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Osteoporosis: HELP
Articles from Minnesota
Based on 241 articles published since 2009
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These are the 241 published articles about Osteoporosis that originated from Minnesota during 2009-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10
1 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.

2 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.

3 Editorial Our Evolving Understanding of the Relationship Between Diabetes and Bone. 2017

Kotwal, Anupam / Drake, Matthew T. ·Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota. · Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota. Electronic address: drake.matthew@mayo.edu. ·Am J Med Sci · Pubmed #29078835.

ABSTRACT: -- No abstract --

4 Editorial A Crisis in the Treatment of Osteoporosis. 2016

Khosla, Sundeep / Shane, Elizabeth. ·Robert and Arlene Kogod Center on Aging and Endocrine Research Unit, Mayo Clinic College of Medicine, Rochester, MN, USA. · Division of Endocrinology, Department of Medicine, Columbia University, New York, NY, USA. ·J Bone Miner Res · Pubmed #27335158.

ABSTRACT: -- No abstract --

5 Editorial Vertebral fracture assessment: is lateral spine imaging in the supine or decubitus position better? 2012

Schousboe, John T. ·Park Nicollet Health Services; and Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA. Electronic address: schouj@parknicollet.com. ·J Clin Densitom · Pubmed #22921775.

ABSTRACT: -- No abstract --

6 Review Causes of low peak bone mass in women. 2018

Chew, Chee Kian / Clarke, Bart L. ·Mayo Clinic E18-A, 200 1st Street SW, Rochester, MN, 55905, USA. · Mayo Clinic E18-A, 200 1st Street SW, Rochester, MN, 55905, USA. Electronic address: clarke.bart@mayo.edu. ·Maturitas · Pubmed #29673833.

ABSTRACT: Peak bone mass is the maximum bone mass that accrues during growth and development. Consolidation of peak bone mass normally occurs during early adulthood. Low peak bone mass results from failure to achieve peak bone mass genetic potential, primarily due to bone loss caused by a variety of conditions or processes occurring at younger ages than usual. Recognized causes of low peak bone mass include genetic causes, endocrine disorders, nutritional disorders, chronic diseases of childhood or adolescence, medications, and idiopathic factors.

7 Review Inhibiting Cellular Senescence: A New Therapeutic Paradigm for Age-Related Osteoporosis. 2018

Khosla, Sundeep / Farr, Joshua N / Kirkland, James L. ·Division of Endocrinology and Metabolism and Kogod Center on Aging, Mayo Clinic, Rochester, Minnesota 55905. ·J Clin Endocrinol Metab · Pubmed #29425296.

ABSTRACT: Context: With the aging of the population and projected increase in osteoporotic fractures coupled with the declining use of osteoporosis medications, there is a compelling need for new approaches to treat osteoporosis. Given that age-related osteoporosis generally coexists with multiple other comorbidities (e.g., atherosclerosis, diabetes, frailty) that share aging as the leading risk factor, there is growing interest in the "Geroscience Hypothesis," which posits that manipulation of fundamental aging mechanisms will delay the appearance or severity of multiple chronic diseases because these diseases share aging as the underlying risk factor. In this context, one fundamental aging mechanism that has received considerable attention recently as contributing to multiple age-related morbidities is cellular senescence. This mini-review provides an overview on cellular senescence with a focus on its role in mediating age-related bone loss. Methods: This summary is based on the authors' knowledge of the field supplemented by a PubMed search using the terms "senescence," "aging," and "bone." Results: There is compelling evidence from preclinical models and supportive human data demonstrating an increase in senescent cells in the bone microenvironment with aging. These cells produce a proinflammatory secretome that leads to increased bone resorption and decreased bone formation, and approaches that either eliminate senescent cells or impair the production of their proinflammatory secretome have been shown to prevent age-related bone loss in mice. Conclusions: Targeting cellular senescence represents a novel therapeutic strategy to prevent not only bone loss but potentially multiple age-related diseases simultaneously.

