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ISO2026: Bone Medication and Cardiovascular Risk
This session examines the cardiovascular safety of contemporary osteoporosis therapies and places that safety profile within a broader framework for weighing the benefits and risks of treatment. It opens with the recognized association between low bone density and cardiovascular risk, including the supporting epidemiologic data, the biological plausibility that links bone mineralization to vascular calcification, and the risk factors and inflammatory pathways shared by the two conditions. The session then addresses calcium metabolism, reviewing the cardiovascular consequences of chronic hypoparathyroidism and chronic hyperparathyroidism and offering a pragmatic position on dietary calcium intake and supplementation. It proceeds through each major drug class in turn, summarizing the skeletal effects and the cardiovascular evidence for menopausal hormone therapy, selective estrogen receptor modulators, bisphosphonates, denosumab, the parathyroid hormone and parathyroid hormone related protein analogs, and romosozumab. Across these classes the session draws on randomized trials, large observational cohorts, and meta-analyses, including HERS, the Women's Health Initiative, RUTH, HORIZON, the Fracture Intervention Trial, ACTIVE, FRAME, ARCH, BRIDGE, and STRUCTURE, with particular attention to the atrial fibrillation signal observed with bisphosphonates, the venous thromboembolism and fatal stroke findings with raloxifene, the hypocalcemia warning carried by denosumab, and the boxed warning for cardiovascular risk carried by romosozumab. The session closes with a structured approach to the risk and benefit conversation, distinguishing adverse events from adverse reactions and side effects, addressing the role of relative versus absolute risk and the value of tools such as icon arrays and number needed to treat, and framing the final decision as an individualized judgment for the patient rather than for a population.
Target Audience
This continuing education activity is intended for use by health professionals who participate in the care of patients at risk for or suffering from osteoporosis, in the areas of primary care, endocrinology, geriatrics, gynecology, internal, obstetrics, orthopedics, osteopathy, pediatrics, physiatry, radiology, rheumatology and physical therapy.
This includes physicians, nurse practitioners, registered nurses, pharmacists, physician assistants, technologists, researchers, public health professionals and health educators with an interest in osteoporosis and bone health.
Learning Objectives
Upon completion of this session, participants will be able to:
1. Describe the recognized association between low bone density and cardiovascular risk, including the epidemiologic evidence, the biological plausibility linking bone mineralization to vascular calcification, and the shared risk factors and inflammatory pathways.
2. Explain the cardiovascular implications of disordered calcium metabolism, including chronic hypoparathyroidism and chronic hyperparathyroidism, and apply a reasoned approach to dietary calcium intake and supplementation.
3. Summarize the cardiovascular evidence for each major osteoporosis drug class, including menopausal hormone therapy, selective estrogen receptor modulators, bisphosphonates, denosumab, parathyroid hormone and parathyroid hormone related protein analogs, and romosozumab.
4. Interpret the principal cardiovascular safety signals across the major trials, including the atrial fibrillation signal with bisphosphonates, the venous thromboembolism and fatal stroke findings with raloxifene, the hypocalcemia warning for denosumab, and the boxed warning for cardiovascular risk for romosozumab.
5. Apply a structured risk and benefit framework to individualized treatment decisions, distinguishing adverse events from adverse reactions and side effects and using absolute risk and visual decision aids to support shared decision making.
Name of Individual | Individual's Role(s) in Activity | Name of Ineligible Company(s) | Nature of Relationship(s) |
| Steve Harris, MD, FACP, FASBMR | Speaker | N/A | N/A |
| Amy Mitchell, MSN, FNP-C | Planner/Accredited Provider Program Director & Content Expert | Amgen & Radius Health | Speaker’s Bureau, Scientific Advisory Board, Consulting |
Ami Patel | BHOF Staff, Vice President of Science & Education | N/A | N/A |
Andrea Medeiros | BHOF Staff, Vice President of Public Health & Policy | N/A | N/A |
Disclosures:
• Sponsored Presentations
– Amgen
– Ascendis Pharma
– Radius Health/Paratek
• Consultation
– Amgen
– Akero Therapeutics
– Bone Health Technologies
– Kyowa Kirin
– Radius Health/Paratek
Accreditation Statement
The Bone Health and Osteoporosis Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The Bone Health and Osteoporosis Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
CME Program Eligibility
Method of Participation in the Learning Process: Clinician learners will view and analyze the subject matter, conduct additional informal research through related internet searches on the subject matter, and complete a post-test assessment of knowledge and skills gained as a result of the activity.
After participating in this activity, the reader has the option of taking an evaluation for this activity. It is estimated it will take 1.0 hour(s) to complete the reading and take the evaluation. Continuing education credit will be available for two years from the date of publication.
Disclosure of Commercial Support
It is the policy of the Bone Health & Osteoporosis Foundation (BHOF) to ensure balance, independence, objectivity, and scientific rigor in all its sponsored publications and programs. BHOF requires the disclosure of the existence of any significant financial interest or any other relationship the sponsor, Editorial Board or Guest Contributors have with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. All authors and contributors to this continuing education activity have disclosed any real or apparent interest that may have direct bearing on the subject matter of this program.
Please be advised that BHOF’s accreditation status with ACCME and ANCC does not imply endorsement by BHOF, ACCME or ANCC of any commercial products displayed in conjunction with this activity or endorsement of any point of view.
Refund Policy
BHOF offers no returns or refunds on online internet CME activities purchased through our store. All sales are final. Meeting and workshop registrations will be refunded in accordance with the cancellation policy of the meeting and/or workshop, as outlined at registration.
Available Credit
- 1.00 AMA PRA Category 1 Credit™The National Osteoporosis Foundation is an approved Accreditation Council for Continuing Medical Education (ACCME) accredited CME provider through March 2023. ACCME accreditation accelerates learning, change and improvement in the field of osteoporosis. The National Osteoporosis Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The National Osteoporosis Foundation designates educational activities for AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
- 1.00 ANCCThe mission of the American Nurses Credentialing Center (ANCC), a subsidiary of the American Nurses Association (ANA), is to promote excellence in nursing and health care globally through credentialing programs. The National Osteoporosis Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. The National Osteoporosis Foundation designates educational activities for continuing nursing education credit(s).
- 1.00 Participation
- 1.00 Participation/AttendanceA certificate of attendance will be provided to all other attending healthcare professionals. Nurse practitioners and physician assistants may request AMA PRA Category 1 Credit(s)™ certificate of participation. Please refer to your provider to determine whether this program will qualify for other categories of continuing education credits. The American Academy of Physician Assistants (AAPA) also accepts educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the Accreditation Council for Continuing Education (ACCME).