摘要:

PurposeReview of recent literature supporting the clinical applications of biochemical markers of bone turnover.Recent findingsThe most valuable markers of bone turnover are those that change substantially with antiresorptive treatment but have minimal spontaneous variability, such as serum CTX (amino-terminal propeptide of type I collagen) and PINP (peptide-bound C-telopeptide crosslinks of type I collagen). Markers are valuable in the monitoring of Paget disease, although newer markers have few advantages over the more economical total alkaline phosphatase. Although markers are elevated in patients with osseous metastases, there is little practical reason to use them in this setting. Markers of bone turnover are of limited utility in monitoring patients with arthritis, but new markers of cartilage turnover may be of much greater use. Markers of turnover such as bone-specific alkaline phosphatase are elevated in patients with high-turnover renal osteodystrophy, but it is not clear that bone-specific alkaline phosphatase is superior to serum parathyroid hormone in supporting this diagnosis. Markers of bone turnover probably have the greatest application to the selection of patients at high risk for bone loss and for monitoring patients receiving antiresorptive therapy for osteoporosis. Some published reports suggest that a decrease of 40 to 60% in markers of turnover with antiresorptive treatment is ideal. However, more research needs to be done to determine the ideal bone turnover target to indicate optimal treatment.SummaryBiochemical markers of bone turnover have clinical utility in diverse settings, especially in the selection of patients for treatment with antiresorptive therapy and in assessing the adequacy of antiresorptive therapy in patients receiving treatment.

ISSN:1068-3097    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewPrimary hyperparathyroidism is the third most common endocrine disorder and the second most common cause of hypercalcemia. Because of the changing patterns of presentation, currently, a vast majority of patients with this disease are asymptomatic, and the role of parathyroidectomy has been called into question. However, emergence of minimally invasive parathyroidectomy and concern about nonclassical manifestations of the disease has rekindled interest in a more liberal approach to surgery. Therefore, it is appropriate to review the state of the management of primary hyperparathyroidism.Recent findingsModern day primary hyperparathyroidism is largely asymptomatic, rarely presents with classic bone disease or recurrent stones, and in the absence of treatment the disease course remains stable over extended periods. However, there is growing concern about nonclassical manifestations of the disease such as cardiovascular disease, hypertension, dyslipidemia, and diabetes, resulting in excess mortality. It is argued that parathyroidectomy reduces this risk. Although surgery is the treatment of choice for patients with symptomatic disease, uncertainty exists about its benefits in mild asymptomatic disease. Availability of effective therapies that increase bone density has added a new dimension in the management of such patients.SummaryChanging incidence and patterns of presentation of primary hyperparathyroidism have created a dilemma for today's clinician to decide on the optimal management of patients with this disease. Advances in surgical techniques and the availability of drugs to increase bone density have added new dimensions to the management of this common endocrine disorder.

ISSN:1068-3097    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

For more than 50 years, treatments have been available to replace the declining hormone levels of postmenopausal women. Until recently, an estimated 38% of postmenopausal women in the United States have been using hormone replacement therapy. Women are now living an average of 30 years after menopause begins, and it is during those years that they are at increased risk of chronic medical conditions such as osteoporosis, coronary heart disease, cancers, urinary stress incontinence, and dementia. In addition to managing or minimizing symptoms associated with menopause, hormone replacement therapy had been thought to provide women with some degree of protection against some of these conditions. Numerous studies have examined the proposed risks and benefits; however, a recent, large clinical trial by the Women's Health Initiative concluded that the benefits of hormone replacement therapy do not outweigh the risks and recommends that patients discontinue its use for long-term therapy. This trial has been extremely influential because it is the first well-controlled and adequately powered randomized primary prevention trial of postmenopausal hormones in healthy women. The results have led many to believe that hormone replacement therapy should be limited to short-term use for the treatment of menopausal symptoms. Nevertheless, there are some limitations to this study. This study by the Women's Health Initiative, along with several others, is examined, with a focus on the potential benefits and risks of hormone replacement therapy. At present, most physicians agree that the benefits of hormone replacement therapy include the decreased incidence of osteoporotic fractures and colorectal cancer. The risks include increased chance of breast cancer, coronary heart disease, stroke, thromboembolic events, cognitive impairment, dementia, and cholecystitis. Despite the risks associated with hormone replacement therapy, it should still be considered the best treatment option for the short-term therapy of menopausal symptoms. Furthermore, there may be additional benefits to different regimens of hormone replacement therapy that have not yet been determined. Finally, other possibilities for the use of estrogens and related alternatives for postmenopausal women are also discussed.

ISSN:1068-3097    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1068-3097    

出版商:OVID    

年代:2003

数据来源: OVID