PBLD Table #8. Pediatric Vertebral Body Compression Fracture: Diagnosis and Therapeutic Options for Severe Pain
|
|
- Matthew Dwain Owens
- 6 years ago
- Views:
Transcription
1 PBLD Table #8 Pediatric Vertebral Body Compression Fracture: Diagnosis and Therapeutic Options for Severe Pain Moderators: Jacob Aubuchon MD, Rosemary Foster MD Institution: St Louis Children s Hospital, Washington University School of Medicine, St Louis, Missouri Disclosure: We have no conflicts of interest to disclose Objectives: - Discuss the risk factors, diagnostic tests and physical exam when there is concern for vertebral body compression fracture - Review the treatment options for patients with vertebral body compression fractures: interventions (vertebroplasty), medical management, and bracing - Review the evidence for vertebroplasty in pediatrics: risks, long term effects, etc -Besides analgesics (NSAIDs, opioids, acetaminophen), examine the evidence for other medications (bisphosphonates, nasal calcitonin, etc). Case history: A 14 y/o male is referred to the pain clinic for management of severe back pain. He has a h/o T cell ALL diagnosed at 3 y/o, s/p bone marrow transplant at 5 y/o, complicated by GVHD of the skin requiring long term steroid use. What additional information would you like on history? What would be in your differential diagnosis? Case history continued: After complaining of back pain, he was diagnosed with osteoporosis and vertebral compression fractures at 7 yo. His pain eventually resolved over the following year with back bracing, bisphosphonates, calcium, vitamin D and narcotic pain medications. However, at age 14, he had a complicated 3 month hospital course related to complications after undergoing a subtotal colectomy for colonic polyposis. During this hospitalization, he had return of his back pain and imaging showed worsening of his spinal vertebral compression fractures. At the time of referral, he was taking methadone 7.5 mg TID, oxycodone 5mg prn, Tylenol, ibuprofen, cyclobenzaprine, calcium, vitamin D, and risedronate. 1
2 What risk factors does this patient have for vertebral compression fractures? What history and physical exam findings are consistent with vertebral compression fractures? Case history and diagnostics: At 7 y/o, the patient s initial vertebral compression fractures were identified with Thoracic and Lumbar spine plain films after the patient complained of back pain. At 8 y/o, he had a DEXA scan which showed low bone mineral density (BMD) with an L spine z-score of What is the preferred diagnostic/imaging modality to assess for vertebral compression fracture? Any additional studies if you are concerned there is associated osteoporosis? Can DEXA z-score values be used to predict those at risk for vertebral compression fractures? How common are vertebral compression fractures in patients with ALL? What percentage of patients are asymptomatic? What other disease states put patients at risk for vertebral compression fractures? Should patients with ALL or these other disease states be screened for bone health and/or vertebral compression fractures? Case history and treatment: This patient was placed in a brace with initial presentation of compression fractures after which some time the pain resolved. When he had additional worsening compression fractures at age 14, bracing was not an option as the patient had an ostomy. He had a variety of treatments aimed at improving BMD and bone growth in the associated setting of delayed puberty and short stature including bisphosphonates, calcium, vitamin D, and growth hormone. His response to treatment was monitored by repeat DEXA scans. Does bracing provide therapeutic benefit for vertebral compression fractures or just symptomatic relief during the natural progression? What is the natural progression of vertebral compression fractures in children? Does age matter? What are the pathophysiologic mechanisms by which patients with ALL and patients on chronic steroids develop osteoporosis and vertebral compression fractures? How do bisphosphonates counteract these mechanisms? How do bisphosphonate treated vertebral compression fractures compare to non-treated vertebral compression fractures? Case history, further imaging, and treatment options: On referral to the pain clinic in November 2014, at age 14, MRI showed the following: Compression fractures at all levels of the spine with relative sparing of C1-T3. Mid-lower thoracic compression fractures had markedly worsened since CT in 8/2014 (3 months prior). New vertebral plana was present at L1, L2, and L4 since imaging in 10/2014 with marrow edema consistent with acute or subacute fractures. 2
