67 research outputs found
The role of calcium supplementation in healthy musculoskeletal ageing : An expert consensus meeting of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the International Foundation for Osteoporosis (IOF).
The place of calcium supplementation, with or without concomitant vitamin D supplementation, has been much debated in terms of both efficacy and safety. There have been numerous trials and meta-analyses of supplementation for fracture reduction, and associations with risk of myocardial infarction have been suggested in recent years. In this report, the product of an expert consensus meeting of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the International Foundation for Osteoporosis (IOF), we review the evidence for the value of calcium supplementation, with or without vitamin D supplementation, for healthy musculoskeletal ageing. We conclude that: 1) calcium and vitamin D supplementation leads to a modest reduction in fracture risk, although population-level intervention has not been shown to be an effective public health strategy; 2) supplementation with calcium alone for fracture reduction is not supported by the literature; 3) side effects of calcium supplementation include renal stones and gastrointestinal symptoms; 4) vitamin D supplementation, rather than calcium supplementation, may reduce falls risk; and 5) assertions of increased cardiovascular risk consequent on calcium supplementation are not convincingly supported by current evidence. In conclusion, we recommend, on the basis of the current evidence, that calcium supplementation, with concomitant vitamin D supplementation, is supported for patients at high risk of calcium and vitamin D insufficiency, and in those who are receiving treatment for osteoporosis
Osteoporosis treatment in Austria—assessment of FRAX-based intervention thresholds for high and very high fracture risk
Summary
The adoption of the management pathway proposed by the National Osteoporosis Guideline Group (NOGG), UK applied using the Austrian FRAX® tool in a referral population of Austrian women categorises 22–29% of women age 40 years or more eligible for treatment of whom 28–34% are classified at very high risk.
Purpose
The aim of this study is to provide a reference document for the further development of existing guidelines for the management of osteoporosis in Austria, considering FRAX-based intervention thresholds for high and very high fracture risk.
Methods
The model development was based on two Austrian hospital referral cohorts. Baseline information was collected to compute the 10-year probability (using the Austrian FRAX model) of a major osteoporotic fracture (MOF) and hip fracture both with and without the inclusion of femoral neck bone mineral density (BMD). Assessment thresholds for BMD testing were defined, as well as intervention thresholds. In addition, thresholds that characterise men and women at high and very high fracture risk were established. The management pathway followed that currently recommended by the UK National Osteoporosis Guideline Group (NOGG).
Results
The two cohorts comprised a total of 1306 women and men with a mean age of 66.7 years. Slightly more than 50% were eligible for treatment by virtue of a prior fragility fracture. In those women without a prior fracture, 22% (n = 120) were eligible for treatment based on MOF probabilities. Of these, 28% (n = 33) were found to be at very high risk. When both MOF and hip fracture probabilities were used to characterise risk, 164 women without a prior fracture were eligible for treatment (29%). Of these, 34% (n = 56) were found to be at very high risk. Fewer men without prior fracture were eligible for treatment compared with women.
Conclusion
The management pathway as currently outlined is expected to reduce inequalities in patient management. The characterisation of very high risk may aid in the identification of patients suitable for treatment with osteoanabolic agents
X-ray monitoring of classical novae in the central region of M 31. II. Autumn and winter 2007/2008 and 2008/2009
[Abridged] Classical novae (CNe) represent the major class of supersoft X-ray
sources (SSSs) in the central region of our neighbouring galaxy M 31. We
performed a dedicated monitoring of the M 31 central region with XMM-Newton and
Chandra between Nov 2007 and Feb 2008 and between Nov 2008 and Feb 2009
respectively, in order to find SSS counterparts of CNe, determine the duration
of their SSS phase and derive physical outburst parameters. We systematically
searched our data for X-ray counterparts of CNe and determined their X-ray
light curves and spectral properties. We detected in total 17 X-ray
counterparts of CNe in M 31, only four of which were known previously. These
latter sources are still active 12.5, 11.0, 7.4 and 4.8 years after the optical
outburst. From the 17 X-ray counterparts 13 were classified as SSSs. Four novae
displayed short SSS phases (< 100 d). Based on these results and previous
studies we compiled a catalogue of all novae with SSS counterparts in M 31
