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Own the Bone Midwest Regional Educational Symposium
Join bone health experts on Friday, November 11, 2011 from 10:00am until 2:00pm CST at the Westin O'Hare in Rosemont, IL for a complimentary symposium to learn about your role in improving patient bone health.
The symposium will feature:
- an overview of the worrisome statistics associated with fragility fractures and why systems-based interventions, such as Own the Bone, are needed to help improve patient care;
- an update on osteoporosis treatments;
- a best practices panel that focuses on practice management aspects of establishing an osteoporotic fracture program;
- practical advice on coordination of post-fracture care among various medical specialties;
- and plenty of time for group discussion and networking among attendees.
The American Academy of Orthopaedic Surgeons designates this live activity for a maximum of 3 AMA PRA Category 1 Credits.™
Visit the Own the Bone website to view the preliminary agenda and learn more about the event.
To register call 847-318-7336 or e-mail ownthebone@aoassn.org.
Headlines
Program Updates and Announcements:
New Webinar Recording Available: Own the Bone in Practice at Greenville Hospital System University Medical Center
Own the Bone® Program Highlighted in The Journal of Bone and Joint Surgery
Own the Bone Sites Recognized in US News and World Report “Best Hospitals” Guide
New Organizational Alliance Partners
Patient Education Opportunities: World Osteoporosis Day and Upcoming National Osteoporosis Foundation Webinar
Own the Bone Survey Results
Link to Bone Health News:
Breast Cancer Patients Benefit From Bone Drug
Scientists Pinpoint Gene That Carries Osteoporosis Risk
Hip Fracture Is Associated With Increased Short-Term Death Rates for Some Older Women
History Repeats Itself on Fracture in Men
Does Long-term Levothyroxine Use Cause Bone Loss?
Vitamin D Supplementation Q3M Does Not Reduce Fall Rates
Initiative Designed to Help Elderly
FDA Okays Denosumab for Cancer-Induced Bone Loss
Support for Calcium Supplementation Eroding
US FDA Advisers Wary of Time Limit on Bone Drugs
MU Researchers Use New Video Gaming Technology to Detect Illness, Prevent Falls in Older Adults
Program Updates and Announcements:
New Webinar Recording Available: Own the Bone in Practice at Greenville Hospital System University Medical Center
Kyle J. Jeray, MD from Greenville Hospital System University Medical Center in Greenville, South Carolina discusses how Own the Bone has been implemented at Greenville Hospital System. His presentation provides practical advice for clinicians who are interested in starting Own the Bone at their institutions.
A few key features about the Greenville's program discussed in the presentation include:
- a reminder for staff incorporated in the EMR system to ensure that eligible patients are counseled and entered into the registry;
- scheduling patients for a DXA before leaving the hospital; and
- referring patients in need of osteoporosis drug therapies to a rheumatologist.
To view the full webinar, visit the Own the Bone website.
Own the Bone® Program Highlighted in The Journal of Bone and Joint Surgery
Own the Bone was highlighted in "Addressing Secondary Prevention of Osteoporosis in Fracture Care: Follow-up to 'Own the Bone,'" published online in August 2011 by The Journal of Bone and Joint Surgery (JBJS). Own the Bone Steering Committee members, Beatrice J. Edwards, MD, MPH and Andrew D. Bunta, MD, were two of the co-authors on the paper.
The study explored the effects of immediate and delayed care for osteoporosis following a fragility fracture. The rate of bone-mineral density testing was 92% in the immediate-care group compared with 76% in the delayed-care group. Osteoporosis therapy had been initiated within six months after the fracture in 67% of the patients in the immediate-care group compared to 30% of the patients in the delayed-care group.
To learn more or to view the article abstract, visit JBJS. JBJS subscribers can log in to view the full article.
Own the Bone Sites Recognized in US News and World Report “Best Hospitals” Guide
In August, The American Orthopaedic Association and the National Osteoporosis Foundation recognized all enrolled Own the Bone sites in the 2011 US News and World Report “Best Hospitals” Guide. You can view the ad on the Own the Bone website. Copies of the U.S. News Guide have been provided to all Own the Bone subscribers.
