RESUMEN
INTRODUCTION: The aim of this study was to evaluate quantitative changes in OPG and RANKL proteins after treatment with strontium ranelate (SR) and ibandronate in patients with postmenopausal osteoporosis. MATERIAL AND METHODS: A total of 89 women with postmenopausal osteoporosis (PO), aged 51-85 years, patients of the Outpatient Clinic of Osteoporosis of the Military Teaching Hospital in Lodz, were enrolled in the study. The patients were randomly assigned to different therapies: ibandronate and (SR). Patients of the control group received only calcium and vitamin D3 supplements. The patients' visits were repeated after three and six months. Measurements of beta-CTX (C-terminal Telopeptide of type 1 collagen), osteocalcin, RANKL, osteoprotegerin (OPG), alkaline phosphatase concentrations in serum, as well as of total 24-hour calcium and phosphate levels in serum and urine, were carried out in material collected at baseline and after three and six months of therapy. Left hip and lumbar spine densitometry was done twice (at baseline visit and after six months). RESULTS: In all three groups there were no significant differences noted in the concentrations of OPG and RANKL serum protein levels during the study period. Both negative and positive correlations or tendencies of correlations were found between OPG serum concentrations and BMD changes in the SR group. CONCLUSIONS: Both ibandronate and SR do not seem to cause any significant changes in OPG and RANKL protein serum levels during the first six months of treatment. OPG may play a role in osteoclast activity suppression in the course of treatment with ibandronate in patients with PO. OPG may play an important role in the mechanism of SR therapy and may be viewed as a potentially valuable parameter for monitoring and predicting the course of treatment with SR in PO.
Asunto(s)
Difosfonatos/farmacología , Osteoporosis Posmenopáusica/sangre , Osteoprotegerina/sangre , Ligando RANK/sangre , Tiofenos/farmacología , Anciano , Anciano de 80 o más Años , Fosfatasa Alcalina/sangre , Fosfatasa Alcalina/efectos de los fármacos , Remodelación Ósea/efectos de los fármacos , Difosfonatos/uso terapéutico , Quimioterapia Combinada , Femenino , Humanos , Ácido Ibandrónico , Persona de Mediana Edad , Osteocalcina/sangre , Osteocalcina/efectos de los fármacos , Osteoporosis Posmenopáusica/tratamiento farmacológico , Osteoprotegerina/efectos de los fármacos , Ligando RANK/efectos de los fármacos , Tiofenos/uso terapéuticoRESUMEN
INTRODUCTION: The aim of the study was to assess the role of patient counselling, nurse assistance and effects of biochemical examinations in adherence of women with postmenopausal osteoporosis to alendronate 70 administration over 12 months of therapy. MATERIAL AND METHODS: Compliance and persistence to alendronate 70 therapy were assessed in a prospective study of 123 postmenopausal women, followed up for one year. The patients were divided into 4 groups (controls, counselled group, biochemical group and nurse assisted group) with monitoring every 6 months; in the nurse assisted group, additional phone contacts were made after 3 and 9 months of treatment. After 12 months, compliance and persistence were analysed. The medication possession ratio (MPR) was regarded as optimal when its value exceeded 80%. RESULTS: The compliance to alendronate 70 therapy was 54.03% in the control group and the mean persistence with medication was 197 days. The MPR above 80% was observed in 37.5%, and, after 1 year, 43.75% of patients were found persistent with the therapy. In the remaining groups, both compliance and persistence were higher but not statistically significantly, compared to the control group. Neither patient's age, education, diet, nor physical activity influenced the compliance with prescribed therapy. The most common reason to discontinue therapy was either its side effects or smoking. CONCLUSIONS: The obtained results suggest that better adherence with medical recommendations is observed in patients who receive additional attention, e.g. counselling, biochemical tests or nursing care. The critical elements for therapy discontinuation were side effects and smoking.
RESUMEN
CONTEXT: Recent research results have confirmed the high significance of the OPG/RANK/RANKL system in the development of bone diseases. AIM: The aim of the reported study was to assess gene expression levels of the OPG/RANK/RANKL system in peripheral blood mononuclear cells (PBMCs) after strontium ranelate (SR) and ibandronate administered to patients with postmenopausal osteoporosis. PATIENTS AND METHODS: A total of 89 postmenopausal women, aged 51 to 85 years, patients of the Outpatient Clinic of Osteoporosis of the Military Teaching Hospital in Lodz, were enrolled into the study. The patients were randomly assigned to different medical therapies: ibandronate and SR. Patients of the control group received only calcium and vitamin D3 supplements. Patient visits were repeated after 3 and 6 months. Measurements of serum alkaline phosphatase concentrations and of RNA expression in PBMCs as well as of total serum calcium and phosphate levels and of their 24-hour urine excretion rates were carried out in material, collected at baseline and after 3 and 6 months of the therapy. Densitometry of the left hip and of the lumbar spine was done at the baseline visit and after 6 months. RESULTS: The differences in gene expressions of RANKL and RANK were not significant during the study period and did not differ between the groups in a statistically significant manner. No OPG gene expression was observed in PBMCs of patients in any of the studied groups and at any time point. The tendency of correlation (P = .07) was observed between decreasing RANK gene expression and increasing bone mineral density in the patients treated with SR. CONCLUSIONS: Both ibandronate and SR do not seem to cause any significant changes in gene expression levels of OPG/RANK/RANKL in PBMCs during the first 6 months of treatment.
Asunto(s)
Conservadores de la Densidad Ósea/uso terapéutico , Regulación de la Expresión Génica/efectos de los fármacos , Leucocitos Mononucleares/efectos de los fármacos , Osteoporosis Posmenopáusica/tratamiento farmacológico , Osteoprotegerina/metabolismo , Ligando RANK/metabolismo , Receptor Activador del Factor Nuclear kappa-B/metabolismo , Anciano , Anciano de 80 o más Años , Densidad Ósea/efectos de los fármacos , Calcio de la Dieta/uso terapéutico , Colecalciferol/uso terapéutico , Terapia Combinada , Suplementos Dietéticos , Difosfonatos/uso terapéutico , Femenino , Humanos , Ácido Ibandrónico , Leucocitos Mononucleares/metabolismo , Persona de Mediana Edad , Compuestos Organometálicos/uso terapéutico , Osteoporosis Posmenopáusica/sangre , Osteoporosis Posmenopáusica/dietoterapia , Osteoporosis Posmenopáusica/metabolismo , Osteoprotegerina/sangre , Osteoprotegerina/genética , Ligando RANK/sangre , Ligando RANK/genética , ARN Mensajero/metabolismo , Receptor Activador del Factor Nuclear kappa-B/sangre , Receptor Activador del Factor Nuclear kappa-B/genética , Tiofenos/uso terapéuticoRESUMEN
INTRODUCTION: More than half of those with chronic diseases, including osteoporosis, discontinue treatment during the first year of its administration. This problem increases over the course of continued follow-up. Additionally, it has been observed that 13% of women, prescribed oral daily alendronate, do not even start the treatment, while 20% of patients discontinue the therapy during the first four months. On the other hand, those patients who are compliant achieve increased bone mass density with a simultaneous decrease of fracture risk. The aim of our study was to assess the adherence to the recommended alendronate 70 administration protocol over the course of 12 months by women with post-menopausal osteoporosis. MATERIAL AND METHODS: Adherence (compliance plus persistence) to alendronate 70 therapy was assessed in a prospective study of 153 post-menopausal women, followed up for one year with monitoring every two months. RESULTS: Adherence to therapy of all the study participants was high during the entire study period, the patients remaining compliant after a year in 95.08 ± 1.39% (mean ± SEM) of cases, and the mean persistence with medication was 347.05 ± 5.07 days. In the group of patients who interrupted treatment, the mean persistence was 212.44 days. One of the study participants did not start the treatment, and another two discontinued the therapy within 30-60 days of the study onset (between the first two visits). Facilitated contacts with the doctor, continuous access to prescribed treatment and frequent visits significantly improved patient compliance. The common reason for discontinuation was side effects, while age (but not education) affected the rate of compliance with therapy. The worst results were obtained in the group of patients with osteoporosis diagnosed more than five years before the study, particularly in the subgroup where alendronate was being used for the first time or where treatment resumed after a substantial break. CONCLUSIONS: The obtained results indicate that better adherence to alendronate 70 therapy, administered once a week, depends on more frequent monitoring of treated patients.