In patients with a suppressed bone turnover, strontium ranelate relaunches bone formation
Several medications have proved to be effective in reducing the fracture risk in patients with osteoporosis. However, the optimal duration of use of these medications and the effects of changes between treatment strategies remain to be established. The latter are of special clinical value in patients who have been on bisphosphonate therapy for years and present with persistent high fracture risk. To gain insight into the effects of strontium ranelate therapy after long-term biphosphonate treatment (average 32 months) in patients with suppressed bone turnover, the authors [1] performed paired transiliac crest biopsies from 15 patients previously treated with biphosphonates and presenting with persistent osteoporosis.
GM-CSF stimulates osteoclastogenesis: therapeutic caution is required
Patients with a variety of tumors, including those with breast cancer, are often treated with granulocyte-monocyte colony stimulating factor (GM-CSF), a cytokine that increases white cell counts. GM-CSF stimulates the proliferation and differentiation of hematopoietic precursors, thereby replenishing blood cells ravaged by chemotherapy.
Glucocorticoid-induced osteoporosis: a defect in bone formation
Glucocorticoids (GCs) are central to the treatment of inflammatory and immune disorders. These steroids, however, profoundly impact the skeleton, particularly when administered at high doses for prolonged periods, causing one of the most crippling forms of osteoporosis. Although the effect of GCs on osteoblasts is well documented (decreased number related to apoptosis), the mechanism underlying their effect is less clear because they do not seem to act directly on bone-forming cells.
High-trauma fractures and low bone mineral density in older adults
As the population ages, the number of fractures is projected to increase dramatically, and hip fractures in particular are expected to increase almost 4-fold by 2050 if effective prevention strategies are not implemented. The criteria used to define osteoporotic fractures warrant further investigation. By the current definition, fractures are recognized as osteoporotic if they are associated with low bone mineral density (BMD), and if they increase the risk of subsequent fracture. It remains unclear whether degree of trauma should be included in the definition of osteoporotic fractures. The objective of a recent study [1] was to examine the association between BMD and high-trauma fracture and between high-trauma fracture and subsequent fracture in older women and men.
 Download here the slide set presented by Prof. Friedlander, on Thursday, November 10th. |
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