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See detailAbaloparatide for risk reduction of nonvertebral and vertebral fractures in postmenopausal women with osteoporosis: a network meta-analysis
Reginster, Jean-Yves ULiege; Bianic, F.; Campbell, R. et al

in Osteoporosis International (in press)

Summary: This network meta-analysis assessed the efficacy of abaloparatide versus other treatment options to reduce the risk of fractures in women with postmenopausal osteoporosis. The analysis indicates ... [more ▼]

Summary: This network meta-analysis assessed the efficacy of abaloparatide versus other treatment options to reduce the risk of fractures in women with postmenopausal osteoporosis. The analysis indicates that abaloparatide reduces the risk of fractures in women with postmenopausal osteoporosis versus placebo and compared with other treatment options. Introduction: This network meta-analysis (NMA) assessed the relative efficacy of abaloparatide versus other treatments to reduce the risk of fractures in women with postmenopausal osteoporosis (PMO). Methods: PubMed®, Embase®, and the Cochrane Central Register of Controlled Trials were searched for randomized controlled trials published before December 20, 2017, that included women with PMO who were eligible to receive interventions for primary or secondary fracture prevention. The NMA was conducted by fracture site (vertebral [VF], nonvertebral [NVF], and wrist), with the relative risk (RR) of fracture versus placebo the main clinical endpoint. The NMA used fixed-effects and random-effects approaches. Results: A total of 4978 articles were screened, of which 22 were included in the analysis. Compared with other treatments, abaloparatide demonstrated the greatest treatment effect relative to placebo in the VF network (RR = 0.13; 95% credible interval [CrI] 0.04–0.34), the NVF network (RR = 0.50; 95% CrI 0.28–0.85), and the wrist fracture network (RR = 0.39; CrI 0.15–0.90). Treatment ranking showed that abaloparatide had the highest estimated probability of preventing fractures in each of the networks (79% for VF, 70% for NVF, and 53% for wrist fracture) compared with other treatments. Individual networks demonstrated a good level of agreement with direct trial evidence and direct pair-wise comparisons. Conclusions: This NMA indicates that abaloparatide reduces the RR of VF, NVF, and wrist fracture in women with PMO with or without prior fracture versus placebo, compared with other treatment options. Limitations include that adverse events and drug costs were not considered, and that generalizability is limited to the trial populations and endpoints included in the NMA. © 2019, The Author(s). [less ▲]

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See detailReview of the guideline of the American College of Physicians on the treatment of osteoporosis.
Kanis, J.A.; Cooper, C.; Rizzoli, R et al

in Osteoporosis International (in press)

Summary: This review, endorsed by the International Osteoporosis Foundation and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases ... [more ▼]

Summary: This review, endorsed by the International Osteoporosis Foundation and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases, summarizes several failings of the recent guidelines of the American College of Physicians (ACP) on the treatment of low bone density or osteoporosis to prevent fractures. Introduction: The ACP recently issued guidelines for the treatment of low bone density or osteoporosis to prevent fractures. Methods : Literature review and critical review of the ACP guidelines. Results :The guideline is lacking in scope due to the endorsement of treatment based on T-scores rather than fracture risk assessment and in failure to adequately consider anabolic therapies. Conclusions :The ACP guideline appears outdated. [less ▲]

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See detailBone metabolism markers are associated with neck circumference in adult Arab women.
Albassam, R.S.; Sabico, S.; Alnaami, A.M. et al

in Osteoporosis International (in press)

Summary: The study aimed to determine whether neck circumference is associated with bone metabolism markers among adult Arab women and found modest but significant associations with bone resorption ... [more ▼]

