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Osteoporosis SCORE Estimation

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1. Comparison of the Male Osteoporosis Risk Estimation Score (MORES) With FRAX in Identifying Men at Risk for Osteoporosis (PubMed)

Comparison of the Male Osteoporosis Risk Estimation Score (MORES) With FRAX in Identifying Men at Risk for Osteoporosis We wanted to compare the male osteoporosis risk estimation score (MORES) with the fracture risk assessment tool (FRAX) in screening men for osteoporosis.This study reports analysis of data from the Third National Health and Nutrition Examination Survey (NHANES III), a nationally representative sample of the US population, comparing the operating characteristics of FRAX (...) and MORES to identify men at risk for osteoporosis using a subset of 1,498 men, aged 50 years and older, with a valid dual-energy x-ray absorptiometry (DXA) scan. DXA-derived bone mineral density using a T score of -2.5 or lower at either the femoral neck or total hip defined the diagnosis of osteoporosis. Outcomes included the operating characteristics, area under the receiver-operator characteristic curve, and agreement of the FRAX and MORES.Sixty-seven (4.5%) of the 1,498 men had osteoporosis

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2016 Annals of family medicine

2. Osteoporosis SCORE Estimation

Osteoporosis SCORE Estimation Osteoporosis SCORE Estimation Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Osteoporosis SCORE (...) Estimation Osteoporosis SCORE Estimation Aka: Osteoporosis SCORE Estimation , Simple Calculated Osteoporosis Risk Estimation II. Indications III. Background See for additional risk factors Majority of risk is predicted by age, weight and ethnicity Consider instead for estimating risk in white or asian patients without other risks For those with prior s or , use this SCORE tool or FRAX Calculator IV. Criteria Race not black: 5 points : 4 points after age 45 of wrist, hip or rib: 4 points per Age over 65

2018 FP Notebook

3. Osteoporosis Risk Estimation Score in Men

Osteoporosis Risk Estimation Score in Men Osteoporosis Risk Estimation Score in Men Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 (...) Osteoporosis Risk Estimation Score in Men Osteoporosis Risk Estimation Score in Men Aka: Osteoporosis Risk Estimation Score in Men , Male Osteoporosis Risk Estimation Score II. Indications Tool III. Criteria: Tally a total score from the age, weight and COPD scores Age Score 0: Age <55 years Score 3: Age 56-74 years Score 4: Age over 75 years Score 3: Weight Score 6: Weight <154 pounds (<70 kg) Score 4: Weight 155-176 pounds (70-80 kg) Score 0: Weight >176 pounds (>80 kg) IV. Interpretation Score of 6

2018 FP Notebook

4. Estimating the long-term functional burden of osteoporosis-related fractures. (PubMed)

Estimating the long-term functional burden of osteoporosis-related fractures. Although fractures are associated with short-term reductions in functional status, there is limited information on longer-term burden of fracture. This study documents evidence of an association between fractures and significant declines and functional health and activities that persist but attenuate beyond two years.Although fractures are associated with short-term reductions in functional status and may have other (...) short-term effects on healthcare utilization (hospitalization and follow-up care), there is limited information on long-term burden of fracture beyond 12 to 24 months post-fracture. Analysis of the long-term health burden can inform policymakers, health care practitioners, and payers.We acquired a data set containing the 1992-2012 Health and Retirement Survey data linked to the same individuals' Medicare claims. Fracture cases (n = 745) were matched to non-fracture controls using propensity scores

2017 Osteoporosis International

5. Osteoporosis

fractures may occur spontaneously, or as a result of routine activities. In England and Wales, it is estimated that annually around 180,000 fractures occur as a result of osteoporosis . Risk factors for osteoporosis 2016 5. Diagnosis and Management of Osteoporosis DIAGNOSIS AND MANAGEMENT OF OSTEOPOROSIS Clinical Practice Guideline | February 2016 These recommendations are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical (...) increase the risk of morbidity and mortality and cause considerable socioeconomic burden. Objective: To evaluate the association between statin use and risks of osteoporosis and fracture in stroke patients. Design: Population-based propensity score-matched cohort study. Setting: National Health Insurance Research Database in Taiwan. Patients (...) : Patients newly diagnosed with a stroke, between 2000 and 2012, were identified. After propensity score matching, 5,254 patients were included, with 2,627

