Dr. Sehdev explains bone health as it relates to cancer, including bone metastases, treatment options, the impact of cancer treatment on bone health, and what you can do to keep your bones strong.
Dr Jennifer Walsh's presentation from Osteoporosis 2016: Management of osteoporosis in the young adult.
Find out more at: https://nos.org.uk/conference
Dr. Sehdev explains bone health as it relates to cancer, including bone metastases, treatment options, the impact of cancer treatment on bone health, and what you can do to keep your bones strong.
Dr Jennifer Walsh's presentation from Osteoporosis 2016: Management of osteoporosis in the young adult.
Find out more at: https://nos.org.uk/conference
Prof. Richard Eastell's presentation from Osteoporosis 2016: Patients receiving bisphosphonates should take holidays from treatment. The case for holidays.
Find out more at: https://nos.org.uk/conference
Dr Steve Cummings presentation from Osteoporosis 2016: Patients receiving bisphosphonates should not take holidays from treatment.
Find out more at: https://nos.org.uk/conference
Dr Trevor Cole's presentation from Osteoporosis 2016: From family history to epigenetics of osteoporosis.
Find out more at: https://nos.org.uk/conference
Update on the 18th International Conference on Co-morbidities and Adverse Drug Reactions in HIV
Daniel Lee, M.D.
January 20th, 2017
UCSD HIV & Global Health Rounds
We report the 11-year follow-up of a premenopausal woman with osteogenesisimperfecta (OI) who
was treated with alendronate. A 41-year-old Japanese premenopausal woman with OI type I who had
frequently experienced painful fragility fractures consulted our clinic because of chronic back pain associated
with spinal osteoporosis. She had undergone heart surgery (aortic valve replacement) because of aortic
regurgitation 5 years before her first consultation with our clinic. After surgery, she began taking warfarin (3
mg/day), and this treatment was continued during our follow-up period. She was treated with alendronate (5
mg/day or 35 mg/week) for 11 years. The patient’s urinary cross-linked N-terminal telopeptides of type I
collagen and serum alkaline phosphatase levels decreased, while the bone mineral density of her lumbar
spine (L2–L4) increased, as measured using dual energy X-ray absorptiometry. The serum calcium and
phosphorus levels stayed within the normal ranges. Three non-vertebral fractures occurred at the hip, ankle,
and ring finger during the 11-year treatment period, but no adverse effects were observed. Thus, the present
case report showed the long-term outcome and safety of alendronate treatment in a premenopausal woman
with OI type I.
Presented by Linus Lay, Pharm.D. Candidate from the University of Rhode Island Class of 2022.
This presentation is on behalf of the Hackettstown Medical Center Pharmacy at Hackettstown, New Jersey as part of Continuing Education.
The Osteoporosis Overview goes over a brief introduction to osteoporosis and current/updated treatment guidelines based on global usage, drug effectiveness, and American association of clinical endocrinologists.
View MyCred Portfolio: https://mycred.com/p/2929377185
Prof. Richard Eastell's presentation from Osteoporosis 2016: Patients receiving bisphosphonates should take holidays from treatment. The case for holidays.
Find out more at: https://nos.org.uk/conference
Dr Steve Cummings presentation from Osteoporosis 2016: Patients receiving bisphosphonates should not take holidays from treatment.
Find out more at: https://nos.org.uk/conference
Dr Trevor Cole's presentation from Osteoporosis 2016: From family history to epigenetics of osteoporosis.
Find out more at: https://nos.org.uk/conference
Update on the 18th International Conference on Co-morbidities and Adverse Drug Reactions in HIV
Daniel Lee, M.D.
