References of "REGINSTER, Jean-Yves"
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See detailCan we identify patients with high risk of osteoarthritis progression who will respond to treatment ? A focus on epidemiology and phenotype of osteoarthritis
Bruyère, Olivier ULg; Cooper, C; Arden, N et al

in Drugs & Aging (in press)

Osteoarthritis is a syndrome affecting a variety of patient profiles. A European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis and the European Union Geriatric Medicine ... [more ▼]

Osteoarthritis is a syndrome affecting a variety of patient profiles. A European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis and the European Union Geriatric Medicine Society working meeting explored the possibility of identifying different patient profiles in osteoarthritis. The risk factors for the development of osteoarthritis include systemic factors (e.g., age, sex, obesity, genetics, race, and bone density) and local biomechanical factors (e.g., obesity, sport, joint injury, and muscle weakness); most also predict disease progression, particularly joint injury, malalignment, and synovitis/effusion. The characterization of patient profiles should help to better orientate research, facilitate trial design, and define which patients are the most likely to benefit from treatment. There are a number of profile candidates. Generalized, polyarticular osteoarthritis and local, monoarticular osteoarthritis appear to be two different profiles; the former is a feature of osteoarthritis comorbid with inflammation or the metabolic syndrome, while the latter is more typical of post-trauma osteoarthritis, especially in cases with severe malalignment. Other biomechanical factors may also define profiles, such as joint malalignment, loss of meniscal function, and ligament injury. Early- and late-stage osteoarthritis appear as separate profiles, notably in terms of treatment response. Finally, there is evidence that there are two separate profiles related to lesions in the subchondral bone, which may determine benefit from bone-active treatments. Decisions on appropriate therapy should be made considering clinical presentation, underlying pathophysiology, and stage of disease. Identification of patient profiles may lead to more personalized healthcare, with more targeted treatment for osteoarthritis. [less ▲]

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See detailDiabetes is a risk factor for knee osteoarthritis progression
Eymard, F; Parsons, C; Edwards, M et al

in Osteoarthritis and Cartilage (in press)

Purpose Recent studies have suggested that metabolic factors (obesity, diabetes, hypertension and dyslipidemia) and their clustering in metabolic syndrome (MetS) might be involved in the pathophysiology ... [more ▼]

Purpose Recent studies have suggested that metabolic factors (obesity, diabetes, hypertension and dyslipidemia) and their clustering in metabolic syndrome (MetS) might be involved in the pathophysiology of knee osteoarthritis (OA). We investigated their impact on radiographic progression by an annualised measure of the joint space narrowing (JSN) of the medial tibiofemoral compartment. Methods 559 patients older than 50 years with symptomatic knee OA were recruited for the placebo arm of the SEKOIA trial. The presence of diabetes, hypertension and dyslipidemia was determined at baseline interview. BMI was calculated, obesity was considered >30 kg/m2. MetS was defined by the sum of metabolic factors ≥3. Minimal medial tibiofemoral joint space on plain radiographs was measured by an automated method at baseline and then annually for up to 3 years. Results The mean age of patients was 62.8 [62.2-63.4] years; 392 were women. A total of 43.8% was obese, 6.6% had type 2 diabetes, 45.1% hypertension, 27.6% dyslipidemia and 13.6% MetS. Mean annualised JSN was greater for patients with type 2 diabetes than without diabetes (0.26 [-0.35 - -0.17] vs. 0.14 [-0.16 - -0.12] mm; p=0.001). This association remained significant after adjustment for sex, age, BMI, hypertension and dyslipidemia (p=0.018). In subgroup analysis, type 2 diabetes was a significant predictor of JSN in males but not females. The other metabolic factors and MetS were not associated with annualised JSN. Conclusion Type 2 diabetes was a predictor of joint space reduction in men with established knee OA. No relationships were found between MetS or other metabolic factors and radiographic progression. [less ▲]

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See detailA 24-month Study Evaluating the Efficacy and Safety of Denosumab for the Treatment of Men With Low Bone Mineral Density: Results From the ADAMO Trial.
Langdahl, Bente L.; Teglbjaerg, Christence S.; Ho, Pei-Ran et al

in The Journal of clinical endocrinology and metabolism (in press)

Context: One in 4 men in the US aged >50 will suffer an osteoporosis-related fracture. Less data are available on osteoporosis treatment in men than women. Objective: Evaluate denosumab therapy in men ... [more ▼]

