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Osteoporosis: HELP
Articles from Indianapolis
Based on 113 articles published since 2008

These are the 113 published articles about Osteoporosis that originated from Indianapolis during 2008-2019.
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5
1 Editorial Dynamic muscle loading and mechanotransduction. 2012

Yokota, Hiroki / Tovar, Andrés / Robling, Alexander. ·Biomechanics and Biomaterials Research Center, Indiana University Purdue University Indianapolis, Indianapolis, IN 46202, USA. hyokota@iupui.edu ·Bone · Pubmed #22864148.

ABSTRACT: -- No abstract --

2 Review Dental Manifestations of Pediatric Bone Disorders. 2017

Yepes, Juan F. ·Department of Pediatric Dentistry, Attending Riley Hospital for Children, Indiana University School of Dentistry, Indianapolis, IN, USA. jfyepes@iupui.edu. ·Curr Osteoporos Rep · Pubmed #28965204.

ABSTRACT: PURPOSE OF REVIEW: Several bone disorders affecting the skeleton often are manifest in the maxillofacial region. This review presents the most common bone disorders in children and their dental-oral manifestations: fibrous dysplasia, Paget's disease, osteogenesis imperfecta, renal osteodystrophy, hypophosphatasia, and osteoporosis. The specific intraoral characteristics will reviewed in detail. RECENT FINDINGS: Recent studies confirmed the close relationship between the mandible and the maxilla with the most prevalent systemic bone disorders in children. This review will help practitioners to integrate the oral health into the systemic health and improve the multidisciplinary approach of pediatric patients between medicine and dentistry.

3 Review Preclinical Models for Skeletal Research: How Commonly Used Species Mimic (or Don't) Aspects of Human Bone. 2017

Allen, Matthew R. ·1 Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana, USA. · 2 Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA. · 3 Department of Biomedical Engineering, Indiana University Purdue University of Indianapolis, Indianapolis, Indiana, USA. ·Toxicol Pathol · Pubmed #28946796.

ABSTRACT: Preclinical studies play an indispensable role in exploring the biological regulation of the musculoskeletal system. They are required in all drug development pipelines where both small and large animal models are needed to understand efficacy and side effects. This brief review highlights 4 aspects of human bone, longitudinal bone growth, intracortical remodeling, collagen/mineral interface, and age-related changes, and discusses how various animal models recapitulate (or don't) these aspects of human skeletal physiology.

4 Review Renal Osteodystrophy or Kidney-Induced Osteoporosis? 2017

Moe, Sharon M. ·Division of Nephrology, Indiana University School of Medicine, 950 W. Walnut Street, R2-202, Indianapolis, IN, 46202, USA. smoe@iu.edu. · Department of Medicine, Roudebush Veterans Affairs Medical Center, Indianapolis, IN, USA. smoe@iu.edu. ·Curr Osteoporos Rep · Pubmed #28497212.

ABSTRACT: PURPOSE OF REVIEW: Chronic kidney disease (CKD) affects nearly 10% of the population. The incidence of fractures in population studies demonstrate an increase with worsening stages of kidney disease suggesting specific CKD related causes of fracture. RECENT FINDINGS: The increase in fractures with CKD most likely represents disordered bone quality due to the abnormal bone remodeling from renal osteodystrophy. There is also an increase in fractures with age in patients with CKD, suggesting that patients with CKD also have many fracture risk factors common to patients without known CKD. Osteoporosis is defined by the National Institutes of Health as "A skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture. Bone strength reflects the integration of two main features: bone quantity and bone quality." Thus, CKD-related fractures can be considered a type of osteoporosis-where the bone quality is additionally impaired above that of age/hormonal-related osteoporosis. Perhaps using the term CKD-induced osteoporosis, similar to steroid-induced osteoporosis, will allow patients with CKD to be studied in trials investigating therapeutic agents. In this series, we will examine how CKD-induced osteoporosis may be diagnosed and treated.

5 Review On the Emerging Role of the Taste Receptor Type 1 (T1R) Family of Nutrient-Sensors in the Musculoskeletal System. 2017

Kokabu, Shoichiro / Lowery, Jonathan W / Toyono, Takashi / Sato, Tsuyoshi / Yoda, Tetsuya. ·Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Saitama Medical University, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan. r14kokabu@kyu-dent.ac.jp. · Division of Molecular Signaling and Biochemistry, Department of Health Promotion, Kyushu Dental University, Kokurakita-ku, Kitakyushu, Fukuoka 803-8580, Japan. r14kokabu@kyu-dent.ac.jp. · Division of Biomedical Science, Marian University College of Osteopathic Medicine, 3200 Cold Spring Rd., Indianapolis, IN 46222, USA. jlowery@marian.edu. · Bone & Mineral Research Group, Marian University College of Osteopathic Medicine, 3200 Cold Spring Rd., Indianapolis, IN 46222, USA. jlowery@marian.edu. · Division of Anatomy, Department of Health Promotion, Kyushu Dental University, Kokurakita-ku, Kitakyushu, Fukuoka 803-8580, Japan. toyono@kyu-dent.ac.jp. · Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Saitama Medical University, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan. tsato@saitama-med.ac.jp. · Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Saitama Medical University, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan. yoda@saitama-med.ac.jp. ·Molecules · Pubmed #28294983.

