MDedge Rheumatology

Key clinical point: Psoriatic arthritis (PsA) is associated with the risk for low bone mineral density (BMD), but this association is partially mediated by treatment with methotrexate or ciclosporin. Psoriasis excluding PsA in the absence of a secondary condition is not a risk factor for osteoporosis.

Major finding: PsA was associated with low BMD (β-coefficient = −0.014; P = .0006). However, the association became nonsignificant when patients were treated with methotrexate or ciclosporin (β-coefficient = −0.005; P = .28). Psoriasis without arthritis was not associated with low BMD or osteoporosis.

Study details: The data come from a cross-sectional study of 432,513 participants from the UK Biobank dataset.

Disclosures: The study was supported by the Zhejiang Provincial Natural Science Foundation for Distinguished Young Scholars of China and the National Natural Science Foundation of China. The authors declared no conflicts of interest.

Source: Xia J et al. Ann Rheum Dis. 2020 Jul 31. doi: 10.1136/annrheumdis-2020-217892.

Key clinical point: Psoriatic arthritis (PsA) is associated with the risk for low bone mineral density (BMD), but this association is partially mediated by treatment with methotrexate or ciclosporin. Psoriasis excluding PsA in the absence of a secondary condition is not a risk factor for osteoporosis.

Major finding: PsA was associated with low BMD (β-coefficient = −0.014; P = .0006). However, the association became nonsignificant when patients were treated with methotrexate or ciclosporin (β-coefficient = −0.005; P = .28). Psoriasis without arthritis was not associated with low BMD or osteoporosis.

Study details: The data come from a cross-sectional study of 432,513 participants from the UK Biobank dataset.

Disclosures: The study was supported by the Zhejiang Provincial Natural Science Foundation for Distinguished Young Scholars of China and the National Natural Science Foundation of China. The authors declared no conflicts of interest.

Source: Xia J et al. Ann Rheum Dis. 2020 Jul 31. doi: 10.1136/annrheumdis-2020-217892.

Key clinical point: Psoriatic arthritis (PsA) is associated with the risk for low bone mineral density (BMD), but this association is partially mediated by treatment with methotrexate or ciclosporin. Psoriasis excluding PsA in the absence of a secondary condition is not a risk factor for osteoporosis.

Major finding: PsA was associated with low BMD (β-coefficient = −0.014; P = .0006). However, the association became nonsignificant when patients were treated with methotrexate or ciclosporin (β-coefficient = −0.005; P = .28). Psoriasis without arthritis was not associated with low BMD or osteoporosis.

Study details: The data come from a cross-sectional study of 432,513 participants from the UK Biobank dataset.

Disclosures: The study was supported by the Zhejiang Provincial Natural Science Foundation for Distinguished Young Scholars of China and the National Natural Science Foundation of China. The authors declared no conflicts of interest.

Source: Xia J et al. Ann Rheum Dis. 2020 Jul 31. doi: 10.1136/annrheumdis-2020-217892.

Key clinical point: Treatment with abaloparatide is associated with a transient increase in heart rate (HR) and a small decrease in post-dose blood pressure (BP) in postmenopausal women with osteoporosis.

Major finding: Abaloparatide showed a significantly higher mean HR change from pretreatment to 1 hour posttreatment on day 1 vs. placebo (mean [standard deviation]: 7.9 [8.5] vs. 1.2 [7.1] beats per minute; P less than .0001). Abaloparatide showed a significantly higher change in systolic and diastolic blood pressure from pre-dose to 1 hour post-dose vs. placebo (−2.7/−3.6 vs. −1.5/−2.3 mmHg; P less than .05). These changes were not associated with an increased risk of serious cardiac adverse events, major adverse cardiovascular events, and heart failure.

Study details: The findings are based on a post-hoc analysis from the ACTIVE and ACTIVExtend trials including 2,460 postmenopausal women with osteoporosis.

Disclosures: Dr. Felicia Cosman, Dr. Steven R Cummings, Dr. Linda R Peterson, and Dr. Dwight A Towler consulted for/received research grants from pharmaceutical companies/research institutes including Amgen; Radius Health, Inc.; and the National Institutes of Health. Dr. Bruce Mitlak and Dr. Yamei Wang are employees of and hold equity in Radius Health, Inc.

Source: Cosman F et al. J Clin Endocrinol Metab. 2020 Jul 13. doi: 10.1210/clinem/dgaa450.

Key clinical point: Treatment with abaloparatide is associated with a transient increase in heart rate (HR) and a small decrease in post-dose blood pressure (BP) in postmenopausal women with osteoporosis.

Major finding: Abaloparatide showed a significantly higher mean HR change from pretreatment to 1 hour posttreatment on day 1 vs. placebo (mean [standard deviation]: 7.9 [8.5] vs. 1.2 [7.1] beats per minute; P less than .0001). Abaloparatide showed a significantly higher change in systolic and diastolic blood pressure from pre-dose to 1 hour post-dose vs. placebo (−2.7/−3.6 vs. −1.5/−2.3 mmHg; P less than .05). These changes were not associated with an increased risk of serious cardiac adverse events, major adverse cardiovascular events, and heart failure.

Study details: The findings are based on a post-hoc analysis from the ACTIVE and ACTIVExtend trials including 2,460 postmenopausal women with osteoporosis.

Disclosures: Dr. Felicia Cosman, Dr. Steven R Cummings, Dr. Linda R Peterson, and Dr. Dwight A Towler consulted for/received research grants from pharmaceutical companies/research institutes including Amgen; Radius Health, Inc.; and the National Institutes of Health. Dr. Bruce Mitlak and Dr. Yamei Wang are employees of and hold equity in Radius Health, Inc.

Source: Cosman F et al. J Clin Endocrinol Metab. 2020 Jul 13. doi: 10.1210/clinem/dgaa450.

Key clinical point: Treatment with abaloparatide is associated with a transient increase in heart rate (HR) and a small decrease in post-dose blood pressure (BP) in postmenopausal women with osteoporosis.

Major finding: Abaloparatide showed a significantly higher mean HR change from pretreatment to 1 hour posttreatment on day 1 vs. placebo (mean [standard deviation]: 7.9 [8.5] vs. 1.2 [7.1] beats per minute; P less than .0001). Abaloparatide showed a significantly higher change in systolic and diastolic blood pressure from pre-dose to 1 hour post-dose vs. placebo (−2.7/−3.6 vs. −1.5/−2.3 mmHg; P less than .05). These changes were not associated with an increased risk of serious cardiac adverse events, major adverse cardiovascular events, and heart failure.

