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

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

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

Transcription

1 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 Structural deterioration Increased skeletal fragility Increased fracture risk 1

2 Definition of Osteoporosis A disease characterised by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility in fracture risk 1 Osteoporosis: T score < -2.5 Osteopenia: T score between -1.0 and -2.5 NB. T scores compare BMD to the average individual at peak bone mass Z scores are age matched Scanning electron microscopy of normal and osteoporotic bone Normal Osteoporotic Life-time prevalence of fragility fracture* in the over-50s 1 Consensus Development Conference. Am J Med 1991;90: Dempster DW, et al. J Bone Miner Res 1986;1:15 21 * From standing height or less Epidemiology of Fragility Fractures Mortality and morbidity 12 months after hip fracture The Domino Fracture Effect For women > 50: 1 in 3 Vertebral # 1 in 5 Hip # Dead Unable to walk unaided If prior vertebral #: RR of further vertebral # = 4.4 RR of hip # = 2.3 RR of wrist # = 1.4 NICE TA 160, 161 Oct 2008 Difficulty with > 1 60 essential activity Restricted in other 80 activities % 12 months after fracture Am J Med 1997 Osteoporosis Int Fragility Fractures in the UK 180,000 fragility fractures in England/Wales per yr: 70,000 hip # 25,000 vertebral # 41,000 wrist # Combined cost of hospital and social care for hip # = 2.3 billion/yr Assessing Fracture Risk Risk factors for osteoporosis Risk factors for falls Bone mineral density DEXA scan NICE TA 160, 161 Oct

3 Fracture risk tool (FRAX) To estimate the 10yr absolute fracture risk for all osteoporotic fractures and hip fracture the FRAX tool can be accessed at FRAX has only been validated for patients who are treatment naïve and not for those who have been receiving treatment for osteoporosis Use with caution in patients whose spine BMD is lower than their hip BMD Can be used with or without BMD FRAX risk factors Age Sex Weight Height Previous fracture Parent hip fracture Current smoking Glucocorticoids Rheumatoid arthritis Secondary osteoporosis Alcohol 3 units or more / day Osteoporosis management algorithm for postmenopausal women and men > 50 years old Age 75 Low trauma # Age <75 Low trauma # No # Clinical risk factor Assess for underlying causes Lifestyle advice Treat Measure BMD by DEXA Osteoporosis No Osteoporosis (T score <-2.5) (T score > -2.5) Estimate fracture risk using FRAX 3 & 12 month assessment? therapy compliance High risk (NOGG) Low risk (NOGG) Reassure Lifestyle advice These guidelines should not replace clinical judgement Modes of Action of Drugs for Osteoporosis Anti-resorptive (reduce osteoclastic activity) Bisphosphonates (HRT) (Calcitonin) (Raloxifene) Denosumab Anabolic PTH Dual Strontium ranelate (avoid in patients at risk of CVD, VTE) Bisphosphonate Bisphosphonates: Mechanism of action Active osteoclast Inactive osteoclast Apoptotic osteoclast Bisphosphonate taken up by osteoclasts Bone Osteoclasts lose resorptive function upon bisphosphonate uptake Adapted from Rodan GA & Fleish HA. J Clin Invest 1996;12: Osteoclastic apoptosis Suggested Treatment Ladder Alendronic acid Risedronate (better GI tolerability) Strontium (if no CV risk factors) Denosumab/IV Zoledronic acid PTH Ensure adequate calcium and vitamin D intake with all treatments Ensure lifestyle factors are addressed Reassess need for therapy after 5 years 3

4 Case 1 77 yr old female Hypertensive on Bendroflumethiazide # proximal humerus - What questions would you ask? - What (if any) investigations would you request? - What (if any) treatment would you offer? Case 2 73 yr old man Acute on chronic dorsal back pain. Kyphotic. T spine X-ray shows multiple vertebral collapses - What questions would you ask? - What (if any) investigations would you request? - What (if any) treatment would you offer? Case 3 65 year old female Severe RA 35 years Long-term oral steroids (lowest 10mg/day) Recurrent fractures Intolerant of oral bisphosphonates DEXA T score: Lspine Hip On IV bisphosphonate 3 years BMD unchanged but continues to fracture - How would you manage her? Osteomalacia Osteomalacia Decreased mineralisation of newly formed osteoid at sites of bone turnover in adults (NB. Rickets defect of mineralisation in the growing skeleton) Commonest cause in UK Vitamin D deficiency Clinical Features of Osteomalacia May be asymptomatic Bone pain Proximal myopathy Fracture (ribs, vertebrae, long bones, pelvis) Mobility problems ( waddling gait ) Muscle spasms/cramps Tingling/numbness Positive Chvostek s sign, tetany etc 4

