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NEW ORLEANS — Bone health experts offered their share of helpful clinical insights at the annual meeting of the International Society for Clinical Densitometry.
Here are some of the highlights:
Low Bone Density in the Young
Low bone density is not uncommon in young adults but—at least in the short term—does not carry with it the same relative risk of fracture as in older individuals unless secondary causes of metabolic bone disease are identified, said Andrew J. Laster, M.D., a rheumatologist practicing in North Carolina.
Secondary causes of low BMD include endocrinopathies (hypercalciuria, hypogonadism, hyperparathyroidism, and Cushing's syndrome), some GI disorders (gastrectomy, inflammatory bowel disease, celiac disease, intestinal bypass surgery, primary biliary cirrhosis, and pancreatic insufficiency), genetic disorders (Ehlers-Danlos syndrome, Marfan syndrome, and homocystinuria), and eating disorders (anorexia nervosa, bulimia nervosa, and female athlete triad).
Assessing Fracture Risk Factors
Before experts declare the benefits of addressing a particular risk factor in an individual patient, they should stop and ask some key questions, advised John Kanis, M.D., director of the World Health Organization's Collaborating Centre for Metabolic Bone Diseases in Sheffield, England.
The questions are: Is the risk factor internationally validated? Is it feasible for a primary care physician to assess the risk factor? Is the risk factor intuitive?
When to Do Vertebral Assessments
Paul Miller, M.D., director of the Colorado Center for Bone Research in Lakewood, recommended performing a vertebral assessment in patients with any of the following:
▸ Loss of 1.5 inches or more in height.
▸ Back pain in patients coming to your office for osteoporosis assessment.
▸ Known vertebral deformities or hip fractures.
▸ Kyphosis.
▸ Chronic glucocorticoid therapy.
▸ Age older than 60 years.
Turnover Markers
There are a number of potential advantages to using bone turnover markers, according to Douglas C. Bauer, M.D., of the University of California, San Francisco.
These measurements provide a more dynamic assessment of skeletal metabolism than BMD. More importantly, bone turnover markers rapidly reflect changes as a result of therapy, providing a better means of assessing treatment efficacy.
The most significant disadvantage to using clinical markers is that there is typically very high day-to-day and even time-of-day variability in the results, Dr. Bauer said.
Timing
For a patient who has been on an antiresorptive therapy and who will be taking teriparatide, there is no need for a break between the two therapies, said John Bilezikian, M.D., professor of medicine and pharmacology at Columbia University, New York.
For patients starting therapy for low BMD, Dr. Bilezikian recommends monotherapy with either an antiresorptive or with parathyroid hormone.
NEW ORLEANS — Bone health experts offered their share of helpful clinical insights at the annual meeting of the International Society for Clinical Densitometry.
Here are some of the highlights:
Low Bone Density in the Young
Low bone density is not uncommon in young adults but—at least in the short term—does not carry with it the same relative risk of fracture as in older individuals unless secondary causes of metabolic bone disease are identified, said Andrew J. Laster, M.D., a rheumatologist practicing in North Carolina.
Secondary causes of low BMD include endocrinopathies (hypercalciuria, hypogonadism, hyperparathyroidism, and Cushing's syndrome), some GI disorders (gastrectomy, inflammatory bowel disease, celiac disease, intestinal bypass surgery, primary biliary cirrhosis, and pancreatic insufficiency), genetic disorders (Ehlers-Danlos syndrome, Marfan syndrome, and homocystinuria), and eating disorders (anorexia nervosa, bulimia nervosa, and female athlete triad).
Assessing Fracture Risk Factors
Before experts declare the benefits of addressing a particular risk factor in an individual patient, they should stop and ask some key questions, advised John Kanis, M.D., director of the World Health Organization's Collaborating Centre for Metabolic Bone Diseases in Sheffield, England.
The questions are: Is the risk factor internationally validated? Is it feasible for a primary care physician to assess the risk factor? Is the risk factor intuitive?
