OSTEOPOROSIS: AN OPPORTUNITY OR OBLIGATION

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "OSTEOPOROSIS: AN OPPORTUNITY OR OBLIGATION"

Transcription

1 OSTEOPOROSIS: AN OPPORTUNITY OR OBLIGATION Debra L. Sietsema, PhD, RN Director, Bone Health Clinical Operations October 5, 2016 OTA NP/PA Course 1

2 Osteoporosis Definition A skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture Normal Bone Osteoporotic Bone NIH Consensus Development Panel on Osteoporosis. JAMA. 2001;285:

3 WHO Classification 3

4 Fragility Fracture Resulting from a: Fall from a standing height Spontaneous fracture Establishes osteoporosis diagnosis regardless of DXA results Siris, et al. The clinical diagnosis of osteoporosis. Ost Int. 2014; 25:

5 Shifting the Osteoporosis Paradigm: Bone Strength Bone Density abmd = g/cm 2 vbmd = g/cm 3 Bone Quality Bone Strength Mineralization Bone remodeling Damage accumulation Trabecular connectivity Architecture NIH Consensus Development Panel on Osteoporosis. JAMA. 2001;285:

6 What s the problem? 6

7 7

8 Prevalence of Osteoporosis and Low Bone Mass Americans Age 50 and Above Affected by Osteoporosis/Low Bone Mass, 2010 to 2030 (projected) 80 Osteoporosis Prevalence of Osteoporosis and Low Bone Mass 54 million of 99 million Americans age 50+ (2010) 17% of the ENTIRE U.S. POPULATION (2010) Millions Wright NC, et al. JBMR doi: /jbmr % change from 2010 to 2030 Low Bone Mass Osteoporosis 8

9 Hospitalization Burden for Osteoporotic Fractures and Other Serious Diseases in Older US Women Figure 1. Percent of hospitalizations* for osteoporotic fractures and other serious diseases combined, *Principal diagnosis codes were used to define the outcomes. Singer AJ, et al. Osteoporosis International. 25(4) suppl: ;2014. Singer AJ, et al. Mayo Clinic Proceedings ,

10 Incidence Rates for Vertebral, Wrist, and Hip Fractures in Women After Age Vertebral 30 Annual Incidence per 1000 Women Wrist Hip Age (Years) Wasnich RD. In: Favus MJ, ed. Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th ed. Philadelphia, PA: Lippincott; 1999:

11 Incidence Rates for Vertebral, Wrist, and Hip Fractures in Women After Age Vertebral Annual Incidence per 1000 Women Youngest Baby Boomers Largest Baby Boomer Group Wrist Hip Age (Years) Oldest Baby Boomers Wasnich RD. In: Favus MJ, ed. Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th ed. Philadelphia, PA: Lippincott; 1999:

12 Incidence Rates for Vertebral, Wrist, and Hip Fractures in Women After Age Annual Incidence per 1000 Women Youngest Baby Boomers Wrist Largest Baby Boomer Group Vertebral Hip Oldest Baby Boomers Age (Years) Wasnich RD. In: Favus MJ, ed. Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 4th ed. Philadelphia, PA: Lippincott; 1999:

13 Distal Radial Fractures The lifetime risk of sustaining a distal radial fracture is about 16% for white women. By age 70, about 20% of women have had at least one distal radial fracture. 13

14 Vertebral fractures 35 to 50% of all women over fifty have at least one vertebral fracture. Between 30-65% are undiagnosed 1 3X risk 3 9X risk Siris, et al. Enhanced prediction of fracture risk combining vertebral fracture status and BMD. Ost Int. 2007;18:

15 Proximal Femoral Fractures A 50-year-old white woman is estimated to have a 17.5% lifetime risk of fracture of the proximal femur. 15

16 Proximal Femoral Fractures Incidence increases each decade for all populations. Highest incidence is found among men and women ages 80 or older. 16

17 1 out of 2 Women will have an osteoporotic fracture 17

18 1 in 4 Men will have an osteoporotic fx More likely to have an osteoporotic fracture than to get prostate cancer 80,000 men have a hip fracture annually Men are more likely to die within a year after hip fracture 18

19 Importance to Orthopedics Unique opportunity sentinel event Reduce subsequent fractures Enhance fracture healing Comprehensive, excellent care 19

20 Osteoporotic Disasters 20

21 Osteoporotic Disasters 21

22 Osteoporotic Disasters 22

23 Osteoporotic Disasters 23

24 Osteoporotic Disasters 24

25 Osteoporotic Disasters 25

26 Osteoporotic Disasters 26

27 Advances to Treat these Fractures Locking technology Cephalomedullary nails Ceramics Osteobiologics 27

28 Identified Treatment Gap - NCQA HEDIS Measure % Compliance Beta-blocker after a heart attack 91.4% Breast cancer screening 82.7% Colorectal cancer screening 73.8% Osteoporosis management after a fracture 20.7% NCQA Medical Evaluation HMO Statistics 28

29 Optimal Management of Care Diagnosis of fragility fracture General fracture management Rehabilitation Secondary prevention: Prevent subsequent fx Identify, assess, treat, & evaluate underlying disease Teach & counsel re: condition & lifestyle behaviors Coordinated, comprehensive manner Ganda. Models of care. Ost Int

30 Fragility Fracture? Injury Pattern Mechanism of injury Low trauma Fall from a standing ht or less Fx that occurred during activity Did others involved fx? Risk Assessment Risk factors for: 1 & 2 osteoporosis Fracture Fall No symptoms of low bone mass until fracture. May be 1 st indication of osteoporosis! 30

31 Physical Findings Clinical Presentation indicating increased fracture risk Impaired ambulation Muscle weakness Impaired balance Reduced vision Macular Degeneration Glaucoma Bifocals Orthostatic hypotension Clinical presentation indicating signs of prior fractures Loss of height Kyphosis Chest deformity Protuberant abdomen Rib-pelvis overlap 31

32 Key Risk Factors for Fractures (RR 2) Age BMD Prior fragility fx Family hx of fragility fx Kanis. Ost Int. 2005; 16 32

33 Causes of Secondary Osteoporosis Endocrine Disorders affecting bone metabolism Menopause < age 45 Hypercalcuria with or without renal stones Hypogonadism Hyperparathyroidism Hyperthyroidism Cushing s syndrome Diabetes (types 1 and 2) Acromegaly Osteogenesis Imperfecta 33

