Osteoporosis: Silverman S

Lewiecki EM, Baim S, Binkley N, Bilezikian JP, Kendler DL, Hans DB, Silverman S, Anonymous00044. · New Mexico Clinical Research and Osteoporosis Center, Albuquerque, NM 87106, USA. · South Med J. · Pubmed #18580720 No free full text.

Abstract: The International Society for Clinical Densitometry (ISCD) periodically holds Position Development Conferences (PDCs) for the purpose of establishing standards and guidelines for the assessment of skeletal health -- the nomenclature, indications, acquisition, analysis, quality control, interpretation, and reporting of bone density tests. Topics are selected for consideration according to criteria that include clinical relevancy, uncertainty in the application of medical evidence to clinical practice, and the likelihood of the expert panel achieving agreement. The most recent Adult PDC was held July 20 to 22, 2007, in Lansdowne, Virginia. Topics included technical and clinical issues relevant to dual-energy x-ray absorptiometry (DXA), vertebral fracture assessment, and bone densitometry technologies other than central DXA. This report describes the methodology and presents the results of this PDC. The first ISCD Pediatric PDC was held June 20 to 21, 2007 in Montreal, Quebec, Canada, and is reported separately.

Shane E, Goldring S, Christakos S, Drezner M, Eisman J, Silverman S, Pendrys D. · No affiliation provided · J Bone Miner Res. · Pubmed #16995804 No free full text.

This publication has no abstract.

Chesnut CH, Azria M, Silverman S, Engelhardt M, Olson M, Mindeholm L. · Osteoporosis Research Group, University of Washington, Seattle, WA, USA. · Osteoporos Int. · Pubmed #18071651 No free full text.

Abstract: Salmon calcitonin, available as a therapeutic agent for more than 30 years, demonstrates clinical utility in the treatment of such metabolic bone diseases as osteoporosis and Paget's disease, and potentially in the treatment of osteoarthritis. This review considers the physiology and pharmacology of salmon calcitonin, the evidence based research demonstrating efficacy and safety of this medication in postmenopausal osteoporosis with potentially an effect on bone quality to explain its abilities to reduce the risk of spine fracture, the development of an oral salmon calcitonin preparation, and the therapeutic rationale for this preparation's chondroprotective effect in osteoarthritis.

Silverman S. · Department of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center/UCLA, The Osteoporosis Medical Center, 8641 Wilshire Boulevard, Suite 301, Beverly Hills, CA 90211, USA. · Rheum Dis Clin North Am. · Pubmed #17288974 No free full text.

Abstract: Although there is a wide variety of osteoporosis medications with varying dosing intervals, adherence to therapies for postmenopausal- or glucocorticoid-induced osteoporosis remains poor. It is associated with long-term consequences, such as increased osteoporotic fractures, including nonvertebral hip fractures. There is a lack of understanding about why patients are not staying on therapy. Potential solutions include newer medications with extended dosing intervals, monitoring, and an open physician-patient relationship.

Cramer JA, Silverman S. · Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06516-2770, USA. · Am J Med. · Pubmed #16563936 No free full text.

Abstract: Poor compliance and persistence are among the most significant reasons for failed pharmacotherapy encountered in clinical practice. Consequences of poor compliance range from minor to serious, depending on drug characteristics, disease state, and severity of disease. Compliance and persistence are particular problems for patients with a disorder such as osteoporosis, which remains asymptomatic for long periods. Poor compliance with bisphosphonate therapy for osteoporosis has been associated with a smaller decrease in the rate of bone turnover and smaller improvements in bone mineral density, and may potentially result in a higher risk of fracture and disability. The compliance problem is additive; complex dosing guidelines may contribute to poor compliance with therapy, and the failure to follow these guidelines may result in treatment-related adverse events that further reduce compliance. In the long term, these issues often result in nonpersistence with treatment. In addition to direct consequences for the patient, poor compliance is associated with significant healthcare costs. Studies suggest that less-frequent dosing regimens improve compliance; however, even among patients receiving weekly bisphosphonates, persistence may remain suboptimal. Several strategies are available to improve compliance and persistence with osteoporosis therapies. Good communication between the healthcare provider and the patient--with continuous reinforcement of the importance of treatment--is a key approach to improving persistence. Patients should receive feedback to confirm that their treatment is having an effect, and individualized reminder systems should be recommended to help the patient adhere to the treatment plan. Potentially, every patient is liable to discontinue treatment even after a long period of regular dosing. It should be assumed that every patient receiving therapy for osteoporosis needs regular reinforcement of the importance of continuing therapy.

