Osteoporosis talk july 2012 4 slideshare
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The 70 year old woman should continue a glass of wine with dinner but stop smoking. Calcium supplements may slightly increase heart attack risk but dietary calcium is fine. While bisphosphonates rarely cause jaw bone damage, dental visits before and after long term use are recommended. The patient's bone density increased slightly but any increase reduces fracture risk. Treatment duration depends on individual risk factors like FRAX score. Drug holidays or alternative drugs may be options after 5 years of bisphosphonates.
Osteoporosis talk july 2012 4 slideshare
- 2. 70 year old Woman I only smoke when I drink I like a glass of wine with my dinner Doctor
- 5. But Calcium supplements cause Heart attacks!
- 6. ?Suggests 20-30% increased risk of myocardial infarction in patients taking Calcium supplements ?No significant increase in CVA¡¯s
- 7. ? Meta-analysis ? Excludes patients taking Ca and Vit D supplements ? At odds with results of WHI study ? Could there be something there?
- 8. Possible reduction of risk of MI with higher dietary Ca Small increased risk of MI with supplements only
- 11. My nephew is a dentist.....
- 12. Osteonecrosis of the jaw
- 13. Rare in bisphosphonate doses used in OP 1:100,000 More common with IV bisphosphonates (but still rare)
- 14. ? Discuss potential risks and symptoms with patient ? Encourage good dental hygiene ? Pretreatment dental visit not necessary
- 15. ? < 3yrs treatment with BP ? Dental extractions and implants as normal ? > 3 yrs treatment ? Stop BP for 3 months before treatment ? Restart when bone healed
- 16. Has the treatment worked Doctor?
- 18. 3.5% Lumbar Spine 2.2% Hip
- 19. What do the changes mean? Fracture risk % Adapted from Chapurlat RD et al Osteoporosis Int 2005:16. pp 842848
- 20. How much change is significant? Ideal is increase in BMD Patients with static BMD still have reduced risk of fracture Only worry about Decrease
- 22. Alternatives to bisphosphonates Vertebral Hip (Protelos) Yes Yes/No* Strontium (Forsteo) Yes No Teriparetide (Evista) Yes No Raloxifene Denosumab Yes Yes (Prolia) * >75yrs osteoporosis femoral neck
- 23. Do we need to treat everybody?
- 24. I¡¯m 51 and healthy T Scores LS- -2.6 Hip -2.6
- 26. Google ¡®FRAX¡¯
- 27. How long do I need to be on treatment?
- 28. Do Bisphosphonates work in long term?
- 30. After 5 years little to support continued benefit on fracture risk Possibility of drug holiday in some (low risk pts) Change to alternative agent
- 32. 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
- 33. I¡¯m 51 and healthy T Scores LS- -2.6 Hip -2.6
- 34. 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