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Osteoporosis: HELP
Articles from New Mexico
Based on 124 articles published since 2010
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These are the 124 published articles about Osteoporosis that originated from New Mexico during 2010-2020.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5
1 Guideline Best Practices for Dual-Energy X-ray Absorptiometry Measurement and Reporting: International Society for Clinical Densitometry Guidance. 2016

Lewiecki, E Michael / Binkley, Neil / Morgan, Sarah L / Shuhart, Christopher R / Camargos, Bruno Muzzi / Carey, John J / Gordon, Catherine M / Jankowski, Lawrence G / Lee, Joon-Kiong / Leslie, William D / Anonymous6650862. ·New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA. Electronic address: mlewiecki@gmail.com. · Osteoporosis Clinical Center and Research Program, University of Wisconsin, Madison, WI, USA. · Division of Clinical Immunology and Rheumatology, Department of Medicine, UAB Osteoporosis Prevention and Treatment Clinic, University of Alabama at Birmingham, Birmingham, AL, USA. · Swedish Medical Group, Seattle, WA, USA. · Rede Mater Dei de Saúde - Densimater, Belo Horizonte, Brazil. · Galway University Hospitals, National University of Ireland, Galway, Ireland. · Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA. · Illinois Bone and Joint Institute, LLC., Morton Grove, IL, USA. · JK Lee Orthopaedics & Traumatology, Petaling Jaya, Malaysia. · University of Manitoba, Winnipeg, Manitoba, Canada. ·J Clin Densitom · Pubmed #27020004.

ABSTRACT: Dual-energy X-ray absorptiometry (DXA) is a technology that is widely used to diagnose osteoporosis, assess fracture risk, and monitor changes in bone mineral density (BMD). The clinical utility of DXA is highly dependent on the quality of the scan acquisition, analysis, and interpretation. Clinicians are best equipped to manage patients when BMD measurements are correct and interpretation follows well-established standards. Poor-quality acquisition, analysis, or interpretation of DXA data may mislead referring clinicians, resulting in unnecessary diagnostic evaluations, failure to evaluate when needed, inappropriate treatment, or failure to provide medical treatment, with potentially ineffective, harmful, or costly consequences. Misallocation of limited healthcare resources and poor treatment decisions can be minimized, and patient care optimized, through meticulous attention to DXA instrument calibration, data acquisition and analysis, interpretation, and reporting. This document from the International Society for Clinical Densitometry describes quality standards for BMD testing at DXA facilities worldwide to provide guidance for DXA supervisors, technologists, interpreters, and clinicians. High-quality DXA testing is necessary for correct diagnostic classification and optimal fracture risk assessment, and is essential for BMD monitoring.

2 Guideline Treat-to-target for osteoporosis: is now the time? 2013

Lewiecki, E Michael / Cummings, Steven R / Cosman, Felicia. ·New Mexico Clinical Research & Osteoporosis Center, 300 Oak Street NE, Albuquerque, New Mexico 87106, USA. mlewiecki@gmail.com ·J Clin Endocrinol Metab · Pubmed #23337726.

ABSTRACT: OBJECTIVES: Current clinical practice guidelines identify patients at high risk for fracture who are likely to benefit from pharmacological therapy and suggest ways to monitor for effectiveness of therapy. However, there is no clear guidance on when fracture risk has been reduced to an acceptably low level. As a consequence, some patients at low risk for fracture may be treated for longer than necessary, whereas others at high risk for fracture may have treatment stopped when they might benefit from continuation of the same treatment or a change to a more potent therapeutic agent. The objective of this statement is to describe the potential clinical utility of developing a "treat-to-target" strategy for the management of patients with osteoporosis. PARTICIPANTS: We recommend that a task force of clinicians, clinical investigators, and other stakeholders in the care of osteoporosis explore the options, review the evidence, and identify additional areas for investigation to establish osteoporosis treatment targets. EVIDENCE: Data from large, prospective, randomized, placebo-controlled registration trials for currently available osteoporosis therapies should be analyzed for commonalities of correlations between easily measured endpoints and fracture risk. CONSENSUS PROCESS: Osteoporosis experts, professional organizations, and patient care advocates should be involved in the process of developing consensus on easily measurable osteoporosis treatment targets that are supported by the best available evidence and likely to be accepted by clinicians and patients in the care of osteoporosis. CONCLUSIONS: A treat-to-target strategy for osteoporosis offers the potential of improving osteoporosis care by reducing the burden of osteoporotic fractures and limiting adverse effects of therapy.

3 Editorial Bone Density Testing Is the Best Way to Monitor Osteoporosis Treatment. 2017

Rothman, Micol S / Lewiecki, E Michael / Miller, Paul D. ·University of Colorado School of Medicine, Department of Medicine, Division of Endocrinology, Diabetes and Metabolism,Aurora, Colo. Electronic address: Micol.Rothman@ucdenver.edu. · New Mexico Clinical Research & Osteoporosis Center,Albuquerque, NM. · Colorado Center for Bone Research,Lakewood, Colo. ·Am J Med · Pubmed #28687261.

ABSTRACT: -- No abstract --

4 Editorial What we don't know about osteoporosis. 2016

Lewiecki, E M / Binkley, N. ·New Mexico Clinical Research & Osteoporosis Center, 300 Oak Street NE, Albuquerque, NM, 87106, USA. mlewiecki@gmail.com. · University of Wisconsin Osteoporosis Clinical Center and Research Program, Madison, WI, USA. ·J Endocrinol Invest · Pubmed #26902997.

