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See detailClinical and biological determinants of sclerostin plasma concentration in hemodialysis patients
DELANAYE, Pierre ULg; KRZESINSKI, Jean-Marie ULg; Warling, Xavier et al

in Nephron. Clinical Practice (in press)

Background: Sclerostin is a potent inhibitor of bone formation, but the meaning of its serum levels remains undetermined. We evaluated the association between sclerostin levels and clinical or biological ... [more ▼]

Background: Sclerostin is a potent inhibitor of bone formation, but the meaning of its serum levels remains undetermined. We evaluated the association between sclerostin levels and clinical or biological data in hemodialyzed patients (HD), notably parathormone (PTH), biomarkers of bone turnover, vascular calcifications and mortality after 2 years. Methods: 164 HD patients were included in this observational study. The calcification score was assessed with the Kauppila method. Patients were followed for 2 years. Results: Median sclerostin levels were significantly (p < 0.0001) higher in HD versus healthy subjects (n = 94) (1,375 vs. 565 pg/ml, respectively). In univariate analysis a significant association (p < 0.05) was found between sclerostin and age, height, dialysis vintage, albumin, troponin, homocysteine, PTH, C-terminal telopeptide of collagen type I, bone-specific alkaline phosphatase and osteoprotegerin, but not with the calcification score. In a multivariate model, the association remained with age, height, dialysis vintage, troponin, homocysteine, phosphate, PTH, but also with vascular calcifications. Association was positive for all variables, except PTH and vascular calcifications. The baseline sclerostin concentration was not different in survivors and non-survivors. Conclusions: We confirm a higher concentration of sclerostin in HD patients, a positive association with age and a negative association with PTH. A positive association with phosphate, homocysteine and troponin calls for additional research. The clinical interest of sclerostin to assess vascular calcifications in HD is limited and no association was found between sclerostin and mortality. [less ▲]

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See detailLetter to the Editor.
Bruyère, Olivier ULg; Reginster, Jean-Yves ULg

in Seminars in arthritis and rheumatism (in press)

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See detailEvaluation of the impact of 6-month training by whole body vibration on the risk of falls among nursing home residents, observed over a 12-month period: a single blind, randomized controlled trial.
Buckinx, Fanny ULg; Beaudart, Charlotte ULg; Maquet, Didier ULg et al

in Aging Clinical & Experimental Research (in press)

BACKGROUND: We have previously shown that short sessions of whole body vibration (WBV) were not able to significantly improve fall risk among nursing home residents but some trends towards an improvement ... [more ▼]

BACKGROUND: We have previously shown that short sessions of whole body vibration (WBV) were not able to significantly improve fall risk among nursing home residents but some trends towards an improvement of motor capacity were observed. OBJECTIVE: The objective of the present study was to evaluate the impact of 6-month training by WBV on functional and motor abilities among nursing home residents observed over a 12-month period. METHODS: Patients were randomized into two groups: the WBV group which received three training sessions every week composed of five series of 15 s of vibration at 30 Hz intensity for a period of 6 months and a control group with normal daily life. The impact of this training on the risk of falls was assessed blindly after 6 and 12 months by the Tinetti Test, the "Timed Up and Go" test and a quantitative evaluation of a 10-s walk performed with a tri-axial accelerometer. The occurrence of falls was also observed. RESULTS: 62 elderly healthy volunteers, (47 women and 15 men, mean age 83.2 +/- 7.9 years) were included in this study. There was no significant difference between the two groups regarding the Tinetti test (p = 0.75), the "Timed Up and Go" test (p = 0.19) and the Locometrix(R) test, except for the step length, measured by dual task (p < 0.01). No significant inter-group difference in the frequency of falls was observed during the 12 months of research. A total of 42 falls were recorded during the first 6 months of experimentation: 24 falls in the treated group and 18 in the control group (p = 0.60). During the next 6 months, 19 falls occurred: 8 falls in the treated group and 11 in the control group (p = 0.52). CONCLUSION: This study failed to establish the effectiveness of low doses of WBV, under the conditions used in our study, on functional and motor abilities of institutionalized elderly patients. However, given the positive results of other studies, further investigations, with modified therapeutic protocols, seem necessary to clarify the effects of WBV in the elderly. [less ▲]

