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Sone T, Ohnaru K, Sugai T, Yamashita A, Okimoto N, Inoue T, Matsumoto T. The effects of abaloparatide on hip geometry and biomechanical properties in Japanese osteoporotic patients assessed using DXA-based hip structural analysis: results of the Japanese phase 3 ACTIVE-J trial. Arch Osteoporos 2023; 18:146. [PMID: 38030806 PMCID: PMC10687120 DOI: 10.1007/s11657-023-01344-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 11/01/2023] [Indexed: 12/01/2023]
Abstract
Daily subcutaneous injection of 80 μg abaloparatide increased bone mineral density in Japanese patients with osteoporosis at high fracture risk in the ACTIVE-J trial. Dual-energy X-ray absorptiometry-based hip structural analysis from ACTIVE-J data showed improved hip geometry and biomechanical properties with abaloparatide compared with placebo. PURPOSE Abaloparatide (ABL) increased bone mineral density (BMD) in Japanese patients with osteoporosis at high fracture risk in the ACTIVE-J trial. To evaluate the effect of ABL on hip geometry and biomechanical properties, hip structural analysis (HSA) was performed using ACTIVE-J trial data. METHODS Hip dual-energy X-ray absorptiometry scans from postmenopausal women and men (ABL, n = 128; placebo, n = 65) at baseline and up to week 78 were analyzed to extract bone geometric parameters at the narrow neck (NN), intertrochanteric region (IT), and proximal femoral shaft (FS). Computed tomography (CT)-based BMD and HSA indices were compared between baseline and week 78. RESULTS ABL treatment showed increased mean percent change from baseline to week 78 in cortical thickness at the NN (5.3%), IT (5.3%), and FS (2.9%); cross-sectional area at the NN (5.0%), IT (5.0%), and FS (2.6%); cross-sectional moment of inertia at the NN (7.6%), IT (5.1%), and FS (2.5%); section modulus at the NN (7.4%), IT (5.4%), and FS (2.4%); and decreased mean percent change in buckling ratio (BR) at the IT (- 5.0%). ABL treatment showed increased mean percent change in total volumetric BMD (vBMD; 2.7%) and trabecular vBMD (3.2%) at the total hip and decreased mean percent change in BR at femoral neck (- 4.1%) at week 78 vs baseline. All the changes noted here were significant vs placebo (P < 0.050 using t-test). CONCLUSION A 78-week treatment with ABL showed improvement in HSA parameters associated with hip geometry and biomechanical properties vs placebo. TRIAL REGISTRATION JAPIC CTI-173575.
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Affiliation(s)
- Teruki Sone
- Department of Nuclear Medicine, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama, 701-0192, Japan.
| | - Kazuhiro Ohnaru
- Department of Orthopedics, Traumatology & Spine Surgery, Kawasaki Medical School, Okayama, Japan
| | - Takumi Sugai
- Division of Pharmaceutical Development and Production, Teijin Pharma Limited, Tokyo, Japan
| | - Akiko Yamashita
- Division of Pharmaceutical Development and Production, Teijin Pharma Limited, Tokyo, Japan
| | | | | | - Toshio Matsumoto
- Fujii Memorial Institute of Medical Sciences, Tokushima University, Tokushima, Japan
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Messina C, Piodi LP, Grossi E, Eller-Vainicher C, Bianchi ML, Ortolani S, Di Stefano M, Rinaudo L, Sconfienza LM, Ulivieri FM. Artificial neural network analysis of bone quality DXA parameters response to teriparatide in fractured osteoporotic patients. PLoS One 2020; 15:e0229820. [PMID: 32160208 PMCID: PMC7065795 DOI: 10.1371/journal.pone.0229820] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 02/16/2020] [Indexed: 02/05/2023] Open
Abstract
Teriparatide is a bone-forming therapy for osteoporosis that increases bone quantity and texture, with uncertain action on bone geometry. No data are available regarding its influence on bone strain. To investigate teriparatide action on parameters of bone quantity and quality and on Bone Strain Index (BSI), also derived from DXA lumbar scan, based on the mathematical model finite element method. Forty osteoporotic patients with fractures were studied before and after two years of daily subcutaneous 20 mcg of teriparatide with dual X-ray photon absorptiometry to assess bone mineral density (BMD), hip structural analysis (HSA), trabecular bone score (TBS), BSI. Spine deformity index (SDI) was calculated from spine X-ray. Shapiro-Wilks, Wilcoxon and Student's t test were used for classical statistical analysis. Auto Contractive Map was used for Artificial Neural Network Analysis (ANNs). In the entire population, the ameliorations after therapy regarded BSI (-13.9%), TBS (5.08%), BMD (8.36%). HSA parameters of femoral shaft showed a worsening. Dividing patients into responders (BMD increase >10%) and non-responders, the first presented TBS and BSI ameliorations (11.87% and -25.46%, respectively). Non-responders presented an amelioration of BSI only, but less than in the other subgroup (-6.57%). ANNs maps reflect the mentioned bone quality improvements. Teriparatide appears to ameliorate not only BMD and TBS, but also BSI, suggesting an increase of bone strength that may explain the known reduction in fracture risk, not simply justified by BMD increase. BSI appears to be a sensitive index of TPD effect. ANNs appears to be a valid tool to investigate complex clinical systems.
