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Revision of an anterior lumbar interbody fusion (ALIF) nonunion
Published in Gregory D. Schroeder, Ali A. Baaj, Alexander R. Vaccaro, Revision Spine Surgery, 2019
Edward Delsole, Rishi Sharma, Gregory D. Schroeder
The etiology of nonunion should be ascertained, and, if possible, optimized prior to undertaking a revision operation. The authors of this technique recommend preoperative smoking cessation at least 2 weeks prior to reoperation with maintenance of a smoke-free lifestyle for at least 2 months postoperatively. Patients with diabetes should have a baseline hemoglobin A1c measured to assess historical glycemic control. Tight glycemic control is suggested in the perioperative period. Osteoporosis may be an important factor to optimize in certain patients, and preoperative recombinant human parathyroid hormone (i.e., teriparatide) may be a valuable adjunct. As a rule, infection should always be ruled out with laboratory testing or preoperative image-guided biopsy and culture.
Precision medicine in osteoporosis and bone diseases
Published in Debmalya Barh, Precision Medicine in Cancers and Non-Communicable Diseases, 2018
Fatmanur Hacievliyagil Kazanci, Fatih Kazanci, M. Ramazan Yigitoglu, Mehmet Gunduz
Recombinant human parathyroid hormone analogues are potent bone anabolic agents (Bhandari et al., 2016) and teriparetide is FDA-approved for osteoporosis treatment in patients at high risk for fracture. Teriparetide initially increases bone formation but subsequently also resorption, so its benefits are quickly lost (Harslof and Langdahl, 2016). Therefore, it is recommended to use an antiresorptive agent following teriparetide treatment (Black et al., 2005).
Metabolic and endocrine bone disorders
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Parathyroid hormone Preotact and Teriparatide (recombinant human parathyroid hormone 1–34) are anabolic agents, given intermittently at low doses that stimulate bone formation to a greater and earlier extent than bone resorption (Pleiner-Duxneuner et al., 2009). They prevent fractures, prevent corticosteroid-induced osteoporosis and are occasionally used in unlicensed situations such as healing of nonunion or atypical femoral fractures.
Biodegradable polymers: an update on drug delivery in bone and cartilage diseases
Published in Expert Opinion on Drug Delivery, 2019
Ana Cláudia Lima, Helena Ferreira, Rui L. Reis, Nuno M. Neves
Although several treatments are currently available to reduce the impact of bone fragility, there is no alternative to restore bone strength with curative effects. Current treatments are limited to anti-resorptive drugs to reduce the bone-resorption rate (e.g. BPs, raloxifene and denosumab), and anabolic agents to increase the bone formation (e.g. recombinant human parathyroid hormone – rPTH- and estrogens). More recently, gene therapies, immunotherapies, and growth factors are in the development stage both in preclinical studies and clinical trials. Due to the lower vascularization of the bone in comparison with soft tissues, biologic agents are usually administered more frequently and at higher doses to have a therapeutic effect. Therefore, one of the most important and persistent problems of osteoporosis treatment is the long-term safety issues of the different current treatments.
Effects and mechanisms of natural plant active compounds for the treatment of osteoclast-mediated bone destructive diseases
Published in Journal of Drug Targeting, 2022
Qiang Xu, Zhiyou Cao, JiaQiang Xu, Min Dai, Bin Zhang, Qi Lai, Xuqiang Liu
Over the past 20 years, a variety of drugs to treat osteoclast-related diseases have emerged. They include bisphosphonates, recombinant human parathyroid hormone (rhPTH), denosumab [11–14], selective oestrogen receptor modulators, such as raloxifene and droloxifen [15], vitamin D analogs, and ipriflavone [16–18]. However, they are associated with adverse effects, such as onset of breast cancer, uterine cancer, ovarian cancer, endometrial carcinoma, stroke, heart attack, gallbladder disease, thrombogenesis, osteonecrosis of the jaw, and atypical fractures [12,19–22]. Therefore, these drugs are not ideal for chronic use to treat bone-destructive diseases; they may also not be suitable as oral medications.
Hypoparathyroidism concomitant with macrothrombocytopenia in an elderly woman with 22q11.2 deletion syndrome
Published in Platelets, 2018
Hsiu-Chien Yang, Shih-Hua Lin, Yi-Ying Wu, Chih-Chien Sung
22q11.2DS management remains challenging without an accurate diagnosis and individually depends on age, phenotype severity, and underlying disease. Teriparatide (recombinant human parathyroid hormone) and parental parathyroid transplantation is a promising novel method to treat patients with 22q11.2DS with chronic hypocalcemia or primary hypoparathyroidism (3). The standard treatment of hypocalcaemia is the use of elemental calcium and calcitriol supplements. In macrothrombocytopenia, most patients with 22q11.2DS lack a bleeding tendency; thus, only platelet transfusion should be considered during major surgery or bleeding.