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See detailCost-effectiveness of vitamin D and calcium supplementation in the treatment of elderly women and men with osteoporosis.
Hiligsmann, Mickaël ULg; Ben Sedrine, Wafa; Bruyère, Olivier ULg et al

in European journal of public health (in press)

BACKGROUND: The supplementation with vitamin D and calcium has been recommended for elderly, specifically those with increased risk of fractures older than 65 years. This study aims to assess the cost ... [more ▼]

BACKGROUND: The supplementation with vitamin D and calcium has been recommended for elderly, specifically those with increased risk of fractures older than 65 years. This study aims to assess the cost-effectiveness of vitamin D and calcium supplementation in elderly women and men with osteoporosis and therefore to assess if this recommendation is justified in terms of cost-effectiveness. METHODS: A validated model for economic evaluations in osteoporosis was used to estimate the cost per quality-adjusted life-year (QALY) gained of vitamin D/calcium supplementation compared with no treatment. The model was populated with cost and epidemiological data from a Belgian health-care perspective. Analyses were conducted in women and men with a diagnosis of osteoporosis (i.e. bone mineral density T-score </=-2.5). A literature search was conducted to describe the efficacy of vitamin D and calcium in terms of fracture risk reduction. RESULTS: The cost per QALY gained of vitamin D/calcium supplementation was estimated at euro40 578 and euro23 477 in women and men aged 60 years, respectively. These values decreased to euro7912 and euro10 250 at the age of 70 years and vitamin D and calcium supplementation was cost-saving at the age of 80 years, meaning that treatment cost was less than the costs of treating osteoporotic fractures of the no-treatment group. CONCLUSION: This study suggests that vitamin D and calcium supplementation is cost-effective for women and men with osteoporosis aged over 60 years. From an economic perspective, vitamin D and calcium should therefore be administrated in these populations including those also taking other osteoporotic treatments. [less ▲]

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See detailOsteoporosis in patients taking selective serotonin reuptake inhibitors: a focus on fracture outcome
Bruyère, Olivier ULg; Reginster, Jean-Yves ULg

in Endocrine (in press)

Depression is one of the most important mental health problems and a leading cause of disability. Selective serotonin reuptake inhibitors (SSRIs) are considered as first-line therapy for the treatment of ... [more ▼]

Depression is one of the most important mental health problems and a leading cause of disability. Selective serotonin reuptake inhibitors (SSRIs) are considered as first-line therapy for the treatment of depressive symptoms among older adults because of their presumed favorable adverse effect profile. However, they could have deleterious effects on the bone. Evidence from longitudinal, crosssectional, and prospective cohort studies suggests that the use of antidepressants at therapeutic doses is associated with decreased bone mineral density and increased fracture risk. The association between SSRIs use and fracture risk could potentially differ depending on dose, exposure duration, time of exposure, age, or sex. However, the risk of fracture declined rapidly after discontinuation of use of SSRIs. The evidence now seems sufficient to consider adding SSRIs to the list of medications that contribute to osteoporosis. In practice, assessment of risk factor for osteoporosis or fractures could be made taking into account age, gender, duration, and severity of depression, length of SSRI treatments, and other concurrent risk factors. [less ▲]

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See detailDevelopment and validation of the French version of a tool assessing patient's expectations in lower limb osteoarthritis
NEUPREZ, Audrey ULg; Delcour, JP; Fatemi, F et al

in Journal of Orthopaedics (in press)

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See detaillES CHUTES DE LA PERSONNE AGEE
GILLAIN, Sophie ULg; ELBOUZ, Leila ULg; Beaudart, Charlotte ULg et al

in Revue Médicale de Liège (in press)

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See detailOne injection of platelet-rich plasma associated to a submaximal eccentric protocol to treat chronic jumper's knee
Kaux, Jean-François ULg; Croisier, Jean-Louis ULg; Bruyère, Olivier ULg et al

in The Journal of sports medicine and physical fitness (in press)

INTRODUCTION: Jumper's knee is a frequent chronic overuse syndrome of the upper part of the patellar tendon. Platelets contain lots of growth factors which could enhance the healing process of tendons ... [more ▼]

