Presentatie nascholing Multidisciplinaire richtlijn aspecifieke KANS
Klachten aan armen, nek en/of schouders (KANS) vormen een belangrijk gezondheidsprobleem. Ruim een derde van de volwassen Nederlanders rapporteert KANS in het afgelopen jaar en ruim een kwart heeft KANS op het moment van navraag. Daarnaast wordt meer dan 10% van de verzuimdagen toegeschreven aan KANS.
Door betere diagnostiek krijgen patiënten met specifieke KANS sneller een gerichte behandeling. Beter inzicht in de behandelresultaten zal leiden tot de keuze voor effectieve behandelingen bij patiënten met aspecifieke KANS, met als gevolg dat meer patiënten de kansrijkste behandeling ontvangen.
Relatie mond(on)gezondheid en algemene (on)gezondheid bij kwetsbare ouderennvgd
Relatie mond(on)gezondheid
en algemene (on)gezondheid bij
kwetsbare ouderen.
Claar Wierink, tandarts-geriatrie
Werkzaam in verpleeghuis Vreugdehof
te Amsterdam, Geriatrische Verwijspraktijk
te Amstelveen
Presentatie nascholing Multidisciplinaire richtlijn aspecifieke KANS
Klachten aan armen, nek en/of schouders (KANS) vormen een belangrijk gezondheidsprobleem. Ruim een derde van de volwassen Nederlanders rapporteert KANS in het afgelopen jaar en ruim een kwart heeft KANS op het moment van navraag. Daarnaast wordt meer dan 10% van de verzuimdagen toegeschreven aan KANS.
Door betere diagnostiek krijgen patiënten met specifieke KANS sneller een gerichte behandeling. Beter inzicht in de behandelresultaten zal leiden tot de keuze voor effectieve behandelingen bij patiënten met aspecifieke KANS, met als gevolg dat meer patiënten de kansrijkste behandeling ontvangen.
Relatie mond(on)gezondheid en algemene (on)gezondheid bij kwetsbare ouderennvgd
Relatie mond(on)gezondheid
en algemene (on)gezondheid bij
kwetsbare ouderen.
Claar Wierink, tandarts-geriatrie
Werkzaam in verpleeghuis Vreugdehof
te Amsterdam, Geriatrische Verwijspraktijk
te Amstelveen
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.
IWO bijeenkomst - 14 april - Prof. Dr. M.C. Zillikens
IWO bijeenkomst - 10 mei - W.F. Lems
1. Unmet Needs in
Osteoporosis
IWO, 10 mei 2017
Prof Dr Willem F Lems
Department of Rheumatology
EULAR Centre of Excellence;
VU University medical centre and Reade,
Amsterdam, the Netherlands
2. (potentiële) belangenverstrengeling
Voor bijeenkomst mogelijk relevante
relaties met bedrijven
Bedrijfsnamen
Sponsoring of onderzoeksgeld
Honorarium of andere (financiële)
vergoeding
Aandeelhouder
Andere relatie, namelijk …
EliLilly, Curaphar, Amgen, MSD,
UCB
Disclosure belangen spreker
3. Prof Dr Willem F Lems
Department of Rheumatology, EULAR Centre of Excellence;
ARC, location VU University medical centre and Reade,
Amsterdam, the Netherlands
behandeling.
Copenhagen, 23 november 2016
4. - Wat is het behandeldoel?
- Hoe monitor je therapie bij osteoporose?
- (primary) Prevention of Osteoporosis
-Epidemiology
-Diagnosis of Osteoporosis
-Non-medical treatment of osteoporotic patients
-Medical Treatment of osteoporotic treatment
a) Surgical treatment
b) Drug treatment for prevention of secondary fractures
- handeling zinnig?)
Unmet needs in Osteoporosis
5. behandeling.
Unmet needs in Osteoporosis,
Prevention of Primary Osteoporosis
Peak Bone
Mass: 60-80%
genetic factors
20-40%
modifiable
factors!
Weaver et al, Ost 2016
6. behandeling.
Unmet needs in Osteoporosis,
Prevention of Primary Osteoporosis
Peak Bone
Mass: 60-80%
genetic factors
20-40%
modifiable
factors!
Weaver et al, Ost 2016
7. behandeling.
Unmet needs in Osteoporosis,
Prevention of Primary Osteoporosis
Healthy life style:
-adequate calcium, vitamin D, diet (including protein)
-exercise
-non smoking, limited alcohol use.
What is an adequate calcium intake? Which exercises, how long?
Vitamin D? magnesium? Vitamin K?
