Osteoporosis. A Silent Killer. David A. Chappell, MD Endocrinology Private Practice Petaluma, California

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Osteoporosis. A Silent Killer. David A. Chappell, MD Endocrinology Private Practice Petaluma, California"

Transcription

1 Osteoporosis A Silent Killer David A. Chappell, MD Endocrinology Private Practice Petaluma, California

2 Relevant Disclosures Speakers Bureau Astra Zeneca Boehringer Ingelheim

3 AACE/ACE Guidelines American Association of Clinical Endocrinologist and American College of Endocrinology Clinical Practice Guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis Endocrine Practice Vol 22 (Suppl 4) September 2016

4 Osteoporosis Q1 How to assess fracture risk and diagnose Osteoporosis Q2 What is the appropriate evaluation? Q3 Fundamental measures for bone health? Q4 Who needs pharmacologic therapy? Q5 What medication should be used to treat Osteoporosis? Q6 How is treatment Monitored? Q7 What is successful treatment of Osteoporosis? Endocrine Practice Vol 22 (Suppl 4) September 2016

5 Osteoporosis Q8 How long should patients be treated? Q9 What is the role for combination treatment? Q10 Should sequential use of agents be considered? Q11 Should vertebral augmentation be considered? Q12 When to refer to Osteoporosis specialist? Endocrine Practice Vol 22 (Suppl 4) September 2016

6 Osteoporosis: A Major Public Health Issue IS 2-million-2 Many? 5,500 Fractures Daily National Bone Health Alliance

7 Osteoporosis is a Common Condition in Women in the U.S. Number or Events Annually 2,000, ,000,000 1,500,000 1,000, , , , , , , Osteoporotic Fracture Heart Attack Stroke Breast Cancer Uterine Cancer Ovarian Cancer NIH Consensus Conference: Osteoporosis Prevention, Diagnosis, and Therapy. JAMA 2001; 285:

8 What are the Consequences of Underdiagnosing and Undertreating Osteoporosis? In women with hip fracture: Fracture begets future fracture Deteriorated quality of life Long-term care admission Mortality 40% had prior fracture 1 40% need assistance walking 2 18% enter LTC 3 23% die within 1 year 4 Lifetime risk of hip fracture in women >50 is 12.1% 5 1. Hajcsar EE, et al. CMAJ 2000, 163: ; 2. Cooper C. Am J Med. 1997:103:12S-19S; 3. Jean et al. JBMR 2012 On-line September Ioannidis G, et al. CMAJ 2009;181: Hopkins et al Osteo Intl 2012; 23:

9 Osteoporosis :Microscopic Structure Normal Moderate Severe Normal Trabecula Thinning of Trabecula Perforation of Trabecula Osteoporosis is a systemic disease characterized by low bone mass & micro-architectural deterioration with a consequent increase in bone fragility and susceptibility to fracture

10 Osteoporosis Q1 How is fracture risk assessed?

11 Osteoporosis Compromises Bone Strength Increases Risk of Fracture Bone Quality Bone Strength + Bone Density + Fall Risk 1. Architecture 2. Turnover 3. Damage Accumulation 4. Mineralization 5. Collagen quality abmd = g/cm 2 vbmd = g/cm 3 Fracture Risk 1. LE Strength 2. Balance 3. Joint Flexibility 4. Vision Adapted from NIH Consensus Development Panel on Osteoporosis. JAMA 2001

12 Evaluation for Osteoporosis Evaluation all post menopausal women > age 50 for Osteoporosis risk Take History to Assess Bone Health Age, Sex, Family History Menstrual history Prior History of Fracture Steroids, Smoking or Alcohol Vitamin D Deficiency Calcium &/or nutrient Malabsorption Eating disorder Seizure disorder (phenobarbital, phenytoin) Bone Density BMD in all > 65 BMD earlier if risk factors present

13 Osteoporosis should be diagnosed if : 1. In the Presence of a Fragility Fracture in the absence of other metabolic bone disorders, or 2. BMD T-Score is 2.5 or lower in any single ROI : Lumbar Spine, Femoral Neck, total hip or 33% radius even in the absence of prevalent fracture, or 3. Osteoporosis may also be diagnosed in patients with low bone mass (T-Score -1.0 to -2.4, Osteopenia ) who are at increased fracture risk using FRAX Country Specific thresholds US Thresholds are: Global fracture risk of 20% or greater or hip fracture risk 3% or greater

