Christian Meier

MD
Universität Basel · Endokrinologie, Diabetologie & Metabolismus

Publications

  • Nicole Nigro, Mirjam Christ-Crain, Christian Meier
    [show abstract] [hide abstract]
    ABSTRACT: The definition of late onset hypogonadism in the aging male is controversially debated, and according to the latest literature consists of at least three especially sexual symptoms such as loss of morning erection, low sexual desire and erectile dysfunction as well as a total testosterone < 8 - 11 nmol/l. Testosterone replacement therapy in the aging male has been shown to have a beneficial effect on muscle and fat mass as well as on bone mineral density, with more conflicting effects observed on muscle strength, sexual function, mood and quality of life. The prescriptions for testosterone products for the indication of the aging male were increased over 170 % in the previous 5 years. Furthermore, there are many epidemiological data showing an inverse relationship between testosterone levels and obesity, insulin resistance, the metabolic syndrome and type 2 diabetes mellitus. However, only few small randomized placebo-controlled studies have investigated the effect of testosterone replacement therapy on insulin resistance and HbA1c levels, with controversial results. Importantly, so far the long-term safety and efficacy of testosterone replacement therapy has not been established. Although until now no clear evidence was found that testosterone replacement therapy has a causative role in prostate cancer or indeed changes the biology of the prostate, in a recent meta-analysis a 4-fold increased risk of prostate-associated event rates in testosterone treated elderly men sounds a note of caution. Also the risk for cardiovascular events is still not clear and caution is warranted especially in elderly men with cardiovascular disease and limited mobility. In summary, the actual available evidence of long-term risks and outcome of testosterone replacement therapy is still very limited and carefully designed placebo-controlled trials of testosterone administration to assess the risks and benefits of such a therapy are required. Until then, testosterone treatment in elderly men should be restricted to elderly men with clearly low testosterone levels in the presence of clinical symptoms and advantages and disadvantages need to be accurately weighted. A careful monitoring of potential side effects is necessary.
    Therapeutische Umschau 04/2014; 71(4):229-37.
  • [show abstract] [hide abstract]
    ABSTRACT: Based on this double-blind, placebo-controlled study, ibandronate has no beneficial effect on clinical and radiological outcome in patients with spontaneous osteonecrosis of the knee over and above anti-inflammatory medication. Observational studies suggest beneficial effects of bisphosphonates in spontaneous osteonecrosis (ON) of the knee. We investigated whether ibandronate would improve clinical and radiological outcome in newly diagnosed ON. In this randomized, double-blind, placebo-controlled trial, 30 patients (mean age, 57.3 ± 10.7 years) with ON of the knee were assigned to receive either ibandronate (cumulative dose, 13.5 mg) or placebo intravenously (divided into five doses 12 weeks). All subjects received additional treatment with oral diclofenac (70 mg) and supplementation with calcium carbonate (500 mg) and vitamin D (400 IU) to be taken daily for 12 weeks. Patients were followed for 48 weeks. The primary outcome was the change in pain score after 12 weeks. Secondary endpoints included changes in pain score, mobility, and radiological outcome (MRI) after 48 weeks. At baseline, both treatment groups (IBN, n = 14; placebo, n = 16) were comparable in relation to pain score and radiological grading (bone marrow edema, ON). After 12 weeks, mean pain score was reduced in both ibandronate- (mean change, -2.98; 95 % CI, -4.34 to -1.62) and placebo- (-3.59; 95 % CI, -5.07 to -2.12) treated subjects (between-group comparison adjusted for age, sex, and osteonecrosis type, p = ns). Except for significant decrease in bone resorption marker (CTX) in ibandronate-treated subjects (p < 0.01), adjusted mean changes in all functional and radiological outcome measures were comparable between treatment groups after 24 and 48 weeks. In patients with spontaneous osteonecrosis of the knee, bisphosphonate treatment (i.e., IV ibandronate) has no beneficial effect over and above anti-inflammatory medication.