January 20th, 2017
UCSD HIV & Global Health Rounds
We report the 11-year follow-up of a premenopausal woman with osteogenesisimperfecta (OI) who
was treated with alendronate. A 41-year-old Japanese premenopausal woman with OI type I who had
frequently experienced painful fragility fractures consulted our clinic because of chronic back pain associated
with spinal osteoporosis. She had undergone heart surgery (aortic valve replacement) because of aortic
regurgitation 5 years before her first consultation with our clinic. After surgery, she began taking warfarin (3
mg/day), and this treatment was continued during our follow-up period. She was treated with alendronate (5
mg/day or 35 mg/week) for 11 years. The patient’s urinary cross-linked N-terminal telopeptides of type I
collagen and serum alkaline phosphatase levels decreased, while the bone mineral density of her lumbar
spine (L2–L4) increased, as measured using dual energy X-ray absorptiometry. The serum calcium and
phosphorus levels stayed within the normal ranges. Three non-vertebral fractures occurred at the hip, ankle,
and ring finger during the 11-year treatment period, but no adverse effects were observed. Thus, the present
case report showed the long-term outcome and safety of alendronate treatment in a premenopausal woman
with OI type I.
Presented by Linus Lay, Pharm.D. Candidate from the University of Rhode Island Class of 2022.
This presentation is on behalf of the Hackettstown Medical Center Pharmacy at Hackettstown, New Jersey as part of Continuing Education.
The Osteoporosis Overview goes over a brief introduction to osteoporosis and current/updated treatment guidelines based on global usage, drug effectiveness, and American association of clinical endocrinologists.
View MyCred Portfolio: https://mycred.com/p/2929377185
Multiple atraumatic osteoporotic vertebral fractures: Unusual cause of pain i...Apollo Hospitals
Secondary osteoporosis may not be detected early, and thus the condition remains clinically silent until the patient presents with multiple atraumatic compression fractures. It is devastating for a young patient to develop multiple vertebral fractures in view of the associated morbidity and mortality. To decrease the risk of additional fractures and preserve the quality of life in these patients, interventions should be initiated early. Hence, it is important to consider multiple osteoporotic vertebral fractures as a complication in any patient on prolonged steroid therapy.
Osteoporosis is a chronic, progressive skeletal disease characterized by low bone mass, microarchitecture deterioration of bone tissue, bone fragility, and a consequent increase in fracture risk.
CLINICAL EVALUATION OF THE EFFECT OF OMEGA-3 FATTY ACIDS ON OSTEOPOROTIC FEMA...Mohamed A. Galal
Mohamed A. Galal ; Mushira A. Dahaba, ; Basma M. Zaki
and Hanaa M. Elshenawy. CLINICAL EVALUATION OF THE EFFECT OF OMEGA-3 FATTY ACIDS ON OSTEOPOROTIC FEMALES HAVING CHRONIC PERIODONTITIS. Cairo Dental Journal (30)Number (1), 1:10January, 2014.
OSTEOPOROSIS:A Barebone guide to diagnosis and managementGovindRankawat1
“Progressive systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk”
True Definition: bone with lower density and higher fracture risk
WHO: utilizes Bone Mineral Density as definition (T score <-2.5)
Osteoporosis is silent because there are no symptoms initially.
The most common are fractures of the spine, hip, and wrist.
Osteoporosis is not an inevitable part of aging, but is a disease that can be prevented and treated, provided it is detected early.
The main goal of treating osteoporosis is to prevent such fractures in the first place.
Bare bone term used for “necked bone with necked eye”
“There is clearly a problem of underdiagnosis and undertreatment of osteoporosis and we want to raise awareness about the risk factors for osteoporosis so that those who need treatment get treatment”.
Learning Objectives
Utilize recent recommendations for osteoporosis prevention and treatment and how to apply them in practice.
Explain controversies surrounding pharmacologic osteoporosis therapy including side effects and the risk/benefit ratio of therapy.
Determine when and how to utilize the current pharmacologic therapies including anabolic versus anti-resorptive approaches and how to transition or discontinue treatment
Osteoporosis only causes symptoms when it is far advanced.
Symptoms include loss of height, deformed spine (“dowager’s hump”), unexplained back pain, and fractures.
It is best to detect problems at an early stage, when treatment is most effective.
The best test for detecting osteoporosis is bone densitometry, done with a technique called “Dual-energy X-ray Absorptiometry” or DXA.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
2. 2
Osteoporosis
Normal = BMD within 1
SD of the young adult
mean
. Low bone mass (osteopenia) =
BMD 1–2.5 SD below the young
adult mean (often seen as T-score
between -1 and -2.5).
