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Osteoporosis: HELP
Articles from Miscellaneous institutions in Madrid
Based on 98 articles published since 2010
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These are the 98 published articles about Osteoporosis that originated from Miscellaneous institutions in Madrid during 2010-2020.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4
1 Guideline Recommendations by the Spanish Society of Rheumatology on Osteoporosis. 2019

Naranjo Hernández, Antonio / Díaz Del Campo Fontecha, Petra / Aguado Acín, María Pilar / Arboleya Rodríguez, Luis / Casado Burgos, Enrique / Castañeda, Santos / Fiter Aresté, Jordi / Gifre, Laia / Gómez Vaquero, Carmen / Candelas Rodríguez, Gloria / Francisco Hernández, Félix Manuel / Guañabens Gay, Núria. ·Servicio de Reumatología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, España. Electronic address: anarher@gobiernodecanarias.org. · Unidad de Investigación, Sociedad Española de Reumatología, Madrid, España. · Servicio de Reumatología, Hospital Universitario La Paz, Madrid, España. · Sección de Reumatología, Hospital Universitario Central de Asturias, Oviedo, España. · Servicio de Reumatología, Hospital Universitari Parc Taulí (UAB), Sabadell, Barcelona, España. · Servicio de Reumatología, IIS Princesa, Madrid, España. · Servicio de Reumatología, Hospital Universitario Son Espases, Palma de Mallorca, España. · Servicio de Reumatología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España. · Servicio de Reumatología, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, España. · Servicio de Reumatología. Hospital Universitario Clínico San Carlos, Madrid, España; Grupo de Revisores de Evidencia de la SER, Madrid, España. · Servicio de Reumatología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, España; Grupo de Revisores de Evidencia de la SER, Madrid, España. · Servicio de Reumatología, Hospital Clínic, Barcelona, España. ·Reumatol Clin · Pubmed #30470636.

ABSTRACT: OBJECTIVE: To update the recommendations on osteoporosis (OP) of the Spanish Society of Rheumatology (SER) based on the best possible evidence. METHODS: A panel of nine expert rheumatologists in OP was created, previously selected by the SER through an open call. The phases of the work were: identification of the key areas for updating the previous consensus, analysis and synthesis of the scientific evidence (using the SIGN levels of evidence) and formulation of recommendations based on this evidence and consensus techniques. RESULTS: This revision of the recommendations implies an update in the diagnostic evaluation and treatment of OP. It proposes some criteria to consider the high risk of fracture and some indications to start treatment. The recommendations also address issues related to the safety of treatments and the management of special situations such as inflammatory diseases and treatment with glucocorticoids. CONCLUSIONS: We present an update of SER recommendations on OP.

2 Guideline None 2018

García-Franco, Alberto López / Baeyens Fernández, José Antonio / Bailón Muñoz, Emilia / Iglesias Piñeiro, M José / Cura González, Isabel Del / Del Moral, Amparo Ortega / Landa Goñi, Jacinta / Alonso Coello, Pablo / Arribas Mir, Lorenzo. ·Especialista en Medicina Familiar y Comunitaria, Centro de Salud Dr. Mendiguchía Carriche, Leganés, Madrid. · Especialista en Medicina Familiar y Comunitaria, Centro de Salud Universitario de Armilla, Armilla, Granada. · Especialista en Medicina Familiar y Comunitaria, Centro de Salud Universitario de Albaycín, Granada. · Especialista en Medicina Familiar y Comunitaria, Centro de Salud Vicente Soldevilla, Madrid. · Especialista en Medicina Familiar y Comunitaria, Unidad de Investigación, Gerencia Asistencial de Atención Primaria, Madrid. · Especialista en Medicina Familiar y Comunitaria, Centro de Salud Gran Capitán, Granada. · Especialista en Medicina Familiar y Comunitaria, Centro de Salud Emisora, Pozuelo de Alarcón, Madrid. · Especialista en Medicina Familiar y Comunitaria, Centro Cochrane Iberoamericano (CIBERESP-IIB Sant Pau), Barcelona. · Especialista en Medicina Familiar y Comunitaria, Centro de Salud Universitario La Chana, Granada. ·Aten Primaria · Pubmed #29866353.

ABSTRACT: -- No abstract --

3 Guideline Recommendations on the effect of antidiabetic drugs in bone. 2017

Rozas-Moreno, Pedro / Reyes-García, Rebeca / Jódar-Gimeno, Esteban / Varsavsky, Mariela / Luque-Fernández, Inés / Cortés-Berdonces, María / Muñoz-Torres, Manuel / Anonymous2550904. ·Sección de Endocrinología, Hospital General Universitario de Ciudad Real, Ciudad Real, España. Electronic address: pedrorozasm@yahoo.es. · Unidad de Endocrinología y Nutrición, Complejo Hospitalario Torrecárdenas; Servicio de Endocrinología, Clínica San Pedro, Almería, España. · Departamento de Endocrinología y Nutrición, Hospitales Universitarios Quirón Salud (Madrid Pozuelo, San Camilo, San José), Madrid, España. · Servicio de Endocrinología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. · Servicio de Endocrinología y Nutrición, Hospital Virgen de la Salud, Toledo, España. · Servicio de Endocrinología y Nutrición, Hospital Ruber Juan Bravo, Madrid, España. · UGC Endocrinología y Nutrición. Complejo Hospitalario Universitario de Granada. Departamento de Medicina. Universidad de Granada. Instituto de Investigación Biosanitaria de Granada, Granada, España. ·Endocrinol Diabetes Nutr · Pubmed #28440761.

ABSTRACT: OBJECTIVE: To provide recommendations on the effect of antidiabetic drugs on bone fragility to help select the most adequate antidiabetic treatment, especially in diabetic patients with high risk of fracture. PARTICIPANTS: Members of the Bone Metabolism Working Group of the Spanish Society of Endocrinology. METHODS: The GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation) was used to establish both the strength of recommendations and the quality of evidence. A systematic search was made in MEDLINE (Pubmed) using the following terms associated to the name of each antidiabetic drug: AND "osteoporosis", "fractures", "bone mineral density", "bone markers", "calciotropic hormones". Papers in English with publication date before 30 April 2016 were reviewed. Recommendations were jointly discussed by the Working Group. CONCLUSIONS: The document summaries the data on the potential effects of antidiabetic drugs on bone metabolism and fracture risk.

