This presentation discusses preventing osteoporotic fractures in men receiving androgen deprivation therapy (ADT) for prostate cancer. ADT is associated with rapid bone loss and increased fracture risk. Effective therapies for preventing bone loss and fractures include bisphosphonates like alendronate and zoledronic acid, which increase bone mineral density, as well as denosumab, which increases BMD and reduces vertebral fractures. Not all men on ADT require drug therapy; screening can help identify those at highest risk due to factors like older age, low body weight, steroid use, or preexisting osteopenia/osteoporosis.
Breast cancer a focus on bone health integrityMohamed Abdulla
This document summarizes information about bone health and integrity in the context of breast cancer. It discusses how breast cancer commonly spreads to bone, causing skeletal-related events like fractures. It notes that bone-targeted therapies like bisphosphonates and denosumab can help prevent these events by inhibiting bone resorption. Clinical trials show these drugs reduce the risk of skeletal complications when used adjuvantly or for metastatic breast cancer in bone. The document thus emphasizes the importance of bone health for breast cancer patients and the role of anti-resorptive therapies.
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.
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
1. Androgen deprivation therapy (ADT) for prostate cancer is associated with rapid bone loss and increased fracture risk. Several treatments have been shown to prevent bone loss and reduce fractures in men receiving ADT, including zoledronic acid, denosumab, and bisphosphonates.
2. Bone markers like N-telopeptide and bone-specific alkaline phosphatase can help predict risks of skeletal-related events and survival in men with bone metastases from prostate cancer. High bone marker levels are associated with worse outcomes.
3. Having multiple bone metastases is also associated with shorter time to first skeletal-related event and reduced survival compared to having fewer bone lesions. Normalizing elevated bone marker levels in response
Dr Jennifer Walsh's presentation from Osteoporosis 2016: Management of osteoporosis in the young adult.
Find out more at: https://nos.org.uk/conference
This document discusses osteoporosis and its treatment. It defines osteoporosis as a bone mineral density (BMD) at least 2.5 standard deviations below the young adult mean. It lists common risk factors for osteoporotic fractures such as female sex, smoking, family history, and low calcium/vitamin D intake. It discusses screening tools like FRAX score and recommendations for BMD testing and lifestyle changes. It provides guidelines for initiating drug therapy and lists common osteoporosis treatments like bisphosphonates, denosumab, calcium/vitamin D, and raloxifene.
Breast cancer a focus on bone health integrityMohamed Abdulla
This document summarizes information about bone health and integrity in the context of breast cancer. It discusses how breast cancer commonly spreads to bone, causing skeletal-related events like fractures. It notes that bone-targeted therapies like bisphosphonates and denosumab can help prevent these events by inhibiting bone resorption. Clinical trials show these drugs reduce the risk of skeletal complications when used adjuvantly or for metastatic breast cancer in bone. The document thus emphasizes the importance of bone health for breast cancer patients and the role of anti-resorptive therapies.
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.
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
1. Androgen deprivation therapy (ADT) for prostate cancer is associated with rapid bone loss and increased fracture risk. Several treatments have been shown to prevent bone loss and reduce fractures in men receiving ADT, including zoledronic acid, denosumab, and bisphosphonates.
2. Bone markers like N-telopeptide and bone-specific alkaline phosphatase can help predict risks of skeletal-related events and survival in men with bone metastases from prostate cancer. High bone marker levels are associated with worse outcomes.
3. Having multiple bone metastases is also associated with shorter time to first skeletal-related event and reduced survival compared to having fewer bone lesions. Normalizing elevated bone marker levels in response
Dr Jennifer Walsh's presentation from Osteoporosis 2016: Management of osteoporosis in the young adult.
Find out more at: https://nos.org.uk/conference
This document discusses osteoporosis and its treatment. It defines osteoporosis as a bone mineral density (BMD) at least 2.5 standard deviations below the young adult mean. It lists common risk factors for osteoporotic fractures such as female sex, smoking, family history, and low calcium/vitamin D intake. It discusses screening tools like FRAX score and recommendations for BMD testing and lifestyle changes. It provides guidelines for initiating drug therapy and lists common osteoporosis treatments like bisphosphonates, denosumab, calcium/vitamin D, and raloxifene.
Risk assessment tools like QFracture are important for evaluating fracture risk based on multiple factors. They can help identify those over age 50 with a 10% or higher 10-year risk of any fracture who should be referred for a DXA scan to determine if osteoporosis treatment is needed. Non-modifiable factors like age, gender, family history and prior fractures are considered alongside modifiable ones like smoking, alcohol use, weight and medications to provide an overall risk assessment.
Long-term bisphosphonate use can lead to rare adverse effects like osteonecrosis of the jaw and atypical femoral fractures. Guidelines recommend treatment reviews after 5 years of bisphosphonates to determine if a "drug holiday" is appropriate to reduce risks. New drugs like romosozumab may provide alternative post-bisphosphonate treatment options to further reduce fracture risk compared to another course of antiresorptives or teriparatide. Overall, the document discusses balancing long-term bisphosphonate benefits with risks of rare adverse effects and considering newer anabolic options.
This document summarizes key findings from the ASBMR 2015 conference related to diabetes and bone health. It describes several studies presented at the conference that investigated the relationship between type 1 and type 2 diabetes and fracture risk. One study found that elderly men with type 2 diabetes did not have an increased risk of vertebral fractures compared to non-diabetic men. Another study found that measures of bone microarchitecture and glycemic control, rather than bone mineral density, were predictors of fractures in individuals with type 1 diabetes. A third study found evidence of altered trabecular microarchitecture in the tibia of youth with type 1 diabetes compared to controls.
1. The document discusses bone metabolism and prostate cancer, describing how factors like RANK ligand and osteoprotegerin regulate the balance between bone formation and resorption.
2. It summarizes a clinical trial comparing denosumab, a RANK ligand inhibitor, to zoledronic acid for treating bone metastases in prostate cancer patients. Denosumab delayed time to first skeletal-related event compared to zoledronic acid and reduced risk of multiple events.
3. Rates of adverse events were generally similar between the treatments, though denosumab resulted in fewer acute phase reactions and more cases of osteonecrosis of the jaw compared to zoledronic acid.
This document discusses glucocorticoid induced osteoporosis. It begins with an epidemiology section noting that glucocorticoids are the most common cause of secondary osteoporosis. Treatment options discussed include adequate calcium and vitamin D, exercise therapy, optimal treatment of underlying disease, smoking cessation, and drug therapies. Drug therapies shown to increase bone mineral density and reduce fractures include alendronate, risedronate, zoledronic acid, teriparatide, and denosumab. Head-to-head trials found that teriparatide was more effective at reducing fractures than alendronate. The EuroGIOPS study similarly found teriparatide more effective at improving bone mineral density and
This document discusses osteoporosis treatment in patients with chronic kidney disease (CKD). It notes that while CKD patients have a high risk of fracture similar to postmenopausal osteoporosis, CKD-mineral and bone disorder (CKD-MBD) is more complex. Evaluating fracture risk in CKD patients is challenging as laboratory tests, bone turnover markers, and imaging modalities all have limitations. Bone biopsy remains the gold standard but has limitations for use in clinical practice. Treatment should be based on the underlying pathophysiology and more research is needed on fracture outcomes in CKD-MBD patients.
