However, in patients with both exogenous (i.e. due to glucocorticoid therapy) and endogenous cortisol excess, the BMD decrease does not fully explain the high risk of fractures. Therefore, the BMD thresholds in guidelines for the prevention of GC-related fractures are different and debated. Quantitative computed tomography (QCT), which is useful to separately study cortical and trabecular bone and to measure true "volumetric" BMD, has been suggested to be a better predictor of vertebral fractures than DXA. However, QCT has the limit of the possible underestimation of bone mass and QCT T-scores may be lower as compared to DXA T-score values for the same skeletal site. Quantitative ultrasound, which is considered to reflect both BMD and structural properties of bone such as connectivity and elasticity, is able to diagnose low BMD in GIOP, but its role in monitoring BMD changes and in predicting fracture's risk remains unknown. Low BMD and high rate of bone loss have been suggested to be possible complications even of subclinical hypercortisolism regardless for gender and gonadal status. On the other hand, low BMD and vertebral fractures may be the initial presentation of an otherwise asymptomatic cortisol excess
Rare earth doped silica optical fibre sensors for dosimetry in medical and technical applications
No full textRadioluminescence optical fibre sensors are gaining importance since these devices are promising in several applications like high energy physics, particle tracking, real-time monitoring of radiation beams, and radioactive waste. Silica optical fibres play an important role thanks to their high radiation hardness. Moreover, rare earths may be incorporated to optimise the scintillation properties (emission spectrum, decay time) according to the particular application. This makes doped silica optical fibres a very versatile tool for the detection of ionizing radiation in many contexts. Among the fields of application of optical fibre sensors, radiation therapy represents a driving force for the research and development of new devices. In this review the recent progresses in the development of rare earth doped silica fibres for dosimetry in the medical field are described. After a general description of advantages and challenges for the use of optical fibre based dosimeter during radiation therapy treatment and diagnostic irradiations, the features of the incorporation of rare earths in the silica matrix in order to prepare radioluminescent optical fibre sensors are presented and discussed. In the last part of this paper, recent results obtained by using cerium, europium, and ytterbium doped silica optical fibres in radiation therapy applications are reviewed
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