Updated trabecular bone score accounting for the soft tissue thickness (TBSTT) demonstrated significantly improved bone microstructure with denosumab in the FREEDOM TBS post hoc analysis

Journal article


Hans, Didier, Shevroja, Enisa, McDermott, Michele, Huang, Shuang, Kim, Min and McClung, Michael Roy. (2022). Updated trabecular bone score accounting for the soft tissue thickness (TBSTT) demonstrated significantly improved bone microstructure with denosumab in the FREEDOM TBS post hoc analysis. Osteoporosis International. 33(12), pp. 2517-2525. https://doi.org/10.1007/s00198-022-06549-x
AuthorsHans, Didier, Shevroja, Enisa, McDermott, Michele, Huang, Shuang, Kim, Min and McClung, Michael Roy
Abstract

TBS algorithm has been updated to account for regional soft tissue noise. In postmenopausal women with osteoporosis, denosumab improved tissue thickness-adjusted TBS vs placebo independently of bone mineral density over 3 years, with the magnitude of changes from baseline or placebo numerically greater than body mass index-adjusted TBS.

Introduction: To evaluate the effect of denosumab on bone microarchitecture assessed by trabecular bone score (TBS) in the FREEDOM study using the updated algorithm that accounts for regional soft tissue thickness (TBSTT) in dual-energy X-ray absorptiometry (DXA) images and to compare percent changes from baseline and placebo with classical body mass index (BMI)-adjusted TBS (TBSBMI).

Methods: Postmenopausal women with lumbar spine or total hip bone mineral density (BMD) T score < - 2.5 and ≥ - 4.0 received placebo or denosumab 60 mg subcutaneously every 6 months. TBSBMI and TBSTT were assessed on lumbar spine DXA scans at baseline and months 1, 12, 24, and 36 in a subset of 279 women (129 placebo, 150 denosumab) who completed the 3-year FREEDOM DXA substudy and rolled over to open-label extension study.

Results: Baseline characteristics were similar between groups. TBSTT in the denosumab group showed numerically greater changes from both baseline and placebo than TBSBMI at months 12, 24, and 36. Denosumab led to progressive increases in BMD (1.2, 5.6, 8.1, and 10.5%) and TBSTT (0.4, 2.3, 2.6, and 3.3%) from baseline to months 1, 12, 24, and 36, respectively. Both TBS changes were significant vs baseline and placebo from months 12 to 36 (p < 0.0001). As expected, BMD and TBSTT were poorly correlated both at baseline and for changes during treatment.

Conclusion: In postmenopausal women with osteoporosis, denosumab significantly improved bone microstructure assessed by TBSTT over 3 years. TBSTT seemed more responsive to denosumab treatment than TBSBMI and was independent of BMD.

KeywordsBone mineral density (BMD); Denosumab; Osteoporosis ; Postmenopausal women; Soft tissue thickness; Trabecular bone score (TBS)
Year01 Jan 2022
JournalOsteoporosis International
Journal citation33 (12), pp. 2517-2525
PublisherSpringer UK
ISSN0937-941X
Digital Object Identifier (DOI)https://doi.org/10.1007/s00198-022-06549-x
PubMed ID36115888
PubMed Central IDPMC9652244
Web address (URL)https://link.springer.com/article/10.1007/s00198-022-06549-x
Open accessPublished as ‘gold’ (paid) open access
Research or scholarlyResearch
Page range2517-2525
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License
File Access Level
Open
Output statusPublished
Publication dates
Online17 Sep 2022
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Accepted01 Sep 2022
Deposited13 Jan 2023
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© The Author(s) 2022.
This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.

Open access funding provided by University of Lausanne This study was funded by Amgen Inc., Thousand Oaks, CA, USA.

