Increasing Options for the Treatment of Osteoporosis

From the Endocrine Research Unit, College of Medicine, Mayo Clinic, Rochester, MN.This article (10.1056/NEJMe0905480) was published on August 11, 2009, at
New England Journal of Medicine (Impact Factor: 55.87). 09/2009; 361(8):818-20. DOI: 10.1056/NEJMe0905480
Source: PubMed
1 Read
    • "In 2009, the Food and Drug Administration has approved the annual injection of zoledronic acid for the prevention of osteoporosis in menopausal populations (Khosla 2009). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To evaluate the 3-year clinical and radiographic data of fixed implant-supported dental prosthesis delivered to patients having taken alendronate 35–70 mg weekly for at least 3 years before implant placement. Materials and Methods: Forty consecutive patients treated with oral bisphosphonates and requiring an implant-supported restoration were recruited in two private centers between January 2008 and December 2011. Implants were inserted through minimally invasive approach under antibacterial and antibiotic treatment, 6 months after alendronate administration stopping. After 4 months of submerged healing, implants underwent prosthetic loading. Hygiene maintenance and clinical assessments were scheduled every 4 months for 3 years. Outcome measures were the following: implant and prosthetic success, survival rates, any observed clinical complications, marginal bone remodeling, probing pocket depth and bleeding-on-probing. Results: At the end of the study, eight patients dropped out. The final sample size resulted in 32 consecutive partially or fully edentulous patients (32 females; mean age 64.6 years) with 98 submerged implants. In only one patient, maxillary implant failed during healing period. No prosthesis failed during the entire follow-up, and no major complications were recorded. Implant and prostheses success resulted in an overall survival rate of 98, 98% and 100%, respectively. Three-year mean marginal bone loss was 1.35 � 0.21 (CI 95% 1.24–1.38). Successful soft tissue parameters were found around all implants. Conclusions: Oral bisphosphonate therapy did not appear to significantly affect implant survival and success in case of accurate treatment time selection, minimally invasive surgical approach and constant follow-up. Further prospective studies involving larger sample sizes and longer durations of follow-up are required to confirm these results.
    Clinical Oral Implants Research 07/2015; DOI:10.1111/clr.12662 · 3.89 Impact Factor
  • Source
    • "We carefully selected sites of fractures that would be expected to be related to AI-associated bone loss, specifically those in the spine, forearm, humerus and proximal femur/hip, which would be considered fragility fractures. All reports of new fractures were reviewed by a team of investigators that included a recognized authority on bone health, Dr Khosla30 from Mayo clinic. We identified patients in these categories who had banked DNA and consented to genetic testing and, after strict quality control, we utilized 231 patients in our analyses. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The most important modality of treatment in the two-thirds of patients with an estrogen receptor (ER)-positive early breast cancer is endocrine therapy. In postmenopausal women, options include the selective ER modulators (SERMs), tamoxifen and raloxifene, and the 'third-generation' aromatase inhibitors (AIs), anastrozole, exemestane and letrozole. Under the auspices of the National Institutes of Health Global Alliance for Pharmacogenomics, Japan, the Mayo Clinic Pharmacogenomics Research Network Center and the RIKEN Center for Genomic Medicine have worked collaboratively to perform genome-wide association studies (GWAS) in women treated with both SERMs and AIs. On the basis of the results of the GWAS, scientists at the Mayo Clinic have proceeded with functional genomic laboratory studies. As will be seen in this review, this has led to new knowledge relating to endocrine biology that has provided a clear focus for further research to move toward truly personalized medicine for women with breast cancer.Journal of Human Genetics advance online publication, 2 May 2013; doi:10.1038/jhg.2013.35.
    Journal of Human Genetics 05/2013; 58(6). DOI:10.1038/jhg.2013.35 · 2.46 Impact Factor
  • Source
    • "As ONJ and atypical femoral subtrochanteric fracture associated with long-term bisphosphonate use are rare, there might be an advantage (albeit small, given the rarity of these events) to the use of denosumab. Moreover, since bisphosphonates are cleared by the kidney and contraindicated in patients with renal insufficiency, denosumab (which is cleared by non-renal metabolism) may prove to be a safe drug in these patients, although studies that directly address this issue need to be done.91 "
    [Show abstract] [Hide abstract]
    ABSTRACT: Denosumab is a breakthrough biological drug approved by the Food and Drug Administration and European Medicines Agency for the treatment of osteoporosis in 2010. It is a fully human monoclonal antireceptor activator of nuclear factor kappa-B ligand antibody, which inhibits the activity of osteoclasts, resulting in an antiresorptive effect with a significant increase in bone mineral density. The FREEDOM (Fracture Reduction Evaluation of Denosumab in Osteoporosis every 6 Months) trial, comparing denosumab with no treatment in 7868 women with postmenopausal osteoporosis, showed an important reduction of fracture risk at hip, vertebral, and nonvertebral sites in the treated group, while no statistically significant difference in the incidence of adverse events was detected between denosumab and placebo groups. The specific action of denosumab directed against a key regulator of osteoclasts makes it a valuable tool in preventing the occurrence of skeletal events caused by bone destruction in patients with advanced malignancies. The drug was approved for postmenopausal osteoporosis in women at increased risk of fracture and for the treatment of bone loss associated with androgen deprivation therapy in men with prostate cancer.
    Therapeutics and Clinical Risk Management 06/2012; 8:253-66. DOI:10.2147/TCRM.S7688 · 1.47 Impact Factor
Show more