Journal of Bone and Mineral Metabolism最新文献

{"title":"History of fragility fracture is associated with cardiovascular mortality in hemodialysis patients: the Q-Cohort study.","authors":"Naoki Haruyama, Masaru Nakayama, Shunsuke Yamada, Shigeru Tanaka, Hiroto Hiyamuta, Masatomo Taniguchi, Masanori Tokumoto, Kazuhiko Tsuruya, Takanari Kitazono, Toshiaki Nakano","doi":"10.1007/s00774-024-01501-x","DOIUrl":"10.1007/s00774-024-01501-x","url":null,"abstract":"<p><strong>Introduction: </strong>In patients undergoing dialysis, major bone fracture is associated with a high risk of mortality, including death of cardiovascular (CV) origin. In the present study, we aimed to determine whether a history of fragility fracture is a predictor of CV death in patients undergoing hemodialysis with long-term follow-up.</p><p><strong>Materials and methods: </strong>In total, 3499 patients undergoing hemodialysis were analyzed for 10 years. We evaluated the history of fragility fracture in each patient at enrollment. The primary outcome was CV death. A Cox proportional hazard model and a competing risk approach were applied to determine the association between a history of fragility fracture and CV death.</p><p><strong>Results: </strong>A total of 346 patients had a history of fragility fracture at enrollment. During a median follow-up of 8.8 years, 1730 (49.4%) patients died. Among them, 621 patients experienced CV death. Multivariable Cox analyses after adjustment for confounding variables showed that a history of fragility fracture was associated with CV death (hazard ratio, 1.47; 95% confidence interval, 1.16-1.85). In the Fine-Gray regression model, a history of fragility fracture was an independent risk factor for CV death (subdistribution hazard ratio, 1.36; 95% confidence interval, 1.07-1.72).</p><p><strong>Conclusion: </strong>In a large cohort of patients undergoing hemodialysis, a history of fragility fracture was an independent predictor of CV death.</p>","PeriodicalId":15116,"journal":{"name":"Journal of Bone and Mineral Metabolism","volume":" ","pages":"253-263"},"PeriodicalIF":2.4,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140174776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term effects of denosumab on bone mineral density and turnover markers in patients undergoing hemodialysis.","authors":"Kazuhiko Kato, Tatsuhiro Yaginuma, Arisa Kobayashi, Akio Nakashima, Ichiro Ohkido, Takashi Yokoo","doi":"10.1007/s00774-024-01505-7","DOIUrl":"10.1007/s00774-024-01505-7","url":null,"abstract":"<p><strong>Introduction: </strong>Denosumab, a fully human anti-RANKL monoclonal antibody, is a widely used osteoporosis treatment that is increasingly being used in patients undergoing dialysis; however, its long-term efficacy and safety in these patients remain unknown.</p><p><strong>Materials and methods: </strong>This observational study comprised individuals aged ≥ 20 years undergoing hemodialysis and receiving denosumab. After denosumab administration, we analyzed the long-term changes in bone mineral density (BMD) and levels of bone turnover markers (BTMs) and calcium.</p><p><strong>Results: </strong>The study included 45 patients who have been receiving denosumab for a median duration of 3.8 (interquartile range, 2.5-6.7) years. Tartrate-resistant acid phosphatase 5b (TRACP-5b) levels decreased from a median of 595 (434-778) mU/dL at baseline to 200 (141-430) mU/dL after 6 months of denosumab administration (P < 0.001) and remained low thereafter. Similarly, bone-specific alkaline phosphatase (BAP) levels decreased from a median of 18.2 (15.9-25.8) μg/L at baseline to 12.4 (9.9-15.6) μg/L after 6 months (P < 0.001) and remained low thereafter. Meanwhile, BMD, as assessed with dual energy X-ray absorptiometry and measured at the distal 1/3 of the radius, did not decrease (0.465 ± 0.112 g/cm² at baseline vs. 0.464 ± 0.112 g/cm² after administration; P = 0.616). Regarding hypocalcemia, corrected calcium levels reached were the lowest at 7 days after administration and normalized within 30 days.</p><p><strong>Conclusion: </strong>The study showed long-term suppression of TRACP-5b and BAP levels and sustaining BMD after denosumab administration over an extended period in patients undergoing hemodialysis.