This document discusses treatment failure in a 72-year-old patient with a new fracture after three years of bisphosphonate therapy. It considers whether the patient should continue or switch treatments. It examines definitions of treatment failure including new fractures occurring after a certain duration of therapy, loss of bone mineral density greater than measurement error, and lack of effect on bone turnover markers. Factors like fracture type, treatment duration, compliance, and persistence are relevant to determining when switch to a new treatment may be appropriate.
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
Denosumab vs bisfosfonato en metástasis óseasMauricio Lema
This document summarizes key findings from three head-to-head clinical trials comparing denosumab to zoledronic acid for the treatment of bone metastases in solid tumors. The main points are:
1) A prespecified integrated analysis of the three trials found that denosumab was superior to zoledronic acid, reducing the risk of first skeletal-related events by 17%.
2) Denosumab provided benefits across multiple solid tumor types, reducing the risk of first skeletal-related events in breast cancer, prostate cancer, and other solid tumors compared to zoledronic acid.
3) Denosumab demonstrated efficacy in reducing both the time to first skeletal-related event and the risk of subsequent skeletal
Bone-targeted therapy can play an important role in preventing fractures for patients with prostate cancer undergoing androgen deprivation therapy (ADT). ADT significantly increases the risk of fractures by causing rapid bone loss. Several therapies including bisphosphonates like zoledronic acid and alendronate, as well as denosumab, have been shown to reduce bone loss and increase bone mineral density when given to men on ADT, thereby decreasing their fracture risk. Large clinical trials are still needed to demonstrate whether these therapies can actually reduce fracture rates.
This document discusses several alternative hormonal treatments for menopausal symptoms. It summarizes research on ospemifene, bazedoxifene, lasofoxifene, and prasterone. For each treatment, it outlines their effects on various tissues like the endometrium and breast, as well as their efficacy in reducing hot flashes, improving sexual function and quality of life, and increasing bone mineral density. It also compares the safety profiles and rates of side effects like breast tenderness for the different treatments. The document provides an overview of the clinical evidence for these alternative treatment options.
This document summarizes guidelines for treating osteoporosis in patients over 50 from a lecture given in Rome, Italy in 2015. It discusses a 5-step plan for fracture prevention: 1) case finding for those at high risk, 2) risk evaluation using tools like DXA scans and clinical factors, 3) differential diagnosis to identify secondary causes, 4) medical therapy options like calcium/vitamin D supplementation, bisphosphonates, and RANK ligand inhibitors, and 5) follow up. It provides details on evaluating fracture risk, identifying secondary osteoporosis, recommended supplementation and drug therapies, and monitoring treatment effectiveness and safety.
This document discusses updates in the diagnosis and treatment of osteoporosis. It defines osteoporosis as a disease characterized by low bone mass and deterioration of bone structure. Osteoporosis increases the risk of fractures, with vertebral fractures being the most common. It can lead to pain, disability, and increased mortality. An estimated 8 million women and 2.5 million men in the US have osteoporosis, and these numbers are expected to increase by 40% by 2020. Osteoporosis poses a significant economic burden and reduces quality of life. Advances have been made in assessing fracture risk levels based on 10-year probability in addition to bone mineral density scores. Treatment involves lifestyle changes and medications
Obésité, quelles conséquences sur la fonction rénale?Vincent Bourquin
Obesity is associated with an increased risk of developing chronic kidney disease, as multiple studies have found a significant correlation between higher BMI and proteinuria or reduced kidney function. Excess weight can lead to glomerulopathy and kidney damage through mechanisms such as macrophage infiltration of adipose tissue causing inflammation, and increased production of hormones like aldosterone and angiotensin II. Obesity-related glomerulopathy is a distinct form of kidney disease seen in biopsies of obese patients, characterized by focal segmental glomerulosclerosis and glomeromegaly.
This document discusses treatment options for patients with hormone receptor-positive, HER2-negative metastatic breast cancer who have progressed on initial endocrine therapy. It considers fulvestrant monotherapy or the combination of everolimus and exemestane as potential second-line hormonal therapies. Trial data is presented showing that fulvestrant 500mg improves median overall survival by 4.1 months compared to 250mg. The TAMRAD trial found the combination of tamoxifen and everolimus increased clinical benefit rate over tamoxifen alone. The BOLERO-2 trial demonstrated that adding everolimus to exemestane significantly prolonged progression-free survival compared to exemestane alone. Subgroup analyses from
- Bone metastases affect up to 70% of breast cancer patients and are a major source of morbidity. They develop through a 'vicious cycle' where tumor cells stimulate bone resorption.
- Bisphosphonates like zoledronic acid and denosumab inhibit bone resorption by targeting RANK ligand, breaking this cycle. They significantly reduce skeletal complications in metastatic breast cancer.
- A large trial found denosumab reduced the risk of first skeletal-related event compared to zoledronic acid and time to first on-study bone metastasis. It provides an effective alternative to bisphosphonates for preventing bone complications.
Pathophysiology of Metastatic Bone Disease and the Role of Bisphosphonatesshabeel pn
This document summarizes metastatic bone disease and the role of bisphosphonates. It discusses how bisphosphonates like pamidronate and zoledronic acid inhibit osteoclast activity to prevent skeletal complications from bone metastases. Clinical trials showed bisphosphonates reduced skeletal complications, bone pain, and hypercalcemia compared to placebo in cancers like breast cancer and multiple myeloma. Zoledronic acid was found to be more potent than pamidronate in suppressing bone turnover based on markers and time to first skeletal event.
The document discusses the long-term side effects of androgen deprivation therapy (ADT) for prostate cancer, including increased risks of osteoporosis, cardiovascular events, sarcopenic obesity, and bone loss. It provides evidence that ADT increases standard cardiovascular risk factors and cardiovascular events. While the effect on cardiovascular mortality is disputed, age and pre-existing conditions are the main risk factors. Exercise and drugs like SERMs may help mitigate side effects, but do not reduce cardiovascular events. Careful management of known risk factors is important when treating with ADT.
Everything you need to know about moa of bone targeted agents amgen 2017Mohamed Abdulla
This document summarizes key information about giant cell tumor of bone (GCTB) and a phase II study of the RANK ligand inhibitor denosumab for treatment of GCTB. The study showed that nearly all GCTB patients treated with denosumab had stable disease or an objective response, with few experiencing disease progression. Histological analysis found that denosumab significantly reduced or eliminated RANK-positive tumor giant cells in GCTB tissue specimens. These results suggest that denosumab is an effective treatment that stabilizes disease in the majority of GCTB patients.
Risk assessment tools like QFracture are important for evaluating fracture risk based on multiple factors. They can help identify those over age 50 with a 10% or higher 10-year risk of any fracture who should be referred for a DXA scan to determine if osteoporosis treatment is needed. Non-modifiable factors like age, gender, family history and prior fractures are considered alongside modifiable ones like smoking, alcohol use, weight and medications to provide an overall risk assessment.
