Proceedings of the 2023 Santa Fe Bone Symposium: Progress and Controversies in the Management of Patients with Skeletal Diseases

Abstract

The Santa Fe Bone Symposium (SFBS) held its 23rd annual event on August 5-6, 2023, in Santa Fe, New Mexico, USA. Attendees participated in-person and remotely, representing many states and countries. The program included plenary presentations, panel discussions, satellite symposia, a Project ECHO workshop, and a session on healthcare policy and reimbursement for fracture liaison programs. A broad range of topics were addressed, including transitions of osteoporosis treatments over a lifetime; controversies in vitamin D; update on Official Positions of the International Society for Clinical Densitometry; spine surgery and bone health; clinical applications of bone turnover markers; basic bone biology for clinicians; premenopausal-, pregnancy-, and lactation-associated osteoporosis; cancer treatment induced bone loss in patients with breast cancer and prostate cancer; genetic testing for skeletal diseases; and an update on nutrition and bone health. There were also sessions on rare bone diseases, including managing patients with hypophosphatasia; treatment of X-linked hypophosphatemia; and assessment and treatment of patients with hypoparathyroidism. There were oral presentations of abstracts by endocrinology fellows selected from those who participated in the Santa Fe Fellows Workshop on Metabolic Bone Diseases, held the 2 days prior to the SFBS. These proceedings of the 2023 SFBS present the clinical highlights and insights generated from many formal and informal discussions in Santa Fe.

Keywords: ECHO; ISCD; Nutrition; Osteoporosis; Vitamin D.

Fig. 1.. Hormonal regulation of calcium mobilization during lactation.

The upper right image shows osteoclastic bone resorption of maternal trabecular bone, resulting in degradation of trabecular microarchitecture seen in the lower right image. Original drawing by Christopher S. Kovacs, MD.

Fig. 2.. Adjusted hazard ratios for fracture by bone mineral density (BMD) and trabecular bone score (TBS) category.

Decreasing BMD (normal, osteopenia, osteoporosis) and TBS categories (lowest ≤ 1.230, middle 1.230–1.310, highest ≥ 1.310) were independently associated with stepwise increased risk for incident major osteoporotic fracture (a), hip fracture (b), and any fracture (c). Adjusted for type of scanner, age, sex, body mass index, previous fracture, parental hip fracture, glucocorticoid exposure in the prior year, smoking status, high alcohol intake, rheumatoid arthritis, and secondary osteoporosis. Reproduced with permission from Goel et al. (102).

Fig. 3.. Effect of changing entered weight and sex on calculated trabecular bone score (TBS).

Large blue circle shows the reference value (TBS = 1.326 for a female weighing 150 pounds). Shaded area indicates the 95 % least significant change (LSC) limits. Adapted from Binkley et al. (108).

Fig. 4.. Average weekly attendance for Bone Health ECHO.

Over the first 8 years of the prototype Bone Health ECHO program, based at the University of New Mexico Health Sciences Center in Albuquerque, NM, USA, weekly attendance has progressively increased. Attendees are located throughout North America and South America, and sometimes European, Middle Eastern, and Asian countries. Original graph with data provided by Project ECHO, Albuquerque, NM, USA.