The Johns Hopkins Arthritis CenterThe mission of the Johns Hopkins Arthritis WebSite is to provide a high quality, interactive, educational program for health care professionals about diseases that cause arthritis and their treatments. The Johns Hopkins Arthritis WebSite will focus primarily on rheumatoid arthritis and osteoarthritis since these diseases serve as prototypes for inflammatory and degenerative joint diseases, respectively. However, the editors may periodically add discussions of other types of arthritis (e.g., gout or spondyloarthropathies or psoriatic arthritis) as prompted by new therapies or other relevant issues.
JointZoneThis site is divided into five key contents sections about rheumatology and a section containing interactive case studies. The table of contents on your left serves as a navigational aid to help you move around the site. Try clicking on each subheading under each key section for a more detailed list. Key Topics:-
A diagnostic approach to the common arthritic conditionsIn this article we review the clinical approach to the diagnosis of some common rheumatic disorders and highlight some common pitfalls in the assessment of the patient presenting with musculoskeletal symptoms.
Treatment of Hypertension in Patients With Rheumatic Disease
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 Source: eshonline.org |
| Clinical Resource: Newsletter |
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| Last Checked: 19/08/15 | Link Error: Report It |
This document, written and produced by Arthritis Research UK, is an evidence-based report on the use of complementary and alternative medicines for arthritis and musculoskeletal conditions. It uses data from randomised controlled trials (RCTs) – the type of studies that give the best evidence on whether a treatment is effective or not – and aims to help people with these conditions select which complementary medicines may be useful for them.
Our first review, Complementary and alternative medicines for the treatment of rheumatoid arthritis, osteoarthritis and fibromyalgia, focused on products that are taken orally or applied to the skin. This second report considers practitioner-based therapies such as acupuncture, chiropractic, osteopathy and hypnotherapy, and other therapies such as magnet therapy and copper bracelets. The purpose is to provide a resource for patients and healthcare professionals by summarising current evidence on the effectiveness and safety of commonly used complementary or alternative therapies available within the UK.
| Source: arthritisresearchuk.org |
| Clinical Resource: Reports |
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| Last Checked: 28/04/14 | Link Error: Report It |
Drug-induced muscle and joint pains are severe adverse reactions.
Major drugs and drug classes associated with myalgia include suxamethonium, statins, fibrates, amiodarone, ciclosporin, colchicine, diuretics and danazol.
| Source: adr.org.uk |
| Clinical Resource: Factsheet |
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| Last Checked: 19/07/13 | Link Error: Report It |
The pain scales are recommended to be used by GP's and Accident and Emergency staff and may well also prove useful in a wider range of situations in which the communication of pain is necessary.
| Source: britishpainsociety.org |
| Clinical Resource: Pain Scales |
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| Last Checked: 17/07/15 | Link Error: Report It |
American Society of Interventional Pain Physicians Guidelines
| Source: asipp.org |
| Clinical Resource: Guidelines |
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| Last Checked: 19/07/13 | Link Error: Report It |
This is a free learning resource for any healthcare professional, seeking evidence based information and education on pain and its management.
The content for this website has been developed by a multidisciplinary team of healthcare professionals and key opinion leaders with specialist clinical and academic roles in pain management.
| Source: paincommunitycentre.org |
| Clinical Resource: Various |
| Register to Access Content: Yes - registration is FREE to healthcare professionals |
| Last Checked: 17/06/14 | Link Error: Report It |
Scottish Intercollegiate Guidelines Network (SIGN) Guideline > Management of Chronic Pain
| Source: sign.ac.uk |
| Clinical Resource: Guideline |
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| Last Checked: 28/09/17 | Link Error: Report It |
A consensus statement prepared on behalf of the British Pain Society, the Faculty of Pain Medicine of the Royal College of Anaesthetists, the Royal College of General Practitioners and the Faculty of Addictions of the Royal College of Psychiatrists
This guidance has been written for all healthcare professionals who manage patients with persistent pain, to help their understanding of the role of opioids in pain management. The document outlines good practice regarding decision making in relation to opioid therapy, ongoing monitoring of treatment and identification and management of problems related to opioid use.
| Source: britishpainsociety.org |
| Clinical Resource: Consensus Statement |
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| Last Checked: 17/07/15 | Link Error: Report It |
Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain
| Source: nationalpaincentre.mcmaster.ca |
| Clinical Resource: Guideline |
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Our goal in creating this handbook is to assist clinicians in managing adult patients with chronic non-malignant pain. We have attempted to provide information and resources that can be easily referenced as individual patient treatment plans are being developed. The information contained in this handbook is based on current consensus guidelines, expert opinion and studies when available. Despite an obvious need, the medical literature does not yet contain the high quality randomized controlled trials required to establish evidenced-based clinical standards for the management of chronic non-malignant pain.
Our discussion focuses on the use of long-term opioids because this is reported to be the area that is most challenging for clinicians, holding both the potential for benefit and the potential for social and medical adverse outcomes.
The handbook is organized in two major parts:
Part I: Principles of Prescribing Opioids—identifies basic issues relating to the use of opioids in chronic non-malignant pain.
