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Osteoporosis: HELP
Articles from New Mexico
Based on 100 articles published since 2008
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These are the 100 published articles about Osteoporosis that originated from New Mexico during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4
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 / Anonymous7130862. ·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 Guideline Report of the International Society for Clinical Densitometry 2007 Adult Position Development Conference and Official Positions. 2008

Lewiecki, E Michael / Baim, Sanford / Binkley, Neil / Bilezikian, John P / Kendler, David L / Hans, Didier B / Silverman, Stuart / Anonymous1120602. ·New Mexico Clinical Research and Osteoporosis Center, Albuquerque, NM 87106, USA. lewiecki@aol.com ·South Med J · Pubmed #18580720.

ABSTRACT: The International Society for Clinical Densitometry (ISCD) periodically holds Position Development Conferences (PDCs) for the purpose of establishing standards and guidelines for the assessment of skeletal health -- the nomenclature, indications, acquisition, analysis, quality control, interpretation, and reporting of bone density tests. Topics are selected for consideration according to criteria that include clinical relevancy, uncertainty in the application of medical evidence to clinical practice, and the likelihood of the expert panel achieving agreement. The most recent Adult PDC was held July 20 to 22, 2007, in Lansdowne, Virginia. Topics included technical and clinical issues relevant to dual-energy x-ray absorptiometry (DXA), vertebral fracture assessment, and bone densitometry technologies other than central DXA. This report describes the methodology and presents the results of this PDC. The first ISCD Pediatric PDC was held June 20 to 21, 2007 in Montreal, Quebec, Canada, and is reported separately.

4 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 --

5 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 --

6 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.

7 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 / Anonymous7240901. ·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.

8 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.

9 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.

10 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.

11 Review Drug-induced osteoporosis: from Fuller Albright to aromatase inhibitors. 2015

Byreddy, D V / Bouchonville, M F / Lewiecki, E M. ·a Division of Endocrinology and Metabolism, Department of Internal Medicine , University of New Mexico , Albuquerque, Albuquerque , New Mexico. · b New Mexico Clinical Research & Osteoporosis Center , University of New Mexico School of Medicine , Albuquerque , New Mexico , USA. ·Climacteric · Pubmed #26488130.

ABSTRACT: Many commonly prescribed medications, such as selective serotonin reuptake inhibitors, proton pump inhibitors, thiazolidinediones, aromatase inhibitors, and androgen deprivation therapy, have been associated with adverse skeletal effects. The levels of evidence in support of a causal relationship between drug use and the development of bone loss and fractures are variable. For some drugs, a causal relationship is suspected (but not proven) based on observational studies, while in others causality is firmly established with randomized, controlled clinical trials. The mechanism of action for skeletal damage is poorly understood for some drugs and well known for others. Guidelines for managing bone health in patients taking some medications with potential skeletal toxicity have been developed using the best available evidence and expert opinion. This is a review of selected medications that have been associated with bone loss and fractures, with recommendations for clinical care.

12 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.

13 Review The potential use of antisclerostin therapy in chronic kidney disease-mineral and bone disorder. 2015

Costa, Aline G / Bilezikian, John P / Lewiecki, E Michael. ·aMetabolic Bone Diseases Unit, Division of Endocrinology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, USA bDivision of Endocrinology, Department of Medicine, São Paulo Federal University, São Paulo, Brazil cNew Mexico Clinical Research Osteoporosis Center, Albuquerque, New Mexico, USA. ·Curr Opin Nephrol Hypertens · Pubmed #26050118.

ABSTRACT: PURPOSE OF REVIEW: Sclerostin is a regulator of the osteoanabolic canonical Wnt signaling pathway, and thus helps to govern rates of bone formation. The Wnt pathway is also recognized as playing an important role in the pathophysiology of the chronic kidney disease-mineral and bone disorder (CKD-MBD). It also may serve as an interface between bone and the vascular system. Pharmacological inhibition of sclerostin has shown promise as an osteoanabolic approach to the treatment of osteoporosis. Inhibition of sclerostin is a potentially useful but unproven strategy in the management of CKD-MBD. RECENT FINDINGS: Clinical trials with humanized monoclonal sclerostin antibodies (Scl-Ab) have shown a rapid initial increase in bone formation and a marked increase in bone mineral density. Although clinical data, to this point, in CKD are not available, animal models of low bone turnover CKD show that Scl-Ab improves trabecular bone volume and mineralization without affecting biochemical indices. SUMMARY: Targeted clinical trials are needed to evaluate the potential effectiveness of Scl-Ab in CKD. Based upon the available data, there is potential not only for this new therapeutic class to improve skeletal health but perhaps also to have substantial cardiovascular benefits in CKD.

