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Osteoporosis HELP
Based on 20,665 articles published since 2008
|||| 17 

These are the 20665 published articles about Osteoporosis that originated from Worldwide during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11 · 12 · 13 · 14 · 15 · 16 · 17 · 18 · 19 · 20
1 Guideline Executive summary of European guidance for the diagnosis and management of osteoporosis in postmenopausal women. 2019

Kanis, J A / Cooper, C / Rizzoli, R / Reginster, J-Y / Anonymous1811088. ·Centre for metabolic bone diseases, University of Sheffield, Sheffield, UK. · University of Sheffield Medical School, Sheffield, UK. · Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia. · MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK. · NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK. · University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland. · Chair for Biomarkers of Chronic Diseses, Department of Biochemistry, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia. jyr.ch@bluewin.ch. · Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium. jyr.ch@bluewin.ch. ·Aging Clin Exp Res · Pubmed #30612282.

ABSTRACT: A guidance on the assessment and treatment of postmenopausal women at risk from fractures due to osteoporosis was recently published in Osteoporosis International as a joint effort of the International Osteoporosis Foundation and European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (Kanis et al. Osteoporos Int, https://doi.org/10.1007/s00198-018-4704-5 , 2018). This manuscript updates the previous guideline document, published in 2013 (Kanis et al. Osteoporos Int 24:23-57, 2013) and is written from a European perspective. The present article reports and summarizes the main recommendations included in this 2018 guidance document (Fig. 1).

2 Guideline Use of CTX-I and PINP as bone turnover markers: National Bone Health Alliance recommendations to standardize sample handling and patient preparation to reduce pre-analytical variability. 2018

Szulc, Pawel / Naylor, Kim / Pickering, Marie-Eva / Hoyle, Nicholas / Eastell, Richard / Leary, Elizabeth. ·Inserm UMR 1033, Service de rhumatologie et de pathologie osseuse, Hôpital Édouard Herriot, Université de Lyon, Lyon, France. · Academic unit of bone metabolism and mellanby centre for bone research, University of Sheffield, Sheffield, United Kingdom. · Murnau laboratory, Murnau, Germany. · ETL Consulting, Seattle, WA 98177, USA, Pacific Biomarkers, Seattle, WA 98119, USA. ·Ann Biol Clin (Paris) · Pubmed #30078776.

ABSTRACT: The International osteoporosis foundation and the International federation of clinical chemistry (IFCC) Bone marker standards working group have identified N-terminal propeptide of type I procollagen (PINP) and C-terminal telopeptide of type I collagen (CTX-I) in blood to be the reference markers of bone turnover for the fracture risk prediction and monitoring of osteoporosis treatment. Although used in clinical research for many years, bone turnover markers (BTM) have not been widely adopted in clinical practice primarily due to their poor within-subject and between-lab reproducibility. The NBHA bone turnover marker project team aim to reduce pre-analytical variability of CTX-I and PINP measurements through standardized sample handling and patient preparation. Recommendations for sample handling and patient preparations were made based on review of available publications and pragmatic considerations to reduce pre-analytical variability. Controllable and un-controllable patient-related factors were reviewed to facilitate interpretation and sample collection. Samples for CTX-I must be collected consistently in the morning hours in the fasted state. EDTA plasma is preferred for CTX-I for its greater sample stability. Sample collection conditions for PINP are less critical as PINP has minimal circadian variability and is not affected by food intake. Sample stability limits should be observed. The uncontrollable aspects (age, sex, pregnancy, immobility, recent fracture, co-morbidities, anti-osteoporotic drugs, other medications) should be considered in BTM interpretation. Adopting standardized sample handling and patient preparation procedures will significantly reduce controllable pre-analytical variability. The successful adoption of such recommendations necessitates the close collaboration of various stakeholders at the global stage, including the laboratories, the medical community, the reagent manufacturers and the regulatory agencies.

3 Guideline Screening for Osteoporosis to Prevent Fractures: US Preventive Services Task Force Recommendation Statement. 2018

Anonymous2470953 / Curry, Susan J / Krist, Alex H / Owens, Douglas K / Barry, Michael J / Caughey, Aaron B / Davidson, Karina W / Doubeni, Chyke A / Epling, John W / Kemper, Alex R / Kubik, Martha / Landefeld, C Seth / Mangione, Carol M / Phipps, Maureen G / Pignone, Michael / Silverstein, Michael / Simon, Melissa A / Tseng, Chien-Wen / Wong, John B. ·University of Iowa, Iowa City. · Fairfax Family Practice Residency, Fairfax, Virginia. · Virginia Commonwealth University, Richmond. · Veterans Affairs Palo Alto Health Care System, Palo Alto, California. · Stanford University, Stanford, California. · Harvard Medical School, Boston, Massachusetts. · Oregon Health and Science University, Portland. · Columbia University, New York, New York. · University of Pennsylvania, Philadelphia. · Virginia Tech Carilion School of Medicine, Roanoke. · Nationwide Children's Hospital, Columbus, Ohio. · Temple University, Philadelphia, Pennsylvania. · University of Alabama at Birmingham. · University of California, Los Angeles. · Brown University, Providence, Rhode Island. · Department of Medicine, Dell Medical School, University of Texas, Austin. · University of Texas, Austin. · Boston University, Boston, Massachusetts. · Northwestern University, Evanston, Illinois. · University of Hawaii, Honolulu. · Pacific Health Research and Education Institute, Honolulu, Hawaii. · Tufts University, Medford, Massachusetts. ·JAMA · Pubmed #29946735.

ABSTRACT: Importance: By 2020, approximately 12.3 million individuals in the United States older than 50 years are expected to have osteoporosis. Osteoporotic fractures, particularly hip fractures, are associated with limitations in ambulation, chronic pain and disability, loss of independence, and decreased quality of life, and 21% to 30% of patients who experience a hip fracture die within 1 year. The prevalence of primary osteoporosis (ie, osteoporosis without underlying disease) increases with age and differs by race/ethnicity. With the aging of the US population, the potential preventable burden is likely to increase in future years. Objective: To update the 2011 US Preventive Services Task Force (USPSTF) recommendation on screening for osteoporosis. Evidence Review: The USPSTF reviewed the evidence on screening for and treatment of osteoporotic fractures in men and women, as well as risk assessment tools, screening intervals, and efficacy of screening and treatment in subgroups. The screening population was postmenopausal women and older men with no known previous osteoporotic fractures and no known comorbid conditions or medication use associated with secondary osteoporosis. Findings: The USPSTF found convincing evidence that bone measurement tests are accurate for detecting osteoporosis and predicting osteoporotic fractures in women and men. The USPSTF found adequate evidence that clinical risk assessment tools are moderately accurate in identifying risk of osteoporosis and osteoporotic fractures. The USPSTF found convincing evidence that drug therapies reduce subsequent fracture rates in postmenopausal women. The USPSTF found that the evidence is inadequate to assess the effectiveness of drug therapies in reducing subsequent fracture rates in men without previous fractures. Conclusions and Recommendation: The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in women 65 years and older. (B recommendation) The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in postmenopausal women younger than 65 years at increased risk of osteoporosis, as determined by a formal clinical risk assessment tool. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis to prevent osteoporotic fractures in men. (I statement).

