Postmenopausal osteoporosis is a systemic
|
|
- Beverly Townsend
- 5 years ago
- Views:
Transcription
1 OSTEOPOROSIS: HARD FACTS ABOUT BONES Steven T. Harris, MD, FACP* ABSTRACT As a consequence of the aging process, osteoporosis affects all men and women. Agerelated loss of bone mass leads to skeletal fragility and increases the risk of fracture. Bone densitometry provides a reasonable estimate of fracture risk, but factors independent of bone density also contribute to fracture risk. Fracture after age 50, either symptomatic or asymptomatic, substantially increases the risk of future fractures. However, data from recent studies suggest high-risk patients frequently do not receive evaluations or treatment for osteoporosis. All currently available agents for prevention and treatment of osteoporosis have proven efficacy for increasing bone density. An accumulation of clinical data show that relatively small increases in bone density are associated with reductions in fracture risk that are substantially greater than would be expected from the observed improvement in bone mass. (Advanced Studies in Medicine 2002;2(15): ) Postmenopausal osteoporosis is a systemic skeletal disease characterized by low bone mass, microarchitectural deterioration of bone tissue, and increased bone fragility and susceptibility to fracture. Bone mineral density (BMD) decreases, and fracture risk increases with aging. If left untreated or treated ineffectively, osteoporosis can cause irreversible deterioration of bone structure, leading to increased fracture risk. Osteoporosis can have major adverse effects on physical, emotional, and social well-being. The management of osteoporosis encompasses both prevention and treatment. An effective clinical strategy should reflect a multidisciplinary approach that addresses issues such as environmental modification to reduce the risk of falling, and lifestyle modifications, including smoking cessation and abstention or moderation of alcohol consumption. Several available medical therapies can reduce the risk of fracture, including the bisphosphonates, which specifically affect bone mass, and raloxifene and estrogen, which offer multiple potential benefits. Numerous studies have documented that even small increases in BMD are associated with disproportionately large reductions in fracture risk. OSTEOPOROSIS: EVOLUTION AND EFFECTS *Clinical Professor, Departments of Medicine and Radiology, University of California, San Francisco Medical Center, San Francisco, California. Address correspondence to: Steven T. Harris, MD, University of California San Francisco Medical Center, 350 Parnassus Ave, #706, San Francisco, CA In women, BMD decreases and fracture risk increases with aging. 1,2 Both men and women can develop osteoporosis, however, as well as individuals of any race. Osteoporosis-related fractures in women may lead to acute and chronic back pain, height loss, kyphosis, abdominal discomfort, rib and pelvic discomfort, sleep disorders, and loss of self-esteem Vol. 2, No. 15 September 2002
2 The risks and impact of fractures should not be underestimated. For example, in the Multiple Outcomes of Raloxifene Evaluation (MORE) study, vertebral fracture occurred twice as often as any other major clinical event in placebo-treated patients who had no history of fracture before entry into the study. Since 1994, BMD scanning has been the standard for diagnosing osteoporosis. BMD values more than 2.5 standard deviations below the mean for normal young adults (ie, T scores below -2.5) have been defined as osteoporotic. Declining BMD poses a continuum of risk for fracture that does not appear to plateau. 4 However, a low BMD is not the only risk factor for fracture. Older age, poor health, poor eyesight, lack of exercise, maternal fracture history, any fracture after age 50, and several other factors are independent predictors of hip fracture. 5 Of particular interest, any fracture after age 50, whether asymptomatic or clinical, greatly increases the risk for subsequent fracture. The observation is noteworthy because approximately two thirds of spinal compression fractures are asymptomatic, meaning that only one third of vertebral compression fractures are associated with back pain. BMD remains an important predictor of osteoporosis and fracture risk, but since the mid 1990s, the clinical perception of osteoporosis has changed in a subtle but important way. Increasingly, osteoporosis has come to be viewed as a risk factor for fracture, rather than the more conventional clinical view of osteoporosis as the fracture after the fact. This shift in perspective places osteoporosis in a clinical context similar to that of hypercholesterolemia as a risk factor for heart disease or hypertension as a risk factor for cardiovascular disease. Somewhat disappointing and even disturbing, a classic osteoporotic fracture often does not result in the diagnosis or treatment of the underlying osteoporosis. In fact, as many as three fourths of all osteoporotic fractures may not be linked to the underlying disease or prompt specific therapy to prevent recurrent fractures. 