gastrointestinal intolerance as one of the major reasons for patient noncompliance. Based on these results, physicians in this study seemed aware that prescribing less frequent dosing regimens would improve patient’s satisfaction and increase the likelihood of long-term compliance with phar- macotherapy. Likewise, citing medication side effects, most physicians incorporated drug holidays into their management of osteoporosispatients, a practice consistent with the recom- mendations of national guidelines. 3,4
10. Varenna M, Binelli L, Casari S, Zucchi F, Sinigaglia L. Effects of dietary calcium intake on body weight and prevalence of osteoporosis in early postmenopausal women. American Society for Clinical Nutrition. September. 2007; 86 (3): 639-644. 11. Rivas A, Romero A, Mariscal-Arcas M, Monteagudo C, López G, Lorenzo ML, et al. Association between dietary antioxidant quality score (DAQs) and bone mineral density in Spanish women. Nutricion Hospitalaria. 2012 Nov-Dec;27(6):1886-93. 12. Sugiura M, Nakamura M, Ogawa K, Ikoma Y, Ando F, Shimokata H, et al. Dietary patterns of antioxidant vitamin and carotenoid intake associated with bone mineral density: findings from post- menopausal Japanese female subjects. Osteoporos International. 2011 Jan;22(1):143-52.
I am thankful to my respected my guide Dr. (Mrs.) Ranjit Kaur for her guidance during research work. I am also thankful to pharmacy department, M S University of Baroda for providing necessary facilities. I am also thankful to SSG Hospital, vadodara for providing patients of osteoporosis.
There were some limitations in this study. First, in this study did not include data on bisphosphonate ad- ministration in osteoporosispatients with kidney func- tion of eGFR < 30 mL/min/1.73 m 2 . Further studies are therefore necessary. Second, this was a post hoc ana- lysis of pooled data from 3 trials, which were originally neither intended to determine the influence of kidney function nor randomized for the level of eGFR. Third, this study did not analyze the samples with the intention to treat, and excluded some patients. Fourth, this study did not assess the effect of risedronate on hip BMD, and did not evaluate the anti-hip fracture efficacy of risedronate due to lack of data. Finally, this study only investigated a 48 weeks period. Adverse events such as osteonecrosis of the jaw and atypical fractures are likely to require long-term observation, which
Method: Three pairs of osteoporosispatients (OP group) and healthy people controls (NC group) were screened by microarray. Quantitative polymerase chain reaction (qRT-PCR) was performed to confirm dysregulated lncRNA expressions in 5 pairs of OP and NC group tissues samples. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were performed to construct the lncRNA-mRNA co-expression network. Result: Through co-expression analysis, differently expressed transcripts were divided into modules, and lncRNAs were functionally annotated. We further analyzed the clinical significance of crucial lncRNAs from modules in public data. Finally, the expression of five lncRNAs, CUST_44695_PI430048170-GeneSymbol:CTA-384D8.35;CUST_39447_ PI430048170,CUST_73298_PI430048170,CUST_108340_PI430048170,CUST_118927_PI430048170,this four lncRNAs have not been annotation genes and have not found GeneSymbols, and by quantitative RT-PCR, which may be associated with osteoporosispatients ’ overall survival.
Results: Patients with osteoporosis had significantly higher risk of major fracture compared to patients with osteopenia (p<0.01). Results from FRAX index in osteoporotic patients showed that more than half (58.70%) of patients had a low risk of fracture; less than one-third of patients (30.43%) had an intermediate risk of major osteoporotic fracture, while almost four out of every 10 (39.96%) had a high risk of hip fracture. The majority of patients with osteopenia (63.89%) had a low risk of major osteoporotic fracture, while 36.11% of them had an intermediate risk. The majority of patients with osteopenia (91.67%) had a low risk of hip fracture. Statistically significant differences in relation to specific fracture risks between patients with osteoporosis and osteopenia, in particu- lar, weight (t=−2.250, p=0.027*) and previous fractures (t=2.985, p=0.004**), were established. Conclusion: Osteoporosispatients had a high risk of major osteoporotic fracture, while there was no association between the intermediate level for major osteoporotic fracture and osteo- penia. For patients suffering from an increased fracture risk, especially those who had already been diagnosed with osteoporosis, preventive measures such as designing individual therapeutic programs should be adopted.
