Journal für
Mineralstoffwechsel &
Muskuloskelettale Erkrankungen
Krause & Pachernegg GmbH • Verlag für Medizin und Wirtschaft • A-3003 Gablitz
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und Mineralstoffwechsels
News-Screen Osteologie Mikosch P
Journal für Mineralstoffwechsel &
Muskuloskelettale Erkrankungen
2016; 23 (4), 157-158
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J MINER STOFFWECHS MUSKULOSKELET ERKRANK 2016; 23 (4)
News-Screen Osteologie
P. Mikosch
High Rate of Non-Treatment Among Osteoporotic Women Enrolled in a US Medicare Plan
Yang X, et al. Curr Med Res Opin 2016; 32: 1849–56.
Abstract
Objective: To estimate the rate of non-treatment among elder- ly women with osteoporosis (OP) and to examine the associa- tion between patient characteristics and receiving treatment.
Research Design and Methods: This cross-sectional, retrospec- tive, observational study utilized patient information and claims from the Humana database to identify Medicare covered women aged ≥ 65 years old and continuously enrolled with evidence of either an OP diagnosis or an OP-related fracture during 2007–
2011. The main outcome was receipt of pharmacological treat- ment of OP during 2012 (follow-up). The percentage of non- treatment was calculated and a stepwise selection logistic regres- sion model was employed to estimate the association between baseline demographic and clinical characteristics and receiv- ing treatment. Results: A total of 109,829 patients were includ- ed. Mean age was 75.7 years and 79.4% were identified with OP through OP diagnosis codes and did not have evidence of a pri- or fracture. Approximately one-third (32%) of patients had used OP medications during the baseline period, and 39% had experienced at least one gastro-intestinal event during base- line. Among all patients, 71.4% did not receive OP therapy dur- ing follow-up. The strongest factor associated with receiving treatment was prior use of OP therapy (odds ratio [OR] = 31.3;
p < .001). Among the subgroup of patients with baseline frac- tures, 75.9% did not receive OP therapy during follow-up and the strongest factor associated with receiving treatment re- mained prior use of OP therapy (OR = 20.4; p < .001). Those with high comorbidity burden were less likely to receive treatment in both the overall cohort and within the subgroup with baseline fractures. Conclusions: Among Medicare-eligible women aged
≥ 65 identified with OP between 2007 and 2011, 71.4% did not receive OP treatment during 2012, including 75.9% of the sub- group of patients with a prior fracture. The use of diagnosis and procedures codes to identify patients with osteoporosis is subject to variation in coding.
Kommentar
In der vorgestellten retrospektiven Observationsstudie mit fast 110.000 Patienten zeigte sich eine hohe Rate von über 70 % von Patienten mit Osteoporose, die keine Osteoporosetherapie erhielten. Auch durch eine osteoporotische Fraktur ergab sich keine erhöhte Th erapierate.
High Cardiorespiratory Fitness Is Asso- ciated with Reduced Risk of Low Bone Density in Postmenopausal Women
DeFina LF, et al. J Womens Health (Larchmt) 2016; 25: 1073–
80.
Abstract
Purpose: The goal of this study was to determine the associa- tion between cardiorespiratory fitness (CRF) and bone miner- al density (BMD) of the femoral neck (FN) in postmenopau- sal women using existing Cooper Center Longitudinal Study data. Materials and Methods: A cohort of 1,720 predominant- ly healthy Caucasian women (57.1 ± 6.9 years) underwent pre- ventive medical examinations that included CRF assessment by maximal Balke treadmill testing and measurement of BMD by dual-energy X-ray absorptiometry. CRF was estimated from to- tal treadmill time and categorized into five categories of CRF (further defined as fitness category 1 = low fitness, 2–3 = mod- erate fitness, and 4–5 = high fitness). Logistic regression was used to characterize the association between CRF and BMD, adjusting for age, weight, and resistance activity level. Results:
Overall, the mean body-mass index (BMI) for all subjects was 25.0 ± 4.5 kg/m2, although BMI was in the obese range in the low fitness group. The prevalence of osteoporosis (T-score ≤ –2.5 at the FN) was greater in the low fit group than moderate or high fit (5.8% vs. 3.0% or 3.9%, respectively); with a similar pattern seen for prevalence of osteopenia (T-score > –2.5 and ≤ –1.0 at the FN) (47.5% vs. 46.4% or 44.8%, respectively). Higher age and lower weight were associated with low BMD. Fully adjusted lo- gistic regression models showed an inverse association between CRF and low BMD of the FN. For T-score ≤ –1.0, the prima- ry outcome, the odds ratio (OR) was 0.50 (95% confidence in- terval [CI] 0.32–0.79) for moderate fitness, and OR of 0.32 (95%
CI 0.21–0.51) for high fitness was seen. For T-score ≤ –2.5 at the FN, OR was 0.30 (95% CI 0.11–0.80) for moderate fitness, and OR was 0.29 (95% CI 0.12–0.71) for high fitness. Conclusion:
Increased CRF levels are associated with reduced risk for low bone density in postmenopausal women.
