The Care Gap. Medical issue Autumn 2016
|
|
- Nora Webb
- 6 years ago
- Views:
Transcription
1 The Care Gap Medical issue Autumn 2016 The Care Gap in Osteoporotic Fracture Management Research Bites: Research Review Surgical Improvements in Osteoporosis Fracture Repair New Sun Exposure Guidelines Osteo-cise Pilot Shows Promise for National Roll-out News Update
2 2 The Care Gap in Osteoporotic Fracture Management: A Disconnect Between Hospital and Primary Care Dr Kirtan Ganda and Professor Markus Seibel Dept of, Concord Repatriation and General Hospital. The University of Sydney. Any osteoporotic fracture predisposes to at least a two-fold risk in further fractures, 1-9 significant morbidity and premature death. 10,11 In a 2009 report of New South Wales hospital admission data from the Agency for Clinical Innovation (ACI), 12 35% of patients with an osteoporotic fracture were re-admitted due to a further fracture over a 6 year period ( ). The re-admissions accounted for 97,347 bed days with an average length of stay of 22 days. However, this figure was most likely an under-estimate as the data only recorded re-fracture admissions to the same hospital as the index fracture. For over two decades, we have known that the timely diagnosis and optimal treatment of osteoporosis prevents further fractures by up to 70% in these people. By now, several safe and effective medications are available and all osteoporosis guidelines recommend long-term treatment for people who have sustained a minimal trauma fracture However, the international literature provides ample proof that the majority (i.e %) of patients presenting with a minimal trauma fracture to their GP or hospital are neither assessed for osteoporosis, nor appropriately managed to prevent further fractures This is highlighted in by two large retrospective studies of primary care practice in Australia, which demonstrated less than one-third of patients presenting with a minimal trauma fracture receive specific osteoporosis pharmaco-therapy. 32,33 Thus, in Australia and internationally, there is a disconnect between the initial fracture repair (which usually happens in hospital) and the subsequent assessment and management of the underlying disease (osteoporosis) in General Practice. In response to this dire situation, a number of systematic interventions have been developed, ranging from education of patients and physicians to interventions that coordinate osteoporosis education, assessment and treatment in an all-encompassing service, known as a Fracture Liaison Service WelCOMe This autumn issue of Osteoblast covers a number of important aspects of osteoporosis care. Prof Chehade s review on surgical improvements in fixing osteoporosis fractures updates you on the newest developments in fracture repair. It is great to see how this area has changed over the past few years, much to the benefit of our patients. While we are really good at fixing osteoporotic fractures, we are much less effective in managing those patients once they have left hospital. In fact, both in Australia and overseas (with the exception of a few countries such as New Zealand and the UK), we are still looking at a wide care gap in osteoporosis management. As reviewed by my colleague Dr Kirtan Ganda, up to 85% of patients with an incident osteoporotic fracture go undiagnosed and untreated and 50% of these will fracture again. This untenable situation needs to change if we ever want to break the costly epidemic of fragility fractures in Australia. Prof Markus Seibel
3 3 The Care Gap in Osteoporotic Fracture Management: A Disconnect Between Hospital and Primary Care (Cont.)...there is a disconnect between initial fracture repair and the subsequent assessment and management of the underlying disease (osteoporosis)... (FLS) or Secondary Fracture Prevention (SFP) program. These programs have demonstrated that systematic, comprehensive interventions generate direct clinical benefits 34 and are highly cost-effective. 35,36 There are a number of factors that contribute to the under-investigation and under-treatment of osteoporosis. Individual barriers include a lack of awareness and understanding amongst patients and doctors of the heightened risk of further fractures following a first fracture. Also, the significant benefits and the excellent safety profile of osteoporosis pharmacotherapy often go unrecognised. Patients are often misinformed of medication side effects and benefits. There is ample, high quality evidence from randomised placebo-controlled trials that antiresorptive agents (e.g., risedronate, alendronate, zoledronic acid, denosumab) and teriparatide (a bone forming drug) reduce the relative risk of fracture by 30 to 70%. Of note, data from these trials demonstrate greater risk reduction for vertebral (50-70%) than for non-vertebral fractures (30-40%). These agents thus have robust efficacy data, which undoubtedly outweighs the rare risk of osteonecrosis of the jaw or atypical femoral shaft fractures, which occur at a rate of 1 in 10,000 to 100,000 patient years. Another common misconception is that treatment for osteoporosis after a minimal trauma fracture is only required if the DEXA scan reveals a bone mineral density in the osteoporotic range. However, once a person has sustained a minimal trauma fracture, treatment should be considered independent of bone mineral density as these patients are at high risk of subsequent fracture. This is reflected in the PBS rules: Once a prevalent or incident minimal trauma fracture has been identified, a BMD scan or T-score is NOT required for a patient to qualify for subsidised treatment. Many healthcare professionals are hesitant to initiate treatment or to change management in response to the sentinel event of a new osteoporotic fracture. Also, the responsibility for post-fracture care often gets diluted between several health care professionals, whether it is the primary care physician, orthopaedic surgeon or specialist physician. As a result the patient more often than not gets lost due to lack of post-fracture care coordination. In summary, the post-fracture care gap represents a systemic failure of disconnect between the hospital and general practice. The osteoporotic fracture is repaired in the hospital setting, yet there is no attempt to prevent the next fracture through osteoporosis assessment and treatment. Although there is strong trial evidence of anti-fracture efficacy with osteoporosis pharmacotherapy, in the majority of patients this evidence is not being translated into current clinical practice. In order to close this care gap, it is necessary to reconnect the acute fracture care in hospital and post-fracture osteoporosis management in the primary care setting. Secondary Fracture Prevention programs are ideally placed to bridge the gap but these programs need to be established in both hospitals and primary care. Such targeted and coordinated programs for the identification, assessment and treatment of patients with minimal trauma fracture provide an effective vehicle to deliver best evidence into clinical practice. References available upon request.
4 4 researchbites Research Review by Dr Lisa Croucher (OA Scientific Advisor) New IOF report caution against automatic drug holidays for osteoporosis An editorial published by the International Osteoporosis Foundation (IOF) argues against the growing movement towards drug holidays for osteoporosis, instead urging doctors to make treatment decisions based on individual fracture risk. 1 Concerns around links between long-term bisphosphonate use and osteonecrosis of the jaw (ONJ) and atypical femoral fracture (AFF) have been compounded by recent media focus on reports that imply over-use of bisphosphonates. Clinical trial outcomes in recent years indicate the importance of basing treatment decisions on individual fracture risk. An extension of the Fracture Intervention Trial (FLEX) demonstrated a significant increase in vertebral fractures after 5 years discontinuation of alendronate, compared to women who continued therapy for 10 years, 2 indicating benefit of continuing therapy in women at high risk of vertebral fractures. Similarly, the HORIZON trial showed continued reduction in vertebral fracture risk with annual zoledronic infusions over 6 years, compared to those who stopped after 3 years. 3 Discussion around the need for a drug holiday has been fuelled recently by fears of rare side effects. In reality, the incidence of ONJ and AFF is extremely low at the therapeutic doses used for osteoporosis. The American Society for Bone and Mineral Research (ASBMR) estimates ONJ incidence at between 1 in 10,000 and less than 100,000 patient-treatment years. The incidence of AFF is estimated to be between 2 in 100,000 after 2 years and 78 in 100,000 after 8 years exposure. Taking into account the substantial morbidity and mortality associated with vertebral fractures, the benefits of bisphosphonate therapy clearly outweigh the risks in women at high risk of fracture. The IOF also points out that adherence to bisphosphonates is low clinicians may be making a bad situation worse by stopping treatment in the low numbers who actually take their medication. The IOF stops short of making clear recommendations, but states that decisions should be based on individual fracture risk. Osteoporosis Australia s Medical and Scientific Committee is broadly in agreement with recent recommendations from a respected US-based group: 4 T-score worse than -2.5 at the femoral neck after 3-5 years treatment: continue bisphosphonate treatment (highest risk of vertebral fracture) T-score worse than -2.0 in a patient with a previous vertebral or hip fracture: likely to benefit from continued treatment T-score better than -2.5 at the femoral neck in a patient without prior vertebral or hip fracture: unlikely to benefit from continued treatment (low risk of vertebral fracture). There is much confusion around best practice, with little global consensus. Long-term trial data is scant and limited to postmenopausal women. More research is needed, in particular on how patients on drug holidays should be monitored and when to re-commence treatment. In the meantime, it s important for both clinicians and patients to remember that AFF and ONJ are extremely rare, but hip and spinal fractures are common and a major cause of disability and early death. The benefits of long-term bisphosphonate therapy for women at moderate to high risk of fracture far outweigh the risks. References available upon request. YOu re invited to attend the THE Annual & Children s WomEn s HEalTH update 2O16 One-day seminar expert speakers practical information AdelAide: 14 May BrisBAne: 23 JUL register at healthed.com.au ^ Perth: 13 aug
5 5 Medical ISSUE AUTUMN 2016 Surgical Improvements in Osteoporosis Fracture Repair Associate Professor Mellick J Chehade Orthopaedic Trauma Surgery, Research and Education, University of Adelaide Many endocrine diseases are lifestyle based and becoming more prevalent as the population ages. Written and peer reviewed by experts, provides all the knowledge you need to keep up to date. APRIL 2015 VOL 4 NO 2 FEATURES FEATURES There have been several areas in which advances have been made with the goal of improving outcomes. In addition to technical developments with surgical implants and techniques, there is a requirement for improved system approaches including improved perioperative assessement, quicker time to surgery and orthogeriatric models of care.2 Large anthropological studies have also allowed anatomical shaping of plates and associated targeting devices for less invasive surgery and to direct screws into predetermined parts of the stronger subchondral bone closer to joints. The poor quality and porous nature of osteoporotic bone leads to major fixation challenges for both repair and replacement options. Importantly the poor bone is often associated with a poor host in terms of cognitive function, medical comorbidities, frailty and sarcopenia all of which impact not only on perioperative