    Osteoporosis International 11/2013; · 4.04 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Endocrine disorders are common in internal medicine. Diagnosis of endocrine diseases are usually based on patient history, clinical assessment and laboratory investigations. Thereby, biochemical analyses are used to confirm clinical diagnosis, to assess the need for treatment and to monitor disease progression, in particular to ascertain treatment efficacy. This article will focus on frequently used laboratory investigations for endocrine diseases such as diabetes, thyroid dysfunction, male hypogonadism and adrenal insufficiency. In particular, pre-analytical and analytical variability of biochemical measures as well as its significance in clinical practice will be discussed.
    Therapeutische Umschau 08/2013; 70(8):481-9.
  • [show abstract] [hide abstract]
    ABSTRACT: BACKGROUND: Intravenous bisphosphonates are widely used for treatment of postmenopausal osteoporosis. They are associated with transient influenza-like symptoms, predominantly after the first zoledronic acid (up to 32 %) or ibandronate (up to 5 %) administration. The experience in clinical practice suggests that the incidence of post-dose symptoms is higher than has been reported in clinical trials. We assessed the safety of annual infusions of zoledronic acid and 3-monthly injections of ibandronate in women with postmenopausal osteoporosis. METHODS: In this retrospective study we analysed safety data from 272 postmenopausal women treated with zoledronic acid (n = 127; mean age 68.6 ± 9.4 years) or intravenous (IV) ibandronate (n = 145; mean age 69.1 ± 9.0 years). Safety data (including occurrence of acute-phase reactions and osteonecrosis of the jaw) were gathered in phone call interviews by using a standardized questionnaire. RESULTS: The number of patients with adverse events was significantly higher in zoledronic acid as compared to ibandronate-treated patients, primarily because of a larger number of post-dose symptoms after bisphosphonate administrations (54.3 % vs. 33.1 %, p < 0.001). Except for occurrence of fever (more common after zoledronic acid infusion), other influenza-like symptoms (myalgia, arthralgia, headache) appeared in a similar proportion of patients after IV treatment (within 24-36 h). Symptoms lasted for >3 days in approximately 50 % of patients. The incidence of symptoms decreased after subsequent infusions. The rate of influenza-like symptoms was more frequent after zoledronic acid than after IV ibandronate in bisphosphonate-naïve patients but comparable in patients pretreated with oral bisphosphonates. There were no spontaneous reports of osteonecrosis of the jaw, arrhythmia or delayed fracture healing. CONCLUSION: Although IV bisphosphonates are generally safe, the occurrence of transient influenza-like symptoms after IV bisphosphonates seems to be more frequent in clinical practice than has been reported in clinical trials.
    Clinical Drug Investigation 11/2012; · 1.92 Impact Factor
  • Christian Meier, Marius E Kraenzlin
    [show abstract] [hide abstract]
    ABSTRACT: A paradigm change is taking place in the diagnosis of osteoporosis - away from the overemphasis on bone mineral density (BMD) as the sole gauge of need for diagnosis and treatment towards a comprehensive risk assessment of all the components of increased bone fragility. The main risk factors, and thereby reasons for further diagnostics, are previous non-traumatic vertebral and non-vertebral fractures, long-term glucocorticoid therapy, low body weight, increased risk of fall, and disorders associated with an increased fracture risk. The indication for osteoporosis therapy is based on the individual fracture risk and should not be based purely on a single BMD value. Monitoring the effectiveness of osteoporosis treatment presents a challenge in everyday clinical practice. As an alternative to fracture incidence, surrogate markers (BMD, biochemical markers of bone turnover) can be used to assess effectiveness of treatment in the individual patient. Correct employment and interpretation of surrogate markers in osteoporosis therapy requires knowledge of pre-analytical and analytical factors which co-determine the measurement methods. The purpose of this overview is to examine the possibilities of clinical investigation, BMD measurement and determination of bone turnover markers for the evaluation of therapeutic response.
    Therapeutische Umschau 03/2012; 69(3):145-52.
