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See detailEfficacy and safety of piroxicam revisited. A global meta-analysis of randomised clinical trials.
Richy, F.; Scarpignato, C.; Lanas, A. et al

in Pharmacological Research (2009), 60

BACKGROUND: The relative efficacy/safety profiles of traditional (non-selective) NSAIDs (t-NSAIDs) have been repeatedly challenged. To better understand the efficacy and safety profile of piroxicam, a ... [more ▼]

BACKGROUND: The relative efficacy/safety profiles of traditional (non-selective) NSAIDs (t-NSAIDs) have been repeatedly challenged. To better understand the efficacy and safety profile of piroxicam, a widely used NSAID, a meta-analysis of comparative RCTs was carried out according to the QUOROM guidance. METHODS: A systematic comprehensive research (years 1980-2006) of any comparative randomised controlled trial (of over 7-day duration) with piroxicam for the treatment of osteoarticular conditions was conducted. Conservative analyses were stratified by comparator, outcome, indication, duration, and doses. Publication bias and robustness were exhaustively investigated. RESULTS: Seventy-five comparative trials were ultimately included for analyses. Regarding global efficacy, piroxicam was more effective than naproxen [OR=1.37 (1.05; 1.77)] and nabumetone [OR=1.72 (1.26; 2.34)], while equivalent to other NSAIDS [OR=1.06 (0.96; 1.18)]. For pain and articular swelling, piroxicam was statistically equivalent to all other NSAIDs. For mobility, piroxicam appeared to be more effective than indomethacin, while equivalent to all other NSAIDs. Piroxicam was globally safer than other NSAIDs OR=0.84 [0.73; 0.96], notably indomethacin [OR=0.53 (0.43; 0.64], naproxen [OR=0.75 (0.65; 0.85)] and salicylates [OR=0.36 (0.17; 0.75)]. From a global GI safety point of view, piroxicam was better tolerated than indomethacin [OR=0.46 (0.36; 0.58)], naproxen [OR=0.66 (0.53; 0.83)] and salicylates [OR=0.45 (0.27; 0.78)] while less tolerated when compared to meloxicam [OR=1.49 (1.05; 2.13)]. Major GI effects were comparable among piroxicam users as in comparator drugs users [OR=1.33 (0.96; 1.84)], except for meloxicam [OR=2.37 (1.13; 4.97)]. The skin safety of piroxicam was statistically comparable to those of comparators [OR=1.01 (0.68; 1.51)]. CONCLUSION: This meta-analysis of RCTs support a similar to more favourable efficacy/safety profile of piroxicam as compared to other t-NSAIDs. [less ▲]

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See detailFlurbiprofen in the symptomatic management of rheumatoid arthritis: a valuable alternative
Richy, F.; Rabenda, Véronique ULg; Mawet, Audrey ULg et al

in International Journal of Clinical Practice (2007), 61(8), 1396-1406

Background: The withdrawal of certain cyclooxygenase-2 selective drugs and the availability of over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) have increased the pressure for researching ... [more ▼]

Background: The withdrawal of certain cyclooxygenase-2 selective drugs and the availability of over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) have increased the pressure for researching and prescribing conventional NSAIDs with a favourable efficacy/tolerance ratio in inflammatory diseases, particularly rheumatoid arthritis. The aim of this comprehensive meta-analysis was to evaluate the absolute and relative efficacy and safety of flurbiprofen in the management of rheumatoid arthritis. Methods: A systematic and exhaustive bibliographic research of published literature has been performed. The inclusion criteria are summarised as follows: randomised trial and rheumatoid arthritis and flurbiprofen and oral administration and anti-inflammatory doses from 100 to 300 mg and (placebo or aspirin or indomethacin or naproxen or ibuprofen or ketoprofen) and (articular pain or stiffness or swelling or mobility or patient/physician reported efficacy or tolerance or gastrointestinal (GI) tolerance). Studies were conducted from January 1975 to January 2006. Analyses have been stratified by comparisons and outcomes. Publication bias and robustness have been extensively investigated. Results: Fourteen studies, accounting for 1103 patient-years, have been included in the quantitative review. The mean daily doses administrated were 200 mg flurbiprofen, 4000 mg aspirin, 150 indomethacin, 750 mg naproxen and 1800 mg ibuprofen. Flurbiprofen was superior to placebo for all outcomes, and superior to three of four other NSAIDs in terms of formal symptomatic measures (pain, stiffness and swelling). Several patients or physicians reported the efficacy of flurbiprofen as superior to indomethacin and naproxen, while its safety, and particularly its GI tolerance were better compared with aspirin and indomethacin. Sensitivity analyses have reported a sufficient robustness against systematic publication bias assumptions. Conclusions: This meta-analysis has shown that flurbiprofen is an interesting alternative to commonly prescribed NSAIDs in the symptomatic management of rheumatoid arthritis, especially given its favourable efficacy/tolerance ratio. [less ▲]

