Pick Topic
Review Topic
List Experts
Examine Expert
Save Expert
  Site Guide ··   
Osteoporosis: HELP
Articles from Portland, OR
Based on 190 articles published since 2009
||||

These are the 190 published articles about Osteoporosis that originated from Portland, OR during 2009-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8
1 Guideline Screening for Osteoporosis to Prevent Fractures: US Preventive Services Task Force Recommendation Statement. 2018

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

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

2 Guideline Interventions to Prevent Falls in Community-Dwelling Older Adults: US Preventive Services Task Force Recommendation Statement. 2018

Anonymous2551380 / Grossman, David C / Curry, Susan J / Owens, Douglas K / Barry, Michael J / Caughey, Aaron B / Davidson, Karina W / Doubeni, Chyke A / Epling, John W / Kemper, Alex R / Krist, Alex H / Kubik, Martha / Landefeld, Seth / Mangione, Carol M / Pignone, Michael / Silverstein, Michael / Simon, Melissa A / Tseng, Chien-Wen. ·Kaiser Permanente Washington Health Research Institute, Seattle. · University of Iowa, Iowa City. · Veterans Affairs Palo Alto Health Care System, Palo Alto, California. · Stanford University, Stanford, California. · Harvard Medical School, Boston, Massachusetts. · Oregon Health & Science University, Portland. · Columbia University, New York, New York. · University of Pennsylvania, Philadelphia. · Virginia Tech Carilion School of Medicine, Roanoke. · Nationwide Children's Hospital, Columbus, Ohio. · Fairfax Family Practice Residency, Fairfax, Virginia. · Virginia Commonwealth University, Richmond. · Temple University, Philadelphia, Pennsylvania. · University of Alabama at Birmingham. · University of California, Los Angeles. · University of Texas at Austin. · Boston University, Boston, Massachusetts. · Northwestern University, Evanston, Illinois. · University of Hawaii, Honolulu. · Pacific Health Research and Education Institute, Honolulu, Hawaii. ·JAMA · Pubmed #29710141.

ABSTRACT: Importance: Falls are the leading cause of injury-related morbidity and mortality among older adults in the United States. In 2014, 28.7% of community-dwelling adults 65 years or older reported falling, resulting in 29 million falls (37.5% of which needed medical treatment or restricted activity for a day or longer) and an estimated 33 000 deaths in 2015. Objective: To update the 2012 US Preventive Services Task Force (USPSTF) recommendation on the prevention of falls in community-dwelling older adults. Evidence Review: The USPSTF reviewed the evidence on the effectiveness and harms of primary care-relevant interventions to prevent falls and fall-related morbidity and mortality in community-dwelling older adults 65 years or older who are not known to have osteoporosis or vitamin D deficiency. Findings: The USPSTF found adequate evidence that exercise interventions have a moderate benefit in preventing falls in older adults at increased risk for falls and that multifactorial interventions have a small benefit. The USPSTF found adequate evidence that vitamin D supplementation has no benefit in preventing falls in older adults. The USPSTF found adequate evidence to bound the harms of exercise and multifactorial interventions as no greater than small. The USPSTF found adequate evidence that the overall harms of vitamin D supplementation are small to moderate. Conclusions and Recommendation: The USPSTF recommends exercise interventions to prevent falls in community-dwelling adults 65 years or older who are at increased risk for falls. (B recommendation) The USPSTF recommends that clinicians selectively offer multifactorial interventions to prevent falls in community-dwelling adults 65 years or older who are at increased risk for falls. Existing evidence indicates that the overall net benefit of routinely offering multifactorial interventions to prevent falls is small. When determining whether this service is appropriate for an individual, patients and clinicians should consider the balance of benefits and harms based on the circumstances of prior falls, presence of comorbid medical conditions, and the patient's values and preferences. (C recommendation) The USPSTF recommends against vitamin D supplementation to prevent falls in community-dwelling adults 65 years or older. (D recommendation) These recommendations apply to community-dwelling adults who are not known to have osteoporosis or vitamin D deficiency.