14 Fracture Risk Assessment How do we Combine these Risks into a usable Fracture Risk Assessment? WHO FRAX tool IOS App FRAX Calculator Android Google Play

15 FRAX Fracture Risk Calculator

16 FRAX Fracture Risk Calculator

17 FRAX Fracture Risk Calculator Limitations of FRAX Under estimates risk as it only reports risk for hip and major fractures which comprise only half of all fractures Under estimates risk in patients with multiple prior osteoporosis-related fractures Under estimates risk in patients with lumbar spine BMD lower than the femoral neck Under estimates risk in patients at high risk of falling May under estimate risk in patients secondary osteoporosis Estimates risk only for those who are drug-naive

18 Lifestyle Modification Lifestyl e Treat Treat Fracture Risk Determines Need for Treatment HIGH RISK FOR FRACTURE CONSIDER FOR TREATMENT IF: 1. Already Fractured 2. Low BMD T-score < -2.5 at any measured site 3. FRAX Global risk > 20% 4. FRAX Hip Risk > 3% 5. Reassess in 1-2 years CONSIDER PREVENTIVE THERAPY IF: 1. Other risk factors present 2. Patient is worried about fracture 3. Lifetime risk considered to be high 4. Reassess in 2-3 years NO NEED FOR PREVENTIVE THERAPY 1. May choose Hormone Therapy for other reasons 2. Reassess in 3-5 years 3. Lifestyle Modification

19 Q2 : Evaluation for Secondary Causes of Osteoporosis Evaluate for prevalent fractures Height loss, Lateral spine x-rays or VFA Many vertebral fractures go undetected Routine tests include: Consider baseline bone turnover markers Serum Ctx, BSAP or P1NP Complete blood cell count (CBC), Serum calcium, PTH, Creatinine, Albumin, PO4, 25 OH Vitamin D, Alkaline Phosphatase Urinary Calcium: Creatinine Ratio Additional tests may be appropriate: WHEN TO CONSIDER VFA Women > 70 Height loss of 1.5 inches Self reported fracture or undocumented back pain Chronic Steroid therapy Thyroid-Stimulating Hormone (TSH), Urinary cortisol, Testosterone in Men, Protein electrophoresis (SPEP/UPEP)

20 Q3 Fundamental measures for bone health Avoid Excess alcohol intake limit to two drinks a day or less Counsel patients to stop or avoid smoking Counsel patients to maintain an active lifestyle including weight-bearing, balance and resistance exercises Improve strength, balance & coordination, Reduce risk of falling Improve joint mobility & flexibility Counsel on fall prevention including a Safe environment: Bathroom safety, Rugs and night lights Avoid sedatives, hypotensive agents Walking aids (cane, walker) Consider referral to physical therapy

21 Calcium Intake Goal is to get as much as possible form dietary sources, supplementing to achieve the daily goal if necessary. Recommended daily intake: Age mg/day Age mg/day Age > mg/dl FOOD CALCIUM FOOD CALCIUM Turnip Greens, ½ cup 100 Plain Yogurt, 8 oz 400 Kale cooked 1 cup 100 Cheese, solid 1.5 oz 300 Cabbage, 1 cup 75 Sardines, 3 oz 325 Bread Slice 75 Milk, 8 oz 300 Tortilla, corn & flower 45 Tofu ½ cup 250 Broccoli ½ cup 25 Cottage Cheese 1 cup 140 Office of Dietary Supplements, National Institute of Health

22 Calcium Intake The optimal intake and utility of calcium supplements is controversial A Swedish study found both dietary and supplement calcium intake of > 1500 mg per day was associated with an increased mortality A Canadian study of 0ver 9,000 subjects found an increased survival advantage to those taking supplements Studies suggest dietary calcium may be preferred over supplements. Total calcium intake should not exceed 1500 mg per day Office of Dietary Supplements, National Institute of Health

23 Vitamin D Recommendations There is considerable disagreement among experts as the optimal and safe upper doses FOOD Vit D Goal Blood Levels of Vit D Ng/dl Cod Liver Oil 1 Tbs 1360 Deficiency <15 Swordfish, 3 oz 566 Insufficiency Salmon, 3 oz 447 Adequate Tuna, 3 oz 154 High Milk, 8 oz 120 Potentially Harmful >150 Egg yoke, 1 40 Institute of Medicine: Age < units/day Age > units/day Safe Maximum dose: 4,000 u/d Maintain 25-OH D levels at least ng/ml Office of Dietary Supplements, National Institute of Health

