Management of osteoporosis in the aging male: Focus on zoledronic acid

Osteoporosis in the aging male remains an important yet under-recognized and undertreated disease. Current US estimates indicate that over 14 million men have osteoporosis or low bone mass, and men suffer approximately 500,000 osteoporotic fractures each year. Men experience fewer osteoporotic fractures than women but have higher mortality after fracture. Bisphosphonates are potent antiresorptive agents that inhibit osteoclast activity, suppress in vivo markers of bone turnover, increase bone mineral density, decrease fractures, and improve survival in men with osteoporosis. Intravenous zoledronic acid may be a preferable alternative to oral bisphosphonate therapy in patients with cognitive dysfunction, the inability to sit upright, or significant gastrointestinal pathology. Zoledronic acid (Reclast) is approved in the US as an annual 5 mg intravenous infusion to treat osteoporosis in men. The zoledronic acid (Zometa) 4 mg intravenous dose has been studied in the prevention of bone loss associated with androgen deprivation therapy

Predictors of Fracture Risk and Bone Mineral Density in Men with Prostate Cancer on Androgen Deprivation Therapy

Decrease of bone mineral density (BMD) and fracture risk is increased in men with prostate cancer receiving androgen deprivation therapy (ADT). We looked at possible predictors of decreased BMD and increased fracture risk in men with prostate cancer; most of whom were on ADT. In a retrospective study, we analyzed serum, BMD, and clinical risk factors used in the Fracture Risk Assessment (FRAX) tool and others in 78 men with prostate cancer with reported height loss. The subjects were divided in two groups: 22 men with and 56 without vertebral fractures. 17 of the 22 men with vertebral fractures on spine X-rays did not know they had a vertebral fracture. Of those 17 men, 9 had not previously qualified for treatment based on preradiograph FRAX score calculated with BMD, and 6 based on FRAX calculated without BMD. Performing spine films increased the predictive ability of FRAX for vertebral fracture. Vertebral fracture was better predicted by FRAX for other osteoporotic fractures than FRAX for hip fractures. The inclusion of BMD in FRAX calculations did not affect the predictive ability of FRAX. The PSA level showed a positive correlation with lumbar spine BMD and accounted for about 9% of spine BMD

Iodine deficiency in Latvia : Current status and need for national recommendations

Publisher Copyright: © 2017 De Gruyter Open Ltd. All rights reserved. Copyright: Copyright 2018 Elsevier B.V., All rights reserved.In the absence of a mandatory salt iodisation programme, two nationwide cross-sectional cluster surveys revealed persisting iodine deficiency among Latvian schoolchildren during the spring season and a noteworthy iodine deficiency in pregnant women in Latvia; these deficiencies warrant intervention. The consequences of mild-to-moderate iodine deficiency during pregnancy and lactation can adversely affect foetal brain development. Data from a Latvian population survey revealed the consumption of approximately 100 μg of iodine per day through foods and iodised salt. Therefore, strategies to increase the consumption of iodine-containing products should be implemented, particularly for children. In addition, to meet the increased iodine requirement during pregnancy, pregnant women should take daily supplements containing 150 μg iodine from the earliest time possible. All women of childbearing age should be advised to increase their dietary iodine intake by using iodised table salt and iodine-rich products: seafood, milk and milk products. For women with pre-existing thyroid pathologies, the medical decision should be considered on a case-by-case basis. Urinary iodine concentration monitoring among schoolchildren and pregnant women and neonatal thyrotropin registry analysis every five years would be an appropriate strategy for maintaining iodine intake within the interval that prevents iodine deficiency disorders.Peer reviewe

Bone Loss in Diabetes: Use of Antidiabetic Thiazolidinediones and Secondary Osteoporosis

