OP/Bone

Post-Menopausal Osteoporosis Review and Recommendations

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Jack Cush, MD

Dec 04, 2023

A recent New England Journal review of post-menopausal osteoporosis (OP) provided updated information, strategies and a review of guidelines and clinical recommendations. Here are the salient highlights.

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TM61 at #ACR23 23 yo M p/w ~3mo of sternal swelling - US probable abscess, drained + multiple abx w/ no improvement - XR R shoulder + L elbow nl but MRI abn - MRI L elbow: possible osteomyelitis (OM) - MRI R shoulder; clavicular osteolysis - Bone Bx clavicle + L Ulna: Chronic… https://t.co/7s9PIwByTs https://t.co/wKaKfnncP5

Meral K. El Ramahi, MD @MeralElRamahiMD( View Tweet )

Nov 14, 2023

ROMO vs DEN. Romosozumab was superior to denosumab (ROMO +7.3±4.5%; p< 0.001) and (DEN +2.3±3.1%; p< 0.001) in raising the spine BMD but not in hip at month 12 in chronic GC users with high fracture risk Mok C Abst#242 #ACR23 @RheumNow https://t.co/q2OKD6C2Me

Dr. Antoni Chan ( View Tweet )

Nov 14, 2023

Mok et al. Romosozumab superior to denosumab in high risk GIO. Superior in improving spine BMD. Not fracture. Fracture is what matters. Abstr#2429 #ACR23 @RheumNow https://t.co/5ModHOGsED

Richard Conway ( View Tweet )

Nov 14, 2023

TM83 #ACR23 @RheumNow 45yo M b/l sacroiliitis, Rx MTX -> ADA -> MTX + Tofa. No improv Low Ca, & Phos, ALP 239. Nml Vit D, High PTH. DEXA: Osteoporosis FGF23 high PET/CT showed soft tissue density in nasal septum, few cortical breaks Dx: oncogenic osteomalacia 2/2 malignancy https://t.co/EOcYNtovBy

Eric Dein ( View Tweet )

Nov 14, 2023

@gurdeep_dulay I ask the same question always, why would you stop denosumab? Nothing comes close to fully ameliorating the negative consequences of doing so. Denosumab is for life, until we figure out how to safely get off it. Don't start it unless that is acceptable #ACR23

Richard Conway ( View Tweet )

Nov 13, 2023

#Denosumab and what to do IF you stop it #ACR23 #osteoporosis #Bisphosphonate #CTX https://t.co/qwdQQjJJlb

Dr Gurdeep S Dulay ( View Tweet )

Nov 12, 2023

Year in Review: Dr. P Seo ⭐️Low dose colchicine assoc w/ ⬇️ incidence of hip/knee replacement ➡️ 5522 pts w/ stable CAD: colchicine 0.5 mg vs PBO for median of 28.6 months ➡️ Hip/knee: 2.5% vs 3.5% ➡️HR 0.69 Similar finding in 2020 CANTOS trial using Ilaris #ACR23 @RheumNow https://t.co/PD26zoolDB

Meral K. El Ramahi, MD @MeralElRamahiMD( View Tweet )

Nov 12, 2023

Orthopedic cohort study of 274,403 pts (180K females, 94K males; mean age=55). The risk of future TKA was signif greater in pts w/ combination of Depression+Obesity group (11.9%); compared to Controls (8.3%), obese (10.2%) or Depression (7.8%) https://t.co/dltVS0Y6PY https://t.co/REgO5tjEUv

Dr. John Cush @RheumNow( View Tweet )

Nov 10, 2023

ACR 2022 Guideline on Glucocorticoid-Induced Osteoporosis The ACR has published its updated recommendations for prevention and treatment of GIOP for patients receiving >3 months treatment with glucocorticoids (GCs) ≥2.5 mg daily. https://t.co/uTDBmRvCV5 https://t.co/Qx6fZSTeS5

Dr. John Cush @RheumNow( View Tweet )

Oct 29, 2023

ACR 2022 Guideline on Glucocorticoid-Induced Osteoporosis

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Jack Cush, MD

Oct 24, 2023

The ACR has published its updated recommendations for prevention and treatment of glucocorticoid-induced osteoporosis (GIOP) for patients receiving >3 months treatment with glucocorticoids (GCs) ≥2.5 mg daily.

Despite increasing treatment options to prevent and treat GIOP, many GC-

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12.3 million Americans over 50 have osteoporosis; 47 million have osteopenia. W/ OP Fx the risk of repeat Fx is highest in 1st 6 mos, yet 8% of Medicare pts w/ Fx have a diagnostic bone density scan (less in African Americans 5%) https://t.co/xBHr7WffYf https://t.co/S27Vs8yyjY https://t.co/eWcOB8fjWH

Dr. John Cush @RheumNow( View Tweet )

Oct 22, 2023

Methotrexate in OA (10.20.2023)

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Jack Cush, MD

Oct 20, 2023

Dr. Jack Cush discusses the news, journal articles and regulatory actions. This week we discuss JAKne, DLE and SLE and more.

