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The fracture risk assessment tool, FRAX ®, was released in 2008. It provides country-specific tools for estimating personalized 10-year probability of hip and major osteoporotic fracture (hip, clinical spine, distal forearm, and proximal humerus). Several adjustments have been developed that extend the range of risk factors considered by FRAX, now available through FRAXplus (www.FRAXplus.org). Meanwhile, there is ongoing research that will inform the next iteration of the FRAX tool.

OBJECTIVES

1. Summarize the development of the FRAX tool, including its strength and limitations.
2. Understand adjustments to FRAX that permit incorporation of additional risk factor information.
3. Explain the clinical impact and application of FRAXplus and, eventually, FRAX-2 on clinical decision-making.

William D. Leslie, MD MSc FRCPC CCD, Professor of Medicine and Radiology

A 25-minute session on hypoparathyroidism. Then, a review of recent ACR 2022 GIOP guidelines.

OBJECTIVES

Hypoparathyroidism:

1. Review new understanding of hypoparathyroidism.
2. Understand limitations and complications of current treatment of hypoparathyroidism.
3. Implication of recent development of new treatment options.

GIOP:

1. Understand the biology of glucocorticoid induced bone loss.
2. Review new American College of Rheumatology guidelines for GIOP.
3. Review therapies to both prevent and treat Glucocorticoid induced osteoporosis.

John P. Bilezikian, MD, PhD, Professor of Medicine, Vice Chair

Nancy E. Lane, MD, Distinguished Professor of Medicine and Rheumatology

This talk will review the clinical presentation, diagnosis and management of hypophosphatasia in a case-based format.

OBJECTIVES

1. Establish an approach to thinking about hypophosphatasia (HPP) and when you should be concerned about this disease in patients.
2. Learn the different clinical manifestations of HPP in adults.
3. Discuss diagnosis and management of HPP.

Chad Deal, MD, Rheumatologist, Head of the Center for Osteoporosis and Metabolic Bone Disease

A 25-minute talk that will discuss the role of nutrition (particularly calcium and vitamin D) and weight-bearing exercise in the treatment of osteoporosis. Then, a 25-minute session that will discuss the impact of gender affirming therapies on bone health in transgender and gender diverse people.

OBJECTIVES

Nutrition, Exercise, and Integrative Approach for Osteoporosis:

1. Understand the role of calcium and vitamin-D on bone density and fracture risk.
2. Understand the value of other minerals and vitamins in skeletal health.
3. Understand the impact of exercise in the treatment of osteoporosis.

Transgender Bone Health in 2024:

1. To discuss the impact of gender affirming hormone therapy on bone density.
2. To list common causes of low bone density among transgender and gender diverse people.
3. To update guidelines on the bone health in transgender and gender diverse people.

Daniel L. Hurley, MD, FACE, Associate Professor of Medicine

Vin Tangpricha, MD, PhD, Professor of Medicine, Eminent Physician

This talk will establish an overview of hypophosphatasia and review the clinical trial data of asfotase alfa, evaluating the efficacy and safety.

OBJECTIVES

1. Establish an overview of hypophosphatasia (HPP) and the critical impact of low ALP.
2. Detailed evaluation of the efficacy and safety of asfotase alfa in HPP patients
3. Detailed information on support and dosing

If you are planning to attend, Alexion would appreciate your RSVP to:

Tasha Bergman
tasha.bergman@alexion.com
773-750-8070

This speaker is a paid consultant of Alexion Pharmaceuticals, Inc.

The intended audience for this program is healthcare professionals (HCPs) involved in the diagnosis of hypophosphatasia. The program is sponsored by Alexion Pharmaceuticals, Inc.

ALEXION and the Alexion logo are registered trademarks of Alexion Pharmaceuticals, Inc. © 2023, Alexion Pharmaceuticals, Inc. All rights reserved. 121 Seaport Blvd, Boston, MA 02210. US/STQ-H/0458 V2 12/2023

NOTE: This session is a sponsored presentation, and attendees will not receive ACCME credit.

