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Osteoporosis: HELP
Articles by Marco Gambacciani
Based on 12 articles published since 2010
(Why 12 articles?)

Between 2010 and 2020, M. Gambacciani wrote the following 12 articles about Osteoporosis.
+ Citations + Abstracts
1 Guideline EMAS position statement: Bone densitometry screening for osteoporosis. 2011

Brincat, Mark / Calleja-Agius, Jean / Erel, C Tamer / Gambacciani, Marco / Lambrinoudaki, Irene / Moen, Mette H / Schenck-Gustafsson, Karin / Tremollieres, Florence / Vujovic, Svetlana / Rees, Margaret / Rozenberg, Serge / Anonymous5800679. ·Department of Obstetrics and Gynaecology, Mater Dei Hospital, BKR 2090 B’Kara, Malta. brincatm@maltanet.net ·Maturitas · Pubmed #21093180.

ABSTRACT: INTRODUCTION: Osteoporosis and its consequent fractures is a major public health problem. AIM: To formulate a position statement on the use of bone densitometry in screening postmenopausal women for osteoporosis and in their management. MATERIALS AND METHODS: Literature review and consensus of expert opinion. RESULTS AND CONCLUSIONS: Bone densitometry has an important role in screening postmenopausal women for osteoporosis. For higher sensitivity and specificity, there may be a stronger case for screening in later life, depending on the extent to which risk factors add to the value of bone mineral density tests.

2 Review Hormone replacement therapy and prevention of chronic conditions. 2019

Gambacciani, M / Cagnacci, A / Lello, S. ·a Department of Obstetrics and Gynecology , University Hospital of Pisa , Pisa , Italy. · b Department of Obstetrics and Gynecology , Universita degli Studi di Udine , Udine , Italy. · c Department of Obstetrics and Gynecology , Policlinico Gemelli , Rome , Italy. ·Climacteric · Pubmed #30626218.

ABSTRACT: Nowadays, postmenopausal women are largely undertreated. Analysis of conflicting results among different studies suggests that hormone replacement therapy (HRT) can prevent osteoporosis and cardiovascular disease in symptomatic, early postmenopausal women. In fact, climacteric symptoms are related to an increased risk of chronic conditions, including hypertension and cardiovascular disease. Different scientific societies have pointed out that patient selection, timing of initiation, and the choice of the type and dose of HRT used are the major determinants of the ultimate effect of HRT on women's health and quality of life in selected women. HRT may prevent chronic conditions when started in symptomatic women before the age of 60 years or within 10 years of the onset of the menopause, taking into consideration the characteristics and risk profiles of each given woman. The bulk of scientific evidence from preclinical, clinical, epidemiological, and also randomized studies indicates that wisely selected HRT is generally useful and rarely dangerous. Following simple and well-established rules, HRT benefits outweigh all of the possible risks. Progestogen choice can make the difference in terms of cardiovascular disease benefits.

3 Review Vasomotor symptoms in menopause: a biomarker of cardiovascular disease risk and other chronic diseases? 2017

Biglia, N / Cagnacci, A / Gambacciani, M / Lello, S / Maffei, S / Nappi, R E. ·a Department of Obstetrics and Gynecology , University of Torino School of Medicine, Ospedale Mauriziano Umberto I , Torino , Italy. · b Department of Obstetrics, Gynecology and Pediatrics, Gynecology and Obstetrics Unit , Azienda Policlinico of Modena , Modena , Italy. · c Department of Obstetrics and Gynecology , Pisa University Hospital , Pisa , Italy. · d Department of Woman and Child Health , Policlinico Gemelli Foundation , Rome , Italy. · e Cardiovascular Gynecological Endocrinology Unit, Cardiovascular Endocrinology and Metabolism Department , Italian National Research Council - Regione Toscana "G. Monasterio Foundation" , Pisa , Italy. · f Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences , University of Pavia , Pavia , Italy. ·Climacteric · Pubmed #28453310.

