The document discusses osteoporosis, including its characteristics, risk factors, diagnosis, and management. It defines osteoporosis as a disease characterized by low bone mass and increased fracture risk. While it has no symptoms, it can be prevented and treated. For a 62-year-old lady with risk factors including diabetes and hypertension, an initial evaluation may include a history, exam, labs, and bone mineral density test to assess fracture risk and diagnose osteoporosis. Management includes lifestyle changes like calcium/vitamin D supplementation and exercise, as well as pharmacologic therapies like bisphosphonates. Monitoring involves follow-up bone density tests and reassessing fracture risk to determine duration of treatment.
Conservative Management of Knee osteoarthritisEsserHealth
Osteoarthritis is a major burden on personal health and international health care expenditures. Learn the basics of osteoarthritis and conservative management options for the physician.
Medicine Science (Med-Science) is an international open access journal which published by Society of TURAZ BİLİM in English language, peer-reviewed electronic journal dealing with General Medicine.
PDF, Full-Text Articles http://www.medicinescience.org
Conservative Management of Knee osteoarthritisEsserHealth
Osteoarthritis is a major burden on personal health and international health care expenditures. Learn the basics of osteoarthritis and conservative management options for the physician.
Medicine Science (Med-Science) is an international open access journal which published by Society of TURAZ BİLİM in English language, peer-reviewed electronic journal dealing with General Medicine.
PDF, Full-Text Articles http://www.medicinescience.org
Introduction to exercise electrocardiographyJavidsultandar
Exercise electrocardiography is a Non- invasive tool to evaluate the cardio vascular system's response to exercise under carefully controlled conditions.
Exercise is the body’s most common physiologic stress- most practical test of cardiac perfusion and function.
During exercise body increases its metabolic rate to greater than 20 times that of rest; cardiac out put as much as six fold. (depends on age,sex,type of exercise,size etc)
Evaluation of functional capacity, heart rate changes, burden of ectopy, and dynamic electrocardiographic changes during and after exercise have emerged as powerful prognostic indicators
Superior Capsular Reconstruction Outcomes Wrightington 2020Lennard Funk
Hariharan Mohan, Jagwant Singh, Michael Walton, Lennard Funk, Puneet Monga
Cautious optimism following SCR may be offered to this challenging subset of patients with symptomatic irreparable rotator cuff tears. It is likely that the relatively low re-operation rates can be further improved by considering the negative prognostic factors in defining indications for surgery. Further studies with longer term followup are recommended.
Hospital Acquired Deconditioning in Older AdultsChris Hattersley
Evidence based information on hospital acquired deconditioning in older adults, links to any studies referenced are included in the notes section of the presentation slides.
AHS13 James Steel — An Ancient Perspective on Deconditioning in Low Back Pain Ancestral Health Society
Low back pain (LBP) is a multifactorial issue that is prevalent across most human populations, westernised, rural and indigenous. Deconditioning of the lumbar extensor musculature is a commonly associated factor and has been shown prospectively to be a risk factor for development of LBP. Here an explanation concerning lumbar spine and pelvic anatomic evolution is offered in attempt to integrate these findings. It appears that anatomically modern humans may be predisposed to LBP as a consequence of their evolutionary heritage; the compromise of relatively strong hip/trunk extensors and relatively weak lumbar extensors in combination with a long flexible lumbar spine.
Introduction to exercise electrocardiographyJavidsultandar
Exercise electrocardiography is a Non- invasive tool to evaluate the cardio vascular system's response to exercise under carefully controlled conditions.
Exercise is the body’s most common physiologic stress- most practical test of cardiac perfusion and function.
During exercise body increases its metabolic rate to greater than 20 times that of rest; cardiac out put as much as six fold. (depends on age,sex,type of exercise,size etc)
Evaluation of functional capacity, heart rate changes, burden of ectopy, and dynamic electrocardiographic changes during and after exercise have emerged as powerful prognostic indicators
Superior Capsular Reconstruction Outcomes Wrightington 2020Lennard Funk
Hariharan Mohan, Jagwant Singh, Michael Walton, Lennard Funk, Puneet Monga
Cautious optimism following SCR may be offered to this challenging subset of patients with symptomatic irreparable rotator cuff tears. It is likely that the relatively low re-operation rates can be further improved by considering the negative prognostic factors in defining indications for surgery. Further studies with longer term followup are recommended.
Hospital Acquired Deconditioning in Older AdultsChris Hattersley
Evidence based information on hospital acquired deconditioning in older adults, links to any studies referenced are included in the notes section of the presentation slides.
AHS13 James Steel — An Ancient Perspective on Deconditioning in Low Back Pain Ancestral Health Society
Low back pain (LBP) is a multifactorial issue that is prevalent across most human populations, westernised, rural and indigenous. Deconditioning of the lumbar extensor musculature is a commonly associated factor and has been shown prospectively to be a risk factor for development of LBP. Here an explanation concerning lumbar spine and pelvic anatomic evolution is offered in attempt to integrate these findings. It appears that anatomically modern humans may be predisposed to LBP as a consequence of their evolutionary heritage; the compromise of relatively strong hip/trunk extensors and relatively weak lumbar extensors in combination with a long flexible lumbar spine.
