COMMENTARY Bone Densitometry: The Best Way to Detect Osteoporosis and to Monitor Therapy
|
|
- Ira Tucker
- 6 years ago
- Views:
Transcription
1 X/99/$03.00/0 Vol. 84, No. 6 The Journal of Clinical Endocrinology & Metabolism Printed in U.S.A. Copyright 1999 by The Endocrine Society COMMENTARY Bone Densitometry: The Best Way to Detect Osteoporosis and to Monitor Therapy PAUL D. MILLER, CAROL ZAPALOWSKI, CAROLINA A. M. KULAK, AND JOHN P. BILEZIKIAN Colorado Center for Bone Research (P.D.M., C.Z.), Lakewood, Colorado 80227; the Departments of Medicine (C.A.M.K., J.P.B.) and Pharmacology (J.P.B.), Columbia University College of Physicians and Surgeons, New York, New York 10032; and the Department of Endocrinology, Federal University of Parana, Hospital de Clinicas (C.A.M.K.), Curitiba, Brazil The development of objective, noninvasive, and highly sensitive techniques to quantitate bone mineral density (BMD) has provided the clinician with a powerful diagnostic tool. Bone mass measurement is the best way to make the diagnosis of osteoporosis, one of the major diseases of our time. Using this technology, osteoporosis can now be detected well before it is obvious by conventional x-rays or when fractures eventuate. The definition of osteoporosis by the World Health Organization (WHO) is a BMD that is 2.5 sd or more below the mean of a young, normal reference population (1). This definition offers the practitioner an objective standard by which to make a diagnosis and to make subsequent management decisions. It has also profound therapeutic implications. Fortuitously, the advent of this technology has been accompanied by an exciting array of new, effective therapies to prevent and treat osteoporosis. The therapeutic optimism resulting from these pharmacological breakthroughs has fueled discussions about the potential widespread applicability of bone mass measurement to the entire population at risk. It has sparked controversy over how widely bone mass measurement modalities should be applied to detect the population at risk and what devices should be used to this end. In this article we provide a perspective on these issues. Defining the population at risk The aging population is inevitably going to become more osteoporotic unless we intervene first with diagnostic tools and then with preventive therapy. The National Osteoporosis Foundation has estimated that the number of postmenopausal women in this country will double from 40 to 80 million over the next 20 yr (2). Projections also call for a tripling of the number of osteoporotic fractures by 2040 from current annual estimates of 1.3 million. Staggering costs are surely going to exceed the 1995 figure of 13.8 billion dollars Received January 22, Accepted February 11, Address all correspondence and requests for reprints to: John P. Bilezikian, M.D., Department of Medicine, Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, New York by countless billions more. The need is clear both to discover the population with osteoporosis and, more importantly, to identify those at risk for the disease. Importance of bone mass measurement Measurement of bone mass is the single best predictor of fracture risk (3 5). The advent of this technology into the clinical arena over the past 15 years is similar in importance to the development of the sphygmomanometer and assays for serum cholesterol. As blood pressure and cholesterol determinations are predictors of stroke and cardiovascular disease, so bone density predicts fracture risk (2 5). In fact, the measurement of bone mass is a much more powerful indicator of fracture risk than cholesterol determination is a predictor of myocardial infarction. Epidemiological studies indicate that the totality of risk for fracture, as represented by bone mass measurement, is 60 70% (6). Because of its predictive power, it is, thus, the most important information to gain about fracture risk. Other independent predictors of fractures are readily known, such as age, history of previous fracture, and low body weight. Together, the risk profile of an individual can be rather accurately determined as long as the BMD is known. Bone mass measurement techniques The most widely used technique is dual energy x-ray absorptiometry (DXA). DXA can measure central sites, such as lumbar spine and hip, as well as peripheral sites, such as distal forearm, heel, and phalanges. DXA is noninvasive, rapid, accurate, and safe. The high precision of the technique usually allows DXA testing of central sites (not peripheral sites) to be used for monitoring as well as diagnosis. The effectiveness of therapy with bisphosphonates is well correlated with changes in bone mass (7). Most of the recent literature with respect to treatment response is based upon central measurements (8 10). It is the gold standard with which all other technologies are compared. Other approaches to bone mass measurement have been developed (11). Quantitative computed tomography (QCT) measures lumbar spine (12) and more recently has been 1867
2 1868 MILLER ET AL. JCE&M 1999 Vol 84 No 6 adapted to measure peripheral sites as well (13). The potential advantage of QCT over DXA is in its ability to measure true volumetric density (grams per cm 3 ) compared with DXA, which gives an areal density (grams per cm 2 ). Moreover, QCT measures cancellous bone of the lumbar spine exclusively, devoid of the cortical envelope. It is less likely, therefore, to detect artifacts of aging, such as osteophytes and aortic calcifications, than DXA. On the other hand, changes in the bone marrow space with aging can confound the lumbar spine density measurement by QCT. Other disadvantages of QCT are the cost of the machines, poor availability, cost of the test, and, to a certain extent, radiation exposure, the latter of which becomes a consideration when patients are monitored. Fracture prediction by QCT is as good as but no better than that by DXA (14). A number of less costly and more portable devices that measure peripheral sites have been developed and approved by the FDA (15). The rationale to develop these densitometers rests with the fact that central machines are relatively expensive and, in some settings, not readily accessible. Some believe that central densitometers are unlikely to proliferate sufficiently or to be distributed proportionately throughout the United States so as to be accessible to all who are in need of bone mass measurement. There are currently about 5000 central DXA machines in the United States. As noted, DXA and QCT have been adapted to peripheral sites. In addition, the radius can be measured by single energy absorptiometry (16), and the phalanges can be measured by radiogrammetric absorptiometry (17) and DXA. In addition to machines that use ionizing radiation, the technique of ultrasound has been developed to measure bone mass (18). Ultrasound can measure the speed of sound as well as broadband ultrasonic attenuation of the site in question. These indexes give a measure of bone mass, although it is still not clear whether ultrasound may also detect certain qualitative aspects of bone. The machines available in the United States at this time detect bone mass in heel and proximal tibia. Ultrasound machines are attractive because they are small, portable, relatively inexpensive, and do not use ionizing radiation. The heel is of particular interest, because its composition, primarily cancellous bone, is similar to the composition of the spine. An example of how useful ultrasound can be in the quest to detect the population at risk is in Japan, where the introduction of ultrasound was associated with a 