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Denosumab has been shown to increase bone mineral density (BMD) and reduce the fracture risk in patients with post-menopausal osteoporosis (PMO). Increase in BMD is linked with an increase in bone matrix mineralisation due to suppression of bone remodelling. However, denosumab anti-resorptive action also leads to an increase in fatigue microdamage, which may ultimately lead to an increased fracture risk. A novel mechanobiological model of bone remodelling was developed to investigate how these counter-acting mechanisms are affected both by exercise and long-term denosumab treatment. This model incorporates Frost's mechanostat feedback, a bone mineralisation algorithm and an evolution law for microdamage accumulation. Mechanical disuse and microdamage were assumed to stimulate RANKL production, which modulates activation frequency of basic multicellular units in bone remodelling. This mechanical feedback mechanism controls removal of excess bone mass and microdamage. Furthermore, a novel measure of bone local failure due to instantaneous overloading was developed. Numerical simulations indicate that trabecular bone volume fraction and bone matrix damage are determined by the respective bone turnover and homeostatic loading conditions. PMO patients treated with the currently WHO-approved dose of denosumab (60 mg administrated every 6 months) exhibit increased BMD, increased bone ash fraction and damage. In untreated patients, BMD will significantly decrease, as will ash fraction; while damage will increase. The model predicted that, depending on the time elapsed between the onset of PMO and the beginning of treatment, BMD slowly converges to the same steady-state value, while damage is low in patients treated soon after the onset of the disease and high in patients having PMO for a longer period. The simulations show that late treatment PMO patients have a significantly higher risk of local failure compared to patients that are treated soon after the onset of the disease. Furthermore, overloading resulted in an increase of BMD, but also in a faster increase of damage, which may consequently promote the risk of fracture, specially in late treatment scenarios. In case of mechanical disuse, the model predicted reduced BMD gains due to denosumab, while no significant change in damage occurred, thus leading to an increased risk of local failure compared to habitual loading.

Teriparatide (TPT) (C181H291N55O51S2) represents a recombinant molecule acting as human osteoanabolic agent. Transitory hypercalcemia (TH) has been reported in osteoporotic patients treated with daily TPT. Our purpose is to analyze the biochemical features as well as clinical risk factors for fractures in patients with severe osteoporosis treated with TPT who developed TH during first 12 months. This is an observational real-life study. In patients with TH biochemical blood markers like osteocalcin, CrossLaps and P1NP assessed at one year have statistically significant higher values than in subjects associating serum calcium within normal limits under the drug.

Background Zoledronate 5 mg intravenous (IV) annually is approved for treatment of post-menopausal osteoporosis. Zoledronate 4 mg which is approved for the treatment of cancer related hypercalcemia can be an alternative for Asian women who have smaller stature. Objectives To examine the efficacy and safety of Zoledronate 4 mg IV annually for the treatment of post-menopausal osteoporosis. Method A prospective open-labeled study was performed on 33 post-menopausal osteoporosis patients. All patients received a dose of IV Zoledronate 4 mg. Bone mineral density (DXA) was examined at baseline and 12 months after treatment. Beta-C-terminal telopeptide (β-CTX) and procollagen type-1-amino-terminal propeptide (P1NP) were obtained at baseline, 6, and 12 months after treatment. Adverse events were recorded. Results The mean age (SD) was 69 (11.1) years old. The lumbar spine BMD increased significantly from the mean (SD) lumbar spine BMD at baseline of 0.833 (0.132) g/cm2 to 0.862 (0.132) after treatment (p = 0.001). There was no significant differences in total hip and femoral neck BMDs between baseline and 12 months after treatment. The β-CTX and P1NP decreased significantly from the mean (SD) of 0.44 (0.24) and 55.57 (38.6) ng/ml at baseline to 0.21 (0.11) and 27.26 (10.95) ng/ml after treatment (p, Highlights • This study examined the effect of Zoledronate 4 mg for postmenopausal osteoporosis. • The lumbar spine BMD increased between baseline and 12 months after treatment. • Bone markers decreased significantly between baseline and 12 months after treatment. • Zoledronate 4 mg is an alternative to 5 mg for postmenopausal osteoporosis treatment.

