| 1. |
- Aapro, M, et al.
(author)
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Guidance on the use of bisphosphonates in solid tumours: recommendations of an international expert panel
- 2008
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In: Annals of Oncology. - : Elsevier BV. - 1569-8041 .- 0923-7534. ; 19:3, s. 420-432
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Journal article (peer-reviewed)abstract
- Bisphosphonates (BP) prevent, reduce, and delay cancer-related skeletal complications in patients, and have substantially decreased the prevalence of such events since their introduction. Today, a broad range of BP with differences in potency, efficacy, dosing, and administration as well as approved indications is available. In addition, results of clinical trials investigating the efficacy of BP in cancer treatment-induced bone loss (CTIBL) have been recently published. The purpose of this paper is to review the current evidence on the use of BP in solid tumours and provide clinical recommendations. An interdisciplinary expert panel of clinical oncologists and of specialists in metabolic bone diseases assessed the widespread evidence and information on the efficacy of BP in the metastatic and nonmetastatic setting, as well as ongoing research on the adjuvant use of BP. Based on available evidence, the panel recommends amino-bisphosphonates for patients with metastatic bone disease from breast cancer and zoledronic acid for patients with other solid tumours as primary disease. Dosing of BP should follow approved indications with adjustments if necessary. While i.v. administration is most often preferable, oral administration (clodronate, IBA) may be considered for breast cancer patients who cannot or do not need to attend regular hospital care. Early-stage cancer patients at risk of developing CTIBL should be considered for preventative BP treatment. The strongest evidence in this setting is now available for ZOL. Overall, BP are well-tolerated, and most common adverse events are influenza-like syndrome, arthralgia, and when used orally, gastrointestinal symptoms. The dose of BP may need to be adapted to renal function and initial creatinine clearance calculation is mandatory according to the panel for use of any BP. Subsequent monitoring is recommended for ZOL and PAM, as described by the regulatory authority guidelines. Patients scheduled to receive BP (mainly every 3-4 weeks i.v.) should have a dental examination and be advised on appropriate measures for reducing the risk of jaw osteonecrosis. BP are well established as supportive therapy to reduce the frequency and severity of skeletal complications in patients with bone metastases from different cancers.
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| 2. |
- Bruyere, O., et al.
(author)
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Post-fracture management of patients with hip fracture: a perspective
- 2008
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In: CURRENT MEDICAL RESEARCH AND OPINION. - : Informa Healthcare. - 0300-7995 .- 1473-4877. ; 24:10, s. 2841-2851
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Conference paper (peer-reviewed)abstract
- Background: Hip fracture creates a worldwide morbidity, mortality and economic burden. After surgery, many patients experience long-term disability or die as a consequence of the fracture. A fracture is a major risk factor for a subsequent fracture, which may occur within a short interval. Methods: A literature search on post-fracture management of patients with hip fracture was performed on the Medline database. Key experts convened to develop a consensus document. Findings: Management of hip-fracture patients to optimize outcome after hospital discharge requires several stages of care co-ordinated by a multidisciplinary team from before admission through to discharge. Further studies that specifically assess prevention and post-fracture management of hip fracture are needed, as only one study to date has assessed an osteoporosis medication in patients with a recent hip fracture. Proper nutrition is vital to assist bone repair and prevent further falls, particularly in malnourished patients. Vitamin D, calcium and protein supplementation is associated with an increase in hip BMD and reduction in falls. Rehabilitation is essential to improve functional disabilities and survival rates. Fall prevention and functional recovery strategies should include patient education and training to improve balance and increase muscle strength and mobility. Appropriate management can prevent further fractures and it is critical that high-risk patients are identified and treated. To foster this process, clinical pathways have been established to support orthopaedic surgeons. Conclusion: Although hip fracture is generally associated with poor outcomes, appropriate management can ensure optimal recovery and survival, and should be prioritized after a hip fracture to avoid deterioration of health and prevent subsequent fracture.
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| 3. |
- Janssen, S., et al.
(author)
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Defining assessment projects and scenarios for policy support: Use of ontology in Integrated Assessment and Modelling
- 2009
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In: Environmental Modelling & Software. - : Elsevier BV. - 1364-8152 .- 1873-6726. ; 24:12, s. 1491-1500
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Conference paper (peer-reviewed)abstract
- Integrated Assessment and Modelling (IAM) provides an interdisciplinary approach to support ex-ante decision-making by combining quantitative models representing different systems and scales into a framework for integrated assessment. Scenarios in IAM are developed in the interaction between scientists and stakeholders to explore possible pathways of future development. As IAM typically combines models from different disciplines, there is a clear need for a consistent definition and implementation of scenarios across models, policy problems and scales. This paper presents such a unified conceptualization for scenario and assessment projects. We demonstrate the use of common ontologies in building this unified conceptualization, e.g. a common ontology on assessment projects and scenarios. The common ontology and the process of ontology engineering are used in a case study, which refers to the development of SEAMLESS-IF, an integrated modelling framework to assess agricultural and environmental policy options as to their contribution to sustainable development. The presented common ontology on assessment projects and scenarios can be reused by IAM consortia and if required, adapted by using the process of ontology engineering as proposed in this paper. (C) 2009 Elsevier Ltd. All rights reserved.
