Refracture Prevention The Role of Primary Care
|
|
- Adele Burke
- 5 years ago
- Views:
Transcription
1 MonashHealth Refracture Prevention The Role of Primary Care Professor Peter R Ebeling AO MBBS MD FRACP Head, Department of Medicine School for Clinical Sciences Monash Health Translation Precinct Monash University, Clayton, Victoria Potential Conflicts Departmental research funding from Merck, Novartis, Amgen and Eli-Lilly Honoraria to Department from Amgen, Gilead and Eli-Lilly The Annual Women s and Children s Health Update 1 th June 1 The Crisis in the Treatment of Osteoporosis Declining Osteoporosis Treatment Rates Post-hip Fracture MonashHealth MonashHealth Media Tries to Provide a Positive Message Half of Hip Fracture Patients Give Us Advance Notice Opportunities for GP intervention Hip fracture is all too often the final destination of a thirty year journey fuelled by decreasing bone strength and increasing falls risk MonashHealth 1. J Endocrinol Invest 1999;3:53-5 Kanis JA & Johnell O. Osteoporosis Review. 9;17(1):1-1 Mitchell PJ 1
2 Diagnosis WHO Criteria for Osteoporosis Confusing! T-score Normal > 1 Osteopenia* 1 to.5 Osteoporosis.5 Severe osteoporosis.5 and 1 fracture Absolute Fracture Risk For every 1 SD from normal, the relative risk of fracture increased by 1.5- to.5- fold *Most fractures (~7%) occur in women with osteopenia Reference standard for normal BMD is a 3-year-old healthy woman Kanis JA, et al. J Bone Miner Res. 199;9: National Osteoporosis Foundation, 3. Vitamin D + Ca in Institutionalised Elderly 37 women, mean age, living in nursing homes, randomised to 1.g Ca + IU Vit D or placebo for 1 mths Vitamin D Plus Calcium Supplementation and Fractures in Community Dwelling Adults > 5 Years of Age % 1 1 p<.15 All Nonvertebral p<. Hip Vit D + Ca Chapuy et al, NEJM, 199 Zhao J-G et al, JAMA 17; 31():-
3 Secondary Prevention: RECORD Trial Recent low trauma fracture Effect of calcium supplements with or without vitamin D on cardiovascular events: Based on patient-level data n 59 Setting Comm Dose IU 5OHD 3 Adherence 5% Grant AM et al. Lancet 5 Bolland M J et al. BMJ 11;3:bmj.d 11 by British Medical Journal Publishing Group MI Risk and Baseline Risk Factors Cardiovascular Events in RCT of 5 Yrs Calcium vs &.5 Yrs Follow up in 1 Postmenopausal Women ITT Analysis Bolland M J et al. BMJ 1 31:C391 Lewis J et al. J Bone Miner Res (epub July 1) Health Benefits of Higher Dietary Calcium Intakes Khan B et al., J Bone Miner Res 15;3:175- Effects of Calcium on Myocardial Infarction Numerous large studies of Ca plus vitamin D have shown no increased risk of cardiovascular events However, concern exists that MI risk is increased Food remains the best source of calcium Supplements should be used only when adequate dietary Ca intake cannot be achieved Beneficial effects of calcium are found with relatively low doses (5- mg) In almost every osteoporosis treatment RCT, adequate Ca and vitamin D were also required Elderly individuals and others with impaired renal function who take calcium supplements may be at higher risk of CVD 3
4 Percent Change (LS Mean ± SE) Percent Change (LS Mean ± SE) Incidence at Month 3 (%) Vitamin D Reduces Falls Meta-analysis showed that vitamin D supplementation reduces falls by % in ambulatory or institutionalised elderly individuals 15 patients would need to be treated with vitamin D to prevent one fall Should be part of multi-faceted falls prevention program Larger doses of, IU per mth, or 5, IU per yr, are associated with an increased falls risk Bischoff-Ferrari HA et al., JAMA, 1 Position Statement Risks and Benefits of Sun Exposure 1 - CCV, ACD, OA, ANZBMS, ESA UV Index >3: A few minutes of mid-morning or mid-afternoon sun exposure to arms and hands (or equivalent area) on most days of the week should be sufficient to maintain adequate vitamin D levels UV Index <3 (May-August in southern states): Sun protection is not recommended - During these times, to support vitamin D production it is recommended that people be outdoors in the middle of the day with some skin uncovered on most days of the week - Being physically active while outdoors will further assist with maintaining vitamin D levels. A brisk walk at lunchtime or gardening are examples of being physically active outdoors Tailoring Therapy- Which Option for Who? First-line drugs for osteoporosis are anti-resorptive The Effect of Denosumab on Fracture Risks at 3 Months FREEDOM Trial Oestrogen +/- progestogen, if menopausal symptoms are present Selective oestrogen receptor modulating drugs (e.g. raloxifene) 9% % RR = % P <.1.% RR = % P =.1 Denosumab Oral bisphosphonates (alendronate, risedronate) 7% 7.