Prevention and management of osteoporotic fractures by non-physician health professionals: a systematic literature review to inform EULAR points to consider

Objective To perform a systematic literature review (SLR) about the effect of non-pharmacological interventions delivered by non-physician health professionals to prevent and manage osteoporotic fractures. Methods Eight clinical questions based on two criteria guided the SLR: (1) adults >= 50 years at high risk of osteoporotic fracture and (2) interventions delivered by non-physician health professionals to prevent and manage osteoporotic fractures. Interventions focused on diagnostic procedures to identify risk of falling, therapeutic approaches and implementation strategies. Outcomes included fractures, falls, risk of falling and change in bone mineral density. Systematic reviews and randomised controlled trials were preferentially selected. Data were synthesised using a qualitative descriptive approach. Results Of 15 917 records, 43 articles were included. Studies were clinically and methodologically diverse. We identified sufficient evidence that structured exercise, incorporating progressive resistance training delivered to people who had undergone hip fracture surgery, and multicomponent exercise, delivered to people at risk of primary fracture, reduced risk of falling. The effectiveness of multidisciplinary fracture liaison services in reducing refracture rate was confirmed. There was insufficient evidence found to support the effectiveness of nutrients and falls prevention programmes in this patient population. Conclusion Despite study heterogeneity, our SLR showed beneficial effects of some interventions delivered by non-physician health professionals and the positive impact of multidisciplinary team working and patient educational approaches to prevent and manage osteoporotic fractures. These results informed a EULAR taskforce that developed points to consider for non-physician health professionals to prevent and manage osteoporotic fractures.This study was funded by the EULAR. Grant reference HPR 032.info:eu-repo/semantics/publishedVersio

Potensi Ekstrak Buah Kecipir (Psophocarpus Tetragonolobus (L.) Dc.) Sebagai Antiosteoporosis Dengan Parameter Peningkatan Alkalin Fosfatase Pada Tikus Wistar Betina Yang Diinduksi Deksametason

Kecipir (Psophocarpus tetragonolobus (L.) DC.) merupakan tanaman polong-polongan (Fabaceae) yang mengandung fitoestrogen, berperan dalam mencegah kehilangan massa tulang akibat defisiensi estrogen. Penelitian ini bertujuan untuk mengetahui aktivitas ekstrak etanol buah kecipir sebagai antiosteoporosis berdasarkan kadar ALP (Alkaline phosphatase) plasma pada tikus yang diinduksi deksametason. Tikus dikelompokkan menjadi tiga kelompok yaitu kontrol positif, kontrol negatif dan kelompok uji (ekstrak dosis 500 mg/kg BB). Kelompok kontrol positif dan kelompok uji diberi induksi deksametason 0,1 mg/kg BB. Pemberian induksi dilakukan selama 29 hari, dan pemberian sediaan uji untuk kelompok uji dilakukan selama 18 hari. Pengukuran kadar ALP dilakukan sebanyak tiga kali yaitu ALP awal, ALP pascainduksi dan ALP pascaterapi. Keberhasilan induksi osteoporosis ditandai dengan adanya penurunan kadar ALP pascainduksi dibandingkan kadar ALP awal. Keberhasilan terapi ditandai dengan adanya peningkatan kadar ALP pascaterapi dibandingkan kadar ALP pascainduksi. Berdasarkan adanya peningkatan kadar ALP plasma pascaterapi pada kelompok uji menunjukkan bahwa ekstrak etanol buah kecipir dosis 500 mg/kg BB berpotensi sebagai antiosteoporosis

Impacts of Patent Expiry and Regulatory Policies on Daily Cost of Pharmaceutical Treatments: OECD Countries, 2004-2010

Cross-country variability in regulatory frameworks, industrial policy, physician/pharmacy autonomy, brand/generic distinctions, and in the practice of medicine contributes to ambiguous interpretations of pharmaceutical cost comparisons. Here we report cross-country comparisons that: (i) focus on 11 therapeutic classes experiencing patent expiration and loss of exclusivity 2004-2010 in eight industrialized countries; (ii) convert revenues and unit sales to cost per day of treatment and number patient days treated using the World Health Organizations’ Defined Daily Dosage metrics; (iii) compare patterns in costs per day of treatment with price index measures based on average price per day of treatment for each molecule computed over all molecule versions; (iv) utilizing econometric methods, model and quantify various factors affecting variations in daily treatment price indexes such as national regulatory and reimbursement policy changes, physician/pharmacy autonomy, and other factors; and (v) simulate changes in expenditures by country and therapeutic class had counterfactual policies been implemented

An in Vitro Antiosteoporotic Activity of 96% Ethanol Extract of Abelmoschus Manihot L. Medik Leaves Using Mc3t3-e1 Preosteoblast Cells

Osteoporosis is a disease characterized by low bone mass and structural deterioration of bone tissue. Estrogen deficiency causes loss of bone mineral density which causes osteoporosis. Phytoestrogen is a potential alternative of estrogen that can be used as Hormone Replacement Therapy on osteoporosis with minimum side effects. Many edible plants contain phytoestrogens that are believed to promote bone health. Abelmoschus manihot (L.) Medik has been known as a plant that is empirically used in the traditional medicine and has potency to prevent osteoporosis. The aim of this research is to determine whether the Abelmoschus manihot (L.) Medik leaves have the potential to increase bone formation in an in vitro assays using preosteoblast cell line MC3T3-E1. The results showed an increasing activity of Alkaline phosphatase using confocal laser scanning microscopy technique

Impacts of Patent Expiry and Regulatory Policies on Daily Cost of Pharmaceutical Treatments: OECD Countries, 2004-2010

