Alendronic acid 70mg / Colecalciferol 140microgram tablets

Vitamin D has been shown to have multiple pleiotropic effects beyond bone and mineral metabolism, with purported roles in cardiovascular disease, cancer, and host immunity. Vitamin D deficiency is common in patients with end-stage kidney disease (ESKD); however, current clinical practice has favored the use of the active hormone. Whether vitamin D deficiency should be corrected in patients with ESKD remains unclear, as few randomized trials have been conducted. In this systematic review, we summarize the current evidence examining whether vitamin D supplementation improves outcomes, beyond mineral metabolism, in patients with ESKD. Data from randomized controlled trials of adults with ESKD were obtained by searching Ovid MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and the Web of Science Core Collection from inception to February 2023. Twenty-three trials composed of 2489 participants were identified for inclusion. Data were synthesized by two independent reviewers and summarized in tables organized by outcome. Outcomes included measures of mortality, cardiovascular disease, inflammation, muscle strength/function, nutrition, patient well-being, and outcomes specific to ESKD including erythropoietin usage, pruritus, and dialysis access maturation. The Cochrane risk of Bias Tool (RoB 2, 2019) was used to assess study quality. Overall, our findings indicate a minimal and varied benefit of native vitamin D supplementation. From the largest studies included, we determine that vitamin D has no demonstrated effect on patient-reported measures of well-being or utilization of erythropoietin, nor does it change levels of the inflammation biomarker C-reactive protein. Included trials were heterogeneous with regards to outcomes, and the majority studied small participant populations with a relatively short follow-up. We conclude that vitamin D supplementation corrects vitamin D deficiency and is safe and well-tolerated in humans with ESKD. However, it is not clear from clinical trials conducted to date that a causal pathway exists between 25(OH)D and pleiotropic effects that is responsive to vitamin D treatment.

Abstract licence: CC BY

Despite the proposed role of the gut microbiota-bone axis, findings on the association between probiotic consumption and bone health are conflicting. This systematic review aimed to assess the effect of probiotic consumption on bone health parameters. A systematic literature search of relevant reports published in PubMed/Medline, Web of Science, SCOPUS, EMBASE, and Google scholar before December 2020 was conducted. All clinical trials or experimental studies, which examined the relationship between probiotic consumption and bone health parameters, were included. No limitation was applied during the search. After screening articles based on inclusion criteria, 44 studies remained. In clinical trials, probiotic consumption affects bone health parameters such as serum calcium levels (3.82; 95% CI: 1.05, 6.59 mmol/l), urinary calcium levels (4.85; 95% CI: 1.16, 8.53 mmol/l), and parathyroid hormone (PTH) levels (-5.53; 95% CI: -9.83, -0.86 ng/l). In most studies, Lactobacillus species such as L. helveticus, L. reuteri, and L. casei were consumed and women aged 50 years or older were assessed. Spinal and total hip bone mineral density (BMD) was not affected significantly by probiotic consumption. In 37 animal experiments, probiotic or symbiotic feeding mostly had effects on bone health parameters. Some strains of Bifidobacterium and Lactobacillus including L. reuteri, L. casei, L. paracasei, L. bulgaricus, and L. acidophilus have indicated beneficial effects on bone health parameters. In conclusion, this systematic review and meta-analysis indicate that probiotic supplementation might improve bone health. Further studies are needed to decide on the best probiotic species and appropriate dosages.

Abstract licence: CC BY

ObjectiveThis study analyzed severe cutaneous adverse reactions (SCARs) linked to anti-osteoporosis drugs using FDA Adverse Event Reporting System (FAERS) data and characterized implicated drugs and clinical features through a literature review.MethodsA retrospective disproportionality analysis of SCAR reports from FAERS (2004-2024) utilized signal detection metrics, including reporting odds ratio (ROR), proportional reporting ratio (PRR), and Bayesian confidence propagation neural network (BCPNN). A structured literature search across PubMed, Web of Science, and Scopus gathered case reports of SCARs induced by anti-osteoporosis drugs.ResultsOf 77,789 SCAR reports, 399 (0.51%) involved anti-osteoporosis drugs, mainly affecting female patients (76.25%) with a median age of 69 years. Denosumab (24%), alendronate (23.25%), and zoledronic acid (17.13%) were most frequently reported. Significant signals included risedronic acid with erythema multiforme [ROR = 9.06; PRR = 9.03; information component (IC) = 3.17], zoledronic acid with cutaneous vasculitis (ROR = 3.15; PRR = 3.15; IC = 1.65), and alendronic acid with Stevens-Johnson syndrome (SJS) (ROR = 4.03; PRR = 4.02; IC = 2.00). The literature review (33 cases) confirmed a median symptom onset of 22 days, with treatments often involving corticosteroids and supportive care.ConclusionAnti-osteoporosis drugs, notably bisphosphonates and strontium ranelate, are rarely linked to SCARs but may cause serious consequences. Increased clinical awareness, pre-treatment risk evaluation, and vigilant monitoring are essential for at-risk patients.

Abstract licence: CC BY