ROLE OF TERIPARATIDE AND DENOSUMAB IN ORTHOPEDICS.pptx
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ROLE OF TERIPARATIDE AND DENOSUMAB IN ORTHOPEDICS in current scenario. This drugs will be widely used in future
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- Bone cement was first used in the 1870s to fix ivory knee prostheses. Modern cementing techniques using PMMA were developed in the 1950s-60s.
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Idiopathic chondrolysis of the hip
Idiopathic chondrolysis of the hip is a rare condition characterized by the destruction of articular cartilage in the hip of unknown cause, mainly affecting adolescent females. It presents with insidious hip, thigh, or knee pain and radiographic evidence of joint space narrowing. While the etiology is unknown, theories include abnormal cartilage metabolism triggered by an environmental event, abnormal intra-articular pressure, or mechanical insult to the cartilage. Treatment focuses on NSAIDs, protected weight bearing, range of motion exercises, and in some cases surgery such as distraction arthroplasty or arthroplasty.
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This document discusses congenital pseudarthrosis of the tibia (CPT), a rare condition where the tibia fails to heal after fractures at an early age. CPT is often associated with neurofibromatosis type 1. The etiology is unclear but is thought to involve periosteal fibrosis. Imaging can help evaluate the extent of disease. Surgical treatment aims to achieve union, prevent refracture, and correct deformities. Common approaches include intramedullary nailing, vascularized fibular grafting, and external fixation. Prognosis remains poor due to risks of nonunion, refracture, limb length discrepancy, and ankle deformity. Close long-term monitoring is needed.
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Examination of foot and ankle slideshare
This document provides details on performing an examination of the foot and ankle. It begins with taking a history including pain characteristics, swelling, deformity, and instability. The physical examination is then described step-by-step including inspection of gait, the feet while standing and sitting, and range of motion testing. Specific tests are outlined to assess the ligaments, tendons, nerves and vasculature. Common foot deformities and injuries are also discussed. The presentation concludes with references for further information.
Triple arthrodesis seminar by Dr Chirag Patel
This seminar mainly useful for all post graduates of orthopeadics and helpful for theory and practical examination.
Dr.S.Senthil Sailesh-functional cast bracing,PTBcast,sarmiento principle
The document discusses functional casting and bracing techniques used to treat fractures while allowing restricted movement. It describes the principles of functional casting which include maintaining stability and reduction while promoting blood flow and muscle contraction to encourage healing. Specific casts for treating fractures of the humerus, tibia, femur and hip are outlined, including the Sarmiento cast and hip spica cast. The timing, positioning and complications of different casts are summarized. Functional casting aims to continue function during fracture healing to accelerate rehabilitation.
Tumor mega prosthesis
- The document discusses principles of limb salvage surgery for bone tumors. It covers staging of tumors, including radiological and surgical staging. Radiological modalities like CT, MRI, PET scans help determine tumor extent and metastases.
- Principles of biopsy and factors affecting success of limb salvage surgery are outlined. Surgical resection aims to remove the tumor with an adequate margin while reconstructing the limb functionally. Pre-operative staging and adjuvant therapy can aid resectability.
- The goal of limb salvage surgery is a painless, functional reconstructed limb while achieving oncologic control.
Triple arthrodesis
Triple arthrodesis is a surgical fusion of the subtalar, calcaneocuboid, and talonavicular joints to provide hindfoot stability and alignment and relieve pain. It is used to treat conditions like rheumatoid arthritis, post-traumatic arthritis, osteoarthritis, Charcot-Marie-Tooth disease, neglected clubfoot, poliomyelitis, and tarsal coalition. The Lambrinudi procedure is used for severe clubfoot and involves wedge resections of the calcaneum, talus, and navicular followed by fixation with K-wires, staples or screws. Postoperatively, the limb is immobilized for 6 weeks followed by ankle-foot orthosis use and weight bearing
Teriparatide
Teriparatide is a recombinant form of parathyroid hormone (PTH) that stimulates bone growth and increases bone mineral density, making it effective for treating osteoporosis. It works by activating osteoblasts more than osteoclasts, resulting in a net increase in new bone formation. While teriparatide is more effective at increasing bone mineral density and reducing fractures than bisphosphonates, its major limitation is its high cost of approximately 3 lakh rupees for treatment. It is generally reserved for cases of severe or refractory osteoporosis due to its prohibitive expense.
