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R Rizzoli

Publications and source records attributed to R Rizzoli.

At least 19 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↗
PubMed2006

Risk factors for vitamin D inadequacy among women with osteoporosis: an international epidemiological study.

A serum 25-hydroxyvitamin D [25(OH)D] level of 75 nmol/l (30 ng/ml) has been proposed as the minimum for adequate vitamin D nutrition as lower levels are associated with increases in serum parathyroid hormone in otherwise healthy adults. Amongst 2589 community-dwelling, postmenopausal women with osteoporosis from 18 countries, recruited to determine risk factors for vitamin D inadequacy, 64% had vitamin D inadequacy. General health, education, ethnicity, sun exposure, skin reactivity, diet, recent travel to sunny climates, vitamin D supplementation, body mass index (BMI), season and latitude were assessed using logistic regression models. Asian ethnicity, BMI >or=30 kg/m(2), living in non-equatorial countries, inadequate vitamin D supplementation, poor/fair health, no education about vitamin D, skin reactivity and no recent travel to sunny areas were significant predictors. Several modifiable risk factors are associated with vitamin D inadequacy worldwide, suggesting potentially simple ways to increase vitamin D and improve bone health in postmenopausal women.

Adult↗
PubMed2005

[Is vertebral fracture diagnosed?].

Vertebral fractures are the most common osteoporotic fractures. Higher morbidity, higher mortality and higher risk of future osteoporotic fractures are associated to them. However, vertebral fractures are largely under-recognized and therefore, a large part of osteoporotic patients remains untreated. An education program which emphasises the importance of vertebral fracture and proposes a detection method applicable in daily practice should improve the diagnosis and the management of osteoporotic patients.

Diagnostic Errors↗
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

[Bisphosphonates and combined treatments osteoporosis].

Bisphosphonates are inhibitors of bone resorption, which reduce vertebral and non-vertebral fracture risk. Their efficacity has been shown in controlled trials up to 5 years, and their safety up to ten years. There is no proven benefit of combining two bone resorption inhibitors.

Bone Resorption↗
PubMed2005

[Parathyroid hormone for osteroporsis: why and who to treat?].

Osteoporosis treatment with anti-catabolic agents, such as bisphosphonates and SERMS, inhibits bone remodeling, resulting in increased bone mineral density and preservation of bone micro-architecture. On another side, daily subcutaneous injections of parathyroid hormone (and PTH(1-34), teriparatide) stimulate osteoblastic functions and bone remodeling, resulting in new bone formation, increased bone mineral density and improved microarchitecture, thereby reducing fracture risk. However, the effects on PTH on cortical bone structure and its use in the context of anticatabolic treatments for osteoporosis remain complex.

Bone Density↗
PubMed2005

LRP5 gene polymorphisms and idiopathic osteoporosis in men.

Mutations in the low-density lipoprotein receptor-related protein 5 gene (LRP5) have demonstrated the role of LRP5 in bone mass acquisition. LRP5 variants were recently reported to contribute to the population-based variance in vertebral bone mass and size in males. To investigate whether LRP5 variants are implicated in idiopathic male osteoporosis, we studied 78 men with low BMD (<2.5 T score or < -2 Z score) aged less than 70 years (mean +/- SD: 50 +/- 16 years) in whom secondary causes of osteoporosis had been excluded and 86 controls (51 +/- 10 years). Genotypes and haplotypes were based on LRP5 missense substitutions in exons 9 (c.2047G > A, p.V667M) and 18 (c.4037C > T, p.A1330V), and their association with osteoporosis evaluated after adjustment for multiple clinical and environmental variables using logistic regression. The presence of osteoporosis was significantly associated with LRP5 haplotypes (P = 0.0036) independent of age (P = 0.006), weight (P = 0.004), calcium intake (P = 0.002), alcohol (P = 0.005) and tobacco (P = 0.004) consumption. Accordingly, the odds ratio for osteoporosis was 3.78 (95% CI 1.27-11.26, P < 0.001) in male carriers of haplotype 3 (c.2047A-4037T, n = 20 cases and 12 controls) versus homozygous carriers of haplotype 1 (c.2047G-4037C, n = 42 cases and 61 controls). In conclusion, these data indicate beyond a significant role for environmental factors, an association between LRP5 variants and idiopathic osteoporosis in males, pointing to a role of LRP5 in this disease.

Adult↗
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 therapy: an example of putting evidence-based medicine into clinical practice.

