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Pharmacological options for pain control in patients with vertebral fragility fractures 椎体脆性骨折患者疼痛控制的药理选择
IF 2 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2022-09-01 DOI: 10.1016/j.afos.2022.09.003
Nuttan Kantilal Tanna , Terence Ong

This review considers the evidence base and current knowledge for pharmacological treatment options that are available for pain control in patients with vertebral fractures sustained after a low trauma incident. Due care needs to be taken when considering prescribed options for pain control. The decision should be based on first establishing whether the presentation is one of acute severe pain at the time of a new vertebral fragility fracture incident or whether the complaint is one of the debilitating, longer term chronic back pain syndrome, accompanied by a clinical suspicion of a possible new fracture. The article also presents currently debated questions in this important area of clinical and patient care and will be of interest to the readership worldwide.

本综述考虑了低创伤事件后椎体骨折患者疼痛控制的药物治疗选择的证据基础和现有知识。在考虑控制疼痛的处方选择时,需要采取适当的注意。该决定应首先确定表现是否为新的椎体脆性骨折事件时的急性剧烈疼痛,还是主诉是一种衰弱的长期慢性背痛综合征,并伴有可能的新骨折的临床怀疑。这篇文章还提出了目前在临床和病人护理这一重要领域有争议的问题,并将对全世界的读者感兴趣。
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引用次数: 1
TOC
IF 2 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2022-06-01 DOI: 10.1016/S2405-5255(22)00034-6
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引用次数: 0
Body composition and functional performance of older adults 老年人的身体组成和功能表现
IF 2 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2022-06-01 DOI: 10.1016/j.afos.2022.04.002
Diane Nogueira Paranhos Amorim , Dahan da Cunha Nascimento , Whitley Stone , Vicente Paulo Alves , Karla Helena Coelho Vilaça e Silva

Objectives

To determine if anthropometric variables, body composition, medication and gender are associated with functional performance and to compare these variables between octogenarians with high and low functional performance.

Methods

Observational, cross-sectional study. Weight, height, body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) were evaluated. Handgrip strength (HGS) was assessed. Participants’ body composition was assessed by dual-energy X-ray absorptiometry (DXA) and functional performance by Short Physical Performance Battery (SPPB). A binomial logistic regression was performed.

Results

One hundred and twenty-two octogenarians were included and separated into high and low function groups. The high function group showed lower values of WHtR (mean difference [MD] = 0.047, P = 0.025) and body fat (BF%) (MD = 3.54, P = 0.032) and higher values of apendicular skeletal muscle mass (ALM) (MD = 3.03, P = 0.001), HGS (MD = 6.11, P = 0.001) and SPPB score (MD = 4.20, P = 0.001). Women were more likely to be classified as low function (OR = 3.66, P = 0.002) and males showed 5.21 odds ratio (P = 0.021) of having high functional performance compared to females. Also, each decrease in age and medication use displayed 1.30 (P = 0.007) and 1.26 odds ratio increases (P = 0.008) in high functional performance.

Conclusions

Older males display better functional performance than women, and decrements in age and medications increase the high functional performance odds ratio. Octogenarians with high functional performance displayed lower BF measurements and higher values of muscle mass and strength.

目的确定人体测量变量、身体成分、药物和性别是否与功能表现相关,并比较功能表现高和低的80多岁老人之间的这些变量。方法采用观察性横断面研究。评估体重、身高、身体质量指数(BMI)、腰围(WC)和腰高比(WHtR)。评估了手握力(HGS)。通过双能x线吸收仪(DXA)评估参与者的身体成分,通过短物理性能电池(SPPB)评估参与者的功能表现。进行二项逻辑回归。结果共纳入122名老年患者,分为高功能组和低功能组。高功能组WHtR(平均差值[MD] = 0.047, P = 0.025)、体脂(BF%) (MD = 3.54, P = 0.032)较低,阑尾骨骼肌质量(ALM) (MD = 3.03, P = 0.001)、HGS (MD = 6.11, P = 0.001)、SPPB评分(MD = 4.20, P = 0.001)较高。与女性相比,女性更容易被归类为低功能(OR = 3.66, P = 0.002),男性具有高功能表现的比值比为5.21 (P = 0.021)。此外,在高功能表现中,年龄和药物使用每减少1.30 (P = 0.007)和1.26 (P = 0.008)的优势比增加(P = 0.007)。结论男性患者的功能表现优于女性患者,年龄和用药的减少增加了功能表现的优势比。具有高功能表现的八旬老人表现出较低的BF测量值和较高的肌肉质量和力量值。
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引用次数: 7
The impact of sex steroids on osteonecrosis of the jaw 性类固醇对颌骨骨坏死的影响
IF 2 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2022-06-01 DOI: 10.1016/j.afos.2022.05.003
Ranhee Kim , Sung Woo Kim , Hoon Kim , Seung-Yup Ku

Sex steroid hormones play a major role in bone homeostasis. Therefore, the use of sex hormones or drugs may increase the risk of osteonecrosis of the jaw (ONJ), a complication caused by damaged bone homeostasis. However, few are known the impact of medications changing sex hormone levels on ONJ.