ABSTRACT: -- No abstract --

5 Editorial Biological therapy: chronicling 15 years of progress. 2015

Lewiecki, E Michael. ·New Mexico Clinical Research & Osteoporosis Center , 300 Oak St. NE, Albuquerque, NM 87106 , USA +1 505 938 2117 ; +1 505 884 4006 ; mlewiecki@gmail.com. ·Expert Opin Biol Ther · Pubmed #25643326.

ABSTRACT: -- No abstract --

6 Review Bone Health TeleECHO: a Force Multiplier to Improve the Care of Skeletal Diseases in Underserved Communities. 2019

Lewiecki, E Michael / Jackson, Avery / Lake, Anne F / Carey, John J / Belaya, Zhanna / Melnichenko, Galina A / Rochelle, Rachelle. ·University of New Mexico Health Sciences Center, Albuquerque, NM, USA. mlewiecki@gmail.com. · New Mexico Clinical Research & Osteoporosis Center, 300 Oak St. NE, Albuquerque, NM, 87106, USA. mlewiecki@gmail.com. · MNI Great Lakes ECHO LLC, Grand Blanc, MI, USA. · Wake Forest Baptist Health, Winston-Salem, NC, USA. · National University of Ireland Galway, Galway, Ireland. · The National Research Medical Centre for Endocrinology, Moscow, Russia. · University of New Mexico Health Sciences Center, Albuquerque, NM, USA. ·Curr Osteoporos Rep · Pubmed #31713181.

ABSTRACT: PURPOSE OF REVIEW: This review describes the global development of a model of technology-enabled collaborative learning for healthcare professionals called Project ECHO (Extension for Community Healthcare Outcomes) and its applications for the management of patients with skeletal diseases. RECENT FINDINGS: The prototype Bone Health TeleECHO was established in 2015, with others now operational in the USA and other countries, and more expected to follow soon. Each teleECHO program, in the right language and convenient time zone, provides a virtual community of practice for healthcare professionals to benefit from real-time interactive case-based learning and brief didactic presentations on topics of interest. Bone Health TeleECHO elevates the level of knowledge of participants and improves self-confidence in managing patients with skeletal diseases. The development of many teleECHO programs worldwide serves as a force multiplier, with the potential to narrow the osteoporosis treatment gap and enhance the effectiveness of fracture liaison services.

7 Review Proceedings of the 2019 Santa Fe Bone Symposium: New Concepts in the Care of Osteoporosis and Rare Bone Diseases. 2019

Lewiecki, E Michael / Bilezikian, John P / Kagan, Risa / Krakow, Deborah / McClung, Michael R / Miller, Paul D / Rush, Eric T / Shuhart, Christopher R / Watts, Nelson B / Yu, Elaine W. ·New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA. Electronic address: mlewiecki@gmail.com. · Columbia University College of Physicians and Surgeons, NYC, NY, USA. · UCSF and Sutter East Bay Medical Foundation, Berkeley, CA, USA. · University of California Los Angeles, Los Angeles, CA, USA. · Oregon Osteoporosis Center, Portland, OR, USA; Mary MacKillop Center for Health Research, Australian Catholic University, Melbourne, VIC, Australia. · University of Colorado Health Sciences Center, Denver, CO, USA. · University of Kansas Medical Center, Kansas City, MO, USA; Children's Mercy Hospital, Kansas City, MO, USA; University of Missouri - Kansas City, Kansas City, MO, USA. · Swedish Medical Center, Seattle, WA, USA. · Mercy Health Osteoporosis and Bone Health Services, Cincinnati, OH, USA. · Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. ·J Clin Densitom · Pubmed #31685420.

ABSTRACT: The 20th annual Santa Fe Bone Symposium was held August 9-10, 2019, in Santa Fe, New Mexico, USA. This is an annual meeting devoted to clinical applications of recent advances in skeletal research that impact the care of patients with osteoporosis, metabolic bone diseases, and inherited bone diseases. Participants included practicing and academic physicians, fellows, advanced practice providers, fracture liaison service (FLS) coordinators, clinical researchers, and bone density technologists. The symposium consisted of lectures, case presentations, and panel discussions, with an emphasis on learning through interaction of all attendees. Topics included new approaches in the use of anabolic agents for the treatment osteoporosis, a review of important events in skeletal health over the past year, new and emerging treatments for rare bone diseases, the use of genetic testing for bone diseases in clinical practice, medication-associated causes of osteoporosis, new concepts in the use of estrogen therapy for osteoporosis, new Official Positions of the International Society for Clinical Densitometry, skeletal consequences of bariatric surgery, and update on the progress and potential of Bone Health TeleECHO, a virtual community of practice using videoconferencing technology to link healthcare professionals for advancing the care of osteoporosis worldwide. Sessions on rare bone diseases were developed in collaboration with the Rare Bone Disease Alliance. Symposium premeetings included an FLS workshop by the National Osteoporosis Foundation and others devoted to the use of new therapeutic agents for the care of osteoporosis and related disorders.

8 Review Dual-energy X-ray Absorptiometry Monitoring with Trabecular Bone Score: 2019 ISCD Official Position. 2019

Krohn, Kelly / Schwartz, Elliott N / Chung, Yoon-Sok / Lewiecki, E Michael. ·Department of Orthopedic Surgery, University of Arizona College of Medicine Phoenix, AZ, USA. · Northern California Institute For Bone Health, Orinda, CA, USA. · Ajou University School of Medicine, Suwon, South Korea. · New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA. Electronic address: mlewiecki@gmail.com. ·J Clin Densitom · Pubmed #31383412.

