Bisphosphonates are first-line treatment for osteoporosis in men and post-menopausal women by promoting bone formation and decreasing resorption. While alendronate, risedronate, and zoledronic acid are approved for both sexes, ibandronate is only FDA-approved for treating osteoporosis in post-menopausal women. Studies of ibandronate's efficacy and safety in men are limited. Calcium and vitamin D supplementation reduces hip, vertebral, and total fracture risk in both men and women, but men have been inadequately studied in trials. Research on osteoporosis therapies has primarily focused on post-menopausal women,
This document discusses sarcopenia, which is the loss of skeletal muscle mass and strength associated with aging. It provides definitions of sarcopenia from leading medical organizations. Tools for assessing sarcopenia include questionnaires to screen for low muscle quantity and quality, strength tests like grip strength and chair rises, and physical performance tests such as gait speed and short physical performance battery. Cut-off scores for diagnosing low muscle mass, strength, and physical performance are presented. The document also reviews epidemiology of sarcopenia and discusses approaches for detecting and diagnosing the condition.
Dr. Sehdev explains bone health as it relates to cancer, including bone metastases, treatment options, the impact of cancer treatment on bone health, and what you can do to keep your bones strong.
Osteoporosis can occur in children as well as adults. While rare, it can cause significant pain and disabilities. The definition of childhood osteoporosis includes low trauma fractures with reduced bone mineral density more than 2 standard deviations below the age-matched mean. Key factors that influence childhood bone health are genetics, nutrition including calcium and vitamin D intake, physical activity, and endocrine status. Treatments include calcium and vitamin D supplementation, calcitonin, and intravenous bisphosphonates which deposit in bone and are effective with intermittent use in children.
Dr Trevor Cole's presentation from Osteoporosis 2016: From family history to epigenetics of osteoporosis.
Find out more at: https://nos.org.uk/conference
Osteoporosis is a disease characterized by low bone mass and deterioration of bone tissue, leading to increased bone fragility and fracture risk. It is diagnosed based on bone mineral density measurements and affects both men and women, with risks including disability, nursing home placement, costs, and mortality. Screening is recommended for those at high risk based on factors like age, gender, family history, and fracture risk assessment scores. Treatment focuses on lifestyle changes, supplements, and medications to prevent bone loss and fractures.
The Use of Resistance Training in the Prevention and Treatment of Osteoporosi...alicia_jade
Resistance training can help prevent and treat osteoporosis in the elderly. It maintains or increases bone mineral density by offsetting age-related declines in bone health. A resistance training program for osteoporosis prevention and treatment should include 2 sessions per week focusing on all areas of the body using 8-10 exercises of 15 reps each at a moderate intensity. Proper form, progression over time, and consideration of safety factors are important. Resistance training is a suitable lifestyle addition to prevent osteoporosis when combined with a healthy diet and regular physical activity.
This document discusses andropause and sarcopenia, which are age-related declines in testosterone and muscle mass. It provides evidence that testosterone levels and muscle mass begin declining in the late 30s and accelerate after age 70. Intrinsic and extrinsic factors like lower hormone levels and muscle protein breakdown contribute to sarcopenia. The document recommends addressing these issues with a balanced diet, exercise, stress reduction, sleep, and potentially testosterone therapy. It summarizes several studies showing that natural supplements like tongkat ali can safely and effectively increase testosterone levels and muscle mass. The document promotes Andraiz T, a supplement containing these ingredients, to help treat andropause and sarcopenia symptoms.
This document discusses sarcopenia, which is the loss of skeletal muscle mass and strength associated with aging. It provides definitions of sarcopenia from leading medical organizations. Tools for assessing sarcopenia include questionnaires to screen for low muscle quantity and quality, strength tests like grip strength and chair rises, and physical performance tests such as gait speed and short physical performance battery. Cut-off scores for diagnosing low muscle mass, strength, and physical performance are presented. The document also reviews epidemiology of sarcopenia and discusses approaches for detecting and diagnosing the condition.
Dr. Sehdev explains bone health as it relates to cancer, including bone metastases, treatment options, the impact of cancer treatment on bone health, and what you can do to keep your bones strong.
Osteoporosis can occur in children as well as adults. While rare, it can cause significant pain and disabilities. The definition of childhood osteoporosis includes low trauma fractures with reduced bone mineral density more than 2 standard deviations below the age-matched mean. Key factors that influence childhood bone health are genetics, nutrition including calcium and vitamin D intake, physical activity, and endocrine status. Treatments include calcium and vitamin D supplementation, calcitonin, and intravenous bisphosphonates which deposit in bone and are effective with intermittent use in children.
Dr Trevor Cole's presentation from Osteoporosis 2016: From family history to epigenetics of osteoporosis.
Find out more at: https://nos.org.uk/conference
Osteoporosis is a disease characterized by low bone mass and deterioration of bone tissue, leading to increased bone fragility and fracture risk. It is diagnosed based on bone mineral density measurements and affects both men and women, with risks including disability, nursing home placement, costs, and mortality. Screening is recommended for those at high risk based on factors like age, gender, family history, and fracture risk assessment scores. Treatment focuses on lifestyle changes, supplements, and medications to prevent bone loss and fractures.
The Use of Resistance Training in the Prevention and Treatment of Osteoporosi...alicia_jade
Resistance training can help prevent and treat osteoporosis in the elderly. It maintains or increases bone mineral density by offsetting age-related declines in bone health. A resistance training program for osteoporosis prevention and treatment should include 2 sessions per week focusing on all areas of the body using 8-10 exercises of 15 reps each at a moderate intensity. Proper form, progression over time, and consideration of safety factors are important. Resistance training is a suitable lifestyle addition to prevent osteoporosis when combined with a healthy diet and regular physical activity.
This document discusses andropause and sarcopenia, which are age-related declines in testosterone and muscle mass. It provides evidence that testosterone levels and muscle mass begin declining in the late 30s and accelerate after age 70. Intrinsic and extrinsic factors like lower hormone levels and muscle protein breakdown contribute to sarcopenia. The document recommends addressing these issues with a balanced diet, exercise, stress reduction, sleep, and potentially testosterone therapy. It summarizes several studies showing that natural supplements like tongkat ali can safely and effectively increase testosterone levels and muscle mass. The document promotes Andraiz T, a supplement containing these ingredients, to help treat andropause and sarcopenia symptoms.
These are the SIMPLE WAYS TO IMPROVE TESTOSTERONE. It is responsible for sex drive, sperm production, fat distribution, maintenance of muscle mass and strength.
What happens as athletes age? The physiological changes are important to note, so that training, recovery and overal healthcare can adapt to maximize the athlete's performance year after year. Dr. David Carfagno offers a unique insider's perspective, as a practitioner of sports medicine, internal medicine and a competitive athlete.
ICED 2014 Workshop on Males with Eating DisordersScoti Riff
Eating disorders in males are understudied, underrecognised and misunderstood. Despite evidence that males constitute 25-33% of diagnoses of anorexia and bulimia nervosa, and up to 50% of diagnoses of binge eating disorder, limited research has focused on the “male experience” of eating and body image concerns. In addition, researchers and clinicians have only recently begun to focus on the role that muscularity plays in males with eating and body image psychopathology. We present evidence that disordered eating behaviours are increasing more rapidly in men than in women, particularly with regard to binge eating. We further present a clinical comparison of men with anorexia nervosa and muscle dysmorphia (“reverse anorexia”) and review community-held attitudes and beliefs about people with these conditions. We conclude with a discussion of clinical treatment guidelines for males with eating disorders. This workshop will (1) present an overview of the evidence base pertinent to males with eating disorders, (2) evaluate evidence for the prevalence of disordered eating amongst males, compare the phenomenology of muscle dysmorphia and anorexia nervosa, and review the stigmatization of males with anorexia nervosa and muscle dysmorphia. Finally, this workshop 3) details treatment guidelines for clinicians working with males.