8 Review Regulation of Bone Metabolism by Sex Steroids. 2018

Khosla, Sundeep / Monroe, David G. ·Robert and Arlene Kogod Center on Aging and Endocrine Research Unit, Mayo Clinic College of Medicine, Rochester, Minnesota 55905. ·Cold Spring Harb Perspect Med · Pubmed #28710257.

ABSTRACT: Osteoporosis is a significant public health problem, and a major cause of the disease is estrogen deficiency following menopause in women. In addition, considerable evidence now shows that estrogen is also a major regulator of bone metabolism in men. Since the original description of the effects of estrogen deficiency on bone by Fuller Albright more than 70 years ago, there has been enormous progress in understanding the mechanisms of estrogen and testosterone action on bone using human and mouse models. Although we understand more about the effects of estrogen on bone as compared with testosterone, both sex steroids do play important roles, perhaps in a somewhat compartment-specific (i.e., cancellous vs. cortical bone) manner. This review summarizes our current knowledge of sex steroid action on bone based on human and mouse studies, identifies both agreements and potential discrepancies between these studies, and suggests directions for future research in this important area.

9 Review Effect of Sex Steroids on the Bone Health of Transgender Individuals: A Systematic Review and Meta-Analysis. 2017

Singh-Ospina, Naykky / Maraka, Spyridoula / Rodriguez-Gutierrez, Rene / Davidge-Pitts, Caroline / Nippoldt, Todd B / Prokop, Larry J / Murad, Mohammad Hassan. ·Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota 55905. · Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, Florida 32610. · Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205. · Division of Endocrinology, Department of Internal Medicine, University Hospital "Dr. Jose E. Gonzalez," Autonomous University of Nuevo Leon, Monterrey, Mexico. · Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota 55905. · Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota 55905. ·J Clin Endocrinol Metab · Pubmed #28945851.

ABSTRACT: Background: The impact of sex steroids on bone health in transgender individuals is unclear. Methods: A comprehensive search of several databases to 7 April 2015 was conducted for studies evaluating bone health in transgender individuals receiving sex steroids. Pairs of reviewers selected and appraised studies. A random effects model was used to pool weighted mean differences and 95% confidence intervals (CIs). Results: Thirteen studies evaluating 639 transgender individuals were identified [392 male-to-female (MTF), 247 female-to-male (FTM)]. In FTM individuals and compared with baseline values before initiation of masculinizing hormone therapy, there was no statistically significant difference in the lumbar spine, femoral neck, or total hip bone mineral density (BMD) when assessed at 12 and 24 months. In MTF individuals and compared with baseline values before initiation of feminizing hormone therapy, there was a statistically significant increase in lumbar spine BMD at 12 months (0.04 g/cm2; 95% CI, 0.03 to 0.06 g/cm2) and 24 months (0.06 g/cm2; 95% CI, 0.04 to 0.08 g/cm2). Fracture rates were evaluated in a single cohort of 53 MTF and 53 FTM individuals, with no events at 12 months. The body of evidence is derived mostly from observational studies at moderate risk of bias. Conclusion: In FTM individuals, masculinizing hormone therapy was not associated with significant changes in BMD, whereas in MTF individuals feminizing hormone therapy was associated with an increase in BMD at the lumbar spine. The impact of these BMD changes on patient-important outcomes such as fracture risk is uncertain.

10 Review Osteoporosis. 2017

Ensrud, Kristine E / Crandall, Carolyn J. ·From the University of Minnesota and Veterans Affairs Health Care System, Minneapolis, Minnesota; and the University of California, Los Angeles, California. ·Ann Intern Med · Pubmed #28761958.

ABSTRACT: Osteoporosis is a common systemic skeletal disorder resulting in bone fragility and increased fracture risk. However, management of osteoporosis and fracture prevention strategies are often not addressed by primary care clinicians, even in older patients with recent fractures. Evidence-based screening strategies will improve identification of patients who are most likely to benefit from drug treatment to prevent fracture. In addition, careful consideration of when pharmacotherapy should be started and choice of medication and duration of treatment will maximize the benefits of fracture prevention while minimizing potential harms of long-term drug exposure.