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Affiliation(s)
- Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
| | - Luca Petruccio Piodi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, UO Gastroenterologia ed Endoscopia Digestiva, Milano, Italy
| | - Enzo Grossi
- Villa Santa Maria Foundation, Centro di Riabilitazioni Neuropsichiatrica, UO Autismo, Tavernerio (CO), Italy
| | | | - Maria Luisa Bianchi
- IRCCS Istituto Auxologico, UO Endocrinologia e Malattie del Metabolismo, Milano, Italy
| | - Sergio Ortolani
- IRCCS Istituto Auxologico, UO Endocrinologia e Malattie del Metabolismo, Milano, Italy
| | - Marco Di Stefano
- A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette, Corso Bramante, Torino, Italy
| | - Luca Rinaudo
- TECHNOLOGIC Srl, Lungo Dora Voghera, Torino, Italy
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
| | - Fabio Massimo Ulivieri
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, UO Medicina Nucleare, Milano, Italy
- * E-mail:
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Sone T, Kon N, Gaither KW, Okubo N, Osakabe T, Nakayama Y, Fukunaga M, Ito M, Nakamura T. Effects of 3-year denosumab treatment on hip structure in Japanese postmenopausal women and men with osteoporosis. Bone Rep 2017; 7:164-171. [PMID: 29188222 PMCID: PMC5701790 DOI: 10.1016/j.bonr.2017.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 11/07/2017] [Accepted: 11/13/2017] [Indexed: 12/31/2022] Open
Abstract
Denosumab, a human monoclonal antibody against RANK ligand, is shown to have strong anti-fracture effects in Japanese osteoporosis patients. However, there have been no data showing actions on Japanese bone architecture. Here we show that denosumab continuously improves several geometrical parameters calculated by hip structural analysis for 3 years. Compared to placebo, denosumab significantly increased bone mineral density, cortical thickness and cross sectional area in all of the three analyzed areas: the narrow neck, intertrochanter and femoral shaft. The subsequent derived mechanical parameters, cross-sectional moment of inertia, section modulus and buckling ratio, were also improved by denosumab. In addition, the improvement of these parameters was also observed in the patients that had switched from placebo to denosumab treatment. The present study suggests the structural evidence explaining the strong anti-fracture efficacy of denosumab and its significant effects on cortical bone in Japanese.
