Oral Cannabidiol Treatment in Two Postmenopausal Women with Osteopenia: A Case Series.

Cannabidiol (CBD), a nonintoxicating cannabinoid, may be involved in bone remodeling, but human studies are limited. In this case series, we explored the effects of oral CBD administration on bone turnover. Two postmenopausal women with osteopenia (T-score=-1 to -2.

Economic and Humanistic Burden Among Medicare-Aged Women With Fragility Fracture in the United States.

Objective: Describe patient characteristics, health care resource utilization, costs, and humanistic burden of women with Medicare insurance with incident fragility fracture who were admitted to post-acute-care (PAC).

Design: Retrospective cohort study using 100% Medicare Fee-for-Service (FFS) data.

Setting And Participants: Community-dwelling female Medicare beneficiaries with incident fragility fracture January 1, 2017, to October 17, 2019, resulting in PAC admission to a skilled nursing facility (SNF), home-health care, inpatient-rehabilitation facility, or long-term acute-care hospital.

Executive Summary of the 2019 ISCD Position Development Conference on Monitoring Treatment, DXA Cross-calibration and Least Significant Change, Spinal Cord Injury, Peri-prosthetic and Orthopedic Bone Health, Transgender Medicine, and Pediatrics.

To answer important questions in the fields of monitoring with densitometry, dual-energy X-ray absorptiometry machine cross-calibration, monitoring, spinal cord injury, periprosthetic and orthopedic bone health, transgender medicine, and pediatric bone health, the International Society for Clinical Densitometry (ISCD) held a Position Development Conference from March 20 to 23, 2019. Potential topics requiring guidance were solicited from ISCD members in 2017. Following that, a steering committee selected, prioritized, and grouped topics into Task Forces.

Repeating Measurement of Bone Mineral Density when Monitoring with Dual-energy X-ray Absorptiometry: 2019 ISCD Official Position.

Bone mineral density (BMD) can be measured at multiple skeletal sites using various technologies to aid clinical decision-making in bone and mineral disorders. BMD by dual-energy X-ray absorptiometry (DXA) has a critical role in predicting risk of fracture, diagnosis of osteoporosis, and monitoring patients. In clinical practice, DXA remains the most available and best validated tool for monitoring patients.

Persistence at 24 months with denosumab among postmenopausal women with osteoporosis: results of a prospective cohort study.

Unlabelled: Persistence with prescribed medications for chronic diseases is important; however, persistence with osteoporosis treatments is historically poor. In this prospective cohort study of postmenopausal women treated for osteoporosis in real-world clinical practice settings in the USA and Canada, 24-month persistence with denosumab was 58%.

Purpose: Patients who persist with their prescribed osteoporosis treatment have increased bone mineral density (BMD) and reduced risk of fracture.

Adverse effects of media reports on the treatment of osteoporosis.

Purpose: The review focused on the role that media reporting plays in the level of public awareness about osteoporosis and its influence on osteoporosis treatment decisions.

Methods: We reviewed the literature on the role of media on three main aspects influencing patient adherence to osteoporosis treatment: the awareness of osteoporosis as a major health problem, the perception of the effectiveness of osteoporosis medications, and the fear of adverse effects with osteoporosis medications.

Results: A review of the literature confirmed what is routinely observed in clinical practice-that media report can strongly influence the level of awareness of osteoporosis and fracture risk.

Romosozumab FRAME Study: A Post Hoc Analysis of the Role of Regional Background Fracture Risk on Nonvertebral Fracture Outcome.

In the pivotal Fracture Study in Postmenopausal Women with Osteoporosis (FRAME; NCT01575834), 1 year of the bone-forming agent romosozumab significantly reduced new vertebral and clinical fracture risk versus placebo. Nonvertebral fracture risk was not significantly reduced in the overall population, influenced by a low placebo-group fracture rate, observed particularly in the highest-enrolling region of Latin America. In year 1 of FRAME, postmenopausal women with a T-score of -2.

Hypophosphatasia in Adults: Clinical Assessment and Treatment Considerations.

Hypophosphatasia (HPP) is a rare inherited disorder of bone affecting approximately 500 to 600 known individuals in the United States. HPP is the result of mutations involving the gene for tissue nonspecific alkaline phosphatase. Five clinical types of HPP are recognized.

Assessing the feasibility of the Effectiveness of Discontinuing Bisphosphonates trial: a pilot study.

Unlabelled: The Effectiveness of Discontinuing Bisphosphonates (EDGE) study is a planned pragmatic clinical trial to guide "drug holiday" clinical decision making. This pilot study assessed work flow and feasibility of such a study. While participant recruitment and treatment adherence were suboptimal, administrative procedures were generally feasible and minimally disrupted clinic flow.

Romosozumab Treatment in Postmenopausal Women with Osteoporosis.

Background: Romosozumab, a monoclonal antibody that binds sclerostin, increases bone formation and decreases bone resorption.

Methods: We enrolled 7180 postmenopausal women who had a T score of -2.5 to -3.

Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus.

The purpose of this review is to assess the most recent evidence in the management of primary hyperparathyroidism (PHPT) and provide updated recommendations for its evaluation, diagnosis and treatment. A Medline search of "Hyperparathyroidism. Primary" was conducted and the literature with the highest levels of evidence were reviewed and used to formulate recommendations.

