70 year old Woman                                I only smoke when I drink I like a glass of winewith my dinner Doctor
But Calcium supplements  cause Heart attacks!
•Suggests 20-30% increased risk of myocardial infarctionin patients taking Calcium supplements•No significant increase in ...
• Meta-analysis• Excludes patients taking Ca and Vit D  supplements• At odds with results of WHI study• Could there be som...
Possible reduction of risk of MI with higher dietary CaSmall increased risk of MI with supplements only
My nephew is a dentist.....
Osteonecrosis of the jaw
Rare in bisphosphonate doses used in OP                    1:100,000More common with IV bisphosphonates (but still rare)
• Discuss potential risks and symptoms with  patient• Encourage good dental hygiene• Pretreatment dental visit not necessary
• < 3yrs treatment with BP   •   Dental extractions and implants as normal• > 3 yrs treatment   •   Stop BP for 3 months b...
Has the treatment worked         Doctor?
Least Significant Change
3.5% Lumbar Spine    2.2% Hip
What do the changes mean?Fracture risk %                  Adapted from Chapurlat RD et al Osteoporosis Int 2005:16. pp 842...
How much change is         significant?Ideal is increase in BMDPatients with static BMD still have reduced  risk of fractu...
Alternatives to bisphosphonates                      Vertebral                  Hip (Protelos)                          Ye...
Do we need to treat   everybody?
I’m 51andhealthy  T Scores  LS- -2.6  Hip -2.6
Google ‘FRAX’
How long do I needto be on treatment?
Do Bisphosphonateswork in long term?
After 5 years little to support continuedbenefit on fracture riskPossibility of drug holiday in some (low riskpts)Change t...
Drug holiday?• Patients with lower risk• May stop for up to 2 years• Possible small drop in BMD• No increased risk of frac...
I’m 51andhealthy  T Scores  LS- -2.6  Hip -2.6
Summary• Encourage Dietary Ca• For most Single dose Ca supplement plenty• Not essential to treat everybody!• Use FRAX to h...
Osteoporosis talk july 2012 4 slideshare
Osteoporosis talk july 2012 4 slideshare
Osteoporosis talk july 2012 4 slideshare
Osteoporosis talk july 2012 4 slideshare
Osteoporosis talk july 2012 4 slideshare
Osteoporosis talk july 2012 4 slideshare
Osteoporosis talk july 2012 4 slideshare
Osteoporosis talk july 2012 4 slideshare
Osteoporosis talk july 2012 4 slideshare
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Osteoporosis talk july 2012 4 slideshare

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Talk for primary care illustrating current hot topics in osteoporosis management

Published in: Health & Medicine, Technology
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Osteoporosis talk july 2012 4 slideshare

  1. 1. 70 year old Woman I only smoke when I drink I like a glass of winewith my dinner Doctor
  2. 2. But Calcium supplements cause Heart attacks!
  3. 3. •Suggests 20-30% increased risk of myocardial infarctionin patients taking Calcium supplements•No significant increase in CVA’s
  4. 4. • Meta-analysis• Excludes patients taking Ca and Vit D supplements• At odds with results of WHI study• Could there be something there?
  5. 5. Possible reduction of risk of MI with higher dietary CaSmall increased risk of MI with supplements only
  6. 6. My nephew is a dentist.....
  7. 7. Osteonecrosis of the jaw
  8. 8. Rare in bisphosphonate doses used in OP 1:100,000More common with IV bisphosphonates (but still rare)
  9. 9. • Discuss potential risks and symptoms with patient• Encourage good dental hygiene• Pretreatment dental visit not necessary
  10. 10. • < 3yrs treatment with BP • Dental extractions and implants as normal• > 3 yrs treatment • Stop BP for 3 months before treatment • Restart when bone healed
  11. 11. Has the treatment worked Doctor?
  12. 12. Least Significant Change
  13. 13. 3.5% Lumbar Spine 2.2% Hip
  14. 14. What do the changes mean?Fracture risk % Adapted from Chapurlat RD et al Osteoporosis Int 2005:16. pp 842848
  15. 15. How much change is significant?Ideal is increase in BMDPatients with static BMD still have reduced risk of fractureOnly worry about Decrease
  16. 16. Alternatives to bisphosphonates Vertebral Hip (Protelos) Yes Yes/No* Strontium (Forsteo) Yes NoTeriparetide (Evista) Yes No RaloxifeneDenosumab Yes Yes (Prolia) * >75yrs osteoporosis femoral neck
  17. 17. Do we need to treat everybody?
  18. 18. I’m 51andhealthy T Scores LS- -2.6 Hip -2.6
  19. 19. Google ‘FRAX’
  20. 20. How long do I needto be on treatment?
  21. 21. Do Bisphosphonateswork in long term?
  22. 22. After 5 years little to support continuedbenefit on fracture riskPossibility of drug holiday in some (low riskpts)Change to alternative agent
  23. 23. Drug holiday?• Patients with lower risk• May stop for up to 2 years• Possible small drop in BMD• No increased risk of fracture• Avoid in high risk patients
  24. 24. I’m 51andhealthy T Scores LS- -2.6 Hip -2.6
  25. 25. Summary• Encourage Dietary Ca• For most Single dose Ca supplement plenty• Not essential to treat everybody!• Use FRAX to help aid decision• Monitor for Bone loss (2 yrs)• Consider revise Bisphosphonates at 5-7yrs• Consider Drug holiday
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