Bone Health

Medication-related osteonecrosis of the jaw (MRONJ) is a rare complication of antiresorptive treatments for osteoporosis. It is characterized as an area of exposed necrotic jawbone that persists >8 weeks in someone with bisphosphonate or denosumab exposure.20 Less than 0.1% of patients with osteoporosis using a bisphosphonate or denosumab develop MRONJ.20 A similar condition has been observed in patients receiving anticancer drugs, glucocorticoids, methotrexate, adalimumab, etanercept, or rituximab.21 The cause of MRONJ is unclear, but may relate to the osteoclastic effects of antiresorptive agents and the antiangiogenic or immunosuppressive effects of other drugs.22 MRONJ in patients with osteoporosis is usually preceded by invasive dental procedures, and antibiotic prophylaxis can reduce risk.20 Periodontal disease, oral infection or trauma, and longer osteoporosis treatment also increase risk.1,20 Limited data suggest patients with RA have a greater risk for MRONJ, possibly because of RA's skeletal effects.1,22 Severe MRONJ may require surgery, whereas early disease is managed conservatively.20

Jaw Osteonecrosis Linked to Treatment for Bone Metastases

January 15, 2021

The cumulative three-year incidence of osteonecrosis of the jaw is 2.8% in cancer patients receiving zoledronic acid for metastatic bone disease.

Osteoporosis

Corticosteroid Exposure Affects Bone Health in Patients With Asthma

October 27, 2020

For patients with asthma, oral corticosteroid and inhaled corticosteroid use is associated with an increased risk for osteoporosis and fragility fractures

$In patients with HIV, the disease process and ART may contribute to bone loss, resulting in osteopenia or osteoporosis and increased fracture risk.3,10 Proinflammatory cytokines and viral load contribute directly to reduced bone mineral density through their effects on osteoclast and osteoblast activity, inhibiting new bone formation and accelerating bone loss.3 Other risk factors for bone loss or fracture in the HIV population include low body mass index, smoking, substance abuse, glucocorticoid therapy, hypogonadism, coinfection with hepatitis B virus or hepatitis C virus, and vitamin D deficiency (affects ~90% of patients).3,11 Bone loss caused by ART emerges within 1 to 2 years after starting therapy.3,11 Tenofovir-based regimens are associated with higher rates of bone loss.3,11 Guidelines suggest avoiding tenofovir disoproxil fumarate or PI-boosting regimens in patients at high risk.3 Bisphosphonates (eg, alendronate or zoledronate) are recommended for those with HIV who have osteoporosis.3$

General Rheumatology

Obstructive Sleep Apnea Tied to Worse Bone Health

September 23, 2020

History of obstructive sleep apnea (OSA) is independently associated with a higher risk for confirmed vertebral fracture.

ASBMR 2020

Type 2 Diabetes Has Detrimental Effects on Trabecular Bone Quality in Osteoporosis

Amit Akirov, MD

September 11, 2020

Researchers evaluated and compared trabecular bone quality in patients with osteoporosis with and without type 2 diabetes.

Osteoporosis

Teriparatide for Severe Osteoporosis Stabilizes Bone Health in Patients With Duchenne Muscular Dystrophy

Morgan E. Meissner

August 6, 2020

Researchers evaluated the safety and efficacy of teriparatide for the treatment of severe osteoporosis in patients with Duchenne muscular dystrophy.

Osteoporosis

Exposures During Gestation and Infancy May Affect Young Adult Bone Health

July 20, 2020

Factors during gestation and infancy may impact bone health in young adulthood.

Osteoporosis

Evaluating Bone Microarchitecture and Strength in Women With HIV

Amit Akirov, MD

July 16, 2020

Bone microarchitecture and strength are reduced in women living with HIV, and tenofovir treatment may contribute to bone deficits.

Osteoporosis

Increased Risk for Fracture Among Patients With Neuromyelitis Optica

Amit Akirov, MD

May 28, 2020

Given the limited data is available on bone health of patients with NMOSD-AQP4, researchers aimed to investigate their risk for fracture and bone loss.

Osteoporosis