The information in this session is provided by Alexion Pharmaceuticals, Inc. and is not endorsed by ISCD.

A talk on the future outlook for assessing bone health.

OBJECTIVES

1. Understand role for various imaging modalities to determine bone quality.
2. To present data on its clinical utility and available evidence supporting it.

S. Bobo Tanner, MD, CCD, Director of the Vanderbilt Osteoporosis Clinic

This talk will review the spectrum of restrictive eating disorders, associated nutritional deficiencies, and their association with bone health in adolescents and young adults.

OBJECTIVES

1. To review the criteria for common restrictive eating disorders.
2. To outline associated nutritional deficiencies and their clinical manifestations.
3. To discuss the mechanisms of bone loss in these young patients and outline a general management approach.

Catherine M. Gordon, MD, MS, CCD, Clinical Director and Senior Investigator

Review basics of bone biology especially as it pertains to fracture healing. Discuss role of bone markers in treatment of bone fragility.

OBJECTIVES

1. Overview of bone formation and resorption.
2. Discuss relevance with anabolic drugs.
3. Review role of bone markers in assessing bone health.

Leila Khan, MD, Medical Co-Director

Krupa Doshi, MD, Clinical Endocrinologist

We will review the fundamentals of what defines artificial intelligence, how it is used, and what was new science this past year.

OBJECTIVES

1. Describe How deep learning differs from previous methods regarding imaging analysis.
2. Describe how large language models work and their strengths and weaknesses for generating clinically relevant text.
3. Describe what advances were made in AI for MSK in 2023 as compared to the year before.

John Shepherd PhD, CCD, Professor/Chief Scientific Officer

Describe guidelines on screening and treating low bone mass prior to spinal fusion surgery.

OBJECTIVES

1. Determine impact of preoperative pharmacotherapy on spine fusion outcomes and reducing risk for osteoporosis related complications.
2. Review current guidelines and literature on bone optimization.

Paul A. Anderson, MD, MS
Emeritus Professor of Orthopedics
University of Wisconsin

First, a 25-minute talk regarding an update on kyphoplasty recommendations and procedures. Then, a 25-minute session where we will discuss the definitions and current data on the occurrence of atypical femoral fracture and osteonecrosis of the jaw as complications of antiresorptive therapies.

OBJECTIVES

 Future Directions in Post-fracture Care: Kyphoplasty:

1. Determine current role for Kyphoplasty/Vertebroplasty in vertebral fracture.
2. Review data on Adjacent level fractures after kyphoplasty.

Complications of Atypical Femoral Fractures and Osteonecrosis of the Jaw: Regaining Patient Trust:

1. Discuss the approach to explaining the risk of atypical femoral fractures and osteonecrosis of the jaw as potential adverse effects of antiresorptive therapies.
2. Explain the current data on risk of occurrence of atypical femoral fracture and osteonecrosis of the jaw as complications of anti-resorptive therapy.
3. Develop an approach to rebuilding trust with a patient who has experienced an adverse effect of antiresorptive therapy.

Ajit Krishnaney, MD
Staff Physician
Cleveland Clinic, Center for Spine Health, Neurosurgery, and Cerebrovascular Center

Marcy Bolster, MD
Professor of Medicine / Director of the Rheumatology Fellowship Training Program
Harvard Medical School / Massachusetts General Hospital

Update on current ISCD Position guidelines 2023-2024.

OBJECTIVES

1. Review 2023 ISCD Position Statements for Screening.
2. Diagnosis of low bone mass/osteoporosis including VFA/Trabecular bone score, BMD reporting, and highlight differences from 2019 positions.

Christopher Shuhart, MD, MHA, CCD
Director of the Bone Health and Osteoporosis Center
Swedish Medical Group

Heenam Goel, MBBS
Endocrinologist, Reproductive Endocrinologist
CentraCare, St. Cloud, MN

Clinical impact and management of bariatric surgery effects on bone.

OBJECTIVES

1. Describe the variable impact of different bariatric procedures on bone metabolism.
2. Define fracture risk after bariatric surgery.
3. Review clinical recommendations for management of skeletal health after bariatric surgery.

