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Osteoporosis: HELP
Articles by Cyrus Cooper
Based on 168 articles published since 2008
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Between 2008 and 2019, C. Cooper wrote the following 168 articles about Osteoporosis.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7
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 European guidance for the diagnosis and management of osteoporosis in postmenopausal women. 2019

Kanis, J A / Cooper, C / Rizzoli, R / Reginster, J-Y / Anonymous1931159. ·Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK. w.j.Pontefract@shef.ac.uk. · Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia. w.j.Pontefract@shef.ac.uk. · 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. · Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium. · Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia. ·Osteoporos Int · Pubmed #30324412.

ABSTRACT: Guidance is provided in a European setting on the assessment and treatment of postmenopausal women at risk from fractures due to osteoporosis. INTRODUCTION: The International Osteoporosis Foundation and European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis published guidance for the diagnosis and management of osteoporosis in 2013. This manuscript updates these in a European setting. METHODS: Systematic reviews were updated. RESULTS: The following areas are reviewed: the role of bone mineral density measurement for the diagnosis of osteoporosis and assessment of fracture risk; general and pharmacological management of osteoporosis; monitoring of treatment; assessment of fracture risk; case-finding strategies; investigation of patients; health economics of treatment. The update includes new information on the evaluation of bone microstructure evaluation in facture risk assessment, the role of FRAX® and Fracture Liaison Services in secondary fracture prevention, long-term effects on fracture risk of dietary intakes, and increased fracture risk on stopping drug treatment. CONCLUSIONS: A platform is provided on which specific guidelines can be developed for national use.

3 Guideline Diagnosis and management of osteoporosis in postmenopausal women and older men in the UK: National Osteoporosis Guideline Group (NOGG) update 2013. 2013

Compston, J / Bowring, C / Cooper, A / Cooper, C / Davies, C / Francis, R / Kanis, J A / Marsh, D / McCloskey, E V / Reid, D M / Selby, P / Anonymous4450762. ·University of Cambridge School of Clinical Medicine, Cambridge, UK. jec1001@hermes.cam.ac.uk ·Maturitas · Pubmed #23810490.

ABSTRACT: Since the launch in 2008 by the National Osteoporosis Guideline Group (NOGG), of guidance for the diagnosis and management of osteoporosis in postmenopausal women and older men in the UK there have been significant advances in risk assessment and treatment. These have been incorporated into an updated version of the guideline, with an additional focus on the management of glucocorticoid-induced osteoporosis, the role of calcium and vitamin D therapy and the benefits and risks of long-term bisphosphonate therapy. The updated guideline is summarised below. The recommendations in the guideline are intended to aid management decisions but do not replace the need for clinical judgement in the care of individuals in clinical practice.

4 Guideline European guidance for the diagnosis and management of osteoporosis in postmenopausal women. 2013

Kanis, J A / McCloskey, E V / Johansson, H / Cooper, C / Rizzoli, R / Reginster, J-Y / Anonymous1041055. ·WHO Collaborating Centre, UK University of Sheffield Medical School, Sheffield, UK. w.j.pontefract@sheffield.ac.uk ·Osteoporos Int · Pubmed #23079689.

ABSTRACT: INTRODUCTION: The International Osteoporosis Foundation and European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis published guidance for the diagnosis and management of osteoporosis in 2008. This manuscript updates these in a European setting. METHODS: Systematic literature reviews. RESULTS: The following areas are reviewed: the role of bone mineral density measurement for the diagnosis of osteoporosis and assessment of fracture risk, general and pharmacological management of osteoporosis, monitoring of treatment, assessment of fracture risk, case finding strategies, investigation of patients and health economics of treatment. CONCLUSIONS: A platform is provided on which specific guidelines can be developed for national use.

5 Guideline An appendix to the 2012 IOF-ECTS guidelines for the management of glucocorticoid-induced osteoporosis. 2012

Lekamwasam, S / Adachi, J D / Agnusdei, D / Bilezikian, J / Boonen, S / Borgström, F / Cooper, C / Perez, A Diez / Eastell, R / Hofbauer, L C / Kanis, J A / Langdahl, B L / Lesnyak, O / Lorenc, R / McCloskey, E / Messina, O D / Napoli, N / Obermayer-Pietsch, B / Ralston, S H / Sambrook, P N / Silverman, S / Sosa, M / Stepan, J / Suppan, G / Wahl, D A / Compston, J E / Anonymous3270744. ·Centre for Metabolic Bone Diseases, Department of Medicine, Faculty of Medicine, Galle, Sri Lanka. ·Arch Osteoporos · Pubmed #23225278.

ABSTRACT: The use of glucocorticoids in the treatment of medical disorders can lead to rapid bone loss and increased risk of fragility fracture. Updated clinical guidelines are needed that accommodate recent advances in fracture risk assessment and new pharmacological interventions to reduce fracture risk. This document serves as an appendix to the 2012 IOF-ECTS guidelines for the management of glucocorticoid-induced osteoporosis.

6 Guideline Treatment failure in osteoporosis. 2012

Diez-Perez, A / Adachi, J D / Agnusdei, D / Bilezikian, J P / Compston, J E / Cummings, S R / Eastell, R / Eriksen, E F / Gonzalez-Macias, J / Liberman, U A / Wahl, D A / Seeman, E / Kanis, J A / Cooper, C / Anonymous5370732. ·Department of Internal Medicine and Infectious Diseases, Hospital del Mar-IMIM, Autonomous University of Barcelona, RETICEF, Instituto Carlos III, P. Maritim 25-29, 08003 Barcelona, Spain. adiez@parcdesalutmar.cat ·Osteoporos Int · Pubmed #22836278.

