Transcript Yes

Osteoporosis Management:
Clinical scenario
Case 1
Status
Medical History
-Women, 49 y
- Asymptomatic
- BMD T-scores: -2.7
-Menopause: 45y
-Mother : hip fracture
at age of 79 y
Further examination?
Yes
Differentiation: Secondary osteoporosis
(Hypogonadism, thyroidism…)
Spinal X-ray?
Yes
Maybe asymptomatic vertebral fracture
(deformity)
No
Because the risk for the patient sustaining
a fracture in the next 10 y is low
Normal
Rx?
Vertebral fx
Yes
Because the risk for a
subsequent fx
is high
Rx?
Anti-resorption
(alendronate,
risedronate or
raloxifene)
Case 2
Status
-Women, 55 y
- Asymptomatic
- BMD T-scores: -1.5
Medical History
-Normal
NO
Further examination?
Considerable when having more
clinical evidence
Spinal X-ray?
Rx?
Normal
Rx?
Vertebral fx
No
calcium
dietary, vitamin D
Because the risk-Adequate
for the patient
sustaining
a fracture in the next 10 y is low
-Icrease weight-bearing exercise
Yes
-Prevent falls
Anti-resorption
Rx?
Because the risk for a
-Very low or ultra-low(alendronate,
HRT or oral
subsequent fx
or
bisphosphonates canrisedronate
be considered
is high
raloxifene)
Status
Case 3
Medical History
-Women, 65 y
- Frequent back pain
- HRT: undesired
-Menaupause: 50y
-Lose ht: 8cm
-Prior fx (distal radius)
Further examination?
Yes
Measure BMD
Spinal X-ray?
Yes
Maybe vertebral fracture (back pain)
Depend
-Osteoporosis: YES
-Non-osteoporosis: NO
Normal
Rx?
Rx?
Vertebral fx
Yes
Anti-resorption
(alendronate,
risedronate or
raloxifene)
Status
Case 4
-Men, 80 y
- Arrival with hip fracture
(fall from standing height)
Medical History
- Difficult to keep balance
when standing
- Susceptible to fall
Further examination?
NO
Spinal X-ray?
NO
Apparently Clinical features
Normal
Rx?
Rx?
Vertebral fx
Anti-resorption
(alendronate,
risedronate or
raloxifene)
Status
- Women, 45 y, teacher
- No height loss.
- Body weight at average
of age group.
- Expiratory wheeze noted.
- BP: 140/82
- BMD T-scores: -2.6
- Lab test results:
 sCa: 8.9 (normal: 8.6-10.2)
 normal CBC
 normal cholesterol
 24-hour urine calcium:
50 mg
 25 OH vitaminD:8ng/mL
(normal: > 20).
Case 5
Medical History
- Never use HRT
- Had asthma since
childhood, current
medications: b.i.d. steroid
inhale+ glucocorticosteroid 56 times/y for 2-6 wk for
exacerbations.
- Diagnosed with a seizure
disorder at aged 20y,
currently well controlled with
Phenytoin 300mg/d.
- Currently use multivitamin
daily
-No history of osteoporotic
fracture.
- Surgical menopause five
years previously
Comments
Case 5
- BMD much lower than
expected level for her age
- Several risk factors for
secondary osteoporosis:
Summary
This case is a timely reminder
that not all low bone density is
simple osteoporosis. Several
potential causes of secondary
osteoporosis needed to be
addressed before she could
be treated successfully for
- early surgical menopause
- chronic exposure to
anticonvulsants
- corticosteroids use
- Vitamin D defficiency +
seizure  high risk of fall
Further examination?
- HRT is suitable
- Bisphosphonates
Rx?
NO