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Osteoporosis: HELP
Articles from Denver
Based on 112 articles published since 2008

These are the 112 published articles about Osteoporosis that originated from Denver during 2008-2019.
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5
1 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 --

2 Review The biology of fracture healing in osteoporosis and in the presence of anti-osteoporotic drugs. 2018

Hak, David J. ·Orthopedic Surgery Denver Health/University of Colorado, 777 Bannock Street MC 0188, Denver, CO 80204 USA. Electronic address: david.hak@dhha.org. ·Injury · Pubmed #29709376.

ABSTRACT: Compromised bone strength in osteoporosis predisposes patients to an increased fracture risk. The management of these fractures is complicated due to the poor bone quality, which may lead to inadequate fixation strength and stability. While a number of studies using osteoporotic animal models have shown a detrimental impact on fracture healing, clinical evidence regarding whether fracture healing is impaired in the presence of osteoporosis is complicated by numerous associated conditions including advancing age. The mechanism of some anti-osteoporotic medications creates concern about a potential detrimental impact on fracture healing, while others appear to enhance fracture healing. The current evidence indicates that the beneficial effects of anti-osteoporosis treatment exceeds any concerns about possible adverse consequences on fracture healing in most circumstances.

3 Review Fshb Knockout Mouse Model, Two Decades Later and Into the Future. 2018

Kumar, T Rajendra. ·Department of Obstetrics and Gynecology, Division of Reproductive Sciences, University of Colorado at Denver, Anschutz Medical Campus, Aurora, Colorado. · Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Colorado at Denver, Anschutz Medical Campus, Aurora, Colorado. ·Endocrinology · Pubmed #29579177.

ABSTRACT: In 1997, nearly 20 years ago, we reported the phenotypes of follicle-stimulating hormone (FSH) β (Fshb) null mice. Since then, these mice have been useful for various physiological and genetic studies in reproductive and skeletal biology. In a 2009 review titled "FSHβ Knockout Mouse Model: A Decade Ago and Into the Future," I summarized the need for and what led to the development of an FSH-deficient mouse model and its applications, including delineation of the emerging extragonadal roles of FSH in bone cells by using this genetic model. These studies opened up exciting avenues of research on osteoporosis and now extend into those on adiposity in postmenopausal women. Here, I summarize the progress made with this mouse model since 2009 with regard to FSH rerouting in vivo, deciphering the role of N-glycosylation on FSHβ, roles of FSH in somatic-germ cell interactions in gonads, and provide a road map that is anticipated to emerge in the near future. Undoubtedly, the next 10 years should be an even more exciting time to explore the fertile area of FSH biology and its implications for basic and clinical reproductive physiology research.

4 Review Basics of bone metabolism and osteoporosis in common pediatric neuromuscular disabilities. 2018

Yaşar, Evren / Adigüzel, Emre / Arslan, Mutluay / Matthews, Dennis J. ·Health Sciences University, Gülhane Medical School, Department of Physical Medicine and Rehabilitation, Ankara, Turkey. · Gaziler Physical Medicine and Rehabilitation Education and Research Hospital, Ankara, Turkey. Electronic address: dremreadiguzel@gmail.com. · Health Sciences University, Gülhane Medical School, Department of Pediatric Neurology, Ankara, Turkey. · Physical Medicine and Rehabilitation, Children's Hospital Colorado, Aurora, CO, USA. ·Eur J Paediatr Neurol · Pubmed #28830650.

ABSTRACT: Bone modeling is a process that starts with fetal life and continues during adolescence. Complex factors such as hormones, nutritional and environmental factors affect this process. In addition to these factors, physical conditioning and medications that have toxic effects on bony tissue should be carefully considered in patient follow-up. Osteoporosis is a significant problem in pediatric population because of ongoing growth and development of skeletal system. Two types of osteoporosis are primary and secondary types and children with neuromuscular disabilities constitute a major group with secondary osteoporosis. Low bone mass in patients with cerebral palsy, spina bifida, and Duchenne muscular dystrophy cause increased bone fragility in even slight traumas. Maximizing peak bone mass and prevention of bone loss are very important to reduce the fracture risk in neuromuscular diseases. This article aims to review the determinants of bone physiology and bone loss in children with cerebral palsy, spina bifida, and Duchenne muscular dystrophy.