30% increase in diagnosis (19). What site(s) should be measured to detect the population at risk? The technologies described above give highly accurate and reproducible information. In general, bone mass at peripheral sites correlates well with measurements at more central (and more important) sites, such as hip and spine. Correlation coefficients between peripheral and central sites in general will be between (Fig. 1). These reasonably good correlations seem to be the case regardless of the sites and the devices compared. Such correlations have led to arguments for and against the use of peripheral measurements to discover the population at risk. General optimism (15, 20) has led to views by some that peripheral sites can be used in FIG. 1. The relationship between bone mineral measurements at a peripheral site (distal radius) and a central site (spine). The study population consisted of 172 postmenopausal and osteoporotic women. Solid lines show the WHO thresholds for the definition of osteoporosis (t score, 2.5). Data are rom Ref. 36. selected subsets and that some therapeutic decisions can be based on them (21). More tempered opinions have questioned the potential utility of peripheral measurements (22 23). The facts that the machines that measure peripheral sites can be portable and are less expensive are an important part of the argument to use peripheral techniques. If we are going to discover the millions of Americans who are at risk, we must use screening approaches that are the easiest and the most affordable. In these respects, peripheral devices are most attractive. If one can identify a large number of individuals who would otherwise not be discovered and do it in a cost-effective manner, a major point against screening the at-risk population, namely cost, is minimized. Within limits, this argument has merit. The good correlation between peripheral and central measurements is precisely the genesis of the counterargument, namely that peripheral sites will miss a substantial number of individuals with osteopenia or osteoporosis. Significant concordance between sites with r values from is not good enough when it comes to predicting bone mass from one site to another in a particular individual (24 26). This discordance has the potential to be a real problem. An individual with normal bone mass at a peripheral site could have substantial reductions at a central site and, therefore, need additional testing for these to be discovered (20). In general, measurement of the site in question gives the best predictive value of the risk of fracture at that site (3). For example, measurement of hip bone density (at any of the five sites: femoral neck, trochanter, intertrochanter, Wards area, and total hip) gives much better predictive information about hip fracture than does measurement of the spine, distal radius, or heel (Fig. 2). This is generally true for the spine also except for older individuals in whom osteoarthritic changes may give artifactually elevated values in the anterio-posterior projection. For these individuals, the lateral spine or hip measurement is a better predictive index than the anterioposterior spine bone density. One point on which most experts agree at this time is that
3 BONE DENSITOMETRY 1869 FIG. 2. Risk ratio values for hip fracture as determined by bone densitometry at the hip and other sites. Measurements of bone density were obtained at five different hip regions, two forearms regions, the heel, and the spine. Although relative risk (RR) for hip fracture was related to bone mass measurement at any site ( 1), at every hip site, the RR showed much higher values ( 2.5). Data are from Ref. 36. peripheral measurements have not yet been shown to be useful to monitor the course of therapy (20, 27). For this important feature of bone mass measurement technology, central sites need to be used. This point raises an important problem. Certainly, peripheral measurement can be used, at least in some individuals, to discover osteoporosis. Bone density at osteoporotic levels in the radius, for example, does define a problem that needs attention (14, 3), particularly in older individuals, in whom bone mass is likely to be low at all skeletal sites. However, the best way to monitor that patient when therapy is established is to use central sites, where remodeling occurs at a more substantial pace. Thus, changes in bone mass can be detected more readily in the course of therapy. A peripheral site, such as the heel, comprised of similar cancellous bone as the lumbar spine, has a greater potential to be used for monitoring purposes, but to date the data are not conclusive, nor has the FDA yet approved this site for monitoring the course of therapy. The FDA has recognized that the precision error of the heel is low enough to be capable of monitoring, but the responsiveness of this site to therapy has not yet been established. At the present time, therefore, it would appear that central sites will have to be measured both at baseline and thereafter if densitometry is going to be used to monitor patients. Discordance among skeletal sites is not surprising, as the composition and metabolism of bone are not uniform from site to site. Different hormonal and mechanical influences lead to differential changes in bone mass as a specific function of site. For example, early postmenopausal bone loss is going to affect the cancellous skeleton first, a feature of estrogen deficiency. In this setting, therefore, a central site will show bone loss first. As osteoporosis is primarily a disorder of postmenopausal women, these central sites have reasonably been emphasized more. With age, the concordance between peripheral and central sites tends to improve, but in women in their early postmenopausal years, a discordance between peripheral and central sites is a source of concern. From the forgoing discussion, there will be a number of individuals whose peripheral measurement is normal, but whose hip or spine is osteopenic or osteoporotic. Miller et al. (20) recently suggested a group of individuals for whom one is encouraged to test beyond the peripheral site simply because they are at much greater risk. For example, any postmenopausal individual with significant risk factors for osteoporosis or a history of fragility fractures should have central measurements (Table 1), even if a peripheral site is normal. An early postmenopausal woman not taking estrogen replacement therapy who is concerned about low bone mass and would consider preventive therapy should also have a central measurement if the peripheral site measured is normal. Another important consideration is the rate of bone metabolism. If bone turnover is elevated, as determined by measurements of biochemical bone markers, these subjects, too, should have the benefit of central measurements even if the peripheral site(s) is normal. The case for selective screening Ideally, one would like to test all individuals at risk for osteoporosis. As all postmenopausal individuals are at risk for developing osteoporosis if they live long enough, one would like to develop an approach that allows the entire population to be screened. Such an approach has important precedents with respect to other widely pervasive diseases, such as hypertension, diabetes, hyperlipidemia, and breast and cervical cancer. In contrast to these conditions, for which inexpensive screening tests have been developed, are readily available, or have simply been accepted, there is no such equivalent with respect to surveying the population for osteoporosis. Nevertheless, osteoporosis is a disorder that meets