Prevention of Osteoporotic Hip Fracture

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Prevention of Osteoporotic Hip Fracture"

Transcription

1 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

2 Objectives Problems of Geriatric Hip Fracture Importance of prevention Level of prevention Mechanism of injuries and Fractures Strategy of prevention Secondary prevention

3 Incidence of 3 Fractures Vertebrae Annual Fracture Incidence, per 100, Youngest BB Oldest baby boomers Hip Wrist Next 5 to 25 years Age

4 Projected number of osteoporotic hip fractures worldwide 3250 Projected to reach million in Asia by Total number of hip fractures: 1950 = 1.66 million 2050 = 6.26 million Estimated number of hip fractures: (1000s) Adapted from Cooper et al, Osteoporos Int. 1992; 2:285-9

5 Consequences of hip fracture One year after hip fracture Patients (%) Death within one year 20% Permanent disability 30% Unable to walk independently 40% Unable to carry out at least one independent activity of daily living 80% Cooper. Am J Med 1997; 103(2A):12s-19s.

6 End result 2004

7 Prevention Primary Prevention Prevention of first fracture Secondary Prevention Prevention of subsequent fracture 7

8 Intrinsic -General degeneration -Balance -Medical problems Extrinsic -Environmental hazard Interaction with environment (e.g. risky behavioral Fall 8

9 Extrinsic Environment Intrinsic Age Muscle weakness Previous falls Gait / balance Visual Arthritis Cognitive impairment Depression Poly-pharmacy Risk taking behavior NEJM 2002

10

11 Elderly with osteoporosis.. Progressive kyphosis Compensatory mechanism

12 12

13 13

14 14

15 Extrinsic factors 15

16 16

17 Fall 1. Orientation of fall 2.protective responses 3.Local shock absorbers Insufficient 4.Bone strength Insufficient Hip Fracture Journal of Geronotology 1989 Vol 44,M

18 Orientation of fall Hip fracture is different from colles fracture 18

19

20 Fall Orientation of fall protective responses Local shock absorbers Insufficient Bone strength Insufficient Hip Fracture Drugs 20

21 Bone strength is more than BMD young elderly Images from L. Mosekilde, Technology and Health Care Image courtesy of David Dempster

22 22

23 Screening for osteoporosis 23

24 24

25 Pharmacological agents for treatment of osteoporosis Effective therapies are widely available and can reduce vertebral, hip and other fractures by 30% to 65%, even in patients who have already suffered a fracture

26 Pharmacological agents shown to reduce fracture risk Bisphosphonates Alendronate (FOSAMAX ) Risedronate (ACTONEL ) Ibandronate Hormone (BONVIVA therapy ) Zolendronate Estrogen / progestin (ACLASTA ) SERMs Raloxifene (EVISTA ) Stimulators of bone formation rh-pth (FORTEO ) Mixed mode of action Strontium ranelate (PROTELOS )

27 Effect on vertebral fracture risk Osteoporosis With prior fractures Osteoporosis Effect on non-vertebral fracture risk With prior fractures Alendronate + + NA + (incl. hip) Risedronate + + NA + (incl. hip) Ibandronate NA + NA + HRT Raloxifene + + NA NA Teriparatide and PTH Strontium ranelate NA + NA (incl. hip) + (incl. hip) NA, No evidence available; +, effective drug ; a women with a prior vertebral fracture Adapted from Boonen S. et al. 2005; Osteoporos Int; 16:239-54

28 Hip protectors ======

29 Hip Protectors protective devices against hip fractures Protective Garments comprise of: Pressurized pants Protective pads on lateral sides

30 Different options in market AHIP protectors, Safe hip et Same principle external and direct protection to the hip region

31 Same Problem Compliance rate: about 40% annually dropping from 70% in autumn to 20% in summer

32 Secondary prevention End result 2004

33 Klotzbuecher et al. J Bone Miner Res 2000; 15: Prior fracture increases the risk of subsequent fracture Site of prior fracture Hip Spine Forearm Minor fracture Hip Risk of subsequent fracture Spine Forearm Minor fracture A prior fracture increases the risk of new fracture 2- to 5-fold

34 Risk of second hip fracture Incidence of second hip fracture. A population based study Osteoporosis International 2007 April 18 Cumulative risk one year ; 5.08 % second year ; 8.11 % At the time of second fracture -Osteoporosis diagnosed : 23% -Bisphonspahte : 16% -Calcium : 20% -Vit D : 16 %

35 Optimal care of the fragility fracture patient Diagnosis of fragility fracture Identify fragility fracture & underlying disease, incorporate into existing workup Influences treatment plan from the onset Fracture management Stabilize patient, pain relief, fracture care Rehabilitation Minimize dependence, maximize mobility Secondary prevention Treat and monitor underlying disease, prevent future fractures

