Anti-fracture efficacy of intravenous ibandronate: how to translate epidemiological studies into daily clinical practice

peer reviewedNumerous epidemiological approaches are used to demonstrate the efficacy of a new chemical entity. In postmenopausal osteoporosis, anti-fracture efficacy can be assessed through prospective, randomized controlled trials, meta-analyses or real-life setting studies. Intravenous ibandronate was recently marketed, with the aim of optimizing drug absorption and adherence to treatment. Furthermore, this new formulation avoids gastrointestinal side effects and constrains linked to the oral intake of the medication. Spinal anti-fracture efficacy of IV ibandronate derives from a non-inferiority bridging study, using surrogate endpoints, i.e., bone mineral density and biochemical markers of bone turnover, compared to the oral daily formulation, previously registered for the treatment of osteoporosis in Europe. Coherent results from two separate meta-analyses have suggested that the non-vertebral anti-fracture efficacy of IV ibandronate is similar to that observed with oral, daily and weekly bisphosphonates. Similarly, a recent real-life setting study, based on claims from an US database, suggests that hip fractures are reduced, with IV ibandronate, to the same extend as they are with oral bisphosphonates. Notwithstanding, those results should probably be confirmed in an European setting, before being extrapolated, in daily practice, to the Belgian population

Aesthetic discomfort in hand osteoarthritis: results from the LIège Hand Osteoarthritis Cohort (LIHOC)

Characteristics of patients reporting high (HAD) or low (LAD) (aesthetic discomfort). (DOC 55 kb

Low dietary calcium in European postmenopausal osteoporotic women

Objective The WHO recommends a daily Ca intake for postmenopausal women of 1300 mg. The objective of the present study was to assess the dietary Ca intake in European postmenopausal osteoporotic women. Design, setting and subjects Assessment of dietary Ca intake (food and supplements) was performed with a validated self-questionnaire in 8524 osteoporotic women from nine European countries (Belgium, Denmark, France, Germany, Hungary, Italy, Poland, Spain and the UK). Results Mean age of the patients was 74·2 (sd 7·1) years, mean BMI was 25·7 (sd 4·2) kg/m2. Of the study population, 37·2 % of the women took Ca supplements. The mean dietary intake of Ca was 930·7 (sd 422·9) mg/d. The lowest Ca intake was found in Hungary (586·7 (sd 319·1) mg/d) and the highest in Denmark (1145·6 (sd 463·0) mg/d). In the whole study population, only 19·1 % of the women had a dietary Ca intake >1300 mg/d. Only 17·1 % of women aged over 75 years achieved 1300 mg/d compared with 20·5 % of women aged less than 75 years (P = 0·0001 for the difference between the two groups). Conclusion Dietary intake of Ca is very low in European postmenopausal women. A greater awareness is needed to resolve this public health problem

High intensive sports, what impacts on the musculoskeletal and endocrine system

peer reviewedLe sport de haut niveau a un impact considérable sur l'appareil locomoteur mais également sur l'ensemble du corps des athlètes. Les principales structures concernées sont les os, les muscles, les articulations mais également le système endocrinien. Les conséquences sur celles-ci sont décrites et analysées afin de mieux comprendre les phénomènes biophysiologiques induits par la pratique sportive. Nous avons également mis l'accent sur les risques et les moyens de prévention de certaines lésions ostéoarticulaires et musculaires. L'influence hormonale de l'activité sportive a aussi été développée, que ce soit en condition d'effort ou au repos. Enfin, un paragraphe a été consacré à l'usage des produits dopants, les effets recherchés mais également les risques engendrés chez les athlètes par l'utilisation de ceux-ci.High performance sport has always had a considerable impact on the musculoskeletal system but also on the whole body of athletes. The main structures concerned are the bones, muscles, joints but also the endocrine system. The impact on these has been analyzed and to better understand the bio-physiological phenomena brought about by sport. We also emphasized the risks and the means of prevention concerning certain osteo-articular and muscular lesions. The influence of sports activity on hormones such as testosterone, growth hormone and cortisol has been developed, whether under stress or at rest. Finally, a paragraph was devoted to the use of doping products, the desired effects but also the risks generated

