Skip to main content
Top

07-04-2017 | Osteoporosis | Review | Article

Osteoporosis: a discussion on the past 5 years

Journal: Current Reviews in Musculoskeletal Medicine

Authors: Kyle M. Schweser, Brett D. Crist

Publisher: Springer US

Abstract

Purpose of the review

The purposes of this study are to examine the literature within the past 5 years regarding osteoporosis and offer a discussion on new topics and controversies.

Recent findings

  • Patient compliance with therapy remains an issue.
  • The effectiveness of Vitamin D and calcium are being called into question
  • Atypical femur fractures have been associated with bisphosphonate and denosumab use. Treatment is both surgical and pharmaceutical.
  • A multidisciplinary approach to osteoporotic fractures is important and having some form of fracture liaison service (FLS) improves the efficacy of osteoporotic care and decreases secondary fractures.
  • Screening for osteoporosis remains low.
  • Ultrasound may be cost-effective for diagnosis.

Summary

Understanding of osteoporosis has come a long way in the medical community, but the translation to the lay community has lagged behind. Patients often take a laissez-faire attitude toward osteoporosis that can affect compliance. Information read by patients often focuses on complications, such as atypical femur fractures and myocardial infarctions. It is essential for providers to be able to discuss these issues with patients. Newer medications and more cost-effective diagnostic tests exist, but availability may be limited. FLS are effective, but the most cost-effective model for therapy still eludes us. Areas for further investigation include FLS models, the effectiveness of vitamin supplementation, and more ubiquitous and cost-effective diagnostic tools.
Literature
1.
Tosi LL, Gliklich R, Kannan K, Koval KJ. The American Orthopaedic Association’s “own the bone” initiative to prevent secondary fractures. J Bone Joint Surg Am. 2008;90(1):163–73. doi:10.​2106/​jbjs.​g.​00682.CrossRefPubMed
2.
FRAX. University of Sheffield. http://​www.​shef.​ac.​uk/​FRAX/​.
3.
Anagnostis P, Karras SN. Compliance with osteoporosis medications—an underestimated determinant of anti-fracture efficacy. Curr Med Res Opin. 2015;31(5):1015–6. doi:10.​1185/​03007995.​2015.​1027186.CrossRefPubMed
4.
Arora VM, Prochaska ML, Farnan JM, D’Arcy MJ, Schwanz KJ, Vinci LM, et al. Problems after discharge and understanding of communication with their primary care physicians among hospitalized seniors: a mixed methods study. J Hosp Med. 2010;5(7):385–91. doi:10.​1002/​jhm.​668.CrossRefPubMedPubMedCentral
5.
Khosla S, Shane E. A crisis in the treatment of osteoporosis. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. 2016;31(8):1485–7. doi:10.​1002/​jbmr.​2888.CrossRef
6.
Sujic R, Gignac MA, Cockerill R, Beaton DE. Factors predictive of the perceived osteoporosis-fracture link in fragility fracture patients. Maturitas. 2013;76(2):179–84. doi:10.​1016/​j.​maturitas.​2013.​07.​014.CrossRefPubMed
7.
Majumdar SR, McAlister FA, Johnson JA, Weir DL, Bellerose D, Hanley DA, et al. Critical impact of patient knowledge and bone density testing on starting osteoporosis treatment after fragility fracture: secondary analyses from two controlled trials. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2014;25(9):2173–9. doi:10.​1007/​s00198-014-2728-z.CrossRef
8.
Curtis JR, Cai Q, Wade SW, Stolshek BS, Adams JL, Balasubramanian A, et al. Osteoporosis medication adherence: physician perceptions vs. patients utilization. Bone. 2013;55(1):1–6. doi:10.​1016/​j.​bone.​2013.​03.​003.CrossRefPubMedPubMedCentral
9.
Smith T, Pelpola K, Ball M, Ong A, Myint PK. Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis. Age Ageing. 2014;43(4):464–71. doi:10.​1093/​ageing/​afu065.CrossRefPubMed
10.
Kannegaard PN, van der Mark S, Eiken P, Abrahamsen B. Excess mortality in men compared with women following a hip fracture. National analysis of comedications, comorbidity and survival. Age Ageing. 2010;39(2):203–9. doi:10.​1093/​ageing/​afp221.CrossRefPubMed
11.