34 Causes of Secondary Osteoporosis Drugs affecting bone quality Excess/length of time on glucocorticoids Excess thyroid hormones Anticoagulants (heparin) GnRH agonists Anticonvulsants Aromatase inhibitors Thiazolidinediones Opiates Cyclosporine Chemotherapy Alcohol Loop diuretics PPI long term use 34

35 Secondary Causes of Osteoporosis GI Tract Disorders Malabsorption Gastrectomy Inflammatory bowel disease Celiac disease Intestinal bypass surgery Primary biliary cirrhosis Pancreatic insufficiency Hepatitis B, C Bone Marrow Based Disorders Multiple myeloma Hemolytic anemia, hemoglobinopathies Myelo-and lymphoproliferative disorders Skeletal metastases (diffuse or localized) Gaucher s disease Mastocytosis 35

36 Secondary Causes of Osteoporosis Inflammatory Disorders RA SLE Ankylosing spondylitis Polymalgia rheumatica Vasculitis Other Propensity to fall Immobilization COPD Chronic renal failure AIDS/HIV Organ transplantation Anorexia / Bulemia Malignancy 36

37 Other Significant Risk Factors Vitamin D insufficiency History of missed menses/estrogen deficiency Smoking Excessive alcohol intake Sedentary lifestyle Environmental risks for fall Collagen deficiency Hypermobility / flexibility 37

38 Clinical Approach to Managing Osteoporosis Assessment Detailed osteoporosis risk factor hx r/t fx & falls Physical exam Diagnostic studies 10-year probability of fx (FRAX) Ultimate Goal Prevent fractures Plan Mutual plan 38

39 Clinical Approach to Managing Osteoporosis Implement Nonmedical interventions Modify risk factors PT/OT Psychosocial support Supplements Prescriptive therapies Evaluate Lifestyle changes Rx Compliance Diagnostic studies Vertebral imaging Fracture occurrence 39

40 Suggested Laboratory Tests Complete blood count Serum chemistry studies Serum 25-hydroxyvitamin D ipth Bone turnover markers CTX & P1NP TSH Testosterone 1, 25 Vitamin D 24 hr urine for calcium Phosphorus Watts NB, et al. AACE Medical Guidelines for Clinical Practice for the diagnosis and treatment of postmenopausal osteoporosis Endocr Pract. 2010;16(suppl 3):1-37. Cosman, et al. Clinician s guide to prevention and treatment of osteoporosis. Ost Int. 2015; 26:

41 Other Laboratory Tests Lab Test Erythrocyte sedimentation rate Urinary cortisol or other tests Serum protein electrophoresis (SPEP) and light chains Tissue transglutaminase antibodies Purpose Malignancy or inflammatory disease Adrenal hypersecretion Myeloma Celiac disease 41

42 Pharmacological Treatment Guidelines Postmenopausal women and men age 50 and older presenting with one of the following: Fracture T-Score - A vertebral or hip fracture - T-score -2.5 at the femoral neck, total hip, or lumbar spine by DXA FRAX - 10-year probability of a major fracture 20% - 10-year probability of a hip fracture 3% Cosman, et al. Clinician s guide to prevention and treatment of osteoporosis. Ost Int. 2015; 26:

43 Treatment Guidelines: Post-menopausal Women And Men 50 Assess Risk Factors and Measure BMD if Patient Has Risk Factors T-score between -1.0 and -2.5 Hip or Vertebral Fractures or T-score -2.5 (Spine, Femoral Neck or Total Hip) FRAX 10-year Probability of Hip Fracture 3% or Probability of All Major Fractures 20% 43

44 Medications for Osteoporosis Inhibit Bone Resorption Bisphosphonates Alendronate (Fosamax) Risedronate (Actonel, Atelvia) Ibandronate (Boniva) Zolendronate (Reclast) Monoclonal antibody Denosumab (Prolia) SERM Raloxifene (Evista) Other Estrogen (various) Calcitonin(Miacalcin, Fortical) Stimulate Bone Formation Anabolic Teriparatide (Forteo) 44

45 FDA Approved Medications: Evidence for Fracture Reduction Medication BMD Vertebral Fx Nonvertebral Fx Hip Fx Alendronate X X * X Risedronate XX X X * Ibandronate XX X No effect No effect Zoledronic acid XX X X X Denosumab XXX X X X Raloxifene X X No effect X Teriparatide XXX X X X * Evidence for effect, but not FDA approved indication 45

46 Challenges of Osteoporosis Rx Success = absence of fracture $$$ Other costs of treatment: Nuisance of taking another medication Reminder of illness/condition Worry about consequences of therapy Adverse effects of treatment 46

47 Atypical Femoral Fractures With every 50 hip fractures prevented with bisphosphonates, 500/1000 women will suffer a fracture without treatment 1 atypical femoral fracture may result. Out of 1,000 people on bisphosphonates for 5 years, < 1 will have an atypical fx (.16/1000) & < 1 will have osteonecrosis of the jaw (.01/1000).

48 Adherence & Persistence Patient Pain & Disability Teachable Moment Begin regimen early Purposes Enhance fracture healing Prevent subsequent fractures Treatment Team Fracture liaison service (FLS) Recognizable face Consistent message Coordinated or Separate appointments Education, counseling and guidance Assure follow-up 48

49 Treatment: Summary Safe and effective therapies are available Anti-remodeling (antiresorptive) agents Prevent bone loss and preserve architecture Reduce the risk of vertebral fractures (all agents) Alendronate, risedronate, zoledronic acid and denosumab reduce the risk of nonvertebral and hip fractures Bone building (anabolic) agent: (teriparatide) Increases bone density and size Improves quality of bone Reduces the risk of vertebral and nonvertebral fractures New Drugs: Abaloparatide (anticipated Q2 2017): anabolic Romosozumab (anticipated late 2017): antisclerostin antibody Patient factors determine the most appropriate drug to use 49

50 Treatment: Summary, continued BMD Change Doesn t Fully Predict the Reduction in Fracture Risk Fracture Risk Anti-remodeling treatment decreases fracture risk more rapidly and to a larger extent than one would predict from the relatively small changes in BMD Fracture protection can be observed in the absence of a significant change in BMD Fracture protection persists even when the BMD reaches a plateau BMD stability does not mean nonresponse 50

51 Treatment: Summary, continued The fracture risk is determined by the complex interactions among bone mineral density (BMD), bone quality, and trauma Contemporary pharmacologic treatments will typically reduce vertebral fracture risk by 30%-70%, with smaller reductions in non-vertebral fracture risk No pharmacologic treatment is likely to reduce fracture risk to zero, in part because of the inability to eliminate trauma There are a number of promising pharmacologic agents with most of the emphasis to be placed on the development of novel anabolic agents 51