ABSTRACT: The special sense of taste guides and guards food intake and is essential for body maintenance. Salty and sour tastes are sensed via ion channels or gated ion channels while G protein-coupled receptors (GPCRs) of the taste receptor type 1 (T1R) family sense sweet and umami tastes and GPCRs of the taste receptor type 2 (T2R) family sense bitter tastes. T1R and T2R receptors share similar downstream signaling pathways that result in the stimulation of phospholipase-C-β2. The T1R family includes three members that form heterodimeric complexes to recognize either amino acids or sweet molecules such as glucose. Although these functions were originally described in gustatory tissue, T1R family members are expressed in numerous non-gustatory tissues and are now viewed as nutrient sensors that play important roles in monitoring global glucose and amino acid status. Here, we highlight emerging evidence detailing the function of T1R family members in the musculoskeletal system and review these findings in the context of the musculoskeletal diseases sarcopenia and osteoporosis, which are major public health problems among the elderly that affect locomotion, activities of daily living, and quality of life. These studies raise the possibility that T1R family member function may be modulated for therapeutic benefit.

6 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.

7 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.

8 Review Lifestyle-Related Metabolic Disorders, Osteoporosis, and Fracture Risk in Asia: A Systematic Review. 2016

Sugimoto, Toshitsugu / Sato, Masayo / Dehle, Francis C / Brnabic, Alan J M / Weston, Adele / Burge, Russel. ·Shimane University Faculty of Medicine, Internal Medicine 1, Shimane, Japan. · Eli Lilly Japan K.K., Lilly Research Laboratories, Kobe, Japan. Electronic address: sato_masayo@lilly.com. · Optum, Sydney, NSW, Australia. · Eli Lilly and Company, Global Health Outcomes, Indianapolis, IN, USA. ·Value Health Reg Issues · Pubmed #27881259.

ABSTRACT: BACKGROUND: The prevalence of both lifestyle-related metabolic disorders and osteoporosis is increasing in Asia. OBJECTIVES: To conduct a systematic review of the published literature to identify studies examining disorders of glucose and lipid metabolism (type 2 diabetes, hyperglycemia, hypercholesterolemia, hyperlipidemia, dyslipidemia, metabolic syndrome [MetS], and atherosclerosis) as risk factors for osteoporosis and fracture in Asian populations. Studies examining the relationship between metabolic disorders and bone mineral density (BMD) were also included. METHODS: EMBASE (including MEDLINE) and the Cochrane Library were searched. Studies conducted only within Asia, which reported multivariate analysis with a sample size of 200 or more subjects, were included. RESULTS: A total of 32 studies were included. All six studies examining diabetes and fracture found that subjects with diabetes had a significantly higher risk of fracture than did subjects without diabetes (risk estimate range 1.26-4.73). Two studies found that subjects with atherosclerosis had a significantly higher risk of fracture (risk estimate range 1.10-2.52). Studies consistently reported that MetS is likely associated with osteoporosis or decreased BMD in men but not women. No consistent association was found for diabetes and BMD, with studies reporting contrasting results. There was limited evidence investigating lipid metabolism and hyperglycemia and risk of fracture or bone loss in Asian populations. CONCLUSIONS: These findings suggest that diabetes is a risk factor for fracture in Asian populations. MetS may be associated with bone loss in Asian men and atherosclerosis associated with increased fractures; however, caution is needed interpreting these findings given limitations in study design.

9 Review Do Selective Serotonin Reuptake Inhibitors (SSRIs) Cause Fractures? 2016

Warden, Stuart J / Fuchs, Robyn K. ·Center for Translational Musculoskeletal Research and Department of Physical Therapy, School of the Health and Rehabilitation Sciences, Indiana University, 1140 W. Michigan St., CF-120, Indianapolis, IN, USA. stwarden@iu.edu. · Center for Translational Musculoskeletal Research and Department of Physical Therapy, School of the Health and Rehabilitation Sciences, Indiana University, 1140 W. Michigan St., CF-120, Indianapolis, IN, USA. ·Curr Osteoporos Rep · Pubmed #27495351.

ABSTRACT: Recent meta-analyses report a 70 % increase in fracture risk in selective serotonin reuptake inhibitor (SSRI) users compared to non-users; however, included studies were observational and limited in their ability to establish causality. Here, we use the Bradford Hill criteria to explore causality between SSRIs and fractures. We found a strong, consistent, and temporal relationship between SSRIs and fractures, which appears to follow a biological gradient. However, specificity and biological plausibility remain concerns. In terms of specificity, the majority of available data have limitations due to either confounding by indication or channeling bias. Self-controlled case series address some of these limitations and provide relatively strong observational evidence for a causal relationship between SSRIs and fracture. In doing so, they suggest that falls contribute to fractures in SSRI users. Whether there are also underlying changes in skeletal properties remains unresolved. Initial studies provide some evidence for skeletal effects of SSRIs; however, the pathways involved need to be established before biological plausibility can be accepted. As the link between SSRIs and fractures is based on observational data and not evidence from prospective trials, there is insufficient evidence to definitively determine a causal relationship and it appears premature to label SSRIs as a secondary cause of osteoporosis. SSRIs appear to contribute to fracture-inducing falls, and addressing any fall risk associated with SSRIs may be an efficient approach to reducing SSRI-related fractures. As fractures stemming from SSRI-induced falls are more likely in individuals with compromised bone health, it is worth considering bone density testing and intervention for those presenting with risk factors for osteoporosis.