8. Calcium en Fysieke activiteit: beide graad A. Dat is bijzonder, en dit behoort te
leiden tot “public health actions”
RCTs met BMD als eindpunt.
Bezwaar: geen data over hoeveelheid en soort calcium en fysieke activiteit die
nodig zijn.
9. behandeling.
Unmet needs in Osteoporosis,
Prevention of Primary Osteoporosis
Healthy life style:
Who is responsible?
-individual (child) and parents
-general practitioner
-endocrinologists/rheumatologists/geriatricians etc; pediatricians?
-government.
What exactly should be implemented?
10. - Wat is het behandeldoel?
- Hoe monitor je therapie bij osteoporose?
- (primary) Prevention of Osteoporosis
-Epidemiology
-Diagnosis of Osteoporosis
-Non-medical treatment of osteoporotic patients
-Medical Treatment of osteoporotic treatment
a) Surgical treatment
b) Drug treatment for prevention of secondary fractures
- handeling zinnig?)
Unmet needs in Osteoporosis
13. Prevalence of Osteoporosis in The Netherlands
- 2010 -
Epidemiology & economic burden of osteoporosis in the Netherlands; report IOF and
EFPIA;
Ivergård et al, Arch Osteoporos, 2013;8:146-153
~ 820.000
14. Leeftijd
aantal
vrouwen in de
populatie1
Percentage
met
osteoporose2
Punt
Prevalentie per
1000
aantal
vrouwen met
osteoporose
50-55 636.675 6,3 63,00 40.110
55-60 584.879 9,6 96,00 56.148
60-65 528.137 14,3 143,00 75.523
65-70 527.476 20,2 202 106.550
70-75 375.866 27,9 279,00 104.866
75-80 303.174 37,5 375,00 113.690
80-85 231.890 47,2 361,02 109.452
> 85 241.231 34,7 347,21 83.759
> 50 3.429.328 21,2 201,23 690.098
Leeftijd
aantal mannen
in de populatie1
Percentage
met
osteoporose2
Punt
Prevalentie per
1000
aantal
mannen met
osteoporose
50-55 643.844 2,5 25,00 16.096
55-60 585.735 3,5 35,00 20.500
60-65 525.615 5,8 58,00 30.485
65-70 519.227 7,4 74,00 38.422
70-75 353.646 7,8 78,00 27.584
75-80 257.171 10,3 103,00 26.488
80-85 163.046 16,6 166,00 27.065
> 85 112.581 21,2 212,20 23.890
> 50 3.160.865 6,3 66,61 210.530
1. Centraal Bureau voor Statistiek. Gegevens van 1 Januari 2016
2. Ivergård et al, Arch Osteoporos, 2013;8:146-153. Epidemiology & economic burden of
osteoporosis in the Netherlands
1 op de 5 vrouwen (50+) heeft osteoporose 1 op de 16 mannen (50+) heeft osteoporose
~ 900.000 osteoporose personen (50+) in NL in
2016
Per HA praktijk n=178 (136♀ en 42♂)
Prevalence of Osteoporosis in The
Netherlands
- 2016 -
15. Incidence of all 50+ fractures and osteoporosis-
related fractures, by gender and fracture type, in
2010
Lötters et al. Calc Tiss Int
19. “”Each patient 50 years and over with a recent fracture should be evaluated
systematically for the risk of subsequent fractures”
• Clinical risk Factors for further fractures:
– fracture location and severity
– suboptimal pre-operative, operative and postoperative phase with
complications and suboptimal rehabilitation
– high age, low BMI, personal and family history of fracture, diseases, medications
and life style (smoking, alcohol, lack of exercise)
– NB: Clinical risk factors can be integrated in FRAX, Garvan or Qfracture
algorithms to estimate future fracture risk
• DXA of lumbar spine and hips
• Imaging of the Spine, by VFA or by conventional radiographs
• Fall risk
• Screening for underlying secondary osteoporosis or other metabolic bone
diseases
Ann Rheum Dis,
december 2016
20. VF ≥ grade 2
VF ≥ grade 1
0%
5%
10%
15%
20%
25%
30%
Minor Major Hip
Van der Velde et al., submitted
Newly diagnosed Vertebral Fracture in 50+ patients at the FLS,
presenting with a non-VF.
Vertebral
Fracture
Major fractures: hip, pelvis, distal femur, proximal tibia/humerus, multiple rib
Minor fractures: all others, except fingers and toes
No significant difference
21. Newly diagnosed Vertebral Fracture in 50+ patients at the FLS,
presenting with a non-VF, according to BMD
VF ≥ grade 2
VF ≥ grade 1
0%
5%
10%
15%
20%
25%
30%
Van der Velde et al.,
Submitted
Vertebral
Fracture
No significant difference
22. 22
Wervelfractuur: in klinische studies hoogteverlies 20% of meer.
