Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0034065 (pulmonary embolism)
 14,979 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

(1) Strontium ranelate is marketed in the European Union for the treatment of postmenopausal osteoporosis. Strontium, a cation closely related to calcium, was already used for this purpose in the 1950s but was abandoned because it caused bone mineralization disorders (mainly due to the high doses used at the time). (2) Strontium has only been compared with placebo: there are no clinical trials versus a diphosphonate. (3) On the basis of bone mineral density, two dose-finding studies suggested that, in women who are also taking calcium and vitamin D, the effective minimal dose of strontium is 1 g/day for primary prevention and 2 g/day for secondary prevention. (4) In secondary prevention, a randomised, double-blind trial (SOTI) involving 1649 postmenopausal women who had already had an osteoporotic fracture and were also taking calcium + vitamin D, showed that 2 g strontium daily reduced the risk of symptomatic vertebral fractures compared with placebo (11.3% versus 17.4%) after three years of treatment. (5) Another randomised, double-blind trial (TROPOS) involved 5091 women with osteoporosis of the femur. After three years of treatment with calcium, vitamin D, and either 2 g/day strontium or placebo, the risk of non vertebral osteoporotic fracture was lower in the strontium arm (10.9% versus 9.1%; relative risk 0.85, 95% confidence interval 0.71-1.01), although the difference was only just significant (p = 0.05). This trial failed to show that strontium reduced the risk of femoral fracture. A retrospective subgroup analysis raised the possibility of a preventive effect on hip fracture in patients aged over 74 years, but again the difference had only borderline significance (relative risk 0.64, confidence interval 0.412-0.997). (6) The SOTI and TROPOS studies were subsequently pooled for analysis. A retrospective subgroup analysis of women aged over 80 suggested some efficacy on non vertebral fractures, but this remains to be confirmed in a comparative trial with relevant outcome measures. (7) The reports of these trials include little information on the adverse effects of strontium. Strontium caused a 50% increase in the risk of venous thromboembolism (including pulmonary embolism). Strontium also increased serum creatine kinase activity in 30% of patients. Strontium can affect mental functions, and this effect needs to be quantified. Neurological and muscular adverse effects were inadequately documented, although disorders of this type were observed in animals. (8) The long-term adverse effects of strontium on bone (osteomalacia, pathological fractures, etc.) are unknown. Data from experimental studies and dialysis patients with renal failure raise the possibility of these adverse effects. (9) In practice, there are too many unknowns surrounding the potential risks of strontium while there is not enough evidence of clinical advantages over diphosphonates.
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PMID:Strontium: new drug. Postmenopausal osteoporosis: too many unknowns. 1639 77

Vertebroplasty (VP) is a mini-invasive percutaneous technique for the treatment of symptomatic, vertebral body fracture (VBF) caused by porotic or other diseases and its outcome has now been demonstrated by many trials. Beyond the results of these trials on the efficacy and safety of VP, the real problem for patients with osteoporotic and non-osteoporotic vertebral fractures is the risk of new fractures to adjacent or distant vertebra following VP that is reported to range from 10% to 30%. It is still unclear whether this is related to the natural history of the underlying disease (osteoporotic and non-osteoporotic diseases) or to the treatment, especially when a single vertebral fracture in an osteoporotic patient is highly predictive of future fractures. To prevent new fractures to adjacent or distant vertebra following VP in porotic patients multiple non-pharmacologic interventions are recommended (diet with vitamin D or calcium supplements, smoking cessation, exercise) in addition to a specific medical therapy to block the activation of osteoclast cells responsible for bone resorption, and to re-establish correct bone remodeling. These drugs include anti-catabolic drugs: bisphosphonate, oestrogen hormone, and anabolic drugs: PTH analogues and strontium ranelate. Bisphosphonate are the most commonly used compounds to treat postmenopausal osteoporosis. However, medical treatment appears to be too slow to prevent the natural history of patients with VBF. One session multilevel VP could be performed to prevent vertebral refracture risk in porotic or non-porotic patients with recurrent VBFs also after the first VP even if there is not a true vertebral collapse. Even if there are no limits to how many body levels can be treated in one session, European and American guidelines suggest doing no more than three body levels in the same session to reduce patient discomfort, and to prevent peri-procedural anesthesiologic problems, like uncontrolled fat-embolism, cement leakage, and pulmonary embolism, that could be increased. How many vertebrae could be treated in same session could be analyzed beforehand based on MDCT vertebral morphology and trabecular structure, or on MRI-signal changes. Added to medical therapy, multilevel VP can be performed in selected cases to treat VBF related to osteoporosis, preventing fractures or refracture without any further thrombo-embolic or fat uncontrolled embolism peri or post-procedural complications.
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PMID:Medical therapy and multilevel vertebroplasty in osteoporosis: when and why. 2414 45