Ikeda S. Hip fracture—epidemiology, management and liaison service. Practice of the secondary fracture prevention of the proximal femoral fracture by the osteoporosis liaison service. Clinical calcium. 2015;25(4):551–8.PubMed
12.
Sale JE, Beaton D, Bogoch E. Secondary prevention after an osteoporosis-related fracture: an overview. Clin Geriatr Med. 2014;30(2):317–32. doi:10.​1016/​j.​cger.​2014.​01.​009.CrossRefPubMed
13.
Eisman JA, Bogoch ER, Dell R, Harrington JT, McKinney Jr RE, McLellan A, et al. Making the first fracture the last fracture: ASBMR task force report on secondary fracture prevention. J Bone Miner Res Off J Am Soc Bone Miner Res. 2012;27(10):2039–46. doi:10.​1002/​jbmr.​1698.CrossRef
14.
Maningat P, Gordon BR, Breslow JL. How do we improve patient compliance and adherence to long-term statin therapy? Current atherosclerosis reports. 2013;15(1):291. doi:10.​1007/​s11883-012-0291-7.CrossRefPubMedPubMedCentral
15.
Jha S, Wang Z, Laucis N, Bhattacharyya T. Trends in media reports, oral bisphosphonate prescriptions, and hip fractures 1996-2012: an ecological analysis. J Bone Miner Res Off J Am Soc Bone Miner Res. 2015;30(12):2179–87. doi:10.​1002/​jbmr.​2565.CrossRef
16.
• Kim SC, Kim DH, Mogun H, Eddings W, Polinski JM, Franklin JM, et al. Impact of the U.S. Food and Drug Administration’s safety-related announcements on the use of bisphosphonates after hip fracture. J Bone Miner Res Off J Am Soc Bone Miner Res. 2016;31(8):1536–40. doi:10.​1002/​jbmr.​2832. Bisphosphonate use after a hip fracture declined from 15% to 3% (2004-2013) and bisphosphonate use, but not other osteoporotic meciation, was negatively affected by FDA announcements regarding side effects. CrossRef
17.
Gambacciani M, Levancini M. Management of postmenopausal osteoporosis and the prevention of fractures. Panminerva Med. 2014;56(2):115–31.PubMed
18.
Lee S, Yin RV, Hirpara H, Lee NC, Lee A, Llanos S, et al. Increased risk for atypical fractures associated with bisphosphonate use. Fam Pract. 2015;32(3):276–81. doi:10.​1093/​fampra/​cmu088.CrossRefPubMed
19.
Donnelly E, Saleh A, Unnanuntana A, Lane JM. Atypical femoral fractures: epidemiology, etiology, and patient management. Current opinion in supportive and palliative care. 2012;6(3):348–54. doi:10.​1097/​SPC.​0b013e3283552d7d​.CrossRefPubMedPubMedCentral
20.
Philipp LM. Osteoporosis and pathologic bone. In: Ricci WM, Ostrum RF, editors. Orthopaedic. Knowledge Update: Trauma; 2016.
21.
Molvik H, Khan W. Bisphosphonates and their influence on fracture healing: a systematic review. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2015;26(4):1251–60. doi:10.​1007/​s00198-014-3007-8.CrossRef
22.
Yue B, Ng A, Tang H, Joseph S, Richardson M. Delayed healing of lower limb fractures with bisphosphonate therapy. Ann R Coll Surg Engl. 2015;97(5):333–8. doi:10.​1308/​003588415x141812​54789321.CrossRefPubMedPubMedCentral
23.
Bhadada SK, Sridhar S, Muthukrishnan J, Mithal A, Sharma DC, Bhansali A, et al. Predictors of atypical femoral fractures during long term bisphosphonate therapy: a case series & review of literature. Indian J Med Res. 2014;140(1):46–54.PubMedPubMedCentral
24.
Fukuda F, Kurinomaru N, Hijioka A. Weekly teriparatide for delayed unions of atypical Subtrochanteric femur fractures. Biol Ther. 2014;4(1–2):73–9. doi:10.​1007/​s13554-014-0013-5.CrossRefPubMedPubMedCentral
25.
Im GI, Lee SH, et al. Journal of bone metabolism. 2015;22(4):183–9. doi:10.​11005/​jbm.​2015.​22.​4.​183.CrossRefPubMedPubMedCentral
26.