Screening for osteoporosis in women can be based on age and weight, using the Osteoporosis Screening Tool for Asians and assessment for other risk factors such as early menopause, Chinese ethnicity and other secondary factors. Based on the resulting risk profile, women can be triaged to dual-energy X-ray absorptiometry (DEXA) scanning for definite diagnosis of osteoporosis. Treatment should be considered in women with previous fragility fractures, DEXA-diagnosed osteoporosis and high risk of fracture. Exercise improves muscle function, can help prevent falls and has moderate effects on improvements in bone mass. Women should ensure adequate calcium intake and vitamin D. Menopausal hormone therapy (MHT) effectively prevents osteoporosis and fractures, and should be encouraged in those aged < 50 years. For women aged < 60 years, MHT or tibolone can be considered, especially if they have vasomotor or genitourinary symptoms. Risedronate or bisphosphonates may then be reserved for those aged over 60 years.

Adherence is important for an exercise program’s efficacy. This study aims at investigating whether the COVID-19 lockdown had different consequences on the adherence to an exercise program specifically designed for women with postmenopausal osteoporosis when administered as individual home training (IHT) or gym group training (GGT). At the start of the lockdown, which imposed the temporary closure of any gym activities, GGT participants were invited to continue to exercise at home. IHT participants continued to exercise at home as usual. Adherence was recorded via logs and measured as the percentage of exercise sessions actually performed out of the total number of scheduled sessions in three 1-month periods: one before (PRE) and two after (M1 and M2) the beginning of lockdown. Before lockdown, IHT (66.8% ± 26.6) and GGT (76.3% ± 26.6) adherence were similar. During lockdown, IHT participation increased (M1: 81.5% ± 31.0, M2: 88.0% ± 28.3), while that of GGT showed no statistical differences (M1: 79.4% ± 34.2, M2: 80.6% ± 36.4). Exercise protocols based on supervised gym practice must consider the possibility of disruptive events, which could cause a sudden interruption of gym activity and include educational initiatives to instruct participants to exercise effectively and safely without a trainer’s direct supervision.

Aim: to evaluate the effect of body composition, nutritional habits (NH), and physical activity (PA) levels on bone mineral density (BMD) in osteoporotic postmenopausal women (OPW). Subjects and method: the demographic characteristics, anthropometric measurements, PA status, information on NH, some biochemical findings, and BMD measurements of 100 OPWs were evaluated. Results: in this study, 48 % of the women were classified as obese. The obese women were found to have lower vitamin D levels and higher parathyroid hormone levels than those of the over-weight women. A positive correlation was found between body mass index and L1L4, L2L4, and femur BMD (r = 0.268, p0.001; r = 0.241, p0.01; r = 0.369, p0.001, respectively). There was a significant decrease in L1L4 and femur BMD with increasing age (r = -0.224, p0.05; r = -0.366, p0.001, respectively). Femur BMD showed a positive correlation with duration (hours/week) and frequency of PA (days/week). According to the logistic regression analysis, body weight, daily tea consumption, and PA were positively associated with femur BMD, while advanced age, the age of menarche, salt and coffee consumption, and postmenopausal fracture status were negatively associated. Conclusion: we observed that body weight, some nutritional factors, and active lifestyle have seemed to effect BMD in OPWs. An adequate, balanced nutrition maintaining the ideal weight, and regular physical activity may improve bone health in OPWs.Objetivo: evaluar el efecto de la composición corporal, los hábitos nutricionales (NH) y los niveles de actividad física (PA) sobre la densidad mineral ósea (BMD) en mujeres posmenopáusicas osteoporóticas (OPW). Sujetos y método: se evaluaron las características demográficas, mediciones antropométricas, estado de PA, información sobre NH, algunos hallazgos bioquímicos y datos de BMD de 100 OPW. Resultados: en este estudio, el 48 % de las mujeres se clasificaron como obesas. Se encontró que las mujeres obesas tenían niveles más bajos de vitamina D y niveles más altos de hormona paratiroidea que los de las pacientes con sobrepeso. Se encontró una correlación positiva entre el índice de masa corporal y L1L4, L2L4 y la BMD del fémur (r = 0,268, p0,001; r = 0,241, p0,01; r = 0,369, p0,001, respectivamente). Hubo una disminución significativa de los valores de L1L4 y BMD femoral con el aumento de la edad (r = -0,224, p0,05; r = -0,366, p0,001, respectivamente). La BMD del fémur mostró una correlación positiva con la duración (horas/semana) y la frecuencia (días/semana) de la PA. Según el análisis de regresión logística, el peso corporal, el consumo diario de té y la PA se asociaron positivamente con la BMD del fémur, mientras que la edad avanzada, la edad de la menarquia, el consumo de sal y café, y la presencia o no de fracturas posmenopáusicas se asociaron negativamente. Conclusión: observamos que el peso corporal, algunos factores nutricionales y el estilo de vida activo parecen haber afectado la BMD en las OPW. Una nutrición adecuada y equilibrada, el mantenimiento del peso ideal y la actividad física regular pueden mejorar la salud ósea de las OPW.

