Challenging the Current Osteoporosis Guidelines. Carolyn J. Crandall, MD, MS Professor of Medicine David Geffen School of Medicine at UCLA

Size: px
Start display at page:

Download "Challenging the Current Osteoporosis Guidelines. Carolyn J. Crandall, MD, MS Professor of Medicine David Geffen School of Medicine at UCLA"

Transcription

1 Challenging the Current Osteoporosis Guidelines Carolyn J. Crandall, MD, MS Professor of Medicine David Geffen School of Medicine at UCLA

2 Whom to screen Which test How to diagnose Whom to treat Benefits and risks of therapy Monitoring Treatment duration

3 Clinical guideline: Diagnosis Adulthood hip or vertebral fracture in the absence of major trauma or Bone mineral density (BMD) T-score -2.5 at lumbar spine or hip by dual-energy x-ray absorptiometry (DXA) (National Osteoporosis Foundation Clinician s Guide to Prevention and Treatment of Osteoporosis

4 Clinical guideline: Treatment Postmenopausal women and men age 50 if: Hip or vertebral (clinical or asymptomatic) fracture, or BMD T-score -2.5 femoral neck, total hip, or lumbar spine, or Low bone mass (T-score between -1.0 and -2.5 at femoral neck, total hip, or spine) if: 10-yr probability of hip fracture 3% or 10-yr probability of major osteoporosis-related fracture 20% based on U.S. WHO FRAX. (National Osteoporosis Foundation Clinician s Guide to Prevention and Treatment of Osteoporosis

5 Why care about wrist fracture? The incidence of wrist and distal forearm fracture rises rapidly after menopause. Wrist fractures occur at younger ages than do other osteoporotic fractures.

6 So the question is: Should wrist fractures be an indication for pharmacotherapy too? No U.S. studies have examined specific anatomical patterns of fracture following wrist fracture in postmenopausal women. First step.

7 Crandall et al, Journal of Bone and Mineral Research, Vol. 30, No. 11, November 2015, pp

8 Goal To determine among postmenopausal women the associations between wrist fracture and subsequent nonwrist fracture, according to anatomic site and age. Through end of WHI Extension 1. (Crandall et al, Journal of Bone and Mineral Research, Vol. 30, No. 11, November 2015, pp )

9 Analytic Sample Enrolled in the Women s Health Initiative Observational Study and Clinical Trials (n=161,808) Excluded: no follow-up (n=878) Analytic sample for fracture analysis (n=160,930) Crandall et al, JBMR 2015

10 Data collection Osteoporosis risk factors Baseline questionnaires Measured weight, height Incident fractures: F/u questionnaires: Has a doctor told you for the first time that you have a new broken, fractured, or crushed bone? Which bone(s)? (Annual in WHI-OS, semi-annual in WHI-CTs) (Crandall et al JBMR 2015)

11 Predictor Wrist fracture: first incident fracture of the radius or ulna (forearm) or carpal bones (Crandall et al, Journal of Bone and Mineral Research, Vol. 30, No. 11, November 2015, pp )

12 Outcome First occurrence of fracture of any of: Clinical spine Humerus Upper extremity non-wrist elbow, hand [except fingers], upper arm/humerus, shoulder Lower extremity non-hip Hip foot [except toes], knee/patella, upper leg, lower leg/ankle (Crandall et al, Journal of Bone and Mineral Research 2015)

13 Statistical analysis Cox proportional hazards: Age Race BMI Education Income Smoking Total METs/week Dietary and supplemental calcium and vit. D intake WHI-HT treatment assignment WHI DM Trial treatment assignment Falls frequency Alcohol intake Cancer history Physical function score (Crandall et al, JBMR, 2015, 30 (11): )

14 Results 8,792 wrist fractures occurred in 160,930 women during mean f/u 11.8 (3.4) years. (Crandall et al, JBMR, 2015, 30 (11): )

15 Baseline Characteristics Total N = 160,930 N (%) N (%) Age BMI (kg/m2) ,087 (35.2) < ,234 (33.1) ,419 (34.7) ,243 (44.9) 30 48,013 (30.1) ,453 (22.0) Meno. HT current 64,607 (40.2) Education Fracture Age ,130 (14.0) HS 35,962 (22.5) Falls last 12 mo Some coll 60,610 (37.9) <2 times 135,119 (87.6) College 63,151 (39.5) 2 times 19,252 (12.5) Ethnicity Alc. 7+ drinks/wk 18,692 (11.7) White 133,032 (82.9) Current Smoker 11,048 (7.0) Black 14,469 (9.0) MET-hrs/wk mean (SD) 12.4 (13.7) Other 13,020 (8.0) Bisphos 3,155 (2.0) * Through end Ext. 1 (Crandall et al, JBMR, 2015)

16 (Crandall et al, JBMR, 2015, 30 (11): )

17 Table 4. Associations between Incident Wrist Fracture and Subsequent Fracture Wrist Fracture No Yes Total N Event HR (95% CI) Any non-wrist Crude 160,930 33,979 1 (ref) 1.54 ( ) Spine Fracture Crude 160,930 5,373 1 (ref) 1.75 ( ) Humerus Crude 160,930 4,361 1 (ref) 1.99 ( ) (Crandall et al, JBMR, 2015, 30 (11): )

18 Table 4. Associations between Incident Wrist Fracture and Subsequent Fracture Wrist Fracture No Yes Total N Event HR (95% CI) Any non-wrist Crude 160,930 33,979 1 (ref) 1.54 ( ) Model 3 136,017 28,790 1 (ref) 1.37 ( ) Spine Fracture Crude 160,930 5,373 1 (ref) 1.75 ( ) Model 3 136,017 4,544 1 (ref) 1.46 ( ) Humerus Crude 160,930 4,361 1 (ref) 1.99 ( ) Model 3 136,017 3,676 1 (ref) 1.67 ( ) (Crandall et al, JBMR, 2015, 30 (11): )

