Search

L'avancée en âge résulte typiquement en une détérioration de l'équilibre global du rachis, avec la mise en jeu de mécanismes de compensation. Le rôle de l'équilibre global — sagittal et frontal — du rachis dans la survenue des chutes et des troubles de la mobilité dans la population générale âgée doit encore être élucidé. Dans la cohorte longitudinale SAFE, nous avons cherché à déterminer l'association entre l'équilibre global du rachis, les performances physiques et les chutes dans la population générale âgée. SAFE est une cohorte prospective observationnelle dont le suivi longitudinal à 3 ans est en cours à Genève (Suisse) et dans laquelle ont été inclus 110 sujets âgés vivant dans la communauté sans antécédent de chirurgie rachidienne instrumentée. Les évaluations incluent, entre autres : radiographies du squelette entier en position debout à partir du système EOS®, absorptiométrie biphotonique à rayons X, examen clinique, recueil rétrospectif et prospectif des chutes, et tests de la fonction physique (e.g., Short Physical Performance Battery [SPPB]). Les paramètres spino-pelviens mesurés incluent notamment, parmi d'autres, l'angle spino-sacré (SSA) et la distance C7-CSL pour l'équilibre global sagittal et frontal, respectivement. À l'inclusion, parmi les 110 sujets (âge moyen, 75 ans ; 76 % femmes), inclus dans l'analyse transversale, 40 (36 %) avaient chuté au moins une fois durant les 12 derniers mois, 19 (17 %) avaient un score SPPB altéré ≤ 9, et 8 (7 %) étaient sarcopéniques selon les critères EWGSOP2. L'équilibre global sagittal du rachis était associé de manière indépendante aux performances physiques, après ajustement pour l'âge, le sexe, les comorbidités et les fractures vertébrales (coefficient de régression ajusté SPPB/SSA = 0,04, IC95 % [0,01–0,08] ; p = 0,024). L'équilibre global frontal du rachis était associé de manière indépendante avec à la fois les antécédents de chute (OR C7-CSL/chuteur = 1,59, IC95 % [1,09–2,30] ; p = 0,015) et les chutes incidentes à 3 ans (n = 66 premiers sujets dans l'analyse longitudinale ; OR C7-CSL/chuteur = 2,25, IC95 % [1,24–4,08] ; p = 0,008 et IRR C7-CSL/nombre de chutes = 1,55, IC95 % [1,21–1,98] ; p = 0,001), après ajustement pour l'âge, le sexe, les comorbidités, les fractures vertébrales et le score SPPB. Ces résultats suggèrent que l'équilibre global sagittal du rachis est un contributeur indépendant de la diminution des performances physiques et l'équilibre global frontal du rachis un prédicteur indépendant des chutes incidentes, chez le sujet âgé. Les analyses en cours de cette cohorte devraient révéler dans quelle mesure l'équilibre global du rachis est associé aux fractures incidentes ainsi que le rôle des mécanismes de compensation. [ABSTRACT FROM AUTHOR]