52 Integrate Own The Bone Program: Ten Important Measures to Achieve Success NUTRITION COUNSELING* 1. Calcium supplementation 2. Vitamin D supplementation PHYSICAL ACTIVITY COUNSELING* 3. Exercise, especially weight-bearing and muscle strengthening 4. Fall prevention education LIFESTYLE COUNSELING* 5. Smoking cessation 6. Limiting excessive alcohol intake PHARMACOLOGY* 7. Pharmacology for the treatment of osteoporosis TESTING* 8. DXA to test bone mineral density COMMUNICATION 9. Physician referral letter 10. Follow-up notes and educational materials provided to patient *Unless contraindicated. Measures listed here are consistent with recommendations from the National Osteoporosis Foundation, the Centers for Medicare & Medicaid Services, the Joint Commission, the World Health Organization, and the American Medical Association. 52

53 Rewards of Osteoporosis Treatment Reduction in the risk of fracture Reduction in pain and disability Preservation of independence Reduction in height loss Positive effect on mortality (?) Positive effect of being proactive Positive effect on BMD Decrease in subsequent fractures Unique benefit to community 53

54 Bone Health Across the Lifespan 54

55 Keep Life in Motion! 55

56 Questions? 56

Osteoporosis/Fracture Prevention

Osteoporosis/Fracture Prevention Osteoporosis/Fracture Prevention NATIONAL GUIDELINE SUMMARY This guideline was developed using an evidence-based methodology by the KP National Osteoporosis/Fracture Prevention Guideline Development Team

More information

Osteoporosis Management

Osteoporosis Management Osteoporosis Management Lisa Voss PA C, CCD Laura Frontiero NP C, CCD Kaiser Healthy Bones Program San Diego Disclosures: Nothing to disclose www.zazzle.com 1 Overview How to diagnose Osteoporosis FRAX

More information

Bone Densitometry Pathway

Bone Densitometry Pathway Bone Densitometry Pathway The goal of the Bone Densitometry pathway is to manage our diagnosed osteopenic and osteoporotic patients, educate and monitor the patient population at risk for bone density

More information

John J. Wolf, DO Family Medicine

John J. Wolf, DO Family Medicine John J. Wolf, DO Family Medicine Objectives: 1. Review incidence & Risk of Osteoporosis 2.Review indications for testing 3.Review current pharmacologic & Non pharmacologic Tx options 4.Understand & Utilize

More information

Pharmacy Management Drug Policy

Pharmacy Management Drug Policy SUBJECT: - Forteo (teriparatide), Prolia (denosumab), Tymlos (abaloparatide) POLICY NUMBER: Pharmacy-35 EFFECTIVE DATE: 9/07 LAST REVIEW DATE: 9/29/2017 If the member s subscriber contract excludes coverage

More information

AACE/ACE Osteoporosis Treatment Decision Tool

AACE/ACE Osteoporosis Treatment Decision Tool AACE/ACE Osteoporosis Treatment Decision Tool What is Osteoporosis? OSTEOPOROSIS is defined as reduced bone strength leading to an increased risk of fracture. Osteoporosis, or porous bones, occurs when

More information

Osteoporosis/Fracture Prevention Clinician Guide SEPTEMBER 2017

Osteoporosis/Fracture Prevention Clinician Guide SEPTEMBER 2017 Kaiser Permanente National CLINICAL PRACTICE GUIDELINES Osteoporosis/Fracture Prevention Clinician Guide SEPTEMBER 2017 Introduction This Clinician Guide was developed to assist Primary Care physicians

More information

The Bare Bones of Osteoporosis. Wendy Rosenthal, PharmD

The Bare Bones of Osteoporosis. Wendy Rosenthal, PharmD The Bare Bones of Osteoporosis Wendy Rosenthal, PharmD Definition A systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase

More information

This Coverage Policy applies to Individual Health Insurance Marketplace benefit plans only.

This Coverage Policy applies to Individual Health Insurance Marketplace benefit plans only. This Coverage Policy applies to Individual Health Insurance Marketplace benefit plans only. INJECTABLE OSTEOPOSIS AGENTS SUBJECT Pharmacologic Agents: Bisphosphonates: Boniva IV (ibandronate) Reclast (zoledronic

More information

Module 5 - Speaking of Bones Osteoporosis For Health Professionals: Fracture Risk Assessment. William D. Leslie, MD MSc FRCPC

Module 5 - Speaking of Bones Osteoporosis For Health Professionals: Fracture Risk Assessment. William D. Leslie, MD MSc FRCPC Module 5 - Speaking of Bones Osteoporosis For Health Professionals: Fracture Risk Assessment William D. Leslie, MD MSc FRCPC Case #1 Age 53: 3 years post-menopause Has always enjoyed excellent health with

More information

Osteoporosis: A Tale of 3 Task Forces!

Osteoporosis: A Tale of 3 Task Forces! Osteoporosis: A Tale of 3 Task Forces! Robert A. Adler, MD McGuire Veterans Affairs Medical Center Virginia Commonwealth University Richmond, Virginia, USA Disclosures The opinions are those of the speaker

More information

Conflict of Interest. Disclosures: Learner Outcome

Conflict of Interest. Disclosures: Learner Outcome Conflict of Interest -primary prevention and secondary fracture prevention for the Advanced Practice Nurse Anne Lake, DNP, ONP-C, FNP-C, CCD I hereby certify that, to the best of my knowledge, no aspect

More information

Clinical Practice. Presented by: Internist, Endocrinologist

Clinical Practice. Presented by: Internist, Endocrinologist Clinical Practice Management of Osteoporosis Presented by: SaeedBehradmanesh, h MD Internist, Endocrinologist Iran, Isfahan, Feb. 2017 Definition: A disease characterized by low bone mass and microarchitectural

More information

Parathyroid Hormone Analog for Osteoporosis Prior Authorization with Quantity Limit Criteria Program Summary

Parathyroid Hormone Analog for Osteoporosis Prior Authorization with Quantity Limit Criteria Program Summary Parathyroid Hormone Analog for Osteoporosis Prior Authorization with Quantity Limit Criteria Program Summary This prior authorization program applies to Commercial, NetResults A series, NetResults F series

