Scottish Intercollegiate Guidelines Network

Summary
This report describes the epidemiology, burden, and treatment of osteoporosis in the 27 countries of the European Union (EU27).

/pdf/osteoporosis-in-the-european-union-medical-management-5gi5e439ck.pdf

Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA).

KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD)

See related commentary by Kanis, page [1829][1]

Since the publication of the Osteoporosis Canada guidelines in 2002, there has been a paradigm shift in the prevention and treatment of osteoporosis and fractures. [1][2],[2][3] The focus now is on preventing fragility fractures and their negative

/pdf/2010-clinical-practice-guidelines-for-the-diagnosis-and-4ttqfkm9wl.pdf

2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary

background Osteoporotic structural damage and bone fragility result from reduced bone formation and increased bone resorption. In a phase 2 clinical trial, strontium ranelate, an orally active drug that dissociates bone remodeling by increasing bone formation and decreasing bone resorption, has been shown to reduce the risk of vertebral fractures and to increase bone mineral density. methods To evaluate the efficacy of strontium ranelate in preventing vertebral fractures in a phase 3 trial, we randomly assigned 1649 postmenopausal women with osteoporosis (low bone mineral density) and at least one vertebral fracture to receive 2 g of oral strontium ranelate per day or placebo for three years. We gave calcium and vitamin D supplements to both groups before and during the study. Vertebral radiographs were obtained annually, and measurements of bone mineral density were performed every six months. results New vertebral fractures occurred in fewer patients in the strontium ranelate group than in the placebo group, with a risk reduction of 49 percent in the first year of treatment and 41 percent during the three-year study period (relative risk, 0.59; 95 percent confidence interval, 0.48 to 0.73). Strontium ranelate increased bone mineral density at month 36 by 14.4 percent at the lumbar spine and 8.3 percent at the femoral neck (P<0.001 for both comparisons). There were no significant differences between the groups in the incidence of serious adverse events. conclusions Treatment of postmenopausal osteoporosis with strontium ranelate leads to early and sustained reductions in the risk of vertebral fractures.

/pdf/the-effects-of-strontium-ranelate-on-the-risk-of-vertebral-4kp45sx3cj.pdf

The Effects of Strontium Ranelate on the Risk of Vertebral Fracture in Women with Postmenopausal Osteoporosis

ContextVertebral fractures significantly increase lifetime risk of future fractures,
but risk of further vertebral fractures in the period immediately following
a vertebral fracture has not been evaluated.ObjectiveTo determine the incidence of further vertebral fracture in the year
following a vertebral fracture.Design and SettingAnalysis of data from 4 large 3-year osteoporosis treatment trials conducted
at 373 study centers in North America, Europe, Australia, and New Zealand
from November 1993 to April 1998.SubjectsPostmenopausal women who had been randomized to a placebo group and
for whom vertebral fracture status was known at entry (n = 2725).Main Outcome MeasureOccurrence of radiographically identified vertebral fracture during
the year following an incident vertebral fracture.ResultsSubjects were a mean age of 74 years and had a mean of 28 years since
menopause. The cumulative incidence of new vertebral fractures in the first
year was 6.6%. Presence of 1 or more vertebral fractures at baseline increased
risk of sustaining a vertebral fracture by 5-fold during the initial year
of the study compared with the incidence in subjects without prevalent vertebral
fractures at baseline (relative risk [RR], 5.1; 95% confidence interval [CI],
3.1-8.4; P<.001). Among the 381 participants who
developed an incident vertebral fracture, the incidence of a new vertebral
fracture in the subsequent year was 19.2% (95% CI, 13.6%-24.8%). This risk
was also increased in the presence of prevalent vertebral fractures (RR, 9.3;
95% CI, 1.2-71.6; P = .03).ConclusionOur data indicate that women who develop a vertebral fracture are at
substantial risk for additional fracture within the next year.

https://jamanetwork.com/journals/jama/articlepdf/193469/joc02244.pdf

Laurent Benhamou

Papers

Risk of New Vertebral Fracture in the Year Following a Fracture