Elaine W. Yu, MD, MMSc
Associate Professor
Harvard Medical School Endocrine Unit, Massachusetts General Hospital

As a validated index of bone microarchitecture, trabecular bone score (TBS), alongside bone mineral density and clinical risk factors, enhances the assessment and management of osteoporosis. The large body of evidence, comprising more than 1,200 peer-reviewed studies, and the adoption by healthcare facilities in over 60 countries, underpins this approach as a recognized standard of care. Not only does it refine the accuracy of fracture risk assessment, but it also has the potential to guide more personalized treatment strategies.

Join clinical experts in this virtual Product Theater Session to learn more. Participants will gain insights into the latest evidence and guidelines, understand the nuances of the Medicare reimbursement process, and explore the innovative future applications of TBS technology. The session will close with Q&A, offering an opportunity for attendees to engage directly with subject matter experts.

TBS: Guideline Updates, US Reimbursement, and Forthcoming Capabilities

Sunday, April 21, 1:00pm-2:00pm EDT

Meet the speakers

• Prof. Karen Hind, Ph.D., Honorary Fellow in the Wolfson Research Institute of Durham University, UK, and is Director of Clinical Affairs and Innovation at Medimaps Group
• Dr. Lauren Nicola, MD., Radiologist, Chief Executive Officer at Triad Radiology, NC
• Prof. Didier Hans, Ph.D., MBA., Head of Research and Development in the Bone and Joint Department at the Interdisciplinary Center of Bone Disease at Lausanne University Hospital, Switzerland and Co-founder and CEO at Medimaps Group

NOTE: This session is a sponsored presentation, and attendees will not receive ACCME credit.

The information in this session is provided by Medimaps Group and is not endorsed by ISCD.

Top papers that changed osteoporosis management.

OBJECTIVES

1. Discuss the top journals for physicians and their application in both the clinical and research setting.
2. Discuss audience recommendations for the inclusion of articles addressing new topics in future editions of JCD.

Paul Miller, MD, HDSc (honorary)
Medical Director
Colorado Center for Bone Health/Miller Bone Center

Get expert input from a panel of global experts as to how best to approach these cases.

OBJECTIVES

1. Review the usual procedures and recommendations for densitometry performance/interpretation.
2. Highlight some unusual presentations and other things to consider.
3. Get expert input from a panel of global experts as to how best to approach these cases.

John J. Carey, MBBChBAO, MS, CCD, FRCPI
Physician in Rheumatology, Osteology, and Medicine / Professor in Medicine
Galway University Hospitals / University of Galway

Serial and combination treatment in osteoporosis.

OBJECTIVES

1. Why sequence matters.
2. Consideration when choosing advanced osteoporosis treatment.

Andrea J. Singer, MD, FACP CCD
Director of Women’s Primary Care, Director of the Bone Densitometry Program, and Medical Director of the Fracture Liaison Service
MedStar Georgetown University Hospital in Washington, DC

A 25-minute talk regarding disparities in osteoporosis treatment. Then, a review of treatment for GIOP prevention in heart and lung transplant patients.

OBJECTIVES

The Clinician’s Role in Resolving Disparities in Osteoporosis Care:

1. Provide at least two examples of racial/ethnic disparities in screening for or treatment of osteoporosis.
2. Identify at least two changes to clinical practice that will address racial/ethnic disparities in screening for or treatment of osteoporosis.
3. Re-examining risk factors for osteoporosis and their impact on health disparities.

Transplant Osteoporosis:

1. Understand the many causes of bone loss and specific metabolic bone issues in patients following heart and lung transplant.
   
2. Create an approach to managing these patients.
3. Discuss treatment options.

Sherri-Ann Burnett-Bowie, MD, MPH
Physician, Associate Professor of Medicine
Massachusetts General Hospital, Harvard Medical School

Sarah Keller, MD
Rheumatologist and Assistant Professor
Cleveland Clinic, Lerner School of Medicine