3 At this time, the patient had been up titrated on methadone with little improvement in pain. His back pain ranged from 5-9/10, averaged 6/10, and was mainly localized to the lumbar region where imaging showed acute/subacute fractures. What are the most common areas for vertebral compression fractures in pediatric patients with ALL and or on chronic steroids? Is this patient a good candidate for vertebroplasty? Why or why not? Does acuity matter? What is/are the evidence/outcomes for vertebroplasty in children? What are contraindications to vertebroplasty? What are complications associated with vertebroplasty? Case history and outcomes: The patient was started on Baclofen and ultimately uptitrated to TID dosing of 5/5/10 mg, which seemed to provide the most benefit. He was transitioned to hydromorphone for breakthrough pain, which was associated with less headaches he was experiencing with oxycodone. His methadone was continued but slowly weaned over follow-up visits and down to 2.5 mg BID on last follow-up. His GVHD subsided and he was able to wean off chronic steroids in January, 2015 for the first time in nearly 10 years. He continues on bisphosphonate treatment for continued osteoporosis and BMD z-scores below -2. His growth hormone therapy had to be discontinued after development of papilledema and headaches possibly related to pseudotumor. He is now 16 yo, has a height of only 3 feet 10 inches, but functioning well in daily life and back pain is well controlled. Besides the medications already discussed, is there evidence for use of other medications, such as inhaled calcitonin, for therapeutic or symptomatic relief in the treatment of vertebral compression fractures? Discussion Outline: In our case, we review a topic that has very little published evidence: pediatric vertebral compression fracture. We will first focus on the presentation of the disease, risk factors, and what further workup is required. We as moderators will then discuss the different treatment options for these compression fractures. The focus will be on the advantages, disadvantages, and potential complications of each therapeutic intervention. Since there is limited data on many of the treatment options, one goal will be to determine what are the best therapies given the adult data and limited pediatric evidence. By the end of the PBLD, our goal is to have a better understanding of vertebral compression fractures in children but also to have an idea of what treatment options are available. References: Carbo E, Riquelme O, Garcia A, et al. Vertebroplasty in a 10-year-old boy with Gorham Stout syndrome. Eur Spine J. 2015; 24: S590 S593. DeCastro L, Kuhn J, Freeman A, et al. Complete remodeling of the vertebrae in a child successfully treated for acute lymphocytic leukemia (ALL). Cancer. 1977; 40:
4 Goldbloom E, Cummings E, Yhap M. Osteoporosis at presentation of Childhood ALL. Pediatric Hematology and Oncology. 2005; 22: Halton J, Gaboury I, Grant R, et al. Advanced Vertebral Fracture Among Newly Diagnosed Children With Acute Lymphoblastic Leukemia: Results of the Canadian Steroid-Associated Osteoporosis in the Pediatric Population (STOPP) Research Program. Journal of Bone and Mineral Research. 2009; 24: Kakihara T, Watanabe A, Imai C, et al. Chemotherapy-induced multiple vertebral compression fractures in a boy with acute lymphoblastic leukemia. Pediatrics International. 2002; 44: Kanatli U, Ataog lu B, O zer M, et al. Kyphoplasty for Intractable Pain Due to Glucocorticosteroid-induced Osteoporotic Vertebra Fracture of a 9-Year-Old Patient With Systemic Lupus Erythematosus: 8-Year Follow-up. J Pediatr Orthop. 2015; 35: e55-e59. Land C, Rauch F, Munns C, et al. Vertebral morphometry in children and adolescents with osteogenesis imperfecta: Effect of intravenous pamidronate treatment. Bone. 2006; 39: Lucarelli S, Borrelli O, Paganelli M, et al. Vertebral Fractures and Increased Sensitivity to Corticosteroids in a Child With Ulcerative Colitis: Successful Use of Pamidronate. J Pediatr Gastroenterol Nutr. 2006; 43: Issa M, Lucas G, Violas P, et al. Vertebroplasty for vertebral hemangioma in children: a report of two cases with 2-year follow-up. Childs Nerv Syst. 2015; 31: Singer G, Parzer S, Castellani C, et al. The influence of brace immobilization on the remodeling potential of thoracolumbar impaction fractures in children and adolescents. Eur Spine J. 2016; 25:
5 5
6 6
Managing Bone Pain in Metastatic Disease. Rachel Schacht PA-C Medical Oncology and Hematology Associates Presented on 11/2/2018
Managing Bone Pain in Metastatic Disease Rachel Schacht PA-C Medical Oncology and Hematology Associates Presented on 11/2/2018 None Disclosures Managing Bone Pain in Metastatic Disease This lecture will
More informationVertebral Augmentation for Compression Fractures. Scott Magnuson, MD Pain Management of North Idaho, PLLC
Vertebral Augmentation for Compression Fractures Scott Magnuson, MD Pain Management of North Idaho, PLLC OVCFs are most common type of fragility fracture 20-25% Caucasian women and men over 50 yrs have
More informationOutline Vertebroplasty and Kyphoplasty: Who, What, and When
Outline Vertebroplasty and Kyphoplasty: Who, What, and When Douglas C. Bauer, MD University of California San Francisco, USA Vertebral fracture epidemiology, consequences and diagnosis Kyphoplasty and
More informationFracture REduction Evaluation (FREE) Study
Fracture REduction Evaluation (FREE) Study Efficacy and Safety of Balloon Kyphoplasty Compared with Non-surgical Care for Vertebral Compression Fracture (FREE): A Randomised Controlled Trial Wardlaw Lancet
More informationOutline. Vertebroplasty and Kyphoplasty. Epidemiology. Identifying Vertebral Fractures. Page 1