4 Guideline [Update of recommendations for evaluation and treatment of osteoporosis associated to endocrine and nutritional conditions. Working Group on Osteoporosis and Mineral Metabolism of the Spanish Society of Endocrinology]. 2015

Reyes-García, Rebeca / García-Martín, Antonia / Varsavsky, Mariela / Rozas-Moreno, Pedro / Cortés-Berdonces, María / Luque-Fernández, Inés / Gómez Sáez, José Manuel / Vidal Casariego, Alfonso / Romero Muñoz, Manuel / Guadalix Iglesias, Sonsoles / Fernández García, Diego / Jódar Gimeno, Esteban / Muñoz Torres, Manuel / Anonymous3690824. ·Unidad de Endocrinología, Hospital General Universitario Rafael Méndez, Lorca, Murcia, España; Unidad de Metabolismo Óseo, Servicio de Endocrinología, Hospital Universitario San Cecilio, Granada, España. Electronic address: rebecarg@yahoo.com. · Unidad de Metabolismo Óseo, Servicio de Endocrinología, Hospital Universitario San Cecilio, Granada, España; Unidad de Endocrinología, Hospital Comarcal del Noroeste, Caravaca de la Cruz, Murcia, España. · Servicio de Endocrinología, Hospital de Sant Pau i Santa Tecla, Tarragona, España. · Unidad de Metabolismo Óseo, Servicio de Endocrinología, Hospital Universitario San Cecilio, Granada, España; Servicio de Endocrinología, Hospital General de Ciudad Real, Ciudad Real, España. · Unidad de Endocrinología, Centro de Endocrinología, Diabetes y Nutrición, Madrid, España. · Servicio de Endocrinología, Hospital Virgen de la Salud de Toledo, Toledo, España. · Servicio de Endocrinología, Hospital Universitario de Bellvitge, Barcelona, España. · Sección de Endocrinología, Complejo Asistencial Universitario de León, León, España. · Unidad de Endocrinología, Hospital General Universitario Rafael Méndez, Lorca, Murcia, España. · Servicio de Endocrinología, Hospital Doce de Octubre, Madrid, España. · Servicio de Endocrinología, Hospital Universitario Virgen de la Victoria, Málaga, España. · Servicio de Endocrinología, Hospital Universitario Quiron, Madrid, España. · Unidad de Metabolismo Óseo, Servicio de Endocrinología, Hospital Universitario San Cecilio, Granada, España. ·Endocrinol Nutr · Pubmed #25797189.

ABSTRACT: OBJECTIVE: To update previous recommendations developed by the Working Group on Osteoporosis and Mineral Metabolism of the Spanish Society of Endocrinology and Nutrition for the evaluation and treatment of osteoporosis associated to different endocrine and nutritional diseases. PARTICIPANTS: Members of the Working Group on Osteoporosis and Mineral Metabolism of the Spanish Society of Endocrinology and Nutrition. METHODS: Recommendations were formulated according to the GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation) to describe both the strength of recommendations and the quality of evidence. A systematic search was made in MEDLINE (Pubmed) using the following terms associated to the name of each condition: AND "osteoporosis", "fractures", "bone mineral density", and "treatment". Papers in English with publication date between 18 October 2011 and 30 October 2014 were included. The recommendations were discussed and approved by all members of the Working Group. CONCLUSIONS: This update summarizes the new data regarding evaluation and treatment of osteoporosis associated to endocrine and nutritional conditions.

5 Guideline EMAS position statement: The ten point guide to the integral management of menopausal health. 2015

Neves-E-Castro, Manuel / Birkhauser, Martin / Samsioe, Goran / Lambrinoudaki, Irene / Palacios, Santiago / Borrego, Rafael Sanchez / Llaneza, Placido / Ceausu, Iuliana / Depypere, Herman / Erel, C Tamer / Pérez-López, Faustino R / Schenck-Gustafsson, Karin / van der Schouw, Yvonne T / Simoncini, Tommaso / Tremollieres, Florence / Rees, Margaret. ·Clinica da Menopausa, Av. Luis Bivar, 93c-1 Dt, Lisboa 1050-143, Portugal. · Gynaecological Endocrinology and Reproductive Medicine, University of Berne, Gartenstrasse 67, CH-4052 Basel, Switzerland. · Department of Clinical Sciences, SUS University Hospital Lund, Lund University, SE-221 85 Lund, Sweden. · Second Department of Obstetrics and Gynecology, National and Capodestrian University of Athens, Greece. · Instituto Palacios, Salud y Medicina de la Mujer, C/Antonio Acuña, 9, 28009 Madrid, Spain. · DIATROS, Clínica de Atención a la Mujer, Barcelona, Spain. · Department of Obstetrics and Gynecology, University Central Hospital of Asturias, University of Oviedo, 33011 Oviedo, Spain. · Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania; Department of Obstetrics and Gynecology, 'Dr. I. Cantacuzino' Hospital, Bucharest, Romania. · Breast Clinic and Menopause Clinic, University Hospital, De Pintelaan 185, 9000 Gent, Belgium. · Department of Obstetrics and Gynecology, Istanbul University, Cerrahpasa School of Medicine, Valikonagi Cad. No: 93/4, Nisantasi, 34365 Istanbul, Turkey. · Department of Obstetrics and Gynecology, Zaragoza University Facultad de Medicina, Hospital Clínico, Zaragoza 50009, Spain. · Department of Medicine, Cardiology Unit, Centre for Gender Medicine, Karolinska Institutet and Karolinska University Hospital, Thorax N3:05, SE 17176 Stockholm, Sweden. · Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. · Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100 Pisa, Italy. · Menopause and Metabolic Bone Disease Unit, Hôpital Paule de Viguier, F-31059 Toulouse cedex 09, France. · Women's Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK. Electronic address: margaret.rees@st-hildas.ox.ac.uk. ·Maturitas · Pubmed #25757366.

ABSTRACT: With increased longevity and more women becoming centenarians, management of the menopause and postreproductive health is of growing importance as it has the potential to help promote health over several decades. Women have individual needs and the approach needs to be personalised. The position statement provides a short integral guide for all those involved in menopausal health. It covers diagnosis, screening for diseases in later life, treatment and follow-up.