Summary: The study aimed to determine whether neck circumference is associated with bone metabolism markers among adult Arab women and found modest but significant associations with bone resorption markers, suggesting that neck circumference, a surrogate measure of upper subcutaneous fat, influences bone turnover expression among adult females. Introduction: Body fat distribution is associated with decreased bone resorption and neck circumference (NC), a surrogate measure for upper body fat, has never been tested as a marker that can reflect bone turnover. This is the first study aimed to analyze the associations between NC and several bone biomarkers among adult Saudi women. Methods: This cross-sectional study included a total of 265 middle-aged Saudi women [86 non-obese (mean age 52.7 ± 8.1; mean BMI 26.9 ± 2.3) and 179 obese (mean age 50.6 ± 7.5; mean BMI 35.7 ± 4.5)] recruited from primary care centers in Riyadh, Saudi Arabia. Anthropometrics included BMI, NC, waist and hip circumferences, total body fat percentage (%), and blood pressure. Biochemical parameters included glucose and lipid profile which were measured routinely. Serum levels of 25(OH) D, parathyroid hormone, RANKl, sclerostin, C-terminal telopeptide of collagen I (CTX-I), Dkk1, IL1β, osteoprotegerin, osteopontin, and osteocalcin were measured using commercially available assays. Results: In all groups, NC was inversely associated with PTH (R = − 0.22; p < 0.05) and positively associated with osteoprotegerin (R=0.20; p < 0.05) even after adjustments for age and BMI. Using all anthropometric indices as independent variables showed that only NC explained the variance perceived in CTX-I (p = 0.049). In the non-obese, waist-hip ratio (WHR) was significantly associated with sclerostin (R = 0.40; p < 0.05) and body fat was significantly associated with osteopontin (R=0.42; p<0.05). Conclusion: NC is modestly but significantly associated with bone biomarkers, particularly the bone resorption markers, among adult Arab women. The present findings highlight the importance of NC as measure of upper body subcutaneous fat in influencing bone biomarker expression in adult females. [less ▲]

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See detailThe risk of subsequent osteoporotic fractures is decreased in subjects experiencing fracture while on denosumab: results from the FREEDOM and FREEDOM Extension studies
Kendler, D.L.; Chines, A.; Brandi, M.L. et al

in Osteoporosis International (2019), 30(1), 71-78

Summary: This post-hoc analysis queried whether women experiencing fracture on denosumab indicates inadequate treatment response or whether the risk of subsequent fracture remains low with continuing ... [more ▼]

Summary: This post-hoc analysis queried whether women experiencing fracture on denosumab indicates inadequate treatment response or whether the risk of subsequent fracture remains low with continuing denosumab. Results showed that denosumab decreases the risk of subsequent fracture and fracture sustained while on denosumab is not necessarily indicative of inadequate treatment response. Introduction: This analysis assessed whether a fracture sustained during denosumab therapy indicates inadequate treatment response and if the risk of a subsequent fracture decreases with continuing denosumab treatment. Methods: In FREEDOM, a clinical trial to evaluate the efficacy and safety of denosumab, postmenopausal women with osteoporosis were randomized to placebo or denosumab for 3 years. In the 7-year FREEDOM Extension, all participants were allocated to receive denosumab. Here we compare subsequent osteoporotic fracture rates between denosumabtreated subjects during FREEDOM or the Extension and placebo-treated subjects in FREEDOM. Results: During FREEDOM, 438 placebo- and 272 denosumab-treated subjects had an osteoporotic fracture. Exposure-adjusted subject incidence per 100 subject-years was lower for denosumab (6.7) vs placebo (10.1). Combining all subjects on denosumab from FREEDOM and the Extension for up to 10 years (combined denosumab), 794 (13.7%) had an osteoporotic fracture while on denosumab. Of these, one or more subsequent fractures occurred in 144 (18.1%) subjects, with an exposure-adjusted incidence of 5.8 per 100 subject-years, similar to FREEDOM denosumab (6.7 per 100 subject-years) and lower than FREEDOM placebo (10.1 per 100 subjectyears). Adjusting for prior fracture, the risk of having a subsequent on-study osteoporotic fracture was lower in the combined denosumab group vs placebo (hazard ratio [95% CI]: 0.59 [0.43–0.81]; P = 0.0012). Conclusions: These data demonstrate that denosumab decreases the risk of subsequent fracture and a fracture sustained while on denosumab is not necessarily indicative of inadequate treatment response. [less ▲]

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See detailEuropean guidance for the diagnosis and management of osteoporosis
Kanis, J.A.; Cooper, C.; Rizzoli, R et al

in Osteoporosis International (2019), 30(1), 3-44

Summary: Guidance is provided in a European setting on the assessment and treatment of postmenopausal women at risk from fractures due to osteoporosis. Introduction: The International Osteoporosis ... [more ▼]

