Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA
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Indian women from low-income groups consume diets that have inadequate calcium coupled with too few calories, proteins and micronutrients. Hospital-based data suggest that these women have osteoporotic hip fractures at a much earlier age than Western women. Studies reporting bone parameters of the Indian population involving large sample sizes are not available. ⋯ In the multiple regression analysis, apart from body weight, age, menopause and calcium intake were the other important determinants of BMD (P<0.05). In addition to these, height was also an important determinant of WB-BMC. This study highlights the urgent need for measures to improve the nutritional status, dietary calcium intake and thus the bone health of this population.
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Localized transient osteoporosis (LTO; bone marrow edema syndrome) is a rare disorder of generally unknown etiology that is characterized by acute onset of disabling bone pain. Treatment options are currently limited and largely ineffective. The locally increased bone turnover and low bone mineral density (BMD) typical of LTO indicate a potential role for bisphosphonate therapy. ⋯ The mean (SD) VAS score decreased from 8.4 (1.3) at baseline to 0.5 (0.7) at 6 months, at which time seven patients had achieved complete pain relief. At 6 months, mean lumbar spine BMD had increased by 4.0% (range -0.8 to 7.7%) in the overall population. I.v. ibandronate injection affords advantages over currently available oral and i.v. bisphosphonates and thus offers a promising therapeutic advance in the treatment of LTO.
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Comparative Study
Bone measures in HIV-1 infected children and adolescents: disparity between quantitative computed tomography and dual-energy X-ray absorptiometry measurements.
Investigators have found that dual-energy X-ray absorptiometry (DXA) of areal bone mineral density (BMD) values in HIV-1 infected children and adolescents are reduced. Volumetric bone density (BD) measured by quantitative computed tomography (CT) in this population has not been studied. This study was designed to evaluate bone measurements in HIV-1 infected children and adolescents using DXA and CT. ⋯ HIV-1 infected children and adolescents have lower vertebral and whole body BMC and BMD DXA measures. In contrast, vertebral BD measurements by CT are normal. The lower bone measurements were primarily due to the decreased bone and body size of the HIV-1 subjects.
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Review Meta Analysis
Effect of osteoporosis treatments on risk of non-vertebral fractures: review and meta-analysis of intention-to-treat studies.
Most osteoporosis treatments have proven efficacy in reducing the risk of vertebral fractures, whereas evidence is less straightforward for prevention of non-vertebral fractures. Conclusions as to the efficacy of a treatment should be based primarily on analyses of the intention to treat (ITT) population rather than on exploratory subgroup analyses; however, non-vertebral anti-fracture efficacy has been largely derived by post-hoc subgroup analyses. This review and meta-analysis was performed to assess non-vertebral anti-fracture efficacy of several osteoporosis therapies, including a more stringent assessment of the ITT populations. ⋯ Risedronate and strontium ranelate were the only treatments to show non-vertebral anti-fracture efficacy in this robust assessment of anti-fracture efficacy of osteoporosis therapy using ITT populations in trials of 3 years or more in duration. Risedronate was the only agent shown to demonstrate efficacy in more than one trial. Meta-analysis showed that both alendronate and risedronate provide non-vertebral anti-fracture efficacy.
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Evidence-based guidelines are increasingly used in the management of osteoporosis and have the potential to produce uniformly high standards of clinical care across different sectors of the health service. National guidelines for the prevention and treatment of osteoporosis are now available in a number of countries and, although sharing similarities, also differ in some respects. This review considers the challenges involved in the development and implementation of guidelines and proposes a paradigm for the unification of guidelines in the future.