Outline Vertebroplasty and Kyphoplasty Douglas C. Bauer, MD University of California San Francisco, USA Vertebral fracture epidemiology, consequences and diagnosis Kyphoplasty and vertebroplasty: what
More informationNew 2010 Osteoporosis Guidelines: What you and your health provider need to know QUESTIONS&ANSWERS
New 2010 Osteoporosis Guidelines: What you and your health provider need to know QUESTIONS&ANSWERS Wednesday, December 1, 2010 1:00 p.m. to 2:00 p.m. ET 1. I m 55 years old. I ve been taking Fosavance
More informationBone Mass Measurement BONE MASS MEASUREMENT HS-042. Policy Number: HS-042. Original Effective Date: 8/25/2008
Easy Choice Health Plan, Inc. Harmony Health Plan of Illinois, Inc. Missouri Care, Inc. Ohana Health Plan, a plan offered by WellCare Health Insurance of Arizona, Inc. WellCare Health Insurance of Illinois,
More informationVertebral Body Augmentation
Vertebral Body Augmentation Nitin Sekhri MD Department of Anesthesiology Department of Radiology Westchester Medical Center Maria Fareri Children's Hospital Assistant Professor of Anesthesiology New York
More informationOsteoporosis and Spinal Fractures
Nader M. Hebela, MD Fellow of the American Academy of Orthopaedic Surgeons http://orthodoc.aaos.org/hebela Cleveland Clinic Abu Dhabi Cleveland Clinic Abu Dhabi Neurological Institute Al Maryah Island
More informationOutline Vertebroplasty and Kyphoplasty: Who, What, and When
Outline Vertebroplasty and Kyphoplasty: Who, What, and When Douglas C. Bauer, MD University of California San Francisco, USA Vertebral fracture epidemiology, consequences and diagnosis Kyphoplasty and
More informationInitial Pathway for DEXA Referral and Treatment for Fracture Risk Reduction in Postmenopausal Women and Men Age 50 or Above
Initial Pathway for DEXA Referral and Treatment for Fracture Risk Reduction in Postmenopausal Women and Men Age 50 or Above 2 or > vertebral fractures Low trauma fracture In past 5 years Risk Factors (table1)
More informationClinician s Guide to Prevention and Treatment of Osteoporosis
Clinician s Guide to Prevention and Treatment of Osteoporosis Published: 15 August 2014 committee of the National Osteoporosis Foundation (NOF) Tipawan khiemsontia,md outline Basic pathophysiology screening
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 informationManagement of the complications of myeloma and side-effects of treatment Christine Morris Clinical Nurse Specialist in Myeloma Royal Derby Hospital
Management of the complications of myeloma and side-effects of treatment Christine Morris Clinical Nurse Specialist in Myeloma Royal Derby Hospital Common problems in myeloma Myeloma-related complications/symptoms
More informationCase Conference: SBRT for spinal metastases D A N I E L S I M P S O N M D 3 / 2 7 / 1 2
Case Conference: SBRT for spinal metastases D A N I E L S I M P S O N M D 3 / 2 7 / 1 2 Case 79 yo M with hx of T3N0 colon cancer diagnosed in 2008 metastatic liver disease s/p liver segmentectomy 2009
More informationOklahoma Spine & Brain Institute is Proud to Introduce Michael Thambuswamy, MD, MBA
Oklahoma Spine & Brain Institute is Proud to Introduce Michael Thambuswamy, MD, MBA Michael Thambuswamy, M.D., is from the Tulsa area where he graduated, with honors, from Jenks High School. He completed
More informationAn Empirical Study of Osteoporotic Vertebral Fracture Review
An Empirical Study of Osteoporotic Vertebral Fracture Review C-H Li 1, M-C Chang 2, Z-P Ho 3, H-Y Chiu 4 ABSTRACT Osteoporotic vertebral fractures (OVF) are most common injuries seen in elder people. The
More informationFREQUENTLY ASKED QUESTIONS
FREQUENTLY ASKED QUESTIONS The following questions are representative of questions that patients and family members ask when they visit the Bone and Cancer Foundation website or contact the Foundation
More informationHyperparathyroidism. When to Suspect, How to Diagnose, When and How to Intervene. Johanna A. Pallotta, MD, FACP, FACE
Hyperparathyroidism When to Suspect, How to Diagnose, When and How to Intervene Johanna A. Pallotta, MD, FACP, FACE Potential conflicts of interest: None Johanna A. Pallotta, MD Outline Definition of hyperparathyroidism
More informationBone Metastases. Sukanda Denjanta, M.Sc., BCOP Pharmacy Department, Chiangrai Prachanukroh Hospital
Bone Metastases Sukanda Denjanta, M.Sc., BCOP Pharmacy Department, Chiangrai Prachanukroh Hospital 1 Outline Pathophysiology Signs & Symptoms Diagnosis Treatment Spinal Cord Compression 2 General Information
More informationOsteoporosis - New Guidelines. Michelle Glass B.Sc. (Pharm) June 15, 2011
Osteoporosis - New Guidelines Michelle Glass B.Sc. (Pharm) June 15, 2011 Outline What is Osteoporosis? Who is at risk? What treatments are available? Role of the Pharmacy technician Definition of Osteoporosis
More informationBone Densitometry. Dr. Tudor H. Hughes M.D., FRCR Department of Radiology University of California School of Medicine San Diego, California
Bone Densitometry Dr. Tudor H. Hughes M.D., FRCR Department of Radiology University of California School of Medicine San Diego, California Interpretation of DEXA Osteoporosis Osteoporosis is the most common
More informationObjectives. Discuss bone health and the consequences of osteoporosis on patients medical and disability status.
