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Sarli M.,Institute Diagnostico e Investigaciones Metabolicas | Rey P.G.,Institute Diagnostico e Investigaciones Metabolicas
Actualizaciones en Osteologia | Year: 2016

High risk osteoporosis treatment is a challenge in daily medical practice. We report three patients that attended our institution with severe osteoporosis who received sequentially teriparatide (20 ug daily) for eighteen months followed by denosumab (60 mg every six months) for twelve months. After teriparatide treatment bone mineral density increased 5.86±1.01% at lumbar spine and 1.92±3.10 % at femoral neck, while after denosumab it continued increasing to reach a total of 10.45±1.70% at lumbar spine and 9.28±3.86% at femoral neck. Teriparatide treatment increased bone resorption evidenced by high serum CTX while after denosumab it fell abruptly, showing the impact of these two drugs on bone turnover. We conclude that sequential treatment with teriparatide and denosumab in approved doses was beneficial for these three patients. Prospective studies are needed. © 2016, Asociacion Argentina de Osteologia y Metabolismo Mineral. All rights reserved.

Zanchetta M.B.,Institute Diagnostico e Investigaciones Metabolicas | Zanchetta M.B.,University of Salvador | Longobardi V.,Institute Diagnostico e Investigaciones Metabolicas | Longobardi V.,University of Salvador | Bai J.C.,University of Salvador
Current Osteoporosis Reports | Year: 2016

More than 50 % of untreated patients with celiac disease (CD) have bone loss detected by bone densitometry (dual-energy X-ray absorptiometry:DXA). Moreover, patients with CD are more likely to have osteoporosis and fragility fractures, especially of the distal radius. Although still controversial, we recommend DXA screening in all celiac disease patients, particularly in those with symptomatic CD at diagnosis and in those who present risk factors for fracture such as older age, menopausal status, previous fracture history, and familial hip fracture history. Bone microarchitecture, especially the trabecular network, may be deteriorated, explaining the higher fracture risk in these patients. Adequate calcium and vitamin D supplementation are also recommended to optimize bone recovery, especially during the first years of gluten free diet (GFD). If higher fracture risk persists after 1 or 2 years of GFD, specific osteoactive treatment may be necessary to improve bone health. © 2016, Springer Science+Business Media New York.

Leder B.Z.,Massachusetts General Hospital | O'Dea L.S.L.,Radius Health Inc. | Zanchetta J.R.,Institute Diagnostico e Investigaciones Metabolicas | Kumar P.,Center for Diabetes and Endocrine Care | And 4 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2015

Context: Abaloparatide is a novel synthetic peptide analog of parathyroid hormone-related protein (PTHrP) that is currently being developed as a potential anabolic agent in the treatment of postmenopausal osteoporosis. Objective: This study sought to assess the effects of abaloparatide on bone mineral density (BMD) at the lumbar spine, total hip, and femoral neck in postmenopausal women with osteoporosis. Design: Multi-center, multi-national, double-blind placebo controlled trial in which postmenopausal women were randomly assigned to receive 24 weeks of treatment with daily sc injections of placebo, abaloparatide, 20, 40, or 80 μg, or teriparatide, 20 μg. A 24-week extension was also performed in a subset of subjects. Participants: Postmenopausal women with osteoporosis (n = 222). Main Outcome Measures: BMD by dual-x-ray absorptiometry and biochemical markers of bone turnover. Results: At 24 weeks, lumbar spine BMD increased by 2.9, 5.2, and 6.7% in the abaloparatide, 20-, 40-, and 80-μg groups, respectively, and 5.5% in the teriparatide group. The increases in the 40-and 80-μg abaloparatide groups and the teriparatide group were significantly greater than placebo (1.6%). Femoral neck BMD increased by 2.7, 2.2, and 3.1% in abaloparatide, 20-, 40-, and 80-μg groups, respectively, and 1.1% in the teriparatide group. The increase in femoral neck BMD with abaloparatide, 80 μg was significantly greater than placebo (0.8%). Total hip BMD increased by 1.4, 2.0, and 2.6% in the abaloparatide, 20-, 40-, and 80-μg groups, respectively. The total hip increases in the 40- and 80-μg abaloparatide groups were greater than both placebo (0.4%) and teriparatide (0.5%). Conclusions: Compared with placebo, 24 weeks of daily sc abaloparatide increases BMD of the lumbar spine, femoral neck, and total hip in a dose-dependent fashion. Moreover, the abalo-paratide-induced BMD increases at the total hip are greater than with the marketed dose of teriparatide. These results support the further investigation of abaloparatide as an anabolic therapy in postmenopausal osteoporosis. Copyright © 2015 by the Endocrine Society.

Zanchetta M.B.,Institute Diagnostico e Investigaciones Metabolicas | Zanchetta M.B.,University of Salvador | Costa F.,Seccion Intestino Delgado | Longobardi V.,Institute Diagnostico e Investigaciones Metabolicas | And 17 more authors.
Bone | Year: 2015

Patients with active celiac disease (CD) are more likely to have osteoporosis and increased risk of fractures. High-resolution peripheral quantitative computed tomography (HR-pQCT) permits three-dimensional exploration of bone microarchitectural characteristics measuring separately cortical and trabecular compartments, and giving a more profound insight into bone disease pathophysiology and fracture. We aimed to determine the volumetric and microarchitectural characteristics of peripheral bones-distal radius and tibia-in an adult premenopausal cohort with active CD assessed at diagnosis. We prospectively enrolled 31 consecutive premenopausal women with newly diagnosed CD (median age 29years, range: 18-49) and 22 healthy women of similar age (median age 30years, range 21-41) and body mass index. Compared with controls, peripheral bones of CD patients were significantly lower in terms of total volumetric density mg/cm3 (mean±SD: 274.7±51.7 vs. 324.7±45.8, p 0.0006 at the radius; 264.4±48.7 vs. 307±40.7, p 0.002 at the tibia), trabecular density mg/cm3 (118.6±31.5 vs. 161.9±33.6, p<0.0001 at the radius; 127.9±28.7 vs. 157.6±15.6, p<0.0001 at the tibia); bone volume/trabecular volume ratio % (9.9±2.6 vs. 13.5±2.8, p<0.0001 at the radius; 10.6±2.4 vs. 13.1±1.3, p<0.0001 at the tibia); number of trabeculae 1/mm (1.69±0.27 vs. 1.89±0.26, p 0.009 at the radius; 1.53±0.32 vs. 1.80±0.26, p 0.002 at the tibia); and trabecular thickness mm (0.058±0.010 vs. 0.071±0.008, p<0.0001 at the radius with no significant difference at the tibia). Cortical density was significantly lower in both regions (D comp mg/cm3 860±57.2 vs. 893.9±43, p 0.02; 902.7±48.7 vs. 932.6±32.6, p 0.01 in radius and tibia respectively). Although cortical thickness was lower in CD patients, it failed to show any significant inter-group difference (a-8% decay with p 0.11 in both bones). Patients with symptomatic CD (n=22) had a greater bone microarchitectural deficit than those with subclinical CD. HR-pQCT was used to successfully identify significant deterioration in the microarchitecture of trabecular and cortical compartments of peripheral bones. Impairment was characterized by lower trabecular number and thickness-which increased trabecular network heterogeneity-and lower cortical density and thickness. In the prospective follow-up of this group of patients we expect to be able to assess whether bone microarchitecture recovers and to what extend after gluten-free diet. © 2015 Elsevier Inc.

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