In this study, the proportion of morphometric verte- bral fractures in patients with IBD was significantly higher (38.3%) than that in the control population (13.7%). After analyzing other publications, the preva- lence of osteoporotic fractures in patients with IBD var- ies according to the different studies. Some authors found a low prevalence (<14%) of vertebral fractures in IBD [11,16], and others observed prevalences between 20% and 27% [3,9,10,17]. An adequate number of cases was included in some studies, although only IBD popu- lations were assessed without comparison with control populations [3,11,16]. In other studies, the incidence of fracture in patients with IBD was estimated based on previous imaging studies without using a semiquantita- tive method . Other studies only included patients with CD [8-11] or patients with low bone mass  with- out comparing them with a control group of healthy subjects studied in parallel. The prevalence of fractures
There are several limitations to consider. This is retro- spective data extraction that may have inaccuracies based on coding and misdiagnosis. Also, we were not able to follow these patients after discharge from the hospital to outside institutions. They may have had BMD or treatment at another medical office or medical center unrelated to our institution. Thus, our data would underestimate the total number of individuals who received the primary outcome. We were unable to exclude the possibility that, the severity of illness could preclude individuals from appropriate follow-up and therefore limit access to care.
more likely to experience another fracture, depending on the location of the subsequent fracture . Appro- priate pharmacotherapy, however can substantially re- duce the risk of fracture. The risk of vertebral fracture can be reduced by 30-70% depending on the therapy and level of adherence; the reduction in risk of non- vertebral fractures varies by fracture site . In ad- dition, bisphosphonates have all been associated with reduced mortality after hip fracture [8-11]. Current Canadian osteoporosis clinical practice guidelines iden- tify patients with prior hip fracture as high risk for future fractures and recommend that these patients are investigated with a bone mineral density (BMD) and offered appropriate pharmacotherapy and lifestyle re- commendations . Alendronate, risedronate, zoledro- nic acid, and denosumab are first-line therapies for the prevention of hip, vertebral and non-vertebral fractures in post-menopausal women, and alendronate, risedro- nate and zoledronic acid and denosumab are first-line therapies for the prevention of fractures in men . Despite the availability and benefit of these therapies, a care gap between recommendations and practice has been identified in Canada for fracture prevention in pa- tients who have had a fracture, with fewer than 20% of women and 10% of men receiving pharmacotherapy to prevent further fractures [12-14].
The number of patients treated is an important com- ponent in the analysis of treatment uptake. The IMS Health sales data allow the estimation of how many treatment years the sales volume can cover. However, not all patients are completely adherent to therapy, and such an approach would consequently result in an un- derestimation of the actual number of patients that have started a treatment since some patients only are treated for a part of the year. This has further implications for clinical outcome, and also means that the treatment effect is lower than that reported from clinical trials where persistence and compliance is high. To correct for suboptimal adherence, an adjustment factor was estimated from data from the Swedish Prescribed Drug Register (see below). The adjustment factor was employed irrespective of country because similar data were not readily available for any other country. The data from IMS Health were available as monthly num- ber of defined daily doses (as defined by WHO, http:// www.whocc.no/atc_ddd_index [DDDs]) sold per coun- try, and the following steps were included in the estimations:
There is a growing body of literature supporting the roles of pharmacists in osteoporosis (33). Studies conducted in various settings around the globe have shown those pharmacists’ interventions improved adherence to osteoporosis medication. Some studies have also reported improvements in both clinical and economic outcome (34-37). Although, most pharmaceutical care services are mainly targeted at treatment of osteoporosis. A further literature search revealed that there are three randomized control trials (RCTs) conducted by community pharmacies in Canada, Australia and US to evaluate the impact of pharmacist’s interventions on osteoporosis management (38-40). However, two of these studies were considered biased (41). Nonetheless, all three studies provided attestation that the
