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Osteoporosis: HELP
Articles by Kenneth G. Saag
Based on 104 articles published since 2008
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Between 2008 and 2019, K. G. Saag wrote the following 104 articles about Osteoporosis.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5
1 Editorial How to use bisphosphonates safely and optimally. 2018

Jagpal, Aprajita / Saag, Kenneth G. ·Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA. ·Rheumatology (Oxford) · Pubmed #29165674.

ABSTRACT: -- No abstract --

2 Editorial Response to the American College of Physicians Osteoporosis Guideline, 2017 Update. 2017

Caplan, Liron / Hansen, Karen E / Saag, Kenneth G. ·University of Colorado Denver School of Medicine and Denver Veterans Affairs Medical Center, Denver, Colorado. · University of Wisconsin School of Medicine & Public Health, Madison. · University of Alabama at Birmingham. ·Arthritis Rheumatol · Pubmed #28881479.

ABSTRACT: -- No abstract --

3 Editorial Challenges in defining quality of care for glucocorticoid-induced osteoporosis: defending good against perfect. 2013

Saag, Kenneth G / Curtis, Jeffrey / Warriner, Amy. ·Division of Immunology and Rheumatology; ·J Rheumatol · Pubmed #24085752.

ABSTRACT: -- No abstract --

4 Review Glucocorticoid-induced Osteoporosis. 2016

Whittier, Xena / Saag, Kenneth G. ·Division of Clinical Immunology and Rheumatology, 851 Faculty Office Tower, 510 20th Street South, Birmingham, AL 35294, USA. · Division of Clinical Immunology and Rheumatology, Department of Medicine, Center for Education and Research on Therapeutics (CERTs), Center for Outcomes, Effectiveness Research and Education (COERE), Center of Research Translation (CORT) in Gout and Hyperuricemia, University of Alabama at Birmingham, 820 Faculty Office Tower, 510 20th Street South, Birmingham, AL 35294, USA. Electronic address: ksaag@uab.edu. ·Rheum Dis Clin North Am · Pubmed #26611558.

ABSTRACT: Glucocorticoid-induced osteoporosis (GIOP) is one of the most common and serious adverse effects associated with glucocorticoid use. This article highlights GIOP pathophysiology, epidemiologic associations, effective treatment, and lifestyle modifications that can reduce fracture risk for long-term glucocorticoid users and additionally emphasizes the importance of early intervention.

5 Review Evaluating and mitigating fracture risk in established rheumatoid arthritis. 2015

Mullen, Matthew B / Saag, Kenneth G. ·University of Alabama-Birmingham, Birmingham, AL, USA. · University of Alabama-Birmingham, Birmingham, AL, USA. Electronic address: ksaag@uab.edu. ·Best Pract Res Clin Rheumatol · Pubmed #26697770.

ABSTRACT: Patients with rheumatoid arthritis are predisposed to systemic bone loss, and they are at an increased risk of fractures. Although there are similarities in the patient demographics between rheumatoid arthritis patients and the general population of osteoporosis patients, there are factors, particularly the use of glucocorticoids, which are specific to rheumatoid arthritis. These factors can lead to an increased risk of bone loss and fracture. Given that fractures are often very debilitating, especially in elderly patients, it is of paramount importance for the practicing rheumatologist to be aware of ways to reduce the risk of fracture in patients with rheumatoid arthritis. This review discusses currently available modalities for fracture risk assessment as well as pharmacologic and lifestyle interventions available to treat and prevent bone loss in rheumatoid arthritis patients.

6 Review Fracture mortality: associations with epidemiology and osteoporosis treatment. 2014

Sattui, Sebastian E / Saag, Kenneth G. ·Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, 820 Faculty Office Tower, 510 20th Street South, Birmingham, AL 35294, USA. ·Nat Rev Endocrinol · Pubmed #25091729.

ABSTRACT: The rates of incident osteoporotic fractures seem to be stabilizing; however, fragility fractures are still associated with considerable disability, costs and an increased risk of mortality, which is particularly the case for fractures of the hip and vertebra. Mortality is usually highest during the first year after fracture; however, a notably increased mortality risk might persist for several years after the event. In addition to its efficacy in the prevention of new and recurrent osteoporotic fractures, medical treatment has been associated with improved survival after osteoporotic fractures. Observational studies and randomized controlled clinical trials have reported increased survival in patients with a fracture who are treated with bisphosphonates. Rates of medical treatment in patients with osteoporosis remain low, and although the rationale for the putative increase in survival is unclear, this emerging evidence might help further justify the use of medical treatment after fracture. However, further work is needed before medical therapy for mortality prevention in patients with osteoporotic fractures is accepted.