Place of publicationUnited Kingdom
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Pinkerton, Jo A.V., Aguirre, Fernando S., Blake, Jennifer, Cosman, F., Hodis, Howard, Hoffstetter, Susan, Kaunitz, Andrew M., Kingsberg, Sheryl A., Maki, Pauline M., Manson, JoAnn E., Marchbanks, Polly, McClung, Michael, Nachtigall, Lila E., Nelson, Lawrence M., Pace, Diane T., Reid, Robert L., Sarrel, Phillip M., Shifren, Jan L., Stuenkel, Cynthia A. and Utian, Wulf H.. (2017). The 2017 hormone therapy position statement of the North American Menopause Society. Menopause: The Journal of the North American Menopause Society. 24(7), pp. 728 - 753. https://doi.org/10.1097/GME.0000000000000921
Using osteoporosis therapies in combination
McClung, Michael. (2017). Using osteoporosis therapies in combination. Current Osteoporosis Reports. 15(4), pp. 343 - 352. https://doi.org/10.1007/s11914-017-0376-x
Observations following discontinuation of long-term denosumab therapy
McClung, Michael, Wagman, Rachel B., Miller, Paul, Wang, Andrea and Lewiecki, E M.. (2017). Observations following discontinuation of long-term denosumab therapy. Osteoporosis International. 28(5), pp. 1723 - 1732. https://doi.org/10.1007/s00198-017-3919-1
Bone mineral density and parathyroid hormone as independent risk factors for mortality in community-dwelling older adults: A population-based prospective cohort study in Brazil. The Sao Paulo Ageing & Health (SPAH) study
Domiciano, Diogo S., Machado, Luana G., Lopes, Jaqueline B., Figueiredo, Camille P., Caparbo, Valeria F., Oliveira, Ricardo M., Scazufca, Marcia, McClung, Michael R. and Pereira, Rosa M.R.. (2016). Bone mineral density and parathyroid hormone as independent risk factors for mortality in community-dwelling older adults: A population-based prospective cohort study in Brazil. The Sao Paulo Ageing & Health (SPAH) study. Journal of Bone and Mineral Research. 31(6), pp. 1146 - 1157. https://doi.org/10.1002/jbmr.2795
A phase 2 study of MK-5442, a calcium-sensing receptor antagonist, in postmenopausal women with osteoporosis after long-term use of oral bisphosphonates
Cosman, F., Gilchrist, N., McClung, Michael R., Foldes, J., de Villiers, T., Santora, A., Leung, A. T., Samanta, S., Heyden, N., McGinnis, J.P., Rosenberg, E. and Denker, A.E.. (2016). A phase 2 study of MK-5442, a calcium-sensing receptor antagonist, in postmenopausal women with osteoporosis after long-term use of oral bisphosphonates. Osteoporosis International. 27(1), pp. 377 - 386. https://doi.org/10.1007/s00198-015-3392-7
Vertebral fractures: Clinical importance and management
Kendler, D. L., Bauer, Doug C., Davison, K. S., Dian, L., Hanley, David A., Harris, S. T., McClung, Michael R., Miller, P. D., Schousboe, J. T., Yuen, C. K. and Lewiecki, E. Michael. (2016). Vertebral fractures: Clinical importance and management. American Journal of Medicine. 129(2), pp. 1 - 10. https://doi.org/10.1016/j.amjmed.2015.09.020
Proceedings of the 2015 Santa Fe Bone Symposium: Clinical applications of scientific advances in osteoporosis and metabolic bone disease
Lewiecki, E. Michael, Baron, Roland, Bilezikian, John P., Gagel, Robert E., Leonard, Mary B., Leslie, William D., McClung, Michael R. and Miller, Paul D.. (2016). Proceedings of the 2015 Santa Fe Bone Symposium: Clinical applications of scientific advances in osteoporosis and metabolic bone disease. United States of America: Elsevier Inc.. pp. 102 - 116 https://doi.org/10.1016/j.jocd.2015.11.003
Denosumab reduces cortical porosity of the proximal femoral shaft in postmenopausal women with osteoporosis
Zebaze, Roger M., Libanati, Cesar, McClung, Michael R., Zanchetta, Jose Ruben, Kendler, David L., Høiseth, Arne, Wang, Andrea, Ghasem-Zadeh, Ali and Seeman, Ego. (2016). Denosumab reduces cortical porosity of the proximal femoral shaft in postmenopausal women with osteoporosis. Journal of Bone and Mineral Research. 31(10), pp. 1827 - 1834. https://doi.org/10.1002/jbmr.2855
Emerging therapies for osteoporosis
McClung, Michael R.. (2015). Emerging therapies for osteoporosis. Endocrinology and Metabolism. 30(4), pp. 429 - 435. https://doi.org/10.3803/EnM.2015.30.4.429
