Beruflich Dokumente
Kultur Dokumente
SECONDARY OSTEOPOROSIS
Awalia
Ebeling PR. Secondary causes of osteoporosis: Bone diseases. In: Osteoporosis, diagnosis
and management. Stovall DW (Ed.). 2013. John Wiley & sons Ltd. London.
Hofbauer LC, Hamann C, Ebeling PR. Approach to the patient with secondary osteoporosis.
European Journal of Endocrinology (2010) 162 1009–1020
Hofbauer LC, Hamann C, Ebeling PR. Approach to the patient with secondary osteoporosis.
European Journal of Endocrinology (2010) 162 1009–1020
Algorhitm for identifying causes of secondary OP
Bone KW. Recognizing and treating secondary osteoporosis. Nat .Rev. Rheumatol 8, 480 (2012)
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Z-score
Patient’s BMD – Age-Matched Mean BMD
1 SD of Age-Matched Mean BMD
Low Z-score (less than -2.0) has been suggested
by some to increase likelihood of secondary
osteoporosis, however . . .
– This is not validated in clinical trials
– High index of suspicion for secondary causes of
osteoporosis is recommended for all patients
Z-score 2 : below expexted range of age
Z-score > 2 : within expexted range of age
Dx OP utk pre-M women cant be made based on BMD alone
Bone turnover marker:
Not for dx OP predictor fr & Mx tx response
Bowles SK. Drug-induced osteoporosis. Women’s and Men’s Health. PASP VII. 2010
Effects of treatments on various diseases
Ferrari S, et al. Osteoporosis of young adults: pathophysiology, diagnosis, and management. Osteoporosis Int (2012) 23:2735
The most common cause of secondary OP
1% of US population is treated with long-term GCs
> 10% have fracture, 30-40% have
radiographic evidence of vertebral fracture
Fracture risk categories in GC-treated pts
2017 ACR Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporois
Non-pharmacologic
Pharmacologic
Bone Health Building Blocks
Bone KW. Recognizing and
treating secondary osteoporosis.
Nat .Rev. Rheumatol 8, 480 (2012)
Calcium Intake Recommendations
Estimated Recommended Dietary Upper Level Intake
Life Stage Group Requirement (mg/day) Allowance (mg/day) (mg/day)
Infants 0 to 6 months * * 1,000
Infants 6 to 12 months * * 1,500
1–3 years old 500 700 2,500
4–8 years old 800 1,000 2,500
9–13 years old 1,100 1,300 3,000
14–18 years old 1,100 1,300 3,000
19–30 years old 800 1,000 2,500
31–50 years old 800 1,000 2,500
51–70 year-old male 800 1,000 2,000
51–70 year-old female 1,000 1,200 2,000
>70 years old 1,000 1,200 2,000
* For infants, adequate intake is 200 mg/day for 0 to 6 months of age and 260 mg/day for 6 to 12 months of age.
Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D: Report Brief. Washington, DC: IOM ; 2010.
Available at: http://www.iom.edu/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D.aspx. Accessed
September 13, 2013.
Vitamin D Intake Recommendations
Estimated Avg Recommended Upper Level Intake
Requirement Dietary Allowance (IU/day)
Life Stage Group (IU/day) (IU/day)
Infants 0 to 6 months * * 1.000
Infants 6 to 12 months * * 1,500
1–3 years old 400 600 2,500
4–8 years old 400 600 3,000
9–13 years old 400 600 4,000
14–18 years old 400 600 4,000
19–30 years old 400 600 4,000
31–50 years old 400 600 4,000
51–70-year-old male 400 600 4,000
51–70-year-old female 400 600 4,000
>70 years old 400 600 4,000
* For infants, adequate intake is 400 IU/day for 0 to 6 months of age and 400 IU/day for 6 to 12 months of age.
Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D: Report Brief. Washington, DC: IOM; 2010.
Available at: http://www.iom.edu/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D.aspx. Accessed
September 13, 2013.
BONE MASS HOMEOSTASIS
Harada S, Rodan GA. Control of osteoblast function and regulation of bone mass. Nature 2003;423:349-55
FDA-Approved Therapeutic Options
Prevention Treatment
Estrogen Calcitonin
Alendronate
Risedronate
Ibandronate
Zoledronic acid
Raloxifene
PTH (teriparatide)
Denosumab
Drugs approved by FDA for treatment of OP
Osteoporosis Algorithm
Hamdy RC. Algorithm for management of osteoporosis. Southern Medical Journal 2010, 103 :1009
Drugs approved by FDA for prevention of OP
Bisphosphonates
Alendronate, Risedronate, Ibandronate, and Zoledronic Acid
National Osteoporosis Foundation. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Washington, DC: National
*
Osteoporosis Foundation; 2013. Available at: http://www.nof.org/hcp/clinicians-guide. Accessed September 13, 2013.
2012 Jun 25;172(12):930-6
Bisphosphonates
Contraindications/Warnings/Precautions
– Hypocalcemia
– Creatinine clearance <30 cc/min (<35 cc/min for zoledronic acid)
– For oral dosing: Esophageal stricture or impaired esophageal motility (alendronate);
inability to stand or sit for at least 30 minutes (alendronate/risedronate) or 60
minutes (ibandronate)
Notes: UGI symptoms per se are not a contraindication to oral dosing.
Use in pregnancy: Class C
Oral dosing requirements
– Tablets (with exception of delayed release risedronate) taken on an empty stomach
after overnight fast with 6 to 8 oz of plain water while in an upright position
– Patients should not eat or lie down for at least 30 minutes (alendronate
and risedronate) or 60 minutes (ibandronate)
– Calcium and vitamin D supplements, if needed, should be taken at a different time
of day than the oral bisphosphonate
Watts NB et al; AACE Osteoporosis Task Force. Endocr Pract. 2010;16(Suppl 3):1-37.
Whitaker M, et al. N Engl J Med. 2012;366(22):2048-2051.
Teriparatide: rhPTH [1-34]
• The only treatment agent that is anabolic—stimulates bone
formation rather than inhibiting bone resorption
• 20 μg daily (subcutaneously) for no more than 2 years
• Indication: treatment of men and postmenopausal women
with osteoporosis who are at high risk for fracture
• Effects:
– Increased bone density in spine by 9% and hip by
3% vs placebo over 18 months
– Reduced incidence of vertebral fractures (65%) and
nonvertebral fragility fractures (53%) in women with
pre-existing vertebral fractures
– Studies too small to evaluate effect on hip fractures
• Adverse reactions: arthralgia, pain, nausea; warning about
osteosarcoma risk in rats
Neer RM, et al. N Engl J Med. 2001;344:1434-1441.
Forteo (prescribing information). Indianapolis, IN: Eli Lilly and Company; March 21, 2012.
Osteoporosis drugs efficacy
Compston J. UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteopor (2017) 12:43
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