The last edition of the clinical training course on Metabolic Bone Diseases spanned over two days in November 2023 and offered a very interesting and multi-faceted programme.
The initial session on Diabetes mellitus and bone fragility covered epidemiological aspects of diabetic bone disease (Dr. Jakob Starup-Linde) with a focus on bone mineral density, bone strength/microarchitecture and fracture risk in type 1 & 2 diabetes mellitus. Dr Martina Rauner elaborated on pathophysiological aspects of this entity comprising direct bone effects (i.e. proinflammatory state, reduced bone vascularization and increased cellular senescence) as well as indirect bone effects (i.e. impact of hypoglycemia and diabetic complications). The session was concluded by Dr. Tatiane Vilaca focusing on management of diabetic bone disease and highlighting the fact that antiresorptive and anabolic therapies have shown efficacy in reducing fracture risk in individuals with type 2 diabetes mellitus, with the evidence being more robust for antiresorptive drugs, while evidence in type 1 diabetes mellitus is scant.
Another highlight of Day 1 was the Workshop on clinical genetics, with Dr Meena Balasubramanian and Dr Marian Schini providing insight on the multi-disciplinary approach of implementing genetics at the Adult and Pediatric Bone Clinics of the University of Sheffield. A subject of ample current interest was Management of denosumab discontinuation by Dr Anne Sophie Solling, who elaborated on different antiresorptive regimens to counteract the off-shoot in bone metabolism ensuing after denosumab cessation.
The workshop of Dr Julien Paccou was focused on Bariatric surgery and skeletal health and highlighted the significant deterioration in bone microarchitecture and strength and the growing body of evidence suggesting an association between bariatric surgery and higher fracture risk in these patients. The last workshop of Day 1 was a FRAX tool update by Dr Eugene McCloskey, who eloquently presented the novel FRAXplus® tool, allowing to modify a probability result derived from conventional FRAX® estimates with additional data on recency of osteoporotic fracture, different exposure to oral glucocorticoids and number of falls in the previous year.
Day 2 of the Clinical Course begun with a session on Early-onset osteoporosis. Dr Carola Zillikens discussed the definition of early-onset osteoporosis and its most common non-genetic and genetic causes and presented a plan of action for evaluation and treatment. On the other hand, Dr Ralf Oheim concentrated on Pregnancy & Lactation associated Osteoporosis (PLAO) analyzing the presence of genetic variants and their potential association with the clinical presentation in PLAO, as well as the importance of a timely diagnosis and a tailored treatment in this entity.
The session was followed by a Workshop by Dr Bente Langdahl providing insight on the efficacy of Sequential osteoporosis treatments and especially highlighting the role of early implementation of osteoanabolic agents in high fracture risk patients. The penultimate session of Day 2 delved into Osteomalacia, comprising a lecture by Dr Elisabeth Curtis on Vitamin D and childhood bone health, including high-quality randomized placebo-controlled trials, such as the UK-based MAVIDOS trial. This was followed by Dr Benedikt Schaefer’s lecture on Osteomalacia after intravenous iron infusions especially in terms of ferric carboxymaltose infusions and the 6H syndrome (hyperphosphaturic hypophosphatemia triggered by high fibroblast growth factor 23 that causes hypovitaminosis D, hypocalcemia and secondary hyperparathyroidism). The ultimate session of Day 2 was presented by Dr Heide Siggelkow, who presented Novel therapeutic modalities in chronic hypoparathyroidism, with a special focus on efficacy and safety of the recently approved TransCon PTH (palopegteriparatide).
A most cordial thank you to all outstanding Speakers and Chairs, to participants for the lively discussion, to ECTS staff for excellent technical assistance and to our sponsors UCB and Kyowa Kirin for supporting the event. See you all for the 2024 clinical training course on Metabolic Bone Diseases!