More information

Who gets Osteoporosis Bone Tested and Why

Who gets Osteoporosis Bone Tested and Why Who gets Osteoporosis Bone Tested and Why Steve Kane, MD Chairman, AMC Orthopedic Surgery Residency Topics for which I should never be at the podium How I summited Mt. Everest How I found the Titanic My

More information

AETNA BETTER HEALTH Prior Authorization guideline for Injectable Osteoporosis Agents

AETNA BETTER HEALTH Prior Authorization guideline for Injectable Osteoporosis Agents AETNA BETTER HEALTH Prior Authorization guideline for Injectable Osteoporosis Agents Injectable Osteoporosis Agents Forteo (teriparatide); zoledronic acid Prolia (denosumab)] Authorization guidelines For

More information

OSTEOPOROSIS: PREVENTION AND MANAGEMENT

OSTEOPOROSIS: PREVENTION AND MANAGEMENT OSTEOPOROSIS: OVERVIEW OSTEOPOROSIS: PREVENTION AND MANAGEMENT Judith Walsh, MD, MPH Departments of Medicine and Epidemiology and Biostatistics UCSF Definitions Key Risk factors Screening and Monitoring

More information

Osteoporosis Clinical Guideline. Rheumatology January 2017

Osteoporosis Clinical Guideline. Rheumatology January 2017 Osteoporosis Clinical Guideline Rheumatology January 2017 Introduction Osteoporosis is a condition of low bone mass leading to an increased risk of low trauma fractures. The prevalence of osteoporosis

More information

Osteoporosis Physician Performance Measurement Set. October 2006

Osteoporosis Physician Performance Measurement Set. October 2006 American Academy of Family Physicians/American Academy of Orthopaedic Surgeons/American Association of Clinical Endocrinologists/American College of Rheumatology/The Endocrine Society/Physician Consortium

More information

Updates in Osteoporosis

Updates in Osteoporosis Updates in Osteoporosis Jeffrey A. Tice, MD Associate Professor of Medicine Division of General Internal Medicine, University of California, San Francisco I have no conflicts of interest What s New in

More information

Prevention of Osteoporotic Hip Fracture

Prevention of Osteoporotic Hip Fracture Prevention of Osteoporotic Hip Fracture Dr Law Sheung Wai 8th July 2007 Associate Consultant Spine team / Orthopedic Rehabilitation Department of Orthopedics and Traumatology NTE Cluster 1 Objectives Problems

More information

Fragile Bones and how to recognise them. Rod Hughes Consultant physician and rheumatologist St Peter s hospital Chertsey

Fragile Bones and how to recognise them. Rod Hughes Consultant physician and rheumatologist St Peter s hospital Chertsey Fragile Bones and how to recognise them Rod Hughes Consultant physician and rheumatologist St Peter s hospital Chertsey Osteoporosis Osteoporosis is a skeletal disorder characterised by compromised bone

More information

Steven W. Ing, M.D., MSCE Assistant Professor of Internal Medicine

Steven W. Ing, M.D., MSCE Assistant Professor of Internal Medicine Osteoporosis Steven W. Ing, M.D., MSCE Assistant Professor of Internal Medicine Department of Internal Medicine Division of Endocrinology, Diabetes, & Metabolism Ohio State University Medical Center Case

More information

Page 1. New Developments in Osteoporosis. What s New in Osteoporosis

Page 1. New Developments in Osteoporosis. What s New in Osteoporosis New Developments in Osteoporosis Eliseo J. Pérez-Stable MD Professor of Medicine Division of General Internal Medicine Department of Medicine July 4, 2013 Declaration of full disclosure: No conflict of

More information

Osteoporosis: A Tale of 3 Task Forces!

Osteoporosis: A Tale of 3 Task Forces! Osteoporosis: A Tale of 3 Task Forces! Robert A. Adler, MD McGuire Veterans Affairs Medical Center Virginia Commonwealth University Richmond, Virginia, USA Disclosures The opinions are those of the speaker

More information

Page 1

Page 1 Osteoporosis Osteoporosis is a condition characterised by weakened bones that fracture easily. After menopause many women are at risk of developing osteoporosis. Peak bone mass is usually reached during

More information

Therapeutic Updates in the Prevention and Treatment of Osteoporosis

Therapeutic Updates in the Prevention and Treatment of Osteoporosis Therapeutic Updates in the Prevention and Treatment of Osteoporosis 2013 Fall Managed Care Forum Las Vegas November 15, 2013 Steven T Harris MD FACP Clinical Professor of Medicine University of California,

More information

Men and Osteoporosis So you think that it can t happen to you

Men and Osteoporosis So you think that it can t happen to you Men and Osteoporosis So you think that it can t happen to you Jonathan D. Adachi MD, FRCPC Alliance for Better Bone Health Chair in Rheumatology Professor, Department of Medicine Michael G. DeGroote School

More information

Kristen M. Nebel, DO PENN/ LGHP Geriatrics. Temple Family Medicine Review

Kristen M. Nebel, DO PENN/ LGHP Geriatrics. Temple Family Medicine Review Kristen M. Nebel, DO PENN/ LGHP Geriatrics 10/3/17 Temple Family Medicine Review OBJECTIVES Define Revised 2017 American College of Physician Recommendations Screening, Prevention and Treatment Application

More information

Osteoporosis. A Silent Killer. David A. Chappell, MD Endocrinology Private Practice Petaluma, California

Osteoporosis. A Silent Killer. David A. Chappell, MD Endocrinology Private Practice Petaluma, California Osteoporosis A Silent Killer David A. Chappell, MD Endocrinology Private Practice Petaluma, California Relevant Disclosures Speakers Bureau Astra Zeneca Boehringer Ingelheim AACE/ACE Guidelines American

More information

TREATMENT OF OSTEOPOROSIS HOLIDAYS OR NO HOLIDAYS? Nelson B. Watts, MD OSTEOPOROSIS AND BONE HEALTH SERVICES CINCINNATI, OHIO

TREATMENT OF OSTEOPOROSIS HOLIDAYS OR NO HOLIDAYS? Nelson B. Watts, MD OSTEOPOROSIS AND BONE HEALTH SERVICES CINCINNATI, OHIO TREATMENT OF OSTEOPOROSIS HOLIDAYS OR NO HOLIDAYS? Nelson B. Watts, MD OSTEOPOROSIS AND BONE HEALTH SERVICES CINCINNATI, OHIO DISCLOSURES Honoraria: Amgen, Merck, Shire Consulting : AbbVie, Amgen, Merck,