Postmenopausal osteoporosis, a quiet plague, has become a significant wellbeing danger, harassing about half of postmenopausal ladies around the world, and is accepted to be a malady that is one of the most well-known face to face who is encountering dementia achieved by mature age. It is a constant, dynamic condition, related with infinitesimal weakening of bone tissue, bringing about diminished bone mass, diminished bone quality which builds the danger of break. Ladies are bound to create osteoporosis than men because of decrease in estrogen during menopause which prompts decrease in bone-development and increment in bone-resorption action. Estrogen can stifle creation of proinflammatory cytokines like IL-1, IL-6, IL-7 and TNF-α. This is the reason these cytokines are raised in postmenopausal ladies. This paper manages the different techniques and parameters most every now and again utilized for screening of antiosteoporotic movement in post-menopausal osteoporesis. The ovariectomized creature model is the most proper model for considering the adequacy of various medications to forestall bone misfortune in postmenopausal osteoporosis. Different parameters dissected are: Biomechanical parameters as Three point bowing of tibia, Compression IV lumbar vertebra, Loading trial of femoral neck, Bone mineral thickness estimation; Biochemical parameters viz. serum calcium and inorganic phosphorus, serum basic phosphatase (ALP), Tartrate safe corrosive phosphatase (TRAP), protein profile, serum ACTH, corticosterone, IL-6, TNF-α, osteoprotegerin (OPG) and deoxypyridinoline crosslinks to creatinine proportion (DPD/Cr); Physical parameters like thickness and the length of the femur, weight of femur, Femur bone volume, bone thickness and so forth; Histopathology of femur to watch histopathological changes like size, shape and bone design; problematic and lytic changes, and fibrocartilageneous lattice with osteodystrophy; therapeutic advancement with mineralization alongside genuinely very much dispersed osteocytes; trabeculae and grid, and shaft size and so on; Histopathology of tibia to watch bone zone, bone volume per tissue volume, bone edge, outright number of dynamic osteoblasts, the proportion of indisputably the quantity of dynamic cuboid osteoblasts per bone border, the proportion of without a doubt the quantity of osteoclasts per osteoclast edge which speak to part of the trabeculae that are secured with osteoclasts, trabecular thickness, trabecular partition, trabecular number, mineralized bone volume per tissue volume, the osteoid volume per bone volume, the osteoid surface per bone surface, the osteoblast surface per bone surface, the disintegrated surface per bone surface. Different parameters as histopathology of uterus and mammary organ tissue, immunohistochemical recoloring to quantify ER level, pee examinations, body weight, organ weight, nourishment utilization, estrogen receptor ligand restricting test (ER-LBA), assurance of oxidative pressure, social test by constrained swimming test, neonatal mouse parietal bone resorption measure and so forth can likewise be completed.

Background Medication adherence is a determinant of therapeutic outcomes in osteoporotic patients treated with bisphosphonates. In this monocentric study, we evaluated whether the regular drug administration may influence the effectiveness of denosumab in preventing vertebral fractures (VFs) in real-world clinical practice. Methods Two-hundred and four women (median age 75 years, range: 54-90 years) under treatment with denosumab for post-menopausal osteoporosis were longitudinally evaluated for incident radiological VFs and changes in lumbar spine bone mineral density (BMD) in relationship with medication adherence. All patients were persistent with denosumab treatment (i.e., maximum delay in administration of a single denosumab dose: 90 days). Patients were defined adherent to denosumab therapy when the drug was administered every 6 months ±28 days. Results One-hundred-seventy-three patients (84.4%) were adherent to denosumab therapy, whereas the remaining 31 patients (15.6%) received in delay one or more denosumab doses (cumulative delay: 52 days, range 29-183 days). Fourteen patients (6.9%) experienced incident VFs during the follow-up (median duration: 30 months, range: 18-48 months), in relationship with non-adherence to denosumab therapy (hazard ratio 4.44; 95% CI: 1.01-19.47) and smaller increase in lumbar spine BMD (hazard ratio 0.85, 95% CI: 0.76-0.94). Conclusions In post-menopausal women at high risk of fractures, the small delay in the administration of denosumab (i.e., not uncommon in clinical practice) was associated with a significant increase in incidence of VFs. Preservation of standard dosing schedule appears to be an important determinant of denosumab effectiveness in the real-life clinical practice.