Summary: Guidance is provided in a European setting on the assessment and treatment of postmenopausal women at risk from fractures due to osteoporosis. Introduction: The International Osteoporosis Foundation and European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis published guidance for the diagnosis and management of osteoporosis in 2013. This manuscript updates these in a European setting. Methods Systematic reviews were updated. Results: The following areas are reviewed: the role of bone mineral density measurement for the diagnosis of osteoporosis and assessment of fracture risk; general and pharmacological management of osteoporosis; monitoring of treatment; assessment of fracture risk; case-finding strategies; investigation of patients; health economics of treatment. The update includes new information on the evaluation of bone microstructure evaluation in facture risk assessment, the role of FRAX® and Fracture Liaison Services in secondary fracture prevention, long-term effects on fracture risk of dietary intakes, and increased fracture risk on stopping drug treatment. Conclusions: A platform is provided on which specific guidelines can be developed for national use. [less ▲]

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See detailRecommendations for the conduct of economic evaluations in osteoporosis: outcomes of an experts' consensus meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the US branch of the International Osteoporosis Foundation
Hiligsmann, Mickaël ULiege; Reginster, Jean-Yves ULiege; Tosteson, A.N.A. et al

in Osteoporosis International (2019), 30(1), 45-57

Summary Economic evaluations are increasingly used to assess the value of health interventions, but variable quality and heterogeneity limit the use of these evaluations by decision-makers. These ... [more ▼]

Summary Economic evaluations are increasingly used to assess the value of health interventions, but variable quality and heterogeneity limit the use of these evaluations by decision-makers. These recommendations provide guidance for the design, conduct, and reporting of economic evaluations in osteoporosis to improve their transparency, comparability, and methodologic standards. Introduction This paper aims to provide recommendations for the conduct of economic evaluations in osteoporosis in order to improve their transparency, comparability, and methodologic standards. Methods A working group was convened by the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis to make recommendations for the design, conduct, and reporting of economic evaluations in osteoporosis, to define an osteoporosis-specific reference case to serve a minimum standard for all economic analyses in osteoporosis, to discuss methodologic challenges and initiate a call for research. A literature review, a face-to-face meeting in New York City (including 11 experts), and a review/approval by a larger group of experts worldwide (including 23 experts in total) were conducted. Results Recommendations on the type of economic evaluation, methods for economic evaluation, modeling aspects, base-case analysis and population, excess mortality, fracture costs and disutility, treatment characteristics, and model validation were provided. Recommendations for reporting economic evaluations in osteoporosis were also made and an osteoporosis-specific checklist was designed that includes items to report when performing an economic evaluation in osteoporosis. Further, 12 minimum criteria for economic evaluations in osteoporosis were identified and 12 methodologic challenges and need for further research were discussed. Conclusion While the working group acknowledges challenges and the need for further research, these recommendations are intended to supplement general and national guidelines for economic evaluations, improve transparency, quality, and comparability of economic evaluations in osteoporosis, and maintain methodologic standards to increase their use by decision-makers. [less ▲]

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See detailCost-effectiveness of gastro-resistant risedronate tablets for the treatment of postmenopausal women with osteoporosis in France.
Hiligsmann, M; Reginster, Jean-Yves ULiege

in Osteoporosis International (2019), 30

Summary. The use of gastro-resistant risedronate, a convenient dosing regimen for oral bisphosphonate therapy, seems a costeffective strategy compared with weekly alendronate, generic risedronate, and no ... [more ▼]

