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Osteoporosis: HELP
Articles from Ohio
Based on 228 articles published since 2008
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These are the 228 published articles about Osteoporosis that originated from Ohio during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10
1 Guideline Screening for Osteoporosis to Prevent Fractures: US Preventive Services Task Force Recommendation Statement. 2018

Anonymous2470953 / Curry, Susan J / Krist, Alex H / Owens, Douglas K / Barry, Michael J / Caughey, Aaron B / Davidson, Karina W / Doubeni, Chyke A / Epling, John W / Kemper, Alex R / Kubik, Martha / Landefeld, C Seth / Mangione, Carol M / Phipps, Maureen G / Pignone, Michael / Silverstein, Michael / Simon, Melissa A / Tseng, Chien-Wen / Wong, John B. ·University of Iowa, Iowa City. · Fairfax Family Practice Residency, Fairfax, Virginia. · Virginia Commonwealth University, Richmond. · Veterans Affairs Palo Alto Health Care System, Palo Alto, California. · Stanford University, Stanford, California. · Harvard Medical School, Boston, Massachusetts. · Oregon Health and Science University, Portland. · Columbia University, New York, New York. · University of Pennsylvania, Philadelphia. · Virginia Tech Carilion School of Medicine, Roanoke. · Nationwide Children's Hospital, Columbus, Ohio. · Temple University, Philadelphia, Pennsylvania. · University of Alabama at Birmingham. · University of California, Los Angeles. · Brown University, Providence, Rhode Island. · Department of Medicine, Dell Medical School, University of Texas, Austin. · University of Texas, Austin. · Boston University, Boston, Massachusetts. · Northwestern University, Evanston, Illinois. · University of Hawaii, Honolulu. · Pacific Health Research and Education Institute, Honolulu, Hawaii. · Tufts University, Medford, Massachusetts. ·JAMA · Pubmed #29946735.

ABSTRACT: Importance: By 2020, approximately 12.3 million individuals in the United States older than 50 years are expected to have osteoporosis. Osteoporotic fractures, particularly hip fractures, are associated with limitations in ambulation, chronic pain and disability, loss of independence, and decreased quality of life, and 21% to 30% of patients who experience a hip fracture die within 1 year. The prevalence of primary osteoporosis (ie, osteoporosis without underlying disease) increases with age and differs by race/ethnicity. With the aging of the US population, the potential preventable burden is likely to increase in future years. Objective: To update the 2011 US Preventive Services Task Force (USPSTF) recommendation on screening for osteoporosis. Evidence Review: The USPSTF reviewed the evidence on screening for and treatment of osteoporotic fractures in men and women, as well as risk assessment tools, screening intervals, and efficacy of screening and treatment in subgroups. The screening population was postmenopausal women and older men with no known previous osteoporotic fractures and no known comorbid conditions or medication use associated with secondary osteoporosis. Findings: The USPSTF found convincing evidence that bone measurement tests are accurate for detecting osteoporosis and predicting osteoporotic fractures in women and men. The USPSTF found adequate evidence that clinical risk assessment tools are moderately accurate in identifying risk of osteoporosis and osteoporotic fractures. The USPSTF found convincing evidence that drug therapies reduce subsequent fracture rates in postmenopausal women. The USPSTF found that the evidence is inadequate to assess the effectiveness of drug therapies in reducing subsequent fracture rates in men without previous fractures. Conclusions and Recommendation: The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in women 65 years and older. (B recommendation) The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in postmenopausal women younger than 65 years at increased risk of osteoporosis, as determined by a formal clinical risk assessment tool. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis to prevent osteoporotic fractures in men. (I statement).

2 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.

3 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.

4 Guideline Osteoporosis in men: an Endocrine Society clinical practice guideline. 2012

Watts, Nelson B / Adler, Robert A / Bilezikian, John P / Drake, Matthew T / Eastell, Richard / Orwoll, Eric S / Finkelstein, Joel S / Anonymous3600728. ·Mercy Health Osteoporosis & Bone Health Services, Cincinnati Ohio 45236, USA. ·J Clin Endocrinol Metab · Pubmed #22675062.