This workshop is delivered by Dr. Daniel Santa Mina, a Registered Kinesiologist and Certified Exercise Physiologist with specialization in oncology. Dr. Daniel Santa Mina is a Scientist at the Princess Margaret Cancer Centre where he leads the Wellness and Exercise for Cancer Survivors Program (WE-Can) and an Assistant Professor in the Faculty of Kinesiology and Physical Education at the University of Toronto. His main areas of clinical-research focus are on the physiological, functional, and psychosocial effects of exercise for cancer survivors.
Postprostatectomy Sexual Dysfunction: Is restoring erections enough?
This document discusses several important points:
1. While erectile dysfunction is the most commonly addressed sexual side effect after radical prostatectomy, other issues like loss of libido, anejaculation, orgasmic dysfunction, penile shortening and Peyronie's disease are gaining recognition.
2. Restoring erections through penile rehabilitation may not be enough, as other sexual dysfunctions can negatively impact quality of life.
3. A multidisciplinary approach is needed to address the range of potential sexual issues after prostatectomy, including psychological factors and partner considerations.
Dr. Vicki Harber of the University of Alberta describes the kind of nutrition female athletes build strong, resilient bodies and stave off the Female Triad: disordered eating, bone loss and dysmenorrhoea.
Penile Rehabilitation after Prostate Cancer Treatment: Is there an Analogy to...Ege Can Serefoglu MD FECSM
Sexual dysfunction follows radical pelvic surgery in both sexes. Nerve sparing surgery is possible for both male and female pelvic cancers. Nature and pathophysiology of sexual dysfunction varies in men and women. Clinical evidence for rehabilitation is limited in men, and absent in women. However, every cancer survivor women deserves sex. It is our responsibility to help them
It is important to have basic knowledge of one of the most important and neglected cause of Low Back Ache in Females that is Pelvic Floor Dysfunction.In this presentation it is tried to touch the important aspects related to pelvic floor dysfunction ,its assessment ,types hyper and hypotonus type and its treatment aspects.
Community Nutrition Assesment final draft of paperJessica Elliott
The document summarizes a study on the Southern Utah University women's distance team that assessed their eating habits, body image, and knowledge of nutrition. It was found that many athletes had abnormal menstrual cycles and low caloric intake. Additionally, there was pressure from their coach to maintain a low body weight that did not account for their muscle mass. This pressure and lack of proper nutrition knowledge contributed to unhealthy eating practices and increased risk of developing the Female Athlete Triad, characterized by energy deficiency, menstrual dysfunction, and low bone mineral density. Better nutrition education and assessment methods are needed to promote healthy lifestyles for these athletes.
1) This study evaluated the influence of autotransplantation of cryopreserved ovarian tissue on bone density in postmenopausal rats.
2) The ovaries of female rats were removed and cryopreserved, then reimplanted after 1 week (early menopause group) or 1 month (late menopause group).
3) Results showed that serum estradiol levels dropped after ovary removal but increased after ovarian tissue reimplantation, and bone biopsies found increased osteoblast activity after implantation compared to after ovary removal, indicating cryopreserved ovarian tissue can support bone tissue after menopause.
This document discusses strategies to improve soldier readiness through reducing injuries during initial military training. It notes that many recruits have nutritional deficiencies, weak bones, poor diets and low fitness levels upon arrival that increase injury risk during demanding training programs. It proposes adjusting the recruitment and accession process to screen recruits for these risk factors and address deficiencies prior to training through improved diets, supplements and exercise programs. Options are provided to integrate these strategies at different stages including the recruitment, medical screening and initial training phases to help graduates enter the force in a healthier, more resilient and deployable status.
This document discusses physical therapy approaches for cancer patients experiencing common symptoms like fatigue, pain, and breathing difficulties. It covers:
1. Definitions and screening tools for cancer-related fatigue and pain. Fatigue is graded on a scale and can interfere with daily activities. Pain is also assessed for intensity.
2. Non-pharmacological treatments for fatigue and pain including energy conservation, exercise, massage, heat/ice therapy, and electrotherapy. Exercise is recommended for patients during and after cancer treatment.
3. Cancer pain has multiple causes and classifications. The WHO pain ladder provides guidance on pain management strategies from non-opioid to opioid approaches. Physical therapy can help address pain through techniques like
Sugar-sweetened beverage consumption in relation to diabetes and cardiovascul...My Healthy Waist
By Frank B. Hu, MD, PhD Professor of Nutrition and Epidemiology Harvard School of Public HealthChanning Laboratory, Harvard Medical School and Brigham and Women’s Hospital
Sex differences in the links between disordered eating and admiration for peo...Scoti Riff
Background: Disordered eating in young women is positively associated with their admiration for women with anorexia nervosa. However, little is known about sex differences in this association, or whether the association extends to muscle dysmorphia.
Aims: The present study aimed to investigate sex differences in the associations between young peoples’ disordered eating and their admiration for people with anorexia nervosa and muscle dysmorphia.
Method: Male (n = 174) and female (n = 325) undergraduates read one of four descriptions of a male or female character with anorexia nervosa or muscle dysmorphia. Participants then answered questions about their admiration for the characters and completed a measure of disordered eating.
Results: Averaged across character diagnosis and character sex, female participants expressed greater desire to be like the characters than males. For females, moderate to large positive correlations were observed between disordered eating and admiration for characters with both anorexia nervosa and muscle dysmorphia. For males, moderate positive correlations emerged between disordered eating and admiration for muscle dysmorphia, and a single small positive correlation was observed for anorexia nervosa.
Conclusions: The results indicate important sex differences in the associations between young peoples’ disordered eating and their admiration for anorexia nervosa and muscle dysmorphia.
This document discusses the complex neurochemistry underlying exercise and human behavior. It notes that every individual's brain chemistry and response to exercise is unique due to genetic and environmental factors. While certain neurotransmitters like dopamine and endorphins generally promote exercise motivation and pain suppression, their levels and effects vary significantly between individuals. The document advocates that trainers and coaches recognize this bioindividuality and psychoindividuality to develop more effective, personalized training programs. It also stresses that more research is still needed to fully understand how exercise impacts the brain.
This document summarizes the evolution of hormone therapy for menopause from 1942 to 2020. It discusses key studies that identified health risks associated with different types of hormone therapy. The Women's Health Initiative trials in the 1990s showed that combined estrogen-progestin therapy increases the risk of breast cancer and heart disease compared to estrogen-only therapy or placebo. Subsequent studies found that the progestin component and type of progestin are important factors in health risks. Ongoing research continues to evaluate the appropriate uses and timing of hormone therapy to maximize benefits and minimize risks.
This document presents a research paper on the female athlete triad among female basketball players in India. The paper defines the three components of the triad as disordered eating, menstrual dysfunction, and osteoporosis. It describes administering a screening questionnaire to 80 female basketball players and analyzing the results. The results found that most players did not exhibit high-risk behaviors or symptoms of the triad, though a few had minor issues. The paper concludes there is no prevalence of the triad among these players but recommends continued education to prevent problems in athletes.
El documento describe la historia de la feria de ganado de Maliaño y la importancia de la ganadería en la región. Explica que la feria se celebraba los segundos domingos de cada mes y era una de las principales ferias de ganado en la zona. También describe las razas de ganado tradicionales y cómo la introducción de ganado holandés en la granja Alday impulsó una mejora significativa de la cabaña ganadera local.
