Registration for a live webinar on 'Innovative Vaccines and Viral Pathogenesis: Insights from Recent Monkeypox Research' is now open.
See webinar detailsWe noted you are experiencing viewing problems
-
Check with your IT department that JWPlatform, JWPlayer and Amazon AWS & CloudFront are not being blocked by your network. The relevant domains are *.jwplatform.com, *.jwpsrv.com, *.jwpcdn.com, jwpltx.com, jwpsrv.a.ssl.fastly.net, *.amazonaws.com and *.cloudfront.net. The relevant ports are 80 and 443.
-
Check the following talk links to see which ones work correctly:
Auto Mode
HTTP Progressive Download Send us your results from the above test links at access@hstalks.com and we will contact you with further advice on troubleshooting your viewing problems. -
No luck yet? More tips for troubleshooting viewing issues
-
Contact HST Support access@hstalks.com
-
Please review our troubleshooting guide for tips and advice on resolving your viewing problems.
-
For additional help, please don't hesitate to contact HST support access@hstalks.com
We hope you have enjoyed this limited-length demo
This is a limited length demo talk; you may
login or
review methods of
obtaining more access.
- Cancer and Oncology
-
3. Latest advances in the development of CAR & TCR T-cell treatments for solid tumours
- Dr. Else Marit Inderberg
-
4. Mode of action of T cells engineered with CAR or TCR for cancer treatment
- Prof. Sebastian Kobold
-
5. Immunotherapy: insights from advanced disease
- Dr. Sara M. Tolaney
-
6. Recent advances in the field of non-coding RNAs in cancer
- Prof. George Calin
- Dr. Maitri Shah
-
7. How tumor-microenvironment interactions drive or inhibit metastasis
- Prof. Isaac P. Witz
-
8. A novel cancer therapy to stimulate oncogenic ERK signalling
- Prof. Reiko Sugiura
-
9. MRD-driven multiple myeloma treatment: next step forward
- Prof. Ola Landgren
-
11. Germinal centre lymphomas: advances in diagnostic and therapeutic intervention
- Dr. Koorosh Korfi
- Prof. Jude Fitzgibbon
-
12. Immunotherapy in lung cancer
- Dr. Mark M. Awad
-
13. Preservation of fertility in cancer patients: the impact of chemotherapy
- Prof. Kutluk H. Oktay
-
15. Solution proposed to a 2000 year old problem in oncology
- Dr. Michael Retsky
- Clinical Practice
-
16. Stillbirth: diagnosis, investigation and aftercare
- Prof. Alexander E. P. Heazell
-
17. Analyzing the medical relevance of skin care trends
- Prof. Zoe Draelos
-
18. Genetic counseling: preconception, prenatal, perinatal
- Prof. Aubrey Milunsky
-
19. The past, present & future of ANA testing: history and challenges of ANA
- Prof. Marvin J. Fritzler
-
20. The past, present & future of ANA testing: changing bandwidth and future of ANA
- Prof. Marvin J. Fritzler
-
22. Mitochondrial diseases: an update
- Dr. Ayesha Saleem
-
23. Hemophilia A
- Dr. Snejana Krassova
-
26. Recent advances in diagnosis and interventions in ophthalmology
- Dr. Rebecca Kaye
- Prof. Andrew Lotery
- Gastroenterology
-
27. Building implantable human liver tissue from pluripotent stem cells
- Prof. David C. Hay
-