Osteoporosis (OP) is a systemic disease of the skeleton characterized by increased risk of fracture. There is a general consensus on the efficacy of physical activity in the prevention of bone loss, falls and fractures, but there is no agreement on the best setting to exercise. The aim of the study is to evaluate the efficacy of a 12-months exercise protocol for women with post-menopausal OP when administered as individual home training (IHT) versus gym group training (GGT). The study is a randomized trial with two parallel groups. Sedentary patients with primary post-menopausal osteoporosis are recruited at the Istituto Ortopedico Rizzoli of Bologna. In the first group, the 12-month ACTLIFE program is performed as IHT, while in the second as GGT. The program is aimed at improving joint mobility, muscle force, balance, motor coordination and endurance. The study is single blinded. Patients are assessed at baseline and after 6 and 12 months. The primary outcome is the modification of quality of life measured with the Short Osteoporosis Quality of Life Questionnaire (ECOS-16). The findings of this study will highlight advantages and disadvantages of exercising in the two different settings and provide evidence on how to increase physical activity in osteoporotic women.

The Colombian Osteoporosis and Mineral Metabolism Association met in early 2017 to update the Colombian Consensus on Osteoporosis. This was first issued in 2005, and is seen as a necessary step in view of the underdiagnosed status of this disease, and the expected impact of population aging. A technical team was formed with specialists with long experience across multiple disciplines, who were assigned to four working groups: definitions and epidemiology, diagnosis, pharmacological treatment, and non-pharmacological treatment. After a scientific literature review and a series of meetings, the definitions and recommendations are summarized in this article.

Objective To determine the change in T-score of post-menopausal osteoporosis patients with weight-bearing exercises. Study design A quasi-experimental study. Place and duration of study Physiotherapy Department and Orthopedic Unit I, Mayo Hospital, Lahore, from May to October 2014. Methodology Two hundred and seventy-four patients were randomly divided into two groups according to inclusion and exclusion criteria using non-probability purposive sampling technique. The group 1 was treated by medication and weightbearing exercises and group 2 was given medication alone. The dual energy X-ray absorptiometry (DEXA)scan was used tofind the T-score before and after treatment and improvement was compared. A p-value less than 0.05 was taken as significant. Results The results showed that improvement was occurred in both groups after treatment. The DEXAscan median values after treatment were changed to 3.00 (0) for group 1 (exercises and medication) and 2.00 (1) for group 2 (medication). Conclusion The physical activity along with medication play vital role in the treatment of post-menopausal osteoporosis than medication alone.

Post-menopausal osteoporosis is one of the most common bone diseases in women. The aim of the present study was to predict the diagnostic function modules from a differential co-expression gene network in order to enhance the current understanding of the biological processes and to promote the early prevention and intervention of post-menopausal osteoporosis. The diagnostic function modules were extracted from a differential co-expression network by the established protein-protein interaction (PPI) network analysis. First, significant genes were identified from the differential co-expression network, which were regarded as seed genes. Starting from the seed genes, the sub-networks in this disease, referred to as diagnostic function modules, were exhaustively searched and prioritized through a snowball sampling strategy to identify genes to accurately predict clinical outcomes. In addition, crucial function inference was performed for each diagnostic function module. Based on the microarray and PPI data, the differential co-expression network was constructed, which contained 1,607 genes and 4,197 interactions. A total of 110 seed genes were identified, and nine diagnostic modules that accurately distinguished post-menopausal osteoporosis from healthy controls were screened out from these seed genes. The diagnostic modules may be associated with five functional pathways with emphasis on metabolism. A total of nine diagnostic functional modules screened in the present study may be considered as potential targets for predicting the clinical outcomes of post-menopausal osteoporosis, and may contribute to the early diagnosis and therapy of osteoporosis.

