Clinician’s Guide to Prevention and Treatment of Osteoporosis

Cosman, Felicia; Beur, Suzanne Jan de; LeBoff, Meryl S.; Lewiecki, E. Michael; Tanner, Bobo; Randall, Susan; Lindsay, Robert

doi:10.1007/s00198-014-2794-2

Cited by 2,795 publications

(2,400 citation statements)

References 90 publications

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“…Many of these data come from epidemiological and retrospective studies, and the level of evidence is often very low. Furthermore, a clear pathophysiological rationale is lacking for many of these associations, and is not known for some (Table VIII) (40)(41)(42). Besides glucocorticoid therapy and aromatase and GnRH inhibitors, which are treated separately in these guidelines, The use of pioglitazone and rosiglitazone is associated with a significant increase (3-to 4-fold) in the risk of hip and humerus fractures in postmenopausal women (46).…”

Section: Osteoporosis Related To Other Drugsmentioning

confidence: 99%

Guidelines for the diagnosis, prevention and management of osteoporosis

et al. 2016

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Osteoporosis poses a significant public health issue. National Societies have developed Guidelines for the diagnosis and treatment of this disorder with an effort of adapting specific tools for risk assessment on the peculiar characteristics of a given population. The Italian Society for Osteoporosis, Mineral Metabolism and Bone Diseases (SIOMMMS) has recently revised the previously published Guidelines on the diagnosis, riskassessment, prevention and management of primary and secondary osteoporosis. The guidelines were first drafted by a working group and then approved by the board of SIOMMMS. Subsequently they received also the endorsement of other major Scientific Societies that deal with bone metabolic disease. These recommendations are based on systematic reviews of the best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on leading experts' experience and opinion, and on good clinical practice. The osteoporosis prevention should be based on the elimination of specific risk factors. The use of drugs registered for the treatment of osteoporosis are recommended when the benefits overcome the risk, and this is the case only when the risk of fracture is rather high as measured with variables susceptible to pharmacological effect. DeFRA (FRAX® derived fracture risk assessment) is recognized as a useful tool for easily estimate the long-term fracture risk. Several secondary forms of osteoporosis require a specific diagnostic and therapeutic management

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Section: Osteoporosis Related To Other Drugsmentioning

confidence: 99%

Guidelines for the diagnosis, prevention and management of osteoporosis

et al. 2016

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“…[1][2][3][4][5]. In Japan, however, the information ©The Japan Endocrine Society Submitted Nov. 9, 2016; Accepted Nov. 11, 2016 as EJ16-0548 Released online in J-STAGE as advance publication Dec. 20,2016 Correspondence to: Ryo Okazaki Classical action of vitamin D is the maintenance of bone and mineral metabolism.…”

Section: Definition and Significancementioning

confidence: 99%

“…We believe that these criteria will be clinically helpful in the assessment of serum 25(OH)D concentrations and further expect that they will form a basis for the future development of guidelines for the management of vitamin D deficiency/insufficiency. [1][2][3][4][5]. In Japan, however, the information…”

mentioning

confidence: 99%

Assessment criteria for vitamin D deficiency/insufficiency in Japan — proposal by an expert panel supported by Research Program of Intractable Diseases, Ministry of Health, Labour and Welfare, Japan, The Japanese Society for Bone and Mineral Research and The Japan Endocrine Society [Opinion]

et al. 2017

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Abstract. Vitamin D is indispensable for the maintenance of bone and mineral health. Inadequate vitamin D action increases the risk for various musculoskeletal/mineral events including fracture, fall, secondary hyperparathyroidism, diminished response to antiresorptives, rickets/osteomalacia, and hypocalcemia. Its most common cause in recent years is vitamin D deficiency/insufficiency, clinically defined by low serum 25-hydroxyvitamin D [25(OH)D] level. Guidelines for vitamin D insufficiency/deficiency defined by serum 25(OH)D concentrations have been published all over the world. In Japan, however, the information on the associations between serum 25(OH)D and bone and mineral disorders has not been widely shared among healthcare providers, partly because its measurement had not been reimbursed with national medical insurance policy until August 2016. We have set out to collect and analyze Japanese data on the relationship between serum 25(OH)D concentration and bone and mineral events. Integrating these domestic data and published guidelines worldwide, here we present the following assessment criteria for vitamin D sufficiency/insufficiency/deficiency using serum 25(OH)D level in Japan. 1) Serum 25(OH)D level equal to or above 30 ng/mL is considered to be vitamin D sufficient. 2) Serum 25(OH)D level less than 30 ng/mL but not less than 20 ng/mL is considered to be vitamin D insufficient. 3) Serum 25(OH)D level less than 20 ng/mL is considered to be vitamin D deficient. We believe that these criteria will be clinically helpful in the assessment of serum 25(OH)D concentrations and further expect that they will form a basis for the future development of guidelines for the management of vitamin D deficiency/insufficiency. [1][2][3][4][5]. In Japan, however, the information