Gold DT, Silverman S. · Department of Psychiatry & Behavioral Sciences, Sociology, & Center for Aging, Duke University Medical Center, Box 3003, Durham, NC 27710, USA. · Curr Osteoporos Rep. · Pubmed #16527004 No free full text.

Abstract: One of the major challenges of successful osteoporosis management is poor patient adherence to current therapies. Individuals who are nonadherent have significant consequences of reduced bone mineral density response, reduced bone marker suppression, and increased risk for fracture compared with individuals who are adherent. Although reducing the dosing interval from daily to weekly oral bisphosphonates has improved adherence, adherence with weekly bisphosphonates remains suboptimal. Barriers to adherence include patient health beliefs, inadequate patient education and age. Potential solutions include increased health care provider-patient interaction, and longer times between doses of medications.

Chesnut CH, Silverman S, Andriano K, Genant H, Gimona A, Harris S, Kiel D, LeBoff M, Maricic M, Miller P, Moniz C, Peacock M, Richardson P, Watts N, Baylink D. · University of Washington (CHC), Seattle, Washington, USA. · Am J Med. · Pubmed #10996576 No free full text.

Abstract: PURPOSE: We conducted a 5-year, double-blind, randomized, placebo-controlled study to determine whether salmon calcitonin nasal spray reduced the risk of new vertebral fractures in postmenopausal women with osteoporosis.SUBJECTS AND METHODS: A total of 1,255 postmenopausal women with established osteoporosis were randomly assigned to receive salmon calcitonin nasal spray (100, 200, or 400 IU) or placebo daily. All participants received elemental calcium (1,000 mg) and vitamin D (400 IU) daily. Vertebral fractures were assessed with lateral radiographs of the spine. The primary efficacy endpoint was the risk of new vertebral fractures in the salmon calcitonin nasal spray 200-IU group compared with the placebo group.RESULTS: During 5 years, 1,108 participants had at least one follow-up radiograph. A total of 783 women completed 3 years of treatment, and 511 completed 5 years. The 200-IU dose of salmon calcitonin nasal spray significantly reduced the risk of new vertebral fractures by 33% compared with placebo [200 IU: 51 of 287, placebo: 70 of 270, relative risk (RR) = 0.67, 95% confidence interval (CI): 0.47- to 0.97, P = 0.03]. In the 817 women with one to five prevalent vertebral fractures at enrollment, the risk was reduced by 36% (RR = 0.64, 95% CI: 0.43- to 0.96, P = 0.03). The reductions in vertebral fractures in the 100-IU (RR = 0.85, 95% CI: 0.60- to 1.21) and the 400-IU (RR = 0.84, 95% CI: 0.59- to 1.18) groups were not significantly different from placebo. Lumbar spine bone mineral density increased significantly from baseline (1% to 1. 5%, P<0.01) in all active treatment groups. Bone turnover was inhibited, as shown by suppression of serum type-I collagen cross-linked telopeptide (C-telopeptide) by 12% in the 200-IU group (P <0.01) and by 14% in the 400-IU group (P<0.01) as compared with placebo.CONCLUSION: Salmon calcitonin nasal spray at a dose of 200 IU daily significantly reduces the risk of new vertebral fractures in postmenopausal women with osteoporosis.

