Transcript Osteoporosis Acove - Medical University of South Carolina
Aging Q3 ACOVE #9 Osteoporosis
Jay Brzezinski, MD Medical University of South Carolina 2011
Osteoporosis ACOVE Work Group
Dr. Jay Brzezinski, Chair Dr. Bill Moran Dr. Pam Pride Dr. Leonard Lichtenstein Dr. Amy Thompson Dr. Brad Keith Dr. Lara Hourani Tamela Sill, RN
25 million Americans have osteoporosis ½ of all post-menopausal women will have an OP related fracture Up to 20% of hip fracture patients die in one year Usually asymptomatic until fracture occurs
Trabecular bone Also called Cancellous bone Vertebral body bone Bone near joint lines Has bone marrow Light weight Has spiculated pattern
Cortical bone Compact bone Long bones Dense Stiff hard heavy
Trabecular bone, 25% replaced per year Cortical bone, 3% replaced per year Osteoporosis occurs in both It makes sense that trabecullar bone fractures easier?
Age Gender Prior fracture Family history Exercise Smoking RA ETOH Drugs….steroids
SCREENING( i.e. asymptomatic)
All women at age 65 Women under 65 with FRAX score >9.3% 9.3% is risk of asymptomatic woman age 65 A previous fracture? We are not screening now!
How to Screen
DEXA is best Heel quantitative ultrasound??
Dual energy x-ray absortiometry One x-ray beam is absorbed by soft tissue One x-ray is absorbed by everything Subtract the two and get bone Problem with ordering a screening BMD on PP???
– Diagnosis: “Pre Menopausal”
-1.0 or better is normal Lower than -2.5 is osteoporosis -1.0 to -2.4 is osteopenia What if I have had a compression fracture?
What if I had a hip replaced?
Calcium Vitamin D Should I measure What does it mean Will replacement help Exercise??
alendronate (Fosamax ® ) 70 mg qweek Ibandronate (Boniva ® ) 150 mg qmonth risedronate (Actonel ® ) 5 qday,35 qweek, 150 qmonth Zoledronic acid (Reclast ® ) qyear IV
Teriparitide sq qday times 2 years Risk…osteosarcoma Used to treat osteoporosis with prior fracture or high risk who cannot take bisphosphonates
How long to Treat?
Until BMD better?
Bisphosphonates accumulate in bone and after stopping leach out over 1-2 years
Mild risk: rx 5 years and follow BMD High risk: rx 10 years and do 1-2 year drug holiday
When to rescan
Normal with no risks: 3-5 year Risk factors that persist: 2 years High risk after menopause: 2 years Treated patients: 2 years than less if responding
Osteonecrosis of jaw=>60,000 and most occurred in cancer patients treated with very high dose zoledronic acid Atypical femur fracture=? 25,000?
Any Fracture = 21 Vertebral Fracture = 8 Hip Fracture = 35 - 46 Other Fracture = 21 - 43
No Prior Fracture
100 29 4.5 - 66 35 – 66
Osteoporosis Blue Sheet
Osteoporosis Aging Q3 ACOVE # 9
Have you ever had a DXA scan (bone density) for osteoporosis? 4.
Have you ever had a fractured bone?
PCT MD ACTION: CIRCLE: YES or NO
YES NO YES NO 1a. If
, Is the DXA documented in Practice Partner? 1b. If
, Was the patient referred for a 2.
DXA? Was the patient’s risk of fracture 3.
(FRAX) calculated? Did the patient’s FRAX score influence any clinical decisions in today’s visit? 4.
, 4a. Did you do a fracture history? 4b. Did the fracture history indicate any need for change in medications or further treatment? If
– No further action needed
CHECK: YES NO MD
Screening FRAX DXA o 65+Female with no Dx of Osteoporosis o 65+ Female with previous fracture but no DXA
Osteoporosis Detailing Sheet
Aging Q 3 Osteoporosis and Aging ACOVE #9 An estimated 25million Americans have osteoporosis. It affects elderly people of all races and ethnicities. 20-25% of persons with a hip fracture are unable to return to independent living and 12-20% die within 1 year. Risk Factors Age Gender Previous fracture Family history Low BMI Physical activity Currently smoking Alcohol use Steroid use * Rheumatoid arthritis *Note: If patient uses >5 mg/day Prednisone or equivalent < 3 months: Warning > 3 months: Rx Bisphosphonate Treat Fracture 65+ Female (Major trauma NA) DXA (Baseline) No Fracture DXA and FRAX http://www.shef.ac.uk/FRAX/tool.jsp?country=9 Look for the FRAX at: FRAX should not be used with persons on treatment for osteoporosis. Treat Treat Treat Screening
DXA for all Women 65+ years
Diagnosis T-Score Osteoporosis ≤ -2.5 Osteopenia -1.0 to - 2.4 Normal > -1.0 False Positives with Compression Fractures No Treatment >-1.0 DXA < -2.5 -1.0 to - 2.4 DXA ≥ 3% FRAX (Hip Fracture) ≥ 20% FRAX (Osteoporotic Related Fracture)
Practice Partner Template Progress Notes
If patient is age 65 or over and female, has the patient ever had a DXA scan?
If patient is 65 or over and female, has the patient’s risk of fracture (FRAX) been calculated?
Does the patient report ever having a fractured bone?
Osteoporosis ACOVE begins in clinic Thursday, July 21, 2011 Thanks for supporting Aging Q