ABSTRACT: OBJECTIVE: The aim was to formulate practice guidelines for management of osteoporosis in men. EVIDENCE: We used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe the strength of recommendations and evidence quality. CONSENSUS PROCESS: Consensus was guided by systematic evidence reviews, one in-person meeting, and multiple conference calls and e-mails. Task Force drafts were reviewed successively by The Endocrine Society's Clinical Guidelines Subcommittee and Clinical Affairs Core Committee; representatives of ASBMR, ECTS, ESE, ISCD; and members at large. At each stage, the Task Force received written comments and incorporated needed changes. The reviewed document was approved by The Endocrine Society Council before submission for peer review. CONCLUSIONS: Osteoporosis in men causes significant morbidity and mortality. We recommend testing higher risk men [aged ≥70 and men aged 50-69 who have risk factors (e.g. low body weight, prior fracture as an adult, smoking, etc.)] using central dual-energy x-ray absorptiometry. Laboratory testing should be done to detect contributing causes. Adequate calcium and vitamin D and weight-bearing exercise should be encouraged; smoking and excessive alcohol should be avoided. Pharmacological treatment is recommended for men aged 50 or older who have had spine or hip fractures, those with T-scores of -2.5 or below, and men at high risk of fracture based on low bone mineral density and/or clinical risk factors. Treatment should be monitored with serial dual-energy x-ray absorptiometry testing.

5 Editorial Sweet and brittle - Diabetes mellitus and the skeleton. 2016

Hofbauer, Lorenz C / Lecka-Czernik, Beata / Seibel, Markus J. ·Division of Endocrinology, Diabetes and Bone Diseases, Department of Medicine III, Technische Universität Medical Center and Center for Regenerative Therapies Dresden, D-01307 Dresden, Germany. Electronic address: lorenz.hofbauer@uniklinikum-dresden.de. · Departments of Orthopaedic Surgery, Physiology and Phamacology, Center for Diabetes and Endocrine Research, University of Toledo Health Science Campus, Toledo, OH 43560, USA. · Bone Research Program, ANZAC Research Institute, and Department of Endcorinology, Concord Hospital, The University Sydney, Sydney, Australia. ·Bone · Pubmed #26363338.

ABSTRACT: -- No abstract --

6 Review Surgical Considerations in Managing Osteoporosis, Osteopenia, and Vitamin D Deficiency During Arthroscopic Rotator Cuff Repair. 2019

Entezari, Vahid / Lazarus, Mark. ·Department of Orthopaedic Surgery, Orthopaedic & Rheumatologic Institute, Cleveland Clinic, 9500 Euclid Avenue, A40, Cleveland, OH 44195, USA. Electronic address: entezav@ccf.org. · Department of Orthopaedic Surgery, The Rothman Institute-Thomas Jefferson University, Philadelphia, PA, USA. ·Orthop Clin North Am · Pubmed #30850081.

ABSTRACT: Osteopenia and osteoporosis are common in older adults and are associated with increased risk of fragility fractures. Vitamin D deficiency caused by chronic disease, poor nutrition, and inadequate sun exposure affects bone quality. Chronic rotator cuff tears can deteriorate the bone mineral density of the greater tuberosity and have been linked to reduced anchor pullout strength and high re-tear rate after repair especially in older patients with larger tear size. This article summarizes the current evidence on rotator cuff tear and bone quality and provides treatment strategies for rotator cuff repair in patients with poor bone quality.

7 Review Bone Health in Women. 2018

Dasarathy, Jaividhya / Labrador, Hallie. ·Department of Family Medicine, Case Western Reserve University, MetroHealth Medical Center, 2500 Metrohealth Drive, Cleveland, OH 44109, USA. Electronic address: jxd114@case.edu. · Primary Care Sports Medicine Fellowship, North Shore University HealthSystem, University of Chicago Pritzker School of Medicine, 920 North Milwaukee Avenue, Lincolnshire, IL 60069, USA. ·Prim Care · Pubmed #30401347.

ABSTRACT: Bone health is critical to overall health and quality of life. Although genetic factors play a key role in bone formation, there are several external factors that can be modified to preserve bone health. Diet, exercise, menstrual irregularities, medications, disease states, weight, and environmental factors can all affect fracture risk. Osteoporosis is characterized by decrease in bone mass and microarchitectural changes in the bone that increases fracture risk. Screening for osteoporosis may help facilitate treatment before fractures occur. Preventing fractures needs patient and physician understanding of bone health to improve and requires a team effort.