Ligamentotaxis principle in the treatment of intra articular fractures of dis...
This study assessed the correlation between radiological outcomes and functional outcomes in 45 patients treated with external fixation for intra-articular fractures of the distal radius. Good or acceptable restoration of radial length and palmar slope on radiographs post-operatively was found to produce good to excellent functional results regardless of fracture type. While poor radiological outcomes did not always lead to poor function, maintenance of radial length and correction of palmar tilt were important for functional outcomes. The study concluded that achieving good function is more important than surgical precision on radiographs alone.
Tens
The document discusses the titanium elastic nailing system (TENS) used to treat fractures in children. TENS involves the use of flexible titanium nails inserted into the medullary canal. It is primarily used for diaphyseal and metaphyseal fractures in children ages 3-15. The appropriate use of TENS depends on considering the child's age as well as the type and location of the fracture. TENS provides stability while allowing bending and early ambulation.
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The document discusses various bone graft substitutes including allograft based, growth factor based, cell based, ceramic based, and polymer based substitutes. It provides details on the composition, properties, and clinical applications of different substitutes. Allografts use donor bone while growth factors and cells aim to stimulate new bone growth. Ceramic materials like hydroxyapatite are osteoconductive and some bioactive glasses can bond directly with bone. The ideal graft substitute should be biocompatible, bioresorbable, osteoconductive, osteoinductive, and structurally similar to bone.
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This document discusses metabolic bone diseases and provides details on osteoporosis. It begins with an overview of metabolic bone diseases including osteoporosis, rickets/osteomalacia, Paget's disease, and hyperparathyroidism. It then focuses on osteoporosis, defining it as a disease with low bone mass and structural defects leading to fragile bones. Epidemiology, risk factors, pathophysiology, clinical features, investigations including DEXA and other bone density tests, and treatment options like bisphosphonates, teriparatide, and denosumab are summarized. Rickets and osteomalacia are also briefly discussed.
Osteoporosis ss
Osteoporosis is a disease characterized by low bone mass and deterioration of bone tissue, leading to increased bone fragility and risk of fractures. The document discusses the definition, pathophysiology, assessment, and management of osteoporosis. It describes how bone mass peaks in early adulthood and then declines, and lists factors such as physical activity, hormones, and calcium intake as primary regulators of adult bone mass. The mechanisms and roles of vitamin D, parathyroid hormone, fibroblast growth factor 23, and calcitonin in bone remodeling are explained. Various pharmacological agents used in the treatment of osteoporosis are also outlined, including bisphosphonates, denosumab, selective estrogen receptor modulators,
Novel therapies for osteoporosis (4)
This document summarizes current and newer therapies for osteoporosis. It describes the FDA-approved pharmacologic options including bisphosphonates, estrogens, raloxifene, calcitonin, parathyroid hormone, and denosumab. It then discusses the efficacy of these current treatments in reducing vertebral and non-vertebral fractures. The document notes the need for newer agents due to safety concerns with long-term bisphosphonate use. It introduces several promising new therapies in development including denosumab, anti-sclerostin antibodies, and cathepsin K inhibitors which have shown increases in bone mineral density and reductions in fracture risk in clinical trials.
