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Differentiation of patented crystalline glucosamine sulfate from other glucosamine preparations will optimize osteoarthritis treatment

Saengnipanthkul S, Waikakul S, Rojanasthien S, Totemchokchyakarn K, Srinkapaibulaya A, Cheh Chin T, et al.

Int J Rheum Dis, 2019 Mar;22(3):376-385.
PMID: 28332780 DOI: 10.1111/1756-185X.13068

Symptomatic slow-acting drugs for osteoarthritis (SYSADOAs) are recommended for the medium- to long-term management of knee osteoarthritis (OA) due to their abilities to control pain, improve function and delay joint structural changes. Among SYSADOAs, evidence is greatest for the patented crystalline glucosamine sulfate (pCGS) formulation (Mylan). Glucosamine is widely available as glucosamine sulfate (GS) and glucosamine hydrochloride (GH) preparations that vary substantially in molecular form, pharmaceutical formulation and dose regimen. Only pCGS is given as a highly bioavailable once-daily dose (1500 mg), which consistently delivers the plasma levels of around 10 μmol/L required to inhibit interleukin-1-induced expression of genes involved in the pathophysiology of joint inflammation and tissue destruction. Careful consideration of the evidence base reveals that only pCGS reliably provides a moderate effect size on pain that is higher than paracetamol and equivalent to non-steroidal anti-inflammatory drugs (NSAIDs), while non-crystalline GS and GH fail to reach statistical significance for pain reduction. Chronic administration of pCGS has disease-modifying effects, with a reduction in need for total joint replacement lasting for 5 years after treatment cessation. Pharmacoeconomic studies of pCGS demonstrate long-term reduction in additional pain analgesia and NSAIDs, with a 50% reduction in costs of other OA medication and healthcare consultations. Consequently, pCGS is the logical choice, with demonstrated medium-term control of pain and lasting impact on disease progression. Physician and patient education on the differentiation of pCGS from other glucosamine formulations will help to improve treatment selection, increase treatment adherence, and optimize clinical benefit in OA.
Fulltext Correction to: Algorithm for the management of patients at low, high and very high risk of osteoporotic fractures

Kanis JA, Harvey NC, McCloskey E, Bruyère O, Veronese N, Lorentzon M, et al.

Osteoporos Int, 2020 Apr;31(4):797-798.
PMID: 32065251 DOI: 10.1007/s00198-020-05297-0

The article 'Algorithm for the management of patients at low, high and very high risk of osteoporotic fractures',written by J. A. Kanis, was originally published Online First without Open Access. After publication in volume [#], issue [#] and page [#-#], the author decided to opt for Open Choice and to make the article an Open Access publication.
Fulltext Algorithm for the management of patients at low, high and very high risk of osteoporotic fractures

Kanis JA, Harvey NC, McCloskey E, Bruyère O, Veronese N, Lorentzon M, et al.

Osteoporos Int, 2020 Jan;31(1):1-12.
PMID: 31720707 DOI: 10.1007/s00198-019-05176-3

Guidance is provided in an international setting on the assessment and specific treatment of postmenopausal women at low, high and very high risk of fragility fractures.
INTRODUCTION: The International Osteoporosis Foundation and European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis published guidance for the diagnosis and management of osteoporosis in 2019. This manuscript seeks to apply this in an international setting, taking additional account of further categorisation of increased risk of fracture, which may inform choice of therapeutic approach.
METHODS: Clinical perspective and updated literature search.
RESULTS: The following areas are reviewed: categorisation of fracture risk and general pharmacological management of osteoporosis.
CONCLUSIONS: A platform is provided on which specific guidelines can be developed for national use to characterise fracture risk and direct interventions.

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