Objectives Discuss bone health and the consequences of osteoporosis on patients medical and disability status. Discuss the pathophysiology of osteoporosis and major risk factors. Assess the major diagnostic
More informationCommon Thoraco- Lumbar Problems in the Mature Athlete
Common Thoraco- Lumbar Problems in the Mature Athlete Diana Heiman, MD Associate Professor, Family Medicine Residency Director East Tennessee State University Objectives Review the pathophysiology of the
More informationChallenging Cases. With Q&A Panel
Challenging Cases With Q&A Panel Case Studies Index Patient #1 Jeffrey Wieder, MD Case # 1 72 year old healthy male with mild HTN Early 2011: Preop bone scan and pelvic CT = no mets Radical prostatectomy
More informationUTERINE FIBROID EMBOLIZATION
INTERVENTIONAL RADIOLOGY PROTOCOLS UTERINE FIBROID EMBOLIZATION Interventional Radiology Tower Health Medical Group offers the option to treat uterine fibroids with fibroid embolization (UFE), an alternative
More informationOsteoporosis/Fracture Prevention
Osteoporosis/Fracture Prevention NATIONAL GUIDELINE SUMMARY This guideline was developed using an evidence-based methodology by the KP National Osteoporosis/Fracture Prevention Guideline Development Team
More informationOsteoporosis and Lupus. Andrew Ruthberg, MD University Rheumatologists
Osteoporosis and Lupus Andrew Ruthberg, MD University Rheumatologists 1 Forget the medical terminology (osteoporosis, osteopenia, low bone mass, DEXA, DXA, T score etc) The bottom line is that you don
More informationPERCUTANEOUS BALLOON KYPHOPLASTY, RADIOFREQUENCY KYPHOPLASTY, AND MECHANICAL VERTEBRAL AUGMENTATION
KYPHOPLASTY, AND MECHANICAL VERTEBRAL AUGMENTATION Non-Discrimination Statement and Multi-Language Interpreter Services information are located at the end of this document. Coverage for services, procedures,
More informationOpioid Rotation. Dr Bruno Gagnon, M.D., M.Sc.
Opioid Rotation Dr Bruno Gagnon, M.D., M.Sc. Associate Professor Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval Consultant in Palliative Medicine CHU de Québec-Université
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 informationDiagnosis and Treatment of Osteoporosis. Department of Endocrinology and Metabolism Ajou University School of Medicine.