5 Review Managing and maintaining bone mineral density in diabetes patients with pharmacotherapy. 2017

Fixen, Cy W / Fixen, Danielle R. ·a Denver Veterans Affairs Medical Center , Denver , CO , USA. · b Department of Clinical Pharmacy , University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences , Aurora , USA. ·Expert Opin Pharmacother · Pubmed #29172834.

ABSTRACT: INTRODUCTION: The population of patients with osteoporosis and diabetes is increasing as the aging population increases. Loss of bone mineral density occurs in patients with diabetes, but is not always a priority in the practice setting. The aim of this review is to discuss clinical considerations when managing osteoporosis in patients with diabetes. Areas covered: The pathophysiology of decreased bone mineral density in patients with diabetes is discussed. Additionally, diabetic risk factors for fracture, such as hypoglycemia, the National Osteoporosis Foundation recommendations for osteoporosis, and secondary causes of osteoporosis, including disease and medication related causes, are discussed. Furthermore, recommendations for antihyperglycemic agents, thiazolidinediones, canagliflozin, insulin, metformin, and sitagliptin are discussed due to their effects on bone mineral density. Expert opinion: Even though diabetes is an important risk factor for osteoporosis, assessing bone health in diabetic patients is often overlooked. Ensuring adequate prevention and treatment strategies for osteoporosis is vitally important with our diabetic patients as the population ages. T-scores and FRAX scores likely underrepresent a diabetic patients risk for fracture, and this should be taken into consideration in treatment decisions. Future studies are needed to determine optimal pharmacologic treatment of hyperglycemia in this population.

6 Review Injuries to the Female Athlete in 2017: Part I: General Considerations, Concussions, Stress Fractures, and the Female Athlete Triad. 2017

Frank, Rachel M / Romeo, Anthony A / Bush-Joseph, Charles A / Bach, Bernard R. ·1Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado 2Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois. ·JBJS Rev · Pubmed #29028750.

ABSTRACT: -- No abstract --

7 Review Management of Spinal Conditions in Patients With Parkinson Disease. 2017

Baker, Joseph F / McClelland, Shearwood / Hart, Robert A / Bess, R Shay. ·From the Department of Orthopaedic Surgery, Waikato Hospital, Hamilton, New Zealand (Dr. Baker), NYU Hospital for Joint Diseases, New York, NY (Dr. McClelland), the Department of Orthopaedic Surgery, Oregon Health and Science University, Portland, OR (Dr. Hart), and the Department of Orthopaedic Surgery, Presbyterian/St. Luke's Medical Center, Denver, CO (Dr. Bess). ·J Am Acad Orthop Surg · Pubmed #28692583.

ABSTRACT: Parkinson disease (PD) is increasingly prevalent in the aging population. Spine disorders in patients with PD may be degenerative in nature or may arise secondary to motor effects related to the parkinsonian disease process. Physicians providing care for patients with PD and spine pathologies must be aware of several factors that affect treatment, including the patterns of spinal deformity, complex drug interactions, and PD-associated osteoporosis. Following spine surgery, complication rates are higher in patients with PD than in those without the disease. Literature on spine surgery in this patient population is limited by small cohort size, the heterogeneous patient population, and variable treatment protocols. However, most studies emphasize the need for preoperative optimization of motor control with appropriate medications and deep brain stimulation, as well as consultation with a movement disorder specialist. Future studies must control for confounding variables, such as the type of surgery and PD severity, to improve understanding of spinal pathology and treatment options in this patient population.

8 Review Bone mineral density at femoral neck and lumbar spine in adults with type 1 diabetes: a meta-analysis and review of the literature. 2017

Shah, V N / Harrall, K K / Shah, C S / Gallo, T L / Joshee, P / Snell-Bergeon, J K / Kohrt, W M. ·Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, 1775 Aurora Ct, Mail Stop A 140, Room 1318, Aurora, CO, 80045, USA. viral.shah@ucdenver.edu. · School of Pharmacy and Center for Women' Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. · SJM College of Pharmacy, Chitradurga, Karnataka, India. · Rocky Vista University, Parker, CO, USA. · Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, 1775 Aurora Ct, Mail Stop A 140, Room 1318, Aurora, CO, 80045, USA. · Department of Medicine, Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. ·Osteoporos Int · Pubmed #28580510.