ABSTRACT: INTRODUCTION: This study aims to provide guidelines concerning the definition of failure of therapies used to reduce the risk of fracture. METHODS: A working group of the Committee of Scientific Advisors of the International Osteoporosis Foundation was convened to define outcome variables that may assist clinicians in decision making. RESULTS: In the face of limited evidence, failure of treatment may be inferred when two or more incident fractures have occurred during treatment, when serial measurements of bone remodelling markers are not suppressed by anti-resorptive therapy and where bone mineral density continues to decrease. CONCLUSION: The provision of pragmatic criteria to define failure to respond to treatment provides an unmet clinical need and may stimulate research into an important issue.

7 Guideline Guidelines for the diagnosis and management of osteoporosis in postmenopausal women and men from the age of 50 years in the UK. 2009

Compston, J / Cooper, A / Cooper, C / Francis, R / Kanis, J A / Marsh, D / McCloskey, E V / Reid, D M / Selby, P / Wilkins, M / Anonymous3550619. ·University of Cambridge School of Clinical Medicine, Department of Medicine, Cambridge, United Kingdom. jec1001@cam.ac.uk ·Maturitas · Pubmed #19135323.

ABSTRACT: In 1999 and 2000 the Royal College of Physicians published guidelines for the prevention and treatment of osteoporosis [Royal College of Physicians. Osteoporosis: clinical guidelines for the prevention and treatment. London: Royal College of Physicians; 1999; Royal College of Physicians and Bone and Tooth Society of Great Britain. Update on pharmacological interventions and an algorithm for management. London, UK: Royal College of Physicians; 2000.; Royal College of Physicians. Glucocorticoid-induced osteoporosis. Guidelines on prevention and treatment; Bone and Tooth Society of Great Britain, National Osteoporosis Society and Royal College of Physicians. London, UK: Royal College of Physicians; 2002]. Since then, there have been significant advances in the field of osteoporosis including the development of new techniques for measuring bone mineral density, improved methods of assessing fracture risk and new treatments that have been shown to significantly reduce the risk of fractures. Against this background, the National Osteoporosis Guideline Group (NOGG), in collaboration with many Societies in the UK, have updated the original guidelines [Royal College of Physicians, National Osteoporosis Guideline Group on behalf of the Bone Research Society, British Geriatrics Society, British Orthopaedic Association, British Society of Rheumatology, National Osteoporosis Society, Osteoporosis 2000, Osteoporosis Dorset, Primary Care Rheumatology Society, Society for Endocrinology. Osteoporosis. Clinical guideline for prevention and treatment, Executive Summary. University of Sheffield Press; 2008], a practical summary of which is detailed below. The management algorithms are underpinned by a health economic analysis applied to the epidemiology of fracture in the UK.

8 Guideline European guidance for the diagnosis and management of osteoporosis in postmenopausal women. 2008

Kanis, J A / Burlet, N / Cooper, C / Delmas, P D / Reginster, J-Y / Borgstrom, F / Rizzoli, R / Anonymous1920592. ·WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX, UK. w.j.Pontefract@shef.ac.uk ·Osteoporos Int · Pubmed #18266020.

ABSTRACT: INTRODUCTION: The European Foundation for Osteoporosis and Bone disease (subsequently the International Osteoporosis Foundation) published guidelines for the diagnosis and management of osteoporosis in 1997. This manuscript updates these in a European setting. METHODS: The following areas are reviewed: the role of bone mineral density measurement for the diagnosis of osteoporosis and assessment of fracture risk; general and pharmacological management of osteoporosis; monitoring of treatment; assessment of fracture risk; case finding strategies; investigation of patients; health economics of treatment. RESULTS AND CONCLUSIONS: A platform is provided on which specific guidelines can be developed for national use.

9 Editorial Osteoporosis epidemiology in UK Biobank: a unique opportunity for international researchers. 2013

Harvey, N C / Matthews, P / Collins, R / Cooper, C / Anonymous1151055. ·MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK, nch@mrc.soton.ac.uk. ·Osteoporos Int · Pubmed #24057481.

ABSTRACT: -- No abstract --

10 Editorial Standardising biochemical assessment of bone turnover in osteoporosis. 2011

Vasikaran, Samuel D / Morris, Howard A / Cooper, Cyrus / Kanis, John A. ·Department of Core Clinical Pathology and Biochemistry, PathWest Laboratory Medicine-Royal Perth Hospital, Perth, WA, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, WA, Australia. Electronic address: samuel.vasikaran@health.wa.gov.au. · School of Pharmacy and Medical Sciences, University of South Australia, Adelaide South Australia 5000, Australia. · MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK; NIHR Musculoskeletal Biomedical Research Unit, Institute of Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK. · Centre for Metabolic Bone Diseases (WHO Collaborating Centre), University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK. ·Clin Biochem · Pubmed #21784064.

ABSTRACT: -- No abstract --

11 Editorial Recommendations for bone marker standards in osteoporosis: what, why and where to now? 2011

Vasikaran, Samuel D / Cooper, Cyrus / Kanis, John A. · ·Ann Clin Biochem · Pubmed #21406559.

ABSTRACT: -- No abstract --

12 Editorial Where now with NICE? 2011

Dennison, E M / Cooper, C. · ·Osteoporos Int · Pubmed #21279505.

ABSTRACT: -- No abstract --

13 Review Inappropriate claims from non-equivalent medications in osteoarthritis: a position paper endorsed by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). 2018

Bruyère, Olivier / Cooper, Cyrus / Al-Daghri, Nasser M / Dennison, Elaine M / Rizzoli, René / Reginster, Jean-Yves. ·Department of Public Health, Epidemiology and Health Economics, University of Liège, CHU Sart Tilman B23, 4000, Liège, Belgium. · WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium. · MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK. · NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK. · Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia. · Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. · Department of Public Health, Epidemiology and Health Economics, University of Liège, CHU Sart Tilman B23, 4000, Liège, Belgium. jyreginster@ulg.ac.be. · WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium. jyreginster@ulg.ac.be. ·Aging Clin Exp Res · Pubmed #29177637.