3 Guideline Vitamin D, Calcium, or Combined Supplementation for the Primary Prevention of Fractures in Community-Dwelling Adults: US Preventive Services Task Force Recommendation Statement. 2018

Anonymous2461380 / Grossman, David C / Curry, Susan J / Owens, Douglas K / Barry, Michael J / Caughey, Aaron B / Davidson, Karina W / Doubeni, Chyke A / Epling, John W / Kemper, Alex R / Krist, Alex H / Kubik, Martha / Landefeld, Seth / Mangione, Carol M / Silverstein, Michael / Simon, Melissa A / Tseng, Chien-Wen. ·Kaiser Permanente Washington Health Research Institute, Seattle. · University of Iowa, Iowa City. · Veterans Affairs Palo Alto Health Care System, Palo Alto, California. · Stanford University, Stanford, California. · Harvard Medical School, Boston, Massachusetts. · Oregon Health & Science University, Portland. · Columbia University, New York, New York. · University of Pennsylvania, Philadelphia. · Virginia Tech Carilion School of Medicine, Roanoke. · Nationwide Children's Hospital, Columbus, Ohio. · Fairfax Family Practice Residency, Fairfax, Virginia. · Virginia Commonwealth University, Richmond. · Temple University, Philadelphia, Pennsylvania. · University of Alabama at Birmingham. · University of California, Los Angeles. · Boston University, Boston, Massachusetts. · Northwestern University, Evanston, Illinois. · University of Hawaii, Honolulu. · Pacific Health Research and Education Institute, Honolulu, Hawaii. ·JAMA · Pubmed #29677309.

ABSTRACT: Importance: Because of the aging population, osteoporotic fractures are an increasingly important cause of morbidity and mortality in the United States. Approximately 2 million osteoporotic fractures occurred in the United States in 2005, and annual incidence is projected to increase to more than 3 million fractures by 2025. Within 1 year of experiencing a hip fracture, many patients are unable to walk independently, more than half require assistance with activities of daily living, and 20% to 30% of patients will die. Objective: To update the 2013 US Preventive Services Task Force (USPSTF) recommendation on vitamin D supplementation, with or without calcium, to prevent fractures. Evidence Review: The USPSTF reviewed the evidence on vitamin D, calcium, and combined supplementation for the primary prevention of fractures in community-dwelling adults (defined as not living in a nursing home or other institutional care setting). The review excluded studies conducted in populations with a known disorder related to bone metabolism (eg, osteoporosis or vitamin D deficiency), taking medications known to be associated with osteoporosis (eg, long-term steroids), or with a previous fracture. Findings: The USPSTF found inadequate evidence to estimate the benefits of vitamin D, calcium, or combined supplementation to prevent fractures in community-dwelling men and premenopausal women. The USPSTF found adequate evidence that daily supplementation with 400 IU or less of vitamin D and 1000 mg or less of calcium has no benefit for the primary prevention of fractures in community-dwelling, postmenopausal women. The USPSTF found inadequate evidence to estimate the benefits of doses greater than 400 IU of vitamin D or greater than 1000 mg of calcium to prevent fractures in community-dwelling postmenopausal women. The USPSTF found adequate evidence that supplementation with vitamin D and calcium increases the incidence of kidney stones. Conclusions and Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of the benefits and harms of vitamin D and calcium supplementation, alone or combined, for the primary prevention of fractures in community-dwelling, asymptomatic men and premenopausal women. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of the benefits and harms of daily supplementation with doses greater than 400 IU of vitamin D and greater than 1000 mg of calcium for the primary prevention of fractures in community-dwelling, postmenopausal women. (I statement) The USPSTF recommends against daily supplementation with 400 IU or less of vitamin D and 1000 mg or less of calcium for the primary prevention of fractures in community-dwelling, postmenopausal women. (D recommendation) These recommendations do not apply to persons with a history of osteoporotic fractures, increased risk for falls, or a diagnosis of osteoporosis or vitamin D deficiency.