A major aim of evidence-based medicine is to assist clinical decision-making by providing the most current and reliable medical information. Systematic reviews and meta-analyses are important tools in this process. Systematic reviews identify and compile relevant evidence, while meta-analyses summarize and quantify the results of such reviews. Results from meta-analyses are, at present, the main source of summary evidence for the efficacy of treatments for a specific condition. They are important tools for helping to choose among treatment options, although they cannot be used to directly compare the magnitude of the effect of various therapies. However, the methods used and the consequent clinical value of the results, may be poorly understood by clinicians, who may therefore not take full advantage of the evidence. Recently, a panel of experts in osteoporosis and evidence-based medicine applied rigorous, validated, scientific standards to produce a systematic review and meta-analysis of randomized controlled trials of anti-resorptive agents used to treat osteoporosis. They found that, although several agents reduced the risk of vertebral fracture, only two, alendronate and risedronate, demonstrated convincing evidence for both non-vertebral and vertebral fracture risk reductions. The clinical implication of these results is that there are important differences in anti-fracture efficacy among currently available agents. In the absence of evidence from head-to-head clinical trials and because of the systematic nature and methodological rigor of the analyses, these data provide important information for clinical decision-making.

Aged↗
PubMed2005

Skeletal site selectivity in the effects of calcium supplementation on areal bone mineral density gain: a randomized, double-blind, placebo-controlled trial in prepubertal boys.

BACKGROUND: Calcium supplementation during childhood and adolescence is considered an early means of preventing osteoporosis in adults. Prepuberty is an opportune time for detecting the benefits of calcium in girls. OBJECTIVE: The objective was to assess whether calcium supplementation increases bone mass gain in prepubertal boys in a skeletal site-specific manner. METHODS: In a 12-month double-blind, placebo-controlled trial with 1-yr follow-up, 235 healthy prepubertal boys aged 7.4 +/- 0.4 yr (mean +/- sd) were randomized to receive two food products providing 850 mg/d calcium (calcium supplement group, n = 116) or an isocaloric placebo (n = 119). Areal bone mineral density (aBMD) was determined by dual-energy x-ray absorptiometry at radius (two sites), hip (two sites), femoral diaphysis (FDia), and L2-L4 vertebrae. RESULTS: At 12 months, aBMD gain was greater at the FDia and at the mean of the five appendicular skeletal sites in the calcium supplement group in both intention-to-treat analysis [76 +/- 32 vs. 64 +/- 33 mg/cm(2).yr; difference, 12.0 (95% confidence interval, CI, 3.6-20.3), P = 0.006; and 33 +/- 16 vs. 28 +/- 16 mg/cm(2).yr; difference, 5.1 (95% CI, 0.9-9.2); P = 0.018, respectively] and active treatment analysis [81 +/- 32 vs. 64 +/- 31 mg/cm(2).yr; difference, 17.2 (95% CI, 7.9-26.5); n = 174, P < 0.001; and 35 +/- 16 vs. 28 +/- 14 mg/cm(2).yr; difference, 7.5 (95% CI, 2.9-12.2); P = 0.002]. There was no beneficial effect of calcium on lumbar spine. The calcium effect was still detectable by ANOVA repeated measures analysis at the FDia (P = 0.004) and at the mean of the five appendicular skeletal sites (P = 0.002) 1 yr after the end of intervention (active treatment analysis). There was no change in bone size. CONCLUSION: In prepubertal boys, calcium-enriched foods increased aBMD at several appendicular skeleton sites, but not at the lumbar spine, and this without any bone size change. This effect was maintained 1 yr after treatment discontinuation.

Body Mass Index↗
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↗
PubMed2005

Gene variants for osteoporosis and their pleiotropic effects in aging.

The prevalence of osteoporosis is raising worldwide as improving conditions of living and treatment of other common diseases continuously increases life expectancy. Thus, osteoporosis affects most women above 80 years of age and, at the age of 50, the lifetime risk of suffering an osteoporosis-related fracture approaches 50% in women and 20% in men. Numerous genetic, hormonal, nutritional and life-style factors contribute to the acquisition and maintenance of bone mass. Among them, genetic variations explain as much as 70% of the variance for bone mineral density (BMD) in the population. Dozens of quantitative trait loci (QTLs) for BMD have been identified by genome screening and linkage approaches in humans and mice, and more than 100 candidate gene polymorphisms tested for association with BMD and/or fracture. Sequence variants in the vitamin D receptor (VDR), collagen 1 alpha 1 chain (Col1A1), estrogen receptor alpha (ESR1), interleukin-6 (IL-6) and LDL receptor-related protein 5 (LRP5) genes were all found to be significantly associated with differences in BMD and/or fracture risk in multiple replication studies. Moreover, some genes, such as VDR and IL-6, were shown to interact with non-genetic factors, i.e. calcium intake and estrogens, to modulate BMD. Since these gene variants have also been associated with other complex disorders, including cancer and coronary heart disease, they may represent common genetic susceptibility factors exerting pleiotropic effects during the aging process.