7 Review Glucocorticoid-related bone changes from endogenous or exogenous glucocorticoids. 2013

Warriner, Amy H / Saag, Kenneth G. ·aDivision of Endocrinology, Metabolism and Diabetes bDivision of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA. ·Curr Opin Endocrinol Diabetes Obes · Pubmed #24468753.

ABSTRACT: PURPOSE OF REVIEW: Glucocorticoids have a negative impact on bone through direct effects on bone cells and indirect effects on calcium absorption. Here, recent findings regarding glucocorticoid-induced osteoporosis, bone changes in patients with endogenous glucocorticoid derangements, and treatment of steroid-induced bone disease are reviewed. RECENT FINDINGS: Although the majority of our understanding arises from the outcomes of patients treated with exogenous steroids, endogenous overproduction appears to be similarly destructive to bone, but these effects are reversible with cure of the underlying disease process. Additionally, there are bone changes that occur in diseases that interrupt adrenal glucocorticoid production, both in response to our inability to perfectly match glucocorticoid replacement and also related to the underlying disease process. More investigation is required to understand which patients with endogenous overproduction or underproduction of glucocorticoid would benefit from osteoporosis treatment. Better understood is the benefit that can be achieved with currently approved treatments for glucocorticoid-induced osteoporosis from exogenous steroids. With growing concern of long-term use of bisphosphonates, however, further investigation into the duration of use and use in certain populations, such as children and premenopausal women, is essential. SUMMARY: Glucocorticoid-induced osteoporosis is a complex disease that is becoming better understood through advances in the study of exogenous and endogenous glucocorticoid exposure. Further advancement of proper treatment and prevention is on the horizon.

8 Review Osteopenia: debates and dilemmas. 2013

Zhang, Jie / Morgan, Sarah L / Saag, Kenneth G. ·Department of Epidemiology, University of Alabama at Birmingham, 1665 University Blvd, Ryals 230K, Birmingham, AL, 35294, USA, jszhang@uab.edu. ·Curr Rheumatol Rep · Pubmed #24222198.

ABSTRACT: Whether or not to use pharmacologic agents for primary prevention of fracture among elderly men and women with osteopenia is debated by clinicians. In this review we provide an update to enable better understanding and characterization of this population, including the prevalence of osteopenia, transitioning from osteopenia to osteoporosis, and clinically applicable tools for fracture risk assessment. We also emphasize the very limited evidence of the benefits and risks of anti-osteoporotic agents for this population for primary fracture prevention, and the need for future studies to guide clinical practice.

9 Review Prevention and treatment of bone changes associated with exposure to glucocorticoids. 2013

Warriner, Amy H / Saag, Kenneth G. ·Division of Endocrinology, Metabolism and Diabetes, University of Alabama at Birmingham, 702 Faculty Office Tower, 510 20th Street South, Birmingham, AL, 35233, USA, warriner@uab.edu. ·Curr Osteoporos Rep · Pubmed #24097304.

ABSTRACT: Rheumatologic diseases are associated with a proinflammatory state, which is thought to lead to many of the bone changes seen in treatment-naive patients. However, glucocorticoids remain a common treatment option for rheumatologic diseases and are known to have a negative impact on bone through direct effects on bone cells and indirect effects on calcium absorption. Despite the anti-inflammatory effect of glucocorticoids, fracture risk rises within the first 3 months of treatment. As such, osteoporosis prevention and treatment needs to be considered in all patients started on chronic glucocorticoids (≥3 months of treatment). For very low risk patients, conservative management with non-pharmacologic strategies may be appropriate. For the moderate to high fracture risk patients treated with glucocorticoids, pharmacologic treatment with 1 of the 4 approved medications should be considered. The challenge of educating physicians and patients of the risks of glucocorticoid induced osteoporosis remain.

10 Review Study design considerations for a large simple trial of bisphosphonates. 2013

Wright, Nicole C / Warriner, Amy H / Saag, Kenneth G. ·Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA. ncwright@uab.edu ·Curr Opin Rheumatol · Pubmed #23656714.

