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7/29/2019 6--PCE Nashville Osteoporosis Knudtson
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Osteoporosis Update:
Prevention, Diagnosis,
and TreatmentMary D. Knudtson, DNSc, NP
Clinical Professor
Department of Family MedicineUniversity of California, Irvine
Irvine, California
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Faculty Disclosure
Dr Knudtson: consultant/speakers bureau:
Procter & Gamble
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How confident are you addressing
modifiable risk factors for osteoporosis
with your patients?
1 2 3
32%
6%
62%
Use your keypad to vote now!
1. Very confident
2. Somewhat
confident
3. Not at all confident
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Learning Objectives
Assess the risk factors associated with osteoporosis
Manage osteoporosis in the context of comorbidities
Evaluate nonpharmacologic preventive approaches
as well as the efficacy and safety of pharmacologicmanagement
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Bone density=grams of mineral/area, volumeBone quality=architecture, turnover, damage
accumulation, mineralization
Bone strength =density + quality
SD = standard deviation; WHO = World Health Organization.
National Osteoporosis Foundation. Clinicians Guide to Prevention and Treatment of Osteoporosis. Available at:
www.nof.org/professionals/Clinicians_Guide.htm. Accessed April 22, 2008; NIH Consensus Statement. 2000;17:1-45
Osteoporosis Defined
Osteoporosis, primary or secondary, is characterized
by compromised bone strength predisposing to an
increased risk of fracture
Osteoporosis = bone mineral density (BMD) 2.5 SD
below young normal mean at hip or spine [WHO]
http://www.nof.org/professionals/Clinicians_Guide.htmhttp://www.nof.org/professionals/Clinicians_Guide.htmhttp://www.who.int/chp/topics/Osteoporosis.pdf.%20Accessed%200410087/29/2019 6--PCE Nashville Osteoporosis Knudtson
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Prevalence of Osteoporosis*
Osteoporosis is a major health threat in the United States 10 million Americans have osteoporosis, 34 million are at risk Osteoporosis disproportionately affects Caucasian and Asian
women; other races/ethnicities are also significantly affected Under-recognized problem in men
In men, involvement of all races and ethnicities is significant
In the United States, women and men aged 50 years 55% have low bone mass 8 million women and 2 million men have osteoporosis 1 of 2 white women, 1 of 5 men will suffer an osteoporosis-
related fracture Asian Americans with osteoporosis have same fracture
risk as white persons
Ebeling PR. N Engl J Med. 2008;358:1474-1482; National Osteoporosis Foundation. Clinicians Guide to
Prevention and Treatment of Osteoporosis. Available at: www.nof.org/professionals/Clinicians_Guide.htm.
Accessed April 22, 2008.
*Estimates based on 2000 census data.
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Which of the following best characterizes
the burden of osteoporosis?
1 2 3 4
72%
2%
20%
6%
Use your keypad to vote now!
MI = myocardial infarction.
1. Osteoporotic fractures aremore common than MI,stroke, and breast cancercombined
2. Only MIs are more prevalent
than osteoporotic fractures3. Incidence of osteoporotic
fractures is equal to thatof MIs
4. None of the above
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American Cancer Society. Cancer Facts and Figures: 2003. Available at:
www.cancer.org/downloads/STT/CAFF2003PWSecured.pdf. Accessed April 15, 2008; American Heart Association.
Heart and Stroke Statistics: 2003 Update. Available at:
www.americanheart.org/downloadable/heart/10590179711482003HDSStatsBookREV7-03.pdf. Accessed April 15, 2008;
Riggs BL, Melton LJ III. Bone. 1995;17(5 Suppl):505S-511S.
*Annual incidence all ages; annual estimate women 29+; **annual estimate women 30+.
