1 / 23

Osteoporosis: SCREENING AND TREATMENT

Presented by: Praharsha R. Menon, MD Emory Family Medicine 10/21/2010. Osteoporosis: SCREENING AND TREATMENT. DEFINITION:. Thick outer shell and a strong inner mesh filled with collagen (protein), calcium salts and other minerals .

herve
Télécharger la présentation

Osteoporosis: SCREENING AND TREATMENT

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Presented by: Praharsha R. Menon, MD Emory Family Medicine 10/21/2010 Osteoporosis: SCREENING AND TREATMENT

  2. DEFINITION: • Thick outer shell and a strong inner mesh filled with collagen (protein), calcium salts and other minerals A progressive systematic skeletal disease characterized by low bone mass and micro-architectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture

  3. A FEW POINTERS… • Prevalence: 15 million in women and 3 million in men

  4. RISK FACTORS For osteoporosis For fragility fractures • Female gender • Increased age • Hypogonadism • White race • Low body mass index • Family history • Tobacco use • History of fracture • Chronic glucocorticoid or anticoagulant use • Endocrinopathies • High bone turnover and microarchitectural changes • History of falls • Poor physical condition • Dementia • Impaired vision • Environmental hazards • Current use of benzodiazepines or anticonvulsants www.aafp.org/afp

  5. SCREENING GUIDELINES • USPSTF(United States Preventive Services Task Force) • NOF (National Osteoporosis Foundation) • ISCD (International Society of Clinical Densitometry

  6. USPSTF: SCREENING • Routine screening: • F >/= 65 yo • F>/= 60 yo if at increased risk for osteoporotic fractures B • No recommendation for or against routine screening in postmenopausal F <60 yo or in F < 60-64 yo who are not at increased risk for osteoporotic fractures C • All men >/= 70 yo (NOF, ISCD) C

  7. DEXA SCAN • Dual-Energy X-Ray Absorptiometry • Uses: • diagnosis of low bonedensity • prediction of fracture • WHO definitions of osteoporosis and osteopenia • Monitoring BMD in patients being treated for osteoporosis • Low radiation, noninvasive, fast

  8. Which Skeletal Site(s) Should BeMeasured? Every Patient: • Spine : L1- L4 • Hip – Total Hip – Femoral Neck Some Patients: • • Forearm (33% radius, • 1/3 radius) • – If hip or spine cannot be • measured • – Hyperparathyroidism • – Very obese NOF: uses femoral neck measurement only ISCD: uses both hip and spine measurements The lowest score across sites determines the diagnosis

  9. WHO classification with a T-score cannot be applied to premenopausal women, men under age 50, or children (Z score used) • Best predictor of osteoporotic fracture: BMD

  10. FRAX: • Measures probability of fracture in the next 10 years • WHO task force led by John Kanis used data from nine epidemiological studies from the US, Europe, Australia, and Asia to determine risk factors for osteoporotic fracture • Independent of BMD • 11 risk factors can be used +/_ BMD by DEXA

  11. RISK FACTORS BY FRAX • Age (between 40 and 90 years) • Sex (female and male) • Weight in kg • Height in cm • Previous fracture while an adult • Parental fracture (mother or father) • Smoking (current) • Alcohol (3 or more drinks daily) • Systemic steroids (5 or more mg prednisone or more for 3 or more months, current or past history) • Rheumatoid arthritis • Secondary osteoporosis

  12. EVALUATION FOR SECONDARY OSTEOPOROSIS • CMP including ALP, liver fxn, kidney fxn • Calcium • CBC • TSH • Total testosterone (men) • 25-hydroxyvitamin D (men) Additional tests (based on level of severity of osteoporosis or clinical suspicion of underlying disease): • Estradiol (pre- or perimenopausal women) • Intact PTH • Serum protein electrophoresis • 25-hydroxyvitamin D (women) www.aafp.org

  13. US TREATMENT THRESHOLD BY FRAX • 10 - year probability of hip fracture > 3 % or • 10 - year probability of major osteoporotic fracture > 20%

  14. TREATMENT • Antiresorptives: Alendronate, Risedronate, Ibandronate, Zoledronic acid, Raloxifene, Calcitonin, Estrogen • Anabolic (bone forming): Teriparatide

  15. TREATMENT INDICATIONS: NOF • Hip or vertebral fracture • T-score -2.5 or less at femoral neck (or total hip) or spine • T-score between -1 and -2.5 and a 3% (or greater) 10-year probability of hip fracture or a 20% (or greater) 10-year probability of major osteoporotic fracture, using FRAX

  16. ALSO… • T - score between -1 and -2.5 and : a disease or medication associated with osteoporosis prior fracture (other than hip or vertebral) and T - score between -1 and -2.5

  17. MEDICATIONS TREATMENT • Alendronate • Risedronate • Ibandronate PO and IV • Zoledronic acid • Raloxifene • Teriparatide • Calcitonin PREVENTION • Alendronate • Risedronate • IbandronatePO • Raloxifene • Estrogen

  18. NON-PHARMACOLOGIC TREATMENT • Fall prevention • Vitamin D: • 800 to 1,000 IU daily for persons 50 years and older (NOF) • Documented vitamin D deficiency: oral vitamin D2 50,000 IU weekly for 8 weeks followed by a maintenance dosage of 50,000 IU every two to four weeks or oral cholecalciferol (vitamin D3) 1,000 IU once daily • Calcium: at least 1200 mg daily

  19. PREVENTION

  20. PREVENTION • Adequate amounts of calcium • Adequate amounts of vitamin D • Regular exercise • Lifestyle modification • Screening in appropriate age groups

  21. HEALTHY BONES FOR HEALTHY SOCIETY…

  22. REFERENCES • Diagnosis and Treatment of Osteoporosis: Sweet MG, et al. American Family Physician Feb., 2009 • Osteoporosis: Part I. Evaluation and AssessmentL South-Paul JE, et al. American Family PhysicianMar. 1, 2001 • www.uspreventiveservicestaskforce.org • Mayoclinic.com

More Related