Miyakoshi N, Aizawa T, Sasaki S, Ando S, Maekawa S, Aonuma H, et al. Healing of bisphosphonate-associated atypical femoral fractures in patients with osteoporosis: a comparison between treatment with and without teriparatide. J Bone Miner Metab. 2015;33(5):553–9. doi:10.​1007/​s00774-014-0617-3.CrossRefPubMed
27.
• Adler RA, El-Hajj Fuleihan G, Bauer DC, Camacho PM, Clarke BL, Clines GA, et al. Managing osteoporosis in patients on long-term bisphosphonate treatment: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res Off J Am Soc Bone Miner Res. 2016;31(1):16–35. doi:10.​1002/​jbmr.​2708. Management of long term bisphosphonate use should include drug holidays after 3-5 years of continuous use depending on the mode of administration. CrossRef
28.
• Gedmintas L, Solomon DH, Kim SC. Bisphosphonates and risk of subtrochanteric, femoral shaft, and atypical femur fracture: a systematic review and meta-analysis. J Bone Miner Res Off J Am Soc Bone Miner Res. 2013;28(8):1729–37. doi:10.​1002/​jbmr.​1893. Meta-analysis providing a link between atypical femur fractures and long term bisphosphonate use. CrossRef
29.
Egol KA, Park JH, Rosenberg ZS, Peck V, Tejwani NC. Healing delayed but generally reliable after bisphosphonate-associated complete femur fractures treated with IM nails. Clin Orthop Relat Res. 2014;472(9):2728–34. doi:10.​1007/​s11999-013-2963-1.CrossRefPubMed
30.
• Miller AN, Lake AF, Emory CL. Establishing a fracture liaison service: an orthopaedic approach. J Bone Joint Surg Am. 2015;97(8):675–81. doi:10.​2106/​jbjs.​n.​00957. Fracture Liaison Services are an important aspect of osteoporosis management with proven benefits to the patient. Article provides a potential model for success involving a coordinator, physician champion (supports an orthopaedic surgeon), and a nurse navigator. CrossRefPubMed
31.
Beaton DE, Sujic R, McIlroy Beaton K, Sale J, Elliot-Gibson V, Bogoch ER. Patient perceptions of the path to osteoporosis care following a fragility fracture. Qual Health Res. 2012;22(12):1647–58. doi:10.​1177/​1049732312457467​.CrossRefPubMed
32.
Ruggiero C, Zampi E, Rinonapoli G, Baroni M, Serra R, Zengarini E, et al. Fracture prevention service to bridge the osteoporosis care gap. Clin Interv Aging. 2015;10:1035–42. doi:10.​2147/​cia.​s76695.PubMedPubMedCentral
33.
Judge A, Javaid MK, Leal J, Hawley S, Drew S, Sheard S et al. Health Services and Delivery Research. Models of care for the delivery of secondary fracture prevention after hip fracture: a health service cost, clinical outcomes and cost-effectiveness study within a region of England. Southampton (UK): NIHR Journals Library Copyright (c) Queen’s Printer and Controller of HMSO 2016. This work was produced by Judge et al. under the terms of a commissioning contract issued by the Secretary of State for Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.; 2016.
34.
Ozalp B, Aspray TJ. Orthogeriatric medicine and fracture liaison going from strength to strength. Age Ageing. 2016;45(2):180–1. doi:10.​1093/​ageing/​afw008.CrossRefPubMed
35.
Huntjens KM, van Geel TA, van den Bergh JP, van Helden S, Willems P, Winkens B, et al. Fracture liaison service: impact on subsequent nonvertebral fracture incidence and mortality. J Bone Joint Surg Am. 2014;96(4):e29. doi:10.​2106/​jbjs.​l.​00223.CrossRefPubMed
36.
Aizer J, Bolster MB. Fracture liaison services: promoting enhanced bone health care. Curr Rheumatol Rep. 2014;16(11):455. doi:10.​1007/​s11926-014-0455-2.CrossRefPubMed
37.
Eekman DA, van Helden SH, Huisman AM, Verhaar HJ, Bultink IE, Geusens PP, et al. Optimizing fracture prevention: the fracture liaison service, an observational study. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2014;25(2):701–9. doi:10.​1007/​s00198-013-2481-8.CrossRef
38.