Osteoporotic Fractures Are More Common Than
MI, Stroke, and Breast Cancer Combined
1,500,000*
0
500,000
1,000,000
1,500,000
2,000,000
Osteoporotic
Fractures
513,000
MI
228,000**
Stroke
184,300
Breast Cancer
750,000vertebral
250,000other sites
250,000forearm
250,000hip
Annualincidence
ofComm
onDiseases
http://www.cancer.org/downloads/STT/CAFF2003PWSecured.pdfhttp://www.americanheart.org/downloadable/heart/10590179711482003HDSStatsBookREV7-03.pdf.%20Accessed%20April%2015http://www.americanheart.org/downloadable/heart/10590179711482003HDSStatsBookREV7-03.pdf.%20Accessed%20April%2015http://www.americanheart.org/downloadable/heart/10590179711482003HDSStatsBookREV7-03.pdf.%20Accessed%20April%2015http://www.americanheart.org/downloadable/heart/10590179711482003HDSStatsBookREV7-03.pdf.%20Accessed%20April%2015http://www.cancer.org/downloads/STT/CAFF2003PWSecured.pdf7/29/2019 6--PCE Nashville Osteoporosis Knudtson
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Which of the following is a common cause
of secondary osteoporosis?
1 2 3 4
10%4%
81%
5%Use your keypad to vote now!
1. Proton pump inhibitors(PPIs)
2. Treatment for ulcerativecolitis
3. Glucocorticoids4. TNF- receptor blockers
and IL-1 receptorantagonists for the treatmentof rheumatoid arthritis
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Factors Contributing to Secondary
Osteoporosis
LifestyleLow calcium intake, high caffeine intake, excessive alcohol
consumption, smoking, immobilization
Endocrine disorders Hyperthyroid, hyperparathyroid, adrenal insufficiency,Cushings syndrome, diabetes
Hypogonadal states Androgen insensitivity, anorexia/bulimia, athleticamenorrhea, hyperprolactinemia, panhypopituitarism
GI disorders Gastrectomy, GI bypass, celiac disease, malabsorption,
inflammatory bowel disease
Hematologic diseases Hemophilia, rheumatic and autoimmune conditions, sickle
cell, thalassemia, lymphoma, myeloma
Miscellaneous conditions Alcoholism, amyloidosis, CHF, epilepsy, ESRD, MS, prior
fracture as adult, epilepsy, depression
Medications Glucocorticoids, anticoagulants, anticonvulsants, aromatase
inhibitors, cyclosporine, lithium, cancer chemotherapy,
depomedroxyprogesterone
CHF = congestive heart failure; ESRD = end-stage renal disease; GI = gastrointestinal; MS = multiple sclerosis.AACE Osteoporosis Task Force. Endocr Prac. 2001;7:293-312; National Osteoporosis Foundation. Clinicians Guide to Prevention
and Treatment of Osteoporosis. Available at: www.nof.org/professionals/Clinicians_Guide.htm. Accessed April 30, 2008.
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Glucocorticoid Use and Fracture Risk
1.171.36
1.64
1.1 1.04 1.190.99
1.77
2.27
1.55
2.59
5.18
0
1
2
3
4
5
6
Low Dose Medium Dose High Dose
All nonvertebral
Forearm
Hip
Vertebral
n = 2192 531 236 191 2486 526 494 440 1665 273 328 400
RelativeRisk
ofFracture
ComparedW
ithControl
Van Staa TP, et al. J Bone Miner Res. 2000;15:993-1000.
(7.5 mg/d)
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Pathophysiology of Osteoporosis
Osteoid Mineralization
Bone
RestingActivationResorption
BoneOsteoclasts
Bone Remodeling
ReversalFormation
BoneBone
Osteoblasts
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Pathophysiology of Osteoporosis
Trauma
Low bonemass/
impairedbone
quality
Inadequatepeak bone
mass
Earlymenopausal
bone loss
Decreasein bone
mass/bone
quality
Calcium/vitamin Ddeficiency
Otherfactors
Fractures
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15
20 years
50 years
80 years
Changes in Trabecular Architecture
Decrease in trabecular thickness, more
pronounced for non load-bearing
horizontal trabeculae
Decrease in connections between
horizontal trabeculae Decrease in trabecular strength and
increased susceptibility to fracture
Mosekilde L. Calcified Tissue Inter. 1993;53(Suppl 1):S121-S126.