19 Table 4. Associations between Incident Wrist Fracture and Subsequent Fracture Wrist Fracture No Yes Total N Event HR (95% CI) Upper extr. (non-wrist) Crude 160,930 7,312 1 (ref) 2.06 ( ) Model 3 136,017 6,184 1 (ref) 1.80 ( ) Lower extr. (non-hip) Crude 160,930 15,034 1 (ref) 1.41 ( ) Model 3 136,017 12,718 1 (ref) 1.30 ( ) Hip fracture Crude 160,930 3,836 1 (ref) 1.97 ( ) Model 3 136,017 3,186 1 (ref) 1.48 ( ) (Crandall et al, JBMR, 2015, 30 (11): )

20 Model 3 vs. crude model Associations between previous wrist fracture and subsequent non-wrist fracture persisted after adjustment for: other osteoporosis risk factors falls alcohol intake history of cancer physical function score (Crandall et al, JBMR, 2015, 30 (11): )

21 Figure 2a. Time to non-wrist fracture in the presence and absence of initial wrist fracture during the WHI follow-up (unadjusted cumulative incidence with vs. without prior wrist fracture) (Crandall et al, JBMR, 2015, 30 (11): )

22 Figure 2a. Time to non-wrist fracture in the presence and absence of initial wrist fracture during the WHI follow-up Guideline: treat women 50 y/o if 10- yr prob. of major osteoporosis -related fracture is 20% (unadjusted cumulative incidence with vs. without prior wrist fracture) (Crandall et al, JBMR, 2015, 30 (11): )

23 Figure 2b. Time to humerus fracture in the presence and absence of initial wrist fracture during the WHI follow-up (unadjusted cumulative incidence with vs. without prior wrist fracture)(crandall et al, JBMR, 2015, 30 (11): )

24 Figure 2c. Time to hip fracture in the presence and absence of initial wrist fracture during the WHI follow-up (unadjusted cumulative incidence with vs. without prior wrist fracture)(crandall et al, JBMR, 2015, 30 (11): )

25 Figure 2d. Time to spine fracture in the presence and absence of initial wrist fracture during the WHI follow-up (unadjusted cumulative incidence with vs. without prior wrist fracture)(crandall et al, JBMR, 2015, 30 (11): )

26 Suppl. Table 4. Associations between wrist fracture and subsequent non-wrist fracture BMD cohort Wrist Fracture No Yes Total N Event HR (95% CI) BMD cohort (n = 11,350) Any non-wrist fracture Crude 11,350 2,303 1 (ref) 1.59 ( ) Model 1 11,260 2,291 1 (ref) 1.42 ( ) Crude + base. FN BMD 11,350 2,303 1 (ref) 1.36 ( ) Model 1 + base. FN BMD 11,115 2,149 1 (ref) 1.30 ( ) [1] Model 1 adjusted for age, race, and BMI (Crandall et al JBMR 2015)

27 Interaction tests Pre-specified interaction tests were performed No interaction by : MET-hrs/week RAND PF Score Falls in past year FRAX-predicted fracture risk But (Crandall et al, JBMR, 2015, 30 (11): )

28 Suppl. Table 2. Associations between incident wrist fracture & subseq. non-wrist fracture by age at wrist fracture Any nonwrist fx No Wrist Fracture Yes person-yrs Event HR (95% CI) P value Current age 0.02 <55 58, (ref) 2.49 ( ) 55-<60 187,258 2,291 1 (ref) 1.96 ( ) 60-<65 316,832 4,626 1 (ref) 1.64 ( ) 65-<70 382,910 6,735 1 (ref) 1.45 ( ) 70-<75 356,914 7,373 1 (ref) 1.35 ( ) 75-<80 251,469 6,926 1 (ref) 1.45 ( ) 80 or older 139,235 5,375 1 (ref) 1.24 ( ) Adjusted for age, race, and BMI (Crandall et al, JBMR, 2015)

29 Sensitivity analyses 1. Excluded data from women who reported during follow-up: Osteoporosis medication Self-initiated menopausal hormone therapy Active arms of WHI Hormone Therapy and CaD trials 2. Included only medical record-confirmed fractures. Results similar to primary analyses. (Crandall et al, JBMR, 2015, 30 (11): )

30 Summary To our knowledge, this study is the first large multisite prospective US study that has focused on associations between wrist fracture and subsequent incidence of upper extremity, lower extremity, and spine fracture. Nearly 1 in 5 women with initial wrist fracture went on to experience a subsequent non-wrist fracture over 11 years of follow-up. (Crandall et al, JBMR, 2015, 30 (11): )

31 Summary Falls did not account for the increased risk of non-wrist fracture after an initial wrist fracture. Because associations persisted after adj. for BMD: Treatment guided by spine and/or hip BMD measurements alone may underestimate the increased risk of subsequent fracture risk in the setting of an initial wrist fracture. Aberrations in bone structure and/or strength may be at least partly responsible for placing women with wrist fracture at increased risk of subsequent fracture. (Crandall et al, JBMR, 2015, 30 (11): )

32 Implications Clinicians should identify postmenopausal women with wrist fractures as being at significantly elevated risk for multiple types of future fracture, including hip fracture. In fully-adjusted models, wrist fracture was associated with a 37% higher relative risk of subsequent nonwrist fracture, which was similar in magnitude to being 10 years older (35% higher). Be aware that the younger the woman is when she experiences wrist fracture, the higher the relative risk of subsequent fracture. (Crandall et al, JBMR, 2015, 30 (11): )

33 Whom to screen Which test How to diagnose Whom to treat Benefits and risks of therapy Monitoring Treatment duration

34 Diagnosis back in the day Physicians should consider a diagnosis of osteoporosis in individuals with a fragility fracture. Prevention and management of osteoporosis, report of a WHO Scientific Group, WHO technical report series 921, 2003

35 Treatment in UK now Women with a prior fragility fracture should be considered for treatment without the need for further risk assessment although BMD measurement may sometimes be appropriate, particularly in younger postmenopausal women. (Guideline for the diagnosis and management of osteoporosis in postmenopausal women and men from the age of 50 years in the UK, National Osteoporosis Guideline Group 2013