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See detailLongitudinal study of magnetic resonance imaging and standard X-rays to assess disease progression in osteoarthritis
Bruyère, Olivier ULg; Genant, H.; Kothari, M. et al

in Osteoarthritis and Cartilage (2007), 15(1), 98-103

Objective: To investigate, over 1-year, the relationship between X-ray and magnetic resonance imaging (MRI) findings in patients with knee osteoarthritis (OA). Methods: Sixty-two osteoarthritic patients ... [more ▼]

Objective: To investigate, over 1-year, the relationship between X-ray and magnetic resonance imaging (MRI) findings in patients with knee osteoarthritis (OA). Methods: Sixty-two osteoarthritic patients (46 women) were followed for 1 year. At baseline and after 1 year, volume and thickness of cartilage of the medial tibia, the lateral tibia and the femur were assessed by MRI. A global score from the multi-feature whole-organ MRI scoring system (WORMS) was calculated for each patient at baseline and after 1 year. This score combined individual scores for articular cartilage, osteophytes, bone marrow abnormality, subchondral cysts and bone attrition in 14 locations. It also incorporated scores for the medial and lateral menisci, anterior and posterior cruciate ligaments, medial and lateral collateral ligaments and synovial distension. Lateral and medial femorotibial joint space width (JSW) measurements, performed by digital image analysis, were assessed from fixed-flexion, postero-anterior knee radiographs. Results: One-year changes in medial femoro-tibial JSW reach 6.7 (20.5) % and changes in medial cartilage volume and thickness reach 0.4 (16.7) % and 2.1 (11.3) %, respectively. Medial femoro-tibial joint space narrowing (JSN) after 1 year, assessed by radiography, was significantly correlated with a loss of medial tibial cartilage volume (r = 0.25, P = 0.046) and medial tibial cartilage thickness (r = 0.28, P = 0.025), over the same period. We found also a significant correlation between the progression of the WORMS and radiographic medial JSN over 1 year (r = -0.35, P = 0.006). All these results remained statistically significant after adjusting for age, sex and body mass index. Conclusion: This study shows a moderate but significant association between changes in JSW and changes in cartilage volume or thickness in knee joint of osteoarthritic patients. (C) 2006 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved. [less ▲]

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See detailDeterminants of gastro-protective drugs co-prescription during treatment with nonselective NSAIDs: a prospective survey of 2197 patients recruited in primary care
Rabenda, Véronique ULg; Burlet, N.; Belaiche, Jacques ULg et al

in Osteoarthritis and Cartilage (2006), 14(7), 625-630

Objective: Our goal was to identify the magnitude of gastro-protective drugs (GPDs) co-prescription and the profile of patients who received GPD co-prescription, during nonsteroidal anti-inflammatory ... [more ▼]

Objective: Our goal was to identify the magnitude of gastro-protective drugs (GPDs) co-prescription and the profile of patients who received GPD co-prescription, during nonsteroidal anti-inflammatory drugs (NSAIDs) treatment in a "real life setting" of primary care practice. Methods: A pragmatic prospective 6-month survey of 2197 new takers of nonselective NSAIDs, selected and followed by general practitioners (GPs) on the bias of their usual standards of care. Results: Forty-seven percent of our survey population used at least one GPD during the 6-month follow-up. No difference was identified between piroxicam, diclofenac, ibuprofen, meloxicam and nimesulid for the GPD co-prescription. Besides the presence of gastro-intestinal (GI) symptoms, previous use of GPD, previous occurrence of GI disorders and increase in age are the most prominent predictive factors of GPD use during NSAID treatment. When adjusted for other risk factors, co-prescription of GPD was significantly increased in patients aged 55 years and above (odds ratio (OR): 1.29, 95% confidence interval (Cl): 1.01-1.64) with no further increase in the co-prescription in older subjects. Conclusion: Patients above 55 years with previous history of GI symptoms or GPD use are more likely to benefit from cytoprotective medications. (C) 2006 OsteoArthritis Research Society International. Published by Elsevier Ltd. All rights reserved. [less ▲]

