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

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

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

Transcription

1 Kristen M. Nebel, DO PENN/ LGHP Geriatrics 10/3/17 Temple Family Medicine Review

2 OBJECTIVES Define Revised 2017 American College of Physician Recommendations Screening, Prevention and Treatment Application in Special Circumstances/ considerations

3 IMPACT 54 million in US; 200 million worldwide 50% of Americans over 50 at risk for osteoporotic fracture Increased morbidity/ mortality with hip fx Risk of 2 nd vertebral fracture within one year is 20% Injuries from falls make up 40% of ECF admissions Guidelines Annals.org 2017 ACP Clinical

4 BONE PATHOPHYSIOLOGY Normal: Osteoclasts: dissolve protein matrix and collagen. Resorption markers: N-telopeptide and C-telopeptide. Serum and Urine NTX Osteoblasts: synthesize new bone. Formation markers: bone-specific alkaline phosphatase and osteocalcin

5 OSTEOPOROSIS: CONSEQUENCES Reduced QOL Increased mortality Only 40% return to prior level of function Depression Multiple thoracic fractures restrictive lung disease L b f t ti ti bd i l i di t ti d d tit d l Lumbar fractures constipation, abdominal pain, distention, reduced appetite, and early satiety

6 RISK FACTORS FOR OSTEOPOROTIC FRACTURE BMI<21 Medications Personal history of fractures as adult First-degree relative with fragility fracture 50% greater if 1 st degree relative had + fx 127% greater if parent had hip fx Current smoking Age Menopause, Hypogonadism Ethnicity Nutrition Decreased activity ETOH Dementia Poor health Recent falls

7 MALE OSTEOPOROSIS Morbidity and mortality much higher in men than women with osteoporotic fracture Secondary causes more common accounting for 50% ETOH (15-20%), glucocorticoid (20%), and hypogonadism (15-20%)

8 SCREENING Annual height measurement : loss of 2 cm or more Dual-energy x-ray absorptiometry Women age 65 and older and men age 70 and older Postmenopausal women and men above age with risk factors Postmenopausal women and men age 50+ with h/o adult age fracture Medicare coverage for: women 65+ q 2 yr Bony abnormalities; glucocorticoid medication; HPTH; abnormal x-ray; estrogen deficiency, vertebral fracture ICD-10 code : M85.88 Other specified disorders of bone density and structure, other site

9 DIAGNOSIS CRITERIA Definition: A disease characterized by low bone mass and microarchitechtural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture incidence. Dexa WHO: BMD T-score of -2.5 or less Any vertebral fracture = Osteoporosis

10 OSTEOPOROSIS EVALUATION Labs CMP, phosphate, CBC, ESR, TSH/FT4 Testosterone/ Estrogen SPEP/UPEP 24 hour urine for calcium and creatinine 25-OH Vit. D Intact PTH Biochemical i markers of bone turnover Imaging X-rays not a primary work-up

11 INITIATING THERAPY- OSTEOPOROSIS ACP Recommendation #1: Offer treatment of Alendronate, Risedronate, Zoledronic acid, or Denosumab to women with known osteoporosis to reduce risk of hip and vertebral fractures (strong; high-quality) ACP Recommendation #2: Treat with medication for duration of 5 years (weak; low quality) ACP Recommendation #3: Offer bisphosphonates to men with osteoporosis to reduce risk of vertebral fracture (weak; low quality) ACP Recommendation #5: Against use of menopausal estrogen or estrogen-progesterone or raloxifene in women (strong; moderate quality) Annals.org 2017 ACP Clinical Guidelines

12 INITIATING THERAPY- OSTEOPENIA ACP Recommendation #6: Clinicians should make decision to treat osteopenic women 65+ yo at high risk for fracture based on shared decision-making [discussion of FRAX patient preferences, fracture risk profile, and benefits/ harm/ cost of treatment] ](weak; low quality) WHO s 10-yr risk assessment of osteoporotic fracture using 9 clinical risk factors +/- hip BMD Therapy indicated if 10-yr. risk of hip fracture >/= 3% or other major fracture risk >/= 20% (Tosteson et al. Osteop. Int. 2007) FRAX calculator Free mobile APP: Dr. FRAX

13 NON-PHARMACOLOGIC TREATMENT Calcium : 1,200 mg/ day via diet and supplement Milk (8 oz) or Yogurt (6 oz) = 300 mg; incidental 250 mg/ day in typical diet Vitamin D: 800-1,000 IU/ day; replete if < 30. Augments activity of bisphosphonates Muscle- strengthening and weight-bearing exercises Tai Chi Home safety assessment Wean off psychotropic medications Stop tobacco and alcohol

14 PHARMACOLOGIC OPTIONS Antiresorptives Estrogens/HRT-- NO Selective-estrogen receptor modulators (SERMS)-- NO Calcitonin NOT a first line Bisphosphonates YES Zoledronic Acid --YES Anabolic PTH Severe, refractory only Antibodies Desonumab YES Do NOT combine medications

15 BISPHOSPHONATES First-line for most NNT Vertebral fracture; hip fracture; cost/ year Alendronate 15; 91 ; $100/ year Risendronate 20; 91 ; $1,330/ year Ibandronate 21; no reduction Avoid if: Unable to follow dosing and administration instructions Hypocalcemic CrCl < 30 ml/min Safe to hold short-term

16 BISPHOSPHONATE SIDE EFFECTS Gastric irritation and ulcers ONJ, A fib, Atypical fractures (to follow) Infusions:1 1 st infusion = acute phase reactants (arthralgia, HA, myalgia, fever)- may pretreat with Tylenol GI upset Risk of side effects tapers with subsequent dosing

17 OSTEONECROSIS OF THE JAW American College of Rheumatology position paper Case review: 60% following oral surgery or dental extraction. 94% of the cases occurred with IV bisphosphonates (Pamidronate or Zoledronic acid) 85% had MM or metastatic breast CA to bone. Non-cancer patients and oral meds not considered d risk factors 0.04% incidence with oral bisphosphonates 93. J Maxillofac Oral Surg 2014;13:386- To avoid ONJ: treat infections and obtain routine dental care prior to therapy Appearance of intraoral lesion with exposed bone +/- painful ulcers, ragged

18 ATRIAL FIBRILLATION Conflicting reports from population-based case controlled studies Reanalysis of several trials did not show increased risk of atrial fibrillation. Current recommendations are not to withdraw therapy

19 ATYPICAL HIP FRACTURE If radiographic changes noted: STOP bisphosphonate Swedish population-based observational study of subtrochanteric (shaft) fractures Concluded the absolute risk of atypical fracture was small compared to benefits of drug in those at high risk for OP fracture ( Schilcher et al NEJM 2011)

20 ZOLEDRONIC ACID IV medication for those unable to take oral bisphosphonate NNT vertebral fracture 14 ; hip fracture 91; cost $300 Duration: 3-5 years (Level C; expert opinion) or 6 year in high-risk patient Rheum Int 2010; 30: Avoid in: Hypocalemia CrCl < 30 ml/min Side effects: Flu-like reaction Osteonecrosis in up to 12% Musculoskeletal pain ARF N Eng J Med 2012;366:

21 DENOSUMAB (PROLIA) RANKL Inhibitor: inhibits osteoclasts NNT vertebral fracture 21; hip fracture 200; cost $2,100/ year Duration: 5 years (Level C; expert opinion) Fracture risk maintained up to 2 years after therapy, but BMD rapidly declines after completion Safe in CKD I-IV Avoid in Hemodialysis, hypocalcemia Side effects: May inhibit fracture healing increase in infections Jaw osteonecrosis in up to 1.7%

22 PTH (1-34): TERIPARATIDE (FORTEO)&ABALOPARATIDE (TYMLOS) Anabolic: Stimulates osteoblast activity-> increased trabecular bone density Treatment of high risk postmenopausal and male OP T-score of -3.5, fractures + T-score -2.5, and those who fail 2 yrs of bisphosphonate therapy Fracture on bisphosphonate Duration: 2 years due to concern for osteosarcoma in non-human trial. Follow with Bisphosphonate

23 PTH (1-34): TERIPARATIDE (FORTEO)&ABALOPARATIDE (TYMLOS) NNT Vertebral fracture; nonvertebral fracture; hip; cost/ year Abaloparatide 28; 50; no reduction; $19,500 Teraparatide 11; 33; no reduction; $36,000 Fracture Prevention Trial : 20mcg/d reduced vertebral and non-vertebral fractures by 65% and 53%, respectively after 18 months Review of FPT to assess safety and efficacy in women 75+ compared with younger women found that lumbar and femoral neck BMD both increased significantly and new vertebral fractures risk NNT =11 (Boonen et al. JAGS 2006)

24 PTH (1-34): TERIPARATIDE (FORTEO)&ABALOPARATIDE (TYMLOS) Side effects: dizziness, leg cramps, increase in severity of patient-reported back pain, (osteosarcoma seen in rat trials) Avoid in: Paget s disease of bone, prior radiation therapy of the skeleton, bone metastases, t hypercalcemia, or a h/o skeletal malignancy CKD: Teriparatide- use with caution in moderate impairment Abaloparatide- no dose adjustment needed in study n=31 Product Info Tymlos. Radius Health Inc. April 2017

25 MONITORING AND FOLLOW-UP Women can have reduced fracture rates from anti-resorptive therapy even without increased BMD. No recommendations for BMD in men on treatment. 2017;166: Annals Int Med 2 year Dexa not indicated after normal screening Dexa or during treatment Only 10% of women had progression to osteoporosis in 15 years A BMD in untreated patients has limited value in predicting fracture when Dexa done within 4 years 2013) (JAMA Sept

26 MONITORING AND FOLLOW-UP ACP Recommendation #4: Against Dexa during 5-year pharmacologic treatment period for osteoporotic women (weak; low quality) At 5 years: can STOP bisphosphonate treatment if no fracture and stable Dexa Continue after 5 years if patient remains high risk for fractures

27 MONITORING AND FOLLOW-UP A fracture on bisphosphonate = failed treatment STOP med Evaluate for secondary cause Change to Forteo, Tymlos, or Prolia based on independent factors Secondary workup: Medications Renal insufficiency secondary HPTH Cushing s Hyperthyroid Multiple myeloma Osteomalacia Paget s Dz GI malabsorption / celiac Mets to bone

28 CONTINUE TREATMENT OR NOT? Tools to help If starting Bisphosphonate consider baseline serum NTx Follow yearly NTx: If NTx < 40 nmol BCE/mmol Cr= effective treatment If at end of treatment: stop therapy and continue Calcium, Vitamin D, and exercise If NTx > 40 + high risk factors consider continuance/ restart of anti-resorptive or change to Prolia Vertebral x-ray New fracture indicates need to restart or change treatment Dexa monitoring can be q 2-4 years after treatment completion or initiation of chronic high risk med.

29 RESTART BISPHOSPHONATE? Consider if: Worsening Dexa after any treatment ends New risk factor develops

30 TREATMENT CONSIDERATIONS IN CKD Bisphosphonates not approved for use with GFR < 35. Post-hoc analyses show off-label use may be safe and effective for Risedronate, Alendronate, and Raloxifene in GFR for limited time of 3 years. IN HD patients: 50% of dose for short duration. Calcitonin is safe Desonumab safe with GFR 15 + for at least 3 years Teriparatide is safe for GFR 30+ unless presence of hyperpth or hypercalcemia Tymlos may be safe < GFR 30, but further data needed

31 THE END QUESTIONS AT NEXT PANEL

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

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

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

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

AACE/ACE Osteoporosis Treatment Decision Tool

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

More information

Osteoporosis 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

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

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

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

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

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

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

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

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

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

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

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

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. 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

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

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

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

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

Clinical Study Effect of Zoledronic Acid on Bone Mineral Density in Men with Prostate Cancer Receiving Gonadotropin-Releasing Hormone Analog

Clinical Study Effect of Zoledronic Acid on Bone Mineral Density in Men with Prostate Cancer Receiving Gonadotropin-Releasing Hormone Analog Hindawi Publishing Corporation Prostate Cancer Volume 2, Article ID 7664, 7 pages doi:.55/2/7664 Clinical Study Effect of Zoledronic Acid on Bone Mineral Density in Men with Prostate Cancer Receiving Gonadotropin-Releasing

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

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

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

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

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

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

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

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

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

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

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

Pharmacologic Agents for Treatment of Osteoporosis

Pharmacologic Agents for Treatment of Osteoporosis SCAN Drugs Medication Status Biphosphonates alendronate tabs 1 1 Pharmacologic Agents for Treatment of Osteoporosis GIO* prevention for men: 5mg PO QD GIO prevention: 5mg PO QD for women receiving estrogen

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

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

Prevention and Management of Osteoporosis

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

More information

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

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

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

More information

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

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

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

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

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

Osteoporosis Evaluation and Treatment

Osteoporosis 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 information

Managing Osteoporosis: Screening, Treatment, and More

Managing Osteoporosis: Screening, Treatment, and More This Clinical Resource gives subscribers additional insight related to the Recommendations published in July 2017 ~ Resource #330702 Managing Osteoporosis: Screening, Treatment, and More Osteoporosis is