2018 Trip Latest and Greatest

6. The Prevention of glucocorticoid?induced osteoporosis in patients with immune thrombocytopenia receiving steroids: Good Practice Paper

is lower in pre‐menopausal women and men aged <50 years, this risk can still be significant in some individuals, for example, the 10‐year fracture risk has been estimated at 5–20% in pre‐menopausal women aged ≥30 years receiving very high doses of glucocorticoids (Buckley et al , ). Other risk factors identified in pre‐menopausal women include prior fragility fracture, low BMD, family history of osteoporosis, low body mass index or low weight, age, age at menarche, major depression and alcohol intake (...) , ; Tantawy et al , ). In one series, 9/36 (25%) children had osteopenia (BMD Z‐score ≤1) and one had osteoporosis (BMD Z‐score ≤−2 plus a clinically significant fracture) (Tantawy et al , ). BMD was significantly lower in children receiving a cumulative dose over 2100 mg/kg compared with those receiving less (Dilber et al , ) and a BMD Z‐score of less than −2 was found in 5/9 children receiving a cumulative dose >1000 mg/kg vs. 0/19 receiving a cumulative dose <1000 mg/kg (Yildirim et al , ). Different

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2019 British Committee for Standards in Haematology

7. Pharmacological Management of Osteoporosis in Postmenopausal Women

those who have experienced a recent fracture, with pharmacological therapies, as the benefits outweigh the risks. (1|⊕⊕⊕⊕) Evidence The goal of using pharmacological therapies to treat low BMD or osteoporosis in postmenopausal women is to decrease the burden of major osteoporotic fractures. Various scientific bodies from different countries have determined treatment thresholds based on either a BMD T-score or various risk assessment tools such as the Fracture Risk Assessment Tool (FRAX), Canadian (...) Association of Radiologists and Osteoporosis Canada calculator, Osteoporosis Self-Assessment Tool, and Garvan Institute fracture risk calculator, as well as the values, preferences, and costs for their populations. Currently there are 52 national guidelines in 36 countries. Some guidelines use fracture-risk thresholds, such as those used in the United States, Canada, and the United Kingdom ( ), whereas other guidelines use T-score–based thresholds, such as those used in Austria, Belgium, India, and Brazil

2019 The Endocrine Society

8. Long-Term Drug Therapy and Drug Holidays for Osteoporosis Fracture Prevention: A Systematic Review

menopause. 19, 28 However, authors minimized their one significant interaction for age because of the many interactions examined. 19 ES-4 Table A. Evidence on efficacy of long-term (>3 years) osteoporosis drug treatment Comparison # Studies by Design Treatment Duration Participant Characteristics Incident Fracture Outcome Relative and Absolute Risk Differences (95% CI) Strength of Evidence* (Justification) Alendronate vs. placebo 1 RCT 14 4 yr 4,432 PM women with osteopenia or osteoporosis (T-score 100 (...) differed in whether fractures cases were excluded for cancer and excess trauma; in whether current bisphosphonate use was compared to no use, limited past use, or nonbisphosphonate osteoporosis drug use; and in how they addressed potential confounding. Few observational studies provided data about risk of ONJ. Different studies provided low and insufficient strength evidence, respectively, about whether long-term alendronate increases risk of ONJ. 41-43 Relative risk estimates varied widely between

