1 Module 5 - Speaking of Bones Osteoporosis For Health Professionals: Fracture Risk Assessment William D. Leslie, MD MSc FRCPC
2 Case #1 Age 53: 3 years post-menopause Has always enjoyed excellent health with no past fracture, medical or surgical history Stable Height = 154 cm (60.5 in.) Stable Weight = 55.5 kg (122 lbs.) High Caffeine Intake
3 2002 Guidelines Who Should Be Tested for Osteoporosis? Brown JP et al. CMAJ 2002.
4 T-scores and Treatment Decisions Age BMD T-scores Action taken 53 Spine: -1.8 Femoral neck: -2.4 Ruled out secondary causes Initiated: - risedronate 35 mg weekly - calcium 1500 mg daily - vitamin D 400 IU daily
5 Question Does this healthy 53 year old woman with femoral neck T-score -2.4 have: (A) normal BMD, (B) osteopenia, (C) osteoporosis or (D) none of the above? Should a healthy 53 year old woman with femoral neck T-score -2.4 receive pharmacotherapy to reduce her fracture risk? Yes or No?
6 2002 Guidelines Who Should Be Treated for Osteoporosis? Long-term glucocorticoid therapy Personal history of fragility fracture after age 40 Non-traumatic vertebral compression deformities Clinical risk factors (1 major or 2 minor) Low DXA BMD (T-score < 2.5) Start bisphosphonate therapy AND Low DXA BMD (T-score < 1.5) Obtain DXA BMD for follow-up Consider therapy Repeat DXA BMD after 1or 2 years Brown JP et al. CMAJ 2002.
7 2002 Guidelines Who Should Be Treated for Osteoporosis? Long-term glucocorticoid therapy Personal history of fragility fracture after age 40 Non-traumatic vertebral compression deformities Clinical risk factors (1 major or 2 minor) Low DXA BMD (T-score < 2.5) Start bisphosphonate therapy AND Low DXA BMD (T-score < 1.5) Obtain DXA BMD for follow-up Consider therapy Repeat DXA BMD after 1or 2 years Brown JP et al. CMAJ 2002.
8 WHO Definition of Osteoporosis A disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk.
9 BMD Categories Age Category Criteria* Severe (established) osteoporosis T-score -2.5 with fragility fracture 50 years Osteoporosis T-score -2.5 X Osteopenia Low bone mass T-score -1.0 to -2.5 Normal T-score -1.0 T-scores: white female reference.
10 What s Changed? - Clinical risk factors - Absolute fracture risk - New fracture risk assessment systems - New integrated management paradigm 1980 s 1990 s 2000 s
11 Key Changes from to Increased focus on the clinical impact of fragility fractures Increased focus on the care gap that exists in the identification and treatment of high-risk individuals 1. Brown JP, Josse RG. CMAJ 2002; 167(10 Suppl):S Papaioannou A, et al. CMAJ 2010.
12 No. of fractures Fracture rate, per 1000 person-years Most Fragility Fractures in Postmenopausal Women Occur with Low Bone Mass ("Osteopenia") Fracture rate No. of fractures > to to to to to to to Normal Osteopenia Osteoporosis 0 T-score WHO category Cranney A, et al. CMAJ 2007; 177(6):
13 Fragility Fracture: Definition A fracture occurring spontaneously or following minor trauma such as a fall from standing height or less 1,2 Excluding craniofacial, hand, ankle, and foot fractures 1. Kanis JA, et al. Osteoporos Int 2001; 12(5): Bessette L, et al. Osteoporos Int 2008; 19:79-86.