10 Review Osteocytic signalling pathways as therapeutic targets for bone fragility. 2016

Plotkin, Lilian I / Bellido, Teresita. ·Department of Anatomy and Cell Biology, Division of Endocrinology, Indiana University School of Medicine. · Department of Medicine, Division of Endocrinology, Indiana University School of Medicine, 635 Barnhill Drive, Indianapolis, Indiana, 46202, USA. · Roudebush Veterans Administration Medical Center, 635 Barnhill Drive, Indianapolis, Indiana, 46202, USA. ·Nat Rev Endocrinol · Pubmed #27230951.

ABSTRACT: Osteocytes are differentiated osteoblasts that become surrounded by matrix during the process of bone formation. Acquisition of the osteocyte phenotype is achieved by profound changes in gene expression that facilitate adaptation to the changing cellular environment and constitute the molecular signature of osteocytes. During osteocytogenesis, the expression of genes that are characteristic of the osteoblast are altered and the expression of genes and/or proteins that impart dendritic cellular morphology, regulate matrix mineralization and control the function of cells at the bone surface are ordely modulated. The discovery of mutations in human osteocytic genes has contributed, in a large part, to our understanding of the role of osteocytes in bone homeostasis. Osteocytes are targets of the mechanical force imposed on the skeleton and have a critical role in integrating mechanosensory pathways with the action of hormones, which thereby leads to the orchestrated response of bone to environmental cues. Current, therapeutic approaches harness this accumulating knowledge by targeting osteocytic signalling pathways and messengers to improve skeletal health.

11 Review Aberrant Myeloid Differentiation Contributes to the Development of Osteoporosis in Neurofibromatosis Type 1. 2016

Rhodes, Steven D / Yang, Feng-Chun. ·Department of Pediatrics, Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, USA. · Sylvester Comprehensive Cancer Center, Department of Biochemistry and Molecular Biology, University of Miami School of Medicine, R. Bunn Gautier Building, 417 1011 NW 15th street, Locator R-629, Miami, FL, 33136, USA. fxy37@med.miami.edu. ·Curr Osteoporos Rep · Pubmed #26932441.

ABSTRACT: Neurofibromatosis type 1 (NF1), also known as von Recklinghausen disease, is a common autosomal dominant genetic disorder affecting approximately 1 in 3000 individuals worldwide. NF1 results from heritable or spontaneous mutations of the NF1 tumor suppressor gene. NF1 encodes the protein neurofibromin, which functions to negatively regulate Ras-activity. Approximately 50 % of NF1 patients develop osteopenia or osteoporosis, resulting in significantly increased rates of long-bone fracture and morbidity. While defective osteoblast bone anabolism has been implicated as a central factor in the pathogenesis of NF1 associated skeletal deficits, recent data suggest that NF1 (Nf1) haploinsufficiency within the hematopoietic compartment, particularly in osteoclasts and myeloid progenitors, plays a pivotal role in engendering NF1 osseous manifestations. In this chapter, we review the latest data from clinical studies and murine models delineating a critical role for hematopoietic compartment, myeloid progenitors of NF1 (Nf1) haploinsufficient and their progeny-osteoclasts, in the pathogenesis of NF1 associated osteopenia/osteoporosis and discuss putative targets for future therapeutics.

12 Review Teriparatide for osteoporosis: importance of the full course. 2016

Lindsay, R / Krege, J H / Marin, F / Jin, L / Stepan, J J. ·Helen Hayes Hospital, West Haverstraw, NY, USA. · Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA. krege_john_henry@lilly.com. · Lilly Research Centre, Eli Lilly and Company, Windlesham, Surrey, UK. · Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA. · Institute of Rheumatology, Faculty of Medicine 1, Charles University, Prague, Czech Republic. ·Osteoporos Int · Pubmed #26902094.

ABSTRACT: Teriparatide (TPTD) is the only currently available therapeutic agent that increases the formation of new bone tissue and can provide some remediation of the architectural defects in the osteoporotic skeleton. The use of teriparatide clinically is limited to 24 months. We review clinical findings during daily teriparatide treatment over time. Teriparatide appears to increase bone formation more than bone resorption as determined biochemically and histologically. Teriparatide exerts its positive effects on bone formation in two distinct fashions. The first is direct stimulation of bone formation that occurs within active remodeling sites (remodeling-based bone formation) and on surfaces of bone previously inactive (modeling-based bone formation). The second is an increase in the initiation of new remodeling sites. Both processes contribute to the final increase in bone density observed by non-invasive tools such as DXA. Remodeling is the repair process by which skeletal tissue is maintained in a young healthy state, and when stimulated by TPTD is associated with a positive bone balance within each remodeling cavity. It seems likely therefore that this component will contribute to the anti-fracture efficacy of TPTD. Teriparatide reduces the risk of fracture, and this effect appears to increase with longer duration of therapy. The use of novel treatment regimens, including shorter courses, should be held in abeyance until controlled clinical trials are completed to define the relative fracture benefits of such approaches in comparison to the 24-month daily use of the agent. Summary In patients with osteoporosis at high risk for fracture, the full continuous 24-month course with teriparatide results in improved skeletal health and outcomes than shorter time periods.