Long-term bisphosphonate use can lead to rare adverse effects like osteonecrosis of the jaw and atypical femoral fractures. Guidelines recommend treatment reviews after 5 years of bisphosphonates to determine if a "drug holiday" is appropriate to reduce risks. New drugs like romosozumab may provide alternative post-bisphosphonate treatment options to further reduce fracture risk compared to another course of antiresorptives or teriparatide. Overall, the document discusses balancing long-term bisphosphonate benefits with risks of rare adverse effects and considering newer anabolic options.
This document summarizes key findings from the ASBMR 2015 conference related to diabetes and bone health. It describes several studies presented at the conference that investigated the relationship between type 1 and type 2 diabetes and fracture risk. One study found that elderly men with type 2 diabetes did not have an increased risk of vertebral fractures compared to non-diabetic men. Another study found that measures of bone microarchitecture and glycemic control, rather than bone mineral density, were predictors of fractures in individuals with type 1 diabetes. A third study found evidence of altered trabecular microarchitecture in the tibia of youth with type 1 diabetes compared to controls.
1. The document discusses bone metabolism and prostate cancer, describing how factors like RANK ligand and osteoprotegerin regulate the balance between bone formation and resorption.
2. It summarizes a clinical trial comparing denosumab, a RANK ligand inhibitor, to zoledronic acid for treating bone metastases in prostate cancer patients. Denosumab delayed time to first skeletal-related event compared to zoledronic acid and reduced risk of multiple events.
3. Rates of adverse events were generally similar between the treatments, though denosumab resulted in fewer acute phase reactions and more cases of osteonecrosis of the jaw compared to zoledronic acid.
This document discusses glucocorticoid induced osteoporosis. It begins with an epidemiology section noting that glucocorticoids are the most common cause of secondary osteoporosis. Treatment options discussed include adequate calcium and vitamin D, exercise therapy, optimal treatment of underlying disease, smoking cessation, and drug therapies. Drug therapies shown to increase bone mineral density and reduce fractures include alendronate, risedronate, zoledronic acid, teriparatide, and denosumab. Head-to-head trials found that teriparatide was more effective at reducing fractures than alendronate. The EuroGIOPS study similarly found teriparatide more effective at improving bone mineral density and
This document discusses osteoporosis treatment in patients with chronic kidney disease (CKD). It notes that while CKD patients have a high risk of fracture similar to postmenopausal osteoporosis, CKD-mineral and bone disorder (CKD-MBD) is more complex. Evaluating fracture risk in CKD patients is challenging as laboratory tests, bone turnover markers, and imaging modalities all have limitations. Bone biopsy remains the gold standard but has limitations for use in clinical practice. Treatment should be based on the underlying pathophysiology and more research is needed on fracture outcomes in CKD-MBD patients.
This document discusses treatment failure in a 72-year-old patient with a new fracture after three years of bisphosphonate therapy. It considers whether the patient should continue or switch treatments. It examines definitions of treatment failure including new fractures occurring after a certain duration of therapy, loss of bone mineral density greater than measurement error, and lack of effect on bone turnover markers. Factors like fracture type, treatment duration, compliance, and persistence are relevant to determining when switch to a new treatment may be appropriate.
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
Denosumab vs bisfosfonato en metástasis óseasMauricio Lema
This document summarizes key findings from three head-to-head clinical trials comparing denosumab to zoledronic acid for the treatment of bone metastases in solid tumors. The main points are:
1) A prespecified integrated analysis of the three trials found that denosumab was superior to zoledronic acid, reducing the risk of first skeletal-related events by 17%.
2) Denosumab provided benefits across multiple solid tumor types, reducing the risk of first skeletal-related events in breast cancer, prostate cancer, and other solid tumors compared to zoledronic acid.
3) Denosumab demonstrated efficacy in reducing both the time to first skeletal-related event and the risk of subsequent skeletal
Bone-targeted therapy can play an important role in preventing fractures for patients with prostate cancer undergoing androgen deprivation therapy (ADT). ADT significantly increases the risk of fractures by causing rapid bone loss. Several therapies including bisphosphonates like zoledronic acid and alendronate, as well as denosumab, have been shown to reduce bone loss and increase bone mineral density when given to men on ADT, thereby decreasing their fracture risk. Large clinical trials are still needed to demonstrate whether these therapies can actually reduce fracture rates.
This document discusses several alternative hormonal treatments for menopausal symptoms. It summarizes research on ospemifene, bazedoxifene, lasofoxifene, and prasterone. For each treatment, it outlines their effects on various tissues like the endometrium and breast, as well as their efficacy in reducing hot flashes, improving sexual function and quality of life, and increasing bone mineral density. It also compares the safety profiles and rates of side effects like breast tenderness for the different treatments. The document provides an overview of the clinical evidence for these alternative treatment options.
This document summarizes guidelines for treating osteoporosis in patients over 50 from a lecture given in Rome, Italy in 2015. It discusses a 5-step plan for fracture prevention: 1) case finding for those at high risk, 2) risk evaluation using tools like DXA scans and clinical factors, 3) differential diagnosis to identify secondary causes, 4) medical therapy options like calcium/vitamin D supplementation, bisphosphonates, and RANK ligand inhibitors, and 5) follow up. It provides details on evaluating fracture risk, identifying secondary osteoporosis, recommended supplementation and drug therapies, and monitoring treatment effectiveness and safety.
This document discusses updates in the diagnosis and treatment of osteoporosis. It defines osteoporosis as a disease characterized by low bone mass and deterioration of bone structure. Osteoporosis increases the risk of fractures, with vertebral fractures being the most common. It can lead to pain, disability, and increased mortality. An estimated 8 million women and 2.5 million men in the US have osteoporosis, and these numbers are expected to increase by 40% by 2020. Osteoporosis poses a significant economic burden and reduces quality of life. Advances have been made in assessing fracture risk levels based on 10-year probability in addition to bone mineral density scores. Treatment involves lifestyle changes and medications
Obésité, quelles conséquences sur la fonction rénale?Vincent Bourquin
Obesity is associated with an increased risk of developing chronic kidney disease, as multiple studies have found a significant correlation between higher BMI and proteinuria or reduced kidney function. Excess weight can lead to glomerulopathy and kidney damage through mechanisms such as macrophage infiltration of adipose tissue causing inflammation, and increased production of hormones like aldosterone and angiotensin II. Obesity-related glomerulopathy is a distinct form of kidney disease seen in biopsies of obese patients, characterized by focal segmental glomerulosclerosis and glomeromegaly.
This document discusses treatment options for patients with hormone receptor-positive, HER2-negative metastatic breast cancer who have progressed on initial endocrine therapy. It considers fulvestrant monotherapy or the combination of everolimus and exemestane as potential second-line hormonal therapies. Trial data is presented showing that fulvestrant 500mg improves median overall survival by 4.1 months compared to 250mg. The TAMRAD trial found the combination of tamoxifen and everolimus increased clinical benefit rate over tamoxifen alone. The BOLERO-2 trial demonstrated that adding everolimus to exemestane significantly prolonged progression-free survival compared to exemestane alone. Subgroup analyses from
- Bone metastases affect up to 70% of breast cancer patients and are a major source of morbidity. They develop through a 'vicious cycle' where tumor cells stimulate bone resorption.