New Organizational Alliance Partners
The AOA welcomes the International Society for Clinical Densitometry (ISCD) and the National Association for Orthopaedic Nurses (NAON) as new members of the Own the Bone® Organizational Alliance. The Organizational Alliance supports the Own the Bone program by educating physicians and allied medical professionals about the need to coordinate care across specialties in order to ensure that patients are educated and treated beyond routine fracture care.
Visit the the Own the Bone website to learn more about the Organizational Alliance.
Patient Education Opportunities: World Osteoporosis Day and Upcoming National Osteoporosis Foundation Webinar
World Osteoporosis Day is October 20th. The International Osteoporosis Foundation recommends taking 3 steps to unbreakable bones: 1) embrace an active lifestyle, 2) embrace calcium rich foods and 3) embrace vitamin D. For additional information and to find out how you can get involved, visit WorldOsteoporosisDay.org.
On World Osteoporosis Day, the National Osteoporosis Foundation invites you and your patients to participate in a free, live educational webinar:
Safe Pilates and Yoga for Bone Health
Presented by: Sherri Betz PT, GCS, CEEAA, PMA® and Matthew J. Taylor PT, PhD, RYT
Date: Thursday, October 20, 2011
Time: 2:00 pm to 3:15 pm (EST)
The webinar will be presented live through the internet. Online participants will have an opportunity to submit questions to the presenters. If you don’t have internet access, you can listen to the presentations by phone.
Please visit www.nof.org/webinars or call Peach New Media toll-free at 1-866-702-3278 to register.
The National Osteoporosis Foundation, an Own the Bone Educational Alliance partner, frequently holds informational webinars for patients and practitioners. Visit the NOF website for more information.
Own the Bone Survey Results
Thank you to all of the institutions that recently participated in the Own the Bone survey.
94% of respondents who have been entering patients into the registry for over 6 months agreed that the Own the Bone program helped improve patient care at their institution.
Respondents noted that the value of the program included improved documentation/tracking of patient care, improved general patient knowledge of Osteoporosis, and improved care coordination, among many others.
The feedback provided will be extremely helpful as we plan for the future of Own the Bone.
Bone Health News:
Breast Cancer Patients Benefit From Bone Drug
Breast cancer patients who take aromatase inhibitors can experience a decline in bone density. A new study published online October 10 in the journal Cancer shows that adding an osteoporosis drug to their medication regimen prevents the bone loss. Aromatase inhibitors halt estrogen production in postmenopausal women, which is good for stopping the growth of cancer cells but bad for bone health, putting patients at higher risk for bone loss and fractures. In the new study, women taking aromatase inhibitors were either prescribed the osteoporosis drug zoledronic acid (also known as Zometa) concurrently with cancer therapy or only after bone loss or a fracture occurred. The study found that the women who took zoledronic acid concurrently had significant increases in bone density. But those who took the medication only after a bone problem arose had steady declines in bone mass. The authors noted, however, that even the women who received it later benefited from the osteoporosis medication and were able to reverse their bone loss.
From "Breast Cancer Patients Benefit From Bone Drug"
Los Angeles Times (10/10/11) Roan, Shari
Scientists Pinpoint Gene That Carries Osteoporosis Risk
A study published in the journal Cell Metabolism has named inositol polyphosphate 4-phosphatase type IIa (Inpp4ba) as a gene that, when disabled, may lead to the relatively rapid onset of osteoporosis. The finding may contribute to more targeted preventive medicine for people who are found to have certain variants of the gene. A bone-mass-regulating strip of DNA, Inpp4ba helps control the production of osteoclasts, which break down bone minerals; osteoblasts operate in concert by building up bone matrix. When a healthy equilibrium is established, osteoblasts and osteoclasts maintain proper bone density. However, researchers found that when Inpp4ba was deactivated in laboratory mice, the animals' osteoclast levels went through the roof. An imbalance in favor of these mineral-dissolving cells can quickly lead to low bone density and, in time, osteoporosis, said the researchers. While the ability to treat osteoporosis on a genetic level is still some years away, many scientists have expressed enthusiasm over the possibility of slowing bone loss by "switching" specific genes on or off. In the case of Inpp4ba, the ability to reactivate the gene if it has been silenced could lead to novel therapies for bone loss.
