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GLOW is an observational, longitudinal, practice-based cohort study of osteoporosis in 60,393 women aged >55 years in 10 countries on three continents. In this Review, we present insights from the first 3 years of the study. Despite cost analyses being frequently based on spine and hip fractures, we found that nonvertebral, nonhip fractures were around five times more common and doubled the use of health-care resources compared with hip and spine fractures combined. Fractures not at the four so-called major sites in FRAX® (upper arm, forearm, hip and clinical vertebral fractures) account for >40% of all fractures. The risk of fracture is increased by various comorbidities, such as Parkinson disease, multiple sclerosis and lung and heart disease. Obesity, although thought to be protective against all fractures, substantially increased the risk of fractures in the ankle or lower leg. Simple assessment by age plus fracture history has good predictive value for all fractures, but risk profiles differ for first and subsequent fractures. Fractures diminish quality of life as much or more than diabetes mellitus, arthritis and lung disease, yet women substantially underestimate their own fracture risk. Treatment rates in patients at high risk of fracture are below those recommended but might be too frequent in women at low risk. Comorbidities and the limits of current therapeutic regimens jeopardize the efficacy of drugs; new regimens should be explored for severe cases. [ABSTRACT FROM AUTHOR]

The article provides information on the "Clinician's Guide to Prevention and Treatment of Osteoporosis." These guidelines, which are developed by the World Health Organization Fracture Risk Assessment Tool and the National Osteoporosis Foundation (NOF), are helpful clinical tools in the management of osteoporosis.

The first bisphosphonate (etidronate) was approved by the FDA in 1977; alendronate was approved in 1995 for the prevention and treatment of osteoporosis. Bisphosphonates have emerged as the agents of choice for the treatment of osteoporosis and have proved useful in the treatment of skeletal complications of malignancy (hypercalcemia, bone metastases) and have been used long-term in millions of patients. Osteonecrosis of the jaw (ONJ) is a newly described condition (2003) defined as exposed bone in the maxillofacial area, not associated with radiation or any other known cause and not healing for 8 weeks. Most cases have followed dental extraction, another invasive dental procedure, or poorly fitting dentures. Although most cases are painful and it can be progressive, approximately one-third of cases are painless and some do resolve. Although ONJ occurs exclusively or almost exclusively in patients receiving bisphosphonate therapy, a causal association has not been shown, and the mechanism is not clear. In patients receiving high-dose IV bisphosphonates for malignant diseases, ONJ may occur in 5 to 10% over 3 years. It does occur in patients receiving oral or IV bisphosphonates for osteoporosis, but is rare in that setting; about 1 case per 100,000. Treatment is conservative (antimicrobial mouthwash, antibiotics for secondary infection, limited debridement). Preventive strategies should include good dental hygiene for all patients and completion of elective invasive dental procedures before initiating high-dose IV bisphosphonate therapy for cancer. Patients with osteoporosis receiving lower-dose bisphosphonate therapy do not require special precautions, but should be informed of the low risk of this complication. [ABSTRACT FROM AUTHOR]

Measurement of bone mineral density (BMD) with central dual-energy X-ray absorptiometry (DXA) is the current “gold standard” for diagnosing osteoporosis and for monitoring patients. Errors in demographic information, improper patient positioning, incorrect scan analysis, and mistakes in interpretation can all lead to a wrong clinical decision or action. This paper reviews the fundamentals of positioning, scan analysis, and interpretation for central DXA and highlights some of the common pitfalls that may lead to erroneous results. [ABSTRACT FROM AUTHOR]

The article discusses the diagnosis and evaluation of patients with Osteoporosis. Osteoporosis is a silent condition characterized by reduced bone mass and abnormal bone architecture, with an associated increase in the risk of fractures. Biochemical markers of bone turnover may be useful to decide if treatment is needed and to determine the effectiveness of treatment. Osteoporosis in adults is commonly caused by estrogen deficiency and aging. However, bone loss may be secondary to a variety of diseases and conditions. Bone biopsy should be considered in patients who have unusual features of osteoporosis, men and young women who have osteoporosis, patients who have very low bone mass, patients who have fragility fractures but normal bone mass and patients failing conventional therapy.

Osteoporosis is a condition that affects approximately 44 million Americans and is characterized by reduced bone mass and an increased risk of fractures. Of the 1.5 million osteoporotic fractures in the United States each year, vertebral fractures are the most common, while hip fractures are the most serious, with 10-20% of those victims dying within one year. The articles focus on the available methods of diagnosing osteoporosis, the existing treatment options, the importance of self-management and low bone mineral density, and the prevention of glucocorticoid-induced osteoporosis.

This paper describes the development of a biosensor based on label-free immunosensing for the detection of the C-terminal telopeptide bone turnover marker from type-1 collagen. A self-assembled monolayer (SAM) of dithiodipropionic acid was deposited on a gold electrode. Then streptavidin and biotinylated anti-human C-terminal telopeptide antibody were successively conjugated on the self-assembled monolayer. Electrochemical impedance measurements were made to characterize each step of the SAM/streptavidin/biotinylated antibody binding. Subsequently, electrochemical impedance was measured with different concentrations of C-teminal telopeptide. A detection limit of 50 ng/mL and a dynamic range up to 3 μg/mL were achieved. To our knowledge, this is the first attempt to develop a label-free immunosensor based on electrochemical impedance with DC bias for detection of bone-related degradation and rebuilding products. The electronic biosensor might eventually be used for quantitative point-of-care screening of bone health. It is hoped that analysis of bone turnover markers can indicate the beginning of bone diseases such as osteoarthritis and osteoporosis so that treatment might start early when it is most effective. [ABSTRACT FROM AUTHOR]

The bisphosphonates (BPs) are well established as the treatments of choice for disorders of excessive bone resorption, including Paget's disease of bone, myeloma and bone metastases, and osteoporosis. There is considerable new knowledge about how BPs work. Their classical pharmacological effects appear to result from two key properties: their affinity for bone mineral and their inhibitory effects on osteoclasts. Mineral binding affinities differ among the clinically used BPs and may influence their differential distribution within bone, their biological potency, and their duration of action. The inhibitory effects of the nitrogen-containing BPs (including alendronate, risedronate, ibandronate, and zoledronate) on osteoclasts appear to result from their inhibition of farnesyl pyrophosphate synthase (FPPS), a key branch-point enzyme in the mevalonate pathway. FPPS generates isoprenoid lipids used for the posttranslational modification of small GTP-binding proteins essential for osteoclast function. Effects on other cellular pathways, such as preventing apoptosis in osteocytes, are emerging as other potentially important mechanisms of action. As a class, BPs share several common properties. However, as with other classes of drugs, there are obvious chemical, biochemical, and pharmacological differences among the various individual BPs. Each BP has a unique profile that may help to explain potential important clinical differences among the BPs, in terms of speed of onset of fracture reduction, antifracture efficacy at different skeletal sites, and the degree and duration of suppression of bone turnover. As we approach the 40th anniversary of the discovery of their biological effects, there remain further opportunities for using their properties for medical purposes. [ABSTRACT FROM AUTHOR]