ABSTRACT: We performed a meta-analysis to evaluate the femoral neck and lumbar spine bone mineral density (BMD) in adults with type 1 diabetes (T1D) compared with controls. Adults with T1D have modestly lower BMD at femoral neck and lumbar spine than adults without diabetes. INTRODUCTION: Fracture risk is four to sixfold higher in adults with T1D. Since BMD is one of the major contributors for fracture risk, we performed a meta-analysis to evaluate differences in femoral neck and lumbar spine BMD between adults with T1D and controls. METHODS: MEDLINE, Ovid, and the Cochrane library and abstracts from various scientific meetings were searched. Studies reporting the femoral neck and/or lumbar spine BMD in adults (age > 20 years) with T1D in comparison with people without diabetes were selected. General linear mixed models were used to assess differences in BMD at femoral neck and lumbar spine between subjects with T1D and controls adjusting for age, sex, and dual x-ray absorptiometry (DXA) instruments. RESULTS: Sixteen studies met the inclusion criteria. The femoral neck BMD was modestly lower in adults with T1D compared to controls (-0.055 g/cm CONCLUSION: Femoral neck and lumbar spine BMD were modestly lower in adults with T1D compared to controls. However, this modest reduction in femoral neck and lumbar spine BMD cannot explain much higher observed fracture risk in adults with T1D.

9 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.

10 Review Physical Activity for Strengthening Fracture Prone Regions of the Proximal Femur. 2017

Fuchs, Robyn K / Kersh, Mariana E / Carballido-Gamio, Julio / Thompson, William R / Keyak, Joyce H / Warden, Stuart J. ·Department of Physical Therapy and Center for Translational Musculoskeletal Research, School of Health and Rehabilitation Sciences, Indiana University, 1140 W. Michigan St, Indianapolis, IN, CF-120, USA. · Department of Mechanical Science and Engineering, College of Engineering, University of Illinois at Urbana-Champaign, Urbana-Champaign, IL, USA. · Department of Radiology, School of Medicine, University of Colorado Denver, Denver, CO, USA. · Departments of Radiological Sciences, Mechanical and Aerospace Engineering, and Biomedical Engineering, University of California, Irvine, CA, USA. · Department of Physical Therapy and Center for Translational Musculoskeletal Research, School of Health and Rehabilitation Sciences, Indiana University, 1140 W. Michigan St, Indianapolis, IN, CF-120, USA. stwarden@iu.edu. ·Curr Osteoporos Rep · Pubmed #28133707.

ABSTRACT: PURPOSE OF REVIEW: Physical activity improves proximal femoral bone health; however, it remains unclear whether changes translate into a reduction in fracture risk. To enhance any fracture-protective effects of physical activity, fracture prone regions within the proximal femur need to be targeted. RECENT FINDINGS: The proximal femur is designed to withstand forces in the weight-bearing direction, but less so forces associated with falls in a sideways direction. Sideways falls heighten femoral neck fracture risk by loading the relatively weak superolateral region of femoral neck. Recent studies exploring regional adaptation of the femoral neck to physical activity have identified heterogeneous adaptation, with adaptation principally occurring within inferomedial weight-bearing regions and little to no adaptation occurring in the superolateral femoral neck. There is a need to develop novel physical activities that better target and strengthen the superolateral femoral neck within the proximal femur. Design of these activities may be guided by subject-specific musculoskeletal modeling and finite-element modeling approaches.

11 Review Effects of ospemifene on bone parameters including clinical biomarkers in postmenopausal women. 2016

Constantine, Ginger D / Kagan, Risa / Miller, Paul D. ·1EndoRheum Consultants, LLC, Malvern, PA 2Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco East Bay Physicians Medical Group affiliated with Sutter East Bay Medical Foundation, Berkeley, CA 3University of Colorado Health Sciences Center, Colorado Center for Bone Research, Lakewood, CO. ·Menopause · Pubmed #27045700.