These are the SIMPLE WAYS TO IMPROVE TESTOSTERONE. It is responsible for sex drive, sperm production, fat distribution, maintenance of muscle mass and strength.
What happens as athletes age? The physiological changes are important to note, so that training, recovery and overal healthcare can adapt to maximize the athlete's performance year after year. Dr. David Carfagno offers a unique insider's perspective, as a practitioner of sports medicine, internal medicine and a competitive athlete.
ICED 2014 Workshop on Males with Eating DisordersScoti Riff
Eating disorders in males are understudied, underrecognised and misunderstood. Despite evidence that males constitute 25-33% of diagnoses of anorexia and bulimia nervosa, and up to 50% of diagnoses of binge eating disorder, limited research has focused on the “male experience” of eating and body image concerns. In addition, researchers and clinicians have only recently begun to focus on the role that muscularity plays in males with eating and body image psychopathology. We present evidence that disordered eating behaviours are increasing more rapidly in men than in women, particularly with regard to binge eating. We further present a clinical comparison of men with anorexia nervosa and muscle dysmorphia (“reverse anorexia”) and review community-held attitudes and beliefs about people with these conditions. We conclude with a discussion of clinical treatment guidelines for males with eating disorders. This workshop will (1) present an overview of the evidence base pertinent to males with eating disorders, (2) evaluate evidence for the prevalence of disordered eating amongst males, compare the phenomenology of muscle dysmorphia and anorexia nervosa, and review the stigmatization of males with anorexia nervosa and muscle dysmorphia. Finally, this workshop 3) details treatment guidelines for clinicians working with males.
This workshop is delivered by Dr. Daniel Santa Mina, a Registered Kinesiologist and Certified Exercise Physiologist with specialization in oncology. Dr. Daniel Santa Mina is a Scientist at the Princess Margaret Cancer Centre where he leads the Wellness and Exercise for Cancer Survivors Program (WE-Can) and an Assistant Professor in the Faculty of Kinesiology and Physical Education at the University of Toronto. His main areas of clinical-research focus are on the physiological, functional, and psychosocial effects of exercise for cancer survivors.
Postprostatectomy Sexual Dysfunction: Is restoring erections enough?
This document discusses several important points:
1. While erectile dysfunction is the most commonly addressed sexual side effect after radical prostatectomy, other issues like loss of libido, anejaculation, orgasmic dysfunction, penile shortening and Peyronie's disease are gaining recognition.
2. Restoring erections through penile rehabilitation may not be enough, as other sexual dysfunctions can negatively impact quality of life.
3. A multidisciplinary approach is needed to address the range of potential sexual issues after prostatectomy, including psychological factors and partner considerations.
Dr. Vicki Harber of the University of Alberta describes the kind of nutrition female athletes build strong, resilient bodies and stave off the Female Triad: disordered eating, bone loss and dysmenorrhoea.
Penile Rehabilitation after Prostate Cancer Treatment: Is there an Analogy to...Ege Can Serefoglu MD FECSM
Sexual dysfunction follows radical pelvic surgery in both sexes. Nerve sparing surgery is possible for both male and female pelvic cancers. Nature and pathophysiology of sexual dysfunction varies in men and women. Clinical evidence for rehabilitation is limited in men, and absent in women. However, every cancer survivor women deserves sex. It is our responsibility to help them
It is important to have basic knowledge of one of the most important and neglected cause of Low Back Ache in Females that is Pelvic Floor Dysfunction.In this presentation it is tried to touch the important aspects related to pelvic floor dysfunction ,its assessment ,types hyper and hypotonus type and its treatment aspects.
Community Nutrition Assesment final draft of paperJessica Elliott
The document summarizes a study on the Southern Utah University women's distance team that assessed their eating habits, body image, and knowledge of nutrition. It was found that many athletes had abnormal menstrual cycles and low caloric intake. Additionally, there was pressure from their coach to maintain a low body weight that did not account for their muscle mass. This pressure and lack of proper nutrition knowledge contributed to unhealthy eating practices and increased risk of developing the Female Athlete Triad, characterized by energy deficiency, menstrual dysfunction, and low bone mineral density. Better nutrition education and assessment methods are needed to promote healthy lifestyles for these athletes.
1) This study evaluated the influence of autotransplantation of cryopreserved ovarian tissue on bone density in postmenopausal rats.
2) The ovaries of female rats were removed and cryopreserved, then reimplanted after 1 week (early menopause group) or 1 month (late menopause group).
3) Results showed that serum estradiol levels dropped after ovary removal but increased after ovarian tissue reimplantation, and bone biopsies found increased osteoblast activity after implantation compared to after ovary removal, indicating cryopreserved ovarian tissue can support bone tissue after menopause.
This document discusses strategies to improve soldier readiness through reducing injuries during initial military training. It notes that many recruits have nutritional deficiencies, weak bones, poor diets and low fitness levels upon arrival that increase injury risk during demanding training programs. It proposes adjusting the recruitment and accession process to screen recruits for these risk factors and address deficiencies prior to training through improved diets, supplements and exercise programs. Options are provided to integrate these strategies at different stages including the recruitment, medical screening and initial training phases to help graduates enter the force in a healthier, more resilient and deployable status.
This document discusses physical therapy approaches for cancer patients experiencing common symptoms like fatigue, pain, and breathing difficulties. It covers:
1. Definitions and screening tools for cancer-related fatigue and pain. Fatigue is graded on a scale and can interfere with daily activities. Pain is also assessed for intensity.
2. Non-pharmacological treatments for fatigue and pain including energy conservation, exercise, massage, heat/ice therapy, and electrotherapy. Exercise is recommended for patients during and after cancer treatment.
3. Cancer pain has multiple causes and classifications. The WHO pain ladder provides guidance on pain management strategies from non-opioid to opioid approaches. Physical therapy can help address pain through techniques like
Sugar-sweetened beverage consumption in relation to diabetes and cardiovascul...My Healthy Waist
By Frank B. Hu, MD, PhD Professor of Nutrition and Epidemiology Harvard School of Public HealthChanning Laboratory, Harvard Medical School and Brigham and Women’s Hospital
Sex differences in the links between disordered eating and admiration for peo...Scoti Riff
Background: Disordered eating in young women is positively associated with their admiration for women with anorexia nervosa. However, little is known about sex differences in this association, or whether the association extends to muscle dysmorphia.
Aims: The present study aimed to investigate sex differences in the associations between young peoples’ disordered eating and their admiration for people with anorexia nervosa and muscle dysmorphia.
Method: Male (n = 174) and female (n = 325) undergraduates read one of four descriptions of a male or female character with anorexia nervosa or muscle dysmorphia. Participants then answered questions about their admiration for the characters and completed a measure of disordered eating.
Results: Averaged across character diagnosis and character sex, female participants expressed greater desire to be like the characters than males. For females, moderate to large positive correlations were observed between disordered eating and admiration for characters with both anorexia nervosa and muscle dysmorphia. For males, moderate positive correlations emerged between disordered eating and admiration for muscle dysmorphia, and a single small positive correlation was observed for anorexia nervosa.
Conclusions: The results indicate important sex differences in the associations between young peoples’ disordered eating and their admiration for anorexia nervosa and muscle dysmorphia.
This document discusses the complex neurochemistry underlying exercise and human behavior. It notes that every individual's brain chemistry and response to exercise is unique due to genetic and environmental factors. While certain neurotransmitters like dopamine and endorphins generally promote exercise motivation and pain suppression, their levels and effects vary significantly between individuals. The document advocates that trainers and coaches recognize this bioindividuality and psychoindividuality to develop more effective, personalized training programs. It also stresses that more research is still needed to fully understand how exercise impacts the brain.