From "Scientists Pinpoint Gene That Carries Osteoporosis Risk"
EndocrineWeb (10/08/2011)
Hip Fracture Is Associated With Increased Short-Term Death Rates for Some Older Women
A study published by Archives of Internal Medicine found that hip fracture is affiliated with an increase in short-term mortality for women ages 65 to 79 years and healthy women ages 80 years and older, although the risk reverts to previous levels after one year for women ages 70 years and older. Earlier research to determine the mortality risk related to hip fracture has not always accounted for differences in health status. "Such methodological limitations have made it difficult to determine whether the noted increase in mortality after hip fracture is the result of underlying poor health or the hip fracture itself," say the study's authors. It was their aim to ascertain the short-term (one year or less), intermediate-term (between one and five years) and long-term (between five and 10 years) mortality associated with hip fracture, as well as whether healthy women ages 80 years and older would have higher mortality associated with hip fracture when compared with healthy controls of the same age. Over 1,100 women with hip fracture were selected and matched with four control participants of the same age who did not have hip fracture for a total of 5,580 subjects. The odds of death were twice as high in the year after the fracture for participants with hip fracture, compared with controls. The odds of short-term mortality climbed in participants ages 65 to 70 years and 70 to 79 years, while an increase also was seen in women ages 80 years or older with good or excellent health. After 12 months following fracture, subjects with fracture and controls had similar mortality, except those with fracture ages 65 to 70 years who continued to exhibit an increase in mortality. The study draws an association between age, health status (in those ages 80 years and older), and short-term mortality following hip fracture. "If our findings are replicated, they would suggest that research should focus on hip fracture prevention and interventions in these groups that could decrease mortality during that high-risk period," the authors write. "Women who are 65 to 70 years of age continue to have an increased risk of mortality for up to five to 10 years; therefore, prevention of hip fractures in these women should be of high priority."
From "Hip Fracture Is Associated With Increased Short-Term Death Rates for Some Older Women"
Newswise (09/23/11)
History Repeats Itself on Fracture in Men
Older men who have suffered a vertebral fracture, or have low bone mineral density, are at a very high risk of developing new fractures in the spine within five years, according to Dennis Black, PhD, of the University of California San Francisco. Black says that among men in a large prospective cohort study, the incidence rate of new vertebral fractures according to quartile of BMD as measured by DXA ranged from 1.7 percent in the highest quartile to 8.8 percent in the lowest quartile. Additionally, the incidence of new fractures over five years was 15.2 percent in men with a previous fracture, and just 4.2 percent in those without a history of vertebral fracture, Black reported at the annual meeting of the American Society for Bone and Mineral Research. Data on risk factors for vertebral fractures in men has been largely limited until recently. Most studies have suggested a link to incident fractures, while others have suggested that additional factors like smoking, alcohol consumption, and body mass index (BMI) may also contribute. In Black's study, risk factors included age, height, BMI, smoking, history of nonvertebral fracture, physical activity, change in height since age 25, and corticosteroid use. Black did not find any associations with smoking, alcohol use, or BMI, and on multivariate analysis, only age and timed chair stand maintained a limited significance.
From "History Repeats Itself on Fracture in Men"
MedPage Today (09/22/11) Walsh, Nancy
Does Long-term Levothyroxine Use Cause Bone Loss?
Bone loss can be caused by a variety of factors, including age and menopausal status, and both hypo- and hyperthyroidism have been associated with an increased fracture risk in adults. Lower bone mass associated with hyperthyroidism may be the result of higher bone turnover due to an imbalance between bone reabsorption and formation. The use of levothyroxine in older patients can be traced to a decline of thyroid hormone production and secretion, but a decline of thyroid degradation also occurs as people age. Consequently, patients who start taking levothyroxine when middle aged may need lower doses as they get older. Over-treatment is common despite required regular thyroid-stimulating hormone (TSH) monitoring. In a nested case-control study, current levothyroxine treatment was associated with increased risk for fracture in elderly patients over 70 years old, compared to matched controls of remote users of levothyroxine. Fracture risk was significantly higher in current users, particularly among women. Research suggests that suppressed TSH is associated with increased bone turnover markers, and an observational cohort study found that patients with a suppressed TSH had a greater risk for fracture while patients with a low, unsuppressed TSH did not. TSH levels should be observed at least annually in patients taking levothyroxine, and patients should be instructed on how to take levothyroxine properly, with levothyroxine taken at a consistent time to avoid fluctuations in TSH levels.
