International Society for Clinical Densitometry 13th Annual Meeting Pediatrics to Geriatrics Tampa Marriott Waterside Hotel & Marina Tampa, Florida, USA March 14-17, 2007

Wednesday, March 14, 2007

Thursday, March 15, 2007

Down to the Bone: Issues in the Maintenance and Evaluation of Bone Health

6:00 – 7:00 pm Reception in Exhibit Hall

7:00 – 9:00 pm Symposium in Florida Ballroom

• Welcome and Introductions  Sydney Bonnick, MD, CCD, Chair
• Choosing an Osteoporosis Therapy  Christine Simonelli, MD, CCD
• Vitamin D and Antifracture Efficacy  Robert P. Heaney, MD
• Mechanical and Structural Properties of Cortical and Trabecular Bone in Order to Better Distinguish the Determiners of Bone Strength  Anthony I. Sebba, MD

• Review of Bone Quality Measurement Methodologies  Sydney Bonnick, MD, CCD

Program Overview

By examining the impact of several issues involved in the maintenance and/or evaluation of bone health, attendees will be better able to treat their patients suffering from debilitating conditions such as osteoporosis. Discussion of recent pharmacologic data relating to bone mineral density and biochemical markers of turnover will enhance the attendees’ store of knowledge for the optimum treatment of bone patients. In addition, assessment of vitamin D in terms of fall reduction and antifracture efficacy is a promising field of investigation as is the Hip Structure Analysis (HSA) method in the measurement of bone strength, in both its current form and its development towards even greater accuracy. Moreover, examining mechanical and structural properties of bone in terms of cortical and trabecular architecture can aid clinicians in delineating bone health and the impact of its debilitation.

Learning Objectives

After completing this activity, the participant should be better able to:

• Identify recent pharmacological data in the context of selecting optimum treatment strategies
• Explain the role vitamin D has in antifracture efficacy
• Describe the mechanical and structural properties of cortical and trabecular bone in order to better distinguish the determiners of bone strength
• Define current bone quality measurement methodologies, including the utility and current limitations of HSA

This activity is jointly sponsored by Postgraduate Institute for Medicine and Fission Communications.

This activity is supported by an educational grant from Merck and Co., Inc.

Friday, March 16, 2007

The Basic Biology of Bone – Osteoclasts, Osteoblasts, and Osteocytes

3:45 – 4:15 pm Break in Exhibit Hall

4:15 – 5:15 pm Symposium in Florida Ballroom

• Presenter, David Dempster, PhD

Program Overview

When it comes to function, the skeleton can be considered as a prototype for multi-tasking.  The long bones serve as levers for the muscles, supporting locomotion and all other forms of motion.  The flat bones, such as the ribs and those of the skull serve as armor for the vital organs that they surround. It is common knowledge that the skeleton serves as the body’s main repository for calcium and plays a key role in homeostatic regulation of serum calcium concentration.  It is less well known that the skeleton plays a similar role with regard to acid-base balance . Bone also serves as a rich source of growth factors and cytokines, a prime example of which is the finding that osteoblasts produce a number of factors that are important for the differentiation and survival of hematopoietic stem cells.  Half a century ago, Dr. A.M. Cooke wrote eloquently  that  “The skeleton, out of site and often out of mind, is a formidable mass of tissue occupying about 9% of the body by bulk and no less than 17% by weight.  The stability and immutability of dry bones and their persistence for centuries, and even millions of years after the soft tissues have turned to dust, give us a false impression of bone during life.  Its fixity after death is in sharp contrast to its ceaseless activity during life” (13).  In the adult skeleton, the “ceaseless activity” largely refers to the process of bone remodeling. One of the more remarkable features of mammalian bone is its ability to constantly rejuvenate itself through the process of remodeling, which begins in utero and continues until death.  Remodeling is achieved by the sequential action of osteoclasts and osteoblasts and the process is regulated by osteocytes. The rate of remodeling and balance between resorption and formation in each remodeling unit differs depending on anatomical location and also as a function of age and in disease states.   Knowledge of the fundamental principles of remodeling provides an excellent framework for understanding age-related changes in bone structure and geometry, as well as the pathogenesis of metabolic bone diseases and the effects of drugs used to treat them.

Learning Objectives

• Understand the basic cellular and extracellular components of bone and why bone is a classic example of  “form fits function”.
• Describe the cellular processes involved in bone remodeling and the possible implications of too little and too much remodeling.
• Discuss the role of the osteocyte in regulating bone remodeling
• Review age-related changes in bone and the pathogenesis of osteoporosis

This activity is supported by an educational grant from Amgen, Inc.

Friday, March 16, 2007

Current Controversies in Osteoporosis
7:00 – 7:45 pm Reception in Exhibit Hall

7:45 – 9:45 pm Symposium in Florida Ballroom

• Introductions and Opening Remarks  Paul Miller, MD, CCD
• Addressing Compliance and Persistence in Osteoporosis Management  Joyce A. Cramer
• Influence of Therapeutic Decisions on Trabecular and Cortical Bone  Solomon Epstein, MD
• The Effects of Bisphosphonates on Bone Strength  David B. Burr, PhD
• Case Study and Panel Discussion

Program Overview:

Bone health is a composite of bone mineral density (BMD) and bone mass, strength and architecture. BMD is important in the diagnosis of osteoporosis. However, evidence suggests that other factors are also involved in the assessment of overall bone health, because a reduction in the fracture risk may occur well before changes in BMD become apparent. Therefore, defining the strengths and limitations of various methods used to determine bone quality is key to optimal osteoporosis management. Furthermore, although effective pharmacotherapies are available, patient persistence can impact disease progression and is difficult to assess.

Using combined traditional didactic presentations and an interactive case-based approach, an expert panel will lead a discussion on the appropriate clinical use of bone-quality measurement tools and will review how resultant data are interpreted in the context of fracture risk for various bone types. Panelists will also discuss the impact of osteoporosis management on patient compliance and persistence and will identify treatment strategies to improve long-term patient outcomes. Real-time audience polling will provide immediate feedback on patient practices and clinical perceptions.

Learning Objectives:

At the conclusion of this program, participants should be able to:

• Define the relationship between BMD and bone turnover markers and relate these to fracture risk in different types of bone
• Determine the appropriate utilization of bone quality measurement tools in directing management strategies for osteoporosis
• Assess the impact of different bisphosphonate dosing regimens on patient compliance/ persistence

This activity is jointly sponsored by Medical Education Collaborative, Inc. (MEC) and CPE Communications.

This activity was made possible by an educational grant from Roche Laboratories Inc. and GlaxoSmithKline.

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