Hooven FH, Adachi JD, Adami S, Boonen S, Compston J, Cooper C, Delmas P, Diez-Perez A, Gehlbach S, Greenspan SL, LaCroix A, Lindsay R, Netelenbos JC, Pfeilschifter J, Roux C, Saag KG, Sambrook P, Silverman S, Siris E, Watts NB, Anderson FA. · Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA 01605, USA. · Osteoporos Int. · Pubmed #19468663 links to  free full text

Abstract: SUMMARY: The Global Longitudinal study of Osteoporosis in Women (GLOW) is a prospective cohort study involving 723 physicians and 60,393 women subjects >or=55 years. The data will provide insights into the management of fracture risk in older women over 5 years, patient experience with prevention and treatment, and distribution of risk among older women on an international basis. INTRODUCTION: Data from cohort studies describing the distribution of osteoporosis-related fractures and risk factors are not directly comparable and do not compare regional differences in patterns of patient management and fracture outcomes. METHODS: The GLOW is a prospective, multinational, observational cohort study. Practices typical of each region were identified through primary care networks organized for administrative, research, or educational purposes. Noninstitutionalized patients visiting each practice within the previous 2 years were eligible. Self-administered questionnaires were mailed, with 2:1 oversampling of women >or=65 years. Follow-up questionnaires will be sent at 12-month intervals for 5 years. RESULTS: A total of 723 physicians at 17 sites in ten countries agreed to participate. Baseline surveys were mailed (October 2006 to February 2008) to 140,416 subjects. After the exclusion of 3,265 women who were ineligible or had died, 60,393 agreed to participate. CONCLUSIONS: GLOW will provide contemporary information on patterns of management of fracture risk in older women over a 5-year period. The collection of data in a similar manner in ten countries will permit comparisons of patient experience with prevention and treatment and provide insights into the distribution of risk among older women on an international basis.

Silverman S. · Cedars-Sinai/UCLA, Beverly Hills, California, USA. · J Bone Miner Res. · Pubmed #19364282 No free full text.

This publication has no abstract.

Lewiecki EM, Gordon CM, Baim S, Binkley N, Bilezikian JP, Kendler DL, Hans DB, Silverman S, Bishop NJ, Leonard MB, Bianchi ML, Kalkwarf HJ, Langman CB, Plotkin H, Rauch F, Zemel BS. · New Mexico Clinical Research & Osteoporosis Center, 300 Oak Street NE, Albuquerque, NM 87106, USA. · Osteoporos Int. · Pubmed #18633664 No free full text.

Abstract: The International Society for Clinical Densitometry (ISCD) conducts Position Development Conferences (PDCs) for the purpose of establishing standards and guidelines in the field of bone densitometry. Topics for consideration are selected according to clinical relevance, a perceived need for standardization, and the likelihood of achieving agreement. Questions regarding nomenclature, indications, acquisition, analysis, quality control, interpretation, and reporting of bone density tests for each topic area are assigned to task forces for a comprehensive review of the scientific literature. The findings of the review and recommendations are then presented to an international panel of experts at the PDC. The expert panel votes on potential Official Positions for appropriateness, necessity, quality of the evidence, strength of the recommendation, and applicability (worldwide or variable according to local requirements). Recommendations that are approved by the ISCD Board of Directors become Official Positions. The first Pediatric PDC was 20-21 June 2007 in Montreal, QC, Canada. The most recent Adult PDC was held 20-22 July 2007, in Lansdowne, VA, USA. This Special Report summarizes the methodology of the ISCD PDCs and presents selected Official Positions of general interest.

Baim S, Binkley N, Bilezikian JP, Kendler DL, Hans DB, Lewiecki EM, Silverman S. · Medical College of Wisconsin, Milwaukee, WI, USA. <> · J Clin Densitom. · Pubmed #18442754 No free full text.