Prevention and therapy: suggestions for the future:-The prevention of osteoporosis in COPD patients is dependent on an awareness of the magnitude of the problem. There is little impetus for screening and/or preventive therapy because patients are generally asymptomatic until they experience a fracture. However, early recognition and the institution of preventive therapy are essential in avoiding fractures (Biskobing, 2002).In order to assess the efficacy of treatments, more information on the risk factors and the pathogenesis of COPD-induced osteoporosis is needed. Such information could be gathered through prospective studies designed to assess the rate of decline of the BMD and the contributing factors such as the type of corticotherapy, the presence of hypogonadism, ongoing smoking, reduced physical activity and the weakness of the skeletal muscles (Ionescu and Schoon, 2003). In view of the relationship between the skeletal muscle mass and the BMD (Sandler, 1989; Henderson et al., 1998; Aniansson et al., 1984; Winett and Carpinelli, 2001), it is likely that training programmes and conditioning will have beneficial effects on the maintenance of BMD in patients with COPD. However, the types of training and the specific programmes of rehabilitation need to be designed. Hormone replacement therapy is likely to be beneficial in patients with COPD and hypogonadism. In view of the age group and exposure to corticosteroid treatment, which are associated with hypogonadism, the assessment of the hormonal status should be part of the general investigation of osteoporosis in patients with COPD (Ionescu and Schoon, 2003). The intake of calcium and vitamin D should be assessed, in view of some reports that supplementation is beneficial for the preservation of the bone mass, mainly in subjects with a reduced intake (Eastell, 1998; Ionescu and Schoon, 2003; Chapuy et al., 1994). According to the current nutritional recommendations the daily intake of calcium (1,200–1,500 mg·day −1 ) and vitamin D (at least 400 IU·day −1 ) should be ensured (Goldstein et al., 1999; Lane and Lukert, 1998; American College of Rheumatology, 1996). More promising in view of the available research in patients with chronic lung disease is the therapy with bisphosphonates. The patients with COPD and osteoporosis treated with long-term systemic corticosteroids should be considered for such treatments. For patients with osteopenia, those on long-term inhaled corticosteroids and/or intermittent courses of oral corticosteroids without florid osteoporosis, regular monitoring of BMD by DEXA scanning should be undertaken (Ionescu and Schoon, 2003).
Within these 2 frameworks, specific benchmarking metrics are detailed in each domain. To aid this and ensure key improvements in quality are to be achieved, central data collection and monitoring, allowing comparison between ser- vices, are needed. In the UK, the introduction of the National Hip Fracture Database (NHFD) in 2007 has led to improved quality of care for hip fracture patients, such as reduced 30-day mortality and length of acute hospital stay. The act of collecting and publishing benchmarking metrics of indi- vidual hospitals allows health care providers to understand their own service, compare with other health care providers, track the progress of their service and inform changes, with the ultimate aim of improving the care delivered. Similar to what has been seen with the NHFD, such a database for FLSs could potentially lead to similar clinical benefits. Certainly, both the IOF and the NOS advocate a national database for this exact purpose. In the UK, a national audit program for FLSs was recently launched. 67
The second meta-analysis by Loke et al was based on 16 RCTs and 7 observational studies. 10 Unlike the ﬁ rst, this analysis evaluated all types of bone fractures. The authors found that ICS exposure was signi ﬁ cantly (P=0.04) associated with a relative increase of more than 20% in the likelihood of bone fractures in patients with COPD receiving ICSs in RCTs. 10 The number needed to harm was estimated to be 83 over a 3-year ICS treatment period based on the 5.1% bone fracture rates in the salme- terol and placebo arms of the TORCH trial. 36 Again, the authors of this analysis reported some limitations of their study, such as the use of data from unpublished, non-peer reviewed company reports. Moreover, most of the RCTs included did not use speci ﬁ c methods to de ﬁ ne and report the bone fractures, and it is possible that misclassi ﬁ cation or underdiagnosis occurred. The timing of fractures with relation to the use of ICSs was also not reported, and results may have been affected by the inclusion of patients who received ICSs before joining their trial and the receipt of oral glucocorticoids by some control group patients on study.