Odanacatib for the treatment of postmenopausal osteoporosis: Development history and design and participant characteristics of LoFT, the Long-term odanacatib Fracture Trial
Bone, Henry G., Dempster, David W., Eisman, John A., Greenspan, S. L., McClung, Michael R., Nakamura, T., Papapoulos, S., Shih, W. J., Rybak-Feiglin, A., Santora, A. C., Verbruggen, Nadia, Leung, A. T. and Lombardi, Antonio. (2015). Odanacatib for the treatment of postmenopausal osteoporosis: Development history and design and participant characteristics of LoFT, the Long-term odanacatib Fracture Trial. Osteoporosis International. 26(2), pp. 699 - 712. https://doi.org/10.1007/s00198-014-2944-6
A 24-month study evaluating the efficacy and safety of denosumab for the treatment of men with low bone mineral density: Results from the ADAMO trial
Langdahl, Bente Lomholt, Teglbjaerg, Christence S., Ho, Pei-Ran, Chapurlat, Roland D., Czerwinski, Edward, Kendler, David L., Reginster, Jean Yves, Kivitz, Alan, Lewiecki, E. Michael, Miller, Paul D., Bolognese, Michael A., McClung, Michael R., Bone, Henry G., Ljunggren, Östen, Abrahamsen, Bo, Gruntmanis, Ugis, Yang, Yu-Ching, Wagman, Rachel B., Mirza, Faisal, ... Orwoll, Eric. (2015). A 24-month study evaluating the efficacy and safety of denosumab for the treatment of men with low bone mineral density: Results from the ADAMO trial. The Journal of Clinical Endocrinology and Metabolism. 100(4), pp. 1335 - 1342. https://doi.org/10.1210/jc.2014-4079
Serum 25-hydroxyvitamin D levels: Variability, knowledge gaps, and the concept of a desirable range
El-Hajj Fuleihan, Ghada, Bouillon, Roger, Clarke, Bart, Chakhtoura, Marlene, Cooper, Cyrus, McClung, Michael R. and Singh, Ravinder J.. (2015). Serum 25-hydroxyvitamin D levels: Variability, knowledge gaps, and the concept of a desirable range. Journal of Bone and Mineral Research. 30(7), pp. 1119 - 1133. https://doi.org/10.1002/jbmr.2536
Comparison of proximal femur and vertebral body strength improvements in the FREEDOM trial using an alternative finite element methodology
Zysset, Philippe, Pahr, Dieter, Engelke, Klaus, Genant, Harry K., McClung, Michael R., Kendler, David L., Recknor, Christopher, Kinzl, Michael, Schwiedrzik, Jakob, Museyko, Oleg, Wang, Andrea and Libanati, Cesar. (2015). Comparison of proximal femur and vertebral body strength improvements in the FREEDOM trial using an alternative finite element methodology. Bone. 81(December), pp. 122 - 130. https://doi.org/10.1016/j.bone.2015.06.025
Denosumab rapidly increases cortical bone in key locations of the femur: A 3D bone mapping study in women with osteoporosis
Poole, Kenneth E.S., Treece, Graham M., Gee, Andrew H., Brown, Jacques P., McClung, Michael R., Wang, Andrea and Libanati, Cesar. (2015). Denosumab rapidly increases cortical bone in key locations of the femur: A 3D bone mapping study in women with osteoporosis. Journal of Bone and Mineral Research. 30(1), pp. 46 - 54. https://doi.org/10.1002/jbmr.2325
Creation of an age-adjusted, dual-energy x-ray absorptiometry-derived trabecular bone score curve for the lumbar spine in non-hispanic US white women
Simonelli, Christine, Leib, Edward, Mossman, Ned, Winzenrieth, Renaud, Hans, Didier and McClung, Michael R.. (2014). Creation of an age-adjusted, dual-energy x-ray absorptiometry-derived trabecular bone score curve for the lumbar spine in non-hispanic US white women. Journal of Clinical Densitometry. 17(2), pp. 314 - 319. https://doi.org/10.1016/j.jocd.2013.09.002
Femoral and vertebral strength improvements in postmenopausal women with osteoporosis treated with denosumab
Keaveny, Tony M., McClung, Michael R., Genant, Harry K., Zanchetta, Jose Ruben, Kendler, David, Brown, Jacques P., Goemaere, Stefan, Recknor, Christopher, Brandi, Maria Luisa, Eastell, Richard, Kopperdahl, David L., Engelke, Klaus, Fuerst, Thomas, Radcliffe, Hoi-Shen and Libanati, Cesar. (2014). Femoral and vertebral strength improvements in postmenopausal women with osteoporosis treated with denosumab. Journal of Bone and Mineral Research. 29(1), pp. 158 - 165. https://doi.org/10.1002/jbmr.2024
