Page 1. New Developments in Osteoporosis. What s New in Osteoporosis
|
|
- Aileen Flowers
- 6 years ago
- Views:
Transcription
1 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 interest What s New in Osteoporosis Absolute risk Under-recognition Poor medication adherence When to stop bisphosphonates New treatments 55 year old woman for routine visit, what do you ask and do about bone health? A) Screening DxA of hip and spine B) Screening DxA of hip only C) Recommend calcium and vitamin D supplements D) Ask about family history, alcohol, smoking, get BMI and check Vitamin D E) Defer until age 60 or 65 What Would You Do? Mrs. C 66 WF recently moved to Switzerland. No previous fracture. Sister had breast cancer, 3 drinks/d, healthy. No meds. Exam normal. About 5 7 and weighs 130 Hip BMD T-score -2.2 No contraindication to treatment What tests would you order? How would you manage her? Page 1
2 Osteoporosis in a Nutshell What is it? Risk factors Evaluation Treatments Efficacy of available agents New side effects and clinical implications What is Osteoporosis? In adults, bone is constantly removed and replaced Osteoporosis is loss of mineral and structural integrity with resulting fragility Fractures common in older individuals What About Trauma? Even nonosteoporotic bone will fracture with extreme trauma There is no threshold for skeletal fragility The weaker the bone the less trauma required to fracture Traditional Risk Factors for Fracture The Big Three: Older age, Postmenopausal woman, and Caucasian/East Asian race Other important risk factors - Family history of fracture - Low body weight (<127 lbs. in women) - Smoker, >3 drinks/d - Certain drugs (steroids, PPIs) and diseases - Previous fracture (especially hip or spine) Measurement of bone mineral density (BMD) strongly predicts fracture Page 2
3 Bone Mineral Density (DXA) Interpretation of DXA Scans: Really Confusing Absolute mineral (calcium) content using x-rays Relative to young adult reference population T-score is the number of standard deviations above or below average 30 year old T greater than -1.0 = normal T between -1.0 and -2.5 = osteopenia (now called low bone mass ) T less than -2.5 = osteoporosis Large studies show low BMD increases fractures risk in both women and men BMD Tertile and Risk Factors Who Should Have a DXA? Cummings et al., NEJM 332(12): , 1995 Guidelines for general population* All women > 65 y or older Postmenopausal with fracture, family history, smoker, weight <127 lbs, certain medications Women <65 y with fracture risk equal to 65 y old White woman Usually covered by insurance (Medicare: pays $128) Revised 2013 National Osteoporosis Foundation Guidelines Page 3
4 Hip BMD and Fracture Risk at Age 50 Hip fracture risk T-score 5 year Lifetime > -1 <1% 10% -1 to -2 1% 16% -2 to -3 1% 27% < -3 2% 41% Hip BMD and Fracture Risk at Age 70 Hip fracture risk T-score 5 year Lifetime > -1 1% 4% -1 to -2 1% 8% -2 to -3 4% 16% < -3 9% 29% Calculating Absolute Fracture Risk: FRAX Treatment Threshold Concept AGE Current treatment threshold based on T-score Treatment threshold concept based on WHO Absolute Fracture Risk Adapted from JA Kanis et al, Osteoporos Int. 2001;12: Page 4
5 What About Interval Screening? Recommendations of q 2 y as interval to measure change No evidence based guidelines 4597 women in Study of Osteoporosis Fractures: BMD baseline, 2, 6, 10, 16 y Estimated interval to transition from normal to low bone mass, to osteoporosis Risk of Osteoporosis in 15 years by BMD Result at Age 65 (NEJM 2012; 366: ) BMD Result Femoral Neck Risk of Osteoporosis Time to 10% BMD < 2.5 Normal 0.8% 16.8 y > 1.0 Mild Osteopenia T = 1.01 to % 17.3 y Moderate Osteopenia T = 1.50 to 1.99 Advanced Osteopenia T = 2.00 to % 4.7 y 62.3% 1.1 y Implications for Screening BMD results of more than 1.49 at age 65 can defer repeat screening to age 80 BMD results of 1.50 to 1.99 at age 65 can merits repeat screening BMD at 5 years BMD results 2.00 to 2.49 may need rescreening at 2 years Caution: 49% original SOF sample had osteoporosis Gourlay ML, et al. NEJM 2012; 366: Under Recognition of Osteoporosis Among women with fracture or BMD T < 2.5 only 20-30% are evaluated and treated! 12 months after hip fracture at the VA: 2% had DXA, 15% treated with appropriate drug Implications for providers: Ask about fracture history, note vertebral fractures, use chart reminders for DXA Soloman, Mayo Clin Proc, 2005 Shibli-Rahhal, Osteo Internat, 2011 Page 5