ABSTRACT: Osteoarthritis (OA) is a progressive joint disease, that occurs frequently in the aging population and is a major cause of disability worldwide. Both glucosamine and chondroitin are biologically active molecules that are substrates for proteoglycan, an essential component of the cartilage matrix. Evidence supports the use of glucosamine and chondroitin as symptomatic slow-acting drugs for osteoarthritis (SYSADOAs) with impact on OA symptoms and disease-modifying effects in the long term. Glucosamine and chondroitin are administered in exogenous form as a sulfate salt and multiple formulations of these agents are available, both as prescription-grade products and nutritional supplements. However, while all preparations may claim to deliver a therapeutic level of glucosamine or chondroitin not all are supported by clinical evidence. Only patented crystalline glucosamine sulfate (pCGS) is shown to deliver consistently high glucosamine bioavailability and plasma concentration in humans, which corresponds to demonstrated clinical efficacy. Similarly, clinical evidence supports only the pharmaceutical-grade chondroitin sulfate. The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) advocates, through careful consideration of the evidence base, that judicious choice of glucosamine and chondroitin formulation is essential to maximize clinical benefit, patient adherence and satisfaction with treatment. In future, the ESCEO recommends that complex molecules with biological activity such as pCGS may be treated as "biosimilars" akin to the European Medicines Agency guidance on biological medicinal products. It seems likely that for all other complex molecules classed as SYSADOAs, the recommendation to use only formulations clearly supported by the evidence-base should apply.

14 Review Quality of life assessment in musculo-skeletal health. 2018

Beaudart, Charlotte / Biver, Emmanuel / Bruyère, Olivier / Cooper, Cyrus / Al-Daghri, Nasser / Reginster, Jean-Yves / Rizzoli, René. ·Department of Public Health, Epidemiology and Health Economics, University of Liège, Quartier Hôpital, Avenue Hippocrate 13, CHUB23, 4000, Liège, Belgium. c.beaudart@ulg.ac.be. · Division of Bone Diseases, Faculty of Medicine, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, 1211, Geneva 14, Switzerland. · Department of Public Health, Epidemiology and Health Economics, University of Liège, Quartier Hôpital, Avenue Hippocrate 13, CHUB23, 4000, Liège, Belgium. · MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK. · NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK. · Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia. · Director of the Bone, Cartilage and Muscle Metabolism Unit and Chair of the Department of Public Health Sciences, CHU Liège, Quai Godefroid Kurth 45, 4000, Liège, Belgium. ·Aging Clin Exp Res · Pubmed #28664458.

ABSTRACT: Musculoskeletal disorders affect morbidity, quality of life and mortality, and represent an increasing economic and societal burden in the context of population aging and increased life expectancy. Improvement of quality of life should be one of the priorities of any interventions to prevent and treat musculoskeletal disorders in the ageing population. Two main approaches, namely generic and disease-specific instruments, can be applied to measure health-related quality of life. Among the generic tools available in scientific literature, the short form 36 questionnaire (SF-36) and the Euroqol five item questionnaire (EQ-5D) are two of the most popular questionnaires used to quantify the health related quality of life in people with musculoskeletal disorders. However, because generic tools may not always be able to detect subtle effects of a specific condition on quality of life, a specific tool is highly valuable. Specific tools improve the ability to clinically characterize quality of life in subjects with a specific musculoskeletal disorder, as well as the capacity to assess changes over time in the QoL of these subjects. The recent development of specific tools should help to validate preventive and therapeutic interventions in this field.

15 Review Mind the (treatment) gap: a global perspective on current and future strategies for prevention of fragility fractures. 2017

Harvey, N C W / McCloskey, E V / Mitchell, P J / Dawson-Hughes, B / Pierroz, D D / Reginster, J-Y / Rizzoli, R / Cooper, C / Kanis, J A. ·MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK. · NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK. · MRC ARUK Centre for Integrated Research in Musculoskeletal Ageing, Metabolic Bone Centre, Northern General Hospital, Sheffield, UK. e.v.mccloskey@sheffield.ac.uk. · Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK. e.v.mccloskey@sheffield.ac.uk. · Synthesis Medical NZ Ltd, Auckland, New Zealand. · University of Notre Dame Australia, Sydney, Australia. · Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA. · International Osteoporosis Foundation (IOF), Nyon, Switzerland. · Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium. · Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. · NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK. · Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK. · Institute for Health and Aging, Catholic University of Australia, Melbourne, Australia. ·Osteoporos Int · Pubmed #28175979.

ABSTRACT: This narrative review considers the key challenges facing healthcare professionals and policymakers responsible for providing care to populations in relation to bone health. These challenges broadly fall into four distinct themes: (1) case finding and management of individuals at high risk of fracture, (2) public awareness of osteoporosis and fragility fractures, (3) reimbursement and health system policy and (4) epidemiology of fracture in the developing world. Findings from cohort studies, randomised controlled trials, systematic reviews and meta-analyses, in addition to current clinical guidelines, position papers and national and international audits, are summarised, with the intention of providing a prioritised approach to delivery of optimal bone health for all. Systematic approaches to case-finding individuals who are at high risk of sustaining fragility fractures are described. These include strategies and models of care intended to improve case finding for individuals who have sustained fragility fractures, those undergoing treatment with medicines which have an adverse effect on bone health and people who have diseases, whereby bone loss and, consequently, fragility fractures are a common comorbidity. Approaches to deliver primary fracture prevention in a clinically effective and cost-effective manner are also explored. Public awareness of osteoporosis is low worldwide. If older people are to be more pro-active in the management of their bone health, that needs to change. Effective disease awareness campaigns have been implemented in some countries but need to be undertaken in many more. A major need exists to improve awareness of the risk that osteoporosis poses to individuals who have initiated treatment, with the intention of improving adherence in the long term. A multisector effort is also required to support patients and their clinicians to have meaningful discussions concerning the risk-benefit ratio of osteoporosis treatment. With regard to prioritisation of fragility fracture prevention in national policy, there is much to be done. In the developing world, robust epidemiological estimates of fracture incidence are required to inform policy development. As the aging of the baby boomer generation is upon us, this review provides a comprehensive analysis of how bone health can be improved worldwide for all.

16 Review The impact of fragility fracture and approaches to osteoporosis risk assessment worldwide. 2017

Curtis, Elizabeth M / Moon, Rebecca J / Harvey, Nicholas C / Cooper, Cyrus. ·MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK. · MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK; Paediatric Endocrinology, Southampton University Hospitals NHS Foundation Trust, Southampton SO16 6YD, UK. · MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK. · MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK; NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford OX3 7LD, UK. Electronic address: cc@mrc.soton.ac.uk. ·Bone · Pubmed #28119181.

ABSTRACT: Osteoporosis constitutes a major public health problem, through its association with age-related fractures, particularly of the hip, vertebrae, distal forearm and humerus. Substantial geographic variation has been noted in the incidence of osteoporotic fractures worldwide, with Western populations (North America, Europe and Oceania), reporting increases in hip fracture throughout the second half of the 20th century, with a stabilisation or decline in the last two decades. In developing populations however, particularly in Asia, the rates of osteoporotic fracture appears to be increasing. The massive global burden consequent to osteoporosis means that fracture risk assessment should be a high priority among health measures considered by policy makers. The WHO operational definition of osteoporosis, based on a measurement of bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA), has been used globally since the mid-1990s. However, although this definition identifies those at greatest individual risk of fracture, in the population overall a greater total number of fractures occur in individuals with BMD values above the threshold for osteoporosis diagnosis. A number of web-based tools to enable the inclusion of clinical risk factors, with or without BMD, in fracture prediction algorithms have been developed to improve the identification of individuals at high fracture risk, the most commonly used globally being FRAX®. Access to DXA, osteoporosis risk assessment, case finding and treatment varies worldwide, but despite such advances studies indicate that a minority of men and women at high fracture risk receive treatment. Importantly, research is ongoing to demonstrate the clinical efficacy and cost-effectiveness of osteoporosis case finding and risk assessment strategies worldwide. The huge burden caused by osteoporosis related fractures to individuals, healthcare systems and societies should provide a clear impetus for the progression of such approaches.

17 Review Clinical settings in knee osteoarthritis: Pathophysiology guides treatment. 2017

Herrero-Beaumont, Gabriel / Roman-Blas, Jorge A / Bruyère, Olivier / Cooper, Cyrus / Kanis, John / Maggi, Stefania / Rizzoli, René / Reginster, Jean-Yves. ·Joint and Bone Research Unit, Rheumatology Department, Fundación Jiménez Díaz, Autonomous University of Madrid, Madrid, Spain. Electronic address: gherrero@fjd.es. · Joint and Bone Research Unit, Rheumatology Department, Fundación Jiménez Díaz, Autonomous University of Madrid, Madrid, Spain. · Support Unit in Epidemiology and Biostatistics, Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium. · MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; NHIR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK. · WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK. · Aging Program, National Research Council, Padova, Italy. · Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. · Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium. ·Maturitas · Pubmed #28041596.

ABSTRACT: Osteoarthritis (OA) is the most common chronic joint disorder and its prevalence increases rapidly during midlife. Complex interactions of genetic alterations, sex hormone deficit, and aging with mechanical factors and systemic inflammation-associated metabolic syndrome lead to joint damage. Thus, the expression of a clinical phenotype in the early stages of OA relies on the main underlying pathway and predominant joint tissue involved at a given time. Moreover, OA often coexists with other morbidities in the same patient, which in turn condition the OA process. In this scenario, an appropriate identification of clinical phenotypes, especially in the early stages of the disease, may optimize the design of individualized treatments in OA. An ESCEO-EUGMS (European Union Geriatric Medicine Society) working group has recently suggested possible patient profiles in OA. Hereby, we propose the existence of 4 clinical phenotypes - biomechanical, osteoporotic, metabolic and inflammatory - whose characterization would help to properly stratify patients with OA in clinical trials or studies. Further research in this field is warranted.

18 Review Case-Based Review of Osteonecrosis of the Jaw (ONJ) and Application of the International Recommendations for Management From the International Task Force on ONJ. 2017

Khan, Aliya A / Morrison, Archie / Kendler, David L / Rizzoli, Rene / Hanley, David A / Felsenberg, Dieter / McCauley, Laurie K / O'Ryan, Felice / Reid, Ian R / Ruggiero, Salvatore L / Taguchi, Akira / Tetradis, Sotirios / Watts, Nelson B / Brandi, Maria Luisa / Peters, Edmund / Guise, Teresa / Eastell, Richard / Cheung, Angela M / Morin, Suzanne N / Masri, Basel / Cooper, Cyrus / Morgan, Sarah L / Obermayer-Pietsch, Barbara / Langdahl, Bente L / Dabagh, Rana Al / Davison, K Shawn / Sándor, George K / Josse, Robert G / Bhandari, Mohit / El Rabbany, Mohamed / Pierroz, Dominique D / Sulimani, Riad / Saunders, Deborah P / Brown, Jacques P / Compston, Juliet / Anonymous3310890. ·Department of Medicine, Divisions of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada. Electronic address: Aliya@mcmaster.ca. · Division of Oral and Maxillofacial Surgery, Dalhousie University, Halifax, NS, Canada. · Department of Medicine, Division of Endocrinology, University of British Columbia, Vancouver, BC, Canada. · Division of Bone Diseases, Geneva University Hospitals, Geneva, Switzerland. · Departments of Medicine, Community Health Sciences and Oncology, University of Calgary, Calgary, AB, Canada. · Centre of Muscle & Bone Research, Charité-University Medicine Berlin, Campus Benjamin Franklin, Free University & Humboldt University Berlin, Berlin, Germany. · Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA. · Division of Maxillofacial Surgery, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA. · Department of Medicine, University of Auckland, Auckland, New Zealand. · Division of Oral and Maxillofacial Surgery, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA; Stony Brook School of Dental Medicine, Stony Brook, NY, USA; New York Center for Orthognathic and Maxillofacial Surgery, New York, NY, USA. · Department of Oral and Maxillofacial Radiology, School of Dentistry, Matsumoto Dental University, Shojiri, Japan. · Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA, USA. · Mercy Health Osteoporosis and Bone Health Services, Cincinnati, OH, USA. · Department of Surgery and Translational Medicine, University of Florence, Florence, Italy. · Department of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada. · Department of Medicine, Division of Endocrinology at Indiana University, Indianapolis, IN, USA. · Department of Human Metabolism, University of Sheffield, Sheffield, UK. · Department of Medicine, University of Toronto, Toronto, ON, Canada; Centre of Excellence in Skeletal Health Assessment, Joint Department of Medical Imaging, University Health Network (UHN), Toronto, ON, Canada; Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada. · Department of Medicine, McGill University, Montreal, QC, Canada. · Jordan Osteoporosis Center, Jordan Hospital & Medical Center, Amman, Jordan. · MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; NIHR Nutrition Biomedical Research Centre, University of Southampton, Southampton, UK; NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK. · Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham Osteoporosis Prevention and Treatment Clinic, Birmingham, AL, USA. · Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University Graz, Graz, Austria. · Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark. · Faculty of Dentistry, University of Toronto, Toronto, Canada. · Department of Education, University of Victoria,Victoria, BC, Canada. · Department of Oral and Maxillofacial Surgery, Oulu University Hospital, University of Oulu, Oulu, Finland. · Division of Endocrinology and Metabolism, University of Toronto, Toronto, ON, Canada. · Division of Orthopaedic Surgery, Department of Surgery, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. · Faculty of Dentistry, University of Toronto, Toronto, ON, Canada. · International Osteoporosis Foundation (IOF), Nyon, Switzerland. · College of Medicine, King Saud University, Riyadh, Saudi Arabia. · Department of Dental Oncology, Northeast Cancer Centre/Health Science North, Sudbury, ON, Canada. · Rheumatology Division, CHU de Québec Research Centre, Laval University, Quebec City, QC, Canada. · Department of Medicine, Cambridge Biomedical Campus, Cambridge, UK. ·J Clin Densitom · Pubmed #27956123.

ABSTRACT: Osteonecrosis of the jaw (ONJ) has been associated with antiresorptive therapy in both oncology and osteoporosis patients. This debilitating condition is very rare and advances in diagnosis and management may now effectively reduce the risk of its development and offer valuable treatment options for affected patients. This paper provides a case-based review of ONJ and application of the International Task Force on ONJ (referred to as the "Task Force") recommendations for the diagnosis and management of ONJ. The Task Force was supported by 14 international societies and achieved consensus from representatives of these multidisciplinary societies on key issues pertaining to the diagnosis and management of ONJ. The frequency of ONJ in oncology patients receiving oncology doses of bisphosphonate (BP) or denosumab is estimated at 1%-15%, and the frequency in the osteoporosis patient population receiving much lower doses of BP or denosumab is estimated at 0.001%-0.01%. Although the diagnosis of ONJ is primarily clinical, imaging may be helpful in confirming the diagnosis and staging. In those with multiple risk factors for ONJ for whom major invasive oral surgery is being planned, interruption of BP or denosumab therapy (in cancer patients) is advised, if possible, before surgery, until the surgical site heals. Major oral surgery in this context could include multiple extractions if surgical extractions are required, not simple forceps extractions. ONJ development may be reduced by optimizing oral hygiene and postoperatively using topical and systemic antibiotics as appropriate. Periodontal disease should be managed before starting oncology doses of BP or denosumab. Local debridement may be successful in disease unresponsive to conservative therapy. Successful surgical intervention has been reported in those with stage 3 disease; less severe disease is best managed conservatively. Teriparatide may be helpful in healing ONJ lesions and may be considered in osteoporosis patients at a high fracture risk in the absence of contraindications. Resumption of BP or denosumab therapy following healing of ONJ lesions is recommended, and there have not been reports of subsequent local recurrence.

19 Review Biologic therapies and bone loss in rheumatoid arthritis. 2017

Zerbini, C A F / Clark, P / Mendez-Sanchez, L / Pereira, R M R / Messina, O D / Uña, C R / Adachi, J D / Lems, W F / Cooper, C / Lane, N E / Anonymous1030886. ·Centro Paulista de Investigação Clínica, Rua Moreira e Costa, 342-Ipiranga, São Paulo, SP, 04266-010, Brazil. criszerb@uol.com.br. · Hospital Infantil Federico Gómez-Faculty of Medicine UNAM, Ciudad de México D.F, Mexico. · Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. · IRO Clinical Research Center Buenos Aires, Buenos Aires, Argentina. · Actavis Chair for Better Bone Health in Rheumatology, Hamilton, ON, Canada. · Amsterdam Rheumatology and Immunology Centre, VU University Medical Centre, Amsterdam, The Netherlands. · MRC Lifecourse Epidemiology Unit, Southampton, UK. · Faculty of Medicine, University of Southampton, Southampton, UK. · University of Oxford, Oxford, UK. · Center for Musculoskeletal Health, Sacramento, CA, USA. · UC Davis Health System, University of California, Sacramento, CA, USA. ·Osteoporos Int · Pubmed #27796445.