Genant, et al., J Bone Miner Res 1993
Normaal
Graad 0
Wigvormige
fractuur
Biconcave
fractuur
Crush fractuur
Lichte fractuur
(Graad 1, ~20-25%
Matig-ernstige
fractuur
Graad 2, ~25-40%
Ernstige fractuur
Graad 3, ~40%
23. 23
VFA en CBO
• Rontgenfoto: drempelwaarde behandelingsindicatie:
25%;
- VFA: meer dan 40% hoogteverlies: behandelingsindicatie;
- VFA: 25-40% hoogteverlies: rontgenfoto maken voor
bevestiging.
- Radiologen wordt geadviseerd te rapporteren volgens
Genant-methode.
24. 24
Wervelfractuur: in klinische studies hoogteverlies 20% of meer;
in dagelijkse praktijk 25% of meer.
Genant, et al., J Bone Miner Res 1993
Normaal
Graad 0
Wigvormige
fractuur
Biconcave
fractuur
Crush fractuur
Lichte fractuur
(Graad 1, ~20-25%
Matig-ernstige
fractuur
Graad 2, ~25-40%
Ernstige fractuur
Graad 3, ~40%
27. - Wat is hDDDiagnosis of Osteoporosis
- DXA unavailable for many patients;
- Underuse of VFA;
- Underuse of FRAX;
- No reliable methods avaliable that measure bone
strength superiorly to DXA;
- Implementation of prevention of fall events.
- Secondary Osteoporosis: in 40-50%! (after a fracture)
28. - Wat is het behandeldoel?
- Hoe monitor je therapie bij osteoporose?
- (primary) Prevention of Osteoporosis
-Epidemiology
-Diagnosis of Osteoporosis
-Non-medical treatment of osteoporotic patients
-Medical Treatment of osteoporotic treatment
a) Surgical treatment
b) Drug treatment for prevention of secondary fractures
- handeling zinnig?)
Unmet needs in Osteoporosis
29. 29
Over vitamine D (aanbevelingen CBO 2011)
• Het is wenselijk dat patiënten met osteoporose een vitamine D-supplement
van 800 IE per dag gebruiken.
• Het is wenselijk dat bewoners van verzorgings- en verpleeghuizen een
vitamine D-supplement van 800 IE per dag gebruiken.
29
Paradoxaal: hoge piekdoseringen vitamine D verhogen val- en fractuurrisico;
Vitamine D bij andere aandoeningen (COPD, artrose etc): nog niet overtuigend aangetoond
30. 30
Over calcium (aanbevelingen)
• Het is wenselijk dat patiënten met osteoporose een calciumsupplement van
500 of 1000 mg per dag gebruiken wanneer de inname van calcium met de
voeding lager is dan 1000-1200 mg per dag.
• De suppletiedosis van 1000 mg geldt vooral wanneer de patiënt helemaal
geen zuivelproducten gebruikt
30
Bolland, BMJ 2008
36. - Wat is het behandeldoel?
- Hoe monitor je therapie bij osteoporose?
- (primary) Prevention of Osteoporosis
-Epidemiology
-Diagnosis of Osteoporosis
-Non-medical treatment of osteoporotic patients
-Medical Treatment of osteoporotic treatment
a) Surgical treatment
b) Drug treatment for prevention of secondary fractures
- handeling zinnig?)
Unmet needs in Osteoporosis
37. EULAR-EFORT RECOMMENDATIONS FOR MANAGEMENT OF PATIENTS
OLDER THAN 50 YEARS WITH A FRAGILITY FRACTURE AND PREVENTION OF
SUBSEQUENT FRACTURES
• Fragility fractures should be managed in the context of a multidisciplinary
clinical system, guaranteeing adequate preoperative assessment and
preparation of patients including adequate pain and fluid management
and surgery within 48 hours
• To improve functional outcome, and to reduce length of hospital stay and
mortality, orthogeriatric co-management should be provided, especially in
elderly hip fracture patients
• Appropriate treatment of the fractures in these often elderly and multi-
morbid patients with frail bones requires a balanced approach in regard to
operative vs. non-operative treatment and the choice of the most
promising fixation device
Ann Rheum Dis 2016
38. 1-year Mortality: 35.1% (usual care)
versus 23,2% (orthogeriatric care)
( p<0.001)
Ook in komend
nummer Osteoporose
Journaal
39. “”Each patient 50 years and over with a recent fracture should be evaluated
systematically for the risk of subsequent fractures”
• Clinical risk Factors for further fractures:
– fracture location and severity
– suboptimal pre-operative, operative and postoperative phase with
complications and suboptimal rehabilitation
– high age, low BMI, personal and family history of fracture, diseases, medications
and life style (smoking, alcohol, lack of exercise)
– NB: Clinical risk factors can be integrated in FRAX, Garvan or Qfracture
algorithms to estimate future fracture risk
• DXA of lumbar spine and hips
• Imaging of the Spine, by VFA or by conventional radiographs
• Fall risk
• Screening for underlying secondary osteoporosis or other metabolic bone
diseases
Ann Rheum Dis 2016
40. - Wat is het behandeldoel?