ABSTRACT: Menopausal disorders may include shorter-term symptoms, such as hot flushes and night sweats (vasomotor symptoms, VMS) and longer-term chronic conditions such as cardiovascular disease (CVD), osteoporosis, and cognitive impairment. Initially, no clear link between the shorter-term symptoms and longer-term chronic conditions was evident and these disorders seemed to occur independently from each other. However, there is a growing body of evidence demonstrating that VMS may be a biomarker for chronic disease. In this review, the association between VMS and a range of chronic postmenopausal conditions including CVD, osteoporosis, and cognitive decline is discussed. Prevention of CVD in women, as for men, should be started early, and effective management of chronic disease in postmenopausal women has to start with the awareness that VMS during menopause are harbingers of things to come and should be treated accordingly.

4 Review EMAS clinical guide: selective estrogen receptor modulators for postmenopausal osteoporosis. 2012

Palacios, Santiago / Brincat, Mark / Erel, C Tamer / Gambacciani, Marco / Lambrinoudaki, Irene / Moen, Mette H / Schenck-Gustafsson, Karin / Tremollieres, Florence / Vujovic, Svetlana / Rees, Margaret / Rozenberg, Serge. ·Palacios Institute of Woman's Health Antonio Acuna, Madrid, Spain. ipalacios@institutopalacios.com ·Maturitas · Pubmed #22176952.

ABSTRACT: Osteoporosis and the resulting fractures are major public health issues as the world population is ageing. Various therapies such as bisphosphonates, strontium ranelate and more recently denosumab are available. This clinical guide provides the evidence for the clinical use of selective estrogen modulators (SERMs) in the management of osteoporosis in postmenopausal women.

5 Review HRT misuse and the osteoporosis epidemic. 2012

Gambacciani, M. ·Department of Obstetrics and Gynecology, Pisa University Hospital, Pisa, Italy. ·Climacteric · Pubmed #22132704.

ABSTRACT: A new study by Karim and colleagues has highlighted the intriguing issue of the consequences of cessation of long-term postmenopausal hormone use. While potential reductions in breast cancer risk and in the incidence of newly diagnosed breast cancer in the era after the Women's Health Initiative study have been heavily debated, the implications of withdrawal from hormone therapy for bone health and fracture risk have remained outside the main scope. This new study has now demonstrated that there is a very clear downside in skeletal outcome that should be considered while evaluating the pros and cons of discontinuing hormone therapy. During 532 686 person-years of observation and a follow-up period of 6.5 years, a 55% increased risk for hip fracture was observed in women who stopped hormone therapy. In view of the dramatic decline in the number of hormone users all around the world, this mini-review discusses the 'neglected' skeletal outcomes of such global trends.

6 Article Effects of ospemifene on bone in postmenopausal women. 2019

de Villiers, T J / Altomare, C / Particco, M / Gambacciani, M. ·Department of Gynecology, Faculty of Health Sciences, Stellenbosch University , Stellenbosch , South Africa. · Shionogi , Florham Park , NJ , USA. · Shionogi Europe , London , UK. · Department of Obstetrics and Gynecology, Santa Chiara University Hospital , Pisa , Italy. ·Climacteric · Pubmed #31294631.

ABSTRACT: Ospemifene is a selective estrogen-receptor modulator approved for treating menopause-related moderate to severe dyspareunia and vaginal dryness, symptoms of vulvovaginal atrophy (VVA), in the United States, and for treating menopause-related, symptomatic VVA in women not appropriate for local estrogen therapy in Europe. This review summarizes the effects of ospemifene on bone, including bone biomarker data from a phase 3 vaginal dryness study. Early-phase studies of postmenopausal women showed that ospemifene dose-dependently decreased bone turnover markers versus placebo, similar to raloxifene. A 12-week, phase 3 study of ospemifene 60 mg/day in postmenopausal women showed improvements in all VVA parameters and significantly greater decreases in seven of nine bone biomarkers versus placebo. Lower bone resorption markers with ospemifene were observed regardless of time since menopause (≤5 years or >5 years) or baseline bone mineral density (BMD) (normal [