This powerpoint presentation deals with the chief recommendations of ISBMR osteoporosis recommendations. It also encompasses relevant articles which have been cited for formulation of the article.
اختبار قصير: ماذا تعلم عن التغطية الصحية الشاملة؟
أَجِب على أسئلة هذا الاختبار القصير لتتأكد من صحة إجاباتك.
1 تحتفل منظمة الصحة العالمية (المنظمة) في يوم 7 نيسان/ أبريل من كل عام بذكرى إنشائها، باليوم الذي دخل فيه دستورها حيز النفاذ. فكم ستبلغ المنظمة من العمر هذا العام (2018)؟
30 عاماً
50 عاماً
70 عاماً
90 عاماً
2 ما المقصود بالتغطية الصحية الشاملة؟
يُقصد بالتغطية الصحية الشاملة حصول جميع الأفراد والمجتمعات المحلية على الخدمات الصحية اللازمة لهم متى وحيثما لزمتهم.
التغطية الصحية الشاملة تحمي الناس من الوقوع في دائرة الفقر حينما يُسددون تكاليف الخدمات الصحية اللازمة لهم من أموالهم الخاصة.
التغطية الصحية الشاملة تُمكّن جميع الأشخاص من الحصول على الخدمات التي تعالج أهم أسباب الإصابة بالمرض والوفاة.
التغطية الصحية الشاملة تعني تقديم خدمات صحية للأفراد ومختلف فئات السكان كالقضاء على مواقع تكاثر البعوض.
جميع ما سبق.
3 ما نسبة سكان العالم غير القادرين على الحصول على الخدمات الصحية اللازمة لهم؟
ما لا يقل عن 30% من سكان العالم
ما لا يقل عن 50% من سكان العالم
ما لا يقل عن 70% من سكان العالم
ما لا يقل عن 90% من سكان العالم
4 يُدفع نحو 100 مليون شخص في العالم إلى دائرة ’الفقر المدقع‘ (أي يعيشون بدخل لا يتجاوز 1.90 دولاراً أمريكياً في اليوم) بسبب اضطرارهم إلى سداد تكاليف خدمات الرعاية الصحية اللازمة لهم.
صحيح
خطأ
5 من له دور يؤديه في الدعوة إلى تحقيق التغطية الصحية الشاملة؟
أنت
الجماعات غير الهادفة إلى الربح
العاملون في مجال الصحة
وسائط الإعلام
جميع ما سبق
Session 6 se and complications [repaired]
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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.
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.
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
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
2. Osteoporosis
• Is characterized by low bone mass, microarchitectural
disruption, and skeletal fragility, resulting in
decreased bone strength and an increased risk of
fracture.
• Osteoporosis is preventable and treatable, but
because there are no warning signs prior to a
fracture, many people are not being diagnosed in time
to receive effective therapy during the early phase of
the disease.
3. • 62 years old lady
• Known to have:
• Diabetic on metformin
• HTN on Lisinopril
• Dyslipidemia on atorvastatin
• Came with generalized bodyache.
• Her daughter asking you, could she has osteoporosis?
4. The initial evaluation includes:
A history to assess for clinical risk factors for fracture and to
evaluate for other conditions that contribute to bone loss (chronic
disease, medication, smoking, excessive alcohol, physical
inactivity, and poor nutrition).
A physical examination( Height and weight) .
Basic laboratory tests.
•Biochemistry profile (especially calcium, phosphorous, albumin,
total protein, creatinine, liver enzymes including alkaline
phosphatase, electrolytes).
•25-hydroxyvitamin D (25[OH]D).
•Complete blood count (CBC).
5. • Clinical manifestation :
• has no clinical manifestations until there is a fracture.
• Most of these fractures (about two-thirds) are
asymptomatic; they are diagnosed as an incidental finding
on chest or abdominal radiograph.
• Hip fractures are relatively common in osteoporosis,
affecting up to 15% of women.
6.
7. DIAGNOSIS
• Made in the presence of:
• ●Fragility fracture, particularly at the spine, hip, wrist,
humerus, rib, and pelvis.
• Or
• ●T-score ≤-2.5 standard deviations (SD) at any site based
upon bone mineral density (BMD) measurement by dual-
energy x-ray absorptiometry (DXA).
8. • Fragility fractures:
• Occurring from a fall from a standing height or less,
without major trauma such as a motor vehicle accident.
• Spine fracture occurs spontaneously with minimal or no
trauma.
• (Certain skeletal locations, including the skull, cervical
spine, hands, feet, and ankles, are not associated with
fragility fractures.
• Stress fractures are also not considered fragility fractures,
as they are due to repetitive injury).
14. ●Fracture Risk Assessment Tool
(FRAX)
• A computer-based calculator which estimates the 10-year
probability of hip fracture and major osteoporotic fracture
(hip, clinical spine, proximal humerus, or forearm)
between ages 40 and 90 years, using easily obtainable
clinical risk factors for fracture, with or without femoral
neck bone mineral density (BMD).
15.