Diagnosis and Treatment of Osteoporosis Department of Endocrinology and Metabolism Ajou University School of Medicine Yoon-Sok CHUNG WCIM, COEX, Seoul, 27Oct2014 Case 1 71-year old woman Back pain Emergency
More informationDISEASES WITH ABNORMAL MATRIX
DISEASES WITH ABNORMAL MATRIX MSK-1 FOR 2 ND YEAR MEDICAL STUDENTS Dr. Nisreen Abu Shahin CONGENITAL DISEASES WITH ABNORMAL MATRIX OSTEOGENESIS IMPERFECTA (OI): also known as "brittle bone disease" a group
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 informationIndications for Kyphoplasty and Vertebroplasty
Transcript Details This is a transcript of a continuing medical education (CME) activity accessible on the ReachMD network. Additional media formats for the activity and full activity details (including
More informationWhat Lung Cancer Patients Need to Know About Bone Health. A Publication of The Bone and Cancer Foundation
What Lung Cancer Patients Need to Know About Bone Health A Publication of The Bone and Cancer Foundation Contents THIS PUBLICATION PROVIDES IMPORTANT INFORMATION ABOUT THE RELATIONSHIP BETWEEN LUNG CANCER
More informationMedical Coverage Policy Percutaneous Vertebroplasty and Scaroplasty
Medical Coverage Policy Percutaneous Vertebroplasty and Scaroplasty EFFECTIVE DATE: 02 01 2011 POLICY LAST UPDATED: 07 02 2013 OVERVIEW Percutaneous vertebroplasty is an interventional technique involving
More informationKyphoplasty and Vertebroplasty
Kyphoplasty and Vertebroplasty Policy Number: Original Effective Date: MM.06.007 01/11/2005 Line(s) of Business: Current Effective Date: HMO; PPO 02/01/2012 Section: Surgery Place(s) of Service: Inpatient;
More informationPractical Management Of Osteoporosis
Practical Management Of Osteoporosis CONFERENCE 2012 Education Centre, Bournemouth.19 November The following companies have given funding towards the cost of this meeting but have no input into the agenda
More informationSeCondary Osteoporosis & its Therapy Duchenne Muscular Dystrophy SCOT-DMD
SeCondary Osteoporosis & its Therapy Duchenne Muscular Dystrophy SCOT-DMD Acknowledgement S Joseph J Dunne M DiMarco C Duncanson I Horrocks S Shepherd and students Research radiographers & MRI Physics
More informationSection 1. What is osteoporosis? Your bones. Bones and osteoporosis. Who is affected by osteoporosis? Consequences of osteoporosis
4 Section 1 What is osteoporosis? Your bones Bones and osteoporosis Who is affected by osteoporosis? Consequences of osteoporosis Less common types of osteoporosis Other bone conditions 5 Osteoporosis
More informationChapter 39: Exercise prescription in those with osteoporosis
Chapter 39: Exercise prescription in those with osteoporosis American College of Sports Medicine. (2010). ACSM's resource manual for guidelines for exercise testing and prescription (6th ed.). New York:
More information1
www.osteoporosis.ca 1 2 Overview of the Presentation Osteoporosis: An Overview Bone Basics Diagnosis of Osteoporosis Drug Therapies Risk Reduction Living with Osteoporosis 3 What is Osteoporosis? Osteoporosis:
More informationSpeaker s Disclosure Statement. Starvation, Death and Destruction: The Battlefield of AVN. Objectives. Risk Factors
Starvation, Death and Destruction: The Battlefield of AVN Speaker s Disclosure Statement I have no industry relationships to disclose I will discuss off-label use of medications Dana-Farber/Boston Children
More informationSuspecting Tumors, or Could it be cancer?
Suspecting Tumors, or Could it be cancer? Donna E. Reece, M.D. Princess Margaret Cancer Centre University Health Network Toronto, ON CANADA 07 February 2018 Background Low back pain is common However,
More information28/03/2017. Content. Non-Pharmacological Treatments for Osteoporosis. Managing Pain from A Vertebral Fracture. Traditional Conservative Approach
Content Non-Pharmacological Treatments for Osteoporosis T.Masud Nottingham University Hospitals NHS Trust University of Nottingham University of Derby University of Southern Denmark Back Pain Back Supports
More informationJohn J. Wolf, DO Family Medicine
John J. Wolf, DO Family Medicine Objectives: 1. Review incidence & Risk of Osteoporosis 2.Review indications for testing 3.Review current pharmacologic & Non pharmacologic Tx options 4.Understand & Utilize
More informationNew Dual-energy X-ray Absorptiometry Machines (idxa) and Vertebral Fracture Assessment
Case 1 New Dual-energy X-ray Absorptiometry Machines (idxa) and Vertebral Fracture Assessment (VFA) History and Examination Your wealthy friend who is a banker brings his 62-year-old mother to your office
More informationOverview. Bone Biology Osteoporosis Osteomalacia Paget s Disease Cases. People Centred Positive Compassion Excellence
Overview Osteoporosis and Metabolic Bone Disease Dr Chandini Rao Consultant Rheumatologist Bone Biology Osteoporosis Osteomalacia Paget s Disease Cases Bone Biology Osteoporosis Increased bone remodelling
More informationBone Health in the Cancer Patient. Stavroula Otis, M.D. Primary Care and Oncology: Practical Lessons Conference Brea Community Center May 10, 2018
Bone Health in the Cancer Patient Stavroula Otis, M.D. Primary Care and Oncology: Practical Lessons Conference Brea Community Center May 10, 2018 Overview Healthy bone is in a constant state of remodelling
More informationNATIONAL COALITION FOR OSTEOPOROSIS AND RELATED BONE DISEASES
NATIONAL COALITION FOR OSTEOPOROSIS AND RELATED BONE DISEASES Fact Sheet FY 2007 What is the Mission of the Bone Coalition? The National Coalition for Osteoporosis and Related Bone Diseases is dedicated
More informationNew Osteoporosis Guidelines: What you and your health provider need to know QUESTION & ANSWER
The first of the newsletters on these Qs and As should include a refresher on the Virtual Forums what they are, how they work, etc. The fact is that less than 5% of COPN members tune in for any given Forum.