6 Medical Work-up: Opinion, Little Data A reasonable start: Vitamin D (25-OH, not 1,25-OH) Serum calcium, kidney, TSH Additional tests to consider: Sprue serology, SPEP, UEP Unlikely to help: PTH, urine calcium Jamal et al, Osteo Inter, 2005 Summary: Osteoporosis Risk Factors and Evaluation Osteoporosis is silent until something bad happens: Under recognized Routine assessment of risk factors and screening DXA. Extensive lab testing wasteful. Everyone should receive lifestyle and nutritional counseling Calculation of absolute risk (FRAX) at helps clinicians/ patients Mrs. C Who Should Be Treated*? Preventive measures for everyone: adequate calcium and vitamin D in diet, exercise, no tobacco, limit alcohol When to offer pharmacologic therapy: Anyone with hip or vertebral fracture T-score 2.5 in femoral neck, hip, or spine Low bone mass and 10-year fracture risk 20% or hip fracture risk 3% *Revised 2013 National Osteoporosis Foundation Guidelines Page 6
7 What Can Be Done To Prevent Osteoporosis? Non-pharmacologic Interventions Smoking cessation, avoid alcohol abuse Physical activity: modest transient effect on BMD but reduces fracture risk Conflicting data on hip protector pads (adherence is big problem) Calcium and vitamin D Calcium and Vitamin D Chapuy, 1992 Elderly women in longterm care 30% decrease in hip fracture Porthouse, 2005: Independent women >70 with 1+ risk factor No benefit on hip or other fractures Chapuy, NEJM, 1992 Pooled studies: 12% fewer fractures together, little benefit alone News Flash: Calcium Kills!!! Pooled 15 calcium trials: cardiovascular events up 30% Not 1 endpoint; trials with vitamin D excluded Calcium + vitamin D in WHI did not increase risk Pool calcium + D trials? Similar but only after excluding those taking personal calcium supplements in WHI Little supporting scientific data No effect on other surrogates (coronary calcium on CT) Dietary calcium not implicated in German study The weight of the evidence is insufficient to conclude that calcium supplements cause adverse CV events Bolland, BMJ, 2010, 2011 Bockman, ASBMR, 2010 Page 7
8 How Much Is Enough for Skeletal Health? The Institute of Medicine Calcium 1200 mg/d for women >50, men >70 Vitamin D Recommends daily intake IU/d, no more than 4,000/d Recommends serum levels ng/ml Non-skeletal benefits not established, harms minimized IOM Report, 2010 US Preventive Task Force Recommendations Insufficient evidence to assess risks/benefits for daily supplementation with calcium >1000 mg/d and vitamin D3 400 IU Recommends against daily supplements of Vitamin D 400 IU or less and calcium 1000 mg or less to prevent fractures Vitamin D supplements effective in preventing fractures in 65 y at risk of falls Moyer VA, USPTF, Ann Intern Med 2013; Bisphosphonates Bind to bone and prevent absorption and remodeling Resides in bone for decades Four approved agents: alendronate, risedronate, ibandronate, and zoledronic acid No head-to-head fracture studies What we know: fracture risk reduced 30-50% if Existing vertebral fracture OR Low BMD (T-score < -2.5) May not be as useful if higher BMD ( osteopenia ) Effect of Alendronate on Non-spine Fracture Depends on Baseline BMD Baseline hip BMD T T T < -2.5 Overall 1.06 (0.77, 1.46) 0.97 (0.72, 1.29) 0.69 (0.53, 0.88) 0.86 (0.73, 1.01) Relative Hazard (± 95% CI) Cummings, Jama, 1998 Page 8
9 Risedronate HIP Study: Two Groups Group age <80; hip BMD T-score < % decreased hip fracture risk Group age >80; risk factors for hip fx No significant effect on hip fracture risk McClung, NEJM, 2001 Adherence with Bisphosphonates is Poor Burdensome oral administration (fasting, remain upright for 30 minutes) Upset stomach and heartburn can occur 50-60% persistence after one year with daily dosing Similar to other preventative tx Multiple practice settings Likely better with weekly, monthly and yearly (intravenous) administration Bisphosponates Once-a-week Does Dosing Interval Matter? Identical effects on BMD Possibly fewer effects on esophagus No fracture trials Alendronate: Daily vs. Weekly Schnitzer, Aging, 20 Poor quality data: Daily to weekly may improve compliance Weekly to monthly may not Yearly dosing now available: zolendronate Extremely potent bisphosphonate 3 year, multicenter controlled trial 7741 women 55-89, T-score <-2.5 or < -1 + vertebral fracture Zolendronate 5mg IV once/yr vs. placebo Black et al, NEJM, 2007 Page 9
10 A New Side Effect of Potent Bisphosphonates? Osteonecrosis of the Jaw Associated with potent bisphosphonate use: 94% treated with IV bisphosphonates 4% of cases have OP, most have cancer 60% caused by tooth extraction. Other risk factors unknown. Infection? Key points: extremely rare, early identification, conservative treatment Dental exam recommended before Rx, but no need to stop for dental procedures Atypical Subtrochanteric Fractures? Rare case reports in long-term bisphosphonate users (and others) Transverse not spiral, cortical thickening, minimal trauma Often bilateral, preceding pain, abnormal x-ray or bone scan ASBMR Task Force (2011) Causation not established Risk factors uncertain Mechanism unknown How Long to Use Bisphosphonates? Prolonged use (decades) common Long half-life suggests that life-long treatment is not always necessary What happens when you stop? FIT Long-term Extension (FLEX) study Women given ALN in FIT for 5 yr. Randomized to ALN or PBO for 5 yr. Black; Jama, 2006 Page 10
