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Karine Briot,
Bernard Cortet,
Thierry Thomas,
Maurice Audran,
Hubert Blain,
Véronique Breuil,
Laure Chapuis,
Roland Chapurlat,
Patrice Fardellone,
Jean-Marc Feron,
Jean-Bernard Gauvain,
Pascal Guggenbuhl,
Sami Kolta,
Eric Lespessailles,
Brigitte Letombe, Christian Marcelli,
Philippe Orcel,
Patrick Seret,
Florence Trémollières,
Christian Roux
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ABSTRACT: To update the evidence-based position statement published by the French National Authority for Health (HAS) in 2006 regarding the pharmacological treatment of postmenopausal osteoporosis, under the auspices of the French Society for Rheumatology and Groupe de Recherche et d'Information sur les Ostéoporoses (GRIO), and with the participation of several learned societies (Collège National des Gynécologues et Obstétriciens Français, Groupe d'Étude de la Ménopause et du Vieillissement hormonal, Société Française de Chirurgie Orthopédique, Société Française d'Endocrinologie, and Société Française de Gériatrie et de Gérontologie).
A multidisciplinary panel representing the spectrum of clinical specialties involved in managing patients with postmenopausal osteoporosis developed updated recommendations based on a systematic literature review conducted according to the method advocated by the HAS.
The updated recommendations underline the need for osteoporosis pharmacotherapy in women with a history of severe osteoporotic fracture. In these patients, any osteoporosis medication can be used; however, zoledronic acid is the preferred first-line medication after a hip fracture. In patients with non-severe fractures or no fractures, the appropriateness of osteoporosis pharmacotherapy depends on the bone mineral density and FRAX(®) values; any osteoporosis medication can be used, but raloxifene and ibandronate should be reserved for patients at low risk for peripheral fractures. Initially, osteoporosis pharmacotherapy should be prescribed for 5 years. The results of the evaluation done at the end of the 5-year period determine whether further treatment is in order.
These updated recommendations are intended to provide clinicians with clarifications about the pharmacological treatment of osteoporosis.
Joint, bone, spine: revue du rhumatisme 04/2012; 79(3):304-13. · 2.25 Impact Factor
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ABSTRACT: To assess the feasibility of ultrasound-guided surgery for carpal tunnel syndrome.
We first studied the ultrasound and anatomic findings in 30 cadaver wrists to determine the best surgical approach and the best plane for releasing the flexor retinaculum. We then used 104 cadaver wrists to assess the feasibility of our technique by performing the surgical procedure then extensively dissecting each wrist and hand. Our evaluation criteria were full release of the transverse carpal ligament and absence of injury to the vessels, nerves, and tendons.
The transverse carpal ligament was fully released in all 104 forearms. Full release required a single pass in 61 forearms, two passes in 27 forearms, and three passes in 16 forearms. No injuries to adjacent structures were identified.
Our cadaver study supports the feasibility of percutaneous surgery under ultrasound-guidance for carpal tunnel syndrome.
Joint, bone, spine: revue du rhumatisme 01/2011; 78(5):516-8. · 2.25 Impact Factor
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Christian Marcelli
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ABSTRACT: Although several effective drugs are available for the treatment of osteoporosis, patient adherence to osteoporosis treatment regimens is poor overall. Poor treatment adherence considerably increases the financial burden generated by osteoporosis. Patients report many factors responsible for poor adherence. As with other chronic diseases, studies have established that patient participation in specific therapeutic education programs improves treatment persistence. These programs are usually coordinated by a nurse but may involve a number of other healthcare professionals.
