Effects of Anti RANK ligand Denosumab on Beta Thalassemia induced osteoporosis

Size: px
Start display at page:

Download "Effects of Anti RANK ligand Denosumab on Beta Thalassemia induced osteoporosis"

Transcription

1 Effects of Anti RANK ligand Denosumab on Beta Thalassemia induced osteoporosis Mohamed Yassin 1 Ashraf T. Soliman2, Mohamed O. Abdelrahman3, Vincenzo De Sanctis 4 Departments of, 1 Hematology 2Pediatric Endocrinology, and 3 Clinical Chemistry, Hamad Medical Center (HMC), Doha, Qatar, 4 Department of Pediatrics, Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy

2 Osteoporosis Osteoporosis is a disease characterized by low bone mass and microarchitectural deterioration of bone issue, leading to enhanced bone fragility and a consequential increase in fracture risk.. Osteoporosis is the silent disease that makes bones prone to fracture and is a major public health

3 T-score Number of standard deviations (SD) that a patient s bone mass is above or below the mean peak bone mass for a 30-year-old healthy woman T-score 1 to +1 = normal BMD 1 SD decrease in T-score = 10% to 15% decrease in BMD Z-score Number of SDs that a patient s bone mass is above or below the mean bone mass for age- and sex-matched controls

4 Bone Disease in Patients With Haemoglobinopathies Abnormalities in children with undermanaged thalassemia include Enlarged cranial and facial bones Spinal deformities Nerve compression Spontaneous fractures All thalassemia and SCD patients: effects of bone marrow expansion and other imbalances Localized changes in bone (loss and formation) Generalized decrease in bone mineral density (BMD), osteppenia/osteoporosis Mikroinfarction of vertebral bone marrow (fish mouth)

5 Acquired Factors in the Pathogenesis of Thalassemia and SCD-Induced Osteoporosis Iron overload and chelation therapies Iron deposition in bone Impaired maturation of bone cells (osteoids) Local mineralisation High-dose iron chelation therapy with desferoxamine Differentiation and proliferation of bone-forming cells (osteoblasts) Collagen (bone matrix) formation Osteoblast programmed cell death (apoptosis) Deficiencies in vitamins and minerals Vitamin D deficiency Impaired regulation of bone metabolism Zinc deficiency Prevalent in hemoglobinopathies and associated with low bone mineral density Role of zinc is not well defined, but might involve activation of bone-specific alkaline phosphatase (balp) and inhibition of osteoclast activity 1,2 1. King JC. Am J Clin Nutr. 1996;64(3): ; 2. Reviewed in Voskaridou E, et al. Br J Haematol. 2004;127(2):2004;

6 Genetic predisposition to reduced BMD Polymorphisms in genes that play key roles in bone maintenance and remodeling: - Collagen type I - Vitamin D receptor - Transforming growth factor β 1 - Calcitonin receptor - Oestrogen receptor - Interleukin 6 To date, although some genetic traits correlate with thalassaemia-induced osteoporosis, their roles in its development are unclear Reviewed in Voskaridou E, et al. Br J Haematol. 2004;127(2):

7 Bone Metabolism: A Balance Between Osteoblasts and Osteoclasts Reproduced from Seeman E, et al. N Engl J Med. 2006;354(21):

8 Biochemical Markers of Bone Metabolism Enzymes, protein fragments, or other molecules released into blood as a result of bone turnover In order to be clinically useful, markers should be Highly specific to bone Detectable in body fluids (blood or urine) using standard assay methods (chemical, enzymatic or immunologic)

9 Biochemical Markers of Bone Metabolism Formation Resorption BALP Collagen type I propeptides Osteocalcin Calcium TRAcP-5b BSP OH-proline OH-lysine glycosides Pyridinium crosslinks Collagen type I telopeptides (eg, NTX, CTX) Osteoblasts Bone matrix Osteoclasts

10 The RANK/RANKL RANKL is a key that promotes osteoclast formation pathway and activation, and prolongs osteoclast survival. Osteoprotegerin (OPG) acts as a decoy receptor for RANKL and prevents its interaction with RANK thereby inhibiting osteoclast formation, function and survival. Alteration of the RANK/RANKL/OPG system in favor of increased osteoclastic activity and enhanced osteoblastic dysfunction is proposed as an important mechanism Endocr Rev in 2008;29: the etiology of Clin Endocrinol (Oxf). 2003;58(3):273-9 osteoporosis in BTM.

11 In Thalassemic Patients The ratio of srankl/opg is increased in patients with TM and low BMD. Alterations in the RANK/RANKL/OPG system in favor of osteoclasts are characteristic in thalassaemia due to complicated not clearly delineated mechanisms Hematology. 2006;11(3): British Journal of Haematology. 2001;112(1): Osteoporosis International. 2001;12(7): Journal of Bone and Mineral Research. 2004;19(5):

12 BTM- Hormones and RANK RANKL- OPG Patients with BTM frequently system have 1. Gonadotrophin and sex steroid deficiency 2. Defective growth hormone (GH) insulin-like growth factor-i (IGF-I) axis Pediatr Endocrinol Rev. 2011; 8 (Suppl 2) :284-9 Clin Endocrinol (Oxf). 2008;69:

13 Androgens RANKL/OPG Androgens block RANKL-induced osteoclastic formation. Testosterone increases the proliferation of osteoblast-like cells in culture, and induce osteoblast differentiation. RANKL expression was found to be up-regulated in osteoblastic cells from androgen receptordeficient mice J Bone Miner Res 1992; 7: Eur J Endocrinol. 2002;147: Biochemical and Biophysical Research Communications. 2009;389: Endocrinology. 2001;142: J Bone Miner Res. 2005;20:

14 Androgens RANKL/OPG Androgens block RANKL-induced osteoclastic formation. Testosterone increases the proliferation of osteoblast-like cells in culture, and induce osteoblast differentiation. RANKL expression was found to be up-regulated in osteoblastic cells from androgen receptor-deficient mice J Bone Miner Res 1992; 7: Eur J Endocrinol. 2002;147: Biochemical and Biophysical Research Communications. 2009;389: Endocrinology. 2001;142: J Bone Miner Res. 2005;20:

15 Low IGF-I : Defective GH-IGF-I axis in thalassemia Osteoclasts express IGF-1 receptors and IGF-1 has direct effects on their function. GH and IGF-I stimulate the production of OPG and its accumulation in the bone matrix. In thalassemic patients, it is suggested that decreased OPG production with increased RANKL/OPG ratio can induce more osteoclastic activity. J Clin Endocrinol Metab Sep;87(9): Exp Cell Res 2004, 294:

16 In Thalassemia: Low Androgens Increases RANKL -induced osteoclastic activity Low IGF-I Decreases OPG expression that increases RANKL activity

17 Denosumab Is a fully human monoclonal antibody to the receptor activator of nuclear factor kappab ligand (RANKL). Inhibits osteoclast formation, Decreases bone resorption, Increases bone mineral density (BMD) The efficacy and safety of Denosumab in BTMinduced osteoporosis has not been tested Anastasilakis ADHorm Metab Res. 2009;41(10):721.