11 Review Hepatitis C virus infection and risk of osteoporosis: A meta-analysis. 2017

Wijarnpreecha, Karn / Thongprayoon, Charat / Panjawatanan, Panadeekarn / Phatharacharukul, Parkpoom / Ungprasert, Patompong. ·Department of Internal Medicine, Bassett Medical Center, Cooperstown, New York, USA. · Department of Biochemistry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. · Department of Internal Medicine, University of Minnesota, Minneapolis, USA. · Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA; Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. ·Saudi J Gastroenterol · Pubmed #28721974.

ABSTRACT: BACKGROUND/AIMS: Hepatitis C virus (HCV) infection is one of the most common infections worldwide. Several epidemiologic studies have suggested that patients with HCV infection might be at an increased risk of osteoporosis. However, the data on this relationship remains inconclusive. This meta-analysis was conducted with the aim to summarize all available evidence. MATERIALS AND METHODS: A literature search was performed using MEDLINE and EMBASE databases from inception to June 2016. Studies that reported relative risks, odd ratios (OR), or hazard ratios comparing the risk of osteoporosis among HCV-infected patients versus those without HCV infection were included. Pooled OR and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. RESULTS: Four studies met our eligibility criteria and were included in the analysis. We found a higher risk of osteoporosis among patients with chronic HCV with OR of 1.65 (95% CI: 0.98-2.77). Sensitivity analysis including only studies with higher quality yielded a higher OR, and the result was statistically significant (OR: 2.47; 95% CI: 1.03-5.93). CONCLUSIONS: Our study demonstrated a higher risk of osteoporosis among HCV-infected patients. Further studies are required to clarify how this risk should be addressed in clinical practice.

12 Review Osteoporosis treatment: recent developments and ongoing challenges. 2017

Khosla, Sundeep / Hofbauer, Lorenz C. ·Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN, USA; Endocrine Research Unit, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN, USA. Electronic address: khosla.sundeep@mayo.edu. · Division of Endocrinology, Diabetes, and Bone Diseases, Carl Gustav Carus University Hospital, Dresden Technical University, Dresden, Germany; Centre for Healthy Aging, Carl Gustav Carus University Hospital, Dresden Technical University, Dresden, Germany. ·Lancet Diabetes Endocrinol · Pubmed #28689769.

ABSTRACT: Osteoporosis is an enormous and growing public health problem. Once considered an inevitable consequence of ageing, it is now eminently preventable and treatable. Ironically, despite tremendous therapeutic advances, there is an increasing treatment gap for patients at high fracture risk. In this Series paper, we trace the evolution of drug therapy for osteoporosis, which began in the 1940s with the demonstration by Fuller Albright that treatment with oestrogen could reverse the negative calcium balance that developed in women after menopause or oophorectomy. We note a watershed in osteoporosis drug discovery around the year 2000, when the approach to developing novel therapeutics shifted from one driven by discoveries in animal studies and clinical observations (eg, oestrogen, calcitonin, and teriparatide) or opportunistic repurposing of existing compounds (eg, bisphosphonates) to one driven by advances in fundamental bone biology (eg, denosumab) coupled with clues from patients with rare bone diseases (eg, romosozumab, odanacatib). Despite these remarkable advances, concerns about rare side-effects of anti-resorptive drugs, particularly bisphosphonates, and the absence of clear evidence in support of their long-term efficacy is leading many patients who could benefit from drug therapy to not take these drugs. As such, there remains an important clinical need to develop ways to enhance patient acceptance and compliance with these effective drugs, and to continue to develop new drugs that do not cause these side-effects and have prolonged anabolic effects on bone. Such changes could lead to a true reversal of this potentially devastating disease of ageing.

13 Review Cathepsin K Inhibitors for Osteoporosis: Biology, Potential Clinical Utility, and Lessons Learned. 2017

Drake, Matthew T / Clarke, Bart L / Oursler, Merry Jo / Khosla, Sundeep. ·Division of Endocrinology and Kogod Center on Aging, Mayo Clinic College of Medicine, Rochester, Minnesota 55905. ·Endocr Rev · Pubmed #28651365.