6 Current clinical practices suggest a need for increased clinical suspicion and diligence in identifying and treating osteoporosis. Physicians and their patients can then consider a variety of therapies with proven efficacy for minimizing the hazards of osteoporosis. TREATMENT GOALS AND OPTIONS Clinical objectives differ for the management of established osteoporosis versus prevention. In patients with osteoporosis, the goals are to prevent further fractures, maximally increase bone density, relieve pain, and improve functional capabilities. Prevention strategies center on preventing bone loss and preventing an increase in fracture risk. Of the available therapies, some are better suited for prevention, whereas others are better suited for the treatment of established osteoporosis. NONPHARMACOLOGIC APPROACHES Some of the nonpharmacologic interventions for osteoporosis are fairly intuitive. Environmental modification and related strategies are obvious ways to prevent falls. Abstention or moderation of alcohol consumption can decrease the risk of falling and, thus, fractures. Because smoking increases the risk of osteoporosis, smoking cessation becomes an obvious clinical strategy. As previously noted, physical inactivity is associated with an increased fracture risk. Regular exercise improves strength and balance and may induce subtle, but important, increases in bone density. Women who are at risk for hip fracture due to frailty and falling can benefit from wearing hip protectors. The efficacy of hip protectors has been demonstrated in at least 2 large, randomized clinical trials. 7,8 Nutrition-based strategies include calcium and vitamin D supplementation. Older patients should consume 1200 mg to 1500 mg of calcium daily; 1000 mg of calcium daily is reasonable for younger patients. Total calcium intake can come from any combination of diet, fortified foods, and supplementation. Vitamin D supplementation plays an important role in managing osteoporosis risk. For most people, the principal sources of vitamin D are sunlight and fortified dairy products such as milk. An older person who mainly stays indoors and rarely consumes milk or other dairy products has a significant risk of vitamin D deficiency. The routine measurement of vitamin D metabolites may not be necessary in clinical practice, but a daily vitamin D supplement may warrant recommendation. A reasonable goal is 800 IU daily for older patients and about one half of that dose for younger patients. Calcium and vitamin Advanced Studies in Medicine 547
3 D supplementation should be given concomitantly with most pharmacologic therapies for osteoporosis. PHARMACOLOGIC STRATEGIES Normal BMD reflects a balance between bone resorption and bone formation, whereas osteoporosis often reflects an imbalance in these 2 key components of bone metabolism, with resorption occurring at a greater rate than formation. Pharmacologic therapies for osteoporosis attempt to restore balance to bone metabolism. All antiresorptive therapies decrease bone resorption, but also decrease bone formation as a consequence of the normal coupling of these 2 physiologic processes. However, the decrease in bone resorption occurs at a faster rate than the decrease in bone formation, resulting in an overall increase in BMD. The greatest improvement in BMD occurs during the first year of antiresorptive therapy; smaller increases in density occur in subsequent years, with the density eventually reaching a plateau. Results from several clinical studies of antiresorptive therapies have shown that even small increases in BMD result in disproportionately large reductions in fracture risk. The observation emphasizes that change in bone density does not reflect the entire benefit of therapy. The other factors that contribute to reduced fracture risk have yet to be elucidated, but improvement in bone quality has emerged as a recurrent theme in studies of osteoporosis therapies. Osteoporosis literature on estrogen replacement therapy (ERT) is similar to the cardiovascular literature. Epidemiologic data show that women who use ERT have fewer fractures; however, no large-scale, randomized clinical trial has been conducted on this subject. ERT also reflects the clinical dichotomy that exists