Talk:Osteoporosis

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 1 July 2019 and 23 August 2019. Further details are available on the course page. Student editor(s): Sabrinabulla, Amandabair, Knguyen525, NoraCortez.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 05:53, 17 January 2022 (UTC)

Milk & Dairy

The article currently does not even dare to mention the words "milk" and "dairy". This is too wimpy! Whatever the competing claims pro and con, they ought to be acknowledged, in the article; if the upshot is "nothing conclusively proven" say so... People will come to this article to try to understand if they should perhaps be drinking more milk; what is known?-71.174.175.150 (talk) 20:57, 12 November 2014 (UTC)

as of nov 2020 it says dairy consumption is a risk factor, footnoting a source that says the opposite! — Preceding unsigned comment added by 2003:CF:5F29:1C23:B03C:1B37:7FFF:87E0 (talk) 08:40, 24 November 2020 (UTC)

and citing that source as of 2014. SandyGeorgia (Talk) 08:11, 18 December 2020 (UTC)

Cardiac risks

Crandall, Annals of Internal Medicine, p. 716, said "most ... but not all ... original studies and meta-analyses have concluded that there is no increased risk, and concern about atrial fibrillation has faded." --Nbauman (talk) 20:35, 24 November 2014 (UTC)

Genetics

From Br Med Bull doi:10.1093/bmb/ldu042 JFW | T@lk 16:37, 5 March 2015 (UTC)

US Preventative Task Force

PMID 23440163 says: "These recommendations apply to noninstitutionalized or community-dwelling asymptomatic adults without a history of fractures. This recommendation does not apply to the treatment of persons with osteoporosis or vitamin D deficiency." Can someone who has access to the full text explain why it is used in the "Nutrition" section here? SandyGeorgia (Talk) 01:44, 9 April 2015 (UTC)

Hum yes more about preventing fractures. Not about treating osteoporosis. Moved to section on prevention were it is still not ideal. Doc James (talk · contribs · email) 13:12, 18 May 2015 (UTC)

NEJM does postmenopausal osteoporosis

... here: doi:10.1056/NEJMcp1513724 JFW | T@lk 11:52, 21 January 2016 (UTC)

Non pharmacological treatment

1:Vertebroplasty:-percutaneous injection of cement methyl methacrylate in vertebral bodies. 2: kyphoplasty 3:-prptective hip pads Khalidmehraj1993 (talk) 20:24, 29 April 2016 (UTC)

CKD

doi:10.2215/​CJN.11031017 - the specific entity of CKD-osteoporosis. JFW | T@lk 15:29, 10 June 2018 (UTC)

"White people?"

The refs given make no mention of 'white people'. If the article points to trends within trial subjects of a Caucasian background, then it should state that. The phrase "white people" means nothing at all. Anna (talk) 22:38, 2 June 2019 (UTC)

More than a year old, OP is correct, not addressed. SandyGeorgia (Talk) 08:35, 18 December 2020 (UTC)

UCSF Foundations 2 2019, Group 6a goals

I am currently a Student Pharmacist at the University of California, San Francisco, and will be making the following edits for my Foundations II course:

• Updating information regarding Physical Exercise (last citation was from an article written in 2011)
• Updating new medication(s) available for osteoporosis
• Adding information about Milk & Dairy and addressing the talk question posted on November 12th, 2014
• Updating epidemiology information

Please let me know whether or not any of the aforementioned topics/edits are appropriate for this article. Thank you kindly! Knguyen525 (talk) 21:53, 30 July 2019 (UTC)

UCSF Foundations 2 2019, Group 6C Peer Reviews

--- Rachel's Peer Review (Group 6C)

• Group 6A made improvements to the article by adding a "Diet" section and elaborating more on the epidemiology of osteoporosis.
• Group 6A achieved 2 out of the 4 goals for improvement ( did not see edits for updating new medications for osteoporosis and information about physical activity.
• Group 6A's draft submission reflects a neutral point of view.

AMONGxicillin (talk) 16:20, 6 August 2019 (UTC)

Roy's Peer Review (Group 6C)

1. Your group made useful and insightful additions to the Osteoporosis article. The "Diet" section and additions to epidemiological information were well thought out and written. I would consider adding in data about the incidence of osteoporosis in people on the preventative-diet compared to people on normal diets.
2. Your group achieved some of your goals. While the sections on dietary improvements and epidemiology data were improved, I did not see edits for osteoporosis medications or information about physical exercise.
3. Your group's edits were consistently formatted with Wikipedia's manual of style.

