OP/Bone

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Osteoporosis: Thinking outside the box

Robert Chao, MD

As rheumatologists, most of us manage osteoporosis in some form every single day. We have newer agents, newer sequencing strategies, and an increasing number of patients asking for “less medicinal” options that go beyond a prescription. At RWCS, Dr. Gina Woods opened her talk by reframing

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3 Months of Romosozumab in Postmenopausal Osteoporosis A report in The Lancet Diabetes & Endocrinology suggested that 3 months of romosozumab (ROMO) followed by denosumab is as effective at increasing hip bone mineral density (BMD) as the standard 12-month course. https://t.co/HPM7DdRFBM
Dr. John Cush @RheumNow( View Tweet )
3 Months of Romosozumab in Postmenopausal Osteoporosis A report in The Lancet Diabetes & Endocrinology suggested that 3 months of romosozumab (ROMO) followed by denosumab is as effective at increasing hip bone mineral density (BMD) as the standard 12-month course. https://t.co/6HfGFZqavF
Dr. John Cush @RheumNow( View Tweet )
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3 Months of Romosozumab in Postmenopausal Osteoporosis

Jack Cush, MD

A report in The Lancet Diabetes & Endocrinology suggested that 3 months of romosozumab (ROMO) followed by denosumab is as effective at increasing hip bone mineral density (BMD) as the standard 12-month course.

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New studies posted this week in Arthritis & Rheumatology: Adalimumab ± MTX as first-line therapy for childhood-onset chronic uveitis https://t.co/L4QiZZBBG7 Bisphosphonates & PPI/H2RA coprescriptions in polymyalgia rheumatica https://t.co/62Pqt5Ab58 Phase 3b SOLSTICE trial: https://t.co/MsK4XC3eNh

Links:

American College of Rheumatology @ACRheum( View Tweet )
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A Modern Approach to Osteoporosis Management

Adela Castro, MD

Currently, fewer than half of patients diagnosed with osteoporosis receive appropriate pharmacologic therapy. This treatment gap reflects several challenges in osteoporosis management, including limited disease awareness, barriers to medication access, clinician discomfort with therapy selection

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RT @richardPAconway Updated data on RA-ILD from Olmstead County. Cumulative incidence of 15.3% over 20 years! #RNL26 https://t.co/wVrTc3QM6Y
Dr. John Cush @RheumNow( View Tweet )
TOPKAT Trial: Partial vs Total Knee Replacement Patients with osteoarthritis (OA) primarily affecting only one knee joint compartment did just as well with partial knee replacement (PKR) as with total arthroplasty after 10 years in a randomized trial -- and maybe a little bit https://t.co/MNpVeHQbJ2
Dr. John Cush @RheumNow( View Tweet )
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Canada's 2025 Top 10 Funded Rheumatology Projects

Arthritis Society

Arthritis Society Canada (ASC) is Canada’s largest charitable funder of cutting-edge arthritis research, investing more than $240 million in research projects since its founding, and over $7 million invested in 2024-2025. Below are the investigators and projects that were funded in 2025.

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Consensus on Managing Vertebral Fractures in Advanced CKD A coalition of leading international experts has released the first comprehensive Consensus Statement on the Management of Vertebral Fractures in Chronic Kidney Disease (CKD) Stages G4–G5D. The statement highlights a https://t.co/gilX13EaUi
Dr. John Cush @RheumNow( View Tweet )
Rheum Survey> 40 yoF RA pt on Prednisone 5 mg/d is at increased risk for ?

Dr. John Cush @RheumNow( View Tweet )

Rheum Survey> 40 yoF RA pt on Prednisone 5 mg/d is at increased risk for ?

Dr. John Cush @RheumNow( View Tweet )

