Use of DXA-based technology for detection and assessment of risk of vertebral fracture in rheumatology practice.

Measurement of bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA) is the recommended method for diagnosis of osteoporosis and assessment of future fracture risk. However, most patients who will suffer fractures do not have osteoporosis by DXA (T-score of -2.5 or less).

Assessing the Effects of Teriparatide Treatment on Bone Mineral Density, Bone Microarchitecture, and Bone Strength.

Background: To gain insight into how teriparatide affects various bone health parameters, we assessed the effects of teriparatide treatment with use of standard DXA (dual x-ray absorptiometry) technology and two newer technologies, high-resolution MRI (magnetic resonance imaging) and finite element analysis of quantitative CT (computed tomography) scans.

Methods: In this phase-4, open-label study, postmenopausal women with severe osteoporosis received 20 μg/day of teriparatide. Assessments included (1) changes in areal BMD (bone mineral density) (in g/cm) at the radius, spine, and hip on DXA, (2) changes in volumetric BMD (in mg/cm) at the spine and hip on quantitative CT scans, (3) changes in bone microarchitecture at the radius on high-resolution MRI, (4) estimated changes in spine and hip strength according to finite element analysis of quantitative CT scans, (5) changes in bone turnover markers in serum, and (6) safety.

Twice daily versus once nightly dosing of pregabalin for fibromyalgia: a double-blind randomized clinical trial of efficacy and safety.

Objective: To compare the efficacy, discontinuation rates, and safety of once nightly versus twice daily dosing of pregabalin in a community-based trial.

Methods: This multicenter, double-blind, 8-week randomized clinical trial compared the effects of 300-mg daily doses of pregabalin given either twice daily or once nightly for the treatment of fibromyalgia in 177 patients. The primary outcome was the comparison of end point mean pain scores derived from a daily diary.

Oral calcitonin.

Both injectable and nasal spray calcitonins have been utilized in the treatment of postmenopausal osteoporosis for over 25 years. More widespread use of calcitonin in the treatment of osteoporosis has been hampered in part due to poor patient acceptability and compliance and the inability of patients to take this medication as an oral pill. In recent years, an oral preparation of calcitonin has been developed that combines the active peptide hormone with a caprylic acid derivative to enhance bioavailability.

Update on glucocorticoid-induced osteoporosis.

Glucocorticoid-induced osteoporosis (GIOP) is the most common form of secondary osteoporosis, and fractures are the most frequent adverse effects of this medication. Glucocorticoids have several direct and indirect adverse effects on bone, primarily through reduction in osteoblasts and osteocyte activity, and life span. Recent advances in the pathophysiology and prevention of this complication of therapy provide hope for its amelioration in patients being treated with glucocorticoids.

Osteoporosis update from the 2010 santa fe bone symposium.

The 11th Santa Fe Bone Symposium was held in Santa Fe, NM, USA, on August 6-7, 2010. This annual event addresses clinically relevant advances in the fields of osteoporosis and metabolic bone disease. The venue includes plenary presentations by internationally recognized experts, oral presentations of abstracts, and interactive panel discussions of challenging cases and controversial issues.

The role of zoledronic acid in the management of osteoporosis.

Bisphosphonates are the current standard of care for treatment of osteoporosis. However, oral bisphosphonates are associated with complicated dosing regimens because of poor absorption and have the potential for upper gastrointestinal (GI) tract irritation, resulting in poor adherence and persistence. Zoledronic acid (ZOL) 5 mg, a once-yearly intravenous bisphosphonate, is approved for treatment and prevention of postmenopausal osteoporosis, increasing bone mass in men with osteoporosis, and treatment and prevention of glucocorticoid-induced osteoporosis.

Intravenous zoledronic acid: what are the indications for male osteoporosis?

Osteoporosis and fractures are under-recognized and undertreated, both in men and women worldwide. Male osteoporosis is not the epidemic problem that female osteoporosis is; however, the National Osteoporosis Foundation estimates that over 14 million American men have osteoporosis or low bone mass, and approximately 25% to 30% of all hip fractures occur in male individuals who incur greater morbidity and mortality than their female counterparts. Until recently, alendronate, risedronate, and teriparatide were the only pharmacologic agents approved by the US Food and Drug Administration for treating male osteoporosis.