18 RANKL: An Essential Mediator of Osteoclasts

19 Osteoprotegerin (OPG): The Decoy Receptor of RANKL Osteoclast formation, function, and survival RANKL inhibited by OPG RANK OPG Growth factors Hormones Cytokines CFU-M Prefusion osteoclast Multinucleated osteoclast Osteoblast lineage Bone Inactive osteoclast

20 RANKL/OPG Balance Drives Osteoclast Activity Alterations of the RANKL / OPG ratio are critical in the pathogenesis of bone diseases that result in increased bone resorption 1-3 Promotes OC activation Prevents OC activaion OC Activity

21 Not recommended Pediatric use : May impair bone growth in children with open growth plates and may inhibit eruption of dentition Pregnancy Category: May cause fetal harm when administered pregnant women based on animal studies; in utero resulted in increased fetal loss, stillbirths, and postnatal mortality, including absent lymph nodes, abnormal bone growth and decreased neonatal growth Women with reproductive potential must use highly effective contraception during therapy and for at least 5 months after the last dose

22 Design and Patients: Longitudinal study for a year Patients: 30 (19 M, 11 F) ( yr) on regular Bld Transfusiondependent BTM patients above 18 years with No history of treatment with bisphosphonates BMD T-scores < -2.5 at the lumbar spine [LS] or total hip [TH]). All patients were on vitamin D replacement Pubertal development (Tanner s stage 5) None has IGT, hypothyroidism, hypoparathyroidism or other systemic illness. No fracture reported.

23 Investigations Serum ferritin levels (3488 +/- 1557ng/ml). Every patient underwent DEXA scan as baseline and after 12 months of Denosumab therapy. Biochemical evaluation, at baseline 1, 3, 6,12 months Serum creatinine, Na, K, calcium, phosphorus, Parathormone (PTH), Bone specific alkaline phosphatase (ALP) Type 1 collagen carboxy telopetide (1CCT) (ELISA)

24 Before treatment mean ± SD After treatment mean ± SD Type 1 collagen telopeptide 1634 ± ±211* PTH 31± ±34.6 Calcium 2.13± ±0.16 Phosphate ( PO4) 1.51± ±0.24 Bone Akaline phosphatase u/l 97 +/ /- 98 BMD Femur / /- 0.17* BMD SDS Femur (-) 2.14±0.18 (-) 1.44 ± 0.21* BMD SDS lumber (-) 2.77±0.27 (-) 1.45 ± 0.63* IGF-I 175± ±106 IGF-I SDS / /- 1.4 Testosterone (males) 16.1± ±5.1

25 Table 2 : Biochemical and bone mineral density data in males and females thalassaemia major patients before and after treatment with Denosumab * p < 0.01 after Denosumab versus before treatment Males Females Before After Before After Type 1 collagen telopeptide (pg/ml) 1754± ±200* 1439± ±237* PTH (ng/ml) 33± ± ± ±29.9 Calcium (mmol/l) 1.97± ± ± ±0.13 Phosphate (mmol/l) 1.47± ± ± ±0.16 BMD SDS 1 Femur (-)2.1±0.19 (-)1.42±0.24* -2.13± ±0.16* BMD SDS Lumbar (-)2.8±0.34 (-)1.6±0.32* -2.67± ±0.89* IGF-1 (ng/ml) 196± ± ±78 188±83 IGF-1 SDS / ± / /-1.5

26 Results: Denosumab therapy for a year Significant increase in BMD of : 9.2% (95% CI, 8.2 to 10.1) at the lumbar spine and 6.0% (95% CI, 5.2 to 6.7) at the total hip. Decreased serum ICCT levels by 56% at 1 month and normalized them in all patients at 1 year.

27 0 Bone Mineral Density Before vs 1 year after Denosumab BMD SDS Femur BMD SDS lumber Before Deno After Deno

28 Correlations Significant correlations were found between BMD T score before and 1year after Denosumab in : Lumbar vertebrae (r = = 0.752, p < 0.001) and Hips (r = respectively p < 0.001).

29 Side effects in our patients Pain in the back and/or extremities 4/30 Nausea 3/30. Asymptomatic hypocalcaemia in 2/30 None required stopping therapy

30 Side effects in our patients Pain in the back and/or extremities 4/30 Nausea 3/30. Asymptomatic hypocalcaemia in 2/30 None required stopping therapy

31 Conclusion Denosumab therapy for a year significantly increased : 1. Bone mineral density at vertebrae and hips of patients with BTM and 2. Associated with a rapid and sustained reduction in bone turnover markers. Further studies are required to confirm longterm effects of this therapy

La terapia dell osteoporosi nel soggetto talassemico Therapy of Thalassemia Major-Induced Osteoporosis

La terapia dell osteoporosi nel soggetto talassemico Therapy of Thalassemia Major-Induced Osteoporosis La terapia dell osteoporosi nel soggetto talassemico Therapy of Thalassemia Major-Induced Osteoporosis Ashraf Soliman, Vincenzo De Sanctis Mohamed A Yassin, Institutes Departments of Pediatric Endocrinology,

More information

Hormone related problems (Endocrinopathies and osteoporosis) Vincenzo de Sanctis Ferrara.

