ASBMR 2018 to Tackle 'Problems Bone Doctors Struggle With'

Marlene Busko

September 27, 2018

This year's American Society for Bone and Mineral Research (ASBMR) 2018 Annual Meeting in Montreal will highlight what is top of mind in the field now, from practical new recommendations for secondary fracture prevention to a debate about whether osteoporosis drugs are associated with a longer life.  

As usual, the meeting organizers culled the best submitted research and organized poster sessions, oral sessions, and symposia.

Moreover, "what we [also] did for this meeting, for the clinical side was [ask] what are the kinds of problems that our members get patients referred to them [for] and [that] they really struggle with?" ASBMR Council president and meeting chair Michael J. Econs, MD, from Indiana University, Indianapolis, told Medscape Medical News.

Clinicians will want to attend three highly relevant symposia, he said, on "Fall assessment and prevention," "The Athlete's skeleton: Going the distance," and "Multimorbidity and its impact on clinical management," which are being given on three different days.

"All of us get referred patients with these kinds of things," Econs noted, "so we're going to go over the data and also say what we think is reasonable," which will make for exciting sessions.

In a related study, researchers will present data from a multipronged fall-prevention program that older adults living in "retirement villages" in Australia participated in, which appears to decrease the risk for multiple falls (Abstract 1060).  

Secondary Fracture Prevention; Gender Differences, Similarities

A "key" presentation, according to Econs,  will be ASMBR's recommendations for preventing secondary fractures, which will be given by Douglas P. Kiel, MD, from the Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts, and a former ASBMR president, in a session called "Closing the treatment gap."

Related to this, researchers will report on a study of secondary fractures in a cohort of 58,000 women and 18,000 men in the Canadian province of Manitoba who were followed for 25 years. Surprisingly, men had a much higher risk of another fracture than women, especially in the first years after their initial broken bone (Abstract 1038).

Another study shows that it is better to keep active as long as possible to maintain bone health. Investigators will present data from men who were on average 84 years old that shows that those who were most active over a 5-day assessment had stronger bones. 

These findings are "not shocking," Econs noted, but they reinforce the notion that older "men who exercise, like [older] women who exercise, are going to have better bone mass" (Abstract 1118).

In other research, a meta-analysis, again of men, suggests that when trying to predict the risk of fractures in people with sarcopenia (loss of muscle mass), other measures apart from appendicular lean mass/height or bone mineral density (BMD) may be better (Abstract 1040).

Bone Drug Holidays, "Old" Drug's Possible CV Benefit

Econs next drew attention to a late-breaking oral abstract where researchers will present 6-year outcomes from a large randomized controlled trial of the bisphosphonate zoledronic acid given every 18 months to prevent fractures in osteopenic postmenopausal women.

The study hints that in addition to reducing the risk of fractures, this osteoporosis drug may lower the risk of myocardial infarction and cancer (Abstract 1166).  

Other research has hinted that osteoporosis drugs might lengthen life, but not everyone is convinced, Econs noted.

So this will also be the topic of what promises to be a "hot" debate, "Treatment for osteoporosis does not reduce mortality."  

Roland Chapurlat, MD, PhD, from E. Herriot Hospital and Lyon University, in France will argue that these drugs do improve survival, whereas Steven R. Cummings, MD, San Francisco Coordinating Center and University of California, San Francisco, will take the opposing view.

Cummings is also presenting a poster of a meta-analysis that has found no mortality benefit with osteoporosis drugs (Abstract 905).

And clinicians who treat patients with osteoporosis are sure to find a study about drug holidays interesting, according to Econs.

The investigators will report on the 2-year fracture rates among women who stopped taking bisphosphonates after taking them for at least 3 years (Abstract 1006).  

If those data show an increased risk of fracture, then "to my way of thinking," Econs said, "it's going to shorten my times that I put people on [drug] holidays."

Fracture Surrogate, Hip Replacements, and Probiotics

Other researchers will present evidence that changes in BMD could be a useful surrogate marker for fracture risk in future clinical trials (Abstract 1070).

They looked at 21 trials of different therapies in patients with vertebral, nonvertebral, and hip fractures, and found that changes in BMD at 24 months explained a large percentage of the treatment-related reduction in fractures.

"We've had to always do trials in osteoporosis with 4-year fracture endpoints for every indication," Econs said, but these findings indicate that perhaps, in future, levels of this surrogate marker over a shorter period could be used instead. 

In other work, scientists will report on a potential marker for fracture risk in people with type 2 diabetes who had hip replacements. BMD was normal, but patients with increased fracture risk had higher levels of advanced glycation end products (Abstract 1039).

Another study, "Probiotic treatment using a mix of three lactobacillus strains protects against lumbar bone spine loss in healthy early postmenopausal women" (Abstract 1071) is interesting, Econs said, because it supports earlier findings in mice.

In this study of 234 postmenopausal women, "the probiotic treatment group lost less bone than the placebo group and it was mildly statistically significant," he noted, so this line of research starts to suggest this probiotic mixture works in mice and maybe it's useful in humans.

Burosumab for Rare Rickets, Romosozumab Update

In other sessions, researchers will present longer-term data from studies of burosumab (Crysvita, Ultragenyx Pharmaceutical), the monoclonal antibody that was recently approved to treat X-linked hypophosphatemia (XLH), a rare, inherited, progressive form of rickets.

The XLH treatment is based on patented discoveries Econs and Kenneth E. White, PhD, also from Indiana University, made.

As reported by Medscape Medical News, in April burosumab became the first therapy approved by the US Food and Drug Administration to treat adults and children age 1 year and older who have XLH.  It was also approved in the European Union earlier this year for the same indication.

As spelled out in a company news release, the pediatric-indication approval was supported by 64-week data in 52 patients age 5 to 12 years with XLH (study CL201) published in May (N Engl J Med. 2018;378:1987-1998).

That application was also supported by 40-week data from 13 patients age 1 to 4 years with XLH (study CL205). The adult-indication approval was supported by 24-week data on 134 adult patients with the disease (CL303) and by a bone biopsy study in 14 adult patients.

At ASBMR, researchers will present 88-week results from study CL201 in the older children (Abstract 1020) and 64-week results from study CL205 in the younger children (Abstract 1154), both showing sustained improvement during the longer follow-up.

Econs was not involved with these studies, but finds the results, "as somebody who takes care of these patients, very interesting and exciting."

Finally, as previously reported by Medscape Medical News, in July the FDA asked for more data for romosozumab (Amgen/UCB Pharma) for osteoporosis, which was expected after the company reported a higher rate of adverse cardiovascular events with the investigational drug compared with alendronate in the ARCH study

At ASBMR, researchers will present further data from ARCH, which investigates the use of a T-score as an indicator for fracture risk (Abstract 1074).

The meeting, Econs summarized, promises to be an exciting one where clinicians will have the opportunity to look at the latest research, mingle with colleagues, and potentially come away with practice-changing insights.

Econs has disclosed that he has a patent for burosumab.

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