INTRODUCTION: Jumper's knee is a frequent chronic overuse syndrome of the upper part of the patellar tendon. Platelets contain lots of growth factors which could enhance the healing process of tendons. METHODS: Twenty patients with chronic upper patellar tendinopathy were enrolled. Assessments were made before infiltration of PRP, and 6 weeks and 3 months after the infiltration, using a 10--point Visual Analogic Scale, clinical examinations with a pressure algometer, algofunctional scores (IKDC and VISA--P), functional assessments (isokinetic and optojump evaluations) and imagery (ultrasounds and MRI). The PRP was obtained with an apheresis system (COM.TEC, Fresenius). Six millilitres of PRP were injected without local anaesthetic. One week after infiltration, patients started a standardised sub--maximal eccentric reeducation. RESULTS: Pain during daily activities significantly decreased with time. During functional evaluation, it decreased as well, but without significant functional improvement. No improvements in the imagery measurements were observed. Younger patients seemed to be more susceptible to have an improvement of pain by the PRP infiltration. CONCLUSION: This study demonstrates that a local infiltration of PRP associated with a submaximal eccentric protocol can improve symptoms of chronic jumper's knee in patients non--responsive to classical conservative treatments. [less ▲]

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See detailDabigatran Etexilate and Risk of Myocardial Infarction, Other Cardiovascular Events, Major Bleeding, and All-Cause Mortality: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
Douxfils, Jonathan; Buckinx, Fanny ULg; Mullier, Francois et al

in Journal of the American Heart Association (in press)

BACKGROUND: Signals of an increased risk of myocardial infarction (MI) have been identified with dabigatran etexilate in randomized controlled trials (RCTs). METHODS AND RESULES: We conducted searches of ... [more ▼]

BACKGROUND: Signals of an increased risk of myocardial infarction (MI) have been identified with dabigatran etexilate in randomized controlled trials (RCTs). METHODS AND RESULES: We conducted searches of the published literature and a clinical trials registry maintained by the drug manufacturer. Criteria for inclusion in our meta-analysis included all RCTs and the availability of outcome data for MI, other cardiovascular events, major bleeding, and all-cause mortality. Among the 501 unique references identified, 14 RCTs fulfilled the inclusion criteria. Stratification analyses by comparators and doses of dabigatran etexilate were conducted. Peto odds ratio (ORPETO) values using the fixed-effect model (FEM) for MI, other cardiovascular events, major bleeding, and all-cause mortality were 1.34 (95% CI 1.08 to 1.65, P=0.007), 0.93 (95%CI 0.83 to 1.06, P=0.270), 0.88 (95% CI 0.79 to 0.99, P=0.029), and 0.89 (95% CI 0.80 to 1.00, P=0.041). When compared with warfarin, ORPETO values using FEM were 1.41 (95% CI 1.11 to 1.80, P=0.005), 0.94 (95%CI 0.83 to 1.06, P=0.293), 0.85 (95% CI 0.76 to 0.96, P=0.007), and 0.90 (95% CI 0.81 to 1.01, P=0.061), respectively. In RCTs using the 150-mg BID dosage, the ORPETO values using FEM were 1.45 (95% CI 1.11 to 1.91, P=0.007), 0.95 (95% CI 0.82 to 1.09, P=0.423), 0.92 (95% CI 0.81 to 1.05, P=0.228), and 0.88 (95% CI 0.78 to 1.00, P=0.045), respectively. The results of the 110-mg BID dosage were mainly driven by the RE-LY trial. CONCLUSIONS: This meta-analysis provides evidence that dabigatran etexilate is associated with a significantly increased risk of MI. This increased risk should be considered taking into account the overall benefit in terms of major bleeding and all-cause mortality. [less ▲]

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See detailEpidémiologie de la lithiase urinaire en Province de Liège
GADISSEUR, Romy ULg; Castiglione, Vincent ULg; JOURET, François ULg et al

in Néphrologie & Thérapeutique (2014, September), 10(5), 270

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See detailAdaptation interculturelle et validation du questionnaire VISA-P en français
Oppong-Kyei, Julian; Bruyère, Olivier ULg; Delvaux, François ULg et al

in 7ème Congrès National SFMES & SFTS 2014 (2014, September)

Introduction La tendinopathie patellaire est une affection musculo-squelettique très fréquentes chez le sportif et la plus fréquente au niveau du genou. Elle affecte le plus souvent des disciplines qui ... [more ▼]