- Bisphosphonates like zoledronic acid and denosumab inhibit bone resorption by targeting RANK ligand, breaking this cycle. They significantly reduce skeletal complications in metastatic breast cancer.
- A large trial found denosumab reduced the risk of first skeletal-related event compared to zoledronic acid and time to first on-study bone metastasis. It provides an effective alternative to bisphosphonates for preventing bone complications.
Pathophysiology of Metastatic Bone Disease and the Role of Bisphosphonatesshabeel pn
This document summarizes metastatic bone disease and the role of bisphosphonates. It discusses how bisphosphonates like pamidronate and zoledronic acid inhibit osteoclast activity to prevent skeletal complications from bone metastases. Clinical trials showed bisphosphonates reduced skeletal complications, bone pain, and hypercalcemia compared to placebo in cancers like breast cancer and multiple myeloma. Zoledronic acid was found to be more potent than pamidronate in suppressing bone turnover based on markers and time to first skeletal event.
The document discusses the long-term side effects of androgen deprivation therapy (ADT) for prostate cancer, including increased risks of osteoporosis, cardiovascular events, sarcopenic obesity, and bone loss. It provides evidence that ADT increases standard cardiovascular risk factors and cardiovascular events. While the effect on cardiovascular mortality is disputed, age and pre-existing conditions are the main risk factors. Exercise and drugs like SERMs may help mitigate side effects, but do not reduce cardiovascular events. Careful management of known risk factors is important when treating with ADT.
Everything you need to know about moa of bone targeted agents amgen 2017Mohamed Abdulla
This document summarizes key information about giant cell tumor of bone (GCTB) and a phase II study of the RANK ligand inhibitor denosumab for treatment of GCTB. The study showed that nearly all GCTB patients treated with denosumab had stable disease or an objective response, with few experiencing disease progression. Histological analysis found that denosumab significantly reduced or eliminated RANK-positive tumor giant cells in GCTB tissue specimens. These results suggest that denosumab is an effective treatment that stabilizes disease in the majority of GCTB patients.
The document discusses osteoporosis prevention and management. It describes how gynecologists can help achieve peak bone mass during adolescence and adulthood, prevent bone loss during peri-menopause through screening and treatment if needed, and manage age-related osteoporosis. Key roles include promoting physical activity and nutrition, addressing drug-related bone loss, and treating with exercise, calcium/vitamin D supplementation, and medications like bisphosphonates or hormones if screening shows low bone mineral density.
The document summarizes key points from the 18th International Conference on Co-morbidities and Adverse Drug Reactions in HIV. It discusses findings related to bone health, cardiovascular health, and physical activity levels in people living with HIV. Regarding bone health, studies showed bone mineral density loss with tenofovir-containing antiretroviral therapy and PrEP. Loss was also seen with glucocorticoid use. For cardiovascular health, studies suggested lower risk of atherosclerotic events with NNRTI-based initial ART and possible lower risk with atazanavir. Physical activity levels were associated with comorbidity risk, with higher risk at lower activity levels.
Lifestyle and chronic diseases - Dr.Ravi Andrews Apollo Hospitals
1) Lifestyle factors like diet, exercise, behavior and substance abuse have a significant impact on chronic diseases like cardiovascular disease, diabetes, hypertension, cancer and chronic kidney disease.
2) Modifiable risk factors associated with metabolic syndrome like abdominal obesity, elevated blood pressure, high blood glucose, high triglycerides and low HDL cholesterol can be addressed through lifestyle modifications to reduce the risk of chronic diseases.
3) Simple lifestyle changes like following a healthy diet low in salt and high in potassium, engaging in regular physical activity, avoiding smoking and excessive alcohol, and managing stress can help control chronic conditions and may have similar benefits as medications.
Osteoporosis poses a significant disease burden, with over 2 million fractures occurring annually in the United States due to low bone density or previous fractures. Bisphosphonates are the mainstay treatment for osteoporosis, approved in the 1990s, but there is ongoing research into their potential links to rare adverse events like osteonecrosis of the jaw or atypical femoral fractures. While more data is still needed, the overall benefits of bisphosphonates in reducing fracture risk are considered to outweigh the potential risks for most osteoporosis patients. Treatment duration should be individualized based on fracture history and risk level.
This document discusses challenges that can arise after starting treatment for osteoporosis, including motivating patients to adhere to their medication regimen and monitoring them to ensure benefits are achieved. It also reviews evidence on how adherence impacts outcomes and strategies to improve adherence through patient education, communication, and nurse monitoring. Biomarkers like bone mineral density and bone turnover markers are discussed as tools to monitor treatment response, but they have limitations in clinical practice.
1) Anti-angiogenic therapy targets tumor angiogenesis and has become an established treatment for metastatic colorectal cancer (mCRC).
2) Bevacizumab, a monoclonal antibody targeting VEGF, has shown efficacy in multiple phase III trials in combination with chemotherapy as first-line and maintenance therapy for mCRC.
3) Additional anti-angiogenic agents approved for mCRC include aflibercept, ramucirumab, and regorafinib, which have demonstrated benefits in later lines of therapy.
Colon cancer is the second and third most common cancer in males and females. Screening programs have led to a reduction in late-stage diagnoses and mortality. Precise identification of prognostic patient groups allows for more targeted adjuvant therapy, improving disease-free and overall survival. Molecular markers of tumor aggressiveness aid in selecting optimal treatment approaches, increasing response rates, progression-free, and overall survival. A multidisciplinary team approach is essential for managing metastatic colon cancer with the goal of surgical cure in organ-limited disease.
Ckd-MBD & osteoporosis the management dilemma Ayman Seddik
This document discusses the management of chronic kidney disease-mineral and bone disorder (CKD-MBD) and osteoporosis in elderly patients. It outlines that CKD-MBD and osteoporosis are common in elderly populations and impact mortality and morbidity. Management is based on the stage of CKD and involves controlling serum phosphorus and calcium levels, using phosphate binders to treat hyperphosphatemia, and treating abnormal PTH levels. Guidelines recommend treating bone disease with bisphosphonates and other osteoporosis medications according to the condition and stage of CKD. The risks and benefits of different treatment options must be considered based on each patient's situation.
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.
The document discusses optimizing treatment for patients with post-menopausal osteoporosis (PMO) including identifying patients at high risk for fracture using tools like the CAROC guidelines, considering treatment for moderate risk patients based on certain risk factors, and evaluating treatment options based on mechanisms of action, efficacy, safety profiles, and patient preferences. The goal is to reduce fractures and their consequences through early diagnosis and appropriate evidence-based treatment.
Optimizing Medical Nutrition Therapy in sarcopenia of Elderly patients Chomarhlaing
The document discusses optimizing medical nutrition therapy for sarcopenia in elderly patients. It defines sarcopenia as the loss of skeletal muscle mass and strength that occurs with aging. The prevalence of sarcopenia increases with age, affecting 5-13% of 60-70 year olds and 11-50% of those over 80. Consequences of sarcopenia include physical impairment, falls, disability and mortality. Screening tools like SARC-F can help diagnose sarcopenia based on measures of muscle mass, strength and physical performance. Management involves exercise programs and medical nutrition therapy, with a focus on adequate protein intake, particularly high-quality proteins containing amino acids like leucine, arginine and glutamine.
