Table of Contents
1.
Osteoporosis: Prevalence, Diagnosis
2.
Osteoporosis:
3.
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4.
Osteoporosis:
5.
Human Costs of Osteoporosis
6.
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7.
Incidence of Osteoporosis and Osteopenia
8.
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9.
Osteoporosis: Identifying the Problem
10.
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Relationship Between BMD and
14.
Correlates with life time fracture risk for Caucasian Women
15.
Utility of bone densitometry
16.
What is the rationale for expecting that improvements in bone density will be associated with reduction in fracture risk?
17.
Relationship Between BMD and
18.
How to deal with the patient whose bone density is in the osteopenic range (AACE Guidelines)
19.
Design Longitudinal, observational study of postmenopausal women in the U.S. Objectives To describe the occurrence of low bone mineral density (BMD) in postmenopausal women, its risk factors, and fracture incidence during short-term follow-up Study Participants 200,160 postmenopausal women aged 50 and older not previously assessed, or diagnosed with “osteoporosis”
20.
Fracture Rate Ratio Within
21.
1-Year-Risk of New Fracture by T-score Category: all Caucasian NORA women
22.
Fracture Rates, Population T-Score Distribution and
23.
How to deal with the patient whose bone density is in the osteopenic range (AACE Guidelines)
24.
How to deal with the patient whose bone density is in the osteopenic range (AACE Guidelines)
25.
Other Factors that Contribute to Fracture Risk
26.
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27.
Other Factors that Contribute to Fracture Risk
28.
The Importance of One Vertebral Fracture
29.
The Osteoporotic Fracture Does Not Often
30.
Osteoporosis Treatment Rate after Fracture Decreases with Age as Fracture Incidence Rises
31.
SECONDARY CAUSES OF OSTEOPOROSIS
32.
Case Study: Joan, Age 50
33.
Is this post-menopausal osteoporosis?
34.
Primary osteoporosis (postmenopausal or age-related) Secondary osteoporosis (caused, wholly or in part, by other diseases or medications) Other bone diseases Osteogenesis imperfecta Osteomalacia
35.
Some Causes of Secondary Osteoporosis in Adults
36.
Most Common Causes of Secondary Osteoporosis
37.
Low BMD and Other Factors Multiply Risk
38.
How Often Do Healthy Women with Osteoporosis Have Unsuspected Disorders?
39.
Osteoporotic Women with New Diagnoses
40.
Case Study: Joan
41.
All patients deserve at least a limited laboratory evaluation prior to treatment Consider additional testing or referral if Z-score is less than -1.5 or -2.0 without a known cause
42.
Evaluation of the Patient
43.
Patient Joan: Lab Tests
44.
Correction of Vitamin D Deficiency
45.
Patient Joan:
46.
Low T-score
47.
Therapies of osteoporosis
48.
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50.
CALCIUM CONTENT OF MEDICINAL SALTS
51.
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EXERCISE, SMOKING, ALCOHOL
53.
Therapies of osteoporosis
54.
Estrogen Therapy….
55.
Women’s Health Initiative
56.
WHI HRT Study
57.
WHI HT Study: Combination Arm
58.
Women’s Health Initiative
59.
Women’s Health Initiative
60.
WHI: Conclusions regarding the skeleton
61.
Effect of Estrogen Withdrawal on Spine BMD in Early Postmenopausal Women: The EPIC Study
62.
How to deal with the patient whose bone density is in the osteopenic range (AACE Guidelines)
63.
Therapies of osteoporosis
64.
Effects of Raloxifene on New Vertebral
65.
Effects of Raloxifene on Nonvertebral
66.
Effects of Raloxifene on BMD:
67.
Impact of Raloxifene on Bone Markers:
68.
Effect of Raloxifene on the Risk of Invasive Breast Cancer: The MORE Trial–48 Months
69.
Raloxifene Summary
70.
THE FUTURE OF SERMS AND ESTROGEN-LIKE MOLECULES
71.
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72.
Bisphosphonates
73.
Bone Density
74.
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75.
Risedronate (VERT-Multinational study)
76.
Risedronate (VERT:Multinational study)
77.
Risedronate Effect on Hip Fracture
78.
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79.
Risedronate: Annualized Incidence of
80.
Antifracture Efficacy of Antiresorptive Agents
81.
slide 81
82.
