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Rheumatology

Osteoporosis   

Questions discussed in this category

Would you continue Forteo treatment past the recommended 2 years if T scores remain low and procollagen (P1NP) is elevated and if so, how would you monitor response?
1 Answer available
Do you recommend adjusting the duration of a drug holiday based on the specific bisphosphonate used when treating osteoporosis?
1 Answer available
Would you recommend waiting for a low Vitamin D level to correct to goal prior to giving a scheduled Prolia injection when transitioning a patient from Zolendronic acid to Prolia therapy for worsening osteoporosis?
2 Answers available
How do you determine osteoporosis treatment response when patients have discrepant DEXA scan results during monitoring (eg improved BMD of the hip and spine but worsening BMD of the femoral neck)?
1 Answer available
What treatment options would you consider for a young patient with limited mobility, low bone mass and multiple vertebral compression fractures who is on dialysis for advanced kidney disease?
1 Answer available
How do you reduce the risk of contralateral fracture in a patient with atypical femur fracture from prolonged bisphosphonate use?
Do anabolic agents have a role?
1 Answer available
How frequently do you monitor for hypocalcemia in patients on romosozumab?
1 Answer available
Would you consider using Evenity in an elderly patient with rate controlled atrial fibrillation without history of MI or CVA?
1 Answer available
When discontinuing Denosumab after more than 2-3 years of therapy, when do you recommend giving the first dose of zoledronic acid?
2 Answers available
How do you manage osteoporosis treatment following parathyroidectomy for primary hyperparathyroidism?
1 Answer available
Would you stop denosumab in a patient with chronic kidney disease if they develop asymptomatic hypocalcemia after the injection?
4 Answers available
Would you consider PTH analogue in a patient with mildly elevated PTH?
2 Answers available
Have you been able to safely use other bisphosphonates in patients who developed an allergic reaction (angioedema) to fosamax?
1 Answer available
Would you discontinue romosozumab in a patient who develops a hemorrhagic stroke while on therapy?
5 Answers available
When do you recommend using trabecular bone score (TBS) for managing osteoporosis?
1 Answer available
Are there any concerns with live vaccine innoculation and patients who are on denosumab?
1 Answer available
When transitioning from anabolic agent to denosumab, do you stop teriparatide 1 day prior to transition and romosozumab 1 month prior to transition?
1 Answer available
Which fracture sites outside of the classical spine and hip are considered to be osteoporotic fractures even in the absence of a bone density diagnosis?
2 Answers available
How do you approach a patient with elevated bone specific ALP (>2X the normal limit), but no other evidence of Paget's disease?
Normal Vitamin D, bone scan showed osteoarthritis
1 Answer available
Do you recommend a particular antiresorptive/anabolic agent for patients who are at high risk for fractures but have high risk of osteonecrosis of the jaw?
3 Answers available
Is there any contraindication for use of Invisalign teeth aligners in patients undergoing treatment for osteoporosis?
Do treatments for osteoporosis have a large enough effect on tooth movement to make Invisalign less effective?
1 Answer available
Would you transition from denosumab to anabolic agents in patients who are in urgent need for extensive dental work?
2 Answers available
What is your approach to a patient on long-term denosumab who now requires multiple invasive dental procedures?
2 Answers available
Do you delay spinal surgery (e.g. lumbar decompression for stenosis) in men or women with newly diagnosed osteoporosis and multiple thoracic compression fractures (not involving site of potential surgery) in order to initiate anabolic or anti-resorptive therapy to potentially improve surgical healing outcomes?
2 Answers available
Is it safe to continue administering Prolia per schedule for osteoporosis treatment shortly after a patient has undergone extensive spinal surgery?
1 Answer available
Given the risk of hypocalcemia in dialysis dependent patients treated with denosumab, what is the best method of treatment for osteoporosis for these patients, and should we be transitioning to a different agent?
2 Answers available
How would you manage a middle-aged patient with Paget's disease who received one dose of zolendronic acid 2 years ago, currently suppressed CTX, normal bone-specific Alkaline phos, and a recent hairline fracture in the thoracic spine?
Is there any data on the use of anabolic agents in Paget's disease?
2 Answers available
How would you approach a finding of osteoporosis (Z score -4.5) in a recently postpartum patient who had DEXA sent for long-term low-dose glucocorticoid use?
The patient is actively breastfeeding.
1 Answer available
Is there any evidence regarding bone density gains/fracture reduction in the setting of treatment with romosozumab after a two year course of teriparatide?
Many patients are interested in romosozumab for "maximizing bone gain" and preventing future fractures. Some have had anabolic therapy with teriparati...