among current osteoporosis therapies. Some agents are bone-specific; the benefits from ERT, however, go beyond preservation of bone mineral density. In addition to increasing BMD, ERT addresses symptoms of estrogen deficiency and may confer other extraskeletal benefits. On the other hand, ERT may also increase the risk of breast cancer, and the effect on fracture risk has yet to be demonstrated in a controlled trial. Numerous studies have documented that even small increases in bone mineral density are associated with disproportionately large reductions in fracture risk. Intranasal calcitonin has antiresorptive and analgesic effects. The agent offers the advantage of flexible timing of administration, has no known drug-drug interactions, and is well tolerated. Calcitonin treatment demonstrated antifracture efficacy in the Prevent Recurrence of Osteoporotic Fractures (PROOF) trial, which initially involved 1255 elderly women with a history of osteoporotic fractures. 9 Spinal BMD increased by less than 1%, but the vertebral fracture rate decreased by 36% in women randomized to calcitonin, again emphasizing the concept of improved bone quality. The PROOF study showed no evidence of a reduction in nonvertebral fractures in women treated with calcitonin, although the study had very limited statistical power to do so. 9 Raloxifene, the first of the selective estrogen receptor modulators (SERMs), demonstrated its ability to improve BMD and reduce fracture risk in the MORE (Multiple Outcomes of Raloxifene Evaluation) trial, which involved 7705 postmenopausal women. All patients had prevalent vertebral fractures or BMD T- score values of 2.5 or less. 10 The patients were randomized to placebo or to 1 of 2 doses of raloxifene (60 mg or 120 mg daily). Over 4 years of therapy, patients in the raloxifene groups had BMD increases of 1% to 3% in the hip and spine, primarily during the first year. 11 Those modest changes in BMD translated into a 34% reduction in new vertebral fractures in patients with a history of fracture, and a 49% reduction in fracture risk in patients without prevalent vertebral fractures. 12 The benefits of raloxifene therapy emerged during the first year of therapy, when patients on active treatment had a 68% overall reduction in fracture risk compared with the placebo group. 13 During the 4 years of therapy, however, raloxifene therapy did not decrease the risk of nonvertebral fractures. Results of the MORE trial also highlighted another key observation about raloxifene therapy: regardless of the degree of improvement in BMD, patients receiving raloxifene plus calcium and vitamin D had a reduced fracture risk compared with patients receiving calcium, vitamin D, and a placebo Vol. 2, No. 15 September 2002
4 Like estrogen, raloxifene s benefits may extend beyond the skeletal system. The potential of SERMs for preventing breast cancer is being evaluated in the Study of Tamoxifen and Raloxifene (STAR), and their potential cardiovascular benefits are under investigation in the Raloxifene Use for The Heart (RUTH) study. The bisphosphonates comprise almost a dozen different agents; only 2 alendronate and risedronate are approved in the United States for osteoporosis prevention and treatment. In contrast to estrogen and raloxifene, the bisphosphonates have a single function, and the benefits are bone-specific. The relative merits of using bone-specific therapies versus those that have multiple effects are the subject of ongoing debate. Alendronate increases hip, spine, and total body BMD, and clinical trials have documented that the drug reduces vertebral and nonvertebral fracture risk. 15 Results with risedronate are fairly comparable with those achieved with alendronate. In clinical trials, rates of vertebral and nonvertebral fracture have been reduced by approximately 40%. 16 One study showed that 1 hip fracture could be prevented for every 29 elderly women with low BMD and prevalent vertebral fractures who were treated with risedronate for 3 years. 