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Osteoporosis: HELP
Articles by Maria Luisa Brandi
Based on 80 articles published since 2008
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Between 2008 and 2019, M. Brandi wrote the following 80 articles about Osteoporosis.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4
1 Guideline Clinical guidelines for the prevention and treatment of osteoporosis: summary statements and recommendations from the Italian Society for Orthopaedics and Traumatology. 2017

Tarantino, Umberto / Iolascon, Giovanni / Cianferotti, Luisella / Masi, Laura / Marcucci, Gemma / Giusti, Francesca / Marini, Francesca / Parri, Simone / Feola, Maurizio / Rao, Cecilia / Piccirilli, Eleonora / Zanetti, Emanuela Basilici / Cittadini, Noemi / Alvaro, Rosaria / Moretti, Antimo / Calafiore, Dario / Toro, Giuseppe / Gimigliano, Francesca / Resmini, Giuseppina / Brandi, Maria Luisa. ·Policlinico Tor Vergata Foundation, Orthopaedics and Traumatology, University of Rome Tor Vergata, Rome, Italy. · Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Naples, Italy. · Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy. · Nursing Science, Center of Excellence for Culture and Nursing Research-IPASVI, University of Rome Tor Vergata, Rome, Italy. · Section of Orthopaedics and Traumatology, Centre for the Study of Osteoporosis and Metabolic Bone Disease, Treviglio-Caravaggio Hospital, Bergamo, Italy. · Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy. marialuisa.brandi@unifi.it. ·J Orthop Traumatol · Pubmed #29058226.

ABSTRACT: BACKGROUND: The Italian Society for Orthopaedics and Traumatology conceived this guidance-which is primarily addressed to Italian orthopedic surgeons, but should also prove useful to other bone specialists and to general practitioners-in order to improve the diagnosis, prevention, and treatment of osteoporosis and its consequences. MATERIALS AND METHODS: Literature reviews by a multidisciplinary team. RESULTS: The following topics are covered: the role of instrumental, metabolic, and genetic evaluations in the diagnosis of osteoporosis; appraisal of the risk of fracture and thresholds for intervention; general strategies for the prevention and treatment of osteoporosis (primary and secondary prevention); the pharmacologic treatment of osteoporosis; the setting and implementation of fracture liaison services for tertiary prevention. Grade A, B, and C recommendations are provided based on the main levels of evidence (1-3). Toolboxes for everyday clinical practice are provided. CONCLUSIONS: The first up-to-date Italian guidelines for the primary, secondary, and tertiary prevention of osteoporosis and osteoporotic fractures are presented.

2 Guideline Guidance for the prevention of bone loss and fractures in postmenopausal women treated with aromatase inhibitors for breast cancer: an ESCEO position paper. 2012

Rizzoli, R / Body, J J / DeCensi, A / Reginster, J Y / Piscitelli, P / Brandi, M L / Anonymous2040716. ·Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. ·Osteoporos Int · Pubmed #22270857.

ABSTRACT: INTRODUCTION: Aromatase inhibitors (AIs) are now the standard treatment for hormone receptor-positive breast cancer. However, deleterious effects of AIs on bone health have been reported. An ESCEO working group proposes guidance for the prevention of bone loss and fragility fractures in post-menopausal women with breast cancer receiving AIs. METHODS: A panel of experts addressed the issue of skeletal effects of AIs and effectiveness of antifracture therapies for the prevention of AI-induced bone loss and fractures. Recommendations by national and international organizations, and experts' opinions on this topic were evaluated. RESULTS: All aromatase inhibitors are associated with negative effects on the skeleton, resulting in bone loss and increased risk of fragility fractures. Current guidelines suggest approaches that differ both in terms of drugs proposed for fracture prevention and duration of treatment. CONCLUSION: The ESCEO working group recommends that all AI-treated women should be evaluated for fracture risk. Besides general recommendations, zoledronic acid 4 mg i.v. every 6 months, denosumab s.c., or possibly oral bisphosphonates should be administered for the entire period of AI treatment to all osteoporotic women (T-score hip/spine <-2.5 or ≥ 1 prevalent fragility fracture), to women aged ≥ 75 irrespective of BMD, and to patients with T-score <-1.5 + ≥ 1 clinical risk factor or T-score <-1.0 + ≥ 2 clinical risk factors. Alternatively, therapy could be considered in patients with a FRAX-determined 10-year hip fracture probability ≥ 3%.

3 Guideline [Guidelines for the diagnosis, prevention and treatment of osteoporosis]. 2009

Adami, S / Bertoldo, F / Brandi, M L / Cepollaro, C / Filipponi, P / Fiore, E / Frediani, B / Giannini, S / Gonnelli, S / Isaia, G C / Luisetto, G / Mannarino, E / Marcocci, C / Masi, L / Mereu, C / Migliaccio, S / Minisola, S / Nuti, R / Rini, G / Rossini, M / Varenna, M / Ventura, L / Bianchi, G / Anonymous3110650. ·Membri del Consiglio Direttivo SIOMMMS. ·Reumatismo · Pubmed #20143003.

ABSTRACT: DEFINITION: Osteoporosis is defined as a quantitative and qualitative deterioration of bone tissue leading to increased risk of fracture. Postmenopausal and senile osteoporosis are defined as primitive. DIAGNOSIS: The cornerstone for the diagnosis of osteoporosis is the measurement of bone mineral density (BMD) by DXA (dual-energy X-ray absortiometry) at the femoral neck with T-score values <-2.5, following the WHO definition. Other DXA sites or technologies for measuring bone mass are also acceptable when the former is not accessible. A BMD evaluation is recommended to all women above 65 years of age. At younger age or in man the bone assessment is recommended only in subjects with specific risk factors. A control of bone mass measurement is seldom required before 2 years. DIFFERENTIAL DIAGNOSIS: A few biochemical tests such as serum and urinary calcium, protein electrophoresis, serum creatinine and ESR are usually sufficient to exclude most secondary types of osteoporosis. The value of the so called bone turnover markers for the diagnosis and follow-up of osteoporosis remains uncertain. Several secondary forms of osteoporosis require a specific diagnostic and therapeutic management. PREVENTION: The osteoporosis prevention should be based on the elimination of specific risk factors such as inadequate calcium and vitamin D intake, smoking and sedentary life. The use of pharmacological agents in subjects with BMD values >-2.5 is usually not justified. Pharmacological intervention: The use of drugs registered for the treatment of osteoporosis are recommended when the benefits overcome the risk. This is the case only when the risk of fracture is rather high. FRAX is recognized as a useful tool for easily estimate the long-term fracture risk. SIOMMMS with these guidelines is committed to validate and further develop this diagnostic tool.

4 Editorial Fracture prevention in osteoporosis: assessing risks, providing solutions. 2010

Reginster, J-Y / Brandi, M L. · ·Osteoporos Int · Pubmed #20464372.

