When to Treat Osteoporosis Alan Jacobs M.D. Arthritis Center

8/14/2019 When to Treat Osteoporosis Alan Jacobs M.D. Arthritis Center

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When to Treat Osteoporosis

Alan Jacobs M.D.

Arthritis Center of NebraskaLincoln, Nebraska


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We are like twigsbut green is better than brown

calculate how green you are


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Treatment Concerns

Too many young people are being treated who are not at animmediate risk of a fracture


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Treatment Concerns


Long-term complications of treatmento ONJ - osteonecrosis of jawo "frozen bone" adynamic fractureo eye inflammation


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Treatment Concerns


Long-term complications of treatmento ONJ - osteonecrosis of jawo "frozen bone" adynamic fractureo atrial fibrillationo eye inflammation

Too much emphasis on BMD


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Treatment Concerns


Long-term complications of treatmento ONJ - osteonecrosis of jawo "frozen bone" adynamic fractureo atrial fibrillationo eye inflammation

Too much emphasis on BMD T-score misinterpretations


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Risk - predicting the future

"Relative risk" - old method in osteoporosis predictiono "It is twice as likely to rain today than 1 year ago"

"Absolute risk" - new method with FRAXo "There is an 80% chance of rain today"

We finally have a useful tool!


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Calculate an absolute risk with

FRAX

WHO Fracture Assessment Tool

http://www.shef.ac.uk/FRAX/index.htm


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FRAX - fracture risk over 10 years

WHO project - NOF, IOF endorsed Web based calculation compilation of fracture studies and risk factors applies to men and women above 40 varies according to the country and race

BMD is not needed treatment suggestions based on FRAX vary according to country

and cost of medication


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FRAX risk factors

age ht/weight parental hip fracture rheumatoid arthritis

glucocorticosteroid use

explained on Web site

past fractures smoking alcohol use secondary osteoporosis

femoral neck T-score


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Treatment guidelines

"Cost-effective" for standard treatments if:o greater than 20% Major Fracture 10 year risko or greater than 3% Hip Fracture 10 year risk


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T-score conversion

FRAX patch utility - http://www.nof.org/frax_patch_full.htm


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What FRAX does

reduces treatment for younger people increases treatment for older people ability to discuss absolute risk with the patient

Does not address prevention of bone loss other risk factors BMD in other sites


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Vertebral fracture detection

criteria for treatment 2/3 fractures are asymptomatic often neglected plain x-rays ok but VFA better


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VFA - vertebral fracture analysis

from T4 to L4 manually determine the borders minimal x-ray exposure


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VFA or IVA

vertebral fracture analysis computer evaluation of the rectangular shape of the vertebra with

comparisons to the adjacent ones useful for subtle fracture detection and serial comparisons


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Results of VFA


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When to Treat Osteoporosis ?


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NOF Treatment Guidelines - 2008

Women and men over age 50:

1. A vertebral or hip fracture


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2. Low bone mass and a US-adapted WHO 10-year probability of ahip fracture 3% or 10-year probability of any major osteoporosis-

related fracture 20%


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3. A DXA hip (femoral neck) or spine T-score -2.5


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3. A DXA hip (femoral neck) or spine T-score -2.54. Patient preferences may indicate treatment for people with 10-year

fracture probabilities above or below these levels


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Review the slides

http://alan.jacobs.googlepages.com/FRAXor

http://tinyurl.com/treatingosteoporosis

URL of FRAX

http://www.shef.ac.uk/FRAX/index.htm

Patient Video

http://www.nebraskaarthritis.com/resources.htm

When to Treat Osteoporosis Alan Jacobs M.D. Arthritis Center

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