management but rehabilitation potential. Surgical approaches have to be aimed at restoration of function sufficient to allow immediate mobility including unrestricted weight bearing as mobility restrictions are very poorly tolerated and lead to a cascade of further problems which contribute to the high morbidity and mortality in this cohort. Modern trends in managing hypertension in diabetes Statins and dysglycaemia Sleep apnoea and diabetes: common bedfellows Detecting diabetic peripheral neuropathy Managing diabetic ketoacidosis Hypopituitarism: new causes, reducing complications ACUTE PRESENTATIONS IN GENERAL PRACTICE Diabetes and heart disease INVESTIGATIONS IN ENDOCRINOLOGY Investigating thyroid function in pregnancy Reducing the future risk of diabetic retinopathy Identifying and managing diabetes distress Klinefelter s syndrome Limitations of blood glucose monitoring A too often overlooked diagnosis Type 2 diabesity ET_Feb Cover-with cover linesml_v4.indd /02/15 12:49 PM Special edition Focus on diabetes ACUTE PRESENTATIONS Hyperosmolar type 2 diabetes INVESTIGATIONS Investigating diabetes in Indigenous communities Cover_May ET_New_HR-ML.indd 400 7/05/ :09 pm JULY 2015 VOL 4 NO 4 OCTOBER 2015 VOL 4 NO 5 FEATURE Caring for the elderly with diabetes in institutions FEATURE Safe perioperative diabetes management Staging strategies for individualised care Sex hormone prescribing in postmenopausal women Bone failure or osteoporosis: what s in a name? Addressing vascular risk factors in diabetes INVESTIGATIONS Investigating new diabetes in young adults ACUTE PRESENTATIONS Managing an acute case of Addison s disease Congenital adrenal hyperplasia INVESTIGATIONS Investigating hyperprolactinaemia ACUTE PRESENTATIONS A possible case of testosterone deficiency Diabetes and mental illness Testosterone replacement therapy and diabetes Absolute fracture risk: what it means for your patient Polycystic ovarian syndrome A multifaceted disorder CASE STUDY A case of osteosclerosis INVESTIGATIONS When to investigate weight gain ACUTE PRESENTATION An elderly woman with muscle cramps and tingling Management strategies in children and adults ET_Cover_July_MM_2.indd 400 ET_Cover_April-MM.indd 400 3/07/ :32 am ET_Cover_Oct_ML_2-JS.indd /09/ :52 am 10/04/15 11:26 AM Complimentary for GPs. Don't miss an issue. Register at: Association National Joint Replacement Registry is providing high 4 levelad.indd evidence Osteoporosis_ET 13 for best practice. Techniques to improve the quality of bone fixation by addressing New surgical approaches that limit collateral surgical damage the bone deficiencies have also improved. Bone augmentation and preserve biological healing potential such a fragment specific may be achieved using autograft, allograft, synthetic bone or approaches are also contributing to improved outcomes.5 cementing techniques. Hip fixation has also changed with the evolution of intramedullary Aftercare Finally, essential to long-term success is multidisciplinary integrated nails increasingly replacing the dynamic hip screw. Inserted care and follow-up for ongoing and sustained rehabilitation, bone percutaneously, they provide more reliable fixation with health and falls assessment and secondary fracture prevention.6 less fracture collapse and more anatomical healing whilst allowing unrestricted weight bearing for the more unstable fracture patterns.3 Arthroplasty is used for fractures around joints not suitable for repair (too damaged to be fixed or require too long a delay in mobilisation). This is more commonly performed acutely for hip (hemi and total joint replacements) and shoulder fractures (hemi and reverse total), but also knee and elbow arthroplasty. The successful implementation of the Australian Orthopaedic References available upon request. Conventional plate Screws in tension Compression at fracture site Plate-bone friction Screw interface loosening Locking plate Screws in shear Plate-bone gap No compression screw loosening Technical Advances The approach in most fractures is surgical repair which relies on the interplay between fixation device, bone properties and patient s capacity for rehabilitation. Inability to restrict load Minimising complications in young people with type 1 diabetes Cushing s syndrome versus simple obesity FEATURE necessitates solid initial fixation. Ongoing developments in locking plate technologies have significantly improved the surgeon s ability to achieve solid fixation in many osteoporotic fractures, particularly around the wrist and proximal humerus where the risk of screw cut out and fixation failure are high. Essentially the head of the screw is designed to lock directly into the plate creating a fixed angle device with improved bone fixation. Traditional fixation relies on a better screw purchase to compress the plate to the bone with the screw head that is otherwise free to toggle in the plate hole (Figure 1). MAY 2015 VOL 4 NO 3 Diagnosing Addison s disease Palliative care for people with diabetes Background The burden on our society and hospital system from osteoporosis related fractures is high. There were 60,530 reported hospitalisations in for a principal diagnosis of minimal trauma fracture including the hip (31.2%), forearm (15.7%), lumbar spine and pelvis (12.3%). The actual number is far greater with many either not requiring hospitalisation (eg spine) or unrecorded at discharge. Hip fractures increased 18.4% in 10 years.1 With the challenges on subacute geriatric/ rehabilitation resources, this also blocks acute hospital beds. FEBRUARY 2015 VOL 4 NO 1 18/09/