ABSTRACT: INTRODUCTION: Rheumatoid arthritis (RA) is a common systemic autoimmune disease of unknown cause, characterized by a chronic, symmetric, and progressive inflammatory polyarthritis. One of the most deleterious effects induced by the chronic inflammation of RA is bone loss. During the last 15 years, the better knowledge of the cytokine network involved in RA allowed the development of potent inhibitors of the inflammatory process classified as biological DMARDs. These new drugs are very effective in the inhibition of inflammation, but there are only few studies regarding their role in bone protection. The principal aim of this review was to show the evidence of the principal biologic therapies and bone loss in RA, focusing on their effects on bone mineral density, bone turnover markers, and fragility fractures. METHODS: Using the PICOST methodology, two coauthors (PC, LM-S) conducted the search using the following MESH terms: rheumatoid arthritis, osteoporosis, clinical trials, TNF- antagonists, infliximab, adalimumab, etanercept, certolizumab, golimumab, IL-6 antagonists, IL-1 antagonists, abatacept, tocilizumab, rituximab, bone mineral density, bone markers, and fractures. The search was conducted electronically and manually from the following databases: Medline and Science Direct. The search period included articles from 2003 to 2015. The selection included only original adult human research written in English. Titles were retrieved and the same two authors independently selected the relevant studies for a full text. The retrieved selected studies were also reviewed completing the search for relevant articles. The first search included 904 titles from which 253 titles were selected. The agreement on the selection among researchers resulted in a Kappa statistic of 0.95 (p < 0.000). Only 248 abstracts evaluated were included in the acronym PICOST. The final selection included only 28 studies, derived from the systematic search. Additionally, a manual search in the bibliography of the selected articles was made and included into the text and into the section of "small molecules of new agents." CONCLUSION: Treatment with biologic drugs is associated with the decrease in bone loss. Studies with anti-TNF blocking agents show preservation or increase in spine and hip BMD and also a better profile of bone markers. Most of these studies were performed with infliximab. Only three epidemiological studies analyzed the effect on fractures after anti-TNF blocking agent's treatment. IL-6 blocking agents also showed improvement in localized bone loss not seen with anti-TNF agents. There are a few studies with rituximab and abatacept. Although several studies reported favorable actions of biologic therapies on bone protection, there are still unmet needs for studies regarding their actions on the risk of bone fractures.

20 Review The role of calcium supplementation in healthy musculoskeletal ageing : An expert consensus meeting of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the International Foundation for Osteoporosis (IOF). 2017

Harvey, N C / Biver, E / Kaufman, J-M / Bauer, J / Branco, J / Brandi, M L / Bruyère, O / Coxam, V / Cruz-Jentoft, A / Czerwinski, E / Dimai, H / Fardellone, P / Landi, F / Reginster, J-Y / Dawson-Hughes, B / Kanis, J A / Rizzoli, R / Cooper, C. ·MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK. · NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK. · Service of Bone Diseases, University Hospitals Geneva, Geneva, Switzerland. · Department of Internal Medicine, section Endocrinology, Ghent University, Ghent, Belgium. · Department of Geriatric Medicine, Klinikum, Carl von Ossietzky University, Ammerländer Heerstrasse 114-118, 26129, Oldenburg, Germany. · CEDOC - NOVA Medical School, UNL and Rheumatology Department, CHLO/Hospital Egas Moniz, Lisbon, Portugal. · Head, Bone and Mineral Metabolic Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy. · Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium. · INRA, UMR 1019, UNH, CRNH Auvergne, F-63000, Clermont-Ferrand, France. · Clermont Université, Université d'Auvergne, Unité de Nutrition Humaine, BP 10448, F-63000, Clermont-Ferrand, France. · Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (Irycis), Madrid, Spain. · Department of Bone and Joint Diseases, Faculty of Health Sciences, Krakow Medical Centre, Jagiellonian University, Krakow, Poland. · Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria. · CHU Amiens, Université Picardie - Jules Verne, INSERM U 1088, Amiens, France. · Geriatric Department, Catholic University of Sacred Heart, Milan, Italy. · Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA. · Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK. · Institute for Health and Ageing, Catholic University of Australia, Melbourne, Australia. · MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK. cc@mrc.soton.ac.uk. · NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK. cc@mrc.soton.ac.uk. · Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, The Botnar Research Centre, University of Oxford, Oxford, UK. cc@mrc.soton.ac.uk. ·Osteoporos Int · Pubmed #27761590.

ABSTRACT: The place of calcium supplementation, with or without concomitant vitamin D supplementation, has been much debated in terms of both efficacy and safety. There have been numerous trials and meta-analyses of supplementation for fracture reduction, and associations with risk of myocardial infarction have been suggested in recent years. In this report, the product of an expert consensus meeting of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the International Foundation for Osteoporosis (IOF), we review the evidence for the value of calcium supplementation, with or without vitamin D supplementation, for healthy musculoskeletal ageing. We conclude that (1) calcium and vitamin D supplementation leads to a modest reduction in fracture risk, although population-level intervention has not been shown to be an effective public health strategy; (2) supplementation with calcium alone for fracture reduction is not supported by the literature; (3) side effects of calcium supplementation include renal stones and gastrointestinal symptoms; (4) vitamin D supplementation, rather than calcium supplementation, may reduce falls risk; and (5) assertions of increased cardiovascular risk consequent to calcium supplementation are not convincingly supported by current evidence. In conclusion, we recommend, on the basis of the current evidence, that calcium supplementation, with concomitant vitamin D supplementation, is supported for patients at high risk of calcium and vitamin D insufficiency, and in those who are receiving treatment for osteoporosis.

21 Review Clinical usefulness of bone turnover marker concentrations in osteoporosis. 2017

Morris, H A / Eastell, R / Jorgensen, N R / Cavalier, E / Vasikaran, S / Chubb, S A P / Kanis, J A / Cooper, C / Makris, K / Anonymous13260873. ·School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA 5000, Australia. Electronic address: Howard.Morris@sa.gov.au. · Mellanby Centre for Bone Research, University of Sheffield and Metabolic Bone Centre, Northern General Hospital, Herries Road, Sheffield, UK. · Research Centre for Aging and Osteoporosis, Department of Clinical Biochemistry, Rigshospitalet, Ndr Ringvej 57-59, DK-2600 Glostrup, Denmark; OPEN, Odense Patient data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, Odense, Denmark. · University of Liège, CHU Sart-Tilman, Domaine du Sart-Tilman, B-4000 Liège, Belgium. · Department of Clinical Biochemistry, PathWest Laboratory Medicine, Fiona Stanley Hospital, Murdoch, WA 6150, Australia. · Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK. · The MRC Epidemiology Resource Centre, Southampton General Hospital, University of Southampton, Southampton SO16 6YD, UK. · Clinical Biochemistry Department, KAT General Hospital, 14651 Athens, Greece. ·Clin Chim Acta · Pubmed #27374301.