24 Other Supplements Magnesium may be beneficial in those using proton pump inhibitors or diuretics long term Vitamin A, K and phytoestrogen Excessive vitamin A, > 10,000 iu/d, should be avoided as it has been shown to have detrimental effects on bone Data on Vitamin K is inconclusive not recommended Phytoestrogens/ isoflavones No evidence of benefit NOT recommended Caffeine high intake associated with increase fractures Protein Adequate protein intake of ~ 0.8 g/kg /day Office of Dietary Supplements, National Institute of Health

25 AACE Osteoporosis Practice Guidelines-2016 Q4: Who needs treatment for Osteoporosis? 1. Patients with low bone mass and a history of fragility fracture of the hip or spine 2. Patients with a T-score of 2.5 or lower in the spine, femoral neck, total hip or 33% radius 3. Patients with a T-Score between-1.0 and 2.5 if the FRAX 10 year probability for major osteoporotic fracture is > 20%, or the hip fracture risk is > 3%. (US country specific recommendations) Endocrine Practice Vol 22 (Suppl 4) September 2016

26 Q5 What Osteoporosis Medications should be used? 1. Approved agents with efficacy to reduce hip, non-vertebral and spine fractures 1. Alendronate, Residronate, Zolendronate, & Denosumab are appropriate as initial therapy 2. Teriparatide, Denosumab, or Zolendronate should be considered for patients unable to use oral therapy 3. Denosumab is the agent of choice for patients with CKD 4. Raloxifene or Ibandronate may be appropriate in some cases where patients requiring drugs with spine-specific efficacy 5. Calcitonin (increases cancers) and Strontium ( increased CV risk) therefore their use is not recommended 6. Estrogen use for non skeletal benefits will also serve to help prevent postmenopausal bone loss Endocrine Practice Vol 22 (Suppl 4) September 2016

27 Anti-fracture Efficacy of Current Therapies Type of Fracture Therapeutic Options for Fracture Prevention in PMO Women 1 * Alendronate Bisphosphonates Risedronate Antiresorptive Therapy Zoledronic Acid Denosumab Raloxifene Estrogen * (Hormone Therapy) Bone Formation Therapy Teriparatide Vertebral Hip - - Nonvertebral - * Based on GRADE A evidence as assessed in the Osteoporosis Canada 2010 Clinical Practice Guidelines for the Diagnosis and Management of Osteoporosis in Canada For postmenopausal women, indicates first line therapies and Grade A recommendation. Hormone therapy (estrogen) can be used as first-line therapy in women with menopausal symptoms. In Clinical trials, non-vertebral fractures are a composite endpoint including hip, femur, pelvis, tibia, humerus, radius, and clavicle. 1. Papaioannou A, et al. CMAJ. 2010;182:

28 Mechanism of Action of Available Osteoporosis Therapies Osteoclast Precursors Estrogen therapy Selective estrogen receptor modulators Hormones Multinucleated Osteoclast RANKL RANK Bisphosphonates Binds to bone; inhibits osteoclasts Teriparatide PTH analog Denosumab RANK Ligand inhibitor Osteoblast Osteoclast Adapted from: Boyle WJ et al. Nature 2003; 423:

29 Safety and Tolerability of Available Treatments Bisphosphonates Denosumab Raloxifene Teriparatide Hypocalcemia* Hypocalcemia* Vasodilation Transient orthostatic hypotension GI symptoms Postmarketing reports of musculoskeletal pain Infections (serious events 4.1% vs. 3.4% placebo) Dermal events (10.8% vs. 8.2% placebo) Osteonecrosis of jaw Osteonecrosis of jaw Stroke Venous thromboembolism ( risk vs. placebo) Lipid and triglyceride monitoring Osteosarcoma (only observed in animal trials, not clinical trials) Urolithiasis Atypical Fracture (rare) Atypical Fracture (rare) Renal impairment ** Atrial fibrillation (2.5% vs. 1.9% placebo) Suppression of bone turnover * Correct with adequate calcium & Vitamin D intake prior to initiating therapy. Rarely, oral bisphosphonates have been associated with severe esophageal events. Uncommon; mostly with cancer patients and/or dental procedures. Consider risk/benefit balance for women with a history of stroke or risk factors for stroke or venous thromoboembolism. Urinary calcium monitoring should be considered for patients with active urolithiasis and hypercalciuria. ** Recommended that all patients have their renal function assessed prior to treatment. Refer to respective Product Monographs for full Prescribing Information.