36 The future Findings highlight the need for future studies that focus on developing and testing interventions specifically to prevent subsequent fractures after an initial wrist fracture. (Crandall et al, JBMR, 2015, 30 (11): )

37 Acknowledgements Jane A. Cauley, DrPh Meryl Leboff, MD Jeffrey R. Curtis, MD, MS, MPH Jean Wactawski-Wende, PhD Nicole C. Wright, PhD Wenjun Li, PhD Kristen Beavers, PhD Kathleen M. Hovey, MS Christopher A. Andrews, PhD

38

Carolyn J. Crandall, MD, MS On behalf of the WHI Bone SIG

Carolyn J. Crandall, MD, MS On behalf of the WHI Bone SIG Carolyn J. Crandall, MD, MS On behalf of the WHI Bone SIG Background One half of all postmenopausal women will have an osteoporosis related fracture during their lifetimes. Background Low body weight is

More information

Osteoporosis: An Overview. Carolyn J. Crandall, MD, MS

Osteoporosis: An Overview. Carolyn J. Crandall, MD, MS Osteoporosis: An Overview Carolyn J. Crandall, MD, MS Osteoporosis: An Overview Carolyn J. Crandall, MD, MS Professor of Medicine David Geffen School of Medicine at UCLA Objectives Review osteoporosis

More information

Characteristics of Sleep and the Risk of Falls and Fractures: The Women s Health Initiative (WHI)

Characteristics of Sleep and the Risk of Falls and Fractures: The Women s Health Initiative (WHI) Characteristics of Sleep and the Risk of Falls and Fractures: The Women s Health Initiative (WHI) Jane A. Cauley, Kathleen M. Hovey, Katie L. Stone, Chris A. Andrews, Kamil E. Barbour, Lauren Hale Rebecca

More information

Learning Objectives. Controversies in Osteoporosis Prevention and Management. Etiology. Presenter Disclosure Information. Epidemiology.

Learning Objectives. Controversies in Osteoporosis Prevention and Management. Etiology. Presenter Disclosure Information. Epidemiology. 12:45 1:30pm Controversies in Osteoporosis Prevention and Management SPEAKER Carolyn Crandall, MD, MS Presenter Disclosure Information The following relationships exist related to this presentation: Carolyn

More information

Learning Objectives. Controversies in Osteoporosis Prevention and Management. Definition. Presenter Disclosure Information.

Learning Objectives. Controversies in Osteoporosis Prevention and Management. Definition. Presenter Disclosure Information. 4 4:45 pm Controversies in Osteoporosis Prevention and Management SPEAKER Carolyn Crandall, MD, MS Presenter Disclosure Information The following relationships exist related to this presentation: Carolyn

More information

Module 5 - Speaking of Bones Osteoporosis For Health Professionals: Fracture Risk Assessment. William D. Leslie, MD MSc FRCPC

Module 5 - Speaking of Bones Osteoporosis For Health Professionals: Fracture Risk Assessment. William D. Leslie, MD MSc FRCPC Module 5 - Speaking of Bones Osteoporosis For Health Professionals: Fracture Risk Assessment William D. Leslie, MD MSc FRCPC Case #1 Age 53: 3 years post-menopause Has always enjoyed excellent health with

More information

Advanced medicine conference. Monday 20 Tuesday 21 June 2016

Advanced medicine conference. Monday 20 Tuesday 21 June 2016 Advanced medicine conference Monday 20 Tuesday 21 June 2016 Osteoporosis: recent advances in risk assessment and management Juliet Compston Emeritus Professor of Bone Medicine Cambridge Biomedical Campus

More information

Osteoporosis Screening and Treatment in Type 2 Diabetes

Osteoporosis Screening and Treatment in Type 2 Diabetes Osteoporosis Screening and Treatment in Type 2 Diabetes Ann Schwartz, PhD! Dept. of Epidemiology and Biostatistics! University of California San Francisco! October 2011! Presenter Disclosure Information

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

Use of DXA / Bone Density in the Care of Your Patients. Brenda Lee Holbert, M.D. Associate Professor Senior Staff Radiologist

Use of DXA / Bone Density in the Care of Your Patients. Brenda Lee Holbert, M.D. Associate Professor Senior Staff Radiologist Use of DXA / Bone Density in the Care of Your Patients Brenda Lee Holbert, M.D. Associate Professor Senior Staff Radiologist Important Websites Resources for Clinicians and Patients www.nof.org www.iofbonehealth.org

More information

Interpreting DEXA Scan and. the New Fracture Risk. Assessment. Algorithm

Interpreting DEXA Scan and. the New Fracture Risk. Assessment. Algorithm Interpreting DEXA Scan and the New Fracture Risk Assessment Algorithm Prof. Samir Elbadawy *Osteoporosis affect 30%-40% of women in western countries and almost 15% of men after the age of 50 years. Osteoporosis

More information

Using the FRAX Tool. Osteoporosis Definition

Using the FRAX Tool. Osteoporosis Definition How long will your bones remain standing? Using the FRAX Tool Gary Salzman M.D. Director Banner Good Samaritan/ Hayden VAMC Internal Medicine Geriatric Fellowship Program Phoenix, Arizona Using the FRAX

More information

Coordinator of Post Professional Programs Texas Woman's University 1

Coordinator of Post Professional Programs Texas Woman's University 1 OSTEOPOROSIS Update 2007-2008 April 26, 2008 How much of our BMD is under our control (vs. genetics)? 1 2 Genetic effects on bone loss: longitudinal twin study (Makovey, 2007) Peak BMD is under genetic

More information

Osteoporosis/Fracture Prevention

Osteoporosis/Fracture Prevention Osteoporosis/Fracture Prevention NATIONAL GUIDELINE SUMMARY This guideline was developed using an evidence-based methodology by the KP National Osteoporosis/Fracture Prevention Guideline Development Team

