Medscape Conference Coverage Osteoporoza Barbati

8/20/2019 Medscape Conference Coverage Osteoporoza Barbati

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Medscape Conference Coverage, based on selected sessions at the:International Osteoporosis Foundation World Congress on OsteoporosisCME

Complete author affiliations and disclosures are at the end of this activity.

The materials presented here were prepared by independent authors under the editorial supervision of Medscape, and donot represent a publication of the International Osteoporosis Foundation World Congress on Osteoporosis. These materialsand the related activity are not sanctioned by the International Osteoporosis Foundation World Congress on Osteoporosis orthe sponsors of the conference, and do not constitute an official part of that conference.

Release Date: June , !""! #alid for credit through June , !""$

%arget &udience

This activity is intended for O!"#$%s, primary care physicians, endocrinologists and internal medicinespecialists.

'oal

The goal of this activity is to provide clinicians with an overview of the current state&of&the art ofosteoporosis prevention and management.

(earning Ob)ectives

'pon completion of this activity, participants should be able to(). *ecogni+e that the gold standard for comparing antiosteoporotic therapies is the reduction of

vertebral, nonvertebral, and hip fractures.. -valuate currently available antiresorptive therapies on the basis of fracture reduction, adverse

effects, and additional therapeutic benefits.. /escribe new antiresorptive and anabolic agents in development for the management of

osteoporosis.0. Outline the ris1 factors for osteoporosis for men and women.

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@. %ew Ways of !isphosphonate 6dministration in Osteoporosis8ocrates -. 2apapoulos, M/, 2h/

G. 8-*Ms for the 2revention and Treatment of Osteoporosis( What7s ere, What7s Coming/ennis !lac1, 2h/

H. Optimi+ing Therapy for Osteoporosis( The 2otential of !one 6nabolic 6gents/ennis !lac1, 2h/

)3. IOF 8ymposium on *ecent 6dvances in Osteoarthritis

Michael C. %evitt, 2h/

*ighlights of the IOF World Congress on Osteoporosis

-go 8eeman, M/

The World Congress on Osteoporosis 4held May )3&)B, ?isbon, 2ortugal5 was organi+ed by theInternational Osteoporosis Foundation 4IOF5, an organi+ation made up of )H member societiesrepresenting @) countries. This was the largest meeting ever held in the field of osteoporosis, with overB333 attendees see1ing a better understanding of the epidemiology, pathogenesis, prevention, andtreatment of osteoporosis. Over 0B3 abstracts were submitted addressing these topics. -ight plenarylectures covered the biomechanical and structural basis of bone fragility, the genetics of osteoporosis,bone fragility in children, the use of animal models to understand the pathogenesis of osteoporosis, the=uality of life in women with osteoporosis, and the role of bone biology and molecular targets in thedevelopment of new treatments for osteoporosis. I emphasi+e that the information highlighted below issummari+ed from abstracts, oral presentations, and posters and that the results and their interpretationas presented at the meeting have not yet been sub:ect to rigorous peer review.

%he Epideiolog., *ealth, and Financial /urden of Fractures

The health and financial burden imposed by vertebral fractures is underestimated, costing H million-uro&dollars 4euros5 annually in the -uropean 'nion associated hospital costs are only BA less thanthose associated with hip fractures.9); %ew data show that the reduction in =uality of life 4O?5 aftersustaining vertebral fractures can be more severe than that which occurs after a hip fracture. 9,;

Eertebral fractures of even mild deformity increase the ris1 for further fractures and can cause severepain, increase the number of bed days, and result in long&term disability.

8tudies presented at this conference confirm that hip fractures have profound impact on O?. Twentypercent of patients die within the first D months of fracture, fewer patients are able to live at home, andmany re=uire nursing homes or assistance from family members and health professionals. 90,B; In ?isbon,hospital costs attributed to hip fracture are D333 euros per patient, twice that of treating obstructiveairways disease or myocardial infarction and times more costly than alcoholic liver disease. 9D;

Doctors, -atients, 'overnents Don0t 1no2

/espite the impact on O? and costs to healthcare systems throughout the world, governments,communities, and doctors do not recogni+e the burden imposed by fractures. 2atients are not being

evaluated for osteoporosis many are not offered treatment after being diagnosed with a fracture,despite the fact that any fracture 4vertebral, forearm, or other nonvertebral fracture5 is one of the mostimportant ris1 factors for further fractures && a fact that was reiterated in the findings of a number ofstudies presented at the WCO.9,@&)H;

One of the reasons for this failure to treat is the mista1en belief that osteoporosis and fractures are :ustan inevitable conse=uence of aging and that nothing can be done to prevent them. We now have safeand effective ways of measuring bone mineral density 4!M/5. /ensitometry, ultrasound, and =uantitativecomputed tomography, readily available in most urban communities, can be used to identify women andmen at greatest ris1 for fracture because of low !M/.

The loss of bone during aging can be effectively and safely prevented. The high rate of remodeling canbe reduced using any of the available antiresorptive agents, such as alendronate, risedronate,ralo


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risedronate reduces the depth of bone resorption and the amount of bone formed in the more shallowresorption cavity, yielding a less negative bone balance in the remodeled site. 9); 6lendronate has beenreported to reduce the porosity of the cortical shell. 9; In addition, bone architecture can be reconstructedusing newer anabolic treatments 4see The Cure && 8ome %ew Jids on the !loc1, below5.

/ata presented at the WCO indicate that nutritional supplementation with calcium and vitamin / orantiresorptive agents is cost&effective. 2K Meunier, -douard erriot ospital, ?yon, France, andcolleagues9; reported the results of an economic evaluation of a &year trial of calcium and vitamin / in@3 women in which BA fewer hip fractures in the treated group resulted in a net benefit of @H to @))euros per person treated, depending on the country studied. 6t this meeting, there were also studiesthat compared the relative cost& effectiveness of different antiresorptive agents. For e


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This study ma1es several points( mild deformities cannot be ignored, multiple deformities increase theimperative to intervene, and ralo


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presented for the first time at this meeting. 9BH; In this &year study, oral strontium ranelate at a dosage of g"day was administered in a double&blind, randomi+ed, placebo&controlled trial involving ) countriesand )D0H women 4mean age @3 years5 [email protected] of patients had at least ) prevalent vertebral fracture4average( . per patient5.

6fter the first year, the number of women having new vertebral fractures was reduced by about 03A inthe treatment group 900 4D.)A5 vs GB 4)).GA5 in the placebo group;. The incidence of patients having atleast ) clinical spine fracture was halved 4.)A vs D.0A, P .335. For the entire &year period, a 0)Areduction in ris1 of e


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We have new information indicating that vertebral fractures are associated with overall greater morbidityand mortality compared with hip fractures, that the costs of vertebral and nonvertebral fractures aresimilar and high && sometimes greater than the costs associated with myocardial infarction or obstructiveairways disease. In most countries, there is a lac1 of recognition of the burden of fractures in terms ofcost and O? at all levels from the patient to the doctor, community, and government.

We have learned that even mild vertebral deformities confer disability and ris1 for further fractures. Theburden of fractures in men is better defined, and the fact that it is higher than in women has beenconfirmed. We have evidence of cost&effectiveness of treatment and of the efficacy of new antiresorptiveand bone&forming agents. %ew treatments such as 2T and strontium, agents that increase boneformation as well as reduce bone resorption, should be available soon. %ew data on establishedtreatments such as alendronate, risedronate, and ralo


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Osteoporos Int. 33)4suppl )5(8D. 2rogram and abstracts of the IOF World Congress onOsteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 2)30.

). ren *, 8alobir !, !re+ni1 M, Joci:ancic 6. 2roposal of rational screening for osteoporosis inthe primary care setting. Osteoporos Int. 33)4suppl )5(8G). 2rogram and abstracts of theIOF World Congress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 2BH.