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| 4. |
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| 5. |
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| 6. |
- Kanis, J, et al.
(author)
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Letter
- 2006
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In: Osteoporosis International. - : Springer Science and Business Media LLC. - 1433-2965 .- 0937-941X. ; 17:3, s. 493-494
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Journal article (other academic/artistic)
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| 7. |
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| 8. |
- Kanis, JA, et al.
(author)
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The perspective of the International Osteoporosis Foundation on the official positions of the International Society for Clinical Densitometry
- 2005
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In: Journal of Clinical Densitometry. - 1094-6950. ; 8:2, s. 145-147
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Journal article (peer-reviewed)abstract
- The International Society for Clinical Densitometry (ISCD) has published position statements on topics relating to the use and interpretation of measurements of bone mineral density (BMD). The most recent appeared in the Journal of Clinical Densitometry (1) and was republished in the Journal of Endocrinology and Metabolism and in Osteoporosis International (2,3). The topics included the indications for testing with BMD, the use of central dual energy X-ray absorptiometry (DXA) for the diagnosis of osteoporosis, the use of the Z-score and some recommendations for the spelling of the T-score and Z-score. Although these topics were chosen in an attempt to produce international consistency and consensus, most of the position statements lack a scientific basis.
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| 9. |
- Lippuner, K, et al.
(author)
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FRAX(R) assessment of osteoporotic fracture probability in Switzerland.
- 2009
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In: Osteoporosis international. - : Springer Science and Business Media LLC. - 1433-2965 .- 0937-941X.
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Journal article (peer-reviewed)abstract
- A Swiss-specific FRAX(R) model was developed. Patient profiles at increased probability of fracture beyond currently accepted reimbursement thresholds for bone mineral density (BMD) measurement by dual X-ray absorptiometry (DXA), and osteoporosis treatment were identified. INTRODUCTION: This study aimed to determine which constellations of clinical risk factors, alone, or combined with BMD measurement by DXA, contribute to improved identification of Swiss patients with increased probability of fracture. METHODS: The 10-year probability of hip and any major osteoporotic fracture was computed for both sexes, based on Swiss epidemiological data, integrating fracture risk and death hazard, in relation to validated clinical risk factors, with and without BMD values. RESULTS: Fracture probability increased with age, lower body mass index (BMI), decreasing BMD T-score, and all clinical risk factors used alone or combined. Several constellations of risk factor profiles were identified, indicating identical or higher absolute fracture probability than risk factors currently accepted for DXA reimbursement in Switzerland. With identical sex, age and BMI, subjects with parental history of hip fracture had as high a probability of any major osteoporotic fracture as patients on oral glucocorticoids or with a prevalent fragility fracture. The presence of additional risk factors further increased fracture probability. CONCLUSIONS: The customised FRAX(R) model indicates that a shift from the current DXA-based intervention paradigm, toward a fracture risk continuum based on the 10-year probability of any major osteoporotic fracture may improve identification of patients at increased fracture risk.
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| 10. |
- Lippuner, K, et al.
(author)
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Remaining lifetime and absolute 10-year probabilities of osteoporotic fracture in Swiss men and women.
- 2009
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In: Osteoporosis international. - : Springer Science and Business Media LLC. - 1433-2965 .- 0937-941X. ; 20:7, s. 1131-40
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Journal article (peer-reviewed)abstract
- SUMMARY: Remaining lifetime and absolute 10-year probabilities for osteoporotic fractures were determined by gender, age, and BMD values. Remaining lifetime probability at age 50 years was 20.2% in men and 51.3% in women and increased with advancing age and decreasing BMD. The study validates the elements required to populate a Swiss-specific FRAX model. INTRODUCTION: Switzerland belongs to high-risk countries for osteoporosis. Based on demographic projections, burden will still increase. We assessed remaining lifetime and absolute 10-year probabilities for osteoporotic fractures by gender, age and BMD in order to populate FRAX algorithm for Switzerland. METHODS: Osteoporotic fracture incidence was determined from national epidemiological data for hospitalised fractured patients from the Swiss Federal Office of Statistics in 2000 and results of a prospective Swiss cohort with almost 5,000 fractured patients in 2006. Validated BMD-associated fracture risk was used together with national death incidence and risk tables to determine remaining lifetime and absolute 10-year fracture probabilities for hip and major osteoporotic (hip, spine, distal radius, proximal humerus) fractures. RESULTS: Major osteoporotic fractures incidence was 773 and 2,078 per 100,000 men and women aged 50 and older. Corresponding remaining lifetime probabilities at age 50 were 20.2% and 51.3%. Hospitalisation for clinical spine, distal radius, and proximal humerus fractures reached 25%, 30% and 50%, respectively. Absolute 10-year probability of osteoporotic fracture increased with advancing age and decreasing BMD and was higher in women than in men. CONCLUSION: This study validates the elements required to populate a Swiss-specific FRAX model, a country at highest risk for osteoporotic fractures.
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