30 Osteonecrosis of the Jaw (ONJ) Bisphosphonate-Related Osteonecrosis of the Jaw Frequency: 1:1,700 to 1:20,000 Risk factors: Dento-alveolar surgery Steroid therapy Chemotherapy High dose Bisphosphonate Duration of therapy Treatment Avoid surgical manipulation Antibiotics

31 Atypical Subtrochanteric Femur Fracture Ask about new thigh or pelvic pain Plain X-ray of the femur best screening tool Discontinue antiresorptive Consider prophylactic rodding Some recommending teriparatide therapy

32 Is your patient afraid to take their medication? Help put patient concerns in perspective Fatal motor vehicle accidents 8.4/100,000 person/year 1 Murder 1.8/100,000 person/year 2 ONJ* <1/100,000 pts/year 3 Atypical fracture** 2/100,000 pts on 2 yrs BPs 113.3/100,000 pts on 8 yrs BPs 4 For every 100 hip fractures prevented there is 1 atypical femur fracture 5 *The risk of ONJ is higher among cancer patients treated with high doses anti-resorptives 6 **Reports of AFF have also been documented with other osteoporosis therapies 7-8 and in patients who have never received BP therapy 9 1. Transportation Canada Casualty Rates Statistics Canada Homicide Rate Khan A, et al.j Rheumatol. 2011;38: Dell R, et al. JBMR (12): Wang et al JBMR 2011; 26: Khosla S et al. JBMR 2007:22: Kim SY et al. JBMR. 26(5): Amgen, data on file. 9. Shane E et al. JBMR 2010; 25:

33 AACE Osteoporosis Practice Guidelines-2016 Q7: What is successful treatment? Successful treatment is defined as stable or increasing BMD with no evidence of new fractures For patients taking antiresorptive agents target for success is Bone turnover at or below median value for PM women Consider alternative therapy or reassessment for secondary causes in those who have recurrent fractures or significant bone loss

34 AACE Osteoporosis Practice Guidelines-2016 Q8: How long should patients be treated Treatment with teriparatide should be limited to 2 years For Oral bisphosphonates, consider a bisphosphonate holiday after 5 years of stability in moderate risk patients For oral bisphosphonates, consider a bisphosphonate holiday after 6-10 years of stability in higher risk patients For IV zolendronic acid, consider a drug holiday after 3 annual doses and in moderate risk patients, and after 6 doses in higher risk patients Teriparatide or raloxifene may be considered during bisphosphonate holidays A holiday is NOT recommended with Denosumab Resume therapy in those at high risk for fracture after two years of Drug Holiday Endocrine Practice Vol 22 (Suppl 4) September 2016

35 BMD Efficacy of Long-term Treatment* In long term trials, BMD continues to increase or remains stable Medication Pivotal Study Extended Treatment Duration (yrs) # of Participants % Change Lumbar Spine BMD Ŧ % Change Total Hip BMD Ŧ Risedronate 1 VERT-MN Alendronate 2 FLEX Zoledronic Acid 3 Denosumab 4 HORIZON ( Analysis of 9 year study) FREEDOM (Analysis 10 year study) / * Not head to head analyses: Results cannot be compared due to differing study populations and methodologies. Ŧ Represents % change from BL of Pivotal Trial. Represents 10 mg dose only. 1. Mellstrom D et al. Calcif Tissue Int 2004;75: Bone HG et al. N Engl J Med 2004;350: Black DM, et al. J Bone Miner Res. 2012; 27(2): Brown JP, et al ACR Annual Meeting. Presentation L8

36 AACE Osteoporosis Practice Guidelines-2016 Q9: What About Combination Therapy? AACE does not recommend combination therapy Estrogen given for menopausal symptoms or raloxifene for prevention of breast cancer may be used with other agents Combined Denosumab and teriparatide achieves greater BMD increases but no fracture data is available