More information

NICE SCOOP OF THE DAY FRAX with NOGG. Eugene McCloskey Professor of Adult Bone Diseases University of Sheffield

NICE SCOOP OF THE DAY FRAX with NOGG. Eugene McCloskey Professor of Adult Bone Diseases University of Sheffield NICE SCOOP OF THE DAY FRAX with NOGG Eugene McCloskey Professor of Adult Bone Diseases University of Sheffield Disclosures Consultant/Advisor/Speaker for: o ActiveSignal, Amgen, AstraZeneca, Consilient

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

FRAX, NICE and NOGG. Eugene McCloskey Professor of Adult Bone Diseases University of Sheffield

FRAX, NICE and NOGG. Eugene McCloskey Professor of Adult Bone Diseases University of Sheffield FRAX, NICE and NOGG Eugene McCloskey Professor of Adult Bone Diseases University of Sheffield Disclosures Research funding and/or honoraria and/or advisory boards for: o ActiveSignal, Amgen, Bayer, Boehringer

More information

Building Bone Density-Research Issues

Building Bone Density-Research Issues Building Bone Density-Research Issues Helping to Regain Bone Density QUESTION 1 What are the symptoms of Osteoporosis? Who is at risk? Symptoms Bone Fractures Osteoporosis 1,500,000 fractures a year Kyphosis

More information

Bone Mass Measurement BONE MASS MEASUREMENT HS-042. Policy Number: HS-042. Original Effective Date: 8/25/2008

Bone Mass Measurement BONE MASS MEASUREMENT HS-042. Policy Number: HS-042. Original Effective Date: 8/25/2008 Easy Choice Health Plan, Inc. Harmony Health Plan of Illinois, Inc. Missouri Care, Inc. Ohana Health Plan, a plan offered by WellCare Health Insurance of Arizona, Inc. WellCare Health Insurance of Illinois,

More information

New 2010 Osteoporosis Guidelines: What you and your health provider need to know QUESTIONS&ANSWERS

New 2010 Osteoporosis Guidelines: What you and your health provider need to know QUESTIONS&ANSWERS New 2010 Osteoporosis Guidelines: What you and your health provider need to know QUESTIONS&ANSWERS Wednesday, December 1, 2010 1:00 p.m. to 2:00 p.m. ET 1. I m 55 years old. I ve been taking Fosavance

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

Risk Factors for Postmenopausal Fractures What We Have Learned from The OSTPRE - study

Risk Factors for Postmenopausal Fractures What We Have Learned from The OSTPRE - study Risk Factors for Postmenopausal Fractures What We Have Learned from The OSTPRE - study Heikki Kröger Kuopio Musculoskeletal Research Unit, University of Eastern Finland (UEF) Dept. of Orthopaedics, Traumatology

More information

Management of postmenopausal osteoporosis

Management of postmenopausal osteoporosis Management of postmenopausal osteoporosis Yeap SS, Hew FL, Chan SP, on behalf of the Malaysian Osteoporosis Society Committee Working Group for the Clinical Guidance on the Management of Osteoporosis,

More information

Meta-analysis: analysis:

Meta-analysis: analysis: 1 Diabetes and TZDs: Risk Factors for Fracture Ann Schwartz, PhD Dept. of Epidemiology and Biostatistics University of California San Francisco July 2010 Osteoporosis CME Presenter Disclosure Information

More information

Fractures: Epidemiology and Risk Factors. Osteoporosis in Men (more this afternoon) 1/5 men over age 50 will suffer osteoporotic fracture 7/16/2009

Fractures: Epidemiology and Risk Factors. Osteoporosis in Men (more this afternoon) 1/5 men over age 50 will suffer osteoporotic fracture 7/16/2009 Fractures: Epidemiology and Risk Factors Mary L. Bouxsein, PhD Department of Orthopaedic Surgery Beth Israel Deaconess Medical Center Harvard Medical School, Boston, MA Outline Fracture incidence and impact

More information

Fractures: Epidemiology and Risk Factors. July 2012 CME (35 minutes) 7/24/ July12 1. Osteoporotic fractures: Comparison with other diseases

Fractures: Epidemiology and Risk Factors. July 2012 CME (35 minutes) 7/24/ July12 1. Osteoporotic fractures: Comparison with other diseases Financial Disclosures Fractures: Epidemiology and Risk Factors Research grants, speaking or consulting: Amgen, Lilly, Merck, Novartis, Radius Dennis M. Black, PhD Department of Epidemiology and Biostatistics

More information

Assessment of the risk of osteoporotic fractures in Prof. J.J. Body, MD, PhD CHU Brugmann Univ. Libre de Bruxelles

Assessment of the risk of osteoporotic fractures in Prof. J.J. Body, MD, PhD CHU Brugmann Univ. Libre de Bruxelles Assessment of the risk of osteoporotic fractures in 2008 Prof. J.J. Body, MD, PhD CHU Brugmann Univ. Libre de Bruxelles Estimated lifetime fracture risk in 50-year-old white women and men Melton et al.;

More information

The NOF & NBHA Quality Improvement Registry

The NOF & NBHA Quality Improvement Registry In collaboration with CECity The NOF & NBHA Quality Improvement Registry This registry is approved by CMS as a Qualified Clinical Data Registry (QCDR) for Eligible Professionals and GPRO Practices for

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

John J. Wolf, DO Family Medicine

John J. Wolf, DO Family Medicine John J. Wolf, DO Family Medicine Objectives: 1. Review incidence & Risk of Osteoporosis 2.Review indications for testing 3.Review current pharmacologic & Non pharmacologic Tx options 4.Understand & Utilize

More information

OSTEOPOROSIS: PREVENTION AND MANAGEMENT

OSTEOPOROSIS: PREVENTION AND MANAGEMENT OSTEOPOROSIS: OVERVIEW OSTEOPOROSIS: PREVENTION AND MANAGEMENT Judith Walsh, MD, MPH Departments of Medicine and Epidemiology and Biostatistics UCSF Definitions Key Risk factors Screening and Monitoring

