Osteoporosis and Bone Health Overview
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Questions and Answers

What factor is considered the most powerful risk factor for future fractures in individuals over 50?

  • Chronic medication use
  • Low bone mineral density (BMD)
  • A fracture (correct)
  • Previous history of falls

    • Which intervention can help prevent falls in at-risk patients?

  • Promotion of unsupervised mobility
  • Increasing physical activity without supervision
  • Using multiple medications that cause drowsiness
  • Formal home safety evaluation (correct)

    • What is the recommended action after a successful treatment of a fracture?

  • Discontinue all medications
  • Conduct further medical assessments and treatments (correct)
  • Opt for a wait-and-see approach
  • Avoid further evaluations to prevent additional costs

    • Which of the following is NOT a strategy to improve bone health?

    <p>Ignoring risk assessments for osteoporosis</p> Signup and view all the answers

    What are patients being treated for low BMD at high risk of?

    <p>Spontaneous fractures</p> Signup and view all the answers

    What is a significant consequence of a hip fracture in older adults?

    <p>Permanent inability to walk</p> Signup and view all the answers

    At what age do people typically begin to lose bone mass?

    <p>After age 30</p> Signup and view all the answers

    Which of the following is considered a non-modifiable risk factor for osteoporosis?

    <p>Family history of osteoporosis</p> Signup and view all the answers

    Which of the following is a FDA-approved bisphosphonate for osteoporosis treatment?

    <p>Ibandronate</p> Signup and view all the answers

    Which of these conditions can be a modifiable risk factor for weak bones?

    <p>Vitamin D deficiency</p> Signup and view all the answers

    What is the main mechanism of action for bisphosphonates?

    <p>Induce osteoclast apoptosis</p> Signup and view all the answers

    What is a common fracture site for individuals with weak bones?

    <p>Wrist</p> Signup and view all the answers

    For whom are bisphosphonates FDA-approved for increasing bone mass?

    <p>Both men and women on glucocorticoids</p> Signup and view all the answers

    How is osteoporosis primarily diagnosed?

    <p>Bone mineral density measurement</p> Signup and view all the answers

    How should bisphosphonates be taken for optimal absorption?

    <p>With plain water only, before food</p> Signup and view all the answers

    What is a symptom that may indicate the presence of osteoporosis?

    <p>Loss of height</p> Signup and view all the answers

    Which medication is associated with increased risk for osteoporosis?

    <p>Oral glucocorticoids</p> Signup and view all the answers

    What is a common clinical benefit of bisphosphonates in postmenopausal women?

    <p>Relative risk reduction for fractures</p> Signup and view all the answers

    What method is commonly used to measure Bone Mineral Density?

    <p>Dual-energy X-ray absorptiometry (DEXA) scan</p> Signup and view all the answers

    Which of the following blood tests is NOT typically done to investigate bone health?

    <p>Liver function test</p> Signup and view all the answers

    Who is advised to have a Bone Density Test according to current guidelines?

    <p>Men ages 70 and older</p> Signup and view all the answers

    What does a T-score of -2.5 indicate?

    <p>Osteoporosis</p> Signup and view all the answers

    What criterion indicates treatment for osteoporosis is cost-effective?

    <p>10-year fracture risk over 4%</p> Signup and view all the answers

    Which hormone levels are important for evaluating bone turnover?

    <p>Parathyroid hormone</p> Signup and view all the answers

    Which method can detect thoracic and lumbar vertebral fractures?

    <p>Plain film x-rays of lumbar spine</p> Signup and view all the answers

    What is the primary outcome of the Fracture Risk Assessment Tool (FRAX)?

    <p>Calculates fracture likelihood over the next 10 years</p> Signup and view all the answers

    What is one of the patient care goals related to fractures?

    <p>Enhance quality of life</p> Signup and view all the answers

    Which step focuses on improving muscle strength and balance?

    <p>Be physically active every day</p> Signup and view all the answers

    What type of exercise is considered weight-bearing?

    <p>Walking</p> Signup and view all the answers

    What is an appropriate treatment for vitamin D deficiency?

    <p>50,000 IU vitamin D weekly for 6-8 weeks</p> Signup and view all the answers

    Which dietary source is high in vitamin D?

    <p>Fortified milk</p> Signup and view all the answers

    Why is vitamin D important for older adults?

    <p>It helps improve muscle function</p> Signup and view all the answers

    What should individuals talk to their doctor about regarding bone health?

    <p>Bone density test results</p> Signup and view all the answers

    What does routine bone health monitoring involve?

    <p>Have a bone density test when appropriate</p> Signup and view all the answers

    What is one of the FDA-approved uses of bisphosphonates?

    <p>To treat glucocorticoid-induced osteoporosis in men and women</p> Signup and view all the answers

    What mechanism of action do bisphosphonates primarily employ?

    <p>Reducing osteoclastic activity and bone resorption</p> Signup and view all the answers

    How should a patient properly take bisphosphonates for optimal absorption?

    <p>At least half an hour before breakfast with plain water</p> Signup and view all the answers

    Which of the following is NOT an example of a bisphosphonate medication?

    <p>Teriparatide</p> Signup and view all the answers

    What is a key clinical benefit of bisphosphonates in osteoporosis treatment?

    <p>Reduction in the risk of spinal and hip fractures</p> Signup and view all the answers

    What is a critical component in the management of patients who have had a fracture after age 50?

    <p>Subsequent medical assessment and treatment to prevent future fractures</p> Signup and view all the answers

    Which of the following strategies is aimed at reducing the risk of falls in at-risk patients?