Cross-country variability in regulatory frameworks, industrial policy, physician/pharmacy autonomy, brand/generic distinctions, and in the practice of medicine contributes to ambiguous interpretations of pharmaceutical cost comparisons. Here we report cross-country comparisons that: (i) focus on 11 therapeutic classes experiencing patent expiration and loss of exclusivity 2004-2010 in eight industrialized countries; (ii) convert revenues and unit sales to cost per day of treatment and number patient days treated using the World Health Organizations’ Defined Daily Dosage metrics; (iii) compare patterns in costs per day of treatment with price index measures based on average price per day of treatment for each molecule computed over all molecule versions; (iv) utilizing econometric methods, model and quantify various factors affecting variations in daily treatment price indexes such as national regulatory and reimbursement policy changes, physician/pharmacy autonomy, and other factors; and (v) simulate changes in expenditures by country and therapeutic class had counterfactual policies been implemented

Potensi Stabilisasi Membran Sel dari Ekstrak Berbeda Kepolaran Sirih Bumi (Peperomia pellucida [L.] Kunth) sebagai Agen Antiinflamasi

Sirih bumi (Peperomia pellucida [L.] Kunth.) is a medicinal herb. Anti-inflammatory activities are reported. These plant extracts have been shown to reduce inflammation in many studies, but it is unknown which extract works best. The objectives if this study were determine the extract that has the best anti-inflammatory activity from sirih bumi. The activity was assessed from the impact of stabilising red blood cell membranes in vitro. The research was then continued with a literature study on the chemical compounds containing the best extracts. To determine the prediction of the compound responsible for its activity and potency, several in silico tests were carried out, such as PASS online, Pre-ADMET online, and Protox II. The test results showed that the ethyl acetate extract at 200 g/mL concentration showed similar activity to aspirin at the same concentration. The activity of this extract increased with increasing concentration of the extract. Six compounds were reported to be isolated from this type of extract. Dillapiol and its derivative 6-allyl-5-methoxy-1,3-benzodioxol-4-ol are predicted to be compounds that have anti-inflammatory effects by inhibiting the membrane permeability mechanism of ethyl acetate extract. Ethyl acetate extract showed the best anti-inflammatory activity among the other type of extract from sirih bumi. Ethyl acetate extract is a type of extract with the best anti-inflammatory activity from sirih bumi.Sirih bumi (Peperomia pellucida [L.] Kunth.) termasuk tanaman gulma yang kaya akan manfaat farmakologis. Salah satu efek yang dilaporkan yaitu antiinflamasi. Banyak penelitian dilakukan untuk membuktikan aktivitas antiinflamasi dari ekstrak sirih bumi. Namun belum diketahui ekstrak dengan jenis pelarut yang mana memiliki efek terbaik. Penelitian ini bertujuan mengetahui jenis ekstrak yang memiliki aktivitas antiinflamasi terbaik dari sirih bumi. Aktivitas antiinflamasi dinilai dari efek stabilisasi membran sel darah merah secara in vitro. Penelitian kemudian dilanjutkan dengan studi pustaka terkait senyawa kimia kandungan jenis ekstrak terbaik. Untuk mengetahui prediksi senyawa yang bertanggung jawab terhadap aktivitas dan potensinya, dilakukan beberapa uji in silico seperti PASS online, Pre-ADMET, dan Protox II. Hasil uji menunjukkan ekstrak etil asetat pada konsentrasi 200 μg/mL menunjukkan aktivitas yang sebanding dengan aspirin pada konsentrasi yang sama. Aktivitas dari ekstrak ini semakin meningkat seiring dengan meningkatnya konsentrasi ekstrak. Enam senyawa dilaporkan diisolasi dari jenis ekstrak ini. Apiol, dillapiol, dan derivatnya yaitu 6-allil-5-metoksi-1,3-benzodioksol-4-ol serta β-sitosterol-D-glicopyranoside diprediksi menjadi senyawa yang memiliki efek antiinflamasi dengan mekanisme penghambatan permeabilitas membran dari ekstrak etil asetat. Ekstrak etil asetat merupakan jenis ekstrak dengan aktivitas antiinflamasi terbaik dari sirih bumi

AH-35 Potence for Osteogenesis of (Cissus quadrangularis Salisb) Ekstract in Ovariectomized Rats

Potence for Osteogenesis of (Cissus quadrangularis Salisb) Ekstract in Ovariectomized Rat

Establishing and evaluating FRAX® probability thresholds in Taiwan

Background/purpose: The Taiwanese FRAX® calculator was launched in 2010. However, cost-effectiveness thresholds for the prescription of antiosteoporosis medications were not established. This study aims to establish and evaluate FRAX®-based probability thresholds in Taiwan. Methods: Using previous data from Taiwan and literature, we determined cost-effectiveness thresholds for prevention of osteoporotic fractures by alendronate with a Markov model, as well as using two other translational approaches. Sensitivity analysis was applied using different alendronate prices. A clinical sample was used to test these Taiwan-specific thresholds by determining the percentages of high-risk patients who would be qualified for current National Health Insurance reimbursement. Results: With the Markov model, the intervention threshold for hip fracture was 7% for women and 6% for men; for major osteoporotic fracture, it was 15% for women and 12.5% for men. Both translational approach models were cost effective only for certain age groups. However, if branded alendronate was reimbursed at 60% of the current price, they became cost effective in almost all age groups. This clinical screening study showed that the National Health Insurance Administration model identified the highest proportion (44%) of patients qualified for National Health Insurance reimbursements, followed by the Markov model (30%), and the United States model (22%). Conclusion: Three FRAX®-based models of alendronate use were established in Taiwan to help optimize treatment strategies. The government is encouraged to incorporate FRAX®-based approaches into the reimbursement policy for antiosteoporosis medicines