Part II: Guide to Prescribing Opioids for Chronic Non-Malignant Pain—provides detailed prescribing information that can be referenced quickly while seeing patients.
| Source: careoregon.org |
| Clinical Resource: Handbook |
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| Last Checked: 19/07/13 | Link Error: Report It |
The intent of this book is to help clinicians make practical sense of the varied and often conflicting issues (pharmacological, clinical, and regulatory) surrounding opioid pharmacotherapy, in order to promote the most healthful outcomes possible for patients in pain. The aim is to improve knowledge and skills related to both the principles of prescribing and the management of risk. In this way, healthcare professionals and those they serve may benefit increasingly from the unique therapeutic potential of this drug class, and fear less the undeniable, yet manageable, potential for harm.
| Source: stoppain.org |
| Clinical Resource: Book |
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| Last Checked: 08/07/13 | Link Error: Report It |
Withdrawal occurs in patients taking opioids regularly when:
| Source: knowledgex.camh.net |
| Clinical Resource: Advice |
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| Last Checked: 19/07/13 | Link Error: Report It |
A consensus statement prepared by The British Pain Society in collaboration with The Royal College of Psychiatrists, The Royal College of General Practitioners and The Advisory Council on the Misuse of Drugs
This document aims to identify elements of good practice in the management of pain and in the prescription of opioid drugs. It provides non-specialists with appropriate information to assess the needs of and manage pain in patients who are or have previously been substance misusers. The document also gives guidance on models of collaborative working among relevant healthcare professionals involved in the care of patients with pain who are using, or are at risk of using, drugs inappropriately. It therefore aims to improve practice in managing this group of patients with complex needs.
| Source: britishpainsociety.org |
| Clinical Resource: Consensus Statement |
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| Last Checked: 17/07/15 | Link Error: Report It |
Patients who require opioids for chronic pain management might need to be switched to another opioid either due to:
| Source: knowledgex.camh.net |
| Clinical Resource: Advice |
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| Last Checked: 19/07/13 | Link Error: Report It |
Persistent pain—painful sensation that continues for a prolonged period of time and may or may not be associated with a well defined disease process—is prevalent in older adults. The American Geriatrics Society is pleased to provide tools to assist clinicians in providing optimal care to older adults who suffer from pain, as well as resources for patients and caregivers on pain management and treatment.
| Source: americangeriatrics.org |
| Clinical Resource: Guideline |
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| Last Checked: 20/08/15 | Link Error: Report It |
The purpose of this article is to review acute illnesses that interact with the management of pain, where misuse of analgesic agents would be detrimental to the patient. Two broad etiologies can be applied to most of the discussion: increased drug toxicity due to acute illness and worsened acute illness due to improper analgesic selection.
| Source: uspharmacist.com |
| Clinical Resource: Journal Article |
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| Last Checked: 19/07/13 | Link Error: Report It |
This site aims to gather together information on topical analgesics.
| Source: bandolier.org.uk |
| Clinical Resource: Evidence Based Abstracts |
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| Last Checked: 13/06/17 | Link Error: Report It |
The purpose of this paper is to draw together information which will enable secondary care providers to make an informed choice about the strategies they could adopt to support safer prescribing of NSAIDs within their trusts.
| Source: suffolkextranet.nhs.uk |
| Clinical Resource: Briefing Paper |
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| Last Checked: 19/07/13 | Link Error: Report It |
This article summarises current evidence of relative CV and GI risks for non-aspirin NSAIDs and highly selective COX-2 inhibitors (coxibs), and provides prescribing advice which is consistent with previous advice from the Commission on Human Medicines.
| Source: webarchive.org.uk |
| Clinical Resource: National Prescribing Centre Publication |
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| Last Checked: 24/04/15 | Link Error: Report It |
| Source: wales.nhs.uk |
| Clinical Resource: Guideline |
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| Last Checked: 22/04/13 | Link Error: Report It |
American College of Gastroenterology Guidelines for Prevention of NSAID-Related Ulcer Complications
| Source: gi.org |
| Clinical Resource: Guideline |
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| Last Checked: 19/07/13 | Link Error: Report It |
Pharmacy letter insert with advice on appropriate use of NSAIDs to minimise risk to patients from their use.
| Source: nps.org.au |
| Clinical Resource: National Prescribing Service Publication |
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| Last Checked: 19/07/13 | Link Error: Report It |
As the debate continues about whether the EC formulation provides gastro-protection compared with the uncoated tablets, in addition to the cost differential of the two products (three-fold difference at time of writing based on Drug Tariff June 2013), a summary of the findings of the DTB and an update of the literature with a focus on the implications of switching formulations are presented
| Source: sps.nhs.uk |
| Clinical Resource: Medicines Question and Answer |
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| Last Checked: 22/09/16 | Link Error: Report It |
| Source: sign.ac.uk |
| Clinical Resource: Guideline |
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| Last Checked: 28/09/17 | Link Error: Report It |
This bulletin will focus on the contemporary management of RA.
| Source: stjames.ie |
| Clinical Resource: Medicines Information Centre Bulletin |
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| Last Checked: 19/07/13 | Link Error: Report It |
This review will focus on elderly-onset RA (EORA) but the principles of therapy are identical for RA in the elderly.
| Source: shpa.org.au |
| Clinical Resource: Journal Article |
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| Last Checked: 19/07/13 | Link Error: Report It |
Table of disease-modifying antirheumatic drugs (DMARDs) includes contraindications and monitoring.