% Intravenous bisphosphonates (zoledronic acid) Subcutaneous denosumab injections (human RANK ligand Ab) % 5% % NNT =.5% NNT = NNT = Second-line drugs Stimulates bone formation [subcutaneous PTH(1-3) or teriparatide injections] Strontium ranelate (uncertain mode of action; CV safety) 3% % 1% %.3% 1.% RR = % P =. New Vertebral Nonvertebral Hip.7% RR = risk reduction Cummings SR, et al. N Engl J Med. 9;31: Denosumab Re-treatment and Changes in Lumbar Spine and Total Hip BMD Phase Study in Women With Low BMD Lumbar Spine Months Discontinued Treatment Re-treatment mg QM - - Total Hip Months 3 mg Q3M Discontinued Treatment Re-treatment mg QM FREEDOM Extension Study Design R A N D O M I Z A T I O N FREEDOM EXTENSION Year a Year a Denosumab mg SC QM (N = 3,9) SC QM (N = 3,9) Denosumab mg SC QM (N =,33) Calcium and Vitamin D Denosumab mg SC QM (N =,7) Long-term denosumab treatment Crossover denosumab treatment Miller PD, et al. Bone. ;3:-9 a Year = years of denosumab treatment. Bone HG et al. Lancet Diabetes Endocrinol 17;5:
5 Total Hip Percent Change From Baseline Effect of 7 or 1 Years Treatment with Denosumab on Vertebral and Non-vertebral Fractures FREEDOM Extension Trial Effect of 7 or 1 Years Treatment with Denosumab on Spinal and Total Hip BMD FREEDOM Extension Trail Bone HG et al., Lancet Diabetes Endocrinol. 17; 5: Bone HG et al., Lancet Diabetes Endocrinol. 17; 5: Why Change Therapy? Sequential therapy for osteoporosis may be considered When there has been significant bone loss or a fracture on antiresorptive therapy for >1 months In the presence of adverse events Insufficient adherence, e.g. the elderly Dosing inconvenience or intolerance with oral bisphosphonate therapy Patients with CKD where bisphosphonates are contraindicated To consolidate increases in BMD following anabolic therapy MonashHealth Head-to-head Studies of Denosumab vs Bisphosphonates in Both Pre-treated or Treatment-naïve Subjects Pre-treated 1.%* RIS Pre-treated 1.%* IBN Pre-treated.9%* 1.%* Treatmentnaïve Data are least-squares means and 95% confidence intervals. *p <.1 denosumab vs BP. 1 Recknor C et al. ASBMR Poster FR3. Kendler DL et al. J Bone Miner Res. 1;5: Brown JP et al. J Bone Miner Res. 9;: Menu Roux C et al, ASBMR; Minneapolis, MN; October 1-15, 1. This information has been provided to you in response to your unsolicited request. ALN ALN 1 3 PBS Reimbursement for Teriparatide in Patients with Severe Osteoporosis Severe osteoporosis Radiographic Features T score < -3. minimal trauma fractures One fracture occurred after 1 mths of antiresorptive drugs Or, intolerance to oral and intravenous bisphosphonates and denosumab Treatment initiated by specialist, but may be continued by GP - limited to 1 months per lifetime Short-oblique configuration No comminution Medial spike Diffuse cortical thickening Focal lateral cortical thickening ( beaking ) 5
6 Early Detection - Radionuclide Bone Scintigraphy - Risk of Atypical Femoral Fracture Associated with Bisphosphonate Use during the 3 Years (5 ) Preceding the Fracture. Schilcher J et al. N Engl J Med 11;3: Clinical Features I Prodromal pain in 7% (15 of 7) Concomitant GC use in 3% ( of 7) incr fracture risk in one large series (OR 5.) Bilateral fractures present in % ( of 15) Bilateral radiological changes present in % (3 of ) Delayed healing in % (9 of 11) Physician and Patient Education The majority have a prodrome of thigh or groin pain Educate physicians and patients about this symptom physicians to ask patients on BPs and other potent antiresorptive agents about thigh or groin pain Urgent radiographic evaluation of both femora (even if pain is unilateral) is needed if plain radiographs are normal, MRI or radionuclide scintigraphy scans should be performed Jaw Osteonecrosis Medication Related- Osteonecrosis of the Jaw (MRONJ) Area of exposed bone in maxillofacial region that has been present for more than weeks 1 Khosla S et al (7); JBMR Associated with bisphosphonates and denosumab Incidence IV bisphosphonates and malignancy (. 1%) Oral bisphosphonates and osteoporosis (1/1,-1/1,) Impaired QOL and chronic sequelae Often does not resolve in oncology cases Miksad et al (11); Oncologist