). Woolf 6/, 1esson J, a+es KMW, and the WO 8cientific #roup on The !urden ofMusculos1eletal Conditions. The !one and Koint /ecade Monitor 2ro:ect( the burden of

musculos1eletal conditions at the start of the new millennium. Osteoporos Int. 33)4suppl)5(8G0. 2rogram and abstracts of the IOF World Congress on Osteoporosis May )3&)0, 33?isbon, 2ortugal. 6bstract 2@).

)0. Eersluis #*, 2apapoulos 8-. Osteoporosis in general practice( failure to lin1 fractures to thediagnosis osteoporosis. Osteoporos Int. 33)4suppl )5(8GB. 2rogram and abstracts of theIOF World Congress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 2@.

)B. Canhao , Fonseca K-, *esende C, et al. Osteoporosis awareness among both gender2ortuguese young adults and adults over B3 years. Osteoporos Int. 33)4suppl )5(8H3.2rogram and abstracts of the IOF World Congress on Osteoporosis May )3&)0, 33 ?isbon,2ortugal. 6bstract 2H.

)D. Jabir 8*, /ey 6!, anda *, !hatla %. Osteoporosis awareness among Indian patients.Osteoporos Int. 33)4suppl )5(8H3. 2rogram and abstracts of the IOF World Congress onOsteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 2H0.

)@. 8atomura J, %a1ahara T, Miyagishima J, et al. 2revention activities against osteoporosis in

municipalities in Kapan. Osteoporos Int. 33)4suppl )5(8H). 2rogram and abstracts of theIOF World Congress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 2HB.)G. Thomas K, 8teel 8, /oherty 8M. Fracture prevalence and two year follow up in the elderly male

population. Osteoporos Int. 33)4suppl )5(8H0. 2rogram and abstracts of the IOF WorldCongress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 23D.

)H. Manolova 6, *ibarova F, 8ider ?. !ulgarian women7s 1nowledge about osteoporosis.Osteoporos Int. 33)4suppl )5(8HB. 2rogram and abstracts of the IOF World Congress onOsteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 23H.

3. !orah !, /ufresne T-, Chmielews1i 26, 2renger MC, Manhart M/. *isedronate 4*I85preserves trabecular architecture in early postmenopausal women in :ust ) year( a pairedbiopsy study using / microCT. Osteoporos Int. 33)4suppl )5(8B. 2rogram and abstractsof the IOF World Congress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 2DH.

). !oyce *W, 2addoc1 C?, #leason K*, 8letsema WJ, -ri1sen -F. The effects of risedronate oncanine cancellous bone remodeling( three&dimensional 1inetic reconstruction of the remodelingsite. K !one Miner *es. )HHB)3())&).

. *oschger 2, *innerthaler 8, $ates K, *odan #6, Frat+l 2, Jlaushofer J. 6lendronate increasesdegree and uniformity of minerali+ation in cancellous bone and decreases the porosity incortical bone of osteoporotic women. !one. 33)H()GB&)H).

. Meunier 2K, 2amphile *, Chapuy MC, 8chulten K, 6rlot M, ?illiu . 6 Calcium&vitamin /combined supplementation is cost&saving for preventing hip fractures in institutionalised elderlywomen( an economic evaluation from the perspective of seven -uropean countries 4!elgium,France, #ermany, The %etherlands, 8pain, 8weden, 'nited Jingdom5. Osteoporos Int.33)4suppl )5(8)0. 2rogram and abstracts of the IOF World Congress on OsteoporosisMay )3&)0, 33 ?isbon, 2ortugal. 6bstract OB.

0. #rima /, !urge *T, !ec1er /, Tosteson 6%6. Cost&effectiveness of bisphosphonate therapy inhigh&ris1 osteoporotic women. Osteoporos Int. 33)4suppl )5(8G. 2rogram and abstracts of the IOF World Congress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 2D0.

B. Kavaid MJ, 8hore 8*, Taylor 2, *obinson 8, #odfrey JM, Cooper C. /eterminants of maternaland fetal circulating leptin concentration and intrauterine bone mineral accrual 7 Osteoporos Int.

33)4suppl )5(80. 2rogram and abstracts of the IOF World Congress on Osteoporosis May)3&)0, 33 ?isbon, 2ortugal. 6bstract O.

D. enry $M, Fatayer:i /, -astell *. 8e< steroids and growth factors during adolescence andyoung adulthood( relevance to bone turnover. Osteoporos Int. 33)4suppl )5(80. 2rogramand abstracts of the IOF World Congress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract O.

@. ?ehtonen&Eeromaa M, MRttRnen T, %uotio I, Ir:ala J, ?eino 6, Eii1ari K. Eitamin / andattainment of pea1 bone mass among peripubertal Finnish girls( a &year prospective study.Osteoporos Int. 33)4suppl )5(8B. 2rogram and abstracts of the IOF World Congress onOsteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract O0.

G. 6mmann 2, #arcia I, !on:our K2, *i++oli *. 2rotein undernutrition&induced bone resorption isdependent on tumor necrosis factor alfa 4T%F5. Osteoporos Int. 33)4suppl )5(8B. 2rogramand abstracts of the IOF World Congress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract OB.

H. /uan $!, !ec1 TK, Wang F, 8eeman -. 8tructural and biomechanical basis for femoral nec1bone fragility in men and women. Osteoporos Int. 33)4suppl )5(8D. 2rogram and abstractsof the IOF World Congress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract O@.


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3. 2lui:m 8MF, 8mit K, Tromp 6M, et al. Identifying community&dwelling elderly at high ris1 forrecurrent falling( results of a three&year prospective study. Osteoporos Int. 33)4suppl )5(8H.2rogram and abstracts of the IOF World Congress on Osteoporosis May )3&)0, 33 ?isbon,2ortugal. 6bstract O)G.

). /u1as ?, !ischoff 6, 8chacht -, 8taehelin !. %ormal B4O5 vitamin / serum levels do note


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#erman men. Osteoporos Int. 33)4suppl )5(8)3H. 2rogram and abstracts of the IOF WorldCongress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 2BG.

0G. Eargas #, Monteiro M, 6lmeida M, et al. /ecreased bone mineral density associated withandrogen deficiency in young hypogonadic males. Osteoporos Int. 33)4suppl )5(8)0.2rogram and abstracts of the IOF World Congress on Osteoporosis May )3&)0, 33 ?isbon,2ortugal. 6bstract 20)).

0H. 8avic1iene 6, !aranaus1aite 6. !one mineral density in males with chronic inflammatory

rheumatic diseases. Osteoporos Int. 33)4suppl )5(8)H. 2rogram and abstracts of the IOFWorld Congress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 20DD.

B3. %evitt M, !ent 8, ?ui ?, et al. Eertebral deformities in urban Chinese men( the !ei:ingOsteoarthritis 8tudy. Osteoporos Int. 33)4suppl )5(8DD. 2rogram and abstracts of the IOFWorld Congress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 2)3.

B). $evsigneeva ?2, ?esnya1 OM, 2iven 6I. The prevalence of vertebral fracture in the populationaged B3 years and over according to different morphometric algorithm. Osteoporos Int.33)4suppl )5(8@H. 2rogram and abstracts of the IOF World Congress on OsteoporosisMay )3&)0, 33 ?isbon, 2ortugal. 6bstract 2B0.

B. 8+ulc 2, !ec1 TK, /elmas 2/. 2ossible role of se


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D0. !ensen W#, *ibot C, !olognese M, Currie 6, #eusens 2. *isedronate significantly reducesosteoporosis&related nonvertebral fracture ris1 in :ust one year. Osteoporos Int. 33)4suppl)5(8)G. 2rogram and abstracts of the IOF World Congress on Osteoporosis May )3&)0, 33?isbon, 2ortugal. 6bstract 20D.