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Fracture Patterns By Age
Riggs B. N Engl J Med1986;314:1676.
Age (years)
AnnualFrac
ture
Incidence/10
0,0
00
0
1000
2000
3000
4000
35 45 55 65 75 85+
Vertebrae
Hip
Colles'
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Behavioral/Lifestyle Measures
to Prevent Osteoporosis
Adequate intake of dietary calcium, vitamin D,
and protein throughout life
Regular physical activity; load-bearing exercise
Minimal alcohol intake Stop smoking
Take measures to prevent falls
Use of hip protectors by patients prone to falling
Ebeling PR. N Engl J Med. 2008;358:1474-1482; National Osteoporosis Foundation. Clinicians Guide to Prevention and
Treatment of Osteoporosis. Available at: www.nof.org/professionals/Clinicians_Guide.htm. Accessed April 22, 2008.
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Which of the following is true with regard
to vitamin D and bone health?
1 2 3 4
88%
3%2%7%
Use your keypad to vote now!
1. Oral vitamin D reduces the riskof hip fractures by 26%
2. Oral vitamin D has no benefitin preventing falls in osteoporoticpatients
3. Only vitamin D absorbed throughthe skin is effective in preventingosteoporosis
4. Vitamin D supplementationhas no effect on nonvertebralfractures
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Vitamin D Protects Against
Osteoporosis
Oral vitamin D supplementation 700-800 IU/d
reduces risk of
Hip fracture by 26%
Nonvertebral fracture by 23% Falls by 22% ( muscle strength, better balance)
Optimal fracture prevention achieved with
25-hydroxyvitamin D mean serum level 100 nmol/L
Best sourcesMilk, salmon, canned tuna, sardines,
eggs, liver, sunlight
Bischoff-Ferrari HA , et al. JAMA. 2005;293:2257-2264.
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National Osteoporosis Foundation Clinical
Recommendations 2008
National Osteoporosis Foundation Clinical Recommendations
February 2008 are based on the newly developed WHO 10-
year fracture risk model (FRAX) adapted to different
population groups
The FRAX algorithm Estimates the likelihood of a person breaking a bone due
to osteoporosis during the next 10 years
Provides a useful way to ensure that people at risk of
fracture receive treatment
Takes into account 9 clinical risk factors in addition to bonemineral density
Available online at http://www.shef.ac.uk/FRAX
National Osteoporosis Foundation. Clinicians Guide to Prevention and Treatment of Osteoporosis.
Available at: www.nof.org/professionals/Clinicians_Guide.htm. Accessed April 22, 2008.
http://www.shef.ac.uk/FRAXhttp://www.nof.org/professionals/Clinicians_Guide.htmhttp://www.nof.org/professionals/Clinicians_Guide.htmhttp://www.shef.ac.uk/FRAX7/29/2019 6--PCE Nashville Osteoporosis Knudtson
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Risk Factors Used to Calculate
WHO 10-Year Fracture Risk
Femoral neck T-score
Age
Sex
Secondary osteoporosis Previous low-trauma
fracture
Low BMI
Steroid exposure
Family history of hip
fracture Current cigarette smoking
Alcohol intake >2 units/day*
*1 unit = 8 g alcohol ~ pt beer ~ 1 glass wine.
BMI = body mass index.Kanis JA, et al. Bone. 2002;30:251-258; Kanis JA, et al. Osteoporos Int. 2005;16:581-589; National Osteoporosis
Foundation. Clinicians Guide to Prevention and Treatment of Osteoporosis. Available at:
www.nof.org/professionals/Clinicians_Guide.htm. Accessed April 22, 2008.
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10-Year Fracture Risk: Age and BMD
For a given BMD, risk increases with age
Kanis JA, et al. Osteoporos Int. 2001;12:989-995.
HipFractureR
isk
(%/10Years
)
-3
60
70
80
Age
0
5
10
15
20
50
BMD T-Score
-2.5 -2 -1.5 -1 -0.5 0 0.5 1
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Clinical Evaluation of
Risk Factors for Osteoporosis
Medical history
Risk factors
Signs and symptoms
Physical examination
Height assessment (with stadiometer)
BMD testing
Laboratory tests
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Central Dual Energy X-Ray Absorptiometry
(DEXA): Test of Choice for Diagnosing Osteoporosis
Benefits
Highly accurate and precise
Profiles all skeletal areas
Requires little time
Emits low dose of radiation
Limitations
AP spine measurement affected by vascularcalcifications and spinal osteoarthritis
Trabecular and cortical bone measured together
AP = anteroposterior.
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Who Should Have a Bone Density
Test?
YesAll men with a fragility fracture
YesMen aged 70 yearsYesYesAnyone considering therapy for osteoporosis
YesYesAnyone receiving treatment for osteoporosis
YesYesYesDiseases/conditions/drugs causing osteoporosis
YesYesYesAll women with a fragility fracture
YesYesYesAll women 65 with risk factorYesYesYesYesWomen 60 64 with risk factor
YesYesYesYesWomen 65 years of age
ISCDAACENOFUSPSTFPatient Category
USPTF. Ann Intern Med 2002 137:526-8; Leib, E. S., et al. J Clin Densitom 1998 7:1-6; Endocr Pract 7:293-312
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T-Score
Number of SDs above or below sex-matched mean reference
value of young adults
T-score = (BMD patient BMD young normal reference)
SD young normal reference
Comparison to peak bone mass Peak adult bone mass follows a normal distribution
(bell curve). Low bone mass on initial DEXA does not
necessarily mean bone loss. Person may be at low end
of bell curve
Used for adult diagnosis Each SD decrease = doubling of fracture risk
NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Treatment. JAMA.
2000;285:785-795.
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Which of the following applies to the
WHO/NOF criteria for diagnosis of osteoporosis?
1 2 3 4
6%
77%
2%
15%
Use your keypad to vote now!
1. T-score > -1.02. T-score between
-1 and -2.3
3. T-score is not a
WHO/NOF criterionfor diagnosingosteoporosis
4. T-score -2.5
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*Measured in T-scores. T-score indicates the number of standard deviations below or above the
average peak bone mass in young adults.
WHO/NOF Criteria for Diagnosis
of Bone Status
Ebeling PR. N Engl J Med. 2008;358:1474-1482; National Osteoporosis Foundation. Clinicians Guide to Prevention
and Treatment of Osteoporosis. Available at: www.nof.org/professionals/Clinicians_Guide.htm.
Accessed April 22, 2008.
Diagnostic Criteria* Classification
T-score > -1.0
T-score -1.0 to -2.5
T-score -2.5 T-score -2.5 +
fracture(s)
Normal
Osteopenia
Osteoporosis Severe or established
osteoporosis
Fracture Rates Correlate With T Scores:
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FractureRate/100
Person-Years
Siris ES, et al. JAMA. 2001;286:2815-2822.
Fracture Rates Correlate With T-Scores:National Osteoporosis Risk Assessment(NORA) Study
Data From More Than 163,000 Women
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National Osteoporosis Foundation:
Treatment Recommendations
Postmenopausal women and men aged >50 years
with either of the following
Low bone mass (T-score -1 to -2.5, osteopenia)
at femoral neck, total hip, or spine and 10-yearhip fracture risk >3%
10-year all major osteoporosis-related
fracture risk >20% based on US-adapted
WHO FRAX model
National Osteoporosis Foundation. Clinicians Guide to Prevention and Treatment of Osteoporosis. Available at:
www.nof.org/professionals/Clinicians_Guide.htm. Accessed April 22, 2008.
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ACR Recommendations:
Bisphosphonate Use in GIO
Prevention of bone loss in patients initiating
long-term (3 months) glucocorticoid therapy
Patients with low BMD (T-score 1) receiving
long-term glucocorticoid therapy Patients receiving long-term glucocorticoid therapy
who cannot tolerate HRT or had fractures during HRT
ACR = American College of Rheumatology; GIO = glucocorticoid-induced osteoporosis;
HRT = hormone replacement therapy.American College of Rheumatology Ad Hoc Committee on Glucocorticoid-Induced Osteoporosis.