ABSTRACT: PURPOSE OF REVIEW: To evaluate design considerations for an osteoporosis large simple trial (LST). RECENT FINDINGS: There is a growing need for more comparative effectiveness studies in osteoporosis. However, the design of such studies is challenged by issues surrounding study design, choosing comparator therapies, participant and outcome selection, data acquisition and data analysis. SUMMARY: LSTs are real-world studies that can have high levels of generalizability, if designed properly. We propose novel approaches to LSTs focusing on some of the challenges associated with comparative effectiveness research in osteoporosis. In this review, we discuss these considerations in the context of bisphosphonate active comparator initiation and discontinuation trials, while presenting advantages and disadvantages of the various design aspects for such studies.

11 Review Osteoporosis diagnosis and medical treatment. 2013

Warriner, Amy H / Saag, Kenneth G. ·Division of Endocrinology, Metabolism and Diabetes, University of Alabama at Birmingham, Birmingham, AL 35233, USA. warriner@uab.edu ·Orthop Clin North Am · Pubmed #23544819.

ABSTRACT: Osteoporosis, the presence of either low bone mineral density or a history of a fragility fracture, is known to be associated with an increased risk of future fracture. Fracture prevention is possible through use of both nonpharmacologic and prescription treatments. Despite recent controversy regarding the safety of calcium supplementation and the appropriate dosing of calcium and vitamin D, calcium and vitamin D remain an important part of bone health. However, prescription osteoporosis treatments should be considered for those at higher risk for fracture, and there are currently several treatment options available.

12 Review From fracture risk prediction to evaluating fracture patterns: recent advances in the epidemiology of osteoporosis. 2012

Wright, Nicole C / Saag, Kenneth G. ·Department of Epidemiology, University of Alabama at Birmingham, 35294, USA. ncwright@uab.edu ·Curr Rheumatol Rep · Pubmed #22453874.

ABSTRACT: Understanding the factors associated with fracture is one of the main research objective of the osteoporosis epidemiology field. Tools such as FRAX have overall improved the ability of clinicians and researchers to identify individuals at high risk of fragility fractures. However, the performance of these tools in specific subpopulations needs further examination. We highlight recent studies that have shown under- or overestimation of fractures using FRAX in subpopulations, as well as recently proposed modifications to this important algorithm. We also discuss recent evaluations of secular trends in fracture incidence.

13 Review Long-term safety concerns of antiresorptive therapy. 2011

Zhang, Jie / Saag, Kenneth G / Curtis, Jeffrey R. ·Health Services/Comparative Effectiveness Research Training Program, Department of Epidemiology, University of Alabama at Birmingham, 1665 University Boulevard, RPHB 517B, Birmingham, AL 35294, USA. ·Rheum Dis Clin North Am · Pubmed #22023898.

ABSTRACT: Bisphosphonates reduce the risk of major osteoporotic fractures and are the most commonly used medications for the prevention and treatment of osteoporosis. Although these medications are well tolerated and safe during large-scale clinical trials, several rare and serious adverse events are suspected to be associated with long-term bisphosphonate use. These adverse events include osteonecrosis of the jaw, atypical fractures, and esophageal cancer. This review summarizes studies examining the association between bisphosphonate use and these adverse outcomes, with a focus on large case series and controlled epidemiologic studies.

14 Review Potential and pitfalls of using large administrative claims data to study the safety of osteoporosis therapies. 2011

Zhang, Jie / Yun, Huifeng / Wright, Nicole C / Kilgore, Meredith / Saag, Kenneth G / Delzell, Elizabeth. ·Department of Epidemiology and Health Services/Comparative Effectiveness Research Training Program, University of Alabama at Birmingham, 1665 University Boulevard, RPHB 517B, Birmingham, AL 35294, USA jszhang@uab.edu ·Curr Rheumatol Rep · Pubmed #21312073.

ABSTRACT: Long-term bisphosphonate use may be associated with several rare adverse events. Such associations are not optimally evaluated in conventional randomized controlled trials due to the requirements of large numbers of patients and long-term follow-up. Alternatively, administrative claims data from various sources such as Medicare have been used. Because claims data are collected for billing and reimbursement purposes, they have limitations, including uncertain diagnostic validity and lack of detailed clinical information. Using such data for pharmacoepidemiologic research requires complex methodologies that may be less familiar to many researchers and clinicians. In this review, we discuss the strengths and limitations of using claims data for osteoporosis drug safety research, summarize recent advancements in methodologies that may be used to address the limitations, and present directions for future research using claims data.