Osteoporosis is a systemic skeletal disease characterized by low bone mass and deterioration of bone tissue, leading to increased bone fragility and risk of fractures. It is most commonly seen in elderly women. Bone mineral density testing is used to diagnose osteoporosis, with scores more than 2.5 standard deviations below normal indicating the disease. Treatment options include calcium, vitamin D, exercise, bisphosphonates, calcitonin, parathyroid hormone, and selective estrogen receptor modulators.
This document discusses osteoporosis and bone health. It begins by noting the impact of osteoporosis on older patients, including increased hospital admissions and length of stay. It then discusses definitions of osteoporosis from WHO and treatment gaps. The document covers bone structure, cells, mineralization, remodeling cycles, and factors influencing bone health like hormones and lifestyle. Diagnostic methods like DXA are summarized. Treatment options focused on prevention of fractures through calcium, vitamin D, bisphosphonates, PTH, and fall prevention are outlined.
This document summarizes key findings from the 2015 Annual Meeting of the American Society for Bone and Mineral Research (ASBMR). It discusses several studies on rare bone diseases, bisphosphonate therapy, vitamin D supplementation, and the risk of atypical femur fractures among different racial/ethnic groups. It also summarizes a debate on whether the diagnosis of osteoporosis should be based on bone mineral density scores or fracture risk assessment tools.
1) The document discusses the role of bone-targeted therapies in treating prostate cancer and preventing fractures. It provides an overview of fracture risk in men, how androgen deprivation therapy can increase that risk, and guidelines for fracture prevention.
2) Studies show that bisphosphonates like zoledronic acid and denosumab can increase bone mineral density and reduce fractures in men receiving androgen deprivation therapy for prostate cancer.
3) For men with non-metastatic castration-resistant prostate cancer at high risk for bone metastases, denosumab was shown to delay the onset of bone metastases compared to placebo based on markers like PSA and PSADT.
The document discusses diagnostic criteria and therapies for multiple myeloma, including first and second line treatment options as well as adjunctive therapies. It provides details on diagnostic testing, disease staging, prognostic factors, and guidelines for treating bone disease and anemia in multiple myeloma patients. The goal of treatment is to address the underlying malignancy, decrease fatigue, reduce transfusions needs, and manage the patient rather than a single lab value.
This document provides an overview and highlights of trends in rheumatology from 2012. It discusses updated guidelines and recommendations for osteoporosis management, the approval and use of belimumab for systemic lupus erythematosus, rituximab for ANCA associated vasculitis, tocilizumab for rheumatoid arthritis, and collagenase clostridium histolyticum for Dupuytren's contracture. It also reviews musculoskeletal ultrasound, challenges with treatment adherence, and new data on bisphosphonates, denosumab, teriparatide, and other drugs.
Πρόσκληση στο 14ο Σχολείο - 14ο Uroschool 2021 | Web Scientific Event
Α’ μέρος > 5-6 ΙΟΥΝΙΟΥ: ΟΓΚΟΛΟΓΙΑ
Β’ μέρος > 12-13 ΙΟΥΝΙΟΥ: ΑΝΔΡΟΛΟΓΙΑ - ΛΕΙΤΟΥΡΓΙΚΗ ΟΥΡΟΛΟΓΙΑ - ΕΝΔΟΟΥΡΟΛΟΓΙΑ
Πάλι στα «θρανία» – του σπιτιού µας φέτος-, τα δύο πρώτα Σαββατοκύριακα του Ιουνίου, στο Σχολείο που όλοι µας τόσο αγαπήσαµε και στηρίζουµε!
∆ηµήτρης Χατζηχρήστου
Καθηγητής Ουρολογίας ΑΠΘ
Πρόεδρος ΙΜΟΠ
Η ανάπτυξη διαγνωστικών και θεραπευτικών πρωτοκόλλων είναι πλέον γεγονός σε πολλές παθήσεις και καθορίζουν την καθημερινή ιατρική πράξη και στη χώρα μας. Το ΙΜΟΠ ανέλαβε πριν από 18 μήνες την πρωτοβουλία για να καλύψει το αντίστοιχο κενό στην Ανδρολογία.
Για το όλο εγχείρημα υιοθετήθηκε η επίσημη μεθοδολογία που χρησιμοποιείται σε όλα τα θεραπευτικά πρωτόκολλα. Σε πρώτη φάση σε καθένα από τα μέλη της ομάδα εργασίας ανατέθηκε ένα πρωτόκολλο και ζητήθηκε να ολοκληρώσει την ανασκόπηση της σχετικής βιβλιογραφίας και σε συνδυασμό με την προσωπική του εμπειρία και τις συνθήκες των υποδομών της χώρας να προτείνει ρεαλιστικό διαγνωστικό και θεραπευτικό αλγόριθμο.
Η ομάδα εργασίας παρουσίασε πέρυσι το αποτέλεσμα στο Andrology update 2019 στη Θεσσαλονίκη και έγινε εκτενής συζήτηση με τους συναδέλφους.‘Ολες οι βελτιώσεις ενσωματώθηκαν στους τελικούς αλγόριθμους που παρουσιάζονται σε ειδική έκδοση του ΙΜΟΠ.
Ήρθε λοιπόν η ώρα για την κλινική εφαρμογή των πρωτοκόλλων. Στο φετινό Andrology Update παρουσιάζονται 2-3 περιστατικά και συζητιούνται οι διαγνωστικές και θεραπευτικές τους προσεγγίσεις με βάση τα νέα διαγνωστικά και θεραπευτικά πρωτόκολλα. Σε τέσσερις ενότητες παρουσιάζονται τα βασικά πρακτικά θέματα της υποειδίκευσης, για πρακτική άσκηση και απόκτηση δεξιοτήτων.
Όπως διαμορφώθηκε η νέα πραγματικότητα στην κοινωνία μας, μετά την απειλή του Covid-19, αποφασίσαμε το Andrology Update, αντί για την Αθήνα, όπου αρχικά είχε σχεδιαστεί να υλοποιηθεί, να γίνει διαδικτυακό. Με αυτόν τον τρόπο, πολλοί περισσότεροι θα μπορέσουν να παρακολουθήσουν την εκδήλωση, να διαδράσουν και να μοιραστούν την γνώση, με την ασφάλεια που επιτάσσουν οι καιροί, συνδεόμενοι από το σπίτι η το γραφείο τους.
Σας καλώ όλους να αγκαλιάσετε για μια ακόμη φορά αυτήν την ιδιαίτερα σημαντική επιστημονική εκδήλωση και με την ενεργό συμμετοχή σας να συμβάλλετε στην επιτυχή ολοκλήρωσή της προς όφελος όλων των συναδέλφων Ουρολόγων, αλλά κυρίως των αντρών με σεξουαλικά προβλήματα ή πρόβλημα γονιμότητας.
Δημήτρης Χατζηχρήστου
Καθηγητής Ουρολογίας ΑΠΘ
Πρόεδρος ΙΜΟΠ
Το Σχολείο Ουρολογίας στην Πορταριά ξεκίνησε με ένα ερώτημα: μπορεί να σταθεί μια εκπαιδευτική διαδικασία με έντονο ολοήμερο πρόγραμμα, χωρίς κάτι τουριστικό, που απαιτεί 8-10 ώρες παρουσία στην αίθουσα καθημερινά;
Η θετική απάντηση τεκμηριώθηκε στα 12 χρόνια που πέρασαν.