  • [show abstract] [hide abstract]
    ABSTRACT: The objective of this study was to explore the association between use of metformin or other antidiabetic drugs, diabetes, and the risk of pancreatic cancer. We conducted a case-control study using the UK-based General Practice Research Database (GPRD). Cases had a first-time diagnosis of pancreatic cancer, and six controls per case were matched on age, sex, calendar time, general practice, and number of years of active history in the GPRD before the index date. Results were further adjusted in multivariate logistic regression analyses for potential confounders such as body mass index, smoking, alcohol consumption, and diabetes duration. In all, 2,763 case patients with a recorded diagnosis of pancreatic cancer were identified. Mean age ± s.d. was 69.5 ± 11.0 years. Long-term use (≥ 30 prescriptions) of metformin was not associated with a materially altered risk of pancreatic cancer (adjusted odds ratio (adj. OR): 0.87, 95% confidence interval (CI): 0.59-1.29), but there was a suggestion of effect modification by gender, as long-term use of metformin was linked to a decreased risk in women (adj. OR: 0.43, 95% CI: 0.23-0.80). Both use of sulfonylureas (≥ 30 prescriptions, adj. OR: 1.90, 95% CI: 1.32-2.74) and of insulin (≥ 40 prescriptions, adj. OR: 2.29, 95% CI: 1.34-3.92) were associated with an increased risk of pancreatic cancer. Use of metformin was associated with a decreased risk of pancreatic cancer in women only, whereas use of sulfonylureas and of insulin was associated with an increased risk of pancreatic cancer.
    The American Journal of Gastroenterology 01/2012; 107(4):620-6. · 7.55 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: To explore the association between use of metformin or other antidiabetic drugs and the risk of colorectal cancer. Using the United Kingdom-based General Practice Research Database (GPRD), we conducted a nested case-control analysis in patients with diabetes mellitus. Cases had an incident diagnosis of colorectal cancer, and up to 6 controls per case were matched on age, sex, calendar time, general practice, and number of years of active history in the GPRD prior to the index date. Results were adjusted for multiple potential confounders. We identified 920 diabetic patients with colorectal cancer. Mean age ± SD was 70.2 ± 8.6 years and 63.3% were male. Extensive use (≥50 prescriptions) of metformin was associated with a slightly increased risk of colorectal cancer (adjusted OR = 1.43, 95% CI: 1.08-1.90) as compared with non use, with an adjustment of OR = 1.81 (95% CI: 1.25-2.62) in men and of 1.00 (95% CI: 0.63-1.58) in women. Neither extensive use of sulfonylureas (adjusted OR = 0.79, 95% CI: 0.60-1.03) nor insulin (adjusted OR = 0.90, 95% CI: 0.63-1.28) were associated with an increased risk of colorectal cancer. A long-term history of diabetes (>10 years) was not associated with a materially increased risk of colorectal cancer compared with short-term diabetes duration (<2 years; adjusted OR = 1.14, 95% CI: 0.90-1.46). Use of metformin was linked to an increased risk of colorectal cancer in men. Use of sulfonylureas or insulin was not associated with an altered risk of colorectal cancer. Impact: Metformin does not prevent colorectal cancer.
    Cancer Epidemiology Biomarkers &amp Prevention 12/2011; 21(2):280-6. · 4.56 Impact Factor
  • Source
    Christian Meier, Marius E Kraenzlin
    [show abstract] [hide abstract]
    ABSTRACT: In recent years there has been increasing evidence suggesting that epilepsy and its treatment can have adverse effects on bone mineralization and calcium metabolism. Many studies have shown a significant reduction in bone mineral density (BMD) and an increased fracture risk in patients treated with enzyme-inducing antiepileptics (phenobarbital, carbamazepine, phenytoin). It is assumed that CYP450-inducing antiepileptic drugs (AEDs) upregulate the enzymes which are responsible for vitamin D metabolism, with the effect of converting 25(OH) vitamin D into inactive metabolites, resulting in reduced calcium absorption with consecutive secondary hyperparathyroidism. Data on bone-specific effects of newer AEDs are limited; nevertheless, alterations of bone metabolism have been reported for oxcarbazepine, gabapentin and, in preclinical studies, for levetiracetam. Prophylactic administration of adequate amounts of calcium and vitamin D is recommended for all patients. For patients with long-term AED exposure, BMD measurement is recommended as part of osteoporosis investigation (especially for patients treated with enzyme-inducing AEDs and where there are major risk factors for fractures). Drug therapy (bisphosphonates) is reserved for the treatment of patients who have a high fracture risk; there are no specific intervention studies available in patients with epilepsy.
