Aanbevelingen zoals samengebracht in de richtlijn "Urineweginfecties bij de kwetsbare oudere" van Verenso, in zijn geheel terug te vinden op:
https://www.verenso.nl/kwaliteit-en-richtlijnen/richtlijnendatabase/urineweginfecties
new information about pre-exposure profylaxis for
HIV/aids in seronegative persons, MSM, transgenders. a new way to help stopping the spread of HIV, presentation in dutch,
Aanbevelingen zoals samengebracht in de richtlijn "Urineweginfecties bij de kwetsbare oudere" van Verenso, in zijn geheel terug te vinden op:
https://www.verenso.nl/kwaliteit-en-richtlijnen/richtlijnendatabase/urineweginfecties
new information about pre-exposure profylaxis for
HIV/aids in seronegative persons, MSM, transgenders. a new way to help stopping the spread of HIV, presentation in dutch,
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
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.
This document discusses recommendations from the European Calcified Tissue Society (ECTS) regarding treatment after stopping denosumab therapy. It summarizes findings from ECTS papers in 2017 and 2021 on risks of rebound vertebral fractures when discontinuing denosumab. The ECTS recommends pretreatment or post-treatment with bisphosphonates to prevent bone mineral density loss and fractures after stopping denosumab, especially for those on long-term denosumab therapy of over 2.5 years. New Dutch guidelines advise treating with denosumab for 3 years, then reevaluating fracture risk before extending treatment another 3 years up to a maximum of 10 years, and ensuring adequate bisphosphonate treatment after stopping to prevent
IWO bijeenkomst - 14 april - Prof. Dr. J.P. van den Bergh
IWO bijeenkomst - 14 april - Prof. Dr. M.C. Zillikens
1. COVID EN OSTEOPOROSE
Annegreet Vlug
Internist-endocrinoloog
Jan van Goyen Medisch Centrum, Amsterdam
OLVG, Amsterdam
Centrum voor Botkwaliteit, LUMC, Leiden
2. COVID EN OSTEOPOROSE
Is er een relatie tussen osteoporose en COVID?
Rol van vitamine D?
Zorg voor osteoporose patienten tijdens COVID pandemie veranderd
Starten behandeling
Doorgaan behandeling
Vaccinatie
Toekomstige ontwikkelingen
3. WERVELFRACTUREN
114 covid patienten (57 jaar,
75% man) op SEH met laterale
X-thorax
80% werd opgenomen, 12 %
daarvan naar IC, 15% dood
Voorafgaande diagnose
osteoporose bij 3%
41 patienten (36%)
wervelinzakkingen op X-thorax
bij opname, 19 daarvan
meerdere
Di Filippo JCEM 2021
4. VITAMINE D
216 patienten (61 jaar, 62%
man) opgenomen met COVID
vergeleken met 197 controles,
gemiddeld vit D 14 vs 21 ng/ml
19 COVID patienten gebruikten
vitamine D supplementen
Vitamine D deficientie in 82%
COVID patienten vs 47%
controles
Geen relatie vitamine D
concentratie en ernst COVID
infectie
Hernandez JCEM 2021
5. RCT VITAMINE D EN COVID
240 patienten (56 jaar, 56%
man, vit D 21 ng/ml) opgenomen
met matig-ernstige COVID
200.000 IU vitD3 versus placebo
bij opname
Geen verschil in opname duur
van 7 dagen, IC opname,
beademing of mortaliteit
MAAR kleine groep, hoge dosis
Murai JAMA 2021
14. ADVIES ACTIEVE MEDICATIE
Overweeg behandeling via thuiszorg (eurocept homecare,
apotheekzorg)
Indien niet mogelijk:
Bisfosfonaat: uitstel enkele maanden waarschijnlijk veilig
Denosumab:
niet langer dan 1 maand uitstellen (7 maanden na vorige injectie) ivm
rebound botverlies en wervelfracturen
Alternatief: over op oraal bisfosfonaat ter overbrugging
Teriparatide en romosozumab:
Niet langer dan 2-3 maanden uitstellen
Alternatief: over op oraal bisfosfonaat ter overbrugging of definitief
Yu JBMR 2020
15. ADVIES MEDICATIE EN VACCINATIE
Osteoporose geen reden om eerder of niet te vaccineren
Geen interactie osteoporose medicatie en vaccinatie
Timing en plek vaccinatie en osteoporose medicatie:
Oraal bisfosfonaat: continueren
IV bisfosfonaat: week interval tussen vaccinatie en infuus ivm acute
fase reactie
Denosumab: week interval en niet op zelfde plek injecteren ivm
injectieplaats reacties
Teriparatide en romosozumab: continueren, niet op zelfde plek
injecteren
Tsourdi JBMR 2021
16. ADVIES NIEUWE PATIENTEN
Heupfractuur klinisch:
tijdens opname lab en behandeling starten
Wervelfractuur klinisch of poliklinisch:
behandeling starten
Dexa uitstellen, lab via huisarts of alleen indien noodzakelijk
(verminderde nierfunctie, verdenking secundaire osteoporose)
Andere fractuur of verdenking osteoporose poliklinisch:
Lab via huisarts of alleen indien noodzakelijk
Dexa prioriteren of uitstellen (eerdere beeldvorming herbeoordelen
zoals X-thorax of CT)
Fractuur risico inschatting maken met FRAX
Teleconsult
Medicatie starten oraal of parenteraal via thuiszorg of huisarts
19. UITDAGINGEN
Inhalen osteoporose zorg ‘oude patienten’
UItbreiden osteoporose zorg ‘nieuwe patienten’ met verhoogd fractuur
risico door:
COVID opname en behandeling
Lockdown omstandigheden
Osteoporose zorg herorganiseren:
Eerste en tweede lijn samenwerking
Teleconsulten
Thuistoediening
Fractuur risico inschatting FRAX versus DEXA
20. CONCLUSIE
Wervelfracturen komen veel voor bij COVID patienten, mogelijk als
uiting van frailty. Behandeling van osteoporose na opname is
belangrijk om nieuwe fracturen te voorkomen!
COVID verhoogt het risico op osteoporose en botbreuken; aandacht
voor botgezondheid na COVID is belangrijk
Vitamine D in hoge dosering verbetert waarschijnlijk niet de uitkomst
van opgenomen COVID patienten, maar vitamine D kan wel
botgezondheid na opname verbeteren
Osteoporose zorg tijdens COVID afgenomen, nieuwe ontwikkelingen
in teleconsultatie, thuisbehandeling en fractuur risico inschatting
belangrijk om zorg te continueren