14 Consequences of Fracture Increased risk of Hospitalization 1 Institutionalization 2 Death 3-5 Subsequent fracture 6-8 Decreased quality of life 9-12 Economic burden on healthcare system 2 1. Papaioannou A, et al. Osteoporos Int 2001; 12(10): Wiktorowicz ME, et al. Osteoporos Int 2001; 12(4): Ioannidis G, et al. CMAJ 2009; 181(5): Papaioannou A, et al. J SOGC 2000; 22(8): Tosteson AN, et al. Osteoporos Int 2007; 18(11): Papaioannou A, et al. J SOGC 2000; 22(8): Colon-Emeric C, et al. Osteoporos Int 2003; 14: Lindsay R, et al. JAMA 2001; 285: Sawka AM, et al. Osteoporos Int 2005; 16: Cranney A, et al. J Rheumatol 2005; 32(12): Pasco JA, et al. Osteoporos Int 2005; 16(12): Papaioannou A, et al. Osteoporos Int 2009; 20(5):
15 Undertreatment of Osteoporosis Post Fracture in women 1 5.5% 15.4% No diagnosis or treatment for osteoporosis Diagnosis of osteoporosis only 79.0% Prescribed treatment for osteoporosis This care gap is even wider in men and those who reside in long-term care 2,3 1. Bessette L, et al. Osteoporos Int 2008; 19: Papaioannou A, et al. Osteoporos Int 2008; 19(4): Giangregorio L, Osteoporos Int 2009; 20(9):
16 % of patients being treated Post-fracture Care Gap: Comparison with Heart Attack ~80% ~15% 0 Anti-osteoporosis medication 1 post fracture Beta-blockers post heart attack 1. Bessette L, et al. Osteoporos Int 2008; 19: Austin PC, et al. CMAJ 2008; 179(9):
17 Fracture Risk Assessment: Where Are We in 2012? Selected Fracture Systems 2010 Canadianized FRAX / CAROC
18 10-year Risk Assessment: CAROC Semiquantitative method for estimating 10-year absolute risk of a major osteoporotic fracture* in postmenopausal women and men over age 50 Three zones (low: < 10%, moderate, high: > 20%) * Fractures of proximal femur, vertebra [clinical], forearm, and proximal humerus Siminoski K, et al. Can Assoc Radiol J 2005; 56(3):
19 10-year Risk Assessment for Women (CAROC Basal Risk) Adapted from Siminoski K, et al. Can Assoc Radiol J 2005; 56(3):
20 Risk Assessment with CAROC: Important Additional Risk Factors Factors that increase CAROC basal risk by one category (i.e., from low to moderate or moderate to high) Fragility fracture after age 40 Recent prolonged systemic glucocorticoid use
21 Example of Adjusting Basal Risk: Based on Additional Risk Factors 60-year-old woman Femoral neck T-score = -2.8 Based on age and T-score alone = moderate risk History of fragility fracture or prolonged systemic glucocorticoid use would shift her to high risk Adapted from Siminoski K, et al. Can Assoc Radiol J 2005; 56(3):
22 Calculating Fracture Risk
25 Sweden Switzerland US Caucasian Austria United Kingdom CANADA Belgium Japan Italy Argentina Hong Kong Finland Germany US Hispanic US Asian France New Zealand US Black Spain Lebanon China Turkey Percent fracture Variations in Estimated 10-Year Fracture Probabilities According to Country Year Major Fracture Probability Age 65 years, prior fracture with femoral neck T-score -2.5 Female Male Year Hip Fracture Probability Age 65 years, prior fracture with femoral neck T-score -2.5 Leslie WD, et al. J Bone Miner Res Leslie WD, et al. Osteoporos Int 2010.
26 Evaluating Prediction Models Independent validation Risk stratification Model calibration
27 Comparison: 10y Fracture Risk Systems 2010 CAROC Canadian FRAX Model Semi-quantitative (low, moderate, high) Quantitative (fracture probability) BMD * Femoral neck (required) Femoral neck (optional) Clinical Fragility fracture Prolonged steroids Fragility fracture Prolonged steroids BMI Parental hip fracture Current smoking High alcohol use Rheumatoid arthritis Secondary causes Output Major fracture Major fracture Hip fracture High risk >20% >20% Validation Level 1 evidence Level 1 evidence
28 Which One Is Better? Canadian FRAX FRAX Lite
29 It s Not the Model, It s the Management The stone age was marked by man s clever use of crude tools; the information age, to date, has been marked by man s crude use of clever tools. Anonymous
30 2010 Guidelines Integrated Management Model Algorithm (Basic Paradigm) Fracture Risk Assessment Low Risk Don t Treat Moderate Risk Stop and Think High Risk Treat
31 2010 Guidelines Integrated Management Model Algorithm, part 1 of 2 Basic Bone Health Calcium up to 1200 mg daily (diet and supplement) Vitamin D IU daily (over age 50) Regular weight bearing exercise
32 2010 Guidelines Integrated Management Model Algorithm, part 1 of 2 Basic Care (suitable for all) Lifestyle changes; adequate calcium intake & vitamin D; falls prevention Age < 50 Age Age 65 Identify medical conditions associated with osteoporosis and fractures Identify medical conditions and other clinical risk factors associated with osteoporosis and fractures All men and women Initial BMD Testing Continued on next slide
33 2010 Guidelines Integrated Management Model Algorithm, part 1 of 2 Initial BMD Testing Fracture Risk Assessment FRAX Canada 3.1 CAROC 2010
34 2010 Guidelines Integrated Management Model Algorithm, part 2 of 2 Continued from previous slide Fracture Risk Assessment FRAX or CAROC Low Risk 10-year fracture risk < 10% Moderate Risk 10-year fracture risk 10-20% High Risk 10-year fracture risk > 20% or Prior fragility fracture of hip or spine or More than one fragility fracture
35 2010 Guidelines Integrated Management Model Algorithm, part 2 of 2 Continued from previous slide Fracture Risk Assessment FRAX or CAROC Low Risk 10-year fracture risk < 10% Unlikely to benefit from pharmacotherapy. Reassess risk in 5 years. Moderate Risk 10-year fracture risk 10-20% High Risk 10-year fracture risk > 20% or Prior fragility fracture of hip or spine or More than one fragility fracture Good evidence of benefit from pharmacotherapy
36 2010 Guidelines Integrated Management Model Algorithm, part 2 of 2 Continued from previous slide Fracture Risk Assessment FRAX or CAROC Low Risk 10-year fracture risk < 10% Moderate Risk 10-year fracture risk 10-20% Perform spine imaging (x-ray or vertebral fracture assessment) to identify vertebral fractures High Risk 10-year fracture risk > 20% or Prior fragility fracture of hip or spine or More than one fragility fracture
37 VFA Recognition and Reporting Vertebral fractures unrelated to trauma are associated with a 5x risk for another vertebral fracture Vertebral fracture assessment (VFA) is a DXA scanning/software option.
38 2010 Guidelines Integrated Management Model Algorithm, part 2 of 2 Continued from previous slide Fracture Risk Assessment FRAX or CAROC Low Risk 10-year fracture risk < 10% Moderate Risk 10-year fracture risk 10-20% Perform spine imaging (x-ray or vertebral fracture assessment) to identify vertebral fractures High Risk 10-year fracture risk > 20% or Prior fragility fracture of hip or spine or More than one fragility fracture Look for additional factors that warrant consideration for pharmacological therapy
39 First Line Therapies with Evidence for Fracture Prevention in Postmenopausal Women* Type of Fracture Alendronate Bisphosphonates Risedronate Antiresorptive therapy Zoledronic acid Denosumab Raloxifene Hormone therapy (Estrogen)** Bone formation therapy Teriparatide Vertebral Hip - - Nonvertebral - +
40 Case #1: Question Does this healthy 53 year old woman with femoral neck T-score -2.4 have: (A) normal BMD, (B) osteopenia, (C) osteoporosis or (D) none of the above? Should a healthy 53 year old woman with femoral neck T-score -2.4 receive pharmacotherapy to reduce her fracture risk? Yes or No?
41 FRAX Calculation (Age 53 Six Years Ago)
42 CAROC Calculation (Age 53 Six Years Ago) 53-year-old woman Femoral neck T-score = -2.4 Based on age and T-score alone = low risk
43 Case #1: Answer Does a healthy 53 year old woman with femoral neck T-score -2.4 have: (A) normal BMD, (B) osteopenia, (C) osteoporosis or (D) none of the above? Should a healthy 53 year old woman with femoral neck T-score -2.4 receive pharmacotherapy to reduce her fracture risk? Yes or No?
44 2010 Guidelines Integrated Management Model Algorithm, part 2 of 2 Continued from previous slide Fracture Risk Assessment FRAX or CAROC Low Risk 10-year fracture risk < 10% Unlikely to benefit from pharmacotherapy. Reassess risk in 5 years. Moderate Risk 10-year fracture risk 10-20% High Risk 10-year fracture risk > 20% or Prior fragility fracture of hip or spine or More than one fragility fracture
45 Case #2 65-year-old woman Natural menopause at age year history of hypertension (currently) Body mass index (BMI): 24.8 kg/m 2 Blood Pressure: 136 / 84 mmhg
46 Case #2: Risk Factor Assessment No hormone treatment No personal fracture history Positive family history: Hip fracture in her mother at age 75 (fell in own home; ended up in personalcare home) Non smoker No history of systemic steroid use No history of rheumatoid arthritis No potential secondary causes of osteoporosis Alcohol use: < 3 drinks/day Femoral neck T-score -2.3
47 Case #2: Questions What is the fracture risk? What is the impact of family history of hip fracture on risk assessment? Is pharmacologic treatment indicated?
