Clinical calcium
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Excessive actions of fibroblast growth factor 23(FGF23)result in several kinds of hypophosphatemic rickets and osteomalacia. A combination of oral active vitamin D3 and phosphate is the current standard therapy for FGF23-related hypophosphatemia. However, these medications can lead to long-term complications, such as secondary hyperparathyroidism and renal impairment. ⋯ The efficacy of anti-FGF23 antibody was confirmed in a Hyp mouse, a murine model of XLHR. A recent phase 1 double-blind, placebo-controlled study and the subsequent open-label phase 1/2 study in adults with XLHR showed the safety and the efficacy of human anti-FGF23 antibody, KRN23. KRN23 has a potential for effectively treating patients with XLHR and other types of FGF23-related hypophosphatemia as well.
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Review
[Hip Fracture--Epidemiology, Management and Liaison Service. Osteoporosis liaison service in Japan].
Osteoporosis liaison service (OLS) is a coordinator-based service provided by Japan Osteoporosis Society. Fracture Liaison Services, commonly known as FLS, are coordinator-based, secondary fracture prevention services implemented by health care systems for the treatment of osteoporotic patients. ⋯ Japan Osteoporosis Society gives coordinators the certificate as a specialist for OLS since 2015. OLS in Japan should facilitate better performance of the treatment of osteoporosis and should contribute the reduction of clinical fractures.
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Glucocorticoids (GCs) were widely used for the treatment of various disorders. And Osteoporosis is one of the major complications of glucocorticoid therapy. ⋯ The skeletal effects of glucocorticoids include both direct and indirect actions on bone that result in an early, transient increase in bone resorption accompanied by a decrease in bone formation, which is maintained for the duration of glucocorticoid therapy. Bisphosphonates are the front-line choice for prevention of fracture in glucocorticoid-treated patients and are recommended renewal GIOP guideline from Japan.
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The aim of osteoporosis treatment is to reduce fracture risk. Many kinds of anti-osteoporosis drugs are available in these days, and most of them increase bone mineral density and reduce the risk of fractures. Japanese 2011 guidelines for prevention and treatment of osteoporosis documents the recommendation level of each osteoporosis drugs. It is important to select drugs appropriate for each osteoporosis patient considering the mechanisms of drug action and their clinical efficiency.
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Oral bisphosphonates are the first class of drugs other than estrogen that have been proven to reduce fracture incidence substantially. Since they are agents that inhibit bone resorption and are hardly absorbed through intestine, researchers have been focusing on augmentation of inhibitory effects of bisphosphonates on bone resorption and prolongation of the interval of drug administration. Even though they have a break-through efficacy on preventing fractures, there remain some rare problems to be solved, such as osteonecrosis of the jaw and atypical femoral fracture, after long-term exposure to bisphosphonates.