The pathophysiology of ONJ is not clearly understood and many hypotheses exist: cessation of bone remodeling caused by its anti-resorptive effect on osteoclasts; compromised microcirculation due to medication affecting angiogenesis, including bisphosphonate; and impairment of defense mechanism toward local infection.

The use of high-dose intravenous bisphosphonate in cancer patients is associated with a high prevalence of ONJ. Exogenous estrogen or androgen replacement was reported to be associated with ONJ. Polycystic ovarian syndrome (PCOS) patients demonstrate an androgen excess status, and androgen overproduction serves as a protective factor in the bone mineral density of young women. To date, there are no reports of ONJ occurrence due to androgen overproduction. In contrast, few reports on the occurrence of ONJ due to estrogen deficiency induced by drugs, such as selective estrogen receptor modulator (SERM), aromatase inhibitors, and gonadotropin-releasing hormone (GnRH) agonists, are available.

Thus, the role of sex steroids in the development of ONJ is not known. Further studies are required to demonstrate the exact role of sex steroids in bone homeostasis and ONJ progression. In this review, we will discuss the relationship between medication associated with sex steroids and ONJ.

性类固醇激素在骨骼稳态中起着重要作用。因此,使用性激素或药物可能会增加颌骨骨坏死(ONJ)的风险,这是一种由骨稳态受损引起的并发症。然而,很少有人知道药物改变性激素水平对ONJ的影响。ONJ的病理生理机制尚不清楚,存在多种假说:其对破骨细胞的抗吸收作用导致骨重塑停止;由于影响血管生成的药物(包括双膦酸盐)导致微循环受损;对局部感染的防御机制受损。在癌症患者中静脉注射大剂量双膦酸盐与ONJ的高患病率相关。据报道,外源性雌激素或雄激素替代与ONJ有关。多囊卵巢综合征(PCOS)患者表现出雄激素过量的状态,雄激素过量的产生是年轻女性骨矿物质密度的保护因素。到目前为止,还没有因雄激素分泌过多而发生ONJ的报道。相比之下,由于选择性雌激素受体调节剂(SERM)、芳香化酶抑制剂和促性腺激素释放激素(GnRH)激动剂等药物引起的雌激素缺乏而发生ONJ的报道很少。因此,性类固醇在ONJ发展中的作用尚不清楚。需要进一步的研究来证明性类固醇在骨稳态和ONJ进展中的确切作用。在这篇综述中,我们将讨论与性类固醇相关的药物与ONJ的关系。
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引用次数: 3
South Asian Working Action Group on SARCOpenia (SWAG-SARCO) – A consensus document 南亚肌肉减少症工作行动小组(SWAG-SARCO) -一份共识文件
IF 2 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2022-06-01 DOI: 10.1016/j.afos.2022.04.001
Minakshi Dhar , Nitin Kapoor , Ketut Suastika , Mohammad E. Khamseh , Shahjada Selim , Vijay Kumar , Syed Abbas Raza , Umal Azmat , Monika Pathania , Yovan Parikshat Rai Mahadeb , Sunny Singhal , Mohammad Wali Naseri , IGP Suka Aryana , Subarna Dhoj Thapa , Jubbin Jacob , Noel Somasundaram , Ali Latheef , Guru Prasad Dhakal , Sanjay Kalra

The South Asian population is rapidly ageing and sarcopenia is likely to become a huge burden in this region if proper action is not taken in time. Several sarcopenia guidelines are available, from the western world and from East Asia. However, these guidelines are not fully relevant for the South Asian healthcare ecosystem. South Asia is ethnically, culturally, and phenotypically unique. Additionally, the region is seeing an increase in non-communicable lifestyle disease and obesity. Both these conditions can lead to sarcopenia. However, secondary sarcopenia and sarcopenic obesity are either not dealt with in detail or are missing in other guidelines. Hence, we present a consensus on the screening, diagnosis and management of sarcopenia, which addresses the gaps in the current guidelines. This South Asian consensus gives equal importance to muscle function, muscle strength, and muscle mass; provides cost-effective clinical and easy to implement solutions; highlights secondary sarcopenia and sarcopenic obesity; lists commonly used biomarkers; reminds us that osteo-arthro-muscular triad should be seen as a single entity to address sarcopenia; stresses on prevention over treatment; and prioritizes non-pharmacological over pharmacological management. As literature is scarce from this region, the authors call for more South Asian research guided interventions.