7 Cumulative incidence, % Patients with new vertebral fractures (%) BMD change from FIT baseline mean % Frequency of MRONJ Benign Indications Retrospective assessment ASBMR consensus rep. 1/1,-1/1, German study 1/13,5 ADA < 1/1, Canadian study < 1/1, Kaiser-Permanente 1/95-1/1,537 Prospective assessment HORIZON (>1, pts) BP/1 placebo (incl follow up study),, pts used zoledronic acid so far Not a single ONJ case reported Risk in oncology trials is much higher 1-% In oncology trials, denosumab has the same risk of ONJ as zoledronic acid also 13 pts in osteoporosis 7-year FREEDOM trial extension with denosumab Risk Factors for ARONJ Age > 5 yrs Periodontitis Use of bisphosphonates > yrs Smoking Denture wearing Diabetes mellitus Invasive bone procedures such as tooth extractions Antiresorptive Drug Holidays Insufficient evidence to recommend a holiday from Antiresorptive drug therapy or waiting periods before performing dental treatment for prevention of ARONJ Hellstein JW et al, JADA 11 Significant therapeutic benefits of AR agents in patients with osteoporosis far outweigh the small risk of developing ARONJ There is no drug holiday for denosumab McClung M et al, JBMR 1 How Long to Continue Bisphosphonate Therapy? Effect of Continuing or Stopping Alendronate after 5 Years of Treatment on Total Hip BMD FIT Black et al JAMA ;9:97-93 Total Hip FLEX Year Year Alendronate 5 5 * * *Measured in clinical fracture arm only. All subjects had received alendronate during FIT. FLEX treatment group Alendronate (pooled) Effect of Continuing or Stopping Alendronate After 5 Years of Treatment on Clinical Vertebral Fractures Effect of Continuing or Stopping Zoledronate After 3 Years of Treatment: Fractures 15 1 Clinical vertebral fractures RR,.5 (.-.) FLEX treatment group Alendronate (pooled) 15 1 Core PBO 1.9% Morphometric vertebral fractures Z3P3.% Odds ratio =.51 (.-.95) Increase in vertebral fractures if stop ZOL after 3 years Core ZOL 3.3% Z 3% Time to first fracture, mo No. at risk Alendronate Extension study (year 3-) Black et al JAMA ;9:97-93 Black et al J Bone Miner Res 1;7:3-5 7
8 Managing Osteoporosis in Patients on Long-Term Bisphosphonate Treatment: Report of a Task Force of ASBMR Thank You! Adler RA et al., J Bone Miner Res 1
Page 1. Diagnosis and Treatment of Osteoporosis: What s New and Controversial in 2018? What s New in Osteoporosis
Diagnosis and Treatment of Osteoporosis: What s New and Controversial in 2018? Douglas C. Bauer, MD Professor of Medicine and Epidemiology & Biostatistics University of California, San Francisco What s
More informationDiagnosis and Treatment of Osteoporosis: What s New and Controversial in ? What s New in Osteoporosis
Diagnosis and Treatment of Osteoporosis: What s New and Controversial in 2018-19? What s New in Osteoporosis The crisis in treatment and compliance Douglas C. Bauer, MD Professor of Medicine and Epidemiology
More information2017 Santa Fe Bone Symposium McClung
217 Santa Fe Bone Symposium Insights into the Use of Anti-remodeling and Anabolic Agents for Osteoporosis Developing a Long-term Management Plan Michael R., MD, FACP Oregon Osteoporosis Center Portland,
More informationLong-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 informationTREATMENT 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 informationControversies in Osteoporosis Management
Controversies in Osteoporosis Management 2018 Northwest Rheumatism Society Meeting Portland, OR April 28, 2018 Michael R. McClung, MD, FACP Director, Oregon Osteoporosis Center Portland, Oregon, USA Institute
More informationDifferentiating Pharmacological Therapies for Osteoporosis
Differentiating Pharmacological Therapies for Osteoporosis Socrates E Papapoulos Department of Endocrinology & Metabolic Diseases Leiden University Medical Center The Netherlands Competing interests: consulting/speaking
More informationOsteoporosis Update. Greg Summers Consultant Rheumatologist
Osteoporosis Update Greg Summers Consultant Rheumatologist DEFINITION OSTEOPOROSIS is LOW BONE MASS (& micro-architectural deterioration) causing AN INCREASED RISK OF FRACTURE 23 years 82 years 23 y/o
More informationUpdates in Osteoporosis. I have no conflicts of interest. What Would You Do? Mrs. C. What s New in Osteoporosis. Page 1
Updates in Osteoporosis Jeffrey A. Tice, MD Associate Professor of Medicine Division of General Internal Medicine, University of California, San Francisco I have no conflicts of interest What s New in
More informationAn Update on Osteoporosis Treatments
An Update on Osteoporosis Treatments Dr Mike Stone University Hospital Llandough Treatments for osteoporosis Calcium and vitamin D HRT Raloxifene Etidronate Alendronate Risedronate Ibandronate (oral and
More informationDisclosures D. Black. Bisphosphonates: Background, Efficacy and Recent Controversies. Page 1. Research Funding: Novartis, Merck
Bisphosphonates: Background, Efficacy and Recent Controversies Disclosures D. Black Research Funding: Novartis, Merck Dennis M. Black, PhD Consulting: Amgen, Lilly, Zosano, Nycomed Dept. of Epidemiology
More informationCalcium, Vitamin D and Bisphosphonates: Disclosures. Benefits, Risks and Drug Holiday. Calcium YES or NO? Calcium Bad News!!