This document summarizes the evolution of hormone therapy for menopause from 1942 to 2020. It discusses key studies that identified health risks associated with different types of hormone therapy. The Women's Health Initiative trials in the 1990s showed that combined estrogen-progestin therapy increases the risk of breast cancer and heart disease compared to estrogen-only therapy or placebo. Subsequent studies found that the progestin component and type of progestin are important factors in health risks. Ongoing research continues to evaluate the appropriate uses and timing of hormone therapy to maximize benefits and minimize risks.
This document presents a research paper on the female athlete triad among female basketball players in India. The paper defines the three components of the triad as disordered eating, menstrual dysfunction, and osteoporosis. It describes administering a screening questionnaire to 80 female basketball players and analyzing the results. The results found that most players did not exhibit high-risk behaviors or symptoms of the triad, though a few had minor issues. The paper concludes there is no prevalence of the triad among these players but recommends continued education to prevent problems in athletes.
El documento describe la historia de la feria de ganado de Maliaño y la importancia de la ganadería en la región. Explica que la feria se celebraba los segundos domingos de cada mes y era una de las principales ferias de ganado en la zona. También describe las razas de ganado tradicionales y cómo la introducción de ganado holandés en la granja Alday impulsó una mejora significativa de la cabaña ganadera local.
die Werbeagentur VON DER SEE aus Emden gibt in dieser Präsentation eine Übersicht über Sinn und Nutzen von Social Media für kleine und mittelständische Unternehmen.
This document provides a brief guide to the rites of Hajj and Umrah. It discusses:
1. The obligation of Hajj once in a lifetime for those who are able.
2. Assuming the state of Ihram at designated places called Mawaaqeet before entering Makkah.
3. The rites of Umrah which are Ihram, seven circuits of Tawaf around the Ka'bah, seven circuits of Sa'ee between Safa and Marwah hills, and ending the state of Ihram.
4. The rites of Hajj including staying in Mina, Arafat and Muzdalifah on
This document provides an overview of semantic technologies and the semantic web. It discusses standards and languages from the World Wide Web Consortium (W3C) including the Resource Description Framework (RDF), RDF Schema (RDFS), and Web Ontology Language (OWL). RDF allows data to be represented as graphs of triples consisting of subjects, predicates, and objects. RDFS adds vocabulary for describing properties and classes of RDF resources. OWL builds on RDF and RDFS to provide additional constructs for describing properties and classes. Together, these standards enable data on the web to be defined and linked in a way that machines can process for tasks like automation, integration and reuse across applications.
Customers want high-speed Internet connections they can count on whether at home or work, and wireless broadband applications provide sustainable business opportunities for rural telco's.
Join ANPI and Vecima Networks to explore the business and technology opportunities WaveRider and VistaMAX products provide to your network. Vecima's solutions require minimal investment in network equipment, user-friendly CPE and are scalable, ensuring you can deliver high speeds, reliability and features for business and residential subscribers.
Carretillas Mayor diversifica su actividad gracias a la innovación. La empresa amplía su cartera de
servicios a las estanterías tubulares y los contenedores de manutención
Learning by Doing ProjectGuidelines for adventure tourism innovators USAIDJack Delf
This document provides step-by-step guidelines for developing new tourism products through a "Learning by Doing" model. It outlines five stages: 1) Identifying opportunities through market research and auditing local assets, 2) Creating partnerships between local businesses, 3) Designing new products and experiences, 4) Marketing the new products, and 5) Supporting replication by other local businesses. The document then provides more detailed guidance for each stage, including examples from wildlife and culinary tourism product development in Macedonia and Bosnia and Herzegovina. It emphasizes understanding market trends, designing experiences to meet consumer demand, and collaborating across local tourism sectors to create commercially viable new offers.
Este documento presenta un resumen de 10 obras de arte público en Bogotá, incluyendo fotografías, títulos, autores y breves descripciones de cada obra. Las obras cubren una variedad de medios como murales, esculturas de metal y obras tridimensionales.
Luffy nació en la villa Fucsia y conoció a la tripulación pirata de Shanks a los 6 años. Desde entonces, quería convertirse en pirata. A los 7 años, Luffy se apuñaló debajo del ojo izquierdo para demostrar que era lo suficientemente fuerte para unirse a la tripulación de Shanks. Más tarde, Luffy accidentalmente comió la Fruta del Diablo Gomu Gomu que le dio la habilidad de estirarse como goma. Luffy formó su propia tripulación pirata y juró
This document provides instructions for Year 10 history students to analyze 10 images from the 20th century by addressing questions about what happened, why it happened, historical sources, consequences, and links to Australia for each image. Students are to inquire into the images using these guiding questions to understand significant events from the past century.
Este documento ofrece una guía para padres cuyo bebé recientemente ha sido diagnosticado con parálisis cerebral. Explica qué es la parálisis cerebral, incluyendo sus causas y principales tipos. También describe posibles dificultades asociadas como problemas visuales, de percepción espacial, auditivos, de habla, epilepsia y dificultades de aprendizaje. El objetivo es informar a los padres sobre la condición de su hijo y cómo pueden apoyar su desarrollo.
This document discusses soil management practices at Pleasant Valley Farm in Argyle, New York. The farm focuses on building healthy soil through increasing organic matter, using mulch, cover crops, and soil amendments based on annual soil tests. When the owners purchased the land in 1988, the soil had very low organic matter after 30 years of conventional corn production. They prioritized building organic matter through applying thick layers of straw mulch annually and using a bale chopper to incorporate crop residues. This increased the organic matter to over 4% and created highly productive soil. The farm also relies on soil tests, compost, and a variety of organic fertilizers and amendments tailored to the soil needs.
This document discusses operative vaginal delivery techniques such as forceps delivery and vacuum extraction. It covers topics like the history of these procedures, indications for their use, techniques for performing them safely, potential complications, and post-operative care. It also mentions newer devices that may replace traditional forceps and notes trends showing forceps use is declining while vacuum extraction and C-sections are preferred. The overall message is that operative vaginal delivery requires skill and documentation to benefit the woman and baby when less invasive options have failed.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
Este documento presenta las tecnologías de la información y la comunicación (TIC) en la educación, tanto en el presente como en el futuro. Explica que las TIC pueden ser aliados poderosos para enseñar a pensar críticamente, trabajar en equipo y gestionar información de manera efectiva. Sin embargo, su uso no mejora automáticamente la educación, sino que requiere un cambio pedagógico más profundo. El documento también describe varias herramientas TIC que pueden usarse para investigar, compartir información y col
Osteoporosis is a disease where bone density and bone strength decreases, leading to an increased risk of fractures. It is most common in postmenopausal women due to declining estrogen levels, but also affects some men. Key differences between male and female osteoporosis include women having smaller and weaker bones from a younger age, as well as experiencing more rapid bone loss after menopause. Common osteoporosis medications include bisphosphonates, which are first-line treatment for both men and women, as well as PTH analogues, estrogen therapy, and calcium and vitamin D supplements. While women are more likely to survive osteoporotic fractures, men have higher mortality rates and are less likely to
Osteoporosis is common in nursing home residents, affecting around 86% of residents. It is associated with higher rates of fractures. Treatment focuses on calcium, vitamin D, bisphosphonates, denosumab, and teriparatide depending on mobility and swallowing ability. Treatment aims to increase bone mineral density and reduce fractures, but medications also need to be considered based on renal function and goals of care including end of life care.
