open access: Treatment To Prevent Fractures in Men and Women With Low Bone Density or Osteoporosis: Update of a 2007 Report

 Blogger's Note: extensive review = 438 pages; study includes ovarian/cancer patients, adverse effects of differing drugs/populations (supporting research documentation eg. % risk)

CER53_LowBoneDensity_FinalReport_20120329.pdf (application/pdf Object)



Abstract - 

Results:

Alendronate, risedronate, zoledronic acid, denosumab, and teriparatide reduce the risk of vertebral and nonvertebral fractures among postmenopausal women with osteoporosis.

Ibandronate and raloxifene reduce the risk of vertebral but not nonvertebral fractures.

Alendronate, risedronate, zoledronic acid, and denosumab prevent hip fractures among postmenopausal women with osteoporosis. Risedronate decreases the risk of vertebral and

nonvertebral fracture among men with osteoporosis.

Among those treated with glucocorticoids, fracture risk reduction was demonstrated for risedronate and alendronate compared to placebo; and for teriparatide compared to alendronate.

Few studies have compared osteoporosis therapies head-to-head.

Adherence to pharmacotherapy is poor in patients with osteoporosis, as with other chronic conditions. Many factors affect adherence to medications, including dosing frequency, side effects of medications, knowledge about osteoporosis, and cost. Age, prior history of fracture,

and concomitant medication use do not appear to have an independent association with adherence. Dosing frequency appears to affect adherence: Adherence is improved with weekly compared to daily regimens, but evidence is lacking to show that monthly regimens improve adherence over that of weekly regimens. Decreased adherence to bisphosphonates is associated with less than optimal reduction in the risk of fracture. Insufficient evidence is available to make conclusions about how adherence to and persistence with newer osteoporosis therapies compare to that with bisphosphonates.

Assessment of adverse effects finds that raloxifene is associated with an increased risk for pulmonary embolism and vasomotor flushing; and limited data support a possible association between bisphosphonate use and atypical subtrochanteric fractures of the femur. Evidence is

limited on the utility of monitoring and long-term treatment.

Conclusions.  

There is a high level of evidence that shows that fracture risk reduction is greatest in women with a diagnosis of osteoporosis and/or prevalent fractures. The level of evidence is low to moderate for fracture risk reduction in postmenopausal women with osteopenia and
without prevalent fractures. The evidence is low for benefits of treatment for other populations, including men; for the benefits and risks of long-term treatment; and for the need (if any) for
monitoring bone density; and mixed with regard to factors that influence adherence.

Announcement: Genomics of Drug Sensitivity in Cancer (includes BRCA1/2 in charts)

Announcements for the Genomics of Drug Sensitivity Website
Subject:  Genomics of Drug Sensitivity in Cancer
 
Genomics of Drug Sensitivity in Cancer v1 release
 
We have launched a new website to present genomic markers of sensitivity to
anti-cancer compounds screened across our >1000 cancer cell line resource.
 
New website 
 
The website (http://www.cancerRxgene.org) has enhanced user interfaces
making it simple to access our data and analyses. All of our genetic and
drug sensitivity data, including results from future screening, are freely
available and can be downloaded. The website will be regularly updated as
new data becomes available.
 
Drug sensitivity data
 
We have released sensitivity data for 130 anti-cancer drugs screened across
a large subset of our cell line resource.  Drug sensitivity data for more
than 600 cell lines have been correlated with extensive genetic data to
identify genomic events associated with sensitivity and resistance. This is
the largest publicly available dataset of its type, representing >48,000
drug-cell line combinations, and provides a comprehensive view of the
genomics of drug sensitivity in cancer.
 
Cancer cell line resource
 
Our >1000 cell line resource represents the spectrum of common and rare
types of adult and childhood cancers of epithelial, mesenchymal and
haematopoietic origin. Cell lines have been subjected to sequencing of the
full coding exons of 64 commonly mutated cancer genes, genome-wide analysis
of copy number gain and loss using Affymetrix SNP6.0 microarrays, and
expression profiling of 14,500 genes using Affymetrix HT-U133A microarrays.
The presence of seven commonly rearranged cancer genes and of microsatellite
instability (MSI) has also been investigated.  Genetic data for the cell
lines are available through our website and the Cancer Genome Project
webpages. The cell lines have been submitted for whole-exome sequencing and
this data will soon be available.
 
Integration with COSMIC
 
Our analyses have been integrated with the Catalogue of Somatic Mutations in
Cancer (COSMIC) database providing a comprehensive resource linking somatic
mutations and other information related to cancer with drug sensitivity
information.
 