Bone safety with risedronate: histomorphometric studies at different dose levels and exposure
Recker, Robert R., SteMarie, L.-G., Chavassieux, P., McClung, Michael R. and Lundy, M. W.. (2014). Bone safety with risedronate: histomorphometric studies at different dose levels and exposure. Osteoporosis International. 26(1), pp. 327 - 337. https://doi.org/10.1007/s00198-014-2850-y
Romosozumab in postmenopausal women with low bone mineral density
McClung, Michael R., Grauer, Andreas, Boonen, Steven and Bolognese, Michael A.. (2014). Romosozumab in postmenopausal women with low bone mineral density. New England Journal of Medicine. 370(5), pp. 412 - 420. https://doi.org/10.1056/NEJMoa1305224
Tibolone
McClung, M. R.. (2013). Tibolone. In In Genazzani, Andrea R. (Ed.). Postmenopausal osteoporosis : Hormones and other therapies pp. 233-238 Taylor & Francis. https://doi.org/10.1201/b14631-28
Bisphosphonate therapy for osteoporosis: Benefits, risks, and drug holiday
McClung, Michael R., Harris, Steven T., Miller, Paul D., Bauer, Doug C., Davison, K. Shawn, Dian, Larry, Hanley, David A., Kendler, David L., Yuen, Chui Kin and Lewiecki, E. Michael. (2013). Bisphosphonate therapy for osteoporosis: Benefits, risks, and drug holiday. American Journal of Medicine. 126(1), pp. 13 - 20. https://doi.org/10.1016/j.amjmed.2012.06.023
A novel monthly dosing regimen of risedronate for the treatment of postmenopausal Osteoporosis: 2-year data
McClung, Michael R., Benhamou, Claude-Laurent, Man, Zulema, Tlustochowicz, Witold, Zanchetta, Jose Ruben, Eusebio, Rachelle, Balske, Ana M., Matzkin, Ellen, Olszynski, Wojciech P., Recker, Robert R. and Delmas, Pierre D.. (2013). A novel monthly dosing regimen of risedronate for the treatment of postmenopausal Osteoporosis: 2-year data. Calcified Tissue International. 92(1), pp. 59 - 67. https://doi.org/10.1007/s00223-012-9668-4
Impact of denosumab on the peripheral skeleton of postmenopausal women with osteoporosis: Bone density, mass, and strength of the radius, and wrist fracture
Simon, James A., Recknor, Christopher, Moffett, Alfred H., Adachi, Jonathan D., Franek, Edward, Lewiecki, E. Michael, McClung, Michael R., Mautalen, Carlos A., Ragi-Eis, Sergio, Nicholson, Geoffrey Charles, Muschitz, Christian, Nuti, Ranuccio, Torring, Ove, Wang, Andrea and Libanati, Cesar. (2013). Impact of denosumab on the peripheral skeleton of postmenopausal women with osteoporosis: Bone density, mass, and strength of the radius, and wrist fracture. Menopause. 20(2), pp. 130 - 137. https://doi.org/10.1097/gme.0b013e318267f909
Efficacy and safety of risedronate 150-mg once a month in the treatment of postmenopausal osteoporosis: 2-year data
McClung, Michael R., Zanchetta, Jose Ruben, Racewicz, A., Roux, Christian, Benhamou, Claude-Laurent, Man, Zulema, Eusebio, Rachelle, Beary, J. F., Burgio, D.E., Matzkin, Ellen, Boonen, Steven and Delmas, P. D.. (2013). Efficacy and safety of risedronate 150-mg once a month in the treatment of postmenopausal osteoporosis: 2-year data. Osteoporosis International. 24(1), pp. 293 - 299. https://doi.org/10.1007/s00198-012-2056-0
Treatment of postmenopausal osteoporosis with delayed-release risedronate 35 mg weekly for 2 years
McClung, Michael R., Balske, Ana M., Burgio, D. E., Wenderoth, D. and Recker, Robert R.. (2013). Treatment of postmenopausal osteoporosis with delayed-release risedronate 35 mg weekly for 2 years. Osteoporosis International. 24(1), pp. 301 - 310. https://doi.org/10.1007/s00198-012-2175-7
Effects of pioglitazone on bone in postmenopausal women with impaired fasting glucose or impaired glucose tolerance: A randomized, double-Blind, placebo-controlled study
Bone, Henry G., Lindsay, Robert, McClung, Michael R., Perez, Alfonso T., Raanan, Marsha G. and Spanheimer, Robert G.. (2013). Effects of pioglitazone on bone in postmenopausal women with impaired fasting glucose or impaired glucose tolerance: A randomized, double-Blind, placebo-controlled study. The Journal of Clinical Endocrinology and Metabolism. 98(12), pp. 4691 - 4701. https://doi.org/10.1210/jc.2012-4096
Controversies in osteoporosis management: Concerns about bisphosphonates and when are "drug holidays" required?