More information

Official Positions on FRAX

Official Positions on FRAX 196 96 DEPLIANT 3,5x8,5.indd 1 2010 Official Positions on FRAX 21.03.11 11:45 Interpretation and Use of FRAX in Clinical Practice from the International Society for Clinical Densitometry and International

More information

Osteoporosis Management

Osteoporosis Management Osteoporosis Management Lisa Voss PA C, CCD Laura Frontiero NP C, CCD Kaiser Healthy Bones Program San Diego Disclosures: Nothing to disclose www.zazzle.com 1 Overview How to diagnose Osteoporosis FRAX

More information

One half of all postmenopausal women will have an

One half of all postmenopausal women will have an ORIGINAL ARTICLE JBMR Osteoporosis Screening in Postmenopausal Women 50 to 64 Years Old: Comparison of US Preventive Services Task Force Strategy and Two Traditional Strategies in the Women s Health Initiative

More information

Osteoporosis Update. Case 2. Case 1: Monday morning, 8:15

Osteoporosis Update. Case 2. Case 1: Monday morning, 8:15 Osteoporosis Update Laura E. Ryan, MD Assistant Director for Special Programs Center for Women s Health Clinical Assistant Professor of Medicine Division of Endocrinology, Diabetes and Metabolism The Ohio

More information

New Osteoporosis Guidelines: What you and your health provider need to know QUESTION & ANSWER

New Osteoporosis Guidelines: What you and your health provider need to know QUESTION & ANSWER The first of the newsletters on these Qs and As should include a refresher on the Virtual Forums what they are, how they work, etc. The fact is that less than 5% of COPN members tune in for any given Forum.

More information

DEVELOPMENT OF A RISK SCORING SYSTEM TO PREDICT A RISK OF OSTEOPOROTIC VERTEBRAL FRACTURES IN POSTMENOPAUSAL WOMEN

DEVELOPMENT OF A RISK SCORING SYSTEM TO PREDICT A RISK OF OSTEOPOROTIC VERTEBRAL FRACTURES IN POSTMENOPAUSAL WOMEN October 2-4, Liverpool, UK EURO SPINE 2013 DEVELOPMENT OF A RISK SCORING SYSTEM TO PREDICT A RISK OF OSTEOPOROTIC VERTEBRAL FRACTURES IN POSTMENOPAUSAL WOMEN D. Colangelo, L. A. Nasto, M. Mormando, E.

More information

Disclosures. Diagnostic Challenges in Osteoporosis: Whom To Treat 9/25/2014

Disclosures. Diagnostic Challenges in Osteoporosis: Whom To Treat 9/25/2014 Disclosures Diagnostic Challenges in Osteoporosis: Whom To Treat Ethel S. Siris, MD Columbia University Medical Center New York, NY Consultant on scientific issues for: AgNovos Amgen Eli Lilly Merck Novartis

More information

nice bulletin NICE provided the content for this booklet which is independent of any company or product advertised

nice bulletin NICE provided the content for this booklet which is independent of any company or product advertised nice bulletin NICE provided the content for this booklet which is independent of any company or product advertised nice bulletin Welcome In August 2012, the National Institute for Health and Clinical Excellence

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

Talking to patients with osteoporosis about initiating therapy

Talking to patients with osteoporosis about initiating therapy Talking to patients with osteoporosis about initiating therapy Deborah Sellmeyer, MD Director, Johns Hopkins Metabolic Bone Center Dept of Medicine, Division of Endocrinology Disclosure DSMB member for

More information

Clinical Practice. Presented by: Internist, Endocrinologist

Clinical Practice. Presented by: Internist, Endocrinologist Clinical Practice Management of Osteoporosis Presented by: SaeedBehradmanesh, h MD Internist, Endocrinologist Iran, Isfahan, Feb. 2017 Definition: A disease characterized by low bone mass and microarchitectural

More information

Disclosures Fractures:

Disclosures Fractures: Disclosures Fractures: A. Schwartz Epidemiology and Risk Factors Research Funding: GlaxoSmithKline, Merck Ann V. Schwartz, PhD Department of Epidemiology and Biostatistics UCSF Outline Fracture incidence

More information

Part I : Study of Osteoporotic Fractures (SOF) Fractures and Falls History: History of Fractures Questionnaire

Part I : Study of Osteoporotic Fractures (SOF) Fractures and Falls History: History of Fractures Questionnaire PhenX Measure: Fracture History (#170900) PhenX Protocol: Fracture History (#170901) Date of Interview/Examination (MM/DD/YYYY): Part I : Study of Osteoporotic Fractures (SOF) Fractures and Falls History:

More information

BAD TO THE BONE. Peter Jones, Rheumatologist QE Health, Rotorua. GP CME Conference Rotorua, June 2008

BAD TO THE BONE. Peter Jones, Rheumatologist QE Health, Rotorua. GP CME Conference Rotorua, June 2008 BAD TO THE BONE Peter Jones, Rheumatologist QE Health, Rotorua GP CME Conference Rotorua, June 2008 Agenda Osteoporosis in Men Vitamin D and Calcium Long-term treatment with Bisphosphonates Pathophysiology

More information

O. Bruyère M. Fossi B. Zegels L. Leonori M. Hiligsmann A. Neuprez J.-Y. Reginster

O. Bruyère M. Fossi B. Zegels L. Leonori M. Hiligsmann A. Neuprez J.-Y. Reginster DOI 10.1007/s00296-012-2460-y ORIGINAL ARTICLE Comparison of the proportion of patients potentially treated with an anti-osteoporotic drug using the current criteria of the Belgian national social security

More information

July 2012 CME (35 minutes) 7/12/2016

July 2012 CME (35 minutes) 7/12/2016 Financial Disclosures Epidemiology and Consequences of Fractures Advisory Board: Amgen Janssen Pharmaceuticals Inc. Ann V. Schwartz, PhD Department of Epidemiology and Biostatistics UCSF Outline Osteoporotic

