Now with @sonali_khandy on #osteoporosis at #ACR22
BISPHOSPHONATES
Alendronate- FIT, FLEX ('00, '06)
Zolendronate- HORIZON ('03, '12)
- BMD decline at all sites
- IOF recs assessing bone formation (P1NP) and bone resorption CTX (ltd evid)
#ACRAmbassador
BISPHOSPHONATES
Alendronate- FIT, FLEX ('00, '06)
Zolendronate- HORIZON ('03, '12)
- BMD decline at all sites
- IOF recs assessing bone formation (P1NP) and bone resorption CTX (ltd evid)
#ACRAmbassador
Rx length of bisphos
- postmenopause not severe - consider drug holiday at 5yr for oral, 3 yr for IV
Bisphosph = prolonged skeletal retention
- off the drug may reduce ONJ / AFF
- holiday lengths may depend on various factors
- binding affinity highest w ZOL, lowest w RIS
#ACR22
- postmenopause not severe - consider drug holiday at 5yr for oral, 3 yr for IV
Bisphosph = prolonged skeletal retention
- off the drug may reduce ONJ / AFF
- holiday lengths may depend on various factors
- binding affinity highest w ZOL, lowest w RIS
#ACR22
drug holiday doesn't mean stopping everything else
-cont exercise/vit/fall prevention
- DEXA
- clinical fx RF assessment
- can trend BTMs (controversial)
#ACR22 #ACRAmbassador
-cont exercise/vit/fall prevention
- DEXA
- clinical fx RF assessment
- can trend BTMs (controversial)
#ACR22 #ACRAmbassador
ONJ
- risk can be lowered with good oral hygiene, reg dental care
incidence 1/10-1/100K patient treatment years
- risk can be lowered with good oral hygiene, reg dental care
incidence 1/10-1/100K patient treatment years
Denosumab
FREEDOM:9% incr spine, 4-5% incr hip BMD
OLE: 10 yr a/w low risk of infxn, malig
๐๐พrisk of AFF 0.8/10K pt yr
๐๐พrisk of ONJ 5.2/10K pt yr
Bis --> denos = greater gains in BMD vs
Bis --> bis
greatest gains of bis-->deno where bis use < 3yr
#ACR22 #ACRAmbassador
FREEDOM:9% incr spine, 4-5% incr hip BMD
OLE: 10 yr a/w low risk of infxn, malig
๐๐พrisk of AFF 0.8/10K pt yr
๐๐พrisk of ONJ 5.2/10K pt yr
Bis --> denos = greater gains in BMD vs
Bis --> bis
greatest gains of bis-->deno where bis use < 3yr
#ACR22 #ACRAmbassador
๐จdrug holid w denosumab NOT RECOMMENDED๐จ
- rapid bone loss, incr bone markers
- incr risk of multiple vert fractures
- do not stop without replacing w alt Rx
๐๐พ dental work + denosumab: 4-5 mos post-Rx
#ACR22 #ACRAmbassador
- rapid bone loss, incr bone markers
- incr risk of multiple vert fractures
- do not stop without replacing w alt Rx
๐๐พ dental work + denosumab: 4-5 mos post-Rx
#ACR22 #ACRAmbassador
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