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See detailActivite antalgique de la glucosamine dans l'arthrose: quoi de neuf en 2006?
Reginster, Jean-Yves ULg; Richy, F.; Bruyère, Olivier ULg

in Revue Médicale de Liège (2006), 61(3), 169-72

Glucosamine is widely used as a symptom-modifying drug in osteoarthritis. New clinical trials, from Europe and the United-States bring some clarification regarding the optimal formulation and doses to be ... [more ▼]

Glucosamine is widely used as a symptom-modifying drug in osteoarthritis. New clinical trials, from Europe and the United-States bring some clarification regarding the optimal formulation and doses to be used in knee osteoarthritis. Their results are supported by new pharmacokinetic and preclinical studies, explaining the mode of action of glucosamine in osteoarthritis. [less ▲]

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See detailA simple method for detecting and adjusting meta-analyses for publication Bias
Richy, F.; Reginster, Jean-Yves ULg

in Internet Journal of Epidemiology (2006), 3(2),

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See detailInteret de la densitometrie osseuse dans le depistage et le suivi therapeu- tique des patients osteoporotiques: integration avec les facteurs cliniques et biologiques
Richy, F.; Lecart, Marie-Paule ULg; Mawet, A. et al

in Revue Médicale de Liège (2006), 61(5-6, May-Jun), 291-300

The diagnosis of osteoporosis and the monitoring of antiosteoporosis therapies imply a better and more rational use of bone densitometry. The optimal prescription modalities of this fundamental ... [more ▼]

The diagnosis of osteoporosis and the monitoring of antiosteoporosis therapies imply a better and more rational use of bone densitometry. The optimal prescription modalities of this fundamental examination are favorably correlated with the efficacy of modern therapeutics. The rationale of this article is to provide the general practitioner with a factual update on the diagnostic and prognostic use of bone densitometry. [less ▲]

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See detailDiagnosis of osteoporosis without prevalent fractures: are we missing our main target?
Richy, F.; Reginster, Jean-Yves ULg

in Osteoporosis Action (2006), 1

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See detailThree year joint space narrowing predicts long term incidence of knee surgery in patients with osteoarthritis: an eight year prospective follow up study
Bruyère, Olivier ULg; Richy, F.; Reginster, Jean-Yves ULg

in Annals of the Rheumatic Diseases (2005), 64(12), 1727-1730

OBJECTIVE: To assess the clinical relevance of mean and minimum femorotibial joint space narrowing (JSN) for predicting future osteoarthritis related surgery in patients with knee osteoarthritis. METHODS ... [more ▼]

OBJECTIVE: To assess the clinical relevance of mean and minimum femorotibial joint space narrowing (JSN) for predicting future osteoarthritis related surgery in patients with knee osteoarthritis. METHODS: 126 subjects with primary knee osteoarthritis were followed prospectively for a mean eight years. Minimum and mean joint space width (JSW) were assessed from standard x rays at baseline and after a follow up of three years. The rate of knee osteoarthritis related surgery was recorded for the following five years. RESULTS: After a mean follow up of eight years, 16 patients (12.7%) had received osteoarthritis related joint surgery. The areas under the curves (AUC) resulting from the receiver operating characteristic curve analyses for predicting osteoarthritis surgery were 0.73 (p=0.006) for minimum JSN and 0.55 (p=0.54) for mean JSN. The cut off for minimum JSN maximising sensitivity and specificity for predicting future surgery was a change of 0.7 mm or more in minimum joint space width over a period of three years. However, no meaningful differences were observed for cut off values between 0.5 and 0.8 mm The relative risk (adjusted for age, body mass index, baseline symptoms, and baseline JSW) of experiencing osteoarthritis related surgery during the eight year of follow up was 5.15 (95% confidence interval, 1.70 to 15.60) (p=0.004) in patients with a minimum joint space narrowing of 0.7 mm or more during the first three years of the study. CONCLUSIONS: A cut off of 0.5 to 0.8 mm in minimum JSN, measured on standard x rays, reflects a clinically relevant progression in patients with knee osteoarthritis. [less ▲]