6 DXA as easy as ABC. When choosing DXA for BMD, sometimes your patients may also benefit from VFA, TBS or AFF assessments. Hologic systems offer the flexibility to do them all, regardless of your patient s BMI, with razor sharp images and scans that are almost as quick as 1,2,3. To find an imaging centre offering Hologic DXA call Powerful images. Clear answers. TBS (Trabecular Bone Score) AFF (Atypical Femoral Fracture) VFA (Vertebral Fracture Assessment) 2016 Hologic, Inc. All rights reserved. Hologic and associated logos are trademarks and/or registered trademarks of Hologic, Inc. and/or its subsidiaries in the United States and/or other countries. This information is intended for medical professionals in the U.S. and other markets and is not intended as a product solicitation or promotion where such activities are prohibited. Hologic (Australia) Pty Ltd, Level 4, 2 4 Lyon Park Rd, Macquarie Park NSW Tel ABN SM. DXA0001.
7 7 New Sun Exposure Guidelines Peak national bodies, including Osteoporosis Australia, have collaborated to release new recommendations for balancing sun exposure and vitamin D intake in an effort to reduce the risk of skin cancer, while maintaining adequate vitamin D levels. In addition to Osteoporosis Australia, the recommendations have been jointly published by Cancer Council Australia, the Australasian College of Dermatologists, the Australian and New Zealand Bone and Mineral Society and the Endocrine Society of Australia. The Cancer Council s latest national survey found that almost a quarter of those surveyed had been advised by their doctor to get more vitamin D. However, the experts agree that adequate vitamin D can be obtained without risking skin cancer due to harmful UV exposure. The recommendations state that if the UV level is below 3, then sun protection is not required. During summer, when the UV index is above 3 in all of Australia, most people can obtain sufficient vitamin D going about their daily activities and sun protection should be used if outside for an extended period of time. During winter, vitamin D levels are traditionally very low for most Australians. The experts have recommended that during winter, time is spent outdoors when the UV index is below 3 without sun protection. This will ensure that sufficient vitamin D can be maintained for bone health. Some patients are considered at higher risk of vitamin D deficiency, including those who are naturally very dark skinned; avoid sun exposure because of a high risk of skin cancer; are frail and/or elderly, chronically ill or institutionalised and live largely indoors; take particular medications; have conditions causing poor absorption of calcium and vitamin D; or cover up for religious or cultural reasons. For these patients, if they cannot obtain sufficient vitamin D, then a supplement may be required if appropriate. Patients can check the UV index with the SunSmart app: cancer.org.au/sunsmartapp or visit Osteo-cise Pilot Shows Promise for National Roll-out Osteoporosis Australia s preventative exercise program, Osteo-cise: Strong Bones for Life, has just completed a pilot implementation in community fitness centres. Osteo-cise is a research and evidence based multi-modal community program designed to improve musculoskeletal health and functional capacity in the over 50s. Crucially, the program incorporates exercise specificity and progressive overload, targeting the muscles of the hip, spine and wrist. 38 trainers took part in practical workshops in 3 states, and over 300 fitness centre clients participated in the pilot. An unexpected but highly encouraging finding was the adaptability of Osteo-cise and its capacity for integration into established disease-specific exercise programs for the over 50s. Recognising the potential of Osteo-cise to expand from its bonespecific foundation to address the multiple chronic disease priorities of the over 50s population, Osteoporosis Australia is seeking government support for a major re-development and national roll-out of Osteo-cise. The new program will include a web-based self-directed program for consumers, and the creation of GP referral pathways will be a significant feature. If support is granted, the new program is expected to launch in early 2018.