Study details: The findings are based on a post-hoc analysis from the ACTIVE and ACTIVExtend trials including 2,460 postmenopausal women with osteoporosis.

Disclosures: Dr. Felicia Cosman, Dr. Steven R Cummings, Dr. Linda R Peterson, and Dr. Dwight A Towler consulted for/received research grants from pharmaceutical companies/research institutes including Amgen; Radius Health, Inc.; and the National Institutes of Health. Dr. Bruce Mitlak and Dr. Yamei Wang are employees of and hold equity in Radius Health, Inc.

Source: Cosman F et al. J Clin Endocrinol Metab. 2020 Jul 13. doi: 10.1210/clinem/dgaa450.

Key clinical point: Women with a previous fracture or who had an inflammatory rheumatic disease were more likely to start antiosteoporotic drugs (AODs) within 1 year from glucocorticoid (GC) initiation. However, the proportions starting an AOD were much lower than clinically indicated.

Major finding: Women with vs. without previous fracture were twice as likely to start an AOD within 1 year after initiating GC treatment, but the cumulative incidences were low: 9.1% vs. 4.6%, respectively. Women with a diagnosis of rheumatoid arthritis or another inflammatory rheumatic disease were more likely to start an AOD compared with women with other diagnoses.

Study details: This Norwegian population-based study evaluated the initiation of osteoporosis prophylaxis with AOD in women starting treatment with oral GC (n=105,477; age, 55 years or older).

Disclosures: Open Access funding was provided by the University of Bergen. Astrid Lunde is involved in the Denosumab Global Safety Study. Department of Clinical Epidemiology, Aarhus University receives an institutional research funding from several pharmaceutical companies, some of which manufacture AOD. None of these companies was involved in the current study. Vera Ehrenstein is a salaried employee of the Aarhus University. Ellen M Apalset, Mari Hoff, and Grethe S Tell declared no conflicts of interest.

Source: Apalset EM et al. Arch Osteoporos. 2020 Aug 5. doi: 10.1007/s11657-020-00783-8.

Key clinical point: Women with a previous fracture or who had an inflammatory rheumatic disease were more likely to start antiosteoporotic drugs (AODs) within 1 year from glucocorticoid (GC) initiation. However, the proportions starting an AOD were much lower than clinically indicated.

Major finding: Women with vs. without previous fracture were twice as likely to start an AOD within 1 year after initiating GC treatment, but the cumulative incidences were low: 9.1% vs. 4.6%, respectively. Women with a diagnosis of rheumatoid arthritis or another inflammatory rheumatic disease were more likely to start an AOD compared with women with other diagnoses.

Study details: This Norwegian population-based study evaluated the initiation of osteoporosis prophylaxis with AOD in women starting treatment with oral GC (n=105,477; age, 55 years or older).

Disclosures: Open Access funding was provided by the University of Bergen. Astrid Lunde is involved in the Denosumab Global Safety Study. Department of Clinical Epidemiology, Aarhus University receives an institutional research funding from several pharmaceutical companies, some of which manufacture AOD. None of these companies was involved in the current study. Vera Ehrenstein is a salaried employee of the Aarhus University. Ellen M Apalset, Mari Hoff, and Grethe S Tell declared no conflicts of interest.

Source: Apalset EM et al. Arch Osteoporos. 2020 Aug 5. doi: 10.1007/s11657-020-00783-8.

Key clinical point: Women with a previous fracture or who had an inflammatory rheumatic disease were more likely to start antiosteoporotic drugs (AODs) within 1 year from glucocorticoid (GC) initiation. However, the proportions starting an AOD were much lower than clinically indicated.

Major finding: Women with vs. without previous fracture were twice as likely to start an AOD within 1 year after initiating GC treatment, but the cumulative incidences were low: 9.1% vs. 4.6%, respectively. Women with a diagnosis of rheumatoid arthritis or another inflammatory rheumatic disease were more likely to start an AOD compared with women with other diagnoses.

Study details: This Norwegian population-based study evaluated the initiation of osteoporosis prophylaxis with AOD in women starting treatment with oral GC (n=105,477; age, 55 years or older).

Disclosures: Open Access funding was provided by the University of Bergen. Astrid Lunde is involved in the Denosumab Global Safety Study. Department of Clinical Epidemiology, Aarhus University receives an institutional research funding from several pharmaceutical companies, some of which manufacture AOD. None of these companies was involved in the current study. Vera Ehrenstein is a salaried employee of the Aarhus University. Ellen M Apalset, Mari Hoff, and Grethe S Tell declared no conflicts of interest.

Source: Apalset EM et al. Arch Osteoporos. 2020 Aug 5. doi: 10.1007/s11657-020-00783-8.

Key clinical point: Delaying denosumab doses by more than 16 weeks is associated with an increased risk of vertebral fracture in patients with osteoporosis vs. on-time injections. However, evidence is insufficient to conclude that fracture risk is increased at other anatomical sites with a long delay.

Major finding: Compared with on-time injections (within 4 weeks after the recommended date), short delay (by 4-16 weeks) had a hazard ratio (HR) of 1.03 and long delay (by more than 16 weeks) an HR of 1.44 (P for trend = .093) for composite fracture. For vertebral fractures, short delay had an HR of 1.48 and long delay an HR of 3.91 (P for trend = .005).

Study details: This U.K. population-based cohort study included 2,594 patients (age, 45 years or older) who initiated denosumab therapy for osteoporosis.

Disclosures: The study was supported by a grant from the National Institutes of Health and by the internal resources from the National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation (Beijing) and Xiangya Hospital, Central South University. The authors declared no conflicts of interest in relation to the subject of the study. Three of the authors reported receiving grants from 1 or more pharma companies, outside the submitted work.

Source: Lyu H et al. Ann Intern Med. 2020 Jul 28. doi: 10.7326/M20-0882.

Key clinical point: Delaying denosumab doses by more than 16 weeks is associated with an increased risk of vertebral fracture in patients with osteoporosis vs. on-time injections. However, evidence is insufficient to conclude that fracture risk is increased at other anatomical sites with a long delay.

Major finding: Compared with on-time injections (within 4 weeks after the recommended date), short delay (by 4-16 weeks) had a hazard ratio (HR) of 1.03 and long delay (by more than 16 weeks) an HR of 1.44 (P for trend = .093) for composite fracture. For vertebral fractures, short delay had an HR of 1.48 and long delay an HR of 3.91 (P for trend = .005).

