Bone diseases

Delaying denosumab injections by more than 16 weeks is associated with an increased risk for vertebral fracture among patients with osteoporosis, study findings indicate.

Romosozumab and other sclerostin inhibitors may increase cardiovascular risk, suggests evidence from a meta-analysis of randomized trials and a study of genetic variants that mimic pharmacologic inhibition of sclerostin.

Findings from a meta-analysis published in JAMA Internal Medicine indicate that drug treatments for osteoporosis, particularly bisphosphonates, are not associated with a significant reduction in overall mortality risk.

Patients with early rheumatoid arthritis who are treated with the interleukin-6 receptor inhibitor tocilizumab experience more pronounced repair of bone erosions than those given adalimumab plus methotrexate, indicate findings from the REBONE study.

US research shows that the use of opioids, selective serotonin reuptake inhibitors, or glucocorticoids may increase the risk for all types of osteoporotic fracture in patients with rheumatoid arthritis.

Findings from a systematic review suggest that long-term drug treatment is associated with a reduction in fracture risk among women with osteoporosis, with different agents having varying long-term safety profiles.

Editorial board member Oliver FitzGerald presents a family with two siblings having features consistent with angel-shaped phalango-epiphyseal dysplasia (ASPED), and a mother with a normal phenotype but with severe, early-onset multi-joint osteoarthritis.

Malachi McKenna explains the risks of long-term bisphosphonate therapy in patients with osteoporosis, and the rationale for a drug holiday. He also compares bisphosphonates with denosumab, and explains why denosumab should not be followed by a drug holiday.

Treatment with zoledronate once every 18 months significantly reduces the risk for nonvertebral or vertebral fragility fractures, compared with placebo, in postmenopausal women with osteopenia, study findings indicate.

Hussain S et al. Rheumatol Int 2018. doi: 10.1007/s00296-018-4142-x

The authors present a rare case of sporadic chronic recurrent multifocal osteomyelitis in which the patient eventually developed cytoplasmic anti-neutrophil cytoplasmic antibodies-associated renal vasculitis and hyperparathyroidism.

Snipaitiene A et al. Pediatr Rheumatol 2018; 16: 49. doi: 10.1186/s12969-018-0267-4

Liu J et al. Osteoporos Int 2018. doi: 10.1007/s00198-018-4630-6

The aim of this review is to provide healthcare professionals with evidence-based physical activity recommendations, and tips for implementing them in practice.

Ponzano M, Rodrigues IB, Giangregorio LM. Curr Treat Options in Rheum 2018. doi: 10.1007/s40674-018-0103-5

Editorial board member Sangeeta Sule discusses the causes of low bone mineral density and osteoporosis in pediatric patients with rheumatic diseases, and suggests strategies for risk prevention and treatment of this disease.

Advisory board member and consultant endocrinologist Malachi McKenna summarizes the use of dual-energy X-ray absorptiometry in monitoring bone health and diagnosing low bone mineral mass in children.

This summary of systematic reviews and meta-analyses addresses the benefits and risks of dietary protein intakes for bone health in adults.

Rizzoli R et al. Osteoporos Int 2018; Advance online publication. doi: 10.1007/s00198-018-4534-5

Patients with glucocorticoid-induced osteoporosis who are treated with denosumab have greater improvements in bone mineral density than those treated with risedronate, phase III trial results suggest.

The authors report the case of a 24-year-old woman diagnosed with glucocorticoid-induced osteoporosis in which initial treatment with teriparatide followed by treatment of kyphosis with correction fusion achieved a favorable outcome.

Uei H et al. Osteoporos Int 2018; Advance online publication. doi: 10.1007/s00198-018-4425-9

This case report describes a 38-year-old woman, who presented with bilateral femoral stress fractures and osteoporosis after years of excessive levothyroxine treatment. How would you respond when presented with such a patient?

Laine CM, K. Landin-Wilhelmsen K. Osteoporos Int 2017; 28: 2247–2250. doi:10.1007/s00198-017-3981-8