</p>","PeriodicalId":15116,"journal":{"name":"Journal of Bone and Mineral Metabolism","volume":" ","pages":"264-270"},"PeriodicalIF":2.4,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10982096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140184546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Androgen deprivation therapy-related fracture risk in prostate cancer: an insurance claims database study in Japan.","authors":"Hisashi Matsushima, Tetsuya Taguchi, Sho Kodama, Naoki Okubo, Kengo Saito, Katarzyna Jabłońska, Seiji Fukumoto, Toshio Matsumoto","doi":"10.1007/s00774-024-01497-4","DOIUrl":"10.1007/s00774-024-01497-4","url":null,"abstract":"<p><strong>Introduction: </strong>Androgen deprivation therapy (ADT) is widely used for the treatment of prostate cancer. ADT is associated with reduced bone density leading to an increased risk of osteoporotic fracture. The objective of this retrospective cohort study was to quantify fracture risk in men treated with ADT for prostate cancer in real-world practice in Japan.</p><p><strong>Materials and methods: </strong>Data were extracted from the Japanese Medical Data Vision (MDV) database. Men initiating ADT for treatment of prostate cancer between April 2010 and March 2021 were identified and matched to a cohort of prostate cancer patients not taking ADT using a propensity score. Fracture rates were estimated by a cumulative incidence function and compared between cohorts using a Cox cause-specific hazard model. Information was extracted on demographics, comorbidities and bone densitometry.</p><p><strong>Results: </strong>30,561 men with PC starting ADT were matched to 30,561 men with prostate cancer not treated with ADT. Following ADT initiation, <5% of men underwent bone densitometry. Prescription of ADT was associated with an increased fracture risk compared to not taking ADT (adjusted hazard ratio: 1.63 [95% CI 1.52-1.75]).</p><p><strong>Conclusion: </strong>ADT is associated with a 1.6-fold increase in the risk of osteoporotic fracture in men with prostate cancer. Densitometry in this population is infrequent and monitoring urgently needs to be improved in order to implement effective fracture prevention.</p>","PeriodicalId":15116,"journal":{"name":"Journal of Bone and Mineral Metabolism","volume":" ","pages":"223-232"},"PeriodicalIF":2.4,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10982088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140143456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Histomorphometric analysis of patients with femoral neck fracture and 25-hydroxyvitamin D deficiency: a cross-sectional study.","authors":"Go Okumura, Noriaki Yamamoto, Hayato Suzuki, Hiroshi Ninomiya, Yuki Hirano, Yoshiaki Tei, Yasuyuki Tomiyama, Taketoshi Shimakura, Hideaki E Takahashi, Norio Imai, Hiroyuki Kawashima","doi":"10.1007/s00774-024-01495-6","DOIUrl":"10.1007/s00774-024-01495-6","url":null,"abstract":"<p><strong>Introduction: </strong>Vitamin D deficiency causes osteoporosis, bone mineralization disorders, and osteomalacia. Osteomalacia is diagnosed using blood biochemical tests, clinical symptoms, and imaging; however, accurate detection of mineralization disorders requires tissue observation. We investigated the prevalence of bone mineralization disorders and their relationship with serum 25-hydroxyvitamin D (25OHD) levels in patients with untreated osteoporosis with femoral neck fractures.</p><p><strong>Materials and methods: </strong>A non-demineralized specimen was prepared from the femoral head removed during surgery in 65 patients. Bone histomorphometry of cancerous bone in the femoral head center was conducted. Osteoid volume per bone volume (OV/BV) and osteoid thickness (O.Th) were measured as indicators of mineralization disorder.</p><p><strong>Results: </strong>The mean serum 25OHD level (11.9 ± 5.7 ng/mL) was in the deficiency range (< 12 ng/mL). There were no clinically diagnosed cases of osteomalacia (OV/BV > 10% and O.Th > 12.5 µm); however, one case of mineralization disorder, considered histologically pre-osteomalacia (OV/BV > 5% and O.Th < 12.5 µm), was observed (OB/BV, 17.6%; O.Th, 12.3 µm). Excluding this case, those with severe (25OHD < 12 ng/mL, at risk of osteomalacia; n = 39) and non-severe deficiency (25OHD ≥ 12 ng/mL; n = 25) did not significantly differ in OV/BV (%; 0.77 ± 0.54 vs. 0.69 ± 0.38, p = 0.484) or O.Th (µm; 5.32 ± 1.04 vs. 5.13 ± 0.78, p = 0.410). Further, 25OHD and OV/BV were not significantly correlated (R = - 0.124, p = 0.327).</p><p><strong>Conclusion: </strong>This is the first study in the twenty-first century to examine serum 25OHD concentrations and bone mineralization disorders in Japanese patients with osteoporosis. The results indicate that vitamin D deficiency does not necessarily cause bone mineralization disorders and rarely leads to osteomalacia.