Study details: This U.K. population-based cohort study included 2,594 patients (age, 45 years or older) who initiated denosumab therapy for osteoporosis.

Disclosures: The study was supported by a grant from the National Institutes of Health and by the internal resources from the National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation (Beijing) and Xiangya Hospital, Central South University. The authors declared no conflicts of interest in relation to the subject of the study. Three of the authors reported receiving grants from 1 or more pharma companies, outside the submitted work.

Source: Lyu H et al. Ann Intern Med. 2020 Jul 28. doi: 10.7326/M20-0882.

Key clinical point: Delaying denosumab doses by more than 16 weeks is associated with an increased risk of vertebral fracture in patients with osteoporosis vs. on-time injections. However, evidence is insufficient to conclude that fracture risk is increased at other anatomical sites with a long delay.

Major finding: Compared with on-time injections (within 4 weeks after the recommended date), short delay (by 4-16 weeks) had a hazard ratio (HR) of 1.03 and long delay (by more than 16 weeks) an HR of 1.44 (P for trend = .093) for composite fracture. For vertebral fractures, short delay had an HR of 1.48 and long delay an HR of 3.91 (P for trend = .005).

Study details: This U.K. population-based cohort study included 2,594 patients (age, 45 years or older) who initiated denosumab therapy for osteoporosis.

Disclosures: The study was supported by a grant from the National Institutes of Health and by the internal resources from the National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation (Beijing) and Xiangya Hospital, Central South University. The authors declared no conflicts of interest in relation to the subject of the study. Three of the authors reported receiving grants from 1 or more pharma companies, outside the submitted work.

Source: Lyu H et al. Ann Intern Med. 2020 Jul 28. doi: 10.7326/M20-0882.

Key clinical point: Postmenopausal women with osteoporosis have a lower concentration of serum magnesium (Mg). However, the association between serum Mg concentration and osteopenia is not significant.

Major finding: Serum Mg concentration was lower in postmenopausal women with osteoporosis vs. healthy controls (standardized mean difference [SMD], −0.56; 95% confidence interval [CI], −1.02 to −0.09). However, the concentration of serum Mg did not differ between those with osteopenia and healthy controls (SMD, −0.30; 95% CI, −0.69 to 0.09).

Study details: A meta-analysis of 11 studies including 2,776 postmenopausal women.

Disclosures: The study was financially supported through grants from the Natural Science Foundation of Shandong Province, the Medical and Health Science and Technology Development Project of Shandong Province, the Clinical Medical Science and Technology Innovation Program of the Jinan Science and Technology Bureau, and the Traditional Chinese Medicine Technology Development Plan of Shandong Province. The authors declared no conflicts of interest.

Source: Chang J et al. Front Med. 2020 Aug 4. doi: 10.3389/fmed.2020.00381.

Key clinical point: Postmenopausal women with osteoporosis have a lower concentration of serum magnesium (Mg). However, the association between serum Mg concentration and osteopenia is not significant.

Major finding: Serum Mg concentration was lower in postmenopausal women with osteoporosis vs. healthy controls (standardized mean difference [SMD], −0.56; 95% confidence interval [CI], −1.02 to −0.09). However, the concentration of serum Mg did not differ between those with osteopenia and healthy controls (SMD, −0.30; 95% CI, −0.69 to 0.09).

Study details: A meta-analysis of 11 studies including 2,776 postmenopausal women.

Disclosures: The study was financially supported through grants from the Natural Science Foundation of Shandong Province, the Medical and Health Science and Technology Development Project of Shandong Province, the Clinical Medical Science and Technology Innovation Program of the Jinan Science and Technology Bureau, and the Traditional Chinese Medicine Technology Development Plan of Shandong Province. The authors declared no conflicts of interest.

Source: Chang J et al. Front Med. 2020 Aug 4. doi: 10.3389/fmed.2020.00381.

Key clinical point: Postmenopausal women with osteoporosis have a lower concentration of serum magnesium (Mg). However, the association between serum Mg concentration and osteopenia is not significant.

Major finding: Serum Mg concentration was lower in postmenopausal women with osteoporosis vs. healthy controls (standardized mean difference [SMD], −0.56; 95% confidence interval [CI], −1.02 to −0.09). However, the concentration of serum Mg did not differ between those with osteopenia and healthy controls (SMD, −0.30; 95% CI, −0.69 to 0.09).

Study details: A meta-analysis of 11 studies including 2,776 postmenopausal women.

Disclosures: The study was financially supported through grants from the Natural Science Foundation of Shandong Province, the Medical and Health Science and Technology Development Project of Shandong Province, the Clinical Medical Science and Technology Innovation Program of the Jinan Science and Technology Bureau, and the Traditional Chinese Medicine Technology Development Plan of Shandong Province. The authors declared no conflicts of interest.

Source: Chang J et al. Front Med. 2020 Aug 4. doi: 10.3389/fmed.2020.00381.

Key clinical point: Early treatment with romosozumab significantly improves bone mineral density (BMD) of the lumbar spine (LS) in postmenopausal osteoporosis. The response is attenuated by previous treatment and predicted by early changes in bone turnover markers.

Major finding: At 6 months of romosozumab induction, the naïve group had the highest increase in LS BMD (13.6%; P less than .001), followed by teriparatide (8.7%; P less than .001), bisphosphonates (7.5%; P less than .001), and denosumab (3.6%; P less than .001) groups. Serum N-terminal type I procollagen propeptide value at baseline and 1 month and isoform 5b of tartrate-resistant acid phosphatase value at baseline and its percentage change at 1 and 6 months were significant predictors (P less than .05) of LS BMD change at 6 months.

Study details: The data come from a prospective, observational, multicenter study of postmenopausal patients with osteoporosis who were either treatment naïve and received romosozumab (n = 37) or were previously treated with bisphosphonates (n = 33), denosumab (n = 45), or teriparatide (n = 15) and switched to romosozumab.

Disclosures: The study received no commercial funding. Dr. Kosuke Ebina and Dr. Ken Nakata are affiliated with the Department of Musculoskeletal Regenerative Medicine, Osaka University, Graduate School of Medicine, which is supported by Taisho. Dr. Kosuke Ebina, Dr. Makoto Hirao, Dr. Hideki Tsuboi, Dr. Yoshio Nagayama, and Dr. Masafumi Kashii have received research grants from various pharmaceutical companies. The remaining authors reported no conflicts of interest.

Source: Ebina K et al. Bone. 2020 Aug 7. doi: 10.1016/j.bone.2020.115574.

