Research Update Love Your Bones 2016
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1 Research Update Love Your Bones 2016 Dr Mark Edwards BSc MBChB MRCP PhD MRC Lifecourse Epidemiology Unit University of Southampton Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust Portsmouth Hospitals NHS Trust
2 Why do bones break? Fracture Bone strength Trauma Bone microarchitecture Bone mass Risk of fall Type of fall Bone size and geometry Bone mineral density Bone turnover Intrinsic Extrinsic
3 How to we stop bones breaking?
4 How to we stop bones breaking? Interventions to reduce falls Medications that strengthen bones
5 How to we stop bones breaking? Interventions to reduce falls Medications that strengthen bones However, all medications have side effects
6 How do we improve the risk:benefit ratio for treatment of osteoporosis?
7 How do we improve the risk:benefit ratio for treatment of osteoporosis? 1. Identify people at high risk of fracture 2. Develop treatments that are more effective 3. Find out why individuals are at increased risk and target therapy?
8 How do we improve the risk:benefit ratio for treatment of osteoporosis? 1. Identify people at high risk of fracture 2. Develop treatments that are more effective 3. Find out why individuals are at increased risk and target therapy?
9 FRAX
10 National Osteoporosis Guidelines Group (NOGG) x
11 What is the most important factor in Future Fracture Prediction?
12 What is the most important factor in Future Fracture Prediction?
13 Risk of Fracture
14 Secondary Fracture Prevention Globally Poor Stop at One National Osteoporosis Society Fracture liaison service Capture the Fracture International Osteoporosis Foundation
15 Capture the Fracture
16 IMMINENT RISK OF MAJOR OSTEOPOROTIC FRACTURE AFTER FRACTURE (REYKJAVIK STUDY) N. C. HARVEY, H. JOHANSSON, K. SIGGEIRSDOTTIR, A. ODEN, V. GUDNASON, E. MCCLOSKEY, G. SIGURDSSON, J. A. KANIS, UNIVERSITY OF SOUTHAMPTON, SOUTHAMPTON, UNITED KINGDOM MOF: past Major Osteoporotic Fracture, CI: Confidence Interval, RR: Relative Risk Congress Highlights WCO-IOF-ESCEO Malaga
17 How do we improve the risk:benefit ratio for treatment of osteoporosis? 1. Identify people at high risk of fracture 2. Develop treatments that are more effective 3. Find out why individuals are at increased risk and target therapy?
18 Current and Future Drugs
19 Bone marrow-derived mesenchymal progenitors Bone marrow-derived haemopoietic progenitors Lining cells Osteocytes
20 Bone marrow-derived mesenchymal progenitors Bone marrow-derived haemopoietic progenitors Bisphosphonates Lining cells Osteocytes
21 Bone marrow-derived mesenchymal progenitors Bone marrow-derived haemopoietic progenitors Bisphosphonates Lining cells Denosumab Osteocytes
22 Bone marrow-derived mesenchymal progenitors Bone marrow-derived haemopoietic progenitors Teriparatide Lining cells Osteocytes
23 Bone marrow-derived mesenchymal progenitors Bone marrow-derived haemopoietic progenitors Teriparatide Strontium Lining cells Osteocytes
24 Bone marrow-derived mesenchymal progenitors Bone marrow-derived haemopoietic progenitors Odanacatib Lining cells Osteocytes
25 Bone marrow-derived mesenchymal progenitors Bone marrow-derived haemopoietic progenitors Odanacatib Lining cells Osteocytes
26 Bone marrow-derived mesenchymal progenitors Bone marrow-derived haemopoietic progenitors Sclerostin Lining cells Osteocytes
27 Bone marrow-derived mesenchymal progenitors Bone marrow-derived haemopoietic progenitors Sclerostin Lining cells Osteocytes
28 Bone marrow-derived mesenchymal progenitors Bone marrow-derived haemopoietic progenitors Romosozumab Sclerostin Lining cells Osteocytes
29 Bone marrow-derived mesenchymal progenitors Bone marrow-derived haemopoietic progenitors Romosozumab Sclerostin Lining cells Osteocytes
30 Bone marrow-derived mesenchymal progenitors Bone marrow-derived haemopoietic progenitors Romosozumab Sclerostin Lining cells Osteocytes
31 % Change SUPERIOR GAINS IN BONE MINERAL DENSITY AND ESTIMATED STRENGTH AT THE HIP FOR ROMOSOZUMAB COMPARED WITH TERIPARATIDE IN WOMEN WITH POSTMENOPAUSAL OSTEOPOROSIS TRANSITIONING FROM BISPHOSPHONATE THERAPY: RESULTS OF THE PHASE 3 OPEN-LABEL STRUCTURE STUDY J. MALOUF, B. LANGDAHL, C. LIBANATI, D. B. CRITTENDEN, M. A. BOLOGNESE, J. P. BROWN, N. S. DAIZADEH, E. DOKOUPILOVA, K. ENGELKE, J. S. FINKELSTEIN, H. K. GENANT, S. GOEMAERE, L. HYLDSTRUP, E. JODAR- GIMENO, T. M. KEAVENY, D. KENDLER, P. LAKATOS, J. MADDOX, F. E. MASSARI, J. F. MOLINA, M. R. ULLA, A. GRAUER UNIVERSITAT AUTÒNOMA DE BARCELONA, BARCELONA, SPAIN % DXA % change at 12 months 8 RESULTS 6 5.4% Romo 4 2.9% TPTD Lumbar Spine Total Hip -0.5% TPTD: Teriparatide, Romo: Romosozumab Congress Highlights WCO-IOF-ESCEO Malaga
32 How do we improve the risk:benefit ratio for treatment of osteoporosis? 1. Identify people at high risk of fracture 2. Develop treatments that are more effective 3. Find out why individuals are at increased risk and target therapy?
33 DXA
34 DXA
35 DXA Hip T score (Bone mineral density) Lumbar spine T score (Bone mineral density) Almost doubling of risk for every point lower in T score
36 Bone Microstructure Courtesy of Nick Harvey Jones, P. et al. BMJ 2007;335:
37
38 Microscopic effects of osteoporosis on bone
39 Xtreme CT
40 Xtreme CT
41 Type II Diabetes and Bone Compared with controls Fracture rate higher BMD similar Why?
42 Type II Diabetes and Bone
43 Summary FRAX is available to help us target therapy to those at highest risk New drugs including odanacatib and romosozumab are under investigation High resolution imaging techniques allow us to identify specific area of bone disease
44 Research Update Love Your Bones 2016 Dr Mark Edwards BSc MBChB MRCP PhD MRC Lifecourse Epidemiology Unit University of Southampton Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust Portsmouth Hospitals NHS Trust
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