Osteoporosis
Osteoporosis is a condition characterized by low bone mass and quality, leading to an increased risk of bone fractures. It is most common in postmenopausal women over age 50 and men over age 80. Risk factors include female gender, advancing age, family history, hypogonadism, glucocorticoid use, low body mass index, smoking, and nutritional deficiencies. Diagnosis is made through bone density scans and confirmed by fragility fractures. Treatment focuses on lifestyle modifications, calcium and vitamin D supplementation, bisphosphonates, estrogen therapy, selective estrogen receptor modulators, parathyroid hormone, calcitonin, and surgery for fractures. Monitoring involves repeat bone density scans and biochemical markers to assess response to
Osteoporosis and teriparatide
Teriparatide (brand name Forteo) is a form of parathyroid hormone that stimulates new bone formation. It is the only osteoporosis drug approved to build new bone.
The document discusses how teriparatide works by activating osteoblasts through intermittent exposure to parathyroid hormone. This leads to increased bone mineral density, especially in the spine and hip. Clinical trials showed teriparatide reduced the risk of vertebral fractures by 65% and nonvertebral fractures by 53% compared to placebo.
Teriparatide is recommended for patients with severe osteoporosis who have failed or cannot tolerate bisphosphonate therapy. It may also be used off-label to
Osteoporosis
This document provides an overview of osteoporosis including its definition, epidemiology, pathophysiology, causes, clinical features, diagnosis, and treatment. Some key points include:
- Osteoporosis is a skeletal disorder characterized by compromised bone strength and increased risk of fracture. It is defined by the WHO as a bone density 2.5 standard deviations below the mean.
- It is a major global health problem, particularly affecting post-menopausal women and the elderly. Lifetime risk of osteoporotic fractures is 30-50% in females and 15-30% in males.
- Causes include failure to achieve peak bone mass, increased bone resorption, and inadequate bone formation
Osteoporosis
This document discusses osteoporosis, including its causes, risk factors, symptoms, diagnosis, and treatment. It defines osteoporosis as a condition where low bone mass and deterioration of bone tissue lead to fragile bones that break easily. Key tests for diagnosis include bone mineral density testing and blood tests. Treatment focuses on lifestyle changes and medications to slow bone loss such as bisphosphonates, selective estrogen receptor modulators, parathyroid hormone, and monoclonal antibodies. Surgical treatment aims to stabilize fractures from fragile bones through minimally invasive techniques.
Postmenopausal Osteoporosis.pptx
Osteoporosis is a skeletal disorder characterized by compromised bone strength and increased fracture risk. It is common, resulting in significant costs, morbidity, and mortality. Healthcare professionals should identify those at high risk for screening via DXA scan or FRAX assessment. Those at high fracture risk should be treated individually with proven medications like bisphosphonates that are generally safe and effective in reducing fractures. Ongoing monitoring and lifestyle management are also important to maintain strong, healthy bones.
pharmacotherapy of osteoporosis.pptx
Osteoporosis is a disease characterized by low bone mass and deterioration of bone structure. It increases bone fragility and risk of fractures. Primary types include postmenopausal osteoporosis in women over 50 and senile osteoporosis in those over 70. Treatment focuses on preventing bone loss and increasing bone mass. First line drugs are bisphosphonates like alendronate and risedronate. Second line includes selective estrogen receptor modulators like raloxifene. Non-pharmacological prevention focuses on calcium, vitamin D, and weight-bearing exercise.
osteoporosis
Osteoporosis is a systemic bone disease characterized by low bone mass and deterioration of bone tissue, leading to increased bone fragility and risk of fractures. It is most common in postmenopausal women. Risk factors include smoking, low body weight, steroid use, excess alcohol intake, and family history of fractures. Diagnosis involves measuring bone mineral density via DEXA scan. Treatment aims to prevent fractures and bone loss, and includes adequate calcium and vitamin D, weight-bearing exercise, falls prevention, pharmacologic agents like bisphosphonates, and surgery for fractures. Regular screening and monitoring of at-risk individuals is important.
Metabolic and endocrine bone disorders.pdf
This document discusses metabolic and endocrine bone disorders like osteoporosis. It describes how these disorders may present as bone deformities in children, fractures in elderly patients, or bone pain and fractures in those taking corticosteroids. It covers examining patients, diagnostic tests like x-rays and bone density scans, biochemical tests, and bone biopsies. Risk factors, features, and treatments of postmenopausal osteoporosis are outlined, along with secondary causes of osteoporosis from endocrine, respiratory, metabolic, gastrointestinal, and other conditions. Prevention and treatment aim to reduce future fracture risk through medications or surgery.
