Moderate-quality evidence from 1 study that detected fractures radiographically showed that zoledronic acid reduced vertebral fractures in osteoporotic men In women, some bisphosphonates alendronate, risedronate, and zoledronic acid reduce vertebral, nonvertebral, and hip fractures. The overall quality of evidence was downgraded to low owing to indirectness. Bisphosphonates are associated with adverse effects, including mild gastrointestinal symptoms, atypical subtrochanteric fractures, and osteonecrosis of the jaw.
Current evidence does not show any benefit for bone density monitoring during treatment. Moderate-quality evidence showed that women treated with antiresorptive treatment including bisphosphonates, raloxifene, and teriparatide benefited from reduced fractures with treatment, even if there was no increase in BMD or if BMD decreased.
There was no evidence for BMD monitoring for men. Moderate-quality evidence showed that menopausal estrogen treatment did not reduce fracture risk in postmenopausal women with established osteoporosis. Evidence from a previous systematic review showed that estrogen decreased fracture risk; however, many of these studies focused on postmenopausal women with low bone density, or on postmenopausal women in general rather than those with established osteoporosis. Estrogen treatment is associated with serious harms, such as increased risk for cerebrovascular accidents and venous thromboembolism, and these harms significantly outweigh the potential benefits.
Although raloxifene has some benefit in reducing vertebral fractures, it does not reduce hip fracture or nonvertebral fractures and is associated with serious harms, including thromboembolism. Low-quality evidence showed that treatment with risedronate in women with osteopenia defined as a T score of —1. This effect is similar to fracture reductions seen in women with osteoporosis undergoing the similar treatment. Duration of treatment in these studies was 1. Although the current evidence is limited to a post hoc evaluation of risedronate in women with advanced osteopenia, the CGC believes that the benefit of fracture reduction is likely to be similar across all bisphosphonates, on the basis of data in osteoporotic women.
However, the efficacy of other bisphosphonates has not been directly evaluated in osteopenic women, and no study has been conducted to primarily assess the effects of fracture prevention in women with osteopenia. The rate of progressive bone loss and the risk for fracture range widely across the osteopenic spectrum and according to additional factors, such as age. The risk for severe adverse effects increases with prolonged use of bisphosphonates. Given the limited evidence supporting benefit, the balance of benefits and harms of treating osteopenic women is most favorable when the risk for fracture is high.
Women younger than 65 years with osteopenia and women older than 65 years with mild osteopenia T score between —1. Clinicians can use their own judgment based on risk factors for fracture, or they can use a risk assessment tool. Factors that increase the risk for fracture in women include lower body weight, smoking, weight loss, family history of fractures, decreased physical activity, alcohol or caffeine use, low calcium and vitamin D intake, and corticosteroid use 7 , , Comparative effectiveness trials evaluating pharmacologic treatments for low bone density or osteoporosis are lacking.
One post hoc analysis of a trial with raloxifene showed that treatment efficacy did not vary according to FRAX score , and at age 75 years, the risk reduction for vertebral fracture was similar across FRAX scores. The current evidence does not support frequent monitoring of women with normal bone density for osteoporosis, because data showed that most women with normal DXA scores did not progress to osteoporosis within 15 years. The data also do not support monitoring BMD during the initial 5 years of treatment in patients receiving pharmacologic agents to treat osteoporosis.
Clinicians should select generic drugs to treat osteoporotic patients when possible Table 2. This guideline update is based on an AHRQ evidence report and an update of the systematic review , The key questions addressed are:. What are the comparative benefits in fracture reduction among various pharmacologic treatments for low bone density? How does fracture risk reduction resulting from treatments vary between individuals with different risks for fracture, as determined by the following factors:. What are the short- and long-term harms of the various treatments when used specifically to treat or prevent low bone density or osteoporotic fracture?
Do these vary by any specific subpopulations? How often should patients be monitored via measurement of BMD during therapy, and how does the antifracture benefit vary with long term continued use of pharmacotherapy? Evidence was further updated specifically for bisphosphonates, calcium, vitamin D, and estrogen through 12 July Only RCTs and published systematic reviews of RCTs that met inclusion criteria were included in the assessment of effectiveness. Where no RCTs were available, large observational studies with more than participants , systematic reviews, and case reports for rare events were included for example, assessment of effects in subgroups or assessment of particular serious adverse events.