The sequential effects of romosozumab and denosumab in osteoporosis are shown in real-life, while the mechanisms of post-denosumab rebound are reviewed extensively. A network meta-analysis confirms the superiority of anabolics vs anti-resorptives on fracture reduction, while the latter shown a reduction of mortality in a large population-based study. Fracture risk prediction by FRAXPlus is improved. New meta-analyses confirm the benefits of Vitamin D on fractures and falls. Finally, multiples trials with new molecules for the treatment of rare bone diseases, including osteogenesis imperfecta, fibrous dysplasia and hypoparathyroidism, shown promising results., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Vitamin D deficiency is a global health burden, which has been subject to debate in recent years. Although its consequences on patients' general health are debatable, the association between severe vitamin D deficiency and osteomalacia are clearly established. Since the 1st of July 2022, blood testing in individuals who do not meet the recognized risk factors for deficiency is no longer reimbursed in Switzerland. Being a migrant (or refugee) does not constitute a risk factor even though it has repeated been shown that this population is at high risk of deficiency, in particular sever deficiency. This article aims to establish new recommendations for vitamin D deficiency diagnosis and substitution for this population. It is sometimes necessary to adapt our national recommendations to take into account our cultural diversity., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Romosozumab is a monoclonal antibody against sclerostin. Its dual effect on bone is to increase formation and decrease resorption. Sub-cutaneous injections of romosozumab are administered monthly for one year and must be relayed with a bone resorption inhibitor. Romosozumab followed by denosumab is associated with high increase of bone mineral density and decrease of fragility fractures. Gain of bone mineral density and reduction of fragility fractures are more important with romosozumab as compared with alendronate. The increase in bone mineral density is higher with romosozumab as compared to teriparatide in patients previously treated with alendronate. The use of romosozumab (Evenity) is admitted for patients with high risk of fractures but without serious vascular events., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Osteoporosis is a major public health problem linked to fractures and more particularly to those of the hip, which is the major complication in terms of morbidity, mortality and costs. As the risk of a new fragility fracture is greatly increased after a first fracture episode, the concept of the « Osteoporosis pathway » or « Fracture Liaison Service », led by an interdisciplinary team with a coordinator, was developed for the secondary prevention of fractures. Osteoporosis pathways for which key performance indicators have recently been described, have demonstrated their ability to reduce the incidence of new fractures with a favorable cost-effectiveness ratio. Over the past two years, the development of the osteoporosis pathways network in Switzerland has been the main initiative led by the Swiss Association against Osteoporosis., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

New recommendations from the Swiss Association against Osteoporosis (SVGO) concerning fracture risk stratification and treatment delineate two new risk categories : very high risk (FRAX 10-years probability of fracture at least 20 % above the usual intervention threshold) and imminent risk (major osteoporotic fracture in the last 2 years). In these patients, parenteral therapies are recommended first. Among them, romosozumab is now available in Switzerland and is indicated for 1 year in absence of cardiovascular contra-indications, followed by an anti-resorptive. Regarding denosumab, several studies indicate that post-treatment bone loss may be, at least partially, prevented by zoledronate. Finally, monitoring BMD changes and the T-score reached on any therapy could be used as an indicator of anti-fracture efficacy., Competing Interests: Le Dr Emmanuel Biver a des contacts avec Nestlé, AMGEN et Labatec. Le Pr Serge Ferrari a des contacts avec AMGEN, UCB, Agnovos, Radius et Labatec. Les autres auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Except for bisphosphonates, the duration of anti-osteoporotic treatment is not limited to 3 to 5 years. T-score between - 2.0 and - 1.5 DS might be the BMD target to reach before considering discontinuing anti-osteoporosis treatment. A rebound of bone remodeling can occur in some patients despite receiving zoledronate after denosumab discontinuation, and the monitoring of CTX is required. There is no benefit of vitamin D supplementation on musculoskeletal health in the general population, but vitamin D remains indicated in patients with vitamin D deficiency or receiving osteoporosis treatment. A sequential treatment with romosozumab during one year, a bone anabolic anti-sclerostin antibody, followed by two years of denosumab, decreases vertebral and non-vertebral fractures with rapid and substantial BMD gains after 3 years., Competing Interests: le Dr Emmanuel Biver ne déclare aucun conflit d’intérêts en relation avec cet article. Le Pr Serge Ferrari a des contacts avec Amgen, UCB, Gedeon Richter, Eli Lilly.

The management of osteoporosis in patients with mild to moderate chronic kidney disease (CKD) can be established as in general population. In severe or terminal CKD, bone densitometry is indicated. Bone-specific alkaline phosphatase is considered a useful marker for distinguishing among the histologic types of renal osteodystrophy. In ambiguous cases, bone biopsy together with quantitative histomorphometry will be necessary. As far as the treatment is concerned, the bisphosphonates, which had been avoided due to their renal excretion as well as the official warnings against using them in case of renal clearance lower than 30 ml/min, seem to be effective even in advanced stages of renal disease. There are limited data, though, regarding the management of osteoporosis in terminal stages of CKD., Competing Interests: Les auteurs déclarent n’avoir aucun conflit d’intérêts.