南亚人口正在迅速老龄化,如果不及时采取适当行动,肌肉减少症很可能成为该地区的巨大负担。西方世界和东亚都有一些肌肉减少症的指导方针。然而,这些指南并不完全适用于南亚的医疗保健生态系统。南亚在种族、文化和表型上都是独特的。此外,该地区的非传染性生活方式疾病和肥胖症也在增加。这两种情况都会导致肌肉减少症。然而,继发性肌肉减少症和肌肉减少性肥胖要么没有详细处理,要么在其他指南中缺失。因此,我们提出了一个共识的筛选,诊断和管理的肌肉减少症,这解决了目前的指导方针的差距。这种南亚共识对肌肉功能、肌肉力量和肌肉质量给予同等重视;提供具有成本效益的临床和易于实施的解决方案;强调继发性肌肉减少症和肌肉减少性肥胖;列出常用的生物标志物;提醒我们,骨-关节-肌肉三联症应被视为一个单一的实体来解决肌肉减少症;强调预防胜于治疗;将非药物管理置于药物管理之上。由于该地区的文献很少,作者呼吁更多的南亚研究指导干预措施。
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引用次数: 15
Effect of denosumab on renal function in women with osteoporosis evaluated using cystatin C 用胱抑素C评价地诺单抗对骨质疏松女性肾功能的影响
IF 2 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2022-06-01 DOI: 10.1016/j.afos.2022.05.002
Tsuyoshi Ohishi , Tomotada Fujita , Tatsuya Nishida , Kazuhiro Hagiwara , Reina Murai , Yukihiro Matsuyama

Objectives

To investigate renal function during denosumab therapy using the estimated glomerular filtration rate based on cystatin C (eGFRcys) which is more accurate than creatinine (eGFRcr) for renal function.

Methods

Bone mineral densities (BMDs) of lumbar spine and hip regions, eGFRcys, eGFRcr, creatinine clearance (Ccr), and serum total homocysteine (S-Hcy) were measured during 2-year denosumab therapy in 53 women with osteoporosis naïve to anti-osteoporosis drugs (new group) and 64 women who were switched from long-term bisphosphonate treatment to denosumab therapy (switch group).

Results

There were no significant differences in age, eGFRcr, Ccr, eGFRcys, and S-Hcy levels at baseline between the groups. BMDs in the lumbar spine, femoral neck, and total hip increased significantly after 2-year denosumab therapy in both groups. eGFRcr decreased in the switch group, and Ccr decreased in both groups; however, eGFRcys and S-Hcy levels did not change significantly in either group. To investigate the causal factors associated with the decrease in eGFRcr and Ccr, multiple regression analysis was performed in all patients. Denosumab initiation within 3 months after fracture and eGFRcr or Ccr at baseline were independent factors for the decrease in eGFRcr or Ccr during the 2-year denosumab therapy. Decline in creatinine-based renal function could be reflected by increased muscle mass during the ongoing recovery from fracture.

Conclusions

Renal function was preserved in all patients, including those in the switch group during denosumab therapy. Creatinine-based renal function should be cautiously interpreted during denosumab therapy in patients with recent fractures.