Objective: In addition to some well-characterized bone turnover markers (BTMs), cytokines and adipokines have also been suggested to be linked to osteoporosis seen in menopause. However, there is much controversy on the possible association between these markers and bone mineral density (BMD). This study was aimed at measuring circulatory levels of selected cytokines, adipokines and BTMs in postmenopausal women with normal and low BMD. Methods: The study population included 71 post-menopausal women, of whom 25 had normal BMD, 31 had osteopenia and 13 had osteoporosis. Circulatory levels of selected pro-resorptive (TNF-α, IL-1β, IL-6, IL-8, IL-12, IL-17), anti-resorptive (IFN-γ, IL-4, IL-10, IL-13, TGF-β) and five adipokine markers (adiponectin, adipsin, lipocalin-2/NGAL, PAI-1 and resistin) were measured using the Multiplex system and read on the Magpix ELISA platform. Further, two bone turnover markers (PINP, CTX) as well as estradiol levels were assayed from the same samples. Results: While circulatory levels of cytokines were comparable between groups, women with low BMD had statistically significantly higher median circulatory levels of adipokines as compared to those with normal BMD. Further, while levels of CTX were not different between the two groups; PINP, PINP/CTX ratio and estradiol levels were significantly lower in women with low BMD. Levels of adiponectin, PINP, PINP/CTX ratio and estradiol correlated significantly with BMD of the hip and spine. Conclusion: The associations between various markers and BMD are complex and multivariate. Our data provide insights into the possible use of circulatory levels of cytokines, adipokines and bone turnover markers on the pathogenesis of postmenopausal osteoporosis because of the well-documented effects of these molecules on bone tissue and their relevance to osteoporosis.

Objectives: Bazedoxifene was found to be effective and well tolerated for the treatment and prevention of osteoporosis in postmenopausal women. This post-marketing surveillance study (PMSS) examined the safety of bazedoxifene in postmenopausal Korean women with osteoporosis, in a real-world setting. Methods: This PMSS was conducted from 2013 to 2017. A total of 3,423 subjects from 68 centers were enrolled and monitored for about 3 months (± 2 weeks). Bazedoxifene was prescribed at a dose of 20 mg/day. The safety of bazedoxifene was evaluated based on the number and nature of adverse events (AEs), serious AEs (SAEs), adverse drug reactions (ADRs) and serious ADRs (SADRs) in routine medical practice. Results: The mean age of study subjects was 69.51 years. The incidence of AEs and ADRs was 6.11% and 3.86%, respectively, and significantly decreased with increasing age (p= 0.0007). AE and ADR rates with bazedoxifene treatment of 3 months or more were significantly lower than those of less than 3 months (AE, 3.64% vs 30.00%, p < 0.0001; ADR, 1.74% vs 24.38%, p < 0.0001). Conclusion: In this study, bazedoxifene was well tolerated in the management of postmenopausal osteoporosis in Korean women, including those aged 70 years or more.

Osteoporosis is a skeletal disorder characterized by loss of bone mass and strength affecting up to 30-50% of postmenopausal women worldwide. Current therapeutic options include antiresorptives such as aminobisphosphonates or denosumab and osteoanabolic compounds such as teriparatide. Areas covered: In this review, the authors summarize the clinical development, safety and efficacy profile of abaloparatide, a new osteoanabolic agent recently marketed in the US for the treatment of postmenopausal osteoporosis in women who are at high risk for fracture or who fail antiresorptive therapy. Expert opinion: Abaloparatide is a 1-34 PTH related peptide-like molecule that has been modified in order to potentiate the osteoanabolic effect. In its pivotal phase 3 trial in postmenopausal women with osteoporosis, subcutaneous abaloparatide 80 mcg/day reduced the risk of vertebral, nonvertebral, major osteoporotic, and clinical fractures compared with placebo and reduced the risk of major osteoporotic fractures compared with teriparatide. These results, together with a reduced prevalence of hypercalcemia and a lower cost of the marketed compound, point toward improved cost effectiveness with abaloparatide versus teriparatide. However, some concerns have been raised due to a somewhat higher occurrence of adverse effects (particularly with palpitations and increased heart rate) or the resultant discontinuation due to these adverse effects when compared to teriparatide.

Objectives Osteoporosis is a rapidly rising cause of concern for elderly patients. Various classes of drugs are available in the market. Bisphosphonates are considered as a first-line therapy for the prevention and treatment. Denosumab is an antiresorptive agent which is a RANK ligand inhibitor. There is a scarcity of comparison between these two classes of drugs. The aim of this study is to compare efficacy of Bisphosphonates and Denosumab in various parameters. Methods Literature search was done for randomized controlled trials (RCTs) comparing bisphosphonates with denosumab. RCTs with a treatment period of at least one year with a baseline bone mineral density (BMD) and bone turnover markers (BTM) and follow up values at one year were included in the study. All included studies were also analysed for complications. The study has also been registered in PROSPERO International prospective register of systematic reviews. Results A total of five RCTs were identified providing data on 3751 participants. In all five studies, the BMD changes at both hip and spine were statistically significant in favour of denosumab. Result was similar in three studies that studied BMD changes at the wrist. Denosumab also produced significant reduction in BTM as early as one month, but at one year there was no difference compared to the bisphosphonates. There was no statistically significant differences in the complication rates. Conclusions Though both bisphosphonates and denosumab were effective with similar side effects, the latter was statistically superior in increasing the BMD and reducing the BTM.

