Untitled Document

Research

Mary Beth Elliott

Ph.D., Pharmacology, University of
Wisconsin-Madison
PharmD, University of Wisconsin-Madison
School of Pharmacy
Associate Professor, School of Pharmacy
meelliott@pharmacy.wisc.edu
http://www.pharmacy.wisc.edu/sopdir/PersonDetails.cfm?ID=2

Reducing Fracture Risk in Elders

My long-range goal is to discover ways to prevent fractures in nursing home residents and other high-risk individuals. Osteoporosis is often ignored in the nursing home due to uncertainty about appropriate treatment (including calcium and Vitamin D), cost issues, lack of access to bone density testing, and inadequate research.

Ultimately, I plan to develop a simple, inexpensive method to achieve vitamin D adequacy for long term care residents. Also, using peripheral (heel or wrist) bone mineral density (BMD) testing, I plan to develop ways to identify high risk patients. In this way, osteoporosis treatments could be targeted toward those most likely to sustain a fracture. My colleagues and I have discovered the following results from studies carried out in the nursing home or in the outpatient setting: Peripheral (BMD) measurements with a portable X-ray device in nursing homes was efficient and showed a wide spread of BMD values among residents. This indicates the potential to target those with high risk of fracture (lowest BMD); peripheral BMD correlated well with measurements at the hip and spine; physicians were willing to respond to reports of low BMD; and hip fractures in Wisconsin nursing homes cost $18 million annually. Treatment in this setting may actually save money despite the cost of drugs.

The above leads us to believe that peripheral BMD testing can identify high-risk patients in nursing home and other settings, leading to improved treatment.

In other Vitamin D studies we saw that women who received vitamin D according to accepted guidelines were still deficient in vitamin D. We have completed a controlled study in nursing homes, of the effect of a monthly capsule of vitamin D, on vitamin D status and other health outcomes.

Together with other investigators, we are also examining the prevalence of vitamin D insufficiency in groups of individuals who vary by age, gender, and ethnicity.

Much of my work has focused on other groups at high risk of fracture. We showed that men undergoing certain common treatments for prostate cancer develop osteoporosis and fractures, but are rarely given treatment, BMD measurement, or even calcium/vitamin D. The same was true for men who are at high risk of fracture because they have already had a hip fracture, and for men treated long-term with prednisone. We have also studied older individuals with kidney disease to determine if this high-risk group responds well to osteoporosis treatment.

Representative Publications
Bolek-Berquist, J., Elliott, M.E., Gangnon, R.E., Gemar, D., Engelke, J., Lawrence, S.J., & Hansen, K.E. (2008). Use of a questionnaire to assess vitamin D status in young adults. Public Health Nutr., 27, 1-8.

Danielson, K.K., Elliott, M.E., LeCaire, T., Binkley, N., & Palta, M. (2008). Poor glycemic control is associated with low BMD detected in premenopausal women with type 1 diabetes. Osteoporos Int. 2008 Oct 2. [Epub ahead of print].

Buys, L.M., & Elliott, M.E. (2008). Osteoarthritis. In J.T. Dipiro, R.L. Talbert, G.C. Yee, G.R. Matzke, B.G. Wells, & L. Posey (Eds.), Pharmacotherapy: A pathophysiologic approach (7th ed.). New York: McGraw-Hill.

Buys, L.M., & Elliott, M.E. (2008). Osteoarthritis. In W.D. Linn, M.R. Wofford, M.E. O�Keefe, & L. M. Posey (Ed.), Pharmacotherapy in primary care. McGraw-Hill.

Hansen, K.E., Swenson, E.D., Baltz, B., Schuna, A.A., Jones, A.N., & Elliott, M.E. (2008). Adherence to alendronate in male veterans. Osteoporosis Int., 19(3), 349-356.

Swenson, E.D., Elliott, M.E., Baltz, B.L., Schuna, A.A., & Hansen, K.E. (2008). Patient characteristics associated with bone mineral density (BMD) responses to alendronate. Journal of Clinical Densitometry, 11(3), 458.

Lata, P., & Elliott, M.E. (2007). Patient assessment in the diagnosis, prevention, and treatment of osteoporosis [Review]. Nutrition in Clinical Practice, 22(3), 261-75.

Danielson, K.K., Elliott, M.E., & Palta, M. (2007). Multifactorial etiology of weak bones in Type 1 Diabetes (TIDM). Journal of Bone and Mineral Research, 22(Suppl. 1), S216.

Wilcox, A., Carnes, M., Moon, T.D., Tobias, R., Baade H., Stamos E., & Elliott, M.E. (2006). Androgen deprivation in veterans with prostate cancer: Implications for skeletal health. Annals of Pharmacotherapy, 40, 2107-2114. PMID: 17132807.