    Therapeutic advances in musculoskeletal disease 10/2011; 3(5):235-43.
  • [show abstract] [hide abstract]
    ABSTRACT: To explore the association between use of metformin or other antidiabetic drugs and the risk of ovarian cancer. Using the UK-based General Practice Research Database, we conducted a case-control analysis to evaluate whether users of metformin or other antidiabetic drugs had an altered risk of ovarian cancer. Cases had an incident diagnosis of ovarian cancer, and up to 6 controls per case were matched on age, sex, calendar time, general practice, and number of years of active history in the GPRD prior to the index date. Results were further adjusted by multivariate logistic regression analyses for BMI, polycystic ovaries, endometriosis, use of estrogens or oral contraceptives, a history of hysterectomy, and smoking. We identified 1611 case patients with a recorded diagnosis of ovarian cancer. Mean age ± SD was 61.2 ± 13.1 years at the time of cancer diagnosis. Long-term use (≥ 30 prescriptions) of metformin, but not of sulfonylureas, was associated with a tendency towards a reduced risk of ovarian cancer (OR 0.61, 95% CI 0.30-1.25 for metformin and 1.26, 95% CI 0.65-2.44 for sulfonylureas). Long-term use of insulin (≥ 40 prescriptions) was associated with a slightly increased risk for ovarian cancer (OR 2.29, 95% CI 1.13-4.65). In this large epidemiological study long-term use of metformin, but not of sulfonylureas, was associated with a tendency towards a decreased risk of ovarian cancer. Long-term use of insulin was associated with an increased risk of ovarian cancer.
    Gynecologic Oncology 07/2011; 123(2):200-4. · 3.93 Impact Factor
  • Marius E Kraenzlin, Christian Meier
    [show abstract] [hide abstract]
    ABSTRACT: Osteoporosis is characterized by the occurrence of fragility fractures. Over the past years, various treatment options have become available, mostly antiresorptive agents such as bisphosphonates. However, antiresorptive therapy cannot restore bone mass and structure that has been lost due to increased remodeling. In this case, recombinant human parathyroid hormone (PTH) analogues-the full-length PTH(1-84) or the shortened molecule PTH(1-34), which is also known as teriparatide-present the possibility of increasing the formation of new bone substance by virtue of their anabolic effects. The bone formation induced by PTH analogues not only increases BMD or bone mass but also improves the microarchitecture of the skeleton, thereby leading to improved strength of bone and increased mechanical resistance. Controlled trials have shown that both analogues significantly reduce the incidence of vertebral fractures, and PTH(1-34) also reduces the risk of nonvertebral fractures. The need for daily self-injection and the higher cost compared with other forms of treatment limit the widespread use of PTH analogues. Nevertheless, treatment with PTH analogues should be considered in postmenopausal women and men with severe osteoporosis, as well as in patients on established glucocorticoid treatment with a high fracture risk. Concurrent therapy with antiresorptive agents should be avoided, but sequential therapy with these agents might consolidate the beneficial effects on the skeleton.
    Nature Reviews Endocrinology 07/2011; 7(11):647-56. · 11.03 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Primary hyperparathyroidism is frequently an incidental finding in asymptomatic patients. Often the diagnosis of primary hyperparathyroidism is made in evaluation for osteoporosis, rarely in the context of hypercalcemic crisis, myopathy, kidney stones, nephrocalcinosis, and osteitis fibrosa. The most frequent cause for primary hyperparathyroidism is benign parathyroid adenoma, reminders have hyperplasia. Primary hyperparathyroidism is defined as hypercalcemia with inappropriately high parathyroid hormone levels. Surgery is the definitive treatment for patients with symptomatic primary hyperparathyroidism and asymptomatic patients, who meet one of the following criteria: serum calcium>0.25 mmol/L (1.0 mg/dl) above the accepted normal reference range, renal failure (GFR<60 ml/min) and presence of osteoporosis (T-score<-2.5 or fracture). Parathyroidectomy should be performed by an experienced surgeon. As an alternative in inoperable patients or preoperatively in severe hypercalcemia cinacalcet successfully reduces calcium levels. In asymptomatic patients not meeting the above mentioned criteria serum calcium and creatinin levels should be measured once a year and DXA every two years, since 30% of the patients with asymptomatic primary hyperparathyroidism are progressive.