More information

Summary of the risk management plan by product

Summary of the risk management plan by product Summary of the risk management plan by product 1 Elements for summary tables in the EPAR 1.1 Summary table of Safety concerns Summary of safety concerns Important identified risks Important potential risks

More information

Fracture=Bone Attack:

Fracture=Bone Attack: Fracture=Bone Attack: Linking Hip Fractures to Osteoporosis Care Angela M. Cheung, MD, PhD, FRCPC Professor of Medicine, University of Toronto Potential Conflicts of Interests Industry Grants (to UHN)

More information

New 2010 Osteoporosis Guidelines: What you and your health provider need to know QUESTIONS&ANSWERS

New 2010 Osteoporosis Guidelines: What you and your health provider need to know QUESTIONS&ANSWERS New 2010 Osteoporosis Guidelines: What you and your health provider need to know QUESTIONS&ANSWERS Wednesday, December 1, 2010 1:00 p.m. to 2:00 p.m. ET 1. I m 55 years old. I ve been taking Fosavance

More information

10/26/2017. Aging Population = more osteoporosis

10/26/2017. Aging Population = more osteoporosis Sandra Scholten, FNP-BC Discuss burden of osteoporosis (OP) and clinical consequences of OP fractures. Define OP and techniques used to assess bone density and quality. Improve awareness, diagnosis, and

More information

Understanding the Development of Osteoporosis and Preventing Fractures: WHO Do We Treat Now?

Understanding the Development of Osteoporosis and Preventing Fractures: WHO Do We Treat Now? Understanding the Development of Osteoporosis and Preventing Fractures: WHO Do We Treat Now? Steven M. Petak, MD, JD, FACE, FCLM Texas Institute for Reproductive Medicine And Endocrinology, Houston, Texas

More information

Guideline for the investigation and management of osteoporosis. for hospitals and General Practice

Guideline for the investigation and management of osteoporosis. for hospitals and General Practice Guideline for the investigation and management of osteoporosis for hospitals and General Practice Background Low bone density is an important risk factor for fracture. The aim of assessing bone density

More information

Controversies in Osteoporosis Management

Controversies in Osteoporosis Management Controversies in Osteoporosis Management 2018 Northwest Rheumatism Society Meeting Portland, OR April 28, 2018 Michael R. McClung, MD, FACP Director, Oregon Osteoporosis Center Portland, Oregon, USA Institute

More information

Guidelines for the Pharmaceutical Management of Osteoporosis in Adult WA Public Hospitals

Guidelines for the Pharmaceutical Management of Osteoporosis in Adult WA Public Hospitals WA.DRUG EVALUATION PANEL Guidelines for the Pharmaceutical Management of Osteoporosis in Adult WA Public Hospitals Introduction Osteoporotic fracture-related hospitalisations impose a substantial financial

More information

Osteoporosis in Men Eric Orwoll Oregon Health & Science University

Osteoporosis in Men Eric Orwoll Oregon Health & Science University Osteoporosis in Men Eric Orwoll Oregon Health & Science University Ris k Factor Risk factors for hip fracture in men Multivariate HR + 95% CI Age 2.3 (1.6, 2.4) FN BMD 3.0 (2.5, 3.7) 5994 men age >65 yrs

More information

Page 1. Current and Emerging Strategies What s New in Osteoporosis. Osteoporosis. What is Osteoporosis? Traditional Risk Factors for Fracture

Page 1. Current and Emerging Strategies What s New in Osteoporosis. Osteoporosis. What is Osteoporosis? Traditional Risk Factors for Fracture Current and Emerging Strategies for Osteoporosis What s New in Osteoporosis Risk stratification Douglas C. Bauer, MD University of California, San Francisco Under recognition and poor compliance New potential

More information

Diagnosis and Treatment of Osteoporosis. Department of Endocrinology and Metabolism Ajou University School of Medicine.

Diagnosis and Treatment of Osteoporosis. Department of Endocrinology and Metabolism Ajou University School of Medicine. Diagnosis and Treatment of Osteoporosis Department of Endocrinology and Metabolism Ajou University School of Medicine Yoon-Sok CHUNG WCIM, COEX, Seoul, 27Oct2014 Case 1 71-year old woman Back pain Emergency

More information

Osteoporosis Medications: A Case-Based Discussion. Laila S. Tabatabai, MD August 5, 2017

Osteoporosis Medications: A Case-Based Discussion. Laila S. Tabatabai, MD August 5, 2017 Osteoporosis Medications: A Case-Based Discussion Laila S. Tabatabai, MD August 5, 2017 Disclosures Eli Lilly Radius Objectives Determine which patients with low bone density require treatment, along with

More information

Awareness, Diagnosis, and Management of Osteoporosis in Adults with Developmental Disabilities

Awareness, Diagnosis, and Management of Osteoporosis in Adults with Developmental Disabilities Awareness, Diagnosis, and Management of Osteoporosis in Adults with Developmental Disabilities Sunil J. Wimalawansa, MD, PhD, MBA, FACP, FRCP University Professor Professor of Medicine, Physiology & Pharmacology

More information

Overview. Bone Biology Osteoporosis Osteomalacia Paget s Disease Cases. People Centred Positive Compassion Excellence

Overview. Bone Biology Osteoporosis Osteomalacia Paget s Disease Cases. People Centred Positive Compassion Excellence Overview Osteoporosis and Metabolic Bone Disease Dr Chandini Rao Consultant Rheumatologist Bone Biology Osteoporosis Osteomalacia Paget s Disease Cases Bone Biology Osteoporosis Increased bone remodelling

More information

Dumfries and Galloway. Treatment Protocol for Osteoporosis

Dumfries and Galloway. Treatment Protocol for Osteoporosis Dumfries and Galloway Treatment Protocol for Osteoporosis DIAGNOSIS OF OSTEOPOROSIS 2 Diagnostic Criteria 2 Multiple low trauma vertebral fractures in the absence of myeloma or metastatic disease. 2 T-score

More information

Osteoporosis. Skeletal System

Osteoporosis. Skeletal System Osteoporosis Introduction Osteoporosis is a very common bone disease that causes bone to become weak. Bone weakness can lead to fractures of the spine, hip, and wrist from simple falls or even a sneeze

More information

Dartmouth General Hospital Fracture Liaison Service. Carla Purcell BScN, RN, CMSN(C) Fracture Navigator