ABSTRACT: Cathepsin K is a cysteine protease member of the cathepsin lysosomal protease family. Although cathepsin K is highly expressed in osteoclasts, lower levels of cathepsin K are also found in a variety of other tissues. Secretion of cathepsin K from the osteoclast into the sealed osteoclast-bone cell interface results in efficient degradation of type I collagen. The absence of cathepsin K activity in humans results in pycnodysostosis, characterized by increased bone mineral density and fractures. Pharmacologic cathepsin K inhibition leads to continuous increases in bone mineral density for ≤5 years of treatment and improves bone strength at the spine and hip. Compared with other antiresorptive agents, cathepsin K inhibition is nearly equally efficacious for reducing biochemical markers of bone resorption but comparatively less active for reducing bone formation markers. Despite multiple efforts to develop cathepsin K inhibitors, potential concerns related to off-target effects of the inhibitors against other cathepsins and cathepsin K inhibition at nonbone sites, including skin and perhaps cardiovascular and cerebrovascular sites, prolonged the regulatory approval process. A large multinational randomized, double-blind phase III study of odanacatib in postmenopausal women with osteoporosis was recently completed. Although that study demonstrated clinically relevant reductions in fractures at multiple sites, odanacatib was ultimately withdrawn from the regulatory approval process after it was found to be associated with an increased risk of cerebrovascular accidents. Nonetheless, the underlying biology and clinical effects of cathepsin K inhibition remain of considerable interest and could guide future therapeutic approaches for osteoporosis.

14 Review 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 / Byun Robinson, Angela / 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 Care Res (Hoboken) · Pubmed #28585410.

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.

15 Review Low Energy Availability, Menstrual Dysfunction, and Low Bone Mineral Density in Individuals with a Disability: Implications for the Para Athlete Population. 2017

Blauwet, Cheri A / Brook, Emily M / Tenforde, Adam S / Broad, Elizabeth / Hu, Caroline H / Abdu-Glass, Eliza / Matzkin, Elizabeth G. ·Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Harvard Medical School, 300 1st Avenue, Charlestown, Boston, MA, 02129, USA. cblauwet@partners.org. · International Paralympic Committee (IPC) Medical Committee, Bonn, Germany. cblauwet@partners.org. · Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA. · Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Harvard Medical School, 300 1st Avenue, Charlestown, Boston, MA, 02129, USA. · US Paralympics, US Olympic Committee, Chula Vista, CA, USA. · University of Minnesota Medical School, Minneapolis, MN, USA. · Connecticut College, New London, CT, USA. · Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA. ·Sports Med · Pubmed #28213754.

ABSTRACT: Low energy availability, functional hypothalamic amenorrhea, and low bone mineral density are three interrelated conditions described in athletic women. Although described as the female athlete triad (Triad), males experience similar health concerns. The literature suggests that individuals with a disability may experience altered physiology related to these three conditions when compared with the able-bodied population. The goal of this review is to describe the unique implications of low energy availability, low bone mineral density, and, in females, menstrual dysfunction in individuals with a disability and their potential impact on the para athlete population. A literature review was performed linking search terms related to the three conditions with six disability categories that are most represented in para sport. Few articles were found that directly pertained to athletes, therefore, the review additionally characterizes literature found in a non-athlete population. Review of the available literature in athletes suggests that both male and female athletes with spinal cord injury demonstrate risk factors for low energy availability. Bone mineral density may also show improvements for wheelchair athletes or athletes with hemiplegic cerebral palsy when compared with a disabled non-athlete population. However, the prevalence of the three conditions and implications on the health of para athletes is largely unknown and represents a key gap in the sports medicine literature. As participation in para sport continues to increase, further research is needed to understand the impact of these three interrelated health concerns for athletes with a disability, accompanied by educational initiatives targeting athletes, coaches, and health professionals.

