{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,3,14]],"date-time":"2024-03-14T00:15:16Z","timestamp":1710375316703},"reference-count":57,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2004,1,1]],"date-time":"2004-01-01T00:00:00Z","timestamp":1072915200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2004,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>The diagnosis and management of osteoporosis have become increasingly more complex as new drugs enter the marketplace and meta-analyses of randomized trials with \u201cother\u201d agents become more prolific. We describe five common clinical scenarios encountered in the practice of osteoporosis medicine and various road maps that could lead to successful therapy.<\/jats:p>\n               <jats:p>Introduction: The diagnosis and treatment of osteoporosis have changed dramatically in the last decade. Advances in diagnostic technologies and a range of newer treatment options have provided the clinician with a wide array of choices for treating this chronic disease. Despite the issuance of several \u201cguidelines\u201d and practice recommendations, there still remains confusion among clinicians about basic approaches to the management of osteoporosis. This paper should be used as a case-based approach to define optimal therapeutic choices.<\/jats:p>\n               <jats:p>Materials and Methods: Five representative cases were selected from two very large clinical practices (Bangor, ME; Pittsburgh, PA). Diagnostic modalities and treatment options used in these cases were selected on an evidence-based analysis of respective clinical trials. Subsequent to narrative choices by two metabolic bone disease specialists (SG and CR), calculation of future fracture risk and selection of potential alternative therapeutic regimens were reviewed and critiqued by an epidemiologist (DB).<\/jats:p>\n               <jats:p>Results: A narrative about each case and possible management choices for each of the five cases are presented with references to justify selection of the various therapeutic options. Alternatives are considered and discussed based on literature and references through July 2003. The disposition of the individual patient is noted at the end of each case.<\/jats:p>\n               <jats:p>Conclusions: A case-based approach to the management of osteoporosis provides a useful interface between guidelines, evidence-based meta-analyses, and clinical practice dilemmas.<\/jats:p>","DOI":"10.1359\/jbmr.0301216","type":"journal-article","created":{"date-parts":[[2006,4,27]],"date-time":"2006-04-27T05:58:24Z","timestamp":1146117504000},"page":"3-10","source":"Crossref","is-referenced-by-count":6,"title":["Vignettes in Osteoporosis: A Road Map to Successful Therapeutics"],"prefix":"10.1093","volume":"19","author":[{"given":"Clifford J","family":"Rosen","sequence":"first","affiliation":[{"name":"Maine Center for Osteoporosis Research and Education, St. Joseph Hospital, Bangor, Maine, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dennis M","family":"Black","sequence":"additional","affiliation":[{"name":"Prevention Sciences Group, University of California at San Francisco, San Francisco, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan L","family":"Greenspan","sequence":"additional","affiliation":[{"name":"Osteoporosis Prevention and Treatment Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2009,12,2]]},"reference":[{"key":"2024013019220824600_bib1","doi-asserted-by":"crossref","first-page":"526","DOI":"10.7326\/0003-4819-137-6-200209170-00014","article-title":"Screening for osteoporosis in postmenopausal women: Recommendations and rationale","volume":"137","journal-title":"Ann Intern Med"},{"key":"2024013019220824600_bib2","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1385\/JCD:2:3:275","article-title":"Classification of osteoporosis and osteopenia in postmenopausal women is dependent on site-specific analysis","volume":"2","author":"Varney","year":"1999","journal-title":"J Clin Densitom"},{"key":"2024013019220824600_bib3","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1016\/S0889-8529(02)00024-5","article-title":"Summary of meta-analyses of therapies for postmenopausal osteoporosis and the relationship between bone density and fractures","volume":"31","author":"Guyatt","year":"2002","journal-title":"Endocrinol Metab Clin North