Bisphosphonate use for glucocorticoid-induced osteoporosis in older patients with immune thrombocytopenia: a clinical perspective

Yamasaki, Satoshi

doi:10.1007/s00277-023-05266-7

Cited by 4 publications

(3 citation statements)

References 79 publications

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“…The R side chain of zoledronic acid contains a bisphosphonate ring with two nitrogen atoms, which inhibits farnesyl pyrophosphate synthase in the mevalonate pathway, leading to a significantly higher inhibition of bone resorption mediated by osteoclasts compared to similar drugs. 2 However, due to the inhibition of this enzyme, upstream substances such as isopentenyl diphosphate and dimethylallyl diphosphate accumulate, leading to the activation of γδT cells. 3,4 Additionally, studies have shown that zoledronic acid promotes M1 macrophage polarization mediated by TLR-4.…”

Section: Discussionmentioning

confidence: 99%

Posterior scleritis following a single infusion of zoledronate for osteoporosis: A case report and literature review

Ma,

Xiao,

Zhao

et al. 2024

Clinical Case Reports

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Key Clinical MessageThe most frequently reported adverse reaction to zoledronic acid is an acute phase reaction resembling influenza. While rarer adverse events such as osteonecrosis of the jaw and atypical femoral fractures have gained significant recognition, the ocular adverse effects, particularly scleritis, are not yet fully comprehended. Here, we present the case of a 75‐year‐old female patient with osteoporosis who developed bilateral redness and intense eye pain 48 h after receiving a 5 mg intravenous dose of zoledronic acid. Clinical presentation suggested bilateral conjunctivitis, but treatment with levofloxacin eye drops and acyclovir ophthalmic gel exacerbated the symptoms over 2 days, predominantly affecting the left eye. Ocular ultrasonography revealed thickening of the left eyeball wall with a “T” sign, while an orbital CT scan showed increased thickness of the left sclera. Treatment with methylprednisolone 80 mg intravenous infusion twice daily led to gradual symptom improvement and eventual resolution of inflammation. This report, based on a review of relevant literature, investigates the treatment and outcomes of zoledronic acid‐induced scleritis, emphasizing the importance for clinicians to promptly identify and manage this rare and serious ocular adverse reaction.

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Section: Discussionmentioning

confidence: 99%

Posterior scleritis following a single infusion of zoledronate for osteoporosis: A case report and literature review

Ma,

Xiao,

Zhao

et al. 2024

Clinical Case Reports

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“…Previous studies documented that adults receiving corticosteroids a long term developed bone fractures and osteoporosis [ 44 , 46 , 47 ]. Therefore, recent studies recommended use of Bisphosphonates as prophylaxis against corticosteroids-induced osteoporosis in elderly patients with primary immune thrombocytopenia [ 48 , 49 ]. One of the surprising results is that fourteen ITP patients acquired aplastic anemia during corticosteroid therapy which was controlled with allogeneic hematopoietic stem cell transplantation (HSCT) [ 50 ].…”

Section: Discussionmentioning

confidence: 99%

The Outcomes and Adverse Drug Patterns of Immunomodulators and Thrombopoietin Receptor Agonists in Primary Immune Thrombocytopenia Egyptian Patients with Hemorrhage Comorbidity