Hormone related problems (Endocrinopathies and osteoporosis) Vincenzo de Sanctis Ferrara. Hormone related problems (Endocrinopathies and osteoporosis) Vincenzo de Sanctis Ferrara vdesanctis@libero.it 6 th EUROPEAN SYMPOSIUM ON RARE ANAEMIAS 1 st Dutch-Belgian meeting for patients and health

More information

Osteoporosis update. Dr. Claire Vandevelde Consultant Rheumatologist, LTHT

Osteoporosis update. Dr. Claire Vandevelde Consultant Rheumatologist, LTHT Osteoporosis update Dr. Claire Vandevelde Consultant Rheumatologist, LTHT Outline Background BMD Tools for assessing fracture risk Case study Denosumab Treatment breaks BMD BMD predicts fracture risk but

More information

BONE REMODELLING. Tim Arnett. University College London. Department of Anatomy and Developmental Biology

BONE REMODELLING. Tim Arnett. University College London. Department of Anatomy and Developmental Biology BONE REMODELLING Tim Arnett Department of Anatomy and Developmental Biology University College London The skeleton, out of sight and often out of mind, is a formidable mass of tissue occupying about 9%

More information

Osteoporosis Update. Greg Summers Consultant Rheumatologist

Osteoporosis Update. Greg Summers Consultant Rheumatologist Osteoporosis Update Greg Summers Consultant Rheumatologist DEFINITION OSTEOPOROSIS is LOW BONE MASS (& micro-architectural deterioration) causing AN INCREASED RISK OF FRACTURE 23 years 82 years 23 y/o

More information

Overview. Bone Biology Osteoporosis Osteomalacia Paget s Disease Cases. People Centred Positive Compassion Excellence

Overview. Bone Biology Osteoporosis Osteomalacia Paget s Disease Cases. People Centred Positive Compassion Excellence Overview Osteoporosis and Metabolic Bone Disease Dr Chandini Rao Consultant Rheumatologist Bone Biology Osteoporosis Osteomalacia Paget s Disease Cases Bone Biology Osteoporosis Increased bone remodelling

More information

Annual Rheumatology & Therapeutics Review for Organizations & Societies

Annual Rheumatology & Therapeutics Review for Organizations & Societies Annual Rheumatology & Therapeutics Review for Organizations & Societies Biochemical Markers of Bone Turnover: Definitions and Recommendations for Monitoring Therapy Learning Objectives for Biochemical

More information

Fragile Bones and how to recognise them. Rod Hughes Consultant physician and rheumatologist St Peter s hospital Chertsey

Fragile Bones and how to recognise them. Rod Hughes Consultant physician and rheumatologist St Peter s hospital Chertsey Fragile Bones and how to recognise them Rod Hughes Consultant physician and rheumatologist St Peter s hospital Chertsey Osteoporosis Osteoporosis is a skeletal disorder characterised by compromised bone

More information

Ca, Mg metabolism, bone diseases. Tamás Kőszegi Pécs University, Department of Laboratory Medicine Pécs, Hungary

Ca, Mg metabolism, bone diseases. Tamás Kőszegi Pécs University, Department of Laboratory Medicine Pécs, Hungary Ca, Mg metabolism, bone diseases Tamás Kőszegi Pécs University, Department of Laboratory Medicine Pécs, Hungary Calcium homeostasis Ca 1000g in adults 99% in bones (extracellular with Mg, P) Plasma/intracellular

More information

Additional Research is Needed to Determine the Effects of Soy Protein on Calcium Binding and Absorption NDFS 435 3/26/2015. Dr.

Additional Research is Needed to Determine the Effects of Soy Protein on Calcium Binding and Absorption NDFS 435 3/26/2015. Dr. Additional Research is Needed to Determine the Effects of Soy Protein on Calcium Binding and Absorption NDFS 435 3/26/2015 Dr. Tessem Osteoporosis is a public health problem in all stages of life. Many

More information

Osteoporosis. When we talk about osteoporosis, we have to be familiar with the constituents of bone and what it is formed of.

Osteoporosis. When we talk about osteoporosis, we have to be familiar with the constituents of bone and what it is formed of. Osteoporosis When we talk about osteoporosis, we have to be familiar with the constituents of bone and what it is formed of. Osteoblasts by definition are those cells present in the bone and are involved

More information

Breast Cancer and Bone Loss. One in seven women will develop breast cancer during a lifetime

Breast Cancer and Bone Loss. One in seven women will develop breast cancer during a lifetime Breast Cancer and Bone Loss One in seven women will develop breast cancer during a lifetime Causes of Bone Loss in Breast Cancer Patients Aromatase inhibitors Bil Oophorectomy Hypogonadism Steroids Chemotherapy

More information

Elecsys bone marker panel. Optimal patient management starts in the laboratory

Elecsys bone marker panel. Optimal patient management starts in the laboratory bone marker panel Optimal patient management starts in the laboratory Complete solution for osteoporosis The most complete bone metabolism panel on a single platform bone marker assays are important diagnostic

More information

Assessment and Treatment of Osteoporosis Professor T.Masud

Assessment and Treatment of Osteoporosis Professor T.Masud Assessment and Treatment of Osteoporosis Professor T.Masud Nottingham University Hospitals NHS Trust University of Nottingham University of Derby University of Southern Denmark What is Osteoporosis? Osteoporosis

More information

Diagnosis and Treatment of Osteoporosis. Department of Endocrinology and Metabolism Ajou University School of Medicine.

Diagnosis and Treatment of Osteoporosis. Department of Endocrinology and Metabolism Ajou University School of Medicine. Diagnosis and Treatment of Osteoporosis Department of Endocrinology and Metabolism Ajou University School of Medicine Yoon-Sok CHUNG WCIM, COEX, Seoul, 27Oct2014 Case 1 71-year old woman Back pain Emergency

More information

The Role of the Laboratory in Metabolic Bone Disease

The Role of the Laboratory in Metabolic Bone Disease The Role of the Laboratory in Metabolic Bone Disease Howard Morris PhD, FAACB, FFSc(RCPA) President, IFCC Professor of Medical Sciences, University of South Australia, Clinical Scientist, SA Pathology

More information

Osteoporosis. Treatment of a Silently Developing Disease

Osteoporosis. Treatment of a Silently Developing Disease Osteoporosis Treatment of a Silently Developing Disease Marc K. Drezner, MD Senior Associate Dean Emeritus Professor of Medicine Emeritus University of Wisconsin-Madison Auditorium The Forest at Duke October

More information

Clinician s Guide to Prevention and Treatment of Osteoporosis

Clinician s Guide to Prevention and Treatment of Osteoporosis Clinician s Guide to Prevention and Treatment of Osteoporosis Published: 15 August 2014 committee of the National Osteoporosis Foundation (NOF) Tipawan khiemsontia,md outline Basic pathophysiology screening

More information

From Fragile to Firm. Monika Starosta MD. Advocate Medical Group

From Fragile to Firm. Monika Starosta MD. Advocate Medical Group From Fragile to Firm Monika Starosta MD Advocate Medical Group Bone Remodeling 10% remodeled each year Calcium homoeostasis Maintain Mechanical strength Replace Osteocytes Release Growth Factors Bone remodeling

More information

Pathophysiology of Postmenopausal & Glucocorticoid Induced Osteoporosis. March 15, 2016 Bone ECHO Kate T Queen, MD

Pathophysiology of Postmenopausal & Glucocorticoid Induced Osteoporosis. March 15, 2016 Bone ECHO Kate T Queen, MD Pathophysiology of Postmenopausal & Glucocorticoid Induced Osteoporosis March 15, 2016 Bone ECHO Kate T Queen, MD Review: normal bone formation Bone Modeling Remodeling Peak Bone Mass Maximum bone mass

More information

BMD: A Continuum of Risk WHO Bone Density Criteria

BMD: A Continuum of Risk WHO Bone Density Criteria Pathogenesis of Osteoporosis Osteoporosis Diagnosis: BMD, FRAX and Assessment of Secondary Osteoporosis AGING MENOPAUSE OTHER RISK FACTORS RESORPTION > FORMATION Bone Loss LOW PEAK BONE MASS Steven T Harris

More information

ENDOCRINE DISORDERS IN THALASSEMIA MAJOR: QUALITY OF LIFE BEYOND SURVIVAL

ENDOCRINE DISORDERS IN THALASSEMIA MAJOR: QUALITY OF LIFE BEYOND SURVIVAL ENDOCRINE DISORDERS IN THALASSEMIA MAJOR: QUALITY OF LIFE BEYOND SURVIVAL 1,2 Carmen Barbu, 1,2 Alice Albu, 3 Larisa Nitu, 3 Daniela Voicu, 1,3 Florentina Vladareanu, 2 Suzana Florea and 1,2 Simona Fica

More information

ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS

ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS 1 1. NAME OF THE MEDICINAL PRODUCT Prolia 60 mg solution for injection in a pre-filled syringe 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Each pre-filled syringe

More information

Osteoporosis - Pathophysiology and diagnosis. Bente L Langdahl Department of Endocrinology Aarhus University Hospital Aarhus, Denmark

Osteoporosis - Pathophysiology and diagnosis. Bente L Langdahl Department of Endocrinology Aarhus University Hospital Aarhus, Denmark Osteoporosis - Pathophysiology and diagnosis Bente L Langdahl Department of Endocrinology Aarhus University Hospital Aarhus, Denmark Objective General knowledge about osteoporosis Optimise your protocols

More information

An Update on Osteoporosis Treatments

An Update on Osteoporosis Treatments An Update on Osteoporosis Treatments Dr Mike Stone University Hospital Llandough Treatments for osteoporosis Calcium and vitamin D HRT Raloxifene Etidronate Alendronate Risedronate Ibandronate (oral and

More information

Presenter: 翁家嫻 Venue date:

Presenter: 翁家嫻 Venue date: FOR THE TREATMENT OF OSTEOPOROSIS IN POSTMENOPAUSAL WOMEN AT INCREASED RISK OF FRACTURES 1 Presenter: 翁家嫻 Venue date: 2018.03.13 PMO: postmenopausal osteoporosis. 1. Prolia (denosumab), Summary of Product

More information

PART FOUR. Metabolism and Nutrition

PART FOUR. Metabolism and Nutrition PART FOUR Metabolism and Nutrition Advances in Peritoneal Dialysis, Vol. 21, 2005 Maria Mesquita, 1 Eric Wittersheim, 2 Anne Demulder, 2 Max Dratwa, 1 Pierre Bergmann 3 Bone Cytokines and Renal Osteodystrophy

More information

Bad to the Bones: Diabetes and Thiazolidinediones 9/9/2010. Steven Ing, MD, MSCE Assistant Professor Division of Endocrinology, Diabetes & Metabolism

Bad to the Bones: Diabetes and Thiazolidinediones 9/9/2010. Steven Ing, MD, MSCE Assistant Professor Division of Endocrinology, Diabetes & Metabolism Bad to the Bones: Diabetes and Thiazolidinediones 9/9/2010 Steven Ing, MD, MSCE Assistant Professor Division of Endocrinology, Diabetes & Metabolism Any reduction of bone mass in diabetics that is revealed

More information

Osteoporosis. Overview

Osteoporosis. Overview v2 Osteoporosis Overview Osteoporosis is defined as compromised bone strength that increases risk of fracture (NIH Consensus Conference, 2000). Bone strength is characterized by bone mineral density (BMD)

More information

Multiple Myeloma Bone Disease

Multiple Myeloma Bone Disease The 4th World Congress on CONTROVERSIES IN MULTIPLE MYELOMA May 3-5, 2018 Paris, France Multiple Myeloma Bone Disease Evangelos Terpos MD, PhD Plasma Cell Dyscrasias Unit,, National & Kapodistrian, School

More information

Bisphosphonates in the Management of. Myeloma Bone Disease

Bisphosphonates in the Management of. Myeloma Bone Disease Bisphosphonates in the Management of Myeloma Bone Disease James R. Berenson, MD Medical & Scientific Director Institute for Myeloma & Bone Cancer Research Los Angeles, CA Myeloma Bone Disease Myeloma cells

More information

Differentiating Pharmacological Therapies for Osteoporosis

Differentiating Pharmacological Therapies for Osteoporosis Differentiating Pharmacological Therapies for Osteoporosis Socrates E Papapoulos Department of Endocrinology & Metabolic Diseases Leiden University Medical Center The Netherlands Competing interests: consulting/speaking

More information

Practical Management Of Osteoporosis

Practical Management Of Osteoporosis Practical Management Of Osteoporosis CONFERENCE 2012 Education Centre, Bournemouth.19 November The following companies have given funding towards the cost of this meeting but have no input into the agenda

More information

8/6/2018. Glucocorticoid induced osteoporosis: overlooked and undertreated? Disclosure. Objectives. Overview

8/6/2018. Glucocorticoid induced osteoporosis: overlooked and undertreated? Disclosure. Objectives. Overview Disclosure Glucocorticoid induced osteoporosis: overlooked and undertreated? I have no financial disclosure relevant to this presentation Tasma Harindhanavudhi, MD Division of Diabetes and Endocrinology

More information

Bone strength is proportional to bone mass, measured with DXA. Bone turnover markers indicate the status of bone quality.