ABSTRACT: Trabecular bone score (TBS) is a textural index that evaluates pixel gray-level variations in the lumbar spine image by dual-energy X-ray absorptiometry. It provides an indirect assessment of trabecular microarchitecture that is an independent predictor of fracture risk. TBS does not appear to be clinically useful to monitor the skeletal effects of bisphosphonates and denosumab, but is potentially useful as a component of monitoring the skeletal effects of teriparatide and abaloparatide. The least significant change (LSC) for TBS can be conservatively estimated to be about 5.8% (the largest LSC in published data) or calculated by a dual-energy X-ray absorptiometry facility using the same methodology that is used for bone mineral density (BMD) precision assessment to calculate BMD LSC. A review of the best available evidence at the 2019 ISCD Position Development Conference concluded that the role of TBS in monitoring antiresorptive therapy is unclear and that TBS is potentially useful for monitoring anabolic therapy. For patients treated with teriparatide or abaloparatide, a statistically significant increase in TBS may represent a clinically meaningful improvement in trabecular structure. A significant decrease of TBS may represent a worsening of trabecular structure, suggesting the need for further clinical assessment and possible change in treatment strategies. Since BMD measures bone quantity and TBS measures bone quality, these tests can be considered complementary in assessing fracture risk and response to therapy in appropriate patients.

9 Review Repeating Measurement of Bone Mineral Density when Monitoring with Dual-energy X-ray Absorptiometry: 2019 ISCD Official Position. 2019

Kendler, David L / Compston, Juliet / Carey, John J / Wu, Chih-Hsing / Ibrahim, Ammar / Lewiecki, E Michael. ·Department of Medicine, University of British Columbia, Vancouver, Canada. Electronic address: davidkendler@gmail.com. · Department of Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom. · School of Medicine, National University of Ireland, Galway, Ireland. · Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. · New Mexico Clinical Research and Osteoporosis Center, Albuquerque, NM, USA. ·J Clin Densitom · Pubmed #31378452.

ABSTRACT: Bone mineral density (BMD) can be measured at multiple skeletal sites using various technologies to aid clinical decision-making in bone and mineral disorders. BMD by dual-energy X-ray absorptiometry (DXA) has a critical role in predicting risk of fracture, diagnosis of osteoporosis, and monitoring patients. In clinical practice, DXA remains the most available and best validated tool for monitoring patients. A quality baseline DXA scan is essential for comparison with all subsequent scans. Monitoring patients with serial measurements requires technical expertise and knowledge of the least significant change in order to determine when follow-up scans should be repeated. Prior ISCD Official Positions have clarified how and when repeat DXA is useful as well as the interpretation of results. The 2019 ISCD Official Positions considered new evidence and clarifies if and when BMD should be repeated. There is good evidence showing that repeat BMD measurement can identify people who experience bone loss, which is an independent predictor of fracture risk. There is good evidence showing that the reduction in spine and hip fractures with osteoporosis medication is proportional to the change in BMD with treatment. There is evidence that measuring BMD is useful following discontinuation of osteoporosis treatment. There is less documentation addressing the effectiveness of monitoring BMD to improve medication adherence, whether monitoring of BMD reduces the risk of fracture, or effectively discriminates patients who should and should not recommence treatment following an interruption of medication. Further research is needed in all of these areas.

10 Review Repeating Vertebral Fracture Assessment: 2019 ISCD Official Position. 2019

Borges, Joao Lindolfo Cunha / Sousa da Silva, Marina / Ward, Robert J / Diemer, Kathryn M / Yeap, Swan S / Lewiecki, E Michael. ·Centro de Pesquisa Católica do Brasil, Brasilia, Brazil. · Tufts Medical Center, Boston, MA, USA. · Washington University School of Medicine, St. Louis, MO, USA. · Subang Jaya Medical Centre, Selangor, Malaysia. · New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA. Electronic address: elewiecki@salud.unm.edu. ·J Clin Densitom · Pubmed #31375350.

ABSTRACT: Vertebral fracture (VF) is the most common type of osteoporotic fracture. VFs are associated with a decline in quality of life and high morbidity and mortality. The presence of a VF is a significant risk factor for developing another fracture; however, most VFs are not clinically recognized and diagnosed. Vertebral fracture assessment by dual-energy X-ray absorptiometry is a low cost, low radiation, convenient, and reliable method to identify VFs. The finding of a previously unrecognized VF may change the assessment of fracture risk, diagnostic classification, and treatment strategies. Vertebral fracture assessment or radiographic lateral spine imaging should be repeated in patients with continued high risk for fracture (e.g., historical height loss >4 cm [>1.5 inches], self-reported but undocumented vertebral fracture, or glucocorticoid therapy equivalent to ≥5 mg of prednisone or equivalent per day for greater than or equal to 3 months).

11 Review Western Osteoporosis Alliance Clinical Practice Series: Treat-to-Target for Osteoporosis. 2019

Lewiecki, E Michael / Kendler, David L / Davison, K Shawn / Hanley, David A / Harris, Steven T / McClung, Michael R / Miller, Paul D. ·New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM. Electronic address: mlewiecki@gmail.com. · Department of Medicine (Endocrinology), University of British Columbia, Vancouver, Canada. · A Priori Medical Sciences, Inc., Victoria, British Columbia, Canada. · Departments of Medicine, Community Health Sciences, and Oncology, Cumming School of Medicine and McCaig Institute for Bone and Joint Health Cumming School of Medicine, The University of Calgary, Calgary, Alberta, Canada. · University of California, San Francisco, CA. · Oregon Osteoporosis Center and Oregon Health & Science University, Portland, OR; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia. · Colorado Center for Bone Research, Lakewood, CO. ·Am J Med · Pubmed #31152714.