6 Guideline [Consensus statement: recommendations for the management of metabolic bone disease in human immunodeficiency virus patients]. 2014

Martínez, Esteban / Jódar Gimeno, Esteban / Reyes García, Rebeca / Carpintero, Pedro / Casado, José Luis / Del Pino Montes, Javier / Domingo Pedrol, Pere / Estrada, Vicente / Maalouf, Jorge / Negredo, Eugenia / Ocampo, Antonio / Muñoz-Torres, Manuel / Anonymous4940778 / Anonymous4950778 / Anonymous4960778 / Anonymous4970778. ·Unidad de Enfermedades Infecciosas, Hospital Clínic, Barcelona, España. · Servicio de Endocrinología, Hospital Universitario Quirón, Madrid, España. · Unidad de Endocrinología, Hospital General Universitario Rafael Méndez, Lorca, Murcia, España. Electronic address: rebecarg@yahoo.com. · Servicio de Traumatología, Hospital Universitario Reina Sofía, Córdoba, España. · Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Madrid, España. · Servicio de Reumatología, Hospital Universitario de Salamanca, Salamanca, España. · Servicio de Medicina Interna, Hospital de la Santa Creu i Sant Pau, Barcelona, España. · Medicina Interna/Enfermedades Infecciosas, Hospital Clínico San Carlos, Madrid, España. · Unidad de Metabolismo Mineral, Departamento de Medicina Interna, Hospital de la Santa Creu i Sant Pau, Barcelona, España. · Servicio de Medicina Interna, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, España. · Unidad VIH, Hospital Xeral-Cies, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Pontevedra, España. · Unidad de Metabolismo Óseo, Servicio de Endocrinología, Hospital Universitario San Cecilio, Granada, España. ·Enferm Infecc Microbiol Clin · Pubmed #24332711.

ABSTRACT: OBJECTIVE: To provide practical recommendations for the evaluation and treatment of metabolic bone disease in human immunodeficiency virus (HIV) patients. PARTICIPANTS: Members of scientific societies related to bone metabolism and HIV: Grupo de Estudio de Sida (GeSIDA), Sociedad Española de Endocrinología y Nutrición (SEEN), Sociedad Española de Investigación Ósea y del Metabolismo Mineral (SEIOMM), and Sociedad Española de Fractura Osteoporótica (SEFRAOS). METHODS: A systematic search was carried out in PubMed, and papers in English and Spanish with a publication date before 28 May 2013 were included. Recommendations were formulated according to GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation) setting both their strength and the quality of supporting evidence. Working groups were established for each major part, and the final resulting document was later discussed in a face-to-face meeting. All the authors reviewed the final written document and agreed with its content. CONCLUSIONS: The document provides evidence-based practical recommendations on the detection and treatment of bone disease in HIV-infected patients.

7 Editorial [Osteoporosis: How, when and how far]. 2016

López García-Franco, Alberto. ·Medicina Familiar y Comunitaria, Centro de Salud Dr. Mendiguchía Carriche, Leganés, Madrid, España; Presidente de la Sociedad Madrileña de Medicina Familiar y Comunitaria (SoMaMFyC), Madrid, España; Coordinador del grupo de la mujer del PAPPS, España. Electronic address: alopezgfp@gmail.com. ·Aten Primaria · Pubmed #27049040.

ABSTRACT: -- No abstract --

8 Editorial Association between vitamin D and falls in young postmenopausal women. 2016

Palacios, Santiago. ·Palacios Institute of Women's Health, Madrid, Spain. ·Menopause · Pubmed #26818014.

ABSTRACT: -- No abstract --

9 Editorial Antiresorptives and anabolic therapy in sequence or combination for postmenopausal osteoporosis. 2015

Palacios, S / Mejía, A. ·Palacios Institute of Women's Health , Madrid , Spain. ·Climacteric · Pubmed #25740608.

ABSTRACT: Osteoporosis is a chronic disease which may require treatment for many years and requires not only individual management but often sequential or combination treatments. Monotherapy with antiresorptives is usually the first choice. Sometimes, it is necessary to modify this option for therapeutic failure or for the time of use and risk of side-effects. Due to their different mode of action, therapy with anabolic drugs has increased our options in the treatment of osteoporosis. Postmenopausal women and men with severe and progressive osteoporosis despite antiresorptive treatment ('therapeutic failure') should be evaluated for treatment with an anabolic option. Moreover, anabolic agents are indicated for 18-24 months in patients at high risk. Then, sequential antiresorptive therapy is recommended to maintain drug increases in bone mass and support secondary mineralization of the newly formed bone. Combination therapies of antiresorptives and anabolic agents have shown a significant increase in bone mineral density compared to monotherapies. However, none of the combinations have been studied for the prevention of fractures. Combination therapy may not be recommended because of the possible increase in cost.

10 Review Bone health in estrogen-free contraception. 2019

Hadji, P / Colli, E / Regidor, P-A. ·Frankfurter Center of Bone Health, Goethestr. 23, 60313, Frankfurt/Main, Germany. · Philipps University of Marburg, Marburg, Germany. · Exeltis HealthCare Madrid, C/ Manuel Pombo Angulo 28, 4th Floor, 28050, Madrid, Spain. · Exeltis Europe, Adalperostr. 84, 85737, Ismaning, Germany. pedro-antonio.regidor@exeltis.com. ·Osteoporos Int · Pubmed #31446440.

ABSTRACT: Estrogens and progestogens influence the bone. The major physiological effect of estrogen is the inhibition of bone resorption whereas progestogens exert activity through binding to specific progesterone receptors. New estrogen-free contraceptive and its possible implication on bone turnover are discussed in this review. Insufficient bone acquisition during development and/or accelerated bone loss after attainment of peak bone mass (PBM) are 2 processes that may predispose to fragility fractures in later life. The relative importance of bone acquisition during growth versus bone loss during adulthood for fracture risk has been explored by examining the variability of areal bone mineral density (BMD) (aBMD) values in relation to age. Bone mass acquired at the end of the growth period appears to be more important than bone loss occurring during adult life. The major physiological effect of estrogen is the inhibition of bone resorption. When estrogen transcription possesses binds to the receptors, various genes are activated, and a variety modified. Interleukin 6 (IL-6) stimulates bone resorption, and estrogen blocks osteoblast synthesis of IL-6. Estrogen may also antagonize the IL-6 receptors. Additionally, estrogen inhibits bone resorption by inducing small but cumulative changes in multiple estrogen-dependent regulatory factors including TNF-α and the OPG/RANKL/RANK system. Review on existing data including information about new estrogen-free contraceptives. All progestins exert activity through binding to specific progesterone receptors; hereby, three different groups of progestins exist: pregnanes, gonanes, and estranges. Progestins also comprise specific glucocorticoid, androgen, or mineralocorticoid receptor interactions. Anabolic action of a progestogen may be affected via androgenic, anti-androgenic, or synadrogenic activity. The C 19 nortestosterone class of progestogens is known to bind with more affinity to androgen receptors than the C21 progestins. This article reviews the effect of estrogens and progestogens on bone and presents new data of the currently approved drospirenone-only pill. The use of progestin-only contraceptives leading to an estradiol level between 30 and 50 pg/ml does not seem to lead to an accelerate bone loss.