13 Review The potential effect of Wuqinxi exercise for primary osteoporosis: A systematic review and meta-analysis. 2015

Wei, Xu / Xu, Aili / Yin, Yukun / Zhang, Ranxing. ·Department of Scientific Research, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China; Institute of Orthopaedics of Beijing Integrative Medicine, Beijing, China. · Department of Internal Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China. · Department of Biology, Indiana University Purdue University Indianapolis, Indianapolis, USA. · Department of Clinical Laboratory, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China. Electronic address: bjzrx@sina.com. ·Maturitas · Pubmed #26386831.

ABSTRACT: This review aims to assess the effect of Wuqinxi exercise for primary osteoporosis. Literature search was conducted on the seven databases until June 2015. No statistical differences were found between the Wuqinxi versus no intervention, Wuqinxi plus antiosteoporosis medications versus antiosteoporosis medications on lumbar spine bone mineral density (BMD). However, Wuqinxi significantly improved lumbar spine BMD compared with antiosteoporosis medications (MD= 0.02g/cm(2); 95% CI: 0.01-0.03; P<0.0001). Wuqinxi plus antiosteoporosis medications had a better effect on femora BMD (MD=0.24g/cm(2); 95% CI: 0.18-0.30; P<0.00001). Additionally, the results showed a remarkable effect in improving pain score when Wuqinxi (MD=0.7; 95% CI: 0.31-1.09; P=0.0004) or Wuqinxi plus antiosteoporosis medications (MD=1.06; 95% CI: 0.57-1.55; P<0.0001) was used. An improvement was also identified in Wuqinxi plus antiosteoporosis medications on bone gla protein. Overall, Wuqinxi monotherapy or combination therapy can improve pain symptom, but the effect on BMD owing to poor study design and execution, inconsistency and imprecision is uncertain. It is recommended to exercise at least for 6 months, 5 times a week for around 30-60 min each time.

14 Review Systematic review of raloxifene in postmenopausal Japanese women with osteoporosis or low bone mass (osteopenia). 2014

Fujiwara, Saeko / Hamaya, Etsuro / Sato, Masayo / Graham-Clarke, Peita / Flynn, Jennifer A / Burge, Russel. ·Hiroshima Atomic Bomb Casualty Council, Hiroshima, Japan. · Lilly Research Laboratories Japan, Eli Lilly Japan K.K., Kobe, Japan. · Global Health Outcomes, Eli Lilly Australia, Sydney, NSW, Australia. · Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN, USA. ·Clin Interv Aging · Pubmed #25395843.

ABSTRACT: PURPOSE: To systematically review the literature describing the efficacy, effectiveness, and safety of raloxifene for postmenopausal Japanese women with osteoporosis or low bone mass (osteopenia). MATERIALS AND METHODS: Medline via PubMed and Embase was systematically searched using prespecified terms. Retrieved publications were screened and included if they described randomized controlled trials or observational studies of postmenopausal Japanese women with osteoporosis or osteopenia treated with raloxifene and reported one or more outcome measures (change in bone mineral density [BMD]; fracture incidence; change in bone-turnover markers, hip structural geometry, or blood-lipid profile; occurrence of adverse events; and change in quality of life or pain). Excluded publications were case studies, editorials, letters to the editor, narrative reviews, or publications from non-peer-reviewed journals; multidrug, multicountry, or multidisease studies with no drug-, country-, or disease-level analysis; or studies of participants on dialysis. RESULTS: Of the 292 publications retrieved, 15 publications (seven randomized controlled trials, eight observational studies) were included for review. Overall findings were statistically significant increases in BMD of the lumbar spine (nine publications), but not the hip region (eight publications), a low incidence of vertebral fracture (three publications), decreases in markers of bone turnover (eleven publications), improved hip structural geometry (two publications), improved blood-lipid profiles (five publications), a low incidence of hot flushes, leg cramps, venous thromboembolism, and stroke (12 publications), and improved quality of life and pain relief (one publication). CONCLUSION: Findings support raloxifene for reducing vertebral fracture risk by improving BMD and reducing bone turnover in postmenopausal Japanese women with osteoporosis or osteopenia. Careful consideration of fracture risk and the risk-benefit profile of antiosteoporosis medications is required when managing patients with osteoporosis.

15 Review Literature review: The effects of teriparatide therapy at the hip in patients with osteoporosis. 2014

Eriksen, Erik F / Keaveny, Tony M / Gallagher, Eileen R / Krege, John H. ·Department of Endocrinology, Oslo University Hospital, Pb 49596 Nydalen, N-0424 Oslo, Norway. Electronic address: e.f.eriksen@medisin.uio.no. · University of California, Berkeley, Departments of Mechanical Engineering and Bioengineering, 6175 Etcheverry Hall, MC 1740, Berkeley, CA 94720, USA. Electronic address: tmk@me.berkeley.edu. · inVentiv Health Clinical, 504 Carnegie Center, Princeton, NJ 08540, USA. Electronic address: eileen.gallagher@inventivhealth.com. · Lilly USA, LLC, Lilly Technology Center South, Drop Code 5028 Indianapolis, IN 46221, USA. Electronic address: kregejh@lilly.com. ·Bone · Pubmed #25053463.