Patients with a high risk of fragility fractures, and those with recent fractures, must receive the highest priority for anti-osteoporotic treatment, because of the consequences of some of these fractures (hip, vertebrae, pelvis, humerus). Both non pharmacological and pharmacological treatments must be used. The duration of the treatment is based on the assessment of fracture risk.

Resumen Introduccion La insuficiencia de vitamina D se considera una epidemia mundial. Se estima que un billon de personas a escala mundial padecen de insuficiencia de vitamina D. Segun diferentes estudios el 100% de la poblacion adulta mayor de Estados Unidos y Europa presentan esta condicion, la cual se ha tratado de atribuir a la hipovitaminosis D, como factor causal de muchas patologias, entre ellas a la osteoporosis, por su rol esencial en el metabolismo del calcio y en la prevencion de fracturas. Se ha tratado de establecer su frecuencia a escala mundial y en Colombia son pocos los estudios que han estimado la prevalencia en poblacion con osteoporosis. Objetivo Determinar la prevalencia de la insuficiencia de vitamina D en una poblacion de pacientes con osteoporosis, atendidos en una clinica de alta complejidad en Colombia. Materiales y metodos Estudio retrospectivo y descriptivo que incluia pacientes atendidos en la consulta externa, en las diferentes especialidades de medicina interna, en un hospital de alta complejidad en Cali, Colombia, entre los anos 2013 a 2014, con diagnostico de osteoporosis e insuficiencia de vitamina D. Se describieron las caracteristicas sociodemograficas, antecedentes medicos y resultado de niveles de vitamina D, parathormona, densitometria osea. Se determino la prevalencia de deficit de vitamina D en pacientes con osteoporosis. Resultados Se incluyeron 206 pacientes con diagnostico de osteoporosis, de los cuales 114 presentaron insuficiencia de 25-hidroxicolecalciferol, para una prevalencia de 55,3%. El promedio de niveles de vitamina D fue 22 ng/ml (p = 0,00), con reportes de densitometria osea que para el momento del estudio presentaban un promedio de T score de –2,1 en columna vertebral (p = 0,55) y T score de –1,7 en cuello femoral (p = 0,00). Conclusiones La insuficiencia de vitamina D se ha determinado como uno de los factores asociados con osteoporosis. En una poblacion con osteoporosis del suroccidente colombiano, la prevalencia de la insuficiencia de vitamina D fue de 53%, mas baja que la reportada en otras ciudades de Colombia.

Objective: To investigate the effects of Bushen Jiangu decoction (kidney invigorating and bone invigorating decoction) on sex hormones and cytokines in women with postmenopausal osteoporosis (PMOP). Methods: From February 2014 to May 2016, 98 PMOP patients were selected as the research objects, randomly divided into observation group and control group (n=49). Two groups were given oral alendronate 70 mg/ times, 1 time/week, Caltrate D 1 tablets, 2 times/d. The observation group was given Bushen Jiangu decoction, daily 1 agent. The treatment period was 6 months. The fasting peripheral venous blood was collected before and after treatment and analyzed by automated chemiluminescence immunoassay analyzer for determination of serum estradiol (E2), follicle stimulating hormone (FSH) and luteinizing hormone (LH), prolactin (PRL), testosterone (T) and type I collagen carboxy terminal peptide (CTX), type I precollagen (PINP); using radioimmunoassay method of interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-alpha), insulin-like growth factor (IGF-1). Results: The E2 and T levels of the observation group after treatment were significantly increased compared with before treatment (P

Ayurveda is one of the old traditional science which deals with healthy and diseased state of human beings through lifestyle, dietary supplements, medication, yoga, purification techniques. In decades of old age can be reduced by the rasayana therapy, which is the line of treatment for vriddha age groups with dominant of vata dosha, agni mandya, dhatu and upadhatu Kshaya. Women are mostly vulnerable at early stage by the vata dosha, dhatu Kshaya especially asthi dhatu, upadhatu like aartava etc. Kshaya of asthi dhatu in menopausal period can be considered as menopausal osteoporosis. Prevention is better than cure as per this proverb, this study was held to prevent the risk of postmenopausal osteoporosis with the drugs lashuna and shatavari treated in comparison method. By its guna of snigdha, vatahara, rasayana etc.

