Fracture prevention

Calcium should be ingested in adequate amounts to prevent secondary hyperparathyroidism and bone destruction. Although calcium increases BMD, fracture prevention is minimal. It should be combined with vitamin D and osteoporosis medications when needed. 

New SERMS are in different development stages. Lasoftmfene has been shown to have positive effects on bone and lipid metabolism without negative impact on uterine growth (Ke et al. 1998). There is a large-sample, prospective, randomized clinical trial in progress in which breast cancer, together with fracture prevention, is one of the main outcomes. 

Bischoff-Ferrari, H. A., Willet, W. C., Wong, J. B., Giovarmucci, E., Dietrich, T., and Dawson-Hughes, B. (2005). Fracture prevention with vitamin D supplementation A meta-analysis of randomized controlled trials. JAMA 293, 2257-2264. 

An extensive literature review has provided a useful assessment of the benefit to harm balance of raloxifene (20). The findings were reassuring. One large fracture prevention trial provided the best evidence that raloxifene 60 mg/day for 3 years reduced the relative risk of vertebral fractures by 30-50% in women with prevalent fractures or osteoporosis. The extraskeletal effects of raloxifene include a reduction in total cholesterol and low density lipoprotein cholesterol concentrations. Raloxifene was not associated with endometrial hyperplasia, and there was a 72% reduction in the incidence of invasive breast cancer. Adverse events associated with raloxifene included an increase in the absolute risk of venous thromboembolism and increased risks of hot... 

Bisphoshonates are used for treatment of hypercalcemia, fracture prevention and in patients with metastatic cancer. This class of drugs reduce morbidity from hypercalcemia is increasingly recognized to cause nephrotoxicity [14]. Both pamidronate and zoledronate have been associated with nephrotoxicity that features nephrotic syndrome with a collapsing glomerular sclerosis [47]. The mechanism is unkown and the return of renal function is slow. 

Bisphosphonates have clearly estahhshed therapeutic benefits and are widely used to treat both henign and malignant bone disease. Oral bisphosphonates have been prescribed for many years to millions of patients for fracture prevention in the treatment of postmenopausal osteoporosis and have an excellent renal tolerability record. The low incidence of renal complications in patients receiving oral hisphospho-... 

Tribasic calcium phosphate is widely used as a capsule diluent and tablet filler/binder in either direct-compression or wet-granulation processes. The primary bonding mechanism in compaction is plastic deformation. As with dibasic calcium phosphate, a lubricant and a disintegrant should usually be incorporated in capsule or tablet formulations that include tribasic calcium phosphate. In some cases tribasic calcium phosphate has been used as a disintegrant. It is most widely used in vitamin and mineral preparations as a filler and as a binder. It is a source of both calcium and phosphorus, the two main osteogenic minerals for bone health. The bioavailability of the calcium is well known to be improved by the presence of cholecalciferol. Recent research reports that combinations of tribasic calcium phosphate and vitamin D3 are a cost-effective advance in bone fracture prevention. ... 

Lilliu H, Chapuy MC, Meunier PJ, et al. Calcium-vitamin D3 supplementation is cost-effective in hip fractures prevention. Muturitas 2003 44(4) 299-305. 

Patients receiving pharmacotherapy for low bone mass should be examined at least annually. Because the primary therapeutic outcome is fracture prevention, patients should be asked about possible fracture symptoms (primarily bone pain or disability) at each visit. Routine bone x-ray films are not warranted. Patients should be questioned about medication adherence and tolerability at each visit. Collecting a detailed history, according to the pertinent review of systems, should identify commonly occurring or potentially serious side effects unique to each medication. 

Wei, R. P., The Effect of Temperature and Environment on Subcritical Crack Growth, Fracture Prevention and Control, ASM Materials/Metalworking Technology Series No. 3 (1974), 73. 

Supplemental requirements used by Esso Research Engineering Company for brittle fracture prevention, based on the foregoing, are given in Table 4-3. Since these requirements are more severe than the long-standing code requirements, a few words of substantiation are in order. 

Code of Federal Regulations, Title 10, Part 50, Section 50.60, "Acceptance Criteria for Fracture Prevention Measures for Normal Operation" and Section 50.61, "Fracture Toughness Requirements for Protection Against Pressurized Thermal Shock."... 

Acceptance Criteria for Fracture Prevention Measures for Normal Operation... 

For normal operation, the fracture prevention criteria are defined in 10 CFR Part 50.60 and the referenced Part 50 Appendices G and H. 

Cr.31 Fracture prevention of reactor coolant pressure boundary Cr.32 Inspection of reactor coolant pressure boundary... 

V Reactor Containment Cr.51 Fracture prevention of containment pressure boundary... 

Fracture Prevention of Reactor Coolant Pressure Boundary 31... 

Hayes WC, McMahon TA and Robinovitch SN (1997), US Patent 5599290, Bone fracture prevention garment and method. 

Wessel, E.T., Clarck, W.G. Jr. Fracture prevention procedure for heavy section components. ASM conference on fracture control (1970)... 

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