Link Between Fracture Prevention and Treatment Adherence Not Fully Understood by Patients

ScienceDaily (2011-01-12) -- Newly released findings of a multinational survey conducted on behalf of the International Osteoporosis Foundation show clear disparities between patients' and doctors' perceptions of osteoporosis and its management.
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Anti-epileptic drugs associated with increased risk of fracture in older adults

ScienceDaily (2011-01-10) -- Most anti-epileptic drugs are associated with an increased risk of non-traumatic fracture in individuals 50 years of age and older, according to a new study.

Increased Activity Helps in OA from MedPage Today

By Nancy Walsh, Staff Writer, MedPage Today

Increasing physical activity over two years can improve function and even walking speed among adults with osteoarthritis of the knee -- regardless of their level of activity, a large prospective study found.
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Bone Turnover Markers May Predict Fracture Risk

By Rita Baron-Faust, Contributing Writer, MedPage Today

High levels of bone turnover markers (BTMs) may help predict which people are at greatest risk of suffering fragility fractures due to osteoporosis, according to a position paper by an international team of researchers.

A review of 22 studies conducted over a decade found that high levels of BTMs may predict fracture risk independently from bone mineral density (BMD) in postmenopausal women, Samuel D. Vasikaran, MBBS, MD, of the Royal Perth Hospital in Perth, Australia, and colleagues reported online in the journal Osteoporosis International.
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Bone Mineral Density Screening: Older Women With Normal T-Scores Can Wait For 10 Years

Since 2002, the U.S. Preventive Services Task Force has recommended that women ages 65 and older be routinely screened for osteoporosis and has suggested that a 2-year screening interval might be appropriate. However, what length the screening interval should be is a topic that remains controversial and undecided, with no definitive scientific evidence to provide guidance.

Now a new study led by Margaret L. Gourlay, MD, MPH of the University of North Carolina at Chapel Hill School of Medicine finds that women aged 67 years and older with normal bone mineral density scores may not need screening again for 10 years.

"If a woman's bone density at age 67 is very good, then she doesn't need to be re-screened in two years or three years, because we're not likely to see much change," Gourlay said. "Our study found it would take about 16 years for 10 percent of women in the highest bone density ranges to develop osteoporosis."

Source: Tom Hughes University of North Carolina School of Medicine

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Medical News: No Cancer Risk with Bisphosphonates - in Oncology, Other Cancers from MedPage Today

By Charles Bankhead, Staff Writer, MedPage Today

Use of oral bisphosphonates did not increase the risk of esophageal or gastric cancer in a large cohort of patients followed for more than four years.

Bisphosphonate users and nonusers had similar rates of the individual cancers and of both cancers combined, according to a report in the Aug. 11 issue of the Journal of the American Medical Association.

The findings should help allay concerns about a theoretical cancer risk related to bisphosphonates' propensity to cause esophagitis in some patients, researchers Chris R. Cardwell, PhD, of Queen's University Belfast in Ireland, and coauthors noted.

Their analysis of medical records showed esophageal cancer rates of 0.48 cases per 1,000 person-years in bisphosphonate users and 0.44 cases per 1,000 person-years in nonusers.

"These drugs should not be withheld, on the basis of possible esophageal cancer risk, from patients with a genuine clinical indication for their use," they wrote in conclusion.

Widespread use of oral bisphosphonates to treat osteoporosis has shown that some patients develop serious reflux esophagitis, a known risk factor for esophageal cancer. Crystalline material resembling a bisphosphonate has been identified in patients with bisphosphonate-related esophagitis, and follow-up endoscopy showed persistent abnormalities after healing (Gastrointest Endosc. 1998;47:525-528).
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USPSTF Expands Osteoporosis Guidelines from MedPage Today

By Todd Neale, Staff Writer, MedPage Today

Postmenopausal women of any age with a 10-year fracture risk equal to or greater than that of a 65-year-old woman and no other osteoporosis risk factors should be screened for the disease, according to draft guidelines from the U.S. Preventive Services Task Force (USPSTF).

The 2002 USPSTF guidelines recommended routine screening only for women ages 65 and older, as well as women ages 60 to 64 with an increased risk for osteoporotic fractures. The current guidelines contain no recommendation for or against screening in younger women.