8 Review Risks associated with lung transplantation in cystic fibrosis patients. 2018

Li, Susan S / Tumin, Dmitry / Krone, Katie A / Boyer, Debra / Kirkby, Stephen E / Mansour, Heidi M / Hayes, Don. ·a Department of Pediatrics, Nationwide Children's Hospital , The Ohio State University College of Medicine , Columbus , OH , USA. · b Division of Respiratory Diseases, Boston Children's Hospital , Harvard Medical School , Boston , MA, OH , USA. · c Department of Pharmacology and Toxicology , The University of Arizona Colleges of Pharmacy and Medicine , Tucson , AZ , USA. ·Expert Rev Respir Med · Pubmed #30198350.

ABSTRACT: INTRODUCTION: Survival after lung transplantation lags behind outcomes of other solid organ transplants, and complications from lung transplant are the second most common cause of death in cystic fibrosis. Evolving surgical techniques, therapeutics, and perioperative management have improved short-term survival after lung transplantation, yet have not translated into significant improvement in long-term mortality. Areas covered: We review risk factors for poor long-term outcomes among patients with cystic fibrosis undergoing lung transplantation to highlight areas for improvement. This includes reasons for organ dysfunction, complications of immunosuppression, further exacerbation of extrapulmonary complications of cystic fibrosis, and quality of life. A literature search was performed using PubMed-indexed journals. Expert commentary: There are multiple medical and socioeconomic barriers that threaten long-term survival following lung transplant for patients with cystic fibrosis. An understanding of the causes of each could elucidate treatment options. There is a lack of prospective, multicenter, randomized control trials due to cost, complexity, and feasibility. Ongoing prospective studies should be reserved for the most promising interventions identified in retrospective studies in order to improve long-term outcomes.

9 Review Bacteria, Bones, and Stones: Managing Complications of Short Bowel Syndrome. 2018

Johnson, Erika / Vu, Long / Matarese, Laura E. ·Center for Human Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA. · Department of Internal Medicine and Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA. ·Nutr Clin Pract · Pubmed #29926935.

ABSTRACT: Short bowel syndrome (SBS) occurs in patients who have had extensive resection. The primary physiologic consequence is malabsorption, resulting in fluid and electrolyte abnormalities and malnutrition. Nutrient digestion, absorption, and assimilation may also be diminished by disturbances in the production of bile acids and digestive enzymes. Small bowel dilation, dysmotility, loss of ileocecal valve, and anatomical changes combined with acid suppression and antimotility drugs increase the risk of small intestinal bacterial overgrowth, further contributing to malabsorption. Metabolic changes that occur in SBS due to loss of colonic regulation of gastric and small bowel function can also lead to depletion of calcium, magnesium, and vitamin D, resulting in demineralization of bone and the eventual development of bone disease. Persistent inflammation, steroid use, parenteral nutrition, chronic metabolic acidosis, and renal insufficiency may exacerbate the problem and contribute to the development of osteoporosis. Multiple factors increase the risk of nephrolithiasis in SBS. In the setting of fat malabsorption, increased free fatty acids are available to bind to calcium, resulting in an increased concentration of unbound oxalate, which is readily absorbed across the colonic mucosa where it travels to the kidney. In addition, there is an increase in colonic permeability to oxalate stemming from the effects of unabsorbed bile salts. The risk of nephrolithiasis is compounded by volume depletion, metabolic acidosis, and hypomagnesemia, resulting in a decrease in renal perfusion, urine output, pH, and citrate excretion. This review examines the causes and treatments of small intestinal bacterial overgrowth, bone demineralization, and nephrolithiasis in SBS.

10 Review Postmenopausal Osteoporosis: A Clinical Review. 2018

Watts, Nelson B. ·Mercy Health Osteoporosis and Bone Health Services , Cincinnati, Ohio. ·J Womens Health (Larchmt) · Pubmed #29583083.