When to Do Vertebral Assessments
Paul Miller, M.D., director of the Colorado Center for Bone Research in Lakewood, recommended performing a vertebral assessment in patients with any of the following:
▸ Loss of 1.5 inches or more in height.
▸ Back pain in patients coming to your office for osteoporosis assessment.
▸ Known vertebral deformities or hip fractures.
▸ Kyphosis.
▸ Chronic glucocorticoid therapy.
▸ Age older than 60 years.
Turnover Markers
There are a number of potential advantages to using bone turnover markers, according to Douglas C. Bauer, M.D., of the University of California, San Francisco.
These measurements provide a more dynamic assessment of skeletal metabolism than BMD. More importantly, bone turnover markers rapidly reflect changes as a result of therapy, providing a better means of assessing treatment efficacy.
The most significant disadvantage to using clinical markers is that there is typically very high day-to-day and even time-of-day variability in the results, Dr. Bauer said.
Timing
For a patient who has been on an antiresorptive therapy and who will be taking teriparatide, there is no need for a break between the two therapies, said John Bilezikian, M.D., professor of medicine and pharmacology at Columbia University, New York.
For patients starting therapy for low BMD, Dr. Bilezikian recommends monotherapy with either an antiresorptive or with parathyroid hormone.
NEW ORLEANS — Bone health experts offered their share of helpful clinical insights at the annual meeting of the International Society for Clinical Densitometry.
Here are some of the highlights:
Low Bone Density in the Young
Low bone density is not uncommon in young adults but—at least in the short term—does not carry with it the same relative risk of fracture as in older individuals unless secondary causes of metabolic bone disease are identified, said Andrew J. Laster, M.D., a rheumatologist practicing in North Carolina.
Secondary causes of low BMD include endocrinopathies (hypercalciuria, hypogonadism, hyperparathyroidism, and Cushing's syndrome), some GI disorders (gastrectomy, inflammatory bowel disease, celiac disease, intestinal bypass surgery, primary biliary cirrhosis, and pancreatic insufficiency), genetic disorders (Ehlers-Danlos syndrome, Marfan syndrome, and homocystinuria), and eating disorders (anorexia nervosa, bulimia nervosa, and female athlete triad).
Assessing Fracture Risk Factors
Before experts declare the benefits of addressing a particular risk factor in an individual patient, they should stop and ask some key questions, advised John Kanis, M.D., director of the World Health Organization's Collaborating Centre for Metabolic Bone Diseases in Sheffield, England.
The questions are: Is the risk factor internationally validated? Is it feasible for a primary care physician to assess the risk factor? Is the risk factor intuitive?
When to Do Vertebral Assessments
Paul Miller, M.D., director of the Colorado Center for Bone Research in Lakewood, recommended performing a vertebral assessment in patients with any of the following:
▸ Loss of 1.5 inches or more in height.
▸ Back pain in patients coming to your office for osteoporosis assessment.
▸ Known vertebral deformities or hip fractures.
▸ Kyphosis.
▸ Chronic glucocorticoid therapy.
▸ Age older than 60 years.
Turnover Markers
There are a number of potential advantages to using bone turnover markers, according to Douglas C. Bauer, M.D., of the University of California, San Francisco.
These measurements provide a more dynamic assessment of skeletal metabolism than BMD. More importantly, bone turnover markers rapidly reflect changes as a result of therapy, providing a better means of assessing treatment efficacy.
The most significant disadvantage to using clinical markers is that there is typically very high day-to-day and even time-of-day variability in the results, Dr. Bauer said.
Timing
For a patient who has been on an antiresorptive therapy and who will be taking teriparatide, there is no need for a break between the two therapies, said John Bilezikian, M.D., professor of medicine and pharmacology at Columbia University, New York.
For patients starting therapy for low BMD, Dr. Bilezikian recommends monotherapy with either an antiresorptive or with parathyroid hormone.