Clinical calcium
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The aim of osteoporosis treatment is to reduce fracture risk. Many kinds of anti-osteoporosis drugs are available in these days, and most of them increase bone mineral density and reduce the risk of fractures. Japanese 2011 guidelines for prevention and treatment of osteoporosis documents the recommendation level of each osteoporosis drugs. It is important to select drugs appropriate for each osteoporosis patient considering the mechanisms of drug action and their clinical efficiency.
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Oral bisphosphonates are the first class of drugs other than estrogen that have been proven to reduce fracture incidence substantially. Since they are agents that inhibit bone resorption and are hardly absorbed through intestine, researchers have been focusing on augmentation of inhibitory effects of bisphosphonates on bone resorption and prolongation of the interval of drug administration. Even though they have a break-through efficacy on preventing fractures, there remain some rare problems to be solved, such as osteonecrosis of the jaw and atypical femoral fracture, after long-term exposure to bisphosphonates.
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Parathyroid hormone (PTH) is clinically used as therapeutic agent for osteoporosis in Japan. However, the mechanisms for bone anabolic action of PTH are not fully understood. ⋯ Moreover, we identified Tmem119 as new osteoblast differentiation factor, which is involved in an increase inβ-catenin level by PTH in osteoblasts. Further understanding of Wnt-β-catenin signaling in the bone anabolic action by PTH may lead to the development of novel bone anabolic agent.
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Review
[Newly development of phosphate binders in hyperphosphatemic patients with kidney dysfunction].
Hyperphosphatemia is the most common complication among patients with chronic kidney disease. Large scale observational studies have identified hyperphosphatemia as an independent risk factor for cardiovascular disease and mortality in hemodialysis patients. ⋯ Thererfore, phosphate binders is necessary for many dialyzed patients with hyperphosphatemia. In this article, we will review the detail and development of phosphate binders and recommendation for clinical practice in hyperphosphatemia.
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Drug treatment for osteoporosis is intended to prevent osteoporotic fractures. Physicians should assess fracture risk in patients with diabetes not only by measuring bone mineral density (BMD) but also by taking a fracture history and evaluating prior vertebral fractures using spinal X-rays when starting drug therapy. ⋯ Thus, when DM patients have osteopenia, fracture risk could become higher than non-DM counterparts, and drug therapy should be considered to prevent fragility fractures. The criteria for starting drug treatment to prevent fragility fractures in DM patients, albeit tentative, are shown in this article.