Bone strength is proportional to bone mass, measured with DXA. Bone turnover markers indicate the status of bone quality. Bone strength is proportional to bone mass, measured with DXA Bone quality depend on bone architecture, rate of bone turnover, quality of bone matrix. Bone turnover markers indicate the status of bone

More information

Regulation of the skeletal mass through the life span

Regulation of the skeletal mass through the life span Regulation of the skeletal mass through the life span Functions of the skeletal system Mechanical protection skull Movement leverage for muscles Mineral metabolism calcium store Erythropoiesis red blood

More information

Correlation between Thyroid Function and Bone Mineral Density in Elderly People

Correlation between Thyroid Function and Bone Mineral Density in Elderly People IBBJ Spring 2016, Vol 2, No 2 Original Article Correlation between Thyroid Function and Bone Mineral Density in Elderly People Ali Mirzapour 1, Fatemeh Shahnavazi 2, Ahmad Karkhah 3, Seyed Reza Hosseini

More information

SpongeBone Menopants*

SpongeBone Menopants* SpongeBone Menopants* Adam Fershko, MD, FACP Kettering Health Network *Postmenopausal Osteoporosis Objectives O Epidemiology O Clinical significance O Pathophysiology O Screening and Diagnosis O Treatment

More information

Disclosures CONSULTANT WRIGHT MEDICAL CONSULTANT ORTHO FIX

Disclosures CONSULTANT WRIGHT MEDICAL CONSULTANT ORTHO FIX Disclosures CONSULTANT WRIGHT MEDICAL CONSULTANT ORTHO FIX Overview Radiographic Pattern Histopathology Pathways: RANKL/OPG AGE/RAGE Treatment based on Evidence Radiographic Pattern Pattern of Diabetic

More information

A KL/R / AN A K/O / P O G G

A KL/R / AN A K/O / P O G G Outline and New Treatments on the Horizon Steven R. Cummings, MD CPMC and UCSF San Francisco Coordinating Center Support from Lilly and Amgen New treatments, new mechanisms of action Cathepsin K inhibition

More information

Supplemental tables: Abbreviations:

Supplemental tables: Abbreviations: Supplemental tables: Abbreviations: Osteoprotegerin (OPG), Receptor Activator of Nuclear factor Kappa beta Ligand (RANKL), fibroblast growth factor-23 (FGF-23), C-terminal cross-linked telopeptide of type-i

More information

Outline. Estrogens and SERMS The forgotten few! How Does Estrogen Work in Bone? Its Complex!!! 6/14/2013

Outline. Estrogens and SERMS The forgotten few! How Does Estrogen Work in Bone? Its Complex!!! 6/14/2013 Outline Estrogens and SERMS The forgotten few! Clifford J Rosen MD rosenc@mmc.org Physiology of Estrogen and estrogen receptors Actions of estrogen on bone BMD, fracture, other off target effects Cohort

More information

PHARMACOLOGIC PROPERTIES

PHARMACOLOGIC PROPERTIES Denosumab Prolia TM 60mg/mL Solution for Injection PRODUCT DESCRIPTION Each pre-filled syringe contains 60 mg of denosumab in 1.0 ml solution (60 mg/ml). Clear, colourless to slightly yellow solution,

More information

Rama Nada. - Mousa Al-Abbadi. 1 P a g e

Rama Nada. - Mousa Al-Abbadi. 1 P a g e - 1 - Rama Nada - - Mousa Al-Abbadi 1 P a g e Bones, Joints and Soft tissue tumors Before we start: the first 8 minutes was recalling to Dr.Mousa s duties, go over them in the slides. Wherever you see

More information

Chapter 39: Exercise prescription in those with osteoporosis

Chapter 39: Exercise prescription in those with osteoporosis Chapter 39: Exercise prescription in those with osteoporosis American College of Sports Medicine. (2010). ACSM's resource manual for guidelines for exercise testing and prescription (6th ed.). New York:

More information

Vitamin D and calcium are required at the time of denosumab administration during osteoporosis treatment

Vitamin D and calcium are required at the time of denosumab administration during osteoporosis treatment OPEN Citation: Bone Research (2017) 5, 17021; doi:10.1038/boneres.2017.21 www.nature.com/boneres ARTICLE Vitamin D and calcium are required at the time of denosumab administration during osteoporosis treatment

More information

Osteoporosis: current treatment and future prospects. Juliet Compston Professor Emeritus of Bone Medicine Cambridge Biomedical Campus

Osteoporosis: current treatment and future prospects. Juliet Compston Professor Emeritus of Bone Medicine Cambridge Biomedical Campus Osteoporosis: current treatment and future prospects Juliet Compston Professor Emeritus of Bone Medicine Cambridge Biomedical Campus Disclosures Consultancy and speaking fees for Gilead, related to development

More information

Drugs Affecting Bone. Rosa McCarty PhD. Department of Pharmacology & Therapeutics

Drugs Affecting Bone. Rosa McCarty PhD. Department of Pharmacology & Therapeutics Drugs Affecting Bone Rosa McCarty PhD Department of Pharmacology & Therapeutics rmccarty@unimelb.edu.au Objectives At the end of this lecture you should have gained: An understanding of bone metabolism

More information

BIOLOGY and BIOMECHANICS OF NORMAL & OSTEOPOROTIC BONE

BIOLOGY and BIOMECHANICS OF NORMAL & OSTEOPOROTIC BONE BIOLOGY and BIOMECHANICS OF NORMAL & OSTEOPOROTIC BONE Andreas Panagopoulos, MD, PhD Assistant Professor in Orthopaedics University Hospital of Patras, Orthopaedic Clinic Objectives Bone structure and

More information

Biochemistry #02. The biochemical basis of skeletal muscle and bone disorders Dr. Nabil Bashir Bara Sami. 0 P a g e

Biochemistry #02. The biochemical basis of skeletal muscle and bone disorders Dr. Nabil Bashir Bara Sami. 0 P a g e ]Type text[ ]Type text[ ]Type text[ Biochemistry #02 The biochemical basis of skeletal muscle and bone disorders Dr. Nabil Bashir Bara Sami 0 P a g e Greetings everyone, ladies and gentlemen The biochemical

More information

Elderly men with prostate cancer + ADT

Elderly men with prostate cancer + ADT Elderly men with prostate cancer + ADT Background and Rationale ADT and Osteoporosis Proportion of Patients With Fractures 1-5 Yrs After Cancer Diagnosis 21 18 +6.8%; P

More information

Original Article INTRODUCTION:

Original Article INTRODUCTION: Original Article International Journal of Dental and Health Sciences Volume 03,Issue 03 EFFECT OF HEMOGLOBIN AND FERRITIN OF SERUM CONCENTRATIONS ON THE DENSITY OF JAWBONE THAT INTENDED FOR DENTAL IMPLANT

More information

Bone metastases in hematology

Bone metastases in hematology Botziekte bij hematologische tumoren Prof. Dr. Michel Delforge Hematologie, UZ Leuven Bone metastases in hematology The bone marrow is the source of many hematological malignancies However, bone damage

More information

Bone Cell Biology. David W. Dempster, PhD. Professor of Clinical Pathology Columbia University. Bone Remodeling

Bone Cell Biology. David W. Dempster, PhD. Professor of Clinical Pathology Columbia University. Bone Remodeling Bone Cell Biology David W. Dempster, PhD Professor of Clinical Pathology Columbia University Bone Remodeling The skeleton, out of site and often out of mind, is a formidable mass of tissue occupying about

More information

Bone Cell Biology. The Remodeling Cycle. Bone Remodeling. Remodeling Maintains Mechanical Strength. David W. Dempster, PhD

Bone Cell Biology. The Remodeling Cycle. Bone Remodeling. Remodeling Maintains Mechanical Strength. David W. Dempster, PhD Bone Remodeling Bone Cell Biology David W. Dempster, PhD Professor of Clinical Pathology Columbia University The skeleton, out of site and often out of mind, is a formidable mass of tissue occupying about

More information

Forteo (teriparatide) Prior Authorization Program Summary

Forteo (teriparatide) Prior Authorization Program Summary Forteo (teriparatide) Prior Authorization Program Summary FDA APPROVED INDICATIONS DOSAGE 1 FDA Indication 1 : Forteo (teriparatide) is indicated for: the treatment of postmenopausal women with osteoporosis

More information

TEAM SCIENCE AT A PROGRAMMATIC LEVEL. Sundeep Khosla, M.D. Mayo Clinic College of Medicine

TEAM SCIENCE AT A PROGRAMMATIC LEVEL. Sundeep Khosla, M.D. Mayo Clinic College of Medicine TEAM SCIENCE AT A PROGRAMMATIC LEVEL Sundeep Khosla, M.D. Mayo Clinic College of Medicine APPROACH TO TRANSLATIONAL RESEARCH IN OSTEOPOROSIS Epidemiological Studies Clinical Investigation Mouse and Cellular

More information

Biochemistry #01 Bone Formation Dr. Nabil Bashir Farah Banyhany

Biochemistry #01 Bone Formation Dr. Nabil Bashir Farah Banyhany Biochemistry #01 Bone Formation Dr. Nabil Bashir Farah Banyhany Greetings This lecture is quite detailed, but I promise you will make it through, it just requires your 100% FOCUS! Let s begin. Today s

More information

Download slides:

Download slides: Download slides: https://www.tinyurl.com/m67zcnn https://tinyurl.com/kazchbn OSTEOPOROSIS REVIEW AND UPDATE Boca Raton Regional Hospital Internal Medicine Conference 2017 Benjamin Wang, M.D., FRCPC Division

More information

Anabolic Therapy With Teriparatide Indications Beyond Osteoporosis

Anabolic Therapy With Teriparatide Indications Beyond Osteoporosis Anabolic Therapy With Teriparatide Indications Beyond Osteoporosis Andreas Panagopoulos MD, PhD Upper Limb & Sports Medicine Orthopaedic Surgeon Assistant Professor, University of Patras Outline Teriparatide

More information

Vol. 19, Bulletin No. 108 August-September 2012 Also in the Bulletin: Denosumab 120mg for Bone Metastases

Vol. 19, Bulletin No. 108 August-September 2012 Also in the Bulletin: Denosumab 120mg for Bone Metastases ה מ ר א פ הביטאון לענייני תרופות ISRAEL DRUG BULLETIN 19 years of unbiased and independent drug information P H A R x M A Vol. 19, Bulletin No. 108 August-September 2012 Also in the Bulletin: Denosumab

More information

The Skeletal Response to Aging: There s No Bones About It!

The Skeletal Response to Aging: There s No Bones About It! The Skeletal Response to Aging: There s No Bones About It! April 7, 2001 Joseph E. Zerwekh, Ph.D. Interrelationship of Intestinal, Skeletal, and Renal Systems to the Overall Maintenance of Normal Calcium

More information

Prevalence of Osteoporosis among Thalassemia Patients from Zafar Adult Thalassemia Clinic, Iran

Prevalence of Osteoporosis among Thalassemia Patients from Zafar Adult Thalassemia Clinic, Iran ORIGINAL ARTICLE IJBC 2014;6(3): 143-148 Prevalence of Osteoporosis among Thalassemia Patients from Zafar Adult Thalassemia Clinic, Iran Hashemieh M 1, Azarkeivan A 2 *, Radfar M 3, Saneifard H 4, Hosseini-Zijoud

More information

Current and Emerging Strategies for Osteoporosis

Current and Emerging Strategies for Osteoporosis Current and Emerging Strategies for Osteoporosis I have nothing to disclose. Anne Schafer, MD Assistant Professor of Medicine Division of Endocrinology & Metabolism December 12, 2014 Outline Osteoporosis

More information

Study of secondary causes of male osteoporosis

Study of secondary causes of male osteoporosis Study of secondary causes of male osteoporosis Suárez, S.M., Giunta J., Meneses G., Costanzo P.R., Knoblovits P. Department of Endocrinology, Metabolism and Nuclear Medicine of Hospital Italiano of Buenos

More information

Bone Disease in Thalassemia: A Molecular and Clinical Overview

Bone Disease in Thalassemia: A Molecular and Clinical Overview REVIEW Bone Disease in Thalassemia: A Molecular and Clinical Overview Phillip Wong, Peter J. Fuller, Matthew T. Gillespie, and Frances Milat Department of Endocrinology (P.W., P.J.F., F.M.), Monash Health,

More information

Kobe University Repository : Kernel

Kobe University Repository : Kernel Title Author(s) Citation Issue date 2009-09 Resource Type Resource Version DOI URL Kobe University Repository : Kernel Marked increase in bone formation markers after cinacalcet treatment by mechanisms

More information

Generation of post-germinal centre myeloma plasma B cell.