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See detailImportance of alfacalcidol in clinical conditions characterized by high rate of bone loss
Reginster, Jean-Yves ULg; Lecart, M. P.; Richy, F.

in Journal of Rheumatology (2005), 32(Suppl. 76), 21-25

In postmenopausal osteoporosis, the administration of alfacalcidol to women resulted in an increase in trabecular bone mineral density (BMD), prevention of cortical bone loss, and a significant reduction ... [more ▼]

In postmenopausal osteoporosis, the administration of alfacalcidol to women resulted in an increase in trabecular bone mineral density (BMD), prevention of cortical bone loss, and a significant reduction in the incidence of further vertebral fractures. There is now robust evidence that alfacalcidol may be particularly active in conditions characterized by an increased rate of bone loss. Alfacalcidol 1 microg/day fully prevented vertebral bone loss over 3 years in women after the first year of menopause. In a large cohort of individuals starting treatment with high dose corticosteroid (CS, 46.6 mg equivalent prednisolone per day), the spinal bone loss observed in untreated patients was fully prevented by administration of 1 microg/day alfacalcidol. In patients with established CS-induced osteoporosis, with or without prevalent vertebral fractures, 1 microg/day of alfacalcidol, given for 3 years, increased lumbar spine density, reduced back pain, and showed a significant reduction in the rate of new vertebral fractures, compared to native vitamin D. In cardiac transplant recipients, alfacalcidol and calcium reduced spinal and femoral bone loss, compared to a control group treated with etidronate and calcium. Alfacalcidol-treated patients experienced fewer new vertebral fractures over the 2-year followup. When alfacalcidol and vitamin D3 were compared in elderly women with radiologic evidence of vertebral fracture, fractional calcium absorption was increased after 3 months with alfacalcidol but was unchanged with vitamin D3. In a recent metaanalysis of 14 studies of native vitamin D and 19 studies of D-hormone analogs (alfacalcidol and calcitriol), the D-analogs exerted a higher preventive effect on bone loss and fracture rates in patients with no exposure to CS. In head-to-head studies comparing D-analogs and native vitamin D in patients receiving CS, this metaanalysis identified significant effects favoring D-analogs for femoral neck BMD and spinal fractures. In conclusion, improvement in bone turnover, increase in BMD, and reduction in fracture rates have been described during alfacalcidol treatment in situations characterized by a high rate of bone loss, including CS-induced osteoporosis, early postmenopausal bone loss, and organ transplant. Compared to plain vitamin D, alfacalcidol exerts higher bone-protective effects, thus allowing the doses to be minimized and lowering the risk of adverse effects, including hypercalcemia. [less ▲]

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See detailPerformance of osteoporosis risk assessment tools in postmenopausal women aged 45-64 years
Gourlay, M. L.; Miller, W. C.; Richy, F. et al

in Osteoporosis International (2005), 16(8), 921-927

Osteoporosis risk factor assessment is of uncertain utility in women under 65 years of age. Previous comparative studies of osteoporosis risk assessment tools were not stratified by age. We compared the ... [more ▼]

Osteoporosis risk factor assessment is of uncertain utility in women under 65 years of age. Previous comparative studies of osteoporosis risk assessment tools were not stratified by age. We compared the discriminatory ability of three previously validated osteoporosis risk assessment tools in a referral population of postmenopausal women aged 45-64 years (n=2539) and aged 65-96 years (n=1496) seen at a university-based outpatient osteoporosis center in Belgium. Risk scores for the Osteoporosis Self-assessment Tool, Osteoporosis Risk Assessment Instrument, and Simple Calculated Osteoporosis Risk Estimation were calculated for each patient. The reference standard was osteoporosis at the femoral neck, defined as a T-score <=-2.5 based on bone mineral density measured by dual energy X-ray absorptiometry. Osteoporosis was present in 139 of 2539 (5.5%) women aged 45-64 years and 241 of 1496 (16.1%) women aged 65 years or older. The tools had similar overall discriminatory ability to identify women with osteoporosis [area under the ROC curve 0.750-0.768, P=0.23 for women aged 45-64 years; area under the ROC curve 0.745-0.762, P=0.06 for women aged 65 years or older (P > 0.05 indicates no difference among tools)]. The likelihood ratios for the high-risk score categories ranged from 3.60 to 6.73 for the younger women and 3.45 to 6.99 for the older women when different score thresholds were set to maximize the performance of each tool in each age group. We conclude that the diagnostic accuracy of three osteoporosis risk assessment tools was similar in postmenopausal women aged 45-64 years and women aged 65 years or older. Use of structured risk assessment tools to identify women at high risk of osteoporosis in the early postmenopausal period warrants further study. Of the three tools evaluated, the OST is the simplest and has the best potential for use in clinical practice. [less ▲]

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See detailD-Hormone analog alfacalcidol: an update on its role in post-menopausal osteoporosis and rheumatoid arthritis management
Richy, F.; Deroisy, Rita ULg; Lecart, Marie-Paule ULg et al

in Aging Clinical & Experimental Research (2005), 17(2), 133-142

Alfacalcidol (1-alpha-hydroxyvitamin D is a non-endogenous analog of vitamin D which can bypass the renal and intestinal regulatory mechanisms that control the production of calcitriol (1,25 ... [more ▼]

Alfacalcidol (1-alpha-hydroxyvitamin D is a non-endogenous analog of vitamin D which can bypass the renal and intestinal regulatory mechanisms that control the production of calcitriol (1,25-hydroxyvitamin D-3, the active form of vitamin D, D-Hormone). Alfiacalcidol may be metabolized into calcitriol with a limited risk of hypercalcemia. Alfacalcidol and calcitriol have been evaluated in animal and human studies assessing their effects on bone mineral density and fracture rates. More recently, they have been shown to produce beneficial effects in muscle, immune system, and autoimmune diseases, including rheumatoid arthritis. This paper discusses the therapeutic efficacy of alfacalcidol in reports in which it has been proposed as an interesting alternative to vitamin D or calcitriol. Some recent findings about general metabolism and regulation of vitamin D and its analogs are discussed. The biological and clinical effects of alfacalcidol in post-menopausal osteoporosis are reviewed, followed by critical appraisal of its efficacy in preventing bone loss and falls in the elderly. The lost two sections discuss the role of Danalogs in regulating the immune system, with particular regard to rheumatoid arthritis. The main results of this review show that alfacalcidol may have a wider range of therapeutic applicability, beyond simply restricting it to patients in hemodialysis or peritoneal dialysis with high serum levels of intact PTH. (c) 2005, Editrice Kurtis. [less ▲]

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See detailVitamin D analogs versus native vitamin D in preventing bone loss and osteoporosis-related fractures: A comparative meta-analysis
Richy, F.; Schacht, E.; Bruyère, Olivier ULg et al

in Calcified Tissue International (2005), 76(3), 176-186

It has been suggested that early postmenopausal women and patients treated with steroids should receive preventive therapy (calcium, vitamin D, vitamin D analogs, estrogens, or bisphosphonates) to ... [more ▼]

