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Biomedical subjects

B Uebelhart

Publications and source records attributed to B Uebelhart.

14 recordsLinked to original sources
PubMed2006

Targeted education improves the very low recognition of vertebral fractures and osteoporosis management by general internists.

INTRODUCTION: Vertebral fractures in older persons are strong predictors of subsequent fracture risk but remain largely under-recognized. To evaluate the impact of an educational intervention on the recognition of vertebral fractures and the prescription of anti-osteoporosis treatment among general internists, we conducted a prospective study in a service of general internal medicine of a large university teaching hospital in Geneva, Switzerland. During a 3.5-month observation period (phase 1), all lateral spinal or chest radiographs performed on consecutive inpatients over 60 years were reviewed by two independent investigators, and vertebral fractures were graded according to their severity. METHODS: Results were compared with radiology reports and general internists' discharge summaries. During the following 2-month intervention period (phase 2), internists were actively educated about vertebral fracture identification by means of lectures, posters and flyers. Radiologists did not receive this educational strategy and served as controls. RESULTS: Among 292 consecutive patients (54% men; range: 60-97 years) included in phase 1, 85 (29%) were identified by investigators as having at least one vertebral fracture; radiologists detected 29 (34%), and internists detected 19 (22%). During the intervention phase, 58 (34%) of 172 patients were identified with vertebral fractures by investigators; radiologists detected 13 patients (22%) whereas among internists the detection rate almost doubled (25/58 patients, 43%; p=0.008 compared to phase 1). The percentage of patients with vertebral fracture who benefitted from an osteoporosis medical management increased from 11% (phase 1) to 40% (phase 2, p<0.03). CONCLUSIONS: Our findings confirm the large under-recognition of vertebral fractures, irrespective of their severity, and demonstrate that a simple educational strategy can significantly improve their detection on routine radiographs and, consequently, improve osteoporosis management.

Aged↗
PubMed2006

[Osteoporosis treatment].

As for any chronic disease, adherence to osteoporosis treatment is low. Folates and vitamin B12 decrease hip fracture risk in elderly Japanese with stroke. Raloxifene (Evista) decreases the incidence of positive estrogen receptor breast cancer and could prevent cardiovascular events in patients at high risk. Strontium ranelate (Protélos) prevents hip fracture in elderly women. The action of alendronate (Fosamax) on bone mineral density and markers of bone remodelling is of higher amplitude than that of risedronate (Actonel). Once monthly ibandronate (Bonviva) increases bone mineral density in post menopausal women with osteoporosis. Excessive suppression of bone remodelling and osteonecrosis of the yaws could be related to bisphosphonate intake.

Bone Density↗
PubMed2005

[Osteoporosis and anti-androgenic therapy in case of prostate cancer].

Anti-androgenic therapy for prostate cancer is associated with an increased risk of osteoporosis and of fracture. A fracture occurence has negative influence on survival. An antiresorptive agent like zoledronate, prevents bone loss consecutive to anti-androgenic therapy.

Androgen Antagonists↗
PubMed2005

[Osteoporosis and pain or is osteoporosis painful?].

Osteoporosis as a disease is characterized by skeletal quantitative and qualitative abnormalities, leading to an increased fragility. Classically the disease is painless. The complications of the disease, that is bone fractures, cause a well-known acute symptomatology. Subsequent chronic pain is the consequence of skeletal deformities, joint incongruences and tensions on musculo-tendineous structures. Pain management includes pharmacological, physio- and ergo-therapeutical measures and stabilisation maneuvers.

Acute Disease↗
PubMed2005

[Osteoporosis].

The diagnosis of osteoporosis is based on the bone mineral density measurement using DXA technology, but the concept of bone quality mainly related to bone architecture is of great interest. The diagnostic threshold of osteoporosis is more and more modulated according to fracture risk factors such as age, prevalent fractures, bone turn-over leading to the definition of a therapeutic threshold. The use of bone resorption inhibitors before or with teriparatide decrease the response of the biochemical markers of bone formation and the gain in bone mineral density. The efficacy of strontium ranelate to decrease vertebral fracture incidence is confirmed and presented on non-vertebral fractures. Bisphosphonates are rapidly effective to prevent fractures and with a long term efficacy. Vitamin D treatment is effective to prevent falls.

Bone and Bones↗
PubMed2003

Hormone replacement therapy: what is the evidence today?