Calcium, Vitamin D and Bisphosphonates: Benefits, Risks and Drug Holiday Disclosures I am disclosing financial relationships as follows: Global Advisory Boards: Amgen, Lilly, Merck, Novartis Research grants:
More informationAdvanced medicine conference. Monday 20 Tuesday 21 June 2016
Advanced medicine conference Monday 20 Tuesday 21 June 2016 Osteoporosis: recent advances in risk assessment and management Juliet Compston Emeritus Professor of Bone Medicine Cambridge Biomedical Campus
More informationCurrent Issues in Osteoporosis
Current Issues in Osteoporosis California AACE 18TH Annual Meeting & Symposium Marina del Rey, CA September 15, 2018 Michael R. McClung, MD, FACP,FACE Director, Oregon Osteoporosis Center Portland, Oregon,
More informationPage 1. Updates in Osteoporosis. I have no conflicts of interest. What is osteoporosis? What s New in Osteoporosis
Updates in Osteoporosis Jeffrey A. Tice, MD Professor of Medicine Division of General Internal Medicine, University of California, San Francisco I have no conflicts of interest What s New in Osteoporosis
More informationA Review of Bone Health Issues in Oncology
A Review of Bone Health Issues in Oncology David L. Kendler MD FRCPC CCD Professor of Medicine (Endocrinology) University of British Columbia Vancouver Canada Disclosures David Kendler has received research
More informationOsteoporosis: An Overview. Carolyn J. Crandall, MD, MS
Osteoporosis: An Overview Carolyn J. Crandall, MD, MS Osteoporosis: An Overview Carolyn J. Crandall, MD, MS Professor of Medicine David Geffen School of Medicine at UCLA Objectives Review osteoporosis
More informationPage 1. New Developments in Osteoporosis. What s New in Osteoporosis
New Developments in Osteoporosis Eliseo J. Pérez-Stable MD Professor of Medicine Division of General Internal Medicine Department of Medicine July 4, 2013 Declaration of full disclosure: No conflict of
More informationLearning Objectives. Controversies in Osteoporosis Prevention and Management. Definition. Presenter Disclosure Information.
4 4:45 pm Controversies in Osteoporosis Prevention and Management SPEAKER Carolyn Crandall, MD, MS Presenter Disclosure Information The following relationships exist related to this presentation: Carolyn
More informationUpdates in Osteoporosis
Updates in Osteoporosis Jeffrey A. Tice, MD Associate Professor of Medicine Division of General Internal Medicine, University of California, San Francisco I have no conflicts of interest What s New in
More informationAssessment and Treatment of Osteoporosis Professor T.Masud
Assessment and Treatment of Osteoporosis Professor T.Masud Nottingham University Hospitals NHS Trust University of Nottingham University of Derby University of Southern Denmark What is Osteoporosis? Osteoporosis
More informationOsteoporosis 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 informationBalancing the Risks and Benefits of Osteoporosis Treatment: part I: 3 to 5 years treatment
Balancing the Risks and Benefits of Osteoporosis Treatment: part I: 3 to 5 years treatment Dennis M. Black, PhD Department of Epidemiology and Biostatistics, UCSF Financial Disclosures (past 3 years) -Consulting
More informationPage 1. Current and Emerging Strategies for Osteoporosis. Osteoporosis Warm-Up: Which of the Following is True?
