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Monitoring
Patients may not respond to osteoporosis therapy for a variety of reasons, including poor adherence and undiagnosed secondary medical conditions. Monitoring enables the clinician to identify those patients who are continuing to lose bone mass while on therapy and address the factors compromising response. In this chapter, Dr. E. Michael Lewiecki describes the rationale and specifics of effective monitoring. —
Chapter 6
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Management of the Postfracture Patient
Join Dr. Cheryl L. Lambing for Chapter 5 of the Osteoporosis Living Medical Textbook™ as she outlines postfracture management for patients with osteoporosis-related fractures. Whether of the wrist, hip, or spine, all fractures represent an increased risk for disability and future fracture. Know the steps of the recovery process for your patients with fractures: acute treatment, medical evaluation, and rehabilitation. —
Chapter 5
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Expert Insight Into: Efficacy and Safety of Balloon Kyphoplasty Compared with Nonsurgical Care for Vertebral Compression Fracture: A Randomized Controlled Trial
Most patients with painful vertebral compression fractures forego the risks of conventional open surgical repair and receive supportive care during an extensive recovery period. Balloon kyphoplasty was developed as a minimally invasive treatment for compression vertebral fractures. Dr. Cheryl L. Lambing reviews findings from a randomized trial that compared the efficacy and safety of balloon kyphoplasty and nonsurgical care for improving the quality of life of patients with acute painful vertebral compression fractures.
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Article Review
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Experts Responding to Your Questions: Video Q&A
In this second installment of Interactive Video Q&A: Experts Responding to Your Questions, join Dr. Paul Miller as he responds to your questions about risk factors for fracture and using bone mineral density to diagnose osteoporosis. Send in your questions for our next installment. Visit http://www.projectsinknowledge.com/osteoqa.
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Video Q&A
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Expert Insight Into: Vitamin D Deficiency is Associated with Worse Cognitive Performance and Lower Bone Density in Older African Americans
Recent studies have demonstrated several non-skeletal effects of vitamin D deficiency, including cognitive function and physical performance decrements, prompting an examination of the impact of vitamin D deficiency on these parameters in older African Americans. Dr. E. Michael Lewiecki presents the results of a recent trial comparing the association between vitamin D status and cognitive function, physical performance, and bone mineral density in older African American and European American individuals, and discusses the implications of these findings in treating older patients. —
Article Review
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Treatment of Osteoporosis
Effective osteoporosis treatment plans include a bone-active agent as well as a number of nutritional, environmental, and lifestyle modifications. Together, these pharmacologic and nonpharmacologic interventions help to build or maintain bone mass and prevent fracture. Join Drs. Paul D. Miller and Jeri W. Nieves for chapter 4 of the Osteoporosis Living Medical Textbook™ as they survey the pharmacologic and nonpharmacologic intervention options to assist clinicians in individualizing treatment plans uniquely suited to the needs of each patient. —
Chapter 4
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Expert Insight Into: IV Bisphosphonate Therapy and Clinical Fractures and Mortality After Hip Fracture
One source underlying the high rate of morbidity and mortality subsequent to hip fracture is the occurrence of new osteoporotic fractures. Pharmacologic therapy for osteoporosis, while underutilized, should reduce the rate of new osteoporotic fractures. Join Dr. Cheryl Lambing to learn about the results from the international multicenter HORIZON trial which highlighted the safety and efficacy of annual intravenous infusions of zoledronic acid in the reduction of morbidity and mortality after hip fracture. —
Article Review
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Case Study: Management of Poor Response to Bisphosphonate Therapy
In this newsletter, Dr. E. Michael Lewiecki presents the case of a 58-year-old postmenopausal woman newly diagnosed with osteoporosis who has initiated bisphosphonate therapy. Through this case, Dr. Lewiecki illustrates the importance of monitoring treatment response by outlining the essential components involved, the ins and outs of interpreting DXA BMD results correctly, and what to assess or re-evaluate when treatment response is suboptimal. —
Tx Reporter e-Newsletter
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Selecting Pharmacologic Therapy
Selecting the right pharmacologic agent to treat or prevent osteoporosis for an individual patient requires a thorough knowledge of the different mechanisms of action of these agents, as well as an understanding of the efficacy and safety profile of each. In this engaging audio interview, Dr. Cheryl Lambing and Dr. E. Michael Lewiecki discuss practical considerations in the clinical use of approved agents, and present a preview of potential new therapies on the horizon.