2019 Effective Health Care Program (AHRQ)

9. Management of Osteoporosis in Survivors of Adult Cancers With Nonmetastatic Disease

), and these patients frequently have received cancer treatments that cause particularly high rates of bone loss. It is the coalescence of survivors of cancer and osteoporosis, a health problem of near-epidemic proportion that forms the underlying rationale for this evidence-based guideline. The prevalence of osteoporosis worldwide is estimated at 200 million. At least 40% of postmenopausal women and 15% to 30% of men will experience a fragility fracture. Osteoporosis can be thought of as an equation. The equation (...) . Clinicians should actively encourage patients to stop smoking and to limit alcohol consumption, as smoking and alcohol consumption are risk factors for osteoporosis (Type: evidence based, benefits outweigh harms; Evidence quality: low; Strength of recommendation: moderate). Pharmacologic Intervention Recommendation 3.4. For patients with nonmetastatic cancer with osteoporosis (T scores of −2.5 or less in the femoral neck, total hip, or lumbar spine) or who are at increased risk of osteoporotic fractures

2019 American Society of Clinical Oncology Guidelines

10. Anabolic Therapies for Osteoporosis in Postmenopausal Women: Effectiveness and Value

for Clinical and Economic Review, 2017 Page ES1 Evidence Report – Anabolic Therapies for Osteoporosis Return to Table of Contents Executive Summary Background Osteoporosis, the weakening of the bones through loss of bone mineral content and a decrease in bone quality, is a common disease of aging that is estimated to affect approximately 10 million Americans (based on bone mineral density [BMD] measurements; this does not take into account additional people who have demonstrated osteoporosis as a result (...) of having a fragility fracture). 1 Approximately half of women and one quarter of men will experience at least one fracture due to osteoporosis during their lifetimes. 2 Experts estimate that there are approximately two million osteoporotic fractures each year, which results in $19 billion in related costs. 3 By 2025, these figures are predicted to grow to approximately three million fractures and $25 billion in costs annually as the population of older Americans increases. 3 The goal of treatment

2017 California Technology Assessment Forum

11. Common osteoporosis drugs may prevent breast cancer spreading to bone

Common osteoporosis drugs may prevent breast cancer spreading to bone Common osteoporosis drugs may prevent breast cancer spreading to bone Discover Portal Discover Portal Common osteoporosis drugs may prevent breast cancer spreading to bone Published on 13 March 2018 doi: Drugs commonly prescribed to prevent bone thinning probably help prevent the spread of early breast cancer to the bones in a few women, when taken in addition to standard cancer therapies. However, the overall benefits may (...) outcomes reviewed was moderate to high so that we can be fairly confident in the estimates of these effects. What did it find? For women with early breast cancer, bisphosphonates lowered the chances of cancer spreading to the bone by 14% (relative risk [RR] 0.86, 95% confidence interval [CI] 0.75 to 0.99, based on 11 studies with 15,005 women). The absolute risk was 9% for women who didn’t take a bisphosphonate, compared with 7.7% for women who did take a bisphosphonate, meaning just over one person

2019 NIHR Dissemination Centre

12. Cement injections to treat spinal compression fractures from osteoporosis can reduce short term pain

centres. Share your views on the research. Why was this study needed? Worldwide, an estimated 1.4 million people with osteoporosis experience vertebral fractures. Most osteoporotic vertebral fractures are treated conservatively with painkillers, bed rest and mobility exercises as function improves. However, painkillers and prolonged bed rest can both have adverse effects in older people. Vertebroplasty involves injecting special cement into the broken vertebrae to relieve pain and strengthen the bone (...) in the vertebroplasty group at six months was 7.8 out of 24 compared to 12.4 for the placebo group. Vertebroplasty also improved quality of life at six months compared with placebo (average score on the Quality of Life Questionnaire of the European Foundation for Osteoporosis [QAULEFFO] 38 out of 100 versus 45 out of 100; mean difference 7, 95% CI 1 to 13). Two people in the vertebroplasty group (3%) had serious adverse events related to the procedure, and two people in the placebo group (3%) had serious adverse