Summary. The use of gastro-resistant risedronate, a convenient dosing regimen for oral bisphosphonate therapy, seems a costeffective strategy compared with weekly alendronate, generic risedronate, and no treatment for the treatment of postmenopausal women with osteoporosis in France. Introduction. Gastro-resistant (GR) risedronate tablets are associated with improved persistence compared to common oral bisphosphonates but are slightly more expensive. This study assessed its cost-effectiveness compared to weekly alendronate and generic risedronate for the treatment of postmenopausal women with osteoporosis in France. Methods. A previously validated Markov microsimulation model was used to estimate the lifetime costs (expressed in €2017) per quality-adjusted life-years (QALY) of GR risedronate compared with weekly alendronate, generic risedronate, and no treatment. Pooled efficacy data for bisphosphonates derived from a previous meta-analysis were used for all treatment options, and persistence data (up to 3 years) were obtained from a large Australian longitudinal study. Evaluation was done for high-risk women 60–80 years of age, with a bone mineral density (BMD) T-score≤ − 2.5 and/or prevalent vertebral fractures. Results. In all of the simulated populations, GR risedronate was cost-effective compared to alendronate, generic risedronate, and no treatment at a threshold of €60,000 perQALY gained. Inwomen with aBMD T-score≤ − 2.5 and prevalent vertebral fractures, the cost per QALY gained of GR risedronate compared to alendronate, generic risedronate, and no treatment falls below €20,000 per QALY gained. In women aged 75 years and older, GR risedronate was even shown to be dominant (more QALYs, less costs) compared to alendronate, generic risedronate, and no treatment. Conclusion. This study provides the first economic results about GR risedronate, suggesting that it represents a cost-effective strategy compared with weekly alendronate and generic risedronate for the treatment of postmenopausal women with osteoporosis in France. [less ▲]

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See detailUnderstanding osteoporotic pain and its pharmacological treatment.
Vellucci, R.; Terenzi, R.; Kanis, J.A. et al

in Osteoporosis International (2018), 29(7), 1477-1491

Osteoporosis, a disorder that affects millions of people worldwide, is characterized by decreased bone mass and microstructural alterations giving rise to an increased risk of fractures. Osteoporotic ... [more ▼]

Osteoporosis, a disorder that affects millions of people worldwide, is characterized by decreased bone mass and microstructural alterations giving rise to an increased risk of fractures. Osteoporotic fractures can cause acute and chronic pain that mainly affects elderly patients with multiple comorbidities and commonly on different drug regimens. The aim of this paper is to summarize the pathogenesis and systemic treatment of osteoporotic pain. This narrative review summarizes the main pathogenetic aspects of osteoporotic pain and the cornerstones of its treatment. Osteoporotic fractures induce both acute and chronic nociceptive and neuropathic pain. Central sensitization seems to play a pivotal role in developing and maintaining chronicity of post-fracture pain in osteoporosis. Antiosteoporosis drugs are able to partially control pain, but additional analgesics are always necessary for pain due to bone fractures. Nonsteroidal anti-inflammatory drugs (NSAIDs) and selective COX-2 inhibitors reduce acute pain but with a poor effect on the chronic neuropathic component of pain and with relevant side effects. Opioid drugs can control the whole spectrum of acute and chronic bone pain, but they differ with respect to their efficacy on neuropathic components, their tolerability and safety. Chronic pain after osteoporotic fractures requires a multifaceted approach, which includes a large Spectrum of drugs (antiosteoporosis treatment, acetaminophen, NSAIDs, selective COX-2 inhibitors, weak and strong opioids) and nonpharmacological treatment. Based on a better understanding of the pathogenesis of osteoporotic and post-fracture pain, a guided stepwise approach to post-fracture osteoporotic pain will also better meet the needs of these patients. [less ▲]

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See detailImpact of the frailty status on the cost of drugs consumed in nursing homes: results froim the Senior cohort.
Buckinx, Fanny ULiege; Charles, Alexia ULiege; Quabron, A. et al

in Osteoporosis International (2018, April 05), 29 S1

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See detailVitamin D and muscle function
Bruyère, Olivier ULiege

in Osteoporosis International (2018, April), 29(Suppl1), 124

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See detailReview of terminology of measurement properties for patient-reported outcomes measures.
Rabenda, Véronique ULiege; Leclercq, Victoria ULiege; Reginster, Jean-Yves ULiege et al

in Osteoporosis International (2018, April), 29 S1

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See detailAGN1 local osteo-enhancement procedure (LOEP): an emerging, minimally-invasive surgical treatment to address osteoporosis-related bone loss in proximal femurs.
Ferrari, S.; McCloskey, E.; Bouxsein, M. et al