Am"},{"key":"2024013019220824600_bib4","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1210\/er.2001-9002","article-title":"Meta-analyses of therapies for postmenopausal osteoporosis. IX: Summary of meta-analyses of therapies for postmenopausal osteoporosis","volume":"23","author":"Cranney","year":"2002","journal-title":"Endocr Rev"},{"key":"2024013019220824600_bib5","doi-asserted-by":"crossref","first-page":"2651","DOI":"10.1001\/jama.289.20.2651","article-title":"Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal women. The Women's Health Initiative Memory Study: A randomized controlled trial","volume":"289","author":"Shumaker","year":"2003","journal-title":"JAMA"},{"key":"2024013019220824600_bib6","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1001\/jama.288.7.872","article-title":"Postmenopausal hormone replacement therapy: Scientific review","volume":"288","author":"Nelson","year":"2002","journal-title":"JAMA"},{"key":"2024013019220824600_bib7","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1001\/jama.288.7.882","article-title":"Assessing benefits and harms of hormone replacement therapy: Clinical applications","volume":"288","author":"Nelson","year":"2002","journal-title":"JAMA"},{"key":"2024013019220824600_bib8","doi-asserted-by":"crossref","first-page":"897","DOI":"10.7326\/0003-4819-130-11-199906010-00005","article-title":"The effect of low-dose continuous estrogen and progesterone therapy with calcium and vitamin D on bone in elderly women. A randomized, controlled trial","volume":"130","author":"Recker","year":"1999","journal-title":"Ann Intern Med"},{"key":"2024013019220824600_bib9","doi-asserted-by":"crossref","first-page":"9","DOI":"10.7326\/0003-4819-122-1-199501010-00002","article-title":"Estrogen replacement therapy and fractures in older women. Study of Osteoporotic Fractures Research Group","volume":"122","author":"Cauley","year":"1995","journal-title":"Ann Intern Med"},{"key":"2024013019220824600_bib10","doi-asserted-by":"crossref","first-page":"3609","DOI":"10.1210\/jcem.87.8.8750","article-title":"Efficacy of raloxifene on vertebral fracture risk reduction in postmenopausal women with osteoporosis: Four-year results from a randomized clinical trial","volume":"87","author":"Delmas","year":"2002","journal-title":"J Clin Endocrinol Metab"},{"key":"2024013019220824600_bib11","first-page":"1904","article-title":"The predictive value of biochemical markers of bone turnover for bone mineral density in early postmenopausal women treated with hormone replacement or calcium supplementation","volume":"82","author":"Rosen","year":"1997","journal-title":"J Clin Endocrinol Metab"},{"key":"2024013019220824600_bib12","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1001\/jama.288.3.321","article-title":"Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women's Health Initiative randomized controlled trial","volume":"288","author":"Rossouw","year":"2002","journal-title":"JAMA"},{"key":"2024013019220824600_bib13","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1002\/jbmr.5650090802","article-title":"The diagnosis of osteoporosis","volume":"9","author":"Kanis","year":"1994","journal-title":"J Bone Miner Res"},{"key":"2024013019220824600_bib14","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1007\/s001980200069","article-title":"A new approach to the development of assessment guidelines for osteoporosis","volume":"13","author":"Kanis","year":"2002","journal-title":"Osteoporos Int"},{"key":"2024013019220824600_bib15","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1007\/BF01622200","article-title":"Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: Synopsis of a WHO report. WHO Study Group","volume":"4","author":"Kanis","year":"1994","journal-title":"Osteoporos Int"},{"key":"2024013019220824600_bib16","doi-asserted-by":"crossref","first-page":"4431","DOI":"10.1210\/jc.2002-020275","article-title":"Yield of laboratory testing to identify secondary contributors to osteoporosis in otherwise healthy women","volume":"87","author":"Tannenbaum","year":"2002","journal-title":"J Clin Endocrinol Metab"},{"key":"2024013019220824600_bib17","first-page":"1","author":"Anonymous","year":"1998"},{"key":"2024013019220824600_bib18","first-page":"1","article-title":"NIH consensus declares osteoporosis a major public health issue","volume":"16","author":"Anonymous","year":"2000","journal-title":"Osteoporos