17 As a class, the bisphosphonates are long-acting compounds, a trait that has given rise to investigation of intermittent dosing. Both alendronate and risedronate have demonstrated efficacy with weekly dosing that is similar to the efficacy observed with daily administration. The availability of multiple pharmacologic options has sparked interest in combination therapy for osteoporosis, with data just beginning to emerge for some of the potential combinations. Initial findings suggest that the combination of alendronate and hormone replacement may improve BMD to a greater degree than either agent alone. Similar data have come from evaluations of hormone replacement and risedronate, and of raloxifene and alendronate combined. However, no long-term data are available to determine whether greater improvement in BMD with combination therapy translates into improved fracture prevention compared with results achieved with individual agents. SUMMARY Bone mineral density decreases with age, with a concomitant increase in fracture risk. Available data suggest that the diagnosis and treatment of osteoporosis remain suboptimal, because the vast majority of atrisk patients go unrecognized or untreated. Multiple therapeutic options now exist for the prevention and treatment of osteoporosis. Antiresorptive drugs achieve similar reductions in vertebral fracture risk, but not all agents have demonstrated protection against nonvertebral fractures. Reductions in hip fracture risk have not been demonstrated in every trial of antiresorptive therapy, but some trials lacked sufficient statistical power. Some antiresorptive agents have nonbone effects, whereas others are bone-specific. The appropriate treatment for a given patient may depend on the nonbone advantages offered by a particular therapy as well as the therapy s ability to prevent both vertebral and nonvertebral fractures. REFERENCES 1. Faulkner KG. Bone densitometry: choosing the proper skeletal site to measure. J Clin Densitom. 1998;1: Riggs BL, Melton LJ 3rd. Involutional osteoporosis. N Engl J Med. 1986;314: Silverman SL. The clinical consequences of vertebral compression fracture. Bone. 1992;13(suppl 2):S27-S Meunier PJ, Delmas PD, Eastell R, et al. Diagnosis and management of osteoporosis in postmenopausal women: clinical guidelines. International Committee for Osteoporosis Clinical Guidelines. Clin Ther. 1999;21: Cummings SR, Browner WS, Bauer D, et al. Endogenous hormones and the risk of hip and vertebral fractures among older women. Study of Osteoporotic Fractures Research Group. N Engl J Med. 1998;332: Freedman KS, Kaplan FS, Bilker WB, et al. Treatment of osteoporosis: are physicians missing an opportunity? J Bone Joint Surg Am. 2002;82A: Lauritzen JB, Petersen MM, Lund B. Effect of external hip protectors on hip fractures. Lancet. 1993;350: Kannus P, Parkkari J, Niemi S, et al. Prevention of hip fracture in elderly people with use of a hip protector. N Engl J Med. 2000;343: Chesnut CH 3rd, Silverman S, Andriano K, et al. A randomized trial of nasal spray salmon calcitonin in postmenopausal women with established osteoporosis: the Prevent Recurrence of Osteoporotic Fractures Study. PROOF Study Group. Am J Med. 2000;109: Cummings SR, Eckert S, Krueger KA, et al. The effect of raloxifene on risk of breast cancer in postmenopausal women: results from the MORE randomized trial. Multiple Outcomes of Raloxifene Evaluation. JAMA. 1999; 281: Advanced Studies in Medicine 549
5 11. Ettinger B, Black DM, Mitlak DH, et al. Reduction in vertebral fracture in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA. 1999;282: Eastell R. The effects of raloxifene on incident vertebral fractures in postmenopausal women with osteoporosis: 4-year results from the MORE trial. J Bone Miner Res. 2000; 15(suppl 1):S Maricic M, Adachi J, Meunier P, et al. Raloxifene 60 mg/day has effects within 12 months in postmenopausal osteoporosis treatment and prevention studies. Arthritis Rheum. 2000;43(suppl 9):S Sarkar S, Mitlak BH, Wong M, et al. Relationships between bone mineral density and incident vertebral fracture risk with raloxifene therapy. J Bone Miner Res. 2002;17: Black DM, Cummings SR, Karpf DB, et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet. 1996;348: Harris ST, Watts NB, Genant HK, et al. Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy with Risedronate Therapy (VERT) Study Group. JAMA. 1999;282: McClung MR, Geusens P, Miller PD, et al. Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group. N Engl J Med. 2001;344: Vol. 2, No. 15 September 2002
OSTEOPOROSIS MANAGEMENT AND INVESTIGATION. David A. Hanley, MD, FRCPC
OSTEOPOROSIS MANAGEMENT AND INVESTIGATION David A. Hanley, MD, FRCPC There is a huge care gap in the management of osteoporosis in this country. As yet unpublished findings from the Canadian Multicentre
More informationThe Significance of Vertebral Fractures
Special Report The Significance of Vertebral Fractures Both the prevalence and the clinical significance of vertebral fractures has been greatly underestimated by physicians. Vertebral fractures are much
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 informationUpdates 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 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 informationDoes raloxifene (Evista) prevent fractures in postmenopausal women with osteoporosis?
