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Tamana, Japan

Fukui N.,Clinical Research Center | Watanabe Y.,Teikyo University | Nakano T.,Tamana Central Hospital | Sawaguchi T.,Toyama City Hospital | Matsushita T.,Teikyo University
Journal of Orthopaedic Trauma | Year: 2012

Objectives: To investigate the predictors of functional outcome and changes in the basic activities of daily living in older adults who sustained hip fractures, considering the level of ambulatory ability before injury. Design: A prospective observational cohort study. Setting: One university hospital and 13 community teaching hospitals. Patients: A consecutive cohort of 650 patients who underwent surgery for a hip fracture between December 2004 and January 2006. Main Outcome Measures: Recovery of ambulatory ability and independence in activities of daily living 6 and 12 months after surgery. Results: Ambulatory ability recovered to the prefracture level in approximately half of the patients 6 months after surgery, and those ratios changed little in the next 6 months. In patients who were community ambulators before fractures, the independence in bathing before fractures was a strong predictor of ambulatory ability after surgery, but this was not the case in the former household ambulator group. The attainment of assisted ambulation with a walking cane at hospital discharge was a reliable predictor of ambulatory ability in both former community ambulator and household ambulator groups. Conclusions: Ambulatory ability after hip fractures was considered to be determined within 6 months after surgery. There was some difference in prognostic factors for ambulatory ability according to the level of mobility before fractures. The attainment of single cane (T-cane) gait at hospital discharge can serve as a reliable predictor of ambulatory ability after fractures, irrespective of the level of mobility before the injury. Copyright © 2012 by Lippincott Williams & Wilkins.

Nakano T.,Tamana Central Hospital
Clinical calcium | Year: 2012

The concept and terminology for bone fractures is now in some confusion between two academic fields, one of osteoporosis and the other of orthopedic fracture treatment, concerning the treatment of osteoporosis and the prevention of fragility fractures. In the former field, the terms of "incident or prevalent" fracture are commonly used ; by contrast, bone fracture simply means "fresh" fracture in the latter. Used to be based of X-ray films, diagnosis of osteoporotic fracture are now changing to depend on MRI, because its sensitivity and specificity of detecting fresh fracture of vertebral body is far better than other methods.

Nakano T.,Tamana Central Hospital
Clinical calcium | Year: 2014

Teriparatide (human PTH 1-34) transiently stimulate both bone formation and bone resorption and subsequently bone formation markers increased. The changes in bone turnover markers 24 h after each injection of once-weekly 56.5μg teriparatide were constant for 24 weeks. Once-weekly injections of teriparatide increased bone mineral density by 8.1% at the lumbar spine and reduced the risk of new vertebral fracture with a relative risk reduction of 80% compared to placebo for the patients with osteoporosis. Significant vertebral fracture risk reductions were also observed in the patients with high risk for fracture such as higher age, low bone mineral density, or sever vertebral fracture grade. Once-weekly teriparatide improved cortical bone parameters at proximal femur, may have the potential to prevent hip fracture. The duration of teriparatide treatment was limited. Therefore subsequent treatment for osteoporosis should be need. Bisphosphonates seem to be a useful choice as a subsequent treatment to once-weekly teriparatide.

Hagino H.,Tottori University | Shiraki M.,Research Institute and Practice for Involutional Diseases | Fukunaga M.,Kawasaki Medical School | Nakano T.,Tamana Central Hospital | And 4 more authors.
Journal of Bone and Mineral Metabolism | Year: 2012

The objective of this study was to determine the safety and efficacy of long-term minodronate treatment in women with postmenopausal osteoporosis based on reanalysis of a phase III 2-year clinical trial with a 1-year extension. Women aged 55-80 years old with fragility fractures were enrolled and randomized to take 1 mg minodronate or placebo once a day in the original 2-year study. The subjects who completed the 2-year study were invited to participate in an additional 1-year extension in which all subjects were to receive minodronate. Finally, a total 380 subjects completed the extension study (186 from the placebo group and 194 from the minodronate group). Fracture results observed in the extension study were consistent with those observed in the first 2 years in minodronate group. In contrast, the placebo/minodronate group showed a decreased incidence of new vertebral fractures during year 3 compared to that in year 2. In the patients who received minodronate in the original 2-year study, lumbar bone mineral density (BMD) increased consistently during year 3 and bone turnover markers decreased within the first 6 months and remained constant thereafter over 3 years. Similar positive effects of minodronate on BMD and bone turnover markers occurred when therapy was initiated in the placebo/minodronate group. No new safety concerns observed during the extension period compared to the safety observations made during the 2-year study. It was concluded that daily administration of 1 mg oral minodronate is safe and well tolerated, and that the efficacy of this dose in reducing vertebral fracture risk in postmenopausal women over 2 years is sustained with continuing treatment. © The Japanese Society for Bone and Mineral Research and Springer 2011.

Nakamura T.,University of Occupational and Environmental Health Japan | Nakano T.,Tamana Central Hospital | Ito M.,Nagasaki University | Hagino H.,Tottori University | And 3 more authors.
Calcified Tissue International | Year: 2013

This randomized, double-blind study assessed the antifracture efficacy and safety of intermittent intravenous (IV) ibandronate versus oral daily risedronate in Japanese patients with primary osteoporosis. Ambulatory patients aged ≥60 years were randomized to receive 0.5 or 1 mg/month IV ibandronate plus oral daily placebo or 2.5 mg/day oral risedronate, the licensed dose in Japan, plus IV placebo. The primary end point was noninferiority of ibandronate versus risedronate for first new or worsening vertebral fracture over 3 years. A total of 1,265 patients were randomized. A total of 1,134 patients formed the per-protocol set. Both ibandronate doses were noninferior to risedronate: 0.5 mg, hazard ratio (HR) 1.09 [95 % confidence interval (CI) 0.77-1.54]; 1 mg, HR 0.88 (95 % CI 0.61-1.27). The rate of first new vertebral fracture over 3 years was 16.8 % (95 % CI 12.8-20.8) for 0.5 mg ibandronate, 11.6 % (95 % CI 8.2-15.0) for 1 mg ibandronate, and 13.2 % (95 % CI 9.6-16.9) for risedronate. Significant increases in bone mineral density relative to baseline were observed with all treatments after 6 months, with substantial reductions in bone turnover markers after 3 months. Greatest efficacy was obtained with 1 mg ibandronate. Analyses in women only showed similar results to the overall population. No new safety concerns were identified. This study demonstrated the noninferiority of IV ibandronate to the licensed Japanese dose of oral risedronate and suggested that 1 mg/month is an effective dose in Japanese patients with primary osteoporosis. © 2013 The Author(s).

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