4 Editorial Recombinant growth hormone treatment, osteoporosis and fractures, more complicated than it seems! 2018

Fleseriu, Maria. ·Northwest Pituitary Center, Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, and Department of Neurological Surgery, Oregon Health & Science University, Mail Code: CH8N, 3303 SW Bond Ave., Portland, OR, 97239, USA. fleseriu@ohsu.edu. ·Endocrine · Pubmed #29352456.

ABSTRACT: -- No abstract --

5 Editorial An update on osteoporosis pathogenesis, diagnosis, and treatment. 2017

McClung, Michael / Baron, Roland / Bouxsein, Mary. ·Oregon Osteoporosis Center, Portland,OR, United States. Electronic address: mrmcclung37@gmail.com. · Harvard Medical School, Boston, MA, United States. · Department of Orthopedic Surgery, Harvard Medical School, Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States. ·Bone · Pubmed #28263916.

ABSTRACT: -- No abstract --

6 Editorial Cancel the denosumab holiday. 2016

McClung, M R. ·Oregon Osteoporosis Center, 2881 NW Cumberland Road, Portland, OR, 97210, USA. mmcclung@orost.com. ·Osteoporos Int · Pubmed #26932443.

ABSTRACT: -- No abstract --

7 Editorial Late skeletal effects of early menopause. 2015

McClung, Michael R. ·Oregon Osteoporosis Center Portland, OR. ·Menopause · Pubmed #26397143.

ABSTRACT: -- No abstract --

8 Editorial Bisphosphonate therapy: how long is long enough? 2015

McClung, M R. ·Oregon Osteoporosis Center, 25 NW 23rd Place, Suite 6 #175, Portland, OR, 97210, USA, mmcclung@orost.com. ·Osteoporos Int · Pubmed #25609156.

ABSTRACT: -- No abstract --

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

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

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

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

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

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

11 Review Osteoporosis. 2019

Compston, Juliet E / McClung, Michael R / Leslie, William D. ·Department of Medicine, Cambridge Biomedical Campus, Cambridge, UK. Electronic address: jec1001@cam.ac.uk. · Department of Medicine, Oregon Health and Science University, Portland, OR, USA; Mary MacKillop Institute for Health, Australian Catholic University, Melbourne, VIC, Australia. · Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada. ·Lancet · Pubmed #30696576.

ABSTRACT: Fractures resulting from osteoporosis become increasingly common in women after age 55 years and men after age 65 years, resulting in substantial bone-associated morbidities, and increased mortality and health-care costs. Research advances have led to a more accurate assessment of fracture risk and have increased the range of therapeutic options available to prevent fractures. Fracture risk algorithms that combine clinical risk factors and bone mineral density are now widely used in clinical practice to target high-risk individuals for treatment. The discovery of key pathways regulating bone resorption and formation has identified new approaches to treatment with distinctive mechanisms of action. Osteoporosis is a chronic condition and long-term, sometimes lifelong, management is required. In individuals at high risk of fracture, the benefit versus risk profile is likely to be favourable for up to 10 years of treatment with bisphosphonates or denosumab. In people at a very high or imminent risk of fracture, therapy with teriparatide or abaloparatide should be considered; however, since treatment duration with these drugs is restricted to 18-24 months, treatment should be continued with an antiresorptive drug. Individuals at high risk of fractures do not receive adequate treatment and strategies to address this treatment gap-eg, widespread implementation of Fracture Liaison Services and improvement of adherence to therapy-are important challenges for the future.

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

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

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

13 Review Romosozumab for the treatment of osteoporosis. 2018

McClung, Michael R. ·Oregon Osteoporosis Center, Portland, OR, USA. ·Osteoporos Sarcopenia · Pubmed #30775535.

ABSTRACT: Romosozumab, a specific inhibitor of sclerostin, is a unique approach to therapy for postmenopausal osteoporosis and related disorders. The elucidation of sclerostin deficiency as the molecular defect of syndromes of high bone mass with normal quality, and the pivotal role of sclerostin as a mediator of osteoblastic activity and bone formation, provided the platform for the evaluation of inhibitors of sclerostin to activate bone formation. An extensive preclinical program and 2 large fracture endpoint trials with romosozumab, a sclerostin-binding antibody, have been completed. This review will highlight the results of those studies and describe the current status of romosozumab as a potential therapy for osteoporosis.