requirements for which a screening approach is justifiable. It is a common disease associated with high cost, it causes major morbidity and mortality, accurate and safe diagnostic tests are available, and therapy is efficacious. As more densitometers become available at a lower cost, the concept of screening the population will gain more support. At the moment, the more acceptable approach to this issue is to consider the case for selective screening. The carriers who provide reimbursement for bone densitometry have understandably been slow in developing TABLE 1. Normal peripheral screening and indication for central bone mass measurement Postmenopausal women not receiving HRT, who would consider treatment or prevention if low bone mass was diagnosed Maternal history of hip fracture Personal history of fragility fracture Smoker, tall ( 5 7 ) and thin ( 125 lb) Taking medications such as: steroids, antiseizure and GnRH agonists Diseases or conditions associated with bone loss: hyperthyroidism, posttransplantation, malabsorption, hyperparathyroidism, prolactinoma, immobilization Presence of high markers of bone resorption Adapted from Miller et al. (20).
4 1870 MILLER ET AL. JCE&M 1999 Vol 84 No 6 guidelines for reimbursement, but do agree with the concept of selective screening. The Bone Mass Measurement Act of 1998 detailed, for the first time, a set of uniform indications for bone measurement for which reimbursement is justified (Table 2). They include an estrogen-deficient women at risk for osteoporosis. Although the regulation is somewhat ambiguous on this point, it is reasonable to expect that estrogendeficient subjects at risk include those with a family history of osteoporosis, low body weight, history of anorexia, amenorrhea for at least 1 yr during the reproductive years, associated diseases associated with bone loss and certain medications. Other indications contained in the Bone Mass Measurement Act include any individual with a vertebral abnormality, receiving long term glucocorticoid therapy, or with primary hyperparathyroidism and for the purposes of monitoring a patient s response to an FDA-approved therapy for osteoporosis. The National Osteoporosis Foundation (NOF) has just issued its document, Osteoporosis: review of the evidence for prevention, diagnosis, and treatment and cost-effective analysis (2). In that report, the NOF proceeds one step beyond the Health Care Finance Administration guidelines. It defines three categories of individuals who should have a bone mass measurement: all women over age yr, all women with vertebral fracture, and all woman, yr old, with at least one important risk factor. As we further refine and define our criteria for bone mass measurement and as technologies become more user-friendly, available, and affordable, it is clear that bone mineral densitometry is going to be even more widely application to the population. One looks forward to the day when bone mass measurement will be as much a standard of preventive care as is measurement of blood pressure, blood sugar, and cholesterol and mammography. Monitoring therapy of osteoporosis with bone densitometry Bone mass measurement is indispensable to the early diagnosis of osteoporosis. Early recognition of this disease, before the first or next fracture occurs, is leading to a therapeutic imperative, namely to intervene. With new approaches to prevention and therapy, it is important to be able to monitor the effectiveness of the therapy that has been instituted. It is not enough to state simply that the therapy has been shown to work and that all one has to do is to follow the therapeutic plan. The end point of therapy is a reduction in fracture incidence. Certainly, this end point can be monitored in large clinical trials, but it is relatively useless in the individual patient. It is logical to expect that as bone TABLE 2. Bone mass measurement act: a effective July 1, 1998 (HCFA) Indications for bone mass measurement 1) An estrogen-deficient woman at clinical risk for osteoporosis 2) An individual with vertebral abnormalities 3) An individual receiving long term glucocorticoid therapy ( 7.5 mg prednisone/day for 3 months) 4) An individual with primary hyperparathyroidism 5) An individual being monitored to assess the response to or the efficacy of a FDA-approved drug for osteoporosis therapy a Ref. 35. mass measurement defines risk of fracture, it should be useful as an index of therapeutic effectiveness. Indeed, the large clinical trial experience with the bisphosphonate, alendronate, has shown clearly that impressive increases in bone mass in the lumbar spine are associated with a substantial reduction in fracture incidence (9, 10). Recent analysis of these data also suggests that there is a significant relationship between the magnitude of the change in bone mass and the magnitude of the reduction in fractures (7). These data have led to acceptance of bone mass measurement as a surrogate marker for the true end point, fracture reduction. The bone mass measurement act of 1998 acknowledges this point by providing reimbursement for monitoring the therapeutic course of an osteoporotic subject. The use of bone densitometry to monitor the population receiving agents to prevent or treat osteoporosis is clearly important. However, recent evidence suggests that changes in bone mass do not account for the entire risk reduction associated with a specific therapeutic intervention. In the EPIDOS (28) and SOF (29) studies, large epidemiological studies in Europe and the United States, respectively, changes in bone mass have been shown to account only in part for the reduction in fracture incidence. An additional, important predictive index is the change in bone markers. A reduction in indexes of bone turnover contributes importantly and independently to fracture risk reduction. In a carefully conducted, double blind, placebo-controlled study of calcium and vitamin D, Dawson-Hughes et al. (30) have shown that fracture incidence is significantly reduced over a 3-yr period. This reduction in fracture incidence is associated with minimal changes in bone mass. Bone turnover is reduced, however, by calcium and vitamin D administration. The results of the large multicenter study of nasal calcitonin (PROOF study) show that fracture incidence is reduced, but neither bone density nor bone markers change substantially (31). Also recently, data from a large clinical trial with raloxifene, a selective estrogen receptor modulator, have shown that changes in bone mass and bone markers are much less than one would expect considering the major reduction in fracture incidence (32). These newer data do not negate the value of monitoring changes in bone mass with therapy, but emphasize, rather, that there are other factors that will be helpful in assessing the overall response to therapy. In some cases, the evaluation of bone markers will provide not only confirmatory evidence that a biological effect is occurring and that bone mass will increase over time, but also will provide independent data to substantiate the risk reduction afforded by the change in bone mass. Greenspan et al. have shown, for example, that the extent of reduction of the resorption marker, N-telopeptide of collagen, predicts the ultimate change in lumbar spine and hip density (33). Recognition of the potential value of bone markers has led the Health Care Finance Administration to propose a set of guidelines for their use in the context of FDA-approved therapy (34). They include two baseline determinations, a 3 month posttherapy determination, and yearly measurements thereafter.