Yates CJ, Chauchard MA, Liew D, Bucknill A, Wark JD. Bridging the osteoporosis treatment gap: performance and cost-effectiveness of a fracture liaison service. Journal of clinical densitometry: the official journal of the International Society for Clinical Densitometry. 2015;18(2):150–6. doi:10.​1016/​j.​jocd.​2015.​01.​003.CrossRef
39.
Fraser M. Using nurse-led liaison to prevent further fractures. Nurs Times. 2014;110(27):12–4.PubMed
40.
Yong JH, Masucci L, Hoch JS, Sujic R, Beaton D. Cost-effectiveness of a fracture liaison service—a real-world evaluation after 6 years of service provision. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2016;27(1):231–40. doi:10.​1007/​s00198-015-3280-1.CrossRef
41.
Henderson CY, Shanahan E, Butler A, Lenehan B, O’Connor M, Lyons D, et al. Dedicated orthogeriatric service reduces hip fracture mortality. Ir J Med Sci. 2016; doi:10.​1007/​s11845-016-1453-3.PubMed
42.
Wyller TB, Watne LO, Torbergsen A, Engedal K, Frihagen F, Juliebo V, et al. The effect of a pre- and post-operative orthogeriatric service on cognitive function in patients with hip fracture. The protocol of the Oslo Orthogeriatrics Trial BMC geriatrics. 2012;12:36. doi:10.​1186/​1471-2318-12-36.PubMed
43.
Grigoryan KV, Javedan H, Rudolph JL. Orthogeriatric care models and outcomes in hip fracture patients: a systematic review and meta-analysis. J Orthop Trauma. 2014;28(3):e49–55. doi:10.​1097/​BOT.​0b013e3182a5a045​.CrossRefPubMedPubMedCentral
44.
Leal J, Gray AM, Hawley S, Prieto-Alhambra D, Delmestri A, Arden NK, et al. Cost-effectiveness of Orthogeriatric and fracture liaison service models of Care for hip Fracture Patients: a population-based study. J Bone Miner Res Off J Am Soc Bone Miner Res. 2016; doi:10.​1002/​jbmr.​2995.
45.
Hawley S, Javaid MK, Prieto-Alhambra D, Lippett J, Sheard S, Arden NK, et al. Clinical effectiveness of orthogeriatric and fracture liaison service models of care for hip fracture patients: population-based longitudinal study. Age Ageing. 2016;45(2):236–42. doi:10.​1093/​ageing/​afv204.CrossRefPubMedPubMedCentral
46.
Giles M, Van Der Kallen J, Parker V, Cooper K, Gill K, Ross L, et al. A team approach: implementing a model of care for preventing osteoporosis related fractures. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2011;22(8):2321–8. doi:10.​1007/​s00198-010-1466-0.CrossRef
47.
Institute of Medicine Committee to Review Dietary Reference Intakes for Vitamin D, Calcium. The National Academies Collection: Reports funded by National Institutes of Health. In: Ross AC, Taylor CL, Yaktine AL, Del Valle HB, editors. Dietary Reference Intakes for Calcium and Vitamin D. Washington (DC): National Academies Press (US) National Academy of Sciences. 2011.
48.
Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, et al. Clinician’s guide to prevention and treatment of osteoporosis. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2014;25(10):2359–81. doi:10.​1007/​s00198-014-2794-2.CrossRef
49.
Pro-Risquez A, Harris SS, Song L, Rudicel S, Barnewolt B, Dawson-Hughes B. Calcium supplement and osteoporosis medication use in women and men with recent fractures. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2004;15(9):689–94. doi:10.​1007/​s00198-004-1668-4.CrossRef
50.
• Weaver CM, Alexander DD, Boushey CJ, Dawson-Hughes B, Lappe JM, LeBoff MS, et al. Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2016;27(1):367–76. doi:10.​1007/​s00198-015-3386-5. Meta-analysis supporting the continued use of both Calcium and Vitamin D supplemenation. CrossRef
51.
Harvey NC, Biver E, Kaufman JM, Bauer J, Branco J, Brandi ML, et al. The role of calcium supplementation in healthy musculoskeletal ageing : an expert consensus meeting of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the International Foundation for Osteoporosis (IOF). Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2016; doi:10.​1007/​s00198-016-3773-6.
52.
Reid IR. Should we prescribe calcium supplements for osteoporosis prevention? Journal of bone metabolism. 2014;21(1):21–8. doi:10.​11005/​jbm.​2014.​21.​1.​21.CrossRefPubMedPubMedCentral
53.
Cesareo R, Iozzino M, D’Onofrio L, Terrinoni I, Maddaloni E, Casini A, et al. Effectiveness and safety of calcium and vitamin D treatment for postmenopausal osteoporosis. Minerva Endocrinol. 2015;40(3):231–7.PubMed
54.
Tai V, Leung W, Grey A, Reid IR, Bolland MJ. Calcium intake and bone mineral density: systematic review and meta-analysis. BMJ (Clinical research ed). 2015;351:h4183. doi:10.​1136/​bmj.​h4183.
55.
Bolland MJ, Leung W, Tai V, Bastin S, Gamble GD, Grey A, et al. Calcium intake and risk of fracture: systematic review. BMJ (Clinical research ed). 2015;351:h4580. doi:10.​1136/​bmj.​h4580.
56.
Reid IR, Bristow SM, Bolland MJ. Calcium supplements: benefits and risks. J Intern Med. 2015;278(4):354–68. doi:10.​1111/​joim.​12394.CrossRefPubMed
57.
• Anderson J, Kruszka B, Delany J, He K, Burke G, Alonso A et al. Calcium Intake From Diet and Supplements and the Risk of Coronary Artery Calcification and its Progression Among Older Adults: 10-Year Follow-Up of the Multi-Ethnic Study of Atherosclerosis (MESA). Journal of the American Heart Association. 2016; 5(10). Significant link between calcium and atherosclerosis, but no link to MI.
58.
Raffield LM, Agarwal S, Hsu FC, de Boer IH, Ix JH, Siscovick D, et al. The association of calcium supplementation and incident cardiovascular events in the multi-ethnic study of atherosclerosis (MESA). Nutrition, metabolism, and cardiovascular diseases: NMCD. 2016;26(10):899–907. doi:10.​1016/​j.​numecd.​2016.​07.​007.CrossRefPubMed
59.
Avenell A, MacLennan GS, Jenkinson DJ, McPherson GC, McDonald AM, Pant PR, et al. Long-term follow-up for mortality and cancer in a randomized placebo-controlled trial of vitamin D(3) and/or calcium (RECORD trial). J Clin Endocrinol Metab. 2012;97(2):614–22. doi:10.​1210/​jc.​2011-1309.CrossRefPubMed
60.
Lewis JR, Calver J, Zhu K, Flicker L, Prince RL. Calcium supplementation and the risks of atherosclerotic vascular disease in older women: results of a 5-year RCT and a 4.5-year follow-up. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. 2011;26(1):35–41. doi:10.​1002/​jbmr.​176.CrossRef
61.
Chung M, Tang AM, Fu Z, Wang DD, Newberry SJ. Calcium intake and cardiovascular disease risk: an updated systematic review and meta-analysis. Ann Intern Med. 2016;165(12):856–66. doi:10.​7326/​m16-1165.CrossRefPubMed
62.
• Pesce N. Calcium supplements could give you a heart attack. New York Daily News. 2016. http://​www.​nydailynews.​com/​life-style/​health/​calcium-supplements-give-heart-attack-article-1.​2828098. Recent news article discussing the link between calcium and heart disease. A good representation of how medical research can be presented to the public.
63.
• Kopecky SL, Bauer DC, Gulati M, Nieves JW, Singer AJ, Toth PP, et al. Lack of evidence linking calcium with or without vitamin D supplementation to cardiovascular disease in generally healthy adults: a clinical guideline from the National Osteoporosis Foundation and the American Society for Preventive Cardiology. Ann Intern Med. 2016;165(12):867–8. doi:10.​7326/​m16-1743. Lack of evidence to link calcium supplementation to cardiovascular disease. CrossRefPubMed
64.
Karlsson L, Lundkvist J, Psachoulia E, Intorcia M, Strom O. Persistence with denosumab and persistence with oral bisphosphonates for the treatment of postmenopausal osteoporosis: a retrospective, observational study, and a meta-analysis. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2015;26(10):2401–11. doi:10.​1007/​s00198-015-3253-4.CrossRef
65.
van Boven JF, de Boer PT, Postma MJ, Vegter S. Persistence with osteoporosis medication among newly-treated osteoporotic patients. J Bone Miner Metab. 2013;31(5):562–70. doi:10.​1007/​s00774-013-0440-2.CrossRefPubMed
66.
Lee S, Glendenning P, Inderjeeth CA. Efficacy, side effects and route of administration are more important than frequency of dosing of anti-osteoporosis treatments in determining patient adherence: a critical review of published articles from 1970 to 2009. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2011;22(3):741–53. doi:10.​1007/​s00198-010-1335-x.CrossRef
67.
Kishimoto H, Maehara M. Compliance and persistence with daily, weekly, and monthly bisphosphonates for osteoporosis in Japan: analysis of data from the CISA. Arch Osteoporos. 2015;10:231. doi:10.​1007/​s11657-015-0231-6.CrossRefPubMed
68.
Devine J, Trice S, Finney Z, Yarger S, Nwokeji E, Linton A, et al. A retrospective analysis of extended-interval dosing and the impact on bisphosphonate compliance in the US military health system. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2012;23(4):1415–24. doi:10.​1007/​s00198-011-1729-4.CrossRef
69.
Kolata G. Osteoporosis, a disease with few treatment options. New York Times: May Soon Have One More; 2016.
71.
Chen YC, Sosnoski DM, Mastro AM. Breast cancer metastasis to the bone: mechanisms of bone loss. Breast cancer research: BCR. 2010;12(6):215. doi:10.​1186/​bcr2781.CrossRefPubMedPubMedCentral
72.
Isogai Y, Takao-Kawabata R, Takakura A, Sugimoto E, Nakazono O, Ikegaki I, et al. Early effects of single and low-frequency repeated administration of teriparatide, hPTH(1-34), on bone formation and resorption in ovariectomized rats. Calcif Tissue Int. 2015;97(4):412–20. doi:10.​1007/​s00223-015-0026-1.CrossRefPubMedPubMedCentral
73.
• Miller PD, Hattersley G, Riis BJ, Williams GC, Lau E, Russo LA, et al. Effect of abaloparatide vs placebo on new vertebral fractures in postmenopausal women with osteoporosis: a randomized clinical trial. JAMA. 2016;316(7):722–33. doi:10.​1001/​jama.​2016.​11136. Abaloparatide is a potentially new anabolic drug that could provide an alternative to teriparatide, and has been shown to be effective in preventing osteoporotic fractures. CrossRefPubMed
74.
Miller PD. A review of the efficacy and safety of denosumab in postmenopausal women with osteoporosis. Therapeutic advances in musculoskeletal disease. 2011;3(6):271–82. doi:10.​1177/​1759720x11424220​.CrossRefPubMedPubMedCentral
75.
Papapoulos S, Lippuner K, Roux C, Lin CJ, Kendler DL, Lewiecki EM, et al. The effect of 8 or 5 years of denosumab treatment in postmenopausal women with osteoporosis: results from the FREEDOM extension study. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2015;26(12):2773–83. doi:10.​1007/​s00198-015-3234-7.CrossRef
76.
Scott LJ. Denosumab: a review of its use in postmenopausal women with osteoporosis. Drugs Aging. 2014;31(7):555–76. doi:10.​1007/​s40266-014-0191-3.CrossRefPubMed
77.
Miller PD, Pannacciulli N, Brown JP, Czerwinski E, Nedergaard BS, Bolognese MA, et al. Denosumab or zoledronic acid in postmenopausal women with osteoporosis previously treated with oral bisphosphonates. J Clin Endocrinol Metab. 2016;101(8):3163–70. doi:10.​1210/​jc.​2016-1801.CrossRefPubMedPubMedCentral
78.
Sheedy KC, Camara MI, Camacho PM. Comparison of the efficacy, adverse effects, and cost of zoledronic acid and denosumab in the treatment of osteoporosis. Endocrine practice: official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2015;21(3):275–9. doi:10.​4158/​ep14106.​or.CrossRef
79.
• Zhou Z, Chen C, Zhang J, Ji X, Liu L, Zhang G, et al. Safety of denosumab in postmenopausal women with osteoporosis or low bone mineral density: a meta-analysis. Int J Clin Exp Pathol. 2014;7(5):2113–22. Denosumab significantly decreases the risk of non-vertebral osteoporotic fractures, but was associated with a higher rate of infection. PubMedPubMedCentral
80.
Bone HG, Chapurlat R, Brandi ML, Brown JP, Czerwinski E, Krieg MA, et al. The effect of three or six years of denosumab exposure in women with postmenopausal osteoporosis: results from the FREEDOM extension. J Clin Endocrinol Metab. 2013;98(11):4483–92. doi:10.​1210/​jc.​2013-1597.CrossRefPubMedPubMedCentral
81.
Katsarelis H, Shah NP, Dhariwal DK, Pazianas M. Infection and medication-related osteonecrosis of the jaw. J Dent Res. 2015;94(4):534–9. doi:10.​1177/​0022034515572021​.CrossRefPubMed
82.
Farooki A, Fornier M, Boland P. Atypical femur fractures associated with use of bisphosphonates and denosumab. Annals of oncology: official journal of the European Society for Medical Oncology. 2015;26(4):819–20. doi:10.​1093/​annonc/​mdv014.CrossRef
83.
Shane E, Burr D, Abrahamsen B, Adler RA, Brown TD, Cheung AM, et al. Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. 2014;29(1):1–23. doi:10.​1002/​jbmr.​1998.CrossRef
84.
Tsai JN, Uihlein AV, Lee H, Kumbhani R, Siwila-Sackman E, McKay EA, et al. Teriparatide and denosumab, alone or combined, in women with postmenopausal osteoporosis: the DATA study randomised trial. Lancet (London, England). 2013;382(9886):50–6. doi:10.​1016/​s0140-6736(13)60856-9.CrossRef
85.
Tsai JN, Uihlein AV, Burnett-Bowie SM, Neer RM, Derrico NP, Lee H, et al. Effects of two years of teriparatide, denosumab, or both on bone microarchitecture and strength (DATA-HRpQCT study). J Clin Endocrinol Metab. 2016;101(5):2023–30. doi:10.​1210/​jc.​2016-1160.CrossRefPubMedPubMedCentral
86.
Tsai JN, Uihlein AV, Burnett-Bowie SA, Neer RM, Zhu Y, Derrico N, et al. Comparative effects of teriparatide, denosumab, and combination therapy on peripheral compartmental bone density, microarchitecture, and estimated strength: the DATA-HRpQCT study. J Bone Miner Res Off J Am Soc Bone Miner Res. 2015;30(1):39–45. doi:10.​1002/​jbmr.​2315.CrossRef
87.
Bansal S, Pecina JL, Merry SP, Kennel KA, Maxson J, Quigg S, et al. US preventative services task force FRAX threshold has a low sensitivity to detect osteoporosis in women ages 50-64 years. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2015;26(4):1429–33. doi:10.​1007/​s00198-015-3026-0.CrossRef
88.
Kanis JA, Johansson H, Oden A, Cooper C, McCloskey EV. Worldwide uptake of FRAX. Arch Osteoporos. 2014;9:166. doi:10.​1007/​s11657-013-0166-8.CrossRefPubMed
89.
Gillespie CW, Morin PE. Trends and disparities in osteoporosis screening among women in the United States, 2008-2014: declines in utilization among women 50 to 64 years old and persistent underutilization among women 65 and older. Am J Med. 2016; doi:10.​1016/​j.​amjmed.​2016.​10.​018.PubMed
90.
Office of the Surgeon G. Reports of the Surgeon General. Bone Health and Osteoporosis: A Report of the Surgeon General. Rockville (MD): Office of the Surgeon General (US); 2004.
91.
Zheng J, Mao X, Ling J, He Q, Quan J, Jiang H. Association between serum level of magnesium and postmenopausal osteoporosis: a meta-analysis. Biol Trace Elem Res. 2014;159(1–3):8–14. doi:10.​1007/​s12011-014-9961-3.CrossRefPubMed
92.
Naylor KE, Jacques RM, Paggiosi M, Gossiel F, Peel NF, McCloskey EV, et al. Response of bone turnover markers to three oral bisphosphonate therapies in postmenopausal osteoporosis: the TRIO study. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2016;27(1):21–31. doi:10.​1007/​s00198-015-3145-7.CrossRef
93.
Lee J, Vasikaran S. Current recommendations for laboratory testing and use of bone turnover markers in management of osteoporosis. Annals of laboratory medicine. 2012;32(2):105–12. doi:10.​3343/​alm.​2012.​32.​2.​105.CrossRefPubMedPubMedCentral
94.
Burch J, Rice S, Yang H, Neilson A, Stirk L, Francis R, et al. Systematic review of the use of bone turnover markers for monitoring the response to osteoporosis treatment: the secondary prevention of fractures, and primary prevention of fractures in high-risk groups. Health technology assessment (Winchester, England). 2014;18(11):1–180. doi:10.​3310/​hta18110.