DB. ?indsay *, 6dachi K/, -m1ey */, ?i S, !als1e 6, !rown K. Once&a&wee1 4B mg5 risedronateis as effective as daily 4B mg5. Osteoporos Int. 33)4suppl )5(8)D. 2rogram and abstracts of the IOF World Congress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 20).

DD. #eusens 2, 6dami 8, !ensen W#, Miller 2/, Meunier 2. -ffects of risedronate on ris1 offemoral nec1 and intertrochanteric fractures. Osteoporos Int. 33)4suppl )5(8)@. 2rogramand abstracts of the IOF World Congress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 200.

D@. Wasnich *, McClung M, Wor1man 2, et al, for the -2IC 8tudy #roup. ?ong&term alendronatetherapy for the prevention of postmenopausal osteoporosis( si


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G). Chapuy MC, 2amphile *, 2aris -, et al. Combined calcium and vitamin / supplementation toprevent hip fracture in elderly women. a confirmatory study( /-C6?$O8 II. Osteoporos Int.33)4suppl )5(8B. 2rogram and abstracts of the IOF World Congress on OsteoporosisMay )3&)0, 33 ?isbon, 2ortugal. 6bstract 2DG.

G. %owa1 %6, !adurs1i K-, /obren1o 6, /anilu1 8. Two years calcium and vitamin /supplementation maintains lumbar !M/ with slight decrease in the hip in postmenopausalosteopenic women. Osteoporos Int. 33)4suppl )5. 2rogram and abstracts of the IOF World

Congress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 2)38'.G. #rant 6, Cooper C, for the *-CO*/ trial group M*C. /esign of the record trial( an evaluation

of calcium and"or vitamin / in the secondary prevention of osteoporotic fractures. OsteoporosInt. 33)4suppl )5(80). 2rogram and abstracts of the IOF World Congress on OsteoporosisMay )3&)0, 33 ?isbon, 2ortugal. 6bstract 2)0.

G0. epguler 8, #o1sel 6, Capaci J, 61sit *. The comparison of the effects of vitamin / andalphacalcidiol with /-6 in osteoporosis. Osteoporos Int. 33)4suppl )5(80@. 2rogram andabstracts of the IOF World Congress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 2)0.

GB. /evogelaer K2, /epresseu< #. Can systematic daily supplementation of ) g elemental calciumand GG3 I' vitamin / in any ambulatory postmenopausal women be safely administeredNOsteoporos Int. 33)4suppl )5(8BD. 2rogram and abstracts of the IOF World Congress onOsteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 2)@B.

GD. *inge K/, 8etni1ar I. Monofluorophosphate combined with calcium and hormone replacement

therapy reduces ris1 of vertebral fractures in established postmenopausal osteoporosis.Osteoporos Int. 33)4suppl )5(80. 2rogram and abstracts of the IOF World Congress onOsteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 2)@.

G@. *eginster K$, Felsenberg /, #luer CC, et al. !M/ and fracture effects of monofluorophosphate4MF25 combined with ralo


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treatment groups. The authors conclude that the findings && a reduction in hip bone loss and hip fractureris1 and a remission of senile secondary hyperparathyroidism && are in agreement with /ecalyos I 4**for hip fracture in this study was ).@A, HBA CI ).3,.G5.

In a related paper at the conference presented by 2K Meunier7s group, 9; -douard erriot ospital, ?yon,France, the cost&effectiveness of Ca and vitamin / supplements for preventing hip fracture wasassessed ta1ing into account the medical costs in @ -uropean countries. The economic evaluation wasbased on the results of /ecalyos I and undertoo1 to compute the incremental cost&effectiveness ratio4IC-*5. The IC-* was defined as the ratio of additional cost to the number of avoided hip fractures withCa and vitamin / supplementation compared with placebo. The preventive strategy resulted in asignificant net financial benefit, ranging from @H,333 to @)),333 -uro per )333 women treated,depending on the country.

%6 %owa1 and colleagues,90; Center of Osteoporosis and Osteoarticular /iseases, !ialysto1, 2oland,presented data on the effect of Ca 4B33 mg5 and vitamin / 4B33 I'5 on !M/ and bone mar1ers in ))postmenopausal women and confirmed that the supplementation group maintained lumbar spine bonemass. In a second paper presented by this group, 8 /anilu1 and cowor1ers 9B; e


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B0 years of age, the current clinical practice definition of normal levels of B&4O5/ needs to beredefined.

% #alofr and cowor1ers,9H; ospital Municipal, !adalona, 8pain, presented data from a prospectivestudy designed to determine the lowest concentration of B&4O5/ that maintains 2T in a normalrange. 6 total of 0D female sub:ects were studied 4mean age DD years5. The mean level of B&4O5/ inthis population group was )D.B ng"m?. ?evels of 2T were found to be significantly higher when B&4O5/ levels were Q ) ng"m?. /espite high e


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different dosing schedules of Ca 4) dose of )33 mg at evening or doses of D33 mg at )&hourintervals5. The aim of the study was to determine whether separate doses of Ca lead to more steadysuppression of bone resorption.

*esults indicated that serum Ca was increased and serum 2T reduced by Ca administration witheither dosing schedule as compared with placebo. 'sing the collected 0&hour urine samples, boneresorption was found to be significantly reduced by giving either the single or repeated Ca dosing.owever, of note was that the effect lasted only ) hours after single administration of )33 mg of Ca,whereas a significant second inhibition of bone resorption was evident after the second administration of D33 mg of Ca during treatment with the daily doses. These data indicate that although overallsuppression of 2T and bone resorption obtained with daily doses of D33 mg of Ca is similar to that of a single dose of )33 mg, repeated doses provide a more steady suppression of bone resorption.

2 6lberta++i and cowor1ers,9)D; 'niversity of ull, ull, 'J, presented an important paper comparing types of Ca preparations 4ossein&hydro


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Clinical +ignificance

The clinical relevance of the papers presented and discussed at the World Congress on Osteoporosisare as follows(

• 8upplementation with vitamin / and Ca is effective in normali+ing both the low vitamin / statusand hyperparathyroidism as well as increasing bone mass and reducing fracture ris1 in the

elderly population. /ata also support the view that such a supplementation regimen is cost&effective.• Eitamin / insufficiency"deficiency is a ma:or problem in the elderly population 4particularly for

those living in nursing homes5, and there is an urgent re=uirement for more public healthawareness as the aging population continues to grow.

• Eitamin / is a crucial nutrient for pea1 bone mass development, with evidence suggesting thathypovitaminosis in the growing population is associated with a reduced pea1 bone massattainment.

• Ca supplements are effective in reducing increased bone turnover associated with themenopause, with the evidence suggesting that the provision of repeated doses 4such as <D33 mg compared with ) < )33 mg5 is associated with a more steady suppression of boneresorption.

• There is a continuing emergence of data showing a clear, positive lin1 between the

consumption of al1ali&forming foods 4in particular fruit and vegetables5 and indices of bonehealth in the postmenopausal and aging population. igh inta1es of these food groups 4asmuch as H portions of fruit and vegetables per day5 should be encouraged. It may also beuseful to include measurements of dietary acidity of individuals deemed at ris1 forosteoporosis"osteopenia.

• 6ctive participation in physical activity is 1ey to the optimi+ation of bone health, particularly inpostemenopausal women.

References

). Chapuy MC, 2amphile *, 2aris -, et al. Combined calcium and vitamin / supplementation toprevent hip fracture in elderly women. 6 confirmatory study( /ecalyos II. Osteoporos Int.33)4suppl )5(8B. 2rogram and abstracts of the IOF World Congress on OsteoporosisMay )3&)0, 33 ?isbon, 2ortugal. 6bstract 2DG.

. Chapuy MC, 6rlot M-, /uboeuf F, et al. Eitamin / and calcium to prevent hip fractures inelderly women. % -ngl K Med. )HH@()D@&)D0.

. Meunier 2K. 2amphile *, Chapuy MC, 8chulten K, 6rlot M, ?illu . 6 calcium&vitamin/combined supplementation is cost&saving for preventing hip fractures in institutionalised elderlywomen( an economic evaluation from the perspective of seven -uropean countries.Osteoporos Int. 33)4suppl )5(8)0. 2rogram and abstracts of the IOF World Congress onOsteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract OB

0. %owa1 %6, !adurs1i K-, /obren1o 6, /anilu1 8. Two years calcium and vitamin /supplementation maintains lumbar !M/ with slight decrease in the hip in postmenopausalosteopenic women. Osteoporos Int. 33)4suppl )5(80). 2rogram and abstracts of the IOFWorld Congress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 2)3.

B. /anilu1 8, !adurs1i K-, /obren1o 6, %owa1 %6. -ffect of )G months treatment with ).3 microgalfacalcidol plus calcium supplementation in postmenopausal women with osteoporosis.Osteoporos Int. 33)4suppl )5(8G. 2rogram and abstracts of the IOF World Congress on

Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 2)).D. /evogelaer K2, /epresseu< #. Can systematic daily supplementation of )g elemental Ca and

GG3 I' vitamin / in any ambulatory postmenopausal women be safely administeredNOsteoporos Int. 33)4suppl )5(8BD. 2rogram and abstracts of the IOF World Congress onOsteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract )@B.

@. !arrett&Connor -, Eon Muhlen /, Wan ?. The effect of vitamin / levels on 2T and !M/ inhealthy postmenopausal women. Osteoporos Int. 33)4suppl )5(8DG. 2rogram andabstracts of the IOF World Congress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 2)D.

G. #Vme+ C, %aves M?, Fern]nde+ K?, /Ua+ K!, Coto MT, Cannata K!. 6re the serum vitamin /cut&off levels currently used in aged people accurate enough to avoid the development ofsecondary hyperparathyroidismN Osteoporos Int. 33)4suppl )5(8H@. 2rogram and abstractsof the IOF World Congress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract2)G.

H. #alofr %, *aventVs 6, #on+]le+&6res K6, et al. Eitamin&/ deficiency and secondaryhyperparathroidism. Osteoporos Int. 33)4suppl )5(8)G. 2rogram and abstracts of the IOFWorld Congress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 20D.


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)3. ?ehtonen&Eeromaa M, MRttRnen *, %uotio I, Ir:ala J, ?eiino 6, Eii1ari K. Eitamin / andattainment of pea1 bone mass among peripubertal Finnish girls( a &year prospective study.Osteoporos Int. 33)4suppl )5(8B. 2rogram and abstracts of the IOF World Congress onOsteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract O0.

)). MXhlbauer *C, ?o+ano 6, 6rnaud MK. -ffect of calcium sulfate&rich water and mineral waterson bone resorption in the rat. Osteoporos Int. 33)4suppl )5(8BB. 2rogram and abstracts ofthe IOF World Congress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 2)@).

). Kenvrin C, Muno+ F, de la #ueronni[re E, #arnero 2, Meunier 2K. Consumption of a high Camineral water lowers biochemical indices of bone remodelling in postmenopausal women withlow Ca inta1eN Osteoporos Int. 33)4suppl )5(8G. 2rogram and abstracts of the IOF WorldCongress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 2G3.

). Constant F, 6eschlimann KM, Weryha #, /etalance %, *enaud /, 6rnaud MK. -volution ofbone mar1ers in women with low dietary Ca inta1es after drin1ing a Ca&rich water( arandomised controlled trial. Osteoporos Int. 33)4suppl )5(8BB. 2rogram and abstracts ofthe IOF World Congress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 2)@3.

)0. #uillemant K, 6ccarie C, de la #ueronniere E, #uillemant 8. 6cute effects on parathyroidfunction of the repeated ingestion of a high&calcium mineral water as compared to apharmaceutical preparation. Osteoporos Int. 33)4suppl )5(8. 2rogram and abstracts ofthe IOF World Congress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 2H0.

)B. Ortolani 8, 8cott 6, Cherubini *. Comparison of single versus repeated daily administration oforal Ca to suppress bone resorption in postmenopausal women. Osteoporos Int. 33)4suppl

)5(8H. 2rogram and abstracts of the IOF World Congress on Osteoporosis May )3&)0, 33?isbon, 2ortugal. 6bstract ))B.)D. 6lberta++i 2, 8teel 86, 2urdie /6, owarth -. Comparison of the effects of two different types

of calcium supplementation on mar1ers of bone metabolism in a postmenopausal osteopenicpopulation with low calcium inta1e( double&blind, placebo&controlled trial. Osteoporos Int.33)4suppl )5(80). 2rogram and abstracts of the IOF World Congress on OsteoporosisMay )3&)0, 33 ?isbon, 2ortugal. 6bstract 2).

)@. Macdonald M, %ew 86, Fraser W/, !lac1 6K, #rubb /6, *eid /M. Increased fruit \vegetable inta1e reduces bone turnover in early postmenopausal 8cottish women. OsteoporosInt. 33)4suppl )5(8H@. 2rogram and abstracts of the IOF World Congress on OsteoporosisMay )3&)0, 33 ?isbon, 2ortugal. 6bstract 2)D.

)G. %ew 86, 8mith *, !rown KC, *eid /M. 2ositive association between fruit \ vegetableconsumption and bone mass in late postmenopausal and elderly women. Osteoporos Int.33)4suppl )5(8@@. 2rogram and abstracts of the IOF World Congress on OsteoporosisMay )3&)0, 33 ?isbon, 2ortugal. 6bstract 20B.

)H. %ew 86. The role of the s1eleton in acid&base homeostasis. The 33) %utrition 8ociety Medal?ecture. 2roc %utr 8oc. 33D)()B)&)D0.

3. -ngel1e J, Jemmler W, Weinec1 K, ensen K, Jalender W. -FO28 & year results of a &yearhigh impact e


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osteoporosis, the ultimate goal of osteoporosis treatment and prevention is to reduce the number offractures in the population at ris1. Therefore, studies that provide insight into how and why fracturesoccur, who is at greatest ris1 for fractures, and the effects of interventions on fracture ris1 have greatclinical importance. .

Indeed, a low !M/ may be viewed as a ris1 factor for subse=uent fracture, rather than as a diagnostictool. 6long with other ris1 factors, low !M/ can be used to identify those at greatest ris1 for fracture, tosuggest new interventions to reduce that ris1, and to help target prevention and treatment to those whoare most li1ely to benefit. Of great importance are findings from many studies indicating that some ris1factors for fracture that are independent of !M/ remain predictive of fracture even after ad:usting for!M/. These have been instrumental in the development of the concepts of bone fragility and bone=uality and have reinforced the search for s1eletal factors other than !M/ that determine bone strengthas well as for ris1 factors that operate through an e


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contributing to bone fragility throughout the s1eleton. 6 meta&analysis presented by 8 !oonen,Jatholie1e 'niversiteit ?euven, ?euven, !elgium, and colleagues 90; summari+ed what has been learnedfrom prospective studies about the relationship between wrist and spine fractures and subse=uent hipfracture. Combining data from )3 cohort studies, they calculated that a woman aged B3 or older with ahistory of spine fracture had a .&fold increased ris1 of a subse=uent hip fracture, but a previous wristfracture carried only a ).B&fold increased ris1 of hip fracture. !y comparison, previous wrist and spinefractures in men were associated with .& and .B&fold increased ris1s, respectively, for a subse=uent

hip fracture. 6lthough a previous spine fracture is a clear indicator of the need for further evaluation inboth se


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8J Japtoge, 'niversity of Cambridge, 'nited Jingdom, and cowor1ers,9)); reported an analysis usingdata from the -uropean 2rospective Osteoporosis 8tudy 4-2O85 showing that on a population basis,differences in ris1 of limb fractures are strongly related to rates of falling in both men and women. Theyalso found that for some categories of fracture 4eg, upper&limb fractures in women5, rates of falling weremore important than !M/ in determining fracture ris1. It has been 1nown for years that several easy&to&obtain assessments of fall ris1 were able to predict the ris1 of falling with good accuracy. 8M 2lu:im, Eri:e 'niversiteit Medical Centre, 6msterdam, The %etherlands, and colleagues,9); have reconfirmed this

important 1nowledge in a cohort of elderly in The %etherlands. They found that in men and women agedDB and older, functional limitations, muscle wea1ness, e


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abstracts of the IOF World Congress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract O)D.