ABSTRACT: Teriparatide is a skeletal anabolic treatment for patients with osteoporosis at high risk for fracture. Because adequate clinical trials have not yet been conducted to assess the efficacy of teriparatide for reducing the risk of hip fracture, we review here the literature regarding how treatment with teriparatide affects the hip in patients with osteoporosis. Teriparatide increases cancellous bone volume, improves bone architecture, and - uniquely among osteoporosis treatments - increases cortical thickness and cortical porosity. By bone scan and positron emission tomography, teriparatide increases bone formation throughout the skeleton, including the hip. Consistent with these findings, studies using dual-energy X-ray absorptiometry and quantitative computed tomography for longitudinal assessment of changes at the hip have consistently shown increases in areal and volumetric bone mineral density, cortical thickness, and finite element-estimated hip strength in patients treated with teriparatide. Finally, in clinical fracture-outcome trials, treatment with teriparatide has been shown to reduce the risk of nonvertebral fracture, a composite endpoint that includes hip fracture. Taken together, this body of evidence suggests that teriparatide positively affects the hip in patients with osteoporosis.

16 Review PINP as a biological response marker during teriparatide treatment for osteoporosis. 2014

Krege, J H / Lane, N E / Harris, J M / Miller, P D. ·Lilly USA, Indianapolis, IN, USA. ·Osteoporos Int · Pubmed #24599274.

ABSTRACT: Postmenopausal women with severe osteoporosis may require treatment with the bone anabolic drug teriparatide. While changes in bone mineral density (BMD) are one measure of response, BMD changes often require a minimum of one year to observe measureable changes. Biochemical markers of bone turnover change within 1 to 3 months of initiating osteoporosis therapy. Monitoring with a marker such as procollagen type I N propeptide (PINP), an osteoblast-derived protein, during teriparatide treatment may provide clinically useful information for managing patients with osteoporosis. Clinical trials have shown consistent increases in PINP within 3 months of initiating teriparatide, increases that are significantly greater than placebo and significantly different from baseline. Increases in PINP concentrations during teriparatide treatment correlate well with increases in skeletal activity assessed by radioisotope bone scans and quantitative bone histomorphometry parameters. Individuals treated with teriparatide in clinical trials usually experienced an increase in PINP > 10 mcg/L from baseline, while those given placebo usually did not. In the clinical setting, patients experiencing a significant increase in PINP > 10 mcg/L after initiating teriparatide therapy may receive an earlier confirmation of anabolic effect, while those who do not may be assessed for adherence, proper injection technique, or undetected secondary conditions that might mitigate an anabolic response. PINP monitoring may provide information supplemental to BMD monitoring and be a useful aid in managing patients receiving anabolic osteoporosis treatment in the same way that biochemical markers of bone resorption are useful in monitoring antiresorptive therapy. This review examines PINP as a biological response marker during teriparatide treatment for osteoporosis.

17 Review Functional impairment of bone formation in the pathogenesis of osteoporosis: the bone marrow regenerative competence. 2013

Bidwell, Joseph P / Alvarez, Marta B / Hood, Mark / Childress, Paul. ·Department of Anatomy and Cell Biology, Indiana University School of Medicine (IUSM), Medical Science Bldg 5035, 635 Barnhill Drive, Indianapolis, IN 46202, USA. jbidwell@iupui.edu ·Curr Osteoporos Rep · Pubmed #23471774.

ABSTRACT: The skeleton is a high-renewal organ that undergoes ongoing cycles of remodeling. The regenerative bone formation arm ultimately declines in the aging, postmenopausal skeleton, but current therapies do not adequately address this deficit. Bone marrow is the primary source of the skeletal anabolic response and the mesenchymal stem cells (MSCs), which give rise to bone matrix-producing osteoblasts. The identity of these stem cells is emerging, but it now appears that the term 'MSC' has often been misapplied to the bone marrow stromal cell (BMSC), a progeny of the MSC. Nevertheless, the changes in BMSC phenotype associated with age and estrogen depletion likely contribute to the attenuated regenerative competence of the marrow and may reflect alterations in MSC phenotype. Here we summarize current concepts in bone marrow MSC identity, and within this context, review recent observations on changes in bone marrow population dynamics associated with aging and menopause.

18 Review The emerging role of serotonin (5-hydroxytryptamine) in the skeleton and its mediation of the skeletal effects of low-density lipoprotein receptor-related protein 5 (LRP5). 2010

Warden, Stuart J / Robling, Alexander G / Haney, Elizabeth M / Turner, Charles H / Bliziotes, Michael M. ·Department of Physical Therapy, School of Health and Rehabilitation Sciences, Indiana University, Indianapolis, IN 46202, USA. stwarden@iupui.edu ·Bone · Pubmed #19591966.

ABSTRACT: Novel molecular pathways obligatory for bone health are being rapidly identified. One pathway recently revealed involves gut-derived 5-hydroxytryptamine (5-HT) mediation of the complete skeletal effects of low-density lipoprotein receptor-related protein 5 (LRP5). Mounting evidence supports 5-HT as an important regulatory compound in bone with previous evidence demonstrating that bone cells possess functional pathways for responding to 5-HT. In addition, there is growing evidence that potentiation of 5-HT signaling via inhibition of the 5-HT transporter (5-HTT) has significant skeletal effects. The later is clinically significant as the 5-HTT is a popular target of pharmaceutical agents, such as selective serotonin reuptake inhibitors (SSRIs), used for the management of major depressive disorder and other affective conditions. The observation that 5-HT mediates the complete skeletal effects of LRP5 represents a significant paradigm shift from the traditional view that LRP5 located on the cell surface membrane of osteoblasts exerts direct skeletal effects via Wnt/beta-catenin signaling. This paper discusses the mounting evidence for skeletal effects of 5-HT and the ability of gut-derived 5-HT to satisfactorily explain the skeletal effects of LRP5.