5 BONE DENSITOMETRY 1871 Summary The revolution in the field of osteoporosis has been aided and abetted by the advent of bone mass measurement technologies. As they become more widely applicable and more affordable, it is evident that we have the potential to discover the millions of individuals at risk for or with the disease. With effective therapies at hand, it is now possible to prevent and treat osteoporosis. There is every reason, therefore, to apply bone mass measurements as widely as possible to discover those subjects at risk for osteoporosis in a manner that is effective and affordable. References 1. Ettinger B, Pressman A, Sklarin P, Bauer DC, Cauley JA, Cummings SR Associations between low levels of serum estradiol, bone density and fractures among elderly women: the study of osteoporotic fractures. J Clin Endocrinol Metab. 83: National Osteoporosis Foundation Osteoporosis: prevention, diagnosis, and treatment. Osteop Int. 8(Suppl 4):S1 S Cummings SR, Black DM, Nevitt MC, et al Bone density at various sites for prediction of hip fractures. Lancet. 341: Hui SL, Slemenda CW, Johnston Jr C Age, and bone mass as predictors of fracture in a prospective study. J Clin Invest. 81: Black DM, Cummings SR, Genant HK, Nevitt MC, Palermo L, Browner W Axial and appendicular bone density predict fractures in older women. J Bone Miner Res. 7: Ross PD Risk factors for osteoporotic fracture. Endocrinol Metab Clin North Am. 27: Hochberg MC, Ross PD, Cummings SR, et al Larger increases in bone mineral density with alendronate therapy are associated with lower risk of new vertebral fractures. Osteop Int. 8(Suppl 3): Watts NB, Harris ST, Genant HK, et al Intermittent cyclic etidronate treatment of postmenopausal osteoporosis. N Engl J Med. 323: Liberman UA, Weiss SR, Broll J, et al Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. N Engl J Med. 333: Black DM, Cummings SR, Karpf DB, et al Randomised trial of effect of alendronate on risk fracture in women with existing vertebral fractures. Lancet. 348: Blake GM, Fogelman I Principles of bone densitometry. In: Bilezikian JP, Raisz LG, Rodan GA, eds. Principles of bone biology. New York: Academic Press; Genant HK, Cann CE, Ettinger B, Gordan GS Quantitative computed tomography of vertebral spongiosa: a sensitive method for detecting early bone loss after oophorectomy. Ann Intern Med. 97: Grampp S, Lang P, Jergas M, Gluer CC, Takada M, Engelke K, Genant HK Peripheral quantitative computed tomography: short term in vivo precision and comparison to forearm DXA. J Bone Miner Res. 9:A Ross PD, Genant H, Davis JD, Miller PD, Wasnich R. Predicting vertebral fracture incidence from prevalent fractures and bone density among nonblack, osteoporotic women Osteop Int. 3: Blake GM, Patel R, Fogelman I Peripheral or axial density measurement. J Clin Densitometry. 1: Kelly TL, Crane G, Baran DT Single x-ray absorptiometry of the forearm: precision, correlation and reference data. Calcif Tissue Int. 54: Yates AJ, Ross PD, Lydick E, Epstein RS Radiographic absorptiometry in the diagnosis of osteoporosis. Am J Med. 98: Gluer CC, Genant HK, Hans D, et al Quantitative ultrasound techniques for the assessment of osteoporosis: expert agreement and current status. J Bone Miner Res. 12: Baran DT A sound strategy for bones. J Clin Densitometry. 1: Miller PD, Bonnick SL, Johnston CC, Kleerekoper M, Lindsay RL, Sherwood LM, Siris ES The challenges of peripheral bone density testing. Which patients need additional central density skeletal measurements? J Clin Densitometry. 1: Eastell R, Wahner HW, O Fallon WM, Amadio PC, Melton III LJ, Riggs BL Unequal decrease in bone density of lumbar spine and ultradistal radius in Colles and vertebral fracture syndrome. J Clin Invest. 83: WHO Study Group Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. WHO Tech Rep Ser 843. Geneva: WHO; Drinka PJ, DeSmet AA, Bauwens SF, Rogot A The effect of overlying calcification on lumbar bone densitometry. Calcif Tissue Int. 50: Grampp S, Genant HK, Mathur A, et al Comparisons of noninvasive bone mineral measurements in assessing age related loss, fracture discrimination, and diagnostic classification. J Bone Miner Res. 12: Melton III LJ, Chrischilles EA, Cooper C, Lane AW, Riggs BL How many women have osteoporosis? J Bone Miner Res. 7: Arlot ME, Sornay-Rendu E, Garnero P, Vey-Marty B, Delmas PD Apparent pre- and postmenopausal bone loss evaluated by DXA at different skeletal sites in women: the OFELY cohort. J Bone