11 Review Handling Parathormone Receptor Type 1 in Skeletal Diseases: Realities and Expectations of Abaloparatide. 2019

Ardura, Juan A / Portal-Núñez, Sergio / Alonso, Verónica / Bravo, Beatriz / Gortazar, Arancha R. ·Bone Physiopathology Laboratory, Applied Molecular Medicine Institute (IMMA), Universidad San Pablo-CEU, CEU Universities, Campus Monteprincipe, 28925 Alcorcón, Madrid, Spain; Departamento de Ciencias Médicas Básicas, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Campus Monteprincipe, 28925 Alcorcón, Madrid, Spain. ·Trends Endocrinol Metab · Pubmed #31409530.

ABSTRACT: Musculoskeletal disorders represent an elevated socioeconomic burden for developed aging societies. Osteoporosis (OP) has been treated with antiresorptive therapies or with teriparatide that was until recently the only anabolic therapy. However, approval of osteoporosis treatment in postmenopausal women with abaloparatide, which is an analog of parathyroid hormone-related peptide (PTHrP), has created a new alternative for OP management. The success of this new treatment is related to differential mechanisms of activation of PTH receptor type 1 (PTH1R) by abaloparatide and PTH. Here, we address the distinguishing mechanisms of PTH1R activation; the effects of PTH1R stimulation in osteoblast, osteocytes, and chondrocytes; the differences between PTH and abaloparatide actions on PTH1R; potential safety concerns; and future perspectives about abaloparatide use in other musculoskeletal disorders.

12 Review Practical guidance for engaging patients in health research, treatment guidelines and regulatory processes: results of an expert group meeting organized by the World Health Organization (WHO) and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). 2019

de Wit, Maarten / Cooper, Cyrus / Tugwell, Peter / Bere, Nathalie / Kirwan, John / Conaghan, Philip G / Roberts, Charlotte / Aujoulat, Isabelle / Al-Daghri, Nasser / Araujo de Carvalho, Islene / Barker, Mary / Bedlington, Nicola / Brandi, Maria Luisa / Bruyère, Olivier / Burlet, Nansa / Halbout, Philippe / Hiligsmann, Mickaël / Jiwa, Famida / Kanis, John A / Laslop, Andrea / Lawrence, Wendy / Pinto, Daniel / Prieto Yerro, Concepción / Rabenda, Véronique / Rizzoli, René / Scholte-Voshaar, Marieke / Vlaskovska, Mila / Reginster, Jean-Yves. ·Department of Medical Humanities, Amsterdam University Medical Centre, Amsterdam, The Netherlands. · MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK. · NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK. · WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium. · Department of Medicine, University of Ottawa, Ottawa, Canada. · Public Engagement Department, European Medicines Agency, 30 Churchill Place, Canary Wharf, London, E14 5EU, UK. · Emeritus Professor of Rheumatic Diseases, University of Bristol, Bristol, UK. · Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK. · NIHR Leeds Biomedical Research Centre, Leeds, UK. · International Consortium for Health Outcomes Measurement, Hamilton House, 4 Mabledon Place, Bloomsbury, London, WC1H 9BB, UK. · Université Catholique de Louvain, Institute of Health & Society, Brussels, Belgium. · Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia. · Department of Ageing and Life Course, World Health Organization, 20 Avenue Appia, 1211, Geneva 27, Switzerland. · European Patients' Forum, Chaussée d'Etterbeek 180, Etterbeek, 1040, Brussels, Belgium. · Department of Surgery and Translational Medicine, University of Florence, Florence, Italy. · Fondazione F.I.R.M.O., Florence, Italy. · Department of Public Health, Epidemiology and Health Economics, University of Liège, CHU Sart Tilman B23, 4000, Liège, Belgium. · International Osteoporosis Foundation, 9 Rue Juste-Olivier, 1260, Nyon, Switzerland. · Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands. · Osteoporosis Canada, Toronto, ON, Canada. · Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia. · Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK. · Scientific Office, Federal Office for Safety in Health Care, Austrian Agency for Health and Food Safety, Vienna, Austria. · NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK. · Department of Physical Therapy, College of Health Sciences, Marquette University, Milwaukee, USA. · Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. · Spanish Agency for Drugs and Medical Devices, Calle Campezo 1, Building 8, 28022, Madrid, Spain. · Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. · Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands. · Medical Faculty, Department of Pharmacology, Medical University Sofia, 2, Zdrave Str, 1431, Sofia, Bulgaria. · WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium. jyreginster@uliege.be. · Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia. jyreginster@uliege.be. · Department of Public Health, Epidemiology and Health Economics, University of Liège, CHU Sart Tilman B23, 4000, Liège, Belgium. jyreginster@uliege.be. ·Aging Clin Exp Res · Pubmed #30993659.

ABSTRACT: There is increasing emphasis on patient-centred research to support the development, approval and reimbursement of health interventions that best meet patients' needs. However, there is currently little guidance on how meaningful patient engagement may be achieved. An expert working group, representing a wide range of stakeholders and disciplines, was convened by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the World Health Organization (WHO). Through a structured, collaborative process the group generated practical guidance to facilitate optimal patient engagement in clinical development and regulatory decisions. Patient engagement is a relational process. The principles outlined in this report were based on lessons learned through applied experience and on an extensive dialogue among the expert participants. This practice guidance forms a starting point from which tailoring of the approach to suit different chronic diseases may be undertaken.