FPIN's Clinical Inquiries Raloxifene for Prevention of Osteoporotic Fractures Clinical Inquiries provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries
More informationRisedronate prevents hip fractures, but who should get therapy?
INTERPRETING KEY TRIALS CHAD L. DEAL, MD Head, Center for Osteoporosis and Metabolic Bone Disease, Department of Rheumatic and Immunologic Diseases, The Cleveland Clinic THE HIP TRIAL Risedronate prevents
More informationDECADES OF PUBLISHED STUDIES have confirmed the
JOURNAL OF BONE AND MINERAL RESEARCH Volume 15, Number 2, 2000 2000 American Society for Bone and Mineral Research Perspective Bone Matters: Are Density Increases Necessary to Reduce Fracture Risk? KENNETH
More informationFragile 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 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 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 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 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 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 informationLow Back Pain Accompanying Osteoporosis
Low Back Pains Low Back Pain Accompanying Osteoporosis JMAJ 46(10): 445 451, 2003 Toshitaka NAKAMURA Professor, Department of Orthopedic Surgery, University of Occupational and Environmental Health Abstract:
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 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 informationOsteoporosis 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 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 informationMs. Y. Outline. Updates of SERMs and Estrogen
Ms. Y Updates of SERMs and Estrogen Steven R. Cummings, MD, FACP San Francisco Coordinating Center CPMC Research Institute and UCSF Support from Lilly, Pfizer, Berlex 55 y.o. woman with mild hypertension
More informationEffective Health Care
Number 12 Effective Health Care Comparative Effectiveness of Treatments To Prevent Fractures in Men and Women With Low Bone Density or Osteoporosis Executive Summary Background Osteoporosis is a systemic
More informationCan we improve the compliance to prevention treatment after a wrist fracture? Roy Kessous
Can we improve the compliance to prevention treatment after a wrist fracture? Roy Kessous Distal radius fracture in women after menopause is in many cases a first clinical indication for the presence of
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 informationWhich Bisphosphonate? It s the Compliance!: Decision Analysis
J Bone Metab 2016;23:79-83 http://dx.doi.org/10.11005/jbm.2016.23.2.79 pissn 2287-6375 eissn 2287-7029 Original Article Which Bisphosphonate? It s the Compliance!: Decision Analysis You Jin Lee 1, Chan
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 informationHip Fracture Prevention in the Nursing Home
REVIEW Hip Fracture Prevention in the Nursing Home Hosam K. Kamel, MD, FACP, AGSF Hip fracture prevention in the nursing home should involve measures to increase bone density, prevent falls, and protect
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 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 informationOsteoporosis 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 informationOutline Vertebroplasty and Kyphoplasty: Who, What, and When
Outline Vertebroplasty and Kyphoplasty: Who, What, and When Douglas C. Bauer, MD University of California San Francisco, USA Vertebral fracture epidemiology, consequences and diagnosis Kyphoplasty and
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 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 informationPHC4 Issue Brief. Osteoporosis Facts and Figures. November 19, 1997
PHC4 Issue Brief Osteoporosis Facts and Figures November 19, 1997 Background Information: Osteoporosis is a disease characterized by low bone mass and structural deterioration of bone tissue, leading to
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 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 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 informationOutline Vertebroplasty and Kyphoplasty: Who, What, and When