Miner Res. 12: Bouxsein M, Parker RA, Greenspan SL Forearm bone mineral densitometry cannot be used to monitor improvements in hip and spine bone density after 2.5 years of alendronate therapy. Bone. 23(Suppl):S Garnero P, Hausherr E, Chapuy MC, et al Markers of bone resorption predict hip fracture in elderly women: the EPIDOS prospective study. J Bone Miner Res. 11: Cummings SR, Browner WS, Bauer D, Stone K, Ensrud K, Jamal S, Ettinger B Endogenous hormones and the risk of hip and vertebral fractures among older women. N Engl J Med. 339: Dawson-Hughes B, Harris SS, Krall EA, Dallal GE Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med. 337: Chesnut C, Silverman SL, Andriano K, et al Salmon calcitonin nasal spray reduces the rate of new vertebral fractures independently of known major pre-treatment risk factors: acrrued 5 years analysis of the PROOF study. Bone. 23:S Ensrud K, Black D, Recker R, et al The effect of 2 and 3 years of raloxifene on vertebral and non-vertebral fractures in postmenopausal women with osteoporosis. Bone. 23:S Greenspan SL, Parker RA, Ferguson L, Rosen HN, Maitland-Ramsey, Karpf DB Early changes in biochemical markers of bone turnover predict the long term response to alendronate therapy in representative elderly women: a randomized clinical trial. J Bone Miner Res. 13: DHHS Medicare program: recommended medicare national coverage policy for collagen crosslinks, any method. Federal Register. Washington DC: U.S. Government Printing Office. 35. DHHS Medicare program: medicare coverage of and payment for bone mass measurements. Federal Register. Washington DC: U.S. Government Printing Office; 63(121) Blake GM, Patel R, Fogelman I Peripheral or axial bone density measurements? J Clin Densitometry. 1:55 63.
Comparison of Bone Density of Distal Radius With Hip and Spine Using DXA
ORIGINAL ARTICLE Comparison of Bone Density of Distal Radius With Hip and Spine Using DXA Leila Amiri 1, Azita Kheiltash 2, Shafieh Movassaghi 1, Maryam Moghaddassi 1, and Leila Seddigh 2 1 Rheumatology
More informationOsteoporosis - recent advances in diagnosis and treatment
Title Osteoporosis - recent advances in diagnosis and treatment Author(s) Kung, AWC Citation The 4th Medical Research Conference (MRC 1999), Hong Kong, China, 30-31 January 1999. In Hong Kong Practitioner,
More informationInterpreting 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 informationPostmenopausal osteoporosis is a systemic
OSTEOPOROSIS: HARD FACTS ABOUT BONES Steven T. Harris, MD, FACP* ABSTRACT As a consequence of the aging process, osteoporosis affects all men and women. Agerelated loss of bone mass leads to skeletal fragility
More informationOral Alendronate Vs. Three-Monthly Iv Ibandronate In The Treatment Of Postmenopausal Osteoporosis
Oral Alendronate Vs. Three-Monthly Iv Ibandronate In The Treatment Of Postmenopausal Osteoporosis Miriam Silverberg A. Study Purpose and Rationale More than 70% of fractures in people after the age of
More informationDECADES OF PUBLISHED STUDIES have confirmed the
JOURNAL OF BONE AND MINERAL RESEARCH Volume 15, Number 2, 2000 2000 American Society for Bone and Mineral Research Perspective Bone Matters: Are Density Increases Necessary to Reduce Fracture Risk? KENNETH
More informationObjectives. Discuss bone health and the consequences of osteoporosis on patients medical and disability status.
Objectives Discuss bone health and the consequences of osteoporosis on patients medical and disability status. Discuss the pathophysiology of osteoporosis and major risk factors. Assess the major diagnostic
More informationPrevalence of Osteoporosis p. 262 Consequences of Osteoporosis p. 263 Risk Factors for Osteoporosis p. 264 Attainment of Peak Bone Density p.
Dedication Preface Acknowledgments Continuing Education An Introduction to Conventions in Densitometry p. 1 Densitometry as a Quantitative Measurement Technique p. 2 Accuracy and Precision p. 2 The Skeleton
More informationOSTEOPOROSIS MANAGEMENT AND INVESTIGATION. David A. Hanley, MD, FRCPC
OSTEOPOROSIS MANAGEMENT AND INVESTIGATION David A. Hanley, MD, FRCPC There is a huge care gap in the management of osteoporosis in this country. As yet unpublished findings from the Canadian Multicentre
More informationOsteoporosis. 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 informationSkeletal 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 informationBone mineral density testing: Is a T score enough to determine the screening interval?
