THERAPEUTISCHE UMSCHAU最新文献

Introduction: Glucocorticoid (GC) therapy has been shown to be associated with a dose-dependent significantly elevated risk of osteoporosis and fractures. It is estimated that about 3 % of the population are prescribed systemic GC on a daily basis, and approximately 30-50 % of patients treated with GC experience an osteoporotic fracture. Evidence has been mounting that inhaled, topical, and locally infiltrated GC also adversely affect bone mineral density. At the cellular level, GC have been shown to activate osteoclasts and inhibit the activity of osteoblasts and osteocytes, resulting in a loss of bone mass and a deterioration in bone quality, thereby increasing fracture risk. Patients prescribed a daily dosage of ≥ 5 mg of prednisone equivalents for a period of at least three months should undergo a bone density assessment and a fracture risk evaluation. Lifestyle modifications, including physical activity as well as calcium and vitamin D supplementation are recommended for all patients with GC therapy. In cases of a very high risk for fracture, the administration of osteoanabolic therapy followed by antiresorptive therapy is imperative. In patients with high fracture risk, antiresorptive therapy is recommended, whereas for those at moderate/low risk for fracture selective estrogen receptor modulators or oral bisphosphonates can be considered.

Introduction: Osteoporosis is a chronic disease that requires lifelong therapy management that includes both non-drug and drug-based approaches. The availability of various drugs for osteoporosis therapy, characterized by different mechanisms of action, has significantly changed treatment strategies in recent years. Due to the potential treatment risks associated with long-term monotherapy and the fact that the osteoanabolic therapies used in patients with a high fracture risk are time-limited, sequential treatment strategies are increasingly being used today. The aim of this review article is to present the significance of different treatment sequences in osteoporosis drug therapy.

Introduction: Amino-bisphosphonates (BP), such as zoledronate, alendronate, ibandronate or risedronate, and the antibody therapies with denosumab (DMAb) or romosozumab (ROMO) are highly effective therapies for reducing the risk of vertebral fractures and non-vertebral fractures in patients with osteoporosis. Generally very well tolerated, these antiresorptive therapies have an association with bone-specific adverse events such as osteonecrosis of the jaw (ONJ) and atypical femoral fractures (AFF). This association leads to uncertainty among patients and treating physicians as to how the benefit-risk should be assessed in individual cases. By providing concrete answers to specific questions in connection with these rare events, patients can be informed in a targeted manner.

Introduction: Premenopausal osteoporosis is often overlooked because fragility fractures and low bone mass are uncommon in premenopausal women. The definition and diagnostic criteria for premenopausal osteoporosis are less well defined than for postmenopausal women. Diagnostic procedures should be initiated in premenopausal women with existing fragility fractures or diseases and drug therapies that cause bone loss. Recent studies have shown that lifestyle and dietary habits influence bone mass in the premenopausal phase. Bone mass can be improved by an adequate intake of calcium and vitamin D in combination with increased physical activity in premenopausal women with idiopathic osteoporosis. Secondary causes of osteoporosis should be corrected or treated if possible. In women with recurrent fractures or secondary causes that cannot be reversed, e.g. glucocorticoids or oncological treatments, pharmacological intervention with bisphosphonates or teriparatide (the latter not in patients with carcinomas) may be considered. Antiresorptive and osteoanabolic agents have been shown to effectively increase bone mass; however, no studies have been conducted to date with fractures as the primary endpoint.

Introduction: Bone is continuously remodelled. Bone turnover markers reflect the activity of osteoblasts and osteoclasts during remodelling. Collagen synthesis by osteoblasts is reflected by the formation of bone-specific alkaline phosphatase (BALP), osteocalcin (OC) and procollagen N-propeptides (P1NP). During bone resorption, fragments of collagen (N- and C-terminal telopeptides, pyridinolines) and tartrate-resistant acid phosphatase (TRACP) are released. These markers enable a dynamic assessment of bone remodelling. P1NP is recommended as a reference marker for bone formation and ßCTX for bone resorption. Using and, above all, interpreting the results of bone turnover markers, it is impor-tant to take into account the various sources of variability of these markers, such as diurnal rhythm, day-to-day fluctuations, food intake and also the stability of the marker after blood sampling. The most important area for the clinical use of bone turnover markers is the monitoring of antiresorptive or anabolic treatments of osteoporosis. A short-term decrease in bone turnover during antiresorptive therapy correlates with an increase in bone density after 1-2 years and a decrease in fracture risk. The bone formation markers, especially P1NP, correlate with the increase in bone mineral density on anabolic treatment.