Safety, tolerability, and clinical outcomes after intraarticular injection of a recombinant adeno-associated vector containing a tumor necrosis factor antagonist gene: results of a phase 1/2 Study.

Objective: To assess safety and clinical outcomes in patients with inflammatory arthritis after intraarticular (IA) injection of rAAV2-TNFR:Fc, a recombinant adeno-associated viral vector containing the human tumor necrosis factor (TNF) receptor-immunoglobulin (IgG1) Fc fusion (TNFR:Fc) gene.

Methods: In this phase 1/2 randomized study, adults with persistent moderate or severe inflammation in a target joint, being treated with or without systemic anti-TNF therapy, received a single IA injection of either rAAV2-TNFR:Fc (1 x 10(11), 1 x 10(12), or 1 x 10(13) DNase-resistant particles/ml joint volume) or placebo, followed by open-label rAAV2-TNFR:Fc 12-30 weeks later, depending on when the target joint met predetermined criteria for reinjection.

Results: 127 subjects received the first injection of blinded study drug; 95 subjects received open-label rAAV2-TNFR:Fc.

Osteomalacia.

The finding of low bone mineral density with a T-score of -2.5 or below on dual energy x-ray absorptiometry is usually reported as indicating that the patient has "osteoporosis" according to the World Health Organization classification, and, in postmenopausal women, it is often assumed that this is due to estrogen deficiency. However, up to one third of postmenopausal women have a secondary cause of low density, including osteomalacia.

Dual-Energy X-Ray Absorptiometry Technical issues: the 2007 ISCD Official Positions.

At the 2007 Position Development Conference, the Dual-Energy X-ray Absorptiometry Technical Task Force investigated three major areas of bone density testing. Although bone mineral density (BMD) testing in men had previously been reviewed at the 2005 Position Development Conference, we reviewed the most recent data in men to develop appropriate indications for bone density testing in men. We continue to recommend screening at age 70 and discuss the clinical risk factors that may be an appropriate indication for earlier BMD testing.

Proceedings of the Eighth Annual Santa Fe Bone Symposium, August 3-4, 2007.

The Eighth Annual Santa Fe Bone Symposium convened August 3-4, 2007, in Santa Fe, New Mexico, USA, immediately preceded by the Research Symposium in Metabolic Bone Disease and Osteoporosis Update for Endocrine Fellows, and followed by the International Society for Clinical Densitometry (ISCD) Bone Densitometry Course. The symposium faculty consists of internationally recognized experts in osteoporosis and metabolic bone disease who presented state-of-the-art research data and late-breaking developments in the fields of osteoporosis, metabolic bone disease, and assessment of skeletal health. The presentations and numerous interactive discussions that followed focused on applying what is known from clinical trials, knowledge of bone pathophysiology, and the mechanisms of action of therapeutic interventions, to making real-world patient management decisions.

Zoledronic acid for Paget's disease of bone.

Paget's disease of bone is a common skeletal disorder that often results in significant pain and disability. A number of bisphosphonates are currently available for treatment, however normalization of biochemical markers of bone turnover (the goal of treatment of Paget's disease) is rarely accomplished with currently available medications due to difficulty with administration, poor long-term adherence and possibly resistance to individual bisphosphonates. This review will focus on zoledronic acid, a potent intravenous bisphosphonate that appears to result in a higher percentage of patients with long-term normalization of markers of bone turnover than previously available drugs, thereby improving quality of life in patients with Paget's disease of bone.

New and emerging treatments for osteoporosis.

Purpose Of Review: This review will focus on three new treatments for postmenopausal osteoporosis which have either been recently released (intravenous ibandronate), or have completed (zoledronic acid) or are currently in (denosumab) phase III trials.

Recent Findings: A number of agents have demonstrated fracture risk reduction in randomized clinical trials, however, successful treatment of osteoporosis in the individual patient remains a challenge. Adherence to, and persistence with, all current osteoporosis medications are poor, being approximately 50% at 1 year for weekly bisphosphonates.

Recent developments in bisphosphonate therapy.

Objective: To provide a review of current developments in bisphosphonates indicated for the treatment of several rheumatologic conditions, including postmenopausal and glucocorticoid-induced osteoporosis.

Methods: This review summarizes the pathology, diagnosis, and treatment of both postmenopausal and glucocorticoid-induced osteoporosis and examines the results of current clinical trials of the newest oral and intravenous formulations of nitrogen-containing bisphosphonates. We discuss important adverse events, including upper gastrointestinal symptoms and osteonecrosis of the jaw.

The use of zoledronic acid for Paget's disease of bone.

Paget's disease of bone is a common skeletal disorder of the elderly that often results in significant morbidity and disability. Although there are a number of oral bisphosphonates currently available for treatment, normalization of biochemical markers of bone turnover with these agents is rarely accomplished due to difficulty with administration, adherence, and possibly resistance to individual bisphosphonates. This paper will focus on zoledronic acid, a potent and easily administered intravenous bisphosphonate that appears to result in a higher percentage of patients with normalization of markers of bone turnover and results in improvements in quality of life in patients with Paget's disease of bone.

Review of treatment modalities for postmenopausal osteoporosis.

This review summarizes and updates data presented at recent annual Southern Medical Association conferences on postmenopausal osteoporosis. As part of any osteoporosis treatment program, it is important to maintain adequate calcium and 25-hydroxyvitamin D levels either through diet or supplementation. Among the available pharmacologic therapies, the bisphosphonates alendronate and risedronate have demonstrated the most robust fracture risk reductions-approximately 40 to 50% reduction in vertebral fracture risk, 30 to 40% in nonvertebral fracture risk, and 40 to 60% in hip fracture risk.

Osteoporosis and rate of bone loss among postmenopausal survivors of breast cancer.

Background: Breast cancer diagnosis and treatment may put women at higher risk for osteoporosis in later life.

Methods: In a subgroup of participants in the Women's Health Initiative Observational Study, authors of the current study investigated differences in bone mineral density (BMD, measured by dual-energy x-ray absorptiometry) between breast cancer survivors (n = 209) and a noncancer reference group (n = 5759).

Results: In comparison to the reference group, breast cancer survivors had significantly lower total body BMD value (0.

Glucocorticoid-induced osteoporosis: treatment options and guidelines.

Glucocorticoid-induced osteoporosis and fractures are the most frequent adverse effects of this class of medication. Recent advances in the pathophysiology, epidemiology, detection, and prevention of this complication of therapy provide hope for its amelioration in patients who require treatment with glucocorticoids. A number of effective pharmacologic agents are available and/or under study, and scientific organizations now provide guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis.

Skeletal and nonskeletal effects of raloxifene.

Raloxifene, a selective estrogen receptor modulator, is approved for the prevention and treatment of postmenopausal osteoporosis. Prevention studies with raloxifene have demonstrated preservation of bone density and suppression of bone turnover markers in young postmenopausal women. The Multiple Outcomes of Raloxifene Evaluation study was the pivotal treatment trial for raloxifene.

Clinical use of serum and urine bone markers in the management of osteoporosis.

Osteoporosis is a common disease characterized by decreased bone mass, increased bone turnover, and increased susceptibility to fracture. Almost 44 million Americans are estimated to have low bone mass, which puts them at increased risk of developing osteoporosis and fractures. Osteoporosis is diagnosed by a low bone density (BMD) measurement, because a low BMD is known to contribute to increased fracture risk, which is the main source of morbidity and mortality for osteoporosis.

Fracture risk among breast cancer survivors: results from the Women's Health Initiative Observational Study.

Background: Breast cancer and its treatment may compromise bone health. We tested the hypothesis in the Women's Health Initiative Observational Study that postmenopausal survivors of breast cancer have a higher risk for fractures compared with women who have no cancer history.

Methods: A prospective cohort (5.