The overall quality of evidence and strength of recommendations was graded according to ACPs' clinical practice guidelines grading system Studies were limited to those conducted in adults older than 18 years, healthy adults, those with low bone density, or those with osteoporosis. Pharmacologic agents approved for use in the United States including bisphosphonates alendronate, risedronate, ibandronate, and zoledronic acid , teri-paratide, raloxifene, and menopausal estrogen therapy; the biologic agent denosumab; dietary and supplemental calcium and vitamin D; and physical activity.
The efficacy or effectiveness of the intervention in question were compared with that of placebo or another potency or dosing schedule for the same agent or another agent in the same or another class. Outcomes evaluated include reduction in fracture total, vertebral, nonvertebral, spine, hip, wrist, other and adverse events.
The target audience for this guideline is all clinicians. The target patient population is all adult men and women with low bone density or osteoporosis. The evidence reviews also underwent a peer review process through the journal. The guideline underwent a peer review process through the journal and was posted online for comments from ACP Regents and ACP Governors, who represent physician members at the national and international level.
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Alendronate and estrogen effects in postmenopausal women with low bone mineral density.
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Combination therapy with hormone replacement and alendronate for prevention of bone loss in elderly women: Comparison of change in bone resorption and bone mineral density with once-weekly alendronate and daily risedronate: Effect of alendronate on vertebral fracture risk in women with bone mineral density T scores of Alendronate improves bone mineral density in primary biliary cirrhosis: Meta-analysis of risedronate for the treatment of postmenopausal osteoporosis.
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Long-term efficacy of risedronate: Efficacy of risedronate administration in osteoporotic postmenopausal women affected by inflammatory bowel disease.
Dried Plums, Prunes and Bone Health: A Comprehensive Review
Efficacy and tolerability of once-weekly administration of The efficacy and tolerability of risedronate once a week for the treatment of postmenopausal osteoporosis. Two-year efficacy and tolerability of risedronate once a week for the treatment of women with postmenopausal osteoporosis.
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Randomized controlled trial of zoledronic acid for treatment of osteoporosis in women.
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Effects of 1 alpha-hydroxyvitamin D 3 on lumbar bone mineral density and vertebral fractures in patients with postmenopausal osteoporosis. Effects of a long-term vitamin D and calcium supplementation on falls and parameters of muscle function in community-dwelling older individuals. Effect of ipriflavone on bone in elderly hemiplegic stroke patients with hypovitaminosis D. Amelioration of osteopenia and hypovitaminosis D by 1alpha-hydroxyvitamin D 3 in elderly patients with Parkinson's disease.
Effect of four monthly oral vitamin D 3 cholecalciferol supplementation on fractures and mortality in men and women living in the community: Effects of the combined use of calcitonin and 1 alpha-hydroxycholecalciferol on vertebral bone loss and bone turnover in women with postmenopausal osteopenia and osteoporosis: A case study of discordant overlapping meta-analyses: A meta-analysis of high dose, intermittent vitamin D supplementation among older adults.
Vitamin D and vitamin D analogues for preventing fractures in post-menopausal women and older men. Treatment with intermittent calcitriol and calcium reduces bone loss after renal transplantation. It has been shown that latitude affects risk of osteoporotic fracture. About 22 million women and 5. The EU spends 37 billion euros per year in healthcare costs related to osteoporosis, and the US spends an estimated 19 billion USD annually for related healthcare costs. The link between age-related reductions in bone density and fracture risk goes back at least to Astley Cooper , and the term "osteoporosis" and recognition of its pathological appearance is generally attributed to the French pathologist Jean Lobstein.
Anthropologists have studied skeletal remains that showed loss of bone density and associated structural changes that were linked to a chronic malnutrition in the agricultural area in which these individuals lived. Osteoporosis means "porous bones", from Greek: From Wikipedia, the free encyclopedia. Osteoporosis Elderly woman with osteoporosis showing a curved back from compression fractures of her back bones.
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Comparative effects of dried plum and dried apple on bone in postmenopausal women. The effect of two doses of dried plum on bone density and bone biomarkers in osteopenic postmenopausal women: A randomized, controlled trial. Dried plums improve indices of bone formation in postmenopausal women. Womens Health Gend Based Med. The effect of dried plum on serum levels of receptor activator of NF-kappaB ligand, osteoprotegerin and sclerostin in osteopenic postmenopausal women: A randomised controlled trial. The effects of a 6-month resistance training and dried plum consumption intervention on strength, body composition, blood markers of bone turnover, and inflammation in breast cancer survivors.