4 Guideline Portuguese recommendations for the prevention, diagnosis and management of primary osteoporosis - 2018 update. 2018

Rodrigues, A M / Canhão, H / Marques, A / Ambrósio, C / Borges, J / Coelho, P / Costa, L / Fernandes, S / Gonçalves, I / Gonçalves, M / Guerra, M / Marques, M L / Pimenta, S / Pinto, P / Sequeira, G / Simões, E / Teixeira, L / Vaz, C / Vieira-Sousa, E / Vieira, R / Alvarenga, F / Araújo, F / Barcelos, A / Barcelos, F / Barros, R / Bernardes, M / Canas da Silva, J / Cordeiro, A / Costa, M / Cunha-Miranda, L / Cruz, M / Duarte, A C / Duarte, C / Faustino, A / Figueiredo, G / Fonseca, J E / Furtado, C / Gomes, J / Lopes, C / Mourão, A F / Oliveira, M / Pimentel-Santos, F M / Ribeiro, A / Sampaio da Nóvoa, T / Santiago, M / Silva, C / Silva-Dinis, A / Sousa, S / Tavares-Costa, J / Terroso, G / Vilar, A / Branco, J C / Tavares, V / Romeu, J C / da Silva, Jap. · ·Acta Reumatol Port · Pubmed #29602163.

ABSTRACT: BACKGROUND: Advances in osteoporosis (OP)case definition, treatment options, optimal therapy duration and pharmacoeconomic evidence in the national context motivated the Portuguese Society of Rheumatology (SPR) to update the Portuguese recommendations for the diagnosis and management of osteoporosis published in 2007. METHODS: SPR bone diseases' working group organized meetings involving 55 participants (rheumatologists, rheumatology fellows and one OP specialist nurse) to debate and develop the document. First, the working group selected 11 pertinent clinical questions for the diagnosis and management of osteoporosis in standard clinical practice. Then, each question was investigated through literature review and draft recommendations were built through consensus. When insufficient evidence was available, recommendations were based on experts' opinion and on good clinical practice. At two national meetings, the recommendations were discussed and updated. A draft of the recommendations full text was submitted to critical review among the working group and suggestions were incorporated. A final version was circulated among all Portuguese rheumatologists before publication and the level of agreement was anonymously assessed using an online survey. RESULTS: The 2018 SPR recommendations provide comprehensive guidance on osteoporosis prevention, diagnosis, fracture risk assessment, pharmacological treatment initiation, therapy options and duration of treatment, based on the best available evidence. They attained desirable agreement among Portuguese rheumatologists. As more evidence becomes available, periodic revisions will be performed. Target audience and patient population: The target audience for these guidelines includes all clinicians. The target patient population includes adult Portuguese people. Intended use: These recommendations provide general guidance for typical cases. They may not be appropriate in all situations - clinicians are encouraged to consider this information together with updated evidence and their best clinical judgment in individual cases.

5 Guideline Consensus document on osteoporosis in males. 2018

Varsavsky, Mariela / Romero Muñoz, Manuel / Ávila Rubio, Verónica / Becerra, Antonio / García Martín, Antonia / Martínez Díaz-Guerra, Guillermo / Rozas Moreno, Pedro / Jódar Gimeno, Esteban / Muñoz Torres, Manuel. ·Servicio de Endocrinología, Metabolismo y Medicina Nuclear, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. Electronic address: marie_varsa@hotmail.com. · Unidad de Endocrinología y Nutrición, Hospital General Universitario Rafael Méndez. Lorca, Murcia, España. · Unidad de Metabolismo Óseo, UGC Endocrinología y Nutrición, Complejo Hospitalario Universitario de Granada, Granada, España. · Unidad de Identidad de Género, Hospital Universitario Ramón y Cajal, Madrid, España. · Servicio de Endocrinología y Nutrición, Hospital Campus de la Salud, Granada, España. · Servicio de Endocrinología, Hospital Universitario 12 de Octubre, Madrid, España. · Sección de Endocrinología y Nutrición, Hospital General Universitario de Ciudad Real, Ciudad Real, España. · Departamento de Endocrinología y Nutrición Clínica, Hospital Universitario Quirón Salud Madrid, Universidad Europea de Madrid, Madrid, España. · UGC de Endocrinología y Nutrición, Hospital Universitario Campus de la Salud, CIBERFES, Granada, España. ·Endocrinol Diabetes Nutr · Pubmed #29530627.

ABSTRACT: OBJECTIVE: To provide practical recommendations to assess and treat osteoporosis in males. PARTICIPANTS: Members of the Bone Metabolism Working Group of the Spanish Society of Endocrinology. METHODS: Recommendations were formulated using the GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation) to describe both the strength of recommendations and the quality of evidence. A systematic search was made in Medline (PubMed) using the following associated terms: «osteoporosis», «men», «fractures», «bone mineral density», «treatment», «hypogonadism», and «prostate cancer». Papers in English and Spanish with publication date before 30 August 2017 were included. Current evidence for each disease was reviewed by 2group members. Finally, recommendations were discussed in a meeting of the working group. CONCLUSIONS: The document provides evidence-based practical recommendations for diagnosis, assessment, and management of osteoporosis in men and special situations such as hypogonadism and prostate cancer.

6 Guideline EAA clinical guideline on management of bone health in the andrological outpatient clinic. 2018

Rochira, V / Antonio, L / Vanderschueren, D. ·Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy. · Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy. · Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium. · Department of Clinical and Experimental Medicine, Laboratory of Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium. · Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium. ·Andrology · Pubmed #29499097.

ABSTRACT: Male osteoporosis is now a well-recognized medical disorder with established clinical guidelines for both diagnosis and management. Prevention as well as management of osteoporosis in men consulting the andrological outpatient clinic because of low testosterone, however, is not well established. This gap of knowledge is-at least partly-explained by the controversy with respect to the threshold of testosterone needed for skeletal maintenance. However, testosterone deficiency may be clearly associated with bone loss as well as frailty in men. If anything, andrologists should therefore be aware of the potential silent presence of osteoporosis in men with confirmed hypogonadism. Therefore, the management of patients with potential hypogonadism should include a complete bone health assessment, besides clinical and biochemical evaluation of gonadal status. Such bone health assessment should include specific items in medical history and physical examination related to fracture risk. Furthermore, dual-energy absorptiometry is indicated to evaluate fracture risk in men with confirmed clinical hypogonadism. Regarding treatment, besides general measures to prevent or manage male osteoporosis testosterone replacement can be initiated (as described in guidelines for hypogonadism), but data on its efficacy in preventing fractures are lacking. Thus, additional anti-osteoporotic may be needed, especially in men with very low testosterone who are at high risk of bone loss and/or in men not able to receive testosterone replacement.

7 Guideline CONSENSUS STATEMENT BY THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY ON THE QUALITY OF DXA SCANS AND REPORTS. 2018

Licata, Angelo A / Binkley, Neil / Petak, Steven M / Camacho, Pauline M. · ·Endocr Pract · Pubmed #29466058.

ABSTRACT: OBJECTIVE: High-quality dual-energy X-ray absorptiometry (DXA) scans are necessary for accurate diagnosis of osteoporosis and monitoring of therapy; however, DXA scan reports may contain errors that cause confusion about diagnosis and treatment. This American Association of Clinical Endocrinologists/American College of Endocrinology consensus statement was generated to draw attention to many common technical problems affecting DXA report conclusions and provide guidance on how to address them to ensure that patients receive appropriate osteoporosis care. METHODS: The DXA Writing Committee developed a consensus based on discussion and evaluation of available literature related to osteoporosis and osteodensitometry. RESULTS: Technical errors may include errors in scan acquisition and/or analysis, leading to incorrect diagnosis and reporting of change over time. Although the International Society for Clinical Densitometry advocates training for technologists and medical interpreters to help eliminate these problems, many lack skill in this technology. Suspicion that reports are wrong arises when clinical history is not compatible with scan interpretation (e.g., dramatic increase/decrease in a short period of time; declines in previously stable bone density after years of treatment), when different scanners are used, or when inconsistent anatomic sites are used for monitoring the response to therapy. Understanding the concept of least significant change will minimize erroneous conclusions about changes in bone density. CONCLUSION: Clinicians must develop the skills to differentiate technical problems, which confound reports, from real biological changes. We recommend that clinicians review actual scan images and data, instead of relying solely on the impression of the report, to pinpoint errors and accurately interpret DXA scan images. ABBREVIATIONS: AACE = American Association of Clinical Endocrinologists; BMC = bone mineral content; BMD = bone mineral density; DXA = dual-energy X-ray absorptiometry; ISCD = International Society for Clinical Densitometry; LSC = least significant change; TBS = trabecular bone score; WHO = World Health Organization.

8 Guideline Zalecenia postępowania diagnostycznego i leczniczego w osteoporozie w Polsce. Aktualizacja 2017. 2017

Lorenc, Roman / Głuszko, Piotr / Franek, Edward / Jabłoński, Mirosław / Jaworski, Maciej / Kalinka-Warzocha, Ewa / Karczmarewicz, Elżbieta / Kostka, Tomasz / Księżopolska-Orłowska, Krystyna / Marcinowska-Suchowierska, Ewa / Misiorowski, Waldemar / Więcek, Andrzej. ·Klinika Reumatologii, Narodowy Instytut Geriatrii, Reumatologii i Rehabilitacji, Warszawa, Poland. zruj@mp.pl. ·Endokrynol Pol · Pubmed #29168544.

ABSTRACT: -- No abstract --

9 Guideline Clinical guidelines for the prevention and treatment of osteoporosis: summary statements and recommendations from the Italian Society for Orthopaedics and Traumatology. 2017

Tarantino, Umberto / Iolascon, Giovanni / Cianferotti, Luisella / Masi, Laura / Marcucci, Gemma / Giusti, Francesca / Marini, Francesca / Parri, Simone / Feola, Maurizio / Rao, Cecilia / Piccirilli, Eleonora / Zanetti, Emanuela Basilici / Cittadini, Noemi / Alvaro, Rosaria / Moretti, Antimo / Calafiore, Dario / Toro, Giuseppe / Gimigliano, Francesca / Resmini, Giuseppina / Brandi, Maria Luisa. ·Policlinico Tor Vergata Foundation, Orthopaedics and Traumatology, University of Rome Tor Vergata, Rome, Italy. · Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Naples, Italy. · Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy. · Nursing Science, Center of Excellence for Culture and Nursing Research-IPASVI, University of Rome Tor Vergata, Rome, Italy. · Section of Orthopaedics and Traumatology, Centre for the Study of Osteoporosis and Metabolic Bone Disease, Treviglio-Caravaggio Hospital, Bergamo, Italy. · Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy. marialuisa.brandi@unifi.it. ·J Orthop Traumatol · Pubmed #29058226.

ABSTRACT: BACKGROUND: The Italian Society for Orthopaedics and Traumatology conceived this guidance-which is primarily addressed to Italian orthopedic surgeons, but should also prove useful to other bone specialists and to general practitioners-in order to improve the diagnosis, prevention, and treatment of osteoporosis and its consequences. MATERIALS AND METHODS: Literature reviews by a multidisciplinary team. RESULTS: The following topics are covered: the role of instrumental, metabolic, and genetic evaluations in the diagnosis of osteoporosis; appraisal of the risk of fracture and thresholds for intervention; general strategies for the prevention and treatment of osteoporosis (primary and secondary prevention); the pharmacologic treatment of osteoporosis; the setting and implementation of fracture liaison services for tertiary prevention. Grade A, B, and C recommendations are provided based on the main levels of evidence (1-3). Toolboxes for everyday clinical practice are provided. CONCLUSIONS: The first up-to-date Italian guidelines for the primary, secondary, and tertiary prevention of osteoporosis and osteoporotic fractures are presented.

10 Guideline AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY POSITION STATEMENT ON MENOPAUSE-2017 UPDATE. 2017

Cobin, Rhoda H / Goodman, Neil F / Anonymous5920912. · ·Endocr Pract · Pubmed #28703650.