Benefits of Physical Activities (PA) in Cancer SurvivorsRajat Chauhan
On 4th March 2012, I had the privelege of talking at Asian Breast Cancer Conference. But I wasn't planning on going there and be a yes man.
I took the oncology fraternity to task. If they have known for a long time that exercise and physical activity reduces cancer risk by 25-50% and side effects in survivors from inactivity is as bad as disease itself, then why don't they talk and promote more about it. Only a quarter bring up exercise to their patients. I was looking to get a reaction, whether it be a shoe thrown at me or saying, wow... Let's work together on this... But the audience was very sedated... courtesy the pharmaceutical industry that sponsors conferences like these. There was no response. I finished my talk by saying "my role model is Lance Armstrong, a man who did amazing things in world of sports after he was diagnosed, treated and then survived cancer."
Enjoy the presentation.
This document provides an overview of osteoporosis, including its definition, epidemiology, diagnosis, pathophysiology, clinical features, differential diagnosis, outcome measures, management, and more. Some key points:
- Osteoporosis is defined as a systemic skeletal disease characterized by low bone mass and deterioration of bone tissue, leading to fragile bones and increased susceptibility to fractures.
- It predominantly affects postmenopausal women, with prevalence as high as 80% in India having osteoporosis or osteopenia.
- Diagnosis is based on bone mineral density T-scores measured via dual-energy x-ray absorptiometry. Medical management involves antiresorptive and an
Osteoporosis is a condition where bone density decreases and bone architecture deteriorates, making bones brittle and prone to fracture. It is most common in older adults, especially postmenopausal women. Risk factors include age, gender, family history, small frame size, certain medications and lack of exercise. Screening with a DEXA scan measures bone mineral density via a T-score, with scores below -2.5 indicating osteoporosis. Treatment focuses on lifestyle changes like weight-bearing exercise, adequate calcium intake and potentially medications. Physical therapy can help develop safe exercise routines and provide guidance on posture and fall prevention.
This document provides information on osteoporosis, including its definition, prevalence, risk factors, symptoms, diagnosis, and management. Some key points:
- Osteoporosis is a metabolic bone disease characterized by low bone mass and deterioration of bone tissue, leading to increased bone fragility and fracture risk.
- It is a major public health problem worldwide due to its association with pain, disability, and loss of quality of life.
- Risk factors include age, gender, family history, smoking, excessive alcohol, low body weight, and certain medications like glucocorticoids.
- It is usually asymptomatic until a fracture occurs. Common fracture sites are the spine, hip, and wrist
Points:
Male Sex Hormone - Androgens (Mainly Testosterone)
Synthesis, Regulation & metabolism (By both Hypothalamus & Pituitory gland)
Various Action/ Physiological roles over:
1. Sex organs and secondary sex characters (Androgenic)
2. Testes
3. Skeleton and skeletal muscles (Anabolic)
4. Erythropoiesis
Anabolic Steroids & their uses
Antiandrogens (Classification, MOA & Uses)
Drugs for erectile dysfunction (MOA & Uses)
Main Male Sex Hormone is Testosterone which converts into its highly active form i.e. dihydrotestosteron (DHT).
Main Female Sex Hormones are Estrogen & Progesterone.
Endocrinology on male reproductive healthlaishramdevi3
Testosterone is the principal male sex hormone that causes male sexual development during fetal and pubertal stages. It stimulates the development of male genitalia and secondary sex characteristics. Important male reproductive health issues include prostate concerns like benign prostatic hyperplasia and prostate cancer, low testosterone levels leading to erectile dysfunction, and male infertility. Treatment options depend on the specific condition but may include medication, surgery, hormone therapy, and assisted reproductive technologies. Maintaining a healthy lifestyle supports overall male reproductive health.
Osteoporosis is a systemic bone disease characterized by low bone mass and deterioration of bone tissue, leading to increased bone fragility and risk of fractures. It is most common in postmenopausal women. Risk factors include smoking, low body weight, steroid use, excess alcohol intake, and family history of fractures. Diagnosis involves measuring bone mineral density via DEXA scan. Treatment aims to prevent fractures and bone loss, and includes adequate calcium and vitamin D, weight-bearing exercise, falls prevention, pharmacologic agents like bisphosphonates, and surgery for fractures. Regular screening and monitoring of at-risk individuals is important.
This document discusses recent advances in the treatment of osteoporosis. It begins by defining osteoporosis as a condition characterized by decreased bone strength. It then provides statistics on the prevalence of osteoporosis and risk of fractures. The document goes on to discuss recent withdrawals of osteoporosis medications due to safety concerns. It outlines various drug therapies for osteoporosis including bisphosphonates, denosumab, teriparatide, and emerging therapies targeting mechanisms like sclerostin inhibition. The conclusion states that while many new drugs are in development phases, current treatments should still be optimally used to manage osteoporosis.
This document discusses osteoporosis, which is a systemic skeletal disorder characterized by low bone mass and deterioration of bone tissue. It affects many post-menopausal women, with 1 in 3 women and 1 in 2 women over 50 developing osteoporosis-related fractures. The document outlines prevalence, pathogenesis, risk factors, diagnosis using BMD tests and algorithms, and prevention through lifestyle changes, calcium/vitamin D supplementation, and treatment options including bisphosphonates, calcitonin, and PTH therapies. The key messages are that osteoporosis prevention should begin in childhood and maintaining a bone healthy lifestyle throughout life.
Osteoporosis is a disease characterized by low bone density and deterioration of bone tissue, leading to fragile bones and increased fracture risk. It is diagnosed through bone mineral density tests and can be caused by many factors including older age, female sex, family history, and lifestyle factors. Management focuses on lifestyle modifications like calcium and vitamin D supplementation, exercise, and fall prevention, as well as pharmacological therapies to slow bone loss and increase bone density. Complications include fractures which can lead to disability, loss of independence, and even death in severe cases.
1. The document discusses erectile dysfunction (ED), including its anatomy, physiology, etiology, evaluation, and treatment. It defines ED and describes the neurovascular processes underlying erection.
2. Common organic, psychogenic, and mixed causes of ED are outlined. Evaluation involves history, physical exam, and investigations.
3. Treatment options discussed include lifestyle modifications and first-line oral phosphodiesterase type 5 inhibitors like sildenafil, tadalafil, and vardenafil. Guidelines on their use and dosing are provided.
Osteoporosis is a disease where bones become fragile and more likely to break. It occurs when the body loses more bone than it forms, reducing bone density and bone mass. Key risk factors include a family history of osteoporosis, being Caucasian or Asian, smoking, excessive alcohol use, and low body weight. Diagnosis relies on bone mineral density tests to determine a T-score. Treatment focuses on lifestyle changes like exercise and nutrition, as well as medications to reduce bone loss and increase bone formation.
Osteoporosis affects over 10 million Americans and is a growing problem. It is characterized by low bone mass and deterioration of bone tissue, increasing the risk of fractures. Current therapies can help but have side effects and none provide a cure. Research into new targets and treatments continues in hopes of improving outcomes for those with osteoporosis.
Introduction to Sarcopenia and frailtyMary Hickson
This document provides an introduction to sarcopenia and frailty in older adults. It discusses how sarcopenia is the loss of muscle mass and strength that occurs with age, impacting physical function. Prevalence of sarcopenia increases with age and for those in long-term care facilities. Frailty is a geriatric syndrome characterized by increased vulnerability to stressors and reduced physiological reserves, putting older adults at higher risk for adverse health outcomes like falls and disability. Frailty varies in severity and can be assessed using tools measuring factors like gait speed, weight loss, exhaustion and physical activity levels. While both sarcopenia and frailty are linked to aging, lifestyle interventions around exercise and nutrition may help reduce their negative impacts.