| Source: nps.org.au |
| Clinical Resource: National Prescribing Service Publication |
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| Last Checked: 17/02/14 | Link Error: Report It |
This article covers important aspects of the care of patients taking DMARDs including monitoring requirements, adverse effects and drug interactions.
| Source: bpac.org.nz |
| Clinical Resource: Journal Article |
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| Last Checked: 19/07/13 | Link Error: Report It |
Low-dose oral methotrexate therapy, i.e. less than 25mg taken as a single dose once a week, is generally safe when prescribed for non-neoplastic diseases that are characterised by inflammation, such as rheumatoid arthritis. Compared to second-line disease-modifying anti-rheumatic drugs (DMARDs), methotrexate is usually well tolerated and its side-effects predictable.
| Source: saferx.co.nz |
| Clinical Resource: Bulletin |
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| Last Checked: 19/07/13 | Link Error: Report It |
Methotrexate is a folic acid antagonist with cytotoxic, immunosuppressive and anti-inflammatory actions. Due to its ease of use, low cost and favourable efficacy/toxicity profile, it has become established as the most commonly used disease-modifying anti-rheumatic drug (DMARD) for the treatment of rheumatoid arthritis (RA).
| Source: auspharmlist.net.au |
| Clinical Resource: Pharmacy E-Bulletin |
| Register to Access Content: No |
| Last Checked: 19/07/13 | Link Error: Report It |
Does Folic Acid Reduce the Toxicity of Methotrexate?
| Source: medscape.com |
| Clinical Resource: Question and Response |
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| Last Checked: 19/07/13 | Link Error: Report It |
A: MTX continues to be one of the most important disease-modifying antirheumatic drugs (DMARDs) for the treatment of rheumatoid arthritis.
| Source: duq.edu |
| Clinical Resource: Pharmaceutical Information Centre Publication |
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| Last Checked: 19/07/13 | Link Error: Report It |
Methotrexate (MTX) is an antimetabolite cytotoxic drug with immunosuppressant properties. It is used in high doses (>1g/m2 of body surface area) to treat malignant neoplasms, and in low doses (<25mg) in the treatment of psoriasis and rheumatoid arthritis. This bulletin aims to provide an overview of some clinically significant drug interactions of MTX.
| Source: druginformation.co.nz |
| Clinical Resource: Drug Information Service Bulletin |
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| Last Checked: 19/07/13 | Link Error: Report It |
This guidance has been developed to support practitioners in the safe and effective assessment, screening and management of patients when biologic therapies are being considered. It provides practitioners with practical information to help them care for patients with different forms of inflammatory arthritis, in all care settings.
The aim of this document is to provide practitioners with an outline of current biologic therapies, both licensed and unlicensed, and refers the reader to additional key documents and resources that will support practitioners in the UK to develop a standardised approach to caring for patients receiving biologic therapies.
| Source: rcn.org.uk |
| Clinical Resource: Guidance |
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| Last Checked: 22/02/17 | Link Error: Report It |
First-line therapy for acute gout is nonsteroidal anti-inflammatory drugs or corticosteroids, depending on comorbidities; colchicine is second line therapy.
| Source: aafp.org |
| Clinical Resource: Journal Article |
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| Last Checked: 19/07/13 | Link Error: Report It |
The Bandolier gout site seeks to build good evidence about gout and its treatment.
| Source: bandolier.org.uk |
| Clinical Resource: Evidence Based Abstracts |
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| Last Checked: 13/06/17 | Link Error: Report It |
This article reviews basic pathways in purine metabolism, uric acid handling, and the pathogenic mechanism of clinical gout, as well as the areas in those pathways amenable to intervention. Attention is also given to associated comorbidities, such as hyperuricemia and obesity, hypertension, hyperinsulinemia, and coronary artery disease. The significance of lifestyle modifications, such as weight loss and alcohol reduction, is discussed as an important adjunct to pharmacotherapy in gout. Current and investigational agents used in gout management are also reviewed. Finally, treatment recommendations for acute and chronic gout are suggested.
| Source: ajmc.com |
| Clinical Resource: Journal Article |
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| Last Checked: 19/07/13 | Link Error: Report It |
Even though gout is often thought of as a middle-age malady, it is the most common inflammatory arthritis seen in the elderly. Epidemiologic studies of aging populations have shown rises in the incidence and prevalence of gout in both sexes.
| Source: clinicalgeriatrics.com |
| Clinical Resource: Journal Article |
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| Last Checked: 05/03/13 | Link Error: Report It |
Inpatients with gout often have a wide variety of co-morbidities - including chronic renal failure, ischaemic heart disease, congestive heart failure, peptic ulcer disease, and diabetes mellitus. In addition, gout is often complicated by the concurrence of sepsis, thus presenting a diagnostic challenge and management problem.
| Source: nzma.org.nz |
| Clinical Resource: Journal Article |
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| Last Checked: 13/05/16 | Link Error: Report It |
The purpose of this newsletter is to provide direction on the management of gout in patients with CKD, including pertinent updates from the new guidelines.
| Source: oregonstate.edu |
| Clinical Resource: Newsletter |
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| Last Checked: 19/08/15 | Link Error: Report It |
In this paper, we discuss approaches to and controversies in the management of gout and hyperuricemia in patients with CKD. Unfortunately, the evidence from clinical trials to guide treatment decisions is limited; therefore, decisions must often be based on experience and pathophysiologic principles.