Based on the most recent studies, it clearly appears that long-term hormone replacement therapy (HRT) prevents fractures but does not improve established coronary artery disease. In addition, HRT leads to a small increase in breast cancer incidence and to a decrease in colorectal cancer incidence. HRT increases the incidence of venous thrombosis, pulmonary embolisms and strokes. As a consequence, HRT can no longer be recommended for primary or secondary prevention of cardiovascular diseases. In addition, it was also demonstrated that HRT was not able to improve cognitive functions and prevent dementia. Therefore regarding daily clinical practice, HRT certainly remains useful to control the symptoms of oestrogen deficiency in recently menopausal patients, but it should definitively no longer be recommended for long-term treatment.

Aged↗
PubMed2002

Two-year results of once-weekly administration of alendronate 70 mg for the treatment of postmenopausal osteoporosis.

The aim of this study was to provide confirmation that once-weekly dosing with 70 mg of alendronate (seven times the daily oral dose) and twice-weekly dosing with 35 mg is equivalent to the 10-mg once-daily regimen and to gain more extensive safety experience with this new dosing regimen. Twelve hundred fifty-eight postmenopausal women (aged 42-95 years) with osteoporosis (bone mineral density [BMD] of either lumbar spine or femoral neck at least 2.5 SDs below peak young adult mean or prior vertebral or hip fracture) were assigned to receive oral once-weekly alendronate, 70 mg (n = 519); twice-weekly alendronate, 35 mg (n = 369); or daily alendronate 10 mg (n = 370) for a total of 2 years of double-blind experience. Mean BMD increases from baseline (95% CI) at 24 months in the once-weekly, twice-weekly, and daily treatment groups, respectively, were 6.8% (6.4, 7.3), 7.0% (6.6,7.5), and 7.4% (6.9,7.8) at the lumbar spine and 4.1% (3.8,4.5), 4.3% (3.9,4.7), and 4.3% (3.9,4.7) at the total hip. These increases in BMD as well as the BMD increases at the femoral neck, trochanter, and total body and the reductions of biochemical markers of bone resorption (urinary cross-linked N-telopeptides of type I collagen [NTx]) and bone formation (serum bone-specific alkaline phosphatase [BSAP]) were similar for the three dosing regimens. All treatment regimens were well tolerated with a similar incidence of upper gastrointestinal (GI) adverse experiences. The incidence rates of clinical fractures, captured as adverse experiences, were similar among the groups. The 2-year results confirm the conclusion reached after 1 year that once-weekly alendronate is therapeutically equivalent to daily dosing, providing patients with a more convenient dosing option that may potentially enhance adherence to therapy.

Adult↗
PubMed2001

Osteoporosis in men.

Osteoporosis in men is becoming a public health problem. The complications of the disease that represent fractures are associated with higher mortality and morbidity in men than in women. In the management of the disease, the nurse plays a major role in the education and management of men with osteoporosis.

Aged↗
PubMed2000

Modifications of bone and connective tissue after orthostatic bedrest.

Eight male volunteers were submitted to a 6-week anti-orthostatic bedrest trial followed by a 1-month reambulation period. We prospectively monitored whole-body composition by dual-energy X-ray absorptiometry, bone and connective tissue metabolism by biochemical markers and calcium regulating hormones by 1-84 parathyroid hormone and 1,25-dihydroxyvitamin D(3). Bone mineral density (BMD) did not vary significantly; however, a trend toward an increase in head BMD and a decrease in trunk, lumbar vertebrae and lower limb BMD was observed. A decrease in the lower limb lean content occurred by day 27 and was maximum by day 42 after the beginning of bedrest; it normalized by day 30 after bedrest. The serum levels of both osteocalcin and C-terminal crosslinked telopeptide of type I collagen increased as a consequence of bedrest. A slight increase in the serum levels of the N-terminal propeptide of type III collagen, a marker of connective tissue metabolism, was observed during the bedrest period. Except for the C-terminal extension propeptide of type I collagen, all markers decreased to baseline pre-immobilization levels during the 1-month recovery phase. Serum PTH and 1,25-dihydroxyvitamin D(3) levels were low during the bedrest period and rose during the reambulation phase. These results seem to reflect early changes in bone and connective tissue metabolism as a result of bedrest unloading, but their order of magnitude remains moderate, thus emphasizing the necessity to perform longer-duration trials.

Absorptiometry, Photon↗
PubMed2000

[Prevention and treatment of corticosteroid-induced osteoporosis].

