Osteoporosis treatment and the older patient

2011 ◽  
Vol 21 (3) ◽  
pp. 233-245
Author(s):  
Roger H Jay ◽  
Sarah L Marrinan
Keyword(s):  
Older People ◽  
Population Group ◽  
Osteoporosis Treatment ◽  
Fracture Prevention ◽  
Assessment Tools ◽  
Mineral Density ◽  
Older Patient ◽  
Treatment Of Osteoporosis ◽  
Risk Assessment Tools ◽  
Proven Benefit

SummaryOsteoporosis is a common, chronic condition. Fracture risk assessment tools are increasingly being used to identify those patients who may benefit from treatment, but in older patients clinical judgement is still essential in deciding whom to treat. The treatment of osteoporosis in older people has seen several important developments in recent years. Whilst bisphosphonates are the mainstay of treatment, several newer medications have proven benefit in terms of increases in bone mineral density and fracture prevention. Additionally, some of the newer therapies have characteristics that particularly lend themselves to use in an older population group. This article focuses upon treatment of osteoporosis in older people with an emphasis on newer drug and therapeutic options.

scholarly journals The Effects of Trends in Osteoporosis Treatment on the Incidence of Fractures

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Akira Horikawa ◽  
Naohisa Miyakoshi ◽  
Michio Hongo ◽  
Yuji Kasukawa ◽  
Yoichi Shimada ◽  
...  
Keyword(s):  
Assessment Tool ◽  
Osteoporosis Treatment ◽  
Fracture Prevention ◽  
Mineral Density ◽  
Awareness Campaign ◽  
Subcutaneous Injections ◽  
Oral Medications ◽  
Number Of Patients ◽  
Fracture Assessment ◽  
Hospital Registry

Summary. We analyzed the data about the preferences of medication and incidence of fractures between osteoporosis patients from 2012 to 2016. Our results suggested that the number of patients treated with intravenous and subcutaneous injections increased and the incidence of fracture was lower in intravenous and subcutaneous injections than oral medications. Objective. This study focused on the trends in antiosteoporosis drug preferences and compared the incidence of fractures between patients treated orally and those who were exposed to an awareness campaign and assigned to intravenous/subcutaneous treatment. Methods. Our hospital registry included 1,716 osteoporotic women who were over 65 years of age without preexisting vertebral and nonvertebral fractures over 1 year before this study, with bone mineral density (BMD) < −2.5 standard deviation (SD) and fracture assessment tool (FRAX) score > 20%, who were given 1,337 oral and 379 intravenous/subcutaneous prescriptions to treat their osteoporosis. Self-administered surveys (2012, 2013, 2014, 2015, and 2016) collected data on trends of preferences among nine drugs and fracture prevention using relative risk reduction (RRR). Results. The number of patients taking oral prescriptions decreased gradually from 2012 to 2016, while the number of patients treated with intravenous and subcutaneous injections increased. The incidence of fracture was lower in patients receiving intravenous and subcutaneous injections than in patients taking oral medications. Conclusion. These findings indicate a decrease in oral prescriptions for osteoporosis treatment and that treatment for osteoporosis using intravenous or subcutaneous injections of antiosteoporosis drugs is more effective for preventing fractures.

scholarly journals Practical and validated tool to assess falls risk in the primary care setting: a systematic review

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e045431
Author(s):  
Wytske MA Meekes ◽  
Joke C Korevaar ◽  
Chantal J Leemrijse ◽  
Ien AM van de Goor
Keyword(s):  
Systematic Review ◽  
Risk Assessment ◽  
Primary Care ◽  
Older People ◽  
Care Setting ◽  
Primary Care Setting ◽  
Predictive Performance ◽  
Assessment Tools ◽  
Falls Risk ◽  
Risk Assessment Tools

ObjectiveAlthough several falls risk assessment tools are available, it is unclear which have been validated and which would be most suitable for primary care practices. This systematic review aims to identify the most suitable falls risk assessment tool for the primary care setting (ie, requires limited time, no expensive equipment and no additional space) and that has good predictive performance in the assessment of falls risk among older people living independently.DesignA systematic review based on prospective studies.MethodsAn extensive search was conducted in the following databases: PubMed, Embase, CINAHL, Cochrane and PsycINFO. Tools were excluded if they required expensive and/or advanced software that is not usually available in primary care units and if they had not been validated in at least three different studies. Of 2492 articles published between January 2000 and July 2020, 27 were included.ResultsSix falls risk assessment tools were identified: Timed Up and Go (TUG) test, Gait Speed test, Berg Balance Scale, Performance Oriented Mobility Assessment, Functional Reach test and falls history. Most articles reported area under the curve (AUC) values ranging from 0.5 to 0.7 for these tools. Sensitivity and specificity varied substantially across studies (eg, TUG, sensitivity:10%–83.3%, specificity:28.4%–96.6%).ConclusionsGiven that none of the falls risk assessment tools had sufficient predictive performance (AUC <0.7), other ways of assessing high falls risk among independently living older people in primary care should be investigated. For now, the most suitable way to assess falls risk in the primary care setting appears to involve asking patients about their falls history. Compared with the other five tools, the falls history requires the least amount of time, no expensive equipment, no training and no spatial adjustments. The clinical judgement of healthcare professionals continues to be most important, as it enables the identification of high falls risk even for patients with no falls history.Trial registraion numberThe Netherlands Trial Register, NL7917; Pre-results.