37 AACE Osteoporosis Practice Guidelines-2016 Q10: Should sequential Therapy be considered? Treatment with teriparatide should always be followed by anti-resorptive agents to prevent BMD decline Consider IV Zolendronate dose if Denosumab is discontinued

38 AACE Osteoporosis Practice Guidelines-2016 Q11: Should Vertebral Augmentation be considered for Compression Fracture? Vertebroplasty and Kyphoplasty are NOT recommended as first line treatment of vertebral fractures There is an unclear benefit on overall pain And the potential increased risk of vertebral fractures in adjacent vertebrae

39 AACE Osteoporosis Practice Guidelines-2016 Q12: When to refer to an Osteoporosis Specialist? When patient with normal BMD fractures Recurrent fractures despite receiving appropriate therapy When osteoporosis is unexpectedly severe Patients who experience fragility fracture may benefit form specialist care When the patient has conditions complicating therapy CKD, hyperparathyroid, hyperthyroid

40 Effect of Abaloparatide vs Placebo on New Vertebral Fractures in Postmenopausal Women With Osteoporosis: A Randomized Clinical Trial JAMA. 2016;316(7):

41 Abaloparatide vs Placebo Nonvertebral and Major Osteoporotic Fractures JAMA. 2016;316(7):

42 Romosozumab or Alendronate for Fracture Prevention in Women with Osteoporosis Saag KG et al. N Engl J Med 2017;377: Note: FDA approval denied July 2017 due to CV safety concerns

43 Osteoporosis: A Major Public Health Issue Osteoporosis is a major health problem Patients at risk can be identified Safe and effective therapy is available 2-million-2 is too Many!

44

45 Q u e s t i o n s

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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 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

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

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 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 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

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

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

OSTEOPOROSIS: AN OPPORTUNITY OR OBLIGATION

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

More information

Therapeutic Updates in the Prevention and Treatment of Osteoporosis

Therapeutic Updates in the Prevention and Treatment of Osteoporosis Therapeutic Updates in the Prevention and Treatment of Osteoporosis 2013 Fall Managed Care Forum Las Vegas November 15, 2013 Steven T Harris MD FACP Clinical Professor of Medicine University of California,

More information

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

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

NAMS Practice Pearl. Use of Drug Holidays in Women Taking Bisphosphonates. Released April 1, 2013

NAMS Practice Pearl. Use of Drug Holidays in Women Taking Bisphosphonates. Released April 1, 2013 NAMS Practice Pearl Use of Drug Holidays in Women Taking Bisphosphonates Released April 1, 2013 Dima L. Diab, MD 1, and Nelson B. Watts, MD 2 ( 1 Cincinnati VA Medical Center, Cincinnati, OH, 2 Mercy Health

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 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

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

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

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

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

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

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

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

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

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

Who cares about fractures! is more important. October 3, 2014 CSIM Workshop Brian Wirzba, MD, FRCPC, FACP Clinical Professor Grey Nuns Hospital

Who cares about fractures! is more important. October 3, 2014 CSIM Workshop Brian Wirzba, MD, FRCPC, FACP Clinical Professor Grey Nuns Hospital Isn t Osteoporosis just a T Score less than 2.5?? Who cares about fractures! is more important. Why do I need to know this? October 3, 2014 CSIM Workshop Brian Wirzba, MD, FRCPC, FACP Clinical Professor

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

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

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

Atypical Femoral Fractures Insights and Enigmas

Atypical Femoral Fractures Insights and Enigmas Atypical Femoral Fractures Insights and Enigmas Madhu Mehta, M.D. Clinical Asst. Prof. of Medicine Department of Immunology/Rheumatology The Ohio State University Abreviations used TFF- Typical femoral

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

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

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

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

More information

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

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

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

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

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

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

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: 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

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

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

Hypercalcemia. Hypercalcemic Disorders * PTH

Hypercalcemia. Hypercalcemic Disorders * PTH Hypercalcemia Michael T. McDermott MD Director, Endocrinology and Diabetes Practice University of Colorado Hospital Michael.mcdermott@ucdenver.edu Hypercalcemic Disorders 1 o Hyperparathyroidism Hypercalcemia

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

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

All about Osteoporosis symptoms, diagnosis, treatment

All about Osteoporosis symptoms, diagnosis, treatment Health & Fitness Published : 07 Sep 2017, 14:41 All about Osteoporosis symptoms, diagnosis, treatment By : BD Post Desk Osteoporosis is a bone disease. Its name comes from the Latin for porous bones. The

