Christian Meier

Diabetology, Allergology

MD
37.12

Publications

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    ABSTRACT: Purpose: To describe the clinical and biochemical profile of patients with primary hyperparathyroidism (PHPT) of the Swiss Hyperparathyroidism Cohort, with a focus on neurobehavioral and cognitive symptoms and on their changes in response to parathyroidectomy. Methods: From June 2007 to September 2012, 332 patients were enrolled in the Swiss PHPT Cohort Study, a nationwide prospective and non-interventional project collecting clinical, biochemical, and outcome data in newly diagnosed patients. Neuro-behavioral and cognitive status were evaluated annually using the Mini-Mental State Examination, the Hospital Anxiety and Depression Scale, and the Clock Drawing tests. Follow-up data were recorded every 6 months. Patients with parathyroidectomy had one follow-up visit 3-6 months' postoperatively. Results: Symptomatic PHPT was present in 43 % of patients. Among asymptomatic patients, 69 % (131/189) had at least one of the US National Institutes for Health criteria for surgery, leaving thus a small number of patients with cognitive dysfunction or neuropsychological symptoms, but without any other indication for surgery. At baseline, a large proportion showed elevated depression and anxiety scores and cognitive dysfunction, but with no association between biochemical manifestations of the disease and test scores. In the 153 (46 %) patients who underwent parathyroidectomy, we observed an improvement in the Mini-Mental State Examination (P = 0.01), anxiety (P = 0.05) and depression (P = 0.05) scores. Conclusion: PHPT patients often present elevated depression and anxiety scores and cognitive dysfunction, but rarely as isolated manifestations. These alterations may be relieved upon treatment by parathyroidectomy.
    No preview · Article · Jan 2016 · Journal of endocrinological investigation
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    ABSTRACT: Data on the influence of opioid substitution therapy (OST) on skeletal health in men is limited. This cross-sectional study aimed to determine the prevalence of low bone mass in male drug users and to evaluate the relationship between endogenous testosterone and bone mass. We recruited 144 men on long-term opioid maintenance therapy followed in the Center of Addiction Medicine in Basel, Switzerland. Data on medical and drug history, fracture risk and history of falls were collected. Bone mineral density (BMD) was evaluated by densitometry and serum was collected for measurements of gonadal hormones and bone markers. 35 healthy age- and BMI-matched men served as the control group. The study participants received OST with methadone (69 %), morphine (25 %) or buprenorphine (6 %). Overall, 74.3 % of men had low bone mass, with comparable bone mass irrespective of OST type. In older men (≥40 years, n = 106), 29.2 % of individuals were osteoporotic (mean T-score -3.0 ± 0.4 SD) and 48.1 % were diagnosed with osteopenia (mean T-score -1.7 ± 0.4 SD). In younger men (n = 38), 65.8 % of men had low bone mass. In all age groups, BMD was significantly lower than in age-and BMI-matched controls. In multivariate analyses, serum free testosterone (fT) was significantly associated with low BMD at the lumbar spine (p = 0.02), but not at the hip. When analysed by quartiles of fT, lumbar spine BMD decreased progressively with decreasing testosterone levels. We conclude that low bone mass is highly prevalent in middle-aged men on long-term opioid dependency, a finding which may partly be determined by partial androgen deficiency.
    Full-text · Article · Jan 2016 · Journal of Bone and Mineral Metabolism
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    ABSTRACT: Subclinical hypothyroidism is characterized by elevated thyroid-stimulating hormone (TSH) in the presence of normal peripheral thyroid hormones. Although ‘subclinical,’ this condition is associated with multiple metabolic and clinical changes and possibly with increased cardiovascular morbidity. Individuals with TSH levels above 10 mU l− 1 and those with lower values and risk factors for progression to overt hypothyroidism or impaired action of thyroid hormones at the peripheral target tissues may benefit from replacement therapy.
    No preview · Chapter · Dec 2015
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    ABSTRACT: The increasing importance of preventive measures in the field of orthopedics and trauma surgery becomes apparent because of the demographic changes and the high risk for secondary fractures following osteoporotic fractures. Within the fracture treatment chain, orthopedics and trauma surgery are in the “pole position” to initiate these measures in geriatric patients. In the past orthopedists and trauma surgeons have constantly accused of neglecting secondary fracture prevention in fragility fracture patients. There are several reasons that speak in favor of us undertaking a role in secondary fracture prevention: osteoporosis medication is highly effective in fracture prevention when correctly indicated, the positive effects of osteoporosis therapy on fracture healing and legal issues. Arguments that have been used to justify neglect of secondary fracture prevention are undesired side effects related to osteoporosis medications, such as atypical femoral fractures and osteonecrosis of the jaws, interference of some specific drugs with fracture healing and the working conditions in emergency departments. These run contrary to the consideration of chronic diseases such as osteoporosis, secondary osteoporosis and the underlying disease could be overlooked and the increasing complexity of medicinal osteoporosis therapy. In the first part of the article these arguments are weighed against each other. In the second part the concept of a fracture liaison service (FLS) is discussed. The FLS framework now allows an active role to be taken with respect to secondary fracture prevention despite the busy daily routine schedule. Implementation of an FLS is facilitated by dedicated instruction protocols and programs. Self-financing of an FLS is currently possible only in some specific healthcare systems. In healthcare systems in German-speaking areas a cross-financing must be available and the value of an FLS indirectly presented. Apart from the financial aspects, implementation of a FLS is also worthwhile because it can be looked on as the future driving force of innovation.
    No preview · Article · Dec 2015 · Der Unfallchirurg
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    ABSTRACT: Background: Tendinotoxicity of glucocorticoids (GC) has been shown, but evidence on how this translates into clinical practice remains scarce. Objectives: To explore the association between oral or inhaled GC use and the risk of Achilles or biceps tendon rupture (ATR/BTR). Methods: We identified patients aged 18 to 89 years with incident ATR or BTR (1995-2013) for a matched (1:4) case-control analysis using the UK-based Clinical Practice Research Datalink. We stratified oral GC use by indication, timing and duration of use, continuous versus intermittent use, cumulative dose, and average daily dose. We stratified inhaled GC use by timing and number of prescriptions. Results: Among 8,202 cases, we observed increased odds ratios (ORs) around 3.0 for continuous oral GC use, which declined shortly after therapy cessation (similarly across indications). Odds ratios increased with average daily dose (≥ 10 mg/day, OR 4.05, 95% CI 2.32-7.08) and were elevated after one cycle of high-dose oral GC (≥ 20 mg/day). There was no effect of inhaled GC at any level of exposure. Conclusion: Our results provide evidence that oral GC therapy increases the risk of tendon rupture in a dose-response relationship. A single short-term high-dose GC treatment course may be sufficient transiently to increase the risk of tendon rupture.
    No preview · Article · Sep 2015 · Annals of Medicine
  • Christian Meier