| Source: mdedge.com |
| Clinical Resource: Journal Article |
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| Last Checked: 19/06/17 | Link Error: Report It |
The treatment of gout in patients with heart failure is complicated by their fragile volume state and chronic renal failure, both of which prohibit the use of non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids. Moreover, drug interactions exist between drugs used for the treatment of hyperuricemia and gout and pharmacological agents used for the therapy of heart failure. This review therefore focuses on the treatment of hyperuricemia and gout in patients with heart failure.
| Source: eu.wiley.com |
| Clinical Resource: Journal Article |
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| Last Checked: 17/06/14 | Link Error: Report It |
Fatal poisonings have been reported in patients who have taken as little as 7mg, although some patients have taken up to 60mg and survived. Symptoms of acute colchicine toxicity usually appear 2 to 12 hours after ingestion, and often before the analgesic effects start. Toxic effects may include gastrointestinal (GI) symptoms, electrolyte derangement, haematological effects, renal failure, and hepatic damage.
| Source: saferx.co.nz |
| Clinical Resource: Bulletin |
| Register to Access Content: No |
| Last Checked: 19/07/13 | Link Error: Report It |
Dosing guidelines vary according to the reference source, which may lead to confusion regarding safe and effective dosing.
| Source: dpic.org |
| Clinical Resource: Drug and Poison Information Centre Newsletter |
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| Last Checked: 19/10/15 | Link Error: Report It |
Colchicine can be very effective in the treatment of gout and familial Mediterranean fever. Unfortunately, however, its therapeutic effects (primarily on white blood cells) can lead to life-threatening toxicity if colchicine plasma concentrations become too high. One of the causes of dangerously elevated colchicine concentrations is interaction with other drugs.
| Source: hanstenandhorn.com |
| Clinical Resource: Journal Article |
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| Last Checked: 05/06/15 | Link Error: Report It |
American Academy of Orthopaedic Surgeons Clinical Practice Guidelines
| Source: aaos.org |
| Clinical Resource: Clinical Guidelines |
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| Last Checked: 20/08/15 | Link Error: Report It |
| Source: oarsi.org |
| Clinical Resource: Guideline and Update |
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| Last Checked: 22/11/13 | Link Error: Report It |
Osteoarthritis is the most common arthropathy worldwide and the clinical and radiological prevalence increase with age. The aetiology is uncertain, but genetic and environmental factors are recognised. Symptoms predominantly occur in the spine, hips, knees, hands and feet, in isolation or combination, and may be relapsing – remitting or progressive. The signs may mimic inflammatory arthropathies or non-articular rheumatism, but clinical signs and appropriate investigations are discriminatory.
| Source: rcpe.ac.uk |
| Clinical Resource: Journal Article |
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| Last Checked: 19/07/13 | Link Error: Report It |
Osteoarthritis (OA) is a common condition that causes significant morbidity. The average family doctor can become overwhelmed by both the number of people in their practice with this condition and frustrated with what seems to be a paucity of treatment options available to offer those who suffer from OA.
| Source: stacommunications.com |
| Clinical Resource: Journal Article |
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| Last Checked: 19/07/13 | Link Error: Report It |
Osteoarthritis is the most common form of arthritis and a leading cause of pain and disability around the world. It affects approximately 50% of people aged over 60 years and almost all people aged over 80 years. However osteoarthritis is not just caused by ageing.
| Source: bpac.org.nz |
| Clinical Resource: Journal Article |
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| Last Checked: 19/07/13 | Link Error: Report It |
The rationale for the use of glucosamine in osteoarthritis (OA) is that it is a precursor for glycosaminoglycans and glycoproteins, which are a major constituent of joint cartilage and synovial fluid.
| Source: auspharmlist.net.au |
| Clinical Resource: Pharmacy E-Bulletin |
| Register to Access Content: No |
| Last Checked: 24/02/14 | Link Error: Report It |
Glucosamine is a normal constituent of the proteoglycans found in joint cartilage and synovial fluid. It has been recommended for many years by practitioners of complementary medicine for the treatment of osteoarthritis. Clinical trials have now shown that the use of oral glucosamine sulphate 1.5 g daily in patients with osteoarthritis of the knee results in a significant reduction in joint pain and an improvement in joint function.
| Source: nps.org.au |
| Clinical Resource: Journal Article |
| Register to Access Content: No |
| Last Checked: 08/08/16 | Link Error: Report It |
Glucosamine is available in a variety of over-the-counter dietary supplements and as licensed prescription only medicines, therefore quality and content varies between products. Little information is available about herbs and dietary supplements in patients with renal impairment.
| Source: sps.nhs.uk |
| Clinical Resource: Medicines Question and Answer |
| Register to Access Content: No |
| Last Checked: 22/09/16 | Link Error: Report It |
Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA; also known as temporal arteritis) are common, interrelated inflammatory disorders that occur predominantly in persons older than 50 years. GCA most commonly involves the temporal artery, but arteries in other parts of the body also can be inflamed. It is the most common primary vasculitis among older persons and can lead to blindness if not diagnosed and treated in a timely manner.
