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Osteoporosis

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concepts and controversies in osteoporosis

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Osteoporosis

  1. 1. Hitesh Gopalan U Clinical Assistant Prof, Visiting Lecturer, McMaster University, CA
  2. 2. Classification
  3. 3. WHO Definition  Bone density that falls 2.5 standard deviations (SD) below the mean for young healthy adults of the same sex—also referred to as a T-score of –2.5
  4. 4. Lab  Serum Ca  PTH  25(OH) Vit D  Urine Ca
  5. 5.  High serum Ca (Hyperparathyroidism Vs Malignancy)  Low serum Ca (Osteomalacia)  HypercalciURIA: males with osteoporosis, Hyperparathyroidism, Paget’s disease, Hyperthyroidism
  6. 6. Secondary Osteoporosis  Hypogonadal States: Turner, Klinefleter  Endocrine conditions: Thyrotoxicosis, Cushing’s  GI conditions: Gastrectomy, Liver disease  Rheumatological: RA, AS  Hematologic Disorders: Multiple Myeloma  Inherited Conditions: OI, Marfan
  7. 7.  DEXA  CT Scan  X-rays
  8. 8. Treatment  Estrogen- beneficial- ↑ risk of Endometrial Ca  Estrogen + Progesterone= ↑ Risk of heart disease/stroke  Tibolone
  9. 9. What we Know
  10. 10. SERM  Raloxifene  Reduces risk of vertebral fractures  Reduced incidence of Ca Breast, Cardiovascular and Cerebrovascular Events
  11. 11. Bisphosphonates  Alendronate  Ibandronate  Risedronate  Zolendronic Acid
  12. 12. Bisphosphonates  Osteonecrosis of Jaw, Atypical Subtrochanteric Fractures  ? Ca oesophagus  Perthe’s Disease, Osteogenesis Imperfecta, AVN  Accumulates in the Body
  13. 13. Bisphosphonates- # Healing  Increase BMD at # site- Single Dose  Does not interfere with fracture healing Odvina et al.. J Clin Endocrinol Metab 2005;90(3):1294–301. van der Poest Clement E, J Bone Miner Res 2000;15(3):586–93.
  14. 14. Teriparatide  Recombinant PTH  Daily injection  Cost  Osteogenic Ca
  15. 15. Calcitonin  Nasal Spray  Paget’s Disease
  16. 16. Kyphoplasty Vs Sham
  17. 17. Denosumab
  18. 18. FREEDOM  Fracture Reduction Evaluation of Denosumab in Osteoporosis Every 6 Months (FREEDOM) Trial  No major adverse effects  Supported by AMGEN
  19. 19. Denosumab  Higher incidence of infections  Contraindicated in Hypocalcemia
  20. 20. VEGF-A
  21. 21. Hierarchy of Evidence Randomized Trials Prospective Cohort Studies Case Control Studies Retrospective Case Series Opinion Metaanalysis
  22. 22. Evidence Cycle Ask Act Acquire Apply Appraise “EBM Begins and Ends with the Patient”

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