What was new in 2009?

November 2009

Update Subtrochanteric fractures. Still not finished, but here is more new information.

September 2009: ASBMR meeting

FRAX was still actively debated in a special session. The hip fracture rates in general for the US have been adjusted because the older rates were based on data from 2001 and the more current rates are about 40% lower for middle-aged women. Cummings reported that the efficacy of alendronate was not different according to the FRAX scores, although he also found that the FRAX scores significantly predicted fracture in the placebo arm of the FIT study. His results were in terms of relative risks and he did not present the data for absolute fracture reduction. I have totally revised my page about calculating fracture risk to keep up with these new ideas.

more news will be added soon. (as of January, I am still behind about this, trying to catch up!)

August 2009 Vertebroplasty : Is it worth it?

Buchbinder R. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med 2009;361(6):557-68.

Kallmes DF. A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med 2009;361(6):569-79.

These and several other studies this year suggest that vertebroplasty did not result in better pain control or quality of life when compared to a sham procedure. Other studies of kyphoplasty showed some greater pain relief in the first few months but the control patients healed their fractures and by a year there was no difference in quality of life.

Read more details and view a complicated case on the new page about vertebroplasty.

July 2009 How many people should we treat?

Donaldson MG. Estimates of the proportion of older white women who would be recommended for pharmacologic treatment by the new U.S. National Osteoporosis Foundation Guidelines. J Bone Miner Res 2009;24(4):675-80.

This study shows that the current guidelines from the National Osteoporosis Foundation would recommend treatment with medications for 93% of U.S. Caucasian women older than 75 years, and for 72% of those older than 65. Should all these women be taking osteoporosis drugs? Check the newly revised page about the fracture risk calculator for comparison with recommendations for the UK and details about absolute risk of fractures.

June 2009 New studies about teriparatide

Dobnig H. Teriparatide Reduces Bone Microdamage Accumulation in Postmenopausal Women Previously Treated with Alendronate. J Bone Miner Res 2009.

This biopsy study from patients who had been taking alendronate showed that microcracks improved after a course of treatment with teriparatide. The baseline level of microcrack was higher than in patients who had not taken alendronate, but this did not reach statistical significance. The paper is important because it suggests that prior treatment with alendronate does not cause permanent inhibition of bone formation.

Finkelstein JS. Effects of teriparatide re-treatment in osteoporotic men and women. J Clin Endocrinol Metab 2009.

In this study, retreatment after waiting a year did not stimulate bone formation very much. The response was much less than the original anabolic response. The reason is not known, but it was not due to antibody production. Therefore, at this time retreatment is not advised.

Eastell R. Sequential treatment of severe postmenopausal osteoporosis after teriparatide: final results of the randomized, controlled European Study of Forsteo (EUROFORS). J Bone Miner Res 2009;24(4):726-36.

On the other hand, it is important to follow a course of teriparatide with an antiresorbing medication. This study showed benefits of raloxifene, and others have shown similar results with bisphosphonates. But in all the studies, the bone density drops if nothing is done.

Updates Major update to the page about teriparatide.

March 2009

Updates Minor updates of vitamin D page
Minor update of page about SSRIs

I've been working a lot on the KDIGO report which is almost ready for public release. Stay tuned for discussion of treating patients with kidney diseases.

January 2009

Update The FRAX calculator is using bone density in g/cm2 instead of T-scores, which will eliminate confusion and errors from T-scores. See page about Fracture Risk calculator


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