| Source: aafp.org |
| Clinical Resource: Journal Article |
| Register to Access Content: No |
| Last Checked: 19/07/13 | Link Error: Report It |
Polymyalgia rheumatica (PMR) is an inflammatory condition of the muscles and joints and is characterized by stiffness and pain in the neck, shoulders, hips, and buttocks. Morning stiffness that lasts several hours is common. The onset of pain can be sudden or gradual and affects both sides of the body. Approximately 15% of patients with PMR develop giant cell arteritis (GCA), and nearly 50% of patients with GCA will develop PMR over time.
| Source: uspharmacist.com |
| Clinical Resource: Journal Article |
| Register to Access Content: No |
| Last Checked: 19/07/13 | Link Error: Report It |
Polymyalgia rheumatica (PMR) is a relatively common clinical syndrome of unknown etiology. It is characterized by proximal myalgia of the hip and shoulder girdles with accompanying morning stiffness that lasts for more than 1 hour. Approximately 15% of patients with polymyalgia rheumatica develop giant cell arteritis (GCA), and approximately 50% of patients with giant cell arteritis have associated polymyalgia rheumatica.
| Source: medscape.com |
| Clinical Resource: Article |
| Register to Access Content: No |
| Last Checked: 19/07/13 | Link Error: Report It |
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect almost any organ system; thus, its presentation and course are highly variable, ranging from indolent to fulminant.
| Source: medscape.com |
| Clinical Resource: Article |
| Register to Access Content: No |
| Last Checked: 19/07/13 | Link Error: Report It |
The American College of Rheumatology (ACR) criteria for the classification of lupus are, I understand up for renewal. For over two decades, they have provided the benchmark for clinico-pathological surveys worldwide and have (admittedly with some rust spots) stood the test of time.
| Source: lupus.org.uk |
| Clinical Resource: |
| Register to Access Content: No |
| Last Checked: 19/07/13 | Link Error: Report It |
Welcome to WheelessOnline.com, the premier website for the busy orthopaedist. Duke University Medical Center's Division of Orthopaedic Surgery, in conjunction with Data Trace Internet Publishing, LLC is proud to present Wheeless' Textbook of Orthopaedics. This is the most comprehensive, unparalleled, dynamic online medical textbook in existence. Looking through our 11,000 pages with more than 5,000 images, you'll find this key reference in an easy to read outline format. Each topic is fully searchable by alphabetical, anatomical and keyword searches, or just click on a particular part of the Skeleton for easy access. Wheeless' Textbook of Orthopaedics is updated daily.
| Source: wheelessonline.com |
| Clinical Resource: Textbook |
| Register to Access Content: No |
| Last Checked: 19/07/13 | Link Error: Report It |
This is an educational site for physicians and patients.
| Source: washington.edu |
| Clinical Resource: Various |
| Register to Access Content: No |
| Last Checked: 05/01/15 | Link Error: Report It |
The FRAX® tool has been developed by WHO to evaluate fracture risk of patients. It is based on individual patient models that integrate the risks associated with clinical risk factors as well as bone mineral density (BMD) at the femoral neck.
The FRAX® models have been developed from studying population-based cohorts from Europe, North America, Asia and Australia. In their most sophisticated form, the FRAX® tool is computer-driven and is available on this site. Several simplified paper versions, based on the number of risk factors are also available, and can be downloaded for office use.
The FRAX® algorithms give the 10-year probability of fracture. The output is a 10-year probability of hip fracture and the 10-year probability of a major osteoporotic fracture (clinical spine, forearm, hip or shoulder fracture).
| Source: shef.ac.uk |
| Clinical Resource: Various |
| Register to Access Content: No |
| Last Checked: 17/05/13 | Link Error: Report It |
QFracture is used to estimate an individual's risk of developing
over the next 10 years.
The algorithms can be used to identify people at high risk of these fractures so they can be assessed in more detail to reduce their risk.
| Source: qfracture.org |
| Clinical Resource: Various |
| Register to Access Content: No |
| Last Checked: 17/05/13 | Link Error: Report It |
Osteoporosis Risk Assessment Instrument (ORAI) was developed and validated in a cohort of Canadian women and had a sensitivity of 94.4% and specificity of 41.4% in that population.
| Source: washington.edu |
| Clinical Resource: Clinical Calculator |
| Register to Access Content: No |
| Last Checked: 05/01/15 | Link Error: Report It |
SCORE was developed by Lydick et al. to identify post-menopausal women who may have a T score of < -2 and should be screened.
| Source: washington.edu |
| Clinical Resource: Clinical Calculator |
| Register to Access Content: No |
| Last Checked: 05/01/15 | Link Error: Report It |
The FORE 10-Year Fracture Risk Calculator™ (FORE FRC) Version 2.0 published 12/4/2012 estimates 10-year fracture risk for postmenopausal women and men age 45 and older who are not receiving treatment for osteoporosis.
| Source: fore.org |
| Clinical Resource: Calculator |
| Register to Access Content: No |
| Last Checked: 17/05/13 | Link Error: Report It |
| Source: sign.ac.uk |
| Clinical Resource: Guideline |
| Register to Access Content: No |
| Last Checked: 28/09/17 | Link Error: Report It |
| Source: sign.ac.uk |
| Clinical Resource: Guideline |
| Register to Access Content: No |
| Last Checked: 28/09/17 | Link Error: Report It |
| Source: osteoporosis.ca |
| Clinical Resource: Guideline |
| Register to Access Content: No |
| Last Checked: 19/07/13 | Link Error: Report It |
The Clinician’s Guide to Prevention and Treatment of Osteoporosis was developed by an expert committee of the National Osteoporosis Foundation (NOF) in collaboration with a multispecialty council of medical experts in the field of bone health convened by NOF.
