Bone mineral loss, effect

In another child, who had osteoporotic vertebral collapse, extensive investigations showed reduced bone mineral content, reduced concentrations of osteocalcin, and features of osteoporosis on bone biopsy (SEDA-19, 344). The role of G-CSF was unclear, because bone mineral loss is a possible complication of the underlying disease. Indeed, improvement or stabilization during G-CSF treatment was noted in several patients (6). Furthermore, there was no apparent effect on height, head circumference, or weight in patients under 18 years of age (6). In another study, there was bone mineral loss with features of osteopenia/osteoporosis in 15 of 30 patients treated with G-CSF for a mean of 5.8 years for severe chronic neutropenia (65). However, six of nine patients investigated before G-CSF treatment had evidence of osteopenia/osteoporosis. 

MORABITO N, CRISAFULLI A, VERGARA C, GAUDIO A, LASCO A, FRISINA N, D ANNA R, CORRADO F, PIZZOLEO M A, CINCOTTA M, ALTAVILLA d, lentile r, squadrito f (2002), Effects of genistein and hormone-replacement therapy on bone loss in early postmenopausal women A randomized double-blind placebo-controlled study. J Bone Miner Res 17, 1904-1912. 

Monitor for acute and chronic adverse effects of AEDs. Acute adverse effects are best detected by a thorough neurologic examination at clinic visits. Instruct patients to report sedation, ataxia, rash, or other problems immediately. Monitor for chronic adverse effects including a loss of bone mineral density, which should be measured every 2 years in patients taking phenytoin, phenobarbital, carbamazepine, and valproate. 

Moffett AH, Ettinger M, Bolognese M, Weiss S, Somayaji V, Brunell R, et al. (2004) Lasofoxifene, a next generation SERM, is effective in preventing loss of BMD and reducing LDL-C in postmenopausal women. J Bone Miner Res 19 (Suppl 1) F426... 

Onoe Y, Miyaura C, Ito M, Ohta H, Nozawa S, Suda T (2000) Comparative effects of estrogen and raloxifene on B lymphopoiesis and bone loss induced by sex steroid deficiency in mice. J Bone Miner Res 15 541-549... 

Ca not only works in conjunction with vitamin D to enhance bone health, its effects on bone maintenance have been surmised to be enhanced in postmenopausal women by the presence of other minerals. A 2-year double-blind, placebo-controlled trial evaluated the effect of supplementary Ca (1000 mg elemental Ca/day as CCM) on lumbar spine bone loss in the presence and absence of a combination of trace minerals integral to bone maintenance (i.e., copper, 2.5 mg/day manganese, 5.0 mg/day zinc, 15.0mg/day). Participants included 59 healthy postmenopausal women of mean age ( SD) 66 + 7 years who were on average 18.1 8.9-year postmenopausal (Strause et al, 1994). At baseline, the mean Ca... 

Gastrointestinal complaints (eg, nausea, diarrhea, vomiting, flatulence) are the most common adverse effects but rarely require discontinuation of therapy. Other potential adverse effects include headache and asthenia. Tenofbvir-associated proximal renal tubulopathy causes excessive renal phosphate and calcium losses and 1-hydroxylation defects of vitamin D, and preclinical studies in several animal species have demonstrated bone toxicity (eg, osteomalacia). Monitoring of bone mineral density should be considered with long-term use in those with risk factors for or with known osteoporosis, as well as in children. Reduction of renal function over time, as well as cases of acute renal failure and Fanconi s syndrome, have been reported in patients receiving tenofovir alone or in combination with emtricitabine. For this reason, tenofovir should be used with caution in patients at risk for renal dysfunction. Tenofovir may compete with other drugs that are actively secreted by the kidneys, such as cidofovir, acyclovir, and ganciclovir. 

The loss of bone mineral after organ and tissue transplant associated with immunosuppressive therapy follows a delayed time course. The long-term effects of immunosuppressive therapy on bone density have been determined in 25 cardiac transplant patients (SEDA-20, 375) (219). As expected, there was bone loss in the spine during the first year, but this was not maintained during the second and third years after transplantation, despite continuing maintenance immunosuppression with prednisolone. Only four patients, all of whom were hypogonadal, continued to lose bone. 

Yonemura K, Kimura M, Miyaji T, Hishida A. Short-term effect of vitamin K administration on prednisolone-induced loss of bone mineral density in patients with chronic glomerulonephritis. Calcif Tissue Int 2000 66(2) 123-8. 

The efficacy of clodronate in treating glucocorticoid-induced bone loss in asthmatic subjects has been evaluated in a double-blind study in 74 adults (41 women and 33 men, mean age 57 years) with a long history (mean 8.1 years) of oral and inhaled glucocorticoid use, randomized to clodronate 800,1600, or 2400 mg/day or placebo (130). There was no increase in bone mineral density with placebo or clodronate 800 mg/day, but a significant dose-related increase with clodronate 1600 and 2400 mg/day. The most common adverse effect was gastric irritation in the patients who took the highest dose of clodronate. 

Sambrook P, Birmingham J, Kempler S, Kelly P, Eberl S, Pocock N, Yeates M, Eisman J. Corticosteroid effects on proximal femur bone loss. J Bone Miner Res 1990 5(12) 1211-6. 

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