ABSTRACT: In postmenopausal women, osteoporotic fractures are more common than stroke, myocardial infarction, and breast cancer combined, and fractures can be costly and result in disability or death. Because there are no signs or symptoms of osteoporosis other than fracture, risk assessment is necessary to identify those at higher risk for clinical events. For women, a clinical fracture risk assessment (FRAX) is appropriate at menopause. Bone mineral density (BMD) measurement is recommended for women at age 65, and earlier for those who have risk factors. Adequate calcium, vitamin D, and weight-bearing exercise are important for bone health at all ages, and those at high risk for fracture based on BMD or FRAX should be offered medical therapy to reduce fracture risk after an appropriate medical evaluation. Bisphosphonates can accumulate in bone, so after a period of treatment, lower risk patients may be offered a period off drug therapy. However, the effects of denosumab are not sustained when treatment is discontinued, so there is no "drug holiday" with denosumab. Anabolic therapy can be offered to those with higher risk for fracture. Although rare safety concerns regarding atypical femoral fracture and osteonecrosis of the jaw have received prominent attention, for patients who are appropriately treated according to National Osteoporosis Foundation guidelines, the benefit of hip fracture risk reduction far outweighs the risk of these uncommon side effects. Accurate information for patients and shared decision-making are important for acceptance and persistent with appropriate treatment.

11 Review Bisphosphonate and Teriparatide Use in Thoracolumbar Spinal Fusion: A Systematic Review and Meta-analysis of Comparative Studies. 2018

Buerba, Rafael A / Sharma, Akshay / Ziino, Chason / Arzeno, Alexander / Ajiboye, Remi M. ·UCLA Medical Center, Los Angeles, CA. · Case Western Reserve School of Medicine, Cleveland, OH. · Stanford Medical Center, Redwood City, CA. ·Spine (Phila Pa 1976) · Pubmed #29462070.

ABSTRACT: STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: To compare the efficacy of the use of either bisphosphonates or teriparatide on radiographic and functional outcomes of patients that had thoracolumbar spinal fusion. SUMMARY OF BACKGROUND DATA: Controversy exists as to whether bisphosphonates interfere with successful spinal arthrodesis. An alternative osteoporosis medication is teriparatide, a synthetic parathyroid hormone that has an anabolic effect on osteoblast function. To date, there is limited comparative data on the influence of bisphosphonates or teriparatide on spinal fusion. METHODS: A systematic search of medical reference databases was conducted for comparative studies on bisphosphonate or teriparatide use after thoracolumbar spinal fusion. Meta-analysis was performed using the random-effects model for heterogeneity. Radiographic outcomes assessed include fusion rates, risk of screw loosening, cage subsidence, and vertebral fracture. RESULTS: No statistically significant differences were noted between bisphosphonates and control groups regarding fusion rate and risk of screw loosening (fusion: odds ratio [OR] = 2.2, 95% confidence interval [CI]: 0.87-5.56, P = 0.09; loosening: OR = 0.45, 95% CI: 0.14-1.48, P = 0.19). Teriparatide use was associated with higher fusion rates than bisphosphonates (OR = 2.3, 95% CI: 1.55-3.42, P < 0.0001). However, no statistically significant difference was noted between teriparatide and bisphosphonates regarding risk of screw loosening (OR = 0.37, 95% CI: 0.12-1.18, P = 0.09). Lastly, bisphosphonate use was associated with decreased odds of cage subsidence and vertebral fractures compared to controls (subsidence: OR = 0.29, 95% CI 0.11-0.75, P = 0.01; fracture: OR = 0.18, 95% CI 0.07-0.48, P = 0.0007). CONCLUSION: Bisphosphonates do not appear to impair successful spinal fusion compared to controls although teriparatide use is associated with higher fusion rates than bisphosphonates. In addition, bisphosphonate use is associated with decreased odds of cage subsidence and vertebral fractures compared to controls that had spinal fusion. LEVEL OF EVIDENCE: 3.

12 Review Idiopathic hypercalciuria: Can we prevent stones and protect bones? 2018

Ryan, Laura E / Ing, Steven W. ·Clinical Associate Professor of Medicine, Center for Women's Health, Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University, Columbus, OH, USA. laura.ryan@osumc.edu. · Clinical Associate Professor of Medicine, Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University, Columbus, OH, USA. ·Cleve Clin J Med · Pubmed #29328898.

ABSTRACT: Idiopathic hypercalciuria increases the risk of urinary stones and osteoporosis. The aim of this review is to delineate our current understanding of idiopathic hypercalciuria in the context of bone health, specifically its definition, causes, epidemiology, laboratory evaluation, and potential treatments.

13 Review The Pediatric Endurance Athlete. 2017

Solomon, Mary L / Briskin, Susannah M / Sabatina, Nicole / Steinhoff, Jennifer E. ·Division of Pediatric Sports Medicine, University Hospitals Cleveland Medical Center, Rainbow Babies and Children's Hospital, Solon, OH. ·Curr Sports Med Rep · Pubmed #29135641.