14 Review Orthopedic and Surgical Management of the Patient With Duchenne Muscular Dystrophy. 2018

Apkon, Susan D / Alman, Ben / Birnkrant, David J / Fitch, Robert / Lark, Robert / Mackenzie, William / Weidner, Norbert / Sussman, Michael. ·Department of Rehabilitation Medicine, Seattle Children's Hospital, Seattle, Washington; susan.apkon@seattlechildrens.org. · Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina. · MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio. · Duke University Health System, Department of Orthopedic Surgery, Durham, North Carolina. · Nemours/Alfred I Dupont Hospital for Children, Wilmington, Delaware. · Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and. · Shriner's Hospital for Children, Portland, Oregon. ·Pediatrics · Pubmed #30275252.

ABSTRACT: Orthopedic care is an important aspect of the overall management of patients with Duchenne muscular dystrophy (DMD). In addition to progressive muscle weakness and loss of function, patients may develop joint contractures, scoliosis, and osteoporosis, causing fractures; all of these necessitate intervention by a multidisciplinary team including an orthopedic surgeon as well as rehabilitation specialists such as physio- and occupational therapists. The causes of these musculoskeletal complications are multifactorial and are related to primary effects on the muscles from the disease itself, secondary effects from weak muscles, and the related side effects of treatments, such as glucocorticoid use that affect bone strength. The musculoskeletal manifestations of DMD change over time as the disease progresses, and therefore, musculoskeletal management needs change throughout the life span of an individual with DMD. In this review, we target pediatricians, neurologists, orthopedic surgeons, rehabilitation physicians, anesthesiologists, and other individuals involved in the management of patients with DMD by providing specific recommendations to guide clinical practice related to orthopedic issues and surgical management in this setting.

15 Review Breast cancer in adolescents and young adults. 2018

Johnson, Rebecca H / Anders, Carey K / Litton, Jennifer K / Ruddy, Kathryn J / Bleyer, Archie. ·Mary Bridge Hospital/MultiCare Health System, Tacoma, Washington. · University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina. · The University of Texas MD Anderson Cancer Center, Houston, Texas. · Mayo Clinic, Rochester, Minnesota. · Oregon Health and Science University, Portland, Oregon. ·Pediatr Blood Cancer · Pubmed #30156052.

ABSTRACT: Breast cancer is the most common cancer of adolescents and young adult (AYA) women aged 15 to 39 years, accounting for 5.6% of all invasive breast cancer in women. In comparison with older women, AYAs are more likely to have familial cancer predisposition genes, larger breast tumors, unfavorable biological characteristics, distant metastatic disease at diagnosis, and adverse outcome. Endocrine therapy and some chemotherapy recommendations differ between young and older women. AYAs require coordinated multidisciplinary care, treatment regimens that minimize late effects such as premature menopause and osteoporosis, and proactive management of psychological and sexual health during and after cancer treatment.

16 Review Vitamin D, Calcium, or Combined Supplementation for the Primary Prevention of Fractures in Community-Dwelling Adults: Evidence Report and Systematic Review for the US Preventive Services Task Force. 2018

Kahwati, Leila C / Weber, Rachel Palmieri / Pan, Huiling / Gourlay, Margaret / LeBlanc, Erin / Coker-Schwimmer, Manny / Viswanathan, Meera. ·RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center. · RTI International, Research Triangle Park, North Carolina. · Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill. · Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill. · Kaiser Permanente Center for Health Research Northwest, Portland, Oregon. ·JAMA · Pubmed #29677308.