16 Review Abaloparatide: Recombinant human PTHrP (1-34) anabolic therapy for osteoporosis. 2017

Chew, Chee Kian / Clarke, Bart L. ·Mayo Clinic E18-A, 200 1st Street SW, Rochester, MN, 55905 USA. · Mayo Clinic E18-A, 200 1st Street SW, Rochester, MN, 55905 USA. Electronic address: clarke.bart@mayo.edu. ·Maturitas · Pubmed #28159062.

ABSTRACT: The treatment of osteoporosis is generally either by inhibition of bone resorption with antiresorptive agents or by stimulation of bone formation with anabolic agents. Currently, teriparatide (recombinant human parathyroid hormone 1-34 [rhPTH (1-34)]) is the only available approved anabolic agent in the U.S. Other anabolic agents are under investigation however. Abaloparatide is recombinant human parathyroid hormone-related peptide 1-34. This agent is an anabolic agent that appears more potent than teriparatide, and it may have more rapid onset of fracture reduction than teriparatide. It is currently undergoing FDA review, with approval expected in 2017.

17 Review Caring for Women with Inflammatory Bowel Disease. 2016

Feagins, Linda A / Kane, Sunanda V. ·Division of Gastroenterology and Hepatology, VA North Texas Healthcare System, University of Texas Southwestern Medical Center, 4500 S. Lancaster Rd (111B1), Dallas, TX 75216, USA. · Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA. Electronic address: kane.sunanda@mayo.edu. ·Gastroenterol Clin North Am · Pubmed #27261900.

ABSTRACT: Ulcerative colitis and Crohn disease are chronic inflammatory diseases with typical onset in early adulthood. These diseases, therefore, can affect a woman throughout the many stages of her life, including menstruation, sexuality, pregnancy, and menopause. Unique health issues face women during these stages and can affect the course of their inflammatory bowel disease as well as treatment strategies and health maintenance. This article covers the non-pregnancy-related issues that are important in caring for women with inflammatory bowel disease. The topics of pregnancy and fertility are covered in a separate review.

18 Review Managing Osteoporosis in Patients on Long-Term Bisphosphonate Treatment: Report of a Task Force of the American Society for Bone and Mineral Research. 2016

Adler, Robert A / El-Hajj Fuleihan, Ghada / Bauer, Douglas C / Camacho, Pauline M / Clarke, Bart L / Clines, Gregory A / Compston, Juliet E / Drake, Matthew T / Edwards, Beatrice J / Favus, Murray J / Greenspan, Susan L / McKinney, Ross / Pignolo, Robert J / Sellmeyer, Deborah E. ·McGuire Veterans Affairs Medical Center and Virginia Commonwealth University School of Medicine, Richmond, VA, USA. · American University of Beirut Medical Center, Beirut, Lebanon. · University of California, San Francisco, San Francisco, CA, USA. · Loyola University of Chicago, Maywood, IL, USA. · Mayo Clinic College of Medicine, Rochester, MN, USA. · University of Michigan, Ann Arbor, MI, USA. · University of Cambridge School of Clinical Medicine, Cambridge, UK. · MD Anderson Cancer Center, Houston, TX, USA. · University of Chicago, Chicago, IL, USA. · University of Pittsburgh, Pittsburgh, PA, USA. · Duke University School of Medicine, Durham, NC, USA. · University of Pennsylvania, Philadelphia, PA, USA. · The Johns Hopkins Bayview Medical Center, Baltimore, MD, USA. ·J Bone Miner Res · Pubmed #26350171.