Osteoporosis = BMD
at least 2.5 SD
below the young
adult mean (often
seen as T-score of
less than -2.5).
World Health Organization
(WHO) Definitions Based on T-
scores (T-score indicates that
for every standard deviation [SD]
below the mean young adult
bone mineral density [BMD],
fracture risk increases 2-fold)
3. 3
a. Female sex
b. White race
c. Poor nutrition
d. Early menopause
e. Estrogen deficiency
f. Drugs: glucocorticoids, heparin,
anticonvulsants, excessive levothyroxine,
gonadotropin-releasing hormone (GnRH)
agonists, lithium, cancer drugs
g. Low (BMI) or low weight
h. Family history
i. Low calcium and vitamin D intake
j. Sedentary lifestyle
k. Smoking
l. Alcoholism
m. Dementia
n. Impaired eyesight
o. Previous fractures
p. History of falls
Risk factors for
osteoporotic fractures
4. Origami Agenda Slide 1
2
3
Clinical screening tools (a) FRAX score
(b) Other screening tools
(1) Simple Calculated Osteoporosis Risk Estimation
(2) Osteoporosis Risk Assessment Instrument
(3) Osteoporosis Index of Risk
(4) Osteoporosis Self-Assessment Tool
4
RecommendationsAdvise patient to avoid smoking and to
consume only moderate amounts of alcohol
Encourage regular weight-bearing and
muscle-strengthening exercise.
Encourage adequate intake of calcium (at least 1000 mg/day) and
vitamin D (800–1000 international units/day) according to the NOF
guidelines, or 600 international units/day for those younger than 70
years and 800 international units/day for 70 years or older according to
the Institute of Medicine (IOM
5. Recommended BMD testing
(a) Previous fracture after menopause other than skull
(b) any risk factor
(c) Previous fracture not caused by severe trauma
after age 40–45 (AACE/ACE) .
(d) Thinness (body weight less than 127 lb [58 kg]),
family history of spine or hip fracture (AACE).
(e) (osteopenia) identified radiographically
(AACE/ACE).
(f) Starting or taking long-term systemic
glucocorticoids for 3 months or longer (AACE/ ACE, NOF)
.
(g) USPSTF statement recommends use of a clinical
tool for screening (FRAX, SCORE, OST, ORAI, or OSIRIS) in
women to determine whether BMD assessment is
necessary (JAMA 2018;319:2521-31).
5
i. All women 65 years
and older (NAMS,
ACOG, AACE/ACE,
NOF), men older than
70
(NOF, ES)
ii. Men 50–69
years of age
with previous
fractures or risk
factors
iii. All
postmenopausal
women with
medical causes
of bone loss
(NAMS)
iv.
Postmenopausal
women younger
than 65 years
with at least one
of the following:
6. Initiation of drug therapy (AACE/ACE, NOF,
NAMS, ES)
6
If BMD T-
score is -
2.5 or
below at
spine, hip,
or femoral
neck
If BMD T-score is -1.0 and -2.5 at the
femoral neck or spine and the 10-year
probability of hip fracture is 3% or greater,
or the 10-year probability of osteoporosis-
related fracture is 20% or greater
i. If hip or
spine
fracture
ii
iii
8. 1. Bisphosphonates
Inhibits normal and abnormal bone resorption
First-line therapy; exception: Ibandronate second-line therapy
Efficacy: Reduces vertebral and non-vertebral fractures by 30%–50% ( exception:
Ibandronate reduces only vertebral fractures)
Adverse events
i. Gastrointestinal
ii. Miscellaneous: Headache, musculoskeletal pain, rash , nephrotoxicity,
iii. Laboratory values: Decreases in serum ca , Mg ,K and phosphors in the
first month .
iv. Osteonecrosis of jaw .
v. Atypical fractures and esophageal cancer
vi. Atrial fibrillation
8
9. 9
Drug holidays are
controversial; bone
density may
decrease 5 years
after
discontinuation of
bisphosphonate
i. American Society for Bone and Mineral
Research recommends that, after 5 years of
oral bisphosphonate use or 3 years of
intravenous treatment, women be
reassessed for risk
ii. Women at a high risk of fractures
should continue oral therapy for up to 10
years and up to 6 years with intravenous
therapy with intermittent follow-up
(AACE/ACE).
iii. Women whose fracture risk
decreased after 3–5 years of use
should stop treatment for 2–3
years
10.
