Ca&Bone - 2009;12(01)

Ca&Bone

APRIL 15, 2009

[RANKL-specific denosumab in the treatment of osteoporosis - Possible adverse effects of long-term use]

TANKÓ László

[According to the results of a recent clinical trial, the antiresorptive effect of a single 60-mg injection of denosumab, a monoclonal antibody specific to RANKL (receptor activator of NFκB ligand) substantially exceeds the effect of alendronate (70 mg weekly). Despite these differences, 1-year increases in bone density at the lumbar spine are virtually identical for both agents. The author summarizes experimental and clinical observations illustrating potential consequences of osteoclast deficiency and a constantly low rate of bone resorption for osteoblast function, bone mineralization, bone quality parameters, and mechanical properties, which all may have important implications for bone fragility. These observations also raise the question whether treatment efficiency is truly improved by aggressively pushing the limits of antiresorptive action.]

Ca&Bone

APRIL 15, 2009

[Denosumab - pharmacokinetic and clinical evidences]

MÉSZÁROS SZILVIA

[Denosumab is a fully human monoclonal antibody to RANKL modifying bone resorption in a rapid, sustained and reversible way. In postmenopausal women with low bone mineral density, denosumab 60 mg every 6 months increased mineral density, and reduced bone turnover. In postmenopausal women, it reduced the risk of vertebral, hip, and non-vertebral fractures. Increase in body mass index and reduction in bone turnover was more pronounced with denosumab than with alendronate. In patients who were switched from alendronate to denosumab, positive effects on bone were more pronounced than in those continuing alendronate. Denosumab was safe and well tolerated, and it holds the promise of becoming an efficacious therapy for postmenopausal osteoporosis.]

Ca&Bone

APRIL 15, 2009

[Management of hip fractures: practice, results, and problems in the last decade]

KRICSFALUSY Mihály, FLÓRIS István, CSERHÁTI Péter

[Among fractures attributable to osteoporosis, hip fractures are associated with the most severe consequences and the greatest costs. Surgical therapy for this condition is continuing to improve. Increasingly recent implants and techniques are being developed and introduced to successfully control postoperative adverse events. The authors briefly outline actual practice in Hungary and present some results of the follow-up of their patients in the last decade. These show that, in order to improve outcomes of hip fracture patients, all domains of management need to be addressed.]

Ca&Bone

APRIL 15, 2009

[Rehabilitation of patients with osteoporotic bone fractures]

BORS Katalin

[Consequences of osteoporotic bone fractures are increased mortality, decreased quality of life, and increased direct and indirect costs. After the assessment of remaining function and the level of independence, the goal of rehabilitation is to reach the highest level of function and independence possible, thus decreasing morbidity and mortality, improving the overall quality of life, and decreasing costs.]

Ca&Bone

APRIL 15, 2009

[The role of physiotherapy/therapeutic exercise in the treatment of osteoporotic hip fractures]

MAKOVICSNÉ Landor Erika, KOLTAI Endréné

[The authors briefly present the role of the physiotherapist in the treatment of osteoporosis. Primary, secondary, and tertiary prevention of locomotion system problems is analyzed. The authors’ specific focus is the complex physiotherapeutic treatment of osteoporotic hip fractures. They propose a prevention program involving locomotion exercises for the prevention of falls. Analyzing the physiotherapists’ activities, the authors describe the most important aspects of patient education and patient information.]

Ca&Bone

APRIL 15, 2009

[Significance of quantitative ultrasound bone densitometry and its introduction into pediatric bone medicine]

HOSSZÚ ÉVA, HAZAY Máté, LIPTOVSZKY Janka

[INTRODUCTION - Quantitative Ultrasound (QUS) examination of the bones provides information about not only bone mineral mass but also its quality. Adaptation of the method to the continuous growing of body size allowed its pediatric use. However, for introduction into routine use, a normal reference range in healthy children has to be established. The primary aim of this study was to establish the Hungarian reference range for QUS of the bone - in both genders and across a wide range of ages. As a secondary aim, QUS and the bone density were compared to internationally accepted data to comparatively determine correlations of specific QUS measurements to photon absorption based values. SUBJECTS AND METHODS - Measurement was performed on the calcaneus by Achilles Insight (Lunar, WI) device. Bone Mineral Density (BMD) of the lumbar spine was measured using the Double X-ray Absorptiometry (DXA) device DPX-L (Lunar, WI). Latter was also used to measure total body calcium content. Measurements were performed in 154 healthy boys and girls aged 5 to 18 years. We analyzed data as a function of age, and correlated results of he two types of measurement. RESULTS - Gender-specific reference ranges for normally developing children of the above ages were built up for Broadband Ultrasound Attenuation (BUA) and Speed of Sound (SOS). BUA showed the best correlation to BMD. SOS and Stiffness Index (SI) derived from BUA and SOS, correlated weaker to BMD, consonantly with the fact that SOS reflects bone elasticity (quality) rather than bone mineral mass. CONCLUSION - These newly constructed normal ranges can provide a basis of performing pediatric bone examinations using QUS, which is less expensive and more mobile.]