</p>","PeriodicalId":15116,"journal":{"name":"Journal of Bone and Mineral Metabolism","volume":" ","pages":"214-222"},"PeriodicalIF":2.4,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139702520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Zinc improves Denosumab and eldecalcitol efficacy for bone mineral density in patients with hypozincemia.","authors":"Hotaka Ishizu, Tomohiro Shimizu, Yusuke Ohashi, Kenichi Kusunoki, Masahiro Kanayama, Norimasa Iwasaki, Fumihiro Oha","doi":"10.1007/s00774-024-01498-3","DOIUrl":"10.1007/s00774-024-01498-3","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to investigate the effects of zinc deficiency and zinc medication in osteoporosis patients undergoing denosumab (DMAb).</p><p><strong>Materials and methods: </strong>This retrospective study was conducted at a single hospital. The participants were female osteoporosis patients visiting between April 2019 and April 2020. All patients were treated with DMAb and eldecalcitol and recommended zinc-rich food. Based on zinc medication and serum zinc levels at the 12th month of dietary guidance, patients were categorized into the following four groups: hypozincemia with zinc medication, latent zinc deficiency with zinc medication, without zinc medication, and control without zinc medication. Longitudinal serum zinc concentrations, bone mineral density (BMD), and occurrence of fractures were measured. We investigated the factors influencing no response to DMAb and eldecalcitol treatment.</p><p><strong>Results: </strong>Among the 145 patients followed up for 24 months, dietary guidance did not change the serum zinc concentration; however, zinc medication significantly increased these levels. The hypozincemia group did not show a significant BMD increase in the lumbar spine and femoral neck after DMAb and eldecalcitol treatment during dietary guidance; however, zinc medication increased these to the same levels as the other groups. In multivariate analyses, hypozincemia and thyroid disease were identified as the factors affecting no response. While 28.2% of patients with latent zinc deficiency without zinc medication suffered fractures, no fractures occurred in hypozincemia patients with zinc medication.</p><p><strong>Conclusion: </strong>Hypozincemia may reduce the efficacy of DMAb and eldecalcitol in increasing BMD and fracture prevention.</p>","PeriodicalId":15116,"journal":{"name":"Journal of Bone and Mineral Metabolism","volume":" ","pages":"233-241"},"PeriodicalIF":2.4,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139697521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inhibition of cysteine protease disturbs the topological relationship between bone resorption and formation in vitro.","authors":"Sayaka Ono, Naoki Tsuji, Tomoaki Sakamoto, Shuya Oguchi, Takashi Nakamura, Kazuto Hoshi, Atsuhiko Hikita","doi":"10.1007/s00774-023-01489-w","DOIUrl":"10.1007/s00774-023-01489-w","url":null,"abstract":"<p><strong>Introduction: </strong>Osteoporosis is a global health issue. Bisphosphonates that are commonly used to treat osteoporosis suppress both bone resorption and subsequent bone formation. Inhibition of cathepsin K, a cysteine proteinase secreted by osteoclasts, was reported to suppress bone resorption while preserving or increasing bone formation. Analyses of the different effects of antiresorptive reagents such as bisphosphonates and cysteine proteinase inhibitors will contribute to the understanding of the mechanisms underlying bone remodeling.</p><p><strong>Materials and methods: </strong>Our team has developed an in vitro system in which bone remodeling can be temporally observed at the cellular level by 2-photon microscopy. We used this system in the present study to examine the effects of the cysteine proteinase inhibitor E-64 and those of zoledronic acid on bone remodeling.</p><p><strong>Results: </strong>In the control group, the amount of the reduction and the increase in the matrix were correlated in each region of interest, indicating the topological and quantitative coordination of bone resorption and formation. Parameters for osteoblasts, osteoclasts, and matrix resorption/formation were also correlated. E-64 disrupted the correlation between resorption and formation by potentially inhibiting the emergence of spherical osteoblasts, which are speculated to be reversal cells in the resorption sites.</p><p><strong>Conclusion: </strong>These new findings help clarify coupling mechanisms and will contribute to the development of new drugs for osteoporosis.