ABSTRACT: Patients often start treatment to reduce fracture risk because of a bone mineral density T-score consistent with osteoporosis (≤ -2.5). Others with a T-score above -2.5 may be treated when there is a history of fragility fracture or when a fracture risk algorithm categorizes them as having a high risk for fracture. It is common to initiate therapy with a generic oral bisphosphonate, unless contraindicated, and continue therapy if the patient is responding as assessed by stability or an increase in bone mineral density. However, some patients may respond well to an oral bisphosphonate, yet remain with an unacceptably high risk for fracture. Recognition of this occurrence has led to the development of an alternative strategy: treat-to-target. This involves identifying a biological marker (treatment target) that represents an acceptable fracture risk and then initiating treatment with an agent likely to reach this target. If the patient is on a path to reaching the target with initial therapy, treatment is continued. If it appears the target will not be reached with initial therapy, treatment is changed to an agent more likely to achieve the goal.

12 Review Project ECHO: Telehealth to Expand Capacity to Deliver Best Practice Medical Care. 2019

Lewiecki, E Michael / Rochelle, Rachelle. ·New Mexico Clinical Research & Osteoporosis Center, 300 Oak Street NE, Albuquerque, NM 87106, USA. Electronic address: mlewiecki@gmail.com. · Project ECHO, University of New Mexico Health Sciences Center, 1650 University Boulevard NE Albuquerque, NM 87102, USA. ·Rheum Dis Clin North Am · Pubmed #30952400.

ABSTRACT: Project ECHO (Extension for Community Healthcare Outcomes) was developed at the University of New Mexico Health Sciences Center to educate health care professionals in underserved communities to treat chronic complex diseases, allowing patients to receive better care, closer to home, with greater convenience, and at lower cost than referral to a specialty center. Videoconferencing technology is used to create learning networks, with case-based discussions as the primary method of education. The 3-year experience of Bone Health TeleECHO, a strategy to improve the care of osteoporosis and reduce the large treatment gap, is discussed.

13 Review Proceedings of the 2018 Santa Fe Bone Symposium: Advances in the Management of Osteoporosis. 2019

Lewiecki, E Michael / Bilezikian, John P / Giangregorio, Lora / Greenspan, Susan L / Khosla, Sundeep / Kostenuik, Paul / Krohn, Kelly / McClung, Michael R / Miller, Paul D / Pacifici, Roberto. ·New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA. Electronic address: mlewiecki@gmail.com. · Columbia University College of Physicians and Surgeons, NYC, NY, USA. · University of Waterloo and Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada. · University of Pittsburgh, Pittsburgh, PA, USA. · Mayo Clinic College of Medicine, Rochester, MN, USA. · Phylon Pharma Services, Newbury Park, CA, USA. · The CORE Institute, Phoenix, AZ, USA. · Oregon Osteoporosis Center, Portland, OR, USA; MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia. · University of Colorado Health Sciences Center, Denver, CO, USA. · Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University, Atlanta, GA, USA. ·J Clin Densitom · Pubmed #30366683.

ABSTRACT: The Santa Fe Bone Symposium is an annual meeting devoted to clinical applications of recent advances in skeletal research. The 19th Santa Fe Bone Symposium convened August 3-4, 2018, in Santa Fe, New Mexico, USA. Attendees included physicians of many specialties, fellows in training, advanced practice providers, clinical researchers, and bone density technologists. The format consisted of lectures, case presentations by endocrinology fellows, and panel discussions, with all involving extensive interactive discussions. Topics were diverse, including an evolutionary history of calcium homeostasis, osteoporosis treatment in the very old, optimizing outcomes with orthopedic surgery, microbiome and bone, new strategies for combination and sequential therapy of osteoporosis, exercise as medicine, manifestations of parathyroid hormone excess and deficiency, parathyroid hormone as a therapeutic agent, cell senescence and bone health, and managing patients outside clinical practice guidelines. The National Bone Health Alliance conducted a premeeting on development of fracture liaison services. A workshop was devoted to Bone Health TeleECHO (Bone Health Extension for Community Healthcare Outcomes), a strategy of ongoing medical education for healthcare professions to expand capacity to deliver best practice skeletal healthcare in underserved communities and reduce the osteoporosis treatment gap.

14 Review New and emerging concepts in the use of denosumab for the treatment of osteoporosis. 2018

Lewiecki, E Michael. ·New Mexico Clinical Research & Osteoporosis Center, 300 Oak St NE, Albuquerque, NM 87106, USA. ·Ther Adv Musculoskelet Dis · Pubmed #30386439.

ABSTRACT: Denosumab is a fully human monoclonal antibody to receptor activator of nuclear factor kappa-B ligand (RANKL), a cytokine expressed by cells of the osteoblast lineage that is a key regulator of osteoclastic bone resorption. By binding and neutralizing RANKL, denosumab inhibits osteoclast differentiation, activity, and survival. Clinical trials in postmenopausal women with osteoporosis have shown that it reduces the risk of vertebral fractures, nonvertebral fractures, and hip fractures, with a generally favorable safety profile. With a dose of 60 mg subcutaneously every 6 months, it is approved for: treatment of postmenopausal women and men with osteoporosis, and for women and men with glucocorticoid-induced osteoporosis who are at high risk for fracture; treatment to increase bone mass in men at high risk for fracture receiving androgen-deprivation therapy for nonmetastatic prostate cancer; and treatment to increase bone mass in women at high risk for fracture receiving adjuvant aromatase inhibitor therapy for breast cancer. Atypical femur fractures and osteonecrosis of the jaw have been reported in patients treated with denosumab. Discontinuation of denosumab is followed by rapidly rising bone turnover markers, decreasing bone density, and vertebral fracture risk that returns to baseline, with a possible increase in the risk of multiple vertebral fractures. Further study is needed to clarify this potential risk. After stopping long-term denosumab, patients should be switched to another antiresorptive agent to maintain the benefit achieved with denosumab.