5 Laboratory findings 25(OH) vitamin D < 25nmol/l (10μg/l) Elevated alkaline phosphatase Low serum calcium and phosphate Elevated PTH If investigations equivocal,? Bone biopsy Treatment of Osteomalacia Vitamin D replacement! Standard doses of calcium/vitamin D may be inadequate Colecalciferol 40,000 units/wk for 8 weeks or Fultium D units daily for 8-12 weeks then maintenance of units daily Paget s Disease Paget s Disease Accelerated bone remodelling overgrowth of bone at selected sites and impaired integrity Prevalence 3% (autopsy) Male = Female Aetiology: genetic/viral incidence in Anglo-Saxons Clinical Features of Paget s Mostly asymptomatic Pain worse on weightbearing, at night Skeletal deformities Sites: pelvis, skull, long bones, spine, clavicles Fractures Tumours (0.7-1%) Neurological complications Cardiac failure 5

6 Investigations Normal calcium, phosphate and PTH Alkaline phosphatase urinary hydroxyproline urinary pyridinoline cross-links serum P1NP / CTX, urinary NTX Radiology: plain X-ray, isotope bone scan Treatment of Paget s Indications for therapy: Pain The metabolic activity of pagetic lesions, as determined by bone turnover markers or bone scintigraphy The potential consequences of bony overgrowth at affected sites Planned orthopaedic intervention Treatment: Bisphosphonates - oral Tiludronate/Risedronate - IV Pamidronate or Zoledronic acid Case 4 88yr old male referred with pain in left hip/thigh Reduced mobility Nocturnal pain PMH ca prostate (orchidectomy 2003) O/E L hip ROM 50% ALP 952, egfr 39 X-Ray 6

7 Progress Received one dose IV Zoledronic acid (with calcium supplementation) Some improvement in pain but not mobility 3 months later, ALP 1361, egfr 23 What s going on? What further investigations are needed? 7

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

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

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

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

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

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

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

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

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

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

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

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

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

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

FRAX, NICE and NOGG. Eugene McCloskey Professor of Adult Bone Diseases University of Sheffield

FRAX, NICE and NOGG. Eugene McCloskey Professor of Adult Bone Diseases University of Sheffield FRAX, NICE and NOGG Eugene McCloskey Professor of Adult Bone Diseases University of Sheffield Disclosures Research funding and/or honoraria and/or advisory boards for: o ActiveSignal, Amgen, Bayer, Boehringer

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

Guidelines on Management of Osteoporosis

Guidelines on Management of Osteoporosis Guidelines on Management of Osteoporosis Introduction These guidelines take into account recommendations from the DH Guidance on Falls and Fractures (Jul 2009), NICE Technology appraisals for Primary and

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

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

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

Audit on follow-up of patients with primary Osteoporosis

Audit on follow-up of patients with primary Osteoporosis Abstract Aim: To document the frequency of Dual-energy X- ray absorptiometry (DEXA) scanning and Rheumatology clinic follow-up visits of patients with primary osteoporosis, and compare these with recommended

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

WAHT- TWI Guidelines for Osteoporosis in Worcestershire.

WAHT- TWI Guidelines for Osteoporosis in Worcestershire. GUIDELINES FOR OSTEOPOROSIS IN WORCESTERSHIRE This guidance does not override the individual responsibility of health professionals to make appropriate decisions according to the circumstances of the individual

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

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

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

Effects of Anti RANK ligand Denosumab on Beta Thalassemia induced osteoporosis

Effects of Anti RANK ligand Denosumab on Beta Thalassemia induced osteoporosis Effects of Anti RANK ligand Denosumab on Beta Thalassemia induced osteoporosis Mohamed Yassin 1 Ashraf T. Soliman2, Mohamed O. Abdelrahman3, Vincenzo De Sanctis 4 Departments of, 1 Hematology 2Pediatric

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

The Skeletal Response to Aging: There s No Bones About It!

