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Osteoporosis: HELP
Articles from Portland, OR
Based on 97 articles published since 2008

These are the 97 published articles about Osteoporosis that originated from Portland, OR during 2008-2019.
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4
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 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 --

3 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 --

4 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 --

5 Editorial Late skeletal effects of early menopause. 2015

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

ABSTRACT: -- No abstract --

6 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 --

7 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.

8 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.

9 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.

10 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.

11 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).

12 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 --

13 Review Alcohol: A Simple Nutrient with Complex Actions on Bone in the Adult Skeleton. 2016

Gaddini, Gino W / Turner, Russell T / Grant, Kathleen A / Iwaniec, Urszula T. ·Skeletal Biology Laboratory, School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon. · Center for Healthy Aging Research, Oregon State University, Corvallis, Oregon. · Division of Neuroscience, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, Oregon. ·Alcohol Clin Exp Res · Pubmed #26971854.

ABSTRACT: BACKGROUND: Alcohol is an important nonessential component of diet, but the overall impact of drinking on bone health, especially at moderate levels, is not well understood. Bone health is important because fractures greatly reduce quality of life and are a major cause of morbidity and mortality in the elderly. Regular alcohol consumption is most common following skeletal maturity, emphasizing the importance of understanding the skeletal consequences of drinking in adults. METHODS: This review focuses on describing the complex effects of alcohol on the adult skeleton. Studies assessing the effects of alcohol on bone in adult humans as well as skeletally mature animal models published since the year 2000 are emphasized. RESULTS: Light to moderate alcohol consumption is generally reported to be beneficial, resulting in higher bone mineral density (BMD) and reduced age-related bone loss, whereas heavy alcohol consumption is generally associated with decreased BMD, impaired bone quality, and increased fracture risk. Bone remodeling is the principal mechanism for maintaining a healthy skeleton in adults and dysfunction in bone remodeling can lead to bone loss and/or decreased bone quality. Light to moderate alcohol may exert beneficial effects in older individuals by slowing the rate of bone remodeling, but the impact of light to moderate alcohol on bone remodeling in younger individuals is less certain. The specific effects of alcohol on bone remodeling in heavy drinkers are even less certain because the effects are often obscured by unhealthy lifestyle choices, alcohol-associated disease, and altered endocrine signaling. CONCLUSIONS: Although there have been advances in understanding the complex actions of alcohol on bone, much remains to be determined. Limited evidence implicates age, skeletal site evaluated, duration, and pattern of drinking as important variables. Few studies systematically evaluating the impact of these factors have been conducted and should be made a priority for future research. In addition, studies performed in skeletally mature animals have potential to reveal mechanistic insights into the precise actions of alcohol and associated comorbidity factors on bone remodeling.

14 Review New management options for osteoporosis with emphasis on SERMs. 2015

McClung, M R. ·a Oregon Osteoporosis Center , Portland , Oregon , USA. ·Climacteric · Pubmed #26503459.

ABSTRACT: Albright was the first of many to show that loss of bone mass due to estrogen deficiency is an important part of the pathogenesis of postmenopausal osteoporosis. This led to the use of estrogen therapy which was shown to prevent bone loss at menopause and to reduce the risk of important fragility fractures. Selective estrogen receptor modulators (SERMs), with salutary estrogen-like skeletal effects and with protection from breast cancer, have important roles in the management of young postmenopausal women. New members of the SERM family may approach the effectiveness of estrogen in preventing bone loss and reducing fracture risk. When combined with estrogen, new SERMs prevent endometrial hyperplasia, and that combination reduces menopausal symptoms and prevents bone loss. Drugs that reduce bone turnover or stimulate bone formation by non-estrogen pathways have also been developed to treat osteoporosis. Emerging therapies, with unique mechanisms of action, may provide improved efficacy in treating women who already have osteoporosis.

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

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

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

16 Review Controversies in osteoporosis management: concerns about bisphosphonates and when are "drug holidays" required? 2013

McClung, Michael. ·Oregon Osteoporosis Center, Portland, Oregon. ·Clin Obstet Gynecol · Pubmed #24177063.

ABSTRACT: Bisphosphonates are effective treatments for osteoporosis. The pharmacology and observance of atypical femoral fractures in patients on long-term therapy raise questions about the need for intermittent discontinuation of treatment, a "drug holiday." Fracture protection benefits of bisphosphonate therapy far outweigh the risk of atypical fractures for the first 10 years of therapy. However, because the fracture probability of therapy abates slowly after stopping the treatment while the risk of atypical fracture appears to decrease quickly, a "drug holiday" of 1 to 2 years should be considered after 3 to 5 years of bisphosphonate therapy except in those patients who remain at very high fracture risk.

17 Review Osteoporosis and vertebral fractures in ankylosing spondylitis. 2013

Davey-Ranasinghe, Nicole / Deodhar, Atul. ·Oregon Health & Science University, Portland, Oregon 97239, USA. ·Curr Opin Rheumatol · Pubmed #23719363.

