Publications by authors named "Stuart Ralston"

Osteogenesis imperfecta (OI) is a multisystem disorder most often caused by pathogenic variants in genes that encode type I collagen. Type I collagen is abundant not only in bone but also in multiple tissues including skin, tendons, cornea, blood vessels and heart. Thus, OI can be expected to affect cardiovascular system, and there are numerous reports of cardiovascular disease (CVD) in people with OI.

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Romosozumab, a monoclonal antibody against sclerostin, is a newly licensed dual-acting osteoporosis treatment for patients at very high risk of fracture. Sclerostin inhibition leads to stimulation of bone formation and simultaneous inhibition of bone resorption. Only three cases of atypical femur fractures were reported out of 5,621 patients who received romosozumab in the pivotal randomised controlled trials FRAME and ARCH; however, most enrolled clinical trial patients were osteoporosis treatment-naïve or had a prolonged washout period.

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  • - Gout is a chronic condition caused by the immune system's reaction to monosodium urate crystals due to high uric acid levels, and recent research sheds light on its inflammatory mechanisms.
  • - A large genome-wide association study (GWAS) involving 2.6 million people identified 377 genetic locations linked to gout, with a focus on 149 new loci related to urate and gout inflammation.
  • - The study also pinpointed candidate genes influencing the inflammatory response in gout, including those affecting NLRP3 inflammasome activity, and suggests a potential causal role of specific genetic factors in developing the disease.
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  • Paget's disease of bone (PDB) makes bones grow and change shape in a messy way, which can lead to problems like pain, deafness, and broken bones.
  • A study with 168 people found that about 73% of them had musculoskeletal pain, mainly because of osteoarthritis in joints away from the PDB affected areas.
  • The research showed that pain was more common in older folks and women, and highlighted the need to check each person's pain to treat it correctly.
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Background: Patients with osteoporosis demonstrate increased vascular calcification but the effect of osteoporosis treatments on vascular calcification remains unclear. The present study aimed to examine whether coronary or aortic calcification are influenced by denosumab and alendronic acid treatment.

Methods And Results: In a double-blind randomized controlled SALTIRE2 (Study Investigating the Effect of Drugs Used to Treat Osteoporosis on the Progression of Calcific Aortic Stenosis) trial, patients with aortic stenosis were randomized 2:1:2:1 to denosumab, placebo injection, alendronic acid, or placebo capsule.

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Osteogenesis imperfecta (OI) is a Mendelian connective tissue disorder associated with increased bone fragility and other clinical manifestations most commonly due to abnormalities in production, structure, or post-translational modification of type I collagen. Until recently, most research in OI has focused on the pediatric population and much less attention has been directed at the effects of OI in the adult population. This is a narrative review of the literature focusing on the skeletal as well as non-skeletal manifestations in adults with OI that may affect the aging individual.

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Introduction: Paget's disease of bone (PDB) frequently presents at an advanced stage with irreversible skeletal damage. Clinical outcomes might be improved by earlier diagnosis and prophylactic treatment.

Methods: We randomised 222 individuals at increased risk of PDB because of pathogenic variants to receive 5 mg zoledronic acid (ZA) or placebo.

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  • * The trial will involve adults with OI who will undergo baseline assessments (e.g., spine X-rays, bone mineral density tests) and be randomly assigned to either the TPTD/ZA treatment or standard care over a period of 2 years, with follow-ups for up to 8 years.
  • * Ethical approval was granted for the study, and results will be published in a peer-reviewed journal, contributing to clinical knowledge on fracture prevention in OI
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Objective: Chronic fatigue is a major clinical unmet need among patients with rheumatoid arthritis (RA). Current therapies are limited to nonpharmacological interventions, such as personalized exercise programs (PEPs) and cognitive-behavioral approaches (CBAs); however, most patients still continue to report severe fatigue. To inform more effective therapies, we conducted a magnetic resonance imaging (MRI) brain study of PEPs and CBAs, nested within a randomized controlled trial (RCT), to identify their neurobiological mechanisms of fatigue reduction in RA.

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Pregnancy-associated osteoporosis (PAO) is a rare syndrome which typically presents with vertebral fractures during pregnancy or lactation. The medical records of sixteen patients with PAO who presented to a specialist clinic at the Western General Hospital in Edinburgh over a 20-year period were reviewed to evaluate the mode of presentation, potential risk factors and response to treatment. The most common presentation was back pain occurring in 13/16 (81.