11 FLEX Change in Hip BMD: % Change from FIT Baseline New Fractures During FLEX Mean Percent Change Start of FLEX 0 F 0 F 1 F 2 F 3 F 4 FL 0 FL 1 FL 2 FL 3 FL 4 FL 5 Year FIT FLEX = Placebo P<0.001 ALN vs PBO = ALN (Pooled 5 mg and 10 mg groups) 2% Non-spine Any Hip Vertebral Any Painful PBO (N = 437) 20% 3% 11% 5% ALN (N = 662) RR (95% CI) 19% 3% 2% 1.0 (0.8, 1.4) 1.1 (0.5, 2.3) 10% 0.9 (0.6, 1.2) 0.5 (0.2, 0.8) FDA View of Long-term Bisphosphonate Use (Sept. 2011) Independent review of epidemiologic studies to date and all bisphosphonate trial data After 5 years of treatment, fracture benefit less certain Regarding side effects Atypical fractures: conflicting results causality uncertain no agreement on effects of duration or cumulative dose ONJ: some evidence that risk increases after 4 yr. causality not established Discontinuation of Bisphosphonates After 3-5 Years? NOF recommendation for clinical reassessment after 3-5 years of use Driven by lack of non-spine fracture benefit after 5 yr and accumulating evidence of harm even if small risk No pharmacologic therapy should be considered indefinite Decisions need to be individualized Page 11
12 Implications of Bisphosphonate Trials Bisphosphonates reduce risk of spine, hip and nonspine fracture in women with existing spine fracture or low BMD (T-score < -2.5) May not reduce risk of non-spine fracture in women without spine fracture or BMD < -2.5, even if at high risk. Intermittent dosing, even yearly, effective Best data of any approved treatment After 5 years of treatment, some may stop BMD >-2.5 and no hip or vertebral fractures Other Anti-resorptive Agents Less effective than bisphosphonates Calcitonin (poor quality studies) Raloxifene (prevents vertebral fractures only; use for breast cancer prevention) Hormone replacement: WHI benefits Denosumab (antibody to RANKL) Women s Health Initiative RCT of ERT, PERT or PBO among women age 50-79, 10,739 with hysterectomy. Primary prevention PERT, ERT arms stopped after 5-7 years Follow-up 93% complete Fracture Endpoints: ERT vs. PBO Hip RR = 0.61 (0.41, 0.91) Non-spine RR = 0.70 (0.63, 0.79) CVD RR = 1.12 (1.01, 1.24 WHI Writing Group, Jama, 200 The Future: Anabolic Agents Neer, NEJM, 2001 Most treatments for osteoporosis inhibit bone resorption (and formation) Anabolic agents (anabolic steroids, fluoride, intermittent parathyroid hormone) stimulate formation Daily injections of PTH for 18 mo. reduces vertebral and non-spine fracture. No hip fracture data. Should be followed by bisphosphonate therapy Very expensive, daily self-administered injections... Use with severe OP, when other agents have failed? Page 12
13 Summary of Treatment Bisphosphonates: treatment of choice in selected individuals: Spine/hip fracture or T<-2.5. Benefit for others less clear. Duration of therapy? 3-5 years then off? Other agents available but expensive and unclear when to use New diagnostic tests and better treatments on the way Take Home Points Absolute risk estimates help with decisions Aggressive screening and treatment = fewer fractures; start for all women by 65 yrs Interval screening defined by baseline BMD Identify those who have already have the disease! Bisphosphonates: treatment of choice Use for spine/hip fracture or T< 2.5 Adherence counseling. Intermittent dosing. Duration of therapy? 5 years then off? Page 13
Updates in Osteoporosis. I have no conflicts of interest. What Would You Do? Mrs. C. What s New in Osteoporosis. Page 1
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 informationPage 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 informationCurrent and Emerging Approaches for Osteoporosis
Current and Emerging Approaches for Osteoporosis Douglas C. Bauer, MD Professor of Medicine and Epidemiology & Biostatistics University of California, San Francisco No Disclosures What s New in Osteoporosis
More informationPage 1. Updates in Osteoporosis. I have no conflicts of interest. What is osteoporosis? What s New in Osteoporosis
Updates in Osteoporosis Jeffrey A. Tice, MD Professor of Medicine Division of General Internal Medicine, University of California, San Francisco I have no conflicts of interest What s New in Osteoporosis
More informationUpdates 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 informationPage 1. Current and Emerging Strategies for Osteoporosis. Osteoporosis Warm-Up: Which of the Following is True?