The Skeletal Response to Aging: There s No Bones About It! The Skeletal Response to Aging: There s No Bones About It! April 7, 2001 Joseph E. Zerwekh, Ph.D. Interrelationship of Intestinal, Skeletal, and Renal Systems to the Overall Maintenance of Normal Calcium

More information

Metabolic Bone Disease Related to Chronic Kidney Disease

Metabolic Bone Disease Related to Chronic Kidney Disease Metabolic Bone Disease Related to Chronic Kidney Disease Deborah Sellmeyer, MD Director, Johns Hopkins Metabolic Bone Center Dept of Medicine, Division of Endocrinology Disclosure DSMB member for denosumab

More information

Conflict of Interest. Objectives. Learner Outcome

Conflict of Interest. Objectives. Learner Outcome Foundations of Orthopaedic Nursing Care, Part Four: Metabolic Bone Disease, highlighting Osteoporosis and Paget s Disease Conflict of Interest I hereby certify that, to the best of my knowledge, no aspect

More information

Southern Derbyshire Shared Care Pathology Guidelines. Primary Hyperparathyroidism

Southern Derbyshire Shared Care Pathology Guidelines. Primary Hyperparathyroidism Southern Derbyshire Shared Care Pathology Guidelines Primary Hyperparathyroidism Please use this Guideline in Conjunction with the Hypercalcaemia Guideline Definition Driven by hyperfunction of one or

More information

Use of DXA / Bone Density in the Care of Your Patients. Brenda Lee Holbert, M.D. Associate Professor Senior Staff Radiologist

Use of DXA / Bone Density in the Care of Your Patients. Brenda Lee Holbert, M.D. Associate Professor Senior Staff Radiologist Use of DXA / Bone Density in the Care of Your Patients Brenda Lee Holbert, M.D. Associate Professor Senior Staff Radiologist Important Websites Resources for Clinicians and Patients www.nof.org www.iofbonehealth.org

More information

Bone density scanning and osteoporosis

Bone density scanning and osteoporosis Bone density scanning and osteoporosis What is osteoporosis? Osteoporosis occurs when the struts which make up the mesh-like structure within bones become thin causing them to become fragile and break

More information

COMMITTEE FOR MEDICINAL PRODUCTS FOR HUMAN USE (CHMP) GUIDELINE ON THE EVALUATION OF NEW MEDICINAL PRODUCTS IN THE TREATMENT OF PRIMARY OSTEOPOROSIS

COMMITTEE FOR MEDICINAL PRODUCTS FOR HUMAN USE (CHMP) GUIDELINE ON THE EVALUATION OF NEW MEDICINAL PRODUCTS IN THE TREATMENT OF PRIMARY OSTEOPOROSIS European Medicines Agency Evaluation of Medicines for Human Use London, 14 December 2005 Doc. Ref. CPMP/EWP/552/95 Rev. 2 COMMITTEE FOR MEDICINAL PRODUCTS FOR HUMAN USE (CHMP) DRAFT GUIDELINE ON THE EVALUATION

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

The recent publication of guidance from the National

The recent publication of guidance from the National 216 Clinical Pharmacist May 2009 Vol 1 Several guidelines exist for the identification and treatment of osteoporosis. Patients diagnosed with the condition should be prescribed bisphosphonates, if suitable,

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

Technology appraisal guidance Published: 9 August 2017 nice.org.uk/guidance/ta464

Technology appraisal guidance Published: 9 August 2017 nice.org.uk/guidance/ta464 Bisphosphonates for treating osteoporosis Technology appraisal guidance Published: 9 August 2017 nice.org.uk/guidance/ta464 NICE 2017. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).

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

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

IMPROVING BONE HEALTH AND FRACTURE PREVENTION

IMPROVING BONE HEALTH AND FRACTURE PREVENTION IMPROVING BONE HEALTH AND FRACTURE PREVENTION Helen Ridley, Programme Lead, North East & North Cumbria Academic Health Science Network NORTH EAST REGION 2014/15 AHSN Single Sponsored Project Hadrian Primary

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

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

Femoral Shaft Cortical Pathology associated with longterm Alendronate Therapy: A New Classification

Femoral Shaft Cortical Pathology associated with longterm Alendronate Therapy: A New Classification Malaysian Orthopaedic Journal 2013 Vol 7 No 3 Doi:http://dx.doi.org/10.5704/MOJ.1307.008 MK Kwan, et al Femoral Shaft Cortical Pathology associated with longterm Alendronate Therapy: A New Classification

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

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

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

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

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

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

nice bulletin NICE provided the content for this booklet which is independent of any company or product advertised

nice bulletin NICE provided the content for this booklet which is independent of any company or product advertised nice bulletin NICE provided the content for this booklet which is independent of any company or product advertised nice bulletin Welcome In August 2012, the National Institute for Health and Clinical Excellence

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

Bisphosphonates in the Management of. Myeloma Bone Disease

Bisphosphonates in the Management of. Myeloma Bone Disease Bisphosphonates in the Management of Myeloma Bone Disease James R. Berenson, MD Medical & Scientific Director Institute for Myeloma & Bone Cancer Research Los Angeles, CA Myeloma Bone Disease Myeloma cells

