Inflammatory Localized and Generalized Bone Loss in Recent-onset Rheumatoid Arthritis, Presentatie van dr. Melek Guler-Yuksel op 18 april 2012 voor de Stichting IWO.
Inflammatory Localized and Generalized Bone Loss in Recent-onset Rheumatoid Arthritis, Presentatie van dr. Melek Guler-Yuksel op 18 april 2012 voor de Stichting IWO.
IWO Meeting 1 November 2023 - Stopping with Denosumab and Romosozumab, basic mechanisms and clinical aspects door Prof. dr. S. Ferrari, Geneva, Switzerland. (Engelstalige lezing)
1) DXA scanning is a reliable and low-radiation method to measure bone mineral density (BMD) at the lumbar spine, hip, and wrist to diagnose osteoporosis.
2) DXA can also detect vertebral fractures (VFA) and measure whole body composition, abdominal fat, and aortic calcification.
3) Interpretation of DXA results requires attention to potential variability between devices, accurate placement of regions of interest, and use of appropriate reference data since BMD can be under or overestimated in certain patients.
This document summarizes osteonecrosis of the jaw (ONJ) associated with antiresorptive agents. It defines ONJ and stages its severity. It discusses the pathogenesis of ONJ and risk factors like underlying disease, treatment duration, and dental procedures. Cancer patients on intravenous bisphosphonates have the highest ONJ risk of 1-8% due to higher drug doses and worse oral/general health. Management involves conservative measures like mouthwashes for early stages and surgery with antibiotics for later stages. Discontinuing antiresorptives may help healing but risks fractures. Teriparatide may help healing in some cases but its use in cancer is uncertain. More research is needed on preventing and treating established ON
This systematic review analyzed 895 cases of tumor-induced osteomalacia (TIO) from case reports. TIO is caused by tumors that produce excess fibroblast growth factor 23 (FGF23), which causes hypophosphatemia and osteomalacia. The review found that TIO mostly affects adults aged 40-60 years old, with long diagnostic delays of several years on average. The tumors were located variably but most commonly in the lower limbs or head and neck region. Higher FGF23 levels correlated with larger tumor size. Patients experienced significant bone fragility and fracture rates as high as 60% due to long-term hypophosphatemia. Early tumor detection and removal are important to improve outcomes for
This document discusses real-world evidence on denosumab for osteoporosis treatment and fracture prevention. It summarizes several studies, including one that found denosumab reduced fracture risk by 38% compared to placebo in over 25,000 postmenopausal women. Another study showed good long-term persistence with denosumab therapy in over 800 patients. Additional studies observed that zoledronic acid can prevent bone loss following denosumab discontinuation, and bisphosphonate treatment after denosumab provides protection against new vertebral fractures.
IWO Meeting 16 November 2022 - ASBMR young talent: Silvia Storoni (Amsterdam): Prevalence and Hospital Admissions in Patients With Osteogenesis Imperfecta in The Netherlands: A Nationwide Registry Study
The document appears to be a presentation on highlights from the ASBMR 2021 conference in San Diego. It discusses several topics that were covered at the conference, including fracture risk assessment, the effects of various osteoporosis treatments on bone mineral density, safety issues like osteonecrosis of the jaw and atypical femoral fractures, the role of vitamin D, and applications of artificial intelligence. The entire document is copyrighted by Prof. Dr. Joop van den Bergh.
This document discusses guidelines for medication to prevent fractures in patients using glucocorticoids. It notes that glucocorticoids significantly increase the risk of vertebral and non-vertebral fractures. While effective anti-osteoporosis drugs are available, many glucocorticoid-treated patients remain untreated. The document reviews new guidelines that simplify treatment criteria to improve implementation and outlines recommendations for when to start bone-sparing medications based on patient factors and glucocorticoid dose and duration. The goal is to optimize fracture prevention in glucocorticoid-treated patients.
This document discusses what actions should be taken when a vertebral fracture is discovered incidentally. It notes that vertebral fractures are very common fractures, especially in older individuals, and are often asymptomatic. Having a vertebral fracture significantly increases one's risk for future fractures both in the short and long term. If a vertebral fracture is found incidentally, such as on a CT scan, further investigation is warranted including assessing bone mineral density and checking for underlying bone diseases. Treatment options should also be considered, especially if the individual has low bone density in addition to the vertebral fracture, as this combination confers the highest risk. New automated detection algorithms aim to help identify vertebral fractures on scans to ensure appropriate follow up for individuals.
This document summarizes a cost-effectiveness model of Fracture Liaison Services (FLS) care in the Netherlands. The model found that FLS care would be highly cost-effective, with a cost of €9,076 per quality-adjusted life year gained. Total 5-year costs with FLS would be only 1.7% higher than current costs but would prevent fractures and improve health outcomes. The model can help decision-makers prioritize secondary fracture prevention and allow local payers and FLS to predict costs and benefits of implementation.
More Related Content
More from Stichting Interdisciplinaire Werkgroep Osteoporose
IWO Meeting 1 November 2023 - Stopping with Denosumab and Romosozumab, basic mechanisms and clinical aspects door Prof. dr. S. Ferrari, Geneva, Switzerland. (Engelstalige lezing)
1) DXA scanning is a reliable and low-radiation method to measure bone mineral density (BMD) at the lumbar spine, hip, and wrist to diagnose osteoporosis.
2) DXA can also detect vertebral fractures (VFA) and measure whole body composition, abdominal fat, and aortic calcification.
3) Interpretation of DXA results requires attention to potential variability between devices, accurate placement of regions of interest, and use of appropriate reference data since BMD can be under or overestimated in certain patients.
This document summarizes osteonecrosis of the jaw (ONJ) associated with antiresorptive agents. It defines ONJ and stages its severity. It discusses the pathogenesis of ONJ and risk factors like underlying disease, treatment duration, and dental procedures. Cancer patients on intravenous bisphosphonates have the highest ONJ risk of 1-8% due to higher drug doses and worse oral/general health. Management involves conservative measures like mouthwashes for early stages and surgery with antibiotics for later stages. Discontinuing antiresorptives may help healing but risks fractures. Teriparatide may help healing in some cases but its use in cancer is uncertain. More research is needed on preventing and treating established ON
This systematic review analyzed 895 cases of tumor-induced osteomalacia (TIO) from case reports. TIO is caused by tumors that produce excess fibroblast growth factor 23 (FGF23), which causes hypophosphatemia and osteomalacia. The review found that TIO mostly affects adults aged 40-60 years old, with long diagnostic delays of several years on average. The tumors were located variably but most commonly in the lower limbs or head and neck region. Higher FGF23 levels correlated with larger tumor size. Patients experienced significant bone fragility and fracture rates as high as 60% due to long-term hypophosphatemia. Early tumor detection and removal are important to improve outcomes for
This document discusses real-world evidence on denosumab for osteoporosis treatment and fracture prevention. It summarizes several studies, including one that found denosumab reduced fracture risk by 38% compared to placebo in over 25,000 postmenopausal women. Another study showed good long-term persistence with denosumab therapy in over 800 patients. Additional studies observed that zoledronic acid can prevent bone loss following denosumab discontinuation, and bisphosphonate treatment after denosumab provides protection against new vertebral fractures.
IWO Meeting 16 November 2022 - ASBMR young talent: Silvia Storoni (Amsterdam): Prevalence and Hospital Admissions in Patients With Osteogenesis Imperfecta in The Netherlands: A Nationwide Registry Study
The document appears to be a presentation on highlights from the ASBMR 2021 conference in San Diego. It discusses several topics that were covered at the conference, including fracture risk assessment, the effects of various osteoporosis treatments on bone mineral density, safety issues like osteonecrosis of the jaw and atypical femoral fractures, the role of vitamin D, and applications of artificial intelligence. The entire document is copyrighted by Prof. Dr. Joop van den Bergh.