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Audio Interview Series
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Expert Insight Into: Skeletal Effects of Serotonin Reuptake Inhibitors: Evidence from Clinical Studies
Dr. E. Michael Lewiecki reviews findings from a number of epidemiologic analyses that evaluated the relationship between 5-HTT, depression, pharmacologic treatment of depression, and bone health. Dr. Lewiecki provides insights about the mechanism of action for these relationships and discusses possible strategies to improve bone health for patients treated with SSRIs. —
Article Review
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Assessment of Fracture Risk Using FRAX®
FRAX® is a new web-based tool designed by the World Health Organization to help clinicians worldwide accurately estimate fracture risk in their patients with osteopenia, or low bone mass. The tool, while a powerful statistical predictor, is not without limitations and caveats, however. Join Dr. Marjorie M. Luckey in the written chapter and audio podcast discussion as she guides you through the use of FRAX in clinical practice. —
Chapter 3
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Osteoporosis: A Focus on Fracture Prevention
Although current osteoporosis therapies are effective in reducing the risk of fracture and increasing bone mineral density, all have some issues that limit their use. The GI side effects of oral bisphosphonates may preclude their use in some patients, while agents requiring intravenous or subcutaneous administration may pose problems with compliance for others. Recent advances in understanding bone remodeling and the pathophysiology of osteoporosis have led to the identification of novel therapeutic targets and the development of new emerging agents. Three experts in the field – Dolores M. Shoback, MD, Paul D. Miller, MD, and E. Michael Lewiecki, MD – discuss these important advances and their implications for the treatment of patients at risk of fracture and bone loss. —
Webcast
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Osteoporosis Tips Card
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Tips Card
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Experts Responding to Your Questions: Video Q&A
Do you have a clinical question you would like to ask an expert? In the first quarterly installment of Experts Responding to Your Questions: Video Q&A, Dr. Dolores Shoback answers questions from several practicing clinicians. They wanted to know about duration of therapy, the role of bone markers, safety and efficacy of new therapies, and more. Join Dr. Shoback as she shares her insights regarding these important clinical considerations. Send in your questions for our next installment. —
Video Q&A
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Update on Osteoporosis for the Rheumatologist
Rheumatologists see many patients who are at risk for secondary bone loss resulting from corticosteroid treatment and other factors, not only postmenopausal/elderly patients at risk for primary osteoporosis. In this webcast designed specifically for rheumatologists, four experts in the field discuss the pathophysiology of bone loss, the identification and diagnosis of patients at risk for primary and secondary osteoporosis, current and emerging treatment and prevention strategies for reducing fracture risk, and the challenges in managing osteoporosis patients.
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Webcast
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Expert Insight Into: Secondary Contributors to Bone Loss in Osteoporosis Related Hip Fractures
Identifying and managing possible secondary contributors to bone loss can optimize treatment of hip fractures and prevent recurrent fractures. A recent study compared the presence of specific secondary contributors to bone loss in osteoporotic patients with and without hip fracture. Dr. Marjorie Luckey reviews the findings and helps you identify which conditions to test for and treat among patients with osteoporotic hip fractures to reduce the risk of further fractures. —
Article Review
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Case Study: Preserving Bone Health in a Patient with COPD on Corticosteroid Therapy
Illustrated by the case of a white 60-year-old postmenopausal patient, Dr. Marjorie M. Luckey discusses the impact of glucocorticoids and chronic obstructive pulmonary disease (COPD) on bone loss and fractures, the rationale for bone density testing in patients starting chronic glucocorticoid therapy, and pharmacologic treatments to prevent and treat glucocorticoid-induced osteoporosis. —
Tx Reporter e-Newsletter
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Clinical Insights Based on Proceedings from the ASBMR 31st Annual Meeting
The 31st Annual Meeting of the American Society for Bone and Mineral Research (ASBMR) featured 1300 posters and 300 abstracts reporting on the latest scientific and clinical research in bone diseases and disorders of mineral metabolism. Listen to this informative podcast in which Drs. E. Michael Lewiecki and Marjorie M. Luckey review the findings that are most relevant to managing bone health in patients at high risk of fracture.
DISCLAIMER: This podcast activity was not planned or produced by ASBMR. Projects In Knowledge is solely responsible for the organization and scientific content of this activity in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) and the guidelines of the US Food & Drug Administration (FDA).
The opinions expressed are those of the commentators and presenters. No responsibility is assumed and responsibility is hereby disclaimed by the American Society for Bone and Mineral Research for any injury or damage to persons or property as a matter of product liability, negligence or otherwise or from any use or operation of methods, products, instructions, or ideas presented in the this podcast. Independent verification of diagnoses and drug dosages should be made. —
Podcast Series
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Expert Insight Into: Novel Therapy in Prevention of Fractures in Postmenopausal Women with Osteoporosis
Previous clinical trials have demonstrated that twice-yearly subcutaneous injections of the anti-RANKL antibody denosumab increase bone mineral density and reduce bone turnover. In this course, Dr. Ethel Siris discusses results from the multinational FREEDOM clinical trial, which assessed the effects of denosumab on fracture risk among postmenopausal women with osteoporosis. —
Article Review
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Experts Responding to Your Questions: Video Q&A
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Video Q&A
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Expert Insight Into: Implications of Absolute Fracture Risk Assessment for Osteoporosis Practice Guidelines in the USA
Since the National Osteoporosis Foundation (NOF) current guidelines for fracture prevention were established, new developments have changed the ways in which fracture risk, need for treatment, and cost-effectiveness of therapy are assessed. A recent analysis using the new WHO fracture prevention algorithm (FRAX) was conducted to assess risk of future fractures and to determine the need for revision of the current guidelines. Dr. Siris discusses the results of this analysis and the application of these findings in identifying patients who should be treated. —
Article Review
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Physician's Role in Addressing Bone Health Before Menopause
Learn more about helping your younger patients recognize the importance of building and maintaining good bone health throughout their lives. In this enlightening audio interview, Drs. Jeffrey Levine and Gloria Bachmann discuss the essential components for preventing osteoporosis, including achieving peak bone mass during childhood and young adulthood; maintaining healthy bone mass throughout life; and management strategies for pregnant, lactating, and premenopausal women. —
Audio Interview Series
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Case Study: Assessment and Management of Osteoporosis Secondary to Androgen Deprivation Therapy in Prostate Cancer
Dr. Cheryl L. Lambing presents the case of a 70-year-old hypertensive man with secondary osteoporosis resulting from androgen deprivation therapy for prostate cancer. Throughout this case, Dr. Lambing discusses screening and risk factors, the importance of assessing vitamin D and calcium levels before initiating therapy, and selection of an appropriate pharmacologic therapy for men with osteoporosis based on current guidelines and prescribing information. —
Tx Reporter with Audio
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Identifying Patients at Risk for Osteoporosis and Fractures
Which patients in your practice are at risk for osteoporosis and fracture? Dr. Marjorie M. Luckey helps you recognize risk factors that go beyond postmenopausal status and age. Use tools already at hand—medical history, physical examination, and laboratory testing—to uncover potential secondary causes of osteoporosis. Determine which patients need bone mineral density testing, and interpret dual energy X-ray absorptiometry (DXA) results with confidence. —
Chapter 2
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Expert Insight Into: Serum 25-Hydroxyvitamin D and Hip Fracture Risk in Older US White Adults
A recent study reported a significant, but nonlinear, relationship between serum 25-hydroxyvitamin D [25(OH)D] values and hip fracture risk in non-Hispanic white adults 65 years or older. Dr. Gloria Bachmann discusses the results of this study and comments on their implications for clinical practice, including the proposed serum 25(OH)D cut-off point for the prevention of fracture. —
Article Review
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Hot Topics and Controversies in Osteoporosis Management
Watch Dr. Jeffrey Levine’s interview with Drs. Ethel Siris and Marjorie Luckey in which they address many important issues and controversies surrounding osteoporosis management. The experts consider recent data on rare side effects of bisphosphonates, discuss new indications of several osteoporosis treatments, and present long-term treatment strategies regarding duration of therapy and means of bolstering adherence to optimally reduce risk of fracture. —
Webcast