More information

NEW DEVELOPMENTS IN OSTEOPOROSIS: SCREENING, PREVENTION AND TREATMENT

NEW DEVELOPMENTS IN OSTEOPOROSIS: SCREENING, PREVENTION AND TREATMENT NEW DEVELOPMENTS IN OSTEOPOROSIS: SCREENING, PREVENTION AND TREATMENT Judith Walsh, MD, MPH Departments of Medicine and Epidemiology and Biostatistics UCSF OSTEOPOROSIS: OVERVIEW Definitions Risk factors

More information

Screening Guidelines: Women

Screening Guidelines: Women The Situation 1 in 2 postmenopausal women and 1 in 5 older men will have an osteoporosis-related fracture in their lifetimes Osteoporosis Definition NIH Consensus Conference A skeletal disorder characterized

More information

Skeletal Manifestations

Skeletal Manifestations Skeletal Manifestations of Metabolic Bone Disease Mishaela R. Rubin, MD February 21, 2008 The Three Ages of Women Gustav Klimt 1905 1 Lecture Outline Osteoporosis epidemiology diagnosis secondary causes

More information

AACE/ACE Osteoporosis Treatment Decision Tool

AACE/ACE Osteoporosis Treatment Decision Tool AACE/ACE Osteoporosis Treatment Decision Tool What is Osteoporosis? OSTEOPOROSIS is defined as reduced bone strength leading to an increased risk of fracture. Osteoporosis, or porous bones, occurs when

More information

SUPPLEMENTAL MATERIAL

SUPPLEMENTAL MATERIAL SUPPLEMENTAL MATERIAL Supplemental Table 1. Distribution of Participants Characteristics by Treatment Group at Baseline - The Vitamin D and calcium (CaD) Trial of the Women s Health Initiative (WHI) Study,

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

1

1 www.osteoporosis.ca 1 2 Overview of the Presentation Osteoporosis: An Overview Bone Basics Diagnosis of Osteoporosis Drug Therapies Risk Reduction Living with Osteoporosis 3 What is Osteoporosis? Osteoporosis:

More information

Comparison And Application Of Methods To Address Confounding By Indication In Non- Randomized Clinical Studies

Comparison And Application Of Methods To Address Confounding By Indication In Non- Randomized Clinical Studies University of Massachusetts Amherst ScholarWorks@UMass Amherst Masters Theses 1911 - February 2014 Dissertations and Theses 2013 Comparison And Application Of Methods To Address Confounding By Indication

More information

Bone density scanning and osteoporosis

Bone density scanning and osteoporosis Bone density scanning and osteoporosis What is osteoporosis? Osteoporosis occurs when the struts which make up the mesh-like structure within bones become thin causing them to become fragile and break

More information

FRAX Based Guidelines: Is a Universal Model Appropriate?

FRAX Based Guidelines: Is a Universal Model Appropriate? FRAX Based Guidelines: Is a Universal Model Appropriate? Marlene Chakhtoura, MD Research Fellow Calcium Metabolism & Osteoporosis Program WHO Collaborating Center for Metabolic Bone Disorders American

More information

OSTEOPOROSIS IN INDONESIA

OSTEOPOROSIS IN INDONESIA OSTEOPOROSIS IN INDONESIA Hana Ratnawati Faculty of Medicine Maranatha Christian University Bandung - Indonesia 5th SBA Conference 2013 1 5th SBA Conference 2013 2 INTRODUCTION Indonesia is an archipelago

More information

DXA When to order? How to interpret? Dr Nikhil Tandon Department of Endocrinology and Metabolism All India Institute of Medical Sciences New Delhi

DXA When to order? How to interpret? Dr Nikhil Tandon Department of Endocrinology and Metabolism All India Institute of Medical Sciences New Delhi DXA When to order? How to interpret? Dr Nikhil Tandon Department of Endocrinology and Metabolism All India Institute of Medical Sciences New Delhi Clinical Utility of Bone Densitometry Diagnosis (DXA)

More information

PFIZER INC. What is the difference in incidence of fracture in women who ever or never used DMPA for contraception?

PFIZER INC. What is the difference in incidence of fracture in women who ever or never used DMPA for contraception? PFIZER INC. These results are supplied for informational purposes only. Prescribing decisions should be made based on the approved package insert. For publications based on this study, see associated bibliography.

More information

Osteoporosis challenges

Osteoporosis challenges Osteoporosis challenges Osteoporosis challenges Who should have a fracture risk assessment? Who to treat? Drugs, holidays and unusual adverse effects Fracture liaison service? The size of the problem 1

More information

International Journal of Health Sciences and Research ISSN:

International Journal of Health Sciences and Research  ISSN: International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Original Research Article Osteoporosis- Do We Need to Think Beyond Bone Mineral Density? Dr Preeti Soni 1, Dr Shipra

More information

Nutritional Aspects of Osteoporosis Care and Treatment Cynthia Smith, FNP-BC, RN, MSN, CCD Pars Osteoporosis Clinic, Belpre, Ohio

Nutritional Aspects of Osteoporosis Care and Treatment Cynthia Smith, FNP-BC, RN, MSN, CCD Pars Osteoporosis Clinic, Belpre, Ohio Osteoporosis 1 Nutritional Aspects of Osteoporosis Care and Treatment Cynthia Smith, FNP-BC, RN, MSN, CCD Pars Osteoporosis Clinic, Belpre, Ohio 1) Objectives: a) To understand bone growth and development

More information

nogg Guideline for the diagnosis and management of osteoporosis in postmenopausal women and men from the age of 50 years in the UK

nogg Guideline for the diagnosis and management of osteoporosis in postmenopausal women and men from the age of 50 years in the UK nogg NATIONAL OSTEOPOROSIS GUIDELINE GROUP Guideline for the diagnosis and management of osteoporosis in postmenopausal women and men from the age of 50 years in the UK Produced by J Compston, A Cooper,

More information

Disclosures Fractures: A. Schwartz Epidemiology and Risk Factors Consulting: Merck