Current and Emerging Strategies for Osteoporosis Douglas C. Bauer, MD Professor of Medicine and Epidemiology & Biostatistics University of California, San Francisco No Disclosures Osteoporosis Warm-Up:
More informationPage 1. Diagnosis and Treatment of Osteoporosis: What s New and Controversial in 2018? What s New in Osteoporosis
Diagnosis and Treatment of Osteoporosis: What s New and Controversial in 2018? Douglas C. Bauer, MD Professor of Medicine and Epidemiology & Biostatistics University of California, San Francisco What s
More informationDiagnosis and Treatment of Osteoporosis: What s New and Controversial in ? What s New in Osteoporosis
Diagnosis and Treatment of Osteoporosis: What s New and Controversial in 2018-19? What s New in Osteoporosis The crisis in treatment and compliance Douglas C. Bauer, MD Professor of Medicine and Epidemiology
More informationPage 1. Osteoporosis Warm-Up: Which of the Following is True? Diagnosis and Treatment of Osteoporosis: What is New in What s New in Osteoporosis
Diagnosis and Treatment of Osteoporosis: What is New in 2017 Douglas C. Bauer, MD Professor of Medicine and Epidemiology & Biostatistics University of California, San Francisco No Disclosures Osteoporosis
More information52% 34% 5. Both 1) and 3) Start calcium... Both 1) and 3) Start alendron... Start raloxife... Page 1
New Developments in Osteoporosis Mary S. Beattie, MD, MAS, UCSF Women s Health Thanks to Douglas C. Bauer, MD What s New in Osteoporosis Absolute risk - FRAX Under recognition Poor compliance When to stop
More informationOSTEOPOROSIS: 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 informationNew Developments in Osteoporosis: Screening, Prevention and Treatment
Osteoporosis: Overview New Developments in Osteoporosis: Screening, Prevention and Treatment Judith Walsh, MD, MPH Departments of Medicine and Epidemiology and Biostatistics UCSF Definitions Risk factors
More informationNEW DEVELOPMENTS IN OSTEOPOROSIS: SCREENING, PREVENTION AND TREATMENT
NEW DEVELOPMENTS IN OSTEOPOROSIS: SCREENING, PREVENTION AND TREATMENT Judith Walsh, MD, MPH Departments of Medicine and Epidemiology and Biostatistics UCSF OSTEOPOROSIS: OVERVIEW Definitions Risk factors
More informationCASE 1 WHY IS IT IMPORTANT TO TREAT? FACTS CONCERNS
4:30-5:15pm Ask the Expert: Osteoporosis SPEAKERS Silvina Levis, MD OSTEOPOROSIS - FACTS 1:3 older women and 1:5 older men will have a fragility fracture after age 50 After 3 years of treatment, depending
More informationOsteoporosis: An Overview. Carolyn J. Crandall, MD, MS
Osteoporosis: An Overview Carolyn J. Crandall, MD, MS Osteoporosis: An Overview Carolyn J. Crandall, MD, MS Professor of Medicine David Geffen School of Medicine at UCLA Objectives Review osteoporosis
More informationCurrent and Emerging Strategies for Osteoporosis
Current and Emerging Strategies for Osteoporosis I have nothing to disclose. Anne Schafer, MD Assistant Professor of Medicine Division of Endocrinology & Metabolism December 12, 2014 Outline Osteoporosis
More informationAdvanced medicine conference. Monday 20 Tuesday 21 June 2016
Advanced medicine conference Monday 20 Tuesday 21 June 2016 Osteoporosis: recent advances in risk assessment and management Juliet Compston Emeritus Professor of Bone Medicine Cambridge Biomedical Campus
More informationOsteoporosis/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 informationAACE/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 informationOsteoporosis. Overview
v2 Osteoporosis Overview Osteoporosis is defined as compromised bone strength that increases risk of fracture (NIH Consensus Conference, 2000). Bone strength is characterized by bone mineral density (BMD)
More informationDownload slides:
Download slides: https://www.tinyurl.com/m67zcnn https://tinyurl.com/kazchbn OSTEOPOROSIS REVIEW AND UPDATE Boca Raton Regional Hospital Internal Medicine Conference 2017 Benjamin Wang, M.D., FRCPC Division
More informationLearning Objectives. Controversies in Osteoporosis Prevention and Management. Definition. Presenter Disclosure Information.