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Key Words
- BMD, bone mineral density
- BR, buckling ratio
- Bone quality
- CSA, cross sectional area
- CSMI, cross sectional moment of inertia
- CoTh, cortical thickness
- DIRECT, Denosumab fracture Intervention Randomized placebo Controlled Trial
- DMAb/DMAb, denosumab/denosumab
- DXA, dual-energy X-ray absorptiometry
- Denosumab
- ED, endocortical diameter
- FREEDOM, Fracture Reduction Evaluation of Denosumab in Osteoporosis every 6 Months
- HSA, hip structural analysis
- Hip structural analysis
- Japanese
- OD, outer diameter
- Osteoporosis
- PBO/DMAb, placebo/denosumab
- RANK ligand
- RANK, receptor activator of nuclear factor kappa-B
- SM, section modulus
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Affiliation(s)
- Teruki Sone
- Department of Nuclear Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan
| | - Naohiro Kon
- Medical Science Department, Daiichi Sankyo Co. Ltd., Tokyo, Japan
| | - Kenneth W. Gaither
- Bioclinica, Inc., 11731 Northeast Glenn Widing Drive Portland, Oregon 97220, United States
| | - Naoki Okubo
- Biostatistics and Data Management Department, Daiichi Sankyo Co. Ltd., Tokyo, Japan
| | - Taisuke Osakabe
- Clinical Development Department, Daiichi Sankyo Co. Ltd., Tokyo, Japan
| | - Yutaka Nakayama
- Post-Marketing Regulatory Affairs Department, Daiichi Sankyo Co. Ltd., Tokyo, Japan
| | - Masao Fukunaga
- Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan
| | - Masako Ito
- Center for Diversity and Inclusion, Nagasaki University, 1-14 Bunkyo-machi, Nagasaki 852-8521, Japan
| | - Toshitaka Nakamura
- Touto Sangenjaya Rehabilitation Hospital, 1-24-3 Sangenjaya, Setagaya-ku, Tokyo 154-0024, Japan
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Baker AM, Wagner DW, Kiratli BJ, Beaupre GS. Pixel-Based DXA-Derived Structural Properties Strongly Correlate with pQCT Measures at the One-Third Distal Femur Site. Ann Biomed Eng 2017; 45:1247-1254. [PMID: 28105580 DOI: 10.1007/s10439-017-1796-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 01/11/2017] [Indexed: 11/26/2022]
Abstract
While bone mineral density has been traditionally used to quantify fracture risk for individuals with spinal cord injuries, recent studies are including engineering measurements such as section modulus and cross sectional moment of inertia. These are almost exclusively calculated by peripheral QCT scanners which, unlike DXA scanners, are rarely found in clinical settings. Using fifty-four fresh frozen femora, we developed and validated a pixel-by-pixel method to calculate engineering properties at the distal femur using a Hologic QDR-1000 W DXA scanner and compared them against similar parameters measured using a Stratec XCT-3000 peripheral QCT scanner. We found excellent agreement between standard DXA and pixel-by-pixel measured BMD (r 2 = 0.996). Cross-sectional moment of inertia about the anteroposterior axis measured using DXA and pQCT correlated very strongly (r 2 = 0.99). Cross-sectional moment of inertia about the anteroposterior axis measured using DXA also correlated strongly with pQCT measured bone strength index (r 2 = 0.99). These correlations indicate that DXA scans can measure equivalent pQCT parameters, and some existing DXA scans can be reprocessed with pixel-by-pixel techniques. Ultimately, these engineering parameters may help better quantify fracture-risk in fracture-prone populations such as those with spinal cord injuries.
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Affiliation(s)
- Alexander M Baker
- VA Palo Alto, Musculoskeletal Research Laboratories, Palo Alto, CA, USA.
| | - David W Wagner
- VA Palo Alto, Musculoskeletal Research Laboratories, Palo Alto, CA, USA
| | - B Jenny Kiratli
- VA Palo Alto Health Care System, Spinal Cord Injury & Disorders Center, Palo Alto, CA, USA
- Physical Medicine and Rehabilitation Division, Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA
| | - Gary S Beaupre
- VA Palo Alto, Musculoskeletal Research Laboratories, Palo Alto, CA, USA
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Effectiveness of Teriparatide on Fracture Healing: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0168691. [PMID: 27997614 PMCID: PMC5173248 DOI: 10.1371/journal.pone.0168691] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 12/05/2016] [Indexed: 01/15/2023] Open
Abstract
Purpose Nowadays, the efficacy of teriparatide in treating osteoporosis was widely accepted, but the discussion about using teriparatide to enhance fracture healing hasn’t come to an agreement. This meta-analysis was conducted to evaluate the effectiveness of teriparatide for fracture healing. Methods We searched PubMed, the Cochrane Library, and Embase in August 2016 for randomized controlled trials (RCTs) which concerned the treatment of teriparatide for fracture healing. Results Finally, a total of 380 patients were randomly assigned in the 5 trials included in this meta-analysis. There was a significant effectiveness with regards to function improvement in patients following fracture, however, there was no significant effectiveness with regards to time of radiographic fracture healing, fracture healing rate and reduction in pain. Conclusions This analysis showed that administration of teriparatide following fracture lacked the effectiveness for fracture healing. Moreover, teriparatide administration had no apparent adverse effects. These results should be interpreted with caution because of some clear limitations. If we want to confirm whether teriparatide improves fracture healing, more high-quality randomized controlled trials are needed.