1 Answer available
What range of musculoskeletal complaints have you seen with romosozumab use?
1 Answer available
Would you consider teriparatide use in a patient with prior radiation therapy, given that the black box warning regarding osteosarcoma risk has been removed by the FDA?
1 Answer available
Would you consider PTH-analog therapy in a woman with osteoporotic vertebral fractures who has asymptomatic non-obstructive renal stones and normal 24-hour urine calcium level?
2 Answers available
What is your approach to managing osteoporosis in patients with end stage kidney disease?
1 Answer available
How do you time Evenity after completion of Forteo?
1 Answer available
Would you use romosozumab in a patient with a cardiovascular event more than 2 years prior?
4 Answers available
Do you recommend osteoporosis medication in postmenopausal females on anastrozole with very low Vitamin D (4.5)?
After replacing Vitamin D, what will be your first treatment of choice? Labs including ALP and calcium levels are normal. T scores are -3 or above. Th...
1 Answer available
After completing 12 months romosozumab, what is the next best treatment option for patients with severe osteoporosis, high risk for fracture, and normal kidney function?
1 Answer available
Would you consider anabolic osteoporosis therapy in a young adult male with multiple non-traumatic vertebral compression fractures and low bone density for age (Z-score -2.6)?
A male patient in his 30s with two lumbar compression fractures (non-traumatic) and a Z-score of -2.6 in the spine, Z-score -0.5 in hips. History of 3...
1 Answer available
Can romosozumab be used in patients on dialysis?
1 Answer available
When do you consider stopping denosumab when a patient with osteoporosis is otherwise tolerating it without issues?
Assuming follow-up IV bisphosphonate x2 infusions to prevent rebound fractures 
5 Answers available
What is your approach to treating osteoporosis in patients post bariatric surgery?
Are oral bisphosphonates contraindicated with all types of bariatric procedures?
3 Answers available
Can anabolic agents be used in a patient with history of radioactive iodine treatment for hyperthyroidism?
1 Answer available
Would you switch a patient with glucocorticoid induced osteoporosis to romosozumab if a patient sustained a fragility fracture 1 year into treatment with teriparatide?
1 Answer available
What is your approach to a patient with a low alkaline phosphatase?
What level or additional signs/symptoms trigger a workup? What does your workup typically consist of?
5 Answers available
When do you start bisphosphonates empirically, irrespective of DEXA results, in patients going on chronic glucocorticoids?
1 Answer available
Where do you place romosozumab in your treatment sequence for osteoporosis management?
4 Answers available
Is history of radiation an absolute contraindication to using parathyroid hormone (PTH) analogues?
Does it depend on location of radiation, length of radiation, and time since radiation?
3 Answers available
Have the results of the ancillary study of the VITAL trial, demonstrating that Vitamin D3 supplementation did not reduce the incident rate of fractures in generally healthy midlife and older adults, changed how you prescribe Vitamin D?
PMID 35939577
2 Answers available
How would you approach choosing osteoporosis treatment in a patient with a T score -3.3 in lumbar spine and no prior fracture history who has squamous cell cancer and received radiation therapy?
1 Answer available
What would be your next step in treating a patient with osteoporosis who developed AFF on denosumab and who then completed one year of romosozumab?
3 Answers available
For a patient with osteopenia or osteoporosis, how long can intravenous zoledronic acid be maintained if there are not adverse events?
1 Answer available
Would atypical fractures of the hip in a parent (treated with bisphosphonate) be considered when calculating the FRAX score for a patient with osteopenia?
2 Answers available
Would one year of steroids for JRA during teen years (with subsequently well-controlled autoimmune disease) be sufficient to explain a vertebral T score of -4.4 of a woman in her early 50s without any other risk factors?
1 Answer available
How do you manage calcium and vitamin D replacement in scleroderma and myositis patients with dysphagia and malabsorption?
1 Answer available
What is your approach to treating premenopausal woman with OI with a new compression fracture?
2 Answers available
Would you consider teriparatide in a postmenopausal woman with normal DEXA who had a traumatic humerus fracture three months prior with surgical intervention and plain Xrays showing only partial healing?
2 Answers available
What treatment would you use in a patient with osteoporosis on denosumab for 10 years who develops ONJ at a site of an old implant?
1 Answer available
What is the role of kyphoplasty or vertebroplasty in patients with osteoporotic spinal fractures?
1 Answer available
How do you approach long term management of glucocorticoid-induced osteoporosis in patients who develop osteonecrosis of the jaw on antiresorptive agent?
