Risk Factors for Mucormycosis in COVID-19 Patients

: Opportunistic infections, such as mucormycosis, in coronavirus disease 2019 (COVID-19) patients has become a new health challenge. Since opportunistic infections can exacerbate COVID-19 patients' status, it is vital to identify the risk factors to prevent, diagnose, and treat them as soon as possible. Viral, fungal, environmental, and host factors may be responsible for this situation. Long hospital stays, impaired host immune system function due to viral infection, and excessive consumption of glucocorticoids in managing COVID-19 patients are the main risk factors for the increased risk of mucormycosis in COVID-19 patients. Educating health care workers and considering the association between mucormycosis of the paranasal sinuses and different strains of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as the cause of COVID-19 can help prevent invasive fungal sinusitis in COVID-19 patients.

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Biologic-Induced Infections in Inflammatory Bowel Disease: The TNF-α Antagonists

Annals of Pharmacotherapy ◽

10.1177/1060028018754896 ◽

2018 ◽

Vol 52 (6) ◽

pp. 571-579 ◽

Cited By ~ 4

Author(s):

Sean M. McConachie ◽

Sheila M. Wilhelm ◽

Ashish Bhargava ◽

Pramodini B. Kale-Pradhan

Keyword(s):

Risk Factors ◽

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Opportunistic Infections ◽

Case Series ◽

Infectious Risk ◽

Increased Risk ◽

Tnf Α ◽

Inflammatory Bowel ◽

Meta Analyses

Objective: To review the mechanism and association of infectious risk among the tumor-necrosis factor α (TNF-α) antagonists used in inflammatory bowel disease. Data Sources: A PubMed literature search was performed using the following search terms: infliximab, adalimumab, certolizumab, golimumab, inflammatory bowel disease, crohn’s, ulcerative colitis, adverse effects, adverse events, safety, and infection. Study Selection and Data Extraction: Meta-analyses and cohort studies with outcomes pertaining to quantitative infectious risk were reviewed. Case reports and case series describing association between TNF-α inhibitors and infection were also reviewed. Data Synthesis: A total of 7 recent meta-analyses of randomized trials demonstrate inconclusive association of infection with TNF-α antagonists. Registry data suggest that medications carry an independent risk of opportunistic infections. Risk factors for infection include older age, malnutrition, diabetes, and possibly combination therapy. Reported infections vary widely but include intracellular and granulomatous bacteria, viruses, and fungi. Conclusion: TNF-α antagonists are associated with an increased risk of opportunistic infection, although this risk has not been demonstrated conclusively in randomized controlled trials. Knowledge of concomitant risk factors, mechanism of infectious risk, and available treatment options can improve patient care in the clinical setting.

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HIV Associated Risk Factors for Ischemic Stroke and Future Perspectives

International Journal of Molecular Sciences ◽

10.3390/ijms21155306 ◽

2020 ◽

Vol 21 (15) ◽

pp. 5306

Author(s):

Saifudeen Ismael ◽

Mohammad Moshahid Khan ◽

Prashant Kumar ◽

Sunitha Kodidela ◽

Golnoush Mirzahosseini ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Hiv Infection ◽

Opportunistic Infections ◽

Experimental Studies ◽

Chronic Administration ◽

Cerebrovascular Diseases ◽

Vascular Abnormalities ◽

Increased Risk ◽

The Impact

Although retroviral therapy (ART) has changed the HIV infection from a fatal event to a chronic disease, treated HIV patients demonstrate high prevalence of HIV associated comorbidities including cardio/cerebrovascular diseases. The incidence of stroke in HIV infected subjects is three times higher than that of uninfected controls. Several clinical and postmortem studies have documented the higher incidence of ischemic stroke in HIV infected patients. The etiology of stroke in HIV infected patients remains unknown; however, several factors such as coagulopathies, opportunistic infections, vascular abnormalities, atherosclerosis and diabetes can contribute to the pathogenesis of stroke. In addition, chronic administration of ART contributes to the increased risk of stroke in HIV infected patients. Concurrently, experimental studies in murine model of ischemic stroke demonstrated that HIV infection worsens stroke outcome, increases blood brain barrier permeability and increases neuroinflammation. Additionally, residual HIV viral proteins, such as Trans-Activator of Transcription, glycoprotein 120 and Negative regulatory factor, contribute to the pathogenesis. This review presents comprehensive information detailing the risk factors contributing to ischemic stroke in HIV infected patients. It also outlines experimental evidence demonstrating the impact of HIV infection on stroke outcomes, in addition to possible novel therapeutic approaches to improve these outcomes.

