Clinical calcium
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Minodronic acid hydrate is one of the new-generation bisphosphonates containing nitrogen. This drug has an inhibitory effect on bone resorption by suppressing the osteoclastic function, and it is being developed as a therapeutic drug of osteoporosis. In non-clinical study, the drug has an inhibitory effect on the decrease of the bone mineral density and the bone intensity in ovariectomized rat osteoporosis models. ⋯ The other study conducted that minodronic acid hydrate increases the bone mineral density at least equivalent to that of alendronate for 48 weeks. The safety analysis in the latest study revealed that the adverse events of minodoronic acid hydrate have no statistically significant differences from the placebo group. We expect that minodronic acid hydrate will be used for a number of patients with osteoporosis as a potent and safe domestically created bisphosphonate in the near future.
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Osteoporosis has been successfully treated with anti-resorptive agents. Estrogen, ever regarded as the gold standard in the treatment of osteoporosis, has now been considered as one of the second line agents. ⋯ It has been established that BMD increase is not the primary factor on the prevention of vertebral fracture, but BMD increases seem to be critical to reduce the risk of non-vertebral fractures by anti-resorptive agents. Efficacy of combination of anti-resorptive agents with different action mechanisms such as bisphosphonates and raloxifene has not yet been established whether the combination further reduces the risk of non-vertebral fractures.
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Recently the relationship of vitamin D insufficiency and fracture is noticed in elderly people. Vitamin D nutritional status is evaluated by measuring serum 25 (OH) D. ⋯ This suggests that vitamin D insufficiency is one of fracture risk factor and improvement of vitamin D status reduce fracture risk. With the results of recent studies, we would like to discuss about fractures from the viewpoint of vitamin D insufficiency.
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Review
[Guidelines for the treatment of glucocorticoid-induced osteoporosis and their future problems].
Osteoporosis is the most frequent adverse effect of glucocorticoids. Management guidelines for glucocorticoid-induced osteoporosis have been established in the United States, the United Kingdom, and many other countries. ⋯ The criterion for starting treatment was patients with prior fragility fracture and with new fractures during treatment, patients with less bone mineral density (BMD) than 80% of young adult mean, and patients with using as a dose of 5mg/day or higher (mean daily dose) as prednisolone equivalent. The bisphosphonates have been recommended as first-line drugs and active vitamin D(3) and vitamin K(2) have been recommended as second-line drugs.
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There are several lines of evidence about the effectiveness of parathyroid hormone (PTH) as a bone anabolic reagent for the treatment of osteoporosis, and the large-scale randomized controlled trial revealed that PTH increases and reduces lumbar spine bone mineral density and fracture risk, respectively, more potently than other inhibitors for bone resorption. Moreover, alendronate was useful for the further increase in bone mineral density after the withdrawal of PTH treatment, and the combined treatment of PTH and raloxifene was additive. On the other hand, strontium ranelate significantly inhibited osteoporotic fractures in randomized placebo controlled trial, which is expected as a new bone anabolic reagent for osteoporosis.