Current and Emerging Strategies for Osteoporosis Douglas C. Bauer, MD Professor of Medicine and Epidemiology & Biostatistics University of California, San Francisco No Disclosures Osteoporosis Warm-Up:
More informationFracture=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 informationPage 1. Current and Emerging Strategies What s New in Osteoporosis. Osteoporosis. What is Osteoporosis? Traditional Risk Factors for Fracture
Current and Emerging Strategies for Osteoporosis What s New in Osteoporosis Risk stratification Douglas C. Bauer, MD University of California, San Francisco Under recognition and poor compliance New potential
More informationOsteoporosis: How to Manage Long- Term Use of Bisphosphonates AKA Now What? David E Feinstein, DO, CCD November 15 th, 2017
Osteoporosis: How to Manage Long- Term Use of Bisphosphonates AKA Now What? David E Feinstein, DO, CCD November 15 th, 2017 Introduction A fracture due to OP occurs every 3 seconds around the world. 1
More informationPage 1. Osteoporosis Warm-Up: Which of the Following is True? Diagnosis and Treatment of Osteoporosis: What is New in What s New in Osteoporosis
Diagnosis and Treatment of Osteoporosis: What is New in 2017 Douglas C. Bauer, MD Professor of Medicine and Epidemiology & Biostatistics University of California, San Francisco No Disclosures Osteoporosis
More informationCurrent and Emerging Strategies for Osteoporosis
Current and Emerging Strategies for Osteoporosis I have nothing to disclose. Anne Schafer, MD Assistant Professor of Medicine Division of Endocrinology & Metabolism December 12, 2014 Outline Osteoporosis
More information9/9/2015 OSTEOPOROSIS WHAT S NEW AND ON THE HORIZON IN SCREENING, DRUG HOLIDAYS, SUPPLEMENTS, CONSERVATIVE THERAPY DISCLOSURES
OSTEOPOROSIS WHAT S NEW AND ON THE HORIZON IN SCREENING, DRUG HOLIDAYS, SUPPLEMENTS, CONSERVATIVE THERAPY Nelson B. Watts, MD OSTEOPOROSIS AND BONE HEALTH SERVICES CINCINNATI, OHIO DISCLOSURES Stock options/holdings,
More informationDrug Intervals (Holidays) with Oral Bisphosphonates
Drug Intervals (Holidays) with Oral Bisphosphonates Rizwan Rajak Consultant Rheumatologist & Lead for Osteoporosis GP Postgraduate Meeting April 2018 Contents Case presentation Pathway for Bisphosphonate
More informationCurrent and Emerging Approaches for Osteoporosis
Current and Emerging Approaches for Osteoporosis Douglas C. Bauer, MD Professor of Medicine and Epidemiology & Biostatistics University of California, San Francisco No Disclosures What s New in Osteoporosis
More informationTreatments for Osteoporosis Expected Benefits, Potential Harms and Drug Holidays. Suzanne Morin MD FRCP FACP McGill University May 2014
Treatments for Osteoporosis Expected Benefits, Potential Harms and Drug Holidays Suzanne Morin MD FRCP FACP McGill University May 2014 Learning Objectives Overview of osteoporosis management Outline efficacy
More informationACP Colorado-Evidence Based Management of Osteoporosis
ACP Colorado-Evidence Based Management of Osteoporosis Micol S. Rothman, MD Associate Professor of Medicine and Radiology Clinical Director Metabolic Bone Program University of Colorado School of Medicine
More informationCASE 1 WHY IS IT IMPORTANT TO TREAT? FACTS CONCERNS
4:30-5:15pm Ask the Expert: Osteoporosis SPEAKERS Silvina Levis, MD OSTEOPOROSIS - FACTS 1:3 older women and 1:5 older men will have a fragility fracture after age 50 After 3 years of treatment, depending
More informationMonitoring Osteoporosis Therapy
Monitoring Osteoporosis Therapy SUZANNE MORIN DEPT OF MEDICINE, DIVISION OF GENERAL INTERNAL MEDICINE, MUHC CENTRE FOR OUTCOMES RESEARCH AND EVALUATION, RI MUHC November 2017 Conflict of Interest Disclosures
More informationPharmacy 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 informationDownload slides:
Download slides: https://www.tinyurl.com/m67zcnn https://tinyurl.com/kazchbn OSTEOPOROSIS REVIEW AND UPDATE Boca Raton Regional Hospital Internal Medicine Conference 2017 Benjamin Wang, M.D., FRCPC Division
More informationNew Therapeutic Directions: Osteoanabolic and Antiresorptive Therapy in Combination Therapy and in Sequence
New Therapeutic Directions: Osteoanabolic and Antiresorptive Therapy in Combination Therapy and in Sequence John P. Bilezikian, MD, PhD(hon), MACE Silberberg Professor of Medicine Vice-Chair for International
More informationHow to treat osteoporosis With what and for how long?
How to treat osteoporosis With what and for how long? Professor Neil Gittoes Consultant Endocrinologist & Honorary Professor Where will we be going? Drug therapies Current Indications Contraindications/unmet
More informationAACE. Orlando Drug Holidays. Disclosures. Advisory boards: Alexion, Amgen, Lilly, Merck, Radius Health
AACE Orlando 2016 Drug Holidays Disclosures Advisory boards: Alexion, Amgen, Lilly, Merck, Radius Health Scientific grants: Alexion, Amgen, Immunodiagnostics, Lilly, Merck, Regeneron, Radius Health, Roche
More informationAACE. 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 informationTask Force Co-Chairs. Members
Managing Osteoporosis Patients After Long-Term Bisphosphonate Treatment Report of a Task Force* of the American Society for Bone and Mineral Research Robert A. Adler, MD Task Force Co-Chairs Ghada El-Hajj
More informationEmerging Areas Relating Vitamin D to Health
ILSI SEA Region Vit D Conference, Australia, June 2012 (www.ilsi.org/sea Region) Emerging Areas Relating Vitamin D to Health Peter R Ebeling MD FRACP NorthWest Academic Centre and Dept Endocrinology The
More informationLearning Objectives. Controversies in Osteoporosis Prevention and Management. Etiology. Presenter Disclosure Information. Epidemiology.