This Guide offers concise recommendations regarding prevention, risk assessment, diagnosis, and treatment of osteoporosis in postmenopausal women and men age 50 and older. It includes indications for bone densitometry and fracture risk thresholds for intervention with pharmacologic agents.
| Source: nof.org |
| Clinical Resource: Guide |
| Register to Access Content: No |
| Last Checked: 20/08/15 | Link Error: Report It |
Osteoporosis Australia | Research Papers & Position Papers
This section contains Osteoporosis-related research papers and a selection of recent position papers produced by the our Medical and Scientific Advisory Committee.
| Source: osteoporosis.org.au |
| Clinical Resource: Research Papers and Position Papers |
| Register to Access Content: No |
| Last Checked: 21/08/15 | Link Error: Report It |
Click on a category to see a list of common questions.
General Questions
Top Questions
Epidemiology
Bone Density Measurement
Male Osteoporosis
Drug Therapy
General
Bisphosphonates
Calcitonin
Estrogen
SERMs
Teriparitide
Thiazides
Prevention
Calcium and Vitamin D
Falls and Exercise
Risk Assessment
Screening Issues
Secondary Osteoporosis
Depot Medroxyprogesterone
Eating Disorders
Medication
Vitamin D Deficiency
| Source: washington.edu |
| Clinical Resource: Questions and Answers |
| Register to Access Content: No |
| Last Checked: 05/01/15 | Link Error: Report It |
Osteoporosis Update provides the most current, reliable information to support general practitioners and other health professionals involved in the daily clinical management of osteoporosis.
| Source: osteoporosis.ca |
| Clinical Resource: Periodical |
| Register to Access Content: No |
| Last Checked: 08/05/13 | Link Error: Report It |
These courses encompass information from the causes and diagnosis of osteoporosis through to a review of treatment strategies. Advice on overcoming barriers to improved care is provided. The target audience of this programme is qualified physicians in secondary care and specialist primary care.
Course 1: Understanding bone metabolism
Course 2: Risk assessment and diagnostic techniques
Course 3: Management strategies for osteoporosis
Course 4: Fracture healing and osteoporosis
| Source: iofbonehealth.org |
| Clinical Resource: e-Learning |
| Register to Access Content: Yes - registration is FREE |
| Last Checked: 24/04/15 | Link Error: Report It |
Osteoporosis Resources for Primary Care is a joint initiative of the National Osteoporosis Society and the Royal College of General Practitioners.
It seeks to provide GPs, Practice Nurses and other health professionals in the practice team with the clear, concise information they need to effectively manage osteoporosis and reduce fracture risk in older people.
| Source: osteoporosis-resources.org.uk |
| Clinical Resource: Guide |
| Register to Access Content: No |
| Last Checked: 08/05/13 | Link Error: Report It |
The National Osteoporosis Guideline Group gratefully acknowledges the collaboration of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) and the support of the Bone Research Society, British Geriatrics Society, British Orthopaedic Association, Bone Research Society, British Society of Rheumatology, National Osteoporosis Society, Osteoporosis 2000, Osteoporosis Dorset, Primary Care Rheumatology Society, Royal College of Physicians and Society for Endocrinology.
| Source: shef.ac.uk |
| Clinical Resource: Guideline |
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| Last Checked: 08/05/13 | Link Error: Report It |
| Source: aace.com |
| Clinical Resource: Guideline |
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| Last Checked: 19/07/13 | Link Error: Report It |
European guidance for the diagnosis and management of osteoporosis in postmenopausal women
| Source: iofbonehealth.org |
| Clinical Resource: Position Paper |
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| Last Checked: 08/05/13 | Link Error: Report It |
| Source: nos.org.uk |
| Clinical Resource: Position Statement |
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| Last Checked: 08/05/13 | Link Error: Report It |
This bulletin focuses on the pharmacological management of patients with post-menopausal osteoporosis - both those with clinically evident disease (e.g. prior osteoporotic fracture) and those who are identified as being at high-risk of fracture.
| Source: wemerec.org |
| Clinical Resource: Medicines Resource Centre Bulletin |
| Register to Access Content: No |
| Last Checked: 16/11/17 | Link Error: Report It |
This document presents evidence-based guidelines for the management of glucocorticoidinduced osteoporosis.
| Source: nos.org.uk |
| Clinical Resource: Guideline |
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| Last Checked: 08/05/13 | Link Error: Report It |
Reviewed and supported by the National Osteoporosis Society (NOS), the National Cancer Research Institute (NCRI) Breast Cancer Study Group and the International Osteoporosis Foundation (IOF)
| Source: nos.org.uk |
| Clinical Resource: Consensus Position Statement |
| Register to Access Content: No |
| Last Checked: 08/05/13 | Link Error: Report It |
This issue of “Osteoporosis Clinical Updates” provides tools and suggestions for identifying those CKD patients who would benefit from treatment for osteoporosis in a general practice setting and who would be better served by referral to a specialist with experience in renal-related bone disease.