ABSTRACT: PURPOSE OF REVIEW: To review the recent literature on the prevalence of osteoporosis, risk of vertebral fractures, and the recent advances in the treatment of osteoporosis in patients with ankylosing spondylitis (AS). RECENT FINDINGS: Newer data suggest that the prevalence of osteoporosis is 25% and vertebral fractures is 10% in patients with AS. New advances in the field of osteoimmunology help explain the trabecular bone loss and generalized osteoporosis linked to increased expression of receptor activator of nuclear factor kappa B ligand (RANK-L) due to pro-inflammatory cytokines, and the simultaneous new bone formation (e.g. syndesmophytes) in areas of previous inflammation through suppressed Dickkopf-related protein 1 levels and increased WNT (wingless) signaling. SUMMARY: Osteoporosis is a common problem for patients with AS. We recommend screening within 10 years of diagnosis. Suspecting and promptly recognizing vertebral fractures in patients with AS could prevent serious neurological complications. Although bisphosphonates and tumor necrosis factor-α inhibitors look promising, further prospective trials on the treatment of osteoporosis in AS are needed.

18 Review Bisphosphonate therapy for osteoporosis: benefits, risks, and drug holiday. 2013

McClung, Michael / Harris, Steven T / Miller, Paul D / Bauer, Douglas C / Davison, K Shawn / Dian, Larry / Hanley, David A / Kendler, David L / Yuen, Chui Kin / Lewiecki, E Michael. ·Oregon Osteoporosis Center, Portland, OR 97213, USA. mmcclung@orost.com ·Am J Med · Pubmed #23177553.

ABSTRACT: The amino-bisphosphonates are first-line therapy for the treatment of most patients with osteoporosis, with proven efficacy to reduce fracture risk at the spine, hip, and other nonvertebral skeletal sites. Further, bisphosphonates have been associated with a significant decrease in morbidity and increase in survival. Following the use of bisphosphonates in millions of patients in clinical practice, some unexpected possible adverse effects have been reported, including osteonecrosis of the jaw, atypical femur fractures, atrial fibrillation, and esophageal cancer. Because bisphosphonates are incorporated into the skeleton and continue to exert an antiresorptive effect for a period of time after dosing is discontinued, the concept of a drug holiday has emerged, whereby the risk of adverse effects might be decreased while the patient still benefits from antifracture efficacy. Patients receiving bisphosphonates who are not at high risk for fracture are potential candidates for a drug holiday, while for those with bone mineral density in the osteoporosis range or previous history of fragility fracture, the benefits of continuing therapy probably far outweigh the risk of harm.

19 Review Obesity and fracture in men and women: an epidemiologic perspective. 2012

Nielson, Carrie M / Srikanth, Priya / Orwoll, Eric S. ·Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR 97201, USA. ·J Bone Miner Res · Pubmed #23348758.

ABSTRACT: In Western societies, mean body weight has increased dramatically in older people, and a similar trend exists in Asia. Yet insufficient attention has been directed to the problem of osteoporotic fractures in the overweight and obese. Many, if not most, osteoporotic fractures occur in overweight or obese people, and obese men may be particularly susceptible. We discuss the potential implications of these findings, including the challenge of identifying individuals at highest risk, screening and treatment strategies, and future research directions.

20 Review Management of comorbidities in ankylosing spondylitis. 2012

Rosenbaum, James / Chandran, Vinod. ·Department of Ophthalmology, Oregon Health & Science University, Portland, 97239, USA. rosenbaj@ohsu.edu ·Am J Med Sci · Pubmed #22543539.

ABSTRACT: The major comorbidities of ankylosing spondylitis include uveitis, bowel inflammation, psoriasis and heart disease. The pathogenic mechanism to account for the coexistence of comorbidities remains largely unknown. In some instances, the comorbidity has a major impact on the choice of therapy.

21 Review A prospective model of care for breast cancer rehabilitation: bone health and arthralgias. 2012

Winters-Stone, Kerri M / Schwartz, Anna L / Hayes, Sandra C / Fabian, Carol J / Campbell, Kristin L. ·School of Nursing, Oregon Health & Science University, Portland, Oregon 97239, USA. wintersk@ohsu.edu ·Cancer · Pubmed #22488703.

ABSTRACT: Musculoskeletal health can be compromised by breast cancer treatment. In particular, bone loss and arthralgias are prevalent side effects experienced by women treated with chemotherapy and/or adjuvant endocrine therapy. Bone loss leads to osteoporosis and related fractures, while arthralgias threaten quality of life and compliance to treatment. Because the processes that lead to these musculoskeletal problems are initiated when treatment begins, early identification of women who may be at higher risk of developing problems, routine monitoring of bone density and pain at certain stages of treatment, and prudent application of therapeutic interventions are key to preventing and/or minimizing musculoskeletal sequelae. Exercise may be a particularly suitable intervention strategy because of its potential to address a number of impairments; it may slow bone loss, appears to reduce joint pain in noncancer conditions, and improves other breast cancer outcomes. Research efforts continue in the areas of etiology, measurement, and treatment of bone loss and arthralgias. The purpose of this review is to provide an overview of the current knowledge on the management and treatment of bone loss and arthralgias in breast cancer survivors and to present a framework for rehabilitation care to preserve musculoskeletal health in women treated for breast cancer.

