Current and emerging osteoporosis pharmacotherapy for women: state of the art therapies for preventing bone loss

Introduction: Pharmacological options to address the imbalance between bone resorption and accrual in osteoporosis include anti-resorptive and osteoanabolic agents. Unique biologic pathways such as the Wnt/β-catenin pathway have been targeted in the quest for new emerging therapeutic strategies.

Areas covered: This review provides an overview of existing pharmacotherapy for osteoporosis in women and explore state-of–the-art and emerging therapies to prevent bone loss, with an emphasis on the mechanism of action, indications and side effects.

Expert opinion: Bisphosphonates appear to be a reliable and cost-effective option, whereas denosumab has introduced a simpler dosing regimen and may achieve a linear increase in bone mineral density (BMD) with no plateau being observed, along with continuous anti-fracture efficacy. Abaloparatide, a parathyroid-hormone-related peptide (PTHrP)-analogue, approved by the FDA in April 2017, constitutes the first new anabolic osteoporosis drug in the US for nearly 15 years and has also proven its anti-fracture efficacy. Romosozumab, a sclerostin inhibitor, which induces bone formation and suppresses bone resorption, has also been developed and shown a significant reduction in fracture incidence; however, concerns have arisen with regard to increased cardiovascular risk.     

Alcohol Outcome Expectancies Mediate the Relationship Between Social Anxiety and Alcohol Drinking in University Students: The Role of Gender

College alcohol drinking is a public health concern worldwide. A line of research indicates that higher social anxiety is associated with more severe college drinking. However, other studies reveal a protective role of social anxiety against alcohol drinking in college students. Attempting to reconcile contradictory findings, we examined the hypothesis that there are multiple antagonistic pathways that could explain the social anxiety-college drinking relationship. In addition, there may be individual difference variables that moderate these processes. Furthermore, it was expected that the processes could vary as a function of the alcohol drinking outcomes examined. Expectancy theory emphasizes the role of alcohol outcome expectancies in alcohol drinking. Thus, in the present study we tested whether global positive and negative alcohol outcome expectancies partially mediate the relationship between social anxiety, alcohol consumption, and alcohol-related problems in a sample of 245 university students. We also examined the moderating role of gender in these mediating processes. Results revealed parallel but oppositional processes. Higher social anxiety was associated with heavier alcohol drinking and more serious alcohol-related problems via stronger positive alcohol outcome expectancies. However, the mediating role of positive alcohol outcome expectancies varied as a function of gender. It appears that in female students the mediating effect of positive alcohol outcome expectancies was stronger than in male students. On the other hand, higher social anxiety had a protective role against alcohol consumption but not against alcohol-related problems via stronger negative alcohol outcome expectancies. Finally, there was an inverse direct relationship between social anxiety and alcohol consumption.     

Congruence Between Latent Class and K-Modes Analyses in the Identification of Oncology Patients With Distinct Symptom Experiences

Context

Risk profiling of oncology patients based on their symptom experience assists clinicians to provide more personalized symptom management interventions. Recent findings suggest that oncology patients with distinct symptom profiles can be identified using a variety of analytic methods.

Impact of the longitudinal quantitative assessment of juvenile systemic lupus erythematosus severity on the disease outcome

Clinical Rheumatology - This study on juvenile SLE patients aimed to evaluate retrospectively the impact of a tertiary center’s management policy of the disease severity on its long-term...     

Predictors of severity and necrosis in acute pancreatitis

C-reactive protein remains the single standard biochemical marker for predicting the severity of AP. Because the combination of clinical-physiological scores and CRP provide good information at 48 hours, research has focused on the predictive ability of various markers when applied in the initial 24 hours after admission to the hospital. After detailed review of the literature, the authors conclude that there is no single tool that serves as the optimal predictor of severity. There are, however, data that support the use of certain tests to improve upon the clinician's early predictive ability on the subsequent course of AP. These include an APACHE II score greater than 7 and IL-6 at the time of admission, and urine TAP, urine trypsinogen-2, and serum PMN elastase at 24 hours (Table 4). These markers only will be able to help the clinician's predictive ability if they can be performed locally and if the results can be available ina timely manner. Future research should focus on promising markers such as procalcitonin, IL-8, IL-I ra, sTNFR, CAPAP, PLA-2, novel markers, and the combined use of more than one marker. The conventional research approach in predicting severity used in the last 15 years has limitations and appears to have reached its maximal potential. Novel conceptions and approaches, such as identification of genetic polymorphisms that predispose to severe course and complications of AP or other approaches are needed for a quantum step forward.