11. Questions : R.K. is a 71-year-old white woman (height 63 inches,
weight 64 kg) with a history of rheumatoid arthritis who smokes ½
pack/day. She is lactose intolerant and has minimal intake of dairy
products. She takes calcium 1200 mg orally per day in divided
doses and vitamin D 600 international units/day orally. Her
calculated creatinine clearance (CrCl) is 60–70 mL/minute/1.73 m2.
Her BMD T-score is -2.6 at the hip and -2.1 at the spine. Her FRAX
score indicates she has a 10-year probability of a major
osteoporotic fracture of 22% and a 10-year probability of a hip
fracture of 11%.
Which statement best describes the correct diagnosis for R.K.?
A. She has normal BMD of the spine.
B. She has low bone mass (osteopenia) of the hip.
C. She has osteoporosis of the hip.
D. She has severe osteoporosis of the spine.
11
12. Which is the best therapy for R.K.?
A. No further treatment is needed; continue calcium
1200 mg/vitamin D 600 international units/day orally.
B.Give abaloparatide 80 mcg subcutaneously daily, and
continue calcium 1200 mg/vitamin D 600 international
units/day orally.
C.Give Miacalcin nasal spray 1 spray (200 international
units) in one nostril daily; continue calcium 1200 mg/day
orally, and increase vitamin D to 800 international
units/day orally.
D. Give risedronate 35 mg orally every week; continue
calcium 1200 mg orally per day, and increase vitamin D
to 800 international units/day orally.
12
13. It is recommended that
patients with breast cancer
who have evidence of bone
metastases on plain
radiographs receive either
pamidronate 90 mg over 2
hours or
zoledronic acid 4 mg over
15 minutes every 3–4
weeks
Women with abnormal
bone scan and abnormal
CT scan or MRI showing
bone destruction but a
normal radiograph should
also receive the previously
recommended
bisphosphonates.
Therapy should continue
until the patient has
evidence of a substantial
decline in performance
status
01 02 03
Bisphosphonates may be
used in combination with
other pain therapies in
patients with pain caused
by osteolytic disease
04
Bisphosphonates decrease the worsening of pain by preventing disease progression in the bone in
patients with breast cancer and m.m. when given for 1 year. Skeletal-related events include
pathologic fracture, need for radiation therapy to bone, surgery to bone, and spinal cord
compression.
In 2000, the American Society of Clinical Oncology published initial guidelines for the use of
bisphosphonates in breast cancer (updated in November 2003 and March 2011).
14. A new guideline for adjuvant bisphosphonate use
in breast cancer by the American Society of
Clinical Oncology published in March 2017
recommends that zolendronic acid 4 mg over 15
minutes every 6 months be considered as
adjuvant therapy for postmenopausal patients
with breast cancer who are deemed candidates for
adjuvant systemic therapy.
14
15. In 2002, the American Society of Clinical Oncology published guidelines for the use of
bisphosphonates in multiple myeloma (updated June 2007).
030201
Bisphosphonates are not recommended for patients with solitary
plasmacytoma, smoldering or indolent myeloma, or monoclonal
gammopathy of undetermined significance.
Patients with lytic
bone destruction seen
on plain radiographs
should receive either
pamidronate 90 mg IV
over at least 2 hours
or zoledronic acid 4
mg over 15 minutes
every 3–4 weeks.
Therapy should
continue until
there is evidence
of substantial
decline in a
patient’s
performance
status.
Patients with
osteopenia but no
radiologic evidence of
bone metastases can
receive
bisphosphonates.
Bisphosphonates may
be used in patients
with pain caused by
osteolytic disease
16. 2. Denosumab (Prolia): Approved for postmenopausal women with
osteoporosis and for men and women with bone loss associated with prostate
or breast cancer.
.