Key clinical point: Early treatment with romosozumab significantly improves bone mineral density (BMD) of the lumbar spine (LS) in postmenopausal osteoporosis. The response is attenuated by previous treatment and predicted by early changes in bone turnover markers.

Major finding: At 6 months of romosozumab induction, the naïve group had the highest increase in LS BMD (13.6%; P less than .001), followed by teriparatide (8.7%; P less than .001), bisphosphonates (7.5%; P less than .001), and denosumab (3.6%; P less than .001) groups. Serum N-terminal type I procollagen propeptide value at baseline and 1 month and isoform 5b of tartrate-resistant acid phosphatase value at baseline and its percentage change at 1 and 6 months were significant predictors (P less than .05) of LS BMD change at 6 months.

Study details: The data come from a prospective, observational, multicenter study of postmenopausal patients with osteoporosis who were either treatment naïve and received romosozumab (n = 37) or were previously treated with bisphosphonates (n = 33), denosumab (n = 45), or teriparatide (n = 15) and switched to romosozumab.

Disclosures: The study received no commercial funding. Dr. Kosuke Ebina and Dr. Ken Nakata are affiliated with the Department of Musculoskeletal Regenerative Medicine, Osaka University, Graduate School of Medicine, which is supported by Taisho. Dr. Kosuke Ebina, Dr. Makoto Hirao, Dr. Hideki Tsuboi, Dr. Yoshio Nagayama, and Dr. Masafumi Kashii have received research grants from various pharmaceutical companies. The remaining authors reported no conflicts of interest.

Source: Ebina K et al. Bone. 2020 Aug 7. doi: 10.1016/j.bone.2020.115574.

Key clinical point: Early treatment with romosozumab significantly improves bone mineral density (BMD) of the lumbar spine (LS) in postmenopausal osteoporosis. The response is attenuated by previous treatment and predicted by early changes in bone turnover markers.

Major finding: At 6 months of romosozumab induction, the naïve group had the highest increase in LS BMD (13.6%; P less than .001), followed by teriparatide (8.7%; P less than .001), bisphosphonates (7.5%; P less than .001), and denosumab (3.6%; P less than .001) groups. Serum N-terminal type I procollagen propeptide value at baseline and 1 month and isoform 5b of tartrate-resistant acid phosphatase value at baseline and its percentage change at 1 and 6 months were significant predictors (P less than .05) of LS BMD change at 6 months.

Study details: The data come from a prospective, observational, multicenter study of postmenopausal patients with osteoporosis who were either treatment naïve and received romosozumab (n = 37) or were previously treated with bisphosphonates (n = 33), denosumab (n = 45), or teriparatide (n = 15) and switched to romosozumab.

Disclosures: The study received no commercial funding. Dr. Kosuke Ebina and Dr. Ken Nakata are affiliated with the Department of Musculoskeletal Regenerative Medicine, Osaka University, Graduate School of Medicine, which is supported by Taisho. Dr. Kosuke Ebina, Dr. Makoto Hirao, Dr. Hideki Tsuboi, Dr. Yoshio Nagayama, and Dr. Masafumi Kashii have received research grants from various pharmaceutical companies. The remaining authors reported no conflicts of interest.

Source: Ebina K et al. Bone. 2020 Aug 7. doi: 10.1016/j.bone.2020.115574.

Key clinical point: Diets rich in pro-inflammatory components may increase the risk of osteoporosis, fractures, and lower bone mineral density (BMD) of lumbar spine and total hip.

Major finding: Dietary Inflammatory Index (DII) was negatively linked with BMD of lumbar spine (odds ratios [OR], 0.990; P = .144) and total hip (OR, 0.995; P = .392). The highest category of DII was associated with an elevated risk of osteoporosis (pooled effect size [ES], 1.31; 95% confidence interval [CI], 1.16-1.48) and fractures (pooled ES, 1.26; 95% CI, 1.03-1.59) compared with the lowest category of DII.

Study details: A meta-analysis of 11 studies (4 cohort, 1 case-control, and 6 cross-sectional) involving 127,769 participants.

Disclosures: The study was supported by the National Natural Science Foundation of China. The authors declared no conflicts of interest.

Source: Fang Y et al. Osteoporos Int. 2020 Aug 1. doi: 10.1007/s00198-020-05578-8.

Key clinical point: Diets rich in pro-inflammatory components may increase the risk of osteoporosis, fractures, and lower bone mineral density (BMD) of lumbar spine and total hip.

Major finding: Dietary Inflammatory Index (DII) was negatively linked with BMD of lumbar spine (odds ratios [OR], 0.990; P = .144) and total hip (OR, 0.995; P = .392). The highest category of DII was associated with an elevated risk of osteoporosis (pooled effect size [ES], 1.31; 95% confidence interval [CI], 1.16-1.48) and fractures (pooled ES, 1.26; 95% CI, 1.03-1.59) compared with the lowest category of DII.

Study details: A meta-analysis of 11 studies (4 cohort, 1 case-control, and 6 cross-sectional) involving 127,769 participants.

Disclosures: The study was supported by the National Natural Science Foundation of China. The authors declared no conflicts of interest.

Source: Fang Y et al. Osteoporos Int. 2020 Aug 1. doi: 10.1007/s00198-020-05578-8.

Key clinical point: Diets rich in pro-inflammatory components may increase the risk of osteoporosis, fractures, and lower bone mineral density (BMD) of lumbar spine and total hip.

Major finding: Dietary Inflammatory Index (DII) was negatively linked with BMD of lumbar spine (odds ratios [OR], 0.990; P = .144) and total hip (OR, 0.995; P = .392). The highest category of DII was associated with an elevated risk of osteoporosis (pooled effect size [ES], 1.31; 95% confidence interval [CI], 1.16-1.48) and fractures (pooled ES, 1.26; 95% CI, 1.03-1.59) compared with the lowest category of DII.

Study details: A meta-analysis of 11 studies (4 cohort, 1 case-control, and 6 cross-sectional) involving 127,769 participants.

Disclosures: The study was supported by the National Natural Science Foundation of China. The authors declared no conflicts of interest.

Source: Fang Y et al. Osteoporos Int. 2020 Aug 1. doi: 10.1007/s00198-020-05578-8.

Key clinical point: Postmenopausal osteoporotic women with low body mass index (BMI) have a higher risk of developing osteosarcopenia. Moreover, appropriate assessments, including the presence of comorbidities, will help in identifying patients at a greater risk of developing osteosarcopenia, especially for patients aged 65-74 years.