    No preview · Article · Apr 2015 · Annales d Endocrinologie
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    ABSTRACT: Type 2 diabetes is associated with increased fracture risk and the mechanisms underlying the detrimental effects of diabetes on skeletal health are only partially understood. Anti-diabetic drugs are indispensable for glycemic control in most type 2 diabetics, however, they may, at least in part, modulate fracture risk in exposed patients.
    No preview · Article · Apr 2015 · Bone
  • M.E. Kraenzlin · C. Meier
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    ABSTRACT: Over the past years interest in Vitamin D is growing because of its effect on bone and neuromuscular function and more recently because of its pleitropic effects. Measurement of circulating 25(OH)D concentration is accepted as the best clinical indicator of an individual's Vitamin D status. As such, 25(OH)D measurement is increasingly being obtained by clinicians who utilize this value to assess a patients Vitamin D status, and subsequently make decisions regarding supplementation. However, 25(OH)D measurements are affected by other Vitamin D metabolites such as the 3-epimer of 25(OH)D and 24,25(OH)2D. A substantial within assay variation in 25(OH)D measurement and between-assay variability has been recognized. Furthermore, existing 25(OH)D assays may include other Vitamin D metabolites such as the 3-epimer of 25(OH)D and 24,25(OH)2D. This assay variation confounds attempts to define what constitutes the diagnosis of Vitamin D deficiency. Efforts to standardize Vitamin D measurement are ongoing. Liberal 25(OH)D measurements are not recommended. However, it does seem reasonable to measure 25(OH)D in those patients identified as being at risk for Vitamin D deficiency and in those at risk for falls and fractures.
    No preview · Article · Jan 2015
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    ABSTRACT: Intravenous bisphosphonates are widely used to treat osteoporosis and bone metastasis in cancer patients The risk of hypocalcaemia is a rare but underestimated side effect of anti-resorptive treatment. Clinically apparent hypocalcaemia is mostly related to high-dose treatment with zoledronate and denosumab in cancer patients Particular caution is mandatory in all malnourished patients and patients with renal failure who are treated for either bone metastases or osteoporosis. To avoid serious hypocalcaemia, pre-treatment calcium and vitamin D status should be assessed and corrected if appropriate.
    Full-text · Article · Jun 2014 · Swiss medical weekly: official journal of the Swiss Society of Infectious Diseases, the Swiss Society of Internal Medicine, the Swiss Society of Pneumology
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    ABSTRACT: Osteoporosis is complicated by the occurrence of fragility fractures. Over past years, various treatment options have become available, mostly potent antiresorptive agents such as bisphosphonates and denosumab. However, antiresorptive therapy cannot fully and rapidly restore bone mass and structure that has been lost because of increased remodelling. Alternatively recombinant human parathyroid hormone (rhPTH) analogues do increase the formation of new bone material. The bone formation stimulated by intermittent PTH analogues not only increases bone mineral density (BMD) and bone mass but also improves the microarchitecture of the skeleton, thereby reducing incidence of vertebral and nonvertebral fractures. Teriparatide, a recombinant human PTH fragment available in Switzerland, is reimbursed as second-line treatment in postmenopausal women and men with increased fracture risk, specifically in patients with incident fractures under antiresorptive therapy or patients with glucocorticoid-induced osteoporosis and intolerance to antiresorptives. This position paper focuses on practical aspects in the management of patients on teriparatide treatment. Potential first-line indications for osteoanabolic treatment as well as the benefits and limitations of sequential and combination therapy with antiresorptive drugs are discussed.
    Full-text · Article · Jun 2014 · Swiss medical weekly: official journal of the Swiss Society of Infectious Diseases, the Swiss Society of Internal Medicine, the Swiss Society of Pneumology
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    Full-text · Dataset · May 2014
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    Full-text · Dataset · May 2014
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    Full-text · Dataset · May 2014
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    Full-text · Dataset · May 2014
  • Marius Kraenzlin · Christian Meier