4 4:45 pm Controversies in Osteoporosis Prevention and Management SPEAKER Carolyn Crandall, MD, MS Presenter Disclosure Information The following relationships exist related to this presentation: Carolyn
More informationLearning Objectives. Controversies in Osteoporosis Prevention and Management. Etiology. Presenter Disclosure Information. Epidemiology.
12:45 1:30pm Controversies in Osteoporosis Prevention and Management SPEAKER Carolyn Crandall, MD, MS Presenter Disclosure Information The following relationships exist related to this presentation: Carolyn
More informationOsteoporosis: 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 informationManagement of postmenopausal osteoporosis
Management of postmenopausal osteoporosis Yeap SS, Hew FL, Chan SP, on behalf of the Malaysian Osteoporosis Society Committee Working Group for the Clinical Guidance on the Management of Osteoporosis,
More informationWhat is Osteoporosis?
What is Osteoporosis? 2000 NIH Definition A skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture. Bone strength reflects the integration of
More informationOsteoporosis challenges
Osteoporosis challenges Osteoporosis challenges Who should have a fracture risk assessment? Who to treat? Drugs, holidays and unusual adverse effects Fracture liaison service? The size of the problem 1
More informationJohn 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 informationACP Colorado-Evidence Based Management of Osteoporosis
ACP Colorado-Evidence Based Management of Osteoporosis Micol S. Rothman, MD Associate Professor of Medicine and Radiology Clinical Director Metabolic Bone Program University of Colorado School of Medicine
More informationDisclosures D. Black. Bisphosphonates: Background, Efficacy and Recent Controversies. Page 1. Research Funding: Novartis, Merck
Bisphosphonates: Background, Efficacy and Recent Controversies Disclosures D. Black Research Funding: Novartis, Merck Dennis M. Black, PhD Consulting: Amgen, Lilly, Zosano, Nycomed Dept. of Epidemiology
More informationDrug Intervals (Holidays) with Oral Bisphosphonates
Drug Intervals (Holidays) with Oral Bisphosphonates Rizwan Rajak Consultant Rheumatologist & Lead for Osteoporosis GP Postgraduate Meeting April 2018 Contents Case presentation Pathway for Bisphosphonate
More informationCalcium, Vitamin D and Bisphosphonates: Disclosures. Benefits, Risks and Drug Holiday. Calcium YES or NO? Calcium Bad News!!
Calcium, Vitamin D and Bisphosphonates: Benefits, Risks and Drug Holiday Disclosures I am disclosing financial relationships as follows: Global Advisory Boards: Amgen, Lilly, Merck, Novartis Research grants:
More informationOsteoporosis Treatment Overview. Colton Larson RFUMS October 26, 2018
Osteoporosis Treatment Overview Colton Larson RFUMS October 26, 2018 Burden of Disease Most common bone disease 9.9 million Americans + 43.1 million Americans have low bone mineral density (BMD) Stealthy
More informationPharmacy 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 informationOsteoporosis: How to Manage Long- Term Use of Bisphosphonates AKA Now What? David E Feinstein, DO, CCD November 15 th, 2017
Osteoporosis: How to Manage Long- Term Use of Bisphosphonates AKA Now What? David E Feinstein, DO, CCD November 15 th, 2017 Introduction A fracture due to OP occurs every 3 seconds around the world. 1
More informationDisclosures. Diagnostic Challenges in Osteoporosis: Whom To Treat 9/25/2014
Disclosures Diagnostic Challenges in Osteoporosis: Whom To Treat Ethel S. Siris, MD Columbia University Medical Center New York, NY Consultant on scientific issues for: AgNovos Amgen Eli Lilly Merck Novartis
More informationOsteoporosis/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 informationPharmacy Management Drug Policy
Clinical criteria used to make utilization review decisions are based on credible scientific evidence published in peer reviewed medical literature generally recognized by the medical community. Guidelines
More informationClinician s Guide to Prevention and Treatment of Osteoporosis
Clinician s Guide to Prevention and Treatment of Osteoporosis Published: 15 August 2014 committee of the National Osteoporosis Foundation (NOF) Tipawan khiemsontia,md outline Basic pathophysiology screening
More informationRefracture Prevention The Role of Primary Care
MonashHealth Refracture Prevention The Role of Primary Care Professor Peter R Ebeling AO MBBS MD FRACP Head, Department of Medicine School for Clinical Sciences Monash Health Translation Precinct Monash
More informationOsteoporosis 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 informationOsteoporosis 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 informationCurrent Issues in Osteoporosis
Current Issues in Osteoporosis California AACE 18TH Annual Meeting & Symposium Marina del Rey, CA September 15, 2018 Michael R. McClung, MD, FACP,FACE Director, Oregon Osteoporosis Center Portland, Oregon,
More informationUpdate on Osteoporosis 2016