More informationNewborn with Fractures. Payal Patel, M.D. Pediatric Endocrinology Fellow May 22, 2014
Newborn with Fractures Payal Patel, M.D. Pediatric Endocrinology Fellow May 22, 2014 Chief Complaint 2-day-old F with prenatally dx ed osteogenesis imperfecta (OI). HPI Born via repeat C/S to a 30 yo G3P2
More informationOsteoporosis. Overview
v2 Osteoporosis Overview Osteoporosis is defined as compromised bone strength that increases risk of fracture (NIH Consensus Conference, 2000). Bone strength is characterized by bone mineral density (BMD)
More 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 informationDual-energy Vertebral Assessment
Dual-energy Vertebral Assessment gehealthcare.com Dual-energy Vertebral Assessment More than 40% of women with normal or osteopenic BMD had a moderate or severe vertebral deformation seen with DVA. Patrick
More informationAgenda. Case Discussions. Managing Acute & Chronic Pain (requiring opioid analgesics) in Patients on MAT. Daniel Alford, MD Disclosures
Managing Acute & Chronic Pain (requiring opioid analgesics) in Patients on MAT Case Discussions August 26, 2014 PCSS MAT Webinar Sponsored by the American Psychiatric Association Daniel P. Alford, MD,
More informationAdina Alazraki, MD, FAAP Assistant Professor, Radiology and Pediatrics Emory University School of Medicine Children s Healthcare of Atlanta
Adina Alazraki, MD, FAAP Assistant Professor, Radiology and Pediatrics Emory University School of Medicine Technical: Patient positioning Performance of the scan Analysis of the data Theoretical: Identification
More informationAnalgesics: Management of Pain In the Elderly Handout Package
Analgesics: Management of Pain In the Elderly Handout Package Analgesics: Management of Pain in the Elderly Each patient or resident and their pain problem is unique. A complete assessment should be performed
More informationTalking to patients with osteoporosis about initiating therapy
Talking to patients with osteoporosis about initiating therapy Deborah Sellmeyer, MD Director, Johns Hopkins Metabolic Bone Center Dept of Medicine, Division of Endocrinology Disclosure DSMB member for
More informationBreast Cancer and Bone Loss. One in seven women will develop breast cancer during a lifetime
Breast Cancer and Bone Loss One in seven women will develop breast cancer during a lifetime Causes of Bone Loss in Breast Cancer Patients Aromatase inhibitors Bil Oophorectomy Hypogonadism Steroids Chemotherapy
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 informationGLOSSARY. This glossary includes definitions for patients who have cancer with bone involvement. New definitions will be added periodically.
GLOSSARY This glossary includes definitions for patients who have cancer with bone involvement. New definitions will be added periodically. For more in-depth information, please refer to the Bone and Cancer
More informationQuestions and Answers About Breast Cancer, Bone Metastases, & Treatment-Related Bone Loss. A Publication of The Bone and Cancer Foundation
Questions and Answers About Breast Cancer, Bone Metastases, & Treatment-Related Bone Loss A Publication of The Bone and Cancer Foundation Contents This publication includes important information about
More informationAromatase Inhibitors & Osteoporosis
Aromatase Inhibitors & Osteoporosis Miss Sarah Horn Consultant Oncoplastic Breast Surgeon April 2018 Aims Role of Aromatase Inhibitors (AI) in breast cancer treatment AI s effects on bone health Bone health
More informationNational Imaging Associates, Inc. Clinical guidelines
National Imaging Associates, Inc. Clinical guidelines Original Date: September 1997 THORACIC SPINE CT Page 1 of 5 CPT Codes: 72128, 72129, 72130 Last Review Date: May 2013 Guideline Number: NIA_CG_043
More informationDefinition Prostate cancer
Prostate cancer 61 Definition Prostate cancer is a malignant neoplasm that arises from the prostate gland and the most common form of cancer in men. localized prostate cancer is curable by surgery or radiation
More informationCLINICAL GUIDELINES. Primary Care Guideline Summary Lumbar Spine Thomas J. Gilbert M.D., M.P.P. 3/17/15 revision
CLINICAL GUIDELINES Primary Care Guideline Summary Lumbar Spine Thomas J. Gilbert M.D., M.P.P. 3/17/15 revision TRIAGE At the initial visit, a focused history and physical examination is performed to assign
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 informationSPINE EVALUATION AND CLEARANCE Basic Principles
SPINE EVALUATION AND CLEARANCE Basic Principles General 1. Entire spine is immobilized during primary survey. 2. Radiographic clearance of the spine is not required before emergent surgical procedures.