ABSTRACT: EXECUTIVE SUMMARY This American Association of Clinical Endocrinologists (AACE)/American College of Endocrinology (ACE) Position Statement is designed to update the previous menopause clinical practice guidelines published in 2011 but does not replace them. The current document reviews new clinical trials published since then as well as new information regarding possible risks and benefits of therapies available for the treatment of menopausal symptoms. AACE reinforces the recommendations made in its previous guidelines and provides additional recommendations on the basis of new data. A summary regarding this position statement is listed below: New information available from randomized clinical trials and epidemiologic studies reported after 2011 was critically reviewed. No previous recommendations from the 2011 menopause clinical practice guidelines have been reversed or changed. Newer information enhances AACE's guidance for the use of hormone therapy in different subsets of women. Newer information helps to support the use of various types of estrogens, selective estrogen-receptor modulators (SERMs), and progesterone, as well as the route of delivery. Newer information supports the previous recommendation against the use of bioidentical hormones. The use of nonhormonal therapies for the symptomatic relief of menopausal symptoms is supported. Newer information enhances AACE's guidance for the use of hormone therapy in different subsets of women. Newer information helps to support the use of various types of estrogens, SERMs, and progesterone, as well as the route of delivery. Newer information supports the previous recommendation against the use of bioidentical hormones. The use of nonhormonal therapies for the symptomatic relief of menopausal symptoms is supported. New recommendations in this position statement include: 1. RECOMMENDATION: the use of menopausal hormone therapy in symptomatic postmenopausal women should be based on consideration of all risk factors for cardiovascular disease, age, and time from menopause. 2. RECOMMENDATION: the use of transdermal as compared with oral estrogen preparations may be considered less likely to produce thrombotic risk and perhaps the risk of stroke and coronary artery disease. 3. RECOMMENDATION: when the use of progesterone is necessary, micronized progesterone is considered the safer alternative. 4. RECOMMENDATION: in symptomatic menopausal women who are at significant risk from the use of hormone replacement therapy, the use of selective serotonin re-uptake inhibitors and possibly other nonhormonal agents may offer significant symptom relief. 5. RECOMMENDATION: AACE does not recommend use of bioidentical hormone therapy. 6. RECOMMENDATION: AACE fully supports the recommendations of the Comité de l'Évolution des Pratiques en Oncologie regarding the management of menopause in women with breast cancer. 7. RECOMMENDATION: HRT is not recommended for the prevention of diabetes. 8. RECOMMENDATION: In women with previously diagnosed diabetes, the use of HRT should be individualized, taking in to account age, metabolic, and cardiovascular risk factors. ABBREVIATIONS: AACE = American Association of Clinical Endocrinologists; ACE = American College of Endocrinology; BMI = body mass index; CAC = coronary artery calcification; CEE = conjugated equine estrogen; CEPO = Comité de l'Évolution des Pratiques en Oncologie; CAD = coronary artery disease; CIMT = carotid intima media thickness; CVD = cardiovascular disease; FDA = Food and Drug Administration; HDL = high-density lipoprotein; HRT = hormone replacement therapy; HT = hypertension; KEEPS = Kronos Early Estrogen Prevention Study; LDL = low-density lipoprotein; MBS = metabolic syndrome; MPA = medroxyprogesterone acetate; RR = relative risk; SERM = selective estrogen-receptor modulator; SSRI = selective serotonin re-uptake inhibitor; VTE = venous thrombo-embolism; WHI = Women's Health Initiative.

11 Guideline The 2017 hormone therapy position statement of The North American Menopause Society. 2017

Anonymous1480911. · ·Menopause · Pubmed #28650869.

ABSTRACT: The 2017 Hormone Therapy Position Statement of The North American Menopause Society (NAMS) updates the 2012 Hormone Therapy Position Statement of The North American Menopause Society and identifies future research needs. An Advisory Panel of clinicians and researchers expert in the field of women's health and menopause was recruited by NAMS to review the 2012 Position Statement, evaluate new literature, assess the evidence, and reach consensus on recommendations, using the level of evidence to identify the strength of recommendations and the quality of the evidence. The Panel's recommendations were reviewed and approved by the NAMS Board of Trustees.Hormone therapy (HT) remains the most effective treatment for vasomotor symptoms (VMS) and the genitourinary syndrome of menopause (GSM) and has been shown to prevent bone loss and fracture. The risks of HT differ depending on type, dose, duration of use, route of administration, timing of initiation, and whether a progestogen is used. Treatment should be individualized to identify the most appropriate HT type, dose, formulation, route of administration, and duration of use, using the best available evidence to maximize benefits and minimize risks, with periodic reevaluation of the benefits and risks of continuing or discontinuing HT.For women aged younger than 60 years or who are within 10 years of menopause onset and have no contraindications, the benefit-risk ratio is most favorable for treatment of bothersome VMS and for those at elevated risk for bone loss or fracture. For women who initiate HT more than 10 or 20 years from menopause onset or are aged 60 years or older, the benefit-risk ratio appears less favorable because of the greater absolute risks of coronary heart disease, stroke, venous thromboembolism, and dementia. Longer durations of therapy should be for documented indications such as persistent VMS or bone loss, with shared decision making and periodic reevaluation. For bothersome GSM symptoms not relieved with over-the-counter therapies and without indications for use of systemic HT, low-dose vaginal estrogen therapy or other therapies are recommended.This NAMS position statement has been endorsed by Academy of Women's Health, American Association of Clinical Endocrinologists, American Association of Nurse Practitioners, American Medical Women's Association, American Society for Reproductive Medicine, Asociación Mexicana para el Estudio del Climaterio, Association of Reproductive Health Professionals, Australasian Menopause Society, Chinese Menopause Society, Colegio Mexicano de Especialistas en Ginecologia y Obstetricia, Czech Menopause and Andropause Society, Dominican Menopause Society, European Menopause and Andropause Society, German Menopause Society, Groupe d'études de la ménopause et du vieillissement Hormonal, HealthyWomen, Indian Menopause Society, International Menopause Society, International Osteoporosis Foundation, International Society for the Study of Women's Sexual Health, Israeli Menopause Society, Japan Society of Menopause and Women's Health, Korean Society of Menopause, Menopause Research Society of Singapore, National Association of Nurse Practitioners in Women's Health, SOBRAC and FEBRASGO, SIGMA Canadian Menopause Society, Società Italiana della Menopausa, Society of Obstetricians and Gynaecologists of Canada, South African Menopause Society, Taiwanese Menopause Society, and the Thai Menopause Society. The American College of Obstetricians and Gynecologists supports the value of this clinical document as an educational tool, June 2017. The British Menopause Society supports this Position Statement.

12 Guideline 2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis. 2017

Buckley, Lenore / Guyatt, Gordon / Fink, Howard A / Cannon, Michael / Grossman, Jennifer / Hansen, Karen E / Humphrey, Mary Beth / Lane, Nancy E / Magrey, Marina / Miller, Marc / Morrison, Lake / Rao, Madhumathi / Robinson, Angela Byun / Saha, Sumona / Wolver, Susan / Bannuru, Raveendhara R / Vaysbrot, Elizaveta / Osani, Mikala / Turgunbaev, Marat / Miller, Amy S / McAlindon, Timothy. ·Yale University, New Haven, Connecticut. · McMaster University, Hamilton, Ontario, Canada. · Geriatric Research Education and Clinical Center, VA Health Care System, Minneapolis, Minnesota. · Arthritis Consultants of Tidewater, Virginia Beach, Virginia. · University of California, Los Angeles. · University of Wisconsin, Madison. · Oklahoma University Health Sciences Center, Oklahoma City. · University of California Davis, Sacramento. · Case Western Reserve University, MetroHealth System, Cleveland, Ohio. · Rheumatology Associates, Portland, Maine. · Duke University Medical Center, Durham, North Carolina. · Tufts Medical Center, Boston, Massachusetts. · Rainbow Babies and Children's Hospital, Cleveland, Ohio. · Virginia Commonwealth University, Richmond. · American College of Rheumatology, Atlanta, Georgia. ·Arthritis Rheumatol · Pubmed #28585373.

ABSTRACT: OBJECTIVE: To develop recommendations for prevention and treatment of glucocorticoid-induced osteoporosis (GIOP). METHODS: We conducted a systematic review to synthesize the evidence for the benefits and harms of GIOP prevention and treatment options. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of evidence. We used a group consensus process to determine the final recommendations and grade their strength. The guideline addresses initial assessment and reassessment in patients beginning or continuing long-term (≥3 months) glucocorticoid (GC) treatment, as well as the relative benefits and harms of lifestyle modification and of calcium, vitamin D, bisphosphonate, raloxifene, teriparatide, and denosumab treatment in the general adult population receiving long-term GC treatment, as well as in special populations of long-term GC users. RESULTS: Because of limited evidence regarding the benefits and harms of interventions in GC users, most recommendations in this guideline are conditional (uncertain balance between benefits and harms). Recommendations include treating only with calcium and vitamin D in adults at low fracture risk, treating with calcium and vitamin D plus an additional osteoporosis medication (oral bisphosphonate preferred) in adults at moderate-to-high fracture risk, continuing calcium plus vitamin D but switching from an oral bisphosphonate to another antifracture medication in adults in whom oral bisphosphonate treatment is not appropriate, and continuing oral bisphosphonate treatment or switching to another antifracture medication in adults who complete a planned oral bisphosphonate regimen but continue to receive GC treatment. Recommendations for special populations, including children, people with organ transplants, women of childbearing potential, and people receiving very high-dose GC treatment, are also made. CONCLUSION: This guideline provides direction for clinicians and patients making treatment decisions. Clinicians and patients should use a shared decision-making process that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.

13 Guideline Committee Opinion No.702: Female Athlete Triad. 2017

Anonymous3970907. · ·Obstet Gynecol · Pubmed #28538496.

ABSTRACT: The female athlete triad is a medical condition observed in physically active females involving three components: 1) low energy availability with or without disordered eating, 2) menstrual dysfunction, and 3) low bone density. An individual does not need to show clinical manifestations of all three components of the female athlete triad simultaneously to be affected by the condition. Consequences of these clinical conditions may not be completely reversible, so prevention, early diagnosis, and intervention are critical. All athletes are at risk of the female athlete triad, regardless of body build or sport. All active females should be assessed for components of the triad and further evaluation should be performed if one or more components are identified. The obstetrician-gynecologist has the opportunity to screen athletes for components of the female athlete triad at comprehensive visits for preventive care. Using the menstrual cycle as a vital sign is a useful tool for identifying athletes at risk of female athlete triad and should be an integral part of the preparticipatory sports physical. The goal of treatment for those diagnosed with female athlete triad is restoration of regular menses as a clinical marker of reestablishment of energy balance and enhancement of bone mineral density. The female athlete triad is a result of energy imbalance; thus, adjusting the energy expenditure and energy availability is the main intervention. Pharmacologic treat-ment may be considered when nonpharmacologic treatment has failed. A team approach involving the patient, obstetrician-gynecologist, sports nutritionist, coaches, parents, and mental health care provider, if indicated, is optimal.

14 Guideline Committee Opinion No. 702 Summary: Female Athlete Triad. 2017

Anonymous3930907. · ·Obstet Gynecol · Pubmed #28538492.

ABSTRACT: The female athlete triad is a medical condition observed in physically active females involving three components: 1) low energy availability with or without disordered eating, 2) menstrual dysfunction, and 3) low bone density. An individual does not need to show clinical manifestations of all three components of the female athlete triad simultaneously to be affected by the condition. Consequences of these clinical conditions may not be completely reversible, so prevention, early diagnosis, and intervention are critical. All athletes are at risk of the female athlete triad, regardless of body build or sport. All active females should be assessed for components of the triad and further evaluation should be performed if one or more components are identified. The obstetrician-gynecologist has the opportunity to screen athletes for components of the female athlete triad at comprehensive visits for preventive care. Using the menstrual cycle as a vital sign is a useful tool for identifying athletes at risk of female athlete triad and should be an integral part of the preparticipatory sports physical. The goal of treatment for those diagnosed with female athlete triad is restoration of regular menses as a clinical marker of reestablishment of energy balance and enhancement of bone mineral density. The female athlete triad is a result of energy imbalance; thus, adjusting the energy expenditure and energy availability is the main intervention. Pharmacologic treat-ment may be considered when nonpharmacologic treatment has failed. A team approach involving the patient, obstetrician-gynecologist, sports nutritionist, coaches, parents, and mental health care provider, if indicated, is optimal.

15 Guideline Treatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and Women: A Clinical Practice Guideline Update From the American College of Physicians. 2017

Qaseem, Amir / Forciea, Mary Ann / McLean, Robert M / Denberg, Thomas D / Anonymous411085. ·From the American College of Physicians and University of Pennsylvania Health System, Philadelphia, Pennsylvania, and Yale School of Medicine, New Haven, Connecticut. ·Ann Intern Med · Pubmed #28492856.