ABSTRACT: OBJECTIVE: Ospemifene is an estrogen-receptor agonist/antagonist (also known as a selective estrogen-receptor modulator) that is FDA approved for the treatment of moderate-to-severe dyspareunia, a symptom of vulvovaginal atrophy, due to menopause. Preclinical and clinical data suggest that ospemifene may also have an effect on bone health in postmenopausal women. METHODS: Relevant articles, including cellular and preclinical studies and clinical trials written in English pertaining to ospemifene and bone health, were identified from a database search of PubMed (from its inception to June 2015) and summarized in this comprehensive review. RESULTS: In vitro data suggest that ospemifene may mediate a positive effect on bone through osteoblasts. Ospemifene effectively reduced bone loss and resorption in ovariectomized rats, with activity comparable to estradiol and raloxifene. Clinical data from three phase 1 or 2 clinical trials (2 placebo- and 1 raloxifene-controlled) found ospemifene 60 mg/d to have a positive effect on the biochemical markers for bone turnover in healthy, postmenopausal women with significant improvements relative to placebo and comparable to raloxifene. CONCLUSIONS: Ospemifene 60 mg/d may have a protective effect on the bone health of women being treated for dyspareunia. The initial clinical data for ospemifene follows a trend similar to raloxifene and bazedoxifene, suggesting that ospemifene may have bone-protective effects in postmenopausal women. However, additional rigorous clinical trials are necessary to confirm any positive effects ospemifene may have on vertebral fractures and bone mineral density in healthy and osteoporotic women.

12 Review Bazedoxifene and Conjugated Equine Estrogen: A Combination Product for the Management of Vasomotor Symptoms and Osteoporosis Prevention Associated with Menopause. 2016

Umland, Elena M / Karel, Lauren / Santoro, Nanette. ·Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, Pennsylvania. · Department of Pharmacy, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania. · Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado. ·Pharmacotherapy · Pubmed #27027527.

ABSTRACT: Bazedoxifene (BZA), a third-generation selective estrogen receptor modulator (SERM), has been combined with conjugated equine estrogen (CE) to create a tissue selective estrogen complex (TSEC) for the management of vasomotor symptoms (VMS) and the prevention of osteoporosis (OP) associated with menopause. Both of these outcomes of menopause contribute to significant negative effects on quality of life and increases in utilization of health care resources and dollars. Current treatment modalities for VMS and OP include estrogen therapy that requires the use of progestin in women who have a uterus to reduce the risk of endometrial hyperplasia and resultant cancer. However, progestin use results in nuisance bleeding as well as a further increased risk of breast cancer when combined with estrogen. And while SERMs can be used to prevent OP, their use alone has been shown to increase hot flashes. The combination of BZA and CE does not require progestin treatment with CE as the BZA component acts as an antagonist on endometrial tissue. The U.S. Food and Drug Administration approval of BZA/CE in 2013 was based on a series of five phase 3 studies known as the Selective estrogens, Menopause And Response to Therapy (SMART) trials. These trials, in their entirety, evaluated the impact of BZA/CE on VMS frequency and severity, bone mineral density, bone turnover markers, vaginal symptoms, lipid profiles, sleep, quality of life, breast density, and endometrial safety. The approved dose of BZA/CE is 20 mg BZA and 0.45 mg CE. Although this TSEC manages VMS while opposing breast and endometrial proliferation, preventing bone resorption, and improving lipid profiles, long-term experience with BZA/CE is currently lacking.

13 Review Food fortification for bone health in adulthood: a scoping review. 2016

Whiting, S J / Kohrt, W M / Warren, M P / Kraenzlin, M I / Bonjour, J-P. ·College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada. · Department of Medicine, Division of Geriatric Medicine, University of Colorado, Denver, CO, USA. · Department of Obstetrics and Gynecology and Medicine, Columbia University Medical Center, New York, NY, USA. · Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University Hospital, Bale, Switzerland. · Department of Internal Medicine Specialties, Division of Bone Disease, University Hospitals and Faculty of Medicine, Geneva, Switzerland. ·Eur J Clin Nutr · Pubmed #27026430.