ABSTRACT: Bisphosphonates (BPs) are the most commonly used medications for osteoporosis. This ASBMR report provides guidance on BP therapy duration with a risk-benefit perspective. Two trials provided evidence for long-term BP use. In the Fracture Intervention Trial Long-term Extension (FLEX), postmenopausal women receiving alendronate for 10 years had fewer clinical vertebral fractures than those switched to placebo after 5 years. In the HORIZON extension, women who received 6 annual infusions of zoledronic acid had fewer morphometric vertebral fractures compared with those switched to placebo after 3 years. Low hip T-score, between -2 and -2.5 in FLEX and below -2.5 in HORIZON extension, predicted a beneficial response to continued therapy. Hence, the Task Force suggests that after 5 years of oral BP or 3 years of intravenous BP, reassessment of risk should be considered. In women at high risk, for example, older women, those with a low hip T-score or high fracture risk score, those with previous major osteoporotic fracture, or who fracture on therapy, continuation of treatment for up to 10 years (oral) or 6 years (intravenous), with periodic evaluation, should be considered. The risk of atypical femoral fracture, but not osteonecrosis of the jaw, clearly increases with BP therapy duration, but such rare events are outweighed by vertebral fracture risk reduction in high-risk patients. For women not at high fracture risk after 3 to 5 years of BP treatment, a drug holiday of 2 to 3 years can be considered. The suggested approach for long-term BP use is based on limited evidence, only for vertebral fracture reduction, in mostly white postmenopausal women, and does not replace the need for clinical judgment. It may be applicable to men and patients with glucocorticoid-induced osteoporosis, with some adaptations. It is unlikely that future trials will provide data for formulating definitive recommendations. © 2015 American Society for Bone and Mineral Research.

19 Review Bone Density Screening and Re-screening in Postmenopausal Women and Older Men. 2015

Gourlay, Margaret L / Overman, Robert A / Ensrud, Kristine E. ·Department of Family Medicine, University of North Carolina, Aycock Building; Manning Drive, CB #7595, Chapel Hill, NC, 27599-7595, USA. margaret_gourlay@med.unc.edu. · Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, Kerr Hall, Room 2304, North Carolina, Chapel Hill, NC, 27599-7573, USA. overmar@unc.edu. · Department of Medicine and Division of Epidemiology, General Internal Medicine (111-0), University of Minnesota, Minneapolis, MN, 55417, USA. ensru001@umn.edu. · Department of Medicine, VA Medical Center, One Veterans Drive, Minneapolis, MN, USA. ensru001@umn.edu. ·Curr Osteoporos Rep · Pubmed #26408154.

ABSTRACT: Clinical practice guidelines universally recommend bone mineral density (BMD) screening to identify osteoporosis in women aged 65 years and older. Risk assessment is recommended to guide BMD screening in postmenopausal women under age 65. Insufficient data are available to inform standard ages to start and stop BMD screening in postmenopausal women. Based on longitudinal studies of incident osteoporosis and fracture in postmenopausal women, an initial BMD test should be ordered for all women aged 65, and the frequency of re-screening should be based on age and BMD T score (more frequent testing for older age and lower T score). Although clinical practice guidelines recommend BMD screening according to risk factors for fracture in postmenopausal women under age 65, no standard approach to risk assessment exists. Minimal evidence is available to guide osteoporosis screening in men, but some experts recommend initiation of BMD screening in men at age 70.

20 Review Bisphosphonates for the prevention and treatment of osteoporosis. 2015

Maraka, Spyridoula / Kennel, Kurt A. ·Division of Endocrinology, Diabetes, Nutrition, and Metabolism, Mayo Clinic, Rochester, MN 55905, USA. · Division of Endocrinology, Diabetes, Nutrition, and Metabolism, Mayo Clinic, Rochester, MN 55905, USA kennel.kurt@mayo.edu. ·BMJ · Pubmed #26333528.

ABSTRACT: Osteoporosis is a systemic skeletal disorder characterized by bone loss, which leads to impaired bone strength and an increased risk of fractures. Two million fractures are attributed to osteoporosis annually in the United States and they are associated with serious morbidity and mortality. Bisphosphonates reduce the risk of fracture by suppressing bone resorption and increasing bone strength, and they have been widely used for the prevention and treatment of osteoporosis. However, the use of these drugs for the management of osteoporosis remains a clinical challenge. There are several important considerations including appropriate patient selection, pretreatment evaluation, potential adverse effects, patient preferences, and adherence. This review will discuss the evidence informing the clinical strategy for using bisphosphonates in patients with osteoporosis and those at high risk of fracture, focusing on the benefits and risks of treatment. We will also consider issues related to the monitoring and duration of treatment.