Resumen La Asociación Colombiana de Osteoporosis y Metabolismo Mineral se reunió a principios de 2017 para actualizar el Consenso Colombiano de Osteoporosis, elaborado por primera vez en 2005, un paso que se consideró necesario en vista del subdiagnóstico de esta enfermedad, el impacto esperado del envejecimiento poblacional y los cambios en el tratamiento farmacológico que ha habido desde entonces. Se seleccionó un equipo técnico con especialistas de múltiples áreas y amplia trayectoria, repartidos en 4 grupos de trabajo: definición y epidemiología, diagnóstico, tratamiento farmacológico y medidas no farmacológicas. Luego de una revisión de la literatura científica, en reuniones de trabajo se generaron las definiciones y recomendaciones que se resumen en este documento. Abstract The Colombian Osteoporosis and Mineral Metabolism Association met in early 2017 to update the Colombian Consensus on Osteoporosis. This was first issued in 2005, and is seen as a necessary step in view of the underdiagnosed status of this disease, and the expected impact of population ageing. A technical team was formed with specialists with long experience across multiple disciplines, who were assigned to four working groups: definitions and epidemiology, diagnosis, pharmacological treatment, and non-pharmacological treatment. After a scientific literature review and a series of meetings, the definitions and recommendations are summarised in this article.

Resume Probleme de sante publique en raison de ses repercussions sur l’etat de sante des patientes, l’osteoporose postmenopausique est etudiee a partir de 30 cas pris en charge au Centre de sante Saint-Jacques et evalues en fonction de l’evolution de l’osteodensitometrie. Therapeutique classique, prevention et traitement homeopathique par remedes de constitution et diathesiques sont egalement evoques et illustres par trois observations de patientes du Centre de sante.

Objective: To determine whether generic non innovator once weekly oral alendronate is as effective as the innovator once oral Ibandronate.Method: This was an open label, prospective, randomized control trial conducted at the endocrine unit at the National Hospital of Sri Lanka. Postmenopausal women with a BMD T score of Results: Out of 77 women who entered the study 32 women in the alendronate group and 39 women in the ibandronate group completed treatment with 3 drop outs in each group. Mean ages, age since menopause and pre treatment CTX were similar in both groups.Percentage reduction in beta cross laps levels showed a marginally significant difference favouring the alendronate group (PTreatment success rates were 93.8 percent in the alendronate group and 89.7 percent in the ibandronate group. The difference was not statistically significant.Conclusions: Our study shows that the generic preparation of alendronate is effective in the treatment of osteoporosis.DOI: http://dx.doi.org/10.4038/sjdem.v1i1.4182 Sri Lanka Journal of Diabetes Endocrinology and Metabolism 2011; 1: 14-17

Background: Osteoporosis jeopardizes the quality of life of many post-menopausal women due to its sequelae of fractures on trivial trauma. With a rapid increase in average life expectancy India is becoming home to a huge population at risk of osteoporosis. The aims and objectives of the study were to assess the prevalence of fractures due to trivial trauma and probable symptoms of osteoporosis and prevalence of modifiable and non-modifiable risk factors of osteoporosis in postmenopausal womenMethods: A cross-sectional study, conducted by a door to door survey in 400 post-menopausal women (below 65 yrs) in urban Gwalior city from September to December 2012. The risk factors of osteoporosis in post-menopausal women have been classified into modifiable and non-modifiable risk factors. Modifiable risk factors include exercise/physical activity and consuming milk and milk products while age of menarche, age of menopause, reproductive period and parity were categorized as non-modifiable risk factors.Results: In our study, the overall prevalence of osteoporotic symptoms was 62.75% (251/400). Out of 400 postmenopausal women, 45.25% had backache, 55.75% had joint pain and 24.00% had fractures. Prevalence of osteoporotic fractures was much higher (39.16%) in females not consuming milk and milk products & in females who never exercised (35.22%). 60% of females who underwent hysterectomy had osteoporotic fractures.Conclusions: The overall prevalence of osteoporotic fractures among post-menopausal females was higher in our study when compared to other studies in the same setting. Thus, a multipronged approach involving educational intervention, lifestyle modification and appropriate hormonal treatment is required. Lifestyle modification involves nutritional interventions and motivation for regular physical activity.

