Articles related to BONE HEALTH

Internal medicine physicians play a crucial role in addressing osteoporosis challenges. Many at-risk patients are not screened or educated about fracture prevention, and a significant number of individuals with high fracture risk remain undiagnosed and untreated. Efforts should focus on recognizing fractures as diagnostic indicators, expanding screening, and implementing effective treatments. The recent clinical guideline emphasizes bisphosphonates as first-line therapy, denosumab as second-line, and injectable medications for high-risk cases. Primary care physicians should take an active role in screening, diagnosing, and treating osteoporosis to prevent future fractures, even without immediate subspecialist care. Risk assessment tools, healthy lifestyles, and consideration of benefits, harms, patient values, and costs in medication selection are important. Empowering primary care doctors is vital in bridging the treatment gap and preventing fractures.

Use of Carnett sign, greater trochanter palpation, and a simple extension to typical joint examination can reduce imaging and orthopedic referrals by primary care physicians and bring faster effective treatment to the patient.

This 70-study meta analysis concludes that the evidence is moderate to high that bisphosphonates and denosumab reduce the risk for hip, vertebral, and other fractures. The evidence is moderate to high that abaloparatide and teriparatide reduce clinical fractures and radiographic vertebral fractures, and low to moderate that SERMs reduce radiographic vertebral fractures, but not clinical fractures.

Beyond the strong recommendation for bisphosponates as initial medical therapy in postmenopausal women with osteoporosis, the updated guidelines also suggest (not recommend) denosumab as second line therapy in women, bisphosphonates for osteoporosis in men, and romosozumab in women with very high risk of fractures. For the complete updated guideline, see Pharmacologic Treatment of Primary Osteoporosis or Low Bone Mass to Prevent Fractures in Adults: A Living Clinical Guideline From the American College of Physicians.

The VITAL trial enrolled more than 25,000 men and women over age 50. Supplemental vitamin D showed no significant benefit vs. placebo in preventing the common fractures of osteoporosis.

The knee arthritis meta-analysis reviewed 169 trials involving 21,163 patients, with the evidence demonstrating viscosupplementation is associated with a clinically irrelevant reduction in pain intensity and with an increased risk of serious adverse events compared with placebo. For the meniscus study, the commentary may sum it up best: “Multiple studies, including several with sham surgeries as a control have shown repeatedly over the previous 2 decades that surgery is not superior to physical therapy, yet the issue and use of surgery persist.”