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Sugie-Oya A, Takakura A, Takao-Kawabata R, Sano H, Shimazu Y, Isogai Y, Yamaguchi A, Ishizuya T. Comparison of treatment effects of teriparatide and the bisphosphonate risedronate in an aged, osteopenic, ovariectomized rat model under various clinical conditions. J Bone Miner Metab 2016; 34:303-14. [PMID: 26104116 DOI: 10.1007/s00774-015-0670-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 03/23/2015] [Indexed: 10/23/2022]
Abstract
Teriparatide and bisphosphonates are osteoporosis medications that increase bone mineral density (BMD) and prevent fracture, but each has a different mechanism of action. Teriparatide promotes bone formation, while bisphosphonates suppress bone resorption. In the clinical setting, however, drug selection is not always tailored to the particular clinical condition of the patient or mechanism of action of the drug. We compared the effects of teriparatide and the bisphosphonate risedronate on bone metabolism using two ovariectomized rat models to elucidate the optimal use of these two drugs in the clinical setting. We first performed dose-finding experiments to determine the equivalent effective doses of each drug (5.6 and 3.0 µg/kg for teriparatide and risedronate, respectively). We then compared the effects of these doses on bone metabolism after subcutaneous administration three times weekly for 4 months starting either the day after ovariectomy (preventive study) or 12 months after ovariectomy (therapeutic study). The increase in proximal tibial BMD under the physical conditions that increased bone turnover at 1 to 2 months after ovariectomy was greater in the risedronate group than in the teriparatide group. In contrast, the increases in lumbar vertebral BMD and bone strength under the physical conditions that significantly decreased BMD and bone strength at 12 months after ovariectomy were greater in the teriparatide group than in the risedronate group. The present study provides important information on the selection of antiosteoporotic drugs, including teriparatide and risedronate, in treatment protocols tailored to the clinical conditions of patients and drug mechanisms.
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Affiliation(s)
- Ayano Sugie-Oya
- Pharmaceuticals Research Center, Asahi Kasei Pharma Corporation, 632-1 Mifuku, Izunokuni, Shizuoka, 410-2321, Japan.
| | - Aya Takakura
- Pharmaceuticals Research Center, Asahi Kasei Pharma Corporation, 632-1 Mifuku, Izunokuni, Shizuoka, 410-2321, Japan
| | - Ryoko Takao-Kawabata
- Pharmaceuticals Research Center, Asahi Kasei Pharma Corporation, 632-1 Mifuku, Izunokuni, Shizuoka, 410-2321, Japan
| | - Hiroko Sano
- Pharmaceuticals Research Center, Asahi Kasei Pharma Corporation, 632-1 Mifuku, Izunokuni, Shizuoka, 410-2321, Japan
| | - Yukari Shimazu
- Pharmaceuticals Research Center, Asahi Kasei Pharma Corporation, 632-1 Mifuku, Izunokuni, Shizuoka, 410-2321, Japan
| | - Yukihiro Isogai
- Pharmaceuticals Research Center, Asahi Kasei Pharma Corporation, 632-1 Mifuku, Izunokuni, Shizuoka, 410-2321, Japan
| | - Akira Yamaguchi
- Department of Oral Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshinori Ishizuya
- Pharmaceuticals Research Center, Asahi Kasei Pharma Corporation, 632-1 Mifuku, Izunokuni, Shizuoka, 410-2321, Japan
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Yang Y, Luo X, Xie X, Yan F, Chen G, Zhao W, Jiang Z, Fang C, Shen J. Influences of teriparatide administration on marrow fat content in postmenopausal osteopenic women using MR spectroscopy. Climacteric 2016; 19:285-91. [PMID: 26744910 DOI: 10.3109/13697137.2015.1126576] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective Teriparatide could induce osteoblast differentiation of mesenchymal stem cells while inhibiting adipocyte differentiation. However, there are significant differences between ex vivo and in vivo models. We aimed to evaluate the impact of teriparatide on marrow and abdominal fat accumulation in postmenopausal osteopenic women. Methods Postmenopausal osteopenic women were randomly assigned to receive teriparatide or placebo for 12 months. Subcutaneous (SAT) and visceral adipose tissue (VAT), marrow fat fraction (MFF), bone density (BMD) and bone biomarkers were measured at baseline, 6 and 12 months. Results At 12 months, mean percentage changes in BMD from baseline were 3.51%, 2.21% and 1.80% at lumbar spine, total hip and femoral neck for the teriparatide group, respectively. Relative to baseline conditions, teriparatide reduced MFF (-3.54% at 6 months; -5.87% at 12 months, all p < 0.01). A significant difference in MFF, but not BMD, was first detected at 6 months (p = 0.012) between groups. MFF was negatively associated with SAT (r = -0.479) and positively associated with VAT (r = 0.531) and VAT/SAT (r = 0.415, all p < 0.05). Teriparatide treatment did not alter abdominal fat composition. Conclusion Teriparatide effectively lowers marrow adiposity but not abdominal fat accumulation in postmenopausal osteopenic women.