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Incidence and risk factors for pressure injuries in adults in specialised medical care: a prospective observational study

Journal of Wound Care ◽

10.12968/jowc.2021.30.11.945 ◽

2021 ◽

Vol 30 (11) ◽

pp. 945-953

Author(s):

Sanna Stoltenberg ◽

Jaana Kotila ◽

Anniina Heikkilä ◽

Tarja Kvist ◽

Kristiina Junttila

Keyword(s):

Risk Factors ◽

Medical Care ◽

Injury Risk ◽

Assessment Tool ◽

Conflicts Of Interest ◽

Target Group ◽

Older Age ◽

Increased Risk ◽

Pressure Injury ◽

Hospital Stays

Introduction: Hospital-acquired pressure injuries are one of the most important indicators of quality patient care. It is important to identify high-risk patients to guide the implementation of appropriate prevention strategies. This can be done by using an assessment tool that covers the main risk factors for pressure injuries. Aim: The purpose of the study was to describe the incidence of pressure injuries and the associated risk factors among patients assessed with the Prevent Pressure Injury (PPI) risk assessment tool developed by the Helsinki University Hospital. Method: The study was conducted by selecting six wards from medical, surgical and neurological units. The target group were the patients being treated in the study units who gave their informed consent. The research data were retrieved from electronic patient records. Results: From the target group, 332 patients were eligible to participate in the study. The pressure injury risk was found to increase with longer hospital stays and older age. Surgical patients had an increased risk of pressure injuries compared to other specialty fields. A primary diagnosis of musculoskeletal or connective tissue disease, and secondary diagnoses of hypertension and cerebral haemorrhage, were linked with an increased pressure injury risk. A total of nine pressure injuries occurred in nine patients, with an incidence of 2.5% (stages II−IV). Conclusion: The observation and recording of pressure injuries in specialised medical care remain insufficient. Longer hospital stays, older age and surgery increase pressure injury risk. Also, patients' primary and secondary diagnoses may increase the pressure injury risk. Declaration of interest: The authors have no conflicts of interest to declare.

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Preventing Coronavirus Disease 2019 in Kidney Transplant Recipients: Where Should We Begin?

Nephron ◽

10.1159/000515165 ◽

2021 ◽

pp. 1-5

Author(s):

Leonardo V. Riella ◽

Jamil R. Azzi ◽

Paolo Cravedi

Keyword(s):

Risk Factors ◽

General Population ◽

Kidney Transplant ◽

Opportunistic Infections ◽

Population Data ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Viral Spread ◽

Increased Risk ◽

The Uk

Context: Chronic immunosuppression is associated with an increased risk of opportunistic infections. Although kidney transplant recipients with coronavirus disease 2019 (COVID-19) have higher mortality than the general population, data on their risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are unknown. Subject of Review: A recent single-center screening study from the UK (Transplantation. 2021 Jan 1;105(1):151–7) showed that 89 (10.4%) of 855 consecutive kidney transplant recipients tested positive for SARS-CoV-2 antibodies. Risk factors for infection included a nonwhite background, diabetes, and a history of allograft rejection. Risk factors for mortality in individuals who developed COVID-19 were older age and receiving steroids. Second Opinion: This study shows that the rate of SARS-CoV-2 infection in kidney transplant recipients is similar to the one observed in the general population in the same area (13%), indicating that transplant recipients are not at increased risk of COVID-19. However, the investigators raise the interesting point that since transplant individuals were advised to shelter earlier than the general population, they may be in fact more susceptible. This statement is hard to substantiate, but the identification of specific risk factors for infection and poor outcomes is crucial to tailor strategies to prevent spread of the infection. This is particularly important, considering that kidney transplant recipients may be at increased risk of prolonged viral spread and in-host viral mutations, making them not just a particularly fragile population for COVID-19 but also a potentially major source of further contagions.

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QuantiFERON-TB Gold Plus Testing for the Detection of LTBI in Health Care Workers in the Kyrgyz Republic

10.21203/rs.3.rs-366339/v1 ◽

2021 ◽

Author(s):

Caroline Susan Corbett ◽

Gulmira Kalmambetova ◽

Nagira Umetalieva ◽

Sevim Ahmedov ◽

Uladzimir Antonenka ◽

...

Keyword(s):

Risk Factors ◽

Health Care ◽

Health Care Workers ◽

Multiple Comparisons ◽

Small Sample ◽

Kyrgyz Republic ◽

Care Workers ◽

Increased Risk ◽

Job Position

Abstract Background: Health care workers (HCW) are at increased risk of TB infection due to their close contact with infected patients with active TB. The objectives of the study were (1) to assess the prevalence of LTBI among HCW in major TB hospitals of the Northern Kyrgyz Republic, and (2) to determine the association of LTBI with certain job positions, hospital units, or hospitals. Methods: HCWs from 4 TB hospitals in the Northern Kyrgyz Republic were tested with the interferon-gamma release assay (IGRA) Quantiferon-TB Gold plus (QFT) for the detection of an immune response to TB as marker of TB infection. Age was controlled for as a confounder. Univariate and multivariable analysis were performed using logistic regression to assess the association of the risk factors (age, job position, and hospital unit) with having a QTF positive result. Firth’s penalized-likelihood estimates were used for determining the odd’s of QFT positivity to account for the small-sample size. Pairwise comparisons using the Bonferroni correction (conservative) and comparisons without adjusting for multiple comparisons (unadjusted) were used to identify the categories where differences occurred.Results: QFT yielded valid results for 404 HCW, with 189 (47%) that had a positive test. In the National Tuberculosis Center, there was an increased odds to have a positive QFT test for the position of physician (OR=8.7, 95%, CI=1.2-60.5, p=0.03) and laboratory staff (OR=19.8, 95% CI=2.9-135.4, p<0.01) when administration staff was used as the baseline and controlling for age. No job position was found to have a significantly higher odds of positivity following a pairwise analysis controlling for multiple comparisons. Fifteen of the 49 HCW with follow-up tests converted from negative to positive at follow-up testing. Conclusions: This is the first report on prevalence and risk factors of LTBI for HCW in the Kyrgyz republic, and results indicate an increased risk for LTBI among physicians and laboratory personnel.

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FRI0141 CHARACTERIZATION OF SERIOUS INFECTIONS WITH UPADACITINIB IN PATIENTS WITH RHEUMATOID ARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.2761 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 654-655

Author(s):