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Hip Replacement Surgery After Age 90

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EurekAlert!

Aug 28, 2023

Potentially modifiable comorbid conditions and complications have a major impact on the risks of total hip arthroplasty (THA) for people in their nineties, reports a study in The Journal of Bone & Joint Surgery.

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$Xray,fracture,MD,physician$

Fracture Risk Quantified for Older Spondyloarthritis Patients

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MedPage Today

Aug 22, 2023

Medicare beneficiaries with ankylosing spondylitis (AS) incur frequent bone fractures, a new study indicated, with the risk boosted by some unsurprising factors but also including one that was not expected.

Fee-for-service Medicare claims data from 2016-2018 showed that AS patients

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English for the Biologically-Challenged (8.4.2023)

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Jack Cush, MD

Aug 04, 2023

Dr. Jack Cush reviews the news and journal articles from the past week on RheumNow.com. This week highlights Veterans, Vegetarians and Antenatal Corticosteroids.

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Vegetarians have a significantly higher hip fracture risk (HR 1.50) than regular meat-eaters, partly (28%)explained by BMI. UK Biobank compared meat-eaters (n=regular 258,765, occasional 137,954), pescatarians (9557), & vegetarians (7638) https://t.co/EyL1PPpfYE https://t.co/n0wNDVWMuP

Links:

https://bit.ly/3DFHxSA

Dr. John Cush @RheumNow( View Tweet )

Aug 02, 2023

Adding Trabecular Bone Score (TBS) to FRAX and BMD enhances Fx risk prediction in osteoporosis. TBS is validated index of bone microarchitecture from LS spine DEXA. TBS is good at fragility Fx risk and monitoring response to OP Rx https://t.co/T7EStHyDBq https://t.co/sct79nTzBO

Links:

https://bit.ly/43Xaww9

Dr. John Cush @RheumNow( View Tweet )

Jul 26, 2023

"Ask Cush Anything" Returns (7.21.2023)

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Jack Cush, MD

Jul 21, 2023

Dr. Jack Cush reviews the news and journal reports and this week, takes on 5 cases/questions from "Ask Cush Anything"

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In AUSTRALIA, 30% (~ 7million) have a chronic #MSK condition, costing $14.6 billion (10% of all healthcare spending) in 2019-20. Overall, 4 million w/ back problems, 3 million arthritis, 900,000 osteoporosis, 450,000 w/ #RA. https://t.co/TDV50PoRXj https://t.co/EtSUuv6jMA

Links:

https://bit.ly/3K1GwIc

Dr. John Cush @RheumNow( View Tweet )

Jul 18, 2023

Opioids Ineffective in Acute Lower Back and Neck Pain

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EurekAlert!

Jun 29, 2023

A randomised controlled trial including 347 participants with lower back or neck pain found there was no benefit of taking opioid pain relievers compared to placebo.

There was no significant difference in pain scores in patients with lower back or neck pain who were given opioid pain

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How Often Do You Monitor MTX? (6.16.2023)

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Jack Cush, MD

Jun 15, 2023

Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com, including new drug approval, a new SpA variant and new rules for methotrexate (MTX) monitoring and depression screening.

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Remember to discuss bone density in your pts with #gout! Bone mineral density was significantly lower in pts with hyperuricemia, more so in males and elderly. Large cohort wirh 9017 pts from China! @EULAR2023 @rheumnow abst#AB1639 https://t.co/BGscJxMZno

Bella Mehta @bella_mehta( View Tweet )

May 31, 2023

Gut microbiome studies are implicated in all disease we study! 5 gut microbiota are suggested to have a causal relationship in #gout. 68k controls and 2k gout pts. Can experts comment if it's just data mining or discovery? #EULAR2023 @rheumnow abst#ab1237 https://t.co/d1AkDPG8QR

Bella Mehta @bella_mehta( View Tweet )

May 31, 2023

EULAR 2023 – Day 1 Report

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Jack Cush, MD

May 31, 2023

EULAR 2023 launched today to crowds of attendees. The opening Plenary session and presidential address by Dr. Ian McInnes was followed by a number of overview and review sessions with but a half-day of abstracts presentations, on several therapeutic areas including osteoarthritis, JIA, COVID

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Recent Blogs

Unpopular opinion: spinach can be bad for you

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Lara El Khoury, MD

Oct 20, 2023

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. Read Post

ICYMI: Telemedicine Bloopers and Successes

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Kathryn H. Dao, M.D.

Jul 06, 2020

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. Read Post