Abstract: The International Society for Clinical Densitometry (ISCD) convenes a Position Development Conference (PDC) every 2 yr to make recommendations for standards in the field of bone densitometry. The recommendations are based on clinically relevant issues in bone densitometry such as quality control, acquisition, analysis, interpretation and reporting. Topics for consideration are developed by the ISCD Board of Directors and its Scientific Advisory Committee. Clinically relevant questions related to each topic area are assigned to task forces for a comprehensive review of the medical literature and subsequent presentation of the reports to an international panel of experts. For this PDC, the Expert Panel included representatives of the American Society for Bone and Mineral Research, International Bone and Mineral Society and the National Osteoporosis Foundation. The recommendations of the PDC Expert Panel are then reviewed by the ISCD Board of Directors. Recommendations that are approved become Official Positions of the ISCD. The most recent PDC was held July 20-22, 2007, in Lansdowne, Virginia, USA. Topics considered included vertebral fracture assessment, technical and clinical issues relevant to dual-energy X-ray absorptiometry (DXA), and bone densitometry technologies other than central DXA. This report describes the methodology and the results of the Lansdowne, Virginia, USA 2007 PDC, and a summary of all ISCD Official Positions, including the ones recently adopted by this PDC and the 2007 Pediatric PDC held in Montreal, Quebec, Canada.

Siris ES, Harris ST, Rosen CJ, Barr CE, Arvesen JN, Abbott TA, Silverman S. · Toni Stabile Osteoporosis Center, Department of Medicine, Columbia University Medical Center, Harkness Pavilion 9-964, 180 Fort Washington Ave, New York, NY 10032, USA. · Mayo Clin Proc. · Pubmed #16901023 links to  free full text

Abstract: OBJECTIVE: To characterize the relationships between adherence (complance and persistence) to bisphosphonate therapy and risk of specific fracture types in postmenopausal women. PATIENTS AND METHODS: Data were collected from 45 employers and 100 health plans in the continental United States from 2 claims databases during a 5-year period (January 1, 1999, through December 31, 2003). Claims from patients receiving a bisphosphonate prescription (alendronate or risedronate) were evaluated for 6 months before the Index prescription and during 24 months of follow-up to determine total, vertebral, and nonvertebral osteoporotic fractures, persistence (no gap in refills for >30 days during 24 months), and refill compliance (medication possession ratio > or = 0.80). RESULTS: The eligible cohort included 35,537 women (age, > or = 45 years) who received a bisphosphonate prescription. A subgroup with a specified diagnosis of postmenopausal osteoporosis was also evaluated. Forty-three percent were refill compliant, and 20% persisted with bisphosphonate therapy during the 24-month study period. Total, vertebral, nonvertebral, and hip fractures were significantly lower in refill-compliant and persistent patients, with relative risk reductions of 20% to 45%. The relationship between adherence and fracture risk remained significant after adjustment for baseline age, concomitant medications, and fracture history. There was a progressive relationship between refill compliance and fracture risk reduction, commencing at refill compliance rates of approximately 50% and becoming more pronounced at compliance rates of 75% and higher. CONCLUSIONS: Adherence to bisphosphonate therapy was associated with significantly fewer fractures at 24 months. Increasing refill compliance levels were associated with progressively lower fracture rates. These findings suggest that incremental changes in medication-taking habits could improve clinical outcomes of osteoporosis treatment.

Lewiecki EM, Gordon CM, Baim S, Leonard MB, Bishop NJ, Bianchi ML, Kalkwarf HJ, Langman CB, Plotkin H, Rauch F, Zemel BS, Binkley N, Bilezikian JP, Kendler DL, Hans DB, Silverman S. · New Mexico Clinical Research &Osteoporosis Center, 300 Oak Street NE, Albuquerque, NM 87106, USA. · Bone. · Pubmed #18793764 No free full text.

Abstract: The International Society for Clinical Densitometry (ISCD) periodically convenes Position Development Conferences (PDCs) in order to establish standards and guidelines for the assessment of skeletal health. The most recent Adult PDC was held July 20-22, 2007, in Lansdowne, Virginia, USA; the first Pediatric PDC was June 20-21, 2007 in Montreal, Quebec, Canada. PDC topics were selected according to clinical relevancy, perceived need for standardization, and likelihood of achieving agreement. Each topic area was assigned to a task force for a comprehensive review of the scientific literature. The findings of the review and recommendations were presented to adult and pediatric international panels of experts. The panels voted on the appropriateness, necessity, quality of the evidence, strength, and applicability (worldwide or variable according to local requirements) of each recommendation. Those recommendations that were approved by the ISCD Board of Directors become Official Positions. This is a review of the methodology of the PDCs and selected ISCD Official Positions.