16.
17.
18.
19. • Site of measurement :
• spine and hip because fractures at these sites have the
greatest impact on patients' health.
• In addition, if pharmacologic therapy is planned,
measurement of spine BMD is useful as it shows less
variability and can detect responses to therapy earlier
than hip BMD.
• Diagnosis according to the lowest T-score measured.
20. • T score should not be used in premenopausal women, men
under the age of 50, and in children
• The Z-score is a comparison of the patient's BMD to an age-
matched population.
• A Z-score of -2.0 or lower is considered below the expected
range for age.
• Low Z-scores : A more extensive evaluation should be
undertaken coexisting problems that can contribute to
osteoporosis .
• Laboratory evaluation may help to diagnose secondary causes
of osteoporosis such as renal or liver disease, hyperthyroidism,
hyperparathyroidism, Cushing's syndrome or subclinical
hypercortisolism, early menopause, celiac disease or other
forms of malabsorption, idiopathic hypercalciuria, or rarely,
connective tissue disorders.
21.
22. Hip fractures per 1000 patient-years
WHO category Age 50–64 Age > 64 Overall
Normal 5.3 9.4 6.6
Osteopenia 11.4 19.6 15.7
Osteoporosis 22.4 46.6 40.6
28. LIFESTYLE MEASURES
• Lifestyle measures should be adopted universally to
reduce bone loss in postmenopausal women.
• Include adequate calcium and vitamin D, exercise,
smoking cessation, counseling on fall prevention, and
avoidance of heavy alcohol use.
• Avoid, if possible, drugs that increase bone loss, such as
glucocorticoids.
29. • Calcium/vitamin D :
• An optimal diet for treatment (or prevention) of
osteoporosis includes an adequate intake of calories (to
avoid malnutrition), calcium 1200MG, and vitamin D 800
iu.
• Exercise :
• Women with osteoporosis (or who are seeking to prevent
it) should exercise (prudently) for at least 30 minutes
three times per week.
30.
31. • Initial therapy:
• oral bisphosphonates as first-line therapy because of their
efficacy, favorable cost, and the availability of long-term
safety data.
• alendronate or risedronate as best choice due to efficacy
in reducing vertebral and hip fracture.
• For patients with severe osteoporosis (T-score of -3.5 or
below even in the absence of fractures, or T-score of -2.5
or below plus a fragility fracture), initial treatment with
teriparatide is an alternative.
32. • Side effects:
• -gastrointestinal problems such as difficulty swallowing and
inflammation of the esophagus and stomach.
• can affect renal function.
• osteonecrosis of the jaw (ONJ) with long-term use.
• low-trauma atypical femur fractures with the long-term use of
bisphosphonates.
• Contraindication: esophageal disorders, an inability to follow
the dosing requirements (eg, stay upright for at least 30 to 60
minutes), or chronic kidney disease (CKD) (estimated
glomerular filtration [eGFR] rate <30 mL/min), after certain
types of bariatric surgery in which surgical anastomoses are
present in the GI tract (eg, Roux-en-Y gastric bypass).
33. Monitoring
• A follow-up DXA of hip and spine after one to two years,
and if BMD is stable or improved, less frequent monitoring
thereafter.
34. •Duration of therapy:
• Should be individualized based upon patient characteristics and
preferences.
• Treatment review should be performed after 5 years of treatment
with alendronate, risedronate or ibandronate and after 3 years of
treatment with zoledronic acid .
35. • Reassessment of fracture risk by FRAX with femoral
neck BMD .
• If at low risk for fracture in the near future>>> discontinuing the
drug as there appears to be residual BMD and fracture benefit.
• If at highest risk for fracture (history of osteoporotic fracture
before or during therapy, T-score below -3.5 in the absence of
fractures) >>> continuing therapy for up to 10 years .
• For similar women treated with zoledronic acid >>>continue
therapy up to six years.
• • There is no evidence base to guide decisions about treatment
beyond 10 years and management of such patients should be
considered on an individual basis.
36. • Length of holiday :
• There are no data to support one strategy over another for
determining when to restart bisphosphonates after a drug
holiday.
• Fracture risk should be reassessed:
• • after a new fracture regardless of when this occurs.
• • if no new fracture occurs, after 18 months to 3 years .
• In clinical practice, the decision to resume the drug is often
based on a combination of factors, including duration of the
holiday, decrease in BMD, clinical risk factors for fracture, and
increase in markers of bone turnover.
•
37. • Restart bisphosphonates when there is persistent bone
loss (approximately 5 percent) on at least two (DXA)
measurements taken at least two years apart, using the
same make and model DXA scanner.
• An alternative, bisphosphonates can be restarted after a
three- to five-year holiday in women who showed
improvement during their initial course of
bisphosphonates and did not have a previous fracture.
38.
39. • The aim of the clinician in managing
osteoporosis:
to reduce the risk of fractures.
to identify patients at increased risk of fracture.
to assess that risk accurately.
to improve the patient’s perception of that risk.
to give advice & aid understanding of the disease, the
aims of therapy and the choice of therapy treatment -
lifestyle advice - therapeutic agents