Glucocorticoid-induced osteoporosis and rheumatic diseases. Pathogenesis, prevention and treatment

Glucocorticoids (GC) are diffusely used to treat a wide variety of inflammatory and autoimmune disorders, including rheumatic diseases. GC-induced osteoporosis (GIO) is the most common and serious side-effect for patients receiving GC. Loss of bone mineral density (BMD) is greatest in the first few months of GC use; fracture (Fx) risk is significantly increased at the spine and hip on doses even as low as 2.5 mg of prednisolone daily; Fx risk increases rapidly from the onset of therapy and, for a given BMD, is higher in GIO than in postmenopausal OP. General measures to reduce bone loss include use of the lowest effective dose; consideration of alternative routes of administration; adequate calcium and vitamin D supplementation. Today, results from large randomised controlled clinical trials provide evidence that bone loss and Fx may be prevented through the use of bone sparing agents (hormone therapy, bisphosphonates, PTH 1-34). Bisphosphonates (alendronate, risedronate) are first-choice therapy for the prevention and treatment of GIO; patients at high risk for Fx, for example those in post-menopausal status or aged ³65 years and those with a prior fragility Fx, should be advised to start bone-protective therapy at the time of starting GC. Due to the prevalence of GC use, it is imperative that there be a greater awareness of GIO and of therapies that may be offered to patients both for prevention and treatmen

Muscle Regeneration and Function in Sports: A Focus on Vitamin D

Muscle is one of the main targets for the biological effects of vitamin D. This hormone modulates several functions of skeletal muscles, from development to tissue repair after injury, through genomic and non-genomic mechanisms. Vitamin D deficiency and supplementation seem to significantly affect muscle strength in different populations, including athletes, although optimal serum 25(OH)D3 level for sport performance has not been defined so far. Additionally, vitamin D de- ficiency results in myopathy characterized by fast-twitch fiber atrophy, fatty infiltration, and fibrosis. However, less is known about regenerative effects of vitamin D supplementation after sport-related muscle injuries. Vitamin D receptor (VDR) is particularly expressed in the embryonic mesoderm during intrauterine life and in satellite cells at all stages of life for recovery of the skeletal muscle after injury. Vitamin D supplementation enhances muscle differentiation, growth, and regeneration by increasing the expression of myogenic factors in satellite cells. The objective of this narrative review is to describe the role of vitamin D in sport-related muscle injury and tissue regeneration

Adverse events during longterm low-dose glucocorticoid treatment of polymyalgia rheumatica: a retrospective study

To assess the occurrence of adverse events in a cohort of patients with polymyalgia rheumatica (PMR), treated with low-dose glucocorticoids (GC). METHODS: This was a retrospective study by review of medical records. RESULTS: We identified 222 patients who had a mean duration of followup of 60 ± 22 months and a mean duration of GC therapy of 46 ± 22 months. We found that 95 patients (43%) had at least 1 adverse event after a mean duration of GC therapy of 31 ± 22 months and a mean cumulative dose of 3.4 ± 2.4 g. In particular, 55 developed osteoporosis, 31 had fragility fractures; 27 developed arterial hypertension; 11 diabetes mellitus; 9 acute myocardial infarction; 3 stroke; and 2 peripheral arterial disease. Univariate analysis showed that the duration of GC treatment was significantly associated with osteoporosis (p < 0.0001), fragility fractures (p < 0.0001), arterial hypertension (p < 0.005), and acute myocardial infarction (p < 0.05). Cumulative GC dose was significantly associated with osteoporosis (p < 0.0001), fragility fractures (p < 0.0001), and arterial hypertension (p < 0.01). The adverse events occurred more frequently after 2 years of treatment. Multivariate analysis showed that GC duration was significantly associated with osteoporosis (adjusted OR 1.02, 95% CI 1.02-1.05) and arterial hypertension (adjusted OR 1.03, 95% CI 1.01-1.06); GC cumulative dose was significantly associated with fragility fractures (adjusted OR 1.4, 95% CI 1.03-1.8). CONCLUSION: Longterm, low-dose GC treatment of PMR is associated with serious adverse events such as osteoporosis, fractures, and arterial hypertension; these adverse events occur mostly after 2 years of treatment

Prevenzione e trattamento dell’osteoporosi indotta dagli inibitori dell’aromatasi.

Il carcinoma mammario è il tipo di tumore più frequente nella popolazione femminile (13%) ed il 70% dei casi sono diagnosticati nelle donne in postmenopausa. Gli inibitori dell'aromatasi di terza generazione, divenuti la terapia adiuvante standard del trattamento del carcinoma mammario positivo per i recettori degli estrogeni si accompagnano purtroppo ad effetti osteoscheletrici negativi fra i quali il più rilevante è rappresentato da una maggiore incidenza di osteoporosi e di fratture

I percorsi diagnostico-terapeutici assistenziali nella gestione del paziente con frattura.

Negli ultimi anni il numero di individui con fratture è aumentato rapidamente, divenendo un importante problema di salute pubblica in termini di compromissione della qualità di vita e costi economici. Si stima infatti che un terzo delle donne e un quarto degli uomini con età maggiore di 50 anni andrà incontro ad una frattura nell'arco della vita. Nel 2010, 22 milioni di donne e 5,5 milioni di uomini in Europa avevano osteoporosi e si erano verificate 3,5 milioni di nuove fratture. SCOPE, un progetto indipendente per il miglioramento della gestione e del trattamento dell'osteoporosi in Europa, ha evidenziato che l'accesso alla diagnosi e al trattamento di tale malattia è ampiamente inadeguato; infatti meno della metà delle donne ad elevato rischio di frattura viene trattata, nonostante la disponibilità di farmaci efficaci e sostenibili. Sia in Europa che negli USA sono state sviluppate dei Sistemi Sanitari le Fracture Liaison Services (FLS), con l'obbiettivo di colmare il gap del trattamento delle fratture. In Italia il Sistema Nazionale Sanitario ha sviluppato i percorsi diagnostico assistenziali per assicurare un'appropriata gestione del paziente con frattura, ma la loro disponibilità e diffusione è ancora drammaticamente bassa. Sono pertanto urgenti strategie (PDTA, Nota 79) per ridurre l'impatto debilitante delle fratture sul singolo individuo e sul Sistema Sanitario

Il dolore cronico nelle malattie reumatiche. Fisiopatologia e indicazioni di terapia.

Differenze nell'origine e nella tipologia del dolore rendono spesso necessario un approccio multimodale, strutturato su più livelli, che prevede terapie farmacologiche e non, sistemiche e locali, complementari e alternative

Efficacy of ibandronate: a long term confirmation

Data deriving from randomized clinical trials, observational studies and meta-analyses, including treatment regimens unlicensed for use in clinical practice, clearly support that 150 mg once-monthly oral and 3 mg quarterly i.v. doses of ibandronate are associated with efficacy, safety and tolerability; notably both these marketed regimens, which largely correspond to ACE ≥10.8 mg, may in addition provide a significant efficacy on non-vertebral and clinical fracture (Fx) efficacy. The MOBILE and the DIVA LTE studies confirmed a sustained efficacy of monthly oral and quarterly i.v. regimens respectively, over 5 years. Furthermore, improved adherence rates with monthly ibandronate, deriving from studies evaluating large prescription databases, promise to enhance fracture protection and decrease the social and economic burden of postmenopausal osteoporosis