B. Olsson K, Kohnell O, Janis K, et al. 2revious fracture combined with forearm !M/measurement as a predictor of new fractures. Osteoporos Int. 33)4suppl )5(8)3. 2rogramand abstracts of the IOF World Congress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract O.

D. Kohnell O, /e ?aet C, Kohansson , et al. Oral corticosteroids increase fracture ris1

independently of !M/. Osteoporos Int. 33)4suppl )5(8)0. 2rogram and abstracts of theIOF World Congress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract O0.

@. %ational Osteoporosis Foundation, Osteoporosis( *eview of the -vidence for 2revention,/iagnosis, and Treatment and Cost&-ffectiveness 6nalysis( 8tatus *eport. Osteoporos Int.)HHGG4suppl 05(8)&8GG.

G. Cooper C, 6t1inson -K, O7Fallon WM, Melton ?K. Incidence of clinically diagnosed vertebralfractures( a population&based study in *ochester, Minnesota, )HGB&)HGH. K !one Miner *es.)HH@()&@.

H. van der Jlift M, de ?aet C-/, McClos1ey -E, et al. *is1 factors for incident vertebral fracturesin men and women( the *otterdam 8tudy. Osteoporos Int. 33)4suppl )5(8D@. 2rogram andabstracts of the IOF World Congress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 2).

)3. Cummings 8*, %evitt MC, !rowner W8, et al. *is1 factors for hip fracture in white women. %-ngl K Med. )HHB(@D@&@@.

)). Japtoge 8J, *oy /J, ?unt M, et al. ?ow !M/ is less predictive than ris1 of falling for futurelimb fractures in women across -urope. Osteoporos Int. 33)4suppl )5(8)3. 2rogram andabstracts of the IOF World Congress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract O).

). 2lui:m 8MF), 8mit K, Tromp 6M et al. Identifying community&dwelling elderly at high ris1 forrecurrent falling( results of a three year prospective study. Osteoporos Int. 33)4suppl )5(8H.2rogram and abstracts of the IOF World Congress on Osteoporosis May )3&)0, 33 ?isbon,2ortugal. 6bstract O)G.

Male Osteoporosis: Ris3 Factors and -athoph.siolog.

/ouglas C. !auer, M/

Osteoporosis in men continues to be a popular topic. 6t the International Osteoporosis Foundation 4IOF5World Congress in ?isbon, 2ortugal, osteoporosis in men was discussed widely in abstract and posterpresentations and at a Meet the -


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reduced ris1 of falling is un1nown, but it may relate to greater preservation of muscle mass and"orneuromuscular function in older men compared with women.

Ris3 Factors for Osteoporosis in Men

/r. !ile+i1ian noted that 03A to D3A of men with osteoporosis have an identifiable cause or ris1 factor.

The ma:or ris1 factors in men are corticosteroid use, alcohol abuse, and hypogonadism 4as assessed bybiochemical measurements, particularly free testosterone levels5. Other ris1 factors for osteoporosis inmen include a variety of medical conditions such as renal or liver disease, cancer 4particularlymyeloma5, and gastrointestinal problems that result in calcium and vitamin / deficiency. e cautionedabout using standard laboratory cutpoints for vitamin / measurements, typically H&B ng"d? in most '8laboratories, and suggested using a lower cutoff of 3&B ng"d? for diagnosis.

Diagnosis

Osteoporosis in men is typically diagnosed in ) of ways( after a low&trauma fracture, or less often, bythe presence of an abnormally low bone mineral density 4!M/5. ?ow and moderate trauma fracturesindicate impaired s1eletal strength and, as with women, confer a high ris1 of further fracture events. ?ow!M/ in men, particularly measured at a


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? #ennari and colleagues,90; Institute of Internal Medicine, 'niversity of 8iena, Italy, reported on therelationship between se< hormone levels, bone turnover, and bone loss over years of follow&up in acohort of 33 men aged BB&G. Total testosterone and estradiol levels were corrected for se< hormonebinding globulin 48!#5 and were reported at the free androgen and free estrogen inde


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• The ris1 of hip fracture seems to be similar for men and women at the same absolute level of!M/.

References

). Jhosla 8, Melton ?K III, *iggs !?. Clinical review )00( -strogen and the male s1eleton. K Clin

-ndocrinol Metab. 33G@()00&)0B3.. Jhosla 8, Melton ?K III, 6t1inson -K, O7Fallon WM. *elationship of serum se< steroid levels to

longitudinal changes in bone density in young versus elderly men. K Clin -ndocrinol Metab.33)GD(BBB&BD).

. 8+ulc 2, !ec1 T, Marchand F, /elmas 2. 2ossible role of se


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One biomechanical parameter that has been widely studied is hip a


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The most important ultrasound presentation in ?isbon was from the 8chwei+erische -valuierung derMessmethode des osteoporotischen Fra1turrisi1os 48-MOF5 study, a large prospective study of '8and fracture in 8wiss women.93; 6t baseline, @0H0 women older than age @B underwent '8measurement using commercial devices( calcaneal devices 4Lunar Achilles Plus and HologicSahara5 and ) that measures '8 of the phalan< 4DBM Sonic, Igea, Italy5. 6fter a mean follow&up of .Byears, D hip fractures were documented. 6fter age ad:ustment, the relative ris1 of fracture per standarddeviation 48/5 reduction in '8 was .3 4confidence interval 9CI;( ).B, .@5 for the Achilles, .0 4CI().@,

.5 for the Sahara, and 3.H 4CI( 3.3@, ).5 for the DBM Sonic . Further ad:ustment for weight and clinicalcenter had little effect. 'nfortunately, !M/ measurements were not obtained, so it is not possible tocompare these finding with hip !M/, the current gold standard.

These findings confirm that low calcaneal '8 is associated with an increased ris1 of hip fracture andalso emphasi+e the need for prospective validation previous observational studies, including onepresented in ?isbon,9); have suggested that low '8 measurements are associated with an increase infracture ris1. Meanwhile, clinicians should continue to use hip !M/, when available, to ma1e decisionsabout osteoporosis treatments for important reasons( some studies have found slightly strongerassociations with hip !M/ compared with '8, and virtually all trials of effective osteoporosistreatments have used !M/, not '8, to select high&ris1 patients. 8ome have advocated using '8 asa prescreen for /6 referral,9; but the efficacy and cost&effectiveness of such approaches have notbeen ade=uately evaluated.

Microarchitecture

The e


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References

). Cummings 8*, !lac1 /M, %evitt MC, et al. !one density at various sites for prediction of hipfractures. ?ancet. )HH0)(@&@B.

. Melton ?K III, Orwoll -8, Wasnich */. /oes bone density predict fractures comparably in menand womenN Osteoporos Int. 33))(@3@&@3H.