15 Review Adverse effects of media reports on the treatment of osteoporosis. 2018

Cipriani, Cristiana / Pepe, Jessica / Minisola, Salvatore / Lewiecki, E Michael. ·Department of Internal Medicine and Medical Disciplines, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy. cristiana.cipriani@gmail.com. · Department of Internal Medicine and Medical Disciplines, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy. · New Mexico Clinical Research and Osteoporosis Center, 300 Oak St. NE, Albuquerque, NM, 87106, USA. ·J Endocrinol Invest · Pubmed #29761280.

ABSTRACT: PURPOSE: The review focused on the role that media reporting plays in the level of public awareness about osteoporosis and its influence on osteoporosis treatment decisions. METHODS: We reviewed the literature on the role of media on three main aspects influencing patient adherence to osteoporosis treatment: the awareness of osteoporosis as a major health problem, the perception of the effectiveness of osteoporosis medications, and the fear of adverse effects with osteoporosis medications. RESULTS: A review of the literature confirmed what is routinely observed in clinical practice-that media report can strongly influence the level of awareness of osteoporosis and fracture risk. Inadequate and/or incorrect information on osteoporosis in the media are associated with a low level of awareness of the disease. High-risk patients may have a poor understanding of the need for treatment. Alarming information in the media over the last 2 decades regarding effectiveness and safety of long-term osteoporosis treatment is associated with reduction in the use of osteoporosis medications. CONCLUSIONS: There is a gap between the application of clinical recommendations and patient perceptions of osteoporosis and its treatment. There is a need for better education of patients and practitioners aimed at recognizing the serious consequences of fractures and understanding the expected benefits and potential risks of treatment. Media reports that disseminate evidence-based information on the balance of benefits and risks could help to reduce the osteoporosis treatment gap and mitigate the crisis in osteoporosis care.

16 Review Consensus on best practice standards for Fracture Liaison Service in the Asia-Pacific region. 2018

Chan, Ding-Cheng Derrick / Chang, Lo-Yu / Akesson, Kristina E / Mitchell, Paul / Chen, Chung-Hwan / Lewiecki, E Michael / Lee, Joon Kiong / Lau, Tang Ching / Songpatanasilp, Thawee / Lee, Kin Bong / Kim, Kwang Joon / Chen, Jung-Fu / Huang, Ko-En / Gau, Yih-Lan / Chang, Yin-Fan / Ebeling, Peter / Xia, Weibo / Yu, Wei / Suzuki, Atsushi / Hew, Fen Lee / Mercado-Asis, Leilani B / Chung, Yoon-Sok / Tsai, Keh-Sung / Lin, Gau-Tyan / Yang, Rong-Sen / Wu, Chih-Hsing. ·Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan. · Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. · Superintendent Office, Chutung Branch, National Taiwan University Hospital, Hsinchu County, Taiwan. · School of Medicine, National Taiwan University, Taipei, Taiwan. · Department of Clinical Sciences, Lund University, Malmö, Sweden. · Department of Orthopedics, Skåne University Hospital, Malmö, Sweden. · Synthesis Medical NZ Ltd, Auckland, New Zealand. · University of Notre Dame Australia, Sydney, Australia. · Osteoporosis New Zealand, Wellington, New Zealand. · Orthopaedic Research Center, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. · Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. · Department of Orthopaedics, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. · Department of Orthopaedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. · New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA. · Beacon Hospital, Petaling Jaya, Selangor, Malaysia. · Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. · Department of University Medicine Cluster, National University Health System, Singapore, Singapore. · Department of Orthopaedics, Phramongkutklao Hospital, Bangkok, Thailand. · Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital, Kowloon, Hong Kong. · Division of Geriatrics, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea. · Executive Health Promotion Center, Gangnam Severance Hospital, Executive Health Promotion Center, Gangnam Severance Hospital Yonsei University Health System, Seoul, Republic of Korea. · Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan. · Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan City, Taiwan. · Department of Orthopaedics, Taitung Christian Hospital, Taitung, Taiwan. · Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng Li Road, Tainan, 70428, Taiwan. · Bone and Muscle Health Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia. · Melbourne Medical School (Western Campus), University of Melbourne, St Albans, Australia. · Australian Institute for Musculoskeletal Science, St Albans, Australia. · Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China. · Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China. · Division of Endocrinology and Metabolism, Department of Internal Medicine, Fujita Health University, Toyoake, Aichi, Japan. · Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia. · University of Santo Tomas, Manila City, Philippines. · Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Republic of Korea. · Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan. · Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. · Department of Orthopedics, National Taiwan University Hospital, Room 11-17, Research Build, No7, Chungshan S. Rd., Taipei, Taiwan. rsy0819@gmail.com. · Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng Li Road, Tainan, 70428, Taiwan. paulo@mail.ncku.edu.tw. · Institute of Gerontology, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan, Taiwan. paulo@mail.ncku.edu.tw. ·Arch Osteoporos · Pubmed #29754189.