This document discusses osteoporosis and osteomalacia. It provides information on:
- A case of a 68-year-old woman who presents with a wrist fracture following a fall.
- Risk factors for osteoporosis including corticosteroid use, menopause, family history of fractures.
- Diagnostic tests for osteoporosis including DXA scan, FRAX score to evaluate 10-year fracture risk.
- Treatment involves lifestyle changes like exercise, calcium and vitamin D supplementation, as well as pharmacologic therapies like bisphosphonates or teriparatide.
The musculoskeletal system includes bones, cartilage, ligaments, and muscles. Nutrition plays an important role in bone health. Calcium, vitamins D and K, phosphorus, magnesium, and fluoride are essential for bone mineral density and strength. A bone mineral density test measures bone density and can detect osteopenia or osteoporosis. Factors like age, genetics, lifestyle, trauma, and prior fractures can affect bone mineral density levels.
Architectural and constructions management experience since 2003 including 18 years located in UAE.
Coordinate and oversee all technical activities relating to architectural and construction projects,
including directing the design team, reviewing drafts and computer models, and approving design
changes.
Organize and typically develop, and review building plans, ensuring that a project meets all safety and
environmental standards.
Prepare feasibility studies, construction contracts, and tender documents with specifications and
tender analyses.
Consulting with clients, work on formulating equipment and labor cost estimates, ensuring a project
meets environmental, safety, structural, zoning, and aesthetic standards.
Monitoring the progress of a project to assess whether or not it is in compliance with building plans
and project deadlines.
Attention to detail, exceptional time management, and strong problem-solving and communication
skills are required for this role.
International Upcycling Research Network advisory board meeting 4Kyungeun Sung
Slides used for the International Upcycling Research Network advisory board 4 (last one). The project is based at De Montfort University in Leicester, UK, and funded by the Arts and Humanities Research Council.
Explore the essential graphic design tools and software that can elevate your creative projects. Discover industry favorites and innovative solutions for stunning design results.
Practical eLearning Makeovers for EveryoneBianca Woods
Welcome to Practical eLearning Makeovers for Everyone. In this presentation, we’ll take a look at a bunch of easy-to-use visual design tips and tricks. And we’ll do this by using them to spruce up some eLearning screens that are in dire need of a new look.
1. Bisphosphonates
• Mechanism of Action: promotes bone formation and
decreases bone resorption.
• Application: considered first line treatment for osteoporosis in
both men and post-menopausal women.1
– Aledronate2, Risedronate3 and Zoledronic Acid4: are
approved in both sexes for the prevention and treatment of
osteoporosis.
2. Bisphosphonates
• Ibandronate (Boniva): only FDA approved for use
in the treatment (not prevention) of osteoporosis in
post-menopausal women
– Not FDA approved for males
• Paucity of studies1
• Similar pharmocokinetics in men and women2
• Similar efficacy in men and women probable3
(statement made in the Orwoll study)
Dr. Jenkins: the STRONG study is the only one of its kind that I could find for
Ibandronate testing in males– in the speaker notes I wronte that it’s “one of the only
studies”– I hestistate to write “the only study” of its kind though—do you know of
similar studies?
3. Ibandronate Efficacy in Males
Percent change in L1-L3 BMD Percent change in TH BMD
TH- Total Hip. BMD- Bone Mineral Density.
4. Ibandronate Efficacy in Males
Percent change in sCTX Percent change in BSAP
C-terminal telopeptide of type 1 collagen (sCTX); Bone-specific alkaline phosphatase (BSAP)
5. Bisphosphonates
Drug Vertebral
Fracture RR
Hip Fracture
RR
Non-
vertebral RR
Route/
Frequency
Indicated
for which
gender
Alendronate PO/QDay,
QWeek
Women
Men
Risedronate PO/QDay,
QWeek,
QMonth
Women
Men
Ibandronate NE NE PO/QMonth
IV/Q3Month
Women
Zoledronic
Acid
IV/QYear Women
Men
RR = Risk Reduction NE = No effect demonstrated
Side effects: Heartburn, nausea, bone pain, infusion reaction (zoledronic acid)
6. Other agents
Drug Vertebral
Fracture
RR
Hip
Fracture
RR
Non-
vertebral
RR
Route/
Frequency
Indicated
for which
gender
Raloxifene NE NE PO QDay Women
Calcitonin NE NE Nasal QDay
SQ QDay
Women
Teriparatide NE SQ QDay Women
Men
Denosumab SQ
Q6Months
Women
Men
RR = Risk Reduction NE = No effect demonstrated
Side Effects
• Raloxifene – hot flashes, edema, arthralgia, increased risk of thromoembolism
• Calcitonin – flushing, rhinitis, nausea, back pain, local site reaction (SQ)
• Teriparatide – hypercalcemia, orthostatic hypotension, dizziness, nausea,
injection site reaction
• Denosumab – dermatitis, arthralgia, edema, bone pain
7. Raloxifene
• Mechanism of Action: selective estrogen-receptor modulator,
– Benefits: shown to increase BMD of hip and spine in women1
• Application: approved for treatment and prevention of osteoporosis in
women; not approved for use in males2.
• Study disparities in males
• Narrow study contexts3,5
• Raloxifene is understudied in males was not shown to significantly
impact BMD in males4
Duschek study cited in the notes section is the only one I could find conducted in healthy
males—the sample size was only 30 men! Is there another study out there that I’m missing?
8. Salmon Calcitonin
• Mechanism: inhibits absorption of calcium from intestine and
renal tubules; inhibits osteoclast activity.
• Indications: approved for the treatment (not prevention) of
osteoporosis in women who are ≥5 years post-menopausal
• Approval- FDA doesn’t mention if it’s approved in men as
well– they only state post menopausal women– is Salmon
calcitonin used in men clinically?
10. Teriparatide (Forteo)
• Mechanism of Action: recombinant parathyroid hormone
(PTH); stimulates bone formation.
• Approval: approved for treatment and prevention of
osteoporosis in both men and postmenopausal women1 at high
risk for vertebral fracture. 2
16. Calcium & Vitamin D
• Efficacy: combination Calcium (1200 mg) and
Vitamin D (800 mg) reduces the risk of hip,
vertebral and total fractures in both men and
women1.
• Study flaws: men have not been adequately studied.
– 2010 DIPART Group Meta-Analysis: only14% of 68,500
subjects studied were men1.
– 2007 Tang et al2. Meta-Analysis included only 8% men3.
17. Tissue Selective Estrogen Complex
• Bazedoxifine/Conjugated Estrogen (Duavee)
– Mechanism of Action: SERM that selectively
stimulates lipid metabolism and bone, however, has
no effect on the uterus and breast.
– Benefits
• Increased hip and lumbar BMD
• Improves post menopausal vasomotor symptoms and
sleep disturbances.
18. Tissue Selective Estrogen Complex
• Bazedoxifene/Conjugated Estrogen (Cont’d)
– Application: approved2 for prevention of osteoporosis,
osteopenia & post menopausal vasomotor and sleep
disturbances in post-menopausal women.
– Men: None of the three major clinical trials included men,
despite that estrogen has been demonstrated to play a
significant role in bone formation3.
19. RANK-Ligand Inhibitor
• Denosumab
– Mechanism of Action: monoclonal antibody; prevents
osteoclast maturation.
– Benefits: significant increase in lumbar BMD and reduced
risk of vertebral fracture in both men and women
20. RANK-Ligand Inhibitor
• Indications
– Women: approved for treatment in women with non-
metastatic breast cancer and post-menopausal women with
osteoporosis at high risk for fracture.