in Osteoporosis International (2018, April), 29 S1

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See detailThe polish validation of the Sarquol®, a quality of life questionnaire specific for sarcopenia: the evidence of a good utility.
Konstantynowicz, J.; Abramowicz, P.; Glinkowski, W. et al

in Osteoporosis International (2018, April), 29 S1

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See detailSafety of anti-osteoarthtritis medications: results of ESCEO 2017 working groups.
Reginster, Jean-Yves ULiege

in Osteoporosis International (2018, April), 29 S1

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See detailOwn attitude regarding aging among nursing home residents: results of the Senior cohort.
Buckinx, Fanny ULiege; Charles, Alexia ULiege; Rygaert, X. et al

in Osteoporosis International (2018, April), 29 S1

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See detailKNEE OSTEOARTHRITIS AND PLATELET-RICH PLASMA TREATMENT: HOW TO IMPROVE THE EFFICIENCY?
MILANTS, Christophe ULiege; Bruyère, Olivier ULiege; Kaux, Jean-François ULiege

in Osteoporosis International (2018, April), 29(Supplement 1), 380

Introduction: Knee osteoarthritis (OA) is one of the major causes of pain and physical disability in older sportsmen. The management of chondral disease is challenging because of its inherent low healing ... [more ▼]

Introduction: Knee osteoarthritis (OA) is one of the major causes of pain and physical disability in older sportsmen. The management of chondral disease is challenging because of its inherent low healing potential. New studies have focused on modern therapeutic methods that stimulate cartilage healing process and improve the damage, including the use of platelet-rich plasma (PRP), an autologous growth factor treatment. PRP is prepared from autologous blood by centrifugation to obtain a highly concentrated sample of platelets, which is four to five times higher than that of normal blood. Many papers were published on PRP for knee OA, including a lot of randomized controlled trials (RCTs) and different systematic reviews. Due to the mixed results from controlled studies, the clinical efficacy of PRP in the treatment of knee OA is unclear with shortcomings in the current literature. Purpose: The objective of this study was to evaluate the similarities and differences between the variety of PRP formulations, preparation, and uses of this techniques in literature and to try to determine characteristics of the PRP which tend to give the best responses for the treatment of knee osteoarthritis.. Methods: A comparison of the outcomes of randomized controlled trials (RCTs) included in the 3 most recent and high-quality metaanalyses to classify the different studies in 2 groups (bad responders group (BRG) and very good responders group (VGRG)). The minimal clinically important improvement (MCII) was defined to help determining whether an observed difference is clinically important. We used MCII values to classify the different studies in 2 groups depending on the outcomes: BRG < MCII and VGRG > 2xMCII. Results: From the 19 RCTs analyzed, 7 trials were included in the VGRG and 4 in the BRG. In VGRG, 1 or 2 injections were performed in 4/7 trials, time between injections was 2 to 3 weeks in 4/5 studies with many injections, volume injected varied from 2.5 to 8 mL, and single spinning technique was used in 5/7 studies. PRP classification was Mishra 4B and PAWP2Bβ in 5/7 studies. The use of PRP with leukocytes is only found in the BRG. Conclusion: There is a lack of standardization in PRP preparation technique for knee osteoarthritis. However, our study helped identify features of PRP recommended for knee OA treatment, such as the use of a single spinning technique, a platelet concentration lower than 5 times the baseline (from 3 to 4), and avoiding leukocytes and erythrocytes. We recommend leveraging this information about PRP for future studies. [less ▲]

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See detailEE joint replacement in patients with knee osteoarthritis: a long tem follow-up study in patients of the CL3-12911-018 study.
Cooper, C.; Reginster, Jean-Yves ULiege; Belissa-Mathiot, P.

in Osteoporosis International (2018, April), 29 S1

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See detailCost-effectiveness of abaloparatide for the treatment of postmenopausal women with osteoporosis.
Hiligsmann, M.; Williams, S.A.; Fitzpatrick, L.A. et al

in Osteoporosis International (2018, April), 29 S1

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See detailEvaluation of the responsiveness of the SARQOL® questionnaire: results from the SarcoPhAge study.
GEERINCK, Anton ULiege; Bruyère, Olivier ULiege; Locquet, Médéa ULiege et al

in Osteoporosis International (2018, April), 29 S1

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