Rep"},{"key":"2024013019220824600_bib19","doi-asserted-by":"crossref","first-page":"875","DOI":"10.7326\/0003-4819-137-11-200212030-00008","article-title":"Significant differential effects of alendronate, estrogen, or combination therapy on the rate of bone loss after discontinuation of treatment of postmenopausal osteoporosis. A randomized, double-blind, placebo-controlled trial","volume":"137","author":"Greenspan","year":"2002","journal-title":"Ann Intern Med"},{"key":"2024013019220824600_bib20","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1016\/S0140-6736(96)07088-2","article-title":"Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures","volume":"348","author":"Black","year":"1996","journal-title":"Lancet"},{"key":"2024013019220824600_bib21","doi-asserted-by":"crossref","first-page":"1344","DOI":"10.1001\/jama.282.14.1344","article-title":"Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: A randomized controlled trial. Vertebral Efficacy With Risedronate Therapy (VERT) Study Group","volume":"282","author":"Harris","year":"1999","journal-title":"JAMA"},{"key":"2024013019220824600_bib22","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1056\/NEJM200102013440503","article-title":"Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group","volume":"344","author":"McClung","year":"2001","journal-title":"N Engl J Med"},{"key":"2024013019220824600_bib23","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1001\/jama.282.7.637","article-title":"Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene","volume":"282","author":"Ettinger","year":"1999","journal-title":"JAMA"},{"key":"2024013019220824600_bib24","doi-asserted-by":"crossref","first-page":"477","DOI":"10.2165\/00002512-199812060-00005","article-title":"Pathogenesis and treatment of glucocorticoid-induced osteoporosis","volume":"12","author":"Rackoff","year":"1998","journal-title":"Drugs Aging"},{"key":"2024013019220824600_bib25","doi-asserted-by":"crossref","first-page":"1496","DOI":"10.1002\/1529-0131(200107)44:7<1496::AID-ART271>3.0.CO;2-5","article-title":"Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis: 2001 update","volume":"44","author":"American College of Rheumatology","year":"2001","journal-title":"Arthritis Rheum"},{"key":"2024013019220824600_bib26","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1053\/gast.2002.34779","article-title":"Long-term fracture risk in patients with Crohn's disease: A population-based study in Olmsted County, Minnesota","volume":"123","author":"Loftus","year":"2002","journal-title":"Gastroenterology"},{"key":"2024013019220824600_bib27","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1136\/gut.51.5.654","article-title":"High prevalence of osteoporotic vertebral fractures in patients with Crohn's disease","volume":"51","author":"Klaus","year":"2002","journal-title":"Gut"},{"key":"2024013019220824600_bib28","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1016\/S0889-8529(18)30090-2","article-title":"Glucocorticoids and osteoporosis","volume":"23","author":"Adler","year":"1994","journal-title":"Endocrinol Metab Clin North Am"},{"key":"2024013019220824600_bib29","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1007\/s002230001146","article-title":"Effects of risedronate treatment on bone density and vertebral fracture in patients on corticosteroid therapy","volume":"67","author":"Wallach","year":"2000","journal-title":"Calcif Tissue Int"},{"key":"2024013019220824600_bib30","first-page":"504","article-title":"Bisphosphonates in the treatment of osteoporosis. Principles and efficacy","volume":"151","author":"Papapoulos","year":"2000","journal-title":"Ann Med Interne (Paris)"},{"key":"2024013019220824600_bib31","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/S0002-9343(99)80153-3","article-title":"Etidronate in the management of glucocorticoid-induced osteoporosis","volume":"99","author":"Lukert","year":"1995","journal-title":"Am J Med"},{"key":"2024013019220824600_bib32","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1002\/1529-0131(200101)44:1<202::AID-ANR27>3.0.CO;2-W","article-title":"Two-year effects of alendronate on bone mineral density and vertebral fracture in patients receiving glucocorticoids: A randomized, double-blind, placebo-controlled extension trial","volume":"44","author":"Adachi","year":"2001","journal-title":"Arthritis