13 Review Analysis of the Increase in Bone Mineral Density After Surgical Treatment of Primary Hyperparathyroidism. 2019

Mendoza-Moreno, Fernando / Díez-Alonso, Manuel / Ovejero-Merino, Enrique / Sánchez-Gollarte, Ana / Alvarado-Hurtado, Ricardo / Matías-García, Belén / Rodríguez-Pascual, Ángel / Medina-Reinoso, Carlos / Ratia-Jiménez, Tomás / Hernández-Merlo, Francisco / Granell-Vicent, Javier. ·MD, General and Digestive Surgeon, Department of General and Digestive Surgery, Endocrine Surgery Unit, Príncipe de Asturias Teaching Hospital, Alcalá de Henares, Madrid, Spain. Electronic address: khoril@hotmail.com. · MD, General and Digestive Surgeon, Department of General and Digestive Surgery, Endocrine Surgery Unit, Príncipe de Asturias Teaching Hospital, Alcalá de Henares, Madrid, Spain. · Resident of General Surgery, Príncipe de Asturias Teaching Hospital, Alcalá de Henares, Madrid, Spain. ·J Clin Densitom · Pubmed #30482495.

ABSTRACT: AIM: To analyze the effect of the surgery in bone mineral density (BMD) and to study the value of preoperative clinical and analytical factors as predictors of bone increase. MATERIAL AND METHODS: Prospective observational study. Postmenopausal women who were operated for primary hyperparathyroidism were included. A bone densitometry of the lumbar spine and femoral neck and analytical determinations (parathyroid hormone [PTH], alkaline phosphatase, albumin, phosphate, creatinine, 25-hydroxy-vitamin D3, creatinine clearance, and calciuria) were performed previous to the intervention and after 12 months from surgery. RESULTS: Two hundred and twenty-eight patients were operated on for primary hyperparathyroidism were considered for study, 108 postmenopausal women entered in the final analysis. The mean age was 63 ± 7 yr. After the intervention, a significant increase in BMD was observed in the two locations analyzed, although this increase was significant greater at the level of the lumbar spine. In the lumbar spine, 68 patients (63%) recorded a significant postoperative increase in bone density. Median postoperative BMD was 0.860 g/cm CONCLUSIONS: After surgery, a significant increase in BMD was observed in the lumbar spine and femoral neck. In the multivariate analysis, preoperative bone density was the factor that showed the highest predictive value of the increase in BMD after surgery.

14 Review [Osteosarcopenia: A narrative review]. 2019

Cedeno-Veloz, Bernardo / López-Dóriga Bonnardeauxa, Pedro / Duque, Gustavo. ·Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, VIC, Australia; Department of Medicine-Western Health, The University of Melbourne, St. Albans, VIC, Australia; Servicio de Geriatría, Hospital Universitario de Getafe, Getafe, Madrid, España. Electronic address: Abel.medifmsa@gmail.com. · Servicio de Geriatría, Hospital Universitario de Getafe, Getafe, Madrid, España. · Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, VIC, Australia; Department of Medicine-Western Health, The University of Melbourne, St. Albans, VIC, Australia. ·Rev Esp Geriatr Gerontol · Pubmed #30471719.

ABSTRACT: Osteosarcopenia is a phenotype resulting from the combination of sarcopenia and low bone mineral density. Based on the relationship between bone and muscle, this phenotype is associated with a higher risk of falls, fractures, dependence, and health care costs than its individual components. Given its characteristics, it can be considered as a new geriatric syndrome. Therefore, understanding its pathophysiology and diagnosis, as well as its non-pharmacological and pharmacological management is a task of great importance. The problem in addressing this phenotype arises from the tradition of managing sarcopenia and osteoporosis separately. There is also a lack of consensus on what to call it (sarco-osteopenia, sarco-osteoporosis, osteosarcopenia). The aim of this review is to outline the epidemiology, pathophysiology, diagnoses, adverse events, and management of osteosarcopenia.

15 Review Prevalence and risk factors for osteoporosis and fractures in axial spondyloarthritis: A systematic review and meta-analysis. 2018

Ramírez, Julio / Nieto-González, Juan Carlos / Curbelo Rodríguez, Rafael / Castañeda, Santos / Carmona, Loreto. ·Rheumatology Department, Arthritis Unit, Hospital Clinic and IDIBAPS, Barcelona, Spain. Electronic address: julramga@gmail.com. · Rheumatology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain. · Instituto de Salud Musculoesquelética, Madrid, Spain. · Rheumatology Department, Hospital Universitario La Princesa, IIS-Princesa, Madrid, Spain. ·Semin Arthritis Rheum · Pubmed #29290311.

ABSTRACT: OBJECTIVES: To describe the prevalence of osteoporosis, the prevalence and incidence of fractures, and the frequency of risk factors for low bone mineral density (BMD) in axial spondyloarthritis (Ax-SpA). METHODS: A systematic review and meta-analysis of observational studies was conducted. Medline, Embase, and Cochrane Library databases were searched with a sensitive strategy. Large cross-sectional and longitudinal studies published in the last 10 years (January 2006-2016) with representative samples of patients with Ax-SpA estimating the frequency of osteoporosis, risk factors or fractures were selected. RESULTS: After screening 3597 titles and abstracts, 46 studies were reviewed in detail, of which 35 studies had a cross-sectional design, 5 were prospective and 6 retrospective; 21 studies compared Ax-SpA patients with a control group-either healthy individuals (18 studies) or subjects with other diseases (6 studies). The prevalence of osteoporosis varied from 11.7% to 34.4% and that of fractures from 11% to 24.6%. Alcohol intake (58-61%), use of corticosteroids (11.7-66.9%), and 25-OH vitamin D deficiency (26-76%) were unexpectedly high in Ax-SpA patients. CONCLUSION: The prevalence of osteoporosis and fractures in Ax-SpA varies between 11.7% and 34.4% and 11-24.6%, respectively. Alcohol intake, steroid use, and low levels of 25-OH-vitamin D should be taken into account in osteoporosis assessment in patients with Ax-SpA. Inconsistent results, lack of bone quality assessment, and high likelihood of bias of the published studies confirm the need for performing well-designed studies.