Arthritis Rheum. 2001;44:1496-1503.
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Randomized, controlled trials with the bisphosphonate
alendronate demonstrated reductions in risk of hip fracture
at month 18 by:
1 2 3 4
1%
41%
46%
12%
Use your keypad to vote now!
1. 60%
Effects of Alendronate on Cumulative Incidence
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Effects of Alendronate on Cumulative Incidenceof Symptomatic Vertebral and Hip Fractures(FIT 1 and 2 Trials)
ALN = alendronate; FIT = Fracture Intervention Trial; PBO = placebo.Black DM, et al. J Clin Endocrinol Metab. 2000;85:4118-4124.
*P
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Risedronate Reduces Risk of Vertebral
Fracture in High-Risk Subjects in 1 Year
PlaceboRisedronate 5 mg
0
2
4
6
8
10
12
14
Overall 2 PrevalentFractures
68%(51%, 80%)
P
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Zoledronic Acid
HORIZON study
3-year study to decrease fracture risk in
postmenopausal women with osteoporosis
Pivotal Fracture Trial (PFT)3-year study to decrease fracture risk in
postmenopausal women with osteoporosis
Efficacy 70% vertebral fractures, 40% hip
fractures, 25% nonvertebral fractures
Black DM, et al. N Engl J Med. 2007;356:1809-1822.
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*P= .0024, relative risk reduction vs placebo (95% CI)
CI = confidence interval.Adapted from Black DM, et al. N Engl J Med. 2007;356:1809-1822.
Zoledronic Acid Reduced Cumulative
3-Year Risk of Hip Fractures (Strata I + II)
1
2
3
0
Placebo (n = 3861)
Zoledronic acid (n = 3875)
Time to First Hip Fracture (months)
0 3 6 9 12 15 18 21 24 27 30 33 36
41%*
CumulativeIn
cidence(%)
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Womens Health Initiative:
Effects of HRT in Women Aged 50-79
6700 Women With 5.2 Years of Follow-up
Di
fference(%)vs
Placebo
Advantages
Disadvantages
Manson JE, at al. N Engl J Med. 2003;349:523-534.
38
Cardiovascular
diseases
S
troke
Thromb.v
enous
Breastc
ancer
Intestinalcancer
Vertebralfracture
Hipfract
ure
MORE I i BMD Wi h
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Mean%Change
FromBaseline
MORE: Increase in BMD With
Long-term Raloxifene Treatment
Ettinger B, et al. JAMA. 1999;282:637-645.
3
2
1
0
-1
-2
BMD Femoral Neck
0 12 36
Months24
3
2
1
0
-1
-2
BMD Lumbar Spine
0 12 36
Months24
Placebo (n = 1512) Raloxifene 60 mg (n = 1490)
39
MORE = Multiple Outcomes of Raloxifene Evaluation.
P
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MORE: Reduction in New Vertebral Fractures
Among Women Who Completed the Study
N = 6828
RR = relative risk.Ettinger B, et al. JAMA. 1999;282:637-645.
Placebo
Raloxifene hydrochloride 60 mg/d
Raloxifene hydrochloride 120 mg/d
RR 0.5 (95% CI, 0.4-0.6)25
20
15
10
5
0%
ofPatientsWithIncident
VertebralFracture
RR 0.5 (95% CI, 0.6-0.9)
40
C l it i N l S
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Calcitonin Nasal Spray:
PROOF Study (Analysis at 5 Years)
Reduction in % of New VertebralFractures vs Placebo
N = 511
100 IU18%
(NS)200 IU33%
(P = .03)
400 IU
23%(NS)
100
0
90
80
70
60
50
40
30
20
10
No. of Hip Fractures PerGroup
NS = nonsignificant
2(NS)
4(NS)
7(NS)8
0
5
10
15
20
25
Placebo 100 IU 200 IU 400 IU
IU = international units; PROOF = Prevent Recurrence of Osteoporotic Fractures.Chesnut CH III, et al.Am J Med. 2000;109:267-276.
