Evaluation of Persistence and Adherence to Teriparatide Treatment in Patients Affected by Severe Osteoporosis (PATT): A Multicenter Observational Real Life Study.

Evaluation of persistence and adherence to teriparatide treatment in patients affected by severe osteoporosis (PATT): a multicenter observational real life study.

Clin Cases Miner Bone Metab. 2013 Jan; 10(1): 56-60
Migliaccio S, Resmini G, Buffa A, Fornari R, Di Pietro G, Cerocchi I, Dormi A, Gimigliano F, Mulè R, Celi M, Frigato M, Lenzi A, Tarantino U, Iolascon G, Malavolta N

Osteoporosis is a chronic condition leading to an increased risk of developing fractures, with high morbidity and mortality in aging population. Efficacy of anti-osteoporotic treatment is based on drug potency but also on compliance and persistence to treatment regimen, which is very low, as already described for other diseases. Teriparatide (TPTD) is the first anabolic agent developed for the treatment of osteoporosis. Since it appears that persistence to Teriparatide declines over time, aim of this pilot multicenter observational study was to evaluate persistence and adherence to TPTD (20 ?g daily injection regimen for 18 months) treatment (PATT) in patients affected by severe osteoporosis in an every day clinical practice.Patients affected by severe osteoporosis were selected among those who referred to 5 different specialized centers for osteoporosis in North, Center and South of Italy. A sample of 475 women with severe postmenopausal osteoporosis treated with TPTD in accordance to the Italian osteoporosis guidelines was included. At the beginning of TPTD treatment patients were instructed on the use of the device by the referring specialist of the center, a resident fellow or a nurse. Bone biochemical markers were evaluated the same morning and after 1, 3, 6, 12 and 18 months. Patients were visited at time 0 and after 6, 12 and 18 months for clinical follow up.The results included observations of 441/475 patients (98% women) who completed the 18 months treatment; mean age for women was 73±8 and for men 65±9. After 6 months of TPTD treatment persistence was of 89,79%, 87,75% after 12 months and 86,85% after 18 months. Adherence was of 100% at 6,12 and 18 months. Total dropouts were 13,15% (71/441), which was usually higher within the first 6 months of TPTD treatment. Most common adverse events (arthralgies 2,7%, dizziness 1,8%, migraine 1,8%, depression 1,6%, hypertension 1,1%) were reported in 62/441 patients (14%) of patients, but were not reason for stopping treatment.The persistence and adherence to TPTD treatment obtained in this multicenter observational real life study was very high as compared to studies performed by others. These encouraging results suggest that different key factors such quality of information, frequency of visits, motivations given to patients, opportunity to call the doctor might play a pivotal role in the high persistence and adherence to TPTD treatment obtained in our study and need to be carefully considered before prescribing chronic anti-osteoporotic therapy. HubMed – depression

Skeletal muscle: an endocrine organ.

Clin Cases Miner Bone Metab. 2013 Jan; 10(1): 11-4
Pratesi A, Tarantini F, Di Bari M

Tropism and efficiency of skeletal muscle depend on the complex balance between anabolic and catabolic factors. This balance gradually deteriorates with aging, leading to an age-related decline in muscle quantity and quality, called sarcopenia: this condition plays a central role in physical and functional impairment in late life. The knowledge of the mechanisms that induce sarcopenia and the ability to prevent or counteract them, therefore, can greatly contribute to the prevention of disability and probably also mortality in the elderly. It is well known that skeletal muscle is the target of numerous hormones, but only in recent years studies have shown a role of skeletal muscle as a secretory organ of cytokines and other peptides, denominated myokines (IL6, IL8, IL15, Brain-derived neurotrophic factor, and leukaemia inhibitory factor), which have autocrine, paracrine, or endocrine actions and are deeply involved in inflammatory processes. Physical inactivity promotes an unbalance between these substances towards a pro-inflammatory status, thus favoring the vicious circle of sarcopenia, accumulation of fat – especially visceral – and development of cardiovascular diseases, type 2 diabetes mellitus, cancer, dementia and depression, according to what has been called “the diseasome of physical inactivity”. HubMed – depression

Judeo-Christian concepts related to psychiatry.

Indian J Psychiatry. 2013 Jan; 55(Suppl 2): S201-4
Ponnudurai R

The behavioral manifestations of psychotic disorders that are attributed to evil spirits in the Judeo-Christian scriptures as demonstrated by Jesus Christ have been narrated. The descriptions of false beliefs and the perceptual experiences that are consistent with the psychiatric terminologies “delusions and hallucinations” are briefly discussed. Attempt has been made to analyze the patterns of suicidal behaviors, guilt feelings, and, expressions of depressive symptoms in the Jewish culture. Of interest is the mass suicide by the Jews in the 1st century AD at the Fort Masada, perhaps the first of its kind recorded in the history. Noteworthy are alcohol and related mental health problems prevalent in the Jewish culture. While highlighting the descriptions of dreams and their revelations recorded in the Bible, it is suggested that such concepts about dreams might have influenced Sigmund Freud’s classical works on dreams. The biblical messages and teachings that could be applied for psychotherapy and behavior modification strategies have been outlined. The mental concepts of Jewish culture and their relevance to Indian culture have also been discussed from a cross-cultural perspective. HubMed – depression

Does Guru Granth Sahib describe depression?

Indian J Psychiatry. 2013 Jan; 55(Suppl 2): S195-200
Kalra G, Bhui K, Bhugra D

Sikhism is a relatively young religion, with Guru Granth Sahib as its key religious text. This text describes emotions in everyday life, such as happiness, sadness, anger, hatred, and also more serious mental health issues such as depression and psychosis. There are references to the causation of these emotional disturbances and also ways to get out of them. We studied both the Gurumukhi version and the English translation of the Guru Granth Sahib to understand what it had to say about depression, its henomenology, and religious prescriptions for recovery. We discuss these descriptions in this paper and understand its meaning within the context of clinical depression. Such knowledge is important as explicit descriptions about depression and sadness can help encourage culturally appropriate assessment and treatment, as well as promote public health through education. HubMed – depression