Osteoporosis
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Transcript of Osteoporosis
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Osteoporosis: Best EvidenceHitesh Gopalan U
Clinical Assistant Prof,Visiting Lecturer, McMaster University, CA
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Classification
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WHO DefinitionBone density that falls 2.5 standard
deviations (SD) below the mean for young healthy adults of the same sex—also referred to as a T-score of –2.5
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LabSerum CaPTH25(OH) Vit DUrine Ca
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High serum Ca (Hyperparathyroidism Vs Malignancy)
Low serum Ca (Osteomalacia)
HypercalciURIA: males with osteoporosis, Hyperparathyroidism, Paget’s disease, Hyperthyroidism
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Secondary OsteoporosisHypogonadal States: Turner, KlinefleterEndocrine conditions: Thyrotoxicosis,
Cushing’sGI conditions: Gastrectomy, Liver diseaseRheumatological: RA, ASHematologic Disorders: Multiple MyelomaInherited Conditions: OI, Marfan
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DEXACT ScanX-rays
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TreatmentEstrogen- beneficial- ↑ risk of Endometrial
Ca
Estrogen + Progesterone= ↑ Risk of heart disease/stroke
Tibolone
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What we Know
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SERMRaloxifene
Reduces risk of vertebral fractures
Reduced incidence of Ca Breast, Cardiovascular and Cerebrovascular Events
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BisphosphonatesAlendronate
Ibandronate
Risedronate
Zolendronic Acid
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BisphosphonatesOsteonecrosis of Jaw, Atypical
Subtrochanteric Fractures
? Ca oesophagus
Perthe’s Disease, Osteogenesis Imperfecta, AVN
Accumulates in the Body
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Bisphosphonates- # HealingIncrease BMD at # site- Single Dose
Does not interfere with fracture healing
Odvina et al.. J Clin Endocrinol Metab2005;90(3):1294–301.van der Poest Clement E, J Bone Miner Res 2000;15(3):586–93.
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TeriparatideRecombinant PTH
Daily injection
Cost
Osteogenic Ca
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CalcitoninNasal Spray
Paget’s Disease
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Kyphoplasty Vs Sham
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Denosumab
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FREEDOMFracture Reduction Evaluation of Denosumab
in Osteoporosis Every 6 Months (FREEDOM) Trial
No major adverse effects
Supported by AMGEN
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DenosumabHigher incidence of infections
Contraindicated in Hypocalcemia
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VEGF-A
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Hierarchy of Evidence
Randomized Trials
Prospective Cohort Studies
Retrospective Case Series
Case Control Studies
Opinion
Meta-analysis
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Ask
Acquire
AppraiseApply
Act
“EBM Begins and Ends with the Patient”
Evidence Cycle
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