ABSTRACT: Importance: Osteoporotic fractures result in significant morbidity and mortality. Objective: To update the evidence for benefits and harms of vitamin D, calcium, or combined supplementation for the primary prevention of fractures in community-dwelling adults to inform the US Preventive Services Task Force. Data Sources: PubMed, EMBASE, Cochrane Library, and trial registries through March 21, 2017; references; and experts. Surveillance continued through February 28, 2018. Study Selection: English-language randomized clinical trials (RCTs) or observational studies of supplementation with vitamin D, calcium, or both among adult populations; studies of populations that were institutionalized or had known vitamin D deficiency, osteoporosis, or prior fracture were excluded. Data Extraction and Synthesis: Dual, independent review of titles/abstracts and full-text articles and study quality rating using predefined criteria. Random-effects meta-analysis used when at least 3 similar studies were available. Main Outcomes and Measures: Incident fracture, mortality, kidney stones, cardiovascular events, and cancer. Results: Eleven RCTs (N = 51 419) in adults 50 years and older conducted over 2 to 7 years were included. Compared with placebo, supplementation with vitamin D decreased total fracture incidence (1 RCT [n = 2686]; absolute risk difference [ARD], -2.26% [95% CI, -4.53% to 0.00%]) but had no significant association with hip fracture (3 RCTs [n = 5496]; pooled ARD, -0.01% [95% CI, -0.80% to 0.78%]). Supplementation using vitamin D with calcium had no effect on total fracture incidence (1 RCT [n = 36 282]; ARD, -0.35% [95% CI, -1.02% to 0.31%]) or hip fracture incidence (2 RCTs [n = 36 727]; ARD from the larger trial, -0.14% [95% CI, -0.34% to 0.07%]). The evidence for calcium alone was limited, with only 2 studies (n = 339 total) and very imprecise results. Supplementation with vitamin D alone or with calcium had no significant effect on all-cause mortality or incident cardiovascular disease; ARDs ranged from -1.93% to 1.79%, with CIs consistent with no significant differences. Supplementation using vitamin D with calcium was associated with an increased incidence of kidney stones (3 RCTs [n = 39 213]; pooled ARD, 0.33% [95% CI, 0.06% to 0.60%]), but supplementation with calcium alone was not associated with an increased risk (3 RCTs [n = 1259]; pooled ARD, 0.00% [95% CI, -0.87% to 0.87%]). Supplementation with vitamin D and calcium was not associated with an increase in cancer incidence (3 RCTs [n = 39 213]; pooled ARD, -1.48% [95% CI, -3.32% to 0.35%]). Conclusions and Relevance: Vitamin D supplementation alone or with calcium was not associated with reduced fracture incidence among community-dwelling adults without known vitamin D deficiency, osteoporosis, or prior fracture. Vitamin D with calcium was associated with an increase in the incidence of kidney stones.

17 Review Complementary medicine for axial spondyloarthritis: is there any scientific evidence? 2018

Danve, Abhijeet / Deodhar, Atul A. ·Section of Rheumatology, Yale School of Medicine, New Haven, Connecticut. · Division of Arthritis & Rheumatic Diseases, Oregon Health & Science University, Portland, Oregon, USA. ·Curr Opin Rheumatol · Pubmed #29634580.

ABSTRACT: PURPOSE OF REVIEW: Majority of patients with axial spondyloarthritis (axSpA) report use of complementary and alternative medicine (CAM) therapies before and even after the diagnosis, due to perceived efficacy and wide-spread belief that these modalities lack side effects. In this review, we describe the available scientific evidence for the CAM therapies in axSpA. RECENT FINDINGS: Clinical trials of the CAM therapies in axSpA are generally hampered by small sample size, short duration, difficulties in blinding, lack of control groups and strong placebo effect. Nonetheless, exercise programs like Pilates and mind-body techniques such as Tai Chi may have favorable effect on the disease activity and function. Although not yet confirmed, the modulation of the microbiome with the help of probiotics or fecal transplant has face validity given the evolving scientific rationale. Diet has only limited role in the management of axSpA. Deep tissue massage, omega-3 fatty acids and Stanger bath were found to be useful in small studies. CAM therapies are not always entirely well tolerated, particularly the manipulative techniques like chiropractic and Tui-na in patients with advanced disease and osteoporosis. There are no trials of yoga in axSpA despite the wider acceptance and use of yoga as an effective mind-body technique. SUMMARY: Larger and better quality clinical trials of CAM therapies are needed to confirm their efficacy and safety in the management of axSpA and to include them in the 'mainstream' medicine.