21 Review Bone biology, signaling pathways, and therapeutic targets for osteoporosis. 2015

Iñiguez-Ariza, Nicole M / Clarke, Bart L. ·Mayo Clinic E18-A, 200 1st Street SW, Rochester, Minnesota 55905, USA. Electronic address: nicmiamd@gmail.com. · Mayo Clinic E18-A, 200 1st Street SW, Rochester, Minnesota 55905, USA. Electronic address: clarke.bart@mayo.edu. ·Maturitas · Pubmed #26255682.

ABSTRACT: Major advances have occurred recently in the treatment of osteoporosis in recent years. Most patients are currently treated with bisphosphonates, denosumab, raloxifene, or teriparatide, and in some countries, strontium ranelate. Strontium ranelate and calcitonin have recently had their use restricted due to cardiovascular concerns and malignancy, respectively. The available agents have generally provided excellent options that effectively reduce fracture risk. New targets are being sought based on appreciation of the bone biology and signaling pathways involved in bone formation and resorption. These agents will directly target these signaling pathways, and further expand the options available for treatment of osteoporosis.

22 Review The Pathophysiology and Treatment of Osteoporosis. 2015

Drake, Matthew T / Clarke, Bart L / Lewiecki, E Michael. ·Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic College of Medicine, Rochester, Minnesota. · New Mexico Clinical Research & Osteoporosis Center, University of New Mexico School of Medicine, Albuquerque, New Mexico. Electronic address: mlewiecki@gmail.com. ·Clin Ther · Pubmed #26163201.

ABSTRACT: PURPOSE: The objectives of this article are to review the pathophysiology of bone loss associated with aging and to review current pharmacologic approaches for the treatment of osteoporosis. METHODS: A literature search with PubMed was performed with the terms osteoporosis and pathophysiology and osteoporosis and treatment and limited to studies written in English that were published within the preceding 10 years. Given the large number of studies identified, we selectively reviewed those studies that contained primary data related to osteoporosis pathophysiology or osteoporosis pharmacologic treatments and references included within selected studies identified from abstract review. FINDINGS: Published studies have consistently reported that osteoporosis in older adults is caused by an imbalance of bone resorption in excess of bone formation. The dominant factor leading to bone loss in older adults appears to be gonadal sex steroid deficiency, with multiple genetic and biochemical factors, such as vitamin D deficiency or hyperparathyroidism, that may accelerate bone loss. Conditions that adversely affect growth and development may limit development of peak bone mass and accelerate subsequent bone loss. Studies of bone microarchitecture have shown that trabecular bone loss begins in the third decade of life, before gonadal sex steroid deficiency develops, whereas cortical loss typically begins in the sixth decade, about the time of menopause in women and about the same age in men. Antiresorptive agents for the treatment of osteoporosis act primarily by limiting osteoclast activity, whereas osteoanabolic agents, such as teriparatide, act primarily by stimulating osteoblastic bone formation. Clinical investigation of new compounds for the treatment of osteoporosis is mainly directed to those that stimulate bone formation or differentially decrease bone resorption more than bone formation. Therapies for osteoporosis are associated with adverse effects, but in patients at high risk of fracture, the benefits generally far outweigh the risks. IMPLICATIONS: Current osteoporosis therapies mitigate or reverse the loss of bone associated with age-related decreases of gonadal sex steroids, increase bone strength, and reduce fracture risk. With improved knowledge of the pathophysiology of osteoporosis, new targets for therapeutic intervention have been identified. Clinical investigations of potential new treatments for osteoporosis are primarily directed to stimulating osteoblastic bone formation or to modulating the balance of bone resorption and formation in ways that improve bone strength.

23 Review Skeletal changes through the lifespan--from growth to senescence. 2015

Farr, Joshua N / Khosla, Sundeep. ·Endocrine Research Unit and Kogod Center on Aging, Mayo Clinic, Guggenheim 7-11, 200 First Street SW, Rochester, MN 55905, USA. ·Nat Rev Endocrinol · Pubmed #26032105.