Major finding: Patients with osteosarcopenia had a higher risk of frailty vs. those with osteoporosis alone (odds ratio [OR], 2.33; P = .028). BMI (per 1 kg/m² decrease) seemed to be the strongest factor associated with osteosarcopenia risk (adjusted OR [aOR], 1.71; P less than .01). In patients aged 65-74 years, estimated glomerular filtration rate (per 10 mL/min/1.73m² decrease) and glycated hemoglobin (per 1% decrease) were identified as independent predictors of osteosarcopenia (aOR, 1.75; P = .01 and aOR, 5.01; P = .01, respectively).

Study details: The data come from a retrospective study of 276 patients with postmenopausal osteoporosis (osteoporosis alone: n=222 and osteosarcopenia: n=54).

Disclosures: The study was supported by grants awarded to Dr. Koji Ishikawa by KAKENHI and Grant of Japan Orthopaedics and Traumatology Research Foundation. The authors declared no conflicts of interest.

Source: Okamura H et al. PLoS One. 2020 Aug 7. doi: 10.1371/journal.pone.0237454.

Key clinical point: Postmenopausal osteoporotic women with low body mass index (BMI) have a higher risk of developing osteosarcopenia. Moreover, appropriate assessments, including the presence of comorbidities, will help in identifying patients at a greater risk of developing osteosarcopenia, especially for patients aged 65-74 years.

Major finding: Patients with osteosarcopenia had a higher risk of frailty vs. those with osteoporosis alone (odds ratio [OR], 2.33; P = .028). BMI (per 1 kg/m² decrease) seemed to be the strongest factor associated with osteosarcopenia risk (adjusted OR [aOR], 1.71; P less than .01). In patients aged 65-74 years, estimated glomerular filtration rate (per 10 mL/min/1.73m² decrease) and glycated hemoglobin (per 1% decrease) were identified as independent predictors of osteosarcopenia (aOR, 1.75; P = .01 and aOR, 5.01; P = .01, respectively).

Study details: The data come from a retrospective study of 276 patients with postmenopausal osteoporosis (osteoporosis alone: n=222 and osteosarcopenia: n=54).

Disclosures: The study was supported by grants awarded to Dr. Koji Ishikawa by KAKENHI and Grant of Japan Orthopaedics and Traumatology Research Foundation. The authors declared no conflicts of interest.

Source: Okamura H et al. PLoS One. 2020 Aug 7. doi: 10.1371/journal.pone.0237454.

Key clinical point: Postmenopausal osteoporotic women with low body mass index (BMI) have a higher risk of developing osteosarcopenia. Moreover, appropriate assessments, including the presence of comorbidities, will help in identifying patients at a greater risk of developing osteosarcopenia, especially for patients aged 65-74 years.

Major finding: Patients with osteosarcopenia had a higher risk of frailty vs. those with osteoporosis alone (odds ratio [OR], 2.33; P = .028). BMI (per 1 kg/m² decrease) seemed to be the strongest factor associated with osteosarcopenia risk (adjusted OR [aOR], 1.71; P less than .01). In patients aged 65-74 years, estimated glomerular filtration rate (per 10 mL/min/1.73m² decrease) and glycated hemoglobin (per 1% decrease) were identified as independent predictors of osteosarcopenia (aOR, 1.75; P = .01 and aOR, 5.01; P = .01, respectively).

Study details: The data come from a retrospective study of 276 patients with postmenopausal osteoporosis (osteoporosis alone: n=222 and osteosarcopenia: n=54).

Disclosures: The study was supported by grants awarded to Dr. Koji Ishikawa by KAKENHI and Grant of Japan Orthopaedics and Traumatology Research Foundation. The authors declared no conflicts of interest.

Source: Okamura H et al. PLoS One. 2020 Aug 7. doi: 10.1371/journal.pone.0237454.

Key clinical point: Asthma is associated with an increased risk of osteoporosis and fragility fractures (FF), particularly vertebral and humerus fractures.

Major finding: The risk of osteoporosis and FF was higher in asthma vs. non-asthma group (adjusted hazard ratio [aHR]: 1.18 and 1.12, respectively). The effect was stronger in younger age groups (P_interaction less than .0001). Forearm-wrist (aHR, 1.21) and vertebra (aHR, 1.19) were the sites associated with a higher risk. Among patients with asthma, a single oral corticosteroid course increased the risk of osteoporosis, and greater use of inhaled corticosteroids increased the risk of both bone diseases.

Study details: This population-based matched cohort study included 138,123 patients with asthma and 520,626 age-, sex-, and practice-matched people without asthma using data from the U.K. Clinical Practice Research Datalink.

Disclosures: The study was funded by a research grant from the British Medical Association. The authors declared no conflicts of interest.

Source: Chalitsios CV et al. Eur Respir J. 2020 Aug 6. doi: 10.1183/13993003.01251-2020.

Key clinical point: Asthma is associated with an increased risk of osteoporosis and fragility fractures (FF), particularly vertebral and humerus fractures.

Major finding: The risk of osteoporosis and FF was higher in asthma vs. non-asthma group (adjusted hazard ratio [aHR]: 1.18 and 1.12, respectively). The effect was stronger in younger age groups (P_interaction less than .0001). Forearm-wrist (aHR, 1.21) and vertebra (aHR, 1.19) were the sites associated with a higher risk. Among patients with asthma, a single oral corticosteroid course increased the risk of osteoporosis, and greater use of inhaled corticosteroids increased the risk of both bone diseases.

Study details: This population-based matched cohort study included 138,123 patients with asthma and 520,626 age-, sex-, and practice-matched people without asthma using data from the U.K. Clinical Practice Research Datalink.

Disclosures: The study was funded by a research grant from the British Medical Association. The authors declared no conflicts of interest.

Source: Chalitsios CV et al. Eur Respir J. 2020 Aug 6. doi: 10.1183/13993003.01251-2020.

Key clinical point: Asthma is associated with an increased risk of osteoporosis and fragility fractures (FF), particularly vertebral and humerus fractures.

Major finding: The risk of osteoporosis and FF was higher in asthma vs. non-asthma group (adjusted hazard ratio [aHR]: 1.18 and 1.12, respectively). The effect was stronger in younger age groups (P_interaction less than .0001). Forearm-wrist (aHR, 1.21) and vertebra (aHR, 1.19) were the sites associated with a higher risk. Among patients with asthma, a single oral corticosteroid course increased the risk of osteoporosis, and greater use of inhaled corticosteroids increased the risk of both bone diseases.

Study details: This population-based matched cohort study included 138,123 patients with asthma and 520,626 age-, sex-, and practice-matched people without asthma using data from the U.K. Clinical Practice Research Datalink.