7 Article Hormone replacement therapy and the prevention of postmenopausal osteoporosis. 2014

Gambacciani, Marco / Levancini, Marco. ·Department of Obstetrics and Gynecology, Pisa University Hospital, Italy. · Department of Obstetrics and Gynecology, Pisa University Hospital, Italy ; Department of Obstetrics and Gynecology, Clinica Alemana, Univesidad Del Desarrollo, Santiago, Chile. ·Prz Menopauzalny · Pubmed #26327857.

ABSTRACT: Fracture prevention is one of the public health priorities worldwide. Estrogen deficiency is the major factor in the pathogenesis of postmenopausal osteoporosis, the most common metabolic bone disease. Different effective treatments for osteoporosis are available. Hormone replacement therapy (HRT) at different doses rapidly normalizes turnover, preserves bone mineral density (BMD) at all skeletal sites, leading to a significant, reduction in vertebral and non-vertebral fractures. Tibolone, a selective tissue estrogenic activity regulator (STEAR), is effective in the treatment of vasomotor symptoms, vaginal atrophy and prevention/treatment of osteoporosis with a clinical efficacy similar to that of conventional HRT. Selective estrogen receptor modulators (SERMs) such as raloxifene and bazedoxifene reduce turnover and maintain or increase vertebral and femoral BMD and reduce the risk of osteoporotic fractures. The combination of bazedoxifene and conjugated estrogens, defined as tissue selective estrogen complex (TSEC), is able to reduce climacteric symptoms, reduce bone turnover and preserve BMD. In conclusion, osteoporosis prevention can actually be considered as a major additional benefit in climacteric women who use HRT for treatment of climacteric symptoms. The use of a standard dose of HRT for osteoporosis prevention is based on biology, epidemiology, animal and preclinical data, observational studies and randomized, clinical trials. The antifracture effect of a lower dose HRT or TSEC is supported by the data on BMD and turnover, with compelling scientific evidence.

8 Article Management of postmenopausal osteoporosis and the prevention of fractures. 2014

Gambacciani, M / Levancini, M. ·Department of Obstetrics and Gynecology, Pisa University Hospital, Pisa, Italy - margamba@tin.it. ·Panminerva Med · Pubmed #24942322.

ABSTRACT: Postmenopausal osteoporosis affects millions of women, being estrogen deficiency the key factor in the pathogenesis of involutional osteoporosis. Fracture prevention is one of the public health priorities worldwide. Different treatments for osteoporosis are available. The various options are aimed to maintain bone health and decrease the risk of fractures. The majority of these drugs are antiresorptive agents, i.e., drugs that lower bone turnover, inhibiting osteoclastic bone resorption. Dietary sources of calcium intake and vitamin D are ideal, while pharmachological supplements should be used if diet alone cannot provide the recommended daily intake. Bisphosphonates are first-line therapy for patients with established osteoporosis at high risk of fracture. Some serious, but rare, adverse events have been associated with their long-term administration. The monoclonal antibody to RANKL, named denosumab, administered as a 60-mg subcutaneous injection every 6 months, is a valuable option for the treatment of postmenopausal osteoporosis in women at increased or high risk of fractures, who are unable to take other osteoporosis treatments. Teriparatide (PTH 1-34) is the only available osteoanabolic drugs for osteoporosis treatment at present. Its use is limited to severe osteoporosis because of the high cost of the treatment. In climacteric women, in different stages of menopausal transition, and beyond, hormone replacement therapy at different doses (HRT) rapidly normalizes turnover, preventing and/or treating osteoporosis. HRT is able to preserve and even increase BMD at all skeletal sites, leading to a significant reduction in vertebral and non-vertebral fractures. Selective estrogen modulators (SERMs) as raloxifene and bazedoxifene reduce bone turnover and maintains or increases vertebral and femoral BMDs in comparison to placebo and reduces the risk of vertebral and new vertebral fractures, in high risk women. The combination of a SERM with an estrogen has been defined as tissue selective estrogen complex (TSEC). The bazedoxifene with conjugated estrogen is able to reduce climacteric symptoms, reducing bone turnover and preserving BMD. Studies investigating the actions of phytoestrogens on BMD or bone turnover are largely contradictory, making them inconclusive. At the present time, phytoestrogens cannot be recommended for postmenopausal osteoporosis. In conclusion, the use of HRT for osteoporosis prevention is based on biology, epidemiology, animal and preclinical data, observational studies and randomized, clinical trials. Osteoporosis prevention can actually be considered as a major additional effect in climacteric women who use HRT for treatment of climacteric symptoms. Bone protection is one of the major benefits of HRT. The possibility that low dose HRT or TSEC causes a decrease in fracture risk is not demonstrated but the scientific evidence is compelling. Conversely, established osteoporosis, often occurring in elderly women, can better be treated with specific treatments, such as bisphosphonates or, in more severe and selected cases, anabolic agents (teriparatide).