Outline Vertebroplasty and Kyphoplasty: Who, What, and When Douglas C. Bauer, MD University of California San Francisco, USA Vertebral fracture epidemiology, consequences and diagnosis Kyphoplasty and
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 informationTREATMENT OF OSTEOPOROSIS
TREATMENT OF OSTEOPOROSIS Summary Prevention is the key issue in the management of osteoporosis. HRT is the agent of choice for prevention of postmenopausal osteoporosis. Bisphosphonates and Calcitonin
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 informationChapter 39: Exercise prescription in those with osteoporosis
Chapter 39: Exercise prescription in those with osteoporosis American College of Sports Medicine. (2010). ACSM's resource manual for guidelines for exercise testing and prescription (6th ed.). New York:
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 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 informationOral Alendronate Vs. Three-Monthly Iv Ibandronate In The Treatment Of Postmenopausal Osteoporosis
Oral Alendronate Vs. Three-Monthly Iv Ibandronate In The Treatment Of Postmenopausal Osteoporosis Miriam Silverberg A. Study Purpose and Rationale More than 70% of fractures in people after the age of
More informationORIGINAL INVESTIGATION. Bone Mineral Density Thresholds for Pharmacological Intervention to Prevent Fractures
ORIGINAL INVESTIGATION Bone Mineral Density Thresholds for Pharmacological Intervention to Prevent Fractures Ethel S. Siris, MD; Ya-Ting Chen, PhD; Thomas A. Abbott, PhD; Elizabeth Barrett-Connor, MD;
More informationOsteoporosis is estimated to develop in 1 out of 4 women over the age of 50. Influence of bone densitometry results on the treatment of osteoporosis
Influence of bone densitometry results on the treatment of osteoporosis Nicole S. Fitt, * Susan L. Mitchell, * Ann Cranney, Karen Gulenchyn, Max Huang, * Peter Tugwell Abstract Background: Measurement
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 informationOsteoporosis. Treatment of a Silently Developing Disease
Osteoporosis Treatment of a Silently Developing Disease Marc K. Drezner, MD Senior Associate Dean Emeritus Professor of Medicine Emeritus University of Wisconsin-Madison Auditorium The Forest at Duke October
More informationPage 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 informationPostmenopausal Osteoporosis
clinical practice Postmenopausal Osteoporosis Clifford J. Rosen, M.D. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is
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 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 informationBisphosphonates. Making intelligent drug choices
Making intelligent drug choices Bisphosphonates are a first choice for treating osteoporosis, according to Kedrin E. Van Steenwyk, DO, an obstetrician/gynecologist at Sycamore Women s Center, Miamisburg,
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 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 - recent advances in diagnosis and treatment
Title Osteoporosis - recent advances in diagnosis and treatment Author(s) Kung, AWC Citation The 4th Medical Research Conference (MRC 1999), Hong Kong, China, 30-31 January 1999. In Hong Kong Practitioner,
More informationHORMONE THERAPY A BALANCED VIEW?? Prof Greta Dreyer
HORMONE THERAPY A BALANCED VIEW?? Prof Greta Dreyer -- PART 1 -- Definitions HRT hormone replacement therapy HT genome therapy ERT estrogen replacement therapy ET estrogen EPT estrogen progesterone therapy
More informationW hile the headline-grabbing Women s
OBG MANAGEMENT BY ROBERT L. BARBIERI, MD New options in osteoporosis therapy: Combination and sequential treatment Perhaps the biggest medical question to emerge from the WHI study is how to best treat
More informationHelpful information about bone health & osteoporosis Patient Resource
Helpful information about bone health & osteoporosis Patient Resource Every year In the United States, 2.5 million fractures occur due to osteoporosis. Out of these, 330,000 are hip fractures, and half