ABSTRACT: Food fortification can deliver essential micronutrients to large population segments without modifications in consumption pattern, suggesting that fortified foods may be formulated for populations at risk for fragility fractures. This scoping review determined the extent to which randomized controlled studies have been carried out to test the impact of fortified foods on bone outcomes, searching PubMed for all studies using the terms 'fortified AND bone', and 'fortification AND bone'. Studies were restricted to English language, published between 1996 and June 2015. From 360 articles, 24 studies met the following criteria: human study in adults ⩾18 years (excluding pregnancy or lactation); original study of a fortified food over time, with specific bone outcomes measured pre- and post intervention. Six studies involved adults <50 years; 18 involved adults ⩾50 years. Singly or in combination, 17 studies included calcium and 16 included vitamin D. There were 1 or 2 studies involving either vitamin K, magnesium, iron, zinc, B-vitamins, inulin or isoflavones. For adults <50 years, the four studies involving calcium or vitamin D showed a beneficial effect on bone remodeling. For adults ⩾50 years, n=14 provided calcium and/or vitamin D, and there was a significant bone turnover reduction. No consistent effects were reported in studies in which addition of vitamin K, folic acid or isoflavone was assessed. Results from this scoping review indicate that up to now most studies of fortification with bone health have evaluated calcium and/or vitamin D and that these nutrients show beneficial effects on bone remodeling.

14 Review More than osteoporosis: age-specific issues in bone health. 2016

Erlandson, Kristine M / Guaraldi, Giovanni / Falutz, Julian. ·aUniversity of Colorado, Aurora, Colorado, USA bUniversity of Modena and Reggio Emilia, Modena, Italy cMcGill University, Montreal, Quebec, Canada. ·Curr Opin HIV AIDS · Pubmed #26882460.

ABSTRACT: PURPOSE OF REVIEW: The interaction between fall and fracture risk factors is an area of increasing clinical relevance, but little information is known about the age-specific issues in bone health unique to HIV-infected adults. The present review will focus on what is known about falls and fall risk factors among HIV-infected adults, and then review the association between decreased muscle, increased adiposity, and frailty with both low bone mineral density (BMD) and falls. RECENT FINDINGS: The rate of falls among middle-aged HIV-infected adults is similar to that of HIV-uninfected adults 65 years and older. Many of the clinical factors that contribute to low BMD overlap with risk factors for falls, resulting in a high risk of a serious fall among older adults with the greatest risk for a fracture. Low muscle mass, increased adiposity and metabolic syndrome, physical function impairment and frailty, common among older HIV-infected adults, contribute to an increased risk for low BMD and falls, and subsequently, may increase the risk of fracture among HIV-infected older adults. SUMMARY: Interventions with dual benefit on reducing fall risk and improving BMD are likely to have the greatest impact on fracture prevention in the older, HIV-infected adult.

15 Review Management of severe osteoporosis. 2016

Miller, Paul D. ·a University of Colorado Health Sciences Center , Colorado Center for Bone Research , Lakewood , CO , USA. ·Expert Opin Pharmacother · Pubmed #26605922.

ABSTRACT: INTRODUCTION: Severe osteoporosis represents a disease of high mortality and morbidity. Recognition of what constitutes and causes severe osteoporosis and aggressive intervention with pharmacological agents with evidence to reduce fracture risk are outlined in this review. AREAS COVERED: This review is a blend of evidence obtained from literature searches from PubMed and The National Library of Medicine (USA), clinical experience and the author's opinions. The review covers the recognition of what constitutes severe osteoporosis, and provides up-to-date references on this sub-set of high risk patients. EXPERT OPINION: Severe osteoporosis can be classified by using measurements of bone densitometry, identification of prevalent fractures, and, knowledge of what additional risk factors contribute to high fracture risk. Once recognized, the potential consequences of severe osteoporosis can be mitigated by appropriate selection of pharmacological therapies and modalities to reduce the risk for falling.

16 Review Appropriate prescribing and important drug interactions in older adults. 2015

Wallace, Jeffrey / Paauw, Douglas S. ·Division of Geriatric Medicine, Department of Internal Medicine, University of Colorado School of Medicine, 12631 East 17th Avenue, B-179, Aurora, CO 80045, USA. Electronic address: jeff.wallace@ucdenver.edu. · Division of General Internal Medicine, Department of Medicine, University of Washington, 4245 Roosevelt way NE, #MC354760, Seattle, WA 98105, USA. ·Med Clin North Am · Pubmed #25700585.

