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Osteoporosis: treatment options

Osteoporosis: treatment options. Dr Tuan V. Nguyen Garvan Institute of Medical Research. Purposes of treatment. Reduce fracture risk For individuals with previous fracture: reduce subsequent risk of fracture Reduce or prevent bone loss. Mechanism of actions. Bone remodeling

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Osteoporosis: treatment options

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  1. Osteoporosis: treatment options Dr Tuan V. Nguyen Garvan Institute of Medical Research

  2. Purposes of treatment • Reduce fracture risk • For individuals with previous fracture: reduce subsequent risk of fracture • Reduce or prevent bone loss

  3. Mechanism of actions • Bone remodeling • Bone resorption • Bone formation • Mechanisms • Reduce bone resorption • Increase bone formation

  4. Some common drugs

  5. Some common drugs

  6. Evidence-based medicine

  7. Randomized clinical trials Fx No Fx Treatment Sample Randomise Blinding Placebo Fx No Fx Subjects Blocking

  8. Relative risk: concept

  9. Problem of RR

  10. Coefficient of efficacy Hệ số hiệu nghiệm cho nghiên cứu A (bên trái; với TSNC = 0,6 và khoảng tin cậy 95%: 0,5 đến 0,7) và nghiên cứu B (bên phải; với TSNC = 0,6 và khoảng tin cậy 95%: 0,05 đến 0,95). Hệ số hiệu nghiệm thực chất là diện tích của đường biểu diễn khi TSNC dưới 0.7. Tổng diện tích của đường biểu diễn là 1. Trong nghiên cứu A, mật độ phân phối của TSNC cao hơn mật độ trong nghiên cứu B.

  11. Drug efficacy: RCT results

  12. Coefficient of efficacy: anti-vertebral fracture

  13. Drug efficacy: non-vertebral fracture

  14. Coefficient of efficacy: anti-non-vertebral fracture

  15. Who should be treated

  16. Who should be treated

  17. Some scenarios • Case 1. Woman 49 y.o, concern of fracture, BMD T-score = -2.7 • Examination: Menopausal age: 45. No abnormality. Maternal history of fx. • More investigation: Yes. Hyperparathyroidism? Vit D deficiency. • Xray? Yes • Negative X-ray. No Rx • Positive X-ray: Rx (Aln, Rsx, Rlx)

  18. Some scenarios • Case 2. Woman 65 y.o, back pain, age at menopause: 50, don’t want HRT. • Examination: Height loss. Prior fx when young • More investigation: Yes. Backpain may be resulted from vertebral deformity. • Xray? Depend on BMD result. • Negative X-ray. No Rx • Positive X-ray: Rx (Aln, Rsx, Rlx)

  19. Some scenarios • Case 3. Man 80 y.o, hip fx due to a fall. • Examination: Low level of physical activity. • More investigation: No. • Xray? No. • Rx: Aln, Rsx, etc

  20. Duration of treatment • <= 3 years • 5+ years: ???

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