An additional change from the 2002 guidelines is a mention of men, albeit only to say that evidence is insufficient to assess the balance of benefits and harms of screening in older men. The updated guidance is still in draft form and will be available on the Agency for Healthcare Research and Quality's website for four weeks to receive public comments. After consideration of feedback, the final recommendations will be released.
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In Elderly Men, Age, Ethnicity And Environment Impact On Risk Of Falls

from Medical News Today

Falls and fall prevention are a major concern for the elderly and people with osteoporosis, a common chronic disease which causes weak and fragile bones. People with osteoporosis are at increased risk of fracture, even after a minor fall from standing height. A study presented at the World Congress on Osteoporosis 2010 (IOF WCO-ECCEO10) shows that among elderly men the risk of falling, and thereby breaking a bone, is influenced by age. Most significantly, it also suggests that ethnicity and environment play a role in the risk of falling.


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Diet and Lifestyle Still Top Bone Loss Prevention Strategies - in Endocrinology, Osteoporosis from MedPage Today

By Crystal Phend, Senior Staff Writer, MedPage Today

Diet and lifestyle should remain first among osteoporosis management options despite major advances in evidence for and approval of new treatments over the past few years, according to the North American Menopause Society.

The group's position statement on osteoporosis management in the January/February issue of Menopause emphasized that all postmenopausal women should be encouraged to reduce their risk of bone loss and osteoporotic fractures by:

* Maintaining a healthy weight
* Eating a balanced diet
* Obtaining adequate calcium (1,200 mg per day at age 50 and beyond) and vitamin D (800 to 1,000 IU vitamin D3 per day)
* Participating in appropriate exercise
* Avoiding excessive alcohol consumption
* Not smoking
* Taking measures to prevent falls

Periodic reviews of these measures, including annual assessment of fall risk after menopause or whenever physical or mental status changes, were recommended.

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New Guidance on Hormone Therapy Issued - in OB/Gyn, HRT from MedPage Today

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By Todd Neale, Staff Writer, MedPage Today

After discontinuing long-term hormone therapy, postmenopausal women should have their bone mineral density monitored and should start bone-preserving therapy if necessary, according to the North American Menopause Society.

The guidance is included in a position statement that updates a statement the society issued in 2008.

The new statement, crafted by an advisory panel led by Wulf Utian, MD, PhD, of Case Western Reserve University in Cleveland, was published in the March/April issue of Menopause.

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Osteoporosis Drugs May Weaken Bones in Long Term - from MedPage Today

By Todd Neale, Staff Writer, MedPage Today

The gains bisphosphonate use brings in the structural integrity of the femur decay over time in postmenopausal women with osteoporosis, researchers found.

In women who took oral bisphosphonates for four to five years, buckling ratio, a measure of structural integrity, improved significantly in the proximal femur from baseline, according to Anthony Ding, a medical student at Columbia University College of Physicians and Surgeons in New York City.

However, those improvements started to erode and creep back toward pretreatment levels when bisphosphonate use lasted more than five years, he reported at the American Academy of Orthopaedic Surgeons meeting.
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Risk For Bone Fractures In Older Women Increased By Diabetes Drug

from Medical News Today

A Henry Ford Hospital study finds women with type 2 diabetes who take a commonly prescribed class of medications to treat insulin resistance may be at a higher risk for developing bone fractures.

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H.R. 3856: To amend the Public Health Service Act to provide for osteoporosis and related bone disease... (GovTrack.us)

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To amend the Public Health Service Act to provide for osteoporosis and related bone disease education, research, and surveillance, and for other purposes.

Sponsor: Rep. Shelley Berkley [D-NV1]