12:45 1:30pm Controversies in Osteoporosis Prevention and Management SPEAKER Carolyn Crandall, MD, MS Presenter Disclosure Information The following relationships exist related to this presentation: Carolyn
More informationPresenter: 翁家嫻 Venue date:
FOR THE TREATMENT OF OSTEOPOROSIS IN POSTMENOPAUSAL WOMEN AT INCREASED RISK OF FRACTURES 1 Presenter: 翁家嫻 Venue date: 2018.03.13 PMO: postmenopausal osteoporosis. 1. Prolia (denosumab), Summary of Product
More informationFrom Fragile to Firm. Monika Starosta MD. Advocate Medical Group
From Fragile to Firm Monika Starosta MD Advocate Medical Group Bone Remodeling 10% remodeled each year Calcium homoeostasis Maintain Mechanical strength Replace Osteocytes Release Growth Factors Bone remodeling
More informationOsteoporosis Agents Drug Class Prior Authorization Protocol
Osteoporosis Agents Drug Class Prior Authorization Protocol Line of Business: Medicaid P&T Approval Date: February 21, 2018 Effective Date: April 1, 2018 This policy has been developed through review of
More informationPharmacy Management Drug Policy
SUBJECT: - Forteo (teriparatide), Prolia (denosumab), Tymlos (abaloparatide), Boniva injection (Ibandronate) POLICY NUMBER: Pharmacy-35 EFFECTIVE DATE: 9/07 LAST REVIEW DATE: 10/15/2018 If the member s
More informationRheumatology. keeping Joints in Motion. Treating and Preventing Fractures
Rheumatology keeping Joints in Motion Treating and Preventing Fractures Robin K. Dore, MD Clinical Professor of Medicine David Geffen School of Medicine at UCLA, Los Angeles CA Private practice, Tustin
More informationAN OVERVIEW of TREATMENT: WHO and WHEN to TREAT
AN OVERVIEW of TREATMENT: WHO and WHEN to TREAT Dolores Shoback, MD Professor of Medicine, UCSF San Francisco VA Medical Center July 16, 21 ~ QUESTIONS ~ Who should receive therapy to prevent fractures?
More informationThis house believes that HRT should be the first-line prevention for postmenopausal osteoporosis: the case against
This house believes that HRT should be the first-line prevention for postmenopausal osteoporosis: the case against Juliet Compston Professor of Bone Medicine University of Cambridge School of Clinical
More informationPharmacy Management Drug Policy
Clinical criteria used to make utilization review decisions are based on credible scientific evidence published in peer reviewed medical literature generally recognized by the medical community. Guidelines
More informationConflict of Interest Jonathan D. Adachi
Conflict of Interest Jonathan D. Adachi Consultant/Speaker Actavis Amgen Eli Lilly Merck Clinical Trials Amgen Eli Lilly Merck Novartis Stock None to declare Current Controversies In Osteoporosis Provided
More informationHot Topics in Osteoporosis and Fracture Prevention
Hot Topics in Osteoporosis and Fracture Prevention Sid Feldman, MD CCFP (COE) FCFP Sandra Kim, MD, FRCPC November 15, 2018 Family Medicine Forum, Toronto Faculty/Presenter Disclosure Faculty: Sid Feldman
More informationOSTEOPOROSIS: PREVENTION AND MANAGEMENT
OSTEOPOROSIS: OVERVIEW OSTEOPOROSIS: PREVENTION AND MANAGEMENT Judith Walsh, MD, MPH Departments of Medicine and Epidemiology and Biostatistics UCSF Definitions Key Risk factors Screening and Monitoring
More informationHorizon Scanning Technology Briefing. Zoledronic Acid (Aclasta) once yearly treatment for postmenopausal. National Horizon Scanning Centre
Horizon Scanning Technology Briefing National Horizon Scanning Centre Zoledronic Acid (Aclasta) once yearly treatment for postmenopausal osteoporosis December 2006 This technology summary is based on information
More informationTREATING OSTEOPOROSIS IN 2018: WHAT'S OLD, WHAT'S NEW, WHAT'S UNPROVEN AND WHAT'S TRUE. Nelson B. Watts, MD
TREATING OSTEOPOROSIS IN 2018: WHAT'S OLD, WHAT'S NEW, WHAT'S UNPROVEN AND WHAT'S TRUE Nelson B. Watts, MD OSTEOPOROSIS AND BONE HEALTH SERVICES CINCINNATI, OHIO Honoraria: Amgen, Radius, Shire Consulting
More informationOsteoporosis in practice. Katie Moss Rheumatology Consultant St George s Hospital London
Osteoporosis in practice Katie Moss Rheumatology Consultant St George s Hospital London Disclosures Lilly Educational grant and advisory board Prostrakan Educational grant Osteoporosis Case history 66
More informationChau Nguyen, D.O. Rheumatologist Clinical Assistant Professor of Internal Medicine at Western University of Health Sciences
Chau Nguyen, D.O Rheumatologist Clinical Assistant Professor of Internal Medicine at Western University of Health Sciences I do not have any relationship with the manufacturer of any commercial products
More informationBAD TO THE BONE. Peter Jones, Rheumatologist QE Health, Rotorua. GP CME Conference Rotorua, June 2008
BAD TO THE BONE Peter Jones, Rheumatologist QE Health, Rotorua GP CME Conference Rotorua, June 2008 Agenda Osteoporosis in Men Vitamin D and Calcium Long-term treatment with Bisphosphonates Pathophysiology
More informationOsteoporosis in Men Professor Peter R Ebeling
Osteoporosis in Men MD FRACP Head, Department of Medicine, School for Clinical Sciences Monash Health Translation Precinct Monash University, Clayton, Victoria 1 MonashHealth Potential Conflicts Departmental
More information11/4/2018. Osteoporosis Update. ACP Oregon Chapter November 9 th, 2018 Sarah Hopkins Providence Medical Group Endocrinology East. No disclosures.