RwengUCSF (talk) 16:52, 6 August 2019 (UTC)

David's Peer Review

1. Group 6A made substantial improvements by creating a new section for Diet which was very insightful as well as adding to the epidemiology of osteoporosis.
2. Group 6A achieved most of their goals, however, there may not have been new medication therapies that have been made for treatment of osteoporosis since the article was last edited.
3. Group 6A used secondary sources to support their claims in this article which are publicly available.

Davdang (talk) 17:17, 6 August 2019 (UTC)

Cindy's Peer Review

Group 6A made huge improvements by adding a "Diet" section, discussing links between Celiac Disease and osteoporosis, and increased osteoporotic risk in postmenopausal women. I did not see any updates on medications for osteoporosis even though this was a goal and there have been some recently FDA approved in the last several years. Overall, the edit was well done and I did not find any evidence of plagiarism or copyright violation.

Cindytrac (talk) 17:39, 6 August 2019 (UTC)

All of this needs checking, SandyGeorgia (Talk) 08:41, 18 December 2020 (UTC)

About zeledronic acid

Hi,

My brother is a patient of Ostioporosis and he took Zeledronic acid in Injection format. He was advised by doctor to take that again after one year. If he took the first dose on 01.01.2019 then what is the perfect time for him to take again. I mean if he make a little bit delay like 10 days then will that ok? the previous dose will ok or shall take again? Abedinz1975 (talk) 16:18, 12 October 2019 (UTC)

WP:NOTADVICE, need to look into why Wikipedia has no such article. SandyGeorgia (Talk) 08:39, 18 December 2020 (UTC)

Zoledronic acid, SandyGeorgia (Talk) 08:40, 18 December 2020 (UTC)

Premenopausal osteoporosis in women

Usually some underlying cause. doi:10.1210/clinem/dgaa306 JFW | T@lk 19:27, 1 June 2020 (UTC)

New treatment option with Evenity/Romosozumab

Evenity/Romosozumab is a relatively new treatment for osteoporosis approved in 2019. A little bit more detailed information also on the page on Sclerostin. I think the osteoporosis section on medication should include mention of this new treatment, but it is already very well-structured and I don't really know where it would fit. Anyway, there's something to do there for some volunteer. JunasLB (talk) 19:36, 3 December 2020 (UTC)

The part about dairy is wrong

Protein does not lead to acidosis - this is a myth confirmed by multiple studies: https://pubmed.ncbi.nlm.nih.gov/28404575/; https://pubmed.ncbi.nlm.nih.gov/21102327/ The study cited is observational study which is of poor quality; Higher-quality prospective study shows that dairy consumption REDUCES the risk of osteoporosis - https://pubmed.ncbi.nlm.nih.gov/2294135/; https://pubmed.ncbi.nlm.nih.gov/7699532/ — Preceding unsigned comment added by 87.126.34.134 (talk)

I asked IP to take this to the talk page as their edits at the time were not referenced and I believe this is best discussed. The section Nutrition appears to have been unreferenced for a while. NZFC^(talk)(cont) 22:50, 3 December 2020 (UTC)

The part about dairy is WRONG

Sorry but I do not have the time to learn how to and edit the page properly. The references you need are the links in my previous comment. If you'd like more links to studies I can provide them. I am an MD and I have a Ph.D. in Nutrition.

I am just pointing out a huge mistake that promotes fear of dairy. And this fear leads to more people avoiding dairy and becoming calcium deficient. Supplementation is not a good option due to the risk of side effects. The time it is taking you to fix the error is proof that unfortunately, Wikipedia pages are not always to be trusted with correct information. — Preceding unsigned comment added by 87.126.34.134 (talk) 06:10, 4 December 2020 (UTC)

Thanks for posting here. I flagged your comment over at WP:MED to see if another editor in the field has time to review the two secondary sources that you have suggested. It is great to see experts on here who are willing to make these suggestions and include sources! JenOttawa (talk) 02:32, 18 December 2020 (UTC)