14 Review Sclerostin and skeletal health. 2015

Sharifi, Maryam / Ereifej, Lisa / Lewiecki, E Michael. ·University of New Mexico School of Medicine, Albuquerque, NM, USA. ·Rev Endocr Metab Disord · Pubmed #25669441.

ABSTRACT: Sclerostin is a cysteine-knot glycoprotein product of the SOST gene, predominately expressed by osteocytes, that is a regulator of osteoblastic bone formation. When sclerostin binds to its low-density lipoprotein receptor-related proteins 5 and 6 on the cell membrane of osteoblasts, it inhibits canonical Wnt/β-catenin signaling and reduces osteoblastic bone formation. Sclerostin was first identified in the study of two rare autosomal recessive disorders, sclerosteosis and van Buchem disease, which are associated with absent or reduced levels of sclerostin. Although homozygote patients with these disorders have serious adverse clinical consequences due to excessive bone growth, heterozygote patients have a normal phenotype, high bone mass, and very low risk of fractures. This has led to the concept that downregulation of sclerostin might be effective in the treatment of osteoporosis. Several humanized monoclonal antibodies to sclerostin, including romosozumab and blosozumab, are now in clinical development. Preliminary data show that these agents result in a transient increase in bone formation markers, a sustained decrease in bone resorption markers, and a robust increase in bone mineral density. If any of these agents are found to reduce fracture risk with a favorable safety profile, it will expand the options for osteoanabolic therapy for patients at high risk for fractures.

15 Review Bisphosphonate use in children with pediatric osteoporosis and other bone conditions. 2014

Szalay, Elizabeth A. ·UNM Carrie Tingley Bone Health Center, University of New Mexico School of Medicine, Carrie Tingley Hospital, 1127 University Blvd. NE, Albuquerque, NM 87102, USA. Tel.: +1 505 272 5214; Fax: +1 505 272 6500; E-mail: ESzalay@salud.unm.edu. ·J Pediatr Rehabil Med · Pubmed #25096864.

ABSTRACT: Bisphosphonates (BPs) are used most commonly in children with osteogenesis imperfecta, resulting in increased trabeculae and cortical thickness, increased bone density as measured by DXA (Dual Energy X-ray Absorptiometry), and improved vertebral morphology. Less well documented in controlled trials are decrease in long bone fractures, improved strength and motor function, and decreased pain. Outside of children with osteogenesis imperfecta, use of bisphosphonates in children is increasing, all of which is off-label. This is seen in children with other chronic conditions resulting in pediatric osteoporosis and insufficiency fractures. Additional indications include steroid dependency with progressive loss of bone density, avascular necrosis of bone, and chronic regional pain syndrome. This review highlights the potential benefits and risks of the use of bisphosphonates in these unique children at risk for fracture or bone collapse.

16 Review Conjugated estrogens combined with bazedoxifene: the first approved tissue selective estrogen complex therapy. 2014

Sharifi, Maryam / Lewiecki, E Michael. ·University of New Mexico School of Medicine, Albuquerque, NM, USA. ·Expert Rev Clin Pharmacol · Pubmed #24580081.

ABSTRACT: Menopausal therapy with a tissue selective estrogen complex combines estrogens with a selective estrogen receptor modulator, with the goal of blending the desirable effects of estrogens on menopausal symptoms and bone with the tissue selective properties of a selective estrogen receptor modulator. The first tissue selective estrogen complex to receive regulatory approval is a combination of conjugated estrogens (CE) with bazedoxifene (BZA). Clinical trials with CE/BZA in postmenopausal women have shown improvement in vasomotor symptoms, vulvo-vaginal atrophy, and bone mineral density, without stimulation of the endometrium or breast tissue, with a generally favorable safety and tolerability profile. CE/BZA represents a new approach to the management of menopausal symptoms in women with a uterus.

17 Review Understanding and communicating the benefits and risks of denosumab, raloxifene, and teriparatide for the treatment of osteoporosis. 2014

Lewiecki, E Michael / Miller, Paul D / Harris, Steve T / Bauer, Douglas C / Davison, K Shawn / Dian, Larry / Hanley, David A / McClung, Michael R / Yuen, Chui K / Kendler, David L. ·New Mexico Clinical Research and Osteoporosis Center, Albuquerque, NM, USA. Electronic address: mlewiecki@gmail.com. · Colorado Center for Bone Research, Lakewood, CO, USA. · Department of General Internal Medicine, University of California, San Francisco, CA, USA. · Faculty of Graduate Studies, University of Victoria, British Columbia, Canada. · Prohealth Clinical Research, University of British Columbia, Vancouver Canada. · Department of Medicine, University of Calgary, Calgary, Canada. · Oregon Osteoporosis Center, Portland, OR, USA. ·J Clin Densitom · Pubmed #24206867.

ABSTRACT: The number needed to treat is a valuable metric to determine the benefit of therapy, but it must be viewed against the respective number needed to harm. Denosumab and teriparatide (TPTD) have proven antifracture efficacy at vertebral and nonvertebral sites, whereas raloxifene has proven antifracture efficacy at the spine only. Denosumab use has been associated with a small, yet statistically significant, increased incidence of eczema and serious cellulitis. Raloxifene use has been associated with statistically significant increases in the risk of venous thromboembolism and possibly deadly stroke, although not an increase in total strokes. No significant, nontransient adverse events have been reported with TPTD use. When used for the treatment of postmenopausal osteoporosis, denosumab, raloxifene, and TPTD all generally have favorable risk-to-benefit profiles, but therapy-specific contraindications necessitate thoughtful consideration of all available clinical information and individualization of treatment decisions.

18 Review Bone density measurement and assessment of fracture risk. 2013

Lewiecki, E Michael. ·New Mexico Clinical Research & Osteoporosis Center, Albuquerque, New Mexico. ·Clin Obstet Gynecol · Pubmed #24022502.

ABSTRACT: The most useful methods for estimating fracture risk are bone mineral density (BMD) testing by dual-energy x-ray absorptiometry and consideration of clinical risk factors (CRFs) for fracture. The combination of BMD and CRFs predicts fractures better than BMD or CRFs alone. FRAX is a computer-based fracture risk algorithm developed by the World Health Organization to estimate fracture probability using validated CRFs and femoral neck BMD, when available. BMD and FRAX are included in clinical practice guidelines to identify patients at high fracture risk who are most likely to benefit from pharmacologic therapy to reduce fracture risk.

19 Review Osteoporosis update from the 2012 Santa Fe Bone Symposium. 2013

Lewiecki, E Michael / Adler, Robert A / Bilezikian, John P / Bouxsein, Mary L / Marcus, Robert / McClung, Michael R / Miller, Paul D / Tanner, S Bobo / Randall, Susan. ·New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA. Electronic address: mlewiecki@gmail.com. ·J Clin Densitom · Pubmed #23419827.

ABSTRACT: The core of the 2012 Santa Fe Bone Symposium consisted of plenary presentations on new developments in the fields of osteoporosis and metabolic bone disease, with a focus on current and future implications for patient care. These were complemented by oral abstracts, interactive discussions of challenging cases, a debate on benefits and risks of long-term bisphosphonate therapy, and a panel discussion of controversial issues in the management of osteoporosis. Other topics included a review of the most important scientific publications in the past year, new and emerging therapy for osteoporosis, the benefits and limitations of clinical practice guidelines in the care of individual patients, the effects of metallic elements on skeletal health, clinical applications of bone turnover markers, an engineering perspective of skeletal health and disease, and an update on the role of the International Society for Clinical Densitometry in education, certification, accreditation, and advocacy for high-quality bone density testing. The symposium was highlighted by an inaugural presentation of "2 Million 2 Many," a national campaign of the National Bone Health Alliance to increase awareness of osteoporosis.