Joint, bone, spine: revue du rhumatisme 12/2010; 77 Suppl 2:S117-9. · 2.25 Impact Factor
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Christian Roux,
Cyrille B Confavreux,
Bernard Cortet,
Claire David,
Ariane Leboime,
Michel Laroche,
Erick Legrand, Christian Marcelli,
Nadia Mehsen,
Julien Paccou,
Thierry Thomas
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ABSTRACT: The management of osteoporosis has improved considerably, leading to the development of new goals. A major concern today is the management of patients with severe osteoporosis, in whom the need for pharmacotherapy is clear [1]. Epidemiological data have established that osteoporosis is associated with severe complications [2,3]. Furthermore, osteoporosis is now recognized as a complication of several chronic diseases, whose presence adversely affects the management of osteoporosis. The ODISSEE task force (Osteoporosis DIagnosis and Surveillance of SEvErity) was established to answer practical questions regarding the management of severe osteoporosis, based on evidence in the literature. Several groups conducted an exhaustive literature review, and advice was obtained from a panel of French rheumatologists. The ODISSEE scientific committee then developed the first consensus statement on the diagnosis, follow-up and management of severe osteoporosis. This statement was validated by a panel of 70 French rheumatologists at the first national ODISSEE meeting held on November 13-14, 2009.
Joint, bone, spine: revue du rhumatisme 12/2010; 77 Suppl 2:S139-41. · 2.25 Impact Factor
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La Revue du praticien 11/2009; 59(9):1295-8.
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ABSTRACT: During the past decade, major advances have reported the importance of the vitamin D on the bone metabolism, and recent studies have suggested the potential non skeletal effects of the vitamin D. Adequate vitamin D contributes to reduce the risk of non vertebral fractures, improves the neuromuscular function and reduces the risk of falls when serum 25OHD level are greater than 30ng/mL (75nmol/L). A possible role of vitamin D has been implicated in the reduction of mortality, of the non-skin cancers, of the risk of infections, of inflammatory diseases, of cardiovascular diseases and maybe osteoarthritis. However the current level of evidence for associations is weaker than for skeletal effects. Serum 25OHD level is influenced by several factors (cutaneous vitamin D production, fat mass, dietary sources, UV-B exposure, latitude, season...), and the measurement of the serum 25OHD level is the only way to determine the vitamin D status. It is recommended to measure the serum 25OHD level in patients with osteoporosis or at risk of osteoporosis, and to correct the deficiency.
La Presse Médicale 12/2008; 38(1):43-54. · 0.67 Impact Factor
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ABSTRACT: To develop a cost-effective strategy for improving osteoporosis management in patients admitted to an orthopedic surgery department for low-energy fractures.
From November 2003 to July 2004, all patients over 50 years admitted to the orthopedics department of the Caen Teaching Hospital (France) for low-energy fractures were identified and evaluated by rheumatology department physicians in the same hospital.
During the study period, 313 patients were identified, 257 women (mean age, 79.5+/-10.2 years) and 56 men (mean age, 74.6+/-10.8 years), each with one fracture (proximal femur, 58.9%; wrist, 13%). Among them, 91 (29%) had a previous history of osteoporotic fractures. Mean bone mineral density (BMD) values were lower at the femoral neck than at the total hip or lumbar spine (e.g. in women, -2.3+/-0.9 versus -1.8+/-1.0 and -1.4+/-1.7, respectively). Osteoporosis treatment was given to 88 (28%) patients and consisted of calcium and vitamin D supplements, combined with alendronate in 32 patients. Complete loss of self-sufficiency occurred in 73 patients. Thus, 161 patients (88 with osteoporosis treatment and 73 with loss of self-sufficiency) received optimal treatment.
Cooperation between the orthopedics and rheumatology departments improved the management of osteoporosis in patients with low-energy fractures. However, appropriate investigation and treatment of osteoporosis proved difficult in the oldest old and in patients with cognitive impairments.
Joint, bone, spine: revue du rhumatisme 04/2007; 74(2):160-5. · 2.25 Impact Factor
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ABSTRACT: Clinical and experimental evidence supports a link between the effects of mechanical loading and those of estrogens on bone. The objective of this study was to compare bone loss induced in female rats by hindlimb unloading, ovariectomy, or both.
Thirty-six female Wistar rats aged 12 weeks were randomized to bilateral surgical ovariectomy without tail suspension (OV) or with tail suspension for 30 days (OV-TS) or to sham surgery without tail suspension (control group, C) or with tail suspension for 30 days (TS). Bone mineral density (BMD) of the distal femoral metaphysis was measured in g/cm2 by dual X-ray absorptiometry in all 12 animals on days 0, 7, 14, and 30.