</p>","PeriodicalId":15116,"journal":{"name":"Journal of Bone and Mineral Metabolism","volume":" ","pages":"166-184"},"PeriodicalIF":2.4,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10982105/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139905714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inherited Fanconi renotubular syndromes: unveiling the intricacies of hypophosphatemic rickets/osteomalacia","authors":"Divya C. Ragate, Saba Samad Memon, Manjiri Karlekar, Anurag Ranjan Lila, Vijaya Sarathi, Tukaram Jamale, Sayali Thakare, Virendra A. Patil, Nalini S. Shah, Tushar R. Bandgar","doi":"10.1007/s00774-023-01490-3","DOIUrl":"https://doi.org/10.1007/s00774-023-01490-3","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction</h3><p>Fanconi renotubular syndromes (FRTS) are a rare group of inherited phosphaturic disorders with limited Indian as well as global data on this condition. Here, we describe the experience of a single Endocrinology center from Western India on FRTS.</p><h3 data-test=\"abstract-sub-heading\">Materials and methods</h3><p>Comprehensive clinical, biochemical, radiological, management, and genetic details of FRTS patients managed between 2010 and 2023 were collected and analyzed.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>FRTS probands had mutations (eight novel) in six genes [<i>CLCN5</i> (<i>n</i> = 4)<i>, SLC2A2</i> (<i>n</i> = 2<i>), GATM</i>, <i>EHHADH, HNF4A,</i> and <i>OCRL </i>(1 each)]. Among 15 FRTS patients (11 families), rickets/osteomalacia was the most common (<i>n</i> = 14) presentation with wide inter- and intra-familial phenotypic variability. Delayed diagnosis (median: 8.8 years), initial misdiagnosis (8/11 probands), and syndrome-specific discriminatory features (8/11 probands) were commonly seen. Hypophosphatemia, elevated alkaline phosphatase, normal parathyroid hormone (median: 36 pg/ml), high-normal/elevated 1,25(OH)₂D (median: 152 pg/ml), hypercalciuria (median spot urinary calcium to creatinine ratio: 0.32), and variable proximal tubular dysfunction(s) were observed. Elevated C-terminal fibroblast growth factor 23 in two probands was misleading, till the genetic diagnosis was reached. Novel observations in our FRTS cohort were preserved renal function (till sixth decade) and enthesopathy in FRTS1 and FRTS3 families, respectively.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Our findings underscore frequent under- and misdiagnosis of FRTS; hence, a high index of suspicion for FRTS in phosphopenic rickets/osteomalacia, with early consideration of genetic testing is essential to ensure timely diagnosis of FRTS. The novel variants and phenotypic manifestations described here expand the disease spectrum of FRTS.</p>","PeriodicalId":15116,"journal":{"name":"Journal of Bone and Mineral Metabolism","volume":"254 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139677459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Secondary fracture and mortality risk with very high fracture risk osteoporosis and proximal femoral fracture","authors":"Hotaka Ishizu, Tomohiro Shimizu, Kosuke Arita, Komei Sato, Renya Takahashi, Kenichi Kusunoki, Shun Shimodan, Tsuyoshi Asano, Norimasa Iwasaki","doi":"10.1007/s00774-023-01492-1","DOIUrl":"https://doi.org/10.1007/s00774-023-01492-1","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction</h3><p>We aimed to investigate secondary fracture and mortality rates, and risk factors in patients with proximal femoral fractures.</p><h3 data-test=\"abstract-sub-heading\">Materials and Methods</h3><p>We conducted a multicenter prospective cohort study on female patients with proximal femoral fractures who underwent surgical treatment between April 2020 and March 2021. Postoperative follow-ups were performed at 6-, 12-, 18-, and 24-month intervals to determine the secondary fracture and mortality rates, and the risk factors and its influence were examined.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Of the 279 registered patients, 144 patients (51.6%) were diagnosed with very high fracture risk osteoporosis. The postoperative osteoporosis rate exceeded 96%; however, osteoanabolic agents were used sparingly. The risk factor of both secondary fracture and mortality was very high fracture risk osteoporosis, and secondary fractures within 12 months were markedly occurred. Secondary fracture rates increased as the number of matched very high fracture risk osteoporosis criteria increased. Notably, secondary fractures and mortality were recorded in 21.4% and 23.5% of the patients who met all criteria, respectively.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Over half of the female patients with proximal femoral fractures had very high fracture risk osteoporosis. Although, very high fracture risk osteoporosis demonstrated a notably increased risk of secondary fractures, particularly at 12 months post-surgery, the use of osteoanabolic agents was substantially low. Collectively, our findings highlight the need to consider the risk of very high fracture risk osteoporosis, expand the use of medications to include osteoanabolic agents, and reconsider the current healthcare approach for proximal femoral fractures.