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Rheumatology

Bone and Calcium Disorders   

Questions discussed in this category

Would you continue Forteo treatment past the recommended 2 years if T scores remain low and procollagen (P1NP) is elevated and if so, how would you monitor response?
1 Answer available
Do you recommend adjusting the duration of a drug holiday based on the specific bisphosphonate used when treating osteoporosis?
1 Answer available
Would you recommend waiting for a low Vitamin D level to correct to goal prior to giving a scheduled Prolia injection when transitioning a patient from Zolendronic acid to Prolia therapy for worsening osteoporosis?
2 Answers available
How do you determine osteoporosis treatment response when patients have discrepant DEXA scan results during monitoring (eg improved BMD of the hip and spine but worsening BMD of the femoral neck)?
1 Answer available
What treatment options would you consider for a young patient with limited mobility, low bone mass and multiple vertebral compression fractures who is on dialysis for advanced kidney disease?
1 Answer available
How do you reduce the risk of contralateral fracture in a patient with atypical femur fracture from prolonged bisphosphonate use?
Do anabolic agents have a role?
1 Answer available
How frequently do you monitor for hypocalcemia in patients on romosozumab?
1 Answer available
When discontinuing Denosumab after more than 2-3 years of therapy, when do you recommend giving the first dose of zoledronic acid?
2 Answers available
How do you manage osteoporosis treatment following parathyroidectomy for primary hyperparathyroidism?
1 Answer available
Would you stop denosumab in a patient with chronic kidney disease if they develop asymptomatic hypocalcemia after the injection?
4 Answers available
Would you consider PTH analogue in a patient with mildly elevated PTH?
2 Answers available
Have you been able to safely use other bisphosphonates in patients who developed an allergic reaction (angioedema) to fosamax?
1 Answer available
When do you recommend using trabecular bone score (TBS) for managing osteoporosis?
1 Answer available
Are there any concerns with live vaccine innoculation and patients who are on denosumab?
1 Answer available
Which fracture sites outside of the classical spine and hip are considered to be osteoporotic fractures even in the absence of a bone density diagnosis?
2 Answers available
How do you approach a patient with elevated bone specific ALP (>2X the normal limit), but no other evidence of Paget's disease?
Normal Vitamin D, bone scan showed osteoarthritis
1 Answer available
Do you recommend a particular antiresorptive/anabolic agent for patients who are at high risk for fractures but have high risk of osteonecrosis of the jaw?
3 Answers available
Is there any contraindication for use of Invisalign teeth aligners in patients undergoing treatment for osteoporosis?
Do treatments for osteoporosis have a large enough effect on tooth movement to make Invisalign less effective?
1 Answer available
Would you transition from denosumab to anabolic agents in patients who are in urgent need for extensive dental work?
2 Answers available
Is it safe to continue administering Prolia per schedule for osteoporosis treatment shortly after a patient has undergone extensive spinal surgery?
1 Answer available
What is your approach to progressive calvarial hyperostosis found in an elderly adult not caused by Pagets, acromegaly or hypercalcemia?
No evidence for acromegaly or Pagets. 
1 Answer available
Given the risk of hypocalcemia in dialysis dependent patients treated with denosumab, what is the best method of treatment for osteoporosis for these patients, and should we be transitioning to a different agent?
2 Answers available
How would you approach a finding of osteoporosis (Z score -4.5) in a recently postpartum patient who had DEXA sent for long-term low-dose glucocorticoid use?
The patient is actively breastfeeding.
1 Answer available
Is there any evidence regarding bone density gains/fracture reduction in the setting of treatment with romosozumab after a two year course of teriparatide?
Many patients are interested in romosozumab for "maximizing bone gain" and preventing future fractures. Some have had anabolic therapy with teriparati...
1 Answer available
What range of musculoskeletal complaints have you seen with romosozumab use?
1 Answer available
What is your approach to managing osteoporosis in patients with end stage kidney disease?
1 Answer available
Would you use romosozumab in a patient with a cardiovascular event more than 2 years prior?
4 Answers available
Do you recommend osteoporosis medication in postmenopausal females on anastrozole with very low Vitamin D (4.5)?
After replacing Vitamin D, what will be your first treatment of choice? Labs including ALP and calcium levels are normal. T scores are -3 or above. Th...
1 Answer available
After completing 12 months romosozumab, what is the next best treatment option for patients with severe osteoporosis, high risk for fracture, and normal kidney function?
1 Answer available
Would you consider anabolic osteoporosis therapy in a young adult male with multiple non-traumatic vertebral compression fractures and low bone density for age (Z-score -2.6)?
A male patient in his 30s with two lumbar compression fractures (non-traumatic) and a Z-score of -2.6 in the spine, Z-score -0.5 in hips. History of 3...
1 Answer available
Have the results of the ancillary study of the VITAL trial, demonstrating that Vitamin D3 supplementation did not reduce the incident rate of fractures in generally healthy midlife and older adults, changed how you prescribe Vitamin D?
PMID 35939577
2 Answers available
Can joint replacement surgery be performed in someone with active Paget’s disease elsewhere?
1 Answer available


Papers discussed in this category

The lancet. Diabetes & endocrinology, 2019 Aug 22
Combination denosumab and high dose teriparatide for postmenopausal osteoporosis (DATA-HD): a randomised, controlled phase 4 trial.
Arteriosclerosis, thrombosis, and vascular biology, 2019-07
Cardiovascular Outcomes of Romosozumab and Protective Role of Alendronate.
Joint bone spine, 2021 May 19
Effects of prior osteoporosis treatment on 12-month treatment response of romosozumab in patients with postmenopausal osteoporosis.
Genes, 2022 Oct 17
Hereditary Metabolic Bone Diseases: A Review of Pathogenesis, Diagnosis and Management.
JAMA, 2007-01-24
Risk of subsequent fracture after low-trauma fracture in men and women.
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 2017-07
Osteoporosis in Crisis: It's Time to Focus on Fracture.
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 2019 Dec 01
Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition.
JAMA network open, 2022 Oct 03
Association of Multimorbidity and Excess Mortality After Fractures Among Danish Adults.
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 2022 Oct 17
The Economic Burden of Severe Osteoporotic Fractures in the French Healthcare Database: The FRACTOS Study.
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2020 Mar 16
Fracture risk following high-trauma versus low-trauma fracture: a registry-based cohort study.
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2023 Jul 01
Update on the clinical use of trabecular bone score (TBS) in the management of osteoporosis: results of an expert group meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), and the International Osteoporosis Foundation (IOF) under the auspices of WHO Collaborating Center for Epidemiology of Musculoskeletal Health and Aging.

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