1/16. Prevention for the older woman. A practical guide to prevention and treatment of osteoporosis.osteoporosis causes approximately 1.5 million low-trauma fracture per year, and at all ages the incidence of fracture is higher in women than in men. risk factors for osteoporotic fractures in postmenopausal women include family history of bone fracture, ethnicity, and weight < 127 pounds. densitometry is used to diagnose osteoporosis and can be performed at intervals to monitor bone density during treatment. The older woman's diet should, in general, include 1,200 to 1,500 mg of calcium and 400 to 800 IU of vitamin d. estrogens, bisphosphonates, selective estrogen receptor modulators, calcitonin, and exogenous parathyroid hormone are pharmacologic therapy options that can preserve and increase bone mass and reduce the risk of fracture.- - - - - - - - - - ranking = 1keywords = bisphosphonate (Clic here for more details about this article) |
2/16. An approach to postmenopausal osteoporosis treatment: a case study review.PURPOSE: To review and discuss the clinical evaluation and therapeutic options for a postmenopausal woman with osteoporosis. DATA SOURCES: review of scientific literature, practice guidelines, and a case study. CONCLUSIONS: To prevent and treat postmenopausal osteoporosis, women should be encouraged to perform weight-bearing exercise, to not smoke, and to optimize calcium and vitamin d intake through diet and supplements. Drug regimens are effective and well tolerated in postmenopausal women with osteoporosis. IMPLICATIONS FOR PRACTICE: Drugs currently approved by the U.S. food and Drug Administration for the treatment of postmenopausal osteoporosis include the bisphosphonates risedronate and alendronate; the selective estrogen receptor modulator, raloxifene; and intranasal calcitonin-salmon spray. Bisphosphonates have demonstrated the most impressive fracture risk reduction in prospective clinical trials of women with postmenopausal osteoporosis. Risedronate has consistently demonstrated significant reductions in vertebral fracture risk at 1 year and in vertebral and nonvertebral fracture risk at 3 years. alendronate has demonstrated significant reductions in vertebral and nonvertebral fracture risk after 3 years.- - - - - - - - - - ranking = 1keywords = bisphosphonate (Clic here for more details about this article) |
3/16. osteoporosis--diagnosis, treatment and management.BACKGROUND: osteoporosis is common, asymptomatic and usually undetected until a fracture occurs. Fracture, particularly hip fracture, can be associated with significant mortality, morbidity and loss of independence. OBJECTIVE: This article presents a practical case based approach to identify and manage osteoporosis. DISCUSSION: The major risk factors for osteoporosis in men and women are known, and case finding by dual X-ray absorptiometry and treatment with effective medications are subsidized by the commonwealth government. At the menopause, symptomatic women considering oestrogen replacement should assess their individual risk of osteoporosis, cardiovascular events and breast cancer. Men also develop osteoporosis and this should be on the health agenda along with cardiovascular disease, prostate and colon cancer, and diabetes. Treatment should include supplemental calcium and occasionally vitamin d. There is strong evidence for the benefits of bisphosphonates, the selective oestrogen receptor modulators and oestrogen replacement.- - - - - - - - - - ranking = 1keywords = bisphosphonate (Clic here for more details about this article) |
4/16. alendronate-induced chemical laryngitis.alendronate is a bisphosphonate used in treating osteoporosis. Its recognized side-effects include oesophageal irritation and ulceration. The authors describe a case of laryngitis induced by transient contact of this medication with the laryngeal mucosa. Successful management of this case is also detailed.- - - - - - - - - - ranking = 1keywords = bisphosphonate (Clic here for more details about this article) |
5/16. Bisphosphonate-associated scleritis: a case report and review.An 86-year-old female was treated for osteoporosis with alendronate, an aminobisphosphonate. Six weeks after alendronate therapy began, scleritis developed in the patient's right eye. The alendronate was discontinued, and, with the administration of prednisone, the symptoms of scleritis fully resolved. Rechallenge resulted in recurrence of the symptoms. Bisphosphonates are commonly used in the management of osteoporosis and are generally safe agents. Rarely, they have been linked with ocular inflammation. This case report reviews the literature on the ocular effects of bisphosphonates and discusses a possible mechanism for the association.- - - - - - - - - - ranking = 2keywords = bisphosphonate (Clic here for more details about this article) |
