To explore the understanding of osteoporosis in the context of adult spinal deformity (ASD) surgery with a focus on diagnosis, surgical risks, non-operative, and operative treatment techniques. A comprehensive literature search was performed. Articles were identified using the search terms “osteoporosis,” “adult spinal deformity,” “scoliosis,” and “spine surgery.” Relevant studies were selected based on their focus on the intersection of these topics with an emphasis on utility in spine surgery. This review discusses osteoporosis diagnosis, surgical risks, and non-operative, and surgical treatments in the context of ASD surgery with a focus on clinical applications. Areas for future growth are highlighted. As adult spinal deformity (ASD) patients increase globally, the Scoliosis Research Society (SRS) formed a task force to improve understanding of osteoporosis and its impact on this vulnerable population. This review brings together the latest research on the topic and highlights this area as one of critical importance and growth in the field.
Multiple medication safety recommendations to reduce preventable medication-related hospitalisations have been introduced in the Netherlands. Still, these hospitalisations remain prevalent. This might be due to suboptimal implementation in clinical practice. Therefore, more insight is needed into barriers and facilitators for the implementation of these medication safety recommendations across healthcare sectors. This study aimed to identify barriers and facilitators for implementing medication safety recommendations across healthcare sectors from the perspective of various stakeholders. A selection of 17 Dutch medication safety recommendations targeting medications responsible for a large proportion of medication-related hospitalisations was evaluated in focus groups to identify barriers and facilitators to their implementation. These included recommendations for: reducing fall risk in elderly; initiating prophylactic medication; monitoring patients at risk of electrolyte disorders; clarifying responsibilities for patient care; informing patients about alarm symptoms; and prescribing antithrombotics on strict indication. Stakeholders were selected through purposive sampling based on their profession and healthcare sector. Transcripts of audio-recordings were analysed inductively, after which implementation factors were categorised using the Consolidated Framework for Implementation Research. Thirty stakeholders were divided into five focus groups. These included community pharmacists (n = 9), general practitioners (n = 4), hospital pharmacists (n = 3), representatives from healthcare knowledge organisations (n = 3), patient representatives (n = 2), medical specialists (n = 2), nurses (n = 2), and other stakeholders (n = 5). Forty-nine barriers and facilitators were identified. Key themes were lack of specified responsibilities, limited information exchange, local collaboration and protocol adherence. Recommendations with a lower level of implementation often required collaboration with multiple healthcare providers, whereas recommendations with a higher level of implementation were frequently supported by clinical decision support systems. A broad range of barriers and facilitators to the implementation of medication safety recommendations was identified. Overall, the findings highlight the need for recommendations with specified responsibilities, improved information exchange, strengthened local collaboration, and increased protocol adherence.
Background/Objectives: Methotrexate (MTX) is a cornerstone drug used to treat immune-mediated inflammatory diseases (IMIDs) in low doses (10-30 mg/week), and malignancies in high doses (5000 mg/m2/2 weeks). Its active metabolites, Methotrexate polyglutamates (MTX-PG2-5), quantified in erythrocytes, are associated with efficacy. This study aimed to compare erythrocyte MTX-PG concentrations in patients with IMIDs and pediatric acute lymphoblastic leukemia (ped-ALL) treated with low-dose or high-dose MTX, respectively, and to identify clinical, demographic, and treatment-related factors influencing their concentration. Methods: A total of 567 patients with rheumatoid arthritis, juvenile idiopathic arthritis, Crohn's disease, sarcoidosis, and ped-ALL were included. Erythrocyte MTX-PG concentration data was collected after 3 months (2.5 months for ped-ALL patients) of MTX-use. Multivariate linear regressing modelling adjusting for age, sex, body mass index (BMI), smoking status, starting MTX dose, route of MTX administration, use of predniso(lo)ne, disease-modifying anti-rheumatic drugs (DMARDs), and folic (or folinic) acid was performed. Results: Intravenous high-dose MTX increased MTX-PG4&5 accumulation. Despite 50-fold higher doses in ped-ALL, MTX-PG2-5sum concentrations were similar to those seen with subcutaneous low-dose MTX used in IMIDs. Age positively influenced MTX-PG concentrations, while DMARD use reduced MTX-PG2-3&5 concentrations. Interestingly, predniso(lo)ne use was associated with higher MTX-PG4&5 concentrations and folic (or folinic) acid with higher MTX-PG3-5 concentrations. Conclusions: This is the first study to compare erythrocyte MTX-PG concentration in low-dose and high-dose patients. Intravenous high-dose MTX administration increased long-chain MTX-PG4&5 concentrations, with MTX-PG2-5sum concentrations similar compared to low-dose subcutaneous MTX use. This study demonstrated that route of administration, age, and concomitant therapies such as DMARDs, predniso(lo)ne, and folic (or folinic) acid significantly influence MTX-PG concentrations.