ABSTRACT: Youth sports participation numbers continue to grow in the United States. A shift toward sport specialization has caused an increase in sport training frequency and intensity that places the growing athlete at risk for overtraining, nutritional deficits, and injuries. Individuals who participate in endurance sports are at especially high risk. Youth runners and swimmers are high-risk populations that require special attention to their training schedules, nutritional intake, and injuries. Appropriate scheduling of training, dedicating time to rest, and nutrition education can help prevent problems in the endurance athlete.

14 Review Adverse bone effects of medications used to treat non-skeletal disorders. 2017

Watts, N B. ·Mercy Health Osteoporosis and Bone Health Services, 4760 E. Galbraith Rd., Suite 212, Cincinnati, OH, 45236, USA. nelson.watts@hotmail.com. ·Osteoporos Int · Pubmed #28752332.

ABSTRACT: There is a growing list of medications used to treat non-skeletal disorders that cause bone loss and/or increase fracture risk. This review discusses glucocorticoids, drugs that reduce sex steroids, antidiabetic agents, acid-reducing drugs, selective serotonin reuptake inhibitors, and heparin. A number of drugs are known to cause bone loss, increase fracture risk, or both. These drugs should be used in the lowest dose necessary to achieve the desired benefit and for the shortest time necessary, but in many cases, long-term treatment is required. Effective countermeasures are available for some.

15 Review Osteoporosis Management. 2017

Batur, Pelin / Rice, Sheila / Barrios, Paola / Sikon, Andrea. ·1 Primary Care Women's Health, Medicine Institute , Cleveland Clinic, Cleveland, Ohio. · 2 Cleveland Clinic Lerner College of Medicine, Case Western Reserve University , Cleveland, Ohio. ·J Womens Health (Larchmt) · Pubmed #28686517.

ABSTRACT: The clinical update serves as a brief review of recently published, high-impact, and potentially practice changing journal articles summarized for our readers. Topics include menopause, sexual dysfunction, breast health, contraception, osteoporosis, and cardiovascular disease. In this clinical update, we selected recent publications relevant to osteoporosis management. We highlight articles on the safety of long-term use of denosumab and bisphosphonates, fracture risk after discontinuing menopausal hormone therapy, calcium intake and cardiovascular risk, as well as the value of repeat dual X-ray absorptiometry scanning to monitor those on osteoporosis treatment.

16 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.

17 Review Diabetes, bone and glucose-lowering agents: basic biology. 2017

Lecka-Czernik, Beata. ·Departments of Orthopaedic Surgery, MS 1008, Health Sciences Campus, The University of Toledo, 3000 Arlington Avenue, Toledo, OH, 43614, USA. beata.leckaczernik@utoledo.edu. · Physiology and Pharmacology, Health Sciences Campus, The University of Toledo, Toledo, OH, USA. beata.leckaczernik@utoledo.edu. · Center for Diabetes and Endocrine Research, Health Sciences Campus, The University of Toledo, Toledo, OH, USA. beata.leckaczernik@utoledo.edu. ·Diabetologia · Pubmed #28434032.

ABSTRACT: Skeletal fragility often accompanies diabetes and does not appear to correlate with low bone mass or trauma severity in individuals with diabetes. Instead (and in contrast to those with osteoporotic bone disease), bone remodelling and bone turnover are compromised in both type 1 and type 2 diabetes, contributing to defective bone material quality. This review is one of a pair discussing the relationship between diabetes, bone and glucose-lowering agents; an accompanying review is provided in this issue of Diabetologia by Ann Schwartz (DOI: 10.1007/s00125-017-4283-6 ). This review presents basic science evidence that, alongside other organs, bone is affected in diabetes via impairments in glucose metabolism, toxic effects of glucose oxidative derivatives (advance glycation end-products [AGEs]), and via impairments in bone microvascular function and muscle endocrine function. The cellular and molecular basis for the effects of diabetes on bone are discussed, as is the impact of diabetes on the stem cell niche and fracture healing. Furthermore, the safety of clinically approved glucose-lowering therapies and the possibility of developing a single therapy that would be beneficial for both insulin sensitisation and diabetes bone syndrome are outlined.