WELCOME! Update on Osteoporosis 2016 Jennifer J. Kelly, D.O., F.A.C.E. Associate Professor of Medicine Division of Endocrinology, Diabetes and Metabolism Upstate Medical University Director of the Clinical
More informationOsteoporosis: current treatment and future prospects. Juliet Compston Professor Emeritus of Bone Medicine Cambridge Biomedical Campus
Osteoporosis: current treatment and future prospects Juliet Compston Professor Emeritus of Bone Medicine Cambridge Biomedical Campus Disclosures Consultancy and speaking fees for Gilead, related to development
More informationOsteoporosis Update. Case 2. Case 1: Monday morning, 8:15
Osteoporosis Update Laura E. Ryan, MD Assistant Director for Special Programs Center for Women s Health Clinical Assistant Professor of Medicine Division of Endocrinology, Diabetes and Metabolism The Ohio
More informationChau Nguyen, D.O. Rheumatologist Clinical Assistant Professor of Internal Medicine at Western University of Health Sciences
Chau Nguyen, D.O Rheumatologist Clinical Assistant Professor of Internal Medicine at Western University of Health Sciences I do not have any relationship with the manufacturer of any commercial products
More informationOsteoporosis. Current Trend in Osteoporosis Management for Elderly in HK- Medical Perspective. Old Definition of Osteoporosis
Current Trend in Osteoporosis Management for Elderly in HK- Medical Perspective Dr Dicky T.K. Choy Physician Jockey Club Centre for Osteoporosis Care and Control, CUHK Osteoporosis Global public health
More informationAn Update on Osteoporosis Treatments
An Update on Osteoporosis Treatments Dr Mike Stone University Hospital Llandough Treatments for osteoporosis Calcium and vitamin D HRT Raloxifene Etidronate Alendronate Risedronate Ibandronate (oral and
More informationOsteoporosis Update. Greg Summers Consultant Rheumatologist
Osteoporosis Update Greg Summers Consultant Rheumatologist DEFINITION OSTEOPOROSIS is LOW BONE MASS (& micro-architectural deterioration) causing AN INCREASED RISK OF FRACTURE 23 years 82 years 23 y/o
More informationTreatments for Osteoporosis Expected Benefits, Potential Harms and Drug Holidays. Suzanne Morin MD FRCP FACP McGill University May 2014
Treatments for Osteoporosis Expected Benefits, Potential Harms and Drug Holidays Suzanne Morin MD FRCP FACP McGill University May 2014 Learning Objectives Overview of osteoporosis management Outline efficacy
More informationFrom 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 information2017 Santa Fe Bone Symposium McClung
217 Santa Fe Bone Symposium Insights into the Use of Anti-remodeling and Anabolic Agents for Osteoporosis Developing a Long-term Management Plan Michael R., MD, FACP Oregon Osteoporosis Center Portland,
More informationOsteoporosis 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 informationSummary. Background. Diagnosis
March 2009 Management of post-menopausal osteoporosis This bulletin focuses on the pharmacological management of patients with post-menopausal osteoporosis both those with clinically evident disease (e.g.
More informationOsteoporosis Screening and Treatment in Type 2 Diabetes
Osteoporosis Screening and Treatment in Type 2 Diabetes Ann Schwartz, PhD! Dept. of Epidemiology and Biostatistics! University of California San Francisco! October 2011! Presenter Disclosure Information
More informationOsteoporosis update. Dr. Claire Vandevelde Consultant Rheumatologist, LTHT
Osteoporosis update Dr. Claire Vandevelde Consultant Rheumatologist, LTHT Outline Background BMD Tools for assessing fracture risk Case study Denosumab Treatment breaks BMD BMD predicts fracture risk but
More informationSpongeBone Menopants*
SpongeBone Menopants* Adam Fershko, MD, FACP Kettering Health Network *Postmenopausal Osteoporosis Objectives O Epidemiology O Clinical significance O Pathophysiology O Screening and Diagnosis O Treatment
More informationPharmacy Management Drug Policy
SUBJECT: - Forteo (teriparatide), Prolia (denosumab), Tymlos (abaloparatide), Boniva injection (Ibandronate) POLICY NUMBER: Pharmacy-35 EFFECTIVE DATE: 9/07 LAST REVIEW DATE: 10/15/2018 If the member s
More informationThis house believes that HRT should be the first-line prevention for postmenopausal osteoporosis: the case against
This house believes that HRT should be the first-line prevention for postmenopausal osteoporosis: the case against Juliet Compston Professor of Bone Medicine University of Cambridge School of Clinical
More informationModule 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 informationOsteoporosis: 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 informationA Review of Bone Health Issues in Oncology
A Review of Bone Health Issues in Oncology David L. Kendler MD FRCPC CCD Professor of Medicine (Endocrinology) University of British Columbia Vancouver Canada Disclosures David Kendler has received research
More informationAN OVERVIEW of TREATMENT: WHO and WHEN to TREAT
AN OVERVIEW of TREATMENT: WHO and WHEN to TREAT Dolores Shoback, MD Professor of Medicine, UCSF San Francisco VA Medical Center July 16, 21 ~ QUESTIONS ~ Who should receive therapy to prevent fractures?