48 CAROC Calculation 65-year-old woman Femoral neck T-score = -2.3 Based on age and T-score alone = moderate risk
49 FRAX Calculation with Family History
50 FRAX Calculation without Family History
51 2010 Guidelines Integrated Management Model Algorithm, part 2 of 2 Continued from previous slide Fracture Risk Assessment FRAX or CAROC Low Risk 10-year fracture risk < 10% Moderate Risk 10-year fracture risk 10-20% Perform spine imaging (x-ray or vertebral fracture assessment) to identify vertebral fractures High Risk 10-year fracture risk > 20% or Prior fragility fracture of hip or spine or More than one fragility fracture Look for additional factors that warrant consideration for pharmacological therapy
52 Impact of Family History of Hip Fracture on Risk Assessment For Case #2, the family history of parental hip fracture increases absolute 10-year risk of major osteoporotic fractures by 9.0% This moves her from the lower end to the higher end of the moderate-risk range using FRAX
53 Case #2: To Treat or Not to Treat? Decision on whether to treat patients at moderate risk with pharmacologic therapy also involves Discussion of benefits (e.g., fracture risk reduction) and risks (e.g., adverse events) of treatment Assessment of patient preferences and health priorities to come up with an "individualized intervention threshold"
54 Case #3 66-year-old retired firefighter Complaining his back has been worse than usual the past three weeks Height: 180 cm (5'11") Patient recalls being cm (6'1") Weight: 80 kg (up 5 kg from one year ago) Body mass index (BMI): 24.7 kg/m 2
55 Case #3: Risk Factor Assessment Family history: none significant No medications, systemic glucocorticoids or androgen-deprivation therapy No history of secondary causes of osteoporosis Historical height loss No previous trauma Prior smoker (45 pack/year history) Alcohol use: approximately two drinks per week
56 Case #3: Further Testing Screening for osteoporosis with dual energy X-ray absorptiometry (DXA) is indicated T-score -1.9 at femoral neck Lateral thoraco-lumbar spine x-ray is ordered to rule out fractures X-ray shows two vertebral compression fractures
57 Case #3: Questions What is the fracture risk? What is the impact of vertebral fractures on risk assessment? Is pharmacologic treatment indicated?
58 Case #3: CAROC Calculation 66-year-old man Femoral neck T-score = -1.9 Based on age and T-score alone = low risk History of fragility fracture = moderate risk
59 2010 Guidelines Integrated Management Model Algorithm, part 2 of 2 Continued from previous slide Fracture Risk Assessment FRAX or CAROC Low Risk 10-year fracture risk < 10% Moderate Risk 10-year fracture risk 10-20% High Risk 10-year fracture risk > 20% or Prior fragility fracture of hip or spine or More than one fragility fracture Good evidence of benefit from pharmacotherapy
60 Case #3: Conclusions High risk because of vertebral fractures In this case, 10-year assessment tools underestimate risk Patients at high risk benefit from pharmacologic therapy Recommended agents for first-line use in men are alendronate, risedronate, or zoledronic acid
61 Key Points The management of osteoporosis should be guided by an assessment of the patient s absolute risk of osteoporosis related fractures. Fragility fracture increases the risk of further fractures and should be considered in the assessment. Lifestyle modification and pharmacologic therapy should be individualized to enhance adherence to the treatment plan.
New Guidelines for the Prevention and Treatment of Osteoporosis E. Michael Lewiecki, MD, and Nelson B. Watts, MD Abstract: The World Health Organization Fracture Risk Assessment Tool (FRAX ) and the National
MAKING SENSE OF THE NUMBERS Gary W. Swenson, MD GWS is a partner at Radiologists of North Iowa, which jointly owns with Mercy Medical Center North Iowa, the Forest Park Imaging Center, a provider of DXA
11 BMD: Interpretation and Normal Ranges Introduction Bone mineral density measurements are frequently used in clinical practice to assess fracture risk. The utility of these measurements depends on making
Osteoporosis Assessment Using DXA and Instant Vertebral Assessment Working Together For A Healthier Community Osteoporosis The Silent Thief The Facts About Osteoporosis 1 in 2 women will develop osteoporosis
FRAX Identifying people at high risk of fracture WHO Fracture Risk Assessment Tool, a new clinical tool for informed treatment decisions Authored by Dr. Eugene McCloskey International Osteoporosis Foundation
Drug treatment pathway for Osteoporosis in Postmenopausal Women Version 1.0 Ratified by: East Sussex HEMC Date ratified: 26.01.2011 Job title of originator/author Gillian Ells, East Sussex HEMC Pharmacist
Bone Mineral Density: Back to the Basics Beth Chasen,, MD Assistant Professor MD Anderson Cancer Center Bone Densitometry (DXA)- who needs an evaluation? Women aged 65 and older. Postmenopausal women under
Osteoporosis Overview Osteoporosis is defined as compromised bone strength that increases risk of fracture (NIH Consensus Conference, 2000). Bone strength is characterized by bone mineral density (BMD)
Kaiser Permanente National CLINICAL PRACTICE GUIDELINES Osteoporosis/Fracture Prevention 54TClinician Guide DECEMBER 2015 Introduction This Clinician Guide was developed to assist Primary Care physicians
Clinical Practice Guidelines for the Diagnosis and Management of Osteoporosis in Canada: Background and Technical Report Authors: Alexandra Papaioannou MD MSc 1, Suzanne Morin MD MSc 2, Angela M. Cheung
Falls and Fracture Risk assessment and management Disclosures: Although various guidelines and studies were reviewed, this represents my own personal bias and conclusions. What do we know? 1) Fractures
Recommendations for Care of the Osteoporotic Fracture Patient to Reduce the Risk of Future Fracture Developed by the World Orthopedic Osteoporosis Organization (WOOO) Olof Johnell 1, John Kaufman 2, Steven
PROTOCOL FOR PATIENTS WITH ABNORMAL LAB AND X-RAY VALUES Patients newly diagnosed as osteopenic or osteoporotic on a radiology report or patients receiving abnormal lab values on the following lab tests
Lakeside Family Physicians & Lakeside Primary Care Patient Centered Medical Home Program Bone Densitometry Disease Management Pathway PROTOCOL FOR PATIENTS WITH ABNORMAL LAB AND X-RAY VALUES Patients newly
Osteoporosis Background and Screening Recommendations Maria K Jorgensen Concordia University Master of Public Health Applied Epidemiology December 15, 2014 Osteoporosis Background and Screening Recommendations
BULLETIN Slovak Republic Ministry of Health Part 51-53 November 13, 2009 No. 57 CONTENTS: 52. Slovak Republic Ministry of Health Guidelines for the Diagnosis of Glucocorticoidinduced Osteoporosis 52. Slovak
OHTAC Recommendation Utilization of DXA Bone Mineral Densitometry in Ontario November 2006 The Ontario Health Technology Advisory Committee (OHTAC) met on November 17, 2006, and reviewed the analyses of
Fast Facts on Osteoporosis Definition Osteoporosis, or porous bone, is a disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased susceptibility
When you have osteoporosis, your bones become weak and are more likely to break (fracture). You can have osteoporosis without any symptoms. Because it can be prevented and treated, an early diagnosis is
Clinical Practice Guideline for Osteoporosis Screening and Treatment Osteoporosis is a condition of decreased bone mass, leading to bone fragility and an increased susceptibility to fractures. While osteoporosis
11:05 11:45am Controversies in Osteoporosis Prevention and Management SPEAKER Carolyn Crandall, MD, MS Presenter Disclosure Information The following relationships exist related to this presentation: Carolyn
2-1 Osteoporose Dr. P. Van Wettere Radiologie en medische beeldvorming 2-2 Osteoporose Definitie Incidentie, mortaliteit, morbiditeit, kost Diagnose Radiologie Botdensitometrie FRAX FractureCascade History
Clinical Guideline WIRRAL GUIDELINES FOR THE MANAGEMENT OF OSTEOPOROSIS The scope of these guidelines covers:- Secondary prevention of osteoporotic fragility fractures Primary prevention of osteoporosis
CAR TECHNICAL STANDARDS FOR BONE MINERAL DENSITOMETRY REPORTING APPROVED: JANUARY 25, 2013 KERRY SIMINOSKI, MD, FRCPC; MARGARET O'KEEFFE, MD, FRCPC; JACQUES P. BROWN, MD, FRCPC; STEVEN BURRELL, MD, FRCPC;
The National Osteoporosis Guideline Group NOGG and the International Osteoporosis Foundation IOF present Bristol London Southampton Stirling Cheshire This report of a Guidelines in Practice workshop series
What is osteoporosis? What is osteopenia? Osteoporosis is a problem in which bones are less dense and more fragile and thus at greater risk for fracture, even with a small amount of trauma. This disease
DIAGNOSIS AND MANAGEMENT OF OSTEOPOROSIS Regional Clinical Practice Guideline Diagnosis and Management Of Osteoporosis October 2014 CLINICAL PRACTICE GUIDELINES FOR THE DIAGNOSIS AND MANAGEMENT OF OSTEOPOROSIS
Boning Up On Osteoporosis Nicholas J. Avallone,, M.D. Orthopedic Surgeon Sports Medicine Specialist Conflicts of Interest I have no relationships with any company listed in this talk. Resources National
Guidelines for the Diagnosis and Management of Osteoporosis in Greece. Published in the Greek Journal of Musculoskeletal Health, vol 2, issue 4, December 2004. The improved text was also printed in a book
n DRUG REVIEW Osteoporosis: recent advances in diagnosis and management Heather Woodcraft and Emma M Clark SPL The recommended management of osteoporosis has recently changed, with an emphasis now on assessment
FLS-DB Facilities audit question Standard 1.1 What is the name of your site: Not linked to guidance but needed to report on FLS resources and organisation. 1.2 Is your site based around a (select all that
What You Need to Know for Better Bone Health A quick lesson about bones: Why healthy bones matter The healthier your bones The more active you can be Bone health has a major effect on your quality of life
The Longest Title in the Meeting Steven R. Cummings, MD, FACP S.F. Coordinating Center Financial support from several companies that make treatments for osteopenia and osteoporosis "What is critical for
AACE Post-Menopausal Osteoporosis Guidelines 2015 Pauline Camacho, MD, FACE Steven M. Petak MD, JD, MACE, FCLM Educational Objectives Discuss AACE guidelines related to the prevention of osteoporosis Review
CANADIAN M EDICAL A SSOCIATION J OURNAL J OURNAL DE L ASSOCIATION MÉDICALE CANADIENNE CMAJ JAMC 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada CMAJ 2002;167(10
body DEXA measure your health fit.com.au BONE DENSITY TESTING Diagnosing Osteoporosis HOW STRONG ARE YOUR BONES? 76 Keilor Rd, Essendon North 3041 Tel: 9374 3392 www.bodydexafit.com.au www.facebook.com/bodydexafit
Transcript Details This is a transcript of a continuing medical education (CME) activity accessible on the ReachMD network. Additional media formats for the activity and full activity details (including
Osteoporosis Update Laura E. Ryan, MD Assistant Director for Special Programs Center for Women s Health Clinical Assistant Professor of Medicine Division of Endocrinology, Diabetes and Metabolism The Ohio
Forteo (teriparatide) Prior Authorization Criteria FDA APPROVED INDICATIONS AND DOSAGE 1 FDA Indication 1 : Forteo is indicated for: the treatment of postmenopausal women with osteoporosis who are at high
Indian Medical Gazette FEBRUARY 2012 67 Symposia Update A Treatment Algorithm for Indian Patients of Osteoporosis Shailendra Mohan Lakhotia, Senior Consultant Orthopedic Surgeon, Kolkata 700 045. Prashant
Osteoporosis Fracture Prevention Guideline September 2011 Rationale for Guideline This is a consensus-based guideline. Although many studies have been published about osteoporosis treatment in postmenopausal
OSTEOPOROSIS IS A DISEASE OF THE BONES, WHICH LEADS TO AN INCREASED RISK OF FRACTURE. IN OSTEOPOROSIS, THE DENSITY AND QUALITY OF BONE ARE REDUCED. THE LOSS OF BONE OCCURS SILENTLY AND PROGRESSIVELY. Osteoporosis
Measure #40 (NQF 0048): Osteoporosis: Management Following Fracture of Hip, Spine or Distal Radius for Men and Women Aged 50 Years and Older National Quality Strategy Domain: Effective Clinical Care 2015
Advanced DXA Using TBS insight A New Bone Structure Assessment Technique Enhances Identification of Fracture Risk Introduction The World Health Organization defines osteoporosis as a silent disease characterized
Russells Hall Hospital Emergency Department Emergency Department Management of Fragility Fractures Osteoporosis is a progressive systemic skeletal disease characterised by low bone density and micro-architectural
Osteoporosis Clinical guideline for prevention and treatment Executive Summary Updated November 2014 National Osteoporosis Guideline Group on behalf of the Bone Research Society, British Geriatrics Society,
Virginia Commonwealth University VCU Scholars Compass Case Studies from Age in Action Virginia Center on Aging 1997 Standing Up to Osteoporosis Robert W. Downs Virginia Commonwealth University, email@example.com
Osteoporosis Medications When does a doctor prescribe osteoporosis medications? Healthcare providers look at several pieces of information before prescribing a bone- preserving or bone- building medication.