More information

Osteoporosis, Osteomalasia & rickets. Bone disorders

Osteoporosis, Osteomalasia & rickets. Bone disorders Osteoporosis, Osteomalasia & rickets Bone disorders Thank You for Your comments Voice--- Ok Lecture too long--- this is in schedule??? More interaction--- I can do that inshalla Slides are crowded--- but

More information

O. Bruyère M. Fossi B. Zegels L. Leonori M. Hiligsmann A. Neuprez J.-Y. Reginster

O. Bruyère M. Fossi B. Zegels L. Leonori M. Hiligsmann A. Neuprez J.-Y. Reginster DOI 10.1007/s00296-012-2460-y ORIGINAL ARTICLE Comparison of the proportion of patients potentially treated with an anti-osteoporotic drug using the current criteria of the Belgian national social security

More information

The Biochemical Assessment of Bone Health. Ee Mun Lim Chemical Pathologist, QEII Endocrinologist, SCGH

The Biochemical Assessment of Bone Health. Ee Mun Lim Chemical Pathologist, QEII Endocrinologist, SCGH The Biochemical Assessment of Bone Health Ee Mun Lim Chemical Pathologist, QEII Endocrinologist, SCGH Overview Assessment of Bone Health - Clinical - Biochemical? Fasting Metabolic Bone Study - WA perspective

More information

Trabecular Bone Score (TBS)

Trabecular Bone Score (TBS) Trabecular Bone Score (TBS) From fracture prediction to clinical use Teheran May 2016 Prof. Didier Hans Center for Bone diseases, DAL Lausanne University Hospital, Switzerland didier.hans@ascendys.ch Osteoporosis

More information

DXA When to order? How to interpret? Dr Nikhil Tandon Department of Endocrinology and Metabolism All India Institute of Medical Sciences New Delhi

DXA When to order? How to interpret? Dr Nikhil Tandon Department of Endocrinology and Metabolism All India Institute of Medical Sciences New Delhi DXA When to order? How to interpret? Dr Nikhil Tandon Department of Endocrinology and Metabolism All India Institute of Medical Sciences New Delhi Clinical Utility of Bone Densitometry Diagnosis (DXA)

More information

Chapter 5: Evaluation and treatment of kidney transplant bone disease Kidney International (2009) 76 (Suppl 113), S100 S110; doi: /ki.2009.

Chapter 5: Evaluation and treatment of kidney transplant bone disease Kidney International (2009) 76 (Suppl 113), S100 S110; doi: /ki.2009. http://www.kidney-international.org & 2009 KDIGO Chapter 5: Evaluation and treatment of kidney transplant bone disease ; doi:10.1038/ki.2009.193 Grade for strength of recommendation a Strength Wording

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

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 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

OSTEOPOROSIS: AN OPPORTUNITY OR OBLIGATION

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

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

UK clinical guideline for the prevention and treatment of osteoporosis

UK clinical guideline for the prevention and treatment of osteoporosis Arch Osteoporos (2017) 12:43 DOI 10.1007/s11657-017-0324-5 POSITION PAPER UK clinical guideline for the prevention and treatment of osteoporosis J. Compston 1 & A. Cooper 2 & C. Cooper 3 & N. Gittoes 4

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

Osteoporosis. Information leaflet. This information is also available on request in other formats by phoning

Osteoporosis. Information leaflet. This information is also available on request in other formats by phoning Osteoporosis This information is also available on request in other formats by phoning 01387 241053. Information leaflet Produced by Katrina Martin (2007) Updated Mar. 2010 Review date 2013 Contents Page(s)

More information

European guidance for the diagnosis and management of osteoporosis in postmenopausal women

European guidance for the diagnosis and management of osteoporosis in postmenopausal women DOI 10.1007/s00198-008-0560-z POSITION PAPER European guidance for the diagnosis and management of osteoporosis in postmenopausal women J. A. Kanis & N. Burlet & C. Cooper & P. D. Delmas & J.-Y. Reginster

More information

Pediatric metabolic bone diseases

Pediatric metabolic bone diseases Pediatric metabolic bone diseases Classification and overview of clinical and radiological findings M. Mearadji International Foundation for Pediatric Imaging Aid www.ifpia.com Introduction Metabolic bone

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

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

Assessment of the risk of osteoporotic fractures in Prof. J.J. Body, MD, PhD CHU Brugmann Univ. Libre de Bruxelles

Assessment of the risk of osteoporotic fractures in Prof. J.J. Body, MD, PhD CHU Brugmann Univ. Libre de Bruxelles Assessment of the risk of osteoporotic fractures in 2008 Prof. J.J. Body, MD, PhD CHU Brugmann Univ. Libre de Bruxelles Estimated lifetime fracture risk in 50-year-old white women and men Melton et al.;

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

Bone Mineral Density Studies in Adult Populations

Bone Mineral Density Studies in Adult Populations Bone Mineral Density Studies in Adult Populations Last Review Date: July 14, 2017 Number: MG.MM.RA10aC6 Medical Guideline Disclaimer Property of EmblemHealth. All rights reserved. The treating physician

More information

You have been referred to the osteoporosis clinic because you have sustained a fracture of the *hip / vertebra / wrist.