Osteoporosis and fractures are frequent and severe consequences of long-term treatment with glucocorticoids. Trabecular bone is mainly affected with a decrease of bone formation and an increase of bone resorption. Prevention and treatment of corticosteroid-induced osteoporosis is based upon general measures such as calcium and vitamin D supplementation, adequate+ protein intake, regular physical exercise, hormonal replacement therapy and upon specific means like therapies used in primary osteoporosis. Bisphosphonates which are potent bone resorption inhibitors have been shown to increase bone mineral density and to decrease fracture rate. Therefore they appear as first choice in the prevention as well as in the treatment of corticosteroid-induced osteoporosis.

Anti-Inflammatory Agents↗
PubMed1999

Effect of multiple intravenous pamidronate courses in Paget's disease of bone.

BACKGROUND: Pamidronate is a bisphosphonate whose short-term biological efficacy in Paget's disease of bone was convincingly established many years ago. A less well studied area is the efficacy of pamidronate in slowing disease progression and in preventing and treating complications. MATERIAL AND METHODS: We conducted an uncontrolled retrospective study of 79 Paget's disease patients given multiple intravenous pamidronate courses over a mean period of 45 +/- 19 months. The pamidronate dose per course was 180 mg, usually given over three days. The disease was severe and in some cases had proved refractory to other medications. Reasons for pamidronate therapy were pain or other subjective symptoms; established bone, joint, or nervous system complications; or prevention or these complications in patients with involvement of high-risk sites. RESULTS: Bone and joint pain improved under therapy, and in 78% of cases the outcome in terms of complication treatment and/or prevention was favorable. An important finding was waning of the clinical and biological effects of pamidronate as the number of courses increased. Fourteen percent of patients developed resistance to pamidronate, which seemed more closely related to disease extension than to focal lesion activity. CONCLUSION: These data suggest that a prompt return to normal of laboratory markers, most notably total alkaline phosphatase, should be sought, if needed by using higher doses than in our study.

Adult↗
PubMed1998

Biochemical markers of bone metabolism in draught and warmblood horses.

Concentrations of the cross-linked carboxyterminal telopeptide of type I collagen (ICTP) and osteocalcin (OC) have been determined in the serum of one hundred clinically healthy adult Draught or Warmblood horses. The correlation between these two markers has been evaluated and the influence of gender, age and type of horse described. No significant variations were observed between animals of different sex, but a significant inverse correlation (P < 0.0001) with age was observed for both measured parameters. After correction for age, serum levels of OC were found to be lower in Draught [adjusted least square mean (LSM) = 6.612 micrograms.L-1] than in Warmblood horses (adjusted LSM = 8.596 micrograms.L-1), whereas levels of ICTP were higher in Draughts (adjusted LSM = 8.035 micrograms.L-1) than in Warmbloods (adjusted LSM = 6.643 micrograms.L-1). A significant correlation (P < 0.0001) was observed between OC and ICTP. This correlation was stronger if the type of horse was taken into account in the statistical model. The ratio OC:ICTP was independent of gender and age. A higher OC:ICTP ratio in Warmbloods compared to the Draught horses might reflect a higher bone remodelling level of horses submitted to regular daily work. It was concluded that ICTP and OC are influenced by the type of horse, and probably reflect a physiological difference in bone remodelling between these animals.

Age Factors↗
PubMed1997

Influence of type and breed of horse on serum osteocalcin concentration, and evaluation of the applicability of a bovine radioimmunoassay and a human immunoradiometric assay [corrected].

OBJECTIVES: To evaluate applicability of a human osteocalcin (OC) immunoradiometric assay (IRMA) for use with equine serum and compare it with a bovine radioimmunoassay (RIA) previously proven valid for such samples, and to describe the effect of type and breed of horses on serum OC concentration. ANIMALS: 100 healthy horses of either sex, classified as type I or II (draught or warmblood, respectively). Each type was represented by 2 breed groups, each comprising 25 horses. PROCEDURE: Blood samples were collected in the morning, and the serum was separated. Osteocalcin was measured, using commercially available RIA and IRMA kits, according to the manufacturer's instructions. All samples were evaluated in duplicate. RESULTS: The human IRMA did not recognize equine OC. Significant variations in the bovine RIA results were observed between types of horses. Draught horses had lower OC concentration, compared with warmblood horses. Significant difference was not observed between breeds for type of horse. Sex had no influence on serum OC values, but age was a significant covariable for both types of horses. CONCLUSIONS: No crossreactivity exists between the equine and human amino- and/or carboxy-terminus of OC, using this particular human IRMA kit. Difference in blood OC concentration exists between draught and warmblood types of horses. CLINICAL RELEVANCE: Use of this human IRMA kit is not valid for equine serum. Horse type must be taken into account when evaluating OC concentration in research or clinical situations, especially if small variations in OC concentration are expected.

Aging↗