Introduction La tendinopathie patellaire est une affection musculo-squelettique très fréquentes chez le sportif et la plus fréquente au niveau du genou. Elle affecte le plus souvent des disciplines qui nécessitent soit des impulsions et des sauts soit un travail important du quadriceps. Le Victorian Institute of Sports Assessment–Patellar (VISA-P) est un questionnaire permettant d’évaluer les symptômes et leurs retentissements sur les activités physiques quotidiennes et sportives de la tendinopathie patellaire (Jumper’s knee). Comme la plus part des questionnaires de ce type, le VISA-P fut originalement développé pour des patients anglophones et n'est donc pas adapté à une population francophone. En conséquence, l'objectif de cette étude sera de traduire, adapter et valider une version française fiable du VISA-P et d'en évaluer ses propriétés psychométriques. Matériel et méthode La traduction et l’adaptation interculturelle du VISA-P ont été réalisées selon les recommandations internationales (Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures). Ce processus s'est déroulé en 6 étapes : traductions initiales, synthèse des traductions, traduction de retour vers la langue d’origine, comité expert, test de la version pré-finale et approbation du comité expert. La version française finale obtenue fut ensuite l’objet d’une évaluation de certaines propriétés psychométriques telles que la fidélité test-retest, la cohérence interne, la validité de construit et les effets plancher et plafond. Nonante-deux sujets furent recruté au total afin de tester ces propriétés psychométriques. Trois groupes de sujets furent utilisés pour répondre conjointement aux VISA-P et à un questionnaire supplémentaire, le Medical Outcomes Survey Short Form 36 questionnaire (SF-36) pour la validité de construit : un groupe de sujets pathologiques principalement recrutés parmi les patients du Centre Hospitalier Universitaire de Liège (28), un groupe de sujets asymptomatiques (22) et un groupe de sportifs à risque recrutés dans divers clubs sportif (42). L'ensemble des participants ont été recrutés au sein de la province de Liège. Résultats Aucun sujet ne présenta de grosses difficultés à comprendre le questionnaire suite au test de la version pré-finale. Les différents membres du comité expert se montrèrent satisfait de la version finale et donnèrent donc leur approbation. La moyenne des scores obtenu est de 53 (± 17) pour le groupe pathologique, 99 (± 2) pour le groupe sain et 86 (± 14) pour le groupe à risque. Les corrélations entre le VISA-P et certaines mesures divergentes du SF-36 semblent donner des résultats faibles. Les coefficients de corrélation mesurés entre les scores du VISA-P et les items convergents du SF-36 paraissent être élevés. Aucun effet plancher ou plafond n'a pu être observer lors de l'évaluation des propriétés psychométriques du VISA-P dans le groupe pathologique. Conclusion La version française du VISA-P est donc être un questionnaire compréhensible, fiable et adapté aux patients francophones souffrant d'une tendinopathie patellaire supérieur. [less ▲]

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See detailAdaptation interculturelle et validation du questionnaire VISA-A en français
Oppong-Kyei, Julian; Bruyère, Olivier ULg; Delvaux, François ULg et al

in 7ème Congrès National SFMES & SFTS 2014 (2014, September)

Introduction La tendinopathie d’Achille, dont la discipline athlétique implique une grosse activité de course à pied, représente une source de douleurs et de handicap. Cette pathologie fait actuellement l ... [more ▼]