8 8 NEWS UPDATE Resistance Training in the Spotlight Osteoporosis Australia supported Fernwood Gyms launch of Lift the Nation in February to highlight the importance of resistance training for health. In terms of bone health resistance training must be done at high intensity to have a benefit and combined with weight bearing exercise as part of a regular exercise program. Fernwood gyms will be open for free from June as part of the initiative. Osteoporosis Australia biodensity Equipment Award The Osteoporosis Australia biodensity Equipment Award was awarded to Professor Belinda Beck from Griffith University QLD. Her study will endeavour to determine how the biodensity system can stimulate stronger bones in people who have low bone density. The results for this group will be compared to the results from a group who completed more conventional exercises. Prof Belinda Beck Griffith University QLD Free and Flexible Active Learning Module (alm) for GP s Do you need additional CPD Points? Our online ALM, hosted by ThinkGP is free and flexible. The ALM provides the details you need to effectively treat and manage osteoporosis and fracture risk as well as provide key bone-health information to at-risk patients. Accreditation includes 40 CPD Points with RACGP or 30 CPD Points for ACRRM. Register today at Astronauts and Bedridden Patients Share Something in Common: Progressive Bone Loss According to NASA, astronauts who spend many months on a space mission can lose, on average, 1 to 2 per cent of bone mass each month. They typically experience bone loss in the lower halves of their bodies, particularly in the vertebrae and the leg bones. The proximal femoral bone loses 1.5 percent of its mass per month, or roughly 10 percent over a sixmonth stay in space, with the recovery after returning to Earth taking at least three or four years. The loss of bone mass also triggers a rise in calcium levels in the blood, which increases the risk of kidney stones. To help overcome the effects of bone loss while in orbit, astronauts have to engage in physical exercise for two and a half hours a day, six times a week during their stay in space. Although this does not completely eliminate the risk of bone loss, it does help to reduce it. Other studies are underway to investigate how to combat this issue. Patients who remain immobile in bed over longer periods of time also experience rapid and progressive bone loss. Studies with terranauts (healthy, young Earth-bound volunteers who lie flat without exercising for extended periods of time) have shown that completely immobilised bones can lose up to 15% of mineral density within three months. For ordinary Earth-bound people the message is exercise and bone maintenance are inextricably linked. Source: IOF News MediCAL ISSUE Autumn 2016 Medical Editor: Prof Markus Seibel Editorial: Melita Daru Jessica Wilkinson Advertising: Melita Daru Osteoblast is a publication of: Osteoporosis Australia ABN PO Box 550 Broadway NSW 2007 National office National hotline Copyright Osteoporosis Australia Except as provided by the Copyright Act 1968, no part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means without the prior written permission of the publisher. Resources for General Practice Information and resources for general practice can be accessed online in the GP section of the Osteoporosis Australia website, located under the Healthcare Professional section.
Know Your Bones. Know Your Bones Launches Nationally Treatment Adherence and Fracture Risk Reduction News Update
Know Your Bones Know Your Bones Launches Nationally Treatment Adherence and Fracture Risk Reduction News Update Medical issue special edition 2016 2 Know Your Bones Launches Nationally Osteoporosis Australia
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 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 informationAll about. Osteoporosis
All about Osteoporosis What is osteoporosis? Osteoporosis literally means porous bone. It is a condition that causes bones to become thin and fragile, decreasing bone strength and making them more prone
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: 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 informationReal Men Build Their Strength From Within
Real Men Build Their Strength From Within The State of Men s Bone Health Research Bites: Research Review by Dr Lisa Croucher Hypogonadism and Osteoporosis Latest Research Awards Healthy Bones Australia:
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 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 informationSCHEDULE 2 THE SERVICES. A. Service Specifications
SCHEDULE 2 THE SERVICES A. Service Specifications Service Specification No. 04/MSKT/0013 Service PAN DORSET FRACTURE LIAISON SERVICE Commissioner Lead CCP for Musculoskeletal & Trauma Provider Lead Deputy
More informationAn audit of osteoporotic patients in an Australian general practice
professional Darren Parker An audit of osteoporotic patients in an Australian general practice Background Osteoporosis is a major contributor to morbidity and mortality in Australia, and is predicted to
