PracticeUpdate: Dermatology - Vol 1 - No.1 - 2017

RHEUMATOLOGY 26

Advances in the treatment of osteoporosis British Medical Bulletin Take-home message

Balneotherapy for pain relief, stiffness, and physical function in osteoarthritis of the knee Take-home message • The effectiveness of balneotherapy for knee osteoarthritis was evaluated in this meta-analysis of eight clinical trials, including 359 cases and 375 controls. Bal- neotherapy improved pain, stiffness, and function, although there was high hetero- geneity (88–93%). • Balneotherapy may be beneficial in osteo- arthritis of the knee; however, the authors suggest that the observed heterogeneity was a result of the quality of the trials included. Abstract This meta-analysis was performed to determine the effect of balneotherapy on relieving pain and stiffness and improving physical function, compared to controls, among patients with knee osteoarthritis. We searched electronic databases for eligible studies published from 2004 to December 31, 2016, with language restrictions of English or Japanese. We screened publications in Medline, Embase, Cochrane library, and the Japan Med- ical Abstracts Society Database using two approaches, MeSH terms and free words. Studies that examined the effect of balneotherapy for treating knee osteoar- thritis of a ≥2-week duration were included. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were used as the outcome measure. A total of 102 publications were assessed according to the exclusion criteria of the study; eight clinical trial studies, which comprised a total of 359 cases and 375 controls, were included in this meta-analysis. The meta-analysis analyzed improvement in WOMAC score at the final follow-up visit, which varied from 2 to 12 months post-intervention. Our meta-analysis indicates that balneotherapy was clinically effective in relieving pain and stiffness, and improving function, as assessed by WOMAC score, compared to controls. However, there was high heterogeneity (88 to 93%). It is possible that balneotherapy may reduce pain and stiffness, and improve function, in individuals with knee osteoarthritis, although the quality of current publications contributes to the heterogeneity observed in this meta-analysis. The effect of balneotherapy on pain relief, stiffness, and physical function in patients with osteoarthritis of the knee: a meta-analysis. Clin Rheumatol 2017 Mar 16;[EPub Ahead of Print], H Matsumoto, H Hagino, K Hayashi, et al Clinical Rheumatology

• The authors performed a review of current evidence on existing treatments and novel therapies for osteoporosis, and they discuss the challenge of becoming familiar with treatment agents which are not yet readily available. • Research is required to clarify the optimal duration of therapy, the use of new therapies in combination, and the ordering of available therapies. Abstract INTRODUCTION Osteoporosis is a significant public health issue affecting over half of women aged over 50. With an aging population, its importance is set to increase fur- ther over time. Prevention of fragility fractures avoids significant mortality and morbidity as well as saving significant direct and indirect costs to the economy. In this review, we discuss existing treatments to contextualize the treatment landscape, and demon- strate how our understanding of bone pathophysiology has led to novel therapies-in the form of combinations and altered durations of existing treatments, as well as newer drug therapies.

SOURCES OF DATA PubMed and Embase were searched for randomized controlled trials of new therapies for osteoporosis. These searches were supplemented with material presented in abstract form at international meetings. AREAS OF AGREEMENT New drugs that appear promising in the treatment of osteoporosis include the cathepsin K inhibitor, monoclonal antibodies against sclerostin and parathy- roid hormone-related protein analog. AREAS OF CONTROVERSY Separate to the development of novel drug therapies is the issue of how best to use agents that are currently available to us; specifically which agent to choose, alone or in combination; duration of therapy; how best to identify patients at highest risk of fracture, and to ensure the highest possible adherence to medication. Many of these issues have been addressed in other excellent review papers, and will not be considered in detail here. GROWING POINTS As with all new treatments, we await results of long-term use and expe- rience in ‘real life’ patient populations. AREAS TIMELY FOR DEVELOPING RESEARCH As alluded to above, data are urgently required regarding the optimal duration of therapy; use of combination therapy; ordering of therapies for best therapeutic effect. As stratified medicine becomes more strongly considered in all areas of therapy, its merits in osteoporosis as in other musculoskele- tal conditions, is timely and valuable. Novel advances in the treatment of osteoporosis. Br Med Bull 2016 Sep 01;119(1)129- 42, CK Chan, A Mason, C Cooper, E Dennison.

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