95.
Cavalier E, Bergmann P, Bruyere O, Delanaye P, Durnez A, Devogelaer JP, et al. The role of biochemical of bone turnover markers in osteoporosis and metabolic bone disease: a consensus paper of the Belgian bone Club. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2016;27(7):2181–95. doi:10.​1007/​s00198-016-3561-3.CrossRef
96.
Luo Y, Hu Z, Hao J, Jiang W, Shen J, Zhao J. Significant associations between the A163G and G1181C polymorphisms of the osteoprotegerin gene and risk of osteoporosis, especially in postmenopausal women: a meta-analysis. Genetic testing and molecular biomarkers. 2014;18(3):211–9. doi:10.​1089/​gtmb.​2013.​0420.CrossRefPubMed
97.
Yu KH, Tang J, Dai CQ, Yu Y, Hong JJ. COL1A1 gene -1997G/T polymorphism and risk of osteoporosis in postmenopausal women: a meta-analysis. Genetics and molecular research: GMR. 2015;14(3):10991–8. doi:10.​4238/​2015.​September.​21.​11.CrossRefPubMed
98.
Kanis JA. Assessment of Osteoporosis at the Primary Health-Care Level. Technical Report. World Health Organization Collaborating Centre for Metabolic Bone Disease. In: University of Sheffield U, editor.: University of Sheffield; 2007.
99.
• Nordin C. Screening for osteoporosis: U.S. Preventive services task force recommendation statement. Ann Intern Med. 2011;155(4):276. doi:10.​7326/​0003-4819-155-4-201108160-00021. Current recommendations regarding Osteoporosis Screening, with USPSTF recommendations as well as recommendations of other entities and colleges like the National Osteoporosis Foundation. CrossRefPubMed
100.
Nayak S, Greenspan SL. Cost-effectiveness of osteoporosis screening strategies for men. J Bone Miner Res Off J Am Soc Bone Miner Res. 2016;31(6):1189–99. doi:10.​1002/​jbmr.​2784.CrossRef
101.
Garg MK, Kharb S. Dual energy X-ray absorptiometry: pitfalls in measurement and interpretation of bone mineral density. Indian journal of endocrinology and metabolism. 2013;17(2):203–10. doi:10.​4103/​2230-8210.​109659.CrossRefPubMedPubMedCentral
102.
Link TM. Osteoporosis imaging: state of the art and advanced imaging. Radiology. 2012;263(1):3–17. doi:10.​1148/​radiol.​12110462.CrossRefPubMedPubMedCentral
103.
Pisani P, Renna MD, Conversano F, Casciaro E, Muratore M, Quarta E, et al. Screening and early diagnosis of osteoporosis through X-ray and ultrasound based techniques. World journal of radiology. 2013;5(11):398–410. doi:10.​4329/​wjr.​v5.​i11.​398.CrossRefPubMedPubMedCentral
104.
Karjalainen JP, Riekkinen O, Toyras J, Jurvelin JS, Kroger H. New method for point-of-care osteoporosis screening and diagnostics. Osteoporos Int. 2016;27(3):971–7. doi:10.​1007/​s00198-015-3387-4.CrossRefPubMed
105.
Hoiberg MP, Rubin KH, Hermann AP, Brixen K, Abrahamsen B. Diagnostic devices for osteoporosis in the general population: a systematic review. Bone. 2016;92:58–69. doi:10.​1016/​j.​bone.​2016.​08.​011.CrossRefPubMed
106.
Chin KY, Ima-Nirwana S. Calcaneal quantitative ultrasound as a determinant of bone health status: what properties of bone does it reflect? Int J Med Sci. 2013;10(12):1778–83. doi:10.​7150/​ijms.​6765.CrossRefPubMedPubMedCentral
107.
Mueller D, Gandjour A. Cost effectiveness of ultrasound and bone densitometry for osteoporosis screening in post-menopausal women. Applied health economics and health policy. 2008;6(2–3):113–35. doi:10.​2165/​00148365-200806020-00004.CrossRefPubMed
108.
Lorentzon M, Cummings SR. Osteoporosis: the evolution of a diagnosis. J Intern Med. 2015;277(6):650–61. doi:10.​1111/​joim.​12369.CrossRefPubMed