Parathyroid Hormone (1–84) and Treatment of Osteoporosis

2005 ◽  
Vol 39 (9) ◽  
pp. 1511-1516 ◽  
Author(s):  
Sarah P Shrader ◽  
Kelly R Ragucci
Keyword(s):  
Parathyroid Hormone ◽  
Subcutaneous Injection ◽  
Data Extraction ◽  
Treatment Options ◽  
Osteoporosis Treatment ◽  
Treatment Modalities ◽  
Mineral Density ◽  
Treatment Of Osteoporosis ◽  
Medline Search ◽  
Dosing Strategies

OBJECTIVE: To present the chemistry, pharmacology, and pharmacokinetics of parathyroid hormone (PTH) (1-84%) and review the available clinical trials that evaluate its efficacy and safety; clinical applicability of this agent and its relationship to other Food and Drug Administration (FDA)–approved medications for treatment of osteoporosis are also discussed. DATA SOURCES: A MEDLINE search (1996–December 2004%) was completed, along with a review of information obtained from the manufacturer, NPS Pharmaceuticals. Key search terms included parathyroid hormone, PTH (1–84%), and ALX 111. STUDY SELECTION AND DATA EXTRACTION: Studies were selected based on their relevance and availability. Pertinent information, including objectives, design, demographics, outcomes, adverse events, dosing strategies, and therapeutic controversies, was extracted. DATA SYNTHESIS: PTH (1-84%) is being developed for treatment of osteoporosis. Recent studies have shown that, when administered intermittently as a subcutaneous injection, PTH (1-84%) produces an increase in bone mineral density and prevents vertebral fractures. The fact that this agent contains the C-terminal region of PTH may differentiate it from PTH (1-34%), teriparatide, which is approved by the FDA for treatment of osteoporosis. Further trials are necessary to determine the role of PTH (1-84%) in combination with other treatments for osteoporosis and/or the order in which PTH (1-84%) is given with these other agents. There are currently no comparative trials with other osteoporosis treatment modalities. CONCLUSIONS: PTH (1-84%), when given intermittently as a subcutaneous injection, appears to be a safe and efficacious treatment option for osteoporosis. Further trials are needed to determine its specific place in therapy compared with other treatment options.

scholarly journals 3159 Bone Turnover Biomarkers May Discriminate Low Bone Mineral Density in HIV-Infected Adults

2019 ◽  
Vol 3 (s1) ◽  
pp. 36-36
Author(s):  
Lauren Frances Collins ◽  
Anandi Sheth ◽  
Caitlin Moran ◽  
Laura Ward ◽  
Kehmia Titanji ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Risk Assessment ◽  
Bone Turnover ◽  
Bone Mineral ◽  
Assessment Tools ◽  
Hiv Status ◽  
Mineral Density ◽  
Low Bone Mineral Density ◽  
Risk Assessment Tools ◽  
Bone Turnover Biomarkers

OBJECTIVES/SPECIFIC AIMS: Persons living with HIV (PLWH) are at increased risk for fragility bone disease. Current osteoporosis screening guidelines do not account for HIV status, and clinical risk assessment tools are not sensitive in PLWH. We examined the value of traditional osteoporosis risk factors, HIV-specific indices, and bone turnover biomarkers in predicting low bone mineral density (BMD) in PLWH. METHODS/STUDY POPULATION: Demographic and clinical characteristics, dual energy x-ray absorptiometry (DXA)-derived BMD, HIV indices (viral load, CD4 count, antiretroviral therapy [ART]), and biomarkers of bone turnover (C-terminal telopeptide of collagen [CTx], osteocalcin [OCN]) were evaluated in a cross-sectional analysis of PLWH (n=248) and HIV- controls (n=183). The primary outcome was low BMD, defined as osteopenia or osteoporosis by WHO criteria. Multivariable logistic and modified Poisson regression models were used to assess associations between low BMD and covariates of interest. RESULTS/ANTICIPATED RESULTS: Overall, median age was 44 years, 48% were male, 88% were black, median body mass index (BMI) was 28 kg/m2, 72% smoked cigarettes, and 53% used alcohol; characteristics did not differ by HIV status. PLWH had a mean CD4 of 408 cells/mm3, 55% were ART-naïve, and 45% had viral suppression on ART. Overall, 25% (109/431) had low BMD, including 31% of PLWH compared to 16% of HIV- controls. In multivariable models, HIV was significantly associated with low BMD (aOR 2.46, 95%CI 1.39-4.34; aRR 1.90, 95%CI 1.18-3.07). Adjusting for HIV, three traditional risks– age, race, and BMI– were independently associated with low BMD in the full cohort. However, bone turnover markers, CTx and OCN, were better able to discriminate low vs. normal BMD in PLWH compared to HIV- controls. In PLWH, mean serum CTx was 23% higher in low vs. normal BMD (mean CTx difference=0.06 ug/mL); in HIV- controls, no association with BMD was observed (mean CTx difference=0 ug/mL). In PLWH, mean serum OCN was 38% higher in those with low vs. normal BMD (mean OCN difference=2.48 ug/mL); in HIV- controls, mean serum OCN was only 16% higher in those with low vs. normal BMD (mean OCN difference=1.08 ug/mL). DISCUSSION/SIGNIFICANCE OF IMPACT: In PLWH as opposed to HIV- controls, serum biomarkers reflecting a high bone turnover state, may discriminate individuals with low versus normal BMD. Because changes in biomarkers precede changes in BMD, these markers should be explored further either alone or in combination with traditional risk assessment tools to improve early screening for osteoporosis in PLWH.

scholarly journals SYMPOSIUM PRESS RELEASE “KEY FACTORS OF SUCCESSIN THE TREATMENT OF OSTEOPOROSIS. TREATMENT TO THE GOAL. ’’held at the VIII All-Russian Congress of Osteoporosis in Kazan, September 10, 2016

2016 ◽  
Vol 19 (3) ◽  
pp. 41-45
Author(s):  
Keyword(s):  
Metabolic Diseases ◽  
Systemic Disease ◽  
Osteoporosis Treatment ◽  
Fracture Prevention ◽  
Satellite Symposium ◽  
Low Bone Mass ◽  
Key Factors ◽  
Treatment Of Osteoporosis ◽  
Antiresorptive Agents ◽  
Increased Risk

Osteoporosis - is a systemic disease characterized by low bone mass, microarchitectural violation of its structure that leads to an increased risk of fractures. Currently, the method of finding the optimal therapy for osteoporosisis given special attention. In Kazan, September 9, 2016 in the framework of the Russian Congress on Osteoporosis, osteoarthritis and other metabolic diseases of the skeleton was heldAmgen satellite symposium. The event included reports of Russian and foreign experts, dedicated to practical issues of the treatment of osteoporosis and fracture prevention with the particular emphaseson the benefits of using modern antiresorptive agents.

IMPACT ASSESSMENT ON STORM SURGE RISKS TO CONTAINERS CONSIDERING GLOBAL WARMING

2017 ◽  
Author(s):  
Rikito Hisamatsu ◽  
Rikito Hisamatsu ◽  
Kei Horie ◽  
Kei Horie
Keyword(s):  
Risk Assessment ◽  
Global Warming ◽  
Storm Surge ◽  
Storm Surges ◽  
Assessment Tools ◽  
Inundation Depth ◽  
Risk Assessment Tools ◽  
Risk Maps ◽  
The Impact ◽  
Vulnerability Functions

Container yards tend to be located along waterfronts that are exposed to high risk of storm surges. However, risk assessment tools such as vulnerability functions and risk maps for containers have not been sufficiently developed. In addition, damage due to storm surges is expected to increase owing to global warming. This paper aims to assess storm surge impact due to global warming for containers located at three major bays in Japan. First, we developed vulnerability functions for containers against storm surges using an engineering approach. Second, we simulated storm surges at three major bays using the SuWAT model and taking global warming into account. Finally, we developed storm surge risk maps for containers based on current and future situations using the vulnerability function and simulated inundation depth. As a result, we revealed the impact of global warming on storm surge risks for containers quantitatively.

scholarly journals The Benefits of Risk Assessment Tools for Prostate Cancer

2012 ◽  
Vol 61 (4) ◽  
pp. 662-663 ◽  
Author(s):  
Ian M. Thompson ◽  
Donna P. Ankerst
Keyword(s):  
Prostate Cancer ◽  
Risk Assessment ◽  
Assessment Tools ◽  
Risk Assessment Tools
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