J. Christopher Gallagher

Bio: J. Christopher Gallagher is an academic researcher from Creighton University Medical Center. The author has contributed to research in topics: Osteoporosis & Vitamin D and neurology. The author has an hindex of 17, co-authored 23 publications receiving 5510 citations. Previous affiliations of J. Christopher Gallagher include University of British Columbia & Creighton University.

The 2011 Report on Dietary Reference Intakes for Calcium and Vitamin D from the Institute of Medicine: What Clinicians Need to Know

Abstract: This article summarizes the new 2011 report on dietary requirements for calcium and vitamin D from the Institute of Medicine (IOM). An IOM Committee charged with determining the population needs for these nutrients in North America conducted a comprehensive review of the evidence for both skeletal and extraskeletal outcomes. The Committee concluded that available scientific evidence supports a key role of calcium and vitamin D in skeletal health, consistent with a cause-and-effect relationship and providing a sound basis for determination of intake requirements. For extraskeletal outcomes, including cancer, cardiovascular disease, diabetes, and autoimmune disorders, the evidence was inconsistent, inconclusive as to causality, and insufficient to inform nutritional requirements. Randomized clinical trial evidence for extraskeletal outcomes was limited and generally uninformative. Based on bone health, Recommended Dietary Allowances (RDAs; covering requirements of ≥97.5% of the population) for calcium range...

The 2011 Report on Dietary Reference Intakes for Calcium and Vitamin D From the Institute of Medicine: What Clinicians Need to Know

Abstract: This report summarizes the findings of the 2011 Institute of Medicine Committee on dietary intake requirements for calcium and vitamin D in North America, and provides updated data from the previous Institute of Medicine report of 1997. The Committee extensively reviewed existing published evidence on dietary and supplemental intake requirements for calcium and vitamin D with respect to both skeletal health and extraskeletal chronic disease outcomes. Calcium and vitamin D intake requirements were examined for several risk indictors of bone and skeletal health as well as extraskeletal outcomes (including cancer, cardiovascular disease, diabetes, and autoimmune disorders, infectious diseases, neuropsychological function, and disorders of pregnancy). Recommended Dietary Allowance (RDA) was defined as the level of intake of calcium or serum 25-hydroxyvitamin D that would meet the requirements of at least 97.5% of the population. The available scientific data supported an important role for calcium and vitamin D in bone and skeletal health outcomes that was consistent with a cause-and-effect relationship. However, data from randomized clinical trials for extraskeletal health outcomes were limited and inconclusive regarding a possible relationship with calcium and vitamin D intake requirements, and no evidence was found for dose-response or other established criteria for cause-and-effect. For bone health outcome, RDAs of calcium ranged from 700 to 1300 mg/d for life-stage groups at ≥1 year of age, and RDAs of vitamin D were 600 IU/d for ages 1 to 70 years and 800 IU/d for ages ≥71 (corresponding to a serum 25-hydroxyvitamin D level of at least 20 ng/mL [50 nmol/L]). There was an assumption of minimal or no sun exposure for estimation of RDA levels because of the wide variation in vitamin D synthesis from ultraviolet light and concern over risk of skin cancer. No consistent evidence was found that dietary or supplemental intake of vitamin D levels above the RDA provides additional benefit for bone health or extraskeletal outcomes; several investigators have found an U-shaped curve for several outcomes related to vitamin D intake, with increased risks at both low and high levels. The findings of this report suggest that prevalence of vitamin D deficiency in North America has been overestimated. The data show that almost all individuals in this population meet their RDA for vitamin D.

Effects of denosumab treatment and discontinuation on bone mineral density and bone turnover markers in postmenopausal women with low bone mass.

Abstract: Context Denosumab treatment for 24 months increased bone mineral density (BMD) and reduced bone turnover markers (BTM) in postmenopausal women. Objective The aim was to determine the effects of prior denosumab or placebo injections on BMD, BTM, and safety over 24 months after treatment discontinuation. Design We conducted an off-treatment extension of a phase 3, randomized, double-blind, parallel-group study. Participants A total of 256 postmenopausal women with a mean age of 59 yr and a mean lumbar spine T-score of -1.61 at randomization participated in the study. Interventions Participants received placebo or 60 mg denosumab every 6 months for 24 months, followed by 24 months off treatment. Main outcome measures We measured the percentage changes in BMD and BTM, and evaluated safety. Results Of the 256 participants enrolled in the posttreatment phase, 87% completed the study. During 24 months of denosumab treatment, BMD increased (lumbar spine, 6.4%; total hip, 3.6%; 1/3 radius, 1.4%), and BTM decreased (serum C-terminal telopeptide of type 1 collagen, 63%; and N-terminal propeptide of type 1 procollagen, 47%), compared with placebo. After discontinuation, BMD declined, but the previously treated denosumab group maintained higher BMD than the previously treated placebo group at these sites (P ≤ 0.05). Final BMD at month 48 strongly correlated with month 0 BMD. After denosumab discontinuation, BTM increased above baseline within 3 months (serum C-terminal telopeptide of type 1 collagen) or 6 months (N-terminal propeptide of type 1 procollagen) and returned to baseline by month 48. Adverse event rates during the off-treatment phase were similar between groups. Conclusions In postmenopausal women with low BMD, the effects of 60 mg denosumab treatment for 24 months on BMD and BTM are reversible upon discontinuation, reflecting its biological mechanism of action. Residual BMD measurements remained above those of the group previously treated with placebo.