Το σχολείο έχει ως στόχο την επιλεγμένη γνώση για εφαρμογή στο ιατρείο την επόμενη ημέρα. Με την ενεργό και συνεχή συμμετοχή των συμμετεχόντων έγινε εκδήλωση αναφοράς στην εκπαίδευση των Ουρολόγων.
Συνεχίζουμε, λοιπόν, για 13η χρονιά, πάντα με μικρό αριθμό
εκπαιδευόμενων-συμμετεχόντων Ουρολόγων, οι παρουσιάσεις με επίκεντρο το πρόβλημα (problem solving learning), βασισμένες στην τεκμηριωμένη γνώση (evidence-based medicine) και στην ανθρωποκεντρική προσέγγιση του ασθενή (patient-centred care) αλλά πάνω απ’ όλα με χρόνο συζήτησης κατά πολύ μεγαλύτερο από αυτόν της διδασκαλίας.
Πάλι στα θρανία τον Φεβρουάριο, στην Αγριά φέτος, στο Σχολείο που ΕΣΕΙΣ το κάνατε θεσμό στην εκπαίδευση των Ουρολόγων!
Δημήτρης Χατζηχρήστου
Καθηγητής Ουρολογίας ΑΠΘ
Πρόεδρος ΙΜΟΠ
Πρόγραμμα του 13ου Σχολείου Ουρολογίας | #uroschool2020
➡ Ημερομηνία: 13-16 Φεβρουαρίου
➡ Valis Resort
➡ www.uroschool.gr
Το πρόγραμμα για το 10ο Ελληνικό Διαδραστικό Σχολείο Ουρολογίας που θα γίνει στις 16-19 Φεβρουαρίου 2017 στην Πορταρία του Πηλίου.
Εκδήλωση ενδιαφέροντος: http://bit.ly/uroschool2017
Τα Κλινικά Φροντιστήρια "Andrology update” είναι εκπαιδευτικοί κύκλοι μαθημάτων για Ουρολόγους, που διοργανώνει το ΙΜΟΠ. Πρόκειται για τα πλέον πρακτικά φροντιστήρια που ιστορικά έχει υλοποιήσει το Ινστιτούτο, αφού δημιουργούν μία αναπαραστατική εικόνα του ιατρείου των Ουρολόγων και οι συνάδελφοι βρίσκονται αντιμέτωποι με καθημερινά προβλήματα που αντιμετωπίζουν και στο ίδιο το ιατρείο τους. Κατ’ αυτόν τον τρόπο, και μέσα από την αναγκαία μίξη της τεκμηριωμένης ιατρικής και της κλινικής εμπειρίας, εξασφαλίζεται η ανανέωση της γνώσης.
Σύνδεσμοι που σας ενδιαφέρουν:
• Γενικές Πληροφορίες: http://bit.ly/agria2016info
• Ομιλητές: http://bit.ly/agria2016omilites
• Πρόγραμμα: http://bit.ly/agria2016program
• Πρόγραμμα ISSU: http://bit.ly/agria2016issu
• Πρόγραμμα PDF: http://bit.ly/agria2016programpdf
• Φόρμα Ενδιαφέροντος: http://bit.ly/agria2016
Πρόγραμμα για το 9ο Ελληνικό Διαδραστικό Σχολείο Ουρολογίας, UROSchool, που διοργανώνει το Ινστιτούτο Μελέτης Ουρολογικών Παθήσεων από το 2008 και κάθε χρόνο στην Πορταριά Πηλίου. Ένα μεγάλο ευχαριστώ στους εκπαιδευτές που ήδη δουλεύουν για να ανταποκριθούν στις προσδοκίες των Ουρολόγων.
Σύνδεσμοι που σας ενδιαφέρουν:
Πρόγραμμα: http://bit.ly/uroschool2016program
Πρόγραμμα pdf: http://bit.ly/uroschool2016pdf
Φόρμα Εκδήλωσης Ενδιαφέροντος: http://bit.ly/uroschool2016
(για την φόρμα εκδήλωσης ενδιαφέροντος Θα πρέπει να εισέλθετε ή να εγγραφείτε στην ιστοσελίδα του ΙΜΟΠ)
Τελικό πρόγραμμα για το κλινικό Φροντιστήριο "Κλινικές δεξιότητες στην Ανδρολογία - Andrology Update 2016" που θα γίνει στις 19 Φεβρουάριου 2016 στο Ξενοδοχείο DuLac, Ιωάννινα.
Εκδήλωση ενδιαφέροντος στον σύνδεσμο: http://bit.ly/1SPEtpT
Τελικό πρόγραμμα 8ου Σχολείου Ουρολογίας
Ήδη μετράμε αντίστροφα για την πρώτη εκπαιδευτική συνάντηση Ουρολόγων, το ετήσιο Σχολείο Ουρολογίας στην Πορταριά.
Το πρόγραμμα είναι αναρτημένο στο: http://bit.ly/1J7bLs1
Για εκδήλωση ενδιαφέροντος συμμετοχής επισκεφθείτε σήμερα το: http://bit.ly/TYEY20less
Δείτε και μάθετε από το infographic, της σειράς SexInfographics του Ινστιτούτου Μελέτης Ουρολογικών Παθήσεων, για τις θεραπείες στυτικής δυσλειτουργίας.
Οι σύγχρονες και αποτελεσματικές θεραπείες είναι τα φάρμακα από το στόμα, οι ενδοπεϊκές ενέσεις, τα κρουστικά κύματα και οι πεϊκές προθέσεις.
In 1982, French physician R. Virag announced that the papaverine intracavernous injection can cause penile erection by immediately increasing penile blood flow. This was actually the beginning of the pharmaceutical treatment for erectile dysfunction. Read the infographic to learn more about Oral ED drugs, Penile injections, Shock Wave Therapy and Penile Prosthesis
Το Ινστιτούτο Μελέτης Ουρολογικών Παθήσεων μετείχε ενεργά στην 6η Σύνοδο της Ελληνικής Εταιρείας Έρευνας και Αντιμετώπισης του Ιού των Θηλωμάτων (HPV) της Ελληνικής HPV Εταιρείας, η οποία διοργανώθηκε με φροντίδα του Διοικητικού Συμβουλίου (Δ.Σ.) της Εταιρείας υπό μορφή 3ήμερου Επιστημονικού Συνεδρίου στο Ξενοδοχείο Ηyatt Regency της Θεσσαλονίκης.
Με αφορμή τη σχετική Σύνοδο, το ΙΜΟΠ και η Ελληνική HPV Εταιρεία δημιούργησαν από κοινού ένα πληροφοριακό γράφημα, όπου εύληπτα και απλά παρουσιάζεται όλη η σύγχρονη γνώση σε σχέση με τον ιό και την αντιμετώπισή του.