ABSTRACT: Polypharmacy, specifically the overuse and misuse of medications, is associated with adverse health events, increased disability, hospitalizations, and mortality. Mechanisms through which polypharmacy may increase adverse health outcomes include decreased adherence, increased drug side effects, higher use of potentially inappropriate medications, and more frequent drug-drug interactions. This article reviews clinical problems associated with polypharmacy and presents a framework to optimize prescribing for older adults.

17 Review Biochemical markers for assessment of calcium economy and bone metabolism: application in clinical trials from pharmaceutical agents to nutritional products. 2014

Bonjour, Jean-Philippe / Kohrt, Wendy / Levasseur, Régis / Warren, Michelle / Whiting, Susan / Kraenzlin, Marius. ·Division of Bone Disease, University Hospitals and Faculty of Medicine,Geneva,Switzerland. · Division of Geriatric Medicine, University of Colorado,Denver,CO,USA. · Service de Rhumatologie, CHU Angers,Angers,France. · Department of Obstetrics and Gynecology and Medicine,Columbia University Medical Center,New York,NY,USA. · College of Pharmacy and Nutrition, University of Saskatchewan,Saskatoon,Canada. · Division of Endocrinology, Diabetes and Metabolism, University Hospital,Bale,Switzerland. ·Nutr Res Rev · Pubmed #25394580.

ABSTRACT: Nutrition plays an important role in osteoporosis prevention and treatment. Substantial progress in both laboratory analyses and clinical use of biochemical markers has modified the strategy of anti-osteoporotic drug development. The present review examines the use of biochemical markers in clinical research aimed at characterising the influence of foods or nutrients on bone metabolism. The two types of markers are: (i) specific hormonal factors related to bone; and (ii) bone turnover markers (BTM) that reflect bone cell metabolism. Of the former, vitamin D metabolites, parathyroid hormone, and insulin-like growth factor-I indicate responses to variations in the supply of bone-related nutrients, such as vitamin D, Ca, inorganic phosphate and protein. Thus modification in bone remodelling, the key process upon which both pharmaceutical agents and nutrients exert their anti-catabolic or anabolic actions, is revealed. Circulating BTM reflect either osteoclastic resorption or osteoblastic formation. Intervention with pharmacological agents showed that early changes in BTM predicted bone loss and subsequent osteoporotic fracture risk. New trials have documented the influence of nutrition on bone-tropic hormonal factors and BTM in adults, including situations of body-weight change, such as anorexia nervosa, and weight loss by obese subjects. In osteoporosis-prevention studies involving dietary manipulation, randomised cross-over trials are best suited to evaluate influences on bone metabolism, and insight into effects on bone metabolism may be gained within a relatively short time when biochemical markers are monitored.

18 Review Bone disease in CKD: a focus on osteoporosis diagnosis and management. 2014

Miller, Paul D. ·University of Colorado Health Sciences Center, Colorado Center for Bone Research, Lakewood, CO. Electronic address: millerccbr@aol.com. ·Am J Kidney Dis · Pubmed #24726630.

ABSTRACT: Osteoporosis is defined as a condition of impairment in bone strength due to low bone mineral density and poor bone quality and predisposes individuals to an increased risk of fractures. Osteoporosis may coexist with chronic kidney disease-mineral and bone disorder (CKD-MBD) and osteoporotic fractures occur in all stages of CKD. Management of osteoporosis in CKD should consider the pathophysiology of both disorders. Diagnosis and management of osteoporosis in patients with stages 1-3 CKD and patients without CKD are similar, but diagnosis and management decisions differ greatly once patients have stages 4-5 CKD. Discriminating between osteoporosis and CKD-MBD is best accomplished with quantitative bone histomorphometry. Biochemical markers, especially intact parathyroid hormone and bone-specific alkaline phosphatase, also may be helpful. When the diagnosis of osteoporosis is established, management in stages 4-5 CKD may include antiresorptive or anabolic agents, though evidence for efficacy is marginal in advanced CKD.