Disclosures: The study was funded by a research grant from the British Medical Association. The authors declared no conflicts of interest.

Source: Chalitsios CV et al. Eur Respir J. 2020 Aug 6. doi: 10.1183/13993003.01251-2020.

“When we think about bisphosphonates, we have to think about whether they are good players or bad players,” Marcy B. Bolster, MD, of Harvard Medical School, Boston, said in a virtual presentation at the annual Perspectives in Rheumatic Diseases held by Global Academy for Medical Education.

Although bisphosphonates are a first-line treatment for many patients to reduce fracture risk, rheumatology patients have distinct concerns about these medications, said Dr. Bolster, who is director of the Rheumatology Fellowship Training Program at Massachusetts General Hospital, Boston, and medical lead for the Fracture Liaison Service there.

She shared her insights on four questions most often asked by patients in her practice:

How long do I need to take this medication?

When discussing bisphosphonates with a patient for the first time, “I typically start with the benefits, and include the risks,” she said. “Then I outline my plans for treatment, which would include treatment duration.”

Setting expectations with the patient about planned duration of therapy, reviewing risks and benefits, and preparing to be flexible if changes are needed can help relieve patients’ concerns, she said.

For example, in a hypothetical case of a 69-year-old woman with a 17% chance of a major osteoporotic fracture and 3.8% chance of hip fracture in the next 10 years based on FRAX scores, Dr. Bolster said she would treat with alendronate or zoledronic acid.

Duration must be a clinical decision individualized to the patient, she noted. Research studies support that some patients benefit from a longer duration of therapy. In the Fracture Intervention Trial (FIT) Long-Term Extension, which included 1,099 women, the risk of clinical vertebral fractures significantly declined with 10 years of alendronate treatment, compared with 5 years of treatment, she said.

In the HORIZON trial of 1,233 postmenopausal women, the risk of new morphometric vertebral fractures was significantly lower in those treated with IV zoledronic acid for 6 years versus those treated for 3 years. These studies support that patients at particularly high risk for vertebral fractures may benefit from a longer duration of bisphosphonate therapy, she said.
 

What should I know about infusion side effects?

Infusion side effects remain a concern, and the acute phase reaction of zoledronic acid occurs in about 30% of patients, but most of these are mild and not recurring, Dr. Bolster said. “I tell patients that 90% report mild to moderate infusion side effects, and that it usually occurs only with the first infusion,” she noted.

To potentially prevent an acute-phase reaction, Dr. Bolster has advised patients to take acetaminophen prior to infusion. “I would tend to recommend acetaminophen over NSAIDs to avoid gastric and renal toxicities,” she said.

“Determining the risks of atypical femoral fractures are challenging” but are another potential side effect that worries patients, she said. An atypical femoral fracture (AFF) is a femur fracture in the proximal third of the shaft, she said.

AFF may occur in patients with osteoporosis even in the absence of bisphosphonate use, Dr. Bolster noted. However, AFF “may occur at increased frequency in those patients with osteoporosis and prolonged bisphosphonate use,” she said. AFF is rare overall, and known risk factors include Asian race (in North America), as well as femoral bowing and glucocorticoid use, she said.

A 2019 meta-analysis favored fracture prevention benefits over potential risk associated with bisphosphonate use. Predicting the risk of AFF remains difficult given several factors, including the low incidence of AFF, the unavailability of radiographs in all studies, not accounting for potential confounding by indication in some studies, and lack of adjustment for low bone mineral density or fracture risk, she added.

Osteonecrosis of the jaw has been linked to bisphosphonate use, and some patients ask about it, Dr. Bolster said. Current data show an incidence of 1 in 10,000 to 1 in 100,000 in patients with osteoporosis, while the incidence in the general population is 1 in 100,000, she noted. The highest risk is associated with use of IV bisphosphonates, although it does occur in patients on oral bisphosphonates and denosumab (Prolia), she added. Given the relatively low risk, the American Dental Association states that there is “no need to discontinue bisphosphonates prior to procedures.” Based on current evidence, bisphosphonate treatment outweighs the low risk of medication-related osteonecrosis of the jaw in patients in need of osteoporosis treatment because of the high risk of fragility fractures in the osteoporosis population, she emphasized.
 

When will I need another dual x-ray absorptiometry scan?

Osteoporosis develops in fewer than 10% of older postmenopausal women using a 15-year screening interval for those with normal bone mineral density or mild osteopenia at an initial scan, with T-scores of –1.49 or higher, she noted. Therefore, the need for repeat dual x-ray absorptiometry (DXA) scans should be individualized, so some patients with normal bone density or osteopenia and few comorbidities and risk factors for osteoporosis may not need frequent DXA scans, she added.

Although little evidence exists to specifically demonstrate the value of monitoring bone mineral density during a 5-year drug treatment period, as is noted by the American College of Physicians 2017 clinical practice guideline published in Annals of Internal Medicine, Dr. Bolster said that a DXA scan showing loss of bone mineral density during treatment could indicate incorrect drug use or noncompliance, or a secondary cause for bone loss that may otherwise go unnoticed. For IV zoledronic acid in particular, a DXA scan at 3-4 years can determine whether a drug holiday is warranted, or for patients with severe osteoporosis, whether another 3 years of treatment is necessary. She suggested considering a DXA scan at 2-3 years with alendronate and at 3-4 years with IV zoledronic acid.

Will I need a new medication if I fracture while on treatment?

For patients who ask whether to change medications following a new fracture, Dr. Bolster said it is important to evaluate the patient’s compliance with the treatment regimen and also consider the presence of secondary causes of bone loss. Consideration can be given to keeping the patient on the same regimen because osteoporosis treatment regimens have demonstrated a 50%-70% fracture-risk reduction so they do not prevent all fractures, she said. “It is therefore reasonable, after confirming compliance and ruling out secondary causes of bone loss, to keep a patient on the same regimen following a fracture. For patients using denosumab, there is an increased risk of rapid bone loss and sustaining multiple vertebral fracture with missed doses or discontinuation,” she said.

It is important to evaluate patients who fracture while on therapy for secondary causes of bone loss, assess compliance, and consider strategies such as modifying the route of administration, seeking a different mechanism of action, or continuing on the same regimen, Dr. Bolster noted.

Dr. Bolster disclosed participation in clinical trials for Corbus, Cumberland, and Genentech, as well as research grants from the Rheumatology Research Foundation. She also disclosed serving on advisory boards for Gilead Sciences and Clinical Learning Designs, serving on the American College of Rheumatology’s Committee on Marketing and Communications, and holding investments in Johnson & Johnson.

