- N Engl J Med 2022; 387:368-370
An estimated one third or more of U.S. adults 60 years of age or older take vitamin D supplements, not including those who take multivitamins or other compounds containing vitamin D.1 Yet controversy continues about its overall benefits. In this issue of the Journal, LeBoff and...
- N Engl J Med 2022; 387:299-309
A study ancillary to a large trial showed that supplemental vitamin D3 did not lower the risk of fractures among generally healthy midlife and older adults not selected for vitamin D deficiency, low bone mass, or osteoporosis.
- N Engl J Med 2022; 386:1467-1469
This interactive feature about the use of bisphosphonates to treat osteoporosis offers a case vignette accompanied by two essays, one supporting continuation of bisphosphonate therapy beyond 5 years and the other supporting a “drug holiday.”
- N Engl J Med 2022; 386:594-595
A majority of persons in whom a femoral neck fracture occurs have physical impairment, cognitive impairment, or both. For these patients, a hemiarthroplasty is considered to be the most suitable treatment; bone cement may or may not be used for fixation of the prosthesis. Using an uncemented stem reduces both...
- N Engl J Med 2022; 386:521-530
In this multicenter, randomized trial comparing cemented with modern uncemented hemiarthroplasty in persons 60 years of age or older with an intracapsular hip fracture, cemented hemiarthroplasty resulted in a modestly but significantly better quality of life and a lower risk of periprosthetic fracture than uncemented hemiarthroplasty.
- N Engl J Med 2022; 386:302-303
After her grandmother attempts suicide, a physician finds that the medical team’s avoidance of honest conversation about her grandmother’s reality and desires creates a chasm between the clinicians and the family that is counterproductive and painful.
- N Engl J Med 2020; 383:743-753
In this study involving women 50 years of age or older who were receiving bisphosphonates, the risk of atypical femur fracture was very low as compared with the number of hip and other fractures that were prevented. Risk of atypical fractures increased with longer duration of bisphosphonate use and rapidly...
- N Engl J Med 2018; 379:2407-2416
In this randomized trial, women 65 years of age or older who had osteopenia received four infusions of zoledronate or normal saline at 18-month intervals. Zoledronate was associated with a significantly lower risk of fragility fractures than placebo.
- N Engl J Med 2018; 379:2465-2466
Low bone mineral density (i.e., a T score below −2.5) is the current operational definition of osteoporosis. However, low bone mineral density is actually a risk factor for fracture, not a disease marker. Notwithstanding, nearly all osteoporosis treatment algorithms are based on bone mineral density, frequently combined with the clinical...
- N Engl J Med 2017; 377:2053-2062
Hip fracture, categorized according to location as femoral-neck, intertrochanteric, or subtrochanteric, is treated in most patients with prompt surgery. The specific approach is determined according to fracture location and other patient and fracture characteristics.
- N Engl J Med 2017; 377:1417-1427
Among postmenopausal women with osteoporosis and a high risk of fracture, treatment with the monoclonal antibody romosozumab for 12 months followed by alendronate resulted in a significantly lower risk of fracture than alendronate for 12 months followed by alendronate.
- N Engl J Med 2017; 377:1479-1480
Over the past decade, the osteoporosis landscape has changed. Even though more treatment options are available, fewer measurements of bone mass are being performed and fewer prescriptions for antiosteoporosis agents are being written — the last probably related to concerns about known side effects of bisphosphonates, such as atypical femoral...
- N Engl J Med 2016; 375:1583-1584
There is currently a major crisis in osteoporosis therapy.1 Despite effective treatments to prevent fractures, too few patients receive therapy. Furthermore, those who do get treated often stop taking medication prematurely. To understand this paradox and the potential importance of the article by Cosman et al. now published...
- N Engl J Med 2016; 375:1532-1543
Romosozumab binds sclerostin, increases bone formation, and decreases bone resorption. Postmenopausal women with osteoporosis were assigned to romosozumab or placebo for 1 year, followed by 1 year of denosumab. Romosozumab was associated with lower vertebral and clinical fracture risk.
- N Engl J Med 2016; 374:254-262
Management of postmenopausal osteoporosis includes nonpharmacologic treatment (e.g., weightbearing exercise and fall-prevention strategies) and pharmacologic treatment. Bisphosphonates are considered first-line treatment in most women; benefits and rare potential risks are discussed.
- N Engl J Med 2014; 371:974-976
This letter indicates that there is long-lasting skeletal accumulation of bisphosphonate, and ongoing use appears to be the dominant risk factor for rare fractures.
- N Engl J Med 2014; 370:412-420
This study shows that in postmenopausal women with low bone mineral density, the monoclonal antibody romosozumab, which binds to sclerostin, an osteoblast-activity inhibitor, was associated with increased bone mineral density and bone formation and decreased bone resorption.
- N Engl J Med 2014; 370:476-477
Effective new therapies are still needed for people with osteoporosis. In 2002, the introduction of teriparatide, or recombinant parathyroid hormone (PTH [1-34]), opened a promising chapter in osteoporosis care.1 For the first time, there was an anabolic agent that significantly increased bone mineral density (BMD), reduced fracture risk,...
- N Engl J Med 2012; 367:1714-1723
This multicenter trial evaluated zoledronic acid versus placebo in men with osteoporosis for a primary end point of new morphometric vertebral fracture over 24 months. Zoledronic acid was associated with a significantly reduced risk of vertebral fracture.
- N Engl J Med 2012; 366:2048-2051
In response to reports of rare but serious adverse events associated with bisphosphonates, the FDA reviewed long-term bisphosphonate efficacy. Two FDA committees recommended an update to bisphosphonate labeling but no regulatory restriction on duration of use.