| Source: nof.org |
| Clinical Resource: Update |
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| Last Checked: 20/08/15 | Link Error: Report It |
Bisphosphonate therapy is now the mainstay of treatment for patients with primary and secondary forms of osteoporosis. This class of drugs has earned this role because of multiple studies documenting the reduction in the incidence of vertebral and other fragility fractures in older women with osteoporosis at moderate to high fracture risk and the prevention of bone loss in many other medical conditions with bisphosphonate therapy. After beginning therapy, clinicians then confront the question of how long therapy should be continued.
| Source: sbdens.org.br |
| Clinical Resource: Publication |
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| Last Checked: 08/05/13 | Link Error: Report It |
Clinical Question: Can patients with osteoporosis who have been on bisphosphonates for 5 years discontinue treatment without increasing future fracture risk?
| Source: acfp.ca |
| Clinical Resource: Article |
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| Last Checked: 21/08/15 | Link Error: Report It |
A. The bisphosphonates (alendronate, risedronate, and ibandronate) play an important role in the treatment and prevention of osteoporosis. Intravenous bisphosphonates (pamidronate and zoledronic acid) are also commonly used in the management of hypercalcemia associated with malignancy and in multiple myeloma. Although generally well tolerated, the long-term effect of these drugs on bone turnover has come into question.
| Source: duq.edu |
| Clinical Resource: Pharmaceutical Information Centre Publication |
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| Last Checked: 08/05/13 | Link Error: Report It |
There has recently been considerable debate surrounding the required duration of treatment with bisphosphonates to produce the optimal antifracture activity without subjecting the patient to unnecessary treatment and its possible attendent adverse effects.
| Source: wemerec.org |
| Clinical Resource: Medicines Resource Centre E-Note |
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| Last Checked: 16/11/17 | Link Error: Report It |
Bone disease is commonly associated with chronic kidney disease (CKD), and the prevalence of skeletal abnormalities in those with end-stage renal disease approaches 100%. While renal osteodystrophy is the collective term for various types of uraemia-related bone remodelling, including hyperparathyroid bone disease, adynamic bone disease and osteomalacia, persons with CKD can also develop osteoporosis.
| Source: rcpe.ac.uk |
| Clinical Resource: Journal Article |
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| Last Checked: 17/02/14 | Link Error: Report It |
| Source: aaoms.org |
| Clinical Resource: Position Paper |
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| Last Checked: 20/08/15 | Link Error: Report It |
| Source: caoms.com |
| Clinical Resource: Guideline |
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| Last Checked: 19/07/13 | Link Error: Report It |
On behalf of the Australian and New Zealand Bone and Mineral Society, Osteoporosis Australia, Medical Oncology Group of Australia, and the Australian Dental Association.
| Source: racgp.org.au |
| Clinical Resource: Position Statement |
| Register to Access Content: No |
| Last Checked: 19/07/13 | Link Error: Report It |
This guidance has been developed to inform dental practitioners about how to manage patients prescribed bisphosphonates. Prescribers and dispensers of bisphosphonates, as well as patients may also find the information in this guidance of relevance.
| Source: sdcep.org.uk |
| Clinical Resource: Guidance |
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| Last Checked: 20/08/15 | Link Error: Report It |
Upon completion of this CE material, the participant should be able to:
| Source: nof.org |
| Clinical Resource: Update |
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| Last Checked: 20/08/15 | Link Error: Report It |
The role of calcium and vitamin D in the management of osteoporosis
The role of calcium and vitamin D supplementation in the treatment of osteoporosis has been extensively studied. The aim of this paper was to reach, where possible, consensus views on five key questions relating to calcium and vitamin D supplementation in the management of osteoporosis.
| Source: esceo.org |
| Clinical Resource: Paper |
| Register to Access Content: No |
| Last Checked: 20/08/15 | Link Error: Report It |
A document has been written which lists the available products for treating vitamin D deficiency and insufficiency, including cost, licensing status, and risk category.
| Source: sps.nhs.uk |
| Clinical Resource: Medicines Question and Answer |
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| Last Checked: 22/09/16 | Link Error: Report It |
This briefing paper discusses both the skeletal and regulatory role of calcium, and also calcium homeostasis. This is followed by information on dietary reference values, sources of calcium in the diet and information on calcium intake in the UK, including trends in intake. Bioavailability of calcium from foods is also discussed as this is an important determinant of the relative value of food sources of calcium. Finally, calcium and bone health, and the evidence for a role of calcium in cancer, cardiovascular disease and weight management are discussed.
| Source: nutrition.org.uk |
| Clinical Resource: Briefing Paper |
| Register to Access Content: No |
| Last Checked: 19/07/13 | Link Error: Report It |
Clinical Question: Does calcium (Ca+) supplementation contribute to increased risk of myocardial infarction (MI) and other cardiovascular disease (CVD)?
| Source: acfp.ca |
| Clinical Resource: Article |
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| Last Checked: 21/08/15 | Link Error: Report It |
| Source: endocrine.org |
| Clinical Resource: Guideline |
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| Last Checked: 07/06/13 | Link Error: Report It |
Developed by a group of clinicians and scientists with expertise in vitamin D and osteoporosis to address three key areas: Who to test for vitamin D deficiency, How to interpret vitamin D measurements and How to treat vitamin D deficiency.