2 Answers available
How would you manage a patient with osteoporosis on denosumab who develops significant renal insufficiency where it is difficult to continue denosumab due to increased risk of hypocalcemia (i.e. eGFR in the low 20’s)?
1 Answer available
In a patient with bisphosphonate induced bilateral atypical femur fractures, how would you approach timing of alternative osteoporosis treatments and surgical management?
2 Answers available
What kinds of dental work do you particularly worry about and try to avoid in patients on bisphosphonates?
2 Answers available
In a patient who fractures after several years of denosumab therapy, would you wait 6 months after the last denosumab injection to start an anabolic agent or could start an anabolic agent sooner?
1 Answer available
Would you avoid the entire class of bisphosphonates if a patient develops an allergic reaction, or would you consider the use of an alternative bisphosphonate?
2 Answers available
Would you consider the use of an anabolic agent to promote fracture healing?
2 Answers available
Is it ever appropriate to restart bipshosphonates following a drug holiday in a patient with a prior atypical hip fracture?
5 Answers available
How would you approach an elderly patient with tibial plateau insufficiency fracture and normal DEXA?
Tibial plateau insufficiency fxs are not discussed in the guidelines for dx or treatment.
2 Answers available
For a patient who would benefit from an anabolic agent for osteoporosis, do you prefer romosuzumab over teriparatide in the absence of contraindications to either agent?
3 Answers available
How do you approach a potential drug holiday in a patient with osteoporosis who has had improvement in BMD after several years of denosumab therapy?
1 Answer available
How do you approach treatment of osteoporosis in patients with CKD who develop a fragility fracture while on denosumab?
1 Answer available
Is history of radiation therapy for uterine cancer an absolute contraindication to parathyroid hormone/parathyroid hormone related protein analogues such as teriparatide and abaloparatide in a patient with severe osteoporosis with multiple spine fractures?
2 Answers available
In a patient who completed 5 years of oral bisphosphonate and has a T score persistently in osteoporotic range, what factors help you decide whether it is appropriate to start a drug holiday vs. switch to an alternative agent?
1 Answer available
Do you change management in patients that are taking bisphosphonates and develop atrial fibrillation?
1 Answer available
In postmenopausal osteoporosis, would you switch to romosozumab (rather than a PTH/PTHrP analog) if a patient fractures while on denosumab?
1 Answer available
Do you avoid PTH/PTHrP analogs in patients with recurrent/severe CPPD?
2 Answers available
How do you approach the use of bisphosphonates in reproductive-aged women?
1 Answer available
Does romosozumab need to be followed immediately by an anti-resorptive agent to preserve BMD gains, or could you consider a drug holiday?
1 Answer available
Have you had experience using the new Echolight technology to measure bone density?
2 Answers available
Would you consider using teriparatide beyond a cumulative maximum of two years now that the black box warning regarding osteosarcoma has been removed?
1 Answer available
How do you approach the use of parathyroid hormone-related protein analog drugs in the setting of prior external beam radiation?
If you avoid parathyroid hormone-related protein analog drugs in patients with prior external beam radiation, what data is this based on?
1 Answer available
How do you counsel patients about the risk of osteonecrosis of the jaw with anabolic agents such as teriparatide or romosozumab ?
Would you hold these agents in the setting of invasive dental procedures?
1 Answer available
What strategy do you use to determine the appropriate timing to resume osteoporosis therapy after a drug holiday?
2 Answers available
Would you consider use of an oral bisphosphonate (such as alendronate liquid) in a patient with eosinophilic esophagitis?
1 Answer available
How would you approach osteoporosis management in a patient who fractures while on denosumab therapy?
Would you consider keeping the patient on denosumab or would switch to an anabolic agent?
1 Answer available
How do you approach prophylaxis against glucocorticoid-induced osteoporosis in patients with end-stage renal disease on dialysis?
1 Answer available
How do you interpret DXA results in cases where there is discordance between normal hip and spine BMD with abnormal one-third radius BMD?
2 Answers available
Is there a role for starting an anabolic agent in a patient that developed an atypical femoral fracture while on denosumab sooner than 6 months after the last denosumab dose?
Is there a role for earlier use of anabolic agents to promote bone healing in patients that develop AFFs?
2 Answers available
How do you transition to an anabolic agent in a patient who develops an atypical fracture while on denosumab?
1 Answer available
Do you approach therapy differently for patients with a diagnosis of osteoporosis based on a fragility fracture rather than based on bone mineral density on DXA (assuming no secondary causes of osteoporosis)?
1 Answer available
How do you approach therapy for severe osteoporosis after an initial 12 months of romosozumab?