    Therapeutische Umschau 06/2011; 68(6):321-6.
  • Christian Meier, Marius E Kränzlin
    [show abstract] [hide abstract]
    ABSTRACT: Adequate intakes of calcium and vitamin D are essential preventive strategies and essential parts of any therapeutic regimen for osteoporosis. However, calcium supplementation is not without controversy and benefits on skeletal health need to be balanced against potential risks on cardiovascular disease. The published data so far suggest a potential detrimental effect of calcium supplement on cardiovascular health (i.e. myocardial infarction) although further prospective studies are needed to clarify the gradient of risk. Since food sources of calcium produce similar benefits on bone density as supplements and dietary calcium intake does not seem to be related with adverse cardiovascular effects, calcium intake from nutritional sources needs to be enforced. In patients with low calcium intake supplements are warranted aiming for a total calcium intake of 800 to 1000 mg/d together with adequate vitamin D replacement. Nevertheless we should keep in mind that for significant reduction in fracture risk, pharmacological treatment is mandatory in patients at risk of fractures irrespective of calcium and vitamin D supplementation.
    Schweizerische medizinische Wochenschrift 01/2011; 141:w13260. · 1.68 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Depot medroxyprogesterone acetate (DMPA), which has a high rate of use among teenagers in Europe and the United States, has been associated with impaired bone mineral acquisition during adolescence and accelerated bone loss in later life. Studies on the association between DMPA use and fracture risk are limited. We aimed at evaluating the relationship between use of hormonal contraceptives, specifically DMPA, and fracture risk. We conducted a case-control analysis using the United Kingdom-based General Practice Research Database. Participants were females aged 20-44 yr with an incident fracture diagnosis between 1995 and 2008. Odds ratios (OR) with 95% confidence intervals (CI) of incident fracture in relation to exposure to DMPA or combined oral contraceptives were assessed. Adjustments were made for smoking, body mass index, and additional potential confounders. We identified 17,527 incident fracture cases and 70,130 control patients (DMPA exposure: 11 and 8%, respectively). Compared with nonuse, current use of one to two, three to nine, or 10 or more DMPA prescriptions yielded adjusted OR for fractures of 1.18 (95% CI = 0.93-1.49), 1.36 (95% CI = 1.15-1.60), and 1.54 (95% CI = 1.33-1.78), respectively. Fracture risk was highest after longer treatment duration (>2-3 yr), and there was no difference in patients below and above the age of 30 yr. For users of combined estrogen-containing oral contraceptives, the OR were around 1. This population-based study suggests that use of DMPA is associated with a slightly increased risk of fractures.
    The Journal of clinical endocrinology and metabolism 11/2010; 95(11):4909-16. · 6.50 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Fracture is a major contributor to human morbidity and mortality, especially in the elderly. It has been discussed in the literature that conditions associated with decreased stomach acidity may lead to a decrease in intestinal calcium absorption and, consequently, to an increased fracture risk. In recent years, several observational studies reported a slightly increased fracture risk in association with the use of proton pump inhibitors (PPIs) and/or histamine H(2) receptor antagonists. It was the objective of this review to critically assess the available evidence linking PPI use to an increased fracture risk. A MEDLINE and EMBASE search from 1960 to June 2010 was performed to identify the relevant articles using predefined search terms. Because (i) there is no proven mechanism, (ii) the reported magnitude of the risk elevation associated with the use of PPIs was only weak, and (iii) the likelihood of residual confounding despite adjustment for known co-morbidities and drug use cannot be ruled out, we conclude that the currently available literature does not support the notion that the use of PPIs is causally related to a materially increased fracture risk in humans.