Introduction: We have gained new insights into vitamin D. High quality studies of over 36,000 people have shown that daily vitamin D supplementation of 800 IU reduces the risk of hip fracture and falling in older adults with vitamin D deficiency and existing falling risk. We have also learnt that vitamin D supplementation in healthy middle-aged and elderly people without vitamin D deficiency and without osteoporosis offers no additional protection. Also, large intermittent bolus doses of vitamin D either show no protection against fractures or even lead to an increase in fracture risk and fall risk in vulnerable elderly people and are therefore obsolete. In recent years, however, large randomised studies on daily vitamin D supplementation with 2000 IU in healthy people without vitamin D deficiency at the age of 50 (VITAL) and at the age of 70 (DO-HEALTH) have shown a benefit on the immune system in terms of reducing advanced cancers, cancer mortality and autoimmune diseases.

Introduction: Osteoporosis is a chronic disease that requires lifelong therapy management that includes both preventive measures and pharmacological approaches. The medical treatment of osteoporosis has changed considerably in recent years, particularly due to the availability of new substances, especially osteoanabolic drugs. The wide range of antiresorptive (estrogens, raloxifene, bisphosphonates, denosumab) and osteoanabolic (teriparatide, romosozumab) preparations for the treatment of osteoporosis makes it possible today to use them in a targeted manner based on the individual fracture risk. The uncertainty in their use can contribute to the underuse and lack of treatment of patients with osteoporosis, especially patients with a high fracture risk. This review article will summarize the mechanisms of action and clinical efficacy of antiresorptive and, in particular, anabolic agents and discuss its value for osteoporosis therapy.

Introduction:

Introduction: Metatarsalgia is a generic term for complaints in the forefoot and the metatarsophalangeal joints II-IV. However, it does not describe a specific clinical picture but rather a complex of symptoms, which can have different causes. There are mechanical causes, e.g. due congenital or acquired malformations of the foot. Splayfeet with a bunion malformation combined with transfer a common cause. Other examples include brachimetatarsalgia or an instability of the first ray. Other, non-mechanical causes are Morton's neuroma, stress fractures, systemic diseases (rheumatoid arthritis, gout) or infections and aseptic necrosis. Metatarsalgia is described as stress-dependent pain in the ball of the forefoot, which often has a burning or stabbing character. Sometimes a foreign body feeling is reported, as if one were walking on a «pebble». Wearing tight and hard shoes further provokes the symptoms. The therapy depends on the causes and should initially cover conservative options. This includes wearing proper shoes, foot gymnastic/stretching exercise, orthopedic insoles or even orthopedic shoes. Surgical options comprise of Morton's neuroma removal, deformity correction and ligament reconstruction.

Introduction: The talus has a comparatively high occurrence of osteochondral lesions (OCL), largely due to its unique anatomic characteristics. These lesions can occur post-traumatic or primary. Patients often present with non-specific symptoms, making a thorough clinical examination essential. This examination should include assessing hindfoot alignment, performing antero-lateral and antero-medial palpation with the ankle joint slightly plantar-flexed and evaluating stability. Beyond standard X-ray examinations, additional imaging modalities such as magnetic resonance imaging (MRI) and arthro-computed tomography (CT) are valuable diagnostic tools. Surgical intervention is recommended for symp-tomatic patients with unstable OCL. Besides cartilage reconstructive procedures, options like fusion or prosthetic treatments are available for managing recurring pain.