Via Christi Women's Connection April presentation on osteoporosis prevention and treatment by Dr. Rami Mortada, University of Kansas School of Medicine-Wichita.
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Osteoprevention : Prevention and treatment
1. Osteoporosis
The silent disease
Rami Mortada, MD
Assistant Professor
Division of Endocrinology
Kansas University – Wichita
2. Outline
• What is osteoporosis ??
• Why should you care ??
• Who is at risk ??
• How/who needs to be checked ??
• Treatment
– Ca and Vit D
– Medication
5. Definition of Osteoporosis
Thin and brittle bone which make them more fragile with
increased risk of fractures
.
Normal Bone Osteoporotic Bone
NIH Consensus Development Panel on Osteoporosis. JAMA. 2001;285:785-795.
29. Who needs a bone density ??
• Age 65 or older
• Previous fracture with little trauma or vertebral fracture
• Family history of osteoporosis
• Long term use of glucocorticoids (like prednisone)
• Early Menopause (before age 45)
• Alcohol
• Smoking
31. T score result
Status T-score
Normal +2.5 to −1.0, inclusive
Osteopenia Between −1.0 and −2.5
Osteoporosis ≤−2.5
Severe osteoporosis ≤−2.5 + fragility fracture
32. T score is not enough…
20 AGE
80 The relationship between BMD and
(% per 10 Years)
Hip fracture risk
15 fracture risk varies with age.
70
10
60
5
50
0
-3 -2.5 -2 -1.5 -1 -0.5 0 0.5 1
BMD T-score
Kanis et al, Osteopor Int 2001
33. Risk of Fractures Over 10 Years in Women
AGE T-Score T-Score
= -1.0 = -2.5
50 6% 11 %
60 8% 16 %
70 12 % 23 %
80 13 % 26 %
41. Universal measurement for osteoporosis prevention
and treatment : Fall prevention
1. Make an appointment with your doctor
2. Keep moving
3. Wear sensible shoes
4. Avoid home hazard
5. Light up your living space
6. Use assistive devices
42. Treatment
Calcium 1200 mg / day is recommended
45. Bisphosphonates
• Fosamax, Actonel, Boniva, Reclast
• The big gun in osteoporosis treatment
Effects
• Significantly stop bone loss – anti-resorptive
• Reduce vertebral fractures 60%-70% at 3 years
• Reduce hip fractures 40%-50% at 3 years
• Pills: daily, monthly and weekly
• Intravenous: once yearly
46. Response to Long-term Alendronate
Subjects: Postmenopausal women with low BMD
BMD Urinary N-telopeptide
16 0
% Change from baseline
% change from baseline
Lumbar spine
12 -20
Placebo
-40
8
Femoral Neck -60 Alendronate 10 mg
4
-80
Alendronate 10 mg
0 -100
0 2 4 6 8 10 0 2 4 6 8 10
Years Years
Adapted with permission from Bone HG, et al. N Engl J Med. 2004;350:1189-1199.
47. Safety of bisphosphonate
• Reflux disease and ulcer
• Worsening of kidney disease
Osteonecrosis of the jaw Atypical femur fracture
49. Raloxifene:
Estrogen Agonist/Antagonists
Effects
• Anti-resorptive: Stop bone loss
• Reduces spine fracture and increases BMD
• No hip fracture protection
• Breast cancer risk reduction
• No endometrial proliferation or cancer
Side effects
• Blood clots
• May increase hot flashes
Evista [package insert]. Indianapolis, IN: Eli Lilly and Company; 2007.
50. Estrogen
• Anti-resorptive: stop bone loss
– Risk reduction of 34% for vertebral and hip fractures after
5 years
• Indications
– Prevention of postmenopausal osteoporosis
– Long-term treatment not recommended
• Contraindications
– Thromboembolic disease, breast cancer, CVD, stroke,
abnormal genital bleeding, estrogen-dependent cancer
51. Denosumab
• Skeletal Effects – Anti-resorptive
– Risk reduction vertebral fracture 38%,
hip fracture 58% after 5 years
– Injection,
• Indications
– Severe osteoporosis
– Intolerance to bisphosphonate
• Side effects
– Decreasing Calcium level, increasing
infection ( maybe)
– No long term data about safety profile
52. Teriparatide
• Skeletal Effects –Anabolic
– Decrease vertebral fracture
68%, hip fracture 40%
– Daily injection x 3 years
• Indications
– Severe osteoporosis ( T -2.5-4)
• Best treatment available, must be
followed by a course of anti resorptive
therapy
55. Conclusion
• Osteoporosis is a serious but silent disease
• Due to decreased bone formation or increased bone loss
• Early prevention is the key element to prevent fracture
• Diet and exercise is the cornerstone for osteoporosis
prevention and treatment
• Screen with bone density at age 65, sooner if any risk factor
• Treatment is effective in decreasing fracture risks