It has been suggested that early postmenopausal women and patients treated with steroids should receive preventive therapy (calcium, vitamin D, vitamin D analogs, estrogens, or bisphosphonates) to preserve their bone mineral density (BMD) and to avoid fragility fractures. We designed the present study to compare the effects of native vitamin D to its hydroxylated analogs alfacalcidol 1-alpha(OH)D and calcitriol 1,25(OH)(2)D. All randomized, controlled, double-blinded trials comparing oral native vitamin D and its analogs, alfacalcidol or calcitriol, to placebo or head-to-head trials in primary or corticosteroids-induced osteoporosis were included in the meta-analysis. Sources included the Cochrane Controlled Trials Register, EMBASE, MEDLINE, and a hand search of abstracts and references lists. The study period January 1985 to January 2003. Data were abstracted by two investigators, and methodological quality was assessed in a similar manner. Heterogeneity was extensively investigated. Results were expressed as effect-size (ES) for bone loss and as rate difference (RD) for fracture while allocated to active treatment or control. Publication bias was investigated. Fourteen studies of native vitamin D, nine of alfacalcidol, and ten of calcitriol fit the inclusion criteria. The two vitamin D analogs appeared to exert a higher preventive effect on bone loss and fracture rates in patients not exposed to glucocorticoids. With respect to BMD, vitamin D analogs versus placebo studies had an ES of 0.36 (P < 0.0001), whereas native vitamin D versus placebo had an ES of 0.17 (P = 0.0005), the interclass difference being highly significant (ANOVA-1, P < 0.05). When restricted to the lumbar spine, this intertreatment difference remained significant: ES = 0.43 (P = 0.0002) for vitamin D analogs and ES = 0.21 (P = 0.001) for native vitamin D (analysis of variance [ANOVA-1], P = 0.047). There were no significant differences regarding their efficacies on other measurement sites (ANOVA-1, P = 0.36). When comparing the adjusted global relative risks for fracture when allocated to vitamin D analogs or native vitamin D, alfacalcidol and calcitriol provided a more marked preventive efficacy against fractures: RD = 10% (95% Confidence interval [CI-2] to 17) compared to RD = 2% (95% CI, 1 to 2), respectively. The analysis of the spinal and nonspinal showed that fracture rates differed between the two classes, thereby confirming the benefits of vitamin D analogs, with significant 13.4% (95% CI 7.7 to 19.8) and. 6% (95% CI 1 to 12) lower fracture rates for vitamin D analogs, respectively. In patients receiving corticosteroid therapy, both treatments provided similar global ESs for BMD: ES = 0.38 for vitamin D analogs and ES = 0.41 for native vitamin D (ANOVA-1, P = 0.88). When restriced to spinal BMD, D analogs provided significant effects, whereas native vitamin D did not: ES = 0.43 (P < 0.0001) and ES = 0.33 (P = 0.21), respectively. The intertreatment difference was nonsignificant (ANOVA-1, P = 0.52). Neither D analogs for native vitamin D significantly prevented fractures in this subcategory of patients: RD = 2.6 (95%CI, -9.5 to 4.3) and RD = 6.4 (95%CI, -2.3 to 10), respectively. In head-to-head studies comparing D analogs and native vitamin D in patients receiving corticosteroids, significant effects favoring D analogs were found for femoral neck BMD: ES = 0.31 at P = 0.02 and spinal fractures: RD = 15% (95%CI, 6.5 to 25). Publication bias was not significant. Our analysis demonstrates a superiority of the D analogs atfacalcidol and calcitriol in preventing bone loss and spinal fractures in primary osteoporosis, including postmenopausal women. In corticosteroid-induced osteoporosis, the efficacy of D analogs differed depending on the comparative approach: indirect comparisons led to nonsignificant differences, whereas direct comparison did provide significant differences. In this setting, D analogs seem to prevent spinal fractures to a greater extent than do native vitamin D, but this assumption should be confirmed on a comprehensive basis in multiarm studies including an inactive comparator. [less ▲]

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See detailControlled whole body vibration to decrease fall risk and improve health-related quality of life of nursing home residents
Bruyère, Olivier ULg; Wuidart, M. A.; Di Palma, E. et al

in Archives of Physical Medicine & Rehabilitation (2005), 86(2), 303-307

Objective: To investigate the effects of whole body vibration in the elderly. Design: Randomized controlled trial. Setting: Nursing home. Participants: Forty-two elderly volunteers. Interventions: Six ... [more ▼]

Objective: To investigate the effects of whole body vibration in the elderly. Design: Randomized controlled trial. Setting: Nursing home. Participants: Forty-two elderly volunteers. Interventions: Six-week vibration intervention plus physical therapy (PT) (n=22) or PT alone (n=20). Main Outcome Measures: We assessed gait and body balance using the Tinetti test (maximum scores of 12 for gait, 16 for body balance, 28 for global score), motor capacity using the Timed Up & Go (TUG) test, and health-related quality of life (HRQOL) using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Results: After 6 weeks, the vibration intervention group improved by a mean +/- standard deviation of 2.4 +/- 2.3 points on the gait score compared with no score change in the control group (P<.001). The intervention group improved by 3.5 +/- 2.1 points on the body balance score compared with a decrease of 03 +/- 1.2 points in the control group (P<.001). TUG test time decreased by 11.0 +/- 8.6 seconds in the treated group compared with an increase of 2.6 +/- 8.8 seconds in the control group (P<.001). The intervention group had significantly greater improvements from baseline on 8 of 9 items on the SF-36 compared with the control group. Conclusions: Controlled whole body vibration can improve elements of fall risk and HRQOL in elderly patients. [less ▲]