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Affiliation(s)
- Y Yang
- a Department of Radiology , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China ;,b Department of Radiology , The Second Affiliated Hospital of Soochow University , Suzhou , China
| | - X Luo
- a Department of Radiology , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China ;,c Department of Radiology , Northern Jiangsu People's Hospital and Clinical Medical College of Yangzhou University , Yangzhou , China
| | - X Xie
- d Department of Radiology , First People's Hospital Affiliated to Shanghai Jiaotong University , Shanghai , China
| | - F Yan
- a Department of Radiology , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - G Chen
- b Department of Radiology , The Second Affiliated Hospital of Soochow University , Suzhou , China
| | - W Zhao
- b Department of Radiology , The Second Affiliated Hospital of Soochow University , Suzhou , China
| | - Z Jiang
- b Department of Radiology , The Second Affiliated Hospital of Soochow University , Suzhou , China
| | - C Fang
- e Department of Endocrinology , The Second Affiliated Hospital of Soochow University , Suzhou , China
| | - J Shen
- b Department of Radiology , The Second Affiliated Hospital of Soochow University , Suzhou , China
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Geusens P. New insights into treatment of osteoporosis in postmenopausal women. RMD Open 2015; 1:e000051. [PMID: 26557374 PMCID: PMC4632141 DOI: 10.1136/rmdopen-2015-000051] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 04/22/2015] [Accepted: 04/24/2015] [Indexed: 01/05/2023] Open
Abstract
For the prevention of fractures, antiresorptive drugs (bisphosphonates and denosumab) that decrease high bone resorption and, secondarily, also bone formation, are the mainstream of therapy. Osteoanabolic drugs, such as teriparatide, increase bone formation more than bone resorption, and are used in severe osteoporosis, including patients treated with antiresorptive drugs who still lose bone and have recurrent fractures. New potential drugs for fracture prevention that uncouple bone resorption from bone formation include odanacatib, a specific inhibitor of cathepsin-K, the enzyme that degrades bone collagen type I, that inhibits bone resorption and only temporarily bone formation, and monoclonal antibodies against sclerostin (romosozumab, blosozumab), that stimulate bone formation and decrease bone resorption.
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Affiliation(s)
- Piet Geusens
- Department of Internal Medicine, Division of Rheumatology , CAPHRI School for Public Health and Primary Care, Maastricht University Medical Center , Maastricht , The Netherlands ; Hasselt University, Biomedical Research Institute, and Transnationale Universiteit Limburg , Hasselt , Belgium
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Broy SB, Cauley JA, Lewiecki ME, Schousboe JT, Shepherd JA, Leslie WD. Fracture Risk Prediction by Non-BMD DXA Measures: the 2015 ISCD Official Positions Part 1: Hip Geometry. J Clin Densitom 2015; 18:287-308. [PMID: 26277848 DOI: 10.1016/j.jocd.2015.06.005] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 06/22/2015] [Indexed: 01/19/2023]
Abstract
Bone mineral density (BMD) measured by dual-energy X-ray absorptiometry is the current imaging procedure of choice to assess fracture risk. However, BMD is only one of the factors that explain bone strength or resistance to fracture. Other factors include bone microarchitecture and macroarchitecture. We now have the ability to assess some of these non-BMD parameters from a dual-energy X-ray absorptiometry image. Available measurements include various measurements of hip geometry including hip structural analysis, hip axis length, and neck-shaft angle. At the 2015 Position Development Conference, the International Society of Clinical Densitometry established official positions for the clinical utility of measurements of hip geometry. We present the official positions approved by an expert panel after careful review of the recommendations and evidence prepared by an independent task force. Each question addressed by the task force is presented followed by the official position with the associated medical evidence and rationale.
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Affiliation(s)
- Susan B Broy
- Department of Medicine, Rosalind Franklin School of Medicine, Chicago Medical School, North Chicago, IL, USA.
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael E Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - John T Schousboe
- Park Nicollet Clinic, HealthPartners, Division of Health Policy and Management, University of Minnesota, USA
| | - John A Shepherd
- Department of Radiology and Biomedical Imaging, UCSF School of Medicine, San Francisco, CA, USA
| | - William D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, Canada; Department of Radiology, University of Manitoba, Winnipeg, Canada
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