Osteoporosis

Questions discussed in this category

Would you transition from denosumab to anabolic agents in patients who are in urgent need for extensive dental work?

1 Answer 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

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

Would you use romosozumab in a patient with a cardiovascular event more than 2 years prior?

4 Answers available

Would you discontinue romosozumab in a patient who develops a hemorrhagic stroke while on therapy?

5 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

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

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 is your approach to a patient on long-term denosumab who now requires multiple invasive dental procedures?

2 Answers 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

What is your approach to adjuvant hormone therapy for HR+ breast cancer in post-menopausal women with pre-existing osteoporosis?

Would you consider omitting treatment if small tumor and early stage? Or would you use tamoxifen?

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.

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