Introduction La tendinopathie d’Achille, dont la discipline athlétique implique une grosse activité de course à pied, représente une source de douleurs et de handicap. Cette pathologie fait actuellement l'objet de nouvelles découvertes sur le plan de la physiopathologie permettant l'exploration de nouvelles pistes thérapeutiques. Dans le cadre de telles études, des échelles d’évaluation sont utilisées afin d'évaluer des phénomènes subjectifs ou complexes tels la douleur, la qualité de vie, le handicap, etc. Elles sont généralement composées de plusieurs items dont la cotation est combinée en un score global ou des sous scores dimensionnels. La majorité des échelles algo-fonctionnelles sont développés dans des pays anglophones et sont par conséquence uniquement pertinents pour des sujets parlant l’anglais. Ceci est la cas pour le Victorian Institute of Sports Assessment–Achilles (VISA-A), un questionnaire développé dans le but d'évaluer la sévérité des symptômes de la tendinopathie achilléenne. L’intérêt de ce mémoire est donc de valider une version française fiable de ce questionnaire. Matériel et méthode La traduction et l’adaptation interculturelle du VISA-A ont été réalisées selon les recommandations internationales (Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures). Ce processus s'est déroulé en 6 étapes : traductions initiales, synthèse des traductions, traduction de retour vers la langue d’origine, comité expert, test de la version pré-finale et approbation du comité expert. La version française finale obtenue fut ensuite l’objet d’une évaluation de certaines propriétés psychométriques telles que la fidélité test-retest, la cohérence interne, la validité de construit et les effets plancher et plafond. Pour ces évaluations, 116 sujets furent recruté et répartis en 3 groupes : un groupe de sujets pathologiques principalement recrutés parmi les patients du Centre Hospitalier Universitaire de Liège (31), un groupe de sujets asymptomatiques (22) et un groupe de sportifs à risque (63). Tous ces sujets durent également répondre à un questionnaire supplémentaire, le Medical Outcomes Survey Short Form 36 questionnaire (SF-36) pour la validité de construit. L'ensemble des participants ont été recrutés au sein de la province de Liège. Résultats Aucun sujets ne présenta de difficultés à comprendre le questionnaire suite au test de la version pré-finale. Les différents membres du comité expert se montrèrent satisfait de la version finale et donnèrent donc leur approbation. La moyenne des scores obtenus dans le groupe pathologique est de 59 (± 18), celle du groupe sain est de 99 (± 1) et celle du groupe à risque est de 94 (± 7). Aucun effet plancher ou plafond n'a pu être observer lors de l'évaluation des propriétés psychométriques du VISA-A (dans le groupe pathologique). Les corrélations entre le VISA-A et certaines mesures divergentes du SF-36 semblent être faibles. Les coefficients de corrélation mesurés entre les scores du VISA-A et les items convergents du SF-36 paraissent être élevé. Conclusion La version française du VISA-A est donc être un questionnaire compréhensible, fiable et adapté aux patients francophones souffrant d'une tendinopathie d'Achille. [less ▲]

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See detailOù il est question de se faire une idée juste de la réalité... (partie 1)
Bruyère, Olivier ULg

in Medi-Sphere (2014), 454

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See detailÉvaluer la force de l’association
Bruyère, Olivier ULg; Boutron-Ruault, Marie-Christine

in Medi-Sphere (2014), 451

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See detailPlatelet-rich plasma to treat patellar tendinopathies: a 1 year follow-up.
Kaux, Jean-François ULg; Croisier, Jean-Louis ULg; Bruyère, Olivier ULg et al

in Clinical Chemistry & Laboratory Medicine (2014, June), 52(Special Suppl), 1285

Background: Jumper’s knee is a frequent chronic overuse syndrome of the upper part of the patellar tendon. Platelets contain lots of growth factors which could enhance the healing process of tendons ... [more ▼]

Background: Jumper’s knee is a frequent chronic overuse syndrome of the upper part of the patellar tendon. Platelets contain lots of growth factors which could enhance the healing process of tendons. Infiltration of Platelet Rich Plasma (PRP) may be considered as a recent therapeutic option for chronic tendinopathies. The aim of the current study is to evaluate the clinical status and the return to sports activities in patients with chronic upper patellar tendinopathies up to 1 year after 1 infiltration of PRP. Methods: Twenty patients with chronic upper patellar tendinopathy were enrolled. Assessments were made before infiltration of PRP, and 6 weeks and 3 months and 1 year after the infiltration, using a 10-point Visual Analogic Scale and algofunctional scores (IKDC and VISA-P). Moreover, they had to answer an information questionnaire concerning their life and sports activities. The PRP was obtained with an apheresis system (COM.TEC, Fresenius). Six millilitres of PRP were injected without local anaesthetic. One week after infiltration, patients started a standardised sub-maximal eccentric reeducation. Results: Pain during daily activities significantly decreased with time. VAS has significantly dropped, IKDC and VISA-P significantly improved over the follow-up of 1 year. Seventy percents of patients reported a favourable evolution with decrease of pain, 15% did never report any improvement and 15% were treated surgically. Seventy percents returned to sports activities, 64,3% without any pain, and 50% of them recovered the same sport level. Younger patients seemed to be more susceptible to have an improvement of pain by the PRP infiltration. Conclusions: This study demonstrates that a local infiltration of PRP associated with a submaximal eccentric protocol can improve, at 1 year, symptoms of chronic jumper’s knee in patients non-responsive to classical conservative treatments. [less ▲]