Data for the following drugs are included in this release:
 
681640, 17-AAG, A-443654, A-769662, A-770041, ABT-263, ABT-888, AICAR, AKT
inhibitor VIII, AMG-706, AP-24534, AS601245, ATRA, AUY922, Axitinib, AZ628,
AZD-0530, AZD-2281, AZD-6244, AZD-6482, AZD-7762, AZD-8055, BAY613606,
Bexarotene, BI-2536, BI-D1870, BIBW2992, Bicalutamide, BIRB 0796, Bleomycin,
BMS-509744, BMS-536924, BMS-754807, Bortezomib, Bosutinib, Bryostatin 1,
BX-795, Camptothecin, CEP-701, CGP-082996, CGP-60474, CHIR-99021, CI-1040,
Cisplatin, CMK, Cyclopamine, Cytarabine, Dasatinib, DMOG, Docetaxel,
Doxorubicin, Elesclomol, Embelin, Epothilone B, Erlotinib, Etoposide, FH535,
FTI-277, GDC-0449, GDC0941, Gefitinib, Gemcitabine, GNF-2, GSK-650394,
GSK269962A, GW 441756, GW843682X, Imatinib, IPA-3, JNK Inhibitor VIII,
JNK-9L, JW-7-52-1, KIN001-135, KU-55933, Lapatinib, Lenalidomide, LFM-A13,
Metformin, Methotrexate, MG-132, Midostaurin, Mitomycin C, MK-2206, MS-275,
Nilotinib, NSC-87877, NU-7441, Nutlin-3a, NVP-BEZ235, NVP-TAE684, Obatoclax
Mesylate, OSI-906, PAC-1, Paclitaxel, Parthenolide, Pazopanib, PD-0325901,
PD-0332991, PD-173074, PF-02341066, PF-562271, PHA-665752, PLX4720,
Pyrimethamine, QS11, Rapamycin, RDEA119, RO-3306, Roscovitine,
S-Trityl-L-cysteine, Salubrinal, SB216763, SB590885, Shikonin, SL 0101-1,
Sorafenib, Sunitinib, Temsirolimus, Thapsigargin, Tipifarnib, Vinblastine,
Vinorelbine, Vorinostat, VX-680, VX-702, WH-4-023, WZ-1-84, XMD8-85,
Z-LLNle-CHO, ZM-447439
 
 
Genomics of Drug Sensitivity in Cancer Team - cancerrxgene@sanger.ac.uk
 
http://www.cancerRxgene.org/
 

March 2012 - open access - International Perspectives on Patient Engagement: Results from the 2011 Commonwealth Fund Survey + link to separate blog posting - related issue...Engaging the Already Engaged - 2/2012

International Perspectives on Patient Engagement: Results from the 2011 Commonwealth Fund Survey - The Commonwealth Fund

Key Findings

• To assess the level of patients’ engagement with their regular doctors, the researchers analyzed responses to survey items on whether the doctor spends enough time with patients, explains things in a way that is easy to understand, and encourages questions. Patients in Norway and Sweden were the least likely to be engaged by their regular providers, with only about one of three responding positively to all three questions. At the top end of the range, at least two of three patients in Australia, New Zealand, Switzerland, the U.K., and the U.S. reported positive care interactions.
• In seven of the 11 countries—Australia, Canada, the Netherlands, Norway, Sweden, the U.K., and the U.S.—patients with below-average incomes were significantly less likely to have been engaged by their regular doctor in their care. The U.S. stood out for the widest income-based disparities.
• Survey participants were asked how often the specialist physicians treating them provide opportunities to ask questions about recommended treatments, tell them about their treatment choices, and involve them as much as they would like in decisions about their care. Four-fifths of patients in Switzerland and the U.K. replied “always” or “often” to all three questions, as did two-thirds or more of Dutch, New Zealand, and U.S. respondents. Respondents in France, Germany, Norway, and Sweden were the least likely to report shared decision-making with specialists.
• In all countries, patients reporting positive communication and engagement with their regular doctor were far more likely to rate the quality of care they received in the past year as “excellent” or “very good.” The difference was greatest in the U.S.: 78 percent of patients who said they were engaged in their care rated the quality of their care highly, compared with 43 percent of those who said they were not engaged.
• Engaged patients were also less likely to report a medical, medication, or lab test error in the past two years, and had more positive views of the health system as a whole.  

 

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OVARIAN CANCER and US: the Commonwealth Fund (Harvard ...

Feb 21, 2012

Tuesday, February 21, 2012. the Commonwealth Fund (Harvard): Who Are We Reaching Through the Patient Portal: Engaging the Already Engaged? http://tinyurl.com/6tqadrd. Blogger Sandi Pniauskas at Tuesday, February 21, 2012 ...

abstract: What makes UK Biobank special? : The Lancet + link to UK Biobank includes e-interface/s

What makes UK Biobank special? : The Lancet

"In a prescient move more than a decade ago, the Medical Research Council and Wellcome Trust decided to establish the large UK Biobank prospective cohort to support the investigation of risk factors for the major diseases of middle and old age. 1 , 2 Recruitment of more than 500 000 men and women aged 40—69 years was successfully achieved during 2006—10 and their health is being followed long term. On March 30, 2012, the UK Biobank resource is launched for use by all researchers—without exclusive or pr ..."

End-of-life care: the neglected core business of medicine : The Lancet

End-of-life care: the neglected core business of medicine : The Lancet