More informationSkeletal Manifestations
Skeletal Manifestations of Metabolic Bone Disease Mishaela R. Rubin, MD February 21, 2008 The Three Ages of Women Gustav Klimt 1905 1 Lecture Outline Osteoporosis epidemiology diagnosis secondary causes
More informationOsteoporosis: Current Management Strategies
Osteoporosis: Current Management Strategies Ambrish Mithal*, Nidhi Malhotra** *Senior Consultant, **Clinical Associate, Department of Endocrinology and Diabetes, Indraprastha Apollo Hospital, Sarita Vihar,
More informationFocusing on the Patient: Diagnosis and Management of Osteoporosis
Focusing on the Patient: Diagnosis and Management of Osteoporosis Learning Objectives After participating in this educational activity, participants should be able to: 1. Apply updated guidelines to assess
More informationOverview. 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 informationBMD: A Continuum of Risk WHO Bone Density Criteria
Pathogenesis of Osteoporosis Osteoporosis Diagnosis: BMD, FRAX and Assessment of Secondary Osteoporosis AGING MENOPAUSE OTHER RISK FACTORS RESORPTION > FORMATION Bone Loss LOW PEAK BONE MASS Steven T Harris
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 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 informationRaloxifene, the first selective estrogen
Raloxifene FAQs: Perspectives on the First Approved SERM Where Are We Now? Part 1 A Menopause Management Q & A with Stanley J. Birge, MD; Felicia Cosman, MD; Bruce Ettinger, MD Editor s note: The opinions
More informationVol. 19, Bulletin No. 108 August-September 2012 Also in the Bulletin: Denosumab 120mg for Bone Metastases
ה מ ר א פ הביטאון לענייני תרופות ISRAEL DRUG BULLETIN 19 years of unbiased and independent drug information P H A R x M A Vol. 19, Bulletin No. 108 August-September 2012 Also in the Bulletin: Denosumab
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 informationNew 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 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 informationPrevalence of vertebral fractures on chest radiographs of elderly African American and Caucasian women
Osteoporos Int (2011) 22:2365 2371 DOI 10.1007/s00198-010-1452-6 ORIGINAL ARTICLE Prevalence of vertebral fractures on chest radiographs of elderly African American and Caucasian women D. Lansdown & B.
More informationSERMS, Hormone Therapy and Calcitonin
SERMS, Hormone Therapy and Calcitonin Tiffany Kim, MD Clinical Fellow VA Advanced Women s Health UCSF Endocrinology and Metabolism I have nothing to disclose Thanks to Clifford Rosen and Steven Cummings
More informationInternational Journal of Advanced Research in Biological Sciences ISSN : Research Article
Int. J. Adv. Res. Biol.Sci. 1(7): (2014): 167 172 International Journal of Advanced Research in Biological Sciences ISSN : 2348-8069 www.ijarbs.com Research Article Beneficial effect of Strontium Ranelate
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 informationPage 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 informationOsteoporosis Evaluation and Treatment
Osteoporosis Evaluation and Treatment Anne Schafer, MD Assistant Professor of Medicine Division of Endocrinology & Metabolism October 28, 2011 No conflicts of interest Objectives Explain when to initiate
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 informationBREAST CANCER AND BONE HEALTH
BREAST CANCER AND BONE HEALTH Rowena Ridout, MD, FRCPC Toronto Western Hospital Osteoporosis Program University Health Network / Mount Sinai Hospital rowena.ridout@uhn.ca None to declare Conflicts of Interest
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 informationVertebral fractures are the most common serious complication
Safety and Efficacy of Risedronate in Reducing Fracture Risk in Osteoporotic Women Aged 80 and Older: Implications for the Use of Antiresorptive Agents in the Old and Oldest Old Steven Boonen, MD, PhD,