The risk for a second fracture within two years after a first one is high. Ten years denosumab treatment show favorable results with a risk of early vertebral fractures in patients with prevalent vertebral fractures when treatment is stopped. Teriparatide is more effective than risedronate to prevent vertebral and clinical fractures in high risk patients. Romosozumab acts as an anabolic agent in osteoporosis. Atypical femoral fractures associated with bisphosphonate treatment could be more frequent in patients with particular anatomical features. Management of osteoporosis treatment depends on the drug which is used and on the risk of fracture of the patient.

Introduction: The aims of this investigation were to evaluate associations between orthodontic space closure (including first premolar intrusion and canine extrusion for esthetic reasons) and periodontal tissue deterioration over a 10-year period in subjects with one or both missing maxillary lateral incisors and to investigate the occurrence of signs or symptoms of temporomandibular disorder (TMD)., Methods: This was a retrospective cohort study comprising patients treated by the same orthodontist. The agenesis group included 26 consecutive adolescent and young adult patients (9 male, 17 female) treated with space closure. The control group consisted of 32 orthodontic patients (12 male, 20 female) with no missing teeth and no need for extractions. In the agenesis group, full-mouth probing pocket depths and bleeding on probing were recorded at six locations for each of 657 teeth (3942 periodontal sites). In the control group, comparative data were collected for the maxillary first molars, premolars, canines, and lateral incisors, a total of 264 teeth (1584 periodontal sites). Mobility and gingival recession were also evaluated. Patients in both groups completed questionnaires concerning symptoms related to TMD., Results: The full-mouth assessments in the agenesis group generally demonstrated periodontally healthy conditions, with probing depths below 4 mm and few bleeding sites. Some slight recessions were found, mostly on molars and second premolars, and there was normal mobility of first premolars that substituted for canines. Comparisons between the agenesis and control groups showed no statistically significant differences for the maxillary teeth regarding increased pocket depth (≥ 4 mm) or increased mobility. Interproximal sites in the agenesis group showed less bleeding on probing than in the control group; this was statistically significant. Anterior teeth in the agenesis group did not show any more recession than in the controls. In addition, we observed no difference in signs or symptoms between the two groups; this might be due to the limited sample size or the drawbacks of the surveys of TMD through subjects' recall. Thus, the long-term periodontal tissue health and the incidence of dysfunction or TMD signs were similar in the space-closure agenesis group and in the control group of nonextraction orthodontic patients., Conclusions: Orthodontic space closure including first premolar intrusion and canine extrusion in patients with missing lateral incisors does not incur risks for periodontal tissue deterioration or TMD in the long term., (© EDP Sciences, SFODF, 2017.)

Hypophosphatasia (HPP) is an inborn metabolic bone disorder caused by loss-of-function mutations in the gene encoding tissue nonspecific alkaline phosphatase (TNSALP). The adult form can be mistaken with common osteoporosis and/or present recurrent metatarsal fractures, skeletal and muscular pain. Subtrochanteric femoral pseudofractures resembling bisphosphonate-associated atypical femoral fractures can also be present, and Bps are therefore contraindicated in HPP. Early tooth loss and renal calcifications can orient towards the diagnosis. The diagnosis is based on low serum ALP levels (< 40 U/L) and high ALP substrate levels, such as vitamin B6 (pyridoxin), eventually on genetic testing. Recent development of an enzyme replacement therapy offers new therapeutic perspectives in severe cases., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêt en relation avec cet article.

Estrogen replacement therapy, selective modulators of the estrogen receptor (SERMs), bisphophonates and denosumab are antiresorptive therapies which can be used for several years. Teriparatide is still the only bone forming agent available, its use is limited to 24 months. Except the absence of new fragility fractures, there is no well defined target in the treatment of osteoporosis. Nevertheless persistence of high fracture risk (prevalent fractures and/or low BMD) on therapy indicates to maintain or intensify the treatment. On the contrary, if fracture risk is low, a « therapeutic window » could be considered after treatment with bisphosphonates, whereas after denosumab a short course of another treatment may be necessary., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