– Men: approved for vertebral fracture prevention in men
with non-metastatic prostate cancer who are receiving
Androgen Deprivation Therapy.
22. Post-Operative Mortality
• Men have higher early post-operative mortality and are
less likely to return to independent living or mobility.
• Women are almost twice as likely to survive at 30 days
compared to men (OR 1.93; 95% CI 1.73 to 2.14)
• Women are almost twice as likely to survive at 120 days
compared to men (OR 1.98; 95% CI 1.84 to 2.14)
• Women are more likely to return to their home by 120 days
post-fracture (OR 1.19, 95% CI 1.06-1.32)
• Women are more likely to return to walking unaided at 120
days compared to men (OR 1.25; 95% CI 1.11 to 1.41)
23. Osteoporosis Research
• Research bias
– Majority of research focused on post-menopausal women
– Trials in men
• Outcome of interest rarely hip fracture
• FDA requires vertebral data in men}} CLARIFY THIS–
FIND THE DATA IN ONE OF THE ARTICLES MJ
SENT YOU.
• For agents with hip fracture data in women, if vertebral
BMD gains are similar in men to those seen in women,
data is extrapolated to hip fracture reduction for men
Put that 1 slide that had the Numbers of men v women that MJ sent you.
24. Osteoporosis Research
• Cost effectiveness and Screening
– Women: Cost effective screening methods in women have
been studied adequately and has lent to the use of FRAX
and WHO BMD T-Scores in identifying treatment
candidates.
– Men: Cost-effectiveness has not be adequately studied in
men.
• FRAX underestimates fracture in men.
• NOF guidelines for treatment should be used
conservatively in men.
25. Percentage of non-vertebral, hip, upper humerus and wrist fractures that occurred in men and women with osteoporosis, osteopenia
or normal BMD using gender specific T -scores.
Still need to ask for permission.
Editor's Notes
Speaker Notes
Mechanism of action: more specifically, inhibits apoptosis of osteoblasts and inhibits bone resorptive actions of osteoclasts.
Toxicities: all bisphosphonates are contraindicated in hypocalcemia, hypophosphatemia, Gastro-esophageal disorders (strictures, achalasia, reflux), osteonecrosis of the jaw and renal insufficiency (especially Zoledronic Acid). 1, 2
Calcium and Vitamin D should be replaced prior to treatment with bisphosphonates and maintenance should be continued throughout bisphosphonate therapy.
References
Ebeling, P.R. Osteoporosis in Men. New England Journal of Medicine 2008; 358: 1474-1482. (Level 1).
Orwoli et al. Alendronate for the treatment of osteoporosis in men. NEJM 2000. 343: 604-610.
Zhong et al. Anti-Fracture Efficacy of Riserdronic Acid in Men. Clin Drug Invest 2009; 29(5): 349-357. } Meta-analysis done looking at studies that adequately included men in Riserdronic Acid studies.
Lyles et al. Zoledronic acid and clinical fractures and mortality after hip fracture. NEJM 2007; 357:1799-1809.
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Speaker notes
Ibandronate is an interesting case of paucity. The STRONG study is one of the only studies that has specifically investigated the effects of Ibandronate in men only.
Pharmacokinetics of Ibandronate is similar to other bisphosphonates and thus is expected to be similarly metabolised/eliminated in men.2
The STRONG study noted similar benefits of Ibandronate in men with osteoporosis as has been demonstrated in studies of post-menopausal women with osteoporosis2 (see following slides)
References
Orwoll et al. Efficacy and Safety of Monthly Ibandronate in Men with Low Bone Density. Bone 2010; 46: 970-976.
Barrett et al. Ibandronate: a clinical pharmacological and pharmocokinetic update. Journal of Clinical Pharmacology 2004; 44: 951-965.
Reginster et al. Efficacy and Tolerability of Once-Monthly Oral Ibandronate in Postmenopausal Osteoporosis: 2 year results from the MOBILE study. Annals of Rheumatic Disease 2006; 65:654-661.
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Speaker Notes
The STRONG study demonstrated a significant increases in both L1-L3 BMD and Total Hip (TH) BMD from pre-treatment baseline in males treated with Ibandronate compared to placebo.
Reference
Orwoll et al. Efficacy and Safety of Monthly Ibandronate in Men with Low Bone Density. Bone 2010; 46: 970-976.
Speaker Notes
STRONG study also demonstrated a decrease in bone turnover markers sCTX and BSAP.
LG/MJ slide
Speaker Notes
Speaker Notes
Mechanism of Action: Raloxifene is a SERM that is agonistic to estrogen receptors in the bone and antagonistic to estrogen receptors in the breast and uterus; also approved for the prevention of invasive breast cancer in high risk women.
Disparity in studies: Pharmacotherapeutic studies for SERM application in osteoporosis have largely failed to adequately include men in the study design and hence have failed to adequately assess the risks/benefits of pharmacotherapies in men3. [DY SEX AND GENDER CONSIDERATIONS]
Raloxifene in males has been studied in narrow contexts, though males have estrogen receptors.
Duschek et al.conducted a study in 30 males and found no conclusive data on the benefits of Raloxifene
Most other studies are done in the context of males with non-metastatic prostate cancer receiving androgen deprivation therapy (as these patients are at risk for pathologic fracture).
Toxicities: venous thromboemoblism thus contraindicated in patients with history of thromboembolic events; caution advised in women with impaired hepatic or renal function; the incidence of drug toxicities associated with the pharmaceuticals mentioned thus far has been poorly noted between men and women, with the exception of osteonecrosis which seems to affect both sexes. {SOURCE}
References
(2013). Chapter 42. Drugs that Affect Bone Mineral Homeostasis. In Trevor A.J., Katzung B.G., Kruidering-Hall M.M., Masters S.B. (Eds), Katzung & Trevor’s Pharmacology: Examination & Board Review, 10e. Retrieved April 04, 2014 fromhttp://accesspharmacy.mhmedical.com/content.aspx?bookid=514&Sectionid=41817559. (LEVEL?)
Watts et al. Osteoporosis in Men: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2012; 97 (6): 1802-1822. (Level 1)
Finklstein et al. Raloxifene to prevent gonadotropin-releasing hormone agonist-induced bone loss in men with prostate cancer: a randomized controlled trial. J Clin Endocrinol Metab 2004; 89: 3841-3846
Duschek et al. Effects of raloxifene on gonadotrophins, sex hormones, bone turnover and lipids in healthy elderly men. European Journal of Endocrinology 2004; 150: 539-546.
Dy et al. Sex and gender considerations in male patients with osteoporosis. Clin Orthop relat Res. 2011; 469 (7):1906-12. (Level 1)
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Date submitted: 4//2014
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Speaker Notes
FDA notes that there’s an uncertain link between calcitonin and various cancer types (skin and breast were the majority malignancies seen, but others were also noted).
Toxicities: injected form is associated with hypocalcemic tetany; FDA warns that Salmon Calcitonin’s benefits in treatment of post-menopausal osteoporosis do not outweigh its cancer associations.
References
Sanders et al. Osteoporosis in Postmenopausal Women. Journal of the Southern Medical Association 2013; 106: 698-706. (Level 1)
(2013). Chapter 42. Drugs that Affect Bone Mineral Homeostasis. In Trevor A.J., Katzung B.G., Kruidering-Hall M.M., Masters S.B. (Eds), Katzung & Trevor’s Pharmacology: Examination & Board Review, 10e. Retrieved April 04, 2014 fromhttp://accesspharmacy.mhmedical.com/content.aspx?bookid=514&Sectionid=41817559. (LEVEL?)