41
Eff t f P th id H BMD
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Effect of Parathyroid Hormone on BMD
Over 18 Months
1637 Postmenopausal Women With Prior Vertebral Fracture
PTH = parathyroid hormone.Neer RM, et al. N Engl J Med. 2001;344:1434-1441.
ChangeFromBa
seline
inBMD(%)
-2
0
2
4
6
8
10
14
12
Placebo PTH 20 g
Lumbar spine
Femoral neck
42
S FDA A d
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Summary: FDA-Approved
Osteoporosis Therapies
PMO PMO GIO GIO Men
Generic
Name
Brand
Name Prevention Treatment Prevention Treatment
Weekly
Dosing
Estrogens Various X
Alendronate Fosamax X X X X X
Risedronate Actonel X X X X X X
Ibandronate Boniva X X
Zoledronic
acid
Zometa X
Raloxifene Evista X X
Calcitonin Miacalcin X
Teriparatide Forteo X X
PMO = postmenopausal.National Osteoporosis Foundation. Clinicians Guide to Prevention and Treatment of Osteoporosis. Available at:
www.nof.org/professionals/Clinicians_Guide.htm. Accessed April 22, 2008.
43
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What percent of patients will stop their
medications within 6-12 months of initiation?
1 2 3 4
1%
38%
58%
3%
Use your keypad to vote now!
1.
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Adherence and Persistence
20%-30% of patients taking oral osteoporosis
medications suspend their medications within
6-12 months of initiation due to
Side effectsLack of knowledge
Reluctance to take regular medications
Papaioannou A. Drugs Aging. 2007;24:37-55.
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FLEX Study: Persistence
FLEX
Compared effects of discontinuing alendronate
treatment after 5 years vs continuing treatment
for 10 yearsWomen who discontinued treatment after 5 years
experienced a moderate decline in BMD,
increase in biochemical markers, no higher
fracture risk except clinical vertebral fractures
FLEX = Fracture Intervention Trial Long-Term Extension.Black DM, et al. JAMA. 2006;296:2927-2938.
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Osteonecrosis of Jaw
Osteonecrosis of jaw
Potential complication of bisphosphonate
Rare
60% occur after dental extractionMost cases occur in cancer patients
Most cases associated with high-dose IV
bisphosphonate treatment in metastatic
cancer patients
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Case Study
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Postmenopausal Asian Woman
With Possible Osteoporosis
At annual physical examination for
57-year-old Asian woman
Height: 5 ft 2 in; weight: 101 lb; BMI: 18.5 kg/m2
Postmenopausal for 5 yearsNo HRT
Medications: mesalamine for ulcerative colitis
No known drug allergies
Family history: mother had a hip fracture
at age 76 years
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Postmenopausal Asian Woman
With Possible Osteoporosis
Medical history: GERD, used PPIs daily
for 5 years; ulcerative colitis, uses mesalamine;
has used systemic steroids orally 3 or 4 times
for limited periods of time
Diet: balanced, except does not include dairy
(lactose intolerant)
Exercise: walks 20 minutes a day
Smokes pack a day
GERD = gastroesophageal reflux disease.
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Should this patient have a DEXA scan?
Use your keypad to vote now! 1 2 3
0%
98%
2%
1. No, she is
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Risk Factors for Osteoporotic Fracture
Aged >70 years
Menopause aged
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DEXA scan indicates T score 1.9
lumbar spine; T-score -.9 femoral neck.
Does this patient have osteoporosis?
1 2 3
34%
7%
59%
Use your keypad to vote now!
1.Yes
2.No
3.Not enoughinformation
WHO/NOF Criteria for Classification
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WHO/NOF Criteria for Classification
of Bone Status
National Osteoporosis Foundation. Clinicians Guide to Prevention and Treatment of Osteoporosis.
Available at: www.nof.org/professionals/Clinicians_Guide.htm. Accessed April 22, 2008.
*T-score = number of standard deviations below or above the average peak bone mass inyoung adults.
