Tamana, Japan
Tamana, Japan

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Nakamura T.,University of Occupational and Environmental Health Japan | Sugimoto T.,The University of Shimane | Nakano T.,Tamana Central Hospital | Kishimoto H.,Sanin Rosai Hospital | And 8 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2012

Context: Weekly teriparatide injection at a dose of 56.5 μg has been shown to increase bone mineral density. Objective: A phase 3 study was conducted to determine the efficacy of once-weekly teriparatide injection for reducing the incidence of vertebral fractures in patients with osteoporosis. Design and Setting: In this randomized, multicenter, double-blind, placebo-controlled trial conducted in Japan, the incidence of morphological vertebral fractures by radiographs was assessed. Patients: Subjects were 578 Japanese patients between the ages of 65 and 95 yr who had prevalent vertebral fracture. Intervention: Subjects were randomly assigned to receive once-weekly sc injections of teriparatide (56.5 μg) or placebo for 72 wk. Main Outcome Measure: The primary endpoint was the incidence of new vertebral fracture. Results: Once-weekly injections of teriparatide reduced the risk of new vertebral fracture with a cumulative incidence of 3.1% in the teriparatide group, compared with 14.5% in the placebo group (P < 0.01), and a relative risk of 0.20 (95% confidence interval, 0.09 to 0.45). At 72 wk, teriparatide administration increased bone mineral density by 6.4, 3.0, and 2.3% at the lumbar spine, the total hip, and the femoral neck, respectively, compared with the placebo (P < 0.01). Adverse events (AE) and the dropout rates by AE were more frequently experienced in the teriparatide group, but AE were generally mild and tolerable. Conclusion: Weekly sc administration of teriparatide at a dose of 56.5 μg may provide another option of anabolic treatments in patients with osteoporosis at higher fracture risk. Copyright © 2012 by The Endocrine Society.


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).


Fukui N.,National Hospital Organization | 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.


Hagino H.,Tottori University | Sawaguchi T.,Toyama City Hospital | Endo N.,Niigata University | Ito Y.,Tottori University | And 2 more authors.
Calcified Tissue International | Year: 2012

We investigated the incidence of additional fractures and the rate of prescription of osteoporotic pharmacotherapy after an initial hip fracture. We surveyed female patients aged 65 and over who sustained their first hip fracture between January 1, 2006, and December 31, 2007, treated at 25 hospitals in five geographic areas in Japan. Data for 1 year after the first hip fracture were collected from medical records, and questionnaires were mailed to all patients. In total, 2,663 patients were enrolled, and 335 patients were excluded based on exclusion criteria. The analysis was performed on 2,328 patients. During the 1-year follow-up period 160 fractures occurred in 153 patients and 77 subsequent hip fractures occurred in 77 patients. The incidence of all additional fractures among patients who sustained their first hip fracture was 70 (per 1,000 person-year) and that for second hip fracture was 34. In comparison to the general population, women ≥65 years of age who sustained an initial hip fracture were four times as likely to sustain an additional hip fracture. Antiosteoporosis pharmacotherapy was prescribed for 436 patients (18.7%), while 1,240 patients (53.3%) did not receive any treatment during the 1-year period. Patients who have sustained one hip fracture have a higher risk of a second hip fracture compared to the general population, and most of these women receive no pharmaceutical treatment for osteoporosis. © 2011 Springer Science+Business Media, LLC.


Kurogi K.,Kumamoto University | Kurogi K.,Miyazaki Prefectural Nobeoka Hospital | Sugiyama S.,Kumamoto University | Sakamoto K.,Kumamoto University | And 5 more authors.
Journal of Cardiology | Year: 2013