22 Review Screening for osteoporosis: an update for the U.S. Preventive Services Task Force. 2010

Nelson, Heidi D / Haney, Elizabeth M / Dana, Tracy / Bougatsos, Christina / Chou, Roger. ·Oregon Evidence-based Practice Center, Oregon Health & Science University, Portland, OR 97239-3098, USA. nelsonh@ohsu.edu ·Ann Intern Med · Pubmed #20621892.

ABSTRACT: BACKGROUND: This review updates evidence since the 2002 U.S. Preventive Services Task Force recommendation on osteoporosis screening. PURPOSE: To determine the effectiveness and harms of osteoporosis screening in reducing fractures for men and postmenopausal women without known previous fractures; the performance of risk-assessment instruments and bone measurement tests in identifying persons with osteoporosis; optimal screening intervals; and the efficacy and harms of medications to reduce primary fractures. DATA SOURCES: Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (through the fourth quarter of 2009), MEDLINE (January 2001 to December 2009), reference lists, and Web of Science. STUDY SELECTION: Randomized, controlled trials of screening or medications with fracture outcomes published in English; performance studies of validated risk-assessment instruments; and systematic reviews and population-based studies of bone measurement tests or medication harms. DATA EXTRACTION: Data on patient populations, study design, analysis, follow-up, and results were abstracted, and study quality was rated by using established criteria. DATA SYNTHESIS: Risk-assessment instruments are modest predictors of low bone density (area under the curve, 0.13 to 0.87; 14 instruments) and fractures (area under the curve, 0.48 to 0.89; 11 instruments); simple and complex instruments perform similarly. Dual-energy x-ray absorptiometry predicts fractures similarly for men and women; calcaneal quantitative ultrasonography also predicts fractures, but correlation with dual-energy x-ray absorptiometry is low. For postmenopausal women, bisphosphonates, parathyroid hormone, raloxifene, and estrogen reduce primary vertebral fractures. Trials are lacking for men. Bisphosphonates are not consistently associated with serious adverse events; raloxifene and estrogen increase thromboembolic events; and estrogen causes additional adverse events. LIMITATION: Trials of screening with fracture outcomes, screening intervals, and medications to reduce primary fractures, particularly those enrolling men, are lacking. CONCLUSION: Although methods to identify risk for osteoporotic fractures are available and medications to reduce fractures are effective, no trials directly evaluate screening effectiveness, harms, and intervals. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.

23 Review Rheumatologic sequelae and challenges in organ transplantation. 2010

Schwab, Pascale / Lipton, Sarah / Kerr, Gail S. ·Division of Arthritis and Rheumatic Diseases, Oregon Health and Science University, Portland Veterans Affairs Medical Center, 3181 SW Sam Jackson Park Road, Portland OR 97239, USA. schwabp@ohsu.edu ·Best Pract Res Clin Rheumatol · Pubmed #20534367.

ABSTRACT: Despite the increasing success of transplantation, graft recipients experience a high burden of musculoskeletal symptoms that may hinder quality of life. Post-transplant musculoskeletal problems may result from sequelae of the organ dysfunction that indicated the transplant or from the subsequent anti-rejection therapy. Rheumatology consultants need to be familiar with the spectrum of musculoskeletal syndromes presenting in these unique patients and their appropriate treatment in the context of complex drug regimens and immunosuppression.

24 Review The clinical and epidemiologic consequences of redefining treatment criteria: who should be treated? 2009

McClung, Michael. ·Oregon Osteoporosis Center, Portland, Oregon 97213 , USA. mmcclung@orost.com ·Salud Publica Mex · Pubmed #19287893.

ABSTRACT: Bone mineral density (BMD) is the tool for diagnosing osteoporosis in older adults. However, BMD alone is not sufficient for deciding who should be given treatment at either the individual patient or the public health level. Robust, scientifically validated algorithms that combine BMD with other clinical risk factors provide more accurate assessment of fracture probability. New guidelines for managing osteoporosis are now based on the assessment of absolute fracture risk, not simply on bone mineral density values. Accordingly, treatment resources will be redirected away from young postmenopausal women with low BMD and low fracture risk toward older adults at moderate or high risk for fracture. It is expected that, with these algorithms, the cost and effectiveness of medical care for patients with osteoporosis will be improved.

25 Review Genetics of osteoporosis--utility of mouse models. 2008

Klein, R F. ·Oregon Health and Science University and Portland VA Medical Center, Portland, OR 97201-3098, USA. kleinro@ohsu.edu ·J Musculoskelet Neuronal Interact · Pubmed #19147943.

ABSTRACT: -- No abstract --