Dartmouth General Hospital Fracture Liaison Service. Carla Purcell BScN, RN, CMSN(C) Fracture Navigator Dartmouth General Hospital Fracture Liaison Service Carla Purcell BScN, RN, CMSN(C) Fracture Navigator Acknowledgments Dr. Diane Theriault Heather Francis DGH Ortho Clinics Points to Cover Osteoporotic

More information

S H A R E D C A R E G U I D E L I N E Drug: Denosumab 60mg injection Indication: treatment of osteoporosis in postmenopausal women

S H A R E D C A R E G U I D E L I N E Drug: Denosumab 60mg injection Indication: treatment of osteoporosis in postmenopausal women S H A R E D C A R E G U I D E L I N E Drug: Denosumab 60mg injection Indication: treatment of osteoporosis in postmenopausal women Introduction Indication: Denosumab (Prolia ) is recommended in NICE TA204

More information

HARVARD PILGRIM HEALTH CARE RECOMMENDED MEDICATION REQUEST GUIDELINES

HARVARD PILGRIM HEALTH CARE RECOMMENDED MEDICATION REQUEST GUIDELINES Generic Brand HICL GCN Exception/Other PROLIA, XGEVA 37012 If the caller wishes to initiate a request then a MRF must be completed. This drug requires a written request for prior authorization. All requests

More information

denosumab (Prolia ) Policy # Original Effective Date: 07/21/2011 Current Effective Date: 04/19/2017

denosumab (Prolia ) Policy # Original Effective Date: 07/21/2011 Current Effective Date: 04/19/2017 Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc.(collectively referred to as the Company ), unless otherwise provided

More information

Based on review of available data, the Company may consider the use of denosumab (Prolia) for the

Based on review of available data, the Company may consider the use of denosumab (Prolia) for the Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc.(collectively referred to as the Company ), unless otherwise provided

More information

Building Bone Density-Research Issues

Building Bone Density-Research Issues Building Bone Density-Research Issues Helping to Regain Bone Density QUESTION 1 What are the symptoms of Osteoporosis? Who is at risk? Symptoms Bone Fractures Osteoporosis 1,500,000 fractures a year Kyphosis

More information

Emerging Challenges in Primary Care: Osteoporosis and Fracture Prevention Strategies

Emerging Challenges in Primary Care: Osteoporosis and Fracture Prevention Strategies Emerging Challenges in Primary Care: 2017 Osteoporosis and Fracture Prevention Strategies Faculty Nancy R. Berman, MSN, ANP-BC, NCMP, FAANP Adult Nurse Practitioner Certified Menopause Practitioner Millennium

More information

Emerging Challenges in Primary Care: Osteoporosis and Fracture Prevention Strategies. Faculty. Disclosures. [Insert Lecture Name Here]

Emerging Challenges in Primary Care: Osteoporosis and Fracture Prevention Strategies. Faculty. Disclosures. [Insert Lecture Name Here] Emerging Challenges in Primary Care: 2017 Osteoporosis and Fracture Prevention Strategies Faculty Nancy R. Berman, MSN, ANP-BC, NCMP, FAANP Adult Nurse Practitioner Certified Menopause Practitioner Millennium

More information

Disclosure. Objectives. Osteoporosis. Major Public Health Concern Will I end up like my mother?

Disclosure. Objectives. Osteoporosis. Major Public Health Concern Will I end up like my mother? Everything a Pharmacist Needs to Know About Osteoporosis New Mexico Pharmacists Association Mid-Winter Meeting January 27-28, 2018 Albuquerque, NM Consulting Amgen, Radius Speaking Radius Disclosure E.

More information

Parathyroid Hormone Analogs

Parathyroid Hormone Analogs Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.30.36 Subject: Parathyroid Hormone Analogs Page: 1 of 6 Last Review Date: September 15, 2017 Parathyroid

More information

Management of Osteoporosis Clinical Practice Guideline September 2013

Management of Osteoporosis Clinical Practice Guideline September 2013 Management of Osteoporosis Clinical Practice Guideline September 2013 MedStar Health and MedStar Family Choice accept and endorse the clinical guidelines set forth by the National Osteoporosis Foundation

More information

DENOSUMAB SHARED CARE GUIDLINES

DENOSUMAB SHARED CARE GUIDLINES DENOSUMAB LICENSING Denosumab (PROLIA ) is licensed for the treatment of osteoporosis in postmenopausal women at increased risk of fractures and for bone loss associated with hormone ablation in men with

More information

Osteoporosis Update. Diagnosis and Management. Kara Hawkins, MD Sentara Martha Jefferson Hospital Charlottesville, VA

Osteoporosis Update. Diagnosis and Management. Kara Hawkins, MD Sentara Martha Jefferson Hospital Charlottesville, VA Osteoporosis Update Diagnosis and Management Kara Hawkins, MD Sentara Martha Jefferson Hospital Charlottesville, VA No disclosures Learning Objectives Know when to suspect secondary causes of osteoporosis

More information

Osteoporosis Diagnosis, Treatment and Controversies. Feb, 2018

Osteoporosis Diagnosis, Treatment and Controversies. Feb, 2018 Osteoporosis Diagnosis, Treatment and Controversies Feb, 2018 Shawn Baca, M.D., F.A.C.R. Rheumatology Associates of South Florida RASF RASF Clinical Research Osteoporosis Diagnosis and Treatment Center

More information

Medication Policy Manual. Topic: Prolia, denosumab Date of Origin: August 11, 2010

Medication Policy Manual. Topic: Prolia, denosumab Date of Origin: August 11, 2010 Independent licensees of the Blue Cross and Blue Shield Association Medication Policy Manual Policy No: dru223 Topic: Prolia, denosumab Date of Origin: August 11, 2010 Committee Approval Date: August 11,

More information

Dumfries and Galloway. Treatment Protocol for Osteoporosis

Dumfries and Galloway. Treatment Protocol for Osteoporosis Dumfries and Galloway Treatment Protocol for Osteoporosis DIAGNOSIS OF OSTEOPOROSIS 2 Diagnostic Criteria 2 REFERRAL CRITERIA FOR DEXA 3 TREATMENT 4 Non-Drug Therapy : for all 4 Non-Drug Therapy : in the

More information

Optimizing Osteoporosis Management Dr. Philip A. Baer Seacourses Asia CME December 2017

Optimizing Osteoporosis Management Dr. Philip A. Baer Seacourses Asia CME December 2017 Optimizing Osteoporosis Management Dr. Philip A. Baer Seacourses Asia CME December 2017 Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored,

