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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article discusses various drug therapies that may induce osteoporosis in some patients. These treatments include not only corticosteroids (glucocorticoid), DMARDs, and NSAIDs, as well as recent data where osteoporosis is induced by adjuvant antineoplastic treatment in pre- and postmenopausal women with early breast cancer and by androgen deprivation therapy in men who are being treated for prostate cancer.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Emetabolic bone disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ECorticosteroids - A Balanced View\u003C\/h2\u003E\n         \u003Cp id=\u0022p-2\u0022\u003EWillem Lems, MD, University Medical Centre, Amsterdam, The Netherlands, discussed the pathogenesis of glucocorticoid-induced osteoporosis.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EGlucocorticoids have been shown to stimulate apoptosis of osteoblasts and osteocytes, interfere with the Wntsignaling pathway (a pivotal pathway for modulating osteoblastic activity, bone formation, and bone strength), and increase the lifespan of osteoclasts [Shoback D. \u003Cem\u003EJ Clin Endocrinol Metab\u003C\/em\u003E 2007]. They also reduce the intestinal absorption of calcium and augment calcium excretion in the urine [van Staa T. \u003Cem\u003ECalcif Tissue Int\u003C\/em\u003E 2006].\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EThe increased fracture risk in patients who receive glucocorticoid therapy may be offset by alendronate [Saag KG et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 1998], risedronate [Reid DM et al. \u003Cem\u003EJ Bone Miner Res\u003C\/em\u003E 2000], active vitamin D3, and bisphosphonates [de Nijs RN et al. \u003Cem\u003EOsteoporos Int\u003C\/em\u003E 2004]. Teriparatide, the first anabolic agent, appears to significantly (p\u0026lt;0.001) increase bone mineral density (BMD) and decrease fracture incidence more than alendronate [Saag KG et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2007].\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EDespite increases in the frequency of screening for and treatment of glucocorticoid-induced osteoporosis, adequate prophylaxis is only prescribed in roughly 50% of glucocorticoid-treated patients [Saag K et al. \u003Cem\u003EJ Rheumatology\u003C\/em\u003E 2006].\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ECancer Treatment-Induced Bone Loss\u003C\/h2\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EJean-Jacques Body, MD, PhD, CHU Brugmann, Universite Libre de Bruxelles, Brussels, Belgium, discussed recent data that concern osteoporosis that is induced by adjuvant antineoplastic treatment in pre- and postmenopausal women with early breast cancer and by androgen deprivation therapy (ADT) in men who are being treated for prostate cancer.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EChemotherapy, GnRH analogs, tamoxifen in premenopausal women, ADT, and aromatase inhibitors (anastrozole, letrozole, and exemestane) can increase bone turnover, reduce bone mass (up to 4% to 5% per year), and increase fracture rates as much as 35% to 50%. Risedronate and to a greater extent zoledronic acid as adjunctive therapy, however, have been shown to significantly (p\u0026lt;0.01) prevent bone loss and reduce bone turnover in women with breast cancer and chemotherapy-induced menopause or those who are treated with aromatase inhibitors (anastrozole\/letrozole) [Greenspan SL et al. \u003Cem\u003EJ Clin Endocrinol Metab\u003C\/em\u003E 2007; Gnant MF et al. \u003Cem\u003EJ Clin Oncol\u003C\/em\u003E 2007; Brufsky A et al. \u003Cem\u003EJ Clin Oncol\u003C\/em\u003E 2007]. In men who are being treated with leuprolide, a gonadotropin-releasing hormone agonist, pamidronate significantly (p\u0026lt;0.02) prevents bone loss [Smith MR et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2001]. Zoledronic acid and alendronate even can increase BMD in such patients [Greenspan SL et al. \u003Cem\u003EAnn Intern Med\u003C\/em\u003E 2007]. Prof. Body stated that \u201cthe initiation of therapy should begin early, prior to the occurrence of severe osteoporosis.\u201d\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EWhich Other Dugs Cause Problems?\u003C\/h2\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EBesides the glucocorticoids, Peter Vestergaard, MD, PhD, The Osteoporosis Clinic, Aarhus Amtssygehus, Aarhus, Denmark, summarized studies on other drugs that are used to treat rheumatologic diseases, such as immunosuppressives (methotrexate, cyclosporine, azathioprine) and the older disease-modifying antirheumatic drugs (DMARDs; gold, penicillamine, chloroquine, sulphasalazine). Methotrexate, most DMARDs, and the newer biological agents seem safe in terms of the risk of osteoporosis and fractures, although the number of studies is limited. Some of the newer biological agents may even have positive effects on bone density. For pain medication, nonsteroidal anti-inflammatory drugs (NSAIDs) and opiates also have been associated with an increased risk of fractures, which, in the case of opiates, may be linked to an increased risk of falls. An important confounder is \u201cconfounding by indication,\u201d which means that the effects of the underlying disease may be confounded with the effects of the drugs that are given to control the disease in question. For example, many patients with advanced disease have a higher risk of decreased bone density and fractures due to the effects of the disease per se. However, these patients also may be more likely to receive drugs in high doses for their disease, and the drug treatment may thus be confounded with the effect of the disease. The increase in fracture risk that is shown in some studies may be due to the underlying disease, not the treatment, concluded Prof. Vestergaard.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-4\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EA Victory in the War on Osteoporosis?\u003C\/h2\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EIn contrast to the negative news about osteoporosis, Ms. Amrita Sehgal, a student at Menlo-Atherton High School, Atherton, CA, presented data that showed that in the United States, inpatient days that were attributed to hip fractures dropped by almost 73% between 1988 and 2005 (p\u0026lt;0.0001), despite an 11.4% increase in all-cause hospitalizations. However, the total cost of care for such hospitalizations (in 2005 US dollars, assuming 3% inflation rate) increased from $4.04 billion to $5.9 billion (p\u0026lt;0.05), suggesting that hip fractures continue to be associated with significant costs of care.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2008 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/8\/5\/33.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmfbq\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}