More informationAssessment and Treatment of Osteoporosis Professor T.Masud
Assessment and Treatment of Osteoporosis Professor T.Masud Nottingham University Hospitals NHS Trust University of Nottingham University of Derby University of Southern Denmark What is Osteoporosis? Osteoporosis
More informationOSTEOPOROSIS IN INDONESIA
OSTEOPOROSIS IN INDONESIA Hana Ratnawati Faculty of Medicine Maranatha Christian University Bandung - Indonesia 5th SBA Conference 2013 1 5th SBA Conference 2013 2 INTRODUCTION Indonesia is an archipelago
More informationOsteoporosis - New Guidelines. Michelle Glass B.Sc. (Pharm) June 15, 2011
Osteoporosis - New Guidelines Michelle Glass B.Sc. (Pharm) June 15, 2011 Outline What is Osteoporosis? Who is at risk? What treatments are available? Role of the Pharmacy technician Definition of Osteoporosis
More information9/9/2015 OSTEOPOROSIS WHAT S NEW AND ON THE HORIZON IN SCREENING, DRUG HOLIDAYS, SUPPLEMENTS, CONSERVATIVE THERAPY DISCLOSURES
OSTEOPOROSIS WHAT S NEW AND ON THE HORIZON IN SCREENING, DRUG HOLIDAYS, SUPPLEMENTS, CONSERVATIVE THERAPY Nelson B. Watts, MD OSTEOPOROSIS AND BONE HEALTH SERVICES CINCINNATI, OHIO DISCLOSURES Stock options/holdings,
More information1
www.osteoporosis.ca 1 2 Overview of the Presentation Osteoporosis: An Overview Bone Basics Diagnosis of Osteoporosis Drug Therapies Risk Reduction Living with Osteoporosis 3 What is Osteoporosis? Osteoporosis:
More informationFracture=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 informationControversies 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 informationThe 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 informationOsteoporosis Agents Drug Class Prior Authorization Protocol
Osteoporosis Agents Drug Class Prior Authorization Protocol Line of Business: Medicaid P&T Approval Date: February 21, 2018 Effective Date: April 1, 2018 This policy has been developed through review of
More informationClinical 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 informationOsteoporosis 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 informationGuideline 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 informationScreening Guidelines: Women
The Situation 1 in 2 postmenopausal women and 1 in 5 older men will have an osteoporosis-related fracture in their lifetimes Osteoporosis Definition NIH Consensus Conference A skeletal disorder characterized
More informationClinical Specialist Statement Template
Clinical Specialist Statement Template Thank you for agreeing to give us a statement on your organisation s view of the technology and the way it should be used in the NHS. Healthcare professionals can
More informationOsteoporosis: Are your bones at risk of fracturing? Rachel Wallwork, MD Internal medicine resident Massachusetts General Hospital
Osteoporosis: Are your bones at risk of fracturing? Rachel Wallwork, MD Internal medicine resident Massachusetts General Hospital What is Osteoporosis? Osteoporosis causes bones to lose density, become
More informationUsing the FRAX Tool. Osteoporosis Definition
How long will your bones remain standing? Using the FRAX Tool Gary Salzman M.D. Director Banner Good Samaritan/ Hayden VAMC Internal Medicine Geriatric Fellowship Program Phoenix, Arizona Using the FRAX
More informationHow to treat osteoporosis With what and for how long?
