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Diab D.L.,University of Cincinnati | Watts N.B.,Mercy Health Osteoporosis and Bone Health Services
Current Opinion in Endocrinology, Diabetes and Obesity | Year: 2013

There are numerous effective pharmacologic treatment options for postmenopausal osteoporosis. Bisphosphonate drug holidays continue to be an area of significant debate. ©2013 Wolters Kluwer Health Lippincott Williams & Wilkins. Source


Watts N.B.,Mercy Health Osteoporosis and Bone Health Services
Arquivos Brasileiros de Endocrinologia e Metabologia | Year: 2014

The objective this study was to summarize long-term risks associated with bisphosphonate therapy. Search of relevant medical publications for data from clinical trials, trial extensions, observational studies and post-marketing reports. Trial extensions and modifications did not reveal significant long-term safety issues. Observational data suggest at least as many benefits as risks. Post-marketing reports of musculoskeletal pain, osteonecrosis of the jaw and atypical femur fractures have been widely circulated in the lay press. Most focus on long-terms risks has been on osteonecrosis of the jaw and atypical femur fractures which occur in patients who have not received bisphosphonate therapy but may be more frequent (though still uncommon) in patients who have been on treatment for 5 years or longer. Lower-risk patients may be able to stop treatment after 3-5 years for a "drug holiday," which mitigates these long-term risks; for higher risk patients, therapy through 6-10 years appears to be advisable and offers more bene-fts than risks. © ABE&M todos os direitos reservados. Source


Diab D.L.,University of Cincinnati | Watts N.B.,Mercy Health Osteoporosis and Bone Health Services
Clinical Obstetrics and Gynecology | Year: 2013

There are numerous causes of secondary osteoporosis including endocrine disorders, nutritional deficiencies, and other miscellaneous conditions and medications. It is essential to identify and address these factors to appropriately manage patients with osteoporosis. Failure to do so may result in further bone loss despite pharmacologic intervention for osteoporosis. The following diagnostic studies should be considered initially: complete blood count, complete metabolic panel, 25-hydroxyvitamin D level, testosterone level in men, and 24-hour urinary calcium, sodium, and creatinine. Further testing may be performed in selected patients depending on the clinical picture and results of the initial workup. © 2013, Lippincott Williams & Wilkins. Source


Diab D.L.,University of Cincinnati | Watts N.B.,Mercy Health Osteoporosis and Bone Health Services
Expert Opinion on Drug Safety | Year: 2014

Introduction: Denosumab is a fully human monoclonal antibody against the receptor activator of nuclear factor kappa-B ligand. It is an antiresorptive agent that reduces osteoclastogenesis. Areas covered: This drug evaluation reviews denosumab for use in osteoporosis. Denosumab has been shown to improve bone mineral density (BMD) and to reduce the incidence of new vertebral, hip and nonvertebral fractures in postmenopausal women. It prevents bone loss and reduces vertebral fracture risk in men with nonmetastatic prostate cancer who are receiving androgen deprivation therapy. It has also been shown to improve BMD in men with osteoporosis unrelated to androgen deprivation therapy. Safety concerns include infections, cancer, skin reactions, cardiovascular disease, hypocalcemia, osteonecrosis of the jaw and atypical femur fractures. Expert opinion: Although bisphosphonates are typically preferred as initial therapy for osteoporosis, denosumab could be used as initial therapy in select patients at high risk for fracture, including older patients who have difficulty with the dosing requirements of oral bisphosphonates, patients who are intolerant of or unresponsive to other therapies, and in those with impaired renal function. Additional data is needed to address issues regarding treatment duration and discontinuation, as well as to provide more information regarding denosumab's efficacy and safety. © Informa UK, Ltd. Source


Watts N.B.,Mercy Health Osteoporosis and Bone Health Services | Leslie W.D.,University of Manitoba | Foldes A.J.,Hebrew University of Jerusalem | Miller P.D.,Colorado Center for Bone Research
Journal of Clinical Densitometry | Year: 2013

Following the standard protocol for development of Official Positions for the International Society for Clinical Densitometry, the Expert Panel heard the report and recommendations from the Task Force on Normative Databases; using the RAND methodology, agreement was reached on the following statements:. 1. Manufacturers should continue to use their own databases for the lumbar spine as the reference standard for T-scores.2. Manufacturers should continue to use National Health and Nutrition Examination Survey III data as the reference standard for femoral neck and total hip T-scores.3. If local reference data are available, they should be used to calculate only Z-scores but not T-scores.4. A uniform Caucasian (non-race adjusted) female reference database should be used to calculate T-scores for men of all ethnic groups. © 2013 The International Society for Clinical Densitometry. Source

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