19 Review Osteoporosis and the orthopaedic surgeon: basic concepts for successful co-management of patients' bone health. 2014

Farmer, Ryan P / Herbert, Benoit / Cuellar, Derly O / Hao, Jiandong / Stahel, Philip F / Yasui, Robin / Hak, David J / Mauffrey, Cyril. ·Department of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, 80204, Denver, CO, USA. ·Int Orthop · Pubmed #24652422.

ABSTRACT: Osteoporosis has been recognised as a public health concern for at least three decades but it has been relatively recent that the push has been for orthopaedic surgeons to take a more active role in the diagnosis and treatment of patients with decreased bone mineral density (BMD). Most often these patients are encountered after they have suffered a fracture making secondary prevention the area where orthopaedists may exert the greatest influence on patient care. The purpose of this article is to provide a succinct framework for the diagnosis and treatment of patients with decreased BMD. Patients are deemed to have decreased BMD if they have suffered a fragility fracture, a fracture caused by a low-energy traumatic event. These patients are often encountered in the emergency department and admitted for further treatment of their fractures or recommended for follow-up in the clinic. Regardless of treatment course these are opportunities for the orthopaedic surgeon to intervene in the osteoporotic disease process and positively affect a patient's bone health. This article compiles the available literature on osteoporosis and presents it succinctly with the incorporation of both a diagnosis algorithm and treatment profile table. With the use of these two tools, orthopaedic surgeons everywhere should be able to take a more active role in their patients' bone health.

20 Review Chronic Kidney Disease-Mineral and Bone Disorders (CKD-MBDs): What the Endocrinologist Needs to Know. 2014

Zangeneh, Farhad / Clarke, Bart L / Hurley, Daniel L / Watts, Nelson B / Miller, Paul D. ·Endocrine, Diabetes & Osteoporosis Clinic (EDOC), Sterling, VA. · Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota. · Mercy Health Osteoporosis and Bone Health Services, Cincinnati, Ohio. · Colorado Center for Bone Research, University of Colorado Health Sciences Center. ·Endocr Pract · Pubmed #24325991.

ABSTRACT: OBJECTIVE: Chronic kidney disease-mineral and bone disorders (CKD-MBDs) are a spectrum of abnormalities involving skeletal hormones, minerals, and bone turnover and mineralization. This paper focuses on what the endocrinologist should know about the assessment and management of skeletal and metabolic disorders in CKD-MBDs. METHODS: Relevant literature was reviewed to (1) define disturbances of minerals and hormones in the course of CKD; (2) identify the variable radiographic and histomorphometric changes of CKD-MBDs; (3) review the association among CKD-MBDs, vascular calcification, cardiovascular disease (CVD), and mortality; and (4) clarify issues in CKD-MBDs therapy. RESULTS: Assessment and treatment of CKD-MBDs is complicated by progressive changes in bone minerals and skeletal regulatory hormones as kidney function declines. CKD-MBDs are associated with fracture risk, and studies demonstrate that bone mineral density can be used to assess bone loss and fracture risk in these patients. Treatment of CKD-MBDs continues to evolve. Use of calcium, phosphate binders, vitamin D, vitamin D-receptor analogs, and drugs for osteoporosis and CKD-MBDs treatment are discussed in the context of safety and efficacy for patients with CKD. CONCLUSION: The association of CKD with bone disease, vascular calcification, CVD, and mortality mandates earlier recognition and treatment of CKD-MBDs. Osteoporosis as a distinct entity can be diagnosed and managed in CKD, although assessment of osteoporosis becomes challenging in late (stage 4 to 5) CKD. Diabetes is common in early (stage 1 to 3) CKD. In addition, 96% of all individuals identified as having CKD have early CKD. The endocrinologist is uniquely positioned to address and treat both diabetes and many of the metabolic and skeletal disorders associated with early CKD-MBDs, including osteoporosis.

21 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.

22 Review Renal safety in patients treated with bisphosphonates for osteoporosis: a review. 2013

Miller, Paul D / Jamal, Sophie A / Evenepoel, Pieter / Eastell, Richard / Boonen, Steven. ·Colorado Center for Bone Research, University of Colorado Health Sciences Center, Lakewood, CO, USA. ·J Bone Miner Res · Pubmed #23907861.