28. Microbiome therapies to treat gastrointestinal diseases
- Dr. Patricia Bloom
-
29. Drug-induced liver injury: importance, epidemiology, and mechanisms of DILI
- Prof. James H. Lewis
-
30. Drug-induced liver injury: risk factors and drug development in DILI
- Prof. James H. Lewis
-
31. Drug-induced liver injury: HDS, diagnosing, treating and preventing DILI
- Prof. James H. Lewis
-
32. An update on the multiple faces of celiac disease
- Prof. Aaron Lerner
- Immunology
-
33. Drug allergy: new knowledge
- Prof. Mariana C. Castells
-
34. Biologics as a treatment strategy in food allergy
- Prof. Sayantani B. Sindher
-
35. B cells at the crossroads of autoimmune diseases
- Dr. Xiang Lin
-
36. Studying immune responses “one cell at a time”
- Dr. Mir-Farzin Mashreghi
-
37. Mathematical modeling in immunology
- Prof. Ruy M. Ribeiro
-
38. Therapeutic antibody development
- Prof. Dr. Katja Hanack
-
39. Understanding treatment coverage in mass drug administrations
- Dr. Margaret Baker
-
40. The thymus and T cell development: a primer
- Prof. Georg Holländer
- Infectious Diseases
-
42. The Global Virus Network: collaboration to address pandemic and regional threats
- Prof. Sten H. Vermund
-
43. New concepts in the management of CAP: a focus on severe illness - treatment and therapies
- Prof. Michael S. Niederman
-
44. New concepts in the management of CAP: a focus on severe illness - MRSA and MDR pathogens
- Prof. Michael S. Niederman
-
45. CRISPR-based suppression drives for vector control
- Prof. Andrea Crisanti
-
46. HIV cure: harnessing innate and adaptive strategies
- Prof. Luis Montaner
- Cardiovascular, Metabolism & Nutrition
-
47. Cow’s milk allergy: the future
- Dr. Carina Venter
-
48. Cow's milk allergy: management
- Dr. Carina Venter
-
49. Moving from GWAS hits to functional variants
- Prof. Steve Humphries
-
50. X-linked hypophosphataemia: genetics, diagnosis and management
- Prof. Thomas O. Carpenter
-
51. What is new in type 1 diabetes?
- Prof. Åke Lernmark
-
52. Current concepts for the management of patients with osteoporosis
- Dr. Michael Lewiecki
-
53. Antibodies to control or prevent type 1 diabetes
- Dr. Robert Hilbrands
-
54. Peptide YY (PYY) in obesity and diabetes
- Dr. Nigel Irwin
- Microbiology
-
55. Vaccines and the fight against antimicrobial resistance 1
- Dr. Annaliesa S. Anderson
-
56. Vaccines and the fight against antimicrobial resistance 2
- Dr. Annaliesa S. Anderson
-
57. Vaccines as a weapon against antibiotic resistance
- Dr. Pumtiwitt McCarthy
-
58. PathoLive: pathogen detection while sequencing
- Dr. Simon Tausch
-
60. Successes and failures with vaccines
- Prof. Stanley Plotkin
-
61. Immunology, the microbiome and future perspectives
- Prof. Sheena Cruickshank
-
62. Impact of the HPV vaccine programme – a changing landscape
- Dr. Kevin Pollock
- Neurology and Neuroscience
-
63. Advances in the diagnosis and treatment of tardive dyskinesia
- Prof. Emeritus Stanley N. Caroff
-
64. Cellular therapies for neurological Injuries: bioreactors, potency, and coagulation
- Prof. Charles S. Cox, Jr.