18 Review The Global Spine Care Initiative: a summary of guidelines on invasive interventions for the management of persistent and disabling spinal pain in low- and middle-income communities. 2018

Acaroğlu, Emre / Nordin, Margareta / Randhawa, Kristi / Chou, Roger / Côté, Pierre / Mmopelwa, Tiro / Haldeman, Scott. ·ARTES Spine Center, Ankara, Turkey. acaroglue@gmail.com. · Departments of Orthopedic Surgery and Environmental Medicine, New York University, New York, NY, USA. · World Spine Care Europe, Holmfirth, UK. · Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada. · UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada. · Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, USA. · Department of Medicine, Oregon Health and Science University, Portland, OR, USA. · ARTES Ankara Spine Centre, Life Gaborone Hospital, Gaborone, Botswana. · Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, USA. · Department of Neurology, University of California, Irvine, Irvine, USA. · World Spine Care, Santa Ana, CA, USA. ·Eur Spine J · Pubmed #29322309.

ABSTRACT: PURPOSE: The purpose of this study was to synthesize recommendations on the use of common elective surgical and interventional procedures for individuals with persistent and disabling non-radicular/axial with or without myelopathy, radicular back pain, cervical myelopathy, symptomatic spinal stenosis, and fractures due to osteoporosis. This review was to inform a clinical care pathway on the patient presentations where surgical interventions could reasonably be considered. METHODS: We synthesized recommendations from six evidence-based clinical practice guidelines and one appropriate use criteria guidance for the surgical and interventional management of persistent and disabling spine pain. RESULTS: Lower priority surgery/conditions include fusion for lumbar/non-radicular neck pain and higher priority surgery/conditions include discectomy/decompressive surgery for cervical or lumbar radiculopathy, cervical myelopathy, and lumbar spinal stenosis. Epidural steroid injections are less expensive than most surgeries with fewer harms; however, benefits are small and short lived. Vertebroplasty should be considered over kyphoplasty as an option for patients with severe pain and disability due to osteoporotic vertebral compression fracture. CONCLUSION: Elective surgery and interventional procedures could be limited in medically underserved areas and low- and middle-income countries due to a lack of resources and surgeons and thus surgical and interventional procedures should be prioritized within these settings. There are non-invasive alternatives that produce similar outcomes and are a recommended option where surgical procedures are not available. These slides can be retrieved under Electronic Supplementary Material.

19 Review Denosumab for the treatment of osteoporosis. 2017

McClung, Michael R. ·Institute of Health and Ageing, Australian Catholic University, Melbourne, Australia. · Oregon Osteoporosis Center, 2881 NW Cumberland Road, Portland, OR 97210, USA. ·Osteoporos Sarcopenia · Pubmed #30775498.

ABSTRACT: Denosumab, a specific inhibitor of RANK ligand, is a novel therapy for postmenopausal osteoporosis and related disorders. An extensive clinical development program has evaluated the clinical efficacy and safety of denosumab with several thousand patients being followed for up to 10 years. Combined with more than six years of postmarketing experience, these studies provide substantial confidence that denosumab is a convenient and appropriate treatment for patients, including Asians, at high risk for fracture. This review will summarize the clinical development of denosumab and lessons learned since its approval for clinical use in 2010.

20 Review Sclerostin antibodies in osteoporosis: latest evidence and therapeutic potential. 2017

McClung, Michael R. ·Institute for Health and Ageing, Australian Catholic University, Melbourne, VIC Oregon Osteoporosis Center, 2881 NW Cumberland Road, Portland, OR 97210, USA. ·Ther Adv Musculoskelet Dis · Pubmed #28974988.