After one year of treatment with denosumab, the incidence of fracture is lower in patients previously treated one year with romosozumab as compared with placebo. Cessation of denosumab injections is followed by a rebound of bone resorption, a decrease of bone mineral density and increased risk of multiple vertebral fractures. For safety reasons, odanacatib, an inhibitor of cathepsine K and consecutively of bone resorption will not be available. Abaloparatide, a PTHrp(Parathormon related protein) analog, decreases the incidence of vertebral and non vertebral fractures. In patients with diabetes, the incidence of fractures is increased mainly due to alterations quality of bone., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Calcinosis cutis is characterized by calcified deposits in the skin and in subcutaneous tissues. The potential complications are ulceration, infection, functional limitation. According to serum calcium/phosphate levels, calcinosis cutis is classified in 4 subtypes: dystrophic, metastatic, iatrogenic, idiopathic. In dystrophic calcinosis, calcium/phosphate serum levels are within range. Dystrophic calcinosis occurs in damaged tissues and is associated with several connective tissue diseases (mainly systemic sclerosis and dermatopolymyositis). Its physiopathology remains unclear. Despite different therapeutic modalities in the litterature, there is no standard therapy for calcinosis. Thus, larger controlled studies are necessary.

GERICO (Geneva Retirees Cohort) is a cohort of 953 men and women recruited at the age of 65 in Canton of Geneva, Switzerland, providing a picture of bone health at retirement time. Despite few comorbidities and good nutritional intake and vitamin D status, 30% of subjects have a history of vertebral or clinical fracture after the age of 45, 20% of women and 11% of men have osteoporosis assessed by DXA. 22% have a 10-year probability of a major osteoporotic fracture assessed by FRAX greater than 15%, -i.e. the current intervention thresholds recommended in this age-class in Switzerland. Nevertheless, only 1.4% subject benefits of an anti-osteoporotic drug. These data underscore the importance of primary and secondary prevention of osteoporosis and fractures in healthy elderly at time of retirement.

Objectives: The aim of this clinical prospective trial was to evaluate finishing effectiveness of stainless steel (SS) archwires versus titanium molybdenum alloy (TMA) archwires using SmartClip™ self-ligating brackets., Subjects and Methods: Thirty-two patients were divided in two groups: a group of 21 (G1-SS) and a group of 12 (G2-TMA). The protocol consisted of two different finishing archwires coupled with self-ligating brackets: .019 × .025" SS archwires for G1-SS and .019 × .025" TMA archwires for G2-TMA. Lateral cephalometric radiographs obtained at the beginning (T1) and end (T2) of treatment were used to assess the changes in incisor inclination, and measurements of irregularity index (LII), interdental widths, arch length (AL) and arch depth (AD) were made on dental casts to investigate changes associated with crowding correction., Results: No significant differences from T1 to T2 were found for incisors proclination and AL changes. Statistically significant differences were found for LII (higher decrease in G1-SS), maxillary AD (higher increase in G1-SS) and three interdental maxillary widths (higher in G1-SS)., Conclusion: The statistically significant differences found were few and clinically negligible. Self-ligating brackets system coupled with .019 × .025" archwires showed good finishing effectiveness, but no clinically significant differences were found between SS and TMA., (Copyright © 2013 CEO. Published by Elsevier Masson SAS. All rights reserved.)

Diabetes alters bone mass and/or quality and increases fracture risk. However, in type 2 diabetes, bone mineral density (BMD) is usually not diminished, pertaining to increased weight and fat mass, which complicates the diagnosis of osteoporosis by DXA (T-score <-2.5). Similarly, estimates of fracture probability by FRAX may underestimate fracture risk in type 2 diabetes. Adequate glycemic control with insulin and/or oral antidiabetics decreases fracture risk, whereas thiazolidinediones increase it. Eventually, osteoporosis drugs such as bisphosphonates and SERMs seem to have similar efficacy in diabetic and non-diabetic patients.

Given the significant health and socioeconomic consequences of falls, to develop and promote effective falls prevention strategies among older adults represents a major issue. Jaques-Dalcroze eurhythmics is a music education program through movement method developed in Geneva, Switzerland, in the early 20th century. This new exercise form, adapted for elderly people, features various multitask exercises performed to the rhythm of improvised piano music and mainly challenge gait and balance, but also memory, attention and coordination. We report here the results of a randomized controlled trial conducted in Geneva showing that Jaques-Dalcroze eurythmics practice can improve gait performance under single and dual-task conditions, and balance, as well as reduce both rate of falls and the risk of falling in at-risk elderly community-dwellers.