6/16. Pseudogout attack induced during etidronate disodium therapy.We report the first case of pseudogout attack in the distal interphalangeal (DIP) joints during etidronate disodium therapy. A 64-year-old woman had intermittent administration of etidronate disodium (Didronel; Sumitomo, Osaka, japan) alone because of osteoporosis. Each cycle consisted of a daily dose of 200 mg for 2 weeks, repeating every 12 weeks. Two weeks after completing the third cycle, severe pain and swelling occurred in the DIP joints of the right middle, ring, and left ring finger; and skin ulcer formation was observed on the dorsal side of the DIP joints of the right middle and ring fingers as well as the left ring finger. Because monoclinic calcium pyrophosphate crystals were detected in the synovial fluid from the DIP joints of the right middle finger, we diagnosed these symptoms as induced by pseudogout attack. Oral loxoprofen sodium at a daily dose of 180 mg resulted in rapid symptom resolution. A decrease in function of calcium metabolism in elderly persons has been reported to be a cause of pseudogout attack. On the other hand, distal interphalangeal joint arthritis presenting as Heberden's nodes is a common condition in elderly patients. Therefore, pseudogout attack should be considered as an adverse drug reaction when administering bisphosphonate in elderly patients with Heberden's nodes.- - - - - - - - - - ranking = 1keywords = bisphosphonate (Clic here for more details about this article) |
7/16. osteonecrosis of the jaw and oral bisphosphonate treatment.BACKGROUND: Bisphosphonates are becoming recognized increasingly as having a significant impact on dental therapies. This case report describes adverse clinical sequelae and successful treatment following periodontal surgery in a dental patient receiving bisphosphonate treatment. CASE DESCRIPTION: A 78-year-old woman experienced a nonhealing interproximal wound subsequent to a minor periodontal procedure performed to facilitate restoration of an adjacent tooth. Her medical history revealed that she had been taking an oral bisphosphonate every day for the previous five years for treatment of osteoporosis. After three months of periodic debridement and meticulous oral home care, one of the authors recovered a large piece of necrotic bone. The wound healed after the author performed surgery at the site. CLINICAL IMPLICATIONS: dentists should exercise caution when considering surgical procedures for patients with a history of oral bisphosphonate use. Thorough treatment of nonhealing wounds in these patients can lead to favorable outcomes.- - - - - - - - - - ranking = 7.0008684366808keywords = bisphosphonate, jaw (Clic here for more details about this article) |
8/16. Corneal graft rejection precipitated by uveitis secondary to alendronate sodium therapy.PURPOSE: To report a case of corneal graft rejection precipitated by severe uveitis secondary to alendronate therapy and to review the literature of relevance to this case. methods: A 77-year-old woman with a hypopyon and corneal graft rejection was studied for possible precipitants, including herpes viral and bacterial infection. Results were negative. She was treated unsuccessfully with systemic and topical steroids, systemic antivirals, and intraocular antibiotic therapy. RESULTS: Withdrawal of alendronate resulted in rapid resolution of intraocular inflammation and corneal edema. CONCLUSION: We recommend vigilance in corneal transplant patients on simultaneous bisphosphonate therapy. Caution is advised in the extension to human trials of animal studies investigating the use of bisphosphonates in corneal transplantation.- - - - - - - - - - ranking = 2keywords = bisphosphonate (Clic here for more details about this article) |
9/16. The prevention of osteoporosis.osteoporosis is the most common metabolic bone disorder in the united states. The spine is frequently involved, so that elderly women with kyphosis due to multiple compression fractures ("dowager's hump") are commonly seen in a geriatric practice. However, the most serious manifestations of osteoporosis is hip fracture. Whereas vertebral crush fractures are painful and cause spinal deformity, hip fractures cause significant morbidity and mortality. Some 250,000 hip fractures occur each year in the united states, with a mortality of 12% to 20%. For those who survive the acute event, nearly half have their life-style dramatically changed. Many become chair-bound. Some need to enter nursing homes. Many become so despondent that they lose their will to live. The direct and indirect cost of caring for these patients is 7 billion to 12 billion a year. In the absence of adequate treatment of established osteoporosis, prevention takes on heightened importance. Several strategies require consideration, from dietary measures to hormonal treatments to the newest possibility, bisphosphonate therapy.- - - - - - - - - - ranking = 1keywords = bisphosphonate (Clic here for more details about this article) |
10/16. Pseudogout associated with the use of cyclical etidronate therapy.Recently the use of etidronate in a cyclical fashion has been shown to be of value in the treatment of osteoporosis. Like all bisphosphonates etidronate is structurally similar to pyrophosphate, further it is also known to interfere with phosphate handling by the kidney resulting in elevated plasma phosphate levels. This report describes the case of a patient with established osteoporosis who developed pseudogout associated with cyclical etidronate use. The possible mechanism responsible for this is discussed.- - - - - - - - - - ranking = 1keywords = bisphosphonate (Clic here for more details about this article) |
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