Osteoporosis      The silent disease    Rami Mortada, MD    Assistant Professor Division of EndocrinologyKansas University...
Outline• What is osteoporosis ??• Why should you care ??• Who is at risk ??• How/who needs to be checked ??• Treatment   –...
Osteoporosis: The silent disease
What is osteoporosis ?
Definition of OsteoporosisThin and brittle bone which make them more fragile withincreased risk of fractures              ...
Bone is a living organ
Bone remodeling
RemodelingBone Remodeling Unit:         1. Activation  Average time to complete:   2. Resorption       ~ 6 months         ...
Peak bone mass
Why do we get osteoporosis ??                    X                    X
Why do we get osteoporosis ??              +++ Resorption               + Formation
How does osteoporosis happen ??
Why should you care ??
Fracture and risk of death           SITE             INCREASE IN                           MORTALITY RISK   Vertebrae    ...
Who is at risk ??
Risk Factors: female sex
Risk factors: smoking
Risk factors: Low body weight
Risk factor: Aging
Risk factor: Menopause    20% bone loss in the 5 years after menopause
Risk factor: fragility factor• History of fragility fracture• 1st degree relative with Osteoporosis or fragility  fracture
Other Risk Factors      •   Absence of menstrual cycles      •   Diet low in calcium, low Vitamin D      •   Certain medic...
How do you check for  osteoporosis ??
Bone density
Bone density: DEXA scan
Bone density images
Who needs a bone density ??•   Age 65 or older•   Previous fracture with little trauma or vertebral fracture•   Family his...
T-score
T score resultStatus                T-scoreNormal                +2.5 to −1.0, inclusiveOsteopenia            Between −1.0...
T score is not enough…                       20   AGE                            80       The relationship between BMD and...
Risk of Fractures Over 10 Years in Women    AGE         T-Score       T-Score                 = -1.0        = -2.5     50 ...
Who needs to get treated ??
Who needs to be treated ??
Sample FRAX Calculation:
What are the treatment options ??
Universal measurement for osteoporosis preventionand treatment : Risk factor reduction
Universal measurement for osteoporosis preventionand treatment : Risk factor reduction
Fall prevention: weight bearing exercise
Universal measurement for osteoporosis preventionand treatment : Fall prevention1.   Make an appointment with your doctor2...
Treatment     Calcium 1200 mg / day is recommended
Treatment: Vitamin D
Medication for osteoporosis• Anti resorptive-agents: Stop bone  loss• Anabolic agent: Increase bone  formation
Bisphosphonates • Fosamax, Actonel, Boniva, Reclast • The big gun in osteoporosis treatment Effects •   Significantly stop...
Response to Long-term Alendronate                                       Subjects: Postmenopausal women with low BMD       ...
Safety of bisphosphonate• Reflux disease and ulcer• Worsening of kidney disease  Osteonecrosis of the jaw      Atypical fe...
How about a holiday ???
Raloxifene:Estrogen Agonist/Antagonists       Effects       • Anti-resorptive: Stop bone loss       • Reduces spine fractu...
Estrogen• Anti-resorptive: stop bone loss   – Risk reduction of 34% for vertebral and hip fractures after     5 years• Ind...
Denosumab• Skeletal Effects – Anti-resorptive   – Risk reduction vertebral fracture 38%,     hip fracture 58% after 5 year...
Teriparatide• Skeletal Effects –Anabolic    – Decrease vertebral fracture      68%, hip fracture 40%    – Daily injection ...
Word of wisdom
Conclusion• Osteoporosis is a serious but silent disease• Due to decreased bone formation or increased bone loss• Early pr...
Thank you
Osteoprevention : Prevention and treatment
Osteoprevention : Prevention and treatment
Osteoprevention : Prevention and treatment
Osteoprevention : Prevention and treatment
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Osteoprevention : Prevention and treatment

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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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  • Manifestation or present
  • More holes doesn’t mean that mean osteoporosis
  • Transcript of "Osteoprevention : Prevention and treatment"

    1. 1. Osteoporosis The silent disease Rami Mortada, MD Assistant Professor Division of EndocrinologyKansas University – Wichita
    2. 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
    3. 3. Osteoporosis: The silent disease
    4. 4. What is osteoporosis ?
    5. 5. Definition of OsteoporosisThin and brittle bone which make them more fragile withincreased risk of fractures . Normal Bone Osteoporotic BoneNIH Consensus Development Panel on Osteoporosis. JAMA. 2001;285:785-795.
    6. 6. Bone is a living organ
    7. 7. Bone remodeling
    8. 8. RemodelingBone Remodeling Unit: 1. Activation Average time to complete: 2. Resorption ~ 6 months 3. Reversal 4. Formation
    9. 9. Peak bone mass
    10. 10. Why do we get osteoporosis ?? X X
    11. 11. Why do we get osteoporosis ?? +++ Resorption + Formation
    12. 12. How does osteoporosis happen ??
    13. 13. Why should you care ??
    14. 14. Fracture and risk of death SITE INCREASE IN MORTALITY RISK Vertebrae 8.6 Hip 6.7 Any Clinical Fracture 2.2
    15. 15. Who is at risk ??
    16. 16. Risk Factors: female sex
    17. 17. Risk factors: smoking
    18. 18. Risk factors: Low body weight
    19. 19. Risk factor: Aging
    20. 20. Risk factor: Menopause 20% bone loss in the 5 years after menopause
    21. 21. Risk factor: fragility factor• History of fragility fracture• 1st degree relative with Osteoporosis or fragility fracture
    22. 22. Other Risk Factors • Absence of menstrual cycles • Diet low in calcium, low Vitamin D • Certain medications • Hormone disorder: thyroid, parathyroid, prolactin…24
    23. 23. How do you check for osteoporosis ??
    24. 24. Bone density
    25. 25. Bone density: DEXA scan
    26. 26. Bone density images
    27. 27. 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
    28. 28. T-score
    29. 29. T score resultStatus T-scoreNormal +2.5 to −1.0, inclusiveOsteopenia Between −1.0 and −2.5Osteoporosis ≤−2.5Severe osteoporosis ≤−2.5 + fragility fracture
    30. 30. 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
    31. 31. 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 %
    32. 32. Who needs to get treated ??
    33. 33. Who needs to be treated ??
    34. 34. Sample FRAX Calculation:
    35. 35. What are the treatment options ??
    36. 36. Universal measurement for osteoporosis preventionand treatment : Risk factor reduction
    37. 37. Universal measurement for osteoporosis preventionand treatment : Risk factor reduction
    38. 38. Fall prevention: weight bearing exercise
    39. 39. Universal measurement for osteoporosis preventionand treatment : Fall prevention1. Make an appointment with your doctor2. Keep moving3. Wear sensible shoes4. Avoid home hazard5. Light up your living space6. Use assistive devices
    40. 40. Treatment Calcium 1200 mg / day is recommended
    41. 41. Treatment: Vitamin D
    42. 42. Medication for osteoporosis• Anti resorptive-agents: Stop bone loss• Anabolic agent: Increase bone formation
    43. 43. 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
    44. 44. 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.
    45. 45. Safety of bisphosphonate• Reflux disease and ulcer• Worsening of kidney disease Osteonecrosis of the jaw Atypical femur fracture
    46. 46. How about a holiday ???
    47. 47. 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 flashesEvista [package insert]. Indianapolis, IN: Eli Lilly and Company; 2007.
    48. 48. 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
    49. 49. 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
    50. 50. 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
    51. 51. Word of wisdom
    52. 52. 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
    53. 53. Thank you
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