1 Answer available
How do you approach peri-operative management of anti-resorptive therapies such as denosumab in patients undergoing joint replacement?
Does denosumab effect knee replacement or hip replacement? Should replacement occur right before or after injection? 
1 Answer available
What agent would you choose for a patient who needs osteoporosis therapy after a bisphosphonate holiday?
2 Answers available
How do you manage post-menopausal osteoporosis in a patient with stable bone density and no fractures after three years of holiday after giving zoledronic acid?
1 Answer available
How do you manage osteopenia, osteoporosis and calcium / Vit D supplementation in a patient with calcinosis?
1 Answer available
Is romosozumab an option in a patient who has completed 2 years of teriparatide therapy and has a fracture while on denosumab?
1 Answer available
When treating patients with low bone mineral density, when/how do you monitor bone turnover markers (NTX, CTX, etc)?
1 Answer available
How do you manage calcium and vitamin D supplementation in patients with sarcoidosis on chronic steroids?
1 Answer available
Would you consider an osteoporosis medication in a pre-menopausal/young patient with a low Z score and an ongoing risk factor for secondary osteoporosis such as chronic antiepileptic treatment?
1 Answer available
In which osteoporosis patients would you consider starting with anabolic therapy over antiresorptive therapy?
1 Answer available
Do you regularly do bone density testing to screen for osteoporosis in men with rheumatoid arthritis without any other risk factors?
2 Answers available


Papers discussed in this category

Arthritis Rheumatol, 2017 Aug
2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis.
Current opinion in rheumatology, 2015-05
Current approaches to osteoporosis treatment.
Am J Med, 2012 Nov 20
Bisphosphonate therapy for osteoporosis: benefits, risks, and drug holiday.
Arthritis Care Res (Hoboken), 2017 Aug
2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis.
JAMA, 2006-12-27
Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial.
Lancet (London, England), 2015-09-19
Denosumab and teriparatide transitions in postmenopausal osteoporosis (the DATA-Switch study): extension of a randomised controlled trial.
N Engl J Med,
Bisphosphonate use and atypical fractures of the femoral shaft.
J Clin Densitom, 2020 Dec 13
Bone Turnover Markers: A New Year Resolution?
J Clin Endocrinol Metab, 2020 May 01
Medical Management of Patients After Atypical Femur Fractures: a Systematic Review and Recommendations From the European Calcified Tissue Society.
The lancet. Diabetes & endocrinology, 2017-07
10 years of denosumab treatment in postmenopausal women with osteoporosis: results from the phase 3 randomised FREEDOM trial and open-label extension.
The lancet. Diabetes & endocrinology, 2019 Aug 22
Combination denosumab and high dose teriparatide for postmenopausal osteoporosis (DATA-HD): a randomised, controlled phase 4 trial.
The New England journal of medicine, 2018 Oct 01
Fracture Prevention with Zoledronate in Older Women with Osteopenia.
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 2018-05
Future Osteoporotic Fracture Risk Related to Lumbar Vertebral Trabecular Attenuation Measured at Routine Body CT.
Arteriosclerosis, thrombosis, and vascular biology, 2019-07
Cardiovascular Outcomes of Romosozumab and Protective Role of Alendronate.
Calcified tissue international, 2022 Oct 26
One-Year Romosozumab Treatment Followed by One-Year Denosumab Treatment for Osteoporosis in Patients on Hemodialysis: An Observational Study.
Joint bone spine, 2021 May 19
Effects of prior osteoporosis treatment on 12-month treatment response of romosozumab in patients with postmenopausal osteoporosis.
Genes, 2022 Oct 17
Hereditary Metabolic Bone Diseases: A Review of Pathogenesis, Diagnosis and Management.
JAMA, 2007-01-24
Risk of subsequent fracture after low-trauma fracture in men and women.
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 2017-07
Osteoporosis in Crisis: It's Time to Focus on Fracture.
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 2019 Dec 01
Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition.
JAMA network open, 2022 Oct 03
Association of Multimorbidity and Excess Mortality After Fractures Among Danish Adults.
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 2022 Oct 17
The Economic Burden of Severe Osteoporotic Fractures in the French Healthcare Database: The FRACTOS Study.
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2020 Mar 16
Fracture risk following high-trauma versus low-trauma fracture: a registry-based cohort study.
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2023 Jul 01
Update on the clinical use of trabecular bone score (TBS) in the management of osteoporosis: results of an expert group meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), and the International Osteoporosis Foundation (IOF) under the auspices of WHO Collaborating Center for Epidemiology of Musculoskeletal Health and Aging.

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