BMD,DEXA, Osteoporosis, FRAX, Osteopenia, Cost effective, Drug treatment, Hip fractures, T-score.

1. Osteoporosis More questions than answers Vinod Naneria Consultant orthopaedic surgeon Choithram Hospital & Research Centre Indore , India

12. HOPE SELLING

20. Do you know? Do you know what is your T – Score? Take one minute test! Do you know what are your chances of getting fractures in next 10 years? Go online FRAX site! For Treatment consult your physician or your “ Osteoporosis Society ”

21. Do you know your...Blood pressure? Cholesterol level? Weight? T-score? http://www.usbjd.org/projects/Fit2aT_op.cfm Program especially aimed at men and women in mid-40s to late 60s

24. 25 15 35 40 30 40 35 35 25 30 25 30 20 20 40 The global median age 2010 Be scared of 2050 Hip fractures in USA, Europe, & Oceania – 57% in the year 1990 Hip fractures in Asia, Africa, and South America will be 71% in 2050

25. Percentage of aging population of world 2010 <5% 9% 14% >15% >15% Be scared of 2050 Osteoporosis affects 75 million people in Europe, Japan and USA, and causes 2.3 million fractures annually in Europe and the USA alone.

26. Aging population of the world Look at Europe

27. Sex ratio of population aged over 65 years per country (2006 CIA World Fact book) smooth scale from blue to red: Blue: below 0.39 males/female White: 0.79 males/female (World) Red: above 1.29 males/female (Grey: no data) Male / Female ratio in world population

43. How Big Is ASIA

46. Disease expands through marriage of marketing and machines A sidewalk sign at Kelley-Ross Pharmacy in Seattle advertises bone-density screening. Such screening has proliferated in recent years, targeting younger, healthier people. BETTY UDESEN / THE SEATTLE TIMES

62. A fall to the side increases the risk of hip fracture by about 6 times, compared to falls in other directions.

64. Go for BMD Go for FRAX One minute test Fracture Index Absolute fracture risk 13 seconds to complete &quot;up and go test“ Watch. Be careful. Don't fall Osteoporosis ahead!

78. The Number Game Source: “Changing Disease Definitions: Implications for Disease Prevalence,” Dr.Lisa Schwartz and Steven Woloshin, Effective Clinical Practice, March/April 1999. Diagnosis Old Definition New definition People under Old People under New % increase Year Diabetes Fasting Sugar > 140mg/dl Fasting > 126mg/dl 11.7 M 1.7 M 14% 1997 Hypertension BP > 160/100 BP> 140/90 38.7 M 13.5 M 35% 1997 Cholesterol > 250mg/dl > 200mg/dl 49.5 M 42.6 M 86% 1998 Obesity (BMI) BMI> 27kg/m ² BMI> 25kg/m ² 70.6 M 30.5 M 43% 1998 Pre hypertension Nil 120/80 to 139/89 Nil 45 M - 2003

84. Create a non-profit organization “ Bone Measurement Institute” . Set up own factory to manufacture small, portable peripheral scanning machines. & make machines affordable for individual doctors and clinics. Tie-ups with other manufacturers. lobby directly or through other organizations to governments to pass legislation allowing medical insurance plans. Create Direct To Consumer TV commercials. Own scientific journals,, write or help in writing articles, and sponsor articles in reputed journals. Formation of National and International “Societies” & “Foundations” of Bone, Bone and Mineral,, Densitometry, Osteoporosis, and Calcified Tissue. Event creation like Bone and joint decade, and world osteoporosis day. Game Plan

89. Bone Measurement Institute On its board were six of the most respected osteoporosis researchers in the country. The institute itself had a rather slim staff: Jeremy Allen was the only employee. &quot;There was no payroll, there was no building, there was no office with the name 'Bone Measurement Institute,’ Allen says. Essentially Allen's desk at Merck was the only physical space the Bone Measurement Institute actually inhabited. &quot;I was it,&quot; he says.

98. Hype about hip fractures? Published in The New York Times, May 10, 2010, Company With Osteoporosis Treatment Wins the ‘Super Bowl’ By LORA KOLODNY Courtesy of McCombs School of Business, Texas Venture Labs Biologics MD team competing at Global Moot Corp.

102. Fewer Hip fractures: A study of Canadian Hospital data found that rates of hip fractures have declined significantly over past two decades. Source: JAMA, 2009;302[8]:883-889. Published in The New York Times

106. Bisphosphonates have reduced vertebral fractures in clinical trials of efficacy when about 90% of patients complied with three years of treatment. However, if a T score of –2.5 is used as the indication for treatment, the cost of preventing one vertebral fracture is about £23 500, and 70% of fractures would still occur in the population. Adjusting the threshold to treat more people would sharply increase the costs per averted fracture. Drug treatment is not a panacea

110. Under idealized circumstances, 577 postmenopausal women must be treated for one year to avert one hip fracture, at a cost of about £120 000. Among women older than 80 (a high risk population), for whom drug therapy would theoretically be most effective, prevention of one hip fracture costs about £28 500. This case-finding strategy, however, would prevent only about 20% of hip fractures occurring in the total population.

112. Cochrane Review Alendronate & Risedronate women with low BMD + fragility fracture of Spine: Fracture of the spine - 12 out of 100 women with placebo - 6 out of 100 women with alendronate Fracture in the hip or wrist - 2 out of 100 women with placebo - 1 out of 100 women with alendronate Fractures in bones other than the spine - 9 out of 100 women placebo - 7 out of 100 women alendronate

113. women with normal BMD and no fragility fractures of their spine: Fracture of the spine - 3 out of 100 women with placebo - 1 out of 100 women with alendronate Fractures in bones other than the spine: - 1 out of 100 women with placebo - 1 out of 100 women with alendronate - 3 out of 100 women with placebo - 4 out of 100 women with alendronate - 13 out of 100 women with placebo - 12 out of 100 women with alendronate

120. A lie told often enough becomes the truth. Vladimir Lenin