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How Underweight Women Can Reduce Hip Fracture Risk

Nov 28, 2022

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 Mary Beth Humphrey #ACR22 @RheumNow
Updated ACR Guidelines on Prevention and Rx of GIOP Rx recommendations when new fractures occur after 12 months of initial OP Rx Beth Humphrey #ACR22 @RheumNow
#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
Dr. B Humphrey #ACR22 #Osteoporosis Guidelines: Treatment algorithms for GIO and in special populations (age < 18) @rheumnow
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
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
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
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
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
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
Romo works even better in higher risk patients. More ammunition to use up-front. Availability is a limiting factor though. @RheumNow #ACR22 #osteoporosis
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
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
Good BMD gains in switching BP->denosumab, especially in first few years. #sequentialtherapy @RheumNow #ACR22 #osteoporosis
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
Limited utility for using bone turnover markers in osteoporosis. Perhaps useful to assess adherence to oral therapy. @RheumNow #ACR22 #osteoporosis
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
Ab0574 #ACR22: Osteoporosis in Men - Under-recognized? Under-Screened? Under-Diagnosed! @AMollaeianMD: Retrosp study >65 yo <1% M have DEXA compared to 7-10% in F in 2010, 2018, and 2021 Hip fx 4.1% F, 3% M DEXA declined in M between 2010-2018, no change in 2021 🦴🦴🩻 @RheumNow
Which one to use for prevention and which for treatment? Drugs covered by #Medicare based on indication #osteoporosis #acr22 #acrreview ⁦@RheumNow⁩
#osteoporosis baseline lab work should be completed to assess for secondary causes. DEXA is underutilized in men and should be considered especially in men with inflammatory disease Baseline labs: CBC, BMP, PTH, vit D, TSH, urine ca, testosterone #ACR22 @RheumNow
Medicare will cover #DXA testing for these diagnoses ⁦@RheumNow⁩ #acr22 #acrreview
Did You Know? FDA relaxed warnings on #sarcoma with #Forteo- can use more than 2 years ⁦@RheumNow⁩ #acr22 #acrreview #osteoporosis
Drug holidays for #osteoporosis RX but be note fracture risk may increase with these holidays- consider an anabolic agent during these times - Dr Tanner #acr22 ⁦@RheumNow⁩ #acrreview
Dr Tanner presents the features of AFF👇 It is rare, subtrochanteric in location and often appears w/n 5-10 yrs of BP use. #ACR22 @RheumNow #acrreview #osteoporosis