Global Academy for Medical Education and this news organization are owned by the same parent company.

“When we think about bisphosphonates, we have to think about whether they are good players or bad players,” Marcy B. Bolster, MD, of Harvard Medical School, Boston, said in a virtual presentation at the annual Perspectives in Rheumatic Diseases held by Global Academy for Medical Education.

Although bisphosphonates are a first-line treatment for many patients to reduce fracture risk, rheumatology patients have distinct concerns about these medications, said Dr. Bolster, who is director of the Rheumatology Fellowship Training Program at Massachusetts General Hospital, Boston, and medical lead for the Fracture Liaison Service there.

She shared her insights on four questions most often asked by patients in her practice:

How long do I need to take this medication?

When discussing bisphosphonates with a patient for the first time, “I typically start with the benefits, and include the risks,” she said. “Then I outline my plans for treatment, which would include treatment duration.”

Setting expectations with the patient about planned duration of therapy, reviewing risks and benefits, and preparing to be flexible if changes are needed can help relieve patients’ concerns, she said.

For example, in a hypothetical case of a 69-year-old woman with a 17% chance of a major osteoporotic fracture and 3.8% chance of hip fracture in the next 10 years based on FRAX scores, Dr. Bolster said she would treat with alendronate or zoledronic acid.

Duration must be a clinical decision individualized to the patient, she noted. Research studies support that some patients benefit from a longer duration of therapy. In the Fracture Intervention Trial (FIT) Long-Term Extension, which included 1,099 women, the risk of clinical vertebral fractures significantly declined with 10 years of alendronate treatment, compared with 5 years of treatment, she said.

In the HORIZON trial of 1,233 postmenopausal women, the risk of new morphometric vertebral fractures was significantly lower in those treated with IV zoledronic acid for 6 years versus those treated for 3 years. These studies support that patients at particularly high risk for vertebral fractures may benefit from a longer duration of bisphosphonate therapy, she said.
 

What should I know about infusion side effects?

Infusion side effects remain a concern, and the acute phase reaction of zoledronic acid occurs in about 30% of patients, but most of these are mild and not recurring, Dr. Bolster said. “I tell patients that 90% report mild to moderate infusion side effects, and that it usually occurs only with the first infusion,” she noted.

To potentially prevent an acute-phase reaction, Dr. Bolster has advised patients to take acetaminophen prior to infusion. “I would tend to recommend acetaminophen over NSAIDs to avoid gastric and renal toxicities,” she said.

“Determining the risks of atypical femoral fractures are challenging” but are another potential side effect that worries patients, she said. An atypical femoral fracture (AFF) is a femur fracture in the proximal third of the shaft, she said.

AFF may occur in patients with osteoporosis even in the absence of bisphosphonate use, Dr. Bolster noted. However, AFF “may occur at increased frequency in those patients with osteoporosis and prolonged bisphosphonate use,” she said. AFF is rare overall, and known risk factors include Asian race (in North America), as well as femoral bowing and glucocorticoid use, she said.

A 2019 meta-analysis favored fracture prevention benefits over potential risk associated with bisphosphonate use. Predicting the risk of AFF remains difficult given several factors, including the low incidence of AFF, the unavailability of radiographs in all studies, not accounting for potential confounding by indication in some studies, and lack of adjustment for low bone mineral density or fracture risk, she added.

Osteonecrosis of the jaw has been linked to bisphosphonate use, and some patients ask about it, Dr. Bolster said. Current data show an incidence of 1 in 10,000 to 1 in 100,000 in patients with osteoporosis, while the incidence in the general population is 1 in 100,000, she noted. The highest risk is associated with use of IV bisphosphonates, although it does occur in patients on oral bisphosphonates and denosumab (Prolia), she added. Given the relatively low risk, the American Dental Association states that there is “no need to discontinue bisphosphonates prior to procedures.” Based on current evidence, bisphosphonate treatment outweighs the low risk of medication-related osteonecrosis of the jaw in patients in need of osteoporosis treatment because of the high risk of fragility fractures in the osteoporosis population, she emphasized.
 

When will I need another dual x-ray absorptiometry scan?

Osteoporosis develops in fewer than 10% of older postmenopausal women using a 15-year screening interval for those with normal bone mineral density or mild osteopenia at an initial scan, with T-scores of –1.49 or higher, she noted. Therefore, the need for repeat dual x-ray absorptiometry (DXA) scans should be individualized, so some patients with normal bone density or osteopenia and few comorbidities and risk factors for osteoporosis may not need frequent DXA scans, she added.

Although little evidence exists to specifically demonstrate the value of monitoring bone mineral density during a 5-year drug treatment period, as is noted by the American College of Physicians 2017 clinical practice guideline published in Annals of Internal Medicine, Dr. Bolster said that a DXA scan showing loss of bone mineral density during treatment could indicate incorrect drug use or noncompliance, or a secondary cause for bone loss that may otherwise go unnoticed. For IV zoledronic acid in particular, a DXA scan at 3-4 years can determine whether a drug holiday is warranted, or for patients with severe osteoporosis, whether another 3 years of treatment is necessary. She suggested considering a DXA scan at 2-3 years with alendronate and at 3-4 years with IV zoledronic acid.

Will I need a new medication if I fracture while on treatment?

For patients who ask whether to change medications following a new fracture, Dr. Bolster said it is important to evaluate the patient’s compliance with the treatment regimen and also consider the presence of secondary causes of bone loss. Consideration can be given to keeping the patient on the same regimen because osteoporosis treatment regimens have demonstrated a 50%-70% fracture-risk reduction so they do not prevent all fractures, she said. “It is therefore reasonable, after confirming compliance and ruling out secondary causes of bone loss, to keep a patient on the same regimen following a fracture. For patients using denosumab, there is an increased risk of rapid bone loss and sustaining multiple vertebral fracture with missed doses or discontinuation,” she said.

It is important to evaluate patients who fracture while on therapy for secondary causes of bone loss, assess compliance, and consider strategies such as modifying the route of administration, seeking a different mechanism of action, or continuing on the same regimen, Dr. Bolster noted.

Dr. Bolster disclosed participation in clinical trials for Corbus, Cumberland, and Genentech, as well as research grants from the Rheumatology Research Foundation. She also disclosed serving on advisory boards for Gilead Sciences and Clinical Learning Designs, serving on the American College of Rheumatology’s Committee on Marketing and Communications, and holding investments in Johnson & Johnson.