Osteoporosis Update ACP Oregon Chapter November 9 th, 2018 Sarah Hopkins Providence Medical Group Endocrinology East No disclosures. 1 Goals Review screening recommendations and workup of secondary causes
More informationDrugs Approved for Prevention and Treatment of Postmenopausal Osteoporosis
Other Treatments of Osteoporosis- Who Should Get Bisphosphonates David Slovik, M.D. Endocrine Unit Newton-Wellesley Hospital Massachusetts General Hospital Harvard Medical School Massachusetts Medical
More informationAACE/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 informationVol. 19, Bulletin No. 108 August-September 2012 Also in the Bulletin: Denosumab 120mg for Bone Metastases
ה מ ר א פ הביטאון לענייני תרופות ISRAEL DRUG BULLETIN 19 years of unbiased and independent drug information P H A R x M A Vol. 19, Bulletin No. 108 August-September 2012 Also in the Bulletin: Denosumab
More informationClinical Specialist Statement Template
Clinical Specialist Statement Template Thank you for agreeing to give us a statement on your organisation s view of the technology and the way it should be used in the NHS. Healthcare professionals can
More informationHow long to treat? Disclosure. What is the real problem? Conclusions
Disclosure How long to treat? 11 th Annual Update on Osteoporosis and Skeletal Health Institutional Grant / Research Support Amgen, Eli Lilly, Merck Consulting / Speaking Amgen, Eli Lilly, Merck, Radius
More informationOsteoporosis: current treatment and future prospects. Juliet Compston Professor Emeritus of Bone Medicine Cambridge Biomedical Campus
Osteoporosis: current treatment and future prospects Juliet Compston Professor Emeritus of Bone Medicine Cambridge Biomedical Campus Disclosures Consultancy and speaking fees for Gilead, related to development
More informationCalcium and Vitamin D Supplementation is an Ineffective Strategy for the Prevention of Fractures in Older People
Calcium and Vitamin D Supplementation is an Ineffective Strategy for the Prevention of Fractures in Older People For the Motion: Professor Roger Francis, Institute for Ageing and Health, Newcastle University,
More informationOsteoporosis update. Dr. Claire Vandevelde Consultant Rheumatologist, LTHT
Osteoporosis update Dr. Claire Vandevelde Consultant Rheumatologist, LTHT Outline Background BMD Tools for assessing fracture risk Case study Denosumab Treatment breaks BMD BMD predicts fracture risk but
More informationScreening Guidelines: Women
The Situation 1 in 2 postmenopausal women and 1 in 5 older men will have an osteoporosis-related fracture in their lifetimes Osteoporosis Definition NIH Consensus Conference A skeletal disorder characterized
More informationNew Developments in Osteoporosis: Screening, Prevention and Treatment
Osteoporosis: Overview New Developments in Osteoporosis: Screening, Prevention and Treatment Judith Walsh, MD, MPH Departments of Medicine and Epidemiology and Biostatistics UCSF Definitions Risk factors
More informationOsteoporosis 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 informationTherapeutic 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 informationUpdate on Osteoporosis 2016
WELCOME! Update on Osteoporosis 2016 Jennifer J. Kelly, D.O., F.A.C.E. Associate Professor of Medicine Division of Endocrinology, Diabetes and Metabolism Upstate Medical University Director of the Clinical
More informationOsteoporosis challenges
Osteoporosis challenges Osteoporosis challenges Who should have a fracture risk assessment? Who to treat? Drugs, holidays and unusual adverse effects Fracture liaison service? The size of the problem 1
More informationOsteoporosis: A Tale of 3 Task Forces!