Disclosures Fractures: A. Schwartz Epidemiology and Risk Factors Consulting: Merck Disclosures Fractures: A. Schwartz Epidemiology and Risk Factors Consulting: Merck Ann V. Schwartz, PhD Department of Epidemiology and Biostatistics UCSF Outline Fracture incidence and impact of fractures

More information

Understanding Osteoporosis

Understanding Osteoporosis Understanding Osteoporosis Professor Juliet E. Compston Published by Family Doctor Publications Limited in association with the British Medical Association IMPORTANT NOTICE This book is intended not as

More information

SCHEDULE 2 THE SERVICES. A. Service Specifications

SCHEDULE 2 THE SERVICES. A. Service Specifications SCHEDULE 2 THE SERVICES A. Service Specifications Service Specification No. 04/MSKT/0013 Service PAN DORSET FRACTURE LIAISON SERVICE Commissioner Lead CCP for Musculoskeletal & Trauma Provider Lead Deputy

More information

[If no, skip to question 10.] Y N. 2. Does the member have a diagnosis of Paget s disease of bone? Y N. [If no, skip to question 4.

[If no, skip to question 10.] Y N. 2. Does the member have a diagnosis of Paget s disease of bone? Y N. [If no, skip to question 4. Pharmacy Prior Authorization AETA BETTER HEALTH EW JERSE (MEDICAID) Zoledronic Acid (Medicaid) This fax machine is located in a secure location as required by HIPAA regulations. Complete/review information,

More information

DINE AND LEARN ENDOCRINOLOGY PEARLS. Dr. Priya Manjoo, MD, FRCPC Endocrinology, Victoria, BC

DINE AND LEARN ENDOCRINOLOGY PEARLS. Dr. Priya Manjoo, MD, FRCPC Endocrinology, Victoria, BC DINE AND LEARN ENDOCRINOLOGY PEARLS Dr. Priya Manjoo, MD, FRCPC Endocrinology, Victoria, BC OUTLINE HRT and CVD HRT and Breast Cancer Osteoporosis When to treat How long to treat for Bisphosphonates BMD

More information

Case Finding and Risk Assessment for Osteoporosis

Case Finding and Risk Assessment for Osteoporosis Case Finding and Risk Assessment for Osteoporosis Patient may present as a fragility fracture or risk fracture Fragility fracture age 50 Clinical risk factors aged 50 Very strong clinical risk factors

More information

3. Has bone specific alkaline phosphatase level increased OR does the member have symptoms related to active Paget s?

3. Has bone specific alkaline phosphatase level increased OR does the member have symptoms related to active Paget s? Pharmacy Prior Authorization AETA BETTER HEALTH VIRGIIA CCC PLUS and MEDALLIO/FAMIS 4.0 Zoledronic Acid (Medicaid) This fax machine is located in a secure location as required by HIPAA regulations. Complete/review

More information

Objectives: What is Osteoporosis 10/8/2015. Bone Health/ Osteoporosis: BASICS OF SCREENING, INTERPRETING, AND TREATING

Objectives: What is Osteoporosis 10/8/2015. Bone Health/ Osteoporosis: BASICS OF SCREENING, INTERPRETING, AND TREATING Bone Health/ Osteoporosis: BASICS OF SCREENING, INTERPRETING, AND TREATING TIFFANY PAUL, APN, CNP, CCD Objectives: Review the diagnosis of Osteoporosis Describe the basics of a bone density exam Identify

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

Osteoporosis Treatment Overview. Colton Larson RFUMS October 26, 2018

Osteoporosis Treatment Overview. Colton Larson RFUMS October 26, 2018 Osteoporosis Treatment Overview Colton Larson RFUMS October 26, 2018 Burden of Disease Most common bone disease 9.9 million Americans + 43.1 million Americans have low bone mineral density (BMD) Stealthy

More information

Bone Densitometry. What is a Bone Density Scan (DXA)? What are some common uses of the procedure?

Bone Densitometry. What is a Bone Density Scan (DXA)? What are some common uses of the procedure? Scan for mobile link. Bone Densitometry What is a Bone Density Scan (DXA)? Bone density scanning, also called dual-energy x-ray absorptiometry (DXA) or bone densitometry, is an enhanced form of x-ray technology

More information

Closing the Care Gap in Osteoporosis ICE Conference 2015

Closing the Care Gap in Osteoporosis ICE Conference 2015 Closing the Care Gap in Osteoporosis ICE Conference 2015 Pat McCarthy-Briggs RD, MHEd Thank You! What is osteoporosis? a systemic skeletal disease characterized by low bone mass and microarchitectural

More information

They are updated regularly as new NICE guidance is published. To view the latest version of this NICE Pathway see:

They are updated regularly as new NICE guidance is published. To view the latest version of this NICE Pathway see: : assessing the risk of fragility fracture bring together everything NICE says on a topic in an interactive flowchart. are interactive and designed to be used online. They are updated regularly as new

More information

Osteoporosis. Current Trend in Osteoporosis Management for Elderly in HK- Medical Perspective. Old Definition of Osteoporosis

Osteoporosis. Current Trend in Osteoporosis Management for Elderly in HK- Medical Perspective. Old Definition of Osteoporosis Current Trend in Osteoporosis Management for Elderly in HK- Medical Perspective Dr Dicky T.K. Choy Physician Jockey Club Centre for Osteoporosis Care and Control, CUHK Osteoporosis Global public health

More information

Osteoporosis Management in Older Adults

Osteoporosis Management in Older Adults Osteoporosis Management in Older Adults Angela M Cheung, MD, PhD, FRCPC, CCD Professor of Medicine, University of Toronto Disclosures Relationship with Commercial Entities: Honoraria from: Amgen, Eli Lilly,

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

Section 4. Scans and tests. How do I know if I have osteoporosis? Investigations for spinal fractures. Investigations after you break a bone

Section 4. Scans and tests. How do I know if I have osteoporosis? Investigations for spinal fractures. Investigations after you break a bone Section 4 Scans and tests How do I know if I have osteoporosis? Investigations for spinal fractures Investigations after you break a bone Investigations if you have risk factors Investigations for children