ABSTRACT: Age-related fragility fractures are an enormous public health problem. Both acquisition of bone mass during growth and bone loss associated with ageing affect fracture risk late in life. The development of high-resolution peripheral quantitative CT (HRpQCT) has enabled in vivo assessment of changes in the microarchitecture of trabecular and cortical bone throughout life. Studies using HRpQCT have demonstrated that the transient increase in distal forearm fractures during adolescent growth is associated with alterations in cortical bone, which include cortical thinning and increased porosity. Children with distal forearm fractures in the setting of mild, but not moderate, trauma also have increased deficits in cortical bone at the distal radius and in bone mass systemically. Moreover, these children transition into young adulthood with reduced peak bone mass. Elderly men, but not elderly women, with a history of childhood forearm fractures have an increased risk of osteoporotic fractures. With ageing, men lose trabecular bone primarily by thinning of trabeculae, whereas the number of trabeculae is reduced in women, which is much more destabilizing from a biomechanical perspective. However, age-related losses of cortical bone and increases in cortical porosity seem to have a much larger role than previously recognized, and increased cortical porosity might characterize patients at increased risk of fragility fractures.

24 Review Exercise, hormones and skeletal adaptations during childhood and adolescence. 2014

Farr, Joshua N / Laddu, Deepika R / Going, Scott B. ·Division of Endocrinology, Mayo Clinic College of Medicine, Rochester, MN. ·Pediatr Exerc Sci · Pubmed #25372373.

ABSTRACT: Although primarily considered a disorder of the elderly, emerging evidence suggests the antecedents of osteoporosis are established during childhood and adolescence. A complex interplay of genetic, environmental, hormonal and behavioral factors determines skeletal development, and a greater effort is needed to identify the most critical factors that establish peak bone strength. Indeed, knowledge of modifiable factors that determine skeletal development may permit optimization of skeletal health during growth and could potentially offset reductions in bone strength with aging. The peripubertal years represent a unique period when the skeleton is particularly responsive to loading exercises, and there is now overwhelming evidence that exercise can optimize skeletal development. While this is not controversial, the most effective exercise prescription and how much investment in this prescription is needed to significantly impact bone health continues to be debated. Despite considerable progress, these issues are not easy to address, and important questions remain unresolved. This review focuses on the key determinants of skeletal development, whether exercise during childhood and adolescence should be advocated as a safe and effective strategy for optimizing peak bone strength, and whether investment in exercise early in life protects against the development of osteoporosis and fractures later in life.

25 Review unveiling skeletal fragility in patients diagnosed with MGUS: no longer a condition of undetermined significance? 2014

Drake, Matthew T. ·Division of Endocrinology, Metabolism, Nutrition and Diabetes, Department of Medicine, Mayo Clinic, Rochester, MN, USA. ·J Bone Miner Res · Pubmed #25319751.

ABSTRACT: Monoclonal gammopathy of undetermined significance (MGUS) is a common finding in clinical practice, affecting greater than 3% of adults aged 50 years and older. As originally described, the term MGUS reflected the inherent clinical uncertainty of distinguishing patients with a benign stable monoclonal plasma cell disorder from subjects destined to progress to malignancy. There is now clear epidemiologic evidence, however, that patients with MGUS suffer from a significantly increased fracture risk and that the prevalence of MGUS is increased in patients with osteoporosis. Despite this relationship, no clinical care guidelines exist for the routine evaluation or treatment of the skeletal health of patients with MGUS. Recent work has demonstrated that circulating levels of at least two cytokines (CCL3/MIP-1α and DKK1) with well-recognized roles in bone disease in the related monoclonal gammopathy multiple myeloma are also increased in patients with MGUS. Further, recent imaging studies using high-resolution peripheral quantitative CT have documented that patients with MGUS have substantial skeletal microarchitectural deterioration and deficits in biomechanical bone strength that likely underlie the increased skeletal fragility in these patients. Accordingly, this Perspective provides evidence that the "undetermined significance" portion of the MGUS acronym may be best replaced in favor of the term "monoclonal gammopathy of skeletal significance" (MGSS) in order to more accurately reflect the enhanced skeletal risks inherent in this condition.

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