Rheum"},{"key":"2024013019220824600_bib33","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1056\/NEJM200008313430902","article-title":"Alendronate for the treatment of osteoporosis in men","volume":"343","author":"Orwoll","year":"2000","journal-title":"N Engl J Med"},{"key":"2024013019220824600_bib34","doi-asserted-by":"crossref","first-page":"1627","DOI":"10.1172\/JCI3914","article-title":"Parathyroid hormone treatment can reverse corticosteroid-induced osteoporosis. Results of a randomized controlled clinical trial","volume":"102","author":"Lane","year":"1998","journal-title":"J Clin Invest"},{"key":"2024013019220824600_bib35","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1359\/jbmr.2000.15.5.944","article-title":"Bone mass continues to increase at the hip after parathyroid hormone treatment is discontinued in glucocorticoid-induced osteoporosis: Results of a randomized controlled clinical trial","volume":"15","author":"Lane","year":"2000","journal-title":"J Bone Miner Res"},{"key":"2024013019220824600_bib36","doi-asserted-by":"crossref","first-page":"4118","DOI":"10.1210\/jcem.85.11.6953","article-title":"Fracture risk reduction with alendronate in women with osteoporosis: The Fracture Intervention Trial. FIT Research Group","volume":"85","author":"Black","year":"2000","journal-title":"J Clin Endocrinol Metab"},{"key":"2024013019220824600_bib37","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1001\/jama.283.10.1318","article-title":"Monitoring osteoporosis therapy with bone densitometry: Misleading changes and regression to the mean. Fracture Intervention Trial Research Group","volume":"283","author":"Cummings","year":"2000","journal-title":"JAMA"},{"key":"2024013019220824600_bib38","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1007\/s00586-002-0512-9","article-title":"Load shift of the intervertebral disc after a vertebroplasty: A finite-element study","volume":"12","author":"Baroud","year":"2003","journal-title":"Eur Spine J"},{"key":"2024013019220824600_bib39","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1148\/radiol.2273011930","article-title":"Midterm outcome after vertebroplasty: Predictive value of technical and patient-related factors","volume":"227","author":"Hodler","year":"2003","journal-title":"Radiology"},{"key":"2024013019220824600_bib40","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.2214\/ajr.180.5.1801411","article-title":"Percutaneous vertebroplasty: Treatment of painful vertebral compression fractures with intraosseous vacuum phenomena","volume":"180","author":"Peh","year":"2003","journal-title":"Am J Roentgenol"},{"key":"2024013019220824600_bib41","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1007\/s007760300032","article-title":"Biomechanical evaluation of kyphoplasty and vertebroplasty with calcium phosphate cement in a simulated osteoporotic compression fracture","volume":"8","author":"Tomita","year":"2003","journal-title":"J Orthop Sci"},{"key":"2024013019220824600_bib42","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1016\/S0002-9343(03)00050-0","article-title":"Is percutaneous vertebral augmentation (vertebroplasty) effective treatment for painful vertebral fractures?","volume":"114","author":"Watts","year":"2003","journal-title":"Am J Med"},{"key":"2024013019220824600_bib43","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1359\/jbmr.2001.16.5.925","article-title":"Parathyroid hormone added to established hormone therapy: Effects on vertebral fracture and maintenance of bone mass after parathyroid hormone withdrawal","volume":"16","author":"Cosman","year":"2001","journal-title":"J Bone Miner Res"},{"key":"2024013019220824600_bib44","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1001\/jama.280.12.1067","article-title":"Prevention of estrogen deficiency-related bone loss with human parathyroid hormone-(1\u201334): A randomized controlled trial","volume":"280","author":"Finkelstein","year":"1998","journal-title":"JAMA"},{"key":"2024013019220824600_bib45","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1359\/jbmr.2002.17.5.808","article-title":"Anabolic action of parathyroid hormone is skeletal site specific at the tissue and cellular levels in mice","volume":"17","author":"Iida-Klein","year":"2002","journal-title":"J Bone Miner Res"},{"key":"2024013019220824600_bib46","first-page":"2129","article-title":"Enhancement of bone