ABSTRACT: Description: This guideline updates the 2008 American College of Physicians (ACP) recommendations on treatment of low bone density and osteoporosis to prevent fractures in men and women. This guideline is endorsed by the American Academy of Family Physicians. Methods: The ACP Clinical Guidelines Committee based these recommendations on a systematic review of randomized controlled trials; systematic reviews; large observational studies (for adverse events); and case reports (for rare events) that were published between 2 January 2005 and 3 June 2011. The review was updated to July 2016 by using a machine-learning method, and a limited update to October 2016 was done. Clinical outcomes evaluated were fractures and adverse events. This guideline focuses on the comparative benefits and risks of short- and long-term pharmacologic treatments for low bone density, including pharmaceutical prescriptions, calcium, vitamin D, and estrogen. Evidence was graded according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. Target Audience and Patient Population: The target audience for this guideline includes all clinicians. The target patient population includes men and women with low bone density and osteoporosis. Recommendation 1: ACP recommends that clinicians offer pharmacologic treatment with alendronate, risedronate, zoledronic acid, or denosumab to reduce the risk for hip and vertebral fractures in women who have known osteoporosis. (Grade: strong recommendation; high-quality evidence). Recommendation 2: ACP recommends that clinicians treat osteoporotic women with pharmacologic therapy for 5 years. (Grade: weak recommendation; low-quality evidence). Recommendation 3: ACP recommends that clinicians offer pharmacologic treatment with bisphosphonates to reduce the risk for vertebral fracture in men who have clinically recognized osteoporosis. (Grade: weak recommendation; low-quality evidence). Recommendation 4: ACP recommends against bone density monitoring during the 5-year pharmacologic treatment period for osteoporosis in women. (Grade: weak recommendation; low-quality evidence). Recommendation 5: ACP recommends against using menopausal estrogen therapy or menopausal estrogen plus progestogen therapy or raloxifene for the treatment of osteoporosis in women. (Grade: strong recommendation; moderate-quality evidence). Recommendation 6: ACP recommends that clinicians should make the decision whether to treat osteopenic women 65 years of age or older who are at a high risk for fracture based on a discussion of patient preferences, fracture risk profile, and benefits, harms, and costs of medications. (Grade: weak recommendation; low-quality evidence).

16 Guideline ACR Appropriateness Criteria 2017

Anonymous3730905 / Ward, Robert J / Roberts, Catherine C / Bencardino, Jenny T / Arnold, Erin / Baccei, Steven J / Cassidy, R Carter / Chang, Eric Y / Fox, Michael G / Greenspan, Bennett S / Gyftopoulos, Soterios / Hochman, Mary G / Mintz, Douglas N / Newman, Joel S / Reitman, Charles / Rosenberg, Zehava S / Shah, Nehal A / Small, Kirstin M / Weissman, Barbara N. ·Principal Author, Tufts Medical Center, Boston, Massachusetts. Electronic address: robwardmd@gmail.com. · Panel Chair, Mayo Clinic, Phoenix, Arizona. · Panel Vice-Chair, New York University School of Medicine, New York, New York. · Illinois Bone and Joint Institute, Morton Grove, Illinois; American College of Rheumatology. · UMass Memorial Medical Center, Worcester, Massachusetts. · UK Healthcare Spine and Total Joint Service, Lexington, Kentucky; American Academy of Orthopaedic Surgeons. · VA San Diego Healthcare System, San Diego, California. · University of Virginia Health System, Charlottesville, Virginia. · Medical College of Georgia at Augusta University, Augusta, Georgia. · New York University Medical Center, New York, New York. · Beth Israel Deaconess Medical Center, Boston, Massachusetts. · Hospital for Special Surgery, New York, New York. · New England Baptist Hospital, Boston, Massachusetts. · Medical University of South Carolina, Charleston, South Carolina; North American Spine Society. · Hospital for Joint Diseases, New York, New York. · Brigham and Women's Hospital, Boston, Massachusetts. · Specialty Chair, Brigham and Women's Hospital, Boston, Massachusetts. ·J Am Coll Radiol · Pubmed #28473075.

ABSTRACT: Osteoporosis is a considerable public health risk, with 50% of women and 20% of men >50 years of age experiencing fracture, with mortality rates of 20% within the first year. Dual x-ray absorptiometry (DXA) is the primary diagnostic modality by which to screen women >65 years of age and men >70 years of age for osteoporosis. In postmenopausal women <65 years of age with additional risk factors for fracture, DXA is recommended. Some patients with bone mineral density above the threshold for treatment may qualify for treatment on the basis of vertebral body fractures detected through a vertebral fracture assessment scan, a lateral spine equivalent generated from a commercial DXA machine. Quantitative CT is useful in patients with advanced degenerative bony changes in their spines. New technologies such as trabecular bone score represent an emerging role for qualitative assessment of bone in clinical practice. It is critical that both radiologists and referring providers consider osteoporosis in their patients, thereby reducing substantial morbidity, mortality, and cost to the health care system. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

17 Guideline Recommended vitamin D levels in the general population. 2017

Varsavsky, Mariela / Rozas Moreno, Pedro / Becerra Fernández, Antonio / Luque Fernández, Inés / Quesada Gómez, José Manuel / Ávila Rubio, Verónica / García Martín, Antonia / Cortés Berdonces, María / Naf Cortés, Silvia / Romero Muñoz, Manuel / Reyes García, Rebeca / Jódar Gimeno, Esteban / Muñoz Torres, Manuel / Anonymous810976. ·Servicio de Endocrinología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. · Servicio de Endocrinología, Hospital General Universitario de Ciudad Real, Ciudad Real, España. Electronic address: pedrorozasm@yahoo.es. · Unidad de Identidad de Género, Hospital Universitario Ramón y Cajal; Facultad de Medicina, Universidad de Alcalá, Madrid, España. · Servicio de Endocrinología y Nutrición, Hospital Virgen de la Salud, Toledo, España. · Unidad de Metabolismo Mineral, UGC Endocrinología y Nutrición; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía; RETICEF, Córdoba, España. · Unidad de Metabolismo Óseo, UGC Endocrinología y Nutrición, Complejo Hospitalario Universitario de Granada; RETICEF, Granada, España. · Servicio de Endocrinología y Nutrición, Hospital Ruber Juan Bravo, Madrid, España. · Hospital Universitari Joan XXIII, IISPV, Universitat Rovira i Virgili; CIBERDEM, Tarragona, España. · Unidad de Endocrinología y Nutrición, HGU Rafael Méndez, Lorca, Murcia, España. · Unidad de Endocrinología y Nutrición, Complejo Hospitalario Torrecárdenas; Servicio de Endocrinología, Clínica San Pedro, Almería, España. · Departamento de Endocrinología y Nutrición, Hospitales Universitarios Quirón Salud Madrid; Facultad de Ciencias de la Salud, Universidad Europea de Madrid, Madrid, España. ·Endocrinol Diabetes Nutr · Pubmed #28440763.

ABSTRACT: OBJECTIVE: To provide recommendations based on evidence on the management of vitaminD deficiency in the general population. PARTICIPANTS: Members of the Bone Metabolism Working Group of the Spanish Society of Endocrinology. METHODS: Recommendations were formulated using the GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation) to describe both the strength of recommendations and the quality of evidence. A systematic search was made in MEDLINE (Pubmed) using the term VitaminD and the name of each issue. Papers in English and Spanish with publication date before 17 March 2016 were included. Recommendations were jointly discussed by the Working Group. CONCLUSIONS: This document summarizes the data about vitaminD deficiency in terms of prevalence, etiology, screening indications, adequate levels and effects of supplementation on bone and non-skeletal health outcomes.