Kommentar
Körperliche Fitness wirkt nach den vorliegenden Studien- ergebnissen der Entwicklung von Osteoporose entgegen.
Relevanz für die Praxis
Die Studie bestätigt die weiterhin bestehende medika- mentöse Unterversorgung von Patienten mit Osteopo- rose.
Relevanz für die Praxis
Wie auch für viele andere Erkrankungen ist Patienten gegen die Entwicklung von Osteoporose eine regelmäßi- ge körperliche Aktivität mit dem Ziel des Erhalts von kar- diorespiratorischer Fitness anzuraten.
News-Screen Osteologie
158 J MINER STOFFWECHS MUSKULOSKELET ERKRANK 2016; 23 (4)
Biodegradable Intranasal Nanoparticu- late Drug Delivery System of Risedro- nate Sodium for Osteoporosis
Fazil M, et al. Drug Deliv 2016; 23: 2428–38.
Abstract
Context: Osteoporosis (OP) is the most common metabolic bone disease predominantly found in elderly people. It is asso- ciated with reduced bone mineral density, results in a high- er probability of fractures, especially of the hip, vertebrae, and distal radius. Worldwide prevalence of OP is considered a seri- ous public health concern. Objective: The purpose of the pre- sent work was to develop and evaluate polymeric nanoparticles (NPs) of risedronate sodium (RIS) for the treatment of OP us- ing intranasal (IN) route in order to reduce peripheral toxic ef- fects. Materials and Methods: Polymeric NPs of RIS were pre- pared by nanoprecipitation methods. Formulations were devel- oped and evaluated in context to in vitro drug release, ex vivo permeation, in vivo study, and biochemical studies. Results and Discussions: The particles size, entrapment efficiency (EE) (%), and loading capacity (LC) (%) of optimized formulations were found to be 127.84 ± 6.33 nm, 52.65 ± 5.21, and 10.57 ± 1.48, re- spectively. Release kinetics showed diffusion-controlled, Fickian release pattern. Ex vivo permeation study showed RIS from PL- GA-NPs permeated significantly (p < 0.05) through nasal muco- sa. In vivo study showed a marked difference in micro-structure (trabecu lae) in bone internal environment. Biochemical estima- tion of treated group and RIS PLGA indicated a significant re- covery (p < 0.01) as compared with the toxic group. Conclusion:
Polymeric NPs of RIS were prepared successfully using biode- gradable polymer (PLGA). Intranasal delivery showed a good result in in vivo study. Thus PLGA-NPs have great potential for delivering the RIS for the treatment and prevention of OP after clinical evaluation in near future.
Kommentar
Die orale Einnahme von Bisphosphonaten ist mit bestimm- ten Einnahmebedingungen verknüpft , um eine ausreichen- de intestinale Resorption zu erreichen und gastrointestinale Nebenwirkungen zu vermeiden. Diese Einnahmebedingun- gen (Einnahme nüchtern, nachfolgend nicht mehr hinlegen, Zeitabstand zum nachfolgenden Essen) sind gerade für alte und multimorbide Patienten, die jedoch eine relevante Ziel- gruppe einer Osteoporosetherapie mit Bisphosphonaten dar- stellen, oft mals schwer oder kaum korrekt durchführbar. Die intra venöse Applikation von Bisphosphonaten hat diese Pro- bleme der Medikamentenzufuhr gelöst, die intravenöse Gabe bedarf jedoch eines Arztkontakts. Die intranasale Applikation stellt zu dieser Problemstellung einen weiteren interessanten Lösungsansatz, der auch vom Patienten selbst oder einer Pfl e- gekraft durchgeführt werden kann, dar.
Korrespondenzadresse:
Univ.-Prof. Dr. Peter Mikosch Privatklinik Döbling
A-1190 Wien, Heiligenstädter Straße 48 E-Mail: [email protected]
Relevanz für die Praxis
Mit der Darstellung, dass eine intranasale Gabe des Bis- phosphonates Risedronat möglich ist, ergeben sich neue Perspektiven für den Einsatz von Bisphosphonaten, ins- besondere bei alten multimorbiden Patienten, die eine orale Einnahme von Bisphosphonaten nicht korrekt durchführen können.