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“…Ways to improve osteoporosis treatment include treating a higher percentage of women who screen positive, and either treating women who are at high risk of progression 4,5 or re-screening them in 2 years.…”

Section: T He Us Preventive Services Task Force (Uspstf) Rec-mentioning

confidence: 99%

Capsule Commentary on VanGompel et al., Incidence and Predictors of Repeat Bone Mineral Densitometry: A Longitudinal Cohort Study

Johnson

2017

J GEN INTERN MED

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T he U.S. Preventive Services Task Force (USPSTF) rec-ommends dual x-ray absorptiometry (DXA) scans in women 65 years of age and older, and in younger women with an increased fracture risk. 1 VanGompel and colleagues studied physicians' use of repeat DXA among 6000 women aged 40-84 who received initial DXA screening within a regional health system in California. 2 The vast majority (72%) were younger than 65. Osteoporosis was found in 14% of women; 13% had a high risk of progression to osteoporosis, while most (74%) had a low risk of progression. An osteoporosis drug was prescribed for only 68.9% of those with osteoporosis, but was given to 19.1% of women at low risk. Among those untreated, only 60% of high-risk women had follow-up scans within 5 years, though 43% of women at low risk of progression were scanned. Among treated women, median time to repeat DXA was 3 years. Patients in both the treated and untreated groups who were followed by an endocrinologist were more likely to have repeat DXA.What is disturbing is that only 60% of the untreated highrisk women received a follow-up DXA within 5 years; by this time, half of these women would have already transitioned to osteoporosis. 3 And since only 10% of women with normal density or mild osteopenia will transition to osteoporosis in the ensuing 16 years, 3 many women in the low-risk group were rescreened too soon.Important limitations include the source of data from a single health care system, the use of a complicated definition of low vs. high risk which differs somewhat from national guidelines, and exclusion of 40% of scans due to incomplete T-score data.Based on this study, and in light of recent literature, resource allocation can be improved by limiting DXA screening to women who meet USPSTF guidelines, focusing on those who would consider osteoporosis treatment if positive, and by avoiding a repeat DXA within 15 years for women with low risk of progression. Ways to improve osteoporosis treatment include treating a higher percentage of women who screen positive, and either treating women who are at high risk of progression 4, 5 or re-screening them in 2 years.

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Clinician’s Guide to Prevention and Treatment of Osteoporosis

Cited by 2,795 publications

References 90 publications

Guidelines for the diagnosis, prevention and management of osteoporosis

Guidelines for the diagnosis, prevention and management of osteoporosis

Assessment criteria for vitamin D deficiency/insufficiency in Japan — proposal by an expert panel supported by Research Program of Intractable Diseases, Ministry of Health, Labour and Welfare, Japan, The Japanese Society for Bone and Mineral Research and The Japan Endocrine Society [Opinion]

Capsule Commentary on VanGompel et al., Incidence and Predictors of Repeat Bone Mineral Densitometry: A Longitudinal Cohort Study

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Clinician’s Guide to Prevention and Treatment of Osteoporosis

Cited by 2,795 publications

References 90 publications

Guidelines for the diagnosis, prevention and management of osteoporosis

Guidelines for the diagnosis, prevention and management of osteoporosis

Assessment criteria for vitamin D deficiency/insufficiency in Japan &mdash; proposal by an expert panel supported by Research Program of Intractable Diseases, Ministry of Health, Labour and Welfare, Japan, The Japanese Society for Bone and Mineral Research and The Japan Endocrine Society [Opinion]

Capsule Commentary on VanGompel et al., Incidence and Predictors of Repeat Bone Mineral Densitometry: A Longitudinal Cohort Study

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Assessment criteria for vitamin D deficiency/insufficiency in Japan — proposal by an expert panel supported by Research Program of Intractable Diseases, Ministry of Health, Labour and Welfare, Japan, The Japanese Society for Bone and Mineral Research and The Japan Endocrine Society [Opinion]