18 Guideline Recommendations on the effect of antidiabetic drugs in bone. 2017

Rozas-Moreno, Pedro / Reyes-García, Rebeca / Jódar-Gimeno, Esteban / Varsavsky, Mariela / Luque-Fernández, Inés / Cortés-Berdonces, María / Muñoz-Torres, Manuel / Anonymous800976. ·Sección de Endocrinología, Hospital General Universitario de Ciudad Real, Ciudad Real, España. Electronic address: pedrorozasm@yahoo.es. · Unidad de Endocrinología y Nutrición, Complejo Hospitalario Torrecárdenas; Servicio de Endocrinología, Clínica San Pedro, Almería, España. · Departamento de Endocrinología y Nutrición, Hospitales Universitarios Quirón Salud (Madrid Pozuelo, San Camilo, San José), Madrid, España. · Servicio de Endocrinología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. · Servicio de Endocrinología y Nutrición, Hospital Virgen de la Salud, Toledo, España. · Servicio de Endocrinología y Nutrición, Hospital Ruber Juan Bravo, Madrid, España. · UGC Endocrinología y Nutrición. Complejo Hospitalario Universitario de Granada. Departamento de Medicina. Universidad de Granada. Instituto de Investigación Biosanitaria de Granada, Granada, España. ·Endocrinol Diabetes Nutr · Pubmed #28440761.

ABSTRACT: OBJECTIVE: To provide recommendations on the effect of antidiabetic drugs on bone fragility to help select the most adequate antidiabetic treatment, especially in diabetic patients with high risk of fracture. PARTICIPANTS: Members of the Bone Metabolism Working Group of the Spanish Society of Endocrinology. METHODS: The GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation) was used to establish both the strength of recommendations and the quality of evidence. A systematic search was made in MEDLINE (Pubmed) using the following terms associated to the name of each antidiabetic drug: AND "osteoporosis", "fractures", "bone mineral density", "bone markers", "calciotropic hormones". Papers in English with publication date before 30 April 2016 were reviewed. Recommendations were jointly discussed by the Working Group. CONCLUSIONS: The document summaries the data on the potential effects of antidiabetic drugs on bone metabolism and fracture risk.

19 Guideline The British Menopause Society and Women's Health Concern recommendations on the management of women with premature ovarian insufficiency. 2017

Hamoda, Haitham / Anonymous4190902. ·1 King's College Hospital, London, UK. ·Post Reprod Health · Pubmed #28381102.

ABSTRACT: -- No abstract --

20 Guideline [Argentine guidelines for the diagnosis, prevention and treatment of osteoporosis, 2015]. 2017

Schurman, León / Galich, Ana M / González, Claudio / González, Diana / Messina, Osvaldo D / Sedlinsky, Claudia / Uñas, Claudia R / Sánchez, Ariel. ·Laboratorio de Investigación en Osteopatías y Metabolismo Mineral (LIOMM), Universidad Nacional de La Plata, Buenos Aires, Argentina. · Servicio de Endocrinología, Metabolismo y Medicina Nuclear, Hospital Italiano de Buenos Aires, Argentina. · Departamento de Farmacología (II Cátedra), Universidad de Buenos Aires, Argentina. · Mautalén Salud e Investigación, Buenos Aires, Argentina. · Servicio de Reumatología, Hospital Argerich, Buenos Aires, Argentina. · Unidad Asistencial César Milstein, Buenos Aires, Argentina. · Centro de Endocrinología, Rosario, Argentina. E-mail: asanvir@gmail.com. ·Medicina (B Aires) · Pubmed #28140312.

ABSTRACT: Osteoporosis is an evolving disease which affects over 200 million people worldwide. Our recommendations are guidelines for its diagnosis, prevention and treatment, but they do not constitute standards for clinical decisions in individual cases. The physician must adapt them to individual special situations, incorporating personal factors that transcend the limits of these guidelines and are dependent on the knowledge and art of the practice of Medicine. These guidelines should be reviewed and updated periodically as new, better and more effective diagnostic and therapeutic tools become available.

21 Guideline ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease. 2017

Farraye, Francis A / Melmed, Gil Y / Lichtenstein, Gary R / Kane, Sunanda V. ·Section of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA. · Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA. · Division of Gastroenterology, Hospital of the University of Pennsylvania, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA. · Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA. ·Am J Gastroenterol · Pubmed #28071656.

ABSTRACT: Recent data suggest that inflammatory bowel disease (IBD) patients do not receive preventive services at the same rate as general medical patients. Patients with IBD often consider their gastroenterologist to be the primary provider of care. To improve the care delivered to IBD patients, health maintenance issues need to be co-managed by both the gastroenterologist and primary care team. Gastroenterologists need to explicitly inform the primary care provider of the unique needs of the IBD patient, especially those on immunomodulators and biologics or being considered for such therapy. In particular, documentation of up to date vaccinations are crucial as IBD patients are often treated with long-term immune-suppressive therapies and may be at increased risk for infections, many of which are preventable with vaccinations. Health maintenance issues addressed in this guideline include identification, safety and appropriate timing of vaccinations, screening for osteoporosis, cervical cancer, melanoma and non-melanoma skin cancer as well as identification of depression and anxiety and smoking cessation. To accomplish these health maintenance goals, coordination between the primary care provider, gastroenterology team and other specialists is necessary.

22 Guideline Exercise and Sports Science Australia (ESSA) position statement on exercise prescription for the prevention and management of osteoporosis. 2017

Beck, Belinda R / Daly, Robin M / Singh, Maria A Fiatarone / Taaffe, Dennis R. ·School of Allied Health Sciences, Menzies Health Institute Queensland, Griffith University, Australia. Electronic address: b.beck@griffith.edu.au. · Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Australia. · Exercise, Health and Performance Research Group, Faculty of Health Sciences and Sydney Medical School, The University of Sydney, Australia. · School of Medical and Health Sciences and the Exercise Medicine Research Institute, Edith Cowan University, Australia; School of Human Movement and Nutrition Sciences, University of Queensland, Australia. ·J Sci Med Sport · Pubmed #27840033.

ABSTRACT: OBJECTIVES: Osteoporotic fractures are associated with substantial morbidity and mortality. Although exercise has long been recommended for the prevention and management of osteoporosis, existing guidelines are often non-specific and do not account for individual differences in bone health, fracture risk and functional capacity. The aim of the current position statement is to provide health practitioners with specific, evidence-based guidelines for safe and effective exercise prescription for the prevention or management of osteoporosis, accommodating a range of potential comorbidities. DESIGN: Position statement. METHODS: Interpretation and application of research reports describing the effects of exercise interventions for the prevention and management of low bone mass, osteoporosis and osteoporotic fracture. RESULTS: Evidence from animal and human trials indicates that bone responds positively to impact activities and high intensity progressive resistance training. Furthermore, the optimisation of muscle strength, balance and mobility minimises the risk of falls (and thereby fracture), which is particularly relevant for individuals with limited functional capacity and/or a very high risk of osteoporotic fracture. It is important that all exercise programs be accompanied by sufficient calcium and vitamin D, and address issues of comorbidity and safety. For example, loaded spine flexion is not recommended, and impact activities may require modification in the presence of osteoarthritis or frailty. CONCLUSIONS: Specific guidelines for safe and effective exercise for bone health are presented. Individual exercise prescription must take into account existing bone health status, co-morbidities, and functional or clinical risk factors for falls and fracture.