-
65. Cardiovascular involvement in Parkinson’s disease
- Dr. David S. Goldstein
-
66. Molecular brain imaging (PET) in diseases with dementia
- Prof. Karl Herholz
-
67. Current thinking in pain medicine and some thoughts on back pain
- Dr. Nick Hacking
-
68. Bioelectronic medicine: immunomodulation by vagus nerve stimulation
- Prof. Paul Peter Tak
-
69. Developments & future directions in the management of chronic pain
- Prof. Simon Haroutounian
-
70. Deep Brain Stimulation (DBS) neuromodulation for Schizophrenia
- Prof. Judith Gault
-
71. Parkinson’s at 200 years: an update on Parkinson’s research in 2017
- Prof. Patrick A. Lewis
-
72. Alzheimer's disease: where are we up to?
- Prof. John Hardy
- Pharmaceutical Sciences
-
73. Pharmacokinetics, -dynamics and dosing considerations in children
- Prof. Dr. Karel Allegaert
-
74. Why in vitro permeation test – and not in vivo?
- Prof. Howard Maibach
-
75. The future of plasma-derived medicinal products (PDMP)
- Dr. Daniele Focosi
-
76. RNA therapeutics: clinical applications and methods of delivery
- Prof. John P. Cooke
-
77. Recent advances in the development of gene delivery technologies
- Dr. Takis Athanasopoulos
-
78. Preclinical translation of mesenchymal stem cell therapies
- Dr. Peter Childs
-
79. Modulating gene expression to treat diseases
- Dr. Navneet Matharu
-
80. Accelerating drug discovery with machine learning and AI
- Dr. Olexandr Isayev
-
81. AI and big data in drug discovery
- Mr. Ed Addison
-
82. Emerging big data in medicinal chemistry: promiscuity analysis as an example
- Prof. Dr. Jürgen Bajorath
- Dr. Ye Hu
-
83. Binding kinetics in drug discovery
- Dr. Rumin Zhang
-
84. Modeling of antibody-drug conjugate pharmacokinetics
- Dr. Dhaval K. Shah
-
85. Antibody engineering: beginnings to bispecifics and beyond
- Dr. Ian Wilkinson
-
86. Current challenges in the design of antibody-drug conjugates
- Prof. L. Nathan Tumey
-
87. Inorganic nanostructured interfaces for therapeutic delivery
- Prof. Tejal Desai
-
88. Latest development in therapy-related autophagy research
- Dr. Vignir Helgason
- Respiratory Diseases
-
89. Respiratory syncytial virus vaccination
- Prof. Peter Openshaw
-
90. Advances in gene therapy for respiratory diseases 1
- Prof. John F. Engelhardt
-
91. Advances in gene therapy for respiratory diseases 2
- Prof. John F. Engelhardt
-
92. Asthma
- Prof. William Busse
- Dr. Amanda McIntyre
-
93. New drugs for asthma
- Prof. Peter Barnes
-
94. CompEx asthma: a novel composite exacerbation endpoint
- Dr. Carla A. Da Silva
-
95. Updates in chronic obstructive pulmonary disease (COPD)
- Dr. Omar S. Usmani
Printable Handouts
Navigable Slide Index
- Introduction
- Disclosure
- Objectives
- A brief history of osteoporosis
- Osteoporosis care
- Treatment gap getting worse
- Bisphosphonate prescription rates
- US fracture trends 2007-2017
- Concepts
- AACE guidelines 2020
- High- and low- trauma fractures
- Diagnosis of osteoporosis persists
- DXA quality matters
- Tools for fracture risk assessment
- FRAX
- Vertebral fracture assessment by DXA
- Trabecular bone score
- Imminent fracture risk
- Relative risk of second hip freacture after first hip fracture
- Take home message: fracture = 'bone attack'
- NOF treatment guidelines
- Pharmacological therapy
- Risk stratification and implications
- Anabolic therapy use in very high risk patients
- Head-to-head RCTs of anabolic vs. antiresporptive
- TPT superior to RIS for severe PMO
- Sequence of therapy matters
- BMD decrease with anabolic after antiresorptive
- BMD decreases with TPT after Dmab (but not with Romo after Dmab)
- BMD gains with antiresorptive after anabolic
- Dual-effect' of Romo on bone remodeling
- BMD gains with ALN after ABL
- Sequence of osteoporosis therapy
- Treat-to-target
- Goal-directed therapy
- FNIH meta-regression analyses
- Higher TH T-score with Dmab treatment
- Operationalizing TTT in clinical practice
- Monitoring TTT in clinical practice
- Take home messages
- Technology-enabled collaborative learning
- Bone health TeleECHO
- Summary
Topics Covered
- History of osteoporosis care
- Assessment of fracture risk
- Imminent fracture risk
- Individualized treatment
- Sequence of therapy
- Treat-to-target
- Technology-enabled collaborative learning
Links
Series:
- Bone in Health and Disease
- Periodic Reports: Advances in Clinical Interventions and Research Platforms
- Small Molecule Drug Discovery
Categories:
Therapeutic Areas:
External Links
Talk Citation
Lewiecki, M. (2022, March 30). Current concepts for the management of patients with osteoporosis [Video file]. In The Biomedical & Life Sciences Collection, Henry Stewart Talks. Retrieved October 31, 2024, from https://doi.org/10.69645/BCFQ1770.Export Citation (RIS)
Publication History
Financial Disclosures
- Dr. Michael Lewiecki acts as a consultant for Amgen, Merck, Lilly, Radius, Shire and Alexion. He also sits on the speaker's bureau for Shire and receives grants/research support as a Principal Investigator from Amgen, Merck and Lilly.