Inhibits osteoclast-mediated
bone resorption,monoclonal
antibody against receptor
(RANKL), cytokine essential
for formation, function,
survival of osteoclasts
Considered
alternative first-line
therapy by AACE
and ACP guidelines
i. Increased hip (6%)
and spine (9%) BMD
ii. Reduced spinal
fracture risk by 68%,
hip fracture risk by
40%
f. Safety issues
Administered as
60 mg
subcutaneously
every 6 months
Not
contraindicat
ed in patients
with renal
dysfunction
i. Possible opportunistic
infections
ii. Hypocalcemia: Patients
should take calcium and
vitamin D together with
denosumab.
iii. The FDA has Risk
Evaluation and
Mitigation Strategies
requirements for this
drug (Medication
Guide).
17. 3.Calcium and vitamin D
Vitamin D
a. Recommended for all patients with osteoporosis;
promotes calcium reabsorption.
b. Minimal dose is 800 units/day for those older than 70
years, 600 units/ day 70 years of age and younger (IOM
recommendations 2010); NOF recommendations are 800–
1000 i units/day for those 50 and older.
c. Higher doses of vit. D may be necessary for those with
vit. D conc. less than 30 ng/mL.
Calcium
a. Recommended for all patients with osteoporosis to
maintain normal calcium concentrations and to prevent
hypocalcemia associated with other drug treatments for
osteoporosis
b. Elemental calcium intake: Avoid doses higher than 2500
mg/day; NOF recommends no more than 1200–1500
mg/day. Higher doses may increase risk of constipation,
contribute to kidney stones, and inhibit absorption of zinc or
iron
18. 4. Selective estrogen receptor modulators ( Raloxifene)
L
01
02
03
04
05
06
M. Of action
(a) Reduction in resorption of bone.
(b) Decrease in overall bone
turnover.
(c) Data suggest estrogen antagonist
in uterine and breast tissue
Indication
Prevention and treatment of
osteoporosis in
postmenopausal women
Efficacy
(a) Reduces the risk of vertebral
fractures by 30%–50%; has not been
shown to decrease hip fractures.
(b) Lowers total cholesterol by 7% and
LDL by 11%; does not reduce risk of CHD.
Adverse reactions
(a) Hot flashes:
(b) Leg cramps
(c) VTE: About 1%
Dose
60 mg/day orally .
Contraindications
(a) Pregnancy, nursing,
pediatrics
(b) History of VTE events
19. 5. Human parathyroid hormone related peptide analogs
(Teriparatide , Abaloparatide)
01 02 03
M. Of action
regulates bone metabolism,
intestinal calcium
absorption, and renal
tubular calcium and
phosphate reabsorption.
Indications:
Treatment of
postmenopausal women
with osteoporosis that have
a high risk of fracture( very
low BMD T< –3.0) ,
increase bone mass in men
with primary or
hypogonadal osteoporosis
at high risk for fracture
Contraindications:
Hypercalcemia,
bone metastases,
Paget’s disease.
Adverse effects:
Nausea,
orthostatic
hypotension
Osteosarcoma in
rats; should not be
used longer than 2
years.
Teriparatide : 20 mcg/day subcutaneously
Abaloparatide : 80 mcg/day
subcutaneously
20. 6.Calcitonin-salmon (Miacalcin)
Dosage: 200 IU/DAY in one nostril
200 units nasally = 50–100 units by injection
200 units per actuation, so one bottle will last a
bout 2–3 weeks
Not a first-line drug.
useful for bone pain caused by vertebral compression
fractures, no longer used
a. Inhibition of bone resorption
b. Indicated for treatment of osteoporosis in
women who are more than 5 years
postmenopause.
Adverse effects
i. Nasal : Rhinitis, epistaxis, irritation,
nasal sores, dryness, tenderness
ii. Backache, arthralgia, headache
FDA labeling changes regarding safety in
2014: Malignancies reported to be higher in
those treated with calcitonin than in those
treated with placebo.
21. 7.Menopausal
estrogen therapy or
menopausal estrogen
and progestogen
therapy.
Other medications
8. Lifestyle modifications
a. Weight-bearing
exercise , recommend 30–
40 minutes per session
most days of the week.
b. Smoking cessation
c. Limiting alcohol intake
d. Fall prevention
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