B6.052 Prework 7: Management of Osteoporosis Flashcards
of americans with risk factors for low bone mass
53 mil
major concern in osteoporosis treatment
compliance
less than 25% comply with osteoporosis management after a fracture
what are some causes of the treatment gap of osteoporosis?
under recognized
fractures not recognized as sentinel events
under treated
patient care goals for osteoporosis
identify patients at risk of fractures reduce incidence of fractures maintain quality of life -activity -independence -health
who should have a bone density test?
women 65 and older
men 70 and older
postmenopausal women and men ages 50-69 with clinical risk factors (fractures)
adults with fracture after age 50
adults with a condition or taking meds associated with low bone mass or bone loss
benefits of FRAX tool
10 year prob of clinical event from measurable parameters
internationally recognized and validated
based on data from multiple cohorts
easily accessible
helps identify patients who need treatment
can be used to reassure low risk patients
limitations of FRAX
not valid for monitoring of patients on treatment only femoral neck BMD considered no consideration of "dose" not all risk factors included clinical judgement required
when do you treat for low bone density
2 scenarios
1) t score < -2.5 or hip or spine fracture
2) t score between -1 and -2.5 AND >3% risk for hip fracture OR >20% risk of osteoporotic fracture via FRAX took
drugs with evidence for all types of fracture reduction
alendronate
risendronate
zoledronic acid
denosumab
preventive osteoporosis meds
estrogen
raloxifene
bisphosphonates
meds for treatment of symptomatic osteoporosis
all drugs discussed EXCEPT estrogen
osteoporosis meds for men
alendronate risedronate zolendronate denosumab teriparatide
specific occasions for teriparatide or abaloparatide
quick reduction in fracture, can use right after one occurs
black box warning of teriparatide
osteosarcoma seen in mice w long exposure avoid if: -pagets -elevation of alk phos -open epiphysis -prior radiation
specific uses for denosumab
post menopausal osteoporosis
cancer treatment induced bone loss
pts with kidney dysfunction