IP 87, thanks for weighing in. That entire section was added by a student editor using an old source.[1]. We need to doublecheck and rewrite the entire thing. Thanks for bringing it to our attention. @Helaine (Wiki Ed): could you get the UCSF course to stay in sandbox? SandyGeorgia (Talk) 09:42, 18 December 2020 (UTC)

@SandyGeorgia: I believe these were edits from a summer 2019 course, so the course is long over. Helaine (Wiki Ed) (talk) 18:17, 18 December 2020 (UTC)

User:Helaine (Wiki Ed), correct, but I believe the UCSF program continues? Not sure, but I wanted to alert you to their lack of medical oversight on their student edits. SandyGeorgia (Talk) 18:21, 18 December 2020 (UTC)

Thanks SandyGeorgia. they're done for this year, and won't try it again until next fall. We've been working with them to iron out the problems they've had in the past, so your feedback is helpful. Helaine (Wiki Ed) (talk) 18:25, 18 December 2020 (UTC)

Update needed

Sheesh, just look at the dates of the sources used here, relative to more recent WP:MEDRS and WP:MEDDATE sources available. Doing great on women’s health? Besides general neglect in updating this article for years, two classes of student editors have been here, so a top-to-bottom rewrite is in order here. SandyGeorgia (Talk) 08:06, 18 December 2020 (UTC)

I have archived what little on this page was addressed and left what needs to be checked. SandyGeorgia (Talk) 08:46, 18 December 2020 (UTC)

Yes it need work. Have added the latest systematic review about no adverse effects of protein. Will check back later.Jrfw51 (talk)

Thanks, I am iPad typing (compression fracture limits my computer time), and will do more as I can. I have left sections on the talk page we still need to deal with, along with an overall update. SandyGeorgia (Talk) 09:15, 18 December 2020 (UTC)

See section below for my suggestions. David notMD (talk) 01:40, 19 December 2020 (UTC)

Leads in citations

Unless the statements are not discussed in the body, leads are discouraged to have citations. This is common practice in many articles like Typhoon Gay (1989) and Hurricane Lane (2018). Some of the lead's citations are also repeated, like ref3 in the first paragraph. I deleted all inappropriate citations and kept the appropriate ones, but was reverted by Iztwoz. RexxS cited MOS:LEAD in a summary, which ironically states: "Because the lead will usually repeat information that is in the body, editors should balance the desire to avoid redundant citations in the lead with the desire to aid readers in locating sources for challengeable material. Leads are usually written at a greater level of generality than the body, and information in the lead section of non-controversial subjects is less likely to be challenged and less likely to require a source." GeraldWL 08:45, 18 December 2020 (UTC)

That problem in medical content goes beyond this article. You will need to take it to WT:MEDMOS, where it is an unresolved issue. See WP:MEDLEAD. For the moment, this article is a dated enough that faulty and dated citations in the lead is the least of this article’s problems. SandyGeorgia (Talk) 08:50, 18 December 2020 (UTC)

SandyGeorgia, I'm afraid the current revision of MEDLEAD is "It is sometimes useful to include citations in the lead, but they are not obligatory." Other than MEDRS, I don't think there has to be a special treatment as to whether we have to cite the lead in a medical article. Vague leadcites makes it cluttered and not good-looking.

However I think it's fine to remove the repeated citations (like ref3 in p1), as several statements can be cited with one ref. Could you remove the repetitive ones, since I don't want to be engaged in edit wars? GeraldWL 08:57, 18 December 2020 (UTC)

There are bigger problems here and in most medical articles, where most of what is in the lead is not even in the body at all. In an article that needs a complete rewrite, worrying about the faulty lead citations is not going to be my priority; it is a distraction from the amount of deterioration in the article overall. The bigger problem of MEDLEAD, and how a focus on leads only led to overall deterioration in important articles like this one, is not going to be addressed article by article. SandyGeorgia (Talk) 09:11, 18 December 2020 (UTC)

SandyGeorgia, I understand that the outdatedness of the article is of high priority, I mean, dozens come to this page every day. I view this as a secondary issue; after the article is already updated, this problem could be revisited. However I'll have to, as I stressed, remove the repetitive citations, in style of many other articles. GeraldWL 09:13, 18 December 2020 (UTC)

The problem with removing them is that the bodies of medical articles have rarely been updated, so in some cases, by removing the faulty lead cites, you may be removing the only cites. SandyGeorgia (Talk) 09:16, 18 December 2020 (UTC)

I am watching this page; there is no need to ping me. Pls see the message at the top of my talk page. SandyGeorgia (Talk) 09:18, 18 December 2020 (UTC)

Try checking my two edits. Personally, I don't see any problem with them as many articles do them, and it doesn't remove the cites completely: it's still there, just at a later statement.