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 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 informationFragility Fracture Network - FFN
Fragility Fracture Network - FFN A Global Multidisciplinary Network to Improve Fragility Fracture Management and Prevention Ami Hommel RN, CNS, PhD, Associate Professor Lund University & Skane university
More informationIMPROVING BONE HEALTH AND FRACTURE PREVENTION
IMPROVING BONE HEALTH AND FRACTURE PREVENTION Helen Ridley, Programme Lead, North East & North Cumbria Academic Health Science Network NORTH EAST REGION 2014/15 AHSN Single Sponsored Project Hadrian Primary
More informationNew Osteoporosis Guidelines
New Osteoporosis Guidelines New Osteoporosis Guidelines Released to Help Improve Australia s Bone Health Research Bites: DXA Rates in Men Still Falling Significantly Behind Women Vitamin D and Bone Health
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 informationBONIVA (ibandronate sodium)
BONIVA (ibandronate sodium) Non-Discrimination Statement and Multi-Language Interpreter Services information are located at the end of this document. Coverage for services, procedures, medical devices
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 informationModule 5 - Speaking of Bones Osteoporosis For Health Professionals: Fracture Risk Assessment. William D. Leslie, MD MSc FRCPC
Module 5 - Speaking of Bones Osteoporosis For Health Professionals: Fracture Risk Assessment William D. Leslie, MD MSc FRCPC Case #1 Age 53: 3 years post-menopause Has always enjoyed excellent health with
More 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 informationPage 1
Osteoporosis Osteoporosis is a condition characterised by weakened bones that fracture easily. After menopause many women are at risk of developing osteoporosis. Peak bone mass is usually reached during
More informationDisclosures. Diagnostic Challenges in Osteoporosis: Whom To Treat 9/25/2014
Disclosures Diagnostic Challenges in Osteoporosis: Whom To Treat Ethel S. Siris, MD Columbia University Medical Center New York, NY Consultant on scientific issues for: AgNovos Amgen Eli Lilly Merck Novartis
More informationHorizon Scanning Centre March Denosumab for glucocorticoidinduced SUMMARY NIHR HSC ID: 6329
Horizon Scanning Centre March 2014 Denosumab for glucocorticoidinduced osteoporosis SUMMARY NIHR HSC ID: 6329 This briefing is based on information available at the time of research and a limited literature
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 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 informationAOTrauma Course Fragility Fractures and Orthogeriatrics
Thursday, 22 Oct 2015 (Day 1) 09:00 09:30 Other REGISTATION AND WELCOME COFFEE Sokos Hotel Viru, Bolero venue 30 09:30 12:25 Module 1: The Geriatric Patient and Fracture 175 09:30 09:50 Lecture The Morbidity
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 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 informationTaking Bone Health Seriously
Taking Bone Health Seriously Medical issue Autumn 2014 New Report reveals Australia s Poor Bone Health Research Bites: Research Review by Dr Lisa Croucher Patient Case Study: Doctors Comment on Patient
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 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 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 informationGuidelines to standards. Orthogeriatrics How The UK Care For Fragility Fractures
Guidelines to standards Orthogeriatrics How The UK Care For Fragility Fractures Karen Hertz-SOTN Advanced Nurse Practitioner The NHFD Project - jointly led by BOA and BGS with the involvement of the RCN
More informationTitle: From zero to comprehensive Fracture Liaison service (FLS) within existing resources
Best of Health Staff Awards 2010/11 Best of Health Awards 2013 Dr Abhaya Gupta Consultant Physician Hywel Dda Health Board Title: From zero to comprehensive Fracture Liaison service (FLS) within existing
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 informationOsteoporosis. Treatment of a Silently Developing Disease
Osteoporosis Treatment of a Silently Developing Disease Marc K. Drezner, MD Senior Associate Dean Emeritus Professor of Medicine Emeritus University of Wisconsin-Madison Auditorium The Forest at Duke October
More informationBEST PRACTICE FRAMEWORK QUESTIONNAIRE
CAPTURE the FRACTURE BEST PRACTICE FRAMEWORK QUESTIONNAIRE INTRODUCTION Capture the Fracture invites Fracture Liaison Services (FLS) to apply for Capture the Fracture Best Practice Recognition programme.
More informationBone density scanning and osteoporosis
Bone density scanning and osteoporosis What is osteoporosis? Osteoporosis occurs when the struts which make up the mesh-like structure within bones become thin causing them to become fragile and break
More informationOsteoporosis The Silent Disease
Joel Johnson, Yr, Subtask, Biology ER., 7/9/5 Osteoporosis The Silent Disease What is Osteoporosis? Osteoporosis is a disease which causes bones to become brittle, which increases the risk of broken bones.