    <p>Conducting a formal home safety evaluation</p> Signup and view all the answers

    Which aspect is crucial for enhancing the treatment of patients with osteoporosis?

    <p>Developing strategies to improve patient adherence to treatment</p> Signup and view all the answers

    What are patients at high risk of if their Bone Mineral Density (BMD) remains low despite treatment?

    <p>High risk of fractures</p> Signup and view all the answers

    Which of the following is an essential step in fall prevention for individuals at risk?

    <p>Improving lighting in living areas</p> Signup and view all the answers

    What is the recommended duration for a drug holiday after treatment with bisphosphonates for lower risk patients?

    <p>3-5 years</p> Signup and view all the answers

    What side effect is associated with intravenous bisphosphonates like zoledronic acid?

    <p>Hypocalcemia</p> Signup and view all the answers

    How should bisphosphonates ideally be taken to ensure optimal absorption?

    <p>First thing in the morning with a full glass of water</p> Signup and view all the answers

    What is the typical administration route for zoledronic acid for osteoporosis treatment?

    <p>Intravenous infusion</p> Signup and view all the answers

    What may be a benefit of bisphosphonates despite concerns about long-term treatment?

    <p>A cumulative reservoir effect in bone</p> Signup and view all the answers

    Which of the following adverse effects is rare with bisphosphonate use?

    <p>Visual disturbances</p> Signup and view all the answers

    For which of the following patients may intravenous bisphosphonates be ideal?

    <p>Those with GI contraindications to oral formulations</p> Signup and view all the answers

    What additional supplementation is recommended for patients taking bisphosphonates?

    <p>Calcium and vitamin D</p> Signup and view all the answers

    What measurement does a DEXA scan primarily assess?

    <p>Bone mineral density</p> Signup and view all the answers

    What T-score range indicates osteopenia?

    <p>Between -1.0 and -2.5</p> Signup and view all the answers

    Which group is recommended to have Bone Density Tests?

    <p>Women age 65 and older</p> Signup and view all the answers

    Which investigation is NOT typically part of assessing bone health?

    <p>Blood glucose test</p> Signup and view all the answers

    When does treatment for osteoporosis become cost-effective according to fracture risk?

    <p>When the risk is over 4%</p> Signup and view all the answers

    What is the primary purpose of the FRAX tool?

    <p>To provide fracture risk probability</p> Signup and view all the answers

    What does a T-score of -2.5 indicate?

    <p>Diagnosis of osteoporosis</p> Signup and view all the answers

    Which marker is crucial for assessing bone turnover?

    <p>Parathyroid hormone levels</p> Signup and view all the answers

    What is the recommended daily intake of vitamin D for individuals aged 50 and above?

    <p>800-1000 IU</p> Signup and view all the answers

    Which factor does NOT affect the amount of vitamin D produced in the body?

    <p>Level of physical activity</p> Signup and view all the answers

    Calcium carbonate requires what to dissolve and be absorbed effectively?

    <p>Stomach acid</p> Signup and view all the answers

    Why might individuals aged 50 and over require supplementation of vitamin D?

    <p>They often have lower stomach acid production.</p> Signup and view all the answers

    What is the maximum combined daily total of vitamin D recommended from food and supplements?

    <p>2000 IU or 50 mcg</p> Signup and view all the answers

    Which of the following statements best describes the relationship between calcium and vitamin D absorption?

    <p>Vitamin D enhances calcium absorption.</p> Signup and view all the answers

    When taking calcium citrate, when can it be consumed?

    <p>Anytime, regardless of meals</p> Signup and view all the answers

    What should be a consideration when choosing a calcium supplement?

    <p>Consult with a healthcare provider about individual needs.</p> Signup and view all the answers

    Which of the following conditions is NOT treated with bisphosphonates?

    <p>Rheumatoid arthritis</p> Signup and view all the answers

    What is the primary effect of bisphosphonates on osteoclasts?

    <p>Induce their apoptosis</p> Signup and view all the answers

    Which of the following is a characteristic of Selective Estrogen Receptor Modulators (SERMs) used in osteoporosis treatment?

    <p>They mimic estrogen's beneficial effects on bone.</p> Signup and view all the answers

    Which of the following bisphosphonates is specifically indicated for increasing bone mass in men?

    <p>Risedronate</p> Signup and view all the answers

    What is the recommended method for taking bisphosphonates to ensure optimal absorption?

    <p>At least one-half hour before food with plain water</p> Signup and view all the answers

    What is a common symptom that may suggest the presence of osteoporosis in an individual?

    <p>Loss of height</p> Signup and view all the answers

    Which of the following risk factors is considered non-modifiable?

    <p>Family history of osteoporosis</p> Signup and view all the answers

    How is osteoporosis primarily diagnosed?

    <p>Through bone mineral density measurement</p> Signup and view all the answers

    Which condition is a medical issue linked to increased risk for weak bones?

    <p>Chronic lung disease</p> Signup and view all the answers

    What defines a fragility fracture?

    <p>Fracture resulting from a normal fall from standing height or less</p> Signup and view all the answers

    Which medication is known to increase the risk of osteoporosis?

    <p>Oral glucocorticoids (steroids)</p> Signup and view all the answers

    What happens to bone mass in women after menopause?

    <p>It begins to decrease at an accelerated rate.</p> Signup and view all the answers

    Which of the following factors contributes to a sedentary lifestyle?

    <p>Extended periods of sitting or inactivity</p> Signup and view all the answers

    What is a significant contributor to the risk of experiencing a second fracture following an initial fracture event for individuals over 50?

    <p>Failure to receive subsequent medical assessment and treatment</p> Signup and view all the answers

    Which strategy is specifically designed to enