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ACP Recommends Bisphosphonates as Initial Therapy for Osteoporosis
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EurekAlert!
The American College of Physicians (ACP) has issued an update of its guideline with clinical recommendations for treatments of primary osteoporosis and low bone mass in adults.
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Full read review of advances in bone biology leading to drug development (denosumab, romosuzumab, Burosumab), advances in Pagets and rickets and key regulatory molecules for bone remodeling, RANK, RANKL, OPG, & sclerostin https://t.co/1d6A6MsdbJ https://t.co/IuKEp1PQtr
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Dr. John Cush RheumNow ( View Tweet)
How Underweight Women Can Reduce Hip Fracture Risk
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EurekAlert!
How women can reduce the risk of hip fracture?
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Update on ACR Guideline on Prevention and Treatment of GIOP.
Sequential Rx when initial OP Rx and GC discontinued
https://t.co/TWdI728pCp
Mary Beth Humphrey #ACR22 @RheumNow https://t.co/i320si4RJp
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Dr. Antoni Chan synovialjoints ( View Tweet)
Updated ACR Guidelines on Prevention and Rx of GIOP
Rx recommendations when new fractures occur after 12 months of initial OP Rx
https://t.co/TWdI728pCp
Mary Beth Humphrey #ACR22 @RheumNow https://t.co/wHANvymd5R
Links:
Dr. Antoni Chan synovialjoints ( View Tweet)
#ACR22 #Osteoporosis Guidelines Case Example:
The FRAX score needs to be adjusted (multiply by 1.15 or 1.2) in pts who are expected to have cumulative dose >5 grams/year of steroids @rheumnow https://t.co/wF8LP0iZjw
TheDaoIndex KDAO2011 ( View Tweet)
Dr. B Humphrey #ACR22 #Osteoporosis Guidelines:
Treatment algorithms for GIO and in special populations (age < 18) @rheumnow https://t.co/dZ02kuOUeH
TheDaoIndex KDAO2011 ( View Tweet)
14M111 Updated ACR Guidelines for Glucocorticoid-Induced Osteoporosis #ACR22 🦴🦴
Initial Fracture Risk Assessment - by age - remember: no FRAX scores <40 yo
Fracture re-assessments every 1-2 years with repeat BMD and risk stratifications
@RheumNow https://t.co/QlCVM1lDb0
Eric Dein ericdeinmd ( View Tweet)
Dr. B Humphrey #ACR22 #Osteoporosis Guidelines:
in patients under 40 yo, you cannot calculate #FRAX score, assess BMD and in children get also thoracolumbar xrays. Get repeat testing every 1-2 years #ACR22 @rheumnow https://t.co/CgsvzGKYuV
TheDaoIndex KDAO2011 ( View Tweet)
14M111 Updated ACR Guidelines for Glucocorticoid-Induced Osteoporosis #ACR22 🦴🦴
Reminder: Recalculate FRAX scores with scaling for prednisone equivalent dosing!
Use other clinical fracture risk assessments
@RheumNow https://t.co/qZDlb1Cij7
Eric Dein ericdeinmd ( View Tweet)
Staggering stats after a #osteoporosis hip fracture!
40% cannot walk independently
30% have a permanent disability
20% mortality in surgically fixed hip
40% mortality if not surgically fixed. -Dr. M Humphrey #ACR22 @rheumnow https://t.co/DSYQjDw6pW
TheDaoIndex KDAO2011 ( View Tweet)
ATOM study, Abs 1314, greater proportion of men with OP on abaloparatide vs placebo met the definition of a >3% responder at the LS, TH, and FN. #ACR22 @RheumNow https://t.co/q6gcX5Azts https://t.co/WEjqbl14ZN
Dr. Rachel Tate uptoTate ( View Tweet)
Benefits with receiving anabolic agents upfront before antiresoprtives (as opposed to other way around). Shame about lack of access to this sequence currently
@RheumNow #ACR22 #osteoporosis https://t.co/S2ttbrVaab
Julian Segan JulianSegan ( View Tweet)
Romo works even better in higher risk patients. More ammunition to use up-front. Availability is a limiting factor though.
@RheumNow #ACR22 #osteoporosis https://t.co/90X97jVJcP
Julian Segan JulianSegan ( View Tweet)
Emphasis that drug holiday is NOT drug retirement in osteoporosis. Ideal time to re-initiate is quite uncertain however. Continue to monitor DEXA and fracture risk factors.
@RheumNow #ACR22 #osteoporosis https://t.co/iLKrxdzpAR
Julian Segan JulianSegan ( View Tweet)
Atypical femoral fracture risk increases over time. Risk decreases slowly as well with time off treatment. Absolute risk remains relatively low however.
@RheumNow #ACR22 #osteoporosis https://t.co/pcIfhRW4WJ
Julian Segan JulianSegan ( View Tweet)
Good BMD gains in switching BP->denosumab, especially in first few years. #sequentialtherapy
@RheumNow #ACR22 #osteoporosis https://t.co/t1hItKn8sB
Julian Segan JulianSegan ( View Tweet)
Osteoporotic fx in AS
Abstract #0388 #ACR22 @RheumNow
🦴2k adults in RISE, mean age 68y, 44% female, 76% white
🦴Higher risk with: older age, increased comorbidity index, OP history, chronic use of opioids, low BMI
🦴Men and women were equally likely to fracture
Catherine Sims, MD DrCassySims ( View Tweet)
Limited utility for using bone turnover markers in osteoporosis. Perhaps useful to assess adherence to oral therapy.
@RheumNow #ACR22 #osteoporosis https://t.co/g6f7SnOzNR
Julian Segan JulianSegan ( View Tweet)
Ab0575 #ACR22 MI/CVA in Osteoporosis Pts on DEN/ ZOL, L Spangler
DEN pts more likely CKD, adjusted analysis
At 36 mos, risk for Den vs Zol in 2 database claims:
- MI: 0.97, 1.22 (0.8-1.7)
- CVA: 0.9 (0.6-1.2), 1.0
No incr. risk identified with Den vs Zol in MI or CVA
@RheumNow https://t.co/hgyG1ZmFLT
Eric Dein ericdeinmd ( View Tweet)