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Summary: Fracture prevention in cognitively impaired individuals is lacking. This work highlights the benefits of zoledronic acid on bone health in cognitively impaired older adults. Demonstrating benefits of therapy may increase treatment uptake and reduce fracture risk in this group. Introduction: Osteoporosis has detrimental consequences for frail older adults. The effects on those with both osteoporosis and cognitive impairment are compounded due to increased risk of falls and changes in mobility, both of which can lead to fracture. However, there are limited data on treatment benefits for osteoporotic individuals with cognitive impairment. Methods: This post hoc, secondary analysis of data from a randomized, double-blind, placebo-controlled clinical trial of single-dose zoledronic acid included 179 women age ≥ 65 years residing in assisted living facilities or nursing homes, 43 of whom had mild to severe cognitive impairment. We assessed bone mineral density (BMD) of the total hip, femoral neck, and lumbar spine by dual-energy x-ray absorptiometry and serum bone turnover markers (C-terminal telopeptide of type I collagen and procollagen type I N propeptide) at 6 and 12 months. Results: In participants with cognitive impairment, those who received zoledronic acid had 4.3% greater BMD at the total hip (p=.005) and 5.3% greater BMD at the femoral neck (p<.001) after 12 months compared to those in the placebo group. Bone turnover markers demonstrated significant decreases at 6 months in those with cognitive impairment who received active treatment compared to the placebo group. Improvements in bone health measures with zoledronic acid were similar to those seen in participants without cognitive impairment. Conclusion: Zoledronic acid improves bone health in frail older women with cognitive impairment similar to those without impairment. Further studies are warranted to assess the benefit for fracture reduction in this undertreated population. [ABSTRACT FROM AUTHOR]

The article discusses that the novel coronavirus pandemic continues to have a profound impact on the global population, as well as the US population and healthcare system, as the number of reported COVID-19 cases in the USA continues to rise. It mentions that the National Osteoporosis Foundation (NOF) sought to ascertain the impact on the management and care of osteoporosis and bone health by surveying patients and caregivers.

Studies using total hip replacement surgery as a model for acute hip injury have shown that bone mineral density of the proximal femur decreases 6–18% in the 6 months following surgery. To examine the acute biochemical mechanism associated with bone loss, we measured two indicators of bone formation [serum osteocalcin (OC), serum bone-specific alkaline phosphatase (BSAP)], as well as two markers for bone resorption [urine and serum N-telopeptide cross-linked collagen type 1 (NTx)], in 20 patients (10 men, 10 women, mean age 59.4 years) prior to hip replacement and 1–2 days postsurgery. The average OC value (ng/ml) decreased by 57.3% following surgery (7.5 ± 4.3 to 3.2 ± 1.1, P <0.001), and the average BSAP level (U/L) decreased by 27.6% (19.9 ± 5.6 to 14.4 ± 3.7, P <0.001). In contrast, levels of urine NTx (nmol BCE/mmol Cr) did not change significantly after the surgery (73.9 ± 47.2 to 70.1 ± 29.7). In addition, there was no change in serum NTx (nmol BCE) after surgery (11.8 ± 2.3 to 11.8 ± 3.0). Six months after surgery, bone mass had not changed significantly from baseline. These findings suggest that there is an uncoupling of bone turnover following hip replacement surgery which is characterized by significant reductions in bone formation without compensatory decreases in bone resorption, potentially leading to bone loss. Longer periods of follow-up are needed to assess long-term bone mass changes. [ABSTRACT FROM AUTHOR]

A Correction to this paper has been published: https://doi.org/10.1007/s00198-021-05905-7 [ABSTRACT FROM AUTHOR]

The authors convey their response to a feedback about their report on the effect of bisphosphonate discontinuation on bone mineral density and fracture risk. Topics mentioned include position statement of the European Menopause and Andropause Society in 2017, discontinuation of treatment for one year after three years of prior risedronate treatment, and the null results for the impact of bisphosphonate discontinuation on risk of hip fracture or any clinical fracture.