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See detailVitamin D inadequacy : global prevalence and skeletal implications
Reginster, Jean-Yves ULg; Richy, F.; Rabenda, Véronique ULg et al

in BONE (2005), 36(S2), 462

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See detailThe therapeutic effects of alfacalcidol on bone strength, muscle metabolism and prevention of falls and fractures.
Schacht, E.; Richy, F.; Reginster, Jean-Yves ULg

in Journal of Musculoskeletal & Neuronal Interactions (2005), 5(3), 273-84

Established osteoporosis in older patients of both sexes is characterized by decoupled bone remodelling induced by sex hormone deficits and by somatopause, but also by lack of vitamin D and reduced ... [more ▼]

Established osteoporosis in older patients of both sexes is characterized by decoupled bone remodelling induced by sex hormone deficits and by somatopause, but also by lack of vitamin D and reduced synthesis of the D-Hormone (calcitriol; 1.25 (OH)2D) in the kidneys and bone, as well as from lack of receptors and/or receptor affinity for D-Hormone in the target organs. Parallel to the decreased bone strength a loss of muscle power occurs, together with an increase in balance disorders and an increasing risk of "intrinsic", nonsyncopal locomotoric falls. In alfacalcidol therapy, D-Hormone is provided to the body in circumvention of its own regulation, by means of which higher hormone concentrations can be achieved in the target tissues than by administration of plain vitamin D. In vitro and in vivo experiments have provided growing evidence that D-Hormone analogs tend to normalize PTH, lead to an increase in the number and activity of osteoblasts, reduce the activity of osteoclasts, and might thus normalize the "high bone turnover" in elderly osteoporotic patients ("supercoupling"). In addition, it has been shown that D-Hormone analogs are able to increase muscle power and walking distance in elderly D-Hormone deficient patients. Besides the known effect on the vertebral fracture rate, new clinical data confirm that D-Hormone analogs might reduce peripheral fractures by reducing falls. The expanded understanding of the pathogenesis of glucocorticoid- induced osteoporosis with its disturbed calcium homeostasis and the pharmacological effects of alfacalcidol, which counteract such iatrogenic bone loss, contribute to the understanding of its clinical efficacy in this most frequent form of secondary osteoporosis. Due to its recently discovered immunomodulating properties, alfacalcidol might find a slot in the management of bone loss caused by chronic inflammatory diseases or by organ transplantations. Alfacalcidol has multifactorial effects, among which the best known are its anti-bone loss and anti-fracture efficacies in postmenopausal osteoporosis. This demonstrated efficacy is related to its involvement in bone remodelling, leading to an improved bone strength. Its mode of action on muscle power, which reduces falls, is unique, differentiating this form of therapy from all other anti-osteoporotic drugs, none having demonstrated any influence on falls. [less ▲]

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See detailPrimary prevention of osteoporosis: Mass screening scenario or prescreening with questionnaires? An economic perspective
Richy, F.; Ethgen, Olivier ULg; Bruyère, Olivier ULg et al

in Journal of Bone and Mineral Research (2004), 19(12), 1955-1960

This study focuses on the controversy surrounding selective approaches to screen for osteoporosis. Seven screening approaches were compared in terms of cost-effectiveness and incremental cost ... [more ▼]

This study focuses on the controversy surrounding selective approaches to screen for osteoporosis. Seven screening approaches were compared in terms of cost-effectiveness and incremental cost-effectiveness ratios in a sample of 4035 postmenopausal women. Our results show that certain prescreening strategies are more efficient than DXA-based approaches. These results are of considerable value for health policy decision-makers and the scientific community. [less ▲]

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See detailDevelopment and validation of the ORACLE score to predict risk of osteoporosis
Richy, F.; Deceulaer, F.; Ethgen, Olivier ULg et al

in Mayo Clinic Proceedings (2004), 79(11), 1402-1408

OBJECTIVE: To develop and validate a composite index, the Osteoporosis Risk Assessment by Composite Linear Estimate (ORACLE), that includes risk factors and ultrasonometric outcomes to screen for ... [more ▼]