23 Guideline Osteoporosis management in patients with breast cancer: EMAS position statement. 2017

Trémollieres, Florence A / Ceausu, Iuliana / Depypere, Herman / Lambrinoudaki, Irene / Mueck, Alfred / Pérez-López, Faustino R / van der Schouw, Yvonne T / Senturk, Levent M / Simoncini, Tommaso / Stevenson, John C / Stute, Petra / Rees, Margaret. ·Menopause and Metabolic Bone Disease Unit, Hôpital Paule de Viguier, CHU Toulouse, Toulouse, France. Electronic address: tremollieres.fr@chu-toulouse.fr. · Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, and Department of Obstetrics and Gynecology, 'Dr. I. Cantacuzino' Hospital, Bucharest, Romania. · Breast Clinic and Menopause Clinic, University Hospital, De Pintelaan 185, 9000 Gent, Belgium. · Second Department of Obstetrics and Gynecology, National and Kapodestrian University of Athens, Greece. · University Women's Hospital of Tuebingen, Calwer Street 7, 72076 Tuebingen, Germany. · Department of Obstetrics and Gynecology, Zaragoza University Faculty of Medicine, Lozano-Blesa University Hospital, Zaragoza 50009, Spain. · Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. · Istanbul University Cerrahpasa School of Medicine. Dept. of Obstetrics and Gynecology, Division of Reproductive Endocrinology, IVF Unit, Istanbul, Turkey. · Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100, Pisa, Italy. · National Heart and Lung Institute, Imperial College London, Royal Brompton Campus Hospital, London SW3 6NP, UK. · Department of Obstetrics and Gynecology, University Women's Hospital, Bern, Switzerland. · Women's Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK. ·Maturitas · Pubmed #27802892.

ABSTRACT: Aromatase inhibitors (AIs) are the first-line recommended standard of care for postmenopausal estrogen receptor-positive breast cancer. Because they cause a profound suppression of estrogen levels, concerns regarding their potential to increase the risk of fracture were rapidly raised. There is currently a general consensus that a careful baseline evaluation is needed of the risk of fracture in postmenopausal women about to start treatment with AIs but also in all premenopausal women with early disease. Bisphosphonates have been shown in several phase III trials to prevent the bone loss induced by cancer treatment, although no fracture data are available. Even though they do not have regulatory approval for this indication, their use must be discussed with women at high risk of fracture. Accordingly, several guidelines recommend considering treatment in women with a T-score ≤-2 or those with two or more clinical risk factors. Moreover, recent data suggest that bisphosphonates, especially intravenous zoledronic acid, may have an anticancer effect, in that they reduce bone recurrence as well as extra-skeletal metastasis and breast cancer mortality in postmenopausal women. The anti-RANK ligand antibody denosumab is also emerging as a new adjuvant therapeutic option to prevent AI-induced bone loss. It has been shown to extend the time to first fracture in postmenopausal women treated with AIs. Several issues still need to be addressed regarding the use of these different agents in an adjuvant setting. The purpose of this position statement is to review the literature on antifracture therapy and to discuss the current guidelines for the management of osteoporosis in women with early breast cancer.

24 Guideline AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY CLINICAL PRACTICE GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF POSTMENOPAUSAL OSTEOPOROSIS - 2016. 2016

Camacho, Pauline M / Petak, Steven M / Binkley, Neil / Clarke, Bart L / Harris, Steven T / Hurley, Daniel L / Kleerekoper, Michael / Lewiecki, E Michael / Miller, Paul D / Narula, Harmeet S / Pessah-Pollack, Rachel / Tangpricha, Vin / Wimalawansa, Sunil J / Watts, Nelson B. · ·Endocr Pract · Pubmed #27662240.

ABSTRACT: ABBREVIATIONS: AACE = American Association of Clinical Endocrinologists AFF = atypical femur fracture ASBMR = American Society for Bone and Mineral Research BEL = best evidence level BMD = bone mineral density BTM = bone turnover marker CBC = complete blood count CI = confidence interval DXA = dual-energy X-ray absorptiometry EL = evidence level FDA = U.S. Food and Drug Administration FLEX = Fracture Intervention Trial (FIT) Long-term Extension FRAX

25 Guideline AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY CLINICAL PRACTICE GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF POSTMENOPAUSAL OSTEOPOROSIS - 2016--EXECUTIVE SUMMARY. 2016

Camacho, Pauline M / Petak, Steven M / Binkley, Neil / Clarke, Bart L / Harris, Steven T / Hurley, Daniel L / Kleerekoper, Michael / Lewiecki, E Michael / Miller, Paul D / Narula, Harmeet S / Pessah-Pollack, Rachel / Tangpricha, Vin / Wimalawansa, Sunil J / Watts, Nelson B. · ·Endocr Pract · Pubmed #27643923.

ABSTRACT: ABBREVIATIONS: AACE = American Association of Clinical Endocrinologists AFF = atypical femur fracture ASBMR = American Society for Bone and Mineral Research BEL = best evidence level BMD = bone mineral density BTM = bone turnover marker CBC = complete blood count CI = confidence interval DXA = dual-energy X-ray absorptiometry EL = evidence level FDA = U.S. Food and Drug Administration FLEX = Fracture Intervention Trial (FIT) Long-term Extension FRAX(®) = Fracture Risk Assessment Tool GFR = glomerular filtration rate GI = gastrointestinal HORIZON = Health Outcomes and Reduced Incidence with Zoledronic Acid Once Yearly IOF = International Osteoporosis Foundation ISCD = International Society for Clinical Densitometry IU = international units IV = intravenous LSC = least significant change NBHA = National Bone Health Alliance NOF = National Osteoporosis Foundation 25(OH)D = 25-hydroxy vitamin D ONJ = osteonecrosis of the jaw PINP = serum carboxy-terminal propeptide of type I collagen PTH = parathyroid hormone R = recommendation RANK = receptor activator of nuclear factor kappa-B RANKL = receptor activator of nuclear factor kappa-B ligand RCT = randomized controlled trial RR = relative risk S-CTX = serum C-terminal telopeptide SQ = subcutaneous VFA = vertebral fracture assessment WHO = World Health Organization.

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