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Osteoporosis

A Glimpse Into the Future of Rheumatology

David Pisetsky MD, new President-elect of the US Bone and Joint Initiative, is likely to be influential  in defining the path of rheumatology in coming years. Listen here as he speaks about the role of rheumatologists in a patient-centered, multidisciplinary medical future.

Osteoporosis

Whatever is causing this woman's hip pain, her x-ray looks quite severe. The diagnosis was correct 40 years ago, but it couldn't be treated effectively then. What's the problem?

For the success of total hip replacements, 35 is the magic number, a very large Canadian study finds. Procedures done by surgeons with lower volumes per year have much greater failure risks.

Among women with osteoporosis randomized to discontinue bisphosphonates, results of bone mass testing in subsequent years were unrelated to future fracture risk. This undercuts guidelines and even a law.

(AAOS 2014) Older women with comorbidities are at greatest risk for revision surgery after total knee arthroplasty, a nationwide study shows. Another large analysis shows an interesting quirk about the role of osteoporosis: Bisphosphonates help, but only in some circumstances.

An expert working group says osteoporosis can be diagnosed in postmenopausal women and older men with only marginally low bone density, if they have fractured certain bones in a minor mishap, show vertebral fractures on X-ray, or have high fracture risk for other reasons.

How serious is the risk of atypical femur fracture for osteoporosis patients on bisphosphonates, and when is a "drug holiday" justified? There are no definitive studies or guidelines, but here are some strategies to consider.

New in the New England Journal: Romosozumab, whose target is sclerostin, increased BMD more than teriperatide and alendronate in a phase 2 trial involving postmenopausal women. Also, a puzzle: A rheumatic cause of abdominal pain.

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