ABSTRACT: -- No abstract --

5 Review Bone management in hematologic stem cell transplant recipients. 2018

Kendler, D L / Body, J J / Brandi, M L / Broady, R / Cannata-Andia, J / Cannata-Ortiz, M J / El Maghraoui, A / Guglielmi, G / Hadji, P / Pierroz, D D / de Villiers, T J / Rizzoli, R / Ebeling, P R / Anonymous1981118. ·Department of Medicine, Division of Endocrinology, University of British Columbia, 150 - 943 W. Broadway, Vancouver, V5Z 4E1, Canada. davidkendler@gmail.com. · CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium. · Mineral and Bone Metabolic Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy. · Department of Medicine, Division of Hematology, University of British Columbia, Vancouver, Canada. · Servicio de Metabolismo Óseo y Mineral, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain. · Haematology Department, IIS Princesa, Hospital de la Princesa, Madrid, Spain. · Rheumatology Department, Military Hospital Mohammed V, Mohammed V-Souissi University, Rabat, Morocco. · Department of Radiology, University of Foggia, Foggia, Italy. · Department of Bone Oncology, Endocrinology and Reproductive Medicine, Nord West Hospital, Frankfurt, Germany. · International Osteoporosis Foundation (IOF), Nyon, Switzerland. · Department of Gynaecology, Faculty of Health Sciences, Stellenbosch University, Stellenbosch, South Africa. · Mediclinic Panorama, Cape Town, South Africa. · Division of Bone Diseases, Faculty of Medicine, Geneva University Hospital, Geneva, Switzerland. · Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Australia. ·Osteoporos Int · Pubmed #30178158.

ABSTRACT: Autologous and allogeneic hematopoietic stem cell transplantation (HSCT) is the treatment of choice for patients with some malignant and non-malignant hematological diseases. Advances in transplantation techniques and supportive care measures have substantially increased the number of long-term HSCT survivors. This has led to an increasing patient population suffering from the late effects of HSCT, of which, bone loss and its consequent fragility fractures lead to substantial morbidity. Altered bone health, with consequent fragility fractures, and chronic graft-versus-host disease (GVHD) are factors affecting long-term quality of life after HSCT. Hypogonadism, HSCT preparative regimens, nutritional factors, and glucocorticoids all contribute to accelerated bone loss and increased fracture risk. Management strategies should include bone mineral density examination, evaluation of clinical risk factors, and general dietary and physical activity measures. Evidence has accumulated permitting recommendations for more attentiveness to evaluation and monitoring of bone health, with appropriate application of osteoporosis pharmacotherapies to patients at increased risk of bone loss and fracture.

6 Review Periodontal disease and women's health. 2017

Martelli, Maria Luisa / Brandi, Maria Luisa / Martelli, Marialaura / Nobili, Piero / Medico, Enzo / Martelli, Francesco. ·a IMI (International Microdentistry Institute) , Florence , Italy. · b Universita degli Studi di Firenze , Department of Surgery and Translational Medicine , Florence , Italy. · c AIMOP Accademia Italiana Medicina Orale e Parodontologia , Milano , Italy. · d University of Torino , Department of Oncology , Torino , Italy. ·Curr Med Res Opin · Pubmed #28277873.

ABSTRACT: BACKGROUND: Periodontal disease (PD) is a multifactorial inflammatory condition in which inappropriate interaction between the host immune response and specific groups of bacterial pathogens leads to destruction of connective and bone tissues supporting the tooth. Dissemination of pathogens, toxins, and immune complexes from and to periodontal lesions is at the basis of the increasingly recognized association between PD and various systemic diseases (SDs). Considering the growing attention of the medical community to "gender medicine", this review focuses on the association between PD and six systemic conditions heavily impacting women's health, with the aim of providing evidence in support of a joint effort between physicians and dentists to improve clinical management of these conditions. METHODS: We considered systematic reviews, meta-analyses and narrative reviews evaluating all possible associations between periodontitis, systemic diseases and women. RESULTS: Gender prevalence for PD is discordant, but the literature strongly supports an association between PD and female infertility and adverse pregnancy outcomes. Moreover, PD is bidirectionally linked to several systemic diseases characterized by an established female gender bias, i.e. osteoporosis (OP), cardiovascular diseases (CVD), autoimmunity, Alzheimer's disease (AD) and cancer. CONCLUSIONS: Overall, the literature data reviewed here provides a strong foundation for further characterization of molecular and microbial drivers of PD and of several female-prevalent systemic diseases, highlighting the possible importance of a good oral condition in preventing or attenuating women's systemic diseases.

7 Review Case-Based Review of Osteonecrosis of the Jaw (ONJ) and Application of the International Recommendations for Management From the International Task Force on ONJ. 2017

Khan, Aliya A / Morrison, Archie / Kendler, David L / Rizzoli, Rene / Hanley, David A / Felsenberg, Dieter / McCauley, Laurie K / O'Ryan, Felice / Reid, Ian R / Ruggiero, Salvatore L / Taguchi, Akira / Tetradis, Sotirios / Watts, Nelson B / Brandi, Maria Luisa / Peters, Edmund / Guise, Teresa / Eastell, Richard / Cheung, Angela M / Morin, Suzanne N / Masri, Basel / Cooper, Cyrus / Morgan, Sarah L / Obermayer-Pietsch, Barbara / Langdahl, Bente L / Dabagh, Rana Al / Davison, K Shawn / Sándor, George K / Josse, Robert G / Bhandari, Mohit / El Rabbany, Mohamed / Pierroz, Dominique D / Sulimani, Riad / Saunders, Deborah P / Brown, Jacques P / Compston, Juliet / Anonymous3310890. ·Department of Medicine, Divisions of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada. Electronic address: Aliya@mcmaster.ca. · Division of Oral and Maxillofacial Surgery, Dalhousie University, Halifax, NS, Canada. · Department of Medicine, Division of Endocrinology, University of British Columbia, Vancouver, BC, Canada. · Division of Bone Diseases, Geneva University Hospitals, Geneva, Switzerland. · Departments of Medicine, Community Health Sciences and Oncology, University of Calgary, Calgary, AB, Canada. · Centre of Muscle & Bone Research, Charité-University Medicine Berlin, Campus Benjamin Franklin, Free University & Humboldt University Berlin, Berlin, Germany. · Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA. · Division of Maxillofacial Surgery, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA. · Department of Medicine, University of Auckland, Auckland, New Zealand. · Division of Oral and Maxillofacial Surgery, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA; Stony Brook School of Dental Medicine, Stony Brook, NY, USA; New York Center for Orthognathic and Maxillofacial Surgery, New York, NY, USA. · Department of Oral and Maxillofacial Radiology, School of Dentistry, Matsumoto Dental University, Shojiri, Japan. · Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA, USA. · Mercy Health Osteoporosis and Bone Health Services, Cincinnati, OH, USA. · Department of Surgery and Translational Medicine, University of Florence, Florence, Italy. · Department of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada. · Department of Medicine, Division of Endocrinology at Indiana University, Indianapolis, IN, USA. · Department of Human Metabolism, University of Sheffield, Sheffield, UK. · Department of Medicine, University of Toronto, Toronto, ON, Canada; Centre of Excellence in Skeletal Health Assessment, Joint Department of Medical Imaging, University Health Network (UHN), Toronto, ON, Canada; Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada. · Department of Medicine, McGill University, Montreal, QC, Canada. · Jordan Osteoporosis Center, Jordan Hospital & Medical Center, Amman, Jordan. · MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; NIHR Nutrition Biomedical Research Centre, University of Southampton, Southampton, UK; NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK. · Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham Osteoporosis Prevention and Treatment Clinic, Birmingham, AL, USA. · Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University Graz, Graz, Austria. · Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark. · Faculty of Dentistry, University of Toronto, Toronto, Canada. · Department of Education, University of Victoria,Victoria, BC, Canada. · Department of Oral and Maxillofacial Surgery, Oulu University Hospital, University of Oulu, Oulu, Finland. · Division of Endocrinology and Metabolism, University of Toronto, Toronto, ON, Canada. · Division of Orthopaedic Surgery, Department of Surgery, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. · Faculty of Dentistry, University of Toronto, Toronto, ON, Canada. · International Osteoporosis Foundation (IOF), Nyon, Switzerland. · College of Medicine, King Saud University, Riyadh, Saudi Arabia. · Department of Dental Oncology, Northeast Cancer Centre/Health Science North, Sudbury, ON, Canada. · Rheumatology Division, CHU de Québec Research Centre, Laval University, Quebec City, QC, Canada. · Department of Medicine, Cambridge Biomedical Campus, Cambridge, UK. ·J Clin Densitom · Pubmed #27956123.

ABSTRACT: Osteonecrosis of the jaw (ONJ) has been associated with antiresorptive therapy in both oncology and osteoporosis patients. This debilitating condition is very rare and advances in diagnosis and management may now effectively reduce the risk of its development and offer valuable treatment options for affected patients. This paper provides a case-based review of ONJ and application of the International Task Force on ONJ (referred to as the "Task Force") recommendations for the diagnosis and management of ONJ. The Task Force was supported by 14 international societies and achieved consensus from representatives of these multidisciplinary societies on key issues pertaining to the diagnosis and management of ONJ. The frequency of ONJ in oncology patients receiving oncology doses of bisphosphonate (BP) or denosumab is estimated at 1%-15%, and the frequency in the osteoporosis patient population receiving much lower doses of BP or denosumab is estimated at 0.001%-0.01%. Although the diagnosis of ONJ is primarily clinical, imaging may be helpful in confirming the diagnosis and staging. In those with multiple risk factors for ONJ for whom major invasive oral surgery is being planned, interruption of BP or denosumab therapy (in cancer patients) is advised, if possible, before surgery, until the surgical site heals. Major oral surgery in this context could include multiple extractions if surgical extractions are required, not simple forceps extractions. ONJ development may be reduced by optimizing oral hygiene and postoperatively using topical and systemic antibiotics as appropriate. Periodontal disease should be managed before starting oncology doses of BP or denosumab. Local debridement may be successful in disease unresponsive to conservative therapy. Successful surgical intervention has been reported in those with stage 3 disease; less severe disease is best managed conservatively. Teriparatide may be helpful in healing ONJ lesions and may be considered in osteoporosis patients at a high fracture risk in the absence of contraindications. Resumption of BP or denosumab therapy following healing of ONJ lesions is recommended, and there have not been reports of subsequent local recurrence.

8 Review 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). 2017

Harvey, N C / Biver, E / Kaufman, J-M / Bauer, J / Branco, J / Brandi, M L / Bruyère, O / Coxam, V / Cruz-Jentoft, A / Czerwinski, E / Dimai, H / Fardellone, P / Landi, F / Reginster, J-Y / Dawson-Hughes, B / Kanis, J A / Rizzoli, R / Cooper, C. ·MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK. · NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK. · Service of Bone Diseases, University Hospitals Geneva, Geneva, Switzerland. · Department of Internal Medicine, section Endocrinology, Ghent University, Ghent, Belgium. · Department of Geriatric Medicine, Klinikum, Carl von Ossietzky University, Ammerländer Heerstrasse 114-118, 26129, Oldenburg, Germany. · CEDOC - NOVA Medical School, UNL and Rheumatology Department, CHLO/Hospital Egas Moniz, Lisbon, Portugal. · Head, Bone and Mineral Metabolic Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy. · Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium. · INRA, UMR 1019, UNH, CRNH Auvergne, F-63000, Clermont-Ferrand, France. · Clermont Université, Université d'Auvergne, Unité de Nutrition Humaine, BP 10448, F-63000, Clermont-Ferrand, France. · Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (Irycis), Madrid, Spain. · Department of Bone and Joint Diseases, Faculty of Health Sciences, Krakow Medical Centre, Jagiellonian University, Krakow, Poland. · Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria. · CHU Amiens, Université Picardie - Jules Verne, INSERM U 1088, Amiens, France. · Geriatric Department, Catholic University of Sacred Heart, Milan, Italy. · Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA. · Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK. · Institute for Health and Ageing, Catholic University of Australia, Melbourne, Australia. · MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK. cc@mrc.soton.ac.uk. · NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK. cc@mrc.soton.ac.uk. · Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, The Botnar Research Centre, University of Oxford, Oxford, UK. cc@mrc.soton.ac.uk. ·Osteoporos Int · Pubmed #27761590.

ABSTRACT: 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 to 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.

9 Review Unmet needs and current and future approaches for osteoporotic patients at high risk of hip fracture. 2016

Ferrari, Serge / Reginster, Jean-Yves / Brandi, Maria Luisa / Kanis, John A / Devogelaer, Jean-Pierre / Kaufman, Jean-Marc / Féron, Jean-Marc / Kurth, Andreas / Rizzoli, René. ·Service of Bone Diseases, Department of Internal Medicine Specialties, Geneva University Hospitals and Faculty of Medicine, 1211, Geneva 14, Switzerland. · Bone and Cartilage Metabolism Unit, University of Liège, Liège, Belgium. · Section of Endocrinology, Unit of Bone and Mineral Metabolism, Department of Surgery and Translational Medicine, Florence, Italy. · Institute for Health and Aging, Catholic University of Australia, Melbourne, Australia. · University of Sheffield Medical School, Sheffield, UK. · Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium. · Department of Endocrinology and Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium. · Orthopaedic and Trauma Department, Saint Antoine Hospital, UPMC-Sorbonne Universities, Paris, France. · Department of Orthopaedic Surgery, Themistocles Gluck Hospital, Dusseldorf, Germany. · Service of Bone Diseases, Department of Internal Medicine Specialties, Geneva University Hospitals and Faculty of Medicine, 1211, Geneva 14, Switzerland. rene.rizzoli@unige.ch. ·Arch Osteoporos · Pubmed #27800591.