- Hoe monitor je therapie bij osteoporose?
- (primary) Prevention of Osteoporosis
-Epidemiology
-Diagnosis of Osteoporosis
-Non-medical treatment of osteoporotic patients
-Medical Treatment of osteoporotic treatment
a) Surgical treatment
b) Drug treatment for prevention of secondary fractures
- handeling zinnig?)
Unmet needs in Osteoporosis
41. Effect van medicatie in de primaire analyses van RCTs met
fractuurpreventie als eindpunt, ALLE STUDIES 3-5 jaar!
Medicament Wervel-
fracturen
Niet wervel-
fracturen
Heupfracturen
Follow-
up
Relatief
effect
Kwaliteit
bewijs
Relatief effect Kwaliteit
bewijs
Relatief effect Kwaliteit
bewijs
Alendronaat 1-4 jaar 0.55 (0.45-0.67) Hoog 0.84 (0.74-0.94) Hoog 0.61 (0.4-0.92) Hoog
Risedronaat 2-3 jaar 0.63 (0.51-0.77) Hoog 0.80 (0.72-0.90) Hoog 0.74 (0.59-0.94) Hoog
Etidronaat 2-4 jaar 0.59 (0.36-0.96) Hoog 1.07 (0.72-1.06) Matig 1.20 (0.37-3.88) Matig
Zoledronaat 2 jaar 0.30 (0.24-0.38) Hoog 0.75 (0.64-0.87) Hoog 0.59 (0.42-0.83) Hoog
Strontiumranelaat 3 jaar 0.63 (0.56-0.71) Hoog 0.86 (0.75-0.98) Hoog Niet te bepalen
Teriparatide 1.5 jaar 0.36 (0.28-0.47) Hoog 0.62 (0.48-0.82) Hoog Niet te bepalen
Denosumab 3 jaar 0.32 (0.26-0.41) Hoog 0.80 (0.67-0.95) Hoog 0.60 (0.37-0.96) Hoog
Raloxifen 3 jaar 0.60 (0.50-0.70) Hoog 0.91 (0.79-1.06) Matig Niet te bepalen
Ibandronaat 3 jaar 0.50 (0.34-0.74) Hoog Niet te bepalen Niet te bepalen
CBO Osteoporose en Fractuurpreventie, 2011
No New Anti-osteoporotic Drugs on the market since 2011 !
42. Medicatie CBO 2011
Uitleg: toedieningswijze, frequentie, duur, voorzorgsmaatregelen, tolerantie, compliance
Voldoende calcium en vitamine D
Contra-indicatie orale bisfosfonaten. Intolerantie, non-compliance, nieuwe fractuur of bij vragen
over effect en veiligheid tijdens gestructureerde monitoring
Zoledronaat IV Strontium ranelaat PO
Raloxifeen PO
Ibandronaat PO/IV
Wervel, niet-Wervel en Heup Wervel,niet-Wervel Wervel
Fractuurpreventie in fractuurstudies volgens GRADE:
Denosumab SC
2de keuze: op basis van spectrum van fractuurpreventie, gemak, frequentie, toedieningswijze (PO, SC, IV),
duur, voorzorgsmaatregelen, patiëntkarakteristieken en voorkeur, tolerantie en compliance
Na 3de fractuur waaronder 2 wervelfracturen
Intolerantie/contra-indicaties overige medicaties
Teriparatide SC
PTH (1-84) SC
1ste keuze: alendronaat PO / risedronaat PO
43. Medicatie CBO 2011 en NHG 2012
Uitleg: toedieningswijze, frequentie, duur, voorzorgsmaatregelen, tolerantie, compliance
Voldoende calcium en vitamine D
Contra-indicatie orale bisfosfonaten. Intolerantie, non-compliance, nieuwe fractuur of bij vragen
over effect en veiligheid tijdens gestructureerde monitoring
Zoledronaat IV Strontium ranelaat PO
Raloxifeen PO
Ibandronaat PO/IV
Wervel, niet-Wervel en Heup Wervel,niet-Wervel Wervel
Fractuurpreventie in fractuurstudies volgens GRADE:
Denosumab SC
2de keuze: op basis van spectrum van fractuurpreventie, gemak, frequentie, toedieningswijze (PO, SC, IV),
duur, voorzorgsmaatregelen, patiëntkarakteristieken en voorkeur, tolerantie en compliance
Na 3de fractuur waaronder 2 wervelfracturen
Intolerantie/contra-indicaties overige medicaties
Teriparatide SC
PTH (1-84) SC
1ste keuze: alendronaat PO / risedronaat PO
NHG
44. Persistentie orale osteoporosemedicatie (12 maanden)
Osteoporos Int. 2010
%patiëntennogsteedsoptherapie
Aantal dagen na start therapie
57% van de patiënten in Nederland stopt
binnen 1 jaar met hun anti-osteoporose medicatie
Netelenbos, Geusens et al.