On D14 and D30, BMD (mean+/-S.D.) was significantly lower in the OV, TS, and OV-TS groups than in the control group (D14: 0.239+/-0.014, 0.243+/-0.016, and 0.227+/-0.018, respectively, vs. 0.258+/-0.005 in the controls; P<0.05; and D30: 0.241+/-0.011, 0.227+/-0.015, and 0.200+/-0.018, respectively, vs. 0.279+/-0.009 in the controls; P<0.001). On D30, the percentage BMD change versus baseline (mean+/-S.D.) differed significantly between the combination (OV-TS) group (-14.26+/-8.14) and the single-intervention groups (OV: +0.99+/-6.44, P<0.001; and TS: -6.36+/-4.56, P<0.05). As early as D7, bone loss was significantly greater in the combination (OV + TS) group than in the OV group (-1.79%+/-7.17 vs. +4.29%+/-9.55; P<0.05).
In female rats, the rate and severity of bone loss were greater when estrogen deprivation was combined with mechanical unloading than when either intervention was used alone. Mechanical unloading induced a greater degree of bone loss than did estrogen deprivation. In this model of high-rate bone loss, mechanical unloading may predominate over estrogen deprivation in the genesis of bone loss.
Joint Bone Spine 03/2006; 73(2):189-95. · 2.27 Impact Factor
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ABSTRACT: To investigate the effect of longterm infliximab therapy on serum levels of fluorescent antinuclear and anti-double and single-stranded DNA antibodies (FANA, anti-dsDNA, anti-ssDNA) in patients with rheumatoid arthritis (RA), and their possible association with clinical evolution.
Sera from 58 RA patients, treated for one to 3 years with infliximab, were retrospectively analyzed. Matched control groups were RA patients treated with corticosteroids or methotrexate. FANA were tested using HEp-2 cells, and anti-dsDNA and anti-ssDNA IgG by ELISA. After 28 months of infliximab therapy, clinical status was evaluated in 43/58 patients with uninterrupted therapy and associations with autoantibody levels were investigated. Data were documented for patients who discontinued infliximab.
Over the 3 year period, significant increases in FANA and anti-ssDNA IgG levels were observed in infliximab treated patients (p < 0.001 and p < 0.01, respectively). In 43 patients with an uninterrupted infliximab regimen, association was found between high FANA (>or= 1/1280) and lower age (p = 0.048) and patient's assessment of infliximab's efficacy (p = 0.014). Three patients developed anti-dsDNA IgG, preceded by high anti-ssDNA IgG levels, and one of them developed a lupus-like syndrome. Neither the initial presence of high FANA levels nor their increase >or= 1/1280 was significantly associated with discontinuation of infliximab. In contrast, at baseline (p = 0.0012) and at the time of infliximab discontinuation (p = 0.0078), anti-ssDNA IgG (>or= 500 arbitrary units) were more frequent in 7 patients who stopped infliximab due to skin or systemic anaphylactoid reactions.
Monitoring of serum FANA, anti-dsDNA, and anti-ssDNA IgG antibodies provided predictors of lupus-like symptoms and/or anaphylactoid reactions in patients with RA.
The Journal of Rheumatology 01/2006; 33(1):24-30. · 3.69 Impact Factor
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ABSTRACT: Numerous association studies have dealt with single-nucleotide polymorphisms (SNPs) in coding and intronic regions of the human vitamin D receptor (hVDR) gene. We have hypothesized that phenotypic traits may also be associated with variations in VDR expression due to the presence of SNPs in promoter regions. In this work, we have studied two SNPs located 1521 bp (G/C) and 1012 bp (A/G) upstream of the transcriptional start site of the main human VDR gene promoter. One base-change in any of the two variant sites led to a dramatic change in protein-DNA complex formation using nuclear extracts from HEK293, Caco-2 and COS-7 cells. Genetic analysis of 185 healthy adolescent girls evidenced two major haplotypes: 1521G/1012A and 1521C/1012G and three main genotypes: homozygous for 1521G/1012A (21.1%), homozygous for 1521C/1012G (17.3%) and heterozygous 1521CG/1012GA (57.3%). On the basis of transfection data, promoter activity was nearly 2-fold higher with the 1521G/1012A haplotype, when compared with the 1521C/1012G haplotype. Clinical and biological association study in the adolescent cohort showed that girls with a CC/GG genotype had (i) lower circulating levels of 25-dihydroxyvitamin D, with no detectable consequence on calcium metabolism, (ii) lower serum IGF-1 levels and (iii) smaller height from 11 years of age up to adult height.
Human Molecular Genetics 12/2005; 14(22):3539-48. · 7.64 Impact Factor
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Journal of the American Geriatrics Society 04/2005; 53(3):550-2. · 3.74 Impact Factor
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ABSTRACT: PURPOSE: The pathophysiology of osteoporosis has seen many recent progress especially with the use of genetically modified animal models. CURRENT KNOWLEDGE AND KEY POINTS: Among many discoveries, one can notice the crucial role of LRP5, GH, IGF-1 and the sex hormones receptors in the acquisition of the peak bone mass, the control of bone remodeling by the sympathetic nervous system and his implication as a transmitter of mechanical loading in bone. Also, the role of estrogen and androgen receptors as well as the aromatase is specified according to sexes. The role of growth plate's chondrocytes in the installation of the trabecular bone network is better and better demonstrated. The greater periosteal apposition in men, mediated by androgens receptor, seems to explain the greatest radial growth and so the greatest bone resistance to mechanical strains like a lower fracture rate in men compared to women. The bone microarchitecture and quality explain an important part of the mechanical properties of bones and why considering the same bone mass one bone is breaking and another one not. FUTURE PROSPECTS AND PROJECTS: Many therapeutic applications should finalize the discovery of these new bone cells signalisation pathways.
La Revue de Médecine Interne 01/2005; 25 Suppl 5:S531-7. · 0.61 Impact Factor
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ABSTRACT: A patient presented with an atypical pattern of acute severe shoulder pain. Sonography elucidated the mechanism of the pain and allowed effective treatment. The patient was unable not only to move her shoulder but also to flex and to extend her elbow. Sonography showed a calcific deposit in the subscapularis tendon with local edema displacing the long head of the biceps tendon out of the bicipital groove. Local injection of a glucocorticoid under ultrasonographic control was followed within 7 days by subsidence of the subscapularis tendon edema and by a return of the long head of the biceps tendon to its normal position in the bicipital groove.
Joint Bone Spine 12/2004; 71(6):592-4. · 2.27 Impact Factor
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ABSTRACT: Sympathetic innervation has been demonstrated in bone. Adrenergic stimulation is one of the transmitters of bone loss by uncoupling between decreased bone formation and increased bone resorption.
By using a non-specific antagonist of -adrenergic pathway (propranolol per os), we hypothesized that we could rescue the uncoupling induced mechanical unloading bone loss in the rat model of tail-suspension.
Twenty-two female Wistar rats, 12 week-old, have been divided into three groups: eight tail-suspended rats (SR), six tail-suspended rats treated by propranolol (SRP) and eight non-suspended rats (NSR) during 30 days. Bone mineral density (BMD, g/cm2) has been measured by DXA (Hologic QDR-4500A) at D0 and D30 of the study, in the distal femoral metaphysis (DFM), the femoral diaphysis (FD), the whole body (WB, g) and body composition.
Between D0 and D30, in DFM a significant variation in BMD is observed between NSR and SR (% BMD change: NSR +15.6 +/- 3.1% vs SR -1.0 +/- 1.4%, P < 0.0001) and BMD rescue in SRP group (% BMD change SRP +5.3 +/- 1.5% vs SR -1.0 +/- 1.4%, P = 0.03). In FD, gain of BMD is significant in NSR compared to SR (+17.5 +/- 1.5% vs +8.2 +/- 2.8%, P = 0.007) and to SRP (+17.5 +/- 1.5% vs +10.1 +/- 2.4%, P = 0.046). Gain in SRP group is not significant compared to SR group (P = 0.6). In WB, SRP gain more BMD than NSR (+14.0 +/- 1.8% vs +5.4 +/- 0.7%, P = 0.0002) and than SR (+14.0 +/- 1.8% vs +7.8 +/- 1.4%, P = 0.0043). There is no difference between NSR and SR groups (P = 0.19).