More informationUpdate on the treatment of post-menopausal osteoporosis
Published Online May 12, 2008 Update on the treatment of post-menopausal osteoporosis Zoë Cole, Elaine Dennison, and Cyrus Cooper * MRC Epidemiology Resource Centre, University of Southampton, Southampton
More informationORIGINAL INVESTIGATION. National Trends in Osteoporosis Visits and Osteoporosis Treatment,
ORIGINAL INVESTIGATION National Trends in Osteoporosis Visits and Osteoporosis Treatment, 1988-2003 Randall S. Stafford, MD, PhD; Rebecca L. Drieling, BA; Adam L. Hersh, MD, PhD Background: Research is
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 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 informationOsteoporosis Physician Performance Measurement Set. October 2006 Coding Reviewed and Updated November 2009
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 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 informationHealthy Bones: Osteoporosis Management. Laurel Short, MSN, FNP-C
Healthy Bones: Osteoporosis Management Laurel Short, MSN, FNP-C Disclosure I have no current affiliation or financial interest with any grantor or commercial interests that may have direct interest in
More informationClosing the Care Gap in Osteoporosis ICE Conference 2015
Closing the Care Gap in Osteoporosis ICE Conference 2015 Pat McCarthy-Briggs RD, MHEd Thank You! What is osteoporosis? a systemic skeletal disease characterized by low bone mass and microarchitectural
More informationManagement of Osteoporosis : What Do the Guidelines Say? Robert D. Blank, MD, PhD Endocrinology, U of Wisconsin GRECC Service, Middleton VAMC
Management of Osteoporosis : What Do the Guidelines Say? Robert D. Blank, MD, PhD Endocrinology, U of Wisconsin GRECC Service, Middleton VAMC Learning Goals Review guidelines for osteoporosis Consider
More informationJuly 2012 CME (35 minutes) 7/12/2016
Financial Disclosures Epidemiology and Consequences of Fractures Advisory Board: Amgen Janssen Pharmaceuticals Inc. Ann V. Schwartz, PhD Department of Epidemiology and Biostatistics UCSF Outline Osteoporotic
More informationAromatase Inhibitors & Osteoporosis
Aromatase Inhibitors & Osteoporosis Miss Sarah Horn Consultant Oncoplastic Breast Surgeon April 2018 Aims Role of Aromatase Inhibitors (AI) in breast cancer treatment AI s effects on bone health Bone health
More informationOsteoporosis. When we talk about osteoporosis, we have to be familiar with the constituents of bone and what it is formed of.
Osteoporosis When we talk about osteoporosis, we have to be familiar with the constituents of bone and what it is formed of. Osteoblasts by definition are those cells present in the bone and are involved
More informationBone mineral density testing: Is a T score enough to determine the screening interval?
Interpreting Key Trials CME CREDIT EDUCATIONAL OBJECTIVE: Readers will measure bone mineral density at reasonable intervals in their older postmenopausal patients Krupa B. Doshi, MD, CCD Department of
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 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 informationWhat is a failure of bisphosphonate therapy for osteoporosis?
CURRENT DRUG THERAPY CME CREDIT JOHN J. CAREY, MD Department of Rheumatic and Immunologic Diseases, The Cleveland Clinic Foundation What is a failure of bisphosphonate therapy for osteoporosis? ABSTRACT
More informationEfficacy of risedronate in men with primary and secondary osteoporosis: results of a 1-year study
Rheumatol Int (2006) 26: 427 431 DOI 10.1007/s00296-005-0004-4 ORIGINAL ARTICLE J. D. Ringe Æ H. Faber Æ P. Farahmand Æ A. Dorst Efficacy of risedronate in men with primary and secondary osteoporosis:
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 informationBad to the bones: treatments for breast and prostate cancer
12 th Annual Osteoporosis: New Insights in Research, Diagnosis, and Clinical Care 23 rd July 2015 Bad to the bones: treatments for breast and prostate cancer Richard Eastell, MD FRCP (Lond, Edin, Ireland)
More information