More informationAn Atypical Case of Lumbar Scheuermann s Disease
An Atypical Case of Lumbar Scheuermann s Disease Taner Dandinoglu¹, Murat Karadeniz 2, Ozgur Dandin 3 1 Bursa Military Hospital, Department of Physical Medicine and Rehabilitation, Bursa, Turkey 2 Çorlu
More informationManagement of complications and side-effects of myeloma. Jackie Quinn Myeloma CNS Belfast Trust
Management of complications and side-effects of myeloma Jackie Quinn Myeloma CNS Belfast Trust Common problems in myeloma Myeloma-related complications/symptoms Treatment-related side-effects Myeloma bone
More informationSpine Pain Management Program
Spine Pain Management Program Please complete the following information: Patient Name: Patient ID Number: Patient DOB: The procedure being requested is: Please check the indication (reason) for this procedure
More informationVertebroplasty/Kyphoplasty
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 informationWhat is Osteoporosis?
What is Osteoporosis? 2000 NIH Definition A skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture. Bone strength reflects the integration of
More informationCancer Pain: A Clinical Overview. Linda A. King, MD Section of Palliative Care and Medical Ethics
Cancer Pain: A Clinical Overview Linda A. King, MD Section of Palliative Care and Medical Ethics Objectives Define Palliative Care Review prevalence of cancer pain Know barriers to cancer pain management
More informationDEVELOPMENT OF A RISK SCORING SYSTEM TO PREDICT A RISK OF OSTEOPOROTIC VERTEBRAL FRACTURES IN POSTMENOPAUSAL WOMEN
October 2-4, Liverpool, UK EURO SPINE 2013 DEVELOPMENT OF A RISK SCORING SYSTEM TO PREDICT A RISK OF OSTEOPOROTIC VERTEBRAL FRACTURES IN POSTMENOPAUSAL WOMEN D. Colangelo, L. A. Nasto, M. Mormando, E.
More informationBone Health in Children with Physical Disabilities AACPDM 2014: BRK 10
Bone Health in Children with Physical Disabilities AACPDM 2014: BRK 10 Steven Bachrach, MD Tessa Gresley-Jones, MN, NP-Paeds Disclosure Information AACPDM 68 th Annual Meeting Sept 10-13, 2014 Speaker
More informationchapter Bone Density (Densitometry) RADIOPHARMACY INDICATIONS Radionuclide Localization Quality Control Adult Dose Range Method of Administration
10766-04_CH04_redo.qxd 12/3/07 3:47 PM Page 17 chapter 4 Bone Density (Densitometry) RADIOPHARMACY Radionuclide Single radionuclide: 125 I t 1/2 : 60.1 days Energies: 23 31 kev Type: EC, x, γ, accelerator
More informationRehabilitation in Osteoporosis. Dr. S.Samadzadeh physiatrist
Rehabilitation in Osteoporosis Dr. S.Samadzadeh physiatrist Importance of osteoporosis is purely in its relationship to fracture risk The National Osteoporosis Foundation estimates that 50% of women and
More informationInternational Journal of Scientific & Engineering Research, Volume 6, Issue 8, August ISSN
International Journal of Scientific & Engineering Research, Volume 6, Issue 8, August-2015 484 Osteoporotic Spine Fractures: Incidence and Management Outcomes Dr Shaival Dalal, Dr Karn maheshwari, Dr Jayprakash
More informationVertebral Fragility Fracture
CLINICAL PATHWAY Musculoskeletal Health Vertebral Fragility Fracture Vertebral Fragility Fracture Table of Contents (tap to jump to page) INTRODUCTION 1 Key Points of the Vertebral Fragility Fracture Pathway
More informationDumfries 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 informationA Patient s Guide to Diffuse Idiopathic Skeletal Hyperostosis (DISH)
A Patient s Guide to Diffuse Idiopathic Skeletal Hyperostosis (DISH) 6565 Fannin Street Houston, TX 77030 Phone: 713-790-3333 DISCLAIMER: The information in this booklet is compiled from a variety of sources.
More informationBisphosphonates 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 informationCase Studies: Low Back Pain in the Athlete. Jim Messerly DO
Case Studies: Low Back Pain in the Athlete Jim Messerly DO Nothing to disclose Case #1 History 15 y/o male presents for evaluation of his low back pain. His pain has been present for several months. The
More informationMISSOURI HOSPITALIST
Publisher: MISSOURI SOCIETY MISSOURI Issue 14 February 25, 2009 Division of General IM University of Missouri Columbia, Missouri Editor: Robert Folzenlogen MD Inside this issue: Hospitalist Update Case
More informationRobin R. Dyer, D.O. Associate Dean for Academic Affairs Professor/Chair OMM Department Tulsa, Oklahoma. LBP Prevalence
Robin R. Dyer, D.O. Associate Dean for Academic Affairs Professor/Chair OMM Department Tulsa, Oklahoma LBP Prevalence Approx. 80% adults sometime in their lifetime 2 nd most common pain complaint (headache
More informationInterpreting DEXA Scan and. the New Fracture Risk. Assessment. Algorithm
Interpreting DEXA Scan and the New Fracture Risk Assessment Algorithm Prof. Samir Elbadawy *Osteoporosis affect 30%-40% of women in western countries and almost 15% of men after the age of 50 years. Osteoporosis
More informationBeyond the Break. After Breast Cancer: Osteoporosis in Survivorship. Dr Alexandra Ginty CCFP(EM) FCFP Regional Primary Care Lead CCO
Beyond the Break After Breast Cancer: Osteoporosis in Survivorship Dr Alexandra Ginty CCFP(EM) FCFP Regional Primary Care Lead CCO Disclosures No disclosures Osteoporosis in Breast Cancer Survivorship
More informationPAIN. TREATMENT TABLES Analgesics. NON-OPIOID ANALGESICS Generic Name Trade Names (Examples) Duration Initial Dose
NON-OPIOID SHORT-ACTING LONG-ACTING **** O PAIN TREATMENT TABLES Analgesics NON-OPIOID ANALGESICS Generic Name Trade Names (Examples) Duration Initial Dose Tramadol 50 mg Ultram Every 4 hours 1-2 tabs,
More informationBellwork: Copy the prefixes. Arthr- joint Carp- wrist Costo- ribs Duc- move Flex- bend
Bellwork: Copy the prefixes. Arthr- joint Carp- wrist Costo- ribs Duc- move Flex- bend Myelo- Osteo- Pod- Tars- Meta- bone marrow bone foot ankle beyond The Skeletal System Standards 11) Outline the gross
More informationBone Health for Women: Current Research, Initiatives and Recommendations
Page 1 BONE HEALTH FOR WOMEN: CURRENT RESEARCH, INITIATIVES AND RECOMMENDATIONS Dr. Melissa Kagarise This program has been brought to you by PharmCon PharmCon is accredited by the Accreditation Council
More informationIndex. Rheum Dis Clin N Am 32 (2006) Note: Page numbers of article titles are in boldface type.
Rheum Dis Clin N Am 32 (2006) 775 780 Index Note: Page numbers of article titles are in boldface type. A AACE (American Association of Clinical Endocrinologists), bone mineral density recommendations of,
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 informationEffects of Anti RANK ligand Denosumab on Beta Thalassemia induced osteoporosis
Effects of Anti RANK ligand Denosumab on Beta Thalassemia induced osteoporosis Mohamed Yassin 1 Ashraf T. Soliman2, Mohamed O. Abdelrahman3, Vincenzo De Sanctis 4 Departments of, 1 Hematology 2Pediatric
More informationBone Metastases and Osteoporosis
Diagnosis and Treatment of Patients with Primary and Metastatic Breast Cancer Bone Metastases and Osteoporosis Bone Metastases Version 2002: Dall / Fersis / Friedrich Version 2003 2009: Bischoff / Böhme
More informationQuestions and Answers About Breast Cancer, Bone Metastases, & Treatment-Related Bone Loss. A Publication of The Bone and Cancer Foundation
Questions and Answers About Breast Cancer, Bone Metastases, & Treatment-Related Bone Loss A Publication of The Bone and Cancer Foundation Contents This publication includes important information about
More informationIEHP UM Subcommittee Approved Authorization Guidelines DEXA Scan
Policy: IEHP UM Subcommittee Approved Authorization Guidelines IEHP considers bone mineral density testing using DEXA medically necessary for members who meet any of the following criteria: Women aged
More informationIntractable pain syndrome is defined as persistent pain despite all the reasonable efforts to treat.
Difficult Pain Syndrome/Intractable/Refractory Pain Intractable pain syndrome is defined as persistent pain despite all the reasonable efforts to treat. Reasonable efforts Differs for specialties/regions/countries
More information