18 Review Life after breast, prostate, and colon cancer: Primary care's role. 2017

Jonczak, Emily E / Stone, Elizabeth R / Pravia, Cristina I / Sider, Darby. ·Department of Internal Medicine, Cleveland Clinic Florida, Weston, FL, USA. jonczae@ccf.org. · Department of Hematology and Oncology, Cleveland Clinic Florida, Weston, FL, USA. · Department of Internal Medicine, Cleveland Clinic Florida, Weston, FL, USA. ·Cleve Clin J Med · Pubmed #28388386.

ABSTRACT: When patients survive cancer, they eventually come back to their primary care physicians. This group has special needs, including surveillance for recurrent and new cancer, health promotion, and interventions to mitigate the lingering effects of the cancer and the adverse effects of its treatment.

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

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

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

20 Review Macronutrient Intake and Distribution in the Etiology, Prevention and Treatment of Osteosarcopenic Obesity. 2017

Kelly, Owen J / Gilman, Jennifer C / Kim, Youjin / Ilich, Jasminka Z. ·Abbott Nutrition, Columbus, Ohio, United States. · School of Environmental and Biological Sciences, Rutgers University, New Brunswick, New Jersey, United States. · Department of Nutrition, Food and Exercise Sciences, Florida State University, Tallahassee, Florida, United States. ·Curr Aging Sci · Pubmed #27156951.

ABSTRACT: BACKGROUND: Osteosarcopenic obesity, the combined deterioration of bone, muscle and fat tissues, could become the ultimate trajectory of aging. Aging stem cells are deregulated by low-grade chronic inflammation and possibly by diet. The metabolic shift of stem cells towards adipogenesis results in osteo obesity, sarco obesity and obesity. Macronutrients have numerous physiological functions but are regarded mainly for their energy contribution. Currently, no nutritional causes or treatment/prevention guidelines exist for osteosarcopenic obesity. OBJECTIVE: The aim of this review is to assemble the evidence to elucidate if the macronutrient composition of the Western diet has an effect on the development of osteosarcopenic obesity. In view of the role of brain in locomotion a section examining the macronutrients as possible modulators of brain functioning was included. METHOD: An extensive literature search of PubMed and Medline was conducted for human data using combinations and synonyms of osteoporosis, sarcopenia and obesity, and energy, carbohydrate, protein and lipid, and brain. US National Health and Nutrition Examination Survey (NHANES) food intake data from 2002-2012 were obtained and transposed to Microsoft Excel for analysis. RESULTS: NHANES data showed that energy imbalances in aging, excess high glycemic carbohydrate, lower protein intakes and low long chain polyunsaturated fat intakes may contribute to osteosarcopenic obesity. 135 articles were included in the review. CONCLUSION: Early humans probably consumed a diet closer to what the human body was designed for; however, we do not know the ideal energy and macronutrient proportions for optimal health or for preventing/treating aging and osteosarcopenic obesity.

21 Review Can Unconventional Exercise be Helpful in the Treatment, Management and Prevention of Osteosarcopenic Obesity? 2017

Kelly, Owen J / Gilman, Jennifer C. ·Abbott Nutrition, 3300 Stelzer Road, RP3-2, Columbus, Ohio 43219, United States. ·Curr Aging Sci · Pubmed #27156950.

ABSTRACT: BACKGROUND: Body composition changes occur with aging; bone and muscle mass decrease while fat mass increases. The collective term for these changes is osteosarcopenic obesity. It is known that conventional resistance exercise programs build/maintain lean mass and reduce fat mass. However, unconventional (to Western society/medicine) forms of exercise may be viable for the treatment/prevention of osteosarcopenic obesity. OBJECTIVE: The purpose of this review is to assess relatively unconventional exercises for their efficacy in maintaining/improving bone and muscle mass and reducing fat mass. METHOD: A literature search for unconventional exercise showed Tai Chi, yoga, Pilates, whole body vibration, electrical stimulation of muscle, and the Alexander Technique were considered alternative/ unconventional. A PubMed and Medline search for human data using combinations and synonyms of osteoporosis, sarcopenia and obesity, and each exercise was then conducted. RESULTS: Tai Chi, yoga, and Pilates, in addition to whole body vibration, electrical stimulation of muscle, and the Alexander Technique are all considered low impact. Tai Chi, yoga, and Pilates not only physically support the body, but also increase balance and quality of life. The devices showed promise in reducing or preventing muscle atrophy in older people that are unable to perform conventional exercises. CONCLUSION: Any exercise, conventional or otherwise, especially in sedentary older people, at risk of, or diagnosed with osteosarcopenic obesity may be better than none. Exercise prescriptions should suit the patient and the desired outcomes; the patient should not be forced to fit an exercise prescription, so all potential forms of exercise should be considered.