From "Does Long-term Levothyroxine Use Cause Bone Loss?"
Medscape (09/20/11) Scott, Nicholas Gayle
Vitamin D Supplementation Q3M Does Not Reduce Fall Rates
Elderly women administered vitamin D supplementation in the form of oral cholecalciferol (D3), 150,000 IU every 3 months, show significant increases in serum vitamin D levels, but this increase does not appear to improve the rate of falls or grip strength, according to research presented at the American Society for Bone and Mineral Research. Australian researchers were conducting a study to see if a higher-dose supplementation administered less frequently would improve adherence found that the higher-dose, less frequent group showed vitamin D increases to levels that were approximately 15 nmol/L higher than a placebo group after three, six, and nine months. However, these increases were not associated with significant decreases in falls compared to the placebo group. Additionally, the group that received vitamin D less frequently showed no improvement in muscle strength at 9 months, compared to the placebo group. Studies have previously shown that daily calcium and vitamin D supplementation can reduce the risk of falls and fractures in elderly women, but adherence can be a problem. "Since vitamin D is a fat soluble vitamin, less frequent dosing is theoretically possible and likely to be biologically effective, we hypothesized that a high-dose, supervised, every-3-month oral cholecalciferol regimen would be effective and safe at preventing falls and fall related costs in unselected females over 70 years of age, compared to lifestyle advice alone," says the study's lead author Paul Glendenning, MD, from the Department of Core Clinical Pathology and Biochemistry at Royal Perth Hospital in Australia. "Our data, together with previous findings, confirm that intermittent high doses of vitamin D are ineffective or have a deleterious effect on falls."
From "Vitamin D Supplementation Q3M Does Not Reduce Fall Rates"
Medscape (09/20/11) Melville, Nancy A.
Initiative Designed to Help Elderly
When an elderly person suffers a fall, time is critical when it comes to getting the patient healed and healthy again. Emory-Adventist Hospital (EAH) in Smyrna, Ga., has established a Geriatric Fracture Program designed to facilitate this process. Dr. Jeffrey Kovacic, the founder of the EAH program, says when an elderly person breaks a hip, surgery is inevitable and needs to be done fairly quickly to optimize the outcome. Kovacic says falls are the number one reason elderly people experience broken hips and other bones, with hazards like throw rugs sometimes being the problem. "They don’t have as good of balance as they get older. Our inner ear is what helps us with our balance and sometimes that get compromised as we age," says Kovacic. "Some people have mini strokes. They can get faint for any number of reasons. Sometimes, it’s just bad luck. They don’t have any of those problems. They just trip over their own feet." Kovacic says more women than men suffer from hip fractures, and once the big bone is broken patients cannot walk and the risk of blood clots are high. The Geriatric Fracture Program is not changing the process for these kinds of surgeries, just making them more efficient. In the program, three doctors treat patients, and a lot of work is done with the families to teach them what to expect. "Our goal is to get the patient into surgery within 24 hours of their arrival to the ER. Studies show they do so much better if we can get that surgery done to stabilize that hip fracture and have a much less chance of having complications," says Jana Luce, the program coordinator. Rehabilitation begins the day after surgery, with a physical therapist assessing what the patient is physically able to do. Patients do exercises like walking, standing, and stretching twice a day, which decreases the amount of complications that can occur following surgery.
From "Initiative Designed to Help Elderly"
Marietta Daily Journal (09/19/11) Mosley, Davia L.
FDA Okays Denosumab for Cancer-Induced Bone Loss
The FDA has approved the osteoporosis drug denosumab (Prolia) as a treatment for bone loss in women with breast cancer and men with non-metastatic prostate cancer. Denosumab thus becomes the first drug for approved for treatment-induced bone loss in cancer patients undergoing hormone ablation therapy, according to drug maker Amgen. In a three-year trial of 1,468 prostate cancer patients with non-metastatic cancer, patients treated with denosumab had a significantly higher bone mineral density (BMD) compared to those given a placebo in the lumbar spine at two years. After three years, BMD was increased in the lumbar spine, total hip, and femoral neck, with lower incidence of new vertebral fractures than those treated with placebo. In a second, two-year study of 252 postmenopausal breast cancer patients receiving aromatase inhibitor therapy, BMD was significantly increased in the drug treatment group compared to the placebo group in the lumbar spine at one year, and in the lumbar spine, total hip, and femoral neck after two years. In another phase III trial, denosumab outperformed zoledronic acid in delaying skeletal-related events in prostate cancer patients with bone metastasis.