Clinical evidence indicates that bone status is affected in patients with type 2 diabetes mellitus (T2DM). Regardless of normal or even high bone mineral density, T2DM patients have increased risk of fractures. One class of antidiabetic drugs, thiazolidinediones (TZDs), causes bone loss and further increases facture risk, placing TZDs in the category of drugs causing secondary osteoporosis. Risk factors for development of TZD-induced secondary osteoporosis are gender (women), age (elderly), and duration of treatment. TZDs exert their antidiabetic effects by activating peroxisome proliferator-activated receptor-γ (PPAR-γ) nuclear receptor, which controls glucose and fatty acid metabolism. In bone, PPAR-γ controls differentiation of cells of mesenchymal and hematopoietic lineages. PPAR-γ activation with TZDs leads to unbalanced bone remodeling: bone resorption increases and bone formation decreases. Laboratory research evidence points toward a possible separation of unwanted effects of PPAR-γ on bone from its beneficial antidiabetic effects by using selective PPAR-γ modulators. This review also discusses potential pharmacologic means to protect bone from detrimental effects of clinically used TZDs (pioglitazone and rosiglitazone) by using combinational therapy with approved antiosteoporotic drugs, or by using lower doses of TZDs in combination with other antidiabetic therapy. We also suggest a possible orthopedic complication, not yet supported by clinical studies, of delayed fracture healing in T2DM patients on TZD therapy

Male osteoporosis: deadly, but ignored

Detailed formal protocol with illustrations and extensive bibliography.UT Southwestern--Internal Medicin

Psychological terror in employment relationships

Psiholoģiskais terors ir nopietns un pieaugošs darba vides apdraudējums, kurš nav savienojams ar virkni darbiniekam garantēto tiesību, tostarp, tiesībām uz personas neaizskaramību, tiesībām uz veselības, goda un cieņas aizsardzību. Maģistra darba “Psiholoģiskais terors darba tiesiskajās attiecībās” mērķis ir izpētīt un apzināt psiholoģiskā terora fenomena saturu, kā arī noskaidrot Latvijas tiesiskā regulējuma piemērošanas iespējas, secināt, vai esošais regulējums ir pietiekams, lai darbinieks psiholoģiskā terora gadījumā varētu efektīvi aizsargāt savas tiesības un tiesiskās intereses. Mērķa sasniegšanai autors ir apkopojis un salīdzinājis pieejamās psiholoģiskā terora fenomena definīcijas, saskatījis tajās kopējās iezīmes un atšķirības, apzinājis esošo Latvijas nacionālo regulējumu un psiholoģiskā terora aizlieguma pamatu, konstatējis tiesību aizsardzības līdzekļu esamību psiholoģiskā terora kaitīgo seku novēršanai, konstatējis šo līdzekļu efektīvu piemērojamību psiholoģiskā terora situācijās. Darba rezultāti liecina, ka Latvijas tiesiskais regulējums paredz saprātīgus un efektīvus līdzekļus darbinieka tiesību aizsardzībai. Ja psiholoģiskā terora darbības īsteno vai pieļauj darba devējs, tas veido, tostarp, vienlīdzības principa pārkāpumu, un šajā gadījumā darba tiesisko attiecību regulējums nosaka īpašus darbinieka aizsardzības nosacījumus, atvieglojot tiesību aizskāruma fakta un morālā kaitējuma esamības pierādīšanu tiesvedībā.Psychological terror is a serious and increasing threat to the working environment that is incompatible with a range of rights guaranteed to employees, including the right to personal integrity, health, the protection of honour and dignity. The purpose of the Master’s Thesis “Psychological terror in the employment relationships” is to examine and identify the content of the psychological terror phenomenon, as well as to clarify the possibility of the application of the Latvian legal framework, to conclude whether the existing framework is sufficient for an employee to effectively protect his or her rights and legal interests in case of psychological terror. To achieve the objective, the author has complied and compared available definitions of the phenomenon of psychological terror, identified common features and differences among them, examined the existing national regulations in Latvia and the basis for prohibiting psychological terror, identified the existence of legal remedies for the protection of rights and the prevention of harmful consequences of the psychological terror, and determined the effective applicability of these remedies in situations of psychological terror. The results of the study show that the legal framework in Latvia provides reasonable and effective means to protect the rights of the employee. If the employer perpetuates or tolerates actions of psychological terror, it constitutes a violation of the principle of equality, in which case the employment relationship provisions lay down specific conditions for the protection of the employee, making it easier to prove the existence of an infringement of his rights and of non-material damages in the legal proceedings

Health care systems around the world, socialized, private.....What can we learn?

Detailed formal protocol with illustrations and extensive bibliography.UT Southwestern--Internal Medicin