Osteoporosis
This document discusses the pharmacotherapy of osteoporosis. It describes various classes of drugs used to treat osteoporosis including antiresorptive agents like bisphosphonates, SERMs, denosumab, and calcitonin as well as the bone anabolic agent teriparatide. Specific bisphosphonate drugs discussed include alendronate, risedronate, ibandronate, and zoledronate. The mechanisms of action, indications, dosing, and side effects of these agents are provided.
osteoporosis
Osteoporosis is a disease where bones become fragile and more likely to break. It occurs when the body loses more bone than it forms, reducing bone density and bone mass. Key risk factors include a family history of osteoporosis, being Caucasian or Asian, smoking, excessive alcohol use, and low body weight. Diagnosis relies on bone mineral density tests to determine a T-score. Treatment focuses on lifestyle changes like exercise and nutrition, as well as medications to reduce bone loss and increase bone formation.
Postmenopausal Osteoporosis
This document discusses the management of postmenopausal osteoporosis. It defines osteoporosis as a disease characterized by low bone density and deterioration of bone tissue, causing increased fragility and risk of fractures from low-impact falls. Several treatments for osteoporosis are discussed, including hormone therapy, SERMs like raloxifene, bisphosphonates like alendronate, and PTH analogs like teriparatide. These treatments have been shown to increase bone mineral density at the lumbar spine and hip and reduce the risk of fractures to varying degrees. Lifestyle modifications including adequate calcium and vitamin D intake, exercise, smoking cessation, and fall prevention are also recommended to help manage oste
core_course_lecture_-_osteoprosis_2010.ppt
Osteoporosis is a progressive bone disease characterized by low bone mass and deterioration of bone tissue, leading to increased bone fragility and risk of fractures. It occurs when bone resorption by osteoclasts exceeds bone formation by osteoblasts. Risk factors include age, gender, genetics, smoking, alcohol, obesity, low vitamin D, and medications like corticosteroids. It is diagnosed using DEXA scans and managed through lifestyle changes, calcium/vitamin D supplementation, and pharmacological therapies like bisphosphonates, strontium, raloxifene, teriparatide, calcitonin, and denosumab. Emerging therapies target mechanisms like cathepsin K, sclerost
Osteoporosis.pptx
Osteoporosis is a disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased risk of fractures. Key points:
- It is defined as a bone density 2.5 standard deviations or more below the mean bone density of healthy young adults.
- It occurs more frequently with age and is more common in women, especially after menopause due to estrogen loss.
- Risk factors include family history, smoking, low weight, inactivity, excessive alcohol, and certain medical conditions or medications.
- It is usually asymptomatic until a fracture occurs. Treatment focuses on lifestyle changes, calcium/vitamin D supplementation, and medications to increase bone density
Osteoporosis : nightmare of menopause
This document discusses osteoporosis, which is a systemic skeletal disorder characterized by low bone mass and deterioration of bone tissue. It affects many post-menopausal women, with 1 in 3 women and 1 in 2 women over 50 developing osteoporosis-related fractures. The document outlines prevalence, pathogenesis, risk factors, diagnosis using BMD tests and algorithms, and prevention through lifestyle changes, calcium/vitamin D supplementation, and treatment options including bisphosphonates, calcitonin, and PTH therapies. The key messages are that osteoporosis prevention should begin in childhood and maintaining a bone healthy lifestyle throughout life.
Recent advances in osteoporosis new copy
Osteoporosis is characterized by low bone mass and deterioration of bone structure, making bones fragile and prone to fractures. Key drugs used to treat osteoporosis include calcium, vitamin D, bisphosphonates, SERMs, calcitonin, PTH and teriparatide, and denosumab. Newer drugs under development include romosozumab, a sclerostin inhibitor that strongly increases bone mineral density, abaloparatide, and integrin antagonists. Non-drug approaches also show promise such as biomaterials and gut serotonin inhibitors.