Interpreting Key Trials CME CREDIT EDUCATIONAL OBJECTIVE: Readers will measure bone mineral density at reasonable intervals in their older postmenopausal patients Krupa B. Doshi, MD, CCD Department of
More informationDual-energy Vertebral Assessment
Dual-energy Vertebral Assessment gehealthcare.com Dual-energy Vertebral Assessment More than 40% of women with normal or osteopenic BMD had a moderate or severe vertebral deformation seen with DVA. Patrick
More informationPharmacy Management Drug Policy
SUBJECT: - Forteo (teriparatide), Prolia (denosumab), Tymlos (abaloparatide) POLICY NUMBER: Pharmacy-35 EFFECTIVE DATE: 9/07 LAST REVIEW DATE: 9/29/2017 If the member s subscriber contract excludes coverage
More informationBone 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 informationOSTEOPOROSIS: 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 informationQCT BMD Imaging vs DEXA BMD Imaging
QCT BMD Imaging vs DEXA BMD Imaging by Charles (Chuck) Maack Prostate Cancer Advocate/Activist Disclaimer: Please recognize that I am not a Medical Doctor. I have been an avid student researching and studying
More informationRisedronate prevents hip fractures, but who should get therapy?
INTERPRETING KEY TRIALS CHAD L. DEAL, MD Head, Center for Osteoporosis and Metabolic Bone Disease, Department of Rheumatic and Immunologic Diseases, The Cleveland Clinic THE HIP TRIAL Risedronate prevents
More informationDXA 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 informationFragile 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 informationPharmacy Management Drug Policy
SUBJECT: - Forteo (teriparatide), Prolia (denosumab), Tymlos (abaloparatide), Boniva injection (Ibandronate) POLICY NUMBER: Pharmacy-35 EFFECTIVE DATE: 9/07 LAST REVIEW DATE: 10/15/2018 If the member s
More informationSubmission to the National Institute for Clinical Excellence on
Submission to the National Institute for Clinical Excellence on Strontium ranelate for the prevention of osteoporotic fractures in postmenopausal women with osteoporosis by The Society for Endocrinology
More informationEffect of Precision Error on T-scores and the Diagnostic Classification of Bone Status
Journal of Clinical Densitometry, vol. 10, no. 3, 239e243, 2007 Ó Copyright 2007 by The International Society for Clinical Densitometry 1094-6950/07/10:239e243/$32.00 DOI: 10.1016/j.jocd.2007.03.002 Original
More informationDr Tuan V NGUYEN. Mapping Translational Research into Individualised Prognosis of Fracture Risk
Dr Tuan V NGUYEN Bone and Mineral Research Program, Garvan Institute of Medical Research, Sydney NSW Mapping Translational Research into Individualised Prognosis of Fracture Risk From the age of 60, one
More informationUse 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 informationAN APPROACH TO THE PATIENT WITH OSTEOPOROSIS. Malik Mumtaz
Malaysian Journal of Medical Sciences, Vol. 8, No. 1, Januari 2001 (11-19) BRIEF ARTICLE Department of Medicine School of Medical Sciences, Universiti Sains Malaysia 16150 Kubang Kerian, Kelantan, Malaysia
More informationThis house believes that HRT should be the first-line prevention for postmenopausal osteoporosis: the case against
This house believes that HRT should be the first-line prevention for postmenopausal osteoporosis: the case against Juliet Compston Professor of Bone Medicine University of Cambridge School of Clinical
More informationOSTEOPOROSIS IN MEN. Nelson B. Watts, MD OSTEOPOROSIS AND BONE HEALTH SERVICES CINCINNATI, OHIO
OSTEOPOROSIS IN MEN Nelson B. Watts, MD OSTEOPOROSIS AND BONE HEALTH SERVICES CINCINNATI, OHIO DISCLOSURES Speakers Bureau: Amgen, Radius Consultant: Abbvie, Amgen, Janssen, Radius, Sanofi Watts NB et
More informationAMERICAN COLLEGE OF RHEUMATOLOGY POSITION STATEMENT. Committee on Rheumatologic Care
AMERICAN COLLEGE OF RHEUMATOLOGY POSITION STATEMENT SUBJECT: PRESENTED BY: FOR DISTRIBUTION TO: Bone Mineral Density Measurement and the Role of Rheumatologists in the Management of Osteoporosis Committee
More informationThe Significance of Vertebral Fractures
Special Report The Significance of Vertebral Fractures Both the prevalence and the clinical significance of vertebral fractures has been greatly underestimated by physicians. Vertebral fractures are much
More informationCASE 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 informationOsteoporosis International. Original Article. Bone Mineral Density and Vertebral Fractures in Men
Osteoporos Int (1999) 10:265 270 ß 1999 International Osteoporosis Foundation and National Osteoporosis Foundation Osteoporosis International Original Article Bone Mineral Density and Vertebral Fractures
More informationPharmacy Management Drug Policy
Clinical criteria used to make utilization review decisions are based on credible scientific evidence published in peer reviewed medical literature generally recognized by the medical community. Guidelines
More informationAn audit of bone densitometry practice with reference to ISCD, IOF and NOF guidelines
Osteoporos Int (2006) 17: 1111 1115 DOI 10.1007/s00198-006-0101-6 SHORT COMMUNICATION An audit of bone densitometry practice with reference to ISCD, IOF and NOF guidelines R. Baddoura. H. Awada. J. Okais.
More informationDocumentation, Codebook, and Frequencies
Documentation, Codebook, and Frequencies Dual-Energy X-ray Absorptiometry Femur Bone Measurements Examination Survey Years: 2005 to 2006 SAS Transport File: DXXFEM_D.XPT January 2009 NHANES 2005 2006 Data
More informationUnderstanding the Development of Osteoporosis and Preventing Fractures: WHO Do We Treat Now?
Understanding the Development of Osteoporosis and Preventing Fractures: WHO Do We Treat Now? Steven M. Petak, MD, JD, FACE, FCLM Texas Institute for Reproductive Medicine And Endocrinology, Houston, Texas
More informationAccuracy of DEXA scanning & other methods for determining BMD.