目的利用基于胱抑素C (eGFRcys)的肾小球滤过率评估去地单抗治疗期间的肾功能,该指标比肌酸酐(eGFRcr)更准确。方法对53例骨质疏松症患者naïve(新组)和64例从长期双膦酸盐治疗切换到denosumab治疗的妇女(切换组)进行2年denosumab治疗期间腰椎和髋部骨矿物质密度(bmd)、egfrys、eGFRcr、肌酐清除率(Ccr)和血清总同型半胱氨酸(S-Hcy)的测定。结果两组患者年龄、eGFRcr、Ccr、egfrys、S-Hcy基线水平无显著差异。两组患者在denosumab治疗2年后,腰椎、股骨颈和全髋的bmd均显著增加。开关组eGFRcr降低,两组Ccr均降低;然而,egfrys和S-Hcy水平在两组中均无显著变化。为了探讨与eGFRcr和Ccr降低相关的原因,对所有患者进行多元回归分析。骨折后3个月内开始使用Denosumab和基线时的eGFRcr或Ccr是2年Denosumab治疗期间eGFRcr或Ccr下降的独立因素。在骨折恢复过程中,肌酐基础肾功能的下降可以通过肌肉量的增加来反映。结论所有患者在denosumab治疗期间肾功能均保持正常,包括切换组患者。近期骨折患者在denosumab治疗期间应谨慎解释肌酐肾功能。
{"title":"Effect of denosumab on renal function in women with osteoporosis evaluated using cystatin C","authors":"Tsuyoshi Ohishi ,&nbsp;Tomotada Fujita ,&nbsp;Tatsuya Nishida ,&nbsp;Kazuhiro Hagiwara ,&nbsp;Reina Murai ,&nbsp;Yukihiro Matsuyama","doi":"10.1016/j.afos.2022.05.002","DOIUrl":"10.1016/j.afos.2022.05.002","url":null,"abstract":"<div><h3>Objectives</h3><p>To investigate renal function during denosumab therapy using the estimated glomerular filtration rate based on cystatin C (eGFRcys) which is more accurate than creatinine (eGFRcr) for renal function.</p></div><div><h3>Methods</h3><p>Bone mineral densities (BMDs) of lumbar spine and hip regions, eGFRcys, eGFRcr, creatinine clearance (Ccr), and serum total homocysteine (S-Hcy) were measured during 2-year denosumab therapy in 53 women with osteoporosis naïve to anti-osteoporosis drugs (new group) and 64 women who were switched from long-term bisphosphonate treatment to denosumab therapy (switch group).</p></div><div><h3>Results</h3><p>There were no significant differences in age, eGFRcr, Ccr, eGFRcys, and S-Hcy levels at baseline between the groups. BMDs in the lumbar spine, femoral neck, and total hip increased significantly after 2-year denosumab therapy in both groups. eGFRcr decreased in the switch group, and Ccr decreased in both groups; however, eGFRcys and S-Hcy levels did not change significantly in either group. To investigate the causal factors associated with the decrease in eGFRcr and Ccr, multiple regression analysis was performed in all patients. Denosumab initiation within 3 months after fracture and eGFRcr or Ccr at baseline were independent factors for the decrease in eGFRcr or Ccr during the 2-year denosumab therapy. Decline in creatinine-based renal function could be reflected by increased muscle mass during the ongoing recovery from fracture.</p></div><div><h3>Conclusions</h3><p>Renal function was preserved in all patients, including those in the switch group during denosumab therapy. Creatinine-based renal function should be cautiously interpreted during denosumab therapy in patients with recent fractures.</p></div>","PeriodicalId":19701,"journal":{"name":"Osteoporosis and Sarcopenia","volume":"8 2","pages":"Pages 68-74"},"PeriodicalIF":2.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/70/5f/main.PMC9263171.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40614782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Two-year effectiveness of zoledronic acid with or without eldecalcitol in Japanese patients with osteoporosis: A randomized prospective study 唑来膦酸加或不加依地骨糖醇治疗日本骨质疏松症患者的两年疗效:一项随机前瞻性研究
IF 2 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2022-06-01 DOI: 10.1016/j.afos.2022.05.001
Takeshi Mochizuki , Koichiro Yano , Katsunori Ikari , Ken Okazaki

Objectives

This study aims to examine the 2-year outcomes of zoledronic acid (ZOL) with or without eldecalcitol (ELD) on bone mineral density (BMD) and fracture in Japanese patients with osteoporosis.

Methods

The subjects were 98 patients who were randomly (1:1) assigned to treatment with ZOL combined with ELD (ZOL + ELD group; n = 51) and ZOL alone (ZOL group; n = 47). Treatment efficacy was examined based on a comparison of changes in BMD from baseline (ΔBMD) in the lumbar spine, total hip, and femoral neck in the 2 groups.

Results

The percent change from baseline in BMD values for the lumbar spine, total hip, and femoral neck at 24 months were 10.8% ± 6.1%, 6.0% ± 6.6%, and 5.1% ± 5.1%, respectively, in the ZOL + ELD group, and 7.7% ± 6.2%, 5.1% ± 5.6%, and 2.9% ± 8.3%, respectively, in the ZOL group. The percent change from baseline BMD for the lumbar spine at 24 months differed significantly between the 2 groups.

Conclusions

The effect of a combination of ZOL + ELD on BMD for 24 months was more favorable than that of ZOL alone. This drug combination is promising for the treatment of drug-naïve Japanese patients with primary osteoporosis.

