LAM KID

[Inhibition of receptor activator of nuclear kappa-B ligand: pathophysiology and preclinical data]

LAKATOS Péter, NÁDASI Edit

OCTOBER 20, 2011

LAM KID - 2011;1(02)

[Bone remodeling is a lifelong process, in which the balanced functions of osteoclasts and osteoblasts have a key role. In certain conditions, for example during the dramatical hormonal changes in the postmenopausal period, the upset of this balance leads to a pathologically increased bone loss. Such conditions lead to an increased bone loss, which results in an increased risk of fractures. Bone resorption is primarily regulated by a member of the tumor necrosis factor family, receptor activator of nuclear factor κB ligand, which plays a central role in the development, function and survival of osteoclasts. Catabolic effects of this ligand is inhibited by another member of the tumor necrosis factor family, osteoprotegerin, which binds to the ligand and prevents its interaction with its receptor, the receptor activator of nuclear factor κB. Osteoclast activity is at least partly dependent on the relative balance of the ligand and osteoprotegerin. It has been shown in a number of animal models that inhibition of the ligand markedly decreases bone resorption and increases cortical and cancellous bone volume, density and strength, without having any significant effect on other organs. On the basis of these findings, inhibition of receptor activator of nuclear κB ligand is a promising therapy of conditions characterised by increased bone loss. In phase 3 clinical trials, denosumab therapy significantly increased bone mineral density at various regions of the skeleton and significantly decreased the levels of bone turnover markers compared with placebo and alendronate therapy, and significantly decreased the incidence of new vertebral, total hip and nonvertebral fractures compared with placebo. On the basis of these findings, denosumab therapy offers a novel, revolutionary solution for the treatment of postmenopausal osteoporosis.]

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LAM KID

[Current treatment and rehabilitation of the hip fractures - The role of orthopedic surgeons in the investigation and treatment of osteoporosis]

FLÓRIS István, KRICSFALUSY Mihály, UDVARDY Csaba, SOMOGYI Péter

[The treatment of proximal femoral fractures is one of the most common surgical indications in traumatology, on the other hand, it requires a significant proportion of health expenditures. The structure of our society is going to shift toward the older generation in the next decades, which increases the importance of the above factors. New implants and surgical techniques appear in order to make the treatment more effective, thus allowing the patient’s early rehabilitation. In this article, we summarise the diagnosis and treatment of hip fractures, the most serious consequence of osteoporosis, and describe the results of rehabilitation. We describe the role and possibilities of orthopedic surgeons in the investigation and treatment of patients with osteoporotic hip fractures as well as possibilities of tertiary prevention and suggest possibilities of cooperation among the co-professions dealing with osteoporosis in the treatment of this patient group.]

LAM KID

[Pain relief in the neurologist’s view]

KOMOLY Sámuel

[Pain, on the basis of its anatomical origin, can be nociceptive (somatic, visceral) or neuropathic, that is, occuring as a direct consequence of a lesion or disease affecting the somatosensory system. The past few years’ epidemiological studies showed that chronic neuropathic pain affects 7-8% of the general population. Diagnosis of neuropathic pain can be established without instrumental examinations, with the help of validated tests that can be used by any physician. Neuropathic pain greatly deteriorates the patients’ quality of life, and the effect of traditional analgesics is insufficient for its treatment. Thus, it is important to know those treatment procedures and drugs that have been proved to be efficient for relieving neuropathic pain.]

LAM KID

[Osteoid osteoma]

MAGYAR Péter, KOVÁCS Balázs

LAM KID

[Osteoporotic patient’s use of prescription drugs - pilot study]

BATKA Gábor, SZENTANDRÁSSY Andrea Éva, SZEKERES László

[BACKGROUND - In Hungary, the number of the highest mortality hip fractures is between 12 000-15 000 per year. The cost of treating hip fractures is several times higher than that of preventive medical therapy. Thus, the compliance of patients with osteoporosis is of great importance. METHODS - Using the informatical database of St. András Rheumatology Hospital at Héviz, we collected one year’s prescription drugs for osteoporosis and compared them with the number of drugs obtained by the patients, determined from National Health Insurance data. RESULTS - In general, the patients obtained 75% of prescription drugs. From the 4354 boxes of prescribed antiporotics, 3637 contained bisphosphonate (not considering vitamin D and calcium). Within this group, 88% of combination preparations were obtained, which is a greater ratio than that of non-combination bisphosphonates (84%). CONCLUSIONS - On the basis of our results, we posit that prescription of a combination preparation somewhat improves the patients’ compliance. The low concordance of vitamin D and calcium preparations is worrying.]