You have been referred to the osteoporosis clinic because you have sustained a fracture of the *hip / vertebra / wrist. EXAMPLE 1a FRACTURE PATIENT INVITE LETTER «ClinicPhone» «PatientAddress1» «PatientAddress2» «PatientAddress3» «PatientAddress4» «PatientPostcode» Dear «PatientTitle» «PatientSurname» You have been referred

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

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

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

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

9/26/2016. The Impact of Dietary Protein on the Musculoskeletal System. Research in dietary protein, musculoskeletal health and calcium economy

9/26/2016. The Impact of Dietary Protein on the Musculoskeletal System. Research in dietary protein, musculoskeletal health and calcium economy The Impact of Dietary Protein on the Musculoskeletal System Outline A. The musculoskeletal system and associated disorders Jessica D Bihuniak, PhD, RD Assistant Professor of Clinical Nutrition Department

More information

Analyses of the cost-effectiveness of pooled alendronate and risedronate, compared with strontium ranelate, raloxifene, etidronate and teriparatide

Analyses of the cost-effectiveness of pooled alendronate and risedronate, compared with strontium ranelate, raloxifene, etidronate and teriparatide Analyses of the cost-effectiveness of pooled alendronate and risedronate, compared with strontium ranelate, raloxifene, etidronate and teriparatide Dr Matt Stevenson Sarah Davis July 2006 1 Page Executive

More information

Bone: To DEXA or not to DEXA. Michael Yin, MD MS Associate Professor of Medicine Columbia University Medical Center

Bone: To DEXA or not to DEXA. Michael Yin, MD MS Associate Professor of Medicine Columbia University Medical Center Bone: To DEXA or not to DEXA Michael Yin, MD MS Associate Professor of Medicine Columbia University Medical Center Learning Objectives Upon completion of this presentation, learners should be better able

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

International Journal of Health Sciences and Research ISSN:

International Journal of Health Sciences and Research  ISSN: International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Original Research Article Osteoporosis- Do We Need to Think Beyond Bone Mineral Density? Dr Preeti Soni 1, Dr Shipra

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

Clinical Management Guidelines for Osteoporosis in Hong Kong

Clinical Management Guidelines for Osteoporosis in Hong Kong Clinical Management Guidelines for Osteoporosis in Hong Kong KH Chan 1, KW Chan 2, KMC Cheung 3, TC Cheung 4, ACP Chow 5, DWS Chu 6, FPT Choi 7, AYY Ho 8, TP Ip 9, AWC Kung 1, EMC Lau 10, GKW Lee 11, JCY

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

Prescribing of Denosumab (Prolia ) in Wales: Review. Full document

Prescribing of Denosumab (Prolia ) in Wales: Review. Full document Prescribing of Denosumab (Prolia ) in Wales: Review Full document October 2013 This report has been prepared by a multiprofessional collaborative group, with support from the All Wales Prescribing Advisory

More information

1.2 Health states/risk factors affected by the intervention

1.2 Health states/risk factors affected by the intervention 1.1 Definition of intervention The intervention is opportunistic screening for low bone mineral density (BMD) for women aged 70 to 90 years who present to their GP for an unrelated purpose, and subsequent

More information

Osteoporosis: Not Just for Women Anymore. Osteoporosis is characterized by low bone. By Lisanne G. Laurier, MD, PhD, FRCPC.

Osteoporosis: Not Just for Women Anymore. Osteoporosis is characterized by low bone. By Lisanne G. Laurier, MD, PhD, FRCPC. Focus on CME at the University of Western Ontario Osteoporosis: Not Just for Women Anymore By Lisanne G. Laurier, MD, PhD, FRCPC Osteoporosis is characterized by low bone mass and microarchitectural deterioration

More information

Preliminary Communication

Preliminary Communication Preliminary Communication Prevention of glucocorticoid-induced osteoporosis: a re audit of dual-energy x-ray absorptiometry scan access and management guideline compliance Aim: To evaluate the current

More information