ABSTRACT: Current evidence continues to support the potential for bone turnover markers (BTM) to provide clinically useful information particularly for monitoring the efficacy of osteoporosis treatment. Many of the limitations identified earlier remain, principally in regard to the relationship between BTM and incident fractures. Important data are now available on reference interval values for CTX and PINP across a range of geographic regions and for individual clinical assays. An apparent lack of comparability between current clinical assays for CTX has become evident indicating the possible limitations of combining such data for meta-analyses. Harmonization of units for reporting serum/plasma CTX (ng/L) and PINP (μg/L) is recommended. The development of international collaborations continues with an important initiative to combine BTM results from clinical trials in osteoporosis in a meta-analysis and an assay harmonization program are likely to be beneficial. It is possible that knowledge derived from clinical studies can further enhance fracture risk estimation tools with inclusion of BTM together with other independent risk factors. Further data of the relationships between the clinical assays for CTX and PINP as well as physiological and pre-analytical factors contributing to variability in BTM concentrations are required.

22 Review Novel advances in the treatment of osteoporosis. 2016

Chan, Christopher K Y / Mason, Alice / Cooper, Cyrus / Dennison, Elaine. ·University Hospital Southampton NHS Foundation Trust, Rheumatology Department, Southampton General Hospital, Southampton, SO16 6YD, UK. · MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK. ·Br Med Bull · Pubmed #27558130.

ABSTRACT: INTRODUCTION: Osteoporosis is a significant public health issue affecting over half of women aged over 50. With an aging population, its importance is set to increase further over time. Prevention of fragility fractures avoids significant mortality and morbidity as well as saving significant direct and indirect costs to the economy. In this review, we discuss existing treatments to contextualize the treatment landscape, and demonstrate how our understanding of bone pathophysiology has led to novel therapies-in the form of combinations and altered durations of existing treatments, as well as newer drug therapies. SOURCES OF DATA: PubMed and Embase were searched for randomized controlled trials of new therapies for osteoporosis. These searches were supplemented with material presented in abstract form at international meetings. AREAS OF AGREEMENT: New drugs that appear promising in the treatment of osteoporosis include the cathepsin K inhibitor, monoclonal antibodies against sclerostin and parathyroid hormone-related protein analog. AREAS OF CONTROVERSY: Separate to the development of novel drug therapies is the issue of how best to use agents that are currently available to us; specifically which agent to choose, alone or in combination; duration of therapy; how best to identify patients at highest risk of fracture, and to ensure the highest possible adherence to medication. Many of these issues have been addressed in other excellent review papers, and will not be considered in detail here. GROWING POINTS: As with all new treatments, we await results of long-term use and experience in 'real life' patient populations. AREAS TIMELY FOR DEVELOPING RESEARCH: As alluded to above, data are urgently required regarding the optimal duration of therapy; use of combination therapy; ordering of therapies for best therapeutic effect. As stratified medicine becomes more strongly considered in all areas of therapy, its merits in osteoporosis as in other musculoskeletal conditions, is timely and valuable.

23 Review Recent advances in the pathogenesis and treatment of osteoporosis. 2016

Curtis, Elizabeth M / Moon, Rebecca J / Dennison, Elaine M / Harvey, Nicholas C / Cooper, Cyrus. ·MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK. · MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK, and Paediatric Endocrinology, Southampton University Hospitals NHS Foundation Trust, Southampton, UK. · MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK, and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK. · MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK, NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK, and NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK cc@mrc.soton.ac.uk. ·Clin Med (Lond) · Pubmed #27481382.

ABSTRACT: Over recent decades, the perception of osteoporosis has changed from that of an inevitable consequence of ageing, to that of a well characterised and treatable chronic non-communicable disease, with major impacts on individuals, healthcare systems and societies. Characterisation of its pathophysiology from the hierarchical structure of bone and the role of its cell population, development of effective strategies for the identification of those most appropriate for treatment, and an increasing armamentarium of efficacious pharmacological therapies, have underpinned this evolution. Despite this marked progress, individuals who experience a fragility fracture remain under-treated in many areas of the world, and there is substantial need for investment both in secondary and primary prevention globally. In this brief article, we give an overview of the pathogenesis of osteoporosis, and summarise current and future approaches to its assessment and -treatment.

24 Review A systematic review of intervention thresholds based on FRAX : A report prepared for the National Osteoporosis Guideline Group and the International Osteoporosis Foundation. 2016

Kanis, John A / Harvey, Nicholas C / Cooper, Cyrus / Johansson, Helena / Odén, Anders / McCloskey, Eugene V / Anonymous2681055. ·Centre for Metabolic Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK. w.j.pontefract@sheffield.ac.uk. · Institute of Health and Ageing, Australian Catholic University, Melbourne, Australia. w.j.pontefract@sheffield.ac.uk. · MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK. · Centre for Metabolic Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK. ·Arch Osteoporos · Pubmed #27465509.