Context: One in 4 men in the US aged >50 will suffer an osteoporosis-related fracture. Less data are available on osteoporosis treatment in men than women. Objective: Evaluate denosumab therapy in men with low BMD. Design: Phase 3 study with two treatment periods: a previously reported 12-month double-blind, placebo-controlled phase and a 12-month open-label phase. Setting: Multicenter in North America and Europe. Participants: 228 men entered the open-label phase and 219 completed the study. Intervention: Men from the original denosumab (long-term) and placebo (crossover) groups received denosumab 60 mg SC every 6 months. Main Outcome Measures: BMD, serum C-telopeptide (sCTX), and safety. Results: During the open-label phase, continued BMD increases occurred with long-term denosumab treatment (2.2% lumbar spine; 0.9% total hip; 1.3% femoral neck; 1.3% trochanter; and 0.2% 1/3 radius), resulting in cumulative 24-month gains from baseline of 8.0%, 3.4%, 3.4%, 4.6%, and 0.7%, respectively (all P<0.01). The crossover group showed BMD gains after 12 months of denosumab treatment similar to the long-term denosumab group during the first treatment year. Significant reductions in sCTX were observed following denosumab administration. Adverse events rates were similar between groups and no new safety signals identified. Conclusions: In men with low BMD, denosumab treatment for a second year continued to increase BMD, maintained reductions in bone resorption, and was well tolerated. BMD increased in men initiating denosumab during the second year. These effects were similar to those previously seen in postmenopausal women with osteoporosis and men with prostate cancer on androgen deprivation therapy. [less ▲]

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See detailCommentary on recent therapeutic guidelines for osteoarthritis
Cutolo, M; Berenbaum, F; Hochberg, M et al

in Seminars in Arthritis & Rheumatism (in press)

Background Despite availability of international evidence-based guidelines for osteoarthritis (OA) management, agreement on the different treatment modalities is lacking. Method A symposium of European ... [more ▼]

Background Despite availability of international evidence-based guidelines for osteoarthritis (OA) management, agreement on the different treatment modalities is lacking. Method A symposium of European and US OA experts was held within the framework of the Annual European Congress of Rheumatology to discuss and compare guidelines and recommendations for the treatment of knee OA and to reach a consensus for management, particularly for areas in which there is no clear consensus: non-pharmacological therapy; efficacy and safety of analgesics and non-steroidal anti-inflammatory drugs (NSAIDs); intra-articular (i.a.) hyaluronates (HA); and the role of chondroitin sulfate (CS) and/or glucosamine sulfate (GS). Results All guidelines reviewed agree that knee OA is a progressive disease of the joint whose management requires non-pharmacological and pharmacological approaches. Discrepancies between guidelines are few and mostly reflect heterogeneity of expert panels involved, geographical differences in the availability of pharmacotherapies, and heterogeneity of studies included. Panels chosen for guideline development should include experts with real clinical experience in drug use and patient management. Implementation of agreed guidelines can be thwarted by drug availability and reimbursement plans, resulting in optimal OA treatment being jeopardized, HA and symptomatic slow-acting drugs for osteoarthritis (SySADOAs) being clear examples of drugs whose availability and prescription can greatly vary geographically. In addition, primary care providers, often responsible for OA management (at least in early disease), may not adhere to clinical care guidelines, particularly for non-pharmacological OA treatment. Conclusion Harmonization of the recommendations for knee OA treatment is challenging but feasible, as shown by the step-by-step therapeutic algorithm developed by European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). More easily disseminated and implemented guidance for OA treatment in the primary care setting is key to improved management of OA. [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 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 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 detailA Systematic Review of Cost-Effectiveness Analyses of Drugs for Postmenopausal Osteoporosis.
Hiligsmann, Mickaël ULg; Evers, Silvia M.; Ben Sedrine, Wafa et al

in PharmacoEconomics (2015), 33(3), 205-224

BACKGROUND: Given the limited availability of healthcare resources and the recent introduction of new anti-osteoporosis drugs, the interest in the cost effectiveness of drugs in postmenopausal ... [more ▼]