This document discusses guidelines for medication to prevent fractures in patients using glucocorticoids. It notes that glucocorticoids significantly increase the risk of vertebral and non-vertebral fractures. While effective anti-osteoporosis drugs are available, many glucocorticoid-treated patients remain untreated. The document reviews new guidelines that simplify treatment criteria to improve implementation and outlines recommendations for when to start bone-sparing medications based on patient factors and glucocorticoid dose and duration. The goal is to optimize fracture prevention in glucocorticoid-treated patients.
This document discusses what actions should be taken when a vertebral fracture is discovered incidentally. It notes that vertebral fractures are very common fractures, especially in older individuals, and are often asymptomatic. Having a vertebral fracture significantly increases one's risk for future fractures both in the short and long term. If a vertebral fracture is found incidentally, such as on a CT scan, further investigation is warranted including assessing bone mineral density and checking for underlying bone diseases. Treatment options should also be considered, especially if the individual has low bone density in addition to the vertebral fracture, as this combination confers the highest risk. New automated detection algorithms aim to help identify vertebral fractures on scans to ensure appropriate follow up for individuals.
This document summarizes a cost-effectiveness model of Fracture Liaison Services (FLS) care in the Netherlands. The model found that FLS care would be highly cost-effective, with a cost of €9,076 per quality-adjusted life year gained. Total 5-year costs with FLS would be only 1.7% higher than current costs but would prevent fractures and improve health outcomes. The model can help decision-makers prioritize secondary fracture prevention and allow local payers and FLS to predict costs and benefits of implementation.
More from Stichting Interdisciplinaire Werkgroep Osteoporose (20)
1. t
h lde rs
e herziening r ig 2012
NHG richtlijn fractuurpreventie
y oktober E
2
p .M.
o .J
C P
.
PJM Elders
r
GJ Dinant
D
T van Geel
.
LWF Maartens
w
T Merlijn
RMM Geijer
M
JJXM Geraets,
Huisarts Wet 2012
2. Programma
t
h lde rs
ig E
1 NHG richtlijn in relatie tot CBO richtlijnen
2 Hoofdlijnen
yr .
3
p .M
Inhoud richtlijn
o .J
C P
3 Overeenkomsten met CBO richtlijn
4 Gemiste kansen in richtlijn
r .
. D
M w
3. CBO richtlijn Osteoporose en fractuurpreventie
t rs
November 2011 3e herziene versie
h lde
- multidisciplinair
ig E
r .
- evidence based
y
- compromis
p .M
o .J
C P
NHG richtlijn
Oktober 2012 2e herziene versie
.
- voor huisartsen
D r
- andere populatie dan 2e lijn
w .
- aansluiting met CBO
- tool tijdens spreekuur
M
4. Hoofdlijnen
t
h lde rs
ig E
1 Het gaat om fracturen
yr .
2 Secundaire osteoporose hoort in de tweede lijn
p .M
3 Proactief handelen bij recente fractuur ≥ 50 jaar
o .J
C P
tenzij ziekenhuis al beleid heeft ingezet
6 Ook wervelinzakking is belangrijke onafhankelijke
risicofactor
r .
D
7 Duidelijk onderscheid tussen proactief en
.
vraaggestuurd beleid
w
M
5. Secundaire Osteoporose
t
h lde rs
ig E
• iatrogene vroege menopauze
r .
• antihormonale therapie
y
• chronische ondervoeding
•
• p .M
inflammatoire darmziekten
o .J
type I diabetes mellitus
•
• C P
Langdurig onbehandelde hyperthyreoidie of oversubstitutie
onbehandelde hyperparathyreoïdie, hypopituitarisme;
•
r .
ernstig COPD (GOLD stadium III en IV)
D
• reumatoïde artritis, spondylarthropathie (M Bechterew), SLE en
.
sarcoïdose;
w
• gebruik van glucocorticosteroïden of anti-epileptica;
• ziekte van Cushing;
M
• vitamine D gebrek
6. Secundaire osteoporose
t
h lde rs
ig E
• Meeste patiënten worden behandeld in de 2e lijn
yr .
• Beste behandeling is vaak behandeling van
p .M
onderliggende ziekte
o .J
C P
• Geen uniforme richtlijn te geven
• Behandeling in overleg met specialist
r .
• Niet opgenomen in algoritme
. D
M w
7. Hoofdlijnen
t
h lde rs
ig E
1 Het gaat om fracturen
yr .
2 Secundaire osteoporose hoort in de tweede lijn
p .M
3 Proactief handelen bij recente fractuur ≥ 50 jaar
o .J
C P
tenzij ziekenhuis al beleid heeft ingezet
6 Ook wervelinzakking is belangrijke onafhankelijke
risicofactor
r .
D
7 Duidelijk onderscheid tussen proactief en
.
vraaggestuurd beleid
w
M
8. Tijd sinds fractuur kans op nieuwe
fractuur
t
h lde rs
y ig E
r .
p .M
o .J
C P
r .
. D
M w van Geel T A C M et al. Ann Rheum Dis 2009;68:99-102
9. Beloop niet-wervelfractuur (1)
t
h lde rs
y ig E
r .
p .M
o .J
C P
r .Follow-up (year) 0-1 1-2 2-3 3-4 4-5 Total
D
follow-up
w . Number of
patients at risk
1921 1686 1586 1487 1398 1301
M
Subsequent 123 68 55 46 46 338
fracture (n)
% 6,4 4,0 3,5 3,1 3,3 17,6
Huntjens KMB et al. Osteoporosis Int .2010 9
10. Beloop niet-wervelfractuur (2)
t
h lde rs
y ig E
r .
p .M
o .J
C P
r .
D
Follow-up (year) 0-1 1-2 2-3 3-4 4-5 Total
.
follow-up
w
Number of 1921 1686 1586 1487 1398 1301
M
patients at risk
Mortality (n) 235 108 91 89 97 620
% 12,2 6,4 5,8 6,0 6,9 32,3
Huntjens KMB et al. Osteoporosis Int .2010 10
11. Hoofdlijnen
t
h lde rs
ig E
1 Het gaat om fracturen, fracturen en niets anders dan
r .
fracturen
y
p .M
2 Secundaire osteoporose wel benoemd maar niet in
o .J
hoofdtekst
C P
3 Proactief handelen bij fractuur ≥ 50 jaar tenzij
ziekenhuis al beleid heeft ingezet
r .
6 Ook wervelinzakking is belangrijke onafhankelijke
D
risicofactor
.
w
7 Duidelijk onderscheid tussen proactief en
vraaggestuurd beleid
M
14. Hoofdlijnen
t
h lde rs
ig E
1 Het gaat om fractuurpreventie
yr .
2 Secundaire osteoporose wel benoemd maar niet in
p .M
hoofdtekst
o .J
C P
3 Proactief handelen bij fractuur ≥ 50 jaar tenzij
ziekenhuis al beleid heeft ingezet
r .
6 Ook wervelinzakking is belangrijke onafhankelijke
D
risicofactor
w .
7 Duidelijk onderscheid tussen proactief en
vraaggestuurd beleid
M
15. t
h lde rs
y ig E
r .
p .M
o .J
C P
r .
. D
M w
15
16. t
h lde rs
y ig E
r .
p .M
o .J
C P
r .
. D
M w
16
17. t
h lde rs
y ig E
r .
p .M
o .J
C P
r .
. D
M w
17
18. t
h lde rs
y ig E
r .
p .M
o .J
C P
r .
. D
M w
18
19. t
h lde rs
y ig E
r .
p .M
o .J
C P
r .
. D
M w
19
20. t
h lde rs
y ig E
r .
p .M
o .J
C P
r .
. D
M w
20
21. t
h lde rs
y ig E
r .
p .M
o .J
C P
r .