ABSTRACT: This review provides a critical analysis of currently available approaches to increase bone mass, structure and strength through drug therapy and of possible direct intra-osseous interventions for the management of patients at imminent risk of hip fracture. PURPOSE: Osteoporotic hip fractures represent a particularly high burden in morbidity-, mortality- and health care-related costs. There are challenges and unmet needs in the early prevention of hip fractures, opening the perspective of new developments for the management of osteoporotic patients at imminent and/or at very high risk of hip fracture. Amongst them, preventive surgical intervention needs to be considered. METHODS: A European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO)/International Osteoporosis Foundation (IOF) working group reviewed the presently available intervention modalities including preventive surgical options for hip fragility. This paper represents a summary of the discussions. RESULTS: Prevention of hip fracture is currently based on regular physical activity; prevention of falls; correction of nutritional deficiencies, including vitamin D repletion; and pharmacological intervention. However, efficacy of these various measures to reduce hip fractures is at most 50% and may need months or years before becoming effective. To face the challenges of early prevention of hip fractures for osteoporotic patients at imminent and/or at very high risk of hip fracture, preventive surgical intervention needs further investigation. CONCLUSION: Preventive surgical intervention needs to be appraised for osteoporotic patients at imminent and/or at very high risk of hip fracture.

10 Review Healing of the bone with anti-fracture drugs. 2016

Vannucci, Letizia / Brandi, Maria Luisa. ·a Department of Surgery and Translational Medicine , University of Florence , Florence , Italy. ·Expert Opin Pharmacother · Pubmed #27673358.

ABSTRACT: INTRODUCTION: Fracture healing is a complex physiological process. As impaired fracture healing is more frequent in osteoporotic subjects, anti-osteoporotic drugs could have some impact on this process. Areas covered: We reviewed the current literature to evaluate the effects of these drugs on fracture healing and their potential role in supporting this process, especially when impaired. A PubMed/Medline search was undertaken combining the terms 'fracture healing', 'anti-resorptive drugs', 'anabolic agents', 'anti-osteoporotic drugs'. Expert opinion: As clinical evidence on the role of anti-osteoporotic drugs in the process of fracture healing consists mainly of case reports or studies with a relatively small number of patients, large randomized clinical trials are needed in order to extend to the human setting the promising results on these agents as inductors or co-adjuvants of bone healing derived from animal studies.

11 Review Epigenetic Mechanisms in Bone Biology and Osteoporosis: Can They Drive Therapeutic Choices? 2016

Marini, Francesca / Cianferotti, Luisella / Brandi, Maria Luisa. ·Department of Surgery and Translational Medicine, University of Florence and Metabolic Bone Diseases Unit, University Hospital of Florence, Largo Palagi 1, 50139 Florence, Italy. f.marini@dmi.unifi.it. · Department of Surgery and Translational Medicine, University of Florence and Metabolic Bone Diseases Unit, University Hospital of Florence, Largo Palagi 1, 50139 Florence, Italy. luisella.cianferotti@unifi.it. · Department of Surgery and Translational Medicine, University of Florence and Metabolic Bone Diseases Unit, University Hospital of Florence, Largo Palagi 1, 50139 Florence, Italy. marialuisa.brandi@unifi.it. ·Int J Mol Sci · Pubmed #27529237.

ABSTRACT: Osteoporosis is a complex multifactorial disorder of the skeleton. Genetic factors are important in determining peak bone mass and structure, as well as the predisposition to bone deterioration and fragility fractures. Nonetheless, genetic factors alone are not sufficient to explain osteoporosis development and fragility fracture occurrence. Indeed, epigenetic factors, representing a link between individual genetic aspects and environmental influences, are also strongly suspected to be involved in bone biology and osteoporosis. Recently, alterations in epigenetic mechanisms and their activity have been associated with aging. Also, bone metabolism has been demonstrated to be under the control of epigenetic mechanisms. Runt-related transcription factor 2 (RUNX2), the master transcription factor of osteoblast differentiation, has been shown to be regulated by histone deacetylases and microRNAs (miRNAs). Some miRNAs were also proven to have key roles in the regulation of Wnt signalling in osteoblastogenesis, and to be important for the positive or negative regulation of both osteoblast and osteoclast differentiation. Exogenous and environmental stimuli, influencing the functionality of epigenetic mechanisms involved in the regulation of bone metabolism, may contribute to the development of osteoporosis and other bone disorders, in synergy with genetic determinants. The progressive understanding of roles of epigenetic mechanisms in normal bone metabolism and in multifactorial bone disorders will be very helpful for a better comprehension of disease pathogenesis and translation of this information into clinical practice. A deep understanding of these mechanisms could help in the future tailoring of proper individual treatments, according to precision medicine's principles.

12 Review Balancing benefits and risks of glucocorticoids in rheumatic diseases and other inflammatory joint disorders: new insights from emerging data. An expert consensus paper from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). 2016

Cooper, Cyrus / Bardin, Thomas / Brandi, Maria-Luisa / Cacoub, Patrice / Caminis, John / Civitelli, Roberto / Cutolo, Maurizio / Dere, Willard / Devogelaer, Jean-Pierre / Diez-Perez, Adolfo / Einhorn, Thomas A / Emonts, Patrick / Ethgen, Olivier / Kanis, John A / Kaufman, Jean-Marc / Kvien, Tore K / Lems, Willem F / McCloskey, Eugene / Miossec, Pierre / Reiter, Susanne / Ringe, Johann / Rizzoli, René / Saag, Kenneth / Reginster, Jean-Yves. ·MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK. cc@mrc.soton.ac.uk. · NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK. cc@mrc.soton.ac.uk. · Department of Rhumatologie, Hôpital Lariboisière Assistance Publique Hôpitaux de Paris, University Paris VII, Paris, France. · Department of Internal Medicine, University of Florence, Florence, Italy. · Department Hospitalo-Universitaire I2B, INSERM, UMR S 959, CNRS 7211, UPMC University of Paris 06, Paris, France. · Group Hospitalier Pitié-Salpêtrière, Department of Internal Medicine, Paris, France. · UCB Biosciences, 8010 Arco Corporate Drive, Raleigh, NC, USA. · Division of Bone and Mineral Diseases, Washington University, St. Louis, MO, USA. · Research Laboratories and Clinical Academic Division of Rheumatology, University Medical School of Genoa, Genoa, Italy. · Internal Medicine, University of Utah, Salt Lake City, UT, USA. · Rheumatology Department, Saint-Luc University Hospital, Louvain University in Brussels, Brussels, Belgium. · Servicio de Medicina Interna y Enfermedades Infecciosas, Hospital del Mar-IMIM and RETICEF, Barcelona, Spain. · Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA, USA. · Bone and Cartilage Metabolism Unit, Department of Public Health Sciences, University of Liege, Liège, Belgium. · Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium. · Centre for Metabolic Bone Diseases, Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, UK. · Department of Endocrinology, Ghent University Hospital, Ghent, Belgium. · Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · Department of Rheumatology, VU University Medical Hospital, Amsterdam, The Netherlands. · Immunogenomics and Inflammation Research Unit, Department of Immunology and Rheumatology, University of Lyon 1, Lyon, France. · , Bonn, Germany. · West German Osteoporosis Center (WOC), University of Cologne, Leverkusen, Germany. · Service of Bone Diseases, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland. · Division of Clinical Immunology and Rheumatology, University of Alabama, Birmingham, AL, USA. · Department of Public Health, Epidemiology and Health Economics, University of Liege, Liège, Belgium. ·Aging Clin Exp Res · Pubmed #26746234.

ABSTRACT: PURPOSE: This consensus review article considers the question of whether glucocorticoid (GC) therapy is still relevant in the treatment of rheumatic diseases, with a particular focus on rheumatoid arthritis (RA), and whether its side effects can be adequately managed. Recent basic and clinical research on the molecular, cellular and clinical effects of GCs have considerably advanced our knowledge in this field. An overview of the subject seems appropriate. METHODS: This review is the result of a multidisciplinary expert working group, organised by European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis. The recent literature was surveyed and the salient evidence synthetized. RESULTS: The pathophysiological basis of RA (and other inflammatory rheumatic diseases) now strongly implicates the adaptive immune system in addition to innate mechanisms. The molecular effect of GCs and differential GC sensitivity is better understood, although exploiting this knowledge is still in its infancy. The newer treatment strategies of early and aggressive control of RA have gr eatly improved clinical outcomes, but improvements are still possible. Newer targeted anti-inflammatory drugs have made an important impact, yet they too are associated with numerous side effects. DISCUSSION: Short durations of moderate doses of GCs are generally well tolerated and have a positive benefit/risk ratio. Patients should be assessed for fracture risk and bone preserving agents and be prescribed calcium and vitamin D supplementation. CONCLUSIONS: Within a strategy of a disease modifying approach to inflammatory disease, combination therapy including a GC is effective approach.

13 Review Effects of Dairy Products Consumption on Health: Benefits and Beliefs--A Commentary from the Belgian Bone Club and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases. 2016

Rozenberg, Serge / Body, Jean-Jacques / Bruyère, Olivier / Bergmann, Pierre / Brandi, Maria Luisa / Cooper, Cyrus / Devogelaer, Jean-Pierre / Gielen, Evelien / Goemaere, Stefan / Kaufman, Jean-Marc / Rizzoli, René / Reginster, Jean-Yves. ·Department of Gynaecology-Obstetrics, Université Libre de Bruxelles, Brussels, Belgium. · Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium. · Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium. · Department of Radioisotopes, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium. · Metabolic Bone Unit, Department of Internal Medicine, University of Florence, Florence, Italy. · MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK. · University of Oxford, Oxford, UK. · Department of Rheumatology, Saint Luc University Hospital, Université Catholique de Louvain, Louvain-la-Neuve, Belgium. · Gerontology and Geriatrics Section, Department of Experimental Medicine, Katholiek Universiteit Leuven, Leuven, Belgium. · Department of Rheumatology and Endocrinology, State University of Ghent, Ghent, Belgium. · Department of Endocrinology, State University of Ghent, Ghent, Belgium. · Division of Bones Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. · Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium. jyreginster@ulg.ac.be. ·Calcif Tissue Int · Pubmed #26445771.

ABSTRACT: Dairy products provide a package of essential nutrients that is difficult to obtain in low-dairy or dairy-free diets, and for many people it is not possible to achieve recommended daily calcium intakes with a dairy-free diet. Despite the established benefits for bone health, some people avoid dairy in their diet due to beliefs that dairy may be detrimental to health, especially in those with weight management issues, lactose intolerance, osteoarthritis, rheumatoid arthritis, or trying to avoid cardiovascular disease. This review provides information for health professionals to enable them to help their patients make informed decisions about consuming dairy products as part of a balanced diet. There may be a weak association between dairy consumption and a possible small weight reduction, with decreases in fat mass and waist circumference and increases in lean body mass. Lactose intolerant individuals may not need to completely eliminate dairy products from their diet, as both yogurt and hard cheese are well tolerated. Among people with arthritis, there is no evidence for a benefit to avoid dairy consumption. Dairy products do not increase the risk of cardiovascular disease, particularly if low fat. Intake of up to three servings of dairy products per day appears to be safe and may confer a favourable benefit with regard to bone health.

14 Review The calcium-sensing receptor in bone metabolism: from bench to bedside and back. 2015

Cianferotti, L / Gomes, A R / Fabbri, S / Tanini, A / Brandi, M L. ·Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, 50134, Florence, Italy. ·Osteoporos Int · Pubmed #26100412.

ABSTRACT: INTRODUCTION: The calcium-sensing receptor (CaSR) is a key player in the maintenance of calcium homeostasis through the regulation of PTH secretion and calcium homeostasis, thus indirectly influencing bone metabolism. In addition to this role, in vitro and in vivo evidence points to direct effects of CaSR in bone modeling and remodeling. In addition, the activation of the CaSR is one of the anabolic mechanisms implicated in the action of strontium ranelate, to reduce fracture risk. METHODS: This review is based upon the acquisition of data from a PubMed enquiry using the terms "calcium sensing receptor," "CaSR" AND "bone remodeling," "bone modeling," "bone turnover," "osteoblast," "osteoclast," "osteocyte," "chondrocyte," "bone marrow," "calcilytics," "calcimimetics," "strontium," "osteoporosis," "skeletal homeostasis," and "bone metabolism." RESULTS: A fully functional CaSR is expressed in osteoblasts and osteoclasts, so that these cells are able to sense changes in the extracellular calcium and as a result modulate their behavior. CaSR agonists (calcimimetics) or antagonists (calcilytics) have the potential to indirectly influence skeletal homeostasis through the modulation of PTH secretion by the parathyroid glands. The bone anabolic effect of strontium ranelate, a divalent cation used as a treatment for postmenopausal and male osteoporosis, might be explained, at least in part, by the activation of CaSR in bone cells. CONCLUSIONS: Calcium released in the bone microenvironment during remodeling is a major factor in regulating bone cells. Osteoblast and osteoclast proliferation, differentiation, and apoptosis are influenced by local extracellular calcium concentration. Thus, the calcium-sensing properties of skeletal cells can be exploited in order to modulate bone turnover and can explain the bone anabolic effects of agents developed and employed to revert osteoporosis.

15 Review Trabecular bone score (TBS) as a new complementary approach for osteoporosis evaluation in clinical practice. 2015

Harvey, N C / Glüer, C C / Binkley, N / McCloskey, E V / Brandi, M-L / Cooper, C / Kendler, D / Lamy, O / Laslop, A / Camargos, B M / Reginster, J-Y / Rizzoli, R / Kanis, J A. ·MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; NIHR Southampton Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK. Electronic address: nch@mrc.soton.ac.uk. · Sektion Biomedizinische Bildgebung, Klinik für Radiologie und Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany. · Osteoporosis Clinical Research Program, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. · Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK. · Department of Surgery and Translational Medicine, University of Florence, Florence, Italy. · MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; NIHR Southampton Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK; NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK. · Department of Medicine, University of British Columbia, Vancouver, Canada. · Bone Unit, University Hospital, Lausanne, Switzerland. · Scientific Office, Austrian Agency for Health and Food Safety, Vienna, Austria. · Unidade de Densitometria Óssea, Densimater Rede Materdei de Saúde, Belo Horizonte, MG, Brazil. · Department of Public Health, Epidemiology and Health Economics, University of Liege, Liege, Belgium. · Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. · Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK. Electronic address: w.j.pontefract@sheffield.ac.uk. ·Bone · Pubmed #25988660.

ABSTRACT: Trabecular bone score (TBS) is a recently-developed analytical tool that performs novel grey-level texture measurements on lumbar spine dual X-ray absorptiometry (DXA) images, and thereby captures information relating to trabecular microarchitecture. In order for TBS to usefully add to bone mineral density (BMD) and clinical risk factors in osteoporosis risk stratification, it must be independently associated with fracture risk, readily obtainable, and ideally, present a risk which is amenable to osteoporosis treatment. This paper summarizes a review of the scientific literature performed by a Working Group of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis. Low TBS is consistently associated with an increase in both prevalent and incident fractures that is partly independent of both clinical risk factors and areal BMD (aBMD) at the lumbar spine and proximal femur. More recently, TBS has been shown to have predictive value for fracture independent of fracture probabilities using the FRAX® algorithm. Although TBS changes with osteoporosis treatment, the magnitude is less than that of aBMD of the spine, and it is not clear how change in TBS relates to fracture risk reduction. TBS may also have a role in the assessment of fracture risk in some causes of secondary osteoporosis (e.g., diabetes, hyperparathyroidism and glucocorticoid-induced osteoporosis). In conclusion, there is a role for TBS in fracture risk assessment in combination with both aBMD and FRAX.

16 Review Hip Protectors: Are They Worth it? 2015

Cianferotti, Luisella / Fossi, Caterina / Brandi, Maria Luisa. ·Department of Surgery and Translational Medicine, Section of Endocrinology, Unit of Bone and Mineral Metabolism, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy, luisella.cianferotti@unifi.it. ·Calcif Tissue Int · Pubmed #25926045.

ABSTRACT: Hip fractures are one of the most serious conditions in frail elderly subjects, greatly increasing morbidity and mortality, and decreasing healthy life years. Since their first introduction on the market, hip protectors have been revealed to be a potential preventive measure for hip fractures, in addition to other well-known recognized medical interventions and rehabilitation procedures. However, randomized controlled trials have given contradictory results regarding their efficacy. Moreover, little data are available on the cost effectiveness of hip protectors. Adherence is a major problem in assessing the effectiveness of hip protectors in preventing fractures. Indeed, there is a lack of general consensus on a standard definition and quantitative objective estimation of adherence to hip protectors, along with still scarce evidence on specific interventions on how to ameliorate it. From what is known so far, it seems reasonable to advise the use of hip protectors in aged care facilities, since recent pooled analyses have suggested their efficacy in this setting. The introduction of sensors combined with hip protectors will probably address this issue, both for monitoring and optimizing compliance, especially in elderly people. In the meantime, new, well-designed studies following specific guidelines are strongly encouraged and needed. In particular, studies in community-dwelling elderly individuals at high risk of first or further fragility fractures are required. The optimization of the tested devices in a preclinical setting according to international standard biomechanical testing is necessary.

17 Review The position of strontium ranelate in today's management of osteoporosis. 2015

Reginster, J-Y / Brandi, M-L / Cannata-Andía, J / Cooper, C / Cortet, B / Feron, J-M / Genant, H / Palacios, S / Ringe, J D / Rizzoli, R. ·Department of Public Health, Epidemiology and Health Economics, University of Liège, 4020, Liège, Belgium. jyreginster@ulg.ac.be. · Metabolic Bone Unit, Department of Internal Medicine, University of Florence, Florence, Italy. · Servicio de Metabolismo Óseo y Mineral, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Asturias, Spain. · MRC Lifecourse Epidemiology Unit and NIHR Nutrition Biomedical Research Centre, University of Southampton, Southampton, UK. · Service de Rhumatologie, Hôpital Roger Salengro, Lille, France. · Service de Chirurgie Orthopédique et Traumatologique, Hôpital Saint Antoine, UPMC, Paris, France. · Departments of Radiology, Medicine, Epidemiology and Orthopedic Surgery, University of California, San Francisco, CA, USA. · Instituto Palacios, Salud y Medicina de la Mujer, Madrid, Spain. · Med Klinik 4, Klinikum Leverkusen, Akadem, Lehrkrankenhaus, University of Cologne, Cologne, Germany. · Division of Bone Diseases, Faculty of Medicine, Geneva University Hospital, Geneva, Switzerland. ·Osteoporos Int · Pubmed #25868510.

ABSTRACT: Osteoporosis accounts for about 3 % of total European health-care spending. The low proportion of costs for the pharmacological prevention of osteoporotic fracture means that it is highly cost saving, especially in patient with severe osteoporosis or patients who cannot take certain osteoporosis medications due to issues of contraindications or tolerability. Following recent regulatory changes, strontium ranelate is now indicated in patients with severe osteoporosis for whom treatment with other osteoporosis treatments is not possible, and without contraindications including uncontrolled hypertension, established, current or past history of ischaemic heart disease, peripheral arterial disease, and/or cerebrovascular disease. We review here today's evidence for the safety and efficacy of strontium ranelate. The efficacy of strontium ranelate in patients complying with the new prescribing information (i.e. severe osteoporosis without contraindications) has been explored in a multivariate analysis of clinical trial data, which concluded that the antifracture efficacy of strontium ranelate is maintained in patients with severe osteoporosis without contraindications and also demonstrated how the new target population mitigates risk. Strontium ranelate is therefore an important alternative in today's management of osteoporosis, with a positive benefit-risk balance, provided that the revised indication and contraindications are followed and cardiovascular risk is monitored. The bone community should be reassured that there remain viable alternatives in patients in whom treatment with other agents is not possible and protection against the debilitating effects of fracture is still feasible in patients with severe osteoporosis.