15 Review American College of Rheumatology 2010 recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. 2010

Grossman, Jennifer M / Gordon, Rebecca / Ranganath, Veena K / Deal, Chad / Caplan, Liron / Chen, Weiling / Curtis, Jeffrey R / Furst, Daniel E / McMahon, Maureen / Patkar, Nivedita M / Volkmann, Elizabeth / Saag, Kenneth G. ·University of California, Los Angeles, 90095, USA. jgrossman@mednet.ucla.edu ·Arthritis Care Res (Hoboken) · Pubmed #20662044.

ABSTRACT: -- No abstract --

16 Review From bone biology to clinical outcome: state of the art and future perspectives. 2010

Schett, Georg / Saag, Kenneth G / Bijlsma, Johannes W J. ·Department of Internal Medicine 3, Erlangen, Germany. ·Ann Rheum Dis · Pubmed #20650876.

ABSTRACT: In the last decade progress has been made in our understanding of bone biology. In particular, the relation between inflammation and bone has become much clearer, leading to bone-targeting therapies in inflammatory rheumatic diseases. The clinical sequelae of the influences of both inflammation and immobility (due to arthritis) on bone for different rheumatic diseases (such as rheumatoid arthritis, systemic lupus erythematosus and spondyloarthritides) have also now captured the attention of clinicians. In the last decade the well-known negative influences of glucocorticoids on bone have become more treatable as a result of new drugs that stimulate osteoblasts and restore the negative bone balance.

17 Review Progress in osteoporosis and fracture prevention: focus on postmenopausal women. 2009

Saag, Kenneth G / Geusens, Piet. ·Division of Clinical Immunology and Rheumatology, Center for Education and Research on Therapeutics, University of Alabama at Birmingham, 820 Faculty Office Tower, 510 20th Street South, Birmingham, AL 35294-3708, USA. ksaag@uab.edu ·Arthritis Res Ther · Pubmed #19849819.

ABSTRACT: In the past decade, we have witnessed a revolution in osteoporosis diagnosis and therapeutics. This includes enhanced understanding of basic bone biology, recognizing the severe consequences of fractures in terms of morbidity and short-term re-fracture and mortality risk and case finding based on clinical risks, bone mineral density, new imaging approaches, and contributors to secondary osteoporosis. Medical interventions that reduce fracture risk include sufficient calcium and vitamin D together with a wide spectrum of drug therapies (with antiresorptive, anabolic, or mixed effects). Emerging therapeutic options that target molecules of bone metabolism indicate that the next decade should offer even greater promise for further improving our diagnostic and treatment approaches.

18 Review Management of osteoporosis among home health and long-term care patients with a prior fracture. 2009

Warriner, Amy H / Outman, Ryan C / Saag, Kenneth G / Berry, Sarah D / Colón-Emeric, Cathleen / Flood, Kellie L / Lyles, Kenneth W / Tanner, S Bobo / Watts, Nelson B / Curtis, Jeffrey R. ·University of Alabama at Birmingham, USA. ·South Med J · Pubmed #19279529.

ABSTRACT: Osteoporosis is a growing health concern as the number of senior adults continues to increase worldwide. Falls and fractures are very common among frail older adults requiring home health and long-term care. Preventative strategies for reducing falls have been identified and many therapies (both prescription and nonprescription) with proven efficacy for reducing fracture risk are available. However, many practitioners overlook the fact that a fragility fracture is diagnostic for osteoporosis even without knowledge of bone mineral density testing. As a result, osteoporosis is infrequently diagnosed and treated in the elderly after a fracture. Based on existing literature, we have developed an algorithm for the assessment and treatment of osteoporosis among persons with known prior fracture(s) living in long-term care facilities or receiving home health care based on the data available in the literature.

19 Review Quality health care gaps in osteoporosis: how can patients, providers, and the health system do a better job? 2009

Teng, Gim Gee / Curtis, Jeffrey R / Saag, Kenneth G. ·Center for Education and Research on Therapeutics of Musculoskeletal Disorders, and Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, 510 20th Street South, Birmingham, AL 35294-3708, USA. ·Curr Osteoporos Rep · Pubmed #19239827.