Generation of post-germinal centre myeloma plasma B cell. Generation of post-germinal centre myeloma. DNA DAMAGE CXCR4 Homing to Lytic lesion activation CD38 CD138 CD56 Phenotypic markers Naive Secondary lymphoid organ Multiple myeloma is a malignancy of s caused

More information

Bone and Mineral. Comprehensive Menu for the Management of Bone and Mineral Related Diseases

Bone and Mineral. Comprehensive Menu for the Management of Bone and Mineral Related Diseases Bone and Mineral Comprehensive Menu for the Management of Bone and Mineral Related Diseases Innovation to Assist in Clinical Diagnosis and Treatment DiaSorin offers a specialty line of Bone and Mineral

More information

Non-malignant hematologic disorders associated arthropathies: hemoglobinopathy-associated musculoskeletal manifestations, hemophilia

Non-malignant hematologic disorders associated arthropathies: hemoglobinopathy-associated musculoskeletal manifestations, hemophilia Non-malignant hematologic disorders associated arthropathies: hemoglobinopathy-associated musculoskeletal manifestations, hemophilia HAEMOGLOBINOPATHIES = inherited disorders of globin divided into: Thalassaemia

More information

Journal of Hainan Medical University. Wei Li. 1. Introduction. 28 Journal of Hainan Medical University 2016; 22(21): 28-32

Journal of Hainan Medical University. Wei Li. 1. Introduction. 28 Journal of Hainan Medical University 2016; 22(21): 28-32 28 Journal of Hainan Medical University 2016; 22(21): 28-32 Journal of Hainan Medical University http://www.hnykdxxb.com Dual-energy X-ray absorptiometry assessment of postmenopausal women with vertebral

More information

Genetic examination of diseases affecting bone development. and structure in newborns

Genetic examination of diseases affecting bone development. and structure in newborns Genetic examination of diseases affecting bone development and structure in newborns Examination of molecular genetic markers in osteopenic preterm infants PhD Thesis Simone Funke, MD University of Pécs

More information

Bone Metastases. Sukanda Denjanta, M.Sc., BCOP Pharmacy Department, Chiangrai Prachanukroh Hospital

Bone Metastases. Sukanda Denjanta, M.Sc., BCOP Pharmacy Department, Chiangrai Prachanukroh Hospital Bone Metastases Sukanda Denjanta, M.Sc., BCOP Pharmacy Department, Chiangrai Prachanukroh Hospital 1 Outline Pathophysiology Signs & Symptoms Diagnosis Treatment Spinal Cord Compression 2 General Information

More information

9/26/2016. The Impact of Dietary Protein on the Musculoskeletal System. Research in dietary protein, musculoskeletal health and calcium economy

9/26/2016. The Impact of Dietary Protein on the Musculoskeletal System. Research in dietary protein, musculoskeletal health and calcium economy The Impact of Dietary Protein on the Musculoskeletal System Outline A. The musculoskeletal system and associated disorders Jessica D Bihuniak, PhD, RD Assistant Professor of Clinical Nutrition Department

More information

Breast Cancer and Bone Health. Robert Coleman, Cancer Research Centre, Weston Park Hospital, Sheffield

Breast Cancer and Bone Health. Robert Coleman, Cancer Research Centre, Weston Park Hospital, Sheffield Breast Cancer and Bone Health Robert Coleman, Cancer Research Centre, Weston Park Hospital, Sheffield Breast Cancer and Bone Health Normal Bone Health Impact of Cancer Therapies on Bone Health Therapeutic

More information

Bone Turnover Markers for the Diagnosis and Management of Osteoporosis and Diseases Associated with High Bone Turnover. Original Policy Date

Bone Turnover Markers for the Diagnosis and Management of Osteoporosis and Diseases Associated with High Bone Turnover. Original Policy Date MP 2.04.10 Bone Turnover Markers for the Diagnosis and Management of Osteoporosis and Diseases Associated with High Bone Turnover Medical Policy Section Medicine Issue 12:2013 Original Policy Date 12:2013

More information

CASE 1 WHY IS IT IMPORTANT TO TREAT? FACTS CONCERNS

CASE 1 WHY IS IT IMPORTANT TO TREAT? FACTS CONCERNS 4:30-5:15pm Ask the Expert: Osteoporosis SPEAKERS Silvina Levis, MD OSTEOPOROSIS - FACTS 1:3 older women and 1:5 older men will have a fragility fracture after age 50 After 3 years of treatment, depending

More information

The Latest is the Greatest. Future Directions in the Management of Patients with Bone Metastases from Breast Cancer

The Latest is the Greatest. Future Directions in the Management of Patients with Bone Metastases from Breast Cancer City Wide Medical Oncology Rounds Friday Sept. 21 st, 2007 The Latest is the Greatest Future Directions in the Management of Patients with Bone Metastases from Breast Cancer Mark Clemons Head, Breast Medical

More information

Product: Denosumab (AMG 162) Clinical Study Report: month Primary Analysis Date: 21 November 2016 Page 1

Product: Denosumab (AMG 162) Clinical Study Report: month Primary Analysis Date: 21 November 2016 Page 1 Date: 21 November 2016 Page 1 2. SYNOPSIS Name of Sponsor: Amgen Inc., Thousand Oaks, CA, USA Name of Finished Product: Prolia Name of Active Ingredient: denosumab Title of Study: Randomized, Double-blind,

More information

Silent Killer: Osteoporosis

Silent Killer: Osteoporosis Special Dedication to the Old Females Silent Killer: Osteoporosis David Goltzman, Discoveries, Drugs and Skeletal Disorders Nature, Volume 1, October 2002, pp784-796 BII Journal Club Wang Zhengyuan 5:00-5:30pm

More information

Updates in Osteoporosis. I have no conflicts of interest. What Would You Do? Mrs. C. What s New in Osteoporosis. Page 1

Updates in Osteoporosis. I have no conflicts of interest. What Would You Do? Mrs. C. What s New in Osteoporosis. Page 1 Updates in Osteoporosis Jeffrey A. Tice, MD Associate Professor of Medicine Division of General Internal Medicine, University of California, San Francisco I have no conflicts of interest What s New in

More information

OSSEOUS TISSUE & BONE STRUCTURE PART I: OVERVIEW & COMPONENTS

OSSEOUS TISSUE & BONE STRUCTURE PART I: OVERVIEW & COMPONENTS OSSEOUS TISSUE & BONE STRUCTURE PART I: OVERVIEW & COMPONENTS The Skeletal System Skeletal system includes: bones of the skeleton, cartilages, ligaments, and connective tissues What are the functions of

More information

denosumab (Prolia ) Policy # Original Effective Date: 07/21/2011 Current Effective Date: 04/19/2017

denosumab (Prolia ) Policy # Original Effective Date: 07/21/2011 Current Effective Date: 04/19/2017 Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc.(collectively referred to as the Company ), unless otherwise provided

More information

Based on review of available data, the Company may consider the use of denosumab (Prolia) for the

Based on review of available data, the Company may consider the use of denosumab (Prolia) for the Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc.(collectively referred to as the Company ), unless otherwise provided

More information

HRT and Risedronate Combined Anabolic and Antiresorptive Therapy

HRT and Risedronate Combined Anabolic and Antiresorptive Therapy Optimizing Combined and Sequential Osteoanabolic and Antiresorptive Therapy Benjamin Leder, M.D. Endocrine Unit Massachusetts General Hospital Boston, MA Antiresorptive and Osteoanabolic Therapies Increase

More information

Index. B BMC. See Bone mineral content BMD. See Bone mineral density Bone anabolic impact, Bone mass acquisition

Index. B BMC. See Bone mineral content BMD. See Bone mineral density Bone anabolic impact, Bone mass acquisition A Acid base balance dietary protein detrimental effects of, 19 Acid base balance bicarbonate effects, 176 in bone human studies, 174 mechanisms, 173 174 in muscle aging, 174 175 alkali supplementation

More information

A Case of Cushing Syndrome Diagnosed by Recurrent Pathologic Fractures in a Young Woman

A Case of Cushing Syndrome Diagnosed by Recurrent Pathologic Fractures in a Young Woman A Case of Cushing Syndrome Diagnosed by Recurrent Pathologic Fractures in a Young Woman JY Han, et al CASE REPORT http://dx.doi.org/10.11005/jbm.2012.19.2.153 Vol. 19, No. 2, 2012 A Case of Cushing Syndrome

More information

Sponsor / Company: sanofi-aventis and Proctor & Gamble Drug substance(s): Risedronate (HMR4003)

Sponsor / Company: sanofi-aventis and Proctor & Gamble Drug substance(s): Risedronate (HMR4003) These results are supplied for informational purposes only. Prescribing decisions should be made based on the approved package insert in the country of prescription. Sponsor / Company: sanofi-aventis and

More information

ANATOMY C027A: MINERALIZED TISSUE BIOLOGY: SKELETAL TISSUES. Please answer THREE Questions. All questions carry equal marks.

ANATOMY C027A: MINERALIZED TISSUE BIOLOGY: SKELETAL TISSUES. Please answer THREE Questions. All questions carry equal marks. Module Code: C27A UNIVERSITY OF LONDON (University College London) BSc DEGREE 2001 ANATOMY C027A: MINERALIZED TISSUE BIOLOGY: SKELETAL TISSUES 16 May 2001, 10.00am 1) Discuss the roles of ph, po2, phosphate

More information

Osteoporosis, Osteomalasia & rickets. Bone disorders

Osteoporosis, Osteomalasia & rickets. Bone disorders Osteoporosis, Osteomalasia & rickets Bone disorders Thank You for Your comments Voice--- Ok Lecture too long--- this is in schedule??? More interaction--- I can do that inshalla Slides are crowded--- but

More information

Southern Derbyshire Shared Care Pathology Guidelines. Primary Hyperparathyroidism

Southern Derbyshire Shared Care Pathology Guidelines. Primary Hyperparathyroidism Southern Derbyshire Shared Care Pathology Guidelines Primary Hyperparathyroidism Please use this Guideline in Conjunction with the Hypercalcaemia Guideline Definition Driven by hyperfunction of one or

More information

S^t _j4 A-N.1^.^ A _ WE 2

S^t _j4 A-N.1^.^ A _ WE 2 S^t _j4 A-N.1^.^ A _ WE 2 Name of Sponsor: Amgen Inc. Name of Finished Product: Denosumab (AMG 162) Name of Active Ingredient: Fully human monoclonal antibody to RANKL Title of Study: A Randomized Study

More information

In postmenopausal women with osteoporosis, Prolia reduces the incidence of vertebral, non-vertebral, and hip fractures.

In postmenopausal women with osteoporosis, Prolia reduces the incidence of vertebral, non-vertebral, and hip fractures. 1 INDICATIONS PROLIA (denosumab) TFDA license number 000918 Treatment of Postmenopausal Women with Osteoporosis at High Risk for Fracture Explanation: For postmenopausal women with osteoporosis in any

More information

Peggers Super Summaries Basic Sciences Bone

Peggers Super Summaries Basic Sciences Bone Bone Overview & Turnover BONES Function o Support o Protection o Assisting movement o Storage of minerals o Production of red blood cells from marrow Types o Cancellous o Compact with Haversian systems

More information

Because the low bone mass and deterioration

Because the low bone mass and deterioration OSTEOPOROSIS A look at recent expert guidelines and key studies in bone health, the findings of which affect your patients young and old Steven R. Goldstein, MD Dr. Goldstein is Professor of Obstetrics

More information

PARATHYROID, VITAMIN D AND BONE

PARATHYROID, VITAMIN D AND BONE PARATHYROID, VITAMIN D AND BONE G M Kellerman Pathology North Hunter Service 30/01/2015 BIOLOGY OF BONE Bone consists of protein, polysaccharide components and mineral matrix. The mineral is hydroxylapatite,

More information

NAME OF THE MEDICINE. Prolia is the Amgen Inc. trademark for denosumab (rch). DESCRIPTION

NAME OF THE MEDICINE. Prolia is the Amgen Inc. trademark for denosumab (rch). DESCRIPTION Prolia (denosumab) Product Information Page 1 of 15 NAME OF THE MEDICINE Prolia is the Amgen Inc. trademark for denosumab (rch). DESCRIPTION Denosumab is a fully human IgG2 monoclonal antibody with high

More information

Guideline for the investigation and management of osteoporosis. for hospitals and General Practice

Guideline for the investigation and management of osteoporosis. for hospitals and General Practice Guideline for the investigation and management of osteoporosis for hospitals and General Practice Background Low bone density is an important risk factor for fracture. The aim of assessing bone density

More information

Xgeva (denosumab) injection, for subcutaneous use Initial US Approval: 2010

Xgeva (denosumab) injection, for subcutaneous use Initial US Approval: 2010 HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use XGEVA safely and effectively. See full prescribing information for XGEVA. Xgeva (denosumab) injection,

More information