18 Review Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus. 2015

Khan, Aliya A / Morrison, Archie / Hanley, David A / Felsenberg, Dieter / McCauley, Laurie K / O'Ryan, Felice / Reid, Ian R / Ruggiero, Salvatore L / Taguchi, Akira / Tetradis, Sotirios / Watts, Nelson B / Brandi, Maria Luisa / Peters, Edmund / Guise, Teresa / Eastell, Richard / Cheung, Angela M / Morin, Suzanne N / Masri, Basel / Cooper, Cyrus / Morgan, Sarah L / Obermayer-Pietsch, Barbara / Langdahl, Bente L / Al Dabagh, Rana / Davison, K Shawn / Kendler, David L / Sándor, George K / Josse, Robert G / Bhandari, Mohit / El Rabbany, Mohamed / Pierroz, Dominique D / Sulimani, Riad / Saunders, Deborah P / Brown, Jacques P / Compston, Juliet / Anonymous1361055. · ·J Bone Miner Res · Pubmed #25414052.

ABSTRACT: This work provides a systematic review of the literature from January 2003 to April 2014 pertaining to the incidence, pathophysiology, diagnosis, and treatment of osteonecrosis of the jaw (ONJ), and offers recommendations for its management based on multidisciplinary international consensus. ONJ is associated with oncology-dose parenteral antiresorptive therapy of bisphosphonates (BP) and denosumab (Dmab). The incidence of ONJ is greatest in the oncology patient population (1% to 15%), where high doses of these medications are used at frequent intervals. In the osteoporosis patient population, the incidence of ONJ is estimated at 0.001% to 0.01%, marginally higher than the incidence in the general population (<0.001%). New insights into the pathophysiology of ONJ include antiresorptive effects of BPs and Dmab, effects of BPs on gamma delta T-cells and on monocyte and macrophage function, as well as the role of local bacterial infection, inflammation, and necrosis. Advances in imaging include the use of cone beam computerized tomography assessing cortical and cancellous architecture with lower radiation exposure, magnetic resonance imaging, bone scanning, and positron emission tomography, although plain films often suffice. Other risk factors for ONJ include glucocorticoid use, maxillary or mandibular bone surgery, poor oral hygiene, chronic inflammation, diabetes mellitus, ill-fitting dentures, as well as other drugs, including antiangiogenic agents. Prevention strategies for ONJ include elimination or stabilization of oral disease prior to initiation of antiresorptive agents, as well as maintenance of good oral hygiene. In those patients at high risk for the development of ONJ, including cancer patients receiving high-dose BP or Dmab therapy, consideration should be given to withholding antiresorptive therapy following extensive oral surgery until the surgical site heals with mature mucosal coverage. Management of ONJ is based on the stage of the disease, size of the lesions, and the presence of contributing drug therapy and comorbidity. Conservative therapy includes topical antibiotic oral rinses and systemic antibiotic therapy. Localized surgical debridement is indicated in advanced nonresponsive disease and has been successful. Early data have suggested enhanced osseous wound healing with teriparatide in those without contraindications for its use. Experimental therapy includes bone marrow stem cell intralesional transplantation, low-level laser therapy, local platelet-derived growth factor application, hyperbaric oxygen, and tissue grafting.

19 Review Pharmacogenetics of osteoporosis. 2014

Marini, Francesca / Brandi, Maria Luisa. ·Metabolic Bone Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy. Electronic address: f.marini@dmi.unifi.it. · Metabolic Bone Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy. Electronic address: marialuisa.brandi@unifi.it. ·Best Pract Res Clin Endocrinol Metab · Pubmed #25432352.

ABSTRACT: The challenge of personalized medicine is to move away from the traditional 'one-size-fits-all' pharmacology to genotype-based individualized therapies. As an individual's response to drugs is under the control of genes, personal genetic profiles could help clinicians to predict individual drug response and prescribe the right drug and dose, thereby optimising efficacy and avoiding risk of adverse effects. Currently, the concrete application of pharmacogenetics into clinical practice is limited to a few drugs, and the genetic prediction of drug response is far from clear for many of thve principal complex disorders. This is even more evident in the field of osteoporosis and metabolic bone disorders, for which few pharmacogenetic studies have been conducted, and no conclusive results are available. In this chapter, we review recent research on pharmacogenetics of osteoporosis, evaluate criticisms, and offer possible suggestions for improvements in this field and for possible future applications into clinical practice.

20 Review Management of osteoporosis of the oldest old. 2014

Rizzoli, R / Branco, J / Brandi, M-L / Boonen, S / Bruyère, O / Cacoub, P / Cooper, C / Diez-Perez, A / Duder, J / Fielding, R A / Harvey, N C / Hiligsmann, M / Kanis, J A / Petermans, J / Ringe, J D / Tsouderos, Y / Weinman, J / Reginster, J-Y. ·Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland, Rene.Rizzoli@unige.ch. ·Osteoporos Int · Pubmed #25023900.

ABSTRACT: INTRODUCTION: This consensus article reviews the therapeutic strategies and management options for the treatment of osteoporosis of the oldest old. This vulnerable segment (persons over 80 years of age) stands to gain substantially from effective anti-osteoporosis treatment, but the under-prescription of these treatments is frequent. METHODS: This report is the result of an ESCEO (European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis) expert working group, which explores some of the reasons for this and presents the arguments to counter these beliefs. The risk assessment of older individuals is briefly reviewed along with the differences between some intervention guidelines. The current evidence on the impact of nutritional deficiencies (i.e. calcium, protein and vitamin D) is presented, as are strategies to prevent falls. One possible reason for the under-prescription of pharmacological treatments for osteoporosis in the oldest old is the perception that anti-fracture efficacy requires long-term treatment. However, a review of the data shows convincing anti-fracture efficacy already by 12 months. RESULTS: The safety profiles of these pharmacological agents are generally satisfactory in this patient segment provided a few precautions are followed. CONCLUSION: These patients should be considered for particular consultation/follow-up procedures in the effort to convince on the benefits of treatment and to allay fears of adverse drug reactions, since poor adherence is a major problem for the success of a strategy for osteoporosis and limits cost-effectiveness.

21 Review The ever-expanding conundrum of primary osteoporosis: aetiopathogenesis, diagnosis, and treatment. 2014

Stagi, Stefano / Cavalli, Loredana / Seminara, Salvatore / de Martino, Maurizio / Brandi, Maria Luisa. ·Health Sciences Department, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy. stefano.stagi@yahoo.it. ·Ital J Pediatr · Pubmed #24906390.

ABSTRACT: In recent years, as knowledge regarding the etiopathogenetic mechanisms of bone involvement characterizing many diseases has increased and diagnostic techniques evaluating bone health have progressively improved, the problem of low bone mass/quality in children and adolescents has attracted more and more attention, and the body evidence that there are groups of children who may be at risk of osteoporosis has grown. This interest is linked to an increased understanding that a higher peak bone mass (PBM) may be one of the most important determinants affecting the age of onset of osteoporosis in adulthood. This review provides an updated picture of bone pathophysiology and characteristics in children and adolescents with paediatric osteoporosis, taking into account the major causes of primary osteoporosis (PO) and evaluating the major aspects of bone densitometry in these patients. Finally, some options for the treatment of PO will be briefly discussed.