known so far. We used this catalogue to derive correlations between the
following X-ray and optical nova parameters: turn-on time, turn-off time,
effective temperature (X-ray), t2 decay time and expansion velocity of the
ejected envelope (optical). Furthermore, we found a first hint for the
existence of a difference between SSS parameters of novae associated with the
stellar populations of the M 31 bulge and disk. Additionally, we conducted a
Monte Carlo Markov Chain simulation on the intrinsic fraction of novae with SSS
phase. This simulation showed that the relatively high fraction of novae
without detected SSS emission might be explained by the inevitably incomplete
coverage with X-ray observations in combination with a large fraction of novae
with short SSS states, as expected from the WD mass distribution. In order to
verify our results with an increased sample further monitoring observations are
needed.Comment: 31 pages, 23 figures, 10 tables; submitted to A&
COVID19-associated cardiomyocyte dysfunction, arrhythmias and the effect of Canakinumab
BACKGROUND: Cardiac injury associated with cytokine release frequently occurs in SARS-CoV-2 mediated coronavirus disease (COVID19) and mortality is particularly high in these patients. The mechanistic role of the COVID19 associated cytokine-storm for the concomitant cardiac dysfunction and associated arrhythmias is unclear. Moreover, the role of anti-inflammatory therapy to mitigate cardiac dysfunction remains elusive. AIMS AND METHODS: We investigated the effects of COVID19-associated inflammatory response on cardiac cellular function as well as its cardiac arrhythmogenic potential in rat and induced pluripotent stem cell derived cardiomyocytes (iPS-CM). In addition, we evaluated the therapeutic potential of the IL-1β antagonist Canakinumab using state of the art in-vitro confocal and ratiometric high-throughput microscopy. RESULTS: Isolated rat ventricular cardiomyocytes were exposed to control or COVID19 serum from intensive care unit (ICU) patients with severe ARDS and impaired cardiac function (LVEF 41±5%; 1/3 of patients on veno-venous extracorporeal membrane oxygenation; CK 154±43 U/l). Rat cardiomyocytes showed an early increase of myofilament sensitivity, a decrease of Ca(2+) transient amplitudes and altered baseline [Ca(2+)] upon exposure to patient serum. In addition, we used iPS-CM to explore the long-term effect of patient serum on cardiac electrical and mechanical function. In iPS-CM, spontaneous Ca(2+) release events were more likely to occur upon incubation with COVID19 serum and nuclear as well as cytosolic Ca(2+) release were altered. Co-incubation with Canakinumab had no effect on pro-arrhythmogenic Ca(2+) release or Ca(2+) signaling during excitation-contraction coupling, nor significantly influenced cellular automaticity. CONCLUSION: Serum derived from COVID19 patients exerts acute cardio-depressant and chronic pro-arrhythmogenic effects in rat and iPS-derived cardiomyocytes. Canakinumab had no beneficial effect on cellular Ca(2+) signaling during excitation-contraction coupling. The presented method utilizing iPS-CM and in-vitro Ca(2+) imaging might serve as a novel tool for precision medicine. It allows to investigate cytokine related cardiac dysfunction and pharmacological approaches useful therein
Bone mineral density and fractures in older men with chronic obstructive pulmonary disease or asthma
In 5,541 community dwelling men, chronic obstructive pulmonary disease, or asthma was associated with lower bone mineral density (BMD) at the spine and total hip and an increased risk of vertebral and nonvertebral fractures independent of age, body mass index, and smoking. Men prescribed with corticosteroids had the lowest BMD.
It is unclear whether chronic obstructive pulmonary disease (COPD) is independently associated with BMD and fractures.
In 5,541 men from the Osteoporotic Fractures in Men Study, history of COPD or asthma, current treatment with corticosteroids, BMD, bone loss after 4.5Â years and fractures were ascertained.
Seven hundred fourteen (13%) men reported COPD or asthma, of which 103 were prescribed an oral steroid and 177 an inhaled steroid. Independent of confounders, men prescribed corticosteroids for COPD or asthma had the lowest BMD and a 2-fold increased risk of vertebral osteoporosis compared to men with no history of COPD or asthma (OR 2.13, 95% CI (confidence interval) 1.15–3.93 oral steroids; OR 2.05, 95% CI 1.27–3.31 inhaled steroids). During follow-up, BMD increased at the spine, but there was no difference in bone loss at the hip. However, men with COPD or asthma had a 2.6- and 1.4-fold increased risk of vertebral and nonvertebral fractures, respectively.
Chronic obstructive pulmonary disease or asthma was associated with lower BMD at the spine and hip and increased risk of vertebral and nonvertebral fractures independent of age, clinic site, BMI, and smoking. A history of COPD or asthma may be a useful clinical risk factor to identify patients with osteoporosis
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