European guidance for the diagnosis and management of osteoporosis in postmenopausal women.

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Abstract

Guidance is provided in a European setting on the assessment and treatment of postmenopausal women at risk from fractures due to osteoporosis.

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Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis.

R M Neer, C Arnaud, J. Zanchetta … (2001)

Once-daily injections of parathyroid hormone or its amino-terminal fragments increase bone formation and bone mass without causing hypercalcemia, but their effects on fractures are unknown. We randomly assigned 1637 postmenopausal women with prior vertebral fractures to receive 20 or 40 microg of parathyroid hormone (1-34) or placebo, administered subcutaneously by the women daily. We obtained vertebral radiographs at base line and at the end of the study (median duration of observation, 21 months) and performed serial measurements of bone mass by dual-energy x-ray absorptiometry. New vertebral fractures occurred in 14 percent of the women in the placebo group and in 5 percent and 4 percent, respectively, of the women in the 20-microg and 40-microg parathyroid hormone groups; the respective relative risks of fracture in the 20-microg and 40-microg groups, as compared with the placebo group, were 0.35 and 0.31 (95 percent confidence intervals, 0.22 to 0.55 and 0.19 to 0.50). New nonvertebral fragility fractures occurred in 6 percent of the women in the placebo group and in 3 percent of those in each parathyroid hormone group (relative risk, 0.47 and 0.46, respectively [95 percent confidence intervals, 0.25 to 0.88 and 0.25 to 0.861). As compared with placebo, the 20-microg and 40-microg doses of parathyroid hormone increased bone mineral density by 9 and 13 more percentage points in the lumbar spine and by 3 and 6 more percentage points in the femoral neck; the 40-microg dose decreased bone mineral density at the shaft of the radius by 2 more percentage points. Both doses increased total-body bone mineral by 2 to 4 more percentage points than did placebo. Parathyroid hormone had only minor side effects (occasional nausea and headache). Treatment of postmenopausal osteoporosis with parathyroid hormone (1-34) decreases the risk of vertebral and nonvertebral fractures; increases vertebral, femoral, and total-body bone mineral density; and is well tolerated. The 40-microg dose increased bone mineral density more than the 20-microg dose but had similar effects on the risk of fracture and was more likely to have side effects.

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Diagnosis of osteoporosis and assessment of fracture risk.

John Kanis (2002)

The diagnosis of osteoporosis centres on the assessment of bone mineral density (BMD). Osteoporosis is defined as a BMD 2.5 SD or more below the average value for premenopausal women (T score < -2.5 SD). Severe osteoporosis denotes osteoporosis in the presence of one or more fragility fractures. The same absolute value for BMD used in women can be used in men. The recommended site for diagnosis is the proximal femur with dual energy X-ray absorptiometry (DXA). Other sites and validated techniques, however, can be used for fracture prediction. Although hip fracture prediction with BMD alone is at least as good as blood pressure readings to predict stroke, the predictive value of BMD can be enhanced by use of other factors, such as biochemical indices of bone resorption and clinical risk factors. Clinical risk factors that contribute to fracture risk independently of BMD include age, previous fragility fracture, premature menopause, a family history of hip fracture, and the use of oral corticosteroids. In the absence of validated population screening strategies, a case finding strategy is recommended based on the finding of risk factors. Treatment should be considered in individuals subsequently shown to have a high fracture risk. Because of the many techniques available for fracture risk assessment, the 10-year probability of fracture is the desirable measurement to determine intervention thresholds. Many treatments can be provided cost-effectively to men and women if hip fracture probability over 10 years ranges from 2% to 10% dependent on age.

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Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis.

(1993)

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Author and article information

Journal

Journal ID (iso-abbrev): Osteoporos Int

Title: Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA

Publisher: Springer Science and Business Media LLC

ISSN (Electronic): 1433-2965

ISSN (Print): 0937-941X

Publication date (Electronic): Jan 2019

Volume: 30

Issue: 1

Affiliations

[1 ] Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK. w.j.Pontefract@shef.ac.uk.

[2 ] Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia. w.j.Pontefract@shef.ac.uk.

[3 ] MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.

[4 ] NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK.

[5 ] University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland.

[6 ] Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.

[7 ] Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia.

Article

Publisher Item ID: 10.1007/s00198-018-4704-5

DOI: 10.1007/s00198-018-4704-5

PMC ID: 7026233

PubMed ID: 30324412

SO-VID: 327811d5-eea7-4169-987b-677e7e1680ee

History

Keywords: Bone mineral density,Diagnosis of osteoporosis,FRAX,Fracture risk assessment,Health economics,Treatment of osteoporosis

Data availability:

Keywords: Bone mineral density, Diagnosis of osteoporosis, FRAX, Fracture risk assessment, Health economics, Treatment of osteoporosis

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European guidance for the diagnosis and management of osteoporosis in postmenopausal women.

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Most cited references 266

Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis.

Diagnosis of osteoporosis and assessment of fracture risk.

Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis.

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