9 Article Selective estrogen modulators in menopause. 2013

Gambacciani, M. ·Department of Obstetrics and Gynecology Pisa University Hospital, Pisa, Italy - margamba@tin.it. ·Minerva Ginecol · Pubmed #24346250.

ABSTRACT: Hypoestrogenism is the primary etiologic factor for osteoporosis and related fractures, as well as for a number of clinical symptoms that can reduce the quality of life in postmenopausal women. Alternative to classical hormone replacement therapy (HRT) are needed for women that cannot or don't want to be treated with hormones. Selective estrogen receptor modulators (SERMs) are compounds that lack the steroid structure of estrogens, but interact with estrogen receptors (ERs) as agonists or antagonists depending on the target tissue. Tamoxifen, the first generation of SERMs, has been used for decades in the primary prevention and treatment of breast cancer. Tamoxifen exerts positive estrogenic effect on bone protecting bone mineral density (BMD). However, tamoxifen acts as agonist also on the endometrium, leading to an increased risk of endometrial hyperplasia and cancer. In addition, tamoxifen administration is associated with significantly increased risks of stroke, venous thromboembolism, including both deep-vein thrombosis and pulmonary emboli. Thus, these actions, in addition to the increased risk of and hot flushes, prevent the use of tamoxifen for the prevention of osteoporosis. Further generations of SERM, Raloxifene and bazedoxifene were developed for the prevention and treatment of postmenopausal osteoporosis and are now licensed for this indication. In addition. Raloxifene is as effective as tamoxifen in reducing the risk of invasive breast cancer. On the other hand, the available data indicate that Bazedoxifene exerts a greater anti-fracture activity than Raloxifene. At variance of tamoxifen, both raloxifene and bazedoxifene reduce the risk of endometrial hyperplasia and cancer. However, they are associated with a significant increase the risks of venous thromboembolic events. Although raloxifene and Bazedoxifene prevent postmenopausal osteoporosis, they have not been associated with reductions in climacteric symptoms, particularly hot flushes. In order to find a new approach for menopausal management, SERMs have been combined with estrogens, creating a tissue selective estrogen complex (TSEC) to achieve a favorable clinical profile based on the blended tissue selective activity profiles of the components. Bazedoxifene in association with conjugated estrogens (BZA/CE) is the first TSEC evaluated in an extensive clinical program. BZA/CE administration decreases bone turnover, with an increase in lumbar spine and total hip BMD. The magnitude of these effects are similar to those exerted by HRT and greater than that observed with Raloxifene and Bazedoxifene alone. In addition, BZA/CE significantly reduced the severity and frequency of hot flushes and improved measures of vaginal atrophy and quality-of-life scores, including that for sleep likewise HRT. BZA/CE administration prevents endometrial proliferation, with high rates of amenorrhea over one year. Taken together, all the available data indicate that BZA/CE combination is effective and safe for the treatment for climacteric women, improving the overall quality of life, while protecting the skeleton. The high amenorrhea rate may increase compliance, avoiding the bleedings and side effects related to progestin administration. Further studies are needed to evaluate the ultimate effects of BZA/CE combination on clinical outcomes, such as CVD events, breast and endometrial cancer.