More information

FRAX Based Lebanese Osteoporosis Guidelines Second Update for Lebanese Guidelines for Osteoporosis Assessment and Treatment

FRAX Based Lebanese Osteoporosis Guidelines Second Update for Lebanese Guidelines for Osteoporosis Assessment and Treatment These guidelines are endorsed by the following Lebanese Scientific Societies and Associations: Lebanese Society of Endocrinology Diabetes and Lipids, Lebanese Society of Rheumatology, Lebanese Society

More information

Diagnosis and management of osteoporosis

Diagnosis and management of osteoporosis Diagnosis and management of osteoporosis Ralston SH, Fraser J. Diagnosis and management of osteoporosis. Practitioner 2015;259 (1788):15-19 Professor Stuart H Ralston MD FRCP Professor of Rheumatology,

More information

chapter Bone Density (Densitometry) RADIOPHARMACY INDICATIONS Radionuclide Localization Quality Control Adult Dose Range Method of Administration

chapter Bone Density (Densitometry) RADIOPHARMACY INDICATIONS Radionuclide Localization Quality Control Adult Dose Range Method of Administration 10766-04_CH04_redo.qxd 12/3/07 3:47 PM Page 17 chapter 4 Bone Density (Densitometry) RADIOPHARMACY Radionuclide Single radionuclide: 125 I t 1/2 : 60.1 days Energies: 23 31 kev Type: EC, x, γ, accelerator

More information

Osteoporosis for the PCP and consultant COPYRIGHT. Harold Rosen, MD Director- Osteoporosis Prevention and Treatment Center

Osteoporosis for the PCP and consultant COPYRIGHT. Harold Rosen, MD Director- Osteoporosis Prevention and Treatment Center Osteoporosis for the PCP and consultant Harold Rosen, MD Director- Osteoporosis Prevention and Treatment Center Beth Israel Deaconess Medical Center Potential conflicts of interest None GOALS When to screen/treat?

More information

OSTEOPOROSIS MEDICINES

OSTEOPOROSIS MEDICINES Bone Basics 2010. NOF. All rights reserved. National Osteoporosis Foundation 1150 17th Street, NW, Suite 850 Washington, DC 20036 (800) 223-9994 www.nof.org OSTEOPOROSIS MEDICINES Although there is no

More information

Name of Policy: Boniva (Ibandronate Sodium) Infusion

Name of Policy: Boniva (Ibandronate Sodium) Infusion Name of Policy: Boniva (Ibandronate Sodium) Infusion Policy #: 266 Latest Review Date: April 2010 Category: Pharmacology Policy Grade: Active Policy but no longer scheduled for regular literature reviews

More information

Medical Assistance Division Medicaid Drug Utilization Review Newsletter

Medical Assistance Division Medicaid Drug Utilization Review Newsletter Medical Assistance Division Medicaid Drug Utilization Review Newsletter Volume 5 Issue 3 2 nd Quarter 2011 Osteoporosis: Evolving Treatment Options Janelle Sheen, PharmD Prevalence Osteoporosis is a major

More information

See Important Reminder at the end of this policy for important regulatory and legal information.

See Important Reminder at the end of this policy for important regulatory and legal information. Clinical Policy: (Reclast, Zometa) Reference Number: CP.PHAR.59 Effective Date: 03.11 Last Review Date: 02.18 Line of Business: Commercial, Medicaid Coding Implications Revision Log See Important Reminder

More information

This includes bone loss, endometrial cancer, and vasomotor symptoms.

This includes bone loss, endometrial cancer, and vasomotor symptoms. Hello and welcome. My name is Chad Barnett. I m a Clinical Pharmacy Specialist in the Division of Pharmacy at the University of Texas, MD Anderson Cancer Center and I m very pleased today to be able to

More information

Osteoporosis Management in Older Adults

Osteoporosis Management in Older Adults Osteoporosis Management in Older Adults Angela M Cheung, MD, PhD, FRCPC, CCD Professor of Medicine, University of Toronto Disclosures Relationship with Commercial Entities: Honoraria from: Amgen, Eli Lilly,

More information

Hot Topics in Bone Disease in 2017: Building Better Bones Breaking News in Osteoporosis

Hot Topics in Bone Disease in 2017: Building Better Bones Breaking News in Osteoporosis Hot Topics in Bone Disease in 2017: Building Better Bones Breaking News in Osteoporosis Aromatase Inhibitor-Induced Bone Loss in Early Breast Cancer Rachel Pessah-Pollack, M.D., F.A.C.E. Mount Sinai School

More information

Surviving Breast Cancer

Surviving Breast Cancer Surviving Breast Cancer What to expect after completing treatment Dexter T. Estrada, MD Hematology Oncology Medical Group of Fresno, Inc. November 3, 2012 Epidemiology & Survival Estimates Breast cancer

More information

Bone Disorders in CKD

Bone Disorders in CKD Osteoporosis in Dialysis Patients Challenges in Management David M. Klachko MD FACP Professor Emeritus of Medicine University of Missouri-Columbia Bone Disorders in CKD PTH-mediated high-turnover (osteitis

More information

Bone Health in Women: Getting Strong and Staying Strong Family Medicine Refresher Course

Bone Health in Women: Getting Strong and Staying Strong Family Medicine Refresher Course Bone Health in Women: Getting Strong and Staying Strong Family Medicine Refresher Course Jeannette E. South-Paul, M.D. Andrew W. Mathieson UPMC Professor and Chair University of Pittsburgh Department of

More information

4.7 Studies of Quality Holy Cross Hospital Bone Health Early Stage I ER/PR Positive Breast Cancer Patients December 13, 2017

4.7 Studies of Quality Holy Cross Hospital Bone Health Early Stage I ER/PR Positive Breast Cancer Patients December 13, 2017 4.7 Studies of Quality Holy Cross Hospital 2017 Bone Health Early Stage I ER/PR Positive Breast Cancer Patients December 13, 2017 Bone Health in Stage I ER/PR Positive Breast Cancer Patients To review

More information

A Patient s Guide to Osteoporosis

A Patient s Guide to Osteoporosis A Patient s Guide to Osteoporosis Glendale Adventist Medical Center 1509 Wilson Terrace Glendale, CA 91206 Phone: (818) 409-8000 DISCLAIMER: The information in this booklet is compiled from a variety of