    Drug Safety 10/2010; 33(10):843-52. · 3.41 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Osteonecrosis (ON) in the knee occurs as a localized inflammatory disease in relation to spontaneous or non-traumatic ON. Conservative treatment possibilities are limited, and prognosis appears to be poor; in most cases, ON results in knee arthroplasty. Bisphosphonates are suggested to prevent bone resorption and collapse of necrotic bone. In this observational, prospective study we investigated the effect of bisphosphonate treatment in patients with spontaneous or arthroscopy-induced ON of the knee. Twenty-eight patients with osteonecrotic lesions and bone marrow oedema in the knee were included. In 22 patients (80%), ON was identified after arthroscopic surgery of the knee; six patients were diagnosed with spontaneous ON. Patients were initially given pamidronate 120 mg i.v. divided in 3-4 perfusions over 2 weeks, followed by oral bisphosphonate treatment with alendronate 70 mg weekly for 4-6 months. Bisphosphonate treatment resulted in a rapid pain relief, VAS decreasing from 8.2 ± 1.2 at baseline to 5.02 ± 0.6 after 4-6 weeks (p < 0.001). After 6 months, the VAS decreased by 80% (p < 0.001). At the 6-month follow-up, symptoms had resolved completely in 15 patients out of 28; in 6 patients, minimal symptoms (VAS 1-2) remained. In two patients, treatment effect was unsatisfactory, and surgical intervention was needed (arthroplasty). Bone marrow oedema on MRI resolved completely in 18 patients out of 28 with substantial reduction in the remaining. Furthermore, osteonecrotic area resolved completely or demarcation with sclerotic changes of the necrotic area could be observed. Bisphosphonate treatment in patients with osteonecrosis of the knee was associated with a rapid improvement in pain score and radiological consolidation of the area of osteonecrosis. Further randomized, controlled trials are warranted to confirm the potential beneficial role of bisphosphonates in the treatment of osteonecrosis of the knee. Level of evidence: observational study, level IV.
    Knee Surgery Sports Traumatology Arthroscopy 04/2010; 18(12):1638-44. · 2.68 Impact Factor
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: To evaluate whether use of oral hypoglycemic agents is associated with an altered breast cancer risk in women. Using the U.K.-based General Practice Research Database, we conducted a nested case-control analysis among 22,621 female users of oral antidiabetes drugs with type 2 diabetes. We evaluated whether they had an altered risk of breast cancer in relation to use of various types of oral hypoglycemic agents. Case and control patients with a recorded diagnosis of type 2 diabetes were matched on age, calendar time, and general practice, and the multivariate conditional logistic regression analyses were further adjusted for use of oral antidiabetes drugs, insulin, estrogens, smoking BMI, diabetes duration, and HbA1c (A1C). We identified 305 case patients with a recorded incident diagnosis of breast cancer. The mean +/- SD age was 67.5 +/- 10.5 years at the time of the cancer diagnosis. Long-term use of >or=40 prescriptions (>5 years) of metformin, based on 17 exposed case patients and 120 exposed control patients, was associated with an adjusted odds ratio of 0.44 (95% CI 0.24-0.82) for developing breast cancer compared with no use of metformin. Neither short-term metformin use nor use of sulfonylureas or other antidiabetes drugs was associated with a materially altered risk for breast cancer. A decreased risk of breast cancer was observed in female patients with type 2 diabetes using metformin on a long-term basis.