本研究旨在探讨唑来膦酸(ZOL)联合或不联合骨化醇(ELD)对日本骨质疏松症患者骨密度(BMD)和骨折的2年疗效。方法98例患者随机分为ZOL + ELD组(ZOL + ELD组;n = 51)和单独使用ZOL组(ZOL组;n = 47)。通过比较两组患者腰椎、全髋关节和股骨颈的骨密度变化(ΔBMD),观察治疗效果。结果24个月时,ZOL + ELD组腰椎、全髋关节和股骨颈BMD值与基线相比变化的百分比分别为10.8%±6.1%、6.0%±6.6%和5.1%±5.1%,ZOL组分别为7.7%±6.2%、5.1%±5.6%和2.9%±8.3%。两组患者24个月时腰椎骨密度与基线相比变化的百分比差异显著。结论ZOL + ELD联合治疗24个月对骨密度的影响优于单用ZOL。该药物组合有望治疗drug-naïve日本原发性骨质疏松症患者。
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引用次数: 1
Ultrasound for thigh muscle thickness is a valuable tool in the diagnosis of sarcopenia in Indian patients with predialysis chronic kidney disease 超声大腿肌肉厚度是诊断印度透析前慢性肾病患者肌肉减少症的宝贵工具
IF 2 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2022-06-01 DOI: 10.1016/j.afos.2022.06.001
Namrata S. Rao , Abhilash Chandra , Sai Saran , Ayush Lohiya

Objectives

Patients with chronic kidney disease (CKD) are known to develop sarcopenia, an aging-related disorder, with low muscle mass, strength and physical performance. Ultrasound-derived thigh muscle and rectus femoris thickness (TMT and RFT) can be measured easily in clinical practice, but need validation for use in predialysis CKD (stages III through V) for muscle mass estimation. The study aims to compare ultrasound-derived TMT and RFT with bioelectrical impedance analysis (BIA)-derived muscle mass estimation in the diagnosis of sarcopenia in predialysis CKD.

Methods

Patients with stable CKD stage III, IV, V and not yet on dialysis were recruited, and underwent anthropometric assessment, BIA and ultrasound examination of midthigh region. Appendicular skeletal muscle index (ASMI)/height2 derived from BIA was taken as a standard for the diagnosis of low muscle mass. Gait speed and handgrip were also measured. The Asian Working Group criteria were applied. Cutoff values for low muscle mass by TMT and RFT were obtained using receiver operator curve (ROC) analysis.

Results

Of the total of 117 enrolled study participants, 52 (45%) had low muscle mass, 34 (29%) had sarcopenia, of whom 79% were male, majority (38%) were CKD stage IV and had a mean age of 58 years. Using ROC analysis, TMT cutoffs of 19 mm in males and 17 mm in females were computed. Comparison of TMT cutoffs and ASMI/h2 showed good agreement between the 2 methods using Bland-Altman plots.

Conclusions

Ultrasound-derived TMT and RFT can be used for muscle mass estimation in the diagnosis of sarcopenia.

慢性肾脏疾病(CKD)患者通常会出现肌肉减少症,这是一种与年龄相关的疾病,肌肉质量、力量和体能都较低。超声衍生的大腿肌肉和股直肌厚度(TMT和RFT)在临床实践中可以很容易地测量,但需要验证用于透析前CKD (III期至V期)的肌肉质量估计。该研究旨在比较超声衍生的TMT和RFT与生物电阻抗分析(BIA)衍生的肌肉质量估计在透析前CKD中肌肉减少症的诊断。方法招募尚未透析的稳定CKD III、IV、V期患者,进行人体测量、BIA和大腿中部超声检查。以BIA测定的阑尾骨骼肌指数(ASMI)/高度2作为诊断低肌量的标准。步态速度和握力也被测量。采用了亚洲工作组的标准。采用接收算子曲线(receiver operator curve, ROC)分析获得TMT和RFT对低肌肉质量的临界值。结果在总共117名入组研究参与者中,52名(45%)肌肉质量低,34名(29%)肌肉减少症,其中79%为男性,大多数(38%)为CKD IV期,平均年龄为58岁。使用ROC分析,计算男性的TMT截断值为19 mm,女性为17 mm。用Bland-Altman图比较TMT截止点和ASMI/h2,结果表明两种方法吻合良好。结论超声TMT和RFT可用于肌少症的肌肉质量估计。
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引用次数: 2
Recognizing the importance of physical activity on sarcopenia in chronic kidney disease 认识到体育活动对慢性肾脏病少肌症的重要性
IF 2 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2022-03-01 DOI: 10.1016/j.afos.2022.02.002
Thomas J. Wilkinson, Heitor S. Ribeiro
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引用次数: 2
TOC TOC
IF 2 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2022-03-01 DOI: 10.1016/S2405-5255(22)00013-9
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引用次数: 0
期刊
Osteoporosis and Sarcopenia
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