. Turner C. !iomechanics of bone( determinants of s1eletal fragility and bone =uality.Osteoporos Int. 33)(H@&)30.0. *iggs !?, Melton ?K III. The prevention and treatment of osteoporosis. % -ngl K Med.

)HH@(D3&[email protected]. 8chwart+ 6E, Jelsey K?, Maggi 8, et al. International variation in the incidence of hip fractures(

cross&national pro:ect on osteoporosis for the World ealth Organi+ation 2rogram for *esearchon 6ging. Osteoporos Int. )HHHH(0&B.

D. Faul1ner J#, McClung M, Cummings 8*. 6utomated evaluation of hip a


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33)4suppl )5(8B. 2rogram and abstracts of the IOF World Congress on Osteoporosis May)3&)0, 33 ?isbon, 2ortugal. 6bstract OD.

B. #enant J, #ordon C, Kiang $, et al. 6dvanced imaging of the macrostructure andmicrostructure of bone. orm *es. 333B04suppl )5(0&3.

/iocheical Measureents of /one Reodeling 66 4e2 Data Reportedat the World Congress on Osteoporosis

2ierre /. /elmas, M/, 2h/

Introduction

Tools are needed to predict fracture ris1 in women and men. Fractures do not occur with enoughfre=uency allow for detection of associations between ris1 factors such as age, se


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When the mar1ers were combined, A of women with high turnover at baseline had low turnover 0years later. 6 single measurement of ) or mar1ers accurately classifies most women with high or lowturnover over a prolonged period of time. For those women with intermediate levels, a secondmeasurement may be needed.

Mar3ers %hat -redict /MD and Fracture Ris3

8everal previous studies have shown that postmenopausal women with high bone turnover && ie, withmar1ers above the range of that seen in premenopausal women && have an increased ris1 of fragilityfractures, including hip and spine.

# *iera&-spino+a and colleagues,9; '%I?IM-, 'niversidad de Carabobo, ospital 'niversitario /r. 6ngel ?arralde, Ealencia, Eene+uela, reported results of a study of the use of different mar1ers of boneturnover to evaluate remodeling rates in G osteoporotic postmenopausal women. If the cut&off point for high bone turnover was set at or standard deviations 48/5 above the premenopausal mean of %T,D.A or BB.GA, respectively, had high turnover. 'sing tartrate&resistant acid phosphatase 4T*625 as amar1er, )D.HA and @.0A, respectively, had high turnover. With al1aline phosphatase 4625 as the mar1er,).GA and )G.3A, respectively, had high turnover. The data indicate that GD.BA of the study patientshad resorption greater than the premenopausal mean according to %T determination and that D.Ahad high bone turnover, as defined by 8/ above the control mean. %T was able to identify more

patients with high bone turnover than T*62 or 62.

?. Fran+son and associates,90; 'niversity ospital, *ey1:avi1, Iceland, reported their research onT*62Bb isoform, which is formed in osteoclasts, as a mar1er of bone resorption in 03&GB year olds. 6mong B women and 0H men, T*62Bb correlated with other mar1ers in both se


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% Morabito and cowor1ers,9@; 'niversity of Messina, Messina, Italy, presented results of a studyevaluating the effects of genistein on bone loss. They randomi+ed H3 healthy women, aged B&D3 years,to ) year of continuous *T, genistein, or placebo. *esults are shown in Table ).

%able @7 Effects of 'enistein vs *R% vs -lacebo on /one (oss at %2elve Months >4A B"?

'enistein *R% -lacebo

-


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in %T was comparable to that seen with daily dosing. !62 results were similar. The study indicates thatalendronate, @3 mg once wee1ly, provides a sustained reduction of bone remodeling.

M ochberg, 'niversity of Maryland, !altimore, and colleagues 9); reported that reduced levels ofturnover mar1ers under bone antiresorptive therapy predict the reduction in nonvertebral fractures. Intrials evaluating the antifracture efficacy of alendronate, calcitonin, etidronate, estrogen, ralo


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as measured by urinary /2/ levels. In the pooled data set, risedronate reduced the ris1 of newvertebral fractures after year ) irrespective of remodeling rate 4** Q median /2/ 3.G, P .3 vs **Y median /2/ 3., P .333)5. In the osteoporotic patients from the I2 trial, vertebral fracturereduction in those with higher rate of bone resorption tended to be greater than in those with a lowerrate of bone resorption. This trend was not present in the subgroup with prevalent fractures. The authorsinfer that risedronate reduces the ris1 of new vertebral fractures irrespective of remodeling rate.

+tatins

M 8hibata and colleagues,9)H; Tei1yo 'niversity, Ichihara, Kapan, presented results from a small study onthe effects of cerivastatin on bone turnover in )B postmenopausal women. The results suggest that evenat the low doses of cerivastatin used to treat mild hypercholesterolemia, this statin may inhibit boneresorption in postmenopausal women. 6fter ) month of cerivastatin, 3.)B mg"day, serum totalcholesterol decreased by A. %T level decreased by )).0A after D months, and 62 level did notchange. !M/ at the lumbar spine and hip did not change during this period.

Conclusions

There is growing evidence that measurement of bone turnover mar1ers may be useful in the clinicalinvestigation of osteoporosis, not only in the assessment of fracture ris1 in untreated patients but also,and perhaps mainly, for monitoring therapy. Whether such monitoring will improve patients7 complianceto treatment needs to be investigated.

References

). #arnero 2, -astell *, /elmas 2/. igh and low bone turnover classification of postmenopausalwomen by biochemical mar1ers( influence of the day&to&day variability( the IM26CT study.Osteoporos Int. 33)4suppl )5(8B. 2rogram and abstracts of the IOF World Congress onOsteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 2)D3 .

. #arnero 2, Mulmann /, Muno+ F, 8ornay&*endu -, /elmas 2/. ?ong&term variability ofmar1ers of bone turnover in postmenopausal women and implications for their clinical utility.The OF-?$ 8tudy. Osteoporos Int. 33)4suppl )5(8B. 2rogram and abstracts of the IOFWorld Congress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 2)D0 .

. *iera&-spino+a #, Cordero $, *amos K, Marcano ?. igh remodeling turnover in Eene+uelanosteoporotic patients. Osteoporos Int. 33)4suppl )5(8BG. 2rogram and abstracts of the IOFWorld Congress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 2)G.

0. Fran+son ?, Indridason O8, 8igurdsson #. 8erum tartrate&resistant acid phosphatase Bb is anindependent predictor of bone mineral density in women but not in men. Osteoporos Int.33)4suppl )5(8B. 2rogram and abstracts of the IOF World Congress on OsteoporosisMay )3&)0, 33 ?isbon, 2ortugal. 6bstract 2)D .

B. $oshimura %, %a1atsu1a J, %ishi+awa $, 8a1ata J, ashimoto T, Cooper C. !iochemicalmar1ers of bone turnover and bone loss among men and women in a rural community inKapan, )HH&333 ( The Tai:i 8tudy. Osteoporos Int. 33)4suppl )5(8D3. 2rogram andabstracts of the IOF World Congress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 2)G@.

D. I1i M, 61iba T, %ishino , et al. 2redictive value of biochemical mar1ers of bone turnover forsubse=uent bone loss and fast bone losers. Osteoporos Int. 33)4suppl )5(8DH. 2rogramand abstracts of the IOF World Congress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 2)

@. Morabito %, #audio 6, Crisafulli 6, et al. #enistein prevents bone loss in early postmenopausalwomen. Osteoporos Int. 33)4suppl )5(8. 2rogram and abstracts of the IOF WorldCongress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 2D).

G. Thiebaud /, Crans #, Jung 6, ?impaphayom J, #on+aga F. -ffects of ralo


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Osteoporos Int. 33)4suppl )5(8. 2rogram and abstracts of the IOF World Congress onOsteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 2D.