LAM KID

[A successful story of the science of bone metabolism in Hungary - Interview with István Marton, a founder of Hungarian Society of Osteoporosis and Osteoarthrology]

SZEKERES László

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[Bisphosphonates play a substantial role inthe treatment of postmenopausal osteo-porosis. Ibandronate is the first bisphos-phonate that can be used both orally andintravenously. A number of studies haveproved that ibandronate reduces boneturnover, increases bone mineral densityand reduces the risk of vertebral fractures.It is a well-known fact that the patients’adherence to oral medications is very poorthroughout the world. So far, very fewinternational studies have been performedon the patients’ compliance in medicinetaking. The BOUNCE study, carried out inseveral countries including Hungary tostudy the adherence of patients in the oralintake of ibandronate, aims to fill this gap.]

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[Bone metastases - Current treatment strategy]

BOÉR Katalin, NÉMETH Zsuzsanna

[Bone is the most common site of metastatic disease in many solid tumours, mainly in breast, prostate and lung cancer. Patients with bone metastases are at risk for skeletal-related events such as bone pain, pathological fractures requiring surgery and/or radiation to bone lesions, hypercalcemia, and spinal cord compression. Skeletal-related events are major source of morbidity for cancer patients and may be associated with negative impact on quality of life and survival. Bisphosphonates inhibit osteoclast function and are widely used in the treatment of malignant bone disease, as preventive therapy against skeletal-related events. Recently, the NF-κappa B-ligand (RANKL)-mediated osteoclast activity and this pathway in bone metabolism became a prime target for the treatment of bone metastases. The fi rst drug targeting the RANK-RANKL pathway is denosumab, a fully monoclonal human antibody which binds to RANKL and inhibits osteoclast activity. Nowadays optimal treatment of bone metastases requires multidisciplinary management of patients including the administration of bone-modifying agents such bisphosphonates or denosumab. The use of bone-targeted agents is a valuable additional treatment in the fi ght against bone metastases and multiple, randomised trials have demonstrated the effectivity of these drugs in reducing skeletal morbidity caused by advanced cancer.]

Ca&Bone

[Assessment of quality of life in postmenopausal women with osteoporosis - A comparative study on the Hungarian adaptations of EuroQoL and Nottingham Health Profile]

PÉNTEK Márta, LICKER-FÓRIS Edit, LOVAS Kornélia, KALÓ Zoltán, TÓTH Miklós, TULASSAY Zsolt, RATKÓ István, GENTI György

[INTRODUCTION - After a brief introduction to the definition of quality of life and the importance of its measurement, two questionnaires, the EQ-5D and the Nottingham Health Profile are presented. PATIENTS AND METHODS - Fifty postmenopausal women with osteoporosis were included in the two-year prospective study to assess quality of life by the two generic questionnaires. Correlations were sought between the results of the EQ-5D and the Nottingham Health Profile, as well as between bone fractures and changes in quality of life.The validated Hungarian version of the Nottingham Health Profile was applied for the first time in postmenopausal osteoporosis. RESULTS - With the treatments applied, quality of life dimensions did not change significantly during the follow-up period and no significant correlation was found between the incidence of bone fractures and changes in quality of life.The pain, physical mobility, emotional reactions and energy dimensions of the validated Hungarian Nottingham Health Profile and its derivated index showed significant correlations with those of the EQ-5D. CONCLUSION -The validated Hungarian version of the Nottingham Health Profile quality of life questionnaire is a useful and applicable measurement tool in postmenopausal osteoporosis which correlates with the EQ-5D health state measure.]