1. Preventing Osteoporotic Fractures
in Men With Early-Stage Prostate
Cancer
Michael A. Carducci, MD
AEGON Professor in Prostate Cancer
Research
Johns Hopkins Kimmel Cancer Center
Baltimore, Maryland
This program is supported by an educational donation from
2. Maximizing Skeletal Integrity in Patients With Cancer
clinicaloptions.com/oncology
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been approved by the United States Food and Drug Administration. A qualified healthcare professional
should be consulted before using any therapeutic product discussed. Readers should verify all information
and data before treating patients or using any therapies described in these materials.
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Disclosure
Michael A. Carducci, MD, has disclosed that he has
received consulting fees from Amgen, Bristol-Myers Squibb,
and Novartis.
4. Maximizing Skeletal Integrity in Patients With Cancer
clinicaloptions.com/oncology
Case 1
68-yr-old retired truck driver
High blood pressure; diabetes, noninsulin requiring
BMI: 32 (obese); nonsmoker; alcohol intake: 2-3 beers/day
Presents with PSA 50
DRE clinical stage T3b
TRUS: biopsies with Gleason 4 + 3 in 9 of 12 cores
No detectable metastases by bone scan and CT
After discussing options, patient decides on external beam
radiation therapy + 3 yrs of ADT
5. Maximizing Skeletal Integrity in Patients With Cancer
clinicaloptions.com/oncology
Would you recommend additional therapy
to prevent bone loss/fractures?
A. No, since I did not get a baseline BMD
B. Yes, regardless of baseline BMD
C. Yes, but only if he is osteoporotic
D. Yes, if he is osteopenic or osteoporotic
6. Maximizing Skeletal Integrity in Patients With Cancer
clinicaloptions.com/oncology
ADT-Associated Bone Loss
Healthy men[1] 0.5%
Late menopausal women[1] 1.0%
Early menopausal women[1] 2.0%
AI therapy in postmenopausal women[2] 2.6%
Bone marrow transplant[3] 3.3%
Androgen deprivation therapy[4] 4.6%
AI therapy + GnRH agonist[5] 7.0%
Ovarian failure 7.7%
secondary to chemotherapy[6]
0 2 4 6 8
Lumbar Spine BMD Loss at 1 Yr (%)
1. Kanis JA. Osteoporosis. Blackwell Healthcare Communications Ltd; 1997. 2. Eastell R, et al. J Bone
Mineral Res. 2002;17(suppl 2). Abstract 1170. 3. Lee WY, et al. J Clin Endocrinol Metab. 2002;87:329-
335. 4. Maillefert JF, et al. J Urol. 1999;161:1219-1222. 5. Gnant M. Breast Cancer Res Treat. 2002;
76(suppl 1):S31. Abstract 12. 6. Shapiro CL, et al. J Clin Oncol. 2001;19:3306-3311.
7. Maximizing Skeletal Integrity in Patients With Cancer
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Proportion of Patients With Fractures
1-5 Yrs After Cancer Diagnosis
+6.8%; P < .001
21 No ADT (n = 20,035)
ADT (n = 6650)
18
19.4
15
Frequency (%)
12 12.6
9
+2.8%; P < .001
6
5.2
3
2.4
0
Any Fracture Fracture Resulting in
Hospitalization
Shahinian VB, et al. N Engl J Med. 2005;352:154-164.
8. Maximizing Skeletal Integrity in Patients With Cancer
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Fractures Impact Mortality and Life
Expectancy
Hip fracture
– Affects life expectancy dramatically[1,2]
– Aged 60-69 yrs: 11.5 yrs of decreased life expectancy
– Aged 0-79 yrs: 5.0 yrs of decreased life expectancy
Vertebral facture
– Prevalence in men is high (20%)[3]
– Clinical consequences: pain, kyphosis, loss of height, respiratory problems [4,5]
– 4 x increased risk of subsequent fracture[6]
– Predict increased mortality in men with a 10-yr HR of 2.4
(95% CI: 1.6-3.9)[6,7]
1. Cree M, et al. J Am Geriatr Soc. 2000;48:283-288. 2. Center JR, et al. Lancet. 1999;353:878-882. 3. O’Neill TW, et al. J
Bone Miner Res. 1996;11:1010-1018. 4. Matthis C, et al. Osteoporosis Int. 1998;8: 364-372. 5. Francis RM, et al. QJM.
2004;97:63-74. 6. Johnell O, et al. Osteoporos Int. 2004;15:175-179. 7. Lau E, et al. J Bone Joint Surg Am. 2008;90:1479-
1486. 8. Hasserius R, et al. Osteoporos Int. 2003;14:61-68.
9. Maximizing Skeletal Integrity in Patients With Cancer
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Screening for Bone Loss in Men:
Who Is at Risk?
Demographic Factors 65 yrs of age or older
History Family history of osteoporotic fracture
Fragility fracture after 40 yrs of age
Significant height loss
Lifestyle and Dietary Factors Smoking
Excessive intake of alcohol or caffeine (> 4 cups/day)
Inadequate dietary calcium intake
Weight < 57 kg (or loss of > 10% of weight at 25 yrs of age)
Physical Findings Vertebral deformity (eg, kyphosis) or osteopenia evident on x-ray
Diseases Associated With Bone Loss Prostate cancer
COPD
Malabsorption syndrome
Hyperparathyroidism
Hyperthyroidism
Hypogonadism
Rheumatoid arthritis
Renal insufficiency
Vitamin D deficiency
Treatments Associated With Bone Loss ADT
Anticonvulsants
Heparin
Systemic glucocorticoids (duration > 3 mos)
Entries in bold are considered major risk factors.
Brown JP, et al. CMAJ. 2002;167:S1-S34. Greenspan SL. J Clin Endocrinol Metab. 2008;93:2-7.
10. Maximizing Skeletal Integrity in Patients With Cancer
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The FRAX® Index: Assessing Fracture Risk
Available at: http://www.sheffield.ac.uk/FRAX/. Image used with permission of the WHO Collaborating
Centre for Metabolic Bone Diseases, University of Sheffield. FRAX ® is registered to Professor JA Kanis,
University of Sheffield.
11. Maximizing Skeletal Integrity in Patients With Cancer
clinicaloptions.com/oncology
Case 2
80-yr-old male with biochemically recurrent, nonmetastatic
prostate cancer starting ADT for a PSA of 15
5′9″ (175.3 cm), 158 lbs (72.1 kg)
DEXA scan at baseline reveals T-score of -0.9 at the
femoral neck of the left hip and -0.2 at the spine
Patient also has Crohn’s disease and frequently receives
steroid treatment
Drinks 4 glasses of wine/day and is a 60 pack-yr cigarette
smoker
No previous history of fracture
12. Maximizing Skeletal Integrity in Patients With Cancer
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In addition to lifestyle modification, would
you also recommend bone-targeted
therapy for this patient?
A. No
B. Yes, alendronate 70 mg/wk PO
C. Yes, denosumab 60 mg SC q6m
D. Yes, zoledronic acid 5 mg IV annually
E. Yes, zoledronic acid 4 mg IV annually
F. Yes, zoledronic acid 4 mg IV quarterly
14. Maximizing Skeletal Integrity in Patients With Cancer
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Alendronate Increases BMD During
GnRH Agonist Therapy
5 12-Mo Data
4
BMD Percent Change
3
Placebo
2 Alendronate
1
0
-1
-2
-3
Lumbar Total
Spine Hip
Greenspan SL, et al. Ann Intern Med. 2007;146:416-424.