OBJECTIVE: To develop and validate a composite index, the Osteoporosis Risk Assessment by Composite Linear Estimate (ORACLE), that includes risk factors and ultrasonometric outcomes to screen for osteoporosis. SUBJECTS AND METHODS: Two cohorts of postmenopausal women aged 45 years and older, participated in the development (n = 407) and the validation (n = 202) of ORACLE. Their bone mineral density was determined by dual energy x-ray absorptiometry and quantitative ultrasonometry (QUS), and their historical and clinical risk factors were assessed (January to June 2003). Logistic regression analysis was used to select significant predictors of bone mineral density, whereas receiver operating characteristic (ROC) analysis was used to assess the discriminatory performance of ORACLE. RESULTS: The final logistic regression model retained 4 biometric or historical variables and 1 ultrasonometric outcome. The ROC areas under the curves (AUCs) for ORACLE were 84% for the prediction of osteoporosis and 78% for low bone mass. A sensitivity of 90% corresponded to a specificity of 50% for identification of women at risk of developing osteoporosis. The corresponding positive and negative predictive values were 86% and 54%, respectively, in the development cohort. In the validation cohort, the AUCs for identification of osteoporosis and low bone mass were 81% and 76% for ORACLE, 69% and 64% for QUS T score, 71% and 68% for QUS ultrasonometric bone profile index, and 76% and 75% for Osteoporosis Self-assessment Tool, respectively. ORACLE had the best discriminatory performance in identifying osteoporosis compared with the other approaches (P < .05). CONCLUSION: ORACLE exhibited the highest discriminatory properties compared with ultrasonography alone or other previously validated risk indices. It may be helpful to enhance the predictive value of QUS. [less ▲]

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See detailTime dependent risk of gastrointestinal complications induced by non-steroidal anti-inflammatory drug use: a consensus statement using a meta-analytic approach
Richy, F.; Bruyère, Olivier ULg; Ethgen, Olivier ULg et al

in Annals of the Rheumatic Diseases (2004), 63(7), 759-766

OBJECTIVES: To provide an updated document assessing the global, NSAID-specific, and time dependent risk of gastrointestinal (GI) complications through meta-analyses of high quality studies. METHODS: An ... [more ▼]

OBJECTIVES: To provide an updated document assessing the global, NSAID-specific, and time dependent risk of gastrointestinal (GI) complications through meta-analyses of high quality studies. METHODS: An exhaustive systematic search was performed. Inclusion criteria were: RCT or controlled study, duration of 5 days at least, inactive control, assessment of minor or major NSAID adverse effects, publication range January 1985 to January 2003. The publications retrieved were assessed during a specifically dedicated WHO meeting including leading experts in all related fields. Statistics were performed conservatively. Meta-regression was performed by regressing NSAID adjusted estimates against study duration categories. RESULTS: Among RCT data, indolic derivates provided a significantly higher risk of GI complications related to NSAID use than for non-users: RR = 2.25 (1.00; 5.08) than did other compounds: naproxen: RR = 1.83 (1.25; 2.68); diclofenac: RR = 1.73 (1.21; 2.46); piroxicam: RR = 1.66 (1.14; 2.44); tenoxicam: RR = 1.43 (0.40; 5.14); meloxicam: RR = 1.24 (0.98; 1.56), and ibuprofen: RR = 1.19 (0.93; 1.54). Indometacin users had a maximum relative risk for complication at 14 days. The other compounds presented a better profile, with a maximum risk at 50 days. Significant additional risk factors included age, dose, and underlying disease. The controlled cohort studies provided higher estimates: RR = 2.22 (1.7; 2.9). Publication bias testing was significant, towards a selective publication of deleterious effects of NSAIDs from small sized studies. CONCLUSION: This meta-analysis characterised the "compound" and "time" aspects of the GI toxicity of non-selective NSAIDs. The risk/benefit ratio of such compounds should thus be carefully and individually evaluated at the start of long term treatment. [less ▲]

Detailed reference viewed: 49 (10 ULg)
Peer Reviewed
See detailEpidemiology of lesions in high-level competition judo
Zinzen, E.; Vanbergen, Johanne; Clarijs, Jan Pieter et al

in Abstract Book of the 9th Annual Congress of the European College of Sports Science (2004, July)

Detailed reference viewed: 41 (0 ULg)