K. Winthrop ◽

L. Calabrese ◽

F. Van den Bosch ◽

K. Yamaoka ◽

C. Selmi ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Risk Factors ◽

Cox Regression ◽

Opportunistic Infections ◽

Oral Candidiasis ◽

Univariate Analysis ◽

Janus Kinase ◽

Research Support ◽

Phase 3 ◽

Increased Risk

Background:Upadacitinib (UPA) is a selective and reversible Janus kinase (JAK) inhibitor with an approved dose of 15 mg once daily (QD) for the treatment of rheumatoid arthritis (RA). Patients (pts) receiving JAK inhibitors have been reported to be at increased risk of developing serious infection events (SIE) and opportunistic infections (OI).Objectives:To evaluate the incidence of SIEs and OIs in pts with RA receiving UPA and active comparators in the Phase 3 SELECT clinical trial program.Methods:The exposure-adjusted event rate (EAER) per 100 patient-years (E/100 PY) of SIEs and OIs was determined in pts receiving UPA in five randomized Phase 3 trials (SELECT-EARLY, SELECT-MONOTHERAPY, SELECT-NEXT, SELECT-COMPARE, and SELECT-BEYOND), of which four evaluated both UPA 15 mg and 30 mg QD doses and one (SELECT-COMPARE) evaluated only UPA 15 mg QD. Incidences of SIEs and OIs were also determined in pts receiving adalimumab (ADA) + methotrexate (MTX) in SELECT-COMPARE and MTX monotherapy in SELECT-EARLY. Data were analyzed descriptively, with no statistical comparisons between groups or doses. Risk factors for SIEs were determined using a univariate Cox regression model. The data cut-off was June 30, 2019.Results:Overall, 2629 pts who received UPA 15 mg, 1204 pts who received UPA 30 mg, 579 pts who received ADA + MTX, and 314 pts who received MTX monotherapy were included in this analysis. The EAERs (E/100 PYs [95% CI]) of SIEs were 3.2 (2.7–3.7) in the UPA 15 mg group, 5.7 (4.8–6.8) in the UPA 30 mg group, 3.9 (2.6–5.6) in pts receiving ADA + MTX, and 3.1 (1.7–5.2) in pts receiving MTX monotherapy. Pneumonia was the most common SIE, with EAERs (E/100 PYs [95% CI]) of 0.7 (0.5–1.0), 1.3 (0.9–1.9), 0.7 (0.2–1.5), and 0.7 (0.1–1.9) in the UPA 15 mg, UPA 30 mg, ADA + MTX, and MTX monotherapy groups, respectively. Rates of OIs (including oral candidiasis and disseminated herpes zoster [HZ]) (E/100 PYs [95% CI]) were 0.7 (0.5–1.0), 1.3 (0.9–1.9), 0.4 (0.1–1.1), and 0 (0–0) in the UPA 15 mg, UPA 30 mg, ADA + MTX, and MTX monotherapy groups, respectively. Oral candidiasis was the most frequent OI with EAERs (E/100 PYs [95% CI]) of 0.4 (0.2–0.6) in the UPA 15 mg group, 0.6 (0.3–1.0) in the UPA 30 mg group, 0.4 (0.1–1.1) in the ADA + MTX group, and 0 (0–0) in the MTX monotherapy group. Serious adverse events of HZ were only reported in the UPA groups (0.2 E/100 PYs [95% CI: 0.1–0.3] and 0.6 E/100 PYs [95% CI: 0.4–1.1] in the UPA 15 mg and 30 mg groups, respectively). Overall, there were 3 (4 coded events), 3, 1, and 0 pts who had active tuberculosis events in the UPA 15 mg, UPA 30 mg, ADA + MTX, and MTX monotherapy groups, respectively. Risk factors for SIEs are shown in the Figure. For both UPA doses, age ≥75 years and smoking were noted to have hazard ratios >1.Conclusion:The incidence rate of SIEs and OIs was higher in the UPA 30 mg group than the UPA 15 mg group. SIEs observed with UPA 15 mg were similar to that seen with ADA although the rates of HZ were higher on UPA. Pts with RA who are ≥75 years old and/or smokers may be at higher risk than other pts with RA for SIEs while receiving UPA.Figure.Univariate analysis of SIE risk factorsDisclosure of Interests:Kevin Winthrop Grant/research support from: Bristol-Myers Squibb, Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly, Galapagos, Gilead, GSK, Pfizer Inc, Roche, UCB, Leonard Calabrese Consultant of: AbbVie, GSK, Bristol-Myers Squibb, Genentech, Janssen, Novartis, Sanofi, Horizon, Crescendo, and Gilead, Speakers bureau: Sanofi, Horizon, Crescendo, Novartis, Genentech, Janssen, and AbbVie, Filip van den Bosch Consultant of: AbbVie, Celgene Corporation, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, and UCB, Speakers bureau: AbbVie, Celgene Corporation, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, and UCB, Kunihiro Yamaoka Speakers bureau: AbbVie GK, Astellas Pharma Inc., Bristol-Myers Squibb, Chugai Pharmaceutical Co. Ltd, Mitsubishi-Tanabe Pharma Corporation, Pfizer Japan Inc., and Takeda Pharmaceutical Company Ltd, Carlo Selmi Grant/research support from: AbbVie, Janssen, MSD, Novartis, Pfizer, Celgene, and Leo Pharma, Consultant of: Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, Roche, and Sanofi-Regeneron, Speakers bureau: AbbVie, Aesku, Alfa-Wassermann, Bristol-Myers Squibb, Biogen, Celgene, Eli-Lilly, Grifols, Janssen, MSD, Novartis, Pfizer, Roche, Sanofi-Genzyme, UCB Pharma, Yanna Song Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Barbara Hendrickson Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Ivan Lagunes-Galindo Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Iain McInnes Grant/research support from: Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Janssen, and UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Gilead, Janssen, Novartis, Pfizer, and UCB

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Venous Thromboembolism Requiring Extended Anticoagulation Among HIV-Infected Patients in a Rural, Resource-Constrained Setting in Western Kenya

Annals of Pharmacotherapy ◽

10.1177/1060028016686106 ◽

2017 ◽

Vol 51 (5) ◽

pp. 380-387 ◽

Cited By ~ 3

Author(s):

John Kanyi ◽

Rakhi Karwa ◽

Sonak Dinesh Pastakia ◽

Imran Manji ◽

Simon Manyara ◽

...