How to treat osteoporosis With what and for how long? Professor Neil Gittoes Consultant Endocrinologist & Honorary Professor Where will we be going? Drug therapies Current Indications Contraindications/unmet
More informationHot Topics in Osteoporosis and Fracture Prevention
Hot Topics in Osteoporosis and Fracture Prevention Sid Feldman, MD CCFP (COE) FCFP Sandra Kim, MD, FRCPC November 15, 2018 Family Medicine Forum, Toronto Faculty/Presenter Disclosure Faculty: Sid Feldman
More informationOutline. Switching treatment. Evidence from randomized trials. The effects of switching 7/8/2016. When and for whom? Steven Cummings, MD
Outline Switching treatment When and for whom? Steven Cummings, MD Focus on switching from alendronate or risedronate Evidence about the effects of switching on BMD Purposes of switching Symptoms Poor
More informationTreatment of Osteoporosis: IHFD 6 th March 2015
Treatment of Osteoporosis: IHFD 6 th March 2015 Dr. John J. Carey, MB, MS, FACR, FRCPI, CCD. Consultant Physician Galway University Hospitals Associate Professor in Medicine, NUIG, Galway Vice-President
More information8/6/2018. Glucocorticoid induced osteoporosis: overlooked and undertreated? Disclosure. Objectives. Overview
Disclosure Glucocorticoid induced osteoporosis: overlooked and undertreated? I have no financial disclosure relevant to this presentation Tasma Harindhanavudhi, MD Division of Diabetes and Endocrinology
More informationRheumatology. keeping Joints in Motion. Treating and Preventing Fractures
Rheumatology keeping Joints in Motion Treating and Preventing Fractures Robin K. Dore, MD Clinical Professor of Medicine David Geffen School of Medicine at UCLA, Los Angeles CA Private practice, Tustin
More informationForteo (teriparatide) Prior Authorization Program Summary
Forteo (teriparatide) Prior Authorization Program Summary FDA APPROVED INDICATIONS DOSAGE 1 FDA Indication 1 : Forteo (teriparatide) is indicated for: the treatment of postmenopausal women with osteoporosis
More informationDifferentiating Pharmacological Therapies for Osteoporosis
Differentiating Pharmacological Therapies for Osteoporosis Socrates E Papapoulos Department of Endocrinology & Metabolic Diseases Leiden University Medical Center The Netherlands Competing interests: consulting/speaking
More informationTREATMENT 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 informationRecent 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 informationTherapeutic 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 informationHRT and Risedronate Combined Anabolic and Antiresorptive Therapy
Optimizing Combined and Sequential Osteoanabolic and Antiresorptive Therapy Benjamin Leder, M.D. Endocrine Unit Massachusetts General Hospital Boston, MA Antiresorptive and Osteoanabolic Therapies Increase
More informationTraining Course in Sexual and Reproductive Health Research Geneva, February Osteoporosis. Prof René Rizzoli M.D.
Training Course in Sexual and Reproductive Health Research Geneva, February 17 2009 Osteoporosis Prof René Rizzoli M.D. Division of bone diseases WHO collaborating center for osteoporosis prevention Department
More informationTask Force Co-Chairs. Members
Managing Osteoporosis Patients After Long-Term Bisphosphonate Treatment Report of a Task Force* of the American Society for Bone and Mineral Research Robert A. Adler, MD Task Force Co-Chairs Ghada El-Hajj
More informationBAD TO THE BONE. Peter Jones, Rheumatologist QE Health, Rotorua. GP CME Conference Rotorua, June 2008
BAD TO THE BONE Peter Jones, Rheumatologist QE Health, Rotorua GP CME Conference Rotorua, June 2008 Agenda Osteoporosis in Men Vitamin D and Calcium Long-term treatment with Bisphosphonates Pathophysiology
More informationOsteoporosis and Lupus. Andrew Ruthberg, MD University Rheumatologists
Osteoporosis and Lupus Andrew Ruthberg, MD University Rheumatologists 1 Forget the medical terminology (osteoporosis, osteopenia, low bone mass, DEXA, DXA, T score etc) The bottom line is that you don
More informationOSTEOPOROSIS IN MEN. Nelson B. Watts, MD OSTEOPOROSIS AND BONE HEALTH SERVICES CINCINNATI, OHIO
OSTEOPOROSIS IN MEN Nelson B. Watts, MD OSTEOPOROSIS AND BONE HEALTH SERVICES CINCINNATI, OHIO DISCLOSURES Speakers Bureau: Amgen, Radius Consultant: Abbvie, Amgen, Janssen, Radius, Sanofi Watts NB et
More informationBuilding 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 informationAACE. Orlando Drug Holidays. Disclosures. Advisory boards: Alexion, Amgen, Lilly, Merck, Radius Health
AACE Orlando 2016 Drug Holidays Disclosures Advisory boards: Alexion, Amgen, Lilly, Merck, Radius Health Scientific grants: Alexion, Amgen, Immunodiagnostics, Lilly, Merck, Regeneron, Radius Health, Roche
More information