BACKGROUND: Given the limited availability of healthcare resources and the recent introduction of new anti-osteoporosis drugs, the interest in the cost effectiveness of drugs in postmenopausal osteoporosis remains and even increases. OBJECTIVE: This study aims to identify all recent economic evaluations on drugs for postmenopausal osteoporosis, to critically appraise the reporting quality, and to summarize the results. METHODS: A literature search using Medline, the National Health Service Economic Evaluation database and the Cost-Effectiveness Analysis Registry was undertaken to identify original articles published between January 1, 2008 and December 31, 2013. Studies that assessed cost effectiveness of drugs in postmenopausal osteoporosis were included. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement was used to assess the quality of reporting of these articles. RESULTS: Of 1,794 articles identified, 39 studies fulfilled the inclusion criteria. They were conducted in 14 different countries and nine active interventions were assessed. When compared with no treatment, active osteoporotic drugs were generally cost effective in postmenopausal women aged over 60-65 years with low bone mass, especially those with prior vertebral fractures. Key drivers of cost effectiveness included individual fracture risk, medication adherence, selected comparators and country-specific analyses. Quality of reporting varied between studies with an average score of 17.9 out of 24 (range 7-21.5). CONCLUSION: This review found a substantial number of published cost-effectiveness analyses of drugs in osteoporosis in the last 6 years. Results and critical appraisal of these articles can help decision makers when prioritizing health interventions and can inform the development of future economic evaluations. [less ▲]

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See detailRetour au sport après plastie du ligament croisé antérieur : critères utilisés dans les cubs professionnels de football
Delvaux, François ULg; Rochcongar, P; Bruyère, Olivier ULg et al

in Science et Sports (2015), 30

Résumé Objectifs Analyser la démarche suivie par les médecins de clubs professionnels de football lorsqu’ils décident, en pratique quotidienne, d’autoriser le retour compétitif après plastie du ligament ... [more ▼]

Résumé Objectifs Analyser la démarche suivie par les médecins de clubs professionnels de football lorsqu’ils décident, en pratique quotidienne, d’autoriser le retour compétitif après plastie du ligament croisé antérieur chez un footballeur. Matériels et méthodes Trente-sept médecins responsables de clubs professionnels de football français et belges (Ligue 1, n = 15 ; Ligue 2, n = 14 ; Division 1 belge, n = 8) ont rempli un questionnaire à choix multiple concernant : (1) les critères utilisés afin de déterminer si un joueur est apte à reprendre la compétition après plastie du ligament croisé antérieur ; (2) l’importance relative de chacun de ces critères ; (3) le rôle éventuel d’intervenants spécifiques (kinésithérapeute…) dans cette décision. Résultats Plus de 80 % des médecins interrogés ont déclaré utiliser au moins huit critères (sur 17 proposés) afin d’évaluer la capacité d’un footballeur à reprendre la compétition après plastie du ligament croisé antérieur. Les trois critères considérés comme les plus déterminants étaient, par ordre d’importance : la stabilité dynamique du genou lors d’un exercice spécifique au football, la force musculaire et la récupération complète ou quasi complète d’amplitudes articulaires de flexion et d’extension de genou. Pour certains de ces critères (notamment la force musculaire), nous constatons cependant un manque de consensus sur les modalités pratiques d’évaluation, sur les paramètres ainsi que sur les valeurs-limites tolérées afin de garantir un retour sur terrain sécurisé. La prise en compte de l’avis du kinésithérapeute et du préparateur physique par une très nette majorité de médecins souligne l’importance d’un travail pluridisciplinaire. Conclusion L’utilisation de différents critères objectifs afin d’autoriser le retour compétitif après plastie du ligament croisé antérieur semble être une réalité dans le football professionnel. Des études supplémentaires devraient cependant contribuer à préciser les modalités des épreuves ainsi que des valeurs-seuils. ________________________________________ Summary Purpose To analyze how sport physicians decide, in their daily practice, when a professional soccer player with a reconstructed anterior cruciate ligament is able to get back to competitive activities. Materials and methods Thirty-seven physicians for professional French and Belgian soccer teams filled in a specific questionnaire dedicated to: (1) return-to-play criteria after anterior cruciate reconstruction; (2) the importance they assigned to each of these criteria in the return-to-play decision; (3) the potential role of professionals, such as physiotherapists or physical coaches in this decision. Results More than 80% of the respondents declared to use at least eight criteria in order to assess the player's ability to return to competitive soccer after anterior cruciate ligament reconstruction. The most important ones were (in order of importance): dynamic knee stability during a specific soccer exercise, muscle strength performance and normalization of knee flexion and extension ranges of motion. For most of these criteria (notably muscle strength), there was a lack of consensus about the choice of assessment parameters and the limit values allowing physicians to authorize or forbid the return-to-competition. A large majority of participants stated to take into consideration advices from physiotherapists or physical coaches for the return-to-play decision. Conclusion Sport physicians of professional soccer teams use relevant criteria to assess players’ ability to return to full sport after anterior cruciate ligament reconstruction. Further studies are required to determine the choice of assessment parameters and the limit values to assist physicians in return-to-play decisions. [less ▲]