Speaker Notes
Trovas et al. study demonstrated a significant increases in both lumbar spine and femoral neck BMD from pre-treatment baseline in males treated with salmon Calcitonin compared to placebo.
Additionally, Trovas et. al observed a significant decrease in urinary bone resorption markers (e.g., cTX and NTX) in male osteoporosis patients treated with salmon Calcitonin compared to placebo.
Reference
Trovas et al. A Randomized trial of nasal spray salmon calcitonin in men with idiopathic osteoporosis: effects on bone mineral density and bone markers. Journal of Bone and Mineral Research 2002; 17: 521-527.
Speaker Notes
Data regarding the effects of Teriparatide on extra-vertebral fracture risk is insufficient in men.
PTH analogs have been reported to be equally efficacious in both men and women in the prevention of fractures, however, data is much more limited for men due to under-enrolment in pharmacological studies.
References
Hadji et al. The effect of teriparatide compared with risedronate on reduction of back pain in postmenopausal women with osteoporotic vertebral fractures. Osteoporosis International 2012; 23: 2141-50. (Level 3)
Murad et al. Comparative Effectiveness of Drug Treatments to Prevent Fragility Fractures: A systematic Review and Network Meta-Analysis. J Clin Endocrinol Metab 2012; 97 (6): 1871-1880. (Level 1)
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Speaker Notes
Teriparatide mediated change in spinal BMD is similar in males and females
Graph on the left represents the percent change in lumbar spine BMD from baseline to endpoint at 3, 6 and 12 months. The graph demonstrates a significant increase in lumbar spine BMD from baseline in both Teriparatide dosages (20μg and 40μg) compared to placebo.
Graph on the left demonstrates a decreased incidence of non-vertebral fractures in post-menopausal women receiving 20μg and 40μg Teriparatide treatment over a 20 month period.
References
Orwoll et al. The effect of teriparatide [human parathyroid hormone (1-34)] therapy on bone mineral density in men with osteoporosis. Journal of Bone and Mineral Research 2003; 18: 9-17. (Level 2)
Neer et al. Effect of parathyroid hormone (1-34) on fractures and bone minderal density in postmenopausal women with osteoporosis. NEJM 2001. 344: 1434-1441.
LG/MJ slide
Speaker Notes
Monotherapy: Calcium or vitamin D monotherapies are ineffective for the prevention of total fractures in both men and women1, however, it is considered significant in fracture prevention patients deficient in either Calcium or Vitamin D2
Combination Therapy: has been demonstrated to significantly decrease fracture risk (vertebral, hip and total fractures) in both sexes1.
Reference
The DIPART Group. Patient level pooled analysis of 68,500 patients from seven major Vitamin D fracture trials in US and Europe. BMJ 2010; 340:b5463
Murad et al. Comparative Effectiveness of Drug Treatments to Prevent Fragility Fractures: A systematic Review and Network Meta-Analysis. J Clin Endocrinol Metab 2012; 97 (6): 1871-1880. (Level 1)
Speaker Notes
Combination therapy has been demonstrated to be especially effective in the prevention of hip fractures in both sexes1.
Reference
The DIPART Group. Patient level pooled analysis of 68,500 patients from seven major Vitamin D fracture trials in US and Europe. BMJ 2010; 340:b5463
Speaker Notes
Combination therapy, though demonstrated to be effective in fracture risk reduction, is still considered the least effective option in fracture prevention for both sexes4.
The DIPART Group’s Meta-Analysis utilized seven randomized control trials in the US and Europe, bearing a total of 68,500 study participants, only 14% of which were men.
The Tang et al. 2007 Meta-Analysis utilized 29 randomized trials, yielding 63,897 study participants, only 8% of which were men.
References
The DIPART Group. Patient level pooled analysis of 68,500 patients from seven major Vitamin D fracture trials in US and Europe. BMJ 2010; 340:b5463. (Level 1)
Tang et al. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet 2007;370:657–666. (Level 1)
Becker. Does Supplementation with Calcium Alone or in Combination with Vitamin D Reduce the Risk of Osteoporotic Fracture? Nature Clinical Practice Endocrinology & Metabolism 2008; 4: 190-191. (Level 7)
Murad et al. Comparative Effectiveness of Drug Treatments to Prevent Fragility Fractures: A systematic Review and Network Meta-Analysis. J Clin Endocrinol Metab 2012; 97 (6): 1871-1880. (Level 1)
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References:
Gennari et al. Bazedoxifene for the prevention of postmenopausal osteoporosis. Therapeutics and Clinical Risk Management 2008; 4(6): 1229-1242. (Level 2)
Submitted by: Sati Patel, MSII, TTUHSC School of Medicine; sati.patel@ttuhsc.edu
Date submitted: 4//2014
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Speaker Notes
Toxicities: Overall well tolerated; abdominal pain, headache and flu-like symptoms1.
References
Gennari et al. Bazedoxifene for the prevention of postmenopausal osteoporosis. Therapeutics and Clinical Risk Management 2008; 4(6): 1229-1242. (Level 2)
U.S. Food and Drug Administration. (2013). FDA approves Duavee to treat hot flashes and prevent osteoporosis. Retrieved from http://www.fda.gov/drugs/newsevents/ucm370679.htm
Watts et al. Osteoporosis in Men: An Endocrine Societly Clinical Practice Guideline. J Clinical Endocrinol Metab. 2012; 97 (6): 1802-1822.
Submitted by: Sati Patel, MSII, TTUHSC School of Medicine; sati.patel@ttuhsc.edu
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Speaker Notes
Toxicities: arthralgia, back pain, musculoskeletal pain the extremities and hypocalcemia.
Contraindicated with hypocalcemia; caution with renal insufficiency.
References:
U.S. Food and Drug Administration (2011). Denosumab (Prolia). Retrieved from: http://www.fda.gov/aboutfda/centersoffices/officeofmedicalproductsandtobacco/cder/ucm272420.htm
Sanders et al. Osteoporosis in Postmenopausal Women. Journal of the Southern Medical Association 2013; 106: 698-706. (Level 1)
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References
U.S. Food and Drug Administration (2011). Denosumab (Prolia). Retrieved from: http://www.fda.gov/aboutfda/centersoffices/officeofmedicalproductsandtobacco/cder/ucm272420.htm
Submitted by: Sati Patel, MSII, TTUHSC School of Medicine; sati.patel@ttuhsc.edu
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Comparative effectiveness of drug treatments to prevent fragility fractures:
a systematic review and network meta-analysis
LG/MJ slide
Speaker Notes
FRAX underestimates fracture in men;
Guidance for screening/treatment using BMD T scores is sufficient for women, however, underidenitifes men at risk. For example, the majority of men who experience fracture after age 60 have T scores > -2.5.
References
Schuit et al. Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study. Bone 2003; 34: 195-202. (Level 2).
Watts et al. Osteoporosis in Men: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2012; 97 (6): 1802-1822. (Level 1)
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Date submitted: 4//2014
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Speaker Notes
These graphs demonstrate that a significant proportion of women and especially men with normal BMD T-scores experience non-vertebral fractures.
Thus, though low BMD is a strong risk factor for non-vertebral fractures, relying solely on BMD T-scores for the identification of those at risk for fractures is insufficient.
References
Schuit et al. Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study. Bone 2003; 34: 195-202. (Level 2).
Watts et al. Osteoporosis in Men: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2012; 97 (6): 1802-1822. (Level 1)
Submitted by: Sati Patel, MSII, TTUHSC School of Medicine; sati.patel@ttuhsc.edu
Date submitted: 4//2014
Last Revision date: 4/24/14
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