ABSTRACT: Bisphosphonates are widely used for the treatment of osteoporosis and are generally well tolerated. However, the United States Food and Drug Administration safety reports have highlighted the issue of renal safety in bisphosphonate-treated patients. All bisphosphonates carry labeled "warnings" or a contraindication for use in patients with severe renal impairment (creatinine clearance <30 or <35 mL/min). Data from pivotal trials and their extension studies of bisphosphonates approved for the management of osteoporosis were obtained via PubMed, and were reviewed with support from published articles available on PubMed. Renal safety analyses of pivotal trials of oral alendronate, risedronate, and ibandronate for postmenopausal osteoporosis showed no short-term or long-term effects on renal function. Transient postinfusion increases in serum creatinine have been reported in patients receiving intravenous ibandronate and zoledronic acid; however, studies showed that treatment with these agents did not result in long-term renal function deterioration in clinical trial patients with osteoporosis. All bisphosphonate therapies have "warnings" for use in patients with severe renal impairment. Clinical trial results have shown that even in elderly, frail, osteoporotic patients with renal impairment, intravenous bisphosphonate therapy administration in accordance with the prescribing information did not result in long-term renal function decline. Physicians should follow guidelines for bisphosphonate therapies administration at all times.

23 Review Environmental cadmium exposure and osteoporosis: a review. 2013

James, Katherine A / Meliker, Jaymie R. ·Department of Family Medicine, School of Medicine, University of Colorado, Mail Stop F443, 13991 E Montview Ave Aurora, Denver, CO, 80045, USA, Kathy.james@ucdenver.edu. ·Int J Public Health · Pubmed #23877535.

ABSTRACT: OBJECTIVES: To review the published literature investigating the association between cadmium exposure and osteoporosis. METHODS: A review of published peer-reviewed literature based on a priori criteria was completed. Odds ratios (OR) were abstracted or estimated from observational studies to calculate a pooled OR using inverse variance weighted random effects models. RESULTS: The review identified seven studies with a pooled OR of OR = 2.22 (95 % CI: 1.16, 4.28) [I (2) = 54.8 % (p < 0.05)] (comparing highest urine cadmium category to lowest). In women over the age of 50 years, the pooled OR was 1.82 (95 % CI: 1.63, 2.02) [I (2) = 73.1 % (p < 0.05)]. A dose response evaluation (six studies) suggested increasing odds for osteoporosis with increasing urine cadmium levels. CONCLUSIONS: This review detected an association between cadmium exposure and the occurrence of osteoporosis in a small number of cross-sectional studies which requires confirmation in using prospective study design.

24 Review HIV infection and osteoporosis: pathophysiology, diagnosis, and treatment options. 2012

Rothman, Micol S / Bessesen, Mary T. ·Department of Medicine, Endocrinology Diabetes and Metabolism, University of Colorado School of Medicine, Aurora, 80045, USA. Micol.Rothman@ucdenver.edu ·Curr Osteoporos Rep · Pubmed #23100110.

ABSTRACT: As the population with HIV continues to age, specialists in HIV care are increasingly encountering chronic health conditions, which now include osteoporosis, osteopenia, and fragility fractures. The pathophysiology of the bone effects of HIV infection is complex and includes traditional risk factors for bone loss as well as specific effects due to the virus itself, chronic inflammation, and HAART. Examining risk factors for low bone density and screening of certain patients is suggested, and consideration should be given to treatment for those considered high risk for fracture.

25 Review Unrecognized and unappreciated secondary causes of osteoporosis. 2012

Miller, Paul D. ·Colorado Center for Bone Research, 3190 South Wadsworth Boulevard, Lakewood, CO 80227, USA. millerccbr@aol.com ·Endocrinol Metab Clin North Am · Pubmed #22877432.

ABSTRACT: There are a substantial number of secondary causes of osteoporosis that can be identified through appropriate evaluation. Unrecognized celiac disease, Monoclonal gamopathy of undetermined significance (MGUS), impaired renal function, diabetes mellitus, and renal tubular acidosis are just a few of the more common secondary causes of osteoporosis. Through targeted laboratory tests, many secondary causes of osteoporosis can be identified.