We demonstrate that -adrenergic pathway of sympathetic nervous system is a major transmitter pathway of mechanical loading in rat bone. A specific study is necessary to analyse a possible systemic effect of propranolol in rat bone. Propranolol could be used to prevent the induced mechanical unloading bone loss as weightlessness
Joint Bone Spine 12/2003; 70(6):515-9. · 2.27 Impact Factor
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ABSTRACT: The WHO definition of osteoporosis is based on T-scores, which are calculated from mean bone mineral density values in reference populations composed of young adults. The definition of this reference population is a key-point.
We compared lumbar spine T-scores in three reference populations of young adults, one from the US and two from France.
Reference values were higher in the American population than in the two French populations. As a result, the prevalence of a T-score indicating osteoporosis in a population of 2887 patients aged 20-87 years (mean age, 62.4 +/- 9.5 years) was 32% with the American reference population and 22% and 24% with the two French populations. Thus, about 25% and 32% of patients classified as having osteoporosis with the American reference population did not have osteoporosis with the two French reference populations, respectively. There was no significant difference between the prevalences obtained with the two French populations.
Reference populations of young adults should be representative of the population of each country, for each measurement site, gender, and ethnic group. When evaluating individuals, in addition to the clinical setting and T-score, age should be taken into account. The Z-score remains useful.
Joint Bone Spine 09/2003; 70(4):290-3. · 2.27 Impact Factor
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Christian Marcelli
Servir (Lisbon, Portugal) 50(6):291-6.
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[show abstract]
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ABSTRACT: A patient presented with an atypical pattern of acute severe shoulder pain. Sonography elucidated the mechanism of the pain and allowed effective treatment. The patient was unable not only to move her shoulder but also to flex and to extend her elbow. Sonography showed a calcific deposit in the subscapularis tendon with local edema displacing the long head of the biceps tendon out of the bicipital groove. Local injection of a glucocorticoid under ultrasonographic control was followed within seven days by subsidence of the subscapularis tendon edema and by a return of the long head of the biceps tendon to its normal position in the bicipital groove.
Revue du Rhumatisme.
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Christian Marcelli
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ABSTRACT: There is currently no consensus definition of osteopenia and osteoporosis in children according to bone mineral density (BMD) values measured by dual energy x-ray absorptiometry (DXA); interpretation of BMD measures must take into account the child's weight and pubertal status. In children, primary forms of osteoporosis--juvenile idiopathic osteoporosis and osteogenesis imperfecta--are rare; on the other hand, the frequency of secondary osteoporosis is increasing. Fractures, especially of the forearm, are frequent in children. During the peak growth period, bone growth and mineralization are dissociated; in consequence temporary bone fragility promotes fractures. Several recent studies show that children with fractures have reduced BMD and that the occurrence of fractures in children may constitute a risk factor for osteoporosis and fracture during adulthood. In cases of secondary osteoporosis, close monitoring of the causal disease is the key element of treatment; there are very few controlled studies of the prevention or treatment of osteoporosis in children.
La Presse Médicale 36(7-8):1078-83. · 0.67 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Purpose. —The pathophysiology of osteoporosis has seen many recent progress especially with the use of genetically modified animalmodels.Current knowledge and key points. —Among many discoveries, one can notice the crucial role of LRP5, GH, IGF-1 and the sex hormones receptors in the acquisition of the peak bone mass, the control of bone remodeling by the sympathetic nervous system and his implication as a transmitter of mechanical loading in bone. Also, the role of estrogen and androgen receptors as well as the aromatase is specified according to sexes. The role of growth plate's chondrocytes in the installation of the trabecular bone network is better and better demonstrated. The greater periosteal apposition in men, mediated by androgens receptor, seems to explain the greatest radial growth and so the greatest bone resistance to mechanical strains like a lower fracture rate in men compared to women. The bone microarchitecture and quality explain an important part of the mechanical properties of bones and why considering the same bone mass one bone is breaking and another one not.Future prospects and projects. —Many therapeutic applications should finalize the discovery of these new bone cells signalisation pathways.
La Revue de Médecine Interne.