et al. 2023

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Immune thrombocytopenia (ITP) treatment has evolved recently. However, none of the treatments have only benefits without drawbacks. This study aimed to compare the clinical outcomes and adverse drug patterns of Eltrombopag, Romiplostim, Prednisolone + Azathioprine, High Dose-dexamethasone (HD-DXM) (control group), and Rituximab in primary ITP Egyptian patients. All patients were initiated with corticosteroids, HD-DXM, as a first-line treatment for the first month immediately following diagnosis. Four hundred sixty-seven ITP patients were randomly assigned to five groups. The outcome measures were judged at baseline, at the end of treatment (6 months), and after an additional 6-month free treatment period. The follow-up period for which relapse is noted was 6 months after the end of treatment. Eltrombopag and Romiplostim resulted in a significantly higher incidence of sustained response than Rituximab, HD-DXM, and Prednisolone + Azathioprine (55.2% and 50.6% vs. 29.2%, 29.1%, and 18%, respectively; p-value < 0.001). More patients on immunomodulators (Prednisolone+ Azathioprine, HD-DXM, and Rituximab) relapsed than those on Romiplostim and Eltrombopag (81.9%, 70.8%, and 70.7% vs. 49.3%, and 44.7%, respectively; p-value < 0.01). We also describe 23 reports of pulmonary hypertension with Prednisolone+ Azathioprine and 13 reports with HD-DXM. The thrombotic events occurred in 16.6% and 13% of patients who received Eltrombopag and Romiplostim treatment, respectively. Most patients had at least one or two risk factors (92.8% of cases). Corticosteroids are effective first-line therapy in primary ITP patients. However, relapse is frequent. Eltrombopag and Romiplostim are safer and more effective than Prednisolone, HD-DXM, and Rituximab. They might be reasonable beneficial options after a one-month HD-DXM regimen.

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“…Although drug therapy is critical for mitigating bone loss and preventing fragility fractures in OP patients, existing treatments are limited. Bisphosphonates (BPs), primary anti-bone resorptive agents, have proven effective in various studies ( Black et al, 1996 ; Yamasaki, 2023 ), but their prolonged use can cause serious complications, such as medication-related osteonecrosis of the jaw (MRONJ) ( Kim et al, 2021 ; Wat, 2016 ). While bone formation drugs like teriparatide offer potential benefits ( Yuan et al, 2023 ), they also exhibit limited clinical utility due to their complex delivery, prohibitive cost, and osteosarcoma risks ( Kellier-Steele et al, 2022 ; Krege et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

Potential therapeutic role of spermine via Rac1 in osteoporosis: Insights from zebrafish and mice

Jiang,

Hu,

Deng

et al. 2024

Zoological Research

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Osteoporosis (OP) is a prevalent metabolic bone disease. While drug therapy is essential to prevent bone loss in osteoporotic patients, current treatments are limited by side effects and high costs, necessitating the development of more effective and safer targeted therapies. Utilizing a zebrafish ( Danio rerio ) larval model of osteoporosis, we explored the influence of the metabolite spermine on bone homeostasis. Results showed that spermine exhibited dual activity in osteoporotic zebrafish larvae by increasing bone formation and decreasing bone resorption. Spermine not only demonstrated excellent biosafety but also mitigated prednisolone-induced embryonic neurotoxicity and cardiotoxicity. Notably, spermine showcased protective attributes in the nervous systems of both zebrafish embryos and larvae. At the molecular level, Rac1 was identified as playing a pivotal role in mediating the anti-osteoporotic effects of spermine, with P53 potentially acting downstream of Rac1. These findings were confirmed using mouse ( Mus musculus ) models, in which spermine not only ameliorated osteoporosis but also promoted bone formation and mineralization under healthy conditions, suggesting strong potential as a bone-strengthening agent. This study underscores the beneficial role of spermine in osteoporotic bone homeostasis and skeletal system development, highlighting pivotal molecular mediators. Given their efficacy and safety, human endogenous metabolites like spermine are promising candidates for new anti-osteoporotic drug development and daily bone-fortifying agents.

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Bisphosphonate use for glucocorticoid-induced osteoporosis in older patients with immune thrombocytopenia: a clinical perspective

Cited by 4 publications

References 79 publications

Posterior scleritis following a single infusion of zoledronate for osteoporosis: A case report and literature review

Posterior scleritis following a single infusion of zoledronate for osteoporosis: A case report and literature review

The Outcomes and Adverse Drug Patterns of Immunomodulators and Thrombopoietin Receptor Agonists in Primary Immune Thrombocytopenia Egyptian Patients with Hemorrhage Comorbidity

Potential therapeutic role of spermine via Rac1 in osteoporosis: Insights from zebrafish and mice

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