Patients and methods: This is a retrospective cohort and population-based study in which we extracted newly diagnosed female patients with COPD between 1997 and 2009 from Taiwan’s National Health Insurance (TNHI) database between 1996 and 2011 (International Classification of Diseases, Ninth Revision – Clinical Modification [ICD-9-CM] 491, 492, 496). The patients with COPD were defined by the presence of two or more diagnostic codes for COPD within 12 months on either inpatient or outpatient service claims submitted to TNHI. Patients were excluded if they were younger than 40 years or if osteoporosis had been diagnosed prior to the diagnosis of COPD and cases of asthma (ICD-9 CM code 493.X) before the index date. These enrolled patients were followed up till 2011, and the incidence of osteoporosis was determined. The Cox proportional hazards regression model was also used to estimate hazard ratios (HRs) for incidences of lung cancer.
Periarticular bone loss was determined by examination of radiographs of the hands only, while cytokine levels measured in the circulation probably reflect the degree of inflammation and destruction in several joints. Preanaly- sis sources of variation (different treatment regimens, diurnal variation, comorbidity) as well as possible effects of sampling and storage can affect plasma levels of cyto- kines and must be taken into account in the interpretation of the data. Another important limitation is the small group of patients (n = 13) that were classified as not having a significant loss in DXR BMD at 5 years observation. Thus the group is probably too small to reveal any asso- ciation between the measured cytokines and hand bone loss in a long-term perspective.
In a recent study, extracorporeal shock wave therapy alone was effective in TOH leading to satisfactory clinical results at Harris Hip Score and reduction of mean edema at MRI in a cohort of 22 patients . Other authors proposed pulsated electromagnetic fields (PEMF) as capable of reducing edema and stopping osteonecrosis even in early stage of AVN [39, 40]. Yagishita et al. showed good results in reduction of edema in patients treated with hyperbaric oxygen therapy, but they recommend reserving it for unclear differential diagnosis between AVN and TOH since it does not significantly accelerate recovery in TOH . Even if several authors have proposed core decompression [16, 18, 41], surgical procedures are generally not recommended.
The number of people with low bone mass or osteoporosis around the world is high and increasing rapidly with the aging of the population. Many people are unaware that they are at risk for developing osteoporosis or already have it. Prevention of bone loss and falls is a major goal that if implemented will prevent fractures, decrease morbidity related to fractures, improve quality of life, and reduce mortality. Nurses who are knowledgeable about osteoporosis and its prevention are in a key position to make a significant difference to the quality of life of people who might otherwise experience life-threatening fractures, disability, and premature death. As stated earlier, many measures needed to prevent or minimize bone loss are within the scope of nursing. All patients deserve to learn about the often preventable risks of osteoporosis so that they can live their lives with the quality of life they desire.
Our study has some potential limitations. First, al- though consecutive patients were invited to participate in this study, we cannot exclude selection bias as some patients did not want, or were not able, to fill in the questionnaire. Second, generalizability and transferability of our findings may be limited by recruiting patients from two osteoporosis centers in one country only. A cross-country comparison is ongoing in seven European countries. Preferences for attributes/levels may differ ac- cording to a number of factors including age, income, education or prior fractures . While we do not find evidence of preference variation associated with these factors in our study, the cross-country comparison will investigate this further. Third, we focused on the nature of common side-effects, not on their frequency and rare complications. Rare adverse events will be as (in)fre- quent in all categories of anti-resorptive drugs. There- fore, adding osteonecrosis of the jaw and atypical femoral fracture to the side-effect attribute would Table 5 Differences between high-risk and low-risk patients ’ preferences for osteoporosis drug treatment
postmarketing surveillance (PMS) studies have been con- ducted to confirm the effectiveness and safety of teriparatide in Japanese patients with osteoporosis. Such PMS studies are important because of differences in the way osteoporotic patients in Japan are treated and how they access services via the universal health insurance system. In addition, PMS studies assess the use of teriparatide in real-world conditions, including in patients with complex medical histories who may not be eligible for enrollment in RCTs. PMS of teri- paratide is mandated by the Japan Ministry of Health, Labour and Welfare and will provide clinically relevant information on the use of teriparatide in a real-world clinical setting in Japan. The objectives of this PMS study were to assess the safety and effectiveness of teriparatide. The interim results of the study were reported previously, mainly focusing on patient characteristics and some interim outcomes; 17 and we