Asia-Pacific consensus on long-term and sequential therapy for osteoporosis

Objectives@#This study aimed to present the Asia-Pacific consensus on long-term and sequential therapy for osteoporosis, offering evidence-based recommendations for the effective management of this chronic condition.The primary focus is on achieving optimal fracture prevention through a comprehensive, individualized approach. @*Methods@#A panel of experts convened to develop consensus statements by synthesizing the current literature and leveraging clinical expertise. The review encompassed long-term anti-osteoporosis medication goals, first-line treatments for individuals at very high fracture risk, and the strategic integration of anabolic and anti resorptive agents in sequential therapy approaches. @*Results@#The panelists reached a consensus on 12 statements. Key recommendations included advocating for anabolic agents as the first-line treatment for individuals at very high fracture risk and transitioning to anti resorptive agents following the completion of anabolic therapy. Anabolic therapy remains an option for in dividuals experiencing new fractures or persistent high fracture risk despite antiresorptive treatment. In cases of inadequate response, the consensus recommended considering a switch to more potent medications. The consensus also addressed the management of medication-related complications, proposing alternatives instead of discontinuation of treatment. @*Conclusions@#This consensus provides a comprehensive, cost-effective strategy for fracture prevention with an emphasis on shared decision-making and the incorporation of country-specific case management systems, such as fracture liaison services. It serves as a valuable guide for healthcare professionals in the Asia-Pacific region, contributing to the ongoing evolution of osteoporosis management.

Warfarin induced skin necrosis in a patient with craniopharyngioma

Oral anticoagulants are associated with several adverse skin manifestations ranging from ecchymosis, purpura, and hemorrhagic necrosis to maculopapular rash, vesicular urticarial eruptions and purple toes. Skin necrosis is a rare but serious side effect of warfarin therapy, associated with significant morbidity and mortality. The prevalence of warfarin induced skin necrosis [WISN] is 0.01-0.1%. We report a 20-year-old female patient of craniopharyngioma who developed WISN following postoperative femoropopliteal deep vein thrombosis