16 Review Management of Aromatase Inhibitor-Associated Bone Loss (AIBL) in postmenopausal women with hormone sensitive breast cancer: Joint position statement of the IOF, CABS, ECTS, IEG, ESCEO IMS, and SIOG. 2017

Hadji, Peyman / Aapro, Matti S / Body, Jean-Jacques / Gnant, Michael / Brandi, Maria Luisa / Reginster, Jean Yves / Zillikens, M Carola / Glüer, Claus-C / de Villiers, Tobie / Baber, Rod / Roodman, G David / Cooper, Cyrus / Langdahl, Bente / Palacios, Santiago / Kanis, John / Al-Daghri, Nasser / Nogues, Xavier / Eriksen, Erik Fink / Kurth, Andreas / Rizzoli, Rene / Coleman, Robert E. ·Krankenhaus Nordwest, Frankfurt, Germany. · Genolier Cancer Center, Switzerland. · CHU Brugmann, Université Libre de Bruxelles, Belgium. · Medical University of Vienna, Austria. · University of Florence, Italy. · University of Liège, Belgium. · Erasmus MC, Rotterdam, Netherlands. · Univeristy of Kiel, Germany. · University of Stellenbosch, Cape Town, South Africa. · University of Sydney, Australia. · Indiana University School of Medicine, USA. · University of Southampton, UK. · Aarhus University, Denmark. · Instituto Palacios Madrid, Spain. · Catholic University of Australia, Melbourne, Australia and University of Sheffield, UK. · University of Riyadh, Saudi Arabia. · Autonomous University of Barcelona, Spain. · University of Oslo, Norway. · Klinikum Birkenwerder, Germany. · Geneva University, Switzerland. · University of Sheffield, UK. ·J Bone Oncol · Pubmed #28413771.

ABSTRACT: BACKGROUND: Several guidelines have been reported for bone-directed treatment in women with early breast cancer (EBC) for averting fractures, particularly during aromatase inhibitor (AI) therapy. Recently, a number of studies on additional fracture related risk factors, new treatment options as well as real world studies demonstrating a much higher fracture rate than suggested by randomized clinical controlled trials (RCTs). Therefore, this updated algorithm was developed to better assess fracture risk and direct treatment as a position statement of several interdisciplinary cancer and bone societies involved in the management of AI-associated bone loss (AIBL). PATIENTS AND METHODS: A systematic literature review identified recent advances in the management of AIBL. Results with individual agents were assessed based on trial design, size, follow-up, and safety. RESULTS: Several fracture related risk factors in patients with EBC were identified. Although, the FRAX algorithm includes fracture risk factors (RF) in addition to BMD, it does not seem to adequately address the effects of AIBL. Several antiresorptive agents can prevent and treat AIBL. However, concerns regarding compliance and long-term safety remain. Overall, the evidence for fracture prevention is strongest for denosumab 60 mg s.c. every 6 months. Additionally, recent studies as well as an individual patient data meta-analysis of all available randomized trial data support additional anticancer benefits from adjuvant bisphosphonate treatment in postmenopausal women with a 34% relative risk reduction in bone metastasis and 17% relative risk decrease in breast cancer mortality that needs to be taken into account when advising on management of AIBL. CONCLUSIONS: In all patients initiating AI treatment, fracture risk should be assessed and recommendation with regard to exercise and calcium/vitamin D supplementation given. Bone-directed therapy should be given to all patients with a T-score<-2.0 or with a T-score of <-1.5 SD with one additional RF, or with ≥2 risk factors (without BMD) for the duration of AI treatment. Patients with T-score>-1.5 SD and no risk factors should be managed based on BMD loss during the first year and the local guidelines for postmenopausal osteoporosis. Compliance should be regularly assessed as well as BMD on treatment after 12 - 24 months. Furthermore, because of the decreased incidence of bone recurrence and breast cancer specific mortality, adjuvant bisphosphonates are recommended for all postmenopausal women at significant risk of disease recurrence.

17 Review The multi-faceted role of retinoid X receptor in bone remodeling. 2017

Menéndez-Gutiérrez, María P / Ricote, Mercedes. ·Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Melchor Fernández Almagro, 3, 28029, Madrid, Spain. · Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Melchor Fernández Almagro, 3, 28029, Madrid, Spain. mricote@cnic.es. ·Cell Mol Life Sci · Pubmed #28105491.

ABSTRACT: Retinoid X receptors (RXRs) form a unique subclass within the nuclear receptor (NR) superfamily of ligand-dependent transcription factors. RXRs are obligatory partners for a number of other NRs, placing RXRs in a coordinating role at the crossroads of multiple signaling pathways. In addition, RXRs can function as self-sufficient homodimers. Recent advances have revealed RXRs as novel regulators of osteoclastogenesis and bone remodeling. This review outlines the versatility of RXR action in the control of transcription of bone-forming osteoblasts and bone-resorbing osteoclasts, both through heterodimerization with other NRs and through RXR homodimerization. RXR signaling is currently a major therapeutic target and, therefore, knowledge of how RXR signaling affects bone remodeling creates enormous potential for the translation of basic research findings into successful clinical therapies to increase bone mass and improve bone quality.

18 Review New options for menopausal symptoms after 15 years of WHI Study. 2017

Palacios, Santiago / Coronado, Pluvio J. ·Director of Instituto Palacios, Madrid, Spain - ipalacios@institutopalacios.com. · Department of Obstetrics and Gynecology, San Carlos Clinic Hospital, Madrid, Spain. ·Minerva Ginecol · Pubmed #27973466.

ABSTRACT: Menopausal symptoms include vasomotor symptoms (VMS), vulvar-vaginal atrophy, and loss of bone mass associated with an increased risk of fracture. Treatment of VMS consists of lifestyle changes, hormone treatment (estrogens with and without progestogens, tissue selective estrogens complex or conjugated estrogens and bazedoxifene [CE/BZA], progestogens, and tibolone), and nonhormonal treatments. Genitourinary symptoms due to vulvar-vaginal atrophy are treated with systemic and local hormones, moisturizer creams and gels, CE/BZA, and a selective estrogen receptor modulator (ospemifene). In addition to lifestyle changes, treatments for the risk of fragility fracture include calcium and vitamin D, hormone treatment, selective estrogen receptor modulators (raloxifene, BZA), bisphosphonates, strontium ranelate, denosumab, and teriparatide. This article reviews treatment options and provides treatment algorithms for women with menopausal symptoms.

