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Secondary Osteoporosis

Secondary Osteoporosis. Tuan Van Nguyen and Nguyen Dinh Nguyen Bone and Mineral Research Program Garvan Institute of Medical Reseach Sydney, Australia. Overview. Definitions Causes Corticosteroid Induced Osteoporosis: Machanism Magnitude of the problem Patient managements.

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Secondary Osteoporosis

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  1. Secondary Osteoporosis Tuan Van Nguyen and Nguyen Dinh Nguyen Bone and Mineral Research Program Garvan Institute of Medical Reseach Sydney, Australia

  2. Overview • Definitions • Causes • Corticosteroid Induced Osteoporosis: • Machanism • Magnitude of the problem • Patient managements

  3. Secondary osteoporosis • Results from chronic conditions that contribute significantly to accelerated bone loss. • Treatment of secondary osteoporosis is more complex than that of primary osteoporosis. • Prognosis depends on the underlying disease.

  4. Forms of secondary osteoporosis Endocrine or Metabolic causes Collagen/genetics disorders Secondary Osteoporosis Nutritional disorders Medications

  5. Endocrine or metabolic causes • Hypogonadism • Hyperparathyroidism • Cushing-syndrome • Acidosis • Diabetes (type I) • Androgen insensitivity • Hemochromatosis • Gaucher’s disease

  6. Medications • Corticosteroids • Thyroid • GnRH antagonists • Anti-neoplastic agents • Cyclosporin, methotrexate • Phenobarbital • Phenothiazines, Phenytoin

  7. Collagen/genetic disorders • Ehler-Danlos syndrome • Glycogen storage diseases • Homocysturina • Hypophosphatasis • Marfan syndrome • Osteogenesis Imperfecta

  8. Nutritional • Alcoholism • Calcium deficiency • Chronic liver disease • Gastric operations • Malabsorption syndromes • Vitamin D deficiency

  9. Corticosteroid-induced Osteoporosis (CIOP)

  10. Corticosteroid-induced osteoporosis • CS used in many underlying diseases • Benefits effects on the underlying disease vs. detrimental effects on bone. • High percentage of osteoporosis and fracture • Dose-dependent effect  difficult to define

  11. CIPO-Epidemiology • Prevalence of use of oral corticosteroids: • Population: 0.5% • Among women aged ≥ 55: 1.7% • Main indications: • Rheumatoid arthritis • Polymyalgia • COPD • 14% of patients taking any treatment of osteoporosis L J Walsh et al, BMJ 1996;313:344-6

  12. CIPO: Burden • Most common of drug-related osteoporosis in men and women • Occur at any age, in both sexes, across races • Up to 50% patient of chronic steroid therapy sustain osteoporotic fractures and/or develop osteonecrosis. • Significant bone loss can occur in as little as 3 months. • 50% chance of developing osteoporosis if on steroid for 6 mo.

  13. Corticosteroids-effect on bone Osteoblast Inhibition enhancement Corticosteroids increase Calcium loss Bone resorption Inhibition Inhibition Gonadal hormone Calcium absorption

  14. Who is at high-risk of CIPO? - Prior fracture - Premature menaupause at < 45y - Age > 65 y - Planned or current use CS > 6 mo- Low weight - Other causes of Osteoporosis Eastell R et al, J Intern Med 1998;244:271-92 Tobias JH, Rheumatology 1999;38:198-201

  15. CIPO and fracture (Source: van Staa TP et al., 2000)

  16. Patient assessment After 1 y In 3-5 y BMD measurement High-risk of CIOP? BMD-Tscores? or with CS >15mg/d or with CS 7.5mg/d x 6mo >1 0 to -1.5 < -1.5 • Thoracic and lumbar spine X-ray • FBC, ESR & S-Electrophoresis if necessary • Serum Ca, P, AP, Albumin • Thyroid function • Men: testosterone an women: FSH, LH • Lifestyle • modification advice: • Smoking • Alcohol • Physical activity • Prevent fall Eastell R et al, J Intern Med 1998;244:271-92

  17. CIOP-Management • Primary prevention, PP (treatment started at the time initiation up to 3 mo of CS therapy) • Secondary prevention, SP (treatment started >1y after the time initiation of CS therapy)

  18. Pharmacological therapy

  19. Key messages • Secondary osteoporosis is common • Patients on CS therapy should be consider the need for therapy to prevent or treat CIOP • Data on CIOP fracture reduction with treatment remain sparse

  20. Lời Cảm tạ • Chúng tôi xin chân thành cám ơn Công ty Dược phẩm Bridge Healthcare, Australia là nhà tài trợ cho hội thảo.

  21. Thank you!

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