22 Review Atypical Fractures Following Bisphosphonate Therapy. 2016

Patel, Rati N / Ashraf, Anwar / Sundaram, Murali. ·Department of Radiology, Cleveland Clinic, Cleveland, Ohio. · Department Musculoskeletal Radiology, Cleveland Clinic Imaging Institute, Cleveland, Ohio. · Department of Radiology, Lerner College of Medicine and Case Western Reserve University, Cleveland, Ohio. ·Semin Musculoskelet Radiol · Pubmed #27842430.

ABSTRACT: Bisphosphonates have been widely used in the treatment of osteoporosis with well-documented long-term efficacy and safety, particularly in postmenopausal patients. But over the past decade, low-energy atypical subtrochanteric and proximal diaphyseal femoral fractures have emerged as an unexpected complication of prolonged bisphosphonate use. To the radiologist unfamiliar with this entity, the findings may be subtle and often missed, potentially evolving from an early incomplete fracture to a displaced complete fracture with a delay in diagnosis.In such instances where the radiographic findings are negative or equivocal and patients present with prodromal symptoms of aching or dull groin or thigh pain, additional work-up with advanced imaging techniques, such as magnetic resonance imaging, computed tomography, or bone scintigraphy, may prove diagnostic owing to their multiplanar capabilities and earlier detection of subtle periosteal changes. It is imperative that radiologists develop a search pattern to help identify such fractures and consider imaging evaluation of the contralateral extremity in suspected cases with prodromal symptoms to assess for an incomplete asymptomatic or minimally symptomatic fracture.

23 Review Provision of Clinical Preventive Services by Community Pharmacists. 2016

Kelling, Sarah E / Rondon-Begazo, Angela / DiPietro Mager, Natalie A / Murphy, Bethany L / Bright, David R. ·MPH, Clinical Assistant Professor, Clinical Pharmacy, University of Michigan College of Pharmacy, 428 Church St, Ann Arbor, MI 48104. Email: skelling@med.umich.edu. · University of Michigan College of Pharmacy, Ann Arbor, Michigan. · Ohio Northern University Raabe College of Pharmacy, Ada, Ohio. · Union University School of Pharmacy, Jackson, Tennessee. · Ferris State University College of Pharmacy, Big Rapids, Michigan. ·Prev Chronic Dis · Pubmed #27788064.

ABSTRACT: Community pharmacists are highly accessible health care professionals, providing opportunities for partnerships with other health care and public health professionals to expand the population's access to clinical preventive services. To document examples of the community pharmacist's role in providing clinical preventive services to the general population, we conducted PubMed searches using the key word "community pharmacy" and key words from the US Preventive Services Task Force recommendations rated A or B. We present 4 descriptive summaries of clinical preventive services that can be offered by community pharmacists. Community pharmacists can provide clinical preventive services such as providing education, conducting screenings, and making referrals to improve population health.

24 Review Vitamin D and bone loss in HIV. 2016

Hileman, Corrilynn O / Overton, Edgar T / McComsey, Grace A. ·aDivision of Infectious Disease, MetroHealth Medical Center bCase Western Reserve University School of Medicine, Cleveland, Ohio cDivision of Infectious Disease, University of Alabama at Birmingham, Birmingham, Alabama dDivision of Pediatric Infectious Disease and Rheumatology, Rainbow Babies and Children's Hospital and University Hospitals Case Medical Center, Cleveland, Ohio, USA. ·Curr Opin HIV AIDS · Pubmed #26890209.

ABSTRACT: PURPOSE OF REVIEW: Bone health has become an increasingly important aspect of the care of HIV-infected patients as bone loss with antiretroviral therapy (ART) initiation is significant and osteopenia and osteoporosis are highly prevalent. Vitamin D is tightly linked to calcium balance and bone health, and vitamin D deficiency is common in HIV. This review outlines the epidemiology of vitamin D deficiency in HIV, summarizes our current understanding of the relationship between vitamin D and bone loss in HIV and the impact of vitamin D supplementation in this patient group. RECENT FINDINGS: Although data are conflicting as to whether vitamin D deficiency is more prevalent among HIV-infected individuals than in the general population, there are several reasons for why this patient group may be at heightened risk. Studies linking vitamin D deficiency to bone loss in HIV are limited; however, data from randomized clinical trials suggest a benefit of vitamin D supplementation for the prevention of bone loss with ART initiation and for the treatment of bone loss with bisphosphonate therapy. SUMMARY: There are too limited data to recommend universal screening of vitamin D status or supplementation to all HIV-infected individuals. However, testing 25-hydroxyvitamin D levels in those at risk for deficiency and treating patients found to be deficient or initiating ART or bisphosphonate therapy should be considered. Further study on vitamin D supplementation is needed regarding the potential benefit on immune activation and restoration in this patient group.

