Transcript osteoporosis - Lauren Phillips MD

Osteoporosis
Dr. Lauren Phillips
Sugar Land Women’s Health
Osteoporosis- What is it?
A common disorder resulting in
low bone mass, skeletal fragility,
and an increased risk of fracture
 15% of women over 50 have
osteoporosis
 1.3 million fractures per year in
the US

Bone Remodeling




Osteoblasts- bone forming cells
Osteoclasts- bone destroying cells
These cells must cooperate to
maintain adequate bone metabolism
Regulated by calcium, vitamin D,
estrogen, calcitonin, PTH, and
inflammatory markers called cytokines
Who is at risk?









Postmenopausal women
Previous fracture
Long-term steroid therapy
Low body weight (less than 58 kg [127 lb])
Family history
Cigarette smoking
Excess alcohol intake
Premature or surgical menopause, malabsorption,
chronic liver disease, inflammatory bowel disease
Caucasian or Asian ethnicity
Screening for
osteoporosis

Bone density testing:
Dual energy x ray absorpiometry (DXA)- most
useful and reliable test for measuring BMD (bone
mineral density). It’s a special type of x ray that
gives off little radiation.
Who should get
screened?




All women age greater than 65
Postmenopausal women with one or more
risk factors
No consensus regarding frequency of
screening; most practitioners make
individual recommendations for patients
based on age and risk factors
Typically every 2-5 years after menopause
or yearly if severely osteopenic or
osteoporotic
Measuring bone mineral
density


T score: the standard deviation (SD)
difference between a patient's BMD
and that of a young-adult reference
population
Z score: a comparison of the patient's
BMD to an age-matched population
(less than -2.0 is abnormal)
Diagnosing osteopenia
and osteoporosis


-
-
Measure T scores at spine and hip
T score values:
+1 to -1: normal bone density
-1 to -2.5: osteopenia
-2.5 and lower: osteoporosis
Treatment





All postmenopausal women with a history of
vertebral or hip fracture
Women with a T score of less than -2.5
(osteoporosis)
T-score between -1.0 and -2.5 (osteopenia) with
high risk of fracture such as glucocorticoid use or
total immobilization.
Osteopenia plus a 10-year probability of hip fracture
≥3 % or a 10-year probability of any major
osteoporosis-related fracture ≥20% based upon the
WHO algorithm.
www.shef.ac.uk/FRAX
Non pharmacologic
treatment
Calcium and vitamin D intake:
1200 mg/ day calcium and 800
mg vit D per day
 Exercise: weight bearing exercise
for at least 30 min 3 times a
week.
 Smoking cessation

Non Pharmacalogic
Therapy



Osteostrong.me- a wellness center
uses a BioDensity device to build bone
mass and promote muscle growth
Weekly visits with improvement each
week
4-7% increase in BMD after 12 months
Pharmacologic therapy






Bisphosphates: Fosamax, Actonel (taken
weekly) Boniva (taken monthly), Reclast (IV
once yearly)
Causes osteclasts to undergo apoptosis (cell
death)
First line therapy- can use safely 5-10 years
Must take on empty stomach and stay
sitting up for 30 min
Side effects typically mild and include GI
upset, flu like symptoms
Osteonecrosis of jaw approx 1/10,000
Pharmacolgic therapy




Raloxifene (Evista): a selective
estrogen receptor modulator.
Increases estrogen absorption in the
spine but not other organs. Also
decreases risk of breast cancer and
LDL cholesterol, but increases risk of
DVT slightly
Not as efficatious as bisphosphonates
or HRT.
May increase hot flashes
Pharmacologic Therapy



HRT- estrogen alone or estrogen plus
progesterone
Effective
Due to WHI study in 2002, no longer
used solely for the prevention or
treatment of osteoporosis. Exceptions
include women with persistent
menopausal symptoms and those who
cannot tolerate the other drugs.
Pharmacologic Therapy





Prolia- stops the production of osteoclasts
Injection twice a year
Not first line
Side effects related to injection,
hypocalcemia, infections
Not for people who have hypocalcemia,
malabsorption, kidney problems, have had
thyroid or parathyroid surgery
Goals of Therapy
Introduce/ continue healthy
lifestyle habits
 Prevent fractures!
 Slow or stop progression of bone
loss
 Improve T scores
 Re-evaluate every 1-2 years

Contact information
Dr. Lauren Phillips
17510 West Grand Parkway South
Suite 430
Sugar Land, TX 77479
713-578-3823
www.obgynassociates.com
www.mysugarlandobyn.com