Global Academy for Medical Education and this news organization are owned by the same parent company.

“When we think about bisphosphonates, we have to think about whether they are good players or bad players,” Marcy B. Bolster, MD, of Harvard Medical School, Boston, said in a virtual presentation at the annual Perspectives in Rheumatic Diseases held by Global Academy for Medical Education.

Although bisphosphonates are a first-line treatment for many patients to reduce fracture risk, rheumatology patients have distinct concerns about these medications, said Dr. Bolster, who is director of the Rheumatology Fellowship Training Program at Massachusetts General Hospital, Boston, and medical lead for the Fracture Liaison Service there.

She shared her insights on four questions most often asked by patients in her practice:

How long do I need to take this medication?

When discussing bisphosphonates with a patient for the first time, “I typically start with the benefits, and include the risks,” she said. “Then I outline my plans for treatment, which would include treatment duration.”

Setting expectations with the patient about planned duration of therapy, reviewing risks and benefits, and preparing to be flexible if changes are needed can help relieve patients’ concerns, she said.

For example, in a hypothetical case of a 69-year-old woman with a 17% chance of a major osteoporotic fracture and 3.8% chance of hip fracture in the next 10 years based on FRAX scores, Dr. Bolster said she would treat with alendronate or zoledronic acid.

Duration must be a clinical decision individualized to the patient, she noted. Research studies support that some patients benefit from a longer duration of therapy. In the Fracture Intervention Trial (FIT) Long-Term Extension, which included 1,099 women, the risk of clinical vertebral fractures significantly declined with 10 years of alendronate treatment, compared with 5 years of treatment, she said.

In the HORIZON trial of 1,233 postmenopausal women, the risk of new morphometric vertebral fractures was significantly lower in those treated with IV zoledronic acid for 6 years versus those treated for 3 years. These studies support that patients at particularly high risk for vertebral fractures may benefit from a longer duration of bisphosphonate therapy, she said.
 

What should I know about infusion side effects?

Infusion side effects remain a concern, and the acute phase reaction of zoledronic acid occurs in about 30% of patients, but most of these are mild and not recurring, Dr. Bolster said. “I tell patients that 90% report mild to moderate infusion side effects, and that it usually occurs only with the first infusion,” she noted.

To potentially prevent an acute-phase reaction, Dr. Bolster has advised patients to take acetaminophen prior to infusion. “I would tend to recommend acetaminophen over NSAIDs to avoid gastric and renal toxicities,” she said.

“Determining the risks of atypical femoral fractures are challenging” but are another potential side effect that worries patients, she said. An atypical femoral fracture (AFF) is a femur fracture in the proximal third of the shaft, she said.

AFF may occur in patients with osteoporosis even in the absence of bisphosphonate use, Dr. Bolster noted. However, AFF “may occur at increased frequency in those patients with osteoporosis and prolonged bisphosphonate use,” she said. AFF is rare overall, and known risk factors include Asian race (in North America), as well as femoral bowing and glucocorticoid use, she said.

A 2019 meta-analysis favored fracture prevention benefits over potential risk associated with bisphosphonate use. Predicting the risk of AFF remains difficult given several factors, including the low incidence of AFF, the unavailability of radiographs in all studies, not accounting for potential confounding by indication in some studies, and lack of adjustment for low bone mineral density or fracture risk, she added.

Osteonecrosis of the jaw has been linked to bisphosphonate use, and some patients ask about it, Dr. Bolster said. Current data show an incidence of 1 in 10,000 to 1 in 100,000 in patients with osteoporosis, while the incidence in the general population is 1 in 100,000, she noted. The highest risk is associated with use of IV bisphosphonates, although it does occur in patients on oral bisphosphonates and denosumab (Prolia), she added. Given the relatively low risk, the American Dental Association states that there is “no need to discontinue bisphosphonates prior to procedures.” Based on current evidence, bisphosphonate treatment outweighs the low risk of medication-related osteonecrosis of the jaw in patients in need of osteoporosis treatment because of the high risk of fragility fractures in the osteoporosis population, she emphasized.
 

When will I need another dual x-ray absorptiometry scan?

Osteoporosis develops in fewer than 10% of older postmenopausal women using a 15-year screening interval for those with normal bone mineral density or mild osteopenia at an initial scan, with T-scores of –1.49 or higher, she noted. Therefore, the need for repeat dual x-ray absorptiometry (DXA) scans should be individualized, so some patients with normal bone density or osteopenia and few comorbidities and risk factors for osteoporosis may not need frequent DXA scans, she added.

Although little evidence exists to specifically demonstrate the value of monitoring bone mineral density during a 5-year drug treatment period, as is noted by the American College of Physicians 2017 clinical practice guideline published in Annals of Internal Medicine, Dr. Bolster said that a DXA scan showing loss of bone mineral density during treatment could indicate incorrect drug use or noncompliance, or a secondary cause for bone loss that may otherwise go unnoticed. For IV zoledronic acid in particular, a DXA scan at 3-4 years can determine whether a drug holiday is warranted, or for patients with severe osteoporosis, whether another 3 years of treatment is necessary. She suggested considering a DXA scan at 2-3 years with alendronate and at 3-4 years with IV zoledronic acid.

Will I need a new medication if I fracture while on treatment?

For patients who ask whether to change medications following a new fracture, Dr. Bolster said it is important to evaluate the patient’s compliance with the treatment regimen and also consider the presence of secondary causes of bone loss. Consideration can be given to keeping the patient on the same regimen because osteoporosis treatment regimens have demonstrated a 50%-70% fracture-risk reduction so they do not prevent all fractures, she said. “It is therefore reasonable, after confirming compliance and ruling out secondary causes of bone loss, to keep a patient on the same regimen following a fracture. For patients using denosumab, there is an increased risk of rapid bone loss and sustaining multiple vertebral fracture with missed doses or discontinuation,” she said.

It is important to evaluate patients who fracture while on therapy for secondary causes of bone loss, assess compliance, and consider strategies such as modifying the route of administration, seeking a different mechanism of action, or continuing on the same regimen, Dr. Bolster noted.

Dr. Bolster disclosed participation in clinical trials for Corbus, Cumberland, and Genentech, as well as research grants from the Rheumatology Research Foundation. She also disclosed serving on advisory boards for Gilead Sciences and Clinical Learning Designs, serving on the American College of Rheumatology’s Committee on Marketing and Communications, and holding investments in Johnson & Johnson.

Global Academy for Medical Education and this news organization are owned by the same parent company.