BMD- Measurement Site Accuracy of DEXA scanning & other methods for determining BMD. Ann Larkin In general, densitometry techniques can be performed in either the axial or the appendicular skeleton, depending
More informationClinician 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 informationDXA scanning to diagnose osteoporosis: Do you know what the results mean?
REVIEW CME CREDIT BRADFORD RICHMOND, MD Department of Radiology, The Cleveland Clinic; certification instructor, the International Society for Clinical Densitometry DXA scanning to diagnose osteoporosis:
More informationCorporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: bone_mineral_density_studies 12/1996 9/2017 9/2018 9/2017 Description of Procedure or Service Bone density
More informationOsteoporosis/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 informationNew York State County Comparison of Fall-related Hip Fractures of Older Adults and Number of Dual-X-ray Absorptiometry Machines
New York State County Comparison of Fall-related Hip Fractures of Older Adults and Number of Dual-X-ray Absorptiometry Machines Michael Bauer New York State Department of Health Bureau of Occupational
More informationBone Density Measurement in Women
Bone Density Measurement in Women Revised 2005 Scope This guideline defines the medical necessity of bone mineral density (BMD) measurement using dualenergy x-ray absorptiometry (DXA or DEXA), and applies
More informationSERMS, Hormone Therapy and Calcitonin
SERMS, Hormone Therapy and Calcitonin Tiffany Kim, MD Clinical Fellow VA Advanced Women s Health UCSF Endocrinology and Metabolism I have nothing to disclose Thanks to Clifford Rosen and Steven Cummings
More informationDisclosures 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 informationORIGINAL INVESTIGATION. Bone Mineral Density Thresholds for Pharmacological Intervention to Prevent Fractures
ORIGINAL INVESTIGATION Bone Mineral Density Thresholds for Pharmacological Intervention to Prevent Fractures Ethel S. Siris, MD; Ya-Ting Chen, PhD; Thomas A. Abbott, PhD; Elizabeth Barrett-Connor, MD;
More informationThis 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 informationOmnisense: At Least As Good As DXA
Omnisense: At Least As Good As DXA The following document summarizes a series of clinical studies that have been conducted to compare between different qualities of the Sunlight support the claim that
More informationClinical Study Comparison of QCT and DXA: Osteoporosis Detection Rates in Postmenopausal Women
International Endocrinology Volume 3, Article ID 895474, 5 pages http://dx.doi.org/.55/3/895474 Clinical Study Comparison of QCT and DXA: Osteoporosis Detection Rates in Postmenopausal Women Na Li, Xin-min
More informationIN WOMEN, serum estradiol is an important determinant
0021-972X/98/$03.00/0 Vol. 83, No. 7 Journal of Clinical Endocrinology and Metabolism Printed in U.S.A. Copyright 1998 by The Endocrine Society Associations between Low Levels of Serum Estradiol, Bone
More informationOsteoporosis: Risk Factors, Diagnostic Methods And Treatment Options
ISPUB.COM The Internet Journal of Academic Physician Assistants Volume 1 Number 1 Osteoporosis: Risk Factors, Diagnostic Methods And Treatment Options K Ihrke Citation K Ihrke.. The Internet Journal of
More informationManagement of Osteoporosis : What Do the Guidelines Say? Robert D. Blank, MD, PhD Endocrinology, U of Wisconsin GRECC Service, Middleton VAMC
Management of Osteoporosis : What Do the Guidelines Say? Robert D. Blank, MD, PhD Endocrinology, U of Wisconsin GRECC Service, Middleton VAMC Learning Goals Review guidelines for osteoporosis Consider
More informationForteo (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 informationDisclosures. 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 informationOsteoporosis is a disease that is
Pharmacologic Prevention of Osteoporotic Fractures THOMAS M. ZIZIC, M.D., Johns Hopkins University School of Medicine, Baltimore, Maryland Osteoporosis is characterized by low bone mineral density and
More informationDoes raloxifene (Evista) prevent fractures in postmenopausal women with osteoporosis?
FPIN's Clinical Inquiries Raloxifene for Prevention of Osteoporotic Fractures Clinical Inquiries provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries
More informationOsteoporosis: 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 informationAssessment 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 informationNEW 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 informationThe health economics of calcium and vitamin D3 for the prevention of osteoporotic hip fractures in Sweden Willis M S
The health economics of calcium and vitamin D3 for the prevention of osteoporotic hip fractures in Sweden Willis M S Record Status This is a critical abstract of an economic evaluation that meets the criteria
More informationsad EFFECTIVE DATE: POLICY LAST UPDATED:
Medical Coverage Policy Bone Mineral Density Studies sad EFFECTIVE DATE: 06 07 2011 POLICY LAST UPDATED: 11 06 2018 OVERVIEW Bone density studies can be used to identify individuals with osteoporosis and
More informationjournal of medicine The new england One Year of Alendronate after One Year of Parathyroid Hormone (1 84) for Osteoporosis abstract
The new england journal of medicine established in 112 august 11, 25 vol. 353 no. 6 One Year of Alendronate after One Year of Parathyroid Hormone (1 ) for Osteoporosis Dennis M. Black, Ph.D., John P. Bilezikian,
More informationWhat is Osteoporosis?