ABSTRACT: A significant gap exists between evidence-based advances and real-world clinical practice in the diagnosis and prevention of osteoporosis. The goal of osteoporosis care is to prevent fractures and improve health-related quality of life, and ideally lower mortality. Despite recent advances in osteoporosis detection and treatment options, studies suggest underdiagnosis and undertreatment of osteoporosis, even among those who have already sustained fractures. The challenges in translating knowledge into practice are multifaceted, with efforts directed at the patient, provider, and health care system levels achieving variable success at the population level. Methods to improve quality of care in osteoporosis need to be multipronged, with emphasis on clinical process improvement and reliance on interdisciplinary teams. We review the growing literature on quality of care for osteoporosis.

20 Review Glucocorticoids and the risk of osteoporosis. 2009

Caplan, Liron / Saag, Kenneth G. ·University of Colorado Denver, Denver Veterans Affairs Medical Center, PO Box 6511, B115, Colorado 80045, Denver, USA. liron.caplan@uchsc.edu ·Expert Opin Drug Saf · Pubmed #19236216.

ABSTRACT: BACKGROUND: Glucocorticoid-induced osteoporosis (GIO) refers to a clinical condition in which a class of corticosteroids increases the susceptibility of bones to fracture. Numerous recent studies have improved our understanding of the underlying biology of this condition, whereas data from randomized controlled trials have provided clinicians with more options for prevention of GIO. OBJECTIVE: To review the pathophysiology and epidemiology of GIO, as well as current pharmacologic treatment and prevention modalities available. To review the state of healthcare provider concordance with GIO prevention guidelines. METHODS: Representative examples of various cellular and molecular processes underlying GIO were included, with an emphasis towards more recent discoveries. The data used to describe the epidemiology of GIO were derived from both randomized controlled studies and observational studies, framed through a discussion of known osteoporosis risk factors. RESULTS/CONCLUSION: Progress has been made in clarifying the pathophysiologic mechanisms that result in GIO. Although the options for preventions and treatment of GIO continue to expand, provider compliance with preventive measures remains suboptimal.

21 Review Impact of osteoporosis treatment adherence on fracture rates in North America and Europe. 2009

Siris, Ethel S / Selby, Peter L / Saag, Kenneth G / Borgström, Fredrik / Herings, Ron M C / Silverman, Stuart L. ·Toni Stabile Osteoporosis Center, Department of Medicine, Columbia University Medical Center, New York, New York 10032, USA. es27@columbia.edu ·Am J Med · Pubmed #19187810.

ABSTRACT: Fragility fractures associated with osteoporosis constitute a significant public health concern. Clinical trials have shown that a variety of agents--bisphosphonates, raloxifene, calcitonin, hormone replacement therapy, teriparatide, and strontium ranelate--can reduce the risk of osteoporosis-related fragility fractures. However, low levels of compliance and persistence in the real-life setting mean that efficacy benefits observed in clinical trials with these agents may not translate into equivalent effectiveness in daily practice. The aim of this review is to provide a comprehensive evaluation of compliance and persistence data from retrospective/observational studies, with particular reference to studies that consider the effects on fracture rates. PubMed of the National Center for Biotechnology Information (NCBI) and Web of Science databases were searched for publications detailing observational or retrospective analyses of adherence, compliance, and persistence with osteoporosis therapies. In addition, authors provided relevant studies that were not retrieved using the search criteria. In total, 17 unique publications were identified. Analysis of the publications indicated that low compliance and persistence rates for osteoporosis therapies in the real-life setting result in increased rates of fragility fractures. The results emphasize the importance of good treatment compliance and persistence with osteoporosis therapies in order to achieve a significant therapeutic benefit and thereby reduce the burden that osteoporosis and associated fractures place on individuals and healthcare systems.

22 Review Mortality and osteoporotic fractures: is the link causal, and is it modifiable? 2008

Teng, G G / Curtis, J R / Saag, K G. ·Division of Rheumatology, National University Hospital, Singapore. ·Clin Exp Rheumatol · Pubmed #19026155.

ABSTRACT: Osteoporosis is a global problem with an expected increase in fracture prevalence and public health burden as the world's population ages. Although excess mortality is well-described in those with low bone mineral density as well as those with recent hip and vertebral fractures, some uncertainty remains about whether this link is causal. Survival depends greatly on the fracture types, age, gender, and race. Deaths are predominately due to comorbidities, but may also be attributed to the fracture event itself, either directly or indirectly. The goal of osteoporosis care is prevention of fractures and ultimately reduction in morbidity and mortality. Until recently, there have been no data showing that osteoporosis treatment improves mortality, and even now the extent of these data are rather limited. Large observational cohort studies over considerable time are needed to determine whether improving osteoporosis quality of care will improve mortality rates.