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

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

Postmenopausal Osteoporosis

Postmenopausal Osteoporosis Osteoporosis Products Available in Canada for the Treatment and Prevention of Postmenopausal Osteoporosis Physician Desk Reference - 2nd Edition A clinical resource provided to you by: The Society of Obstetricians

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

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

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

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

Shon E. Meek, M.D., Ph.D. Assistant Professor of Medicine

Shon E. Meek, M.D., Ph.D. Assistant Professor of Medicine Shon E. Meek, M.D., Ph.D. Assistant Professor of Medicine meek.shon@mayo.edu 2016 MFMER 3561772-1 Update on Vitamin D Shon Meek MD, PhD 20 th Annual Endocrine Update January 30-Feb 3, 2017 Disclosure Relevant

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

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

Understanding the Development of Osteoporosis and Preventing Fractures: WHO Do We Treat Now?

Understanding the Development of Osteoporosis and Preventing Fractures: WHO Do We Treat Now? Understanding the Development of Osteoporosis and Preventing Fractures: WHO Do We Treat Now? Steven M. Petak, MD, JD, FACE, FCLM Texas Institute for Reproductive Medicine And Endocrinology, Houston, Texas

More information

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

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

Summary. Treatment. a larger extent than predicted. spine much faster and to. that fracture protection is greater

Summary. Treatment. a larger extent than predicted. spine much faster and to. that fracture protection is greater The Future of Ost eoporosis Care in Research and Practice ACOI Luncheon October 26, 2010 Steven T Harris MD FACP Clinical i l Profess sor of fmedicine i University of California, San Francisco Treatment

More information

Outline Vertebroplasty and Kyphoplasty: Who, What, and When

Outline 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 information

EFFECT OF INTRAVENOUS ZOLENDRONIC ACID ON BONE MINERAL DENSITY IN POST MENOPAUSAL WOMEN WITH LOW BONE MINERAL DENSITY OF NORTH WEST PART OF RAJASTHAN

EFFECT OF INTRAVENOUS ZOLENDRONIC ACID ON BONE MINERAL DENSITY IN POST MENOPAUSAL WOMEN WITH LOW BONE MINERAL DENSITY OF NORTH WEST PART OF RAJASTHAN International Journal of Advanced Research and Review www.ijarr.in EFFECT OF INTRAVENOUS ZOLENDRONIC ACID ON BONE MINERAL DENSITY IN POST MENOPAUSAL WOMEN WITH LOW BONE MINERAL DENSITY OF NORTH WEST PART

More information

UK clinical guideline for the prevention and treatment of osteoporosis

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

More information

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

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

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

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

The widespread introduction of bisphosphonates into. Adverse Effects of Bisphosphonates: Implications for Osteoporosis Management

The widespread introduction of bisphosphonates into. Adverse Effects of Bisphosphonates: Implications for Osteoporosis Management CONCISE REVIEW FOR CLINICIANS ADVERSE EFFECTS OF BISPHOSPHONATES AND OSTEOPOROSIS MANAGEMENT Adverse Effects of Bisphosphonates: Implications for Osteoporosis Management KURT A. KENNEL, MD, AND MATTHEW

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

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

Disclosures. Bisphosphonate Treatment for Osteoporosis: Do the Benefits Outweigh the Risks? Risks vs Benefits. Bisphosphonates: Benefits and Risks

Disclosures. Bisphosphonate Treatment for Osteoporosis: Do the Benefits Outweigh the Risks? Risks vs Benefits. Bisphosphonates: Benefits and Risks Bisphosphonate Treatment for steoporosis: Do the Benefits utweigh the Risks? 37 th Annual Advances in Internal Medicine May 18 and June 22, 29 hsponsored resentations Disclosures Eli Lilly & Company, GlaxoSmithKline,

More information

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

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

More information

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

HIV and Bone Disease: Through Thick and Thin! Pablo Tebas, MD

HIV and Bone Disease: Through Thick and Thin! Pablo Tebas, MD HIV and Bone Disease: Through Thick and Thin! Pablo Tebas, MD April 30 th, 2016 Disclosures I serve in an adjudication panel in a VZV vaccine study (Glaxo) I consult for Merck My research is supported

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