FACTORS TO ACCOUNT FOR IN RELATING CHANGES IN BONE DENSITY TO REDUCTIONS IN FRACTURE RISK
83.
CHARACTERISTICS OF THE REDUCTION IN FRACTURES BY BISPHOSPHONATES
84.
First Year Risedronate Effect on
85.
Evidence for Reduction in Risk of Radiographic New Vertebral Fracture at 1 Year (Prospective Studies)
86.
GLUCOCORTICOID-INDUCED OSTEOPOROSIS
87.
Therapeutic uses of glucocorticoids
88.
STEROIDS ARE USED FOR EVERYTHING EXCEPT CUSHING’S DISEASE
89.
Lumbar Spine BMD
90.
Reduction in Risk of New Vertebral
91.
CHARACTERISTICS OF THE REDUCTION IN FRACTURES BY BISPHOSPHONATES
92.
Change in BMD and Reduction in Fracture
93.
Effects of raloxifene on BMD
94.
Relationship Between Change in Femoral Neck BMD and Vertebral Fracture Risk
95.
Just as other factors, besides a reduction in bone mineral density, contribute to increased fracture risk…. other factors, besides an increase in bone mineral density, contribute to a reduction in fracture risk
96.
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97.
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98.
Bone turnover is an independent risk factor for fracture
99.
100.
Reduction of Turnover
101.
Antiresorptives reduce bone remodelling
102.
Reductions in bone turnover help to account for fracture reduction with antiresorptive therapy
103.
Change in uCTX and vertebral fracture risk: the VERT trial
104.
Can we lower turnover too much?
105.
Microcracks in Dogs Treated with High Doses of Bisphosphonates
106.
How long should they be used?
107.
slide 107
108.
ALENDRONATE: TEN-YEAR EXPERIENCE
109.
slide 109
110.
-GI Events
111.
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112.
Microanalysis of Bone Architecture From
113.
Risedronate Preserves Bone Microarchitecture
114.
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Alendronate Increases Bone Mineralization
116.
Change in Degree of Bone Mineralization
117.
Visualization of Trabecular Remodeling Areas
118.
Visualization of Trabecular Remodeling Areas
119.
Positive effects on essential bone qualities contributing to bone strength are important for the optimal therapeutic effect:
120.
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121.
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122.
Anabolic Agents as Potential Therapies
123.
ANABOLIC
124.
Anabolic Agents as Potential Therapies
125.
slide 125
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slide 126
127.
PTH Mode of Administration, Timing and Dose Determine whether PTH is anabolic or catabolic in the rat skeleton
128.
Mode of Administration and Dose Determine the Effect of PTH on Bone
129.
PTH and Dose Determine Effect on Bone
130.
Teriparatide [hPTH(1-34)] in Women and Men
131.
PTH (1-34) in Postmenopausal Women
132.
rhPTH (1-34) Increases Lumbar Spine and
133.
Effect of Teriparatide on Incidence of Vertebral
134.
Monotherapy With rhPTH (1-34) in
135.
Effect of PTH on BMD in Glucocorticoid-induced Osteoporosis
136.
Glucocorticoid-Induced Osteoporosis
137.
Fracture-Associated Height Loss
138.
hPTH (1-34) Trial in Men With
139.
Bone Density: 30 Months of hPTH (1-34)
140.
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Differences in Kinetics of Bone Formation
142.
Anabolic therapy has generated
143.
PTH Increases Bone Formation Markers
144.
PTH as an Anabolic Agent for Bone:
145.
Antifracture Efficacy of
146.
Cellular Mechanisms
147.
Teriparatide
148.
hPTH(1-34) Treatment Markedly Increases Bone Forming Surfaces
149.
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150.
rhPTH (1-34) Increases the
151.
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152.
Effect of teriparatide on microarchitecture: biopsies before and after hPTH(1-34)
153.
Effect of Teriparatide on Trabecular Connectivity
154.
Effect of Teriparatide on Cortical Bone Thickness
155.
Jiang et al, J Bone Miner Res. 2003
156.
Improved Trabecular Connectivity
157.
Positive effects on essential bone qualities contributing to bone strength are important for the optimal therapeutic effect:
158.
Safety of rhPTH (1-34):
159.
Rat Toxicity Data Are Unlikely to Be
160.
Teriparatide [hPTH(1-34)] in Women and Men
161.
Awareness