Evidence for efficacy of drugs affecting bone metabolism in preventing hip fracture.

Kanis, John А.; Johnell, Olof; Gullberg, Bo; Allander, Erik; Dilsen, G.; Gennari, C; Vaz, Anand; Lyritis, George P.; Mazzuoli, G. F.; Miravet, L

doi:10.1136/bmj.305.6862.1124

Cited by 275 publications

(74 citation statements)

References 19 publications

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“…87 In the last three decades, calcitonin has been used in postmenopausal women to prevent bone loss 88 and reduce pathological fractures. 89 Transcutaneous injection or intranasal intake of salmon calcitonin has been reported to limit immobilization hypercalcemia and hypercalciuria, 40,90,91 to reduce osteoclast activity, 90 and to preserve trabecular bone volume. 90 But a high incidence of nausea and the frequency of injections seem to limit patient compliance.…”

Section: Calcitoninmentioning

confidence: 99%

Bone loss in spinal cord-injured patients: from physiopathology to therapy

et al. 2005

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Study design: Review article on bone metabolism and therapeutic approach on bone loss in patients with spinal cord injury (SCI). Objective: The first part aims to describe the process of bone demineralization and its effects on bone mass in patients with SCI. The second part describes and discusses the therapeutic approaches to limiting the alteration in bone metabolism related to neurological lesions. Setting: Propara Rehabilitation Center, Montpellier, France. Results: During the first 24 months postinjury, demineralization occurs exclusively in the sublesional areas and predominantly in weight-bearing skeletal sites such as the distal femur and proximal tibia, both of which are trabecular-rich sites. Reduced bone mass, in association with a modified bone matrix property and composition, is very likely at the origin of pathological fractures after minor trauma to which these patients are frequently exposed. Since these fractures may be asymptomatic yet may lead to complications, preventing and managing 'neurological osteoporosis' remains a considerable challenge. Two main approaches are considered: the first consists in applying a mechanical stimulus to the bone tissue by standing, orthotically aided walking or functional electrical stimulation (FES). The second uses medications, particularly antiresorptive drugs such as calcitonin or diphosphonates. Conclusion: To develop well-adapted treatments, a more precise understanding of bone loss etiology is needed. The current rehabilitation programs are based on the idea that the bone physiological changes observed in patients with SCI are due to immobility, but results indicate that alterations inherent to neurological damage may play an even greater role in inducing osteoporosis.

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Section: Calcitoninmentioning

confidence: 99%

Bone loss in spinal cord-injured patients: from physiopathology to therapy

et al. 2005

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“…(1)(2)(3)(4) Previous studies about HRT and nonvertebral fractures are few and have mostly been performed on elderly women (5,6) or have examined hip fracture risk related to HRT. (7)(8)(9)(10) The effect of HRT on fractures in younger women is less established. (11,12) Forearm fracture is the most common fracture in early postmenopausal women.…”

Section: Introductionmentioning

confidence: 99%

Does Hormone-Replacement Therapy Prevent Fractures in Early Postmenopausal Women?

Randell

Honkanen

Kröger

et al. 2002

Journal of Bone and Mineral Research

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“…Two randomised controlled prospective studies 24,64 and a retrospective study 37 have examined the effects of calcium and vitamin D supplementation on osteoporotic fracture incidence. In the epidemiological case-control study conducted in six European Mediterranean countries (MEDOS study) treatment with vitamin D has been reported to be associated with a reduced incidence of hip fracture 37 .…”

Section: Vitamin D Status and Bone Healthmentioning

confidence: 99%

“…In the epidemiological case-control study conducted in six European Mediterranean countries (MEDOS study) treatment with vitamin D has been reported to be associated with a reduced incidence of hip fracture 37 . The first prospective study was performed on a French cohort of over 3000 institutionalised elderly women (mean age 84 years) during treatment with either vitamin D (800 IU/day) and calcium (1.2 gr/day) or placebo for three years 64 .…”

Section: Vitamin D Status and Bone Healthmentioning

confidence: 99%

Nutrition intervention strategies in chronically malnourished regions: preventing endemic goitre in Togo

Lezama

Lockwood

Bergmann

2001

PHN

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Osteoporosis, a systemic skeletal disease characterized by a low bone mass, is a major public health problem in EC member states because of the high incidence of fragility fractures, especially hip and vertebral fracture. In EC member states the high incidence of osteoporotic fractures leads to considerable mortality, morbidity, reduced mobility and decreased quality of life. In 1995 the number of hip fractures in 15 countries of EC has been 382.000 and the estimated total care cost of about 9 billion of ECUs. Given the magnitude of the problem public health measures are important for preventive intervention. Skeletal bone mass is determined by a combination of endogenous (genetic, hormonal) and exogenous (nutritional, physical activity) factors. Nutrition plays an important role in bone health. The two nutrients essential for bone health are calcium and vitamin D. Reduced supplies of calcium are associated with a reduced bone mass and osteoporosis, whereas a chronic and severe vitamin D deficiency leads to osteomalacia, a metabolic bone disease characterized by a decreased mineralization of bone. Vitamin D insufficiency, the preclinical phase of vitamin D deficiency, is most commonly found in the elderly. The major causes of vitamin D deficiency and insufficiency are decreased renal hydroxylation of vitamin D, poor nutrition, scarce exposition to sunlight and a decline in the synthesis of vitamin D in the skin. The daily average calcium intake in Europe has been evaluated in the SENECA study concerning the diet of elderly people from 19 towns of 10 European countries. In about one third of subjects the dietary calcium intake results were very low, between 300 and 600 mg/day in women, and 350 and 700 mg/day in men. Calcium supplements reduce the rate of bone loss in osteoporotic patients. Some recent studies have reported a significant positive effect of calcium treatment not only on bone mass but also on fracture incidence. The SENECA study, has also shown that vitamin D insufficiency is frequent in elderly populations in Europe. There are a number of studies on the effects of vitamin D supplementation on bone loss in the elderly, showing that supplementations with daily doses of 400±800 IU of vitamin D, given alone or in combination with calcium, are able to reverse vitamin D insufficiency, to prevent bone loss and to improve bone density in the elderly. In recent years, there has been much uncertainty about the intake of calcium for various ages and physiological states. In 1998, the expert committee of the European Community in the Report on Osteoporosis-Action on prevention, has given the recommended daily dietary allowances (RDA) for calcium at all stage of life. For the elderly population, above age 65 the RDA is 700±800 mg/day. The main source of calcium in the diet are dairy products (milk, yoghurts and cheese) fish (sardines with bones), few vegetables and fruits. The optimal way to achieve adequate calcium intake is through the diet. However, when dietary sources are scarce or not well tolerat...

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Evidence for efficacy of drugs affecting bone metabolism in preventing hip fracture.

Abstract: Objective-To examine the effects of taking drugs affecting bone metabolism on the risk of hip fracture in women aged over 50 years.Design-Retrospective, population based, casecontrol study by questionnaire.Setting

Cited by 275 publications

References 19 publications

Bone loss in spinal cord-injured patients: from physiopathology to therapy

Bone loss in spinal cord-injured patients: from physiopathology to therapy

Does Hormone-Replacement Therapy Prevent Fractures in Early Postmenopausal Women?

Nutrition intervention strategies in chronically malnourished regions: preventing endemic goitre in Togo

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