Osteoporosis fracture risk

Osteoporosis is a skeletal disorder characterized by compromised bone strength predisposing individuals to an increased fracture risk. 

The drug reduces fracture risk in postmenopausal women, but no fracture data are available in men. Lumbar spine BMD increases are higher than with any other osteoporosis therapy. Although wrist BMD is decreased, wrist fractures are not increased. 

Ettinger B, Black DM, Mitlak BH, Knickerbocker RK, Nickelsen T, Genant HK (1999) Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene. Results from a 3-year randomized clinical trial. J Am Med Assoc 282 637-645. Corrections published in J Am Med Assoc 282 2124... 

Delmas PD, Ensrud KE, Adachi JD, Harper KD, Sarkar S, Gennari C, Reginster JY, Pols HAP, Recker RR, Harris ST, Wu W, Genant HK, Black DM, Eastell R for the Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators (2002) Efficacy of raloxifene on vertebral fracture risk reduction in postmenopausal women with osteoporosis four-year results from a randomized clinical trial. J Clin Endocrinol Metab 87 3609-3617... 

Women with osteoporosis, either densitometric or established, and some cases of osteopenia with increased fracture risk require pharmacological intervention. Any intervention for osteoporosis is expected to be long lasting. Thus it is difficult to expect that interventions in young postmenopausal women could be maintained for the remainder of one s fife. The susceptibility to side effects changes either with the process of aging or the repeated use of a given product. Sequential treatment schedules, adapted to the risk profile of each period, would probably be more suitable. 

Black DM, Thompson DE, Bauer DC, Ensrud K, Musliner T, Hochberg MC et al. (2000) Fracture risk reduction with alendronate in women with osteoporosis the Fracture Intervention Trial. FIT Research Group. J Clin Endocrinol Metab 85 4118-4124... 

Ettinger B, Black DM, Mitlak BH et al. (1999) Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene results from... 

WHO (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser 843 1-129... 

Osteoporosis is a metabolic bone disease characterized by low bone mass and micro-architectural deterioration of bone tissue. This will lead to bone fragility and consequent increase in bone fracture risk. Mean bone mineral density (BMD) is measured with dual X-ray absorptiometry (DEXA) and expressed in Tsc (Tscore). WHO standards are a Tsc that is 1 standard deviation (SD) below mean BMD is graded as normal bone, Tsc between 1 and 1.5 SD below mean BMD is graded as osteopenia and a Tsc of more than 2.5 SD below mean BMD is graded as osteoporosis. When the Tsc is below 1.5 SD mean BMD prevention of osteoporosis must be initiated. Primary osteoporosis is caused mainly by hormone deflciency in both women and men. Secondary osteoporosis may result from endocrine, metabolic, nutritional and autoimmune causes or from immobility because of trauma. Also the use of medicaments such as corticosteroids may be contributing. 

Example 1.2 Bone Mineral Density (BMD) and Fracture Risk in Osteoporosis... 

Li, Chines and Meredith (2004) quote three clinical trials evaluating the effectiveness of alendronate, risedronate and raloxifene in increasing BMD and reducing fracture risk in osteoporosis. These treatments are seen to reduce fracture risk by similar amounts 47 per cent, 49 per cent and 46 per cent respectively, yet their effects on increasing BMD are somewhat different 6.2 per cent, 5.8 per cent and 2.7 per cent respectively. Drawing conclusions on the relative effectiveness of these treatments based solely in terms of the surrogate BMD would clearly be misleading. 

Caution [C, /-] Contra Active varicella Infxn, serious Infxn except TB, fungal Infxns Disp Table VI-1 SE T Appetite, hyperglycemia, -i- K+, osteoporosis, nervousness, insomnia, steroid psychosis, adrenal suppression, fat redistribution, hypertension EMS Acute adrenal insufficiency can result w/ hypotension and shock if chronic steroids are abruptly stopped. Sxs can include abd pain, tach, confusion, hypotension, and chills. Support w/ IV fluids and steroid admin. GI perforation w/ chronic use. Can T Infxn risk and fracture risk from osteoporosis. Steroid psychosis can cause anxiety, agitation, euphoria, insomnia, mood swings, personality changes, depression, and memory loss usually at does of prednisone over 20 mg/d OD Acute hyperglycemia supportive care... 

Ringe JD, Dorst A, Faber H, Ibach K, Sorenson F. Intermittent intravenous ibandronate injections reduce vertebral fracture risk in corticosteroid-induced osteoporosis results from a long-term comparative study. Osteoporos Int 2003 14 801-7. 

Although studies in which biochemical markers of bone turnover are measured for periods of 1-2 months do not predict the development of bone thinning, osteoporosis, or fracture, they can be useful in comparing the potential effects on bone of different glucocorticoids. Studies of bone mineral density over longer time periods relate more directly to osteoporosis and fracture risk. 

Meunier PJ. Evidence-based medicine and osteoporosis a comparison of fracture risk reduction data from osteoporosis randomised clinical trials. Int J Clin Pract 1999 53(2) 122-9. 

Since women have a lower initial bone mass than men their fracture risk is higher. Osteoporosis is reversible in premenopausal patients after gonadorelin withdrawal (56). However, the treatment period should be limited to 6 months. 

Teriparatide Forteo (Lilly) Osteoporosis with fracture risk Bone mass increase in hypogonadal men... 

Osteoporosis is the most prevalent metabolic bone disease in the United States and results in 1.5 million fractures each year. Osteoporosis is associated with an increased risk for vertebral, hip, and distal forearm fractures. At age 50, women have a lifetime fracture risk (any of the above three sites) of about 40%. Men have a lifetime fracture risk of approximately one third that of women. Since trabecular bone turns over at five to seven times the rate of cortical bone, fractures of bones that are predominantly trabecular (vertebra and distal forearm) occur earlier in life. One third of women older than 65 years suffer vertebral crush fractures. Vertebral crush fractures can occur acutely and result in disabling pain and discomfort. Long-term complications include immobility and loss of height. Secondary problems include protuberant abdomen, chronic constipation, and loss of self-esteem. Fractures of bone with more cortical bone (proximal femur or hip) occur later in life. For women, the lifetime risk of hip fracture is 15%. The mortality rate accompanying hip fracture may be as high as 20%. Twenty-five percent of the survivors are confined to long-term care... 

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