A selection of talks on Metabolism & Nutrition
Transcript
Please wait while the transcript is being prepared...
0:00
I'm Mike Lewiecki,
Director of New Mexico Clinical
Research and Osteoporosis Center,
and Director of Bone
Health TeleECHO
at the University of New
Mexico Health Sciences Center.
Today I'm going to
talk to you about
current concepts for the management
of patients with osteoporosis.
0:24
Here is my disclosure.
0:28
The objectives of this
presentation are to
characterize the origins of the
osteoporosis treatment gap,
describe important clinical advances
in the management of osteoporosis,
and identify new and emerging concepts in
the care of patients with osteoporosis.
0:49
I'd like to begin by giving you a highly subjective
and brief history of osteoporosis that goes over
how we got to where
we are today.
1:03
Here is a graph where the x-axis
represents going from then to now,
and the y-axis is
from worse to better.
This is how I think we've been doing
with the care of osteoporosis.
We've made great strides
and great progress,
but we currently have
many challenges.
I'd like to begin the
time frame in 1987,
which was when DXA was
first introduced for
clinical applications to measure
bone density in patients.
Following that, in 1994,
the WHO diagnostic
criteria were developed,
allowing us to diagnose osteoporosis in patients,
for the first time, before a fracture occurred.
This was followed a year later
by approval of alendronate,
for the treatment of
postmenopausal osteoporosis.
This was followed in
turn by mass marketing,
which allowed patients and health care
professionals to become more aware of osteoporosis,
and the potential for treatments
to reduce the risk of fractures.
In the United States,
we had the Bone Mass
Measurement Act
that allowed Medicare
to cover the cost of
bone density testing under
certain clinical situations.
This was followed by increasing
the availability of DXA.
We then had the U.S.
Surgeon General's report,
which emphasized that osteoporosis
was a major public health concern,
and challenged all of us to do a better job
of caring for patients with osteoporosis.
More drugs were approved.
We had more marketing
of these drugs,
and more marketing of
osteoporosis as a disease state.
This was followed by the development
of many clinical practice guidelines
which provided a
framework for physicians
to know how to manage
patients with osteoporosis.
FRAX was released,
which allowed us, for the first
time, to get a fully validated,
quantitative assessment of
absolute fracture risk.
The beginning of the downhill
slide on osteoporosis care,
I think followed the release of the
first Women's Health Initiative report.
It emphasized the
imbalance of benefits
and the risks of using
estrogen therapy.
I think it perhaps created
a little bit of mistrust
by women of institutions and
health care professionals,
who are now saying something different about
estrogen treatments than what they had heard before.
In the US, we subsequently
had, what I would call,
draconian reimbursement
cuts in DXA by Medicare,
to levels that were not
fully sustainable and
actually were less than the cost of
providing the procedure in many cases.
Reports started to come out about the risk of
osteonecrosis of the jaw with osteoporosis therapy.
Atypical femur fractures
were reported as well
with long term
bisphosphonate therapies.
Media reports often highlighted rare
possible side effects of medications,
and did not always explain the
balance of benefits and risks.
Fear of side effects
became rampant,
and many patients were
reluctant to start treatment
or continue treatment
because of this fear.
The concept of drug holidays came about
to help to address these concerns,
but often the idea of a drug holiday was
misunderstood and sometimes misused.
There were controversies
concerning calcium,
and whether that had adverse effects in
patients taking calcium supplements.
There were controversies
about vitamin D,
what appropriate replacement is
and what the ideal blood level is.
The bureaucracy of health care has become
quite daunting in many situations,
making it another challenge to
cure patients with osteoporosis.
Limited time for health care
encounters is a common issue.
Competing priorities,
especially for primary care physicians who
are taking care of many patient concerns,
sometimes osteoporosis is
not at the top of the list.
There are many competing guidelines
now that aren't always concordant,
which creates some confusion sometimes on
how to manage patients with osteoporosis.
Risk communication is a skill that can be
acquired with some dedication to learning,
but sometimes we don't always do
as effective a job as we'd like.
Ultimately, this has become a
crisis in the care of osteoporosis.
This is where we are today.
There is a large treatment gap in the
care of patients with osteoporosis,