Hansen, K.E., Hofmann, R.M., Drake, R.K., Argall, T.R., Bier, H.A., Grigg, K.T., Rouse, E.D., Elliott, M.E. (2006). An exploratory analysis of alendronate in older men with low creatinine clearance. J. Aging Pharmacother., 13, 21-33.

Danielson, K.K., Elliott, M.E., Palta, M. (2006). Bone formation is decreased in premenopausal women with Type 1 Diabetes: The Wisconsin Women & Diabetes Study. J. Bone Miner. Res., 21(Suppl 1), 1127.

Hansen, K.E., Baltz, B.L., Swenson, E.D., Schuna, A.A., Elliott, M.E. (2006). Adherence to alendronate among male veterans. J. Bone Miner. Res., 21(Suppl 1), SA350.

Gidal, B.E., Elliott, M., Jones, J.C., & Molina, C. (2005). Treatment of hypovitaminosis D in patients receiving carbamazepine or phenytoin: Biopharmaceutical considerations. Epilepsia, 46, 175.

Elliott, M.E. (2005). Assessing the impact of osteoporosis screening. J. Pharm. Soc. Wisc., Nov./Dec., 41-45.

Elliott, M.E. (2005). Osteoporosis and osteomalacia. In J.E. Tisdale & D.A. Miller (Eds.), Drug induced diseases: Prevention, detection and management. Bethesda, MD: American Society of Health System Pharmacists..

Hansen, K.E., & Elliott, M.E. (2005). Osteoarthritis. In J.T. Dipiro, R.L. Talbert, G.C. Yee, G.R. Matzke, B.G. Wells, & L. Posey, (Eds.), Pharmacotherapy: A pathophysiologic approach (6th ed.). New York: McGraw-Hill.

Elliott, M.E., Nolan N.M. (2004). The role of vitamin D in the prevention and treatment of osteoporosis. Bone and Mineral Metabolism, 2, 373-388.

Calis, K., Hutchison, L., Elliott, M., Ives, T., Lo, J., Poirer, D., Raebel, M., Siu, S., Townsend, K., Woodall, B., Zillich, A. (2004). Healthy people 2010: Challenges, opportunities, and a call to action for America�s pharmacists. Pharmacotherapy, 24, 1241�129.

Leppik, I.E., Bergey, G.K., Ramsay, R.E., Rowan, A.J., Gidal, B.E., Birnbaum, A., Elliott, ME. (2004). Advances in AED Treatments: A rational basis for selecting drugs for older patients with epilepsy. Geriatrics, 59(12), 14-22.

Elliott, M.E., Drinka, P.J., Krause, P., Binkley, N.C., & Mahoney, J.E. (2004). Osteoporosis assessment strategies for male nursing home residents. Maturitas, 48, 225-233.

Elliott, M.E., & Binkley, N. (2004). Evaluation and measurement of bone mass. Epilepsy Behav., 5(Suppl. 2), S16-23.

Christian, R., Hansen, K.E., & Elliott, M.E. (2004). Alendronate treatment of transplant recipients in a veteran population. J. Bone Miner. Res., 19(Suppl. 1), SA40.

Elliott, M.E. (2003). Understanding the role of bone health in seizure management. Profiles in Seizure Management: Pharmacy Series, 2, 10-15.

Elliott, M.E., Petersen, K., Binkley, N.C., Carnes, M.L., Zimmerman, D.R., Kieser, M.A., Knapp, K., Behlke, J., & Ahmann, N. (2003). Fracture risks for women in long-term care: high prevalence of calcaneal osteoporosis and hypovitaminosis D. Pharmacotherapy, 23(6), 702-10.

Elliott, M.E., Martin, B.A., Kanous, N.L., Carnes, M.L., Komoroske, B., & Binkley, N.C. (2003). Osteoporosis risk in elderly nuns: Need for better recognition and treatment. Curr. Ther. Res., 64, 65-80.

Hansen, K.E., Drake, R.K., Good, T.R., Cartledge, M.L., & Elliott, M.E. (2003). Efficacy and tolerability of alendronate in veterans with renal insufficiency. J. Bone Miner. Res., 18(Suppl 1), M327.

Elliott, M.E. (2002). Osteoporotic fractures in older women. Current Women's Health Reports, 2, 356-365.

Elliott, M.E., Binkley, N.C., Meek, P.D., Kanous, N.L, Schill, G., Weinswig, P. Bohlman, J., Zimpel, C., Jensen, B., Walters, D., Sutter, S., Peterson, A., & Peterson, R. (2002). Pharmacy-based bone mass meaurement to assess osteoporosis risk. Ann. Pharmacother., 36, 571-577.