. D
M w
21
22. Risicoscore
rs
(aanvullend onderzoek bij som ≥ 4)
t
h lde
ig E
Score
yr .
p .M
Recente fractuur na 50ste 4*
o .J
Verdenking op wervel # 4*
Leeftijd
Laag gewicht C P ≥60=1, ≥70=2
1
r
≥ 2 vallen in 12 mnd
. 1
. D
niet recente fractuur ≥50 jaar 1=1, ≥ 1 =2
w
* proactief
M
23. Evaluatie van het fractuurrisico op basis van
t
h lde rs
ig E
• Belangrijke klinische risicofactoren:
yr .
fractuur geschiedenis
p .M
oudere leeftijd,
o .J
C P
valrisico (≥ 2x gevallen afgelopen jaar),
magerte
r .
ouder met heupfractuur
•
. D
DEXA heup en LWK
•
w
X WK of VFA
M
24. Indicatie behandelen
t
h lde rs
ig E
• Prevalente wervelinzakking
•
yr .
Recente fractuur (<2 jaar) + BMD< T=-2.5
•
p .M
Meerdere belangrijke risicofactoren + BMD <T=-2.5
o .J
C P
• Langdurig corticosteroidgebruik (eigen algoritme)
• Secundaire osteoporose heeft eigen dynamiek
r .
. D
M w
25. Behandeling
t
h lde rs
ig E
• Valpreventie
• Leefstijl
yr .
p .M
• Vitamine D 800IE/dag
o .J
• Calcium zo nodig
•
C P
Botsparende medicatie
1e keus alendroninezuur, risedroninezuur
r .
2e keus zolendroninezuur of denosumab
D
terughoudend zijn met 2e keus
.
w
andere middelen worden afgeraden
M
26. Begeleiding
rs
(3,6,9,12 maanden en daarna jaarlijks)
t
h lde
ig E
• Levensstijl
• Bijwerkingen
yr .
• Therapietrouw
p .M
o .J
C P
• Lengte meten en vastleggen in dossier (X WK bij
hoogteverlies van >5cm)
• Valrisico
r .
• Fracturen
. D
w
• Nieuwe risicofactoren
M
27. Behandelduur bisfosfonaten
t
h lde rs
ig E
• In principe 5 jaar tenzij……
yr .
• Niet langer dan 10 jaar
p .M
• Bij verdenking op persisterend hoog fractuurrisico na
o .J
C P
5 jaar opnieuw meten en evt therapie maximaal 5 jaar
verlengen
r .
• Na 3 jaar gestopt met bisfosfonaten opnieuw
D
evalueren
w .
• Of eerder bij nieuwe fracturen of nieuwe
risicofactoren
M
28. Overeenkomsten met CBO
t
h lde
• Nieuw algoritme gemaakt rs
• Prioriteiten
y ig E
r .
p .M
• Actief beleid bij recente fractuur na 50ste of
o .J
wervelinzakkingen
C P
• Secundaire osteoporose uitsluiten na fractuur
.
• Evaluatie na 5 jaar met ruimte voor doorbehandelen
D r
• Keuze van medicatie
w .
M
29. Verschillen met CBO
• t
h lde rs
Één beslisboom daardoor één klein afwijkend groepje
•
• ig E
r .
Onderscheid proactief en vraaggestuurd beleid aangescherpt
y
Aanvullend onderzoek alléén bij verdenking op afwijkingen
•
p .M
o .J
(Iets) andere systematiek aanvullende onderzoek
C P
• Vervolg na 5 jaar behandelen gebaseerd op klinische
risicofactoren
.
• Osteopenie geen plaats in de NHG richtlijn. CBO laat ruimte
r
voor medicamenteuze behandeling bij osteopenie (vanaf T≤ -2).
D
.
NHG richtlijn : continueren als voorgeschreven specialist.
M w
30. Gemiste kansen*
t
h lde rs
• Ernstige osteoporose (verlaagde BMD + fracturen) is
ig E
r .
een chronische ziekte en verdient jaarlijkse evaluatie
y
p .M
o .J
• Het belang van het valrisico is m.i. nog iets
onderbelicht
C P
r .
• Geneesmiddelvrije periode is afhankelijk van
. D
medicatie: zolendroninezuur>alendroninzuur>
M w
risedroninezuur >denosumab
*persoonlijke mening