ABSTRACT: Sclerostin is an osteocyte-derived glycoprotein that inhibits Wnt/β-catenin signaling and activation of osteoblast function, thereby inhibiting bone formation. It plays a vital role in the regulation of skeletal growth. In adults, sclerostin secretion is modulated by skeletal loading (increased secretion with immobilization; less with weight bearing) and by hormonal/cytokine actions on the osteocyte. Sclerostin deficiency syndromes in humans and animals are characterized by high bone mass of normal quality. In animal models of osteoporosis, inhibition of sclerostin by monoclonal antibodies induces osteoblast activity and new bone formation, normalizing bone mass and improving bone architecture and strength. In recently completed clinical trials, anti-sclerostin antibody therapy results in marked increases in bone mineral density and rapid and substantial reduction in fracture risk. This review will focus on these recent studies and anticipate the role of anti-sclerostin therapy in the management of patients with osteoporosis.

21 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.

22 Review Using Osteoporosis Therapies in Combination. 2017

McClung, Michael R. ·Institute of Health and Ageing, Australian Catholic University, Melbourne, VIC, Australia. mmcclung.ooc@gmail.com. · Oregon Osteoporosis Center, 2881 NW Cumberland Road, Portland, OR, 97210, USA. mmcclung.ooc@gmail.com. ·Curr Osteoporos Rep · Pubmed #28667435.

ABSTRACT: PURPOSE OF REVIEW: The objective of this review is to update evidence regarding the use of osteoporosis drugs in sequence or in combination to optimize increases in bone mass and strength. RECENT FINDINGS: Simultaneous use of denosumab plus teriparatide produces larger increases in BMD than does monotherapy. The use of bisphosphonates or denosumab after teriparatide results in progressive gains in BMD. When switching from bisphosphonates and especially denosumab to teriparatide, an overlap of 6-12 months may prevent the transient loss of BMD in cortical sites. Phase 3 trials document fracture risk reduction with anabolic therapy for 12-18 months followed by an anti-remodeling drug. With the exception of adding teriparatide to ongoing denosumab therapy, there is little evidence to support the use of more than one osteoporosis drug at a time. In contrast, sequential therapy regimens of anabolic drugs followed by potent anti-remodeling agents will be the new standard for treating patients at imminent risk of fracture.

23 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.

24 Review Prevention and management of glucocorticoid-induced side effects: A comprehensive review: A review of glucocorticoid pharmacology and bone health. 2017

Caplan, Avrom / Fett, Nicole / Rosenbach, Misha / Werth, Victoria P / Micheletti, Robert G. ·Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania. · Department of Dermatology, Oregon Health and Science University, Portland, Oregon. · Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: robert.micheletti@uphs.upenn.edu. ·J Am Acad Dermatol · Pubmed #27986132.

ABSTRACT: Systemic glucocorticoids are an essential therapy for a range of conditions, but their multiple side effects can produce significant morbidity for patients. The objective of this review is to discuss these side effects while addressing 3 questions: 1) What dose and duration of glucocorticoid therapy should prompt concern for individual side effects?; 2) How should clinicians counsel patients about these complications?; and 3) How can these problems be prevented or managed? To accomplish these objectives, we have created a series of tables and algorithms based on a review of relevant data to guide counseling, prophylaxis, and management of 11 glucocorticoid side effects. The first article in this 4-part continuing medical education series begins with a review of glucocorticoid pharmacology followed by a discussion of bone health (ie, osteoporosis and osteonecrosis).

25 Review Double Fixation: Bilateral Bisphosphonate-Related Hip Fractures. 2017

Miura, Lisa N / Srikantom, Sandhya V / Schenck, Joseph. ·Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, Ore; Department of Medicine, Legacy Health System, Portland, Ore. Electronic address: miural@ohsu.edu. · Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, Ore; Department of Medicine, Legacy Health System, Portland, Ore. · The Orthopedic & Sports Medicine Center of Oregon, Portland. ·Am J Med · Pubmed #27452682.

ABSTRACT: -- No abstract --

Next