1 / 25

OSTEOPOROSIS

OSTEOPOROSIS. Definitions Causes Investigations Treatments Case studies. Definitions. Osteoporosis: reduction in amount of bone per unit volume, without a change in its composition- reduction bone mass >2SD below the mean for young healthy adults Osteopaenia: reduction by 1-2.5 SD.

dante
Download Presentation

OSTEOPOROSIS

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. OSTEOPOROSIS • Definitions • Causes • Investigations • Treatments • Case studies

  2. Definitions • Osteoporosis: reduction in amount of bone per unit volume, without a change in its composition- reduction bone mass >2SD below the mean for young healthy adults • Osteopaenia: reduction by 1-2.5 SD.

  3. T scores in DEXA Scanning

  4. Osteoporosis • Group work: produce a list of causes for osteoporosis

  5. Causes of osteoporosis • Age related • Immobility • RA • Endocrine • Nutritional • Genetic • Lifestyle • Idiopathic • Iatrogenic

  6. NICE guidelines (2005) Secondary prevention of osteoporotic fragility fractures in postmenopausal women who have sustained a clinically apparent osteoporotic fracture Due for review October 2007

  7. Bisphosphonates recommended • Women aged 75 and older without need for DEXA scan. • Women aged 65-74 when osteoporosis confirmed by DEXA scan. • Women under 65 if: • have very low BMD (T-score =/< -3SD) or • Confirmed osteoporosis plus one or more risk factors:

  8. Risk factors in women under 65 • BMI<19kg/m2 • family history of hip fracture <75yr • premature menopause • disorders associated with bone loss • conditions associated with prolonged immobility

  9. Available drugs • Calcium and Vitamin D • Alendronate • Etidronate • Risedronate • Tibilone • Raloxifene • HRT • Strontium ranelate • Calcitonin • Teriparatide (parathyroid hormone)

  10. HRT and osteoporosis • 33% reduction in vertebral fractures (review 13 RCTs), and 30% reduction in non vertebral fractures 2001 • But beware in >50yrs. • Several non hormonal alternatives

  11. Vitamin D has a small effect on preventing falls(HA Bischoff-Ferrari et al. Effect of vitamin D on falls: a meta-analysis. JAMA 2004 291: 1999-2006). • 37% of people had a fall with control, compared with 30% with vitamin D. • NNT =14 to prevent one fall

  12. Numbers needed to treat • Alendronate for 3 years in patients with a confirmed vertebral fracture to prevent one hip fracture NNT = 91 (cost £100,000) • Prevention of vertebral fracture NNT = 14 (£18,000) • Risedronate in elderly people with osteoporosis to reduce a hip fracture NNT = 77 • Calcium and vitamin D (800iu) for 3 years to prevent one hip fracture in old people in care homes NNT=20 (cost £3,900)

  13. How does this compare? • Statin for 5 years in secondary prevention of MI to prevent further MI or CVA NNT= 16 (cost £21,000 with atorvastatin) • Beta blocker and thiazide for 6 years to prevent a stroke in people aged 65 to 74 NNT = 45 (cost £16,000) • Drug treatment for hypertension for 5 years in the elderly to prevent any cardiovascular event NNT=18

  14. Alendronate • Fracture Intervention Trial (FIT) • Postmenopausal women • All given calcium and Vitamin D • Provided protection against vertebral fracture in women with osteoporosis but not osteopenia. • Some benefit for hip and wrist fractures for women with osteoporosis.

  15. What does this mean? • Significant effects of alendronate were found in women whose bone mineral density was more than 2.5 standard deviations below that of young white women. • i.e. More effective in postmenopausal women with osteoporosis.

  16. Risedronate • Effective in preventing vertebral, non vertebral and hip fractures in women with severe osteoporosis. • Less effective in women with osteoporosis. • Probably ineffective in women aged 80 and over. • No evidence for benefit in postmenopausal women with normal BMD.

  17. Etidronate • Studies show mixed effect on preventing vertebral fractures. • Effect seen only in women with severe osteoporosis. • No convincing evidence for use of etidronate for prevention of hip fractures. • Difficult dosage regimen

  18. Bisphosphonate administration • 5% absorption if taken perfectly • Take with glass of water • Patient must not drink before or after taking tablet • Remain upright for a period after taking • 50% of people do not comply with instructions • ? Long term compliance over 5 years • Giving as once weekly dose may help.

  19. Raloxifene • A selective oestrogen receptor modulator (SERM) which inhibits bone resorption. • Effective in preventing vertebral fractures in women with existing vertebral fracture or severe osteoporosis • Not effective in preventing wrist and hip fractures. • Increased risk of thromboembolism

  20. Tibilone • Oestrogenic, progestogenic and weak androgenic effects. • Increases BMD but effects on fractures is unknown

  21. Calcitonin • Inhibits osteoclasts and decreases bone • Has analgesic properties. • Useful for pain from bone mets.

  22. Teriparatide (Parathyroid hormone) • Specialist use • Women 65 + with satisfactory response to a bisphosphonate (or intolerant). • T score </= -4SD • Or T score < -3SD plus other risk fracture/fractures (see NICE guide)

  23. Strontium ranelate • Strontium incorporates into bone • Increases bone mineral density by about 8% in spine ? 5% hip • Evidence for reduction in vertebral and non vertebral fractures in post-menopausal women with a vertebral fracture. • Low ADR profile, mostly nausea and diarrhoea. Seeman E, Ortolani S, Spector TD, et al. The effects of strontium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis. N Engl J Med 2004;350:459-68

  24. Conclusion • Calcium and Vitamin D for elderly care home residents and people with poor diet/house bound. • Preferred choice of bisphosphonate weekly. • Second line choice raloxifene(?) or strontium. • Be selective about who to treat • Ensure patient takes dose properly • HRT?

More Related