From "FDA Okays Denosumab for Cancer-Induced Bone Loss"
MedPage Today (09/19/11) Petrochko, Cole
Support for Calcium Supplementation Eroding
While some argue that calcium supplementation is a safe, effective, and necessary treatment for people who do not get enough calcium, but concerns there is growing concern of potential cardiovascular risk related to supplementation. At the American Society for Bone and Mineral Research, Dr. Roger Francis from the Institute for Aging and Health at Newcastle University, earned the society's Golden Femur award when arguing against calcium supplementation. Francis argued that several pivotal studies have shown little substantial benefit on bone mineral density (BMD) or fracture risk from calcium supplementation, while other high-profile but controversial studies have raised questions of cardiovascular risk. For example, one study showed little benefit on BMD associated with calcium intake for women, with the exception of women with low vitamin D. Francis notes that a Women's Health Initiative Study, which randomly assigned more than 36,000 postmenopausal women between 50 and 79 to take calcium and vitamin D or a placebo daily, showed small improvement in BMD in the calcium and vitamin D group, but no reduction in fracture risk. Deaths were lower in the supplementation group, and there was no significant difference rates in cardiovascular disease or cancer, but renal stones were reported in more women in the supplementation group, compared to the placebo group. Francis says the study provides enough evidence to at least raise enough uncertainties to warrant a high level of speculation on the role of calcium supplementation.
From "Support for Calcium Supplementation Eroding"
Medscape (09/19/11) Melville, Nancy A.
US FDA Advisers Wary of Time Limit on Bone Drugs
The FDA declined to suggest how long women should take bisphosphonates to prevent bone fractures, but agreed the labels should be changed to reflect uncertainty about the risks and benefits of long-term use. The agency had asked two of its advisory panels to recommend whether a "drug holiday" or some time limit was warranted on the drugs, which have been linked to unusual thigh fractures and other side effects. Instead, the advisers voted to make changes to the labeling with many in favor of specifying how often patients need a re-evaluation of whether they need the medicine. Panelists raised concerns that they did not have enough evidence to come up with specific suggestions or conclusions, and some recommended raising awareness of such uncertainties in the label as well. The drugs under review, including Merck's Fosamax and Roche's Boniva, have also been linked to osteonecrosis of the jaw, or jaw bone death, and a possible higher cancer risk.
From "US FDA Advisers Wary of Time Limit on Bone Drugs"
Reuters (09/09/11) Selyukh, Alina
MU Researchers Use New Video Gaming Technology to Detect Illness, Prevent Falls in Older Adults
University of Missouri researchers are using motion-sensor technology to monitor changes in assisted-care facility residents. For example, Missouri professor Marjorie Skubic and doctoral student Erik Stone are using Microsoft's Kinect device to monitor behavior and routine changes in patients, which can indicate increased risk for falls or early symptoms of illness. "The Kinect uses infrared light to create a depth image that produces data in the form of a silhouette, instead of a video or photograph," Stone says. He says using Kinect can alleviate "many seniors' concerns about privacy when traditional Web camera-based monitoring systems are used." Meanwhile, Missouri professor Mihail Popescu and doctoral student Liang Liu developed a fall-detection system involving Doppler radar, in which the system identifies changes in walking, bending, and other movements that could reveal an increased risk of falling. "If emergency personnel are informed about a fall right away, it can significantly improve the outcome for the injured patient," Liu says. Both motion-sensing systems provide automated data to care providers, alerting them when a patient needs help.
From "MU Researchers Use New Video Gaming Technology to Detect Illness, Prevent Falls in Older Adults"
MU News Bureau (MO) (09/06/11) Craven, Samantha
Abstract News © Copyright 2011 INFORMATION, INC.
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