10 Article Updated 2013 International Menopause Society recommendations on menopausal hormone therapy and preventive strategies for midlife health. 2013

de Villiers, T J / Pines, A / Panay, N / Gambacciani, M / Archer, D F / Baber, R J / Davis, S R / Gompel, A A / Henderson, V W / Langer, R / Lobo, R A / Plu-Bureau, G / Sturdee, D W / Anonymous2630758. ·MediClinic Panorama and Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa. ·Climacteric · Pubmed #23672656.

ABSTRACT: -- No abstract --

11 Article Recommendations on the management of fragility fracture risk in women younger than 70 years. 2012

Palacios, Santiago / Christiansen, Claus / Sánchez Borrego, Rafael / Gambacciani, Marco / Hadji, Payman / Karsdal, Morten / Lambrinoudaki, Irene / Lello, Stefano / O'Beirne, Barbara / Romao, Fatima / Rozenberg, Serge / Stevenson, John C / Ben-Rafael, Zion. ·Instituto Palacios, Salud y Medicina de la Mujer, C/ Antonio Acuña, Madrid, Spain. ·Gynecol Endocrinol · Pubmed #22558997.

ABSTRACT: The risk for fragility fracture represents a problem of enormous magnitude. It is estimated that only a small fraction of women with this risk take the benefit of preventive measures. The relationship between estrogen and bone mass is well known as they are the other factors related to the risk for fracture. There are precise diagnostic methods, including a tool to diagnose the risk for fracture. Yet there continues to be an under-diagnosis, with the unrecoverable delay in instituting preventive measures. Women under the age of 70 years, being much more numerous than those older, and having risk factors, are a group in which it is essential to avoid that first fragility fracture. Today it is usual not to differentiate between the treatment and the prevention of osteoporosis since the common aim is to prevent fragility fractures. Included in this are women with osteoporosis or with low bone mass and increased risk for fracture, for whom risk factors play a primary role. There is clearly controversy over the type of treatment and its duration, especially given the possible adverse effects of long-term use. This justifies the concept of sequential treatment, even more so in women under the age of 70, since they presumably will need treatment for many years. Bone metabolism is age-dependent. In postmenopausal women under 70 years of age, the increase in bone resorption is clearly predominant, related to a sharp drop in estrogens. Thus a logical treatment is the prevention of fragility fractures by hormone replacement therapy (HRT) and, in asymptomatic women, selective estradiol receptor modulators (SERMs). Afterwards, there is a period of greater resorption, albeit less intense but continuous, when one could utilise anti-resorptive treatments such as bisphosphonates or denosumab or a dual agent like strontium ranelate. Bone formation treatment, such as parathyroid hormone (PTH), in women under 70 years will be uncommon. That is because it should be used in cases where the formation is greatly diminished and there is a high risk for fracture, something found in much older women.

12 Article Updated IMS recommendations on postmenopausal hormone therapy and preventive strategies for midlife health. 2011

Sturdee, D W / Pines, A / Anonymous1990694 / Archer, D F / Baber, R J / Barlow, D / Birkhäuser, M H / Brincat, M / Cardozo, L / de Villiers, T J / Gambacciani, M / Gompel, A A / Henderson, V W / Kluft, C / Lobo, R A / MacLennan, A H / Marsden, J / Nappi, R E / Panay, N / Pickar, J H / Robinson, D / Simon, J / Sitruk-Ware, R L / Stevenson, J C. ·International Menopause Society, Wray, Lancaster, UK. ·Climacteric · Pubmed #21563996.

ABSTRACT: -- No abstract --