CURRENT CHALLENGES IN THE MANAGEMENT OF OSTEOPOROSIS Natalie Horwood PhD MRCP Consultant Rheumatologist CROYDON UNIVERSITY HOSPITAL March 2014 Contents Definitions and Background Clinical need and NICE
PRACTICAL DENSITOMETRY The Challenge of Osteoporosis Osteoporosis is a silent disease that develops over decades Goal: identify patients with osteoporosis before fractures occur Means: measure bone density
OSTEOPOROSIS REHABILITATION PROGRAM Tricia Orme, R.N. BSc(N) Mary Pack Arthritis Program Victoria i Arthritis i Centre Objectives Participants will gain an understanding of what Osteoporosis is and how
Review Article Recent Topics in Treatment of Osteoporosis JMAJ 49(9 10): 309 314, 2006 Satoshi Soen* 1 Abstract It has come to light that osteoporosis-related fractures are more critical than previously
Osteoporosis Treatments That Help Prevent Broken Bones A Guide for Women After Menopause June 2008 fast facts Medicines for osteoporosis (OSS-tee-oh-puh-ROW-sis) can lower your chance of breaking a bone.
Transcript of learning module Osteoporosis: fracture prevention and treatment in primary care (Dur: 20' 18") Contributors: Christine Ward and Alan Cooper Available online at: http://learning.bmj.com/learning/search-
Vol. 34, No. 3 201 Clinical Research and Methods Use of a Peripheral Dexa Measurement for Osteoporosis Screening Julienne K. Kirk, PharmD; Mindy Nichols, RD; John G. Spangler, MD Background and Objectives:
Drugs to prevent bone fractures in people with: Osteoporosis Comparing Effectiveness, Safety, and Price Contents 2: Our Recommendations 3: Welcome 6: Who Needs Drugs to Prevent Fractures? 8: Choosing a
Drug treatments for osteoporosis What is osteoporosis? Osteoporosis occurs when the struts which make up the mesh-like structure within bones become thin causing them to become fragile and break easily,
SIGMA sums it up: Answers to questions about osteoporosis and denosumab therapy Table of contents Who is SIGMA? Frequently asked questions we will address: 1. What is osteoporosis? 2. Why is it important
APPENDIX 1. Algorithm for Assessing and Managing Patients at Risk For Fracture Age 65+ Age 50-64 yr Age < 50 yr All women and > 75 men Note: For men without any risk factors, evidence for universal screening
Osteoporosis Dr Gordon MacDonald BSc MB BChir MRCP Consultant Rheumatologist Rheumatology and Arthritis Seminar Tuesday 5 th February 2013 Plan What is osteoporosis? Consequences of osteoporosis Risk factors
OSTEOPOROSIS The Silent Epidemic National Osteoporosis Awareness Health Project SM 625 Lincoln Avenue Marion Virginia 24354-1663 USA 276-243-8382 E-mail: NOAH.Project@healthprojectsusa.com On The Internet:
VIETNAM Vietnam COUNTRY OVERVIEW The population of Vietnam in 2013 was 92.4 million. Life epectancy was 73 years and is projected to increase by 11% by 2050, at which time the Vietnamese will be living
Osteoporosis Drugs In Asia Pacific Market Growth & Trends by 2022 Report Description Osteoporosis is a progressive, skeletal disease, leading to fragile and abnormally porous bones. It is characterized
16. ARTHRITIS, OSTEOPOROSIS, AND CHRONIC BACK CONDITIONS Goal Reduce the impact of several major musculoskeletal conditions by reducing the occurrence, impairment, functional limitations, and limitation
Osteoporosis Treatment Guide An estimated 10 million Americans have osteoporosis. Another 34 million have low bone mass. If left untreated, osteoporosis can be both debilitating and painful. Fortunately,
Orthogeriatrics Clinical Summary Document Treatment of osteoporosis in fragility fractures Fragility fractures are extremely prevalent in older adults with a staggering cost of treatment. As the population