In Dec 2025, the FDA qualified total hip bone mineral density (BMD) assessed by DXA as a validated surrogate endpoint for osteoporosis clinical trials. Previously OP trials required fracture endpoints as primary efficacy measures, necessitating large 2-5 yr studies https://t.co/5t9rftwX4A
Dr. John Cush @RheumNow( View Tweet )
FIBROSCANS in 60 RA pts on #MTX for 5 yrs w/ liver studies. Mean age = 39.5yrs, w/ Dz Dur 8.2 yrs, mean BMI 24.4 & MTX 12.5–25 mg for ~8 yrs (cum dose 6728mg). All had normal AST, ALT, APRI, Abd US; fibroscan score = 170 ((steatosis grade 0). Only 4(6.7 %) had mild, fibrosis https://t.co/7SACsEYi37
Dr. John Cush @RheumNow( View Tweet )
In Dec 2025, the FDA qualified total hip bone mineral density (BMD) assessed by DXA as a validated surrogate endpoint for osteoporosis clinical trials. Previously OP trials required fracture endpoints as primary efficacy measures, necessitating large 2-5 yr studies https://t.co/q8a7QmoIXs
Dr. John Cush @RheumNow( View Tweet )
FIBROSCANS in 60 RA pts on #MTX for 5 yrs w/ liver studies. Mean age = 39.5yrs, w/ Dz Dur 8.2 yrs, mean BMI 24.4 & MTX 12.5–25 mg for ~8 yrs (cum dose 6728mg). All had normal AST, ALT, APRI, Abd US; fibroscan score = 170 ((steatosis grade 0). Only 4(6.7 %) had mild, fibrosis https://t.co/OOctcfI1sT
Dr. John Cush @RheumNow( View Tweet )
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Glucocorticoid Injections in Knee Osteoarthritis

Jack Cush, MD

A randomized clinical trial of 60 patients found that glucocorticoid injections into the infrapatellar fat pad (IPFP) did not significantly reduce pain scores in patients with inflammatory knee osteoarthritis (compared to placebo).

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Best of 2025: Targeting Obesity in Rheumatic Disease Patients

Jack Cush, MD

Sattar et al. has published an informative overview of the effect of obesity on rheumatic and musculoskeletal diseases (RMDs). They estimate that nearly 70% of RMD patients are overweight or obese.

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Best of 2025: Vitamin D for Prevention of Disease

Jack Cush, MD

JAMA has published a clinical guideline on the use of vitamin D to prevent disease in children and adults.

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Five Fractures You Don’t Want to Miss In orthopedic practice, missing the wrong fracture can significantly alter a patient’s outcome. Certain injuries may appear subtle on initial imaging yet carry serious consequences if not promptly recognized and managed. https://t.co/zyCRdUkMua
Dr. John Cush @RheumNow( View Tweet )
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5 Fractures You Don’t Want to Miss

Jordan Lyons, MS, PA-C

In orthopedic practice, missing the wrong fracture can significantly alter a patient’s outcome. Certain injuries may appear subtle on initial imaging yet carry serious consequences if not promptly recognized and managed. Below are five fractures that warrant a high index of suspicion due to

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Reefer Madness (12.12.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news, journal and regulatory reports from this past week on RheumNow.com.  B cell drugs in SLE and ITP, biomarkers in GCA & PSS and great videos by APPs.

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Betsy Kirchner

Metabolic Bone Pearls

Elizabeth Kirchner, DNP

Betsy Kirchner, DNP, shares practical tips for managing metabolic bone disease, including the importance of VFA imaging to catch asymptomatic vertebral fractures and utilizing fracture liaison services to close care gaps. She highlights key pearls like the doubled fracture risk in RA patients,

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Partial vs Total Knee Replacement: Is One Superior? Patients with osteoarthritis (OA) primarily affecting only one knee joint compartment did just as well with partial knee replacement (PKR) as with total arthroplasty after 10 years in a randomized trial -- and maybe a little https://t.co/KOZwedtnxo
Dr. John Cush @RheumNow( View Tweet )
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Coccyx and Sacrococcygeal Joint Disorders

Jack Cush, MD

Pain from coccygeal or sacrococcygeal disorders is rare, often presenting as a diagnostic challenge. Coccygeal pain is often mistaken for lumbosacral, pelvic, or gastrointestinal disorders. This review presents the epidemiology, anatomy, biomechanics, presentations, diagnostic evaluation,

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Recent Blogs

Unpopular opinion: spinach can be bad for you

Lara El Khoury, MD
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PMR might be one of the most rewarding diagnoses to make in real practice: the patient comes to you in severe debilitating pain, and you prescribe steroids, giving them their lives back! As much as this impressive response makes your intervention appear almost magical, there is the often-forgotten story about the implications of such a diagnosis and treatment on patients' daily lives. 
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ICYMI: Telemedicine Bloopers and Successes

Kathryn H. Dao, M.D.
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At my COVID home command center, I feel pretty prepared for everything. From here, I can run my practice, manage and home-school 3 children and keep the family afloat.  I have 2 computers: one for telemedicine/business meetings and one for e-learning lessons/school updates that teachers and school administrators email me throughout the day for my children.  As a no-nonsense, organized mom and doctor, I felt ready to handle any issues that would arise. 
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Telemedicine Bloopers and Successes

Kathryn H. Dao, M.D.
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