The effectiveness of bisphosphonate treatment for post-menopausal osteoporosis depends on patients adhering to the therapeutic regimen. We previously showed that patients prefer a once-monthly regimen and the present follow-up study aimed to analyse patients' motivation for this preference. Women with post-menopausal osteoporosis ( n = 2035) completed a questionnaire targeting their bisphosphonate treatment preferences. The majority had chosen the once-monthly regimen due to the comfort (69%) and simplicity (59%) of the treatment and the need to take fewer pills (55%). Friends, relatives and print media were highlighted as important sources of information and many patients indicated a need for more information about osteoporosis and its management. Gastrointestinal and muscular side-effects were reported by about one-third of the patients, but these were well tolerated. It is concluded that once-monthly bisphosphonate treatment was preferred due to improved quality of life and should be offered to all patients with post-menopausal osteoporosis.

We would like to evaluate quality of life (QL) using validated indexes (QUALEFFO, SF-36) in non-hospitalised osteoporotic men. We have also compared QL in primary or secondary osteoporosis and we have evaluated QL according to the number of fractures. 142 men aged 18 to 80 years (60.3 ± 12.8 years) completed these questionnaires at least 2 months after a fracture. Among them, 81.6% had osteoporosis with fractures and 58% had 2 or more vertebral fractures. Osteoporosis was primary in 52% of cases. The decrease in quality of life due to osteoporotic fractures in men appears comparable to that caused by post menopausal osteoporosis. The impairment of QL concerns all ITEMs ie pain, mobility, social activities, mental functiun, health perception. The primary or secondary nature of the osteoporosis does not influence the decrease in quality of life. Quality of life decreases as the number of fractures increases.

Resume L'osteoporose postmenopausique est un probleme de sante publique, par son extreme frequence et ses consequences fracturaires. Le gynecologue peut jouer un role important en depistant les patientes qui presentent un risque osseux. Durant les consultations, les gestes de routine tels que la mesure, la pesee, l'interrogatoire permettent de rechercher des facteurs de risque modifiables : regime alimentaire, hygiene de vie (activite physique, consommation d'alcool et de tabac, etc.). Le gynecologue est un intervenant privilegie : il sensibilise et conseille les patientes a risque osseux, en recommandant une alimentation riche en calcium, en vitamine D et en proteines, le maintien d'un indice de masse corporelle correct, une exposition solaire suffisante, une activite physique quotidienne privilegiant les sports non portes, l'arret du tabac et une consommation moderee d'alcool. Ces simples modifications d'hygiene de vie permettent de ralentir la perte osseuse, et ce, bien avant celle liee a la carence estrogenique.

An estimated 3 million people in the UK suffer from osteoporosis costing the NHS and government over £1.7 billion each year. Osteoporosis is not painful in early stage but if left untreated it can cause substantial damage to bone structure resulting in multiple fractures. Development of new pharmacological treatments helped very elderly, patients with gastro-intestinal symptoms or non-compliant patients to recieve treatment as well.

Resume Objectifs : La mesure quantitative par ultrasons (QUS) s’est revelee un nouvel outil pour l’evaluation du risque fracturaire. Le but de cette etude etait de comparer la pertinence clinique des parametres QUS mesures par un appareil realisant une imagerie et un appareil sans imagerie dans l’identification des patientes osteoporotiques. Methodes : Nous avons mesure les parametres QUS suivants : BUA (dB/MHz) et SOS (m/s). Resultats : Les 106 femmes incluses dans cette etude etaient âgees de 65 ± 8 ans. Utilisant l’absorptiometrie biphotonique (DXA) le T score etait ≤ –2,5 au rachis lombaire ou a la hanche chez 59 % des patientes, et 25 % avaient des fractures osteoporotiques. Les resultats QUS differaient entre appareils et ces differences dependaient largement de la valeur mesuree. Il y avait un effet similaire de l’âge et de la duree de la menopause pour tous les parametres. Pour obtenir une sensibilite de 90 % pour le diagnostic d’osteoporose, les seuils etaient 50,80 et 71,70 dB/MHz pour le BUA et 1544,80 et 1551,50 m/s pour le SOS, en utilisant l’appareil realisant une imagerie et l’appareil sans imagerie respectivement. Appartenir au tertile superieur des valeurs QUS avait une valeur predictive negative pour l’osteoporose allant de 59 a 65 %. Dans le tertile inferieur des valeurs QUS, la proportion des femmes osteoporotiques etait entre 73 et 80 %. Tous les parametres QUS, sauf le BUA mesure par l’appareil sans imagerie, apres ajustement pour l’âge et la DMO de la hanche, etaient capables de distinguer les femmes menopausees ayant des fractures. Conclusions : Nos donnees suggerent qu’un systeme dote d’imagerie augmente l’utilite des mesures de BUA, mais pas de SOS, pour l’evaluation de l’osteoporose chez les femmes menopausees.