More information

Prevention and Management of Osteoporosis

Prevention and Management of Osteoporosis Peer-Reviewed Continuing Education Prevention and Management of Osteoporosis by Mary E. Elliott, PharmD, PhD CE for pharmacists only Complete article and CE exam available online: www.pswi.org Osteoporosis

More information

Calcium Nephrolithiasis and Bone Health. Noah S. Schenkman, MD

Calcium Nephrolithiasis and Bone Health. Noah S. Schenkman, MD Calcium Nephrolithiasis and Bone Health Noah S. Schenkman, MD Associate Professor of Urology and Residency Program Director, University of Virginia Health System; Charlottesville, Virginia Objectives:

More information

Osteoporosis: A Review of Treatment Options

Osteoporosis: A Review of Treatment Options Kristie N. Tu, PharmD, BCPS, CGP; Janette D. Lie, PharmD, BCACP; Chew King Victoria Wan, PharmD Candidate; Madison Cameron, PharmD Candidate; Alaina G. Austel, PharmD Candidate; Jenny K. Nguyen, PharmD

More information

From Fragile to Firm. Monika Starosta MD. Advocate Medical Group

From Fragile to Firm. Monika Starosta MD. Advocate Medical Group From Fragile to Firm Monika Starosta MD Advocate Medical Group Bone Remodeling 10% remodeled each year Calcium homoeostasis Maintain Mechanical strength Replace Osteocytes Release Growth Factors Bone remodeling

More information

See Important Reminder at the end of this policy for important regulatory and legal information.

See Important Reminder at the end of this policy for important regulatory and legal information. Clinical Policy: (Prolia, Xgeva) Reference Number: CP.PHAR.58 Effective Date: 03.01.11 Last Review Date: 05.18 Line of Business: Commercial, Medicaid Coding Implications Revision Log See Important Reminder

More information

Costing statement: Denosumab for the prevention of osteoporotic fractures in postmenopausal women

Costing statement: Denosumab for the prevention of osteoporotic fractures in postmenopausal women Costing statement: Denosumab for the prevention of osteoporotic fractures in postmenopausal women Resource impact The guidance Denosumab for the prevention of osteoporotic fractures in postmenopausal women

More information

What Is FRAX & How Can I Use It?

What Is FRAX & How Can I Use It? What Is FRAX & How Can I Use It? Jacqueline Osborne PT, DPT Board Certified Geriatric Clinical Specialist Certified Exercise Expert for the Aging Adult Brooks Rehabilitation; Jacksonville, FL Florida Physical

More information

Name of Policy: Zoledronic Acid (Reclast ) Injection

Name of Policy: Zoledronic Acid (Reclast ) Injection Name of Policy: Zoledronic Acid (Reclast ) Injection Policy #: 355 Latest Review Date: May 2011 Category: Pharmacy Policy Grade: Active Policy but no longer scheduled for regular literature reviews and

More information

Recent advances in the management of osteoporosis

Recent advances in the management of osteoporosis CONFERENCE SUMMARIES Clinical Medicine 2009, Vol 9, No 6: 565 9 Recent advances in the management of osteoporosis Juliet Compston Introduction Osteoporotic fractures are a major cause of morbidity and

More information

Oral Alendronate Vs. Three-Monthly Iv Ibandronate In The Treatment Of Postmenopausal Osteoporosis

Oral Alendronate Vs. Three-Monthly Iv Ibandronate In The Treatment Of Postmenopausal Osteoporosis Oral Alendronate Vs. Three-Monthly Iv Ibandronate In The Treatment Of Postmenopausal Osteoporosis Miriam Silverberg A. Study Purpose and Rationale More than 70% of fractures in people after the age of

More information

LOVE YOUR BONES Protect your future

LOVE YOUR BONES Protect your future www.worldosteoporosisday.org LOVE YOUR BONES Protect your future Know your risk for osteoporosis www.iofbonehealth.org Osteoporosis is a problem worldwide, and in many countries, up to one in three women

More information

Clinical Practice Guideline. Adult Osteoporosis. Version June Unpublished work (c) 2016 United Rheumatology, LLC

Clinical Practice Guideline. Adult Osteoporosis. Version June Unpublished work (c) 2016 United Rheumatology, LLC Clinical Practice Guideline Adult Osteoporosis Version 1.1.2016 June 2016 Unpublished work (c) 2016 United Rheumatology, LLC Table of Contents Introduction... 5 Establishing the Diagnosis of Osteoporosis

More information

Bisphosphonates in Health and Disease

Bisphosphonates in Health and Disease in Health and Disease James J. Stark, MD, FACP Medical Director, Cancer Program and Palliative Care Maryview Medical Center Professor of Medicine, EVMS Case Presentation 52 y.o. woman presented in April

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: bone_mineral_density_studies 12/1996 9/2017 9/2018 9/2017 Description of Procedure or Service Bone density

More information

Osteoporosis: Prevention and Treatment

Osteoporosis: Prevention and Treatment 5 Quality Department Guidelines for Clinical Care Ambulatory Osteoporosis Guideline Team Team Lead Robert W. Lash, MD Endocrinology Team Members R. Van Harrison, PhD Medical Education Jane T. McCort, MD

More information

FORTEO (teriparatide) INJECTION

FORTEO (teriparatide) INJECTION FORTEO (teriparatide) INJECTION Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Medical Coverage

More information

Osteoporosis: fragility fracture risk. Costing report. Implementing NICE guidance

Osteoporosis: fragility fracture risk. Costing report. Implementing NICE guidance Osteoporosis: fragility fracture risk Costing report Implementing NICE guidance August 2012 NICE clinical guideline 146 1 of 15 This costing report accompanies the clinical guideline: Osteoporosis: assessing

More information

Osteoporosis in practice. Katie Moss Rheumatology Consultant St George s Hospital London

Osteoporosis in practice. Katie Moss Rheumatology Consultant St George s Hospital London Osteoporosis in practice Katie Moss Rheumatology Consultant St George s Hospital London Disclosures Lilly Educational grant and advisory board Prostrakan Educational grant Osteoporosis Case history 66

More information

AMERICAN COLLEGE OF RHEUMATOLOGY POSITION STATEMENT. Committee on Rheumatologic Care

AMERICAN COLLEGE OF RHEUMATOLOGY POSITION STATEMENT. Committee on Rheumatologic Care AMERICAN COLLEGE OF RHEUMATOLOGY POSITION STATEMENT SUBJECT: PRESENTED BY: FOR DISTRIBUTION TO: Bone Mineral Density Measurement and the Role of Rheumatologists in the Management of Osteoporosis Committee

More information