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Opportunistic Infections ◽

Univariate Analysis ◽

Retrospective Chart Review ◽

International Normalized Ratio ◽

Western Kenya ◽

Adjusted Analysis ◽

Healthcare Data ◽

Increased Risk

Background: HIV-infected patients are at an increased risk of developing venous thromboembolism (VTE), and minimal data are available to describe the need for extended treatment. Objective: To evaluate the frequency of and determine predictive risk factors for extended anticoagulation of VTE in HIV-infected patients in rural, western Kenya. Methods: A retrospective chart review was conducted at the Anticoagulation Monitoring Service affiliated with Moi Teaching and Referral Hospital and the Academic Model Providing Access to Healthcare. Data were collected on patients who were HIV-infected and receiving anticoagulation for lower-limb deep vein thrombosis. The need for extended anticoagulation, defined as receiving ≥7 months of warfarin therapy, was established based on patient symptoms or Doppler ultrasound–confirmed diagnosis. Evaluation of the secondary outcomes utilized a univariate analysis to identify risk factors associated with extended anticoagulation. Results: A total of 71 patients were included in the analysis; 27 patients (38%) required extended anticoagulation. The univariate analysis showed a statistically significant association between the need for extended anticoagulation and achieving a therapeutic international normalized ratio within 21 days in both the unadjusted and adjusted analysis. Patients with a history of opportunistic infections required an extended duration of anticoagulation in the adjusted analysis: odds ratio = 3.42; 95% CI = 1.04-11.32; P = 0.04. Conclusions: This study shows that there may be a need for increased duration of anticoagulation in HIV-infected patients, with a need to address the issue of long-term management. Guideline recommendations are needed to address the complexity of treatment issues in this population.

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Cumulative incidence of SARS-CoV-2 infection and associated risk factors among frontline health care workers in Paris, France: the SEROCOV prospective cohort study

10.1101/2021.03.09.21253200 ◽

2021 ◽

Author(s):

Pierre Hausfater ◽

David Boutolleau ◽

Karine Lacombe ◽

Alexandra Beurton ◽

Margaux Dumont ◽

...

Keyword(s):

Risk Factors ◽

Health Care ◽

Cohort Study ◽

Intensive Care ◽

Confidence Interval ◽

Health Care Workers ◽

Rt Pcr ◽

First Line ◽

Care Workers ◽

Increased Risk

AbstractBackgroundWith the COVID-19 pandemic, documenting whether health care workers (HCWs) are at increased risk of SARS-CoV-2 contamination and identifying risk factors is of major concern.MethodsIn this multicenter prospective cohort study, HCWs from frontline departments were included in March and April 2020 and followed for 3 months. SARS-CoV-2 serology was performed at month 0 (M0), M1, and M3 and RT-PCR in case of symptoms. The primary outcome was laboratory-confirmed SARS-CoV-2 infection at M3. Risk factors of laboratory-confirmed SARS-CoV-2 infection at M3 were identified by multivariate logistic regression.ResultsAmong 1,062 HCWs (median [interquartile range] age, 33 [28-42] years; 758 [71.4%] women; 321 [30.2%] physicians), the cumulative incidence of SARS-CoV-2 infection at M3 was 14.6% (95% confidence interval [CI] [12.5; 16.9]). Risk factors were the working department specialty, with increased risk for intensive care units (odds ratio 1.80, 95%CI [0.38; 8.58]), emergency departments (3.91 [0.83; 18.43]) and infectious diseases departments (4.22 [0.92; 18.28]); active smoking was associated with reduced risk (0.36 [0.21; 0.63]). Age, sex, professional category, number of years of experience in the job or department, and public transportation use were not significantly associated with laboratory-confirmed SARS-CoV-2 infection at M3.ConclusionThe rate of SARS-CoV-2 infection in frontline HCWs was 14.6% at the end of the first COVID-19 wave in Paris and occurred mainly early. The study argues for an origin of professional in addition to private life contamination and therefore including HCWs in the first-line vaccination target population. It also highlights that smokers were at lower risk.Key messagesDuring the first epidemic wave, 14.6% of 1,062 first-line Health Care Workers had a positive serology and/or RT-PCR test for SARS-CoV-2.Most infections occurred earlyRisk was increased by working in infectious diseases (OR 4.22, 95% confidence interval [0.92; 18.28]), emergency (3.91 [0.83; 18.43]) and intensive care units (1.80, [0.38; 8.58])Being an active smoker was protective (0.36 [0.21; 0.3]).