For paragraph 2: noted, mate. GeraldWL 09:20, 18 December 2020 (UTC)

Sorry, ipad typing, on edits like this, absolutely support. Apart from not being required, we certainly don’t need them repeated for every line! Thanks, SandyGeorgia (Talk) 09:23, 18 December 2020 (UTC)

And it is thousands daily who have been getting outdated info on an important health matter.[2]. Thankfully brought to the attention of wp:med because of an ip. SandyGeorgia (Talk) 09:26, 18 December 2020 (UTC)

Gerald Waldo Luis, where in the guidelines does it say that citations are actually discouraged in the lead? The last time I checked the main MOS section about putting citations in the lead, the consensus was "neither encouraged nor discouraged". WhatamIdoing (talk) 22:35, 18 December 2020 (UTC)

WhatamIdoing, yes the MOS says it is up to the editors themselves. However it is common practice to just make the lead a summary and make the body the specifics. If the body details X problem in more specific way, the lead should summarize it in a shorter and basic way. That also means let the body be the citation handler at all possible time. Too much leadcites make the lead cluttered, and if it is talked about in the body leadcites aren't even gonna be used.

As stated: "Because the lead will usually repeat information that is in the body, editors should balance the desire to avoid redundant citations in the lead with the desire to aid readers in locating sources for challengeable material. Leads are usually written at a greater level of generality than the body, and information in the lead section of non-controversial subjects is less likely to be challenged and less likely to require a source." GeraldWL 03:17, 19 December 2020 (UTC)

Yes, it's been the common practice in many, but not all, well-developed articles, but I was concerned because your original message said it was discouraged, rather than merely unpopular. I do not think that we need to worry about what's popular in this article, at least at this time. WhatamIdoing (talk) 03:26, 19 December 2020 (UTC)

If you look at my top message, I cite two featured articles, whom a lot of FAs don't have citations in leads, except where undiscussed in the body. The lead guideline also suggests as few citations in lead as possible, as quoted above. As I stated above with Sandy, this is all secondary and can be discussed later after the article's updated. I'm simply pointing this out. GeraldWL 09:26, 19 December 2020 (UTC)

Okay: I'll cite Acute myeloid leukemia, Alzheimer's disease, Autism, Chagas disease, and Coeliac disease as examples of FAs whose leads are fully cited. About three-quarters of the FAs for medical conditions contain citations throughout the lead. If you think that everything needs to match, then this one should match the practice for medical articles, not for weather.

Personally, I don't think articles need to match. WhatamIdoing (talk) 01:35, 27 December 2020 (UTC)

Suggested changes

I have a COI (was in research dept of National Dairy Council when NDC was funding a lot of the calcium and osteoporosis research), so not making changes directly to the article.

• Nutrition subsection, first paragraph, there are two sentences that while referenced, are not relevant to osteoporosis: "Furthermore, the same review found moderate-quality evidence that the combination of vitamin D and calcium supplementation increases the risk for developing kidney stones in this population.[96] The evidence was insufficient to determine if supplementation with vitamin D, calcium, for the combination of both had an effect on the risk of cancer, cardiovascular disease, or death from any cause.[96]"

doneJenOttawa (talk) 12:58, 20 December 2020 (UTC)

• Same applies to third paragraph: "While supplementation does not appear to affect the risk of death,[96][100] there is an increased risk of myocardial infarctions with calcium supplementation,[101][102] kidney stones,[96] and stomach problems.[100]"

Note: I left in the potential side effects of calcium supplementation for now... although not directly related to osteoporosis, if moved right after the sentences talking about calcium supplementation, it may be helpful? Please let me know what you think.JenOttawa (talk) 12:31, 20 December 2020 (UTC)

• Nutrition subsection, fourth paragraph: The vitamin K deficiency articles does not mention (nor reference) low K as an osteoporosis risk factor. Vitamin K has a subsection under Research that has some potentially useful text and references. Vitamin K2 has a better ref for reducing bone loss and risk of fractures. "...treatment for osteoporosis..." is bad wording.