15. Maximizing Skeletal Integrity in Patients With Cancer
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Annual Zoledronic Acid Increases BMD
During GnRH Agonist Therapy
6 Final 12-Mo Data
P < .005 for each comparison
4
BMD Percent Change
2 Placebo
Zoledronic acid 4 mg/yr IV
0
-2
-4
-6
Lumbar Total
Spine Hip
Michaelson MD, et al. J Clin Oncol. 2007;25:1038-1042.
16. Maximizing Skeletal Integrity in Patients With Cancer
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Quarterly Zoledronic Acid Increases BMD
During GnRH Agonist Therapy
8 Final 12-Mo Data
P < .001 for each comparison
6
BMD Percent Change
4 Placebo
Zoledronic acid
2
0
-2
-4
Lumbar Total
Spine Hip
Smith MR, et al. J Urol. 2003;169:2008-2012.
17. Maximizing Skeletal Integrity in Patients With Cancer
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Denosumab Increased BMD at All Skeletal
Sites
10 A. Lumbar Spine 10 B. Total Hip
8 8
From Baseline (%)
From Baseline (%)
Change in BMD
Change in BMD
6 Denosumab 6
4 4 Denosumab
Difference at 24 mos,
2 6.7 percentage points 2 Difference at 24 mos,
0 0 4.8 percentage points
-2 Placebo -2
-4 -4 Placebo
-6 -6
01 3 6 12 24 36 01 3 6 12 24 36
Mos Mos
10 C. Femoral Neck 10 D. Distal Third of Radius
8 8
From Baseline (%)
From Baseline (%)
Change in BMD
Change in BMD
6 6
4 Denosumab 4
Denosumab
2 Difference at 24 mos,
2
0 3.9 percentage points 0 Difference at 24 mos,
5.5 percentage points
-2 -2
Placebo Placebo
-4 -4
-6 -6
01 3 6 12 24 36 01 3 6 12 24 36
Mos Mos
Smith MR, et al. N Engl J Med. 2009;361:745-755.
18. Maximizing Skeletal Integrity in Patients With Cancer
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Denosumab for Fracture Prevention
10 Denosumab
Placebo
New Vertebral Fracture (%)
8
P = .004 P = .004 P = .006
6
3.9
4 3.3
1.9
2 1.5
1.0
0.3
0
12 24 36
Patients Mos
at Risk, n 13 2 22 7 26 10
Smith MR, et al. N Engl J Med. 2009;361:745-755.
19. Maximizing Skeletal Integrity in Patients With Cancer
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Conclusions
Osteoporosis and fractures are an important health
problem in older men
ADT for prostate cancer increases risks for osteoporosis
and fractures
Some but not all men require drug therapy to prevent
fractures during ADT
Effective therapies are available
– Bisphosphonates increase BMD
– Denosumab increases BMD and decreases vertebral
fractures
20. Go Online for More Education
on Bone Health
Interactive Decision Support Tools: Experts make treatment
recommendations for patients with prostate or breast cancer
Optimizing Bone Health in Patients With Cancer: Proceedings of an
Independent Expert Panel
Downloadable slides
clinicaloptions.com/oncology
Editor's Notes
This slide lists the disclosure information of the faculty and staff involved in the development of these slides.
Curatio PowerPoint Template 11/30/12 05:01 PSA, prostate specific antigen DRE, digital rectal exam TRUS, transrectal ultrasound
Curatio PowerPoint Template 11/30/12 05:01 Polling question – no right answer
Curatio PowerPoint Template 11/30/12 05:01 CORE
Curatio PowerPoint Template 11/30/12 05:01 Curatio PowerPoint Template Fact check: Data from table 2 in Shahinian (9112) NO PERMISSION NEEDED
Curatio PowerPoint Template 11/30/12 05:01
Curatio PowerPoint Template 11/30/12 05:01 There are many risk factors for bone loss in men, including age ≥ 65 years, prostate cancer itself, and hypogonadism (including ADT-induced hypogonadism) 1,2 References: Brown JP, Josse RG; Scientific Advisory Council of the Osteoporosis Society of Canada. 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ 2002;167(Suppl 10):S1-S34. Greenspan SL. Approach to the prostate cancer patient with bone disease. J Clin Endocrinol Metab 2008;93:2-7.
Curatio PowerPoint Template 11/30/12 05:01
Now, let’s move on to case two. This is an 80-year-old Caucasian gentleman with biochemically recurrent nonmetastatic prostate cancer, who started androgen deprivation therapy when his PSA got up to a level of 15. He had a DXA scan at baseline that revealed a T-score of -0.9 at the femoral neck of the left hip and -2.0 at the spine, so no osteoporosis or osteopenia. The patient, however, also has Crohn’s disease and is frequently put on steroid therapy to help manage his Crohn’s disease. He is a significant drinker by drinking 4 glasses of wine each day, and he also has a 60 pack/year history of cigarette smoking. He, however, has no history of fractures.
So again, the correct answers here are very similar to before. There is data with alendronate, there is data with denosumab, and there is data with zoledronic acid here in this setting. I think the key issue with this gentleman is that he does not have osteopenia or osteoporosis, as diagnosed by DXA scan, but he has a ton of risk factors. He has advanced age, steroid use, he drinks a significant amount of alcohol, he smokes, and of course he is on androgen deprivation therapy. He has many risk factors here, so I think the answers here—B would be fine, C would be fine. I think D might be overkill here at 120 mg subcu every 4 weeks. That was actually the FDA-approved dose for a man with metastatic castration-resistant prostate cancer to the bone for skeletal-related events. I think E is fine, with annual zoledronic acid. F was quarterly zoledronic acid. G—again, this is the zoledronic acid dose for men with metastatic castration-resistant disease to the bone. So, I would say here I certainly would do bone-targeted therapy. I don’t particularly like the answer A. I don’t like the answer of D or G here, but I think the other choices are all very reasonable.
Curatio PowerPoint Template 11/30/12 05:01
Curatio PowerPoint Template 11/30/12 05:01
Curatio PowerPoint Template 11/30/12 05:01
Curatio PowerPoint Template 11/30/12 05:01
Curatio PowerPoint Template 11/30/12 05:01 Mean Percent Changes from Baseline Bone Mineral Density (BMD) Values during the Study Period, According to Skeletal Site and Study Group. Results are presented as least-squares means of the BMDs of the lumbar spine (Panel A), the total hip (Panel B), the femoral neck (Panel C), and the distal third of the radius (Panel D). All values shown were significantly higher in the denosumab group than in the placebo group (P≤0.001). The means were estimated with the use of analysis-of-covariance models adjusting for study group, stratification variables, baseline BMD value, densitometer type, and the interaction between baseline BMD value and densitometer type. The means are based on data for 734 patients in each of the two groups except for the distal third of the radius, for which data were available for 161 patients in the denosumab group and 148 patients in the placebo group. I bars indicate 95% confidence intervals.
Now, what about fracture data? You can see here the bar graphs on the left, middle, and right, looking at 1, 2 and 3 years are all statistically significant in favor of denosumab, with less for osteoporotic fractures compared with placebo.