19 Review Points to consider for reporting, screening for and preventing selected comorbidities in chronic inflammatory rheumatic diseases in daily practice: a EULAR initiative. 2016

Baillet, Athan / Gossec, Laure / Carmona, Loreto / Wit, Maarten de / van Eijk-Hustings, Yvonne / Bertheussen, Heidi / Alison, Kent / Toft, Mette / Kouloumas, Marios / Ferreira, Ricardo J O / Oliver, Susan / Rubbert-Roth, Andrea / van Assen, Sander / Dixon, William G / Finckh, Axel / Zink, Angela / Kremer, Joel / Kvien, Tore K / Nurmohamed, Michael / van der Heijde, Desirée / Dougados, Maxime. ·Department of Rheumatology, Université Joseph Fourier, GREPI-CNRS, Grenoble Hospital, France. · Department of Rheumatology, Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS); AP-HP, Pitié Salpêtrière Hospital, Paris, France. · Instituto de Salud Musculoesquelética, Madrid, Spain. · EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland. · Integrated Care, Maastricht University Medical Centre, Maastricht, The Netherlands. · Salisbury NHS Foundation Trust Hospital, Salisbury, UK. · Cyprus League Against Rheumatism, Cyprus, Nikosia, Cyprus. · Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra; Health Sciences Research Unit: Nursing (UICiSA:E), Coimbra, Portugal. · Independent Nurse Consultant, North Devon, UK. · Department of Internal Medicine, University of Cologne, Cologne, Germany. · Department of Internal Medicine, Division of Infectious Diseases, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands. · Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK. · Division of Rheumatology, Geneva University Hospital, Geneva, Switzerland. · Epidemiology Unit, German Rheumatism Research Centre, and Rheumatology, Charité, University Medicine, Berlin, Germany. · Albany Medical College and The Center for Rheumatology, Albany, USA. · Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · Amsterdam Rheumatology immunology Center | VUmc and Reade, The Netherlands. · Department of Rheumatology, Leiden University Medical Center, The Netherlands. · Department of Rheumatology, Paris Descartes University-Hôpital Cochin. Assistance Publique-Hôpitaux de Paris. INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France. ·Ann Rheum Dis · Pubmed #26984008.

ABSTRACT: In chronic inflammatory rheumatic diseases, comorbidities such as cardiovascular diseases and infections are suboptimally prevented, screened for and managed. The objective of this European League Against Rheumatism (EULAR) initiative was to propose points to consider to collect comorbidities in patients with chronic inflammatory rheumatic diseases. We also aimed to develop a pragmatic reporting form to foster the implementation of the points to consider. In accordance with the EULAR Standardised Operating Procedures, the process comprised (1) a systematic literature review of existing recommendations on reporting, screening for or preventing six selected comorbidities: ischaemic cardiovascular diseases, malignancies, infections, gastrointestinal diseases, osteoporosis and depression and (2) a consensus process involving 21 experts (ie, rheumatologists, patients, health professionals). Recommendations on how to treat the comorbidities were not included in the document as they vary across countries. The literature review retrieved 42 articles, most of which were recommendations for reporting or screening for comorbidities in the general population. The consensus process led to three overarching principles and 15 points to consider, related to the six comorbidities, with three sections: (1) reporting (ie, occurrence of the comorbidity and current treatments); (2) screening for disease (eg, mammography) or for risk factors (eg, smoking) and (3) prevention (eg, vaccination). A reporting form (93 questions) corresponding to a practical application of the points to consider was developed. Using an evidence-based approach followed by expert consensus, this EULAR initiative aims to improve the reporting and prevention of comorbidities in chronic inflammatory rheumatic diseases. Next steps include dissemination and implementation.

20 Review The accuracy of osteoporotic fracture risk prediction tools: a systematic review and meta-analysis. 2015

Marques, Andréa / Ferreira, Ricardo J O / Santos, Eduardo / Loza, Estíbaliz / Carmona, Loreto / da Silva, José António Pereira. ·Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal Health Sciences Research Unit: Nursing (UICiSA:E), Coimbra, Portugal. · Instituto de Salud Musculoesquelética-InMusc, Madrid, Spain. · Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal Faculty of Medicine, Clínica Universitária de Reumatologia, University of Coimbra, Coimbra, Portugal. ·Ann Rheum Dis · Pubmed #26248637.

ABSTRACT: OBJECTIVES: To identify and synthesise the best available evidence on the accuracy of the currently available tools for predicting fracture risk. METHODS: We systematically searched PubMed MEDLINE, Embase and Cochrane databases to 2014. Two reviewers independently selected articles, collected data from studies, and carried out a hand search of the references of the included studies. The Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS) checklist was used, and the primary outcome was the area under the curve (AUC) and 95% CIs, obtained from receiver operating characteristic (ROC) analyses. We excluded tools if they had not been externally validated or were designed for specific disease populations. Random effects meta-analyses were performed with the selected tools. RESULTS: Forty-five studies met inclusion criteria, corresponding to 13 different tools. Only three tools had been tested more than once in a population-based setting: FRAX (26 studies in 9 countries), GARVAN (6 studies in 3 countries) and QFracture (3 studies in the UK, 1 also including Irish participants). Twenty studies with these three tools were included in a total of 17 meta-analyses (for hip or major osteoporotic fractures; men or women; with or without bone mineral density). CONCLUSIONS: Most of the 13 tools are feasible in clinical practice. FRAX has the largest number of externally validated and independent studies. The overall accuracy of the different tools is satisfactory (>0.70), with QFracture reaching 0.89 (95% CI 0.88 to 0.89). Significant methodological limitations were observed in many studies, suggesting caution when comparing tools based solely on the AUC.

21 Review Vitamin D supplementation review and recommendations for women diagnosed with breast or ovary cancer in the context of bone health and cancer prognosis/risk. 2015

Martin-Herranz, Ana / Salinas-Hernández, Pedro. ·Department of Medical Oncology, Hospital La Zarzuela, Madrid, Spain. Electronic address: amartinherranz@hotmail.com. · Department of Medical Oncology, Hospital La Zarzuela, Madrid, Spain. ·Crit Rev Oncol Hematol · Pubmed #26068240.

