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79-year-old post-menopausal woman with humerus fracture during teriparatide treatment.
No full textThe patient, a 79-year-old woman with a history of osteoporosis, presented with acute back pain without trauma, three years ago. Spinal X rays showed a vertebral compression fracture at T7, and DXA indicated a T-score of -2.65 BMD at the total hip. The patient started treatment with alendronate 70 mg once a week, plus calcium and vitamin D supplementation. After two years, she presented new acute back pain, and spinal X-rays revealed new vertebral compression fractures at T8 and T11. In September 2004, she stopped alendronate therapy and began teriparatide 20 microg subcutaneously each day for 18 months, associated with a dose of 1200 mg/day of calcium and 880 IU/day of vitamin D. In July 2005, she fell and sustained a fracture of the left proximal humerus. She was treated with conservative therapy and continued teriparatide therapy. After 25 days of conservative management, left shoulder X-ray showed quick formation of fracture healing. In conclusion, although teriparatide is indicated for the treatment of severe osteoporosis and not to enhance fracture healing, there are many experimental data which indicate that it may be beneficial also in enhancing fracture healing.The patient, a 79-year-old woman with a history of osteoporosis, presented with acute back pain without trauma, three years ago. Spinal X rays showed a vertebral compression fracture at T7, and DXA indicated a T-score of -2.65 BMD at the total hip. The patient started treatment with alendronate 70 mg once a week, plus calcium and vitamin D supplementation. After two years, she presented new acute back pain, and spinal X-rays revealed new vertebral compression fractures at T8 and T11. In September 2004, she stopped alendronate therapy and began teriparatide 20 microg subcutaneously each day for 18 months, associated with a dose of 1200 mg/day of calcium and 880 IU/day of vitamin D. In July 2005, she fell and sustained a fracture of the left proximal humerus. She was treated with conservative therapy and continued teriparatide therapy. After 25 days of conservative management, left shoulder X-ray showed quick formation of fracture healing. In conclusion, although teriparatide is indicated for the treatment of severe osteoporosis and not to enhance fracture healing, there are many experimental data which indicate that it may be beneficial also in enhancing fracture healing
New insights into the role of teriparatide
No full textParathyroid hormone (PTH) is secreted by the parathyroid glands and is an important regulator of blood calcium concentrations. Synthesis and secretion of PTH are stimulated by a decrease in blood calcium. PTH has three actions: 1) to increase the release of calcium from bone, 2) to reduce renal clearance of calcium, and 3) to stimulate the production of 1,25 (OH)(2)D(3). Human parathyroid hormone is a single chain polypeptide with 84 amino acids and a molecular weight of 9425 Da. The N-terminal region, 1-34, is biologically active and sufficient for regulation of mineral ion homeostasis (1). Recombinant teriparatide {human PTH(1-34) [hPTH (1-34)]}, currently the only bone-forming osteoporosis drug available for clinical use, increases bone turnover with a greater stimulation of formation than resorption (2). Bone turnover markers also rise during treatment with teriparatide (TPTD), with markers of bone formation rising early and rapidly, followed by rises in bone resorption markers. (Aging Clin Exp Res 2011; 23 (Suppl. to No. 2): 30-32) (C) 2011, Editrice Kurti
La gestione delle fratture da fragilità ossea - Raccomandazioni per chirurghi ortopedici
No full textTeriparatide and orthopedic surgery
No full textTeriparatide has an anabolic effect on bone tissue, leading to an increase in bone strength with a reduction in the risk of fragility fractures in osteoporotic women. In the last ten years, many animal studies have been conducted to support the hypothesis that this anabolic effect of teriparatide may benefit fracture healing by reducing the time of callus formation and remodeling. Teriparatide also seems to have an effect in the early post-operative period after osteosynthesis or joint replacement, by stimulating new bone formation, increasing bone-implant contact as early as after 1 week, and enhancing the tensile strength of the bone-cement interface, thereby decreasing the risk of late aseptic loosening. Scientific evidence supports the hypothesis that teriparatide may represent a huge resource for wide applications in orthopedic surgery
Mechanobiology of bone.
No full textBone is a tissue that dynamically adapts mass and architecture to the mechanical loads that occur in daily life in a world with gravity. Bone architecture and mass are influenced by the applied tension peak, whereas the bone formation rate is modulated by the stimulus frequency. In bone tissue, osteocytes govern the detection of mechanical afferents and their transformation into biochemical messages, therefore these cells can be considered a mechanosensor that directs osteogenesis to where it is most needed to increase bone strength. The stimulation of osteocytes occurs with several modalities: shear stress and stretch, extracellular pressure modifications, strains, variations of electric field in and around osteocytes lacunae. The osteocyte network, under physiological conditions, activates osteoclastogenesis and suppresses osteoblast function enhancing bone resorption and inhibiting bone formation. In the unloaded condition, the functions of the osteocyte network are augmented, whereas exercise could decrease inhibitory effects on bone mass by reducing both osteoclastogenesis and inhibition on osteoblast function
"Osteoporotic fragility fractures: medical and surgical approaches" II National Congress of the Italian Orthopedic Group for the Study of Severe Osteoporosis (GISOOS)
No full textSevere osteoporosis and its identification
No full textThe severity of osteoporosis depends not only on densitometric data but implies the occurrence of at least one of the following conditions: increased risk of mortality, worsening of quality of life and significant disability in the performance of activities of daily living, presence of comorbidities that increase the risk of falls, the presence of at least one fragility fracture. (Aging Clin Exp Res 2011; 23 (Suppl. to No. 2): 6-7) (C) 2011, Editrice Kurti
Vitamin D: Role and opportunity to prescribe
No full textThe major role of vitamin D in humans is to increase the absorption of calcium and phosphatase for the mineralization of the skeleton. The synthesis of vitamin D3 in the skin under influence of UV light decreases with aging due to insufficient sunlight exposure, and a decreased functional capacity of the skin. Deficiency in vitamin D causes secondary hyperparathyroidism, high bone turnover, bone loss, mineralization defects, proximal myopathy, falls and hip and other fractures. The goal of therapy of hypovitaminosis D is to restore normal serum and deposits of 25 (OH) D. The daily supplementation of vitamin D indicated is about 800-1,000 IU/day but may increase up to a maximum dose of 2,000 IU/day in conditions of severe vitamin D deficiency with a concomitant reduced or no sun exposure, reduced dietary intake and reduced calcium absorption. © 2013 Springer International Publishing Switzerland
Effects of denosumab on cortical and trabecular microarchitecture: evidences from clinical studies.
No full textExcess of bone remodeling is still the major pathogenic factor in involutional osteoporosis. This phenomenon is linked to an imbalance between neoformation (by osteoblasts) and resorption (by osteoclasts). Recently, research in drug development is focused on new and more "physiological" approach to balance bone remodeling. The efficacy of denosumab was proved in the prevention of vertebral and non-vertebral fractures and related to the ability of the drug to penetrate in cortical and trabecular bone. Recently, data from several clinical studies confirm that denosumab improves fracture outcomes, also at skeletal sites rich in cortical bone
Inhibition of RANK ligand: a new option for preventing fragility fractures
No full textCortical and trabecular bone undergo a continuous and balanced remodeling process, consisting of an osteoclast-mediated bone-resorption phase and an osteoblast- mediated bone-formation phase. An imbalance in this process, which favours bone resorption, results in bone loss and in damage to the skeletal microarchitecture. A new targeted anti-resorptive approach is represented by the inhibition of RANK ligand (RANKL), which is one of the primary mediators of osteoclast activity, essential for osteoclast formation, function and survival
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