    No preview · Article · Apr 2014 · Therapeutische Umschau
  • Nicole Nigro · Mirjam Christ-Crain · Christian Meier
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    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.
    No preview · Article · Apr 2014 · Therapeutische Umschau
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    ABSTRACT: To assess gynaecologists' awareness of bone healthcare in women and the prevalence of application of national recommendations on bone healthcare in Switzerland. During the annual meeting of the Swiss Society of Gynaecology and Obstetrics 2012, the Swiss Association against Osteoporosis (SVGO) performed standardised interviews with conference participants (n = 210). Questions addressed responsibility for bone healthcare, and whether diagnostic procedures, initiation of bone-specific treatment and follow-up were performed in accordance with SVGO recommendations. The majority of respondents were aged 30-50 years (60%), female (70%) and working as board-certified gynaecologists (69%). Ninety-three percent of respondents considered care for bone health as part of the gynaecologist's expertise. As diagnostic procedures, 44% recommended performing bone densitometry (DXA) only, 34% ordered additional laboratory testing. Seventy-two percent of respondents initiated a bone-specific treatment. Predictors for not performing diagnostic procedures and not initiating a bone-specific treatment were physician's age below 30, being a trainee gynaecologist, and working at a university clinic. Particularly, young trainee gynaecologists working at a university clinic were especially unlikely to initiate a bone-specific treatment (regression coefficient = -2.68; odds ratio [OR] 0.069, 95% confidence interval [CI] 0.01-0.61; p = 0.16). Follow-ups were performed by 77% of respondents, but were less likely to be by female physicians (OR 0.27, 95% CI 0.09-0.84; p = 0.024). Although the majority of board-certified gynaecologists follow national recommendations on bone healthcare, current medical training in obstetrics and gynaecology does not sufficiently cover the subject of women's health. However, since this is a small study our findings may not reflect the findings in the total population.
    Full-text · Article · Feb 2014 · Schweizerische medizinische Wochenschrift
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    ABSTRACT: A Fragility Fracture is nowadays looked upon to be the most important clinical symptom of osteoporosis. The sportive elderly have a limited risk to suffer from this event. Mechanical loading of the skeleton which is associated with most sporty activities prevents age related bone loss. Furthermore, if a fracture happens as a result from sporty activity, the criterion of a fragility fracture is usually not met. - Elderly sportsmen who want to be reassured or who are going to restart activity after a break can be offered a fracture risk calculation by means of FRAX. Correct interpretation of the risk scores needs knowledge of the boundary conditions the algorithm is based on. In contrast a DEXA scan is rarely indicated in this situation. - Vitamin D Supplementation can generally be adviced for every elderly person in our region, especially for the sportive ones. Sufficient intake of calcium and protein shall be achieved by a healthy diet. - Despite of the risk of falling that is usually associated with any sportive activity it may be summarized, that there is less fractures in active people. As long as human beings stay mobile and active, pharmacological prevention or treatment of osteoporosis is rarely indicated. - An exeption from this is osteoanabolic treatment of insufficiency and stress fractures. This shall be mentioned here even though it is an "off-label" use of the drugs.
    No preview · Article · Jan 2014

  • No preview · Article · Jan 2014
  • C Meier · C Kraenzlin · N F Friederich · T Wischer · L Grize · C R Meier · M E Kraenzlin
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    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.
    No preview · Article · Nov 2013 · Osteoporosis International

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