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Expert Insight Into: Integrated Analysis of Bisphosphonate Therapy for Prevention of Aromatase Inhibitor–Associated Bone Loss in Postmenopausal Women with Early Breast Cancer Receiving Adjuvant Letrozole
The combined results of two recent trials of the bisphosphonate zoledronic acid in postmenopausal breast cancer patients demonstrate the importance of timing of administration in optimizing the benefit of bisphosphonate therapy. Dr. Jeffrey P. Levine discusses these findings and their implications for clinical practice. —
Article Review
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Case Study: Use of FRAX® and Strategies for Management of Increased Fracture Risk in Postmenopausal Women with Osteopenia
Dr. Ethel S. Siris determines treatment candidacy for a 65-year-old woman with osteopenia, using the new FRAX tool and the National Osteoporosis Foundation Clinician’s Guide to Prevention and Treatment of Osteoporosis to assess fracture risk. She also discusses current recommendations regarding calcium and vitamin D supplements, available agents for reducing fracture risk, and optimal follow-up for patients on therapy. —
Tx Reporter e-Newsletter
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Expert Insight Into: Assessing the Clinical Utility of Serum CTX in Postmenopausal Osteoporosis and Its Use in Predicting Risk of Osteonecrosis of the Jaw
The bone turnover marker, sCTX, is a sensitive indicator of bone resorption in postmenopausal women receiving bisphosphonate therapy for osteoporosis and has proven useful in measuring response to treatment. Dr. E. Michael Lewiecki explores the use of this marker as a possible predictor of bisphosphonate-associated osteonecrosis of the jaw and comments on the incorporation of sCTX into current clinical practice. This article review is part of the Osteoporosis Compendium. —
Article Review
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Osteoporosis: A Focus on Fracture Prevention
Gain practical insights into the challenges of managing patients at risk for or with osteoporosis and fractures. A panel of experts will examine normal bone physiology and the pathogenic pathway changes responsible for osteoporosis/fracture development; screening and diagnostic methodologies; mechanisms of action, efficacy, and safety of current and emerging therapies, including antiresorptive agents, anabolic therapies, and the potential role of combination/sequential therapies; and treatment strategies for prevention and treatment of osteoporosis and fractures to improve patient outcomes. Register Now! —
Satellite Symposium
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Assessment and Primary Prevention of Osteoporosis and Fractures
Jeffrey P. Levine, MD, MPH, interviews Ethel S. Siris, MD, on the assessment and primary prevention of osteoporosis and fractures. The discussion begins with a review of the numerous risk factors related to primary and secondary osteoporosis. Dr. Siris then explains the recommended uses, benefits, and limitations of DXA for the diagnosis of osteoporosis, and FRAX, the risk assessment tool recently developed by the World Health Organization, to estimate fracture risk. In addition, Dr. Siris describes primary prevention measures for osteoporosis as well as practical strategies that can prevent fractures, and briefly reviews the role of pharmacologic agents in the prevention of osteoporotic fractures. —
Audio Interview
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Clinical Insights Based on Proceedings from the NOF 8th International Symposium on Osteoporosis
On April 1–5, 2009, osteoporosis experts, researchers, and clinicians from around the world gathered in Washington, DC to discuss recent exciting advances in osteoporosis prevention, diagnosis, and treatment. Among the expert presenters at the 8th International Symposium were Dr. E. Michael Lewiecki and Dr. Marjorie M. Luckey, who also serve on the faculty of Project In Knowledge’s Osteoporosis Compendium. In this 90-minute podcast, Drs. Lewiecki and Luckey distill key symposium topics for Compendium participants. This course is one of 29 courses offered by the Osteoporosis Compendium. —
Podcast Series
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Expert Insight Into: Benefit of Adherence with Bisphosphonates Depends on Age and Fracture Type: Results from an Analysis of 101,038 New Bisphosphonate Users
To what degree does nonadherence compromise treatment efficacy? Dr. Jeffrey P. Levine helps interpret the findings of an observational study that evaluated the impact of nonadherence to long-term oral bisphosphonate therapy on fracture risk in more than 100,000 patients stratified by age and fracture type. This course is part of the Osteoporosis Compendium. —
Article Review
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Expert Insight Into: Long-Term Mortality Associated with Low-Trauma Osteoporotic Fracture and Risk of Subsequent Fracture
Dr. Marjorie Luckey discusses the results of a recent Australian study, which found that major fractures in patients aged 60 years or older as well as minor fractures in persons over 75 years old significantly increase the risk of mortality and the potential for subsequent fractures. —
Article Review
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