45. Approximately 30% of patients in NL stop taking their
OP tablets within three months after start !
Netelenbos et al. Osteoporos Int 2011; 22: 1537-1546
46. Persistentie orale osteoporosemedicatie (12 maanden)
Osteoporos Int. 2010
%patiëntennogsteedsoptherapie
Ongeveer 50% van de patiënten in Nederland stopt
binnen 1 jaar met hun anti-osteoporose medicatie
Netelenbos, Geusens et al.
47. Progressive relationship between MPR and
fracture risk reduction becomes pronounced at
compliance rates > 75%
E. S. Siris et al. Mayo Clin Proc. 2006;81:1013-1022
49. Aantal gebruikers* van Botstructuur en botmineralisatie beïnvloedende
middelen in Nederland tussen 2010-2014 (gip databank)
*(mensen die minstens 1 keer een recept ontvingen in het kalender jaar)
0
50,000
100,000
150,000
200,000
250,000
2010 2011 2012 2013 2014
Aledronaat
Ibandronaat
Risedronaat
Bisfosfonaten
totaal
Denosumab
15%
50. Congress Highlights ASBMR 2016 Annual
Meeting
50
• BMD and bone turnover marker effects of discontinuing denosumab
RESULTS
BMD: Bone Mineral Density; CTX: collagen type 1 cross-linked C-telopeptide
Reproduced with permission from the author
[1100] Discontinuation of denosumab and associated fracture
incidence: analysis from FREEDOM and its extension
JACQUES P BROWN, LAVAL UNIVERSITY AND CHU DE QUÉBEC (CHUL) , CANADA
51. Why is fracture prevention suboptimal?
• Fear of severe side effects
• Lack of education in professionals and in the lay public
• Lack of engagement: osteoporosis is a low medical
priority
• Which professionals are in the driving position?
• Inadequate access to diagnostics such as DXA and VFA
• The treatment gap
• Low adherence and compliance to anti-osteoporotic
drugs
• Generic drugs, nocebo-effect
• Lack of focus on muscle strength and fall prevention
52.
53.
54.
55. The Average Response to Risedronate 5 mg Exceeds
LSC Earlier for BTMs (3 Months) than BMD (18 Months)
Spine BMD (% from baseline)
Time (months)
LSC
Control
Risedronate 5 mg
NTX (% from baseline)
-75
-50
-25
0
0 6 36
LSC
Time (months)
Control
Risedronate 5 mg
LSC = least significant change.
56.
57.
58.
59.
60. • Gegeven de verre van optimale huidige behandeling van
osteoporose met bisfosfonaten in tabletvorm, zijn andere
opties te overwegen:
• Bij begin en na 3 maanden botmarkers bepalingen;
• Alendronaat drank?
• Nieuwe Geneesmiddelen? Treat to target met denosumab of
met anabole middelen (teriparatide?, romosozumab???)
Drug treatment for prevention of secondary fractures
61. - Wat is het behandeldoel?
- Hoe monitor je therapie bij osteoporose?
- (primary) Prevention of Osteoporosis
-Epidemiology
-Diagnosis of Osteoporosis
-Non-medical treatment of osteoporotic patients
-Medical Treatment of osteoporotic treatment
a) Surgical treatment
b) Drug treatment for prevention of secondary fractures
- handeling zinnig?)
Unmet needs in Osteoporosis: op vele gebieden!