Aging↗
PubMed2005

Longitudinal follow-up of body composition in hematopoietic stem cell transplant patients.

Patients with hematological malignancies are well nourished prior to allogeneic hematopoietic stem cell transplantation (HSCT). HSCT and associated complications can affect body composition. The study evaluated cross-sectionally the prevalence and longitudinally the changes in lean body mass index (LBMI) in HSCT patients. Patients (n=82) were classified as normal or low LBMI. Logistic regression analyses were used to estimate odds ratios (OR) for low vs normal LBMI, between healthy volunteers and patients; for limited or extensive vs no chronic graft-versus-host-disease (GVHD); and for decreased (Karnofsky <80) vs normal functional status (>80). Patients were significantly more likely to have low LBMI at 6, 12 months, 2-3, 4-6 and >6 years than volunteers. In all, 38% of patients were below pre-HSCT LBMI at 4-6 years post-HSCT. Low LBMI was significantly associated with steroid treatment (OR 2.6, confidence intervals (CI) 1.3-5.2, P=0.008); limited (OR 5.5, CI 1.7-18.5, P=0.005) or extensive chronic GVHD (OR 20.3, CI 5.7-71.6, P<0.001); and decreased performance status (Karnofsky scores of < or =80) (OR 2.7, CI 1.3-5.9, P=0.01). Patients were more likely to have low LBMI than volunteers. Chronic GVHD and low performance status were associated with low LBMI; thus, complications and/or treatment increase the likelihood of low LBMI.

Body Composition↗
PubMed2005

A new treatment for post-menopausal osteoporosis: strontium ranelate.

Strontium ranelate is a new anti-osteoporotic agent which appears to reduce bone resorption by decreasing osteoclast differentiation and activity, and to stimulate bone formation by increasing replication of pre-osteoblast cells, leading to increased matrix synthesis. This review examines both the scientific rationale for its use in post-menopausal osteoporosis and the evidence of its antifracture efficacy. In the placebo-controlled, phase III trial Spinal Osteoporosis Therapeutic Intervention (SOTI) (no.=1442; mean age 69 yr), there was a 41% decrease over 3 yr in the number of patients with new vertebral fracture in the strontium ranelate (2 g/day) group vs placebo (p<0.001), and a 14.4% difference in lumbar bone mineral density (BMD) at 3 yr vs placebo. This reduction in vertebral fracture risk was already detected after 12 months (49% lower risk, p<0.001). The phase III TReatment Of Peripheral OSteoporosis (TROPOS) study assessed the efficacy of strontium ranelate (2 g/day) in preventing non-vertebral fracture in post-menopausal osteoporosis (no.=4932; mean age 77 yr). Strontium ranelate reduced non-vertebral fracture risk by 16% vs placebo (p=0.04) and hip fracture risk by 36% (p=0.031), in osteoporotic patients older than 74 yr. There was a concomitant increase in BMD throughout the study, reaching +8.2% (femoral neck) and +9.8% (total hip) at 3 yr. Strontium ranelate is thus a first-choice treatment of post-menopausal osteoporosis as it significantly reduces vertebral, non-vertebral and hip fracture risk in post-menopausal osteoporotic women, as well as having an excellent tolerability profile.

Bone and Bones↗
PubMed2004

[Prevention of cortisone-induced osteoporosis].

Osteoporosis and fractures are the frequent consequences of glucocorticoid therapy. Cancellous bone is primarily affected with a decrease of bone formation and an increase of bone resorption. Prevention of corticosteroid-induced osteoporosis is based upon general measures such as calcium and vitamine D supplementation, adequate protein intake, regular physical exercise, and upon specific therapies like those used in primary osteoporosis. Bisphosphonates which are potent bone resorption inhibitors have been shown to reduce bone mineral density and to decrease vertebral fracture rate. Therefore, they appear to be a first choice in the prevention of corticosteroid-induced osteoporosis.

Adrenal Cortex Hormones↗
PubMed2004

[Modifying bone mass in child and adolescent: why?].

Osteoporosis is a major public health problem with an increase of its prevalence with age and growing consequences because of the increase of life expectancy. Peak bone mass which corresponds to the amount of bony tissue present at the end of skeletal maturation, is a major determinant of the risk of fractures, such as those observed at the radial, vertebral, or femoral sites in osteoporotic patients. Therefore, strategies of primary prevention of osteoporosis and associated fractures consist in increasing bone mass acquisition during skeletal growth. Physical activity and some nutrients such as calcium and proteins may influence positively the trajectory of bone mass acquisition and therefore increase peak bone mass.

Adolescent↗