</p>","PeriodicalId":15116,"journal":{"name":"Journal of Bone and Mineral Metabolism","volume":"184 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139662959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of chronic liver disease with bone diseases and muscle weakness","authors":"Chisato Saeki, Mitsuru Saito, Akihito Tsubota","doi":"10.1007/s00774-023-01488-x","DOIUrl":"https://doi.org/10.1007/s00774-023-01488-x","url":null,"abstract":"<p>The liver is a vital organ involved in nutrient metabolism, hormone regulation, immunity, cytokine production, and gut homeostasis. Impairment in liver function can result in malnutrition, chronic inflammation, decreased anabolic hormone levels, and dysbiosis. These conditions eventually cause an imbalance in osteoblast and osteoclast activities, resulting in bone loss. Osteoporosis is a frequent complication of chronic liver disease (CLD) that adversely affects quality of life and increases early mortality. Sarcopenia is another common complication of CLD characterized by progressive loss of skeletal muscle mass and function. Assessment criteria for sarcopenia specific to liver disease have been established, and sarcopenia has been reported to be associated with an increase in the risk of liver disease-related events and mortality in patients with CLD. Owing to their similar risk factors and underlying pathophysiological mechanisms, osteoporosis and sarcopenia often coexist (termed osteosarcopenia), progress in parallel, and further exacerbate the conditions mentioned above. Therefore, comprehensive management of these musculoskeletal disorders is imperative. This review summarizes the clinical implications and characteristics of osteoporosis, extending to sarcopenia and osteosarcopenia, in patients with CLD caused by different etiologies.</p>","PeriodicalId":15116,"journal":{"name":"Journal of Bone and Mineral Metabolism","volume":"83 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139663039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phenytoin is associated with increased risk of osteoporosis and fragility fractures in adult epileptic patients.","authors":"Sterling J DeShazo, Garett L Ozmer, Kyle A Horton, William M Weiss","doi":"10.1007/s00774-023-01475-2","DOIUrl":"10.1007/s00774-023-01475-2","url":null,"abstract":"<p><strong>Introduction: </strong>Osteoporotic fractures lead to significant decreases in the quality of life with increases in morbidity, mortality, and disability. Treatment with a variety of anti-epileptic drugs, such as phenytoin, has been understood to cause a decrease in bone mineral density.</p><p><strong>Materials and methods: </strong>Cohort A was identified as patients that were 18-55 years old that had epilepsy and recurrent seizures that were also prescribed phenytoin. Cohort B was identified as patients that were 18-55 years old that had epilepsy and recurrent seizures but were not prescribed phenytoin or other anti-epileptic medications. Cohorts were matched for relevant confounding pathologies and demographic factors. Outcomes were evaluated from 1 day to 5 years after the indexed event.</p><p><strong>Results: </strong>A total of 35,936 patients with epilepsy that were prescribed phenytoin were matched with 109,335 patients with epilepsy that were not prescribed phenytoin. Patients on phenytoin therapy were at significantly higher risk for osteoporosis without pathological fracture, fracture of metatarsal bone, fracture of shoulder and upper arm, fracture of distal radius, fracture of thoracic vertebra, fracture of cervical vertebra, fracture of lumbar vertebra, fracture of femoral head or neck, pertrochanteric fracture, femoral shaft fracture, and distal tibia fracture (all outcomes p < 0.001).</p><p><strong>Conclusion: </strong>Epileptic patients on phenytoin therapy that were 18-55 years old exhibited higher associated risk of osteoporosis and osteoporotic-fragility fractures of various regions. Patients that undergo phenytoin therapy for epilepsy treatment should be educated on the increased risk of bone fractures and have appropriate lifestyle and diet modifications.</p>","PeriodicalId":15116,"journal":{"name":"Journal of Bone and Mineral Metabolism","volume":" ","pages":"69-76"},"PeriodicalIF":3.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138498455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}