More informationMen 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 informationClosing the Care Gap in Osteoporosis ICE Conference 2015
Closing the Care Gap in Osteoporosis ICE Conference 2015 Pat McCarthy-Briggs RD, MHEd Thank You! What is osteoporosis? a systemic skeletal disease characterized by low bone mass and microarchitectural
More 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 informationWHAT NONPHYSICIAN PROVIDERS CAN DO FOR YOUR FRAGILITY FRACTURE SERVICE
WHAT NONPHYSICIAN PROVIDERS CAN DO FOR YOUR FRAGILITY FRACTURE SERVICE Debra L. Sietsema, PhD, RN October 7, 2016 OTA Meeting 1 Disclosures Speaker and Consultant: Lilly USA Committee Member: AOA Own the
More informationNSW Osteoporotic Refracture Prevention Services
NSW Osteoporotic Refracture Prevention Services Ms Julia Thompson, Musculoskeletal Network Manager, Agency for Clinical Innovation A/Prof Rory Clifton-Bligh, Endocrinology Head of Department, Royal North
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 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 informationnice bulletin NICE provided the content for this booklet which is independent of any company or product advertised
nice bulletin NICE provided the content for this booklet which is independent of any company or product advertised nice bulletin Welcome In August 2012, the National Institute for Health and Clinical Excellence
More informationAdministration of Denosumab (PROLIA ) for the treatment of osteoporosis in postmenopausal women and in men at increased risk of fractures
Administration of Denosumab (PROLIA ) for the treatment of osteoporosis in postmenopausal women and in men at increased risk of fractures 2017 18 1. Purpose of Agreement This agreement outlines the expectations
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 informationA JOINT INITIATIVE FOR FRACTURE PREVENTION. Know Your Bones Community Risk Report October 2018
A JOINT INITIATIVE FOR FRACTURE PREVENTION Forewords Greg Lyubomirsky CEO Osteoporosis Australia 1 Know Your Bones was developed to help Australians understand their risk of poor bone health and discuss
More informationUnderstanding Osteoporosis
Understanding Osteoporosis Professor Juliet E. Compston Published by Family Doctor Publications Limited in association with the British Medical Association IMPORTANT NOTICE This book is intended not as
More informationThe NOF & NBHA Quality Improvement Registry
In collaboration with CECity The NOF & NBHA Quality Improvement Registry This registry is approved by CMS as a Qualified Clinical Data Registry (QCDR) for Eligible Professionals and GPRO Practices for
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 informationOsteoporosis. Definition
Osteoporosis Definition Osteoporosis causes bones to become weak and brittle so brittle that a fall or even mild stresses like bending over or coughing can cause a fracture. Osteoporosis-related fractures
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 informationHip Fracture (HFR) Measures Document
Hip Fracture (HFR) Measures Document HFR Version: 2 - covering patients discharged between 01/10/2017 and present. Programme Lead: Sam Doddridge Clinical Leads: Ms Phil Thorpe Dr John Tsang Number of Measures
More information1231 Zoledronic acid in early breast cancer Page 1 of 5
Zoledronic acid in early breast cancer Zoledronic acid in early breast cancer Zoledronic acid is a bisphosphonate. This is treatment which works by slowing down the rate of bone change. In the bone there
More informationThe 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 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 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 informationPathway from Fracture or Risk Factor to Treatment
Appendix 6A - Guidance on Diagnosis and Management of Osteoporosis Pathway from Fracture or Risk Factor to Treatment Fragility Fracture = fracture sustained from a low energy fall from standing height
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 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 informationSummary 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 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 informationMy hip fracture care: 12 questions to ask A guide for patients, their families and carers
My hip fracture care: 12 questions to ask A guide for patients, their families and carers About this guide This guide is aimed at patients who have a hip fracture, and their families and carers. It explains
More informationProlia 2 shots a year proven to help strengthen bones. next shot appointment
Ask your doctor if Prolia (denosumab) is right for you and visit us at www.prolia.com next shot appointment For women with postmenopausal osteoporosis at high risk for fracture: there s Prolia. Prolia
More informationOsteoporosis/Fracture Prevention Clinician Guide SEPTEMBER 2017
Kaiser Permanente National CLINICAL PRACTICE GUIDELINES Osteoporosis/Fracture Prevention Clinician Guide SEPTEMBER 2017 Introduction This Clinician Guide was developed to assist Primary Care physicians
More informationProlia 2 shots a year proven to help strengthen bones.
Ask your doctor if Prolia (denosumab) is right for you and visit us at www.prolia.com For women with postmenopausal osteoporosis at high risk for fracture: there s Prolia. Prolia 2 shots a year proven
More informationBuilding Bone Density-Research Issues
Building Bone Density-Research Issues Helping to Regain Bone Density QUESTION 1 What are the symptoms of Osteoporosis? Who is at risk? Symptoms Bone Fractures Osteoporosis 1,500,000 fractures a year Kyphosis
More 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 informationNurse to Nurse Hospital or Hiking: You choose
Nurse to Nurse Hospital or Hiking: You choose 24TH BIENNIAL PRNABC CONFERENCE GWEN ELLERT, MEd, RN HEALTH CARE EDUCATOR TRELLE ENTERPRISES INC. MAY 8, 2014 You will learn Osteoarthritis (OA): how to assess
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 informationFRiSCy Oxford Fracture Prevention Service
FRiSCy Oxford Fracture Prevention Service MK Javaid Lecturer in Metabolic Bone Disease, University of Oxford Hon Consultant Rheumatologist, Nuffield Orthopaedic Centre Lead Clinician for FRiSCy Declaration
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 informationFixation in osteoporotic bone. Jeppe Barckman Ortopædkirugisk afd. Aarhus Universitetshospital
Fixation in osteoporotic bone Jeppe Barckman Ortopædkirugisk afd. Aarhus Universitetshospital Objective Highlight current principles of fixation for osteoporotic fractures Woman 75 year Who to fix? The
More informationSubmission to the National Institute for Clinical Excellence on
Submission to the National Institute for Clinical Excellence on Strontium ranelate for the prevention of osteoporotic fractures in postmenopausal women with osteoporosis by The Society for Endocrinology
More informationdenosumab (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 informationBased 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 informationTYMLOS (abaloparatide)
TYMLOS (abaloparatide) Non-Discrimination Statement and Multi-Language Interpreter Services information are located at the end of this document. Coverage for services, procedures, medical devices and drugs
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 informationAROC Outcome Targets Report Inpatient Pathway 3
AROC Outcome Targets Report Inpatient Pathway 3 Anywhere Hospital January 2013 December 2013 Australasian Faculty of Rehabilitation Medicine AROC impairment specific benchmarking process...3 Introducing
More informationSCORECARD Questionnaire September 2012
Introduction SCORECARD Questionnaire September 2012 The Osteoporosis Advisory Panel is an independent project chaired by our president Professor John Kanis, supported by a multi-stakeholder group of experts
More informationOsteoporosis Update: Keys to Improving Diagnosis and Preventing Fractures
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/spotlight-on/osteoporosis-update-keys-improving-diagnosis-preventingfractures/9812/
More informationEU Osteoporosis Report SWEDEN
EU Osteoporosis Report 2007-2008 SWEDEN Completed by: Kristina Åkesson, Bone & Joint Decade Eva Waern, Andreas Kindmark, Caroline Åkerhielm Swedish Rheumatism Association OVERVIEW 2001-2005 2007 Ref: Osteoporosis
More informationSt Leonards Physiotherapy February Newsletter
St Leonards Physiotherapy February Newsletter St Leonards Physiotherapy would like to wish all of our current and past clients a happy new year. We look forward to helping your body move the best it can
More informationUNDERSTANDING FRACTURE CARE CAUSES, DIAGNOSIS, AND TREATMENT
UNDERSTANDING FRACTURE CARE CAUSES, DIAGNOSIS, AND TREATMENT PremierOrtho.com UNDERSTANDING FRACTURE CARE CAUSES, DIAGNOSIS, AND TREATMENT Table of Contents Introduction...3 Causes...4 Who s at Risk?...5
More informationOsteoporosis Update. Case 2. Case 1: Monday morning, 8:15
Osteoporosis Update Laura E. Ryan, MD Assistant Director for Special Programs Center for Women s Health Clinical Assistant Professor of Medicine Division of Endocrinology, Diabetes and Metabolism The Ohio
More informationnogg Guideline for the diagnosis and management of osteoporosis in postmenopausal women and men from the age of 50 years in the UK
nogg NATIONAL OSTEOPOROSIS GUIDELINE GROUP Guideline for the diagnosis and management of osteoporosis in postmenopausal women and men from the age of 50 years in the UK Produced by J Compston, A Cooper,
More informationHelpful information about bone health & osteoporosis Patient Resource
Helpful information about bone health & osteoporosis Patient Resource Every year In the United States, 2.5 million fractures occur due to osteoporosis. Out of these, 330,000 are hip fractures, and half
More informationHIV and your Bones Osteopenia and Osteoporosis
Osteopenia and Osteoporosis Background information For reasons not yet fully understood, higher rates of bone disease are starting to be seen in people living with HIV. These bone diseases include osteopenia
More informationInterventions to reduce emergency hospital admissions for falls. Cath Lewis. Liverpool Public Health Observatory
Interventions to reduce emergency hospital admissions for falls Cath Lewis Liverpool Public Health Observatory Observatory Report Series number 81 clewis@liverpool.ac.uk January 2010 ACKNOWLEDGEMENTS Fran
More informationOsteoporosis: fragility fracture risk. Costing report. Implementing NICE guidance
Osteoporosis: fragility fracture risk Costing report Implementing NICE guidance August 2012 NICE clinical guideline 146 1 of 15 This costing report accompanies the clinical guideline: Osteoporosis: assessing
More informationTHE SCOTTISH ENHANCED SERVICES PROGRAMME FOR PRIMARY AND COMMUNITY CARE ( ) Falls Prevention and Bone Health Service Specification
THE SCOTTISH ENHANCED SERVICES PROGRAMME FOR PRIMARY AND COMMUNITY CARE (2007-2009) Falls Prevention and Bone Health Service Specification Rationale The Delivery Framework for Adult Rehabilitation and
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 informationTechnology appraisal guidance Published: 9 August 2017 nice.org.uk/guidance/ta464
Bisphosphonates for treating osteoporosis Technology appraisal guidance Published: 9 August 2017 nice.org.uk/guidance/ta464 NICE 2017. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).
More informationTamer Mettyas 1* and Clare Carpenter 2
Mettyas and Carpenter Journal of Orthopaedic Surgery and Research 2013, 8:44 RESEARCH ARTICLE Open Access Secondary prevention of osteoporosis in non-neck of femur fragility : is it value for money? A
More informationCarolinas HealthCare System Fragility Fracture Program
Carolinas HealthCare System Fragility Fracture Program Presented By: Monica C. Mowry, MSN, RN, NE-BC, ONC Director, Clinical Program Development Carolinas HealthCare System Charlotte, NC Objectives Expand
More informationGuidelines 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