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Background And Objectives: Pathogenic variants in the valosin-containing protein () gene cause a phenotypically heterogeneous disorder that includes myopathy, motor neuron disease, Paget disease of the bone, frontotemporal dementia, and parkinsonism termed multisystem proteinopathy. This hallmark pleiotropy makes the classification of novel variants challenging. This retrospective study describes and assesses the effect of 19 novel or nonpreviously clinically characterized variants identified in 28 patients (26 unrelated families) in the retrospective VCP International Multicenter Study.

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Skull bone mineral density (SK-BMD) provides a suitable trait for the discovery of key genes in bone biology, particularly to intramembranous ossification, not captured at other skeletal sites. We perform a genome-wide association meta-analysis (n ~ 43,800) of SK-BMD, identifying 59 loci, collectively explaining 12.5% of the trait variance.

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Objectives: Nasal, paranasal sinus and mucosal disorders are common symptoms in autoimmune rheumatic diseases. Soft tissue changes and fluid accumulation in the osteomeatal complexes and paranasal sinuses manifest as opaqueness on radiological images which can be assessed using visual scoring and computational methods on CT scans, but their results do not always correlate. Using MRI, we investigate the applicability of different image analysis methods in SLE.

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Paget's Disease of Bone (PDB) is a metabolic bone disease that is characterized by dysregulated osteoclast function leading to focal abnormalities of bone remodeling. It can lead to pain, fracture, and bone deformity. G protein-coupled receptor kinase 3 (GRK3) is an important negative regulator of G protein-coupled receptor (GPCR) signaling.

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  • The study aimed to evaluate the cost-effectiveness of two interventions, a personalized exercise program (PEP) and a cognitive behavioral approach (CBA), for patients with chronic fatigue linked to inflammatory rheumatic diseases compared to standard care (UC).
  • After analyzing data from a clinical trial over 56 weeks, it was found that both PEP and CBA were more expensive than UC, with PEP being significantly more effective at improving patients' quality of life.
  • The findings suggest that adding PEP to standard care is likely a cost-effective option, with high probability of being beneficial to the UK healthcare system based on cost-per-quality-adjusted life year (QALY) gained.
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  • The study investigates how genetic factors may influence individual responses to teriparatide (TPTD) treatment for osteoporosis, focusing on changes in bone mineral density (BMD).
  • Researchers conducted a genome-wide association study involving 437 osteoporosis patients, discovering a significant genetic marker (rs6430612) affecting BMD response at the lumbar spine and hip.
  • Results indicate that individuals with certain genetic variations show dramatically different improvements in BMD from TPTD, highlighting the potential for personalized treatment approaches based on genetic testing in the future.
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  • The study examines the effects of continuing burosumab treatment on adults with X-linked hypophosphataemia after a 96-week phase 3 study, focusing on lab tests, patient-reported outcomes, and walking ability.
  • Results showed sustained improvements in serum phosphate levels, vitamin D levels, and overall physical health during the 48-week extension.
  • An analysis indicated that stopping burosumab led to a loss of benefits, highlighting that ongoing treatment is essential for maintaining clinical improvements.
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Background: Patients who have Paget's Disease more frequently require total hip arthroplasty (THA) and total knee arthroplasty (TKA) than matched controls. However, controversy remains regarding their outcome. We aimed to evaluate the literature regarding outcomes following THA and TKA in patients who have Paget's Disease.

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  • A study was done to see if remote therapy programs could help people with chronic fatigue who have inflammatory rheumatic diseases.
  • Researchers tested two types of support: cognitive behavioral therapy (CBA) and personalized exercise programs (PEP) against regular care only.
  • They found that both CBA and PEP helped reduce fatigue better than just the usual care among the patients involved.
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Bone science has over the last decades unraveled many important pathways in bone and mineral metabolism and the interplay between genetic factors and the environment. Some of these discoveries have led to the development of pharmacological treatments of osteoporosis and rare bone diseases. Other scientific avenues have uncovered a role for the gut microbiome in regulating bone mass, which have led to investigations on the possible therapeutic role of probiotics in the prevention of osteoporosis.

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Increasing interest has focussed on the possible role of alterations in the microbiome in the pathogenesis of metabolic disease, inflammatory disease, and osteoporosis. Here we examined the role of the microbiome in a preclinical model of osteoarthritis in mice subjected to destabilisation of medical meniscus (DMM). The intestinal microbiome was depleted by broad-spectrum antibiotics from 1 week before birth until the age of 6 weeks when mice were subjected reconstitution of the microbiome with faecal microbial transplant (FMT) followed by the administration of a mixture of probiotic strains Lacticaseibacillus paracasei 8700:2, Lactiplantibacillus plantarum HEAL9 and L.

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