Download Osteoporosis and Aging An estimated 25 million Americans have

Osteoporosis and Aging
An estimated 25 million Americans have osteoporosis. It affects elderly people of
all races and ethnicities. 20-25% of persons with a hip fracture are unable to return
to independent living and 12-20% die within 1 year.
Diagnostic Approach
Screening
Risk Factors
65+ Female
Age
Physical activity
Gender
Currently smoking
Previous fracture
Family history
Rheumatoid
arthritis
Low BMI
Alcohol use
DXA for all Women 65+ years
Fracture
(Major Trauma NA)
No Fracture
DXA (Baseline)
DXA and FRAX
Diagnosis
Osteoporosis
Osteopenia
Normal
Steroid use
>-1.0 DXA
Treat
T-Score
≤ -2.5
-1.0 to -2.4
> -1.0
False Positives with Compression
Fractures
No Treatment
Treatment
Drug
Bisphosphonates
(Reclast®, Fosamax®,
Alendronate®, Boniva®,
Actonel®)
Teriparatide
(Forteo®)
Route
IV/PO
MOA
Inhibits osteoclast-mediated
bone resorption
Oral drugs should be given on
an empty stomach with a fullglass of water, patient should
stay up-right for 30-min after
ingestion
Subq
Self
administered at
home
Stimulates new bone
formation
Not recommended for use
longer than 2-years
ADR
Atrial fibrillation, rash, injection
site reaction, abdominal pain,
constipation, nausea, diarrhea,
vomiting, indigestion,
flatulence, backache, asthenia,
headache,fatigue, fever,
influenza-like symptoms,
bronchitis, upper respiratory
infection
* Zoledronic acid (Reclast®)
should be avoided in patients
with CrCl <30 ml/min
Hypotension, syncope,rash,
sweating, hyperuricemia,
constipation, nausea, diarrhea,
vomiting, indigestion,
arthralgia, spasm, asthenia,
dizziness, increased frequency
of cough, pharyngitis, rhinitis
References: J Clin Epidemiol 50:683; Menopause 5:226; J New Zealand Med 119:1246; J Bone and Min
Res, 2010.
< -2.5
Treat
-1.0 to - 2.4 DXA
≥ 3% FRAX (Hip
Fracture)
Treat
≥ 20% FRAX
(Osteoporotic Related
Fracture)
Treat
To view the online FRAX
calculator, visit:
http://www.shef.ac.uk/FRAX/t
ool.jsp?country=9
FRAX should not be used with persons on treatment
for Osteoporosis
Aging Q3 is funded by the DW Reynolds Foundation