Cosponsors: Donna Christensen [D-VI]Tammy Baldwin [D-WI2]Gus Bilirakis [R-FL9]Corrine Brown [D-FL3]Michael Burgess [R-TX26]Michael Capuano [D-MA8] Kathy Castor [D-FL11]Emanuel Cleaver [D-MO5]Steve Cohen [D-TN9]Joseph Crowley [D-NY7]Danny Davis [D-IL7]Susan Davis [D-CA53] Diana DeGette [D-CO1]Lloyd Doggett [D-TX25]Joe Donnelly [D-IN2]Eliot Engel [D-NY17]Anna Eshoo [D-CA14]Sam Farr [D-CA17]Marcia Fudge [D-OH11]Raymond Green [D-TX29]Deborah Halvorson [D-IL11]Phil Hare [D-IL17]Jane Harman [D-CA36]Brian Higgins [D-NY27]Mazie Hirono [D-HI2]Sheila Jackson-Lee [D-TX18]Eddie Johnson [D-TX30]Steve Kagen [D-WI8]Patrick Kennedy [D-RI1]Carolyn Kilpatrick [D-MI13]Ron Klein [D-FL22]Barbara Lee [D-CA9]John Lewis [D-GA5]Zoe Lofgren [D-CA16]Nita Lowey [D-NY18]Carolyn Maloney [D-NY14]Betsy Markey [D-CO4]Jim Matheson [D-UT2]Doris Matsui [D-CA5]James McDermott [D-WA7]Gwen Moore [D-WI4]Jerrold Nadler [D-NY8]Grace Napolitano [D-CA38]Solomon Ortiz [D-TX27]William Pascrell [D-NJ8]Donald Payne [D-NJ10]Chellie Pingree [D-ME1]Laura Richardson [D-CA37]Loretta Sanchez [D-CA47]Janice Schakowsky [D-IL9]Allyson Schwartz [D-PA13]Carol Shea-Porter [D-NH1] Albio Sires [D-NJ13]Michael Thompson [D-CA1] Dina Titus [D-NV3]Niki Tsongas [D-MA5]Debbie Wasserman Schultz [D-FL20]Diane Watson [D-CA33]Anthony Weiner [D-NY9]Robert Wexler [D-FL19]Lynn Woolsey [D-CA6]John Yarmuth [D-KY3]

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Status:
Introduced Oct 20, 2009
Referred to Committee on Energy and Commerce

Updated Information

Sex Hormone Levels Linked to Fractures in Men - Forbes.com

Testing for estradiol, testosterone and SHBG could predict those at risk, expert says. (HealthDay News) -- Sex hormone levels affect the risk of broken bones in older men, says a new study. The finding comes from a study that included 1,436 men age 65 and older who had their sex hormone levels measured periodically for about five years. The researchers found that men with low levels of estradiol or high levels of sex hormone binding globulin (SHBG) were more likely to suffer osteoporotic fractures. Read More

Osteoporosis and Fracture Prevention

The Ontario Osteoporosis Strategy for Long-Term Care (OOSLTC) has produced a short DVD and a resource kit to ensure long-term care residents are receiving effective osteoporosis and fracture prevention care.

The DVD, entitled “Meeting the Challenge of Osteoporosis and Fracture Prevention,” was launched Nov. 12 in Hamilton, and ntroduced by geriatrician and OOSLTC lead Dr. Alexandra Papaioannou.

Osteoporosis, osteopenia screening and prevention are best done when we're older

By Susan Brink, Los Angeles Times Staff Writer September 22, 2008 Most healthy women can wait until they are 65 to be checked for bone loss instead of 50. Drug therapy, its long-term effects unknown, can also wait.

FDA Panel Endorses Pfizer’s Fablyn, With Reservations

Posted by Jacob Goldstein in the Wall Street Journal Health Blog An FDA advisory committee voted 9-3 that the benefits of Pfizer’s osteoporosis drug Fablyn outweigh the risks. But the committee raised lots of concerns during the meeting.

WHO Fracture Risk Assessment Tool

The FRAX tool has been developed by the World Health Organization to evaluate fracture risk of patients. It is based on individual patient models that integrate the risks associated with clinical risk factors as well as bone mineral density (BMD) at the femoral neck. The FRAX models have been developed from studying population-based cohorts from Europe, North America, Asia and Australia. In their most sophisticated form, the FRAX tool is computer-driven and is available on this site. Several simplified paper versions, based on the number of risk factors are also available, and can be downloaded for office use. The FRAX algorithms give the 10-year probability of fracture. The output is a 10-year probability of hip fracture and the 10-year probability of a major osteoporotic fracture (clinical spine, forearm, hip or shoulder fracture). This is a beta version

NEJM Quote of Week

New England Journal of Medicine Quote of the Week “During her lifetime, one of every two women will have an osteoporotic fracture, one third will have coronary heart disease, one fifth will have a stroke or Alzheimer's disease, and one eighth will have breast cancer.” G. El-Hajj Fuleihan, Editorial, “Tibolone and the Promise of Ideal Hormone-Replacement Therapy.”

The Effects of Tibolone in Older Postmenopausal Women

New England Journal of Medicine Volume 359:697-708 August 14, 2008 Number 7 Conclusions Tibolone reduced the risk of fracture and breast cancer and possibly colon cancer but increased the risk of stroke in older women with osteoporosis. (ClinicalTrials.gov number, NCT00519857 [ClinicalTrials.gov] .)