Objectives:This study aimed to evaluate the time from early-stage systemic sclerosis (SSc), to the onset of significant disease progression. A secondary objective was to identify early clinical features most strongly associated with disease progression. Additionally, the study examined the course of microvascular changes over time. Methods:In this prospective longitudinal cohort study (Hit Hard and Early trial, 3 years open label follow-up), we included patients who met the adjusted Very Early Diagnosis of Systemic Sclerosis criteria, with puffy fingers for less than 3 years. Disease progression was defined as skin or organ involvement. Microvascular changes were tracked through serial nailfold videocapillaroscopy, and Kaplan-Meier estimates were used to analyse time to disease progression. Baseline predictors of progression were explored with univariate logistic regression. Results:Thirty patients were included, 70% female, with a median duration of puffy fingers of 5.5 months. Anticentromere antibodies were present in 73%, and 75% showed an active nailfold capillaroscopy pattern at baseline. Over 3 years, 43% (95% CI: 25.6%-61.2%) developed clinically significant disease progression, predominantly manifesting as pitting scars, digital ulcers, and/or skin thickening. Mean capillary density declined over time, and 55% of patients with an early SSc capillaroscopy pattern progressed to an active or late pattern within 24 months. Conclusions:A large proportion of patients showed clinically relevant disease progression within 3 years. In spite of the limited sample size, the strong association between anti-ribonucleoprotein (anti-RNP) antibodies and disease progression underlines the prognostic value of this biomarker. Frequent and standardised nailfold capillaroscopy imaging provided insights into microvascular changes.
Drug repurposing offers a low-cost and time-efficient approach to discover an effective and safe disease-modifying treatment for osteoarthritis. Although numerous studies have investigated candidate drugs for repurposing, existing narrative reviews are restricted in scope. This scoping review aims to provide an exhaustive overview of the extent and characteristics of clinical research on authorised drugs investigated for treating osteoarthritis. Electronic database searches were performed from inception until July 2025 in MEDLINE, Embase and Cochrane. Authorised drugs approved by the US Food and Drug Administration, European Medicines Agency or Dutch Medicines Evaluation Board, investigated in clinical studies for treating osteoarthritis, were included. Dextrose and drugs indicated for pain (irrespective of aetiology) or osteoarthritis were excluded. Titles and abstracts were screened using ASReview, full texts were assessed accordingly and results were classified per drug. From 26,638 deduplicated records, 201 articles reporting on 220 studies were included in this review: 104 randomised controlled trials (RCTs), including 9 post-hoc analyses, 75 cohort studies, 13 case-control studies, 12 cross-sectional studies, 12 pre–post studies and 4 non-randomised CTs. In total, 52 drugs were identified, with drugs originally indicated for osteoporosis being most frequently investigated. Short-term follow-up studies (< 1 year) were mostly RCTs focussing on symptom-modifying effects, whilst long-term follow-up studies (≥ 1 year) more often used existing data and assessed both symptom- and structure-modifying effects. The most frequently used outcomes were pain (118/220) and function (74/220) for symptoms and grading systems (28/220) for structural changes. Significant effects were observed in 40