Diagnostic criteria*
T-score > -1
T-score between -1 and -2.5
T-score -2.5
T-score -2.5 + fragility
fracture(s)
Classification
Normal
Osteopenia
Osteoporosis
Severe or established
osteoporosis
Wh t t t t h ld b
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What treatment should be
recommended for this patient?
1 2 3
0%
93%
7%
Use your keypad to vote now!
1. Ca+ 1200-1500 mg/d
2. Ca+ 1200-1500 mg/d +
800 IU vitamin D
3. All of the above plus
smoking cessationand consider adding
a bisphosphonate
National Institutes of Health
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National Institutes of Health
Recommendations for Calcium Intake
NIH. Dietary Supplement Fact Sheet: Calcium. 2005. Available at:http://ods.od.nih.gov/factsheets/calcium.asp.
Accessed April 17, 2008.
Age(years)
Calcium Intake(mg/d)
1-3
4-89-18
19-50
>51
>65
500
8001300
1000
1200
1500
56
Nonpharmacologic Approaches
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Nonpharmacologic Approaches
to Postmenopausal Osteoporosis
Adequate intake of dietary calcium, vitamin D,
and protein
Regular physical activity
Minimize alcohol intake Stop smoking
Minimize risk of falls
Recommend hip protectors for those prone to falls
Antiresorptive Therapy With
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Antiresorptive Therapy With
Alendronate in Osteoporosis
Clinical trials indicate increased bone mass over 3 to 4 years
Reduces incidence of fractures in spine, hip, and wrist
by 47%-51%
Prevention or treatment PMO
Approved treatment menApproved treatment GIO
Fracture efficacy (FIT and FOSIT trials)
Year 1 nonvertebral fracture reduction: 47%
Year 3 vertebral fracture reduction: 47% Year 3 hip fracture reduction: 51%
FOSIT = Fossa Intervention Trial.
Black DM, et al. J Clin Endocrinol Metab. 2000;85:4118-4124; Pols HA, et al. Osteoporos Int. 1999;9:461-468.
Antiresorptive Therapy With
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Antiresorptive Therapy With
Risedronate in Osteoporosis
Increased bone mass spine, hip; reduced risk fractures
40%-65% in a 3- to 5-year period
Prevention or treatment of PMO
Approved prevention or treatment of GIO
Approved in treatment for men Dose: 5 mg/d or 35 mg every week or 75 mg 2 consecutive
days a month
Fracture efficacy (VERT and HIP trials)
Year 3 vertebral fracture reduction: 41%-49%
Year 1 vertebral fracture reduction: 65% Year 3 hip fracture reduction: 40%-60%
HIP = Hip Intervention Program; VERT = Vertebral Efficacy With Risedronate Therapy.
Deal CL. Cleve Clin J Med. 2002;69:964,968-970,973-976; Harris ST, et al. JAMA. 1999;282:1344-1352;
Reginster J, et al. Osteoporos Int. 2000;11:83-91.
Antiresorptive Therapy With
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Antiresorptive Therapy With
Ibandronate in Osteoporosis
BONE study
Efficacy: ~50% reduction in vertebral fractures
by year 3
Bisphosphonate for PMO Dosing
150 mg once a month, MOBILE study
3 mg IV once every 3 months, DIVA study
BONE = Bone, Osteogenesis, Nonsteroidal Anti-Inflammatory Drug ; DIVA = Dosing IntraVenous
Administration; MOBILE = Monthly Oral iBandronate In LadiEs.Miller PJ. J Bone Miner Res. 2005;1315.
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Q & A
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PCE Takeaways
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PCE Takeaways
Osteoporosis is a preventable diseasenot a
condition of aging
Technology for accurate bone density measurement
is available
Women and men at risk can be identified
Safe and effective pharmacologic treatments
are available
Patient education is critical to encouragepersistence with medication in the management
of osteoporosis
How confident are you now in
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y
discussing the various modifiable risk
factors for osteoporosis with your patients?
1 2 3
89%
1%
10%
Use your keypad to vote now!
1. Very confident2. Somewhat confident
3. Not at all confident
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Radisson Hotel at Opryland
Nashville, Tennessee
May 31, 2008
SymposiaSeries 22008