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Objectives: This study aimed to present the Asia-Pacific consensus on long-term and sequential therapy for osteoporosis, offering evidence-based recommendations for the effective management of this chronic condition. The primary focus is on achieving optimal fracture prevention through a comprehensive, individualized approach. Methods: A panel of experts convened to develop consensus statements by synthesizing the current literature and leveraging clinical expertise. The review encompassed long-term anti-osteoporosis medication goals, first-line treatments for individuals at very high fracture risk, and the strategic integration of anabolic and antiresorptive agents in sequential therapy approaches. Results: The panelists reached a consensus on 12 statements. Key recommendations included advocating for anabolic agents as the first-line treatment for individuals at very high fracture risk and transitioning to antiresorptive agents following the completion of anabolic therapy. Anabolic therapy remains an option for individuals experiencing new fractures or persistent high fracture risk despite antiresorptive treatment. In cases of inadequate response, the consensus recommended considering a switch to more potent medications. The consensus also addressed the management of medication-related complications, proposing alternatives instead of discontinuation of treatment. Conclusions: This consensus provides a comprehensive, cost-effective strategy for fracture prevention with an emphasis on shared decision-making and the incorporation of country-specific case management systems, such as fracture liaison services. It serves as a valuable guide for healthcare professionals in the Asia-Pacific region, contributing to the ongoing evolution of osteoporosis management.

Qualitative and quantitative analysis is very essential to identify the phytochemical constituents present in medicinal plants. In the present study, qualitative and quantitative analyses of a medically important plant, namely Cissus quadrangularis (CQ) were done. Cissus quadrangularis plays a pivotal role in bone healing. We qualitatively analyzed the flavonoids, terpenoids, steroids, starch, saponins, tannins, phenols, glycosides, cardiac glycosides & protein in petroleum ether (PECQ), chloroform (ChCQ), ethanolic (EtCQ) and water (WCQ) extracts of Cissus quadrangularis. Also, UV spectrophotometry of different extracts was carried out to determine the total phenolic content, total alkaloid content and total flavonoid content. Our study demonstrated that phytosterols are present mainly in PECQ and EtCQ extracts. Terpenoids, flavonoids, alkaloids and glycosides are present in all extracts of Cissus quadrangularis.LC/MS data showed that campesterol, ß-sitosterol, stigmasterol, pterostilbene, resveratrol, apigenin-glucoside, genistein, luteolin and prenylated chalcone are present in EtCQ. Coumarin, amino acids, campestanol, astringin, myricetin, quercetin, kaempferol and amyrin are present in PECQ. The ChCQ extract is mainly constituted of phenolic acids, astringin, campesterol, myricetin, quercetin, amyrone and catalpol. The WCQ mainly contains amino acids, phytol, gallic acid, myricetin and catalpol. Pterostilbene and prenylated chalcones were identified for the first time in CQ extracts.

Introduction: Osteoporosis and osteopenia are progressive disorders characterized by decreased bone mass, especially in postmenopausal women. These can be associated with body pain, fractures, hearing loss and balance disorders. The present study aims to evaluate audio-vestibular function in postmenopausal patients with osteopenia or osteoporosis. Methods: The study included 48 postmenopausal women (new subjects) diagnosed with osteoporosis (n = 23) or osteopenia (n = 25) in the age range of 50–66 years, as well as 28 normal women as controls. Audiological testing included pure tone audiometry (conventional and extended high-frequency audiometry), speech audiometry, impedance audiometry and otoacoustic emissions, including both transient evoked otoacoustic emissions (TEOAEs) and distortion product otoacoustic emissions (DPOAEs). All subjects also underwent vestibular evoked myogenic potentials testing (both ocular and cervical VEMPs). Results: In the present study, hearing was worse at all frequencies in the osteoporosis group in comparison with the osteopenia and control groups, with worse speech recognition and discrimination scores and OAEs. Vestibular function was affected in 95.65% of women with osteoporosis and 76% of those with osteopenia. Conclusion: Osteoporosis and osteopenia are risk factors for vestibular dysfunction and hearing deficits in postmenopausal women. Thus, hearing and vestibular function should be monitored by audiological and vestibular testing periodically in these individuals.

Background: Insulin resistance plays an important role in the pathogenesis of NAFLD. Pharmacological treatment of patients with NAFLD is still evolving. Insulin sensitizing drugs like metformin may be effective in these patients. Twenty five adult patients with NAFLD who did not achieve normalization of alanine transaminases (ALT) after 6 months of lifestyle interventions and UDCA were treated with metformin 500mg tid for 6 months. Insulin resistance was determined by HOMA-IR. Liver function tests were done monthly and patients were defined having no response, partial response or complete biochemical response depending on the change in ALT. Results were compared with 25 patients with NAFLD from the same cohort treated only with lifestyle interventions (disease controls). Results: Thirteen (52%) patients had class III (n = 5) or class IV (n = 8) disease amounting to histological NASH. Of these 13 patients none had severe inflammation and none had stage 4 fibrosis (cirrhosis). All 25 patients with NAFLD had insulin resistance in comparison to healthy controls. In comparison to disease controls (127.5 ± 41.8 vs. 118 ± 21.6 p = NS), all patients treated with metformin had partial biochemical response (mean ALT 122.2 ± 26.8 vs 74.3 ± 4.2 p < 0.01) and 14 (56%) of them achieved complete normalization of ALT. Conclusions: Metformin is effective to achieve biochemical response in patients with NAFLD who do not respond to lifestyle interventions and UDCA.