36 Secondary Prevention of fracture

37 Intrinsic Extrinsic Strategy Accidental ( trip slip etc..) 14% Un-anticipated Physiological 8% Anticipated Physiological 78% ++++ Preventive Education +++ Protective Medical risk reduction Case findings Risk reduction Protective Preventive Rehabilitation

38 Thanks

Osteoporosis and fractures

Osteoporosis and fractures 1 Osteoporosis and fractures An orthopaedic perspective Orthopaedic Surgeons Initiative International Osteoporosis Foundation International Society for Fracture Repair The Bone and Joint Decade Why is

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/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

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

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

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

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

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

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

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

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

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

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

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

PROCTER & GAMBLE and SANOFI-AVENTIS v ROCHE and GLAXOSMITHKLINE

PROCTER & GAMBLE and SANOFI-AVENTIS v ROCHE and GLAXOSMITHKLINE CASES AUTH/1803/2/06 and AUTH/1804/2/06 PROCTER & GAMBLE and SANOFI-AVENTIS v ROCHE and GLAXOSMITHKLINE Bonviva Once Monthly slide kits Procter & Gamble and Sanofi-Aventis complained jointly about two

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

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

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

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

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

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

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

Medical Director Update

Medical Director Update Medical Director Update Articles: Bone Density Test Can Predict Fractures Over Twenty-Five Years Community Awareness Bone Density Testing Program: 18 Months Experience More Attention Should Be Paid To

More information

Bisphosphonate Step Therapy Criteria

Bisphosphonate Step Therapy Criteria ϯ ϯ ϯ A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Bisphosphonate Step Therapy Criteria Program may

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

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

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

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

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

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

Prevent the next fracture. GP Guide

Prevent the next fracture. GP Guide Prevent the next fracture GP Guide 2nd edition, 2008 INTRODUCTION General practitioners play a central role in identifying people at high risk of osteoporotic fractures. Many of their patients may already

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 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

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

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

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

Teriparatide in the management of osteoporosis

Teriparatide in the management of osteoporosis REVIEW Teriparatide in the management of osteoporosis Donald Bodenner Carolyn Redman Ann Riggs Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA Abstract: Fracture

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

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

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

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

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

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

Reducing the Risk of Bone Fracture. A Review of the Research for Adults With Low Bone Density

Reducing the Risk of Bone Fracture. A Review of the Research for Adults With Low Bone Density Reducing the Risk of Bone Fracture A Review of the Research for Adults With Low Bone Density Is This Information Right for Me? Yes, this information is right for you if: Your doctor* has said you have

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

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

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

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

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

Postmenopausal Osteoporosis

Postmenopausal Osteoporosis LITERATURE REVIEW Postmenopausal Osteoporosis Current and Future Treatment Options Carrie McAdam-Marx, RPh, MS, Joanne LaFleur, PharmD, MSPH, Carmen Kirkness, MSc, PT, and Carl Asche, PhD ABSTRACT Purpose:

More information

Treatment of Osteoporosis: IHFD 6 th March 2015

Treatment 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 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

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

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

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

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

Nonsurgical Treatment Strategies after Osteoporotic Hip Fractures

Nonsurgical Treatment Strategies after Osteoporotic Hip Fractures REVIEW ARTICLE Hip Pelvis 27(1): 9-16, 2015 http://dx.doi.org/10.5371/hp.2015.27.1.9 Print ISSN 2287-3260 Online ISSN 2287-3279 Nonsurgical Treatment Strategies after Osteoporotic Hip Fractures Byung-Woo

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

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

Managing the Patient with Osteoporosis Undergoing Spinal Surgery

Managing the Patient with Osteoporosis Undergoing Spinal Surgery 11/4/16 DISCLOSURES Managing the Patient with Osteoporosis Undergoing Spinal Surgery MEDTRONIC LILLY MISONIX SHANE BURCH MD, MS, FRCSC Associate Professor in Residence UCSF Department of Orthopedic Surgery

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

Management of Osteoporosis

Management of Osteoporosis Management of Osteoporosis Clinical Practice Guideline These guidelines are provided to assist physicians and other clinicians in making decisions regarding the care of their patients. They are not a substitute

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

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

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

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

Ministry of Health. BC Chronic Disease and Selected Procedure Case Definitions. Chronic Disease Information Working Group. Date Created: June 29, 2015

Ministry of Health. BC Chronic Disease and Selected Procedure Case Definitions. Chronic Disease Information Working Group. Date Created: June 29, 2015 Ministry of Health BC Chronic Disease and Selected Procedure Case Definitions Author: Chronic Disease Information Working Group Date Created: June 29, 2015 Last Updated: February 01, 2018 Version: Email:

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 is a disease that is

Osteoporosis is a disease that is Pharmacologic Prevention of Osteoporotic Fractures THOMAS M. ZIZIC, M.D., Johns Hopkins University School of Medicine, Baltimore, Maryland Osteoporosis is characterized by low bone mineral density and

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. 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

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

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: 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

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

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

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

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

COMPASS Therapeutic Notes On The Management Of Osteoporosis

COMPASS Therapeutic Notes On The Management Of Osteoporosis COMPASS Therapeutic Notes On The Management Of Osteoporosis In this issue Introduction, Background and Diagnosis Page 1 Risk Assessment 4 Lifestyle, Calcium and 6 Vitamin D Bisphosphonates 9 Denosumab

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

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

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

Preventing and Managing Osteoporosis. Jessica Ewen, MS Exercise Physiologist Alaska Regional Hospital

Preventing and Managing Osteoporosis. Jessica Ewen, MS Exercise Physiologist Alaska Regional Hospital Preventing and Managing Osteoporosis Jessica Ewen, MS Exercise Physiologist Alaska Regional Hospital What Is Osteoporosis? Osteoporosis is a disease of the bones that occurs when: You lose too much bone

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

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

Evidence-based guidelines for the pharmacological treatment of postmenopausal osteoporosis: a consensus document by the Belgian Bone Club

Evidence-based guidelines for the pharmacological treatment of postmenopausal osteoporosis: a consensus document by the Belgian Bone Club DOI 10.1007/s00198-010-1223-4 CONSENSUS STATEMENT Evidence-based guidelines for the pharmacological treatment of postmenopausal osteoporosis: a consensus document by the Belgian Bone Club J.-J. Body &

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

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

The Cost-Effectiveness of Bisphosphonates in Postmenopausal Women Based on Individual Long-Term Fracture Risks

The Cost-Effectiveness of Bisphosphonates in Postmenopausal Women Based on Individual Long-Term Fracture Risks Volume ** Number ** ** VALUE IN HEALTH The Cost-Effectiveness of Bisphosphonates in Postmenopausal Women Based on Individual Long-Term Fracture Risks Tjeerd-Peter van Staa, MD, MA, PhD, 1,2 John A. Kanis,

More information

A rational approach to the treatment of osteoporosis

A rational approach to the treatment of osteoporosis A rational approach to the treatment of osteoporosis Hough S, MBChB, HonsBSc, MMed, MD (Stell), FCP(SA) Professor of Medicine & Endocrinology Faculty of Health Sciences University of Stellenbosch Correspondence

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

AACE. Osteoporosis Treatment: Then and Now

AACE. Osteoporosis Treatment: Then and Now AACE 25 th Annual Scientific and Clinical Congress Osteoporosis Treatment: Then and Now Orlando, FL May 28, 2016 Michael R. McClung, MD Oregon Osteoporosis Center Portland, Oregon, USA Disclosures I am

More information

Forteo (Teriparatide) AHM

Forteo (Teriparatide) AHM Forteo (Teriparatide) AHM Clinical Indications Forteo (Teriparatide) is considered medically necessary if criteria are met for any 1 or more of the following Treatment of post-menopausal women with osteoporosis

More information

JAPAN CURRENT PROJECTED 2050 COUNTRY OVERVIEW

JAPAN CURRENT PROJECTED 2050 COUNTRY OVERVIEW Japan JAPAN COUNTRY OVERVIEW In 13, the population of Japan was 127.2 million with an aver life epectancy of 84 years, rising to 92 years by 50 (Figure 1). The population is epected to decrease by approimately

More information

3-Year Results of a Member and Physician Intervention to Reduce Risk Associated With Glucocorticoid-Induced Osteoporosis in a Health Plan

3-Year Results of a Member and Physician Intervention to Reduce Risk Associated With Glucocorticoid-Induced Osteoporosis in a Health Plan RESEARCH 3-Year Results of a Member and Physician Intervention to Reduce Risk Associated With Glucocorticoid-Induced Osteoporosis in a Health Plan Mona M. Chitre, PharmD, CGP, and William Hayes, BS ABSTRACT

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

MENOPAUSE. Women in Midlife: Menopause & Osteoporosis. Outline for Menopause. STRAW Stages of the Menopausal Transition-NAMS, /29/2012

MENOPAUSE. Women in Midlife: Menopause & Osteoporosis. Outline for Menopause. STRAW Stages of the Menopausal Transition-NAMS, /29/2012 Women in Midlife: Menopause & Osteoporosis Lisa Ward, MD, MScPH, MS UCSF CME Conference March 23rd, 2012 MENOPAUSE Outline for Menopause Definitions Summary of the Evidence Current Guidelines Management

More information