More information

Bone Mineral Density and Its Associated Factors in Naresuan University Staff

Bone Mineral Density and Its Associated Factors in Naresuan University Staff Naresuan University Journal 2005; 13(3): 13-18 13 Bone Mineral Density and Its Associated Factors in Naresuan University Staff Supawitoo Sookpeng *, Patsuree Cheebsumon, Malinee Dhanarun, Thanyavee Pengpan

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

Bariatric Surgery and Bone Health

Bariatric Surgery and Bone Health Bariatric Surgery and Bone Health No conflicts of interest Anne Schafer, MD Assistant Professor of Medicine Division of Endocrinology & Metabolism July 26, 202 BMI and Fracture Risk Low BMI is associated

More information

Osteoporosis: Are your bones at risk of fracturing? Rachel Wallwork, MD Internal medicine resident Massachusetts General Hospital

Osteoporosis: Are your bones at risk of fracturing? Rachel Wallwork, MD Internal medicine resident Massachusetts General Hospital Osteoporosis: Are your bones at risk of fracturing? Rachel Wallwork, MD Internal medicine resident Massachusetts General Hospital What is Osteoporosis? Osteoporosis causes bones to lose density, become

More information

Supplementary appendix

Supplementary appendix Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Prada D, Zhong J, Colicino E, et al. Association

More information

Men and Osteoporosis So you think that it can t happen to you

Men and Osteoporosis So you think that it can t happen to you Men and Osteoporosis So you think that it can t happen to you Jonathan D. Adachi MD, FRCPC Alliance for Better Bone Health Chair in Rheumatology Professor, Department of Medicine Michael G. DeGroote School

More information

La salute dell osso nelle pazienti in trattamento adiuvante. Airoldi Mario - S.C. Oncologia Medica 2 Città della Salute e della Scienza di Torino

La salute dell osso nelle pazienti in trattamento adiuvante. Airoldi Mario - S.C. Oncologia Medica 2 Città della Salute e della Scienza di Torino La salute dell osso nelle pazienti in trattamento adiuvante Airoldi Mario - S.C. Oncologia Medica 2 Città della Salute e della Scienza di Torino BONE STRENGTH OSTEOPOROSIS SKELETAL DISORDER COMPROMISING

More information

Imaging to Assess Bone Strength and its Determinants

Imaging to Assess Bone Strength and its Determinants Imaging to Assess Bone Strength and its Determinants Mary L. Bouxsein, PhD Harvard Medical School, Boston, MA UCSF Osteoporosis Course 26 July 212 Consultant / advisor: Amgen, Eli Lilly, Merck Research

More information

Bone Mineral Density Studies in Adult Populations

Bone Mineral Density Studies in Adult Populations Bone Mineral Density Studies in Adult Populations Last Review Date: July 14, 2017 Number: MG.MM.RA10aC6 Medical Guideline Disclaimer Property of EmblemHealth. All rights reserved. The treating physician

More information

Parathyroid Hormone Analogs

Parathyroid Hormone Analogs Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.30.36 Subject: Parathyroid Hormone Analogs Page: 1 of 6 Last Review Date: September 15, 2017 Parathyroid

More information

The Bare Bones of Osteoporosis. Wendy Rosenthal, PharmD

The Bare Bones of Osteoporosis. Wendy Rosenthal, PharmD The Bare Bones of Osteoporosis Wendy Rosenthal, PharmD Definition A systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase

More information

Factors Associated with Treatment Initiation after Osteoporosis Screening

Factors Associated with Treatment Initiation after Osteoporosis Screening American Journal of Epidemiology Copyright 2004 by the Johns Hopkins Bloomberg School of Public Health All rights reserved Vol. 160, No. 5 Printed in U.S.A. DOI: 10.1093/aje/kwh245 Factors Associated with

More information

Impact of varying data quality on statistical analyses of integrated datasets

Impact of varying data quality on statistical analyses of integrated datasets Impact of varying data quality on statistical analyses of integrated datasets Eugenio Andraca-Carrera Mathematical Statistician Division of Biometrics VII Office of Biostatistics, CDER, FDA ISCTM 11th

More information

This is a repository copy of Microarchitecture of bone predicts fractures in older women.

This is a repository copy of Microarchitecture of bone predicts fractures in older women. This is a repository copy of Microarchitecture of bone predicts fractures in older women. White Rose Research Online URL for this paper: http://eprints.whiterose.ac.uk/130351/ Version: Accepted Version

More information

Page 1. New Developments in Osteoporosis. What s New in Osteoporosis

Page 1. New Developments in Osteoporosis. What s New in Osteoporosis New Developments in Osteoporosis Eliseo J. Pérez-Stable MD Professor of Medicine Division of General Internal Medicine Department of Medicine July 4, 2013 Declaration of full disclosure: No conflict of

More information

Osteoporosis Clinical Guideline. Rheumatology January 2017

Osteoporosis Clinical Guideline. Rheumatology January 2017 Osteoporosis Clinical Guideline Rheumatology January 2017 Introduction Osteoporosis is a condition of low bone mass leading to an increased risk of low trauma fractures. The prevalence of osteoporosis

More information

Technology appraisal guidance Published: 9 August 2017 nice.org.uk/guidance/ta464

Technology appraisal guidance Published: 9 August 2017 nice.org.uk/guidance/ta464 Bisphosphonates for treating osteoporosis Technology appraisal guidance Published: 9 August 2017 nice.org.uk/guidance/ta464 NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).

More information

Screening for Osteoporosis to Prevent Fractures US Preventive Services Task Force Recommendation Statement

Screening for Osteoporosis to Prevent Fractures US Preventive Services Task Force Recommendation Statement Clinical Review & Education JAMA US Preventive Services Task Force RECOMMENDATION STATEMENT Screening for Osteoporosis to Prevent Fractures US Preventive Services Task Force Recommendation Statement US

More information