22 Review Cancer-associated bone disease. 2013

Rizzoli, R / Body, J-J / Brandi, M-L / Cannata-Andia, J / Chappard, D / El Maghraoui, A / Glüer, C C / Kendler, D / Napoli, N / Papaioannou, A / Pierroz, D D / Rahme, M / Van Poznak, C H / de Villiers, T J / El Hajj Fuleihan, G / Anonymous920773. ·Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland, Rene.Rizzoli@unige.ch. ·Osteoporos Int · Pubmed #24146095.

ABSTRACT: Bone is commonly affected in cancer. Cancer-induced bone disease results from the primary disease, or from therapies against the primary condition, causing bone fragility. Bone-modifying agents, such as bisphosphonates and denosumab, are efficacious in preventing and delaying cancer-related bone disease. With evidence-based care pathways, guidelines assist physicians in clinical decision-making. Of the 57 million deaths in 2008 worldwide, almost two thirds were due to non-communicable diseases, led by cardiovascular diseases and cancers. Bone is a commonly affected organ in cancer, and although the incidence of metastatic bone disease is not well defined, it is estimated that around half of patients who die from cancer in the USA each year have bone involvement. Furthermore, cancer-induced bone disease can result from the primary disease itself, either due to circulating bone resorbing substances or metastatic bone disease, such as commonly occurs with breast, lung and prostate cancer, or from therapies administered to treat the primary condition thus causing bone loss and fractures. Treatment-induced osteoporosis may occur in the setting of glucocorticoid therapy or oestrogen deprivation therapy, chemotherapy-induced ovarian failure and androgen deprivation therapy. Tumour skeletal-related events include pathologic fractures, spinal cord compression, surgery and radiotherapy to bone and may or may not include hypercalcaemia of malignancy while skeletal complication refers to pain and other symptoms. Some evidence demonstrates the efficacy of various interventions including bone-modifying agents, such as bisphosphonates and denosumab, in preventing or delaying cancer-related bone disease. The latter includes treatment of patients with metastatic skeletal lesions in general, adjuvant treatment of breast and prostate cancer in particular, and the prevention of cancer-associated bone disease. This has led to the development of guidelines by several societies and working groups to assist physicians in clinical decision making, providing them with evidence-based care pathways to prevent skeletal-related events and bone loss. The goal of this paper is to put forth an IOF position paper addressing bone diseases and cancer and summarizing the position papers of other organizations.

23 Review Calcidiol [25(OH)D3]: from diagnostic marker to therapeutical agent. 2013

Brandi, Maria Luisa / Minisola, Salvatore. ·Department of Surgery and Translational Medicine, University of Florence , Italy. ·Curr Med Res Opin · Pubmed #24020910.

ABSTRACT: OBJECTIVE: Osteoporosis is a skeletal disorder characterized by diminished bone strength, which results in an increased risk of fracture. Currently, osteoporosis is a public health priority due to the large number of individuals affected and the detrimental effect on quality of life. Primary osteoporosis, the most common form, usually results from age-related reduction in bone mineral strength. Over time, the individual's capacity to build bone is impaired, as the synthesis of vitamin D, the hormone responsible for calcium absorption, tends to decline. As serum calcium levels decrease, metabolic control serves to increase the removal of calcium from the skeleton to make up for the deficit. The synthesis of the 'hormone' vitamin D and its control therefore become central to intervention in involutional osteoporosis syndromes. In humans, plain vitamin D (cholecalciferol), also called parental or native vitamin D, is photosynthesized in the skin and then hydroxylated in the liver into the vitamin D analog calcidiol [25(OH)D3], which is hydroxylated again in the kidney into the vitamin D analog calcitriol [1,25(OH)2D3]. The advantage of administering vitamin D analogs is that the pro-drug calcidiol avoids the effect of declines in hepatic function, while calcitriol avoids the effect of declines in hepatic and kidney function. A strategy to enhance [25(OH)D3] levels to the optimal threshold of vitamin D is supplementation with the calcidiol metabolite itself. The goal of this paper is to review published studies on the efficacy of the calcidiol metabolite in increasing 25(OH)D3 serum levels and improving skeletal health parameters in humans. METHODS: A library search of published papers in the area of use of calcidiol in humans from 1967 to 2013 was performed (key words: calcidiol, 25-hydroxy-vitamin D3, vitamin D supplementation, vitamin D metabolism, osteomalacia). RESULTS AND CONCLUSION: The results of the survey made it possible to conclude that calcidiol is characterized by a number of features that make the compound ideal in conditions that require supplementation with a 25-hydroxylated metabolite.

24 Review The future of pharmacogenetics for osteoporosis. 2013

Marini, Francesca / Brandi, Maria Luisa. ·Metabolic Bone Unit, Department of Surgery & Translation Medicine, University of Florence, Florence, Italy. f.marini@dmi.unifi.it ·Pharmacogenomics · Pubmed #23570468.

ABSTRACT: The possibility to predict the outcome of medical treatments, both in terms of efficacy and development of adverse effects, is the main goal of modern personalized medicine. The principal aim of pharmacogenetics is to design specific predictive genetic tests, to be performed prior to any drug treatment, and to tailor the therapy for each patient based on the results of these tests. Few pharmacogenetic tests are today validated and commonly applied in clinical practice, and none in the area of osteoporosis and bone disorders. Surely, the complex regulation of bone metabolism and the involvement of numerous different molecular pathways makes it difficult to individuate responsible genes and polymorphisms involved in the modulation of anti-osteoporotic drug response and, subsequently, in designing specific predictive analyses.

25 Review Treatment of osteoporosis in men. 2013

Kaufman, J-M / Reginster, J-Y / Boonen, S / Brandi, M L / Cooper, C / Dere, W / Devogelaer, J-P / Diez-Perez, A / Kanis, J A / McCloskey, E / Mitlak, B / Orwoll, E / Ringe, J D / Weryha, G / Rizzoli, R. ·Department of Endocrinology and Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, De pintelaan 185, B9000 Gent, Belgium. Jean.Kaufman@ugent.be ·Bone · Pubmed #23201268.

ABSTRACT: SUMMARY: Aspects of osteoporosis in men, such as screening and identification strategies, definitions of diagnosis and intervention thresholds, and treatment options (both approved and in the pipeline) are discussed. INTRODUCTION: Awareness of osteoporosis in men is improving, although it remains under-diagnosed and under-treated. A European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) workshop was convened to discuss osteoporosis in men and to provide a report by a panel of experts (the authors). METHODS: A debate with an expert panel on preselected topics was conducted. RESULTS AND CONCLUSIONS: Although additional fracture data are needed to endorse the clinical care of osteoporosis in men, consensus views were reached on diagnostic criteria and intervention thresholds. Empirical data in men display similarities with data acquired in women, despite pathophysiological differences, which may not be clinically relevant. Men should receive treatment at a similar 10-year fracture probability as in women. The design of mixed studies may reduce the lag between comparable treatments for osteoporosis in women becoming available in men.

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