ABSTRACT: The Fracture Liaison Service (FLS) Consensus Meeting endorsed by the International Osteoporosis Foundation (IOF), Asian Federation of Osteoporosis Societies (AFOS), and Asia Pacific Osteoporosis Foundation (APOF) was hosted by the Taiwanese Osteoporosis Association on October 14, 2017. International and domestic experts reviewed the 13 Best Practice Framework (BPF) standards and concluded that all standards were generally applicable in the Asia-Pacific region and needed only minor modifications to fit the healthcare settings in the region. PURPOSE: To review and generate consensus on best practices of fracture liaison service (FLS) in the Asia-Pacific (AP) region. METHODS: In October 2017, the Taiwanese Osteoporosis Association (TOA) invited experts from the AP region (n = 23), the Capture the Fracture Steering Committee (n = 2), and the USA (n = 1) to join the AP region FLS Consensus Meeting in Taipei. After two rounds of consensus generation, the recommendations on the 13 Best Practice Framework (BPF) standards were reported and reviewed by the attendees. Experts unable to attend the on-site meeting reviewed the draft, made suggestions, and approved the final version. RESULTS: Because the number of FLSs in the region is rapidly increasing, experts agreed that it was timely to establish consensus on benchmark quality standards for FLSs in the region. They also agreed that the 13 BPF standards and the 3 levels of standards were generally applicable, but that some clarifications were necessary. They suggested, for example, that patient and family education be incorporated into the current standards and that communication with the public to promote FLSs be increased. CONCLUSIONS: The consensus on the 13 BPF standards reviewed in this meeting was that they were generally applicable and required only a few advanced clarifications to increase the quality of FLSs in the region.

17 Review Emerging anabolic agents in the treatment of osteoporosis. 2017

Lovato, Christina / Lewiecki, E Michael. ·a Division of Endocrinology, Diabetes and Metabolism , University of New Mexico Health Sciences Center , Albuquerque , NM , USA. · b New Mexico Clinical Research & Osteoporosis Center , Albuquerque , NM , USA. ·Expert Opin Emerg Drugs · Pubmed #28756709.

ABSTRACT: INTRODUCTION: Osteoporosis is a common skeletal disease with serious consequences due to osteoporotic fractures and high costs to society for post-fracture care. Most patients at high risk for fracture are not receiving care to reduce fracture risk. The osteoporosis treatment gap has reached crisis proportions. Strategies to reduce the treatment gap include systematic methods for identifying and treating high risk patients, better education of patients and healthcare providers, better use of currently available drugs, and development of new drugs to treat osteoporosis. Areas covered: Two osteoanabolic agents with novel mechanisms of action have recently completed phase 3 clinical trials. The efficacy and safety findings of these studies are reviewed. Abaloparatide, a synthetic analog of parathyroid hormone-related protein, has received regulatory approval for the treatment of postmenopausal women with osteoporosis at high risk for fracture. Romosozumab, a humanized monoclonal antibody to sclerostin, an endogenous inhibitor of bone formation, is under regulatory review. Expert opinion: Osteoanabolic therapy for osteoporosis can restore, at least in part, the degradation of bone microarchitecture that is a hallmark of this disease. The emergence of new osteoanabolic compounds expands the treatment options for patients at high risk for fracture.

18 Review Hypophosphatasia in Adults: Clinical Assessment and Treatment Considerations. 2017

Shapiro, Jay R / Lewiecki, E Michael. ·Uniformed Services University of the Health Sciences, Bethesda, MD, USA. · New Mexico Clinical Research and Osteoporosis Center, Albuquerque, NM, USA. ·J Bone Miner Res · Pubmed #28731215.

ABSTRACT: Hypophosphatasia (HPP) is a rare inherited disorder of bone affecting approximately 500 to 600 known individuals in the United States. HPP is the result of mutations involving the gene for tissue nonspecific alkaline phosphatase. Five clinical types of HPP are recognized. The clinical presentation of HPP varies from devastating prenatal intrauterine disease to mild manifestations in adulthood. In adults, main clinical involvement includes early loss of primary or secondary teeth, osteoporosis, bone pain, chondrocalcinosis, and fractures. Treatment for HPP is limited. Asfotase alfa is a subcutaneously administered synthetic human alkaline phosphatase that is approved for treatment of patients, including adults, with perinatal/infantile- and juvenile-onset HPP. However, guidelines for the treatment of adults with HPP are not available. This discussion addresses diagnostic and treatment considerations for adults with HPP. © 2017 American Society for Bone and Mineral Research.

19 Review The Clinical Utility of Vertebral Fracture Assessment in Predicting Fractures. 2017

Borges, Joao Lindolfo C / de M Miranda, Isabella Santiago / Lewiecki, E Michael. ·Centro de Pesquisa Clínica do Brasil, Universidade Católica de Brasília, Brazil. Electronic address: jlborges@metabolismo.com.br. · Centro de Pesquisa Clínica do Brasil. · New Mexico Clinical Research & Osteoporosis Center. ·J Clin Densitom · Pubmed #28729044.

ABSTRACT: Vertebral fracture (VF) is the most common type of osteoporotic fracture. VFs are associated with diminished quality of life and high morbidity and mortality. The presence of a VF, especially a recent one, is an important risk factor for developing another fracture. However, most VFs are not clinically recognized. VF assessment by dual-energy X-ray absorptiometry is a convenient, low-cost, low-radiation, reliable method to identify VFs during bone mineral density measurement. The finding of a previously unrecognized VF may change the diagnostic classification, assessment of fracture risk, and treatment strategies. This paper focuses on the utility of VF assessment in clinical practice.

20 Review Western Osteoporosis Alliance Clinical Practice Series: Evaluating the Balance of Benefits and Risks of Long-Term Osteoporosis Therapies. 2017

Hanley, David A / McClung, Michael R / Davison, K Shawn / Dian, Larry / Harris, Steve T / Miller, Paul D / Lewiecki, E Michael / Kendler, David L / Anonymous6460901. ·Departments of Medicine, Oncology, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada. Electronic address: dahanley@ucalgary.ca. · Oregon Osteoporosis Center, Portland; Institute of Health and Ageing, Australian Catholic University, Melbourne, Australia. · A Priori Medical Sciences Inc, Victoria, BC, Canada. · Department of Medicine, University of British Columbia, Vancouver, Canada. · Department of Medicine, University of California, San Francisco. · Colorado Center for Bone Research, Lakewood. · New Mexico Clinical Research & Osteoporosis Center, Albuquerque. · Department of Medicine, University of British Columbia, Vancouver. ·Am J Med · Pubmed #28359721.

ABSTRACT: Osteoporosis is a chronic disease that requires life-long strategies to reduce fracture risk. Few trials have investigated the balance of benefits and risk with long-term use of osteoporosis therapies, and fewer still have investigated the consequences of treatment discontinuation. The best available evidence suggests that up to 10 years of treatment with an oral bisphosphonate maintains the degree of fracture risk reduction observed in the 3-year registration trials. With denosumab, 10 years of therapy appears to provide fracture risk reduction similar to or better than that observed in the 3-year registration trial. Available data suggest an increasing but low risk of fractures with atypical features with increasing duration of bisphosphonate therapy. Published data linking duration of therapy to osteonecrosis of the jaw are lacking for bisphosphonates and denosumab. Other side effects associated with denosumab or bisphosphonates do not appear to be related to therapy duration. The antifracture benefits of long-term therapy with bisphosphonates and denosumab in appropriately selected patients outweigh the low risk of serious side effects.

21 Review Osteoporosis: Treat-to-Target. 2017

Michael Lewiecki, E. ·New Mexico Clinical Research & Osteoporosis Center, 300 Oak St. NE, Albuquerque, NM, 87106, USA. mlewiecki@gmail.com. ·Curr Osteoporos Rep · Pubmed #28236035.

ABSTRACT: PURPOSE OF REVIEW: Treat-to-target (goal-directed therapy) has been proposed as a strategy to assist clinicians in selecting the most appropriate initial treatment for osteoporosis and guiding subsequent decisions to continue, change, or stop treatment. This is a review of the current medical evidence regarding treatment targets and potential clinical applications in managing patients with osteoporosis. RECENT FINDINGS: Analyses of randomized placebo-controlled trials of approved agents to treat osteoporosis have generally shown that larger increases in bone mineral density are associated with greater reduction in fracture risk. Achievement of T-scores > -2.5 to -2.0 with treatment appears to provide little additional fracture protection. The paradigm of treat-to-target is aimed at enhancing and individualizing the care of patients with osteoporosis. Based on the best available data, the most promising target is T-score > -2.5. More data are needed to validate the clinical utility of treat-to-target for osteoporosis.

22 Review Romosozumab for the treatment of osteoporosis. 2017

Bandeira, Leonardo / Lewiecki, E Michael / Bilezikian, John P. ·a Department of Medicine , College of Physicians and Surgeons, Columbia University Medical Center , New York , NY , USA. · b New Mexico Clinical Research & Osteoporosis Center , Albuquerque , NM , USA. ·Expert Opin Biol Ther · Pubmed #28064540.

ABSTRACT: INTRODUCTION: Sclerostin, a glycoprotein produced primarily by osteocytes, blocks the canonical Wnt signaling bone formation pathway. Romosozumab is a humanized monoclonal antibody to sclerostin that binds to sclerostin, permitting the engagement of Wnt ligands with their co-receptors, resulting in an increase in bone formation and bone mineral density (BMD). Clinical studies with romosozumab have shown dramatic improvements in BMD at the spine and hip. Romosozumab is associated with improvement in bone strength through mechanisms that include increases in bone formation and, different from classical osteoanabolic agents, suppression of bone resorption. Areas covered: Herein, the authors highlight the available data on romosozumab for the treatment of osteoporosis. This includes the latest data on the efficacy, pharmacokinetics and pharmacodynamics as well as safety and tolerability data. Expert opinion: Monthly subcutaneous dosing of romosozumab reduces the risk of vertebral and clinical fractures in women with postmenopausal osteoporosis, with a favorable balance of benefits and risks. Romosozumab is a promising emerging anabolic agent with a novel mechanism of action that may expand the options for treating osteoporotic patients at high risk of fracture.

23 Review Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus. 2017

Khan, A A / Hanley, D A / Rizzoli, R / Bollerslev, J / Young, J E M / Rejnmark, L / Thakker, R / D'Amour, P / Paul, T / Van Uum, S / Shrayyef, M Zakaria / Goltzman, D / Kaiser, S / Cusano, N E / Bouillon, R / Mosekilde, L / Kung, A W / Rao, S D / Bhadada, S K / Clarke, B L / Liu, J / Duh, Q / Lewiecki, E Michael / Bandeira, F / Eastell, R / Marcocci, C / Silverberg, S J / Udelsman, R / Davison, K Shawn / Potts, J T / Brandi, M L / Bilezikian, J P. ·McMaster University, Hamilton, Canada. Aliya@mcmaster.ca. · Bone Research and Education Center, 223-3075 Hospital Gate, Oakville, ON, Canada. Aliya@mcmaster.ca. · University of Calgary, Calgary, Canada. · Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. · University of Oslo, Oslo, Norway. · McMaster University, Hamilton, Canada. · Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark. · University of Oxford, Oxford, UK. · CHUM, Montreal, Canada. · Western University, London, ON, Canada. · Division of Endocrinology, University of Toronto, Mississauga, ON, Canada. · McGill University, Montreal, Canada. · Dalhousie University, Halifax, Canada. · Columbia University College of Physicians and Surgeons, New York, NY, USA. · KU, Leuven, Belgium. · University of Aarhus, Aarhus, Denmark. · University of Hong Kong, Hong Kong, China. · Henry Ford Hospital, Detroit, MI, USA. · Postgraduate Institute of Medical Education and Research, Chandigarth, India. · Mayo Clinic, Rochester, MN, USA. · Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China. · University of California, San Francisco, CA, USA. · New Mexico Clinical Research and Osteoporosis Center, University of New Mexico School of Medicine, Albuquerque, NM, USA. · Division of Endocrinology, Diabetes and Metabolic Bone Diseases, Agamenon Magalhaes Hospital, Brazilian Ministry of Health, University of Pernambuco Medical School, Recife, Brazil. · Department of Human Metabolism, University of Sheffield, Sheffield, UK. · Department for Clinical and Experimental Medicine, University of Pisa, Endocrine Unit 2, University Hospital of Pisa, Pisa, Italy. · Division of Endocrinology, Columbia University College of Physicians and Surgeons, New York, NY, USA. · Department of Surgery, Yale University School of Medicine, New Haven, CT, USA. · University of Victoria, Victoria, BC, Canada. · Massachusetts General Hospital, Harvard University, Boston, MA, USA. · University of Florence, Florence, Italy. ·Osteoporos Int · Pubmed #27613721.