Combining fructooligosaccharide and dried plum has the greatest effect on restoring bone mineral density among select functional foods and bioactive compounds. Comparison of dried plum supplementation and intermittent PTH in restoring bone in osteopenic orchidectomized rats. Dried plum reverses bone loss in an osteopenic rat model of osteoporosis. Dietary dried plum increases bone mass in adult and aged male mice. Addition of fructooligosaccharides and dried plum to soy-based diets reverses bone loss in the ovariectomized rat.
The phenolic acids of Agen prunes dried plums or Agen prune juice concentrates do not account for the protective action on bone in a rat model of postmenopausal osteoporosis. Effects of plum extract on skeletal system of fetal and newborn mice. Plum and soy aglycon extracts superior at increasing bone calcium retention in ovariectomized Sprague Dawley rats. Dried plum diet protects from bone loss caused by ionizing radiation. Dietary dried plum increases bone mass, suppresses proinflammatory cytokines and promotes attainment of peak bone mass in male mice. A comparative study of the bone metabolic response to dried plum supplementation and PTH treatment in adult, osteopenic ovariectomized rat.
Dried plums prevent ovariectomy-induced bone loss in rats. Dried plum polyphenols inhibit osteoclastogenesis by downregulating NFATc1 and inflammatory mediators. Evidence for anti-inflammatory and antioxidative properties of dried plum polyphenols in macrophage RAW Craniofacial, limb, and abdominal anomalies in a distinct syndrome: Relation to the spectrum of Pfeiffer syndrome type 3.
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Sonographic findings in a case of cloverleaf skull deformity and prune belly. Familial segregation of cervical ribs, Sprengel anomaly, preaxial polydactyly, anal atresia, and urethral obstruction: Clinical aspects of the prognosis of skull and brain injuries. A study of cases. Pediatric applications of augmentation cystoplasty: The Johns Hopkins experience. Functional outcome of AO type C distal humeral fractures. Dried plum, an emerging functional food that may effectively improve bone health.
Homo erectus and the limits of a paleontological species. Polyostotic hyperostosis in a plum-headed parakeet Psittacula cyanocephala L. Central precocious puberty and chronic renal failure: A reversible condition post renal transplantation. Lower limb deformity due to failed trauma treatment corrected with the Ilizarov technique: Factors affecting the complication rate in 52 patients. Urethral obstruction malformation complex: Phytonutrients for bone health during ageing. Surgical repair of pectus excavatum. Fruits and dietary phytochemicals in bone protection.
Osteoporosis
Skull plasty to correct congenital craniosynostosis. Cranial vault reconstruction of plagiocephaly. Total calvarial reconstruction for sagittal synostosis. Dried plums and their products: Composition and health effects—An updated review.
Electro-acupuncture combined with plum-blossom needle tapping for treatment of supraorbital neuritis-a clinical observation of 59 cases. Combination of acupuncture with cupping increases life quality of patients of osteoporosis. Flavonoid intake and bone health. Markers of bone turnover for the prediction of fracture risk and monitoring of osteoporosis treatment: Support Center Support Center. Please review our privacy policy. Significant increase in BMD at the spine and ulna in both groups, however increases were significantly greater in the DP group compared to dried apple control.
No significant differences between groups or any group-by-time interaction. After surgery to establish bone loss, rats placed on various diets supplemented with 13 different combinations of fructooligosaccharides and DP vs.
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DPs induced a significant increase in vertebra and femoral BMD compared to controls. Higher femur connectivity density, femur and vertebral linear attenuation. Higher cortical thickness and cortical area. Lower average von Mises stresses. Compared to OVX controls: Harlan Sprague Dawley mice. Within both adult and old mice, increasing DP supplementation was associated with greater BV.
1. Introduction
High and low chlorogenic acid dried plum P. Female rats High and low chlorogenic acid dried plum P. High chlorogenic acid DP juice group had significantly higher trabecular distal BMD compared to controls. Both high and low chlorogenic acid DP juice and DP juice concentrate lead to higher urinary calcium excretion compared to controls. Pregnant mice were fed DP extracts vs.