Risks of osteoporosis associated with breast cancer treatment: The need to access to preventive treatment

The results of available clinical studies suggest that breast cancer treatment significantly affect bone turnover, BMD and fracture risk. This is for instance the case for all third-generation aromatase inhibitors.     

Biphosphonates for the therapy of complex regional pain syndrome I – Systematic review

Objectives: Several studies found that biphosphonates counteract locally increased bone resorption and associated pain in patients with complex regional pain syndrome I (CRPS I). We performed a systematic review of all randomised controlled trials to assess the benefit of biphosphonates in the treatment of CRPS I patients with bone loss. Data sources: We searched Medline, Embase (April 2007) and the Cochrane Library and screened bliographies of included studies. Review methods: We selected randomised trials comparing biphosphonates with placebo, with the goal of improving pain, function and quality of life in patients with CRPS I. Two reviewers independently assessed trial eligibility and quality, and extracted data. Where data were incomplete or unclear, conflicts were resolved with discussion and/or trial authors were contacted for further details. We calculated the study size weighted pooled mean reduction of pain intensity (measured with a visual analogue scale (VAS)). Results: Four trials of moderate quality fulfilled our inclusion criteria. In respect to function and quality of life there was a trend in favour of biphosphonates but differences in outcome assessment impeded pooling of results. Two trials provided sufficient data to pool pain outcomes. Biphosphonates reduced pain intensity by 22.4 and 21.6mm on a VAS after 4 and 12 weeks of follow‐up. Data on adverse effects were scarce. Conclusions: The very limited data reviewed showed that bisphosphonates have the potential to reduce pain associated with bone loss in patients with CRPS I. However, at present there is not sufficient evidence to recommend their use in practice.     

Calcitonin versus Clodronate in the Prevention of Ovariectomy-Induced Osteopenia in Rats

The effects of salmon calcitonin and clodronate were compared in ovariectomised rats. Sixty female Wistar rats (∼260 g in weight) were fed the same diet and had the same living conditions. The rats were divided into the following groups: 15 rats with sham ovariectomy and no drug treatment (Sham-OVX); 45 rats with bilateral ovariectomy subdivided into 15 rats not receiving drug treatment (OVX group), 15 rats treated with subcutaneous salmon calcitonin, 2 U/kg/day every 2 days (OVX + CT group) and 15 rats treated with subcutaneous clodronate, 5 mg/kg/day every 2 days (OVX + Cl group). Sixty days after surgery, the rats were sacrificed and their femurs and fifth lumbar vertebrae were dissected and cleaned of soft tissue. Femur length, vertebral height, and bone mineral content and bone mineral density of the femur and fifth lumbar vertebra by dual-energy X-ray absorptiometry were measured. Calcitonin had a significant and stronger effect in preventing ovariectomy-induced osteopenia in the femur (OVX + CT vs OVX groups, p<0.0001); both calcitonin and clodronate had a significant effect on the fifth lumbar vertebra, which was greater in the calcitonin group (OVX + CT vs OVX + Cl groups, p<0.005). These findings indicate that calcitonin has a protective effect on both the axial (trabecular bone) and peripheral (cortical bone) skeletons, but clodronate only has a protective effect on the axial skeleton. Received: 28 May 1999 / Accepted: 29 July 1999     

洛屈联合消炎痛栓治疗骨转移性癌痛疗效观察

目的分析药物联合治疗方法对骨转移癌缓解疼痛、改善生活质量的临床意义。方法对59例原发病均已经过病理学证实，多发性骨转移癌经CT、X线、ECT证实患者，随机分为治疗组30例，予洛屈联合消炎痛栓镇痛；对照组29例，单纯应用美施康定镇痛。结果治疗组CR53．33％（16／30），PR30．00％（9／30）；对照组CR55．17％（16／29），PR27．59％（8／29）。2组总有效率：治疗组83．33％，对照组82．76％，2组疗效比较无显著性差异（P〉0．05）。结论根据患者病灶及全身状况，洛屈联合消炎痛栓对骨转移癌痛治疗安全、有效、经济，且对预防并发症、提高生命质量有重要的临床意义。     

Biphosphonate-induced radiographic changes in two pediatric patients with rheumatic diseases

Biphosphonates are now being used experimentally in children to increase bone mass, but their long-term effects remain an issue of concern. We report two cases of biphosphonate-induced radiographic changes in children with rheumatic diseases. Our experience supports the view that clinical improvement and radiographic findings after biphosphonate therapy are related to increased bone mineral density, without effects on the inflammatory process itself. Biphosphonates seem to act in rheumatic diseases by reducing bone turnover instead of improving disease activity.     

Intramedullary rod fixation of fibrous dysplasia without use of bisphosphonates

Purpose

Controversy exists regarding approach to treatment of pediatric patients with fibrous dysplasia.

Methods

We retrospectively reviewed medical records of seven patients who were treated at our institution for fibrous dysplasia by intramedullary rod fixation without bisphosphonate supplementation.

Results

Seven patients with a total of ten fibrous dysplasia lesion sites surgically treated by intramedullary rod fixation were included. Of these ten lesion sites, eight demonstrated pathologic fracture at the time of fixation. Complete fracture healing was observed in all eight sites, with no incidence of recurrent pathologic fractures examined radiographically. There were no major infections or neurologic deficits, and lesions appeared to stabilize.

Conclusions

In this series, intramedullary rod fixation proved to be successful in treatment of acute pathologic fracture and incompletely healed fibrous dysplasia lesions. We observed partial resolution of fibrous dysplasia lesions at all ten sites without significant long-term complications. Following treatment, there were no refractures.

Level of evidence

Level IV, case series.     

双膦酸盐类药物在骨折急性期患者中的应用

双膦酸盐类药物（BPs）是目前治疗骨质疏松症的首选药物,可以有效降低椎骨和非椎骨骨折的危险。其中,阿仑膦酸钠（ALN）是应用最多的,它可以通过迅速抑制破骨细胞对骨质的重吸收而防止骨量丢失。而正常的骨折愈合过程包括必要的骨形成和骨重吸收。最近发生骨折的患者是否可以服用这类骨质重吸收抑制剂呢？骨折愈合会不会受到影响,导致骨折延迟愈合或不愈合？笔者就此问题在骨折的愈合过程、双膦酸盐药物的作用机制、双膦酸盐药物对骨折愈合的影响以及骨折后骨量丢失的预防等方面做一个综述。结论骨折急性期患者可以服用推荐剂量的双膦酸盐药物治疗骨质疏松症或预防骨折后的骨量丢失。但是,若骨折急性期患者同时合并有疾病需要较大剂量服用双膦酸盐药物,治疗方案的选择应该以风险-受益比为基础,根据每名患者的具体情况进行治疗。     

Home Infusions of Biphosphonate in Cancer Patients: A Prospective Study

Abstract

The objective of the study was to determine outcome and satisfaction of cancer patients treated by home-infusions of biphosphonates. 107 patients entered the study and 97 of them chose to receive infusions of zoledronic acid (Z) in the home setting. Patient satisfaction and quality of care (QoC) were assessed by a 22-item questionnaire. Changes from baseline were determined for bone pain using a 0-10 cm visual analogue scale pain score (VAS). Patients expressed a high level of satisfaction specifically with regard to nursing care. Seventy patients experienced a significant decrease in the median pain score during the home-therapy phase not due to an increased use of analgesic therapy (P = 0.03). Z was well tolerated with no major adverse events. The authors conclude that home infusions of biphosphonates, on the condition that the supportive care team is well-organized, is a safe procedure that could be advantageous for patients by increasing satisfaction and compliance with treatment.