)). !one , 8chnit+er T, *eid I, et al. Once&wee1ly alendronate @3 mg( sustained suppression ofbone resorption. Osteoporos Int. 33)4suppl )5(8H. 2rogram and abstracts of the IOFWorld Congress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 2G .

). ochberg MC, #reenspan 8, Miller 2/, Wasnich */, *oss 2/, Thompson /-. ?argerincreases in bone mineral density 4!M/5 during the first year of treatment are associated with

greater reductions in nonvertebral fracture incidence during antiresorptive therapy. OsteoporosInt. 33)4suppl )5(8). 2rogram and abstracts of the IOF World Congress on OsteoporosisMay )3&)0, 33 ?isbon, 2ortugal. 6bstract 2G@.

). !auer /C, !lac1 /M, #arnero 2, et al. *eduction in bone turnover predicts hip, non&spine, andvertebral fracture in alendronate treated women( the fracture intervention trial. 2resented at the?ate&!rea1ing %ews 8ession, Tuesday, May )0, 33. 6bstract O00.

)0. Jor+h OM, !ondaren1o TI. Influence of alendronate on bone al1aline phosphatase and bonemineral density in postmenopausal osteoporotic women. Osteoporos Int. 33)4suppl )5(8.2rogram and abstracts of the IOF World Congress on Osteoporosis May )3&)0, 33 ?isbon,2ortugal. 6bstract 2D0.

)B. 8tepan KK, Michals1] /, Eo1rouhlic1] K. 8ustained suppression by B3A below premenopausallevels of the mar1er of bone formation 42I%25 in postmenopausal women treated withalendronate. Osteoporos Int. 33)4suppl )5(83. 2rogram and abstracts of the IOF WorldCongress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 2B .

)D. !ertoldo F, Franchina #, Fracalossi 6, et al. T#F&b) gene polymorphism affects bone turnoverchanges after alendronate withdrawal in postmenopausal osteoporosis. Osteoporos Int.33)4suppl )5(8D. 2rogram and abstracts of the IOF World Congress on OsteoporosisMay )3&)0, 33 ?isbon, 2ortugal. 6bstract 2)HB .

)@. -astell *, !arton I, annon *6, et al. 6ntifracture efficacy of risedronate( prediction by changein bone resorption mar1ers. 2resented at the ?ate&!rea1ing %ews 8ession, Tuesday, May )0,33. 6bstract O00.

)G. 8eibel MK, !arton I, #rauer 6. Eertebral fracture incidence in postmenopausal osteoporoticwomen treated with risedronate( the role of pre&treatment bone turnover. Osteoporos Int.33)4suppl )5(83. 2rogram and abstracts of the IOF World Congress on OsteoporosisMay )3&)0, 33 ?isbon, 2ortugal. 6bstract 2B0

)H. 8hibata M, Oo1a , ayashi T, et al. ?ow&dose cerivastatin decreases bone resorption mar1erin postmenopausal women with hypercholesterolemia. Osteoporos Int. 33)4suppl )5(8BD.2rogram and abstracts of the IOF World Congress on Osteoporosis May )3&)0, 33 ?isbon,2ortugal. 6bstract 2)@0.

4e2 Wa.s of /isphosphonate &dinistration in Osteoporosis

8ocrates -. 2apapoulos, M/, 2h/

!isphosphonates are widely used in the management of osteoporosis. /aily administration ofalendronate or risedronate suppresses bone turnover, increases !M/, and reduces the ris1 of vertebraland nonvertebral fractures, including those of the hip. 9)&D; /aily administration is inconvenient, however,because bisphosphonates need to be ta1en on an empty stomach at least 3 minutes before brea1fast,and the patient should remain in an upright position. To overcome this problem, which has rendered

long&term adherence to treatment problematic, alternative ways of bisphosphonate administration havebeen e


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patients and showed consistency of !M/ changes in postmenopausal women with osteoporosisregardless of age 4younger or older than DB or @B years5, prevalent vertebral fractures, baseline !M/4greater or less than the median5, or time since the menopause 4more or less than )3 years5.

The therapeutic concept of the wee1ly dosing was further confirmed with risedronate in a )&year study of )0BD women with osteoporosis.9)3; These women were treated with risedronate B mg daily, B mg oncewee1ly, or B3 mg once wee1ly. 6ll regimens reduced biochemical mar1ers of bone turnover to a similar e


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Finally, results with wee1ly administration of another nitrogen&containing bisphosphonate, ibandronate,were presented for the first time at this conference. Ibandronate is more potent than alendronate andrisedronate, and daily oral administration of .B mg reduces significantly the incidence of vertebralfractures in postmenopausal women with osteoporosis. 9)@; / Felsenberg, 'niversity ospital, !erlin,#ermany, for the Oral Ibandronate 8tudy #roup, 9)G; reported a dose&finding study of ibandronate oncewee1ly in the prevention of bone loss in D3 postmenopausal women with normal !M/ or osteopenia.Three wee1ly ibandronate doses, B mg )3 mg, and 3 mg, were tested against placebo for years.

There were dose&dependent increases in !M/ at the spine and the total hip, and the responses to )3and 3 mg once wee1ly were significantly different from responses to placebo.

It is clear now from the data generated that wee1ly bisphosphonate administration should be consideredtherapeutically e=uivalent to the daily administration with its proven antifracture efficacy rather than asan intermittent regimen. In addition, it is safe, preferred by the vast ma:ority of patients, and e


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ibandronate regimen that was shown to have significant antifracture efficacy. The lessons learned fromthe studies with intravenous in:ections of ibandronate can aid with the design of appropriate efficacioustherapeutic regimens using parenteral administration, at least with this bisphosphonate. 8tudies of theuse of intravenous ibandronate in the prevention of postmenopausal bone loss were also presented atWCO.90;

6dditional data were presented for other bisphosphonates given intravenously for indications other thanpostmenopausal osteoporosis. 2rofessor Francis . #lorieu


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). Watts %!, ?i S, oseyni M8, et al. -fficacy of once&a&wee1 risedronate in reducing vertebralfracture ris1. Osteoporosis Int 33 ) 4suppl )5( 8)@. 2rogram and abstracts of the IOF WorldCongress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 20B.

). 2almisano K, Melton M, #reenspan 8?, et al. 6lendronate @3 mg once wee1ly vs placebo(tolerability study in patients with osteoporosis. Osteoporos Int. 33)4suppl )5(8@. 2rogramand abstracts of the IOF World Congress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract 2@@.

)0. Jendler /?, /ie+&2ere+ 6, #aines J6, et al. 2atient preference of once wee1ly or dailyadministration of alendronate 4Fosama


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/ennis !lac1, 2h/

8elective estrogen receptor modulators 48-*Ms5 designate the class of compounds that are estrogenicin some tissues and antiestrogenic in others. There were few new results relating to 8-*Ms presentedat the IOF World Congress on Osteoporosis, but the sponsored symposia provided good reviews ofpreviously published and"or presented results.

Fracture Reduction is the 'old +tandard for Coparing &ntiresorptive %herapies

In a satellite symposium, /r. 2ierre /elmas,9); I%8-*M 03 'nit, ?yon, France, provided bac1ground forthe presentation of a set of results from ralo


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was the set used in the risedronate studies5, there was a significant reduction in osteoporoticnonvertebral fractures.

This analysis has important limitations, however, including the lac1 of preplanning, the small si+e of thesubgroup, and the ad hoc nature of the end point thus, /r. /elmas ac1nowledged that these resultsshould be viewed as suggestive only. Furthermore, he did not present the results from thecomplementary subgroups 4eg, those with grades 3, ), or vertebral fractures at baseline5 forcomparison. /r. /elmas went on to speculate that women with more severe osteoporosis at baseline4as assessed by having more severe vertebral fractures5 might derive more benefit from antiresorptivetherapy. e suggested the need for parallel analyses of other data sets or additional studies in this area.