ABSTRACT: INTRODUCTION: In most assessment guidelines, treatment for osteoporosis is recommended in individuals with prior fragility fractures, especially fractures at spine and hip. However, for those without prior fractures, the intervention thresholds can be derived using different methods. The aim of this report was to undertake a systematic review of the available information on the use of FRAX® in assessment guidelines, in particular the setting of thresholds and their validation. METHODS: We identified 120 guidelines or academic papers that incorporated FRAX of which 38 provided no clear statement on how the fracture probabilities derived are to be used in decision-making in clinical practice. The remainder recommended a fixed intervention threshold (n = 58), most commonly as a component of more complex guidance (e.g. bone mineral density (BMD) thresholds) or an age-dependent threshold (n = 22). Two guidelines have adopted both age-dependent and fixed thresholds. RESULTS: Fixed probability thresholds have ranged from 4 to 20 % for a major fracture and 1.3-5 % for hip fracture. More than one half (39) of the 58 publications identified utilised a threshold probability of 20 % for a major osteoporotic fracture, many of which also mention a hip fracture probability of 3 % as an alternative intervention threshold. In nearly all instances, no rationale is provided other than that this was the threshold used by the National Osteoporosis Foundation of the USA. Where undertaken, fixed probability thresholds have been determined from tests of discrimination (Hong Kong), health economic assessment (USA, Switzerland), to match the prevalence of osteoporosis (China) or to align with pre-existing guidelines or reimbursement criteria (Japan, Poland). Age-dependent intervention thresholds, first developed by the National Osteoporosis Guideline Group (NOGG), are based on the rationale that if a woman with a prior fragility fracture is eligible for treatment, then, at any given age, a man or woman with the same fracture probability but in the absence of a previous fracture (i.e. at the 'fracture threshold') should also be eligible. Under current NOGG guidelines, based on age-dependent probability thresholds, inequalities in access to therapy arise especially at older ages (≥70 years) depending on the presence or absence of a prior fracture. An alternative threshold using a hybrid model reduces this disparity. CONCLUSION: The use of FRAX (fixed or age-dependent thresholds) as the gateway to assessment identifies individuals at high risk more effectively than the use of BMD. However, the setting of intervention thresholds needs to be country-specific.

25 Review Balancing benefits and risks of glucocorticoids in rheumatic diseases and other inflammatory joint disorders: new insights from emerging data. An expert consensus paper from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). 2016

Cooper, Cyrus / Bardin, Thomas / Brandi, Maria-Luisa / Cacoub, Patrice / Caminis, John / Civitelli, Roberto / Cutolo, Maurizio / Dere, Willard / Devogelaer, Jean-Pierre / Diez-Perez, Adolfo / Einhorn, Thomas A / Emonts, Patrick / Ethgen, Olivier / Kanis, John A / Kaufman, Jean-Marc / Kvien, Tore K / Lems, Willem F / McCloskey, Eugene / Miossec, Pierre / Reiter, Susanne / Ringe, Johann / Rizzoli, René / Saag, Kenneth / Reginster, Jean-Yves. ·MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK. cc@mrc.soton.ac.uk. · NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK. cc@mrc.soton.ac.uk. · Department of Rhumatologie, Hôpital Lariboisière Assistance Publique Hôpitaux de Paris, University Paris VII, Paris, France. · Department of Internal Medicine, University of Florence, Florence, Italy. · Department Hospitalo-Universitaire I2B, INSERM, UMR S 959, CNRS 7211, UPMC University of Paris 06, Paris, France. · Group Hospitalier Pitié-Salpêtrière, Department of Internal Medicine, Paris, France. · UCB Biosciences, 8010 Arco Corporate Drive, Raleigh, NC, USA. · Division of Bone and Mineral Diseases, Washington University, St. Louis, MO, USA. · Research Laboratories and Clinical Academic Division of Rheumatology, University Medical School of Genoa, Genoa, Italy. · Internal Medicine, University of Utah, Salt Lake City, UT, USA. · Rheumatology Department, Saint-Luc University Hospital, Louvain University in Brussels, Brussels, Belgium. · Servicio de Medicina Interna y Enfermedades Infecciosas, Hospital del Mar-IMIM and RETICEF, Barcelona, Spain. · Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA, USA. · Bone and Cartilage Metabolism Unit, Department of Public Health Sciences, University of Liege, Liège, Belgium. · Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium. · Centre for Metabolic Bone Diseases, Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, UK. · Department of Endocrinology, Ghent University Hospital, Ghent, Belgium. · Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · Department of Rheumatology, VU University Medical Hospital, Amsterdam, The Netherlands. · Immunogenomics and Inflammation Research Unit, Department of Immunology and Rheumatology, University of Lyon 1, Lyon, France. · , Bonn, Germany. · West German Osteoporosis Center (WOC), University of Cologne, Leverkusen, Germany. · Service of Bone Diseases, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland. · Division of Clinical Immunology and Rheumatology, University of Alabama, Birmingham, AL, USA. · Department of Public Health, Epidemiology and Health Economics, University of Liege, Liège, Belgium. ·Aging Clin Exp Res · Pubmed #26746234.

ABSTRACT: PURPOSE: This consensus review article considers the question of whether glucocorticoid (GC) therapy is still relevant in the treatment of rheumatic diseases, with a particular focus on rheumatoid arthritis (RA), and whether its side effects can be adequately managed. Recent basic and clinical research on the molecular, cellular and clinical effects of GCs have considerably advanced our knowledge in this field. An overview of the subject seems appropriate. METHODS: This review is the result of a multidisciplinary expert working group, organised by European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis. The recent literature was surveyed and the salient evidence synthetized. RESULTS: The pathophysiological basis of RA (and other inflammatory rheumatic diseases) now strongly implicates the adaptive immune system in addition to innate mechanisms. The molecular effect of GCs and differential GC sensitivity is better understood, although exploiting this knowledge is still in its infancy. The newer treatment strategies of early and aggressive control of RA have gr eatly improved clinical outcomes, but improvements are still possible. Newer targeted anti-inflammatory drugs have made an important impact, yet they too are associated with numerous side effects. DISCUSSION: Short durations of moderate doses of GCs are generally well tolerated and have a positive benefit/risk ratio. Patients should be assessed for fracture risk and bone preserving agents and be prescribed calcium and vitamin D supplementation. CONCLUSIONS: Within a strategy of a disease modifying approach to inflammatory disease, combination therapy including a GC is effective approach.

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