23 Review The effect of thiazolidinediones on BMD and osteoporosis. 2008

McDonough, Allyson K / Rosenthal, Richard S / Cao, Xu / Saag, Kenneth G. ·University of Alabama at Birmingham, Division of Clinical Immunology/Rheumatology, FOT 820D, 1530 3rd Avenue South, Birmingham, AL 35294-3408, USA. ·Nat Clin Pract Endocrinol Metab · Pubmed #18695700.

ABSTRACT: Thiazolidinediones, also known as glitazones, are insulin-sensitizing medications that account for approximately 21% of oral antihyperglycemic drugs used in the US. Although the main therapeutic effects occur in adipose tissue, muscles and the liver, studies suggest effects in bone as well. Currently, two thiazolidinediones are marketed in the US-rosiglitazone and pioglitazone-and several others are under investigation. This Review examines the evidence regarding the effects of thiazolidinediones on skeletal health. These drugs appear to trigger preferential differentiation of mesenchymal stem cells into adipocytes rather than osteoblasts, leading to decreased bone formation and increased adipogenesis. Although only a few small, randomized studies have examined the effects of thiazolidinediones on bone in humans, the available data suggest that these agents contribute to bone loss in postmenopausal women; the relationship is less clear in men. On the basis of this limited evidence, the absolute increase in fracture risk associated with thiazolidinediones seems to be small. Pending data from future randomized, controlled trials of the association between thiazolidinediones and low bone mass, prescribers should consider use of these drugs as a risk factor for the development of osteoporosis in postmenopausal women.

24 Review Improving quality of care in osteoporosis: opportunities and challenges. 2008

Teng, Gim Gee / Warriner, Amy / Curtis, Jeffrey R / Saag, Kenneth G. ·Center for Education and Research on Therapeutics (CERTs) of Musculoskeletal Disorders, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, 820 Faculty Office Tower, 510 20th Street South, Birmingham, AL 35294-3708, USA. ·Curr Rheumatol Rep · Pubmed #18460267.

ABSTRACT: Osteoporosis is a chronic disease with a projected escalation in fracture prevalence and costs as the population ages. Osteoporosis care aims to prevent fractures and ultimately improve health-related quality of life. Despite significant evidence-based advances in testing and treatment, a large proportion of patients with fragility fracture or other osteoporosis risk factors are never evaluated with bone mineral density measurement testing and never receive therapy. This suboptimal quality of care can be attributed to barriers at the patient, provider, and health system levels. In addition, significant disparities in care exist across age, ethnicity, and gender. Recent studies have indicated that restructuring care at the system level is more likely to be successful, dependable, and durable than traditional quality improvement interventions focusing predominantly on physicians.

25 Review Drug Insight: choosing a drug treatment strategy for women with osteoporosis-an evidence--based clinical perspective. 2008

Geusens, Piet P / Roux, Christian H / Reid, David M / Lems, Willem F / Adami, Silvano / Adachi, Jonathan D / Sambrook, Philip N / Saag, Kenneth G / Lane, Nancy E / Hochberg, Marc C. ·Department of Internal Medicine, Division of Rheumatology, University Hospital, P Debyelaan 25, Box 5800, 6202 AZ Maastricht, The Netherlands. piet.geusens@scarlet.be ·Nat Clin Pract Rheumatol · Pubmed #18398411.

ABSTRACT: Many randomized controlled trials (RCTs) have investigated drug treatment for women at high risk of fracture, with a reduction in fracture risk as their end point. There has also been progress in identifying women at the highest risk of fractures. The most important clinical determinant contributing to the clinical decision of initiating and choosing drug therapy for fracture prevention is a woman's fracture risk, which, in RCTs, was determined by menopausal state, age, bone mineral density, fracture history, fall risks and glucocorticoid use. Women with secondary osteoporosis were excluded, except in studies of glucocorticoid use. A second determinant of drug therapy is the evidence for fracture prevention in terms of spectrum (vertebral, nonvertebral and/or hip fractures), size and speed of effect. In the absence of head-to-head RCTs with fracture risk as the end point, however, the efficacy of antifracture drugs cannot be directly compared. Other determinants include the potential extraskeletal benefits and safety concerns of the drug, patient preferences and reimbursement issues.

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