More information

Name of Policy: Boniva (Ibandronate Sodium) Infusion

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

More information

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

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

Medical Assistance Division Medicaid Drug Utilization Review Newsletter

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

More information

The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION. 21 July 2010

The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION. 21 July 2010 The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION 21 July 2010 Review of the dossier of the medicinal product included on the list of reimbursable medicines for a period

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

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

Approach to a patient with hypercalcemia

Approach to a patient with hypercalcemia Approach to a patient with hypercalcemia Ana-Maria Chindris, MD Division of Endocrinology Mayo Clinic Florida 2013 MFMER slide-1 Background Hypercalcemia is a problem frequently encountered in clinical

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

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

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

Complications of Cancer Therapy, Part II: Metabolic Bone Disease and its Treatment

Complications of Cancer Therapy, Part II: Metabolic Bone Disease and its Treatment of Cancer Therapy, Part II: Metabolic Bone Disease and its Treatment James J. Stark, MD, FACP Medical Director, Cancer Program Maryview Medical Center Professor of Medicine, EVMS Case Presentation: #1

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

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

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. 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

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

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

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

More information

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

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

More information

Osteoporosis in Men Eric Orwoll Oregon Health & Science University

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

More information

Reclast Doctor Discussion Guide

Reclast Doctor Discussion Guide For more information about Reclast, visit www.reclast.com Reclast Doctor Discussion Guide Whether you re a newly diagnosed patient or you re currently receiving treatment for osteoporosis, our Reclast

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

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

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

Diagnosis and management of osteoporosis

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

More information

ACLASTA zoledronic acid

ACLASTA zoledronic acid 1 ACLASTA zoledronic acid NAME OF THE MEDICINE The active ingredient of Aclasta is a bisphosphonate, zoledronic acid, or 1-hydroxy- 2-(1H-imidazol-1-yl)ethane-1,1-diphosphonic acid. Although zoledronic

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

FORTEO (teriparatide) INJECTION

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

More information

Osteoporosis: Prevention and Treatment

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

More information

Long-term Osteoporosis Therapy What To Do After 5 Years?

Long-term Osteoporosis Therapy What To Do After 5 Years? Long-term Osteoporosis Therapy What To Do After 5 Years? Developing a Long-term Management Plan North American Menopause Society Philadelphia, PA October 11, 2017 Michael R. McClung, MD, FACP Institute

More information

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

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

More information

What People With Celiac Disease Need to Know About Osteoporosis

What People With Celiac Disease Need to Know About Osteoporosis What People With Celiac Disease Need to Know About Osteoporosis National Institutes of Health Osteoporosis and Related Bone Diseases ~ National Resource Center 2 AMS Circle Bethesda, MD 20892 3676 Tel:

More information

ORIGINAL INVESTIGATION

ORIGINAL INVESTIGATION Parathyroid Hormone for Treatment of Osteoporosis Carolyn Crandall, MD ORIGINAL INVESTIGATION Background: Osteoporosis is a common condition associated with multiple deleterious consequences. No therapy

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

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

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 Update : The Transplant Patient, Cases & Questions

Osteoporosis Update : The Transplant Patient, Cases & Questions Osteoporosis Update : The Transplant Patient, Cases & Questions Bobo Tanner MD Director, Osteoporosis Clinic Marni Groves, NP Division of Rheumatology & Allergy Vanderbilt University Nashville TN Sept.

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

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

HOW I DO IT. Introduction. BARKIN J. How I Do It: Managing bone health in patients with prostate cancer. Can J Urol 2014;21(4):

HOW I DO IT. Introduction. BARKIN J. How I Do It: Managing bone health in patients with prostate cancer. Can J Urol 2014;21(4): HOW I DO IT How I Do It: Managing bone health in patients with prostate cancer Jack Barkin, MD Department of Surgery, University of Toronto, Humber River Hospital, Toronto, Ontario, Canada BARKIN J. How

More information

Osteoporosis in the aging male: Treatment options

Osteoporosis in the aging male: Treatment options REVIEW Osteoporosis in the aging male: Treatment options Stephen P Tuck 1 Harish K Datta 2 1 Departments of Rheumatology, James Cook University Hospital, Marton Road, Middlesbrough, Cleveland, UK; 2 School

More information

Osteoporosis Update: Review of Current Guidelines, Controversies, and Common Questions

Osteoporosis Update: Review of Current Guidelines, Controversies, and Common Questions Osteoporosis Update: Review of Current Guidelines, Controversies, and Common Questions Holly Hofkamp, MD OHSU Family Medicine, Assistant Professor 4/25/14 No disclosures Goals/Objectives Highlight current

More information