Osteoporosis: A Tale of 3 Task Forces! Robert A. Adler, MD McGuire Veterans Affairs Medical Center Virginia Commonwealth University Richmond, Virginia, USA Disclosures The opinions are those of the speaker
More informationOsteoporosis Update DR. SYLVIE OUELLETTE RHEUMATOLOGIST
Osteoporosis Update DR. SYLVIE OUELLETTE RHEUMATOLOGIST Disclosures! Speaker programs! AbbVie, Amgen! Research! Amgen, Novartis! Education/ conference support! Amgen, Roche! Advisory Boards! AbbVie, Amgen,
More informationParathyroid 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 informationFRAX assessment. The patient. The patient. Which drug? UK NOGG Guidance 3/22/17. Safety issues with osteoporosis treatments
The patient Safety issues with osteoporosis treatments 78 year-old lady, retired dentist, active. Family history of osteoporosis (mother, younger sister). Humerus fracture 3 months ago. Type 2 diabetes
More informationNEW DEVELOPMENTS IN OSTEOPOROSIS: SCREENING, PREVENTION AND TREATMENT
NEW DEVELOPMENTS IN OSTEOPOROSIS: SCREENING, PREVENTION AND TREATMENT Judith Walsh, MD, MPH Departments of Medicine and Epidemiology and Biostatistics UCSF OSTEOPOROSIS: OVERVIEW Definitions Risk factors
More informationForteo (teriparatide) Prior Authorization Program Summary
Forteo (teriparatide) Prior Authorization Program Summary FDA APPROVED INDICATIONS DOSAGE 1 FDA Indication 1 : Forteo (teriparatide) is indicated for: the treatment of postmenopausal women with osteoporosis
More informationOsteoporosis. Current Trend in Osteoporosis Management for Elderly in HK- Medical Perspective. Old Definition of Osteoporosis
Current Trend in Osteoporosis Management for Elderly in HK- Medical Perspective Dr Dicky T.K. Choy Physician Jockey Club Centre for Osteoporosis Care and Control, CUHK Osteoporosis Global public health
More informationManagement of postmenopausal osteoporosis
Management of postmenopausal osteoporosis Yeap SS, Hew FL, Chan SP, on behalf of the Malaysian Osteoporosis Society Committee Working Group for the Clinical Guidance on the Management of Osteoporosis,
More informationOsteoporosis in Men. CME Away India & Sri Lanka March 23 - April 7, 2018
Osteoporosis in Men CME Away India & Sri Lanka March 23 - April 7, 2018 Richard A. Bebb MD, ABIM, FRCPC Consultant Endocrinologist Medical Subspecialty Institute Cleveland Clinic Abu Dhabi Copyright 2017
More informationWho 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 informationOsteoporosis: Are your bones at risk of fracturing? Rachel Wallwork, MD Internal medicine resident Massachusetts General Hospital
Osteoporosis: Are your bones at risk of fracturing? Rachel Wallwork, MD Internal medicine resident Massachusetts General Hospital What is Osteoporosis? Osteoporosis causes bones to lose density, become
More informationOsteoporosis 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 informationRenata Caudarella. Fondazione Ettore Sansavini per la Ricerca Scientifica (Health Science Foundation ) - GVM Care & Research
Renata Caudarella Fondazione Ettore Sansavini per la Ricerca Scientifica (Health Science Foundation ) - GVM Care & Research Introduc/on During the past two decades, many randomized controlled trials (RCTs)
More informationA KL/R / AN A K/O / P O G G
Outline and New Treatments on the Horizon Steven R. Cummings, MD CPMC and UCSF San Francisco Coordinating Center Support from Lilly and Amgen New treatments, new mechanisms of action Cathepsin K inhibition
More informationGuideline for the investigation and management of osteoporosis. for hospitals and General Practice
Guideline for the investigation and management of osteoporosis for hospitals and General Practice Background Low bone density is an important risk factor for fracture. The aim of assessing bone density
More informationS 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 informationOutline. Switching treatment. Evidence from randomized trials. The effects of switching 7/8/2016. When and for whom? Steven Cummings, MD
Outline Switching treatment When and for whom? Steven Cummings, MD Focus on switching from alendronate or risedronate Evidence about the effects of switching on BMD Purposes of switching Symptoms Poor
More informationEffective Health Care
Number 12 Effective Health Care Comparative Effectiveness of Treatments To Prevent Fractures in Men and Women With Low Bone Density or Osteoporosis Executive Summary Background Osteoporosis is a systemic
More informationOsteoporosis Evaluation and Treatment
Osteoporosis Evaluation and Treatment Anne Schafer, MD Assistant Professor of Medicine Division of Endocrinology & Metabolism October 28, 2011 No conflicts of interest Objectives Explain when to initiate
More informationUpcoming Agents for Osteoporosis
Upcoming Agents for Osteoporosis May 5, 2017 Michael R. McClung, MD, FACP Director, Oregon Osteoporosis Center Portland, Oregon, USA Professorial Fellow, Institute of Health and Ageing Australian Catholic
More informationBone Health Update Susan L. Greenspan, MD Professor of Medicine University of Pittsburgh
Bone Health Update 2018 Susan L. Greenspan, MD Professor of Medicine University of Pittsburgh The Problem 50% women and 20% of men have an osteoporotic fracture after age 50 2 million fractures annually
More informationManaging Osteoporosis in Patients on Long-Term Bisphosphonate Treatment Report of a Task Force of the American Society for Bone and Mineral Research
Review Managing Osteoporosis in Patients on Long-Term Bisphosphonate Treatment Report of a Task Force of the American Society for Bone and Mineral Research Robert A. Adler 1 *, Ghada El-Hajj Fuleihan 2
More information