ABSTRACT: The purpose of this review is to assess the most recent evidence in the management of primary hyperparathyroidism (PHPT) and provide updated recommendations for its evaluation, diagnosis and treatment. A Medline search of "Hyperparathyroidism. Primary" was conducted and the literature with the highest levels of evidence were reviewed and used to formulate recommendations. PHPT is a common endocrine disorder usually discovered by routine biochemical screening. PHPT is defined as hypercalcemia with increased or inappropriately normal plasma parathyroid hormone (PTH). It is most commonly seen after the age of 50 years, with women predominating by three to fourfold. In countries with routine multichannel screening, PHPT is identified earlier and may be asymptomatic. Where biochemical testing is not routine, PHPT is more likely to present with skeletal complications, or nephrolithiasis. Parathyroidectomy (PTx) is indicated for those with symptomatic disease. For asymptomatic patients, recent guidelines have recommended criteria for surgery, however PTx can also be considered in those who do not meet criteria, and prefer surgery. Non-surgical therapies are available when surgery is not appropriate. This review presents the current state of the art in the diagnosis and management of PHPT and updates the Canadian Position paper on PHPT. An overview of the impact of PHPT on the skeleton and other target organs is presented with international consensus. Differences in the international presentation of this condition are also summarized.

24 Review Pharmacodynamics and pharmacokinetics of oral salmon calcitonin in the treatment of osteoporosis. 2016

Bandeira, Leonardo / Lewiecki, E Michael / Bilezikian, John P. ·a Department of Medicine , College of Physicians and Surgeons, Columbia University , New York , NY , USA. · b New Mexico Clinical Research & Osteoporosis Center , Albuquerque , NM , USA. ·Expert Opin Drug Metab Toxicol · Pubmed #27070719.

ABSTRACT: INTRODUCTION: Salmon calcitonin (sCT) has been used for the treatment of postmenopausal osteoporosis for over 30 years. It is available in injectable and intranasal formulations. Two oral formulations have recently been developed. AREAS COVERED: The basis for oral sCT's bioavailability rests with a carrier molecule (8-(N-2-hydroxy-5-chloro-benzoyl)-amino-caprylic acid) or an acid-resistant enteric coating (Eudragit® polymer containing citric acid). With these formulations, sCT is resistant to gastric acid, and thus becomes available for absorption at the higher pH of the small intestine. Even though the changes in bone mineral density and bone turnover markers are greater with oral compared to nasal sCT, it shows only minor effects on these surrogate markers. EXPERT OPINION: Oral sCT is attractive in concept as it is would be more convenient to patients than other routes of administration. While there may be other advantages to the oral formulation such as improving bone mineral density to a greater extent than nasal CT, anti-fracture efficacy has not been shown in a recent major clinical trial. Together with the possibility of an association between the drug and cancer and the availability of antiresorptive drug classes that are clearly more efficacious than sCT, successful development of oral sCT as a treatment for postmenopausal osteoporosis is uncertain.

25 Review Vertebral Fractures: Clinical Importance and Management. 2016

Kendler, D L / Bauer, D C / Davison, K S / Dian, L / Hanley, D A / Harris, S T / McClung, M R / Miller, P D / Schousboe, J T / Yuen, C K / Lewiecki, E M. ·Department of Medicine, University of British Columbia, Vancouver, Canada. Electronic address: davidkendler@gmail.com. · Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco. · University of Victoria, BC, Canada. · Department of Medicine, University of British Columbia, Vancouver, Canada. · Departments of Medicine, Oncology, and Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Canada. · Oregon Osteoporosis Center, Portland. · Colorado Center for Bone Research, Lakewood. · Park Nicollet Health Services, Park Nicollet Osteoporosis Center, Minneapolis, Minn; Division of Health Policy and Management, University of Minnesota, Minneapolis. · Prohealth Clinical Research, University of British Columbia, Vancouver, Canada. · New Mexico Clinical Research and Osteoporosis Center, Albuquerque. ·Am J Med · Pubmed #26524708.

ABSTRACT: Vertebral fractures are common and can result in acute and chronic pain, decreases in quality of life, and diminished lifespan. The identification of vertebral fractures is important because they are robust predictors of future fractures. The majority of vertebral fractures do not come to clinical attention. Numerous modalities exist for visualizing suspected vertebral fracture. Although differing definitions of vertebral fracture may present challenges in comparing data between different investigations, at least 1 in 5 men and women aged >50 years have one or more vertebral fractures. There is clinical guidance to target spine imaging to individuals with a high probability of vertebral fracture. Radiology reports of vertebral fracture need to clearly state that the patient has a "fracture," with further pertinent details such as the number, recency, and severity of vertebral fracture, each of which is associated with risk of future fractures. Patients with vertebral fracture should be considered for antifracture therapy. Physical and pharmacologic modalities of pain control and exercises or physiotherapy to maintain spinal movement and strength are important components in the care of vertebral fracture patients.

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