Elliott, M.E., Binkley, N.C., Meek, P.D., Kanous, N.L., Schill, G., Weinswig, P., Bohlman, J., Zimpel, C., Jensen, B., Walters, D., Sutter, S., Peterson, A., & Peterson, R. (2002). Osteoporosis screening by community pharmacists: Use of national osteoporosis foundation guidelines. J. Amer. Pharm. Assoc., 42, 101-111.

Lata, P.F., Binkley, N.C., & Elliott, M.E. (2002). Acceptability of pharmacy-based bone density measurement by women and primary health care providers. Menopause, 9, 449-455.

Riley, R.L., Gudmundssonn, A., Carnes, M.L., & Elliott, M.E. (2002). Male veterans with hip fractures: Outcomes and evaluation of secondary osteoporosis prevention. Ann. Pharmacother., 36(1), 17-23.

Elliott, M.E., Wilcox, A., Carnes, M.L., Tobias, R., Baade, H., Stamos, E., & Counts, C.D. (2002). Androgen deprivation in veterans with prostate cancer: Implications for skeletal health. J. Bone Miner. Res., 17(Suppl 1), SU328.

O�Connell, M.B. and Elliott, M.E. (2002). Osteopororis and osteomalacia. In J.T. Dipiro, R.L. Talbert, G.C. Yee, G.R. Matzke, B.G. Wells, & L. Posey (Eds.), Pharmacotherapy: A pathophysiologic approach (5th ed.). New York: McGraw-Hill.

Boh, L.E, & Elliott, M.E. (2002). Osteoarthritis. In J.T. Dipiro, R.L. Talbert, G.C. Yee, G.R. Matzke, B.G. Wells, & L. Posey (Eds.), Pharmacotherapy: A pathophysiologic approach (5th ed.). New York: McGraw-Hill.

Elliott, M.E., Martin, B.A. (2002). PDA adaptation of Boh LE, ed. In L.E. Boh (Ed.), Pharmacy Practice Manual (6th ed.). Baltimore: Lippincott, Williams, & Wilkins.

Elliott, M.E., Willsey, L.D., Beutel, P., Zimmerman, D., Gudmundsson, A., Meek, P. (2001). Cost of hip fractures and estimate of treatment cost effectiveness in Wisconsin nursing home residents. J. Bone Miner. Res., 16(Suppl 1), SA 292.

Elliott, M.E., Drinka, P.J., Krause, P., Mahoney, J.E., & Binkley, N.C. (2001). Osteoporosis in institutionalized male veterans: Common but under-recognized. J. Bone Miner. Res., 16(Suppl 1), M349.

Elliott, M.E., Petersen, K., Binkley, N.C., Carnes, M.L., Zimmerman, D.R., Kieser, M.A., Knapp, K., Behlke, J., & Ahmann, N. (2001). Fracture risks in long term care: Osteoporosis and hypovitaminosis D. American College of Clinical Pharmacy Annual Meeting, Abstract 363, 200.

Elliott, M.E. (2001). Interpretation of clinical laboratory tests. In L.E. Boh (Ed.), Pharmacy Practice Manual (6th ed.). Baltimore: Lippincott, Williams, & Wilkins.

Elliott, M.E., Farrah, R.M., Binkley, N.C., Carnes, M.L., & Gudmundsson, A. (2000). Management of glucocorticoid-induced osteoporosis in male veterans. Ann. Pharmacother., 34, 1380-1384.

Riley, R.L., Gudmundssonn, A., Carnes, M.L., & Elliott, M.E. (2000). Veterans with hip fractures: Outcomes and evaluation of secondary prevention strategies. J. Bone Min. Res., 14(Suppl 1), SU449.

Elliott, M.E., Carnes, M.L., Meek, P.D., Binkley, N.C., Gudmundsson, A., & Sanchez, C. (1999). Osteoporosis: Suggested management strategies. Drug Policy Perspective, 5, 66-69.

Elliott, M.E., Carnes, M.L., & Gudmundsson, A. (1999). Enrollment in a multidisciplinary osteoporosis clinic maintains or improves bone mineral density in male veterans. J. Bone. Min. Res., 14(Suppl 1), SU389.

Elliott, M.E., Binkley, N.C., Meek, P.D., & Kanous, N.L. (1999). Community pharmacy osteoporosis database project with the peripheral instantaneous x-ray imager (PIXI). American Association of Colleges of Pharmacy Annual Meeting, 100(Jul), 26.

Elliott, M.E., Klein, L.C., Carnes, M.L., Gudmundsson, A., Skoronski, R.M., & Binkley, N.C. (1998). Management of glucocorticoid-induced osteoporosis in male veterans. Bone, 2(5 suppl), s583.

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