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Professional practice for COVID-19 risk reduction among health care workers: a Cross-Sectional Study with Matched Case-Control Comparison

10.1101/2021.09.09.21263315 ◽

2021 ◽

Author(s):

Sarah Wilson ◽

Audrey Mouet ◽

Camille Jeanne-Leroyer ◽

France Borgey ◽

Emmanuelle Odinet-Raulin ◽

...

Keyword(s):

Risk Factors ◽

Health Care ◽

Professional Practice ◽

Health Care Workers ◽

Case Control ◽

Risk Of Infection ◽

Case Control Studies ◽

Cross Sectional ◽

Care Workers ◽

Increased Risk

AbstractBackgroundHealth care workers (HCWs) are particularly exposed to COVID-19 and therefore it is paramount to study preventive measures in this population.AimTo investigate socio-demographic factors and professional practice associated with the risk of COVID-19 among HCWs in health establishments in Normandy, FranceMethodsA cross-sectional and 3 case-control studies were conducted in order to explore the possible risk factors that lead to SARS-CoV2 transmission within HCWs, based on an online questionnaire. The case-control studies focused on risk factors associated with care of COVID-19 patients, care of non COVID-19 patients and contacts between colleagues.FindingsAmong 2,058 respondents, respectively 1,363 (66.2%) and 695 (33.8%) in medical and medico-social establishments, 301 (14.6%) reported having been infected by SARS-CoV2. When caring for COVID-19 patients, HCWs who declared wearing respirators, either for all patient care (ORa 0.39; 95% CI: 0.29-0.51) or only when exposed to aerosol-generating procedures (ORa 0.56; 95% CI: 0.43-0.70), had a lower risk of infection compared with HCWs who declared wearing mainly surgical masks. During care of non COVID-19 patients, wearing mainly a respirator was associated with a higher risk of infection (ORa 1.84; 95% CI: 1.06-3.37). An increased risk was also found for HCWs who changed uniform in workplace changing rooms (ORa 1.93; 95% CI: 1.63-2.29).ConclusionCorrect use of PPE adapted to the situation and risk level is essential in protecting HCWs against infection.

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Therapeutic options in male osteoporosis

Osteologie/Osteology ◽

10.1055/s-0038-1630134 ◽

2013 ◽

Vol 22 (04) ◽

pp. 271-276 ◽

Cited By ~ 1

Author(s):

P. Farahmand ◽

J. D. Ringe

Keyword(s):

Risk Factors ◽

Vitamin D ◽

Public Health Problem ◽

Male Osteoporosis ◽

Individual Risk ◽

Modes Of Action ◽

Increased Risk ◽

Study Results ◽

Long Term Treatment ◽

Male Patients

SummaryOsteoporosis in men is increasingly recognized as an important public health problem but affected patients are still under-diagnosed and -treated. As in women the diagnostic and therapeutic strategy has to be adapted to the individual case. In the practical management it is very important to detect possible causes of secondary osteoporosis, to explain the possibilities of basic therapy counteracting individual risk factors and communicate that osteoporosis is a chronic disease and adherence to a long-term treatment is crucial. In established severe osteoporosis a careful analgesic therapy is important to avoid further bone loss related to immobility. In elderly men with increased risk of falling insufficient Vitamin D supply or impaired activation of Vitamin D due to renal insufficiency must be taken into consideration. Specific medications available today for the treatment of male osteoporosis comprise among antiresorptive drugs the bis phosphonates alendronate, risedronate and zoledronic acid. Denosumab, the first biological therapy is approved for men with androgen deprivation therapy for prostate cancer. An important advantage of this potent antiresorptive drug is the increased adherence due to the comfortable application by sixmonthly subcutaneous injections. Study results from the 2-year multi-center randomized controlled ADAMO-Study will very soon allow the use of denosumab in all types of male osteoporosis. Teriparatide, the 34 N-terminal amino acid sequence of parathyroid hormone was approved for men with osteoporosis as an anabolic agent based on proven efficacy by different studies. Among drugs with other modes of action the D-hormone pro-drug alfacalcidol can be used in men alone or in combination with the advantage of pleiotropic effects on calcium absorption, parathyroids, bone and muscle. Recently also Strontium-ranelate was approved for male patients with the limitation to exclude men with clinical relevant cardiovascular risk factors. In general the possibilities to treat male osteoporosis have considerably improved during recent years. Today there is a choice of a spectrum of drugs from mild to strong potency with different modes of action on bone turnover to design strategies for individual male patients.

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