Disorders Associated With Acute Rapid and Severe Bone Loss

Authors

  • Solomon Epstein,

    Corresponding author
    1. Mount Sinai Bone Program, Departments of Medicine, Geriatrics and Physiology, Mount Sinai School of Medicine, Division of Endocrinology, Department of Medicine, Bronx VA Medical Center, New York, New York, USA
    • Address reprint requests to: Solomon Epstein, MD Mount Sinai Bone Program Endocrinology (1055) 1 Gustave L. Levy Place New York, NY 10029, USA
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  • Angela M Inzerillo,

    1. Mount Sinai Bone Program, Departments of Medicine, Geriatrics and Physiology, Mount Sinai School of Medicine, Division of Endocrinology, Department of Medicine, Bronx VA Medical Center, New York, New York, USA
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  • John Caminis,

    1. Arthritis/Bone Section, Novartis Pharmaceutical Corp., East Hanover, New Jersey, USA
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  • Mone Zaidi

    1. Mount Sinai Bone Program, Departments of Medicine, Geriatrics and Physiology, Mount Sinai School of Medicine, Division of Endocrinology, Department of Medicine, Bronx VA Medical Center, New York, New York, USA
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  • Dr Inzerillo has served as a consultant for Novartis Pharmaceuticals and has received a grant from ARA/Pfizer Inc. Dr Caminis is an employee of Novartis Pharmaceuticals. Dr Epstein has served as a consultant for Merck & Co., Inc., Novartis Pharmaceuticals, NPS Pharmaceuticals, Roche, and Wyeth. Dr Zaidi has received a grant from Procter & Gamble.

Abstract

We describe a constellation of bone diseases characterized by the common feature of acute, rapid, and severe bone loss accompanied by dramatic fracture rates. These disorders are poorly recognized, resulting mainly from systemic diseases, frailty, immobilization, and immunosuppressive drugs, such as glucocorticoids and the calcineurin inhibitors. The opportunity to prevent or treat fractures is commonly missed because they are often not detected. Ideally, patients need to be identified early and preventative therapy initiated promptly to avoid the rapid bone loss and fractures. The most effective therapy at present seems to be the bisphosphonates, particularly when bone resorption is predominant. However, more severe forms of bone loss that result from an osteoblastic defect and reduced bone formation may benefit potentially more from newer anabolic agents, such as recombinant human parathyroid hormone (rhPTH).

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