    Diabetes care 03/2010; 33(6):1304-8. · 7.74 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: The long-term result of imbalances in bone turnover (i.e., osteoblastic bone formation and osteoclastic bone resorption) is a change in bone mass, strength, and structure, and ultimately may lead to osteoporosis and fragility fractures. In recent years, considerable progress has been made in the isolation and characterization of cellular and extracellular components of the skeletal matrix, which in turn have facilitated the development of biochemical markers that specifically reflect either bone formation or bone resorption. These biochemical indices are non-invasive, comparatively inexpensive, and, when applied and interpreted correctly, helpful tools in the diagnostic and therapeutic assessment of metabolic bone disease. In clinical practice, bone turnover markers have been shown to predict the risk for fractures, independent from BMD. Furthermore, bone markers may be useful for monitoring anti-osteoporotic treatment in order to evaluate treatment efficacy and patients’ compliance. In contrast, however, bone markers cannot be used for diagnosis of osteoporosis. The following chapter will give an overview on these clinical aspects of bone turnover markers; the basic biochemistry of bone markers and sources of their non-specific variability are reviewed in Chapter 5. Key WordsBone turnover marker-monitoring-antiresorptive treatment-bone loss-fracture risk-compliance
    01/2010: pages 131-155;
  • Markus J. Seibel, Christian Meier
    [show abstract] [hide abstract]
    ABSTRACT: Disorders of bone and mineral metabolism are frequent and constitute an important part of everyday clinical practice. Consequently, there is a need for effective measures to be used in the screening, diagnosis, and follow-up of such pathologies. Together with clinical and imaging techniques, biochemical markers of bone metabolism and other laboratory tests offer useful assistance in the assessment and differential diagnosis of metabolic bone disease. In recent years, the isolation and characterization of cellular and extracellular components of the skeletal matrix have resulted in the development of molecular markers that are considered to reflect either bone formation or bone resorption. These biochemical indices are non-invasive, comparatively inexpensive and, when applied and interpreted correctly, helpful tools in the assessment of metabolic bone disease. The following chapter provides an overview of the basic biochemistry of “bone markers” and sources of their non-specific variability. The clinical use of these markers in osteoporosis will be reviewed in Chapter 6. Key WordsBone metabolism-phosphatase-osteocalcin-propeptide-cross-links-sialoprotein-collagen-osteoblast-osteoclast-bone formation-bone resorption-variability
    01/2010: pages 97-130;
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: Procalcitonin has been well established as an important marker of sepsis and systemic infection. The authors evaluated the diagnostic and predictive value of calcitonin and its prohormone procalcitonin in medullary thyroid cancer. The authors systematically explored the ability of calcitonin and procalcitonin to identify medullary thyroid cancer and predict the endpoints local recurrence and distant metastases, as well as the progression-free survival. Patients with C-cell hyperplasia; patients after thyroidectomy for differentiated thyroid cancer, goiter, or Graves disease; and healthy subjects served as controls. The study was performed in accordance with the Reporting Recommendations for Tumor Marker Prognostic Studies of the National Cancer Institute. Sixty-nine medullary thyroid cancer patients and 96 controls were included (median observed interval: 10.9 years [range, 1.4-47.5 years]; 981.8 patient-years). The 1-year, 5-year, 10-year, and 20-year recurrence rates were 9%, 34%, 45%, and 56%, respectively. Calcitonin had a higher diagnostic accuracy for detecting medullary thyroid cancer than procalcitonin (area under the curve [AUC], 0.94; 95% confidence interval [95% CI], 0.90-0.99 vs AUC, 0.89; 95% CI, 0.83-0.95 [P = .038]). The procalcitonin:calcitonin ratio predicted disease progression (AUC, 0.63; 95% CI, 0.51-0.75 [P = .036]) and progression-free survival (hazards ratio, 1.49; 95% CI, 1.09-2.04 [P = .013]). The results of the current study indicate a superior diagnostic accuracy of calcitonin and an independent predictive value of the procalcitonin:calcitonin ratio. These findings may lead to improved diagnostic and therapeutic strategies for medullary thyroid cancer patients.
    Cancer 11/2009; 116(1):31-40. · 5.20 Impact Factor
  • Christian Meier
    [show abstract] [hide abstract]
    ABSTRACT: Osteoporosis is a generalized disease of bone that increases the fracture risk. Among the multiple factors involved in osteoporosis, some, but not all, are related to bone mass. Although bone mineral density (BMD) measurement is specific for detecting high-risk individuals, it misses a notable proportion of individuals who have clinical or epidemiological risk factors for osteoporotic fractures. Therefore, composite scores that rely both on BMD and on validated clinical risk factors have been developed. The Fracture Risk Assessment Tool (FRAX) was designed to predict the 10-year probabilities of sustaining a major osteoporotic fractures or a hip fracture. The cutoff value beyond which treatment should be initiated needs to be determined, based not only on clinical criteria, but also on economic considerations.
    Praxis 10/2009; 98(20):1141-7.

56 Following View all

58 Followers View all