2019 NIHR Dissemination Centre

13. Diagnosis and treatment of osteoporosis.

al., 2000; Harris et al., 1999 Men with osteoporosis: Chen et al., 2015 Definitions Category Quality Definitions Strong Recommendation Weak Recommendation High Quality Evidence Further research is very unlikely to change confidence in the estimate of effect. The work group is confident that the desirable effects of adhering to this recommendation outweigh the undesirable effects. This is a strong recommendation for or against. This applies to most patients. The work group recognizes (...) of effect and is likely to change. The estimate or any estimate of effect is very uncertain. The work group feels that the evidence consistently indicates the benefit of this action outweighs the harms. This recommendation might change when higher quality evidence becomes available. The work group recognizes that there is significant uncertainty about the best estimates of benefits and harms. A detailed and annotated clinical algorithm titled "Diagnosis and Treatment of Osteoporosis" is provided

2017 National Guideline Clearinghouse (partial archive)

14. American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis

of the treatment options under consideration, the quality of the evi- dence (i.e., confidence in the effect estimates), and patients’ values and preferences. Key to the recommendation is the ACR GUIDELINE FOR GLUCOCORTICOID-INDUCED OSTEOPOROSIS PREVENTION AND TREATMENT 1523tradeoff between desirable and undesirable outcomes and cost; recommendations require estimating the relative value patients place on the outcomes. We are unaware of published literature exploring patient values and preferences regarding (...) American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis ARTHRITIS & RHEUMATOLOGY Vol. 69, No. 8, August 2017, pp 1521–1537 DOI 10.1002/art.40137 V C 2017, American College of Rheumatology SPECIAL ARTICLE 2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis Lenore Buckley, 1 Gordon Guyatt, 2 Howard A. Fink, 3 Michael Cannon, 4 Jennifer Grossman, 5 Karen E. Hansen, 6 Mary

2017 American College of Rheumatology

15. Diagnosis and Management of Osteoporosis

to be individualized. RECOMMENDATIONS GENERAL PATIENT POPULATION (50-64 YEARS OF AGE) ? Use the Osteoporosis Self-assessment tool (OST): Weight (kg) – Age (years) in the context of finding those men and women 50-64 years of age where there is no known risk factors but there could be a future fracture risk. ? Order a bone mineral density (BMD) test only if OST score is 10 indicating patient is at low risk for osteoporosis (see Algorithm). PATIENTS WITH KNOWN RISK FACTORS ? Order BMD* test for men and women >50 (...) INAPPROPRIATE INDICATIONS FOR BMD X DO NOT order BMD for: o Chronic back pain (aiming to rule out vertebral fractures) o Kyphosis (best investigated using lateral thoracic spine X-rays to rule out anterior compression fractures) o Menopause, in the absence of risk factors ASSESSMENT ? Use clinical factors and BMD T-score to determine absolute risk of fracture over the next 10 years with one of: Diagnosis and Management of Osteoporosis | February 2016 Clinical Practice Guideline Page 3 of 17 Recommendations

2016 Toward Optimized Practice

16. Treatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and Women: A Clinical Practice Guideline Update from the American College of Physicians

fragility and fracture ( ). Although osteoporosis can be present in any bone, the hip, spine, and wrist are most likely to be affected. Osteoporosis is found in an estimated 200 million people worldwide ( ), and an estimated 54 million men and women in the United States have osteoporosis or low bone density ( ). Approximately 50% of Americans older than 50 years are at risk for osteoporotic fracture ( ). The economic impact of osteoporosis on the health care system is estimated to be $25.3 billion per (...) without fragility fracture, osteoporosis is often diagnosed by low BMD. Dual-energy x-ray absorptiometry (DXA) is the current gold standard test for diagnosing osteoporosis in people without an osteoporotic fracture. Results of DXA are scored as SDs from a young, healthy norm (usually female) and reported as T scores. For example, a T score of –2 indicates a BMD that is 2 SDs below the comparative norm. The international reference standard for the description of osteoporosis in postmenopausal women

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2017 American College of Physicians

