ISSN:0002-9629    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Postmenopausal osteoporosis is linked clearly to estrogen deprivation. Recent research has identified estrogen receptors in bone cells and in other organ systems that help to regulate bone remodeling and calcium homeostasis. Long-term use of estrogen in appropriate doses reduces the risk of hip fractures by 50% to 60% and the risk of vertebral deformation by 90%. This protective effect is maintained as long as estrogen is taken and adequate levels of biologically active estrogen are achieved. Thus, the type, dose, and route of administration of estrogen need to be individualized and the efficacy of treatment monitored by annual bone density testing and selective ultilization of biochemical bone markers. The ability of estrogen therapy to increase bone mass is enhanced by added androgens and progestin therapy, calcium supplementation, and exercise.

ISSN:0002-9629    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Nasal calcitonin is a newly approved treatment for established osteoporosis. Nasal calcitonin is safe, preventative, and may increase bone mass in the lumbar spine. Fracture efficacy data are not yet available, although preliminary results are promising. The dose of nasal calcitonin for the treatment of established osteoporosis is 200 IU daily. The dose for prevention of postmenopausal osteoporosis has not yet been established. Nasal calcitonin may be analgesic to bone and of benefit in glucocorticoid-induced osteoporosis.

ISSN:0002-9629    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The bisphosphonates are long-lived synthetic analogs of pyrophosphate, a natural, short-lived inhibitor of bone. Oral doses share similar qualities(ie, they inhibit bone resorption, poor absorption, and potential gastrointestinal irritants), but each one has a unique spectrum of potency and a probable mechanism of action. The parent compound, etidronate, was first used in multicentered trials for the treatment of primary osteoporosis and showed some success in increasing bone density and perhaps controlling fracture rates. The recently approved drug alendronate is a more potent agent than etidronate, produces a greater increase in bone density, and decreases fractures. Oral and intravenous pamidronate have similar positive effects on bone density. Studies with tiludronate, risedronate, and clodronate show similar promise as therapeutic agents.

ISSN:0002-9629    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Current therapeutic approaches to postmenopausal bone loss or established osteoporosis vary widely among the different regions of the world. Because no treatment of osteoporosis has unequivocally demonstrated full prevention of the appearance or the recurrence of axial or peripheral fractures so far, many investigational compounds are being developed. Anabolic steroids act mainly as inhibitors of bone resorption with very few, if any, effects on bone formation. Because of the high occurrence of signs of virilization and the weak effects on bone structure, the risk/benefit ratio in osteoporosis should be considered at least problematic. If ongoing large-scale trials confirm the expected benefits of estrogen antagonist/agonists on the skeleton and confirm no cardiovascular risk to postmenopausal women with optimal uterine safety, these substances are likely to become the most prominent alternative to hormonal replacement therapy after the menopause. Additional studies are requested to evaluate the potential benefit of growth hormone or insulin-like growth factors in treatment of osteoporosis. Ipriflavone acts predominantly as an inhibitor of bone resorption. To confirm the efficacy of ipriflavone on the prevention of vertebral fractures and its effects on bone mineral density in women with postmenopausal established osteoporosis, a large multicentric European study is being conducted. Treatment with parathyroid peptides induces a significant gain in bone mass, mainly in the axial skeleton. Long-term studies that compare peptides, doses, and regimes are needed to better understand the exact position of parathyroid peptides as treatment of osteoporosis. Prolonged administration of strontium to postmenopausal osteoporotic women resulted in a decoupling between bone resorption and formation that yielded a significant increase in the lumbar spine bone mineral density of treated subjects. In the view of these promising results and of the excellent tolerance of strontium during preliminary trials, additional investigations of this compound in prevention and treatment of osteoporosis should be promptly initiated. Several other compounds have been punctually suggested for treatment of osteoporosis or are at very early stages of development. Finally, besides pharmacologic approaches to the treatment of osteoporosis, hip fractures may also be reduced by the use of hip protectors.

ISSN:0002-9629    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The pathophysiology of corticosteroid-induced osteoporosis is outlined in this article. Treatment options, based upon our understanding of the pathophysiology, and a review of the available literature are offered.

ISSN:0002-9629    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The objective of this study was to determine the rate of bacteremia in young women admitted to the hospital with presumed pyelonephritis and compare it with other published rates. The study design was a retrospective, structured chart review and a review of published reports of bacteremic pyelonephritis. An urban county teaching hospital provided the setting for the study. The patients were nonpregnant women (n = 98) 44 years of age or younger who were without bladder dysfunction and who had not been admitted to an intensive care unit. Further criteria for participation included discharge with the diagnosis of acute pyelonephritis. Blood cultures were ordered for 69 women; the results of 64 were noted in the chart. Twenty-three women(35.9% of those cultured; 23.4% of all patients) were diagnosed with bacteremia. In patients for whom blood culture results were obtained, trends developed between those patients with bacteremia and those with complicated pyelonephritis, defined as a known or newly discovered genitourinary abnormality or a risk factor (P = 0.044), those who were black (P = .044), those with higher pulses on admission (P = .050), those with more white blood cells per high-powered field after urinalysis (P = 0.007), and those whose fever lasted longer (P = 0.033). Blood culture results were positive in two patients whose urine cultures were negative. This comparatively high bacteremia rate supports routine ordering of blood cultures for urban women suspected of having pyelonephritis.

ISSN:0002-9629    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

A case associated with insulin-dependent diabetes mellitus (IDDM), rheumatoid arthritis (RA), and autoimmune thyroid disease (AITD) was reported. A high titer of antiglutamic acid decarboxylase antibody (GAD) and a positive islet cell antigen were observed. The patient's human leukocyte antibody (HLA) haplotype was a homozygote of DQA1*0301, DQB1*0401, and DRB1*0405. Because this haplotype was in linkage disequilibrium with DPB1*0501, an allele associated with AITD in Japanese patients, the patient was homozygous for alleles susceptible to IDDM, RA, and AITD. A specific HLA haplotype susceptible to several autoimmune disease may result in the development of IDDM, RA, and AITD.

ISSN:0002-9629    

出版商:OVID    

年代:1997

数据来源: OVID