| Source: nos.org.uk |
| Clinical Resource: Guideline |
| Register to Access Content: No |
| Last Checked: 08/06/13 | Link Error: Report It |
Consensus Vitamin D position statement
This consensus statement represents the unified views of the British Association of Dermatologists, Cancer Research UK, Diabetes UK, the Multiple Sclerosis Society, the National Heart Forum, the National Osteoporosis Society and the Primary Care Dermatology Society.
| Source: nos.org.uk |
| Clinical Resource: Position Statement |
| Register to Access Content: No |
| Last Checked: 19/07/13 | Link Error: Report It |
Developed by a group of clinicians and scientists with expertise in vitamin D and osteoporosis to address three key areas: Who to test for vitamin D deficiency, How to interpret vitamin D measurements and How to treat vitamin D deficiency.
| Source: nos.org.uk |
| Clinical Resource: Guideline |
| Register to Access Content: No |
| Last Checked: 08/05/13 | Link Error: Report It |
| Source: esceo.org |
| Clinical Resource: Postion Paper |
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| Last Checked: 23/10/15 | Link Error: Report It |
Update on Drug-Induced Osteoporosis (DIO)
Many commonly prescribed drugs are known to cause bone loss. The aim of this newsletter is to review drugs associated with osteoporosis (OP), the frequency of occurrence, prevention and management.
| Source: usask.ca |
| Clinical Resource: Drug Information Service Newsletter |
| Register to Access Content: No |
| Last Checked: 11/05/15 | Link Error: Report It |
| Source: idsociety.org |
| Clinical Resource: Guideline |
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| Last Checked: 15/05/15 | Link Error: Report It |
| Source: acponline.org |
| Clinical Resource: Guideline and Review |
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| Last Checked: 30/12/13 | Link Error: Report It |
European Guidelines for the Management of Acute Nonspecific Low Back Pain in Primary Care
| Source: backpaineurope.org |
| Clinical Resource: Guideline |
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| Last Checked: 19/07/13 | Link Error: Report It |
European Guidelines for the Management of Chronic Non-Specific Low Back Pain in Primary Care
| Source: backpaineurope.org |
| Clinical Resource: Guideline |
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| Last Checked: 19/07/13 | Link Error: Report It |
| Source: bandolier.org.uk |
| Clinical Resource: Evidence Based Abstracts |
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| Last Checked: 13/06/17 | Link Error: Report It |
This bulletin discusses the appropriate management of acute, uncomplicated or non-specific low back pain in the primary care setting. It focuses on overall management strategies, including appropriate first-line medicines.
| Source: wemerec.org |
| Clinical Resource: Medicines Resource Centre Bulletin |
| Register to Access Content: No |
| Last Checked: 16/11/17 | Link Error: Report It |
Canadian Guidelines for the Diagnosis and Management of Fibromyalgia Syndrome in Adults
Comprehensive, evidence-based and written by a panel of experts from across the country. Endorsed by both the Canadian Pain Society and the Canadian Rheumatology Association.
| Source: canadianpainsociety.ca |
| Clinical Resource: Guideline |
| Register to Access Content: No |
| Last Checked: 19/07/13 | Link Error: Report It |
Most patients complain of widespread musculoskeletal pain. The pain is typically diffuse or multifocal, and its intensity varies over time. Patients also may complain of morning stiffness and swelling of joints or limbs, resembling symptoms of rheumatoid arthritis. Other frequently encountered symptoms are fatigue, reduced energy and drive, and disturbed sleep.
| Source: iasp-pain.org |
| Clinical Resource: Newsletter |
| Register to Access Content: No |
| Last Checked: 07/05/15 | Link Error: Report It |
The following is an evidence-based summary of available therapies for FMS. Generally, the evidence from clinical trials with these agents is limited by the relatively short duration of study and low subject count.
| Source: usask.ca |
| Clinical Resource: Drug Information Services Newsletter |
| Register to Access Content: No |
| Last Checked: 18/03/13 | Link Error: Report It |
The neuromuscular site is a welcome exception. It presents a huge amount of information in a way that allows the viewer to skim or delve as desired. Much of the content is in tabular form that is easy to understand and a link to a more detailed explanation is always available. It is an admirable mixture of molecular biology with clinical medicine. It is well illustrated-the photographs of muscle biopsies are worth a visit in themselves. As one gets deeper into a topic, links are provided to other worthwhile sources, such as the On-Line Mendelian Inheritance of Man.
Even though the focus of this site is a small subspecialty area, there is enough practical basic science to be useful to the general neurologist. The site is regularly updated.
| Source: neuromuscular.wustl.edu |
| Clinical Resource: Various |
| Register to Access Content: No |
| Last Checked: 19/07/13 | Link Error: Report It |
This handbook is written as an aide to all healthcare personnel who are involved in the care and management of patients with myasthenia gravis.
| Source: myasthenia.org |
| Clinical Resource: Manual |
| Register to Access Content: No |
| Last Checked: 19/07/13 | Link Error: Report It |
Medications and Myasthenia Gravis
(A Reference for Health Care Professionals)
| Source: myasthenia.org |
| Clinical Resource: Educational Material |
| Register to Access Content: No |
| Last Checked: 19/07/13 | Link Error: Report It |
What drugs should be avoided in myasthenia gravis?
| Source: uic.edu |
| Clinical Resource: Frequently Asked Question |
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| Last Checked: 04/12/15 | Link Error: Report It |
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