Clinical calcium
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Glucocorticoid-induced osteoporosis is one of the most important side effects of glucocorticoid use, as it leads to an increased risk of fracture. The skeletal effects of glucocorticoids include both direct and indirect actions on bone that result in an early, transient increase in bone resorption accompanied by a decrease in bone formation, which is maintained for the duration of glucocorticoid therapy. ⋯ Bisphosphonates are the front-line choice for prevention of fracture in glucocorticoid-treated patients, with teriparatide as the second-line option ; calcium and vitamin D supplements should be co-prescribed in the majority of individuals. Fracture risk can be assessed using the FRAX(®) algorithm, although risk may be underestimated in patients taking higher doses of glucocorticoids.
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Dietary intake of phosphorus (Pi) is an important determinant of Pi balance in patients who have chronic kidney disease (CKD) and a reduced GFR. High dietary Pi burden may promote vascular calcification and cardiovascular events. ⋯ Accurate information on the Pi content of foods is needed to achieve a low Pi intake and effectively manage CKD and the aging. In this review, we discuss the risk of dietary Pi intake in CKD and the aging.
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Burden of osteoporosis in men on our society is increasing with aging in population. Prevalence of osteoporosis and incidence of osteoporotic fracture are less frequent in men than in women since bone mineral density is higher, bone size is greater, and hence the bone is stronger in men than in women. In spite of these facts, the number of male patients with osteoporosis was projected to be 3 million in 2005 and is increasing thereafter. ⋯ Once a man suffers from hip fracture, prognosis is worse in men than in women. However, screening methods for osteoporosis in men are not established, and this causes delay in diagnosis and treatment. Further studies are necessary to answer whether the current young adult value of bone density necessary for diagnosis is appropriate, whether therapeutic regimens are effective in men, whether the cost for diagnosis and treatment is comparable to benefit, whether a valid screening method for osteoporosis in men exists, and whether the screening method is cost-effective.
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A subchondral insufficiency fracture of the femoral head (SIF) is a recently proposed concept, which has generally been observed in elderly women with osteoporosis as well as in patients who have undergone a renal transplantation. In addition, this fracture is sometimes seen in young adults. ⋯ Therefore, the shape of the low intensity band generally tends to be irregular, disconnected, and convex to the articular surface. This finding has been considered to be useful for the differentiation with osteonecrosis.
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Recently choice of osteoporosis treatment drug in view of fracture healing is getting important because osteoporotic patients under treatment often suffer fragility fractures. Based on our results using animal fracture model, we reviewed radiological, histological and mechanical fracture healing process. Anti-resorptive agents, such as bisphosphonates, do not disturb fracture union and increase mechanical strength of fracture site by increased callus volume, however, they delay fracture healing process especially in restoration of original bony shape and quality in response to the extent of suppressed callus remodeling. In contrast, bone forming agents, such as PTH, shorten natural fracture healing process including restoration of original bony shape or bone quality due to acceleration of callus remodeling.