ABSTRACT: Vitamin D review and supplementation recommendations for women diagnosed with breast or ovary cancer have been defined in the context of bone health and cancer prognosis/risk taking as reference wider cancer patients and postmenopausal women. This specific group has been selected due to its higher osteoporosis risk versus postmenopausal women. Early vitamin D supplementation could help maintain bone health, as well as potentially enhance cancer survival rate. Factors considered for supplementation include daily dose, periodicity, chemical form, administration, and serum levels. Sufficient vitamin D serum levels are recommended to be above 30 ng/ml (75 nmol/l). Maintenance oral supplementation equivalent to a minimum daily dosage of 800-1000 IU (20-25 μg) cholecalciferol provided in a daily to monthly bases is preferred, also advised to start with higher dosages when vitamin D serum levels are <10 ng/ml (25 nmol/l). Calcidiol supplementation is more effective, making it advantageous for cases with very low or difficult to raise vitamin D serum levels.

22 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.

23 Review Chronic iron deficiency as an emerging risk factor for osteoporosis: a hypothesis. 2015

Toxqui, Laura / Vaquero, M Pilar. ·Department of Metabolism and Nutrition, Institute of Food Science, Technology and Nutrition (ICTAN), Spanish National Research Council (CSIC), C/José Antonio Novais 10, Madrid 28040, Spain. laura.toxqui@ictan.csic.es. · Department of Metabolism and Nutrition, Institute of Food Science, Technology and Nutrition (ICTAN), Spanish National Research Council (CSIC), C/José Antonio Novais 10, Madrid 28040, Spain. mpvaquero@ictan.csic.es. ·Nutrients · Pubmed #25849944.

ABSTRACT: Iron is essential in oxygen transport and participates in many enzymatic systems in the body, with important roles in collagen synthesis and vitamin D metabolism. The relationship between iron and bone health comes from clinical observations in iron overload patients who suffered bone loss. The opposite scenario--whether iron deficiency, with or without anemia, affects bone metabolism--has not been fully addressed. This is of great interest, as this nutrient deficiency is a worldwide public health problem and at the same time osteoporosis and bone alterations are highly prevalent. This review presents current knowledge on nutritional iron deficiency and bone remodeling, the biomarkers to evaluate iron status and bone formation and resorption, and the link between iron and bone metabolism. Finally, it is hypothesized that chronic iron deficiency induces bone resorption and risk of osteoporosis, thus complete recovery from anemia and its prevention should be promoted in order to improve quality of life including bone health. Several mechanisms are suggested; hence, further investigation on the possible impact of chronic iron deficiency on the development of osteoporosis is needed.

24 Review Bazedoxifene/conjugated estrogens combination for the treatment of the vasomotor symptoms associated with menopause and for prevention of osteoporosis in postmenopausal women. 2015

Palacios, S / Mejía Ríos, A. ·Palacios Institute of Women's Health, Madrid, Spain. ipalacios@institutopalacios.com. · Palacios Institute of Women's Health, Madrid, Spain. ·Drugs Today (Barc) · Pubmed #25756066.

ABSTRACT: The decrease of estrogen in postmenopausal women has been associated with the presence of different symptoms such as vasomotor symptoms, vulvovaginal atrophy, bone loss, sleep disturbances, and mood and sexual activity alterations. Hormone replacement therapy with estrogen and progestins has been used to improve menopausal symptoms; however, there are still concerns regarding its safety and tolerability, as some progestins have been shown to increase breast cancer and cardiovascular risk. Bazedoxifene is a third-generation selective estrogen receptor modulator (SERM) used for osteoporosis management in postmenopausal women at fracture risk that has demonstrated a powerful antiestrogenic effect on the endometrium. Today we have a new alternative called the tissue-selective estrogen complex (TSEC), which combines bazedoxifene and conjugated estrogens and is designed not only to improve menopausal symptoms and vulvovaginal atrophy but also to prevent bone loss. Therefore, it maintains the benefits of estrogen therapy while antagonizing the stimulation effects on the endometrium and mammary gland without the effects associated with progestins.

25 Review Perspective on prescribing conjugated estrogens/bazedoxifene for estrogen-deficiency symptoms of menopause: a practical guide. 2015

Palacios, Santiago / Currie, Heather / Mikkola, Tomi S / Dragon, Erika. ·Instituto Palacios, Madrid, Spain. Electronic address: ipalacios@institutopalacios.com. · NHS Dumfries & Galloway, Dumfries, Scotland, United Kingdom. · Helsinki University Central Hospital, Helsinki, Finland. · Pfizer, Global Innovative Pharma, Europe, Paris, France. ·Maturitas · Pubmed #25684082.

ABSTRACT: Current guidelines recommend that hormone therapy (HT) in postmenopausal women with a uterus include a progestin to protect against endometrial hyperplasia. However, many concerns relating to HT use appear to be related to the progestin component, including cardiovascular risk, breast stimulation, and irregular vaginal bleeding. Conjugated estrogens (CE) combined with the selective estrogen receptor modulator bazedoxifene (BZA) is a new progestin-free HT option for alleviating estrogen deficiency symptoms in postmenopausal women with a uterus for whom treatment with progestin-containing therapy is not appropriate. Five double-blind, randomized, placebo-controlled, phase 3 studies, known as the Selective estrogens, Menopause, And Response to Therapy (SMART) trials have investigated the efficacy of CE/BZA for relieving vasomotor symptoms (VMS), and effect on bone mass, as well as endometrial and breast safety in postmenopausal women. In a 12-week study, CE 0.45 mg/BZA 20 mg significantly reduced the number and severity of hot flushes compared with placebo at weeks 4 and 12. Unlike estrogen-progestin therapy (EPT), CE 0.45 mg/BZA 20 mg did not increase breast density compared with placebo. In clinical trials up to 2 years, CE/BZA had a favorable tolerability profile, demonstrated by amenorrhea rates similar to placebo. Vascular disorders including venous thromboembolic events (pulmonary embolism, retinal vein thrombosis, deep vein thrombosis, and thrombophlebitis) were rare events, occurring in less than 1 per 1000 patients. CE/BZA was associated with significantly higher incidences of amenorrhea and lower incidences of bleeding compared with CE/medroxyprogesterone acetate in 2 comparative trials. Therefore, CE 0.45 mg/BZA 20mg provides an effective, well-tolerated, progestin-free alternative to EPT for postmenopausal women with a uterus.

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