19 Review Skeletal accumulation of bisphosphonates: implications for osteoporosis treatment. 2008

Allen, Matthew R. ·Indiana University School of Medicine, Department of Anatomy & Cell Biology, 635 Barnhill Drive, MS-5035, IN 46202, Indianapolis, USA. matallen@iupui.edu ·Expert Opin Drug Metab Toxicol · Pubmed #18950279.

ABSTRACT: BACKGROUND: Bisphosphonates (BPs), the gold-standard pharmacological treatment for osteoporosis, are unique in that they become physically bound to the bone matrix and therefore accumulate over time. This skeletal accumulation has important physiological implications that are not completely understood. OBJECTIVE: To review concepts related to the biological effects of BP accumulation in the skeleton. METHODS: Articles concerning skeletal accumulation of BP treatment were identified. RESULTS/CONCLUSIONS: Skeletal accumulation of BP, dictated by both chemical and biological factors, is dose-dependent, differs among skeletal sites and likely differs among the various BPs. Bisphosphonate embedded within the skeletal matrix has lasting biological effects, the results of which have both positive and negative implications for bone remodeling. As alternative anti-remodeling agents gain approval for treatment of osteoporosis, the property of skeletal accumulation will likely be unique to BPs and therefore may be the property that determines the future use of this drug class.

20 Review Review of nonprimate, large animal models for osteoporosis research. 2008

Reinwald, Susan / Burr, David. ·Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA. sureinwa@iupui.edu ·J Bone Miner Res · Pubmed #18505374.

ABSTRACT: Large animal models are required for preclinical prevention and intervention studies related to osteoporosis research. The challenging aspect of this requirement is that no single animal model exactly mimics the progression of this human-specific chronic condition. There are pros and cons associated with the skeletal, hormonal, and metabolic conditions of each species that influence their relevance and applicability to human physiology. Of all larger mammalian species, nonhuman primates (NHPs) are preeminent in terms of replicating important aspects of human physiology. However, NHPs are very expensive, putting them out of reach of the vast majority of researchers. Practical, cost-effective alternatives to NHPs are sought after among ungulate (porcine, caprine, and ovine) and canine species that are the focus of this review. The overriding caveat to using large lower-order species is to take the time in advance to understand and appreciate the limitations and strengths of each animal model. Under these circumstances, experiments can be strategically designed to optimize the potential of an animal to develop the cardinal features of postmenopausal bone loss and/or yield information of relevance to treatment.

21 Review Total hip arthroplasty in patients with bone deficiency of the acetabulum. 2008

Choplin, Robert H / Henley, Christopher N / Edds, Eric M / Capello, William / Rankin, James L / Buckwalter, Kenneth A. ·Department of Radiology, Indiana University School of Medicine, 550 N University Blvd, Room 0279, Indianapolis, IN 46202-5253, USA. rchoplin@iupui.edu ·Radiographics · Pubmed #18480483.

ABSTRACT: Total hip replacement (THR) requires revision in only a minority of cases (approximately 17% of prosthetic hips fail), but when THR failures occur there may be significant acetabular bone deficiency. There is a variety of surgical hardware and strategies available to address this problem. The causes of primary THR revision include aseptic loosening or particle disease, infection, recurrent dislocation, implant failure, periprosthetic fracture, and leg length discrepancy. Almost all patients who need THR revision undergo a standard radiographic evaluation of the pelvis and hip. In general, CT is an excellent tool for evaluating loosening of the prosthesis caused by either mechanical reasons or infection, and MR imaging is best suited for evaluating the soft tissues surrounding the prosthesis. Nuclear medicine studies are performed when results of CT and MR imaging are inconclusive. When patients are evaluated for revision THR, radiologists must check for acetabular cup loosening, the amount and type of bone stock loss, the amount of component migration, and the presence or absence of liner wear. Before revision hardware is placed, bone stock loss must be repaired, either by using bone grafting or by placing accessory acetabular hardware such as cups, rings, or cages. The long-term success of revision acetabular surgery varies; there is acetabular cup presence at 5 years after surgery in 60%-94% of cases. Complications include postoperative infections, repeat liner wear, bone graft failure, periprosthetic or prosthetic fractures, dislocation, vascular injury, and nerve injury.

22 Clinical Trial Soluble corn fiber increases bone calcium retention in postmenopausal women in a dose-dependent manner: a randomized crossover trial. 2016

Jakeman, Steven A / Henry, Courtney N / Martin, Berdine R / McCabe, George P / McCabe, Linda D / Jackson, George S / Peacock, Munro / Weaver, Connie M. ·Departments of Food Science. · Statistics. · Nutrition Science, and. · Physics and Astronomy, Purdue University, West Lafayette, IN; and. · Department of Medicine, Indiana University, Indianapolis, IN. · Nutrition Science, and weavercm@purdue.edu. ·Am J Clin Nutr · Pubmed #27465372.

ABSTRACT: BACKGROUND: Dietary soluble corn fiber (SCF) significantly improves calcium absorption in adolescents and the bone strength and architecture in rodent models. OBJECTIVE: In this study, we aimed to determine the skeletal benefits of SCF in postmenopausal women. DESIGN: We used our novel technology of determining bone calcium retention by following the urinary appearance of (41)Ca, a rare long-lived radioisotope, from prelabeled bone to rapidly and sensitively evaluate the effectiveness of SCF in reducing bone loss. A randomized-order, crossover, double-blinded trial was performed in 14 healthy postmenopausal women to compare doses of 0, 10, and 20 g fiber from SCF/d for 50 d. RESULTS: A dose-response effect was shown with 10 and 20 g fiber from SCF/d, whereby bone calcium retention was improved by 4.8% (P < 0.05) and 7% (P < 0.04), respectively. The bone turnover biomarkers N-terminal telopeptide and osteocalcin were not changed by the interventions; however, a significant increase in bone-specific alkaline phosphatase, which is a bone-formation marker, was detected between 0 and 20 g fiber from SCF/d (8%; P = 0.035). CONCLUSION: Daily SCF consumption significantly increased bone calcium retention in postmenopausal women, which improved the bone calcium balance by an estimated 50 mg/d. This study was registered at clinicaltrials.gov as NCT02416947.

23 Clinical Trial Improvement of cancellous bone microstructure in patients on teriparatide following alendronate pretreatment. 2016

Fahrleitner-Pammer, Astrid / Burr, David / Dobnig, Harald / Stepan, Jan J / Petto, Helmut / Li, Jiliang / Krege, John H / Pavo, Imre. ·Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria. Electronic address: astrid.fahrleitner@medunigraz.at. · Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, USA. · Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria. · Institute of Rheumatology and Faculty of Medicine 1, Charles University, Prague, Czech Republic. · Lilly Research Centre, Vienna, Austria. · Department of Biology, Indiana University Purdue University, Indianapolis, IN, USA. · Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA. ·Bone · Pubmed #27185100.

ABSTRACT: An increase in procollagen type I amino-terminal propeptide (PINP) early after teriparatide initiation was shown to correlate with increased lumbar spine areal BMD and is a good predictor of the anabolic response to teriparatide. Few data exist correlating PINP and bone microstructure, and no data exist in patients on teriparatide following prior potent antiresorptive treatment. This exploratory analysis aimed to investigate the effects of teriparatide on cancellous bone microstructure and correlations of bone markers with microstructure in alendronate-pretreated patients. This was a post hoc analysis of changes in bone markers and three-dimensional indices of bone microstructure in paired iliac crest biopsies from a prospective teriparatide treatment study in postmenopausal women with osteoporosis who were either treatment-naïve (TN, n=16) or alendronate-pretreated (ALN, n=29) at teriparatide initiation. Teriparatide (20μg/day) was given for 24months; biopsies were taken at baseline and endpoint, and serum concentrations of PINP and type 1 collagen cross-linked C-telopeptide (βCTX) were measured at intervals up to 24months. In the TN and ALN groups, respectively, mean (SD) increases in three-dimensional bone volume/tissue volume were 105 (356)% (P=0.039) and 55 (139)% (P<0.005) and trabecular thickness 30.4 (30)% (P<0.001) and 30.8 (53)% (P<0.001). No significant changes were observed in trabecular number or separation. In the ALN patients, 3-month change of neither PINP nor βCTX correlated with indices of cancellous bone microstructure. However, 12-month changes in biochemical bone markers correlated significantly with improvements in bone volume/tissue volume, r=0.502 (P<0.01) and r=0.378 (P<0.05), trabecular number, r=0.559 (P<0.01) and r=0.515 (P<0.01), and reduction of trabecular separation, r=-0.432 (P<0.05) and r=-0.530 (P<0.01), for PINP and βCTX, respectively. We conclude that cancellous bone microstructure improved with teriparatide therapy irrespective of prior antiresorptive use.

24 Clinical Trial A Longitudinal Study of Skeletal Histomorphometry at 6 and 24 Months Across Four Bone Envelopes in Postmenopausal Women With Osteoporosis Receiving Teriparatide or Zoledronic Acid in the SHOTZ Trial. 2016

Dempster, David W / Zhou, Hua / Recker, Robert R / Brown, Jacques P / Bolognese, Michael A / Recknor, Christopher P / Kendler, David L / Lewiecki, E Michael / Hanley, David A / Rao, Sudhaker D / Miller, Paul D / Woodson, Grattan C / Lindsay, Robert / Binkley, Neil / Alam, Jahangir / Ruff, Valerie A / Gallagher, Eileen R / Taylor, Kathleen A. ·Regional Bone Center, Helen Hayes Hospital, West Haverstraw, NY, USA. · School of Medicine, Creighton University, Omaha, NE, USA. · CHU de Québec (CHUL) Research Centre, Laval University, Quebec City, Canada. · Bethesda Health Research, Bethesda, MD, USA. · United Osteoporosis Centers, Gainesville, GA, USA. · Prohealth Clinical Research, Vancouver, British Columbia, Canada. · New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA. · Department of Medicine, University of Calgary, Calgary, Alberta, Canada. · Bone & Mineral Research Laboratory, Detroit, MI, USA. · Colorado Center for Bone Research, Lakewood, CO, USA. · Atlanta Research Center, Atlanta, GA, USA. · University of Wisconsin, Madison, WI, USA. · Lilly USA, LLC, Indianapolis, IN, USA. · inVentiv Health Clinical, Princeton, NJ, USA. ·J Bone Miner Res · Pubmed #26841258.

ABSTRACT: Previously, we reported the effects of teriparatide (TPTD) and zoledronic acid (ZOL) on bone formation based on biochemical markers and bone histomorphometry of the cancellous envelope at month 6 in postmenopausal women with osteoporosis who participated in the 12-month primary Skeletal Histomorphometry in Subjects on Teriparatide or Zoledronic Acid Therapy (SHOTZ) study. Patients were eligible to enter a 12-month extension on their original treatment regimen: TPTD 20 μg/day (s.c. injection) or ZOL 5 mg/year (i.v. infusion). A second biopsy was performed at month 24. Here we report longitudinal changes between and within each treatment group in the cancellous, endocortical, intracortical, and periosteal bone envelopes in patients with evaluable biopsies at months 6 and 24 (paired data set: TPTD, n = 10; ZOL, n = 9). Between-group differences are also reported in the larger set of patients with evaluable biopsies at month 6 (TPTD, n = 28; ZOL, n = 30). Data from the cancellous envelope at month 6 or month 24 provided a reference to compare differences across envelopes within each treatment group. The 24-month results extend our earlier report that TPTD and ZOL possess different tissue-level mechanisms of action. Moreover, these differences persisted for at least 2 years in all four bone envelopes. Few longitudinal differences were observed within or across bone envelopes in ZOL-treated patients, suggesting that the low bone formation indices at month 6 persisted to month 24. Conversely, the magnitude of the effect of TPTD on bone formation varied across individual envelopes: median values for mineralizing surface (MS/BS) and bone formation rate (BFR/BS) at month 6 were approximately 3-fold to 5-fold higher in the endocortical and intracortical envelopes compared to the cancellous envelope. Although MS/BS and BFR/BS declined in these envelopes at month 24, median values continued to exceed, or were not significantly different from, those in the cancellous envelope. This study demonstrates for the first time that bone formation indices are higher with TPTD treatment than with ZOL in all four bone envelopes and the difference persists for at least 2 years. Moreover, the magnitude of the effect of TPTD in cortical bone remains robust at 24 months. © 2016 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research (ASBMR).

25 Clinical Trial Patients with prior vertebral or hip fractures treated with teriparatide in the Direct Assessment of Nonvertebral Fractures in Community Experience (DANCE) observational study. 2016

Beall, D P / Feldman, R G / Gordon, M L / Gruber, B L / Lane, J M / Valenzuela, G / Yim, D / Alam, J / Krege, J H / Krohn, K. ·Clinical Radiology of Oklahoma, 1800 S. Renaissance Blvd, Edmond, OK, 73013, USA. · Senior Clinical Trials, Inc., 23961 Calle de la Magdalena Suite 429, Laguna Hills, CA, 92653, USA. · Newport Orthopedic Institute, Newport Beach 22 Corporate Plaza Drive, Newport Beach, CA, 92660, USA. · Long Island Regional Arthritis and Osteoporosis Care, PC, 500 West Main Street, Suite 110, Babylon, NY, 11702, USA. · Hospital for Special Surgery, Weill Cornell Medical College, Ground Floor 523 East 72nd Street, New York, NY, 10021, USA. · Integral Rheumatology & Immunology Specialists, 140 SW 84th Avenue, Fort Lauderdale, FL, 33324, USA. · UC Irvine Medical Center, 101 The City Drive South, Route 140, Orange, CA, 92868, USA. · Lilly USA, LLC, Indianapolis, IN, 46285, USA. · Lilly USA, LLC, Indianapolis, IN, 46285, USA. krohn_kelly@lilly.com. ·Osteoporos Int · Pubmed #26556737.

ABSTRACT: SUMMARY: In patients in the Direct Assessment of Nonvertebral Fractures in Community Experience (DANCE) observational study with and without a prior vertebral or hip fracture, the incidence of nonvertebral fractures was lower with >6 months of teriparatide treatment than during the first 6 months. INTRODUCTION: Clinical evidence on the effect of teriparatide in patients with prior fracture is limited. In the DANCE observational study, the incidence of nonvertebral fragility fractures (NVFX) decreased significantly in patients receiving teriparatide for >6 months (6-24 months) versus >0 to ≤6 months (reference period). METHODS: We performed a post hoc analysis to assess the effect of teriparatide 20 μg/day in patients who entered DANCE with prior vertebral or hip fractures. The incidence of patients experiencing a NVFX for four 6-month intervals during and after treatment was compared with the reference period. RESULTS: Overall, 4085 patients received ≥1 dose of teriparatide. Of 3720 with sufficient data for efficacy analysis, 692 had prior vertebral fracture, including 179 with previous kyphoplasty/vertebroplasty; 290 had prior hip fracture. These patients were older, and those with prior vertebral fractures had more comorbid conditions at baseline than those without prior vertebral fractures. The incidence of patients experiencing NVFX declined over time in all patient groups. The fracture incidence rate declined 49 and 46%, respectively, in patients with and without prior vertebral fracture and was 63 and 46% lower in patients with previous kyphoplasty/vertebroplasty and without prior vertebral fracture. NVFX declined 43 and 48% in patients with and without prior hip fracture. The reduced incidence over time was consistent in the subgroups (all interaction p values >0.05). Patients with prior fracture were more likely to experience serious adverse events. CONCLUSION: The incidence of NVFX decreased over time in patients receiving teriparatide in DANCE regardless of prior fracture status.