A FRAX model for the assessment of fracture probability in Belgium

peer reviewedRESUME : Cette étude a pour but d’adapter à la population belge l’algorithme FRAX® récemment publié par l’Organisation Mondiale de la Santé (OMS) et permettant de calculer, dans les deux sexes, le risque absolu de fractures ostéoporotiques, à 10 ans. Nous nous sommes attachés à quantifier le risque fracturaire correspondant aux critères actuellement appliqués, en Belgique, pour le remboursement des médicaments de l’ostéoporose et à identifier les situations cliniques correspondant à une probabilité équivalente de fracture. Les probabilités fracturaires ont été calculées, à partir des incidences de fractures et de décès publiées, pour la population belge. Ces probabilités prennent en considération l’âge, le sexe, l’existence de facteurs cliniques de risque (FCR) et la densité minérale osseuse (DMO), mesurée au niveau de la zone propre du col fémoral. L’algorithme FRAX® permet d’identifier différents scénarios d’intervention, en Belgique, correspondant à un risque fracturaire identique ou supérieur à celui servant de base aux critères actuels de remboursement des médicaments. Il est donc possible de recommander une modification des attitudes actuelles, délaissant une stratégie basée sur une évaluation dichotomique de la DMO, au profit d’une intégration progressive des FCR qui permettra, in fine, une meilleure identification des patients à risque accru de fracture. Cette approche devra être substantiée par des analyses pharmaco-économiques appropriées

Innovations in physical and rehabilitation medicine

peer reviewedAu cours de la dernière décennie, la Médecine Physique et Réadaptation (MPR) est une spécialité médicale qui a fortement évolué dans les différents domaines qui la concernent : de la prise en charge des lombalgies et lombosciatalgies ou encore de l’ostéoporose de manière pluridisciplinaire, en passant par l’utilisation des nouvelles technologies en rééducation neuro-locomotrice et de la robotisation en rééducation, chez les patients amputés par exemple, le développement de la médecine à vocation régénérative et la prévention en traumatologie du sport et, enfin, les progrès des techniques d’électrophysiologie pour le diagnostic des neuropathies à petites fibres. Ces différentes avancées seront abordées dans cet article.Over the last decade, Physical and Rehabilitation Medicine (PRM) is a medical specialty that has evolved considerably in the various fields that concern it : from the management of low back pain and lumbosciatalgia or osteoporosis in a multidisciplinary manner, through the use of new technologies in neuro-locomotor rehabilitation and robotisation in amputee patients for example, the development of regenerative medicine and prevention in sports traumatology and, finally, the progress of electrophysiology techniques for the diagnosis of small-fibre neuropathies. These various advances will be discussed in this article

Vitamin D inadequacy in Belgian postmenopausal osteoporotic women

BACKGROUND: Inadequate serum vitamin D [25(OH)D] concentrations are associated with secondary hyperparathyroidism, increased bone turnover and bone loss, which increase fracture risk. The objective of this study is to assess the prevalence of inadequate serum 25(OH)D concentrations in postmenopausal Belgian women. Opinions with regard to the definition of vitamin D deficiency and adequate vitamin D status vary widely and there are no clear international agreements on what constitute adequate concentrations of vitamin D. METHODS: Assessment of 25-hydroxyvitamin D [25(OH)D] and parathyroid hormone was performed in 1195 Belgian postmenopausal women aged over 50 years. Main analysis has been performed in the whole study population and according to the previous use of vitamin D and calcium supplements. Four cut-offs of 25(OH)D inadequacy were fixed : < 80 nmol/L, <75 nmol/L, < 50 nmol/L and < 30 nmol/L. RESULTS: Mean (SD) age of the patients was 76.9 (7.5) years, body mass index was 25.7 (4.5) kg/m(2). Concentrations of 25(OH)D were 52.5 (21.4) nmol/L. In the whole study population, the prevalence of 25(OH)D inadequacy was 91.3 %, 87.5 %, 43.1 % and 15.9% when considering cut-offs of 80, 75, 50 and 30 nmol/L, respectively. Women who used vitamin D supplements, alone or combined with calcium supplements, had higher concentrations of 25(OH)D than non-users. Significant inverse correlations were found between age/serum PTH and serum 25(OH)D (r = -0.23/r = -0.31) and also between age/serum PTH and femoral neck BMD (r = -0.29/r = -0.15). There is a significant positive relation between age and PTH (r = 0.16), serum 25(OH)D and femoral neck BMD (r = 0.07). (P < 0.05) Vitamin D concentrations varied with the season of sampling but did not reach statistical significance (P = 0.09). CONCLUSION: This study points out a high prevalence of vitamin D inadequacy in Belgian postmenopausal osteoporotic women, even among subjects receiving vitamin D supplements

Strontium ranelate: a look back at its use for osteoporosis

Importance of the field: Osteoporosis is now considered as a major health problem in all developed and in most developing (non-African) coutries. Areas covered in this review: In the present review, we provide an extensive literature survey (MEDLINE, PubMed, Cochrane Controlled Register), for articles dealing with osteoporosis management and/or strontium ranelate, from 1920 to 2010. What the reader will gain: The objective is to provide an extensive, unbiased assessment of the available data allowing to place strontium ranelate in perspective, with other anti-osteoporosis treatments. Take home message: Owing to a positive benefit/risk ratio, strontium ranelate may now be considered as a first-line treatment in the management of osteoporosis