What is Bone Densitometry? Every day, physicians use radiography, or x-rays, to view and evaluate bone fractures and other injuries of the musculoskeletal system. However, a plain x-ray test is not the
CONTENT SPECIFICATIONS The Bone Densitometry Examination The purpose of The American Registry of Radiologic Technologist (ARRT ) Bone Densitometry Examination is to assess the knowledge and cognitive skills
Drug treatments to protect your bones This information is an extract from the booklet, Bone health. You may find the full booklet helpful. We can send you a copy free see page 5. Contents Bisphosphonates
Denosumab (Prolia and Xgeva) Page 1 of 15 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Denosumab (Prolia and Xgeva) BCBSKS will review Prior Authorization requests
Cystic fibrosis and bone health Factsheet March 2013 Cystic fibrosis and bone health Introduction As we get older our bones become thinner and weaker, and may become more susceptible to fracture. However
20, 2012 Health Technology Assessment Screening and Monitoring Tests for Osteopenia/Osteoporosis Final Report October 20, 2014 Health Technology Assessment Program (HTA) Washington State Health Care Authority
Osteoporosis Am I at Risk? TABLE OF CONTENTS What is osteoporosis?...1 Who gets osteoporosis?...2 How can I prevent osteoporosis?...3 How do I know if I have osteoporosis?...4 What is a bone mineral density
CAR CLINICAL PRACTICE GUIDELINES / DIRECTIVES CLINIQUES DE LA CAR CAR CLINICAL PRACTICE GUIDELINES / DIRECTIVES CLINIQUES DE LA CAR Recommendations for Bone Mineral Density Reporting in Canada Kerry Siminoski,
Osteoporosis and you Find out about the implications of osteoporosis and what you can do for your bone health 2 What is osteoporosis? Osteoporosis, which literally means porous bone, is a disease in which
Margaret French, Specialist Nurse, Fracture Liaison Service Glasgow Royal Infirmary Rachel Lewis Rheumatology Specialist Physiotherapist, North Bristol NHS Trust Very informal workshop to facilitate discussion
Scans and tests and osteoporosis What is osteoporosis? Osteoporosis occurs when the struts which make up the mesh-like structure within bones become thin causing them to become fragile and break easily,
merican ollege of Rheumatology 2 Recommendations for the Prevention and Treatment of G L U O O R T I O I D - I N D U E D O S T E O P O R O S I S L I N I I N S G U I D E The objective of this guide is to
All about Osteoporosis What is osteoporosis? Osteoporosis literally means porous bone. It is a condition that causes bones to become thin and fragile, decreasing bone strength and making them more prone
37th Annual Advanced Practice in Primary and Acute Care Conference: October 9-11, 2014 1:30 SESSION C2 Session Description: Osteoporosis: Focus on Fractures Susan Ott, MD Osteoporotic fractures are a serious
Osteoporosis Update Jason Wu, DO Rheumatologist The Orthopedic Institute of New Jersey Atlantic Regional Osteopathic Convention 4/14/16 Disclosures None Objectives Who to treat for Osteoporosis? Who gets
Osteoporosis Dr. Pradeep Kumar Shenoy C Consultant Rheumatologist, KMC Hospital, Mangalore What are the major components of the bone? The main structural elements of bone are osteoid, which is a protein
NON-TRAUMATIC FRACTURES IN INDIVIDUALS WITH DIABETES i NON-TRAUMATIC FRACTURES IN INDIVIDUALS WITH DIABETES by LISA-ANN FRASER, M.D., F.R.C.P.(C.), B.Sc. A Thesis Submitted to the School of Graduate Studies
OSTEOPOROSIS FACT SHEET What is osteoporosis? Osteoporosis is a disease in which the density and quality of bone are reduced, leading to weakness of the skeleton and increased risk of fracture, particularly