McClung, Michael R.. (2013). Controversies in osteoporosis management: Concerns about bisphosphonates and when are "drug holidays" required? Clinical Obstetrics and Gynecology. 56(4), pp. 743 - 748. https://doi.org/10.1097/GRF.0b013e3182a98295
Denosumab densitometric changes assessed by quantitative computed tomography at the spine and hip in postmenopausal women with osteoporosis
McClung, Michael R., Zanchetta, Jose Ruben, Høiseth, Arne, Kendler, David L., Yuen, Chui Kin, Brown, Jacques P., Stonkus, Sigtas, Goemaere, Stefan, Recknor, Christopher, Woodson, Grattan C., Bolognese, Michael A., Franek, Edward, Brandi, Maria Luisa, Wang, Andrea and Libanati, Cesar. (2013). Denosumab densitometric changes assessed by quantitative computed tomography at the spine and hip in postmenopausal women with osteoporosis. Journal of Clinical Densitometry. 16(2), pp. 250 - 256. https://doi.org/10.1016/j.jocd.2012.02.014
Effect of denosumab on bone mineral density and biochemical markers of bone turnover: 8-year results of a phase 2 clinical trial
McClung, Michael R., Lewiecki, E. Michael, Geller, M. L. and Bolognese, Michael A.. (2013). Effect of denosumab on bone mineral density and biochemical markers of bone turnover: 8-year results of a phase 2 clinical trial. Osteoporosis International. 24(1), pp. 227 - 235. https://doi.org/10.1007/s00198-012-2052-4
In Memoriam: Sergio Ragi-Eis, MD
McClung, Michael. (2012). In Memoriam: Sergio Ragi-Eis, MD. Archives of Osteoporosis. 7(43862), pp. 1 - 2. https://doi.org/10.1007/s11657-012-0081-4
Effect of denosumab treatment on the risk of fractures in subgroupsof women with postmenopausal osteoporosis
McClung, Michael R., Boonen, Steven, Torring, Ove, Roux, Christian, Rizzoli, Rene, Bone, Henry G., Benhamou, Claude-Laurent, Lems, Willem F., Minisola, Salvatore, Halse, Johan, Hoeck, Hans C., Eastell, Richard, Wang, Andrea, Siddhanti, Suresh and Cummings, Steven R.. (2012). Effect of denosumab treatment on the risk of fractures in subgroupsof women with postmenopausal osteoporosis. Journal of Bone and Mineral Research. 27(1), pp. 211 - 218. https://doi.org/10.1002/jbmr.536
In memoriam: Sergio Ragi-Eis, MD
McClung, Michael R.. (2012). In memoriam: Sergio Ragi-Eis, MD. Journal of Clinical Densitometry. 23(6), pp. 1651 - 1652. https://doi.org/10.1007/s00198-012-1980-3
In memoriam: Sergio Ragi-Eis, MD, CCD, CDT (April 8, 1962-February 22, 2012)
Bilezikian, John P., Zerbini, Cristiano, Lewiecki, E. Michael, Borges, Joao Lindolfo, Miller, Paul D., Hans, Didier, Camargos, Bruno Muzzi and McClung, Michael R.. (2012). In memoriam: Sergio Ragi-Eis, MD, CCD, CDT (April 8, 1962-February 22, 2012). Osteoporosis International. 15(3), pp. 257 - 259. https://doi.org/10.1016/j.jocd.2012.05.003
Revisiting the prevention of bone loss at menopause
McClung, Michael R.. (2012). Revisiting the prevention of bone loss at menopause. Menopause. 19(11), pp. 1173 - 1175. https://doi.org/10.1097/gme.0b013e318274fb1d
Femoral strength in osteoporotic women treated with teriparatide or alendronate
Keaveny, Tony M., McClung, Michael R., Wan, Xiaohai, Kopperdahl, David L., Mitlak, Bruce H. and Krohn, Kelly. (2012). Femoral strength in osteoporotic women treated with teriparatide or alendronate. Bone. 50(1), pp. 165 - 170. https://doi.org/10.1016/j.bone.2011.10.002
Odanacatib in the treatment of postmenopausal women with low bone mineral density: Three-year continued therapy and resolution of effect