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See detailDramatic osteonecrosis of the jaw associated with oral bisphosphonates, periodontitis and dental implant removal
Ayora, A F; HERION, Francine ULg; ROMPEN, Eric ULg et al

in Journal of Clinical Periodontology (2015), 42

Osteoporosis affects millions of elderly patients, and anti-resorptive drugs (ARD) such as bisphosphonates (BP) represent the first-line therapy. Despite the benefits related to the use of these ... [more ▼]

Osteoporosis affects millions of elderly patients, and anti-resorptive drugs (ARD) such as bisphosphonates (BP) represent the first-line therapy. Despite the benefits related to the use of these medications, osteonecrosis of the jaw is a significant complication in a subset of patients receiving these drugs. CASE PRESENTATION: This report documents a case of dramatic bisphosphonate-related osteonecrosis associated with periodontitis and dental implant removal in an osteoporotic patient treated with per os bisphosphonates for an uninterrupted period of 15 years. CONCLUSION: The aim of this report was to discuss the administration period of BP in the treatment of osteoporosis, the decision-making and clinical management of severe MRONJ and the indications for dental implant placement in these specific patients. [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 (2015), 48(1), 65-68

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 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 (2015), 25(1), 20-25

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 detailValidation des paramètres de marche par un système accélérométrique (Locométrix*) à l'aide d'un système opto-électronique 3D (Coda Motion )
GILLAIN, Sophie ULg; Schwartz, Cédric ULg; Boutaayamou, Mohamed ULg et al

in Gériatrie et Psychologie Neuropsychiatrie du Vieillissement (2014), 12(supplément 3),

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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 detailLE ROLE DU TRADIPRATICIEN DANS L’OFFRE DES SOINS DE SANTE DE PROXIMITE EN ZONES DE SANTE SEMI-RURALES : RESULTATS D’UNE ETUDE MENEE DANS LA COMMUNE PERIPHERIQUE DE KISENSO A KINSHASA, CONGO.
Manzambi Kuwekita, Joseph ULg; Bruyère, Olivier ULg; REGINSTER, Jean-Yves ULg

in Journal d’Épidémiologie et de Santé Publique (2014), XIII

Cette étude examine la perception du tradipraticien par les populations et les services publics de Kisenso, afin d’envisager son intégration dans le système de santé, par des focus groupes en 2013. Selon ... [more ▼]

Cette étude examine la perception du tradipraticien par les populations et les services publics de Kisenso, afin d’envisager son intégration dans le système de santé, par des focus groupes en 2013. Selon les principaux résultats de cette étude, 100% de participants reconnaissent l’existence des tradipraticiens auxquels tous ont déjà eu recours. 80% déclarent efficaces les soins offerts par les tradipraticiens, mais reprochent à ces derniers le manque d’hygiène dans la manipulation des produits. Le recours aux tradipraticiens est justifié notamment par l’efficacité des soins, le type de maladie dont souffre le patient, la possibilité de paiement à crédit et la proximité. Les acteurs publics reconnaissent tant l’existence des tradipraticiens que leur efficacité et déplorent leur fonctionnement dans la clandestinité. Les tradipraticiens, qui se déclarent généralistes (60%) ou spécialistes (40%), disent fonctionner dans l’illégalité à cause du coût d’actes administratifs et de la méfiance envers les intellectuels et les praticiens de la biomédecine. les tradipraticiens déplorent l’insolvabilité des patients qui n’honorent pas leurs engagements. Pour intégrer efficacement les tradipraticiens dans le système de santé, il sera utile de supprimer les barrières administratives qui leur sont imposées , leur donner accès à des formations et les considérer comme acteurs à part entière du système sanitaire, et étudier les possibilités d’une contractualisation. [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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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 (2014), 128

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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