Vertebral Fractures: Clinical Importance and Management.

Vertebral fractures are common and can result in acute and chronic pain, decreases in quality of life, and diminished lifespan. The identification of vertebral fractures is important because they are robust predictors of future fractures. The majority of vertebral fractures do not come to clinical attention.

A 24-month study evaluating the efficacy and safety of denosumab for the treatment of men with low bone mineral density: results from the ADAMO trial.

Context: One in 4 men in the United States aged >50 years will have an osteoporosis-related fracture. Fewer data are available on osteoporosis treatment in men than in women.

Objective: The purpose of this study was to evaluate denosumab therapy in men with low bone mineral density (BMD).

Current issues in the presentation of asymptomatic primary hyperparathyroidism: proceedings of the Fourth International Workshop.

Objective: This report summarizes data on traditional and nontraditional manifestations of primary hyperparathyroidism (PHPT) that have been published since the last International Workshop on PHPT.

Participants: This subgroup was constituted by the Steering Committee to address key questions related to the presentation of PHPT. Consensus was established at a closed meeting of the Expert Panel that followed.

Understanding and communicating the benefits and risks of denosumab, raloxifene, and teriparatide for the treatment of osteoporosis.

The number needed to treat is a valuable metric to determine the benefit of therapy, but it must be viewed against the respective number needed to harm. Denosumab and teriparatide (TPTD) have proven antifracture efficacy at vertebral and nonvertebral sites, whereas raloxifene has proven antifracture efficacy at the spine only. Denosumab use has been associated with a small, yet statistically significant, increased incidence of eczema and serious cellulitis.

Skeletal effects of primary hyperparathyroidism: bone mineral density and fracture risk.

Parathyroid hormone (PTH) is associated with anabolic and catabolic skeletal effects that vary according to the kinetics of serum levels and the type of bone. The anabolic effects are manifested in patients with a periodic rapid transient rise in serum PTH, as seen with daily subcutaneous injection of PTH(1-34) and PTH(1-84) in the treatment of osteoporosis. These patients have an increase in bone mineral density (BMD), particularly at skeletal sites with a high trabecular component, such as the lumbar spine, and a reduction in fracture risk.

Sclerostin: a novel target for intervention in the treatment of osteoporosis.

Bone remodeling is the process by which the adult skeleton is continually renewed through the highly coordinated activity of three types of cells - osteoclasts, osteoblasts, and osteocytes. Disruptions in signaling among these cells and alterations in their activity have been associated with skeletal diseases. In a rare accident of nature, some families have been found to have dense and strong bones due to a recessive loss of function mutation in the SOST gene that encodes for sclerostin, a protein expressed by osteocytes that downregulates osteoblastic bone formation.

Intravenous zoledronic acid for the treatment of osteoporosis: The evidence of its therapeutic effect.

Introduction: Osteoporosis is a disease characterized by low bone mineral density and poor bone quality resulting in reduced bone strength and increased risk of fracture. Oral bisphosphonates, first-line therapy for most patients with osteoporosis, are associated with suboptimal adherence to therapy due to factors that include a complex dosing regimen and gastrointestinal intolerance in some patients. Intravenous bisphosphonates address these limitations through infrequent injectable dosing that assures 100% bioavailability.

Evidence-based medicine, clinical practice guidelines, and common sense in the management of osteoporosis.

Objective: To evaluate the benefits and limitations of randomized controlled trials (RCTs), clinical practice guidelines (CPGs), and clinical judgment in the management of osteoporosis.

Methods: A review was conducted of the English-language literature on the origins and applications of RCTs, CPGs, evidence-based medicine, and clinical judgment in the management of osteoporosis.

Results: Evidence-based medicine is use of the currently available best evidence in making clinical decisions for individual patients.

Is denosumab better than alendronate in the treatment of osteoporosis?

Denosumab is a fully human monoclonal antibody to receptor activator of nuclear factor kappaB ligand (RANKL), the principal mediator of osteoclastic bone resorption. By binding to RANKL, denosumab reduces the differentiation, activity and survival of osteoclasts, and thereby slows the rate of bone resorption. These antiresorptive effects led to the development of this agent as a treatment for osteoporosis.

Osteoporosis care at risk in the United States.

Osteoporotic fractures are associated with significant morbidity, mortality, and healthcare expenses. The United States (US) Surgeon General has described osteoporosis as a major public health concern that is underdiagnosed and undertreated. US federal agencies have established funding for bone density testing and put methodologies in place to monitor physician performance in the care of patients with osteoporosis.

Vertebroplasty and kyphoplasty update.

Vertebroplasty and kyphoplasty are minimally invasive vertebral augmentation procedures in which a filler material is percutaneously injected into a vertebral body for the treatment of vertebral fractures associated with osteoporosis, malignant conditions, hemangiomas, and osteonecrosis. In vertebroplasty, the filler is injected directly into the bone, whereas in kyphoplasty, the filler is injected into a cavity created by inflation of a balloon tamp. The goals of treatment include pain relief, fracture stabilization, restoration of vertebral height, and strengthening of the vertebral body to reduce the risk of a future fracture at the same level.