Eisman, John A., Bone, Henry G., Hosking, David J., McClung, Michael R., Reid, Ian R., Rizzoli, Rene, Resch, Heinrich, Verbruggen, Nadia, Hustad, Carolyn M., DaSilva, Carolyn, Petrovic, Romana, Santora, Arthur C., Ince, B. Avery and Lombardi, Antonio. (2011). Odanacatib in the treatment of postmenopausal women with low bone mineral density: Three-year continued therapy and resolution of effect. Journal of Bone and Mineral Research. 26(2), pp. 242 - 251. https://doi.org/10.1002/jbmr.212
Effects of denosumab on fracture and bone mineral density by level of kidney function
Jamal, Sophie A., Ljunggren, Östen, Stehman-Breen, Catherine, Cummings, Steven R., McClung, Michael R., Goemaere, Stefan, Ebeling, Peter R., Franek, Edward, Yang, Yu-ching, Egbuna, Ogo I., Boonen, Steven and Miller, Paul D.. (2011). Effects of denosumab on fracture and bone mineral density by level of kidney function. Journal of Bone and Mineral Research. 26(8), pp. 1829 - 1835. https://doi.org/10.1002/jbmr.403
Effects of denosumab on bone turnover markers in postmenopausal osteoporosis
Eastell, Richard, Christiansen, Claus, Grauer, Andreas, Kutilek, Stepan, Libanati, Cesar, McClung, Michael R., Reid, Ian R., Resch, Heinrich, Siris, Ethel, Uebelhart, Daniel, Wang, Andrea, Weryha, Georges and Cummings, Steven R.. (2011). Effects of denosumab on bone turnover markers in postmenopausal osteoporosis. Journal of Bone and Mineral Research. 26(3), pp. 530 - 537. https://doi.org/10.1002/jbmr.251
Osteoporosis update from the 2010 Santa Fe Bone Symposium
Lewiecki, E. Michael, Bilezikian, John P., Khosla, Sundeep, Marcus, Robert, McClung, Michael R., Miller, Paul D., Watts, Nelson B. and Maricic, Michael. (2011). Osteoporosis update from the 2010 Santa Fe Bone Symposium. Journal of Clinical Densitometry. 14(1), pp. 1 - 21. https://doi.org/10.1016/j.jocd.2010.12.001
Treatment with denosumab reduces the incidence of new vertebral and hip fractures in postmenopausal women at high risk
Boonen, Steven, Adachi, Jonathan D., Man, Zulema, Cummings, Steven R., Lippuner, K., Torring, Ove, Gallagher, J.C., Farrerons, J., Wang, Andrea, Franchimont, N., San Martin, Javier, Grauer, Andreas and McClung, Michael R.. (2011). Treatment with denosumab reduces the incidence of new vertebral and hip fractures in postmenopausal women at high risk. The Journal of Clinical Endocrinology and Metabolism. 96(6), pp. 1727 - 1736. https://doi.org/10.1210/jc.2010-2784
Markers of bone turnover for the prediction of fracture risk and monitoring of osteoporosis treatment: A need for international reference standards
Vasikaran, Samuel, Eastell, Richard, Bruyere, O., Foldes, A. J., Garnero, P., Griesmacher, Andrea, McClung, Michael R., Morris, Howard A., Silverman, S., Trenti, Tommaso, Wahl, D. A., Cooper, Cyrus and Kanis, John A.. (2011). Markers of bone turnover for the prediction of fracture risk and monitoring of osteoporosis treatment: A need for international reference standards. Osteoporosis International. 22(2), pp. 391 - 420. https://doi.org/10.1007/s00198-010-1501-1
Arzoxifene for prevention of fractures and invasive breast cancer in postmenopausal women
Cummings, Steven R., McClung, Michael R., Reginster, Jean-Yves, Cox, David, Mitlak, Bruce, Stock, John, Amewou-Atisso, Messan, Powles, Trevor, Miller, Paul, Zanchetta, Jose Ruben and Christiansen, Claus. (2011). Arzoxifene for prevention of fractures and invasive breast cancer in postmenopausal women. Journal of Bone and Mineral Research. 26(2), pp. 397 - 404. https://doi.org/10.1002/jbmr.191