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ROLE OF TERIPARATIDE AND DENOSUMAB IN ORTHOPEDICS.pptx
- 1. ROLE OF TERIPARATIDE AND DENOSUMAB IN ORTHOPEDICS By Dr. Arghyadeep Biswas Post Graduate Trainee Department of orthopedics, BMCH
- 3. Teriparatide is recombinant form of PTH • Portion of PTH (84 AA). It contains first 34 AA • Anabolic Drug. Promote bone formation rather than resorption • Stimulate Osteoblastic activity • Increase renal tubular and gut resorption of Calcium • Enhance bone formation • Improve bone strength by improving bone architecture
- 4. Intermittent exposure to PTH Stimulate Osteoblasts Given in once daily Injection
- 5. Osteoporosis • T score – Number of SD above or below the average BMD value for young normal Adult of same sex, age and ethnicity Normal - (-1) or above Osteopenia- (-1) to (-2.5) Osteoporosis- (-2.5) or below
- 6. Based on the difference in kinetics of changes between bone formation and resorption markers an “anabolic window” is formed during which the actions of Parathyroid hormone are seen
- 7. Effects • Increases bone density of spine by 9% and Hip by 3% • Reduces incidence of new vertebral # by 65% and non vertebral # by 53% in woman with pre existing vertebral # after median exposure of 19 months
- 8. Side Effects Arthralgia Nausea and vomiting Increased risk of osteosarcoma
- 9. Advantage Disadvantage • High cost • Parenteral daily dose • Unlike anti Resorptive agents which stop by bone turnover, TERIPARATIDE creates new bone tissue • Half life of PTH is 4mins but half life of TERIPARATIDE is 1hr
- 10. TERIPARATIDE IS VERY EFFECTIVE IN • Refractive osteoporosis • Steroid induced osteoporosis • Very sereve osteoporosis that cannot be cured by Bsphosphonate
- 11. Dose 20mcg once daily in abdomen or thigh subcutaneously at same time each day Usually grater than 9 months but not more than 2 years due to increased risk of osteosarcoma
- 12. Contraindication • Unexplained hypercalcaemia • Unexplained increased ALP • Paget Disease • Skeletal radiation • Metastatic cancer • Unfused epiphysis • GFR < 30ml/min
- 13. • Teriparatide and Denosumab(Anti RANK-L Antibody) can be given together as they have synergistic effect • Teriparatide and Bisphosphonates should not be combined
- 14. DENOSUMAB • Monoconal Ab IgG2 • Developed by AMGEN • On 2010 Denosumab was approved by FDA or use in post menopausal women with high risk of osteoporosis with brand name PROLIA • It is the first RANK ligand inhibitor approved by FDA • On 2013 FDA approved Denosumab in skeletally mature adolescent giant cell tumour
- 16. USES o Post Menopausal women with high risk or # o Men with osteoporosis with high risk for # o Treatment of glucocorticoid induced osteoporosis o Non metastatic prostate cancer o Breat cancer receiving aromatase inhibitor therapy o Hypercalcaemia in malignancy o Adolescent giant cell tumour
- 17. Contraindication • Hypocalcaemia • Pregnancy • Known Hypersensitivity Side effects Atypical Femur # Multiple vertebrae # Skin infection, rash, eczema Severe bone, Joint, muscle pain Suppression of bone turnover Osteonecrosis of jaw has been reported
- 18. DOSAGE In Osteoporosis • Injection every 6month as subcutaneously in upper arm, upper thigh and abdomen • Pt should take Calcium 1000mg/D and atleast 400IU vit D daily • Single use prefilled syringe containing 60mg in 1ml solution
- 19. In Giant cell tumour Administer 120mg every 4 weeks with additional 120 mg on day 8 and day 15 on first month of therapy
- 22. THANK YOU