Effect of early menopause on bone mineral density and fractures.

Abstract: Objective: To review the data on the effect of early menopause on bone. Do women undergoing early menopause develop lower bone mineral density at an earlier age and do they have a higher incidence of osteoporotic fractures? Is there a difference on bone between women who undergo early natural menopause compared to women who have early menopause after oophorectomy? Results: The earlier in life that menopause occurs, the lower the bone density will be later in life. Low bone density is associated with a higher fracture rate, and several studies show a relationship between early menopause, oophorectomy, and an increase in osteoporotic fractures. Conclusions: Early menopause is a risk factor for osteoporosis. Women with an early menopause should have bone density testing performed within 10 years of menopause so that osteopenia or osteoporosis will be diagnosed early and appropriate antiresorptive therapy initiated.

Vitamin D deficiency.

Abstract: admission. This proportion could already be greater in some parts of the country and may increase if referrals of cases of self-poisoning increase faster than the facilities for their assessment and management. The provision of social work and psychiatric expertise in casualty departments may be one means of preventing unnecessary medical admissions without risk to the patients. Dr Blake's and Dr Bramble's figures do not demonstrate, however, that any advantage would attach to medical teams taking over assessment from psychiatrists except that, by implication, assessments would be completed sooner by staff working on the ward full time. What the figures actually suggest is that if assessment of overdoses were left to house doctors there would be an increase in admissions to psychiatric units (by 19°U), outpatients (by 5O°'), and referrals to social services (by 140o). So for house doctors to assess overdoses would provide no economy for the psychiatric or social services. The study does not tell us what the consequences would have been for the six patients who the psychiatrists would have admitted but to whom the house doctors would have offered outpatient appointments. E J SALTER

Interventions for preventing falls in older people living in the community

Abstract: As people get older, they may fall more often for a variety of reasons including problems with balance, poor vision, and dementia. Up to 30% may fall in a year. Although one in five falls may require medical attention, less than one in 10 results in a fracture. This review looked at the healthcare literature to establish which fall prevention interventions are effective for older people living in the community, and included 159 randomised controlled trials with 79,193 participants. Group and home-based exercise programmes, usually containing some balance and strength training exercises, effectively reduced falls, as did Tai Chi. Overall, exercise programmes aimed at reducing falls appear to reduce fractures. Multifactorial interventions assess an individual's risk of falling, and then carry out treatment or arrange referrals to reduce the identified risks. Overall, current evidence shows that this type of intervention reduces the number of falls in older people living in the community but not the number of people falling during follow-up. These are complex interventions, and their effectiveness may be dependent on factors yet to be determined. Interventions to improve home safety appear to be effective, especially in people at higher risk of falling and when carried out by occupational therapists. An anti-slip shoe device worn in icy conditions can also reduce falls. Taking vitamin D supplements does not appear to reduce falls in most community-dwelling older people, but may do so in those who have lower vitamin D levels in the blood before treatment. Some medications increase the risk of falling. Three trials in this review failed to reduce the number of falls by reviewing and adjusting medications. A fourth trial involving family physicians and their patients in medication review was effective in reducing falls. Gradual withdrawal of a particular type of drug for improving sleep, reducing anxiety, and treating depression (psychotropic medication) has been shown to reduce falls. Cataract surgery reduces falls in women having the operation on the first affected eye. Insertion of a pacemaker can reduce falls in people with frequent falls associated with carotid sinus hypersensitivity, a condition which causes sudden changes in heart rate and blood pressure. In people with disabling foot pain, the addition of footwear assessment, customised insoles, and foot and ankle exercises to regular podiatry reduced the number of falls but not the number of people falling. The evidence relating to the provision of educational materials alone for preventing falls is inconclusive.

Clinician’s Guide to Prevention and Treatment of Osteoporosis

Abstract: The Clinician’s Guide to Prevention and Treatment of Osteoporosis was developed by an expert committee of the National Osteoporosis Foundation (NOF) in collaboration with a multispecialty council of medical experts in the field of bone health convened by NOF. Readers are urged to consult current prescribing information on any drug, device, or procedure discussed in this publication.