mass in osteoporotic women with parathyroid hormone followed by alendronate","volume":"85","author":"Rittmaster","year":"2000","journal-title":"J Clin Endocrinol Metab"},{"key":"2024013019220824600_bib47","doi-asserted-by":"crossref","first-page":"1434","DOI":"10.1056\/NEJM200105103441904","article-title":"Effect of parathyroid hormone (1\u201334) on fractures and bone mineral density in postmenopausal women with osteoporosis","volume":"344","author":"Neer","year":"2001","journal-title":"N Engl J Med"},{"key":"2024013019220824600_bib48","first-page":"S1;S135","article-title":"Effects of parathyroid hormone, alendronate, or both on bone density in osteoporotic women","volume":"17","author":"Neer","year":"2002","journal-title":"J Bone Miner Res"},{"key":"2024013019220824600_bib49","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1056\/NEJMoa031975","article-title":"The effects of PTH and alendronate alone or in combination in post-menopausal osteoporosis","volume":"349","author":"Black","year":"2003","journal-title":"N Engl J Med"},{"key":"2024013019220824600_bib50","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1056\/NEJM199409293311301","article-title":"A multifactorial intervention to reduce the risk of falling among elderly people living in the community","volume":"331","author":"Tinetti","year":"1994","journal-title":"N Engl J Med"},{"key":"2024013019220824600_bib51","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1210\/edrv.22.4.0437","article-title":"Vitamin D deficiency and secondary hyperparathyroidism in the elderly: Consequences for bone loss and fractures and therapeutic implications","volume":"22","author":"Lips","year":"2001","journal-title":"Endocr Rev"},{"key":"2024013019220824600_bib52","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1136\/bmj.326.7387.469","article-title":"Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: Randomised double blind controlled trial","volume":"326","author":"Trivedi","year":"2003","journal-title":"BMJ"},{"key":"2024013019220824600_bib53","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/0140-6736(93)92480-H","article-title":"Effect of external hip protectors on hip fractures","volume":"341","author":"Lauritzen","year":"1993","journal-title":"Lancet"},{"key":"2024013019220824600_bib54","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1080\/000164702760379495","article-title":"The Cochrane Musculoskeletal Injuries Group","volume":"73","author":"Gillespie","year":"2002","journal-title":"Acta Orthop Scand Suppl"},{"key":"2024013019220824600_bib55","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.2106\/00004623-200109000-00034","article-title":"Systematic reviews, meta-analyses, and methodology","volume":"83","author":"Parker","year":"2001","journal-title":"J Bone Joint Surg Am"},{"key":"2024013019220824600_bib56","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1016\/S0272-2712(18)30046-5","article-title":"Epidemiology of fractures and assessment of fracture risk","volume":"20","author":"Black","year":"2000","journal-title":"Clin Lab Med"},{"key":"2024013019220824600_bib57","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1002\/jbmr.5650070214","article-title":"Incidence of clinically diagnosed vertebral fractures: A population-based study in Rochester, Minnesota, 1985\u20131989","volume":"7","author":"Cooper","year":"1992","journal-title":"J Bone Miner Res"}],"container-title":["Journal of Bone and Mineral Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1359%2Fjbmr.0301216","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/jbmr\/article-pdf\/19\/1\/3\/56473503\/5650190102.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jbmr\/article-pdf\/19\/1\/3\/56473503\/5650190102.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T15:06:01Z","timestamp":1710342361000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jbmr\/article\/19\/1\/3-10\/7592682"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2004,1,1]]},"references-count":57,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2009,12,2]]},"published-print":{"date-parts":[[2004,1,1]]}},"URL":"https:\/\/doi.org\/10.1359\/jbmr.0301216","relation":{},"ISSN":["0884-0431","1523-4681"],"issn-type":[{"value":"0884-0431","type":"print"},{"value":"1523-4681","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2004,1,1]]},"published":{"date-parts":[[2004,1,1]]}}}