pyrophosphate and Osteoporosis--Postmenopausal

During the past ten years the range of treatments available for patients with osteoporosis has increased greatly. A decade ago the only proven therapy was oestrogen, while today the choice includes bisphosphonates, selective oestrogen receptor modulators, calcitonin, calcium and vitamin D supplementation and, in the near future, parathyroid hormone. Clinical trials involving bone mineral density (BMD) scans of the spine and femur have had an important role in the evaluation of these new therapies. Supplementary information about treatments has been provided by BMD scans of the total body and distal radius as well as by measurements of biochemical markers of bone turnover in serum and urine. Most important of all, the efficacy of treatments has been verified in large trials powered to show reductions in fracture risk. In routine clinical use, BMD scanning has an important role in identifying individual patients with osteoporosis and helping to make decisions about their treatment. However, in contrast to the use of BMD scans in clinical trials, their value for monitoring response to therapy in individual patients is less certain because in many cases the increases in BMD are too small to reliably distinguish between true changes and measurement error. However, experience with well established therapies such as oestrogen and bisphosphonates suggests that these treatments have a beneficial effect on bone in the large majority of patients and individual monitoring of BMD is probably not necessary.

Topics: Biomarkers; Biomedical Research; Bone and Bones; Bone Density; Bone Remodeling; Densitometry; Diphosphates; Diphosphonates; Fractures, Bone; Humans; Osteoporosis; Osteoporosis, Postmenopausal; Predictive Value of Tests

Topics: Adipose Tissue; Autophagy; Bone and Bones; Diphosphates; Humans; Multiple Myeloma; Musculoskeletal Diseases; Osteoarthritis; Osteoporosis, Postmenopausal; Pain

To investigate rates of assessment and treatment of osteoporosis among older women during the year after they have had fractures.. Observational, historical, population-based cohort study.. Manitoba, which maintains a comprehensive population-based repository of health care services provided and has a publicly funded health care system.. Women 50 years old and older who had suffered fractures between 1997 and 2002. These women were chosen from among approximately 175,000 women of this age in Manitoba.. We examined each woman's annual medical record between April 1, 1997, and March 31, 2002, to find any International Classification of Diseases fracture codes that have been consistently associated with osteoporosis. We looked for postfracture care during the first 12 months after fractures: bone mineral density (BMD) testing or treated with osteoporosis pharmacotherapy. Analysis was stratified by type of fracture: designated type 1 fractures (spine or hip) and type 2 fractures (not spine or hip).. Use of BMD testing or osteoporosis pharmacotherapy during the first 12 months following fractures.. For type 1 fractures, BMD assessment during the first year after fracture increased from 2.6% in 1997-1998 to 4.6% in 2001-2002 (P for trend .0004). Rates of therapy with osteoporosis medication increased from 4.9% in 1997-1998 to 17.6% in 2001-2002 (P for trend < .0001). Results were similar for type 2 fractures. In the final year of the study, only 20.5% of women with either type of fracture underwent any identifiable intervention (BMD assessment or osteoporosis pharmacotherapy). The intervention rate was substantially higher among women 50 to 64 years old (26.4%) than among those 75 years old or older (17.9%, P for trend < .0001).. Women at highest risk of future fractures are assessed infrequently for osteoporosis with BMD testing and given pharmacotherapy to prevent future fractures just as infrequently. This gap in care was particularly striking for BMD testing despite the fact that testing is free in Manitoba's publicly funded system. Data from this study could be educational for physicians treating osteoporosis and should encourage them to improve their practice patterns and optimize patient care.

Topics: Absorptiometry, Photon; Aged; Bone Density Conservation Agents; Comorbidity; Diphosphates; Female; Follow-Up Studies; Fractures, Bone; Humans; Manitoba; Middle Aged; Osteoporosis, Postmenopausal; Patient Care; Preventive Health Services; Selective Estrogen Receptor Modulators