I started to look at this, will take more time for sure and some work.JenOttawa (talk) 12:58, 20 December 2020 (UTC)

• Nutrition subsection, fifth paragraph, there is an unreferenced sentence that has been present for more than a year that in my opinion has no connection to the article: "However, this would equate to 2-3 glasses of milk, which is over the required amount or a healthy diet."

this has been removed by another editor. JenOttawa (talk) 12:58, 20 December 2020 (UTC)

• Under Risk factors, subsection Potentially modifiable, there is this content: "High dietary protein from animal sources: Research has found an association between diets high in animal protein and increased urinary calcium,[37][38][39] and have been linked to an increase in fractures.[40] A diet high in plant protein may be optimal for bone health, as higher protein diets tend to increase absorption of calcium from the diet and are associated with higher bone density.[41] Indeed, it has recently been argued that low protein diets cause poor bone health.[42] No interventional trials have been performed on dietary protein in the prevention and treatment of osteoporosis.[43]" References 37-40 are old, and are contradicted by the newer refs 41-43 which suggest that a low protein diet increases risk of osteoporosis.

@David notMD: do you mind reviewing my attempts at the prevention- potentially modifiable- section?JenOttawa (talk) 12:31, 20 December 2020 (UTC)

• Of the four refs mentioned by 87.126.34.134. Sham-White is already ref #106 and Kerstetter is ref #41. The other two (Baran and Chan are old, and are individual clinical trials, hence not meeting WP:MEDRS.
  • @JenOttawa: Much improved. Thank you for stepping on on this. David notMD (talk) 14:48, 20 December 2020 (UTC)

I may have more suggestions, but hope that editors with an interest in this article review these as a start. David notMD (talk) 01:40, 19 December 2020 (UTC)

Thanks for the help, David notMD. I struggle to understand how the Vitamin D and calcium supplementation text does not relate to osteoporosis. I am surely not in a minority as a woman who was prescribed precisely that as soon as I turned 50, allegedly to avoid osteoporosis, and sure enough, I developed kidney stones within a few years. Women routinely wonder if they need calcium supplementation to avoid osteoporosis post-menopause, it was routinely prescribed in the not-too-distant past, and women will expect to find the updated facts in this article. (When I quizzed the urologist about whether the calcium might have caused my out-of-nowhere kidney stones in 2009, he insisted there was no connection ... lo and behold, five years later, the facts were known. He was wrong, I was right.) I believe this is still relevant to women's health, and it seems the source does, too. Please help me understand why you find it not relevant? Since calcium can be purchased over-the-counter, women may still believe they should be taking it. Best, SandyGeorgia (Talk) 01:56, 19 December 2020 (UTC)

David notMD, would it be fair to summarize those studies as "taking Calcium pills to prevent osteoporosis won't help and might hurt"? WhatamIdoing (talk) 02:24, 19 December 2020 (UTC)

Perhaps an over-simplification, as the refs are conflicted on calcium supplements. As to SG's question, how about in first paragraph, delete just the sentence starting with "The evidence was insufficient..." while leaving the kidney stones mention. Third paragraph needs to be clear on which adverse effects are from calcium and which from vitamin D. Kidney stones mentioned in it, so why mention stones in first and third paragraph? David notMD (talk) 03:27, 19 December 2020 (UTC)

And, time to delete the maps. The calcium world map is in Calcium and Calcium in biology, but in my opinion does not belong here. In passing, both of those articles need improvement vis-a-vis bone health. The world map of serum vitamin D adds nothing, because there is no connection made between serum concentration and osteoporosis in those countries. David notMD (talk) 10:45, 19 December 2020 (UTC)

Thanks for all these great suggestions. I can see that the map has been removed. I would be happy to help with some of the content improvements. I will work on them live. Please do jump in adjust my edits if you disagree! I added bullets to David's suggestion and noted what has been done. JenOttawa (talk) 12:31, 20 December 2020 (UTC)

Physical exercise subsection

I am doing direct editing here, because unlike for the Nutrition subsection, I have no COI. David notMD (talk) 16:24, 19 December 2020 (UTC)

I really appreciate your help, and I admire your willingness to follow the highest standards around COI. WhatamIdoing (talk) 01:45, 27 December 2020 (UTC)