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.

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

  • 1. Osteoporosis The silent disease Rami Mortada, MD Assistant Professor Division of EndocrinologyKansas 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
  • 3. Osteoporosis: The silent disease
  • 4. What is osteoporosis ?
  • 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. Bone is a living organ
  • 7. Bone remodeling
  • 8. RemodelingBone Remodeling Unit: 1. Activation Average time to complete: 2. Resorption ~ 6 months 3. Reversal 4. Formation
  • 9. Peak bone mass
  • 10. Why do we get osteoporosis ?? X X
  • 11. Why do we get osteoporosis ?? +++ Resorption + Formation
  • 12. How does osteoporosis happen ??
  • 13. Why should you care ??
  • 14. Fracture and risk of death SITE INCREASE IN MORTALITY RISK Vertebrae 8.6 Hip 6.7 Any Clinical Fracture 2.2
  • 15. Who is at risk ??
  • 16. Risk Factors: female sex
  • 17. Risk factors: smoking
  • 18. Risk factors: Low body weight
  • 19. Risk factor: Aging
  • 20. Risk factor: Menopause 20% bone loss in the 5 years after menopause
  • 21. Risk factor: fragility factor• History of fragility fracture• 1st degree relative with Osteoporosis or fragility fracture
  • 22. Other Risk Factors • Absence of menstrual cycles • Diet low in calcium, low Vitamin D • Certain medications • Hormone disorder: thyroid, parathyroid, prolactin…24
  • 23. How do you check for osteoporosis ??
  • 24. Bone density
  • 25. Bone density: DEXA scan
  • 26. Bone density images
  • 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. T-score
  • 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. 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. 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. Who needs to get treated ??
  • 33. Who needs to be treated ??
  • 34. Sample FRAX Calculation:
  • 35. What are the treatment options ??
  • 36. Universal measurement for osteoporosis preventionand treatment : Risk factor reduction
  • 37. Universal measurement for osteoporosis preventionand treatment : Risk factor reduction
  • 38. Fall prevention: weight bearing exercise
  • 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. Treatment Calcium 1200 mg / day is recommended
  • 41. Treatment: Vitamin D
  • 42. Medication for osteoporosis• Anti resorptive-agents: Stop bone loss• Anabolic agent: Increase bone formation
  • 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. 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. Safety of bisphosphonate• Reflux disease and ulcer• Worsening of kidney disease Osteonecrosis of the jaw Atypical femur fracture
  • 46. How about a holiday ???
  • 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. 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. 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. 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. Word of wisdom
  • 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. Thank you