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See detailQuels types d'étude pour quels objectifs?
Bruyère, Olivier ULg; Reginster, Jean-Yves ULg

in Medi-Sphere (2014), 445

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See detailOne-year follow-up of platelet-rich plasma to treat chronic upper patellar tendinopathies
Kaux, Jean-François ULg; Croisier, Jean-Louis ULg; Bruyère, Olivier ULg et al

in European Journal of Physical and Rehabilitation Medicine (2014, May), 50(Suppl. 1 to No. 3), 227250-

Introduction: Infiltration of PRP may be used as a recent therapeutic option for chronic tendinopathies The aim of the current study is to evaluate the clinic and the return to sports activities in ... [more ▼]

Introduction: Infiltration of PRP may be used as a recent therapeutic option for chronic tendinopathies The aim of the current study is to evaluate the clinic and the return to sports activities in patients with chronic upper patellar tendinopathies 1 year after 1 infiltration of PRP. Material and methods: The follow-up of 20 subjects who beneficed from 1 infiltration of PRP was made before infiltration, after 3 months and 1 year after infiltration; it was made as follow: VAS, IKDC and VISA-P scores. Moreover, they had to answer an information questionnaire concerning their life and sports activities. Results: Seventy percents of patients reported a favourable evolution with decrease of pain, 10% did never report any improvement and 20% were treated surgically. Eighty-seven percents returned to sports activities without any pain, and 50% of them recovered the same sport level. VAS has significantly (p<0.0001) dropped, IKDC significantly improved (p=0.0007) and VISA-P also significantly increased (p=0.0087) over the follow-up of 1 year. Discussion: This study confirms that a local injection of PRP coupled with a program of eccentric rehabilitation through a chronic Jumper's knee, improves painful symptoms and the functionality of the subjects’ knee up to a follow-up of 1 year. [less ▲]

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See detailClinically meaningful effect of strontium ranelate on symptoms in knee osteoarthritis: a responder analysis
Bruyère, Olivier ULg; Reginster, Jean-Yves ULg; Bellamy, Nicholas et al

in Rheumatology (2014), 53

Objectives. The aim of this study was to assess the efficacy of strontium ranelate in improving symptoms in knee OA. Methods. Symptoms were assessed over 3 years in patients with primary knee OA receiving ... [more ▼]

Objectives. The aim of this study was to assess the efficacy of strontium ranelate in improving symptoms in knee OA. Methods. Symptoms were assessed over 3 years in patients with primary knee OA receiving strontium ranelate 2 g/day (n = 454), 1 g/day (n = 445) or placebo (n = 472) in the Strontium Ranelate Efficacy in Knee Osteoarthritis Trial. Clinical response was evaluated using WOMAC subscores, minimal perceptible clinical improvement (MPCI), minimal clinically important improvement (MCII) and a modified OMERACT Osteoarthritis Research Society International (OARSI) responder definition. Patients who withdrew prematurely from the study were considered non-responders. Results. There was no significant effect on symptoms for strontium ranelate 1 g/day. At the dosage of 2 g/day, strontium ranelate was associated with greater response than placebo in terms of 520% improvement in WOMAC pain from baseline to the last visit (58% vs 47%, P = 0.002) and 550% improvement in WOMAC pain (42% vs 36%, P = 0.083). Significant differences were found in MPCI response for WOMAC pain (52% vs 40%, P<0.001), stiffness (47% vs 39%, P = 0.009) and physical function (46% vs 37%, P = 0.009) and in MCII response for WOMAC physical function (46% vs 37%, P = 0.013). There were also more OMERACT-OARSI-like responders with strontium ranelate (44% vs 35%, P = 0.004). The treatment placebo difference in MPCI response for WOMAC pain was significant after 6 months (P = 0.024), while that in MPCI and MCII response for WOMAC physical function reached significance after 12 months (P = 0.027 and P = 0.019, respectively). Conclusion. Treatment with strontium ranelate 2 g/day over 3 years is associated with a clinically meaningful improvement in pain from 6 months as well as physical function and stiffness as assessed by the number of responders above thresholds of clinical relevance. [less ▲]

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