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Osteoporosis talk july 2012 4 slideshare

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Talk for primary care illustrating current hot topics in osteoporosis management

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Page 1: Osteoporosis talk july 2012 4 slideshare
Page 2: Osteoporosis talk july 2012 4 slideshare

70 year old Woman

I only smoke when I drinkI only smoke when I drinkI only smoke when I drinkI only smoke when I drinkI like a glass of I like a glass of wine with my wine with my dinner Doctordinner Doctor

I like a glass of I like a glass of wine with my wine with my dinner Doctordinner Doctor

Page 3: Osteoporosis talk july 2012 4 slideshare
Page 4: Osteoporosis talk july 2012 4 slideshare
Page 5: Osteoporosis talk july 2012 4 slideshare

But Calcium But Calcium supplements cause supplements cause

Heart attacks!Heart attacks!

But Calcium But Calcium supplements cause supplements cause

Heart attacks!Heart attacks!

Page 6: Osteoporosis talk july 2012 4 slideshare

•Suggests 20-30% increased risk of myocardial infarction in patients taking Calcium supplements

•No significant increase in CVA’s

Page 7: Osteoporosis talk july 2012 4 slideshare

•Meta-analysis

•Excludes patients taking Ca and Vit D supplements

•At odds with results of WHI study

•Could there be something there?

Page 8: Osteoporosis talk july 2012 4 slideshare

Possible reduction of risk of MI with higher dietary Ca

Small increased risk of MI with supplements only

Page 9: Osteoporosis talk july 2012 4 slideshare
Page 10: Osteoporosis talk july 2012 4 slideshare
Page 11: Osteoporosis talk july 2012 4 slideshare

My nephew is a My nephew is a dentist.....dentist.....

My nephew is a My nephew is a dentist.....dentist.....

Page 12: Osteoporosis talk july 2012 4 slideshare

Osteonecrosis of the Osteonecrosis of the jawjaw

Page 13: Osteoporosis talk july 2012 4 slideshare

Rare in bisphosphonate doses used in OP1:100,000

More common with IV bisphosphonates (but still rare)

Rare in bisphosphonate doses used in OP1:100,000

More common with IV bisphosphonates (but still rare)

Page 14: Osteoporosis talk july 2012 4 slideshare

•Discuss potential risks and symptoms with patient

•Encourage good dental hygiene

•Pretreatment dental visit not necessary

Page 15: Osteoporosis talk july 2012 4 slideshare

•< 3yrs treatment with BP• Dental extractions and implants as normal

•> 3 yrs treatment• Stop BP for 3 months before treatment

• Restart when bone healed

Page 16: Osteoporosis talk july 2012 4 slideshare

Has the treatment Has the treatment worked Doctor?worked Doctor?

Has the treatment Has the treatment worked Doctor?worked Doctor?

Page 17: Osteoporosis talk july 2012 4 slideshare

Least Significant Change

Page 18: Osteoporosis talk july 2012 4 slideshare

3.5% Lumbar Spine2.2% Hip

Page 19: Osteoporosis talk july 2012 4 slideshare

What do the changes mean?What do the changes mean?Fr

actu

re ri

sk %

Adapted from Chapurlat RD et al Osteoporosis Int 2005:16. pp 842848

Page 20: Osteoporosis talk july 2012 4 slideshare

How much change is significant??

Ideal is increase in BMD

Patients with static BMD still have reduced risk of fracture

Only worry about Decrease

Page 21: Osteoporosis talk july 2012 4 slideshare
Page 22: Osteoporosis talk july 2012 4 slideshare

Alternatives to bisphosphonates

(Protelos)Strontium

Yes Yes/No*

(Forsteo)Teriparetide

Yes No

(Evista)Raloxifene

Yes No

Denosumab(Prolia)

Yes Yes

Vertebral Hip

* >75yrs osteoporosis femoral neck

Page 23: Osteoporosis talk july 2012 4 slideshare

Do we need to treat everybody?

Page 24: Osteoporosis talk july 2012 4 slideshare

I’m 51 and healthy

T ScoresLS- -2.6Hip -2.6

Page 25: Osteoporosis talk july 2012 4 slideshare
Page 26: Osteoporosis talk july 2012 4 slideshare

Google ‘FRAX’

Page 27: Osteoporosis talk july 2012 4 slideshare

How long do I need to be on treatment?

Page 28: Osteoporosis talk july 2012 4 slideshare

Do Bisphosphonates work in long term?

Page 29: Osteoporosis talk july 2012 4 slideshare
Page 30: Osteoporosis talk july 2012 4 slideshare

After 5 years little to support continued

benefit on fracture risk

Possibility of drug holiday in some (low risk

pts)

Change to alternative agent

Page 31: Osteoporosis talk july 2012 4 slideshare
Page 32: Osteoporosis talk july 2012 4 slideshare

Drug holiday?

•Patients with lower risk

•May stop for up to 2 years

•Possible small drop in BMD

•No increased risk of fracture

•Avoid in high risk patients

Page 33: Osteoporosis talk july 2012 4 slideshare

I’m 51 and healthy

T ScoresLS- -2.6Hip -2.6

Page 34: Osteoporosis talk july 2012 4 slideshare

Summary

•Encourage Dietary Ca

•For most Single dose Ca supplement plenty

•Not essential to treat everybody!

•Use FRAX to help aid decision

•Monitor for Bone loss (2 yrs)

•Consider revise Bisphosphonates at 5-7yrs

•Consider Drug holiday