High bone remodeling leads to bone loss and microarchitectural deteriorations characteristic of osteoporosis. Bisphosphonates and selective estrogen receptor modulators decrease bone remodeling by preventing osteoclast-mediated bone resorption, whereas parathyroid hormone/teriparatide increase bone remodeling in favor of new bone formation. Better understanding of the molecular processes of bone remodeling has led to the development of agents to inhibit bone resorption, such as the human monoclonal antibody Denosumab targeting osteoclast-activating factor RANK Ligand, and odanacatib targeting the collagen-degrading enzyme cathepsin K. Agents capable to stimulate bone formation independently of bone resorption, such as antagonists of the osteoblast-inhibitory factor sclerostin, may provide new therapeutic approaches to osteoporosis.

Fracture risk depends on density and quality of bone but also on fall risk. Besides the resultant fractures, the human and socio-economic burden of falls pose many challenges to the issue of prevention for the elderly. A systematic approach to falls prevention should be considered as a part of routine care. The identification of intrinsic and extrinsic risk factors is an essential initial step to falls prevention. Intervention should be multidisciplinary and multifactorial, targeting modifiable risk factors, especially for high risk patients. We report the experience of a multidisciplinary program designed to prevent falls and fractures, conducted at the Geneva University Hospital.

Vitamin D is essential for intestinal calcium absorption, bone mineralisation and plays an important role in neuromuscular functions. Vitamin D insufficiency is highly prevalent among postmenopausal women with osteoporosis and in the elderly. In turn, supplements of vitamin D3 (cholecalciferol), and to a lesser extent vitamin D2 (ergocalciferol), may decrease falls and fracture risk by 25%. Despite some recent negative studies, the actual question is not to know whether vitamin D is necessary, but rather how much vitamin D is sufficient to prevent secondary hyperparathyroidism, falls and fractures. Moreover, the risk of osteoporosis and of fragility fractures may be influenced by genetic variation in the vitamin D receptor (VDR).

Bisphosphonates are inhibitors of bone resorption, which reduce vertebral and non-vertebral fracture risk. Their efficacity has been shown in controlled trials up to 5 years, and their safety up to ten years. There is no proven benefit of combining two bone resorption inhibitors.

Osteoporosis treatment with anti-catabolic agents, such as bisphosphonates and SERMS, inhibits bone remodeling, resulting in increased bone mineral density and preservation of bone micro-architecture. On another side, daily subcutaneous injections of parathyroid hormone (and PTH(1-34), teriparatide) stimulate osteoblastic functions and bone remodeling, resulting in new bone formation, increased bone mineral density and improved microarchitecture, thereby reducing fracture risk. However, the effects on PTH on cortical bone structure and its use in the context of anticatabolic treatments for osteoporosis remain complex.

Osteoporosis and fractures are the frequent consequences of glucocorticoid therapy. Cancellous bone is primarily affected with a decrease of bone formation and an increase of bone resorption. Prevention of corticosteroid-induced osteoporosis is based upon general measures such as calcium and vitamine D supplementation, adequate protein intake, regular physical exercise, and upon specific therapies like those used in primary osteoporosis. Bisphosphonates which are potent bone resorption inhibitors have been shown to reduce bone mineral density and to decrease vertebral fracture rate. Therefore, they appear to be a first choice in the prevention of corticosteroid-induced osteoporosis.

Two hundred and six patients were operated for lung metastases from osteosarcoma over a period of 7 years. The operative mortality was 0.3%. The actuarial survival for the overall population was 78% at one year. 50% at two years, 40% at three years and 34% at five years. The most significant prognostic factors (p < 0.01) were the number of metastases, the duration of the free interval and the degree of differentiation. Sex, age, site and type of resection of osteosarcoma or the metastases did not have any influence on prognosis. Surgical resection of lung metastases currently constitutes an essential part of the multidisciplinary management of osteosarcoma.