What is Osteoporosis? 2000 NIH Definition A skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture. Bone strength reflects the integration of
More informationCurrent Issues in Osteoporosis
Current Issues in Osteoporosis California AACE 18TH Annual Meeting & Symposium Marina del Rey, CA September 15, 2018 Michael R. McClung, MD, FACP,FACE Director, Oregon Osteoporosis Center Portland, Oregon,
More informationOsteoporosis. 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 informationAwareness, Diagnosis, and Management of Osteoporosis in Adults with Developmental Disabilities
Awareness, Diagnosis, and Management of Osteoporosis in Adults with Developmental Disabilities Sunil J. Wimalawansa, MD, PhD, MBA, FACP, FRCP University Professor Professor of Medicine, Physiology & Pharmacology
More informationNew Developments in Osteoporosis: Screening, Prevention and Treatment
Osteoporosis: Overview New Developments in Osteoporosis: Screening, Prevention and Treatment Judith Walsh, MD, MPH Departments of Medicine and Epidemiology and Biostatistics UCSF Definitions Risk factors
More information( ) () () () () :.. :. (Bone mineral densiy BMD gr/cm 2 ) Dual-energy x-ray absorptiometry (DXA ) Excell (Femoral neck) (L2-L4) T-score Z-score... ± :. t.. /±/ /±/ ( L2-L4 ) BMD. ± %/. % % Z-score %..
More informationCollagen Crosslinks, Any Method
190.19 - Collagen Crosslinks, Any Method Collagen crosslinks, part of the matrix of bone upon which bone mineral is deposited, are biochemical markers the excretion of which provides a quantitative measurement
More informationFractures: 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 informationNutritional 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 informationBuilding 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 informationFractures: 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 informationJuly 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 informationOsteoporosis 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 informationQuantitative Ultrasound and Bone Mineral Density Are Equally Strongly Associated with Risk Factors for Osteoporosis
JOURNAL OF BONE AND MINERAL RESEARCH Volume 16, Number 2, 2001 2001 American Society for Bone and Mineral Research Quantitative Ultrasound and Bone Mineral Density Are Equally Strongly Associated with
More informationEffect of Alendronate on Risk of Fracture in Women With Low Bone Density but Without Vertebral Fractures
Original Contributions Effect of Alendronate on Risk of Fracture in Women With Low Bone Density but Without Vertebral Fractures Results From the Fracture Intervention Trial Steven R. Cummings, MD; Dennis
More informationInternational 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 informationCollagen Crosslinks, Any Method
190.19 - Collagen Crosslinks, Any Method Collagen crosslinks, part of the matrix of bone upon which bone mineral is deposited, are biochemical markers the excretion of which provides a quantitative measurement
More informationBone 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 informationPage 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 informationDifferentiating 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 informationW hile the headline-grabbing Women s
OBG MANAGEMENT BY ROBERT L. BARBIERI, MD New options in osteoporosis therapy: Combination and sequential treatment Perhaps the biggest medical question to emerge from the WHI study is how to best treat
More informationUpdates 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 informationOsteoporosis: Not Just for Women Anymore. Osteoporosis is characterized by low bone. By Lisanne G. Laurier, MD, PhD, FRCPC.
Focus on CME at the University of Western Ontario Osteoporosis: Not Just for Women Anymore By Lisanne G. Laurier, MD, PhD, FRCPC Osteoporosis is characterized by low bone mass and microarchitectural deterioration
More informationInternational Journal of Advanced Research in Biological Sciences ISSN : Research Article
Int. J. Adv. Res. Biol.Sci. 1(7): (2014): 167 172 International Journal of Advanced Research in Biological Sciences ISSN : 2348-8069 www.ijarbs.com Research Article Beneficial effect of Strontium Ranelate
More informationVasu Pai FRACS, Nat Board, MCh, M.S
Vasu Pai FRACS, Nat Board, MCh, M.S Composition of bone Mineral 70% Protein 22% Water 8% On osteoclast precurssor On Osteoblast Osteoporosis Dx No clinical lsigns No blood tests Gold standard: Bone
More informationMeasuring Bone Mineral Density
Measuring Bone Mineral Density Osteoporosis Screening by Pharmacists 9/20/06 Don Downing Institute for Innovative Pharmacy Practice Today s Topics What is osteoporosis? What causes osteoporosis? Screening
More informationO. 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 informationBreast 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 informationHow can we tell who will fracture? Beyond bone mineral density to the new world of fracture risk assessment
Copyright 2008 by How can we tell who will fracture? Beyond bone mineral density to the new world of fracture risk assessment Dr. Bone density testing: falling short of expectations More than 25 years
More informationGuideline 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 information2013 ISCD Official Positions Adult
2013 ISCD Official Positions Adult These are the Official Positions of the ISCD as updated in 2013. The Official Positions that are new or revised since 2007 are in bold type. Indications for Bone Mineral
More informationOsteoporosis Physician Performance Measurement Set. October 2006
American Academy of Family Physicians/American Academy of Orthopaedic Surgeons/American Association of Clinical Endocrinologists/American College of Rheumatology/The Endocrine Society/Physician Consortium
More information1
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 informationNAMS Practice Pearl. Use of Drug Holidays in Women Taking Bisphosphonates. Released April 1, 2013
NAMS Practice Pearl Use of Drug Holidays in Women Taking Bisphosphonates Released April 1, 2013 Dima L. Diab, MD 1, and Nelson B. Watts, MD 2 ( 1 Cincinnati VA Medical Center, Cincinnati, OH, 2 Mercy Health
More information2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada
2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada Jacques P. Brown, Robert G. Josse, for the Scientific Advisory Council of the Osteoporosis Society of Canada
More informationForeword...v Preface...vii Acknowledgments... xi Dedication... xiii Continuing Medical Education... xxv. Chapter 1: Densitometry Techniques...
CONTENTS Foreword...v Preface...vii Acknowledgments... xi Dedication... xiii Continuing Medical Education... xxv Chapter 1: Densitometry Techniques... 1 Plain Radiography in the Assessment of Bone Density...
More informationCurrent 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