(asofo9ifene

6t a symposium,90; the preclinical and phase results for lasofo


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8tandard for 2ostmenopausal Women 8atellite 8ymposium of IOF&World Congress onOsteoporosis. May )3, 33 ?isbon, 2ortugal.

B. Moffet 6 Kr. -merging data and e


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!M/4spine5change

PHA PGA &)A P)0A PGA &DA

%able !: Reduction in Ris3 of Fracture With -%* %reatent During Randoied-hase and Observational Follo26up

-%* !" cg -%* " cg

End of observationalfollo26up

End of observational follo26up

/uringrandomi+edphase 42T5

From end ofrandomi+edphase

From start ofrandomi+edphase

/uringrandomi+edphase 42T5

From end ofrandomi+edphase

From start ofrandomi+edphase

*eduction invertebralfracture

DHA 00A 0BA D@A B3A 03A

*eduction innonvertebralfracture

D)A BA 0GA D3A 0GA 0A

/r. Orwoll also reviewed the results from the study of 2T4)&05 in men. 6 total of 0@ men with !M/ T&score at the hip or spine below & were recruited. The men were relatively young( mean age BH atbaseline. Forty&one percent had prevalent vertebral fractures at baseline, and the mean T&score for!M/ at the total hip 4male reference5 was &.0. They were randomi+ed to placebo, 3 mcg, or 03 mcg of

2T4)&05 and treated for an average of )) months 4the study was stopped prematurely because ofconcerns about osteosarcoma in laboratory rats given high&dose"long&duration 2T9)&0;5. The resultsshowed that, compared with placebo, 2T4)&05 03 mcg increased spine !M/ by about G.BA, and 3mcg increased spine !M/ by about BA. Corresponding changes at the hip were A and )A,respectively. 6 subgroup analysis 4baseline tertiles5 showed that !M/ increases were independent ofthe following baseline factors( baseline !M/, age, free testosterone, estradiol, and smo1ing. /r. Orwollalso presented data on bone mar1ers, which showed large increases in bone formation and resorptionover the )) months of the study.

In his plenary presentation about potential new medications for osteoporosis, #reg Mundy, 9B; CT*CInstitute for /rug /evelopment, 'niversity of Te


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decrease in !M/ seen in some 2T studies, particularly at cortical&rich sites, may not be harmful andmay, in fact, be associated with increased bone strength.

/r. ?indsay speculated that the increase in the number and life span of osteoblasts and osteocytesmight result in a positive prolonged effect of 2T on bone, even after discontinuation of therapy.2erhaps this e


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antiresorptive therapy is used. For e


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Michael C. %evitt, 2h/

6t the recent World Congress on Osteoporosis 4WCO5, the International Osteoporosis Foundation 4IOF5,Osteoarthritis *esearch 8ociety International 4O6*8I5, and the International ?eague 6gainst*heumatism 4I?6*5 cosponsored a symposium entitled *ecent 6dvances in Osteoarthritis to helpmar1 the start of the World ealth Organi+ation 4WO5&designated !one and Koint /ecade. *eviewswere presented by eminent e


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hormonal abnormalities associated with obesity may also have an effect, as suggested by an increase,albeit modest, in hand O6 in obese women. ip O6 is also modestly increased with obesity.

&nial Models and Estrogen

/r. *oland Mos1owit+,9); of Case Western *eserve 'niversity, Cleveland, Ohio, followed with a

discussion of the importance of animal models in investigations of O6. 6nimal models allow for the studyof disease pathology and etiopathogenesis in the process of O6 and will play a critical role in theevaluation of disease&modifying therapeutic agents.9)0; owever, it remains uncertain which animalmodels best represent the human disease process in O6. 9)B; The canine anterior cruciate ligamentresection and the rabbit partial menisectomy are highly successful models that simulate human 1needisease in terms of cartilage degradation, cartilage metabolism changes, and osteophyte formation.%evertheless, different models may more closely appro


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regeneration && were reviewed by /r. 2ierre /elmas9)G; of I%8-*M *esearch 'nit 03, _pital -douarderriot in ?yon, France. 6s with M*I, the ability of biochemical mar1ers to assess cartilage damage hasreceived the greatest attention from researchers. owever, mar1ers for O6&related changes in othertissues, including the synovium and periarticular bone, are also under development. The hope is thatthese mar1ers 4both biochemical and M*I, see above5 will help identify those who are at the earlystages in the development of O6, before irreparable :oint damage has occurred, and will also besensitive enough to changes in the disease process and progression of :oint damage so that they can

be used in assessing drug efficacy and monitoring treatment effects in patients. 9)H&);

The more practical mar1ers of cartilage, synovium, and bone metabolism are obtained from serum andurine, rather than from the :oint fluid. These mar1ers reflect the body7s overall metabolism of the targettissue and not :ust that of the specific :oint or :oints with O6. Thus, the more specific the biochemicalmar1er for tissue metabolism and destruction characteristic of O6, the greater the potential value of themar1er. 6s /r. /elmas e


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upperI side effects from use of nonselective %86I/s include a history of peptic ulcer disease, ongoingtreatment with glucocorticoids or anticoagulants, e


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). Felson /T, 6nderson KK, %aimar1 6, Wal1er 6M, Meanan *F. Obesity and 1nee osteoarthritis(the Framingham study. 6nn Intern Med. )HGG)3H()G&0.

). Mos1owit+ *W. What do cellular and animal models predict for the clinical management ofosteoarthritisN Osteoporos Int. 33)4suppl )5(8)0. 2rogram and abstracts of the IOF WorldCongress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract O6.

)0. Mos1owit+ *W. The relevance of animal models in osteoarthritis. 8cand K *heumatol.)HH3)H4suppl G)5()&.

)B. van den !erg W!. ?essons from animal models of osteoarthritis. Curr Opin *heumatol.33))(0B&0BD.

)D. *osner I6, #oldberg EM, Mos1owit+ *W. -strogens and osteoarthritis. Clin Orthop.)HGD)(@@&G.

)@. 2eterfy C. Imaging of osteoarthritis. Osteoporos Int. 33)4suppl )5(8)00 2rogram andabstracts of the IOF World Congress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract O6.

)G. /elmas 2. Clinical use of biochemical mar1ers of bone, cartilage and synovium turnover inosteoarthritis Osteoporos Int. 33)4suppl )5(8)0B. 2rogram and abstracts of the IOF WorldCongress on Osteoporosis May )3&)0, 33 ?isbon, 2ortugal. 6bstract O60.

)H. #arnero 2, 2iperno M, #ineyts -, Christgau 8, /elmas 2/, Eignon -. Cross sectionalevaluation of biochemical mar1ers of bone, cartilage, and synovial tissue metabolism inpatients with 1nee osteoarthritis( relations with disease activity and :oint damage. 6nn *heum/is. 33)D3(D)H&DD.

3. Christgau 8, #arnero 2, Fledelius C, et al. Collagen type II C&telopeptide fragments as an inde


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8an Francisco.

/isclosure( /ouglas C. !auer, M/, has disclosed that he has served as an advisor orconsultant for 2roctor \ #amble. e has received grants for clinical research from Merc1.

Dennis /lac3 -hD

2rofessor of -pidemiology and !iostatistics, 'niversity of California, 8an Francisco, California

/isclosure( /ennis !lac1, M/, has disclosed that he has served as an advisor or consultantfor -li ?illy and %28 2harmaceuticals, Inc. e has received grants for clinical research fromMerc1 and %ovartis. e has served as a spea1er for -li ?illy and Merc1. In this activity, /r.!lac1 discusses the unlabeled use of ralo


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Clinical Editors

;rsula +n.der -hD

Women7s ealth 8ite -ditor, Medscape, Inc

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