Mercy Health Osteoporosis and Bone Health Services

Cincinnati, OH, United States

Mercy Health Osteoporosis and Bone Health Services

Cincinnati, OH, United States
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Watts N.B.,Mercy Health Osteoporosis and Bone Health Services
Osteoporosis International | Year: 2017

There is a growing list of medications used to treat non-skeletal disorders that cause bone loss and/or increase fracture risk. This review discusses glucocorticoids, drugs that reduce sex steroids, antidiabetic agents, acid-reducing drugs, selective serotonin reuptake inhibitors, and heparin. A number of drugs are known to cause bone loss, increase fracture risk, or both. These drugs should be used in the lowest dose necessary to achieve the desired benefit and for the shortest time necessary, but in many cases, long-term treatment is required. Effective countermeasures are available for some. © 2017 International Osteoporosis Foundation and National Osteoporosis Foundation

Crandall C.J.,University of California at Los Angeles | Larson J.,Fred Hutchinson Cancer Research Center | Gourlay M.L.,University of North Carolina at Chapel Hill | Donaldson M.G.,University of British Columbia | And 7 more authors.
Journal of Bone and Mineral Research | Year: 2014

The US Preventive Services Task Force (USPSTF) recommends osteoporosis screening for women younger than 65 years whose 10-year predicted risk of major osteoporotic fracture is ≥9.3%. For identifying screening candidates among women aged 50 to 64 years, it is uncertain how the USPSTF strategy compares with the Osteoporosis Self-Assessment Tool (OST) and the Simple Calculated Osteoporosis Risk Estimate (SCORE). We examined data (1994 to 2012) from 5165 Women's Health Initiative participants aged 50 to 64 years. For the USPSTF (Fracture Risk Assessment Tool [FRAX] major fracture risk ≥9.3% calculated without bone mineral density [BMD]), OST (score <2), and SCORE (score >7) strategies, we assessed sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) to discriminate between those with and without femoral neck (FN) T-score ≤-2.5. Sensitivity, specificity, and AUC for identifying FN T-score ≤-2.5 were 34.1%, 85.8%, and 0.60 for USPSTF (FRAX); 74.0%, 70.8%, and 0.72 for SCORE; and 79.8%, 66.3%, and 0.73 for OST. The USPSTF strategy identified about one-third of women aged 50 to 64 years with FN T-scores ≤-2.5. Among women aged 50 to 64 years, the USPSTF strategy was modestly better than chance alone and inferior to conventional SCORE and OST strategies in discriminating between women with and without FN T-score ≤-2.5. © 2014 American Society for Bone and Mineral Research.

Orwoll E.S.,Oregon Health And Science University | Adler R.A.,Virginia Commonwealth University | Binkley N.,University of Wisconsin - Madison | Lewiecki E.M.,New Mexico Clinical Research and Osteoporosis Center | And 4 more authors.
Journal of Bone and Mineral Research | Year: 2013

Concern about the risk of bone loss in astronauts as a result of prolonged exposure to microgravity prompted the National Aeronautics and Space Administration to convene a Bone Summit with a panel of experts at the Johnson Space Center to review the medical data and research evidence from astronauts who have had prolonged exposure to spaceflight. Data were reviewed from 35 astronauts who had served on spaceflight missions lasting between 120 and 180 days with attention focused on astronauts who (1) were repeat fliers on long-duration missions, (2) were users of an advanced resistive exercise device (ARED), (3) were scanned by quantitative computed tomography (QCT) at the hip, (4) had hip bone strength estimated by finite element modeling, or (5) had lost >10% of areal bone mineral density (aBMD) at the hip or lumbar spine as measured by dual-energy X-ray absorptiometry (DXA). Because of the limitations of DXA in describing the effects of spaceflight on bone strength, the panel recommended that the U.S. space program use QCT and finite element modeling to further study the unique effects of spaceflight (and recovery) on bone health in order to better inform clinical decisions. Copyright © 2013 American Society for Bone and Mineral Research.

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.

Lindsay R.,Helen Hayes Hospital | Watts N.B.,Mercy Health Osteoporosis and Bone Health Services | Lange J.L.,Procter and Gamble | Delmas P.D.,University Claude Bernard Lyon 1 | Silverman S.L.,Cedars Sinai Medical Center
Osteoporosis International | Year: 2013

This observational study showed that after 2 years, both risedronate and alendronate lowered the risk of hip and nonvertebral fractures compared with patients filling in a single bisphosphonate prescription. Introduction: Post hoc analyses of the placebo-controlled trials suggested earlier effects for risedronate (6-12 months) than for alendronate (18-24 months). The present study extends our 1-year observational data that confirmed an earlier fracture reduction with risedronate and evaluated the absolute and relative effectiveness of alendronate and risedronate in clinical practice over 2 years. Methods: We observed three cohorts of women aged 65 years and older who initiated once-a-week dosing of bisphosphonate therapy; (1) patients adherent to alendronate (n = 21,615), (2) patients adherent to risedronate (n = 12,215), or (3) patients filling only a single bisphosphonate prescription (n = 5,390) as a referent population. Proportional hazard modeling compared the incidence of hip and nonvertebral fractures among the cohorts over 2 years after the initial prescription. Results: In this cohort, we previously showed at 12 months a significant reduction of hip and nonvertebral fractures with risedronate but not with alendronate. At the end of 2 years, the cumulative incidence of hip fractures in the referent cohort was 1.9 %, and incidence of nonvertebral fractures was 6.3 %. Relative to the referent, 6 months after initiating therapy and continuing through 2 years, both risedronate and alendronate cohorts had approximately a 45 % lower incidence of hip fractures and a 30 % lower incidence of nonvertebral fractures. Conclusion: These observations suggest that both risedronate and alendronate are effective at reducing the risk of hip and nonvertebral fracture after 2 years of treatment and support the post hoc analyses of placebo-controlled trials indicating an earlier effect of risedronate. © 2013 International Osteoporosis Foundation and National Osteoporosis Foundation.

Watts N.B.,Mercy Health Osteoporosis and Bone Health Services | Adler R.A.,Virginia Commonwealth University | Bilezikian J.P.,Columbia University | Drake M.T.,Rochester College | And 3 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2012

Objective: The aim was to formulate practice guidelines for management of osteoporosis in men. Evidence: We used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe the strength of recommendations and evidence quality. Consensus Process: Consensus was guided by systematic evidence reviews, one in-person meeting, and multiple conference calls and e-mails. Task Force drafts were reviewed successively by The Endocrine Society's Clinical Guidelines Subcommittee and Clinical Affairs Core Committee; representatives of ASBMR, ECTS, ESE, ISCD; and members at large. At each stage, the Task Force received written comments and incorporated needed changes. The reviewed document was approved by The Endocrine Society Council before submission for peer review. Conclusions: Osteoporosis in men causes significant morbidity and mortality. We recommend testing higher risk men [aged ≥70 and men aged 50-69 who have risk factors (e.g. low body weight, prior fracture as an adult, smoking, etc.)] using central dual-energy x-ray absorptiometry. Laboratory testing should be done to detect contributing causes. Adequate calcium and vitamin D and weight-bearing exercise should be encouraged; smoking and excessive alcohol should be avoided. Pharmacological treatment is recommended for men aged 50 or older who have had spine or hip fractures, those with T-scores of -2.5 or below, and men at high risk of fracture based on low bone mineral density and/or clinical risk factors. Treatment should be monitored with serial dual-energy x-ray absorptiometry testing. Copyright © 2012 by The Endocrine Society.

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.

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.

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.

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.

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