Osteoporosis treatment monitoring

One chronic adverse effect that is of concern is osteoporosis.32,33 Carbamazepine, phenytoin, phenobarbital, oxcarbazepine, and valproate have all been shown to decrease bone mineral density, even after only 6 months of treatment. Data on the relationship between other AEDs and osteoporosis are not currently available. Multiple studies have shown the risk of osteoporosis due to chronic AED use to be similar to the risk with chronic use of corticosteroids. Patients taking carbamazepine, phenytoin, phenobarbital, or valproate for longer than 6 months should take supplemental calcium and vitamin D. Additionally routine monitoring for osteoporosis should be performed every 2 years, and patients should be instructed on ways to protect themselves from fractures. 

Recommend an appropriate treatment regimen for a patient with osteoporosis, and develop a monitoring plan for the selected regimen. 

Of course, there are still issues regarding the OTC treatment of chronic or recurring illness. Monitoring and compliance questions remain mostly unanswered at this time. However, once some of the conceptual issues are addressed satisfactorily, there will be a kind of domino effect on several indications, such as cholesterol, osteoporosis, and hypertension. 

Glucocorticoid treatment for arthritis or other ailments can very quickly produce a form of osteoporosis caused by the inhibition of bone formation [334]. In such cases, the decrease in bone mass may be as much as 10-20%, but examination of trabecular bone reveals a much greater (30-40%) decrease in this component of bone [335]. Combination therapies with vitamin D and bisphosphonates, calcitonin or fluoride can be effective [336]. Therapy employing vitamin D or 1,25-(OH)2D3, the latter being highly calcaemic, should also include serum calcium monitoring and the use of thiazide diuretics as appropriate. 

Although a dose-response relationship for inhaled corticosteroids has not been demonstrated in COPD, the major clinical trials employed moderate to high doses for treatment. Side effects of inhaled corticosteroids are relatively mild compared with the toxicity from systemic therapy. Hoarseness, sore throat, oral candidiasis, and skin bruising have been reported in the clinical trials. Severe side effects, such as adrenal suppression, osteoporosis, and cataract formation, have been reported less frequently than with systemic corticosteroids, but clinicians should monitor patients who are receiving high-dose chronic therapy. ... 

Patients who are undergoing therapy for menstruation-related disorders should have a monthly examination by a clinician to assess efficacy and adverse effects and adjust dosing, if needed. If first-line treatment approaches are not effective after several months, then alternative or combination therapies should be considered. Perimenopausal women should be monitored every 1 to 2 months to determine the effectiveness of treatment. Once a patient is stable and responding to the treatmentplan, monitoring may be extended to every 3 to 6 months. Peri- and postmenopausal women should be monitored regularly because of the increased risk of osteoporosis, cardiovascular disease, and dementia. Throughout therapy, patients should be... 

Patients on prednisone need to be monitored for hypertension and diabetes mellitus. Some physicians use prophylaxis regimens to prevent gastrointestinal (Gl) bleeding, but the benefit of prophylaxis is unclear. Patients weights should be followed and symptoms of sleep apnea should be elicited. Given the potential for treatment of CS-induced osteoporosis, screening for osteoporosis should be done every one to two years for any patient on chronic CS therapy (77). Bisphosphonate and calcium supplementation should be considered in patients at risk for osteoporosis (47). 

If corticosteroid therapy is not deemed necessary to treat disease, followup examination and objective testing should be performed on a yearly basis to monitor disease progression. Because of the need for lifelong treatment, patients should be informed of the long-term side effects of corticosteroids and be monitored and treated for consequences such as hypertension, hyperglycemia, osteoporosis, and cataracts. 

An LC-MS-MS method with AP-CI to determine the concentration of 25-hydroxyvitamin D (25-OH-D(2)/-D(3)) in human plasma. A deuterated standard is used and the tandem spectrometer is in the multiple-reaction-monitoring mode. Intra- and interassay variations 2-6% recoveries 104-99%. Potential applications are the evaluation of the vitamin D status in postmenopausal women and elderly subjects, the diagnosis of vitamin D insufficiency/deficiency, as well as for the treatment and prevention of osteoporosis. 

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