20 Review Imaging technologies for assessment of skeletal health in men. 2013

Lewiecki, E Michael. ·New Mexico Clinical Research & Osteoporosis Center, 300 Oak Street NE, Albuquerque, NM 87106, USA. mlewiecki@gmail.com ·Curr Osteoporos Rep · Pubmed #23275231.

ABSTRACT: Conventional radiography can detect most fractures, evaluate their healing, and visualize characteristic skeletal abnormalities for some metabolic bone diseases. Dual-energy X-ray absorptiometry (DXA) is used to measure areal bone mineral density (BMD) in order to diagnose osteoporosis, estimate fracture risk, and monitor changes in BMD over time. Vertebral fracture assessment by DXA can diagnose vertebral fractures with less ionizing radiation, greater patient convenience, and lower cost than conventional radiography. Quantitative computed tomography (QCT) measures volumetric BMD separately in cortical and trabecular bone compartments. High resolution peripheral QCT and high resolution magnetic resonance imaging are noninvasive research tools that assess the microarchitecture of bone. The use of these technologies and others has been associated with special challenges in men compared with women, provided insights into differences in the pathogenesis of osteoporosis in men and women, and enhanced understanding of the mechanisms of action of osteoporosis treatments.

21 Review Monoclonal antibodies for the treatment of osteoporosis. 2013

Lewiecki, E Michael. ·New Mexico Clinical Research & Osteoporosis Center, 300 Oak St. NE, Albuquerque, NM 87106, USA. mlewiecki@gmail.com ·Expert Opin Biol Ther · Pubmed #23253281.

ABSTRACT: INTRODUCTION: Osteoporosis is a systemic skeletal disorder that weakens bones and increases the risk of fractures. It is caused by perturbations of bone remodeling, the coupled process whereby bone is continually resorbed and formed in small discrete units. Despite the availability of cost-effective pharmacological agents that reduce fracture risk, many patients who could benefit from treatment are not receiving it. Advances in the understanding of the molecular regulators of bone remodeling have led to the identification of new targets for therapeutic intervention. Monoclonal antibodies directed to these targets have recently been developed, providing new ways of modulating bone remodeling that may provide additional benefits beyond previously available therapy. AREAS COVERED: An approved fully human monoclonal antibody to receptor activator of nuclear factor-κB ligand, the principal regulator of osteoclastic bone resorption, reduces the risk of fractures in postmenopausal women with osteoporosis. Monoclonal antibodies in development include inhibitors of sclerostin and Dickhopf1, with osteoanabolic activity that may be beneficial in the treatment of osteoporosis. EXPERT OPINION: Monoclonal antibodies to molecular regulators of bone remodeling represent a new class of compounds for the management of osteoporosis and other skeletal disorders associated with an imbalance of bone resorption and formation.

22 Review Denosumab for the treatment of osteoporosis and cancer-related conditions. 2012

Lewiecki, E M / Bilezikian, J P. ·New Mexico Clinical Research & Osteoporosis Center, Albuquerque, New Mexico, USA. ·Clin Pharmacol Ther · Pubmed #22158568.

ABSTRACT: Osteoporotic fractures and adverse skeletal effects of malignancies are associated with high bone turnover. Denosumab is a potent inhibitor of bone resorption with a novel mechanism of action. It is administered as an infrequent subcutaneous injection with no restrictions relating to renal function. This review summarizes data on the efficacy and safety of denosumab that led to its approval for the treatment of postmenopausal osteoporosis, cancer treatment-induced bone loss, and skeletal complications of malignancies.

23 Review The role of antiresorptive therapies in improving patient care in early and metastatic breast cancer. 2012

Candelaria-Quintana, Dulcinea / Dayao, Zoneddy R / Royce, Melanie E. ·Department of Internal Medicine, UNM Cancer Center, 1 University of New Mexico, MSC 07-4025, Albuquerque, NM 87131-0001, USA. ·Breast Cancer Res Treat · Pubmed #21987034.

ABSTRACT: Breast cancer is the second most common cancer among American women and has a high rate of metastasis to bone. Patients regularly undergo adjuvant therapy (chemotherapy or hormonal therapy) following surgical resection of the tumor. In addition to potential direct effects on bone cells, both chemotherapy and hormonal therapy induce ovarian dysfunction and dramatically decrease estrogen levels in both pre- and postmenopausal women. This leads to decreased bone mineral density and increased fracture risk. Antiresorptive therapies (e.g, zoledronic acid and denosumab) have demonstrated efficacy in preventing cancer therapy-induced bone loss in patients with breast cancer and are approved for the prevention of skeletal-related events in patients with bone metastases from breast cancer. This review will focus on the evolving role of these antiresorptive therapies in the care of women with early or metastatic breast cancer.

24 Review Sclerostin: a novel target for intervention in the treatment of osteoporosis. 2011

Lewiecki, E Michael. ·New Mexico Clinical Research and Osteoporosis Center, Albuquerque, USA. ·Discov Med · Pubmed #22031665.

ABSTRACT: Bone remodeling is the process by which the adult skeleton is continually renewed through the highly coordinated activity of three types of cells - osteoclasts, osteoblasts, and osteocytes. Disruptions in signaling among these cells and alterations in their activity have been associated with skeletal diseases. In a rare accident of nature, some families have been found to have dense and strong bones due to a recessive loss of function mutation in the SOST gene that encodes for sclerostin, a protein expressed by osteocytes that downregulates osteoblastic bone formation. Individuals who are homozygous for this mutation have sclerosteosis, a disease with no detectable circulating sclerostin, resulting in generalized osteosclerosis with skeletal deformities, cranial nerve compression, and increased intracranial pressure due to boney overgrowth in the skull, and premature death. However, family members who are heterozygous carriers for the mutation have normal phenotype and normal lifespan, with dense bones and low risk of fracture. This observation has led to the concept that compounds that reduce sclerostin levels might mimic the heterozygous carrier state and be effective in the treatment of osteoporosis. To this end, monoclonal antibodies to sclerostin have been developed. Preclinical and early clinical studies of sclerostin inhibitors have shown robust stimulation of osteoblastic bone formation. The investigational compound that has advanced the furthest in development is AMG 785 (CDP7851), a humanized monoclonal antibody to sclerostin. Monoclonal antibodies to sclerostin represent a class of compounds with potential benefit in the treatment of osteoporosis and other skeletal disorders.

25 Review New targets for intervention in the treatment of postmenopausal osteoporosis. 2011

Lewiecki, E Michael. ·New Mexico Clinical Research & Osteoporosis Center, 300 Oak Street NE, Albuquerque, NM 87106, USA. lewiecki@aol.com ·Nat Rev Rheumatol · Pubmed #21931340.

ABSTRACT: Postmenopausal osteoporosis is a disease of high bone remodeling, with an imbalance of bone resorption over bone formation, resulting in decreased bone mineral density and disruption of bone microarchitecture. With our improved understanding of the molecular and cellular regulators and mediators of bone remodeling, new targets for therapeutic intervention have been identified. Receptor activator of nuclear factor κB ligand (RANKL) is the principal regulator of osteoclast differentiation, activity, and survival; denosumab, a fully human monoclonal antibody to RANKL, inhibits bone resorption and is approved for the treatment of women with postmenopausal osteoporosis at high risk of fractures. Cathepsin K is a protease produced by activated osteoclasts that degrades the protein matrix of bone. An inhibitor of cathepsin K, odanacatib, is in phase III clinical trials for the treatment of postmenopausal osteoporosis; it decreases bone resorption while seeming to suppress bone formation less than other antiresorptive agents. Sclerostin is a cytokine produced by osteocytes that inhibits osteoblastic bone formation; investigational monoclonal antibodies to sclerostin, such as AMG 785, have osteoanabolic properties with the potential to improve clinical outcomes in patients with osteoporosis. These and other novel interventions that target newly recognized regulators of bone remodeling are promising agents for the treatment of osteoporosis.

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