Background: Many large-scale clinical trials have confirmed that statins are effective in reducing low-density lipoprotein cholesterol (LDL-C) level, resulting in reducing cardiovascular events. Recent studies have focused on the effects of statins on high-density lipoprotein cholesterol (HDL-C). Here we compared the effects of two statins on lipid profile and other metabolic parameters. Methods: The study population included 129 patients with stable coronary artery disease, hypercholesterolemia, and hypo-HDL-cholesterolemia (HDL-C < 50 mg/dl). They were randomly allocated to treatment by pitavastatin 2-4. mg/day or atorvastatin 10-20. mg/day and followed-up for 30 months. The primary endpoint was percent changes in HDL-C and adiponectin during the study. The secondary endpoints were percent and absolute changes in markers of glucose metabolism, serum lipids, and apolipoproteins. Results: The effects of 30-month treatment with pitavastatin on HDL-C were significantly greater than those of atorvastatin (%change: pitavastatin: 20.1 ± 25.7%, atorvastatin: 6.3 ± 19.8%, p= 0.01; absolute change: pitavastatin: 7.3 ± 9.1. mg/dl, atorvastatin: 2.3 ± 8.0. mg/dl, p= 0.02). A similar trend was seen with regard to apolipoprotein-AI (ApoAI) (%change: pitavastatin: 20.8 ± 19.3%, atorvastatin: 11.4 ± 17.6%, p= 0.03; absolute change: pitavastatin: 23.1 ± 20.2. mg/dl, atorvastatin: 12.1 ± 19.4. mg/dl, p= 0.02). Treatment with pitavastatin, but not atorvastatin, significantly increased adiponectin levels. Neither statin had a significant effect on hemoglobin A1c. No severe adverse events were registered during the study. Conclusion: Long-term treatment with pitavastatin resulted in significantly greater increases in serum HDL-C and ApoAI levels without adverse effects on glucose metabolism, compared with atorvastatin. © 2013.


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.


Nagata K.,Tamana Central Hospital
Rinsho byori. The Japanese journal of clinical pathology | Year: 2010

Gram staining is one of the most simple and inexpensive methods for the rapid diagnosis of bacterial and fungal infections. It yields results much faster than culture, and provides important data for the patient's treatment and prognosis. However, a difference exists in the quality and quantity of information yielded by Gram staining smears based on the experience and knowledge of those conducting the tests. Therefore, a risk of misdiagnosis based on the information obtained from Gram staining smears is also present. The Gram staining conditions and morphology of bacteria sometimes change due to antimicrobial therapy. Species of Gram-negative rods sometimes become filamentous and pleomorphic. Gram-positive bacteria may become gram variable (change in staining condition) after antimicrobial therapy. Even bacteria that are easy to mis-identify exist, because the morphology of bacteria may be similar. Enterococcus faecalis is a Gram-positive diplococcus, forming Gram-positive clustered cocci in specimens from blood culture bottles, resembling Streptococcus pneumoniae. Acinetobacter baumannii is a Gram-negative diplococcus in sputum, resembling Moraxella (Branhamella) catarrhalis. Pasteurella multocida is a small-sized, Gram-negative short rod in the sputum, resembling Haemophilus influenzae. Prevotella intermedia is a small-sized, Gram-negative short rod in sputum, resembling Haemophilus influenzae. Capnocytophaga sp. is a Gram-negative fusiform (thin needle shape) rod present in clinical specimens, resembling Fusobacterium nucleatum.


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.


Ikeda T.,Tamana Central Hospital
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society | Year: 2011

An 80-year-old woman visited her family physician because of back pain. A chest X-ray film showed a mass in the left middle lung field. She was referred to our hospital for further examinations. A computed tomography-guided lung biopsy revealed a solitary fibrous tumor, and a whole body examination demonstrated multiple metastases, including in the spine, ribs, femurs and pubis. Considering her age, chemotherapy was not given, but we administered radiotherapy for the metastatic lesions. Subsequently detected metastases of the left orbit, liver, scapula and humerus were also then irradiated, but she died 11 months after the initial diagnosis due to the complication of bacterial pneumonia. A case of a solitary malignant fibrous tumor with multiple metastases was reported.


The vertebral fractures of the elderly people are correctly diagnosed about 60% of the time if the X-ray is the only one used for diagnosis.The additional physical examination increases the rate dramatically, but it does not help locate the fracture.The follow-up X-ray examination increases the rate ; it becomes, however, too late to start an effective treatment. MRI is the best tool for the accurate diagnosis in the early stage.

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