17. Denosumab for the treatment of postmenopausal women with osteoporosis at high risk of fracture

of Health’s Drug Advisory Committee has recommended: Denosumab 60 mg pre-filled syringe for the treatment of osteoporosis (T-score ≤ -2.5) in post-menopausal women at high risk of fracture, who: have a renal function eGFR > 30 ml/min, and are unable to tolerate or follow the administration instructions for oral bisphosphonates. Patients must also receive adequate calcium and vitamin D supplementation whilst undergoing treatment. Subsidy status Denosumab 60 mg pre-filled syringe is recommended (...) Denosumab for the treatment of postmenopausal women with osteoporosis at high risk of fracture '); } else { document.write(' '); } ACE | Denosumab for the treatment of postmenopausal women with osteoporosis at high risk of fracture Search > > Denosumab for the treatment of postmenopausal women with osteoporosis at high risk of fracture - Denosumab for the treatment of postmenopausal women with osteoporosis at high risk of fracture Published on 3 May 2017 Guidance Recommendations The Ministry

2017 Appropriate Care Guides, Agency for Care Effectiveness (Singapore)

18. Common osteoporosis drugs may prevent breast cancer spreading to bone

Common osteoporosis drugs may prevent breast cancer spreading to bone Common osteoporosis drugs may prevent breast cancer spreading to bone Discover Portal Discover Portal Common osteoporosis drugs may prevent breast cancer spreading to bone Published on 13 March 2018 doi: Drugs commonly prescribed to prevent bone thinning probably help prevent the spread of early breast cancer to the bones in a few women, when taken in addition to standard cancer therapies. However, the overall benefits may (...) outcomes reviewed was moderate to high so that we can be fairly confident in the estimates of these effects. What did it find? For women with early breast cancer, bisphosphonates lowered the chances of cancer spreading to the bone by 14% (relative risk [RR] 0.86, 95% confidence interval [CI] 0.75 to 0.99, based on 11 studies with 15,005 women). The absolute risk was 9% for women who didn’t take a bisphosphonate, compared with 7.7% for women who did take a bisphosphonate, meaning just over one person

2018 NIHR Dissemination Centre

19. Cement injections to treat spinal compression fractures from osteoporosis can reduce short term pain

centres. Share your views on the research. Why was this study needed? Worldwide, an estimated 1.4 million people with osteoporosis experience vertebral fractures. Most osteoporotic vertebral fractures are treated conservatively with painkillers, bed rest and mobility exercises as function improves. However, painkillers and prolonged bed rest can both have adverse effects in older people. Vertebroplasty involves injecting special cement into the broken vertebrae to relieve pain and strengthen the bone (...) in the vertebroplasty group at six months was 7.8 out of 24 compared to 12.4 for the placebo group. Vertebroplasty also improved quality of life at six months compared with placebo (average score on the Quality of Life Questionnaire of the European Foundation for Osteoporosis [QAULEFFO] 38 out of 100 versus 45 out of 100; mean difference 7, 95% CI 1 to 13). Two people in the vertebroplasty group (3%) had serious adverse events related to the procedure, and two people in the placebo group (3%) had serious adverse

2018 NIHR Dissemination Centre

20. American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis

) or a T-score of –2.5 or lower in the lumbar spine (anteroposterior), femoral neck, total hip, and/or 33% (one-third) radius even in the absence of a prevalent fracture (Grade B; BEL 2). • R5b. Osteoporosis may also be diagnosed in patients with osteopenia and increased fracture risk using FRAX ® country-specific thresholds (Grade B; BEL 2). 3.Q2. When Osteoporosis Is Diagnosed, What Is an Appropriate Evaluation? • R6. Evaluate for causes of secondary osteoporosis (Grade B; BEL 2). • R7. Evaluate (...) hyperthyroidism, hypogonadism or premature menopause, chronic malnutrition or malabsorption and chronic liver disease) BMD b . Either T-score or femoral neck BMD can be entered. The model also works without BMD. Abbreviations: BMD = bone mineral density; FRAX ® = Fracture Risk Assessment Tool. a Because the effects of causes of secondary osteoporosis on fracture risk are assumed to be mediated through changes in BMD, a “yes” answer to this question does not change fracture risk if BMD is entered into the risk

2016 American Association of Clinical Endocrinologists

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