Orphan Café, 27 juni 2013
Prof. dr. Gertjan van Ommen (Leiden University Medical Centre)
Bekijk alle presentaties van de Orphan Cafés op:
http://www.orphancafe.nl/presentaties/
Presentatie van verpleegkundig specialist Esther Tomesen op het NVvP Voorjaarscongres 2015 over BMI verandering bij switch van Risperidon naar Aripiprazol.
IWO Meeting 1 November 2023 - Stopping with Denosumab and Romosozumab, basic mechanisms and clinical aspects door Prof. dr. S. Ferrari, Geneva, Switzerland. (Engelstalige lezing)
Orphan Café, 27 juni 2013
Prof. dr. Gertjan van Ommen (Leiden University Medical Centre)
Bekijk alle presentaties van de Orphan Cafés op:
http://www.orphancafe.nl/presentaties/
Presentatie van verpleegkundig specialist Esther Tomesen op het NVvP Voorjaarscongres 2015 over BMI verandering bij switch van Risperidon naar Aripiprazol.
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.
2. DISCLOSURES
Geen persoonlijke belangen
Participant in de ARCH studie (fase 3 studie Romosozumab, Amgen/UCB) en in momenteel
participatie in de fase 4 studie met Natpar (PTH1-84), Shire.
Consulting: Amgen, UCB, Lilly, Shire, Alexion, Kyowa Kyrin. Unpaid member Scientific Board
of Active Life Inc.
Lecture fees: Lilly, Shire
Donaties tbv wetenschappelijk onderzoek naar:
- Fibreuze Dysplasie (Bontius Stichting ‘ Beter Bot’ 2016- heden)
- Ziekte van Paget (Paget vereniging, 2015)
- Primaire hyperparathyroidie (Amgen 2015)
3. Zebaze RM et al 2010
Own material: pictures by dr.N.Bravenboer
Iliac Crest Biopsy
HRpQCT Distal Radius
OPTIMALE BEHANDELING ?
Appelman-Dijkstra, Papopoulos Nat Endo Rev Oct 2018
4. Zebaze RM et al 2010
Own material: pictures by dr.N.Bravenboer
Iliac Crest Biopsy
HRpQCT Distal Radius
OPTIMALE BEHANDELING = GOEDE DUO’S?
Appelman-Dijkstra, Papopoulos Nat Endo Rev Oct 2018
7. CASUS
Vrouw 62 jaar
RA, prednison gebruik, subcapitale humerusfractuur, T score -4 LWK
en nieuwe fractuur onder alendronaat.
Hoe pakt u dit aan?
8. HUIDIGE BEHANDELINGEN
Focus on resorption increased remoddeling
0
(%)100
Resorption
Formation
Time
BPs/RANKL-inhibition
0
Time
(%)200
rhPTH
Resorption
Formation
12. VERO TRIAL
Inclusie:
Ernstige osteoporose en merendeel
had prevalente wervelfracturen.
Significante reductie aantal
vertebrale fracturen in alle
subgroepen ten opzichte van
Risedronaat.
Lancet 2018; 391: 230–40 Kendler et al
16. OVERWEGINGEN BIJ TERIPARATIDE
Te overwegen
Ø Anabool dus cave metastasen solide tumoren
Ø Maximaal 24 maanden
Ø Altijd vervolg behandeling nodig
Vergoedingsbeperkingen zijn per juni 2018 te komen te vervallen
Oude set:
Nieuwe fractuur onder andere therapie bij reeds 2 of meer oude
wervelfracturen (oude indicatieset)
17. CASUS
Vrouw 62 jaar
RA, prednison gebruik, subcapitale humerusfractuur, T score -4 LWK
en nieuwe fractuur onder alendronaat.
Hoe pakt u dit aan?
23. CASUS
Vrouw 68 jaar
(nog steeds met) RA, prednison gebruik, subcapitale humerusfractuur,
en fractuur onder alendronaat. U bent destijds geswitcht naar
teriparatide en denosumab waarna geen fracturen optraden.
T score -2 LWK
Hoe pakt u dit aan?
27. Study Duration of therapy /
therapy naiv
/Age
LS BMD after 12
months
Hip BMD after 12
months
Target
Anastasilakis et al 3-3.4 years / Yes/
64.8±1.8 vs 65.2±1.7
ZOL - 0.1 ± 1.2% vs
NO - 4.82 ± 0.7%
- 0.49% vs
- 4.75%
Osteoporosis to Osteopenia
Sølling et al 4.6 years/ Yes/ 67.7 ZOL
-4.8 ± 0.7%, 6M
-4.2 ± 1.1%, 9M
-4.9 ± 1.4% OBS
ZOL
-2.6 ± 0.5%, 6M
-3.3 ± 0.8%, 9M
-3.8 ± 0.9% OBS
Osteoporosis to Osteopenia
Kendler et al 1 year/Yes/ 65.1 (7.6) ALN
0.6 %±3.4
ALN
0.4 %±2.4% TH
- 0.1 %±3.8 % Fn
Switch standard at 1 year
Tsai et al 1.5 years/Yes/ 52–82
years
ZOL
Maintained BMD
ZOL
Slight but not
significant decrease
Standard ZOL after
Dmab/Teri combination
SUMMARY OF STUDIES
28. CASUS
Vrouw 70 jaar
COPD, prednison gebruik, subcapitale humerusfractuur, en fractuur
onder alendronaat.
T score is -4 , ze heeft 2 wervelfracturen.
Hoe kan u dit aanpakken?
29. Month
0
5
10
15
0 3 6 12
Month
0
2
4
6
-2
Lumbar Spine Total Hip
PercentChangefromBaseline
11.4% 4.2%
0 3 6 12
ROMO ALN TPTD Placebo
-0.1%
-0.7%
McClung MR et al. New Engl J Med. 2014
OPTIES OM BMD TE VERHOGEN
30. SUPERIEUR AAN ALENDRONAAT
Saag NEJM 2017
RR clinical fractures 27%, for non-vertebral fractures 19% and for hip fractures even a 38%
Saag NEJM 2017
31. OOK NA ROMO MOET ER VERVOLG BEHANDELING
PLAATSVINDEN
32. IN DE TOEKOMST
Voor complexe osteoporose zal
– de behandeling in ieder geval
sequentieel zijn
- Dient het concept monotherapie
verlaten te worden