25 Review The National Osteoporosis Foundation's position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations. 2016

Weaver, C M / Gordon, C M / Janz, K F / Kalkwarf, H J / Lappe, J M / Lewis, R / O'Karma, M / Wallace, T C / Zemel, B S. ·Department of Nutritional Sciences, Women's Global Health Institute, Purdue University, 700 W. State Street, West Lafayette, IN, 47907, USA. · Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital, 3333 Burnet Avenue, MLC 4000, Cincinnati, OH, 45229, USA. · Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH, 45267, USA. · Departments of Health and Human Physiology and Epidemiology, University of Iowa, 130 E FH, Iowa City, IA, 52242, USA. · Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7035, Cincinnati, OH, 45229, USA. · Schools of Nursing and Medicine, Creighton University, 601 N. 30th Street, Omaha, NE, 68131, USA. · Department of Foods and Nutrition, University of Georgia, Dawson Hall, Athens, GA, 30602, USA. · The Children's Hospital of Philadelphia Research Institute, 3535 Market Street, Room 1560, Philadelphia, PA, 19104, USA. · Department of Nutrition and Food Studies, George Mason University, MS 1 F8, 10340 Democracy Lane, Fairfax, VA, 22030, USA. taylor.wallace@me.com. · National Osteoporosis Foundation, 1150 17th Street NW, Suite 850, Washington, DC, 20036, USA. taylor.wallace@me.com. · National Osteoporosis Foundation, 251 18th Street South, Suite 630, Arlington, VA, 22202, USA. taylor.wallace@me.com. · University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Room 1560, Philadelphia, PA, 19104, USA. · Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, 3535 Market Street, Room 1560, Philadelphia, PA, 19104, USA. ·Osteoporos Int · Pubmed #26856587.

ABSTRACT: Lifestyle choices influence 20-40 % of adult peak bone mass. Therefore, optimization of lifestyle factors known to influence peak bone mass and strength is an important strategy aimed at reducing risk of osteoporosis or low bone mass later in life. The National Osteoporosis Foundation has issued this scientific statement to provide evidence-based guidance and a national implementation strategy for the purpose of helping individuals achieve maximal peak bone mass early in life. In this scientific statement, we (1) report the results of an evidence-based review of the literature since 2000 on factors that influence achieving the full genetic potential for skeletal mass; (2) recommend lifestyle choices that promote maximal bone health throughout the lifespan; (3) outline a research agenda to address current gaps; and (4) identify implementation strategies. We conducted a systematic review of the role of individual nutrients, food patterns, special issues, contraceptives, and physical activity on bone mass and strength development in youth. An evidence grading system was applied to describe the strength of available evidence on these individual modifiable lifestyle factors that may (or may not) influence the development of peak bone mass (Table 1). A summary of the grades for each of these factors is given below. We describe the underpinning biology of these relationships as well as other factors for which a systematic review approach was not possible. Articles published since 2000, all of which followed the report by Heaney et al. [1] published in that year, were considered for this scientific statement. This current review is a systematic update of the previous review conducted by the National Osteoporosis Foundation [1]. [Table: see text] Considering the evidence-based literature review, we recommend lifestyle choices that promote maximal bone health from childhood through young to late adolescence and outline a research agenda to address current gaps in knowledge. The best evidence (grade A) is available for positive effects of calcium intake and physical activity, especially during the late childhood and peripubertal years-a critical period for bone accretion. Good evidence is also available for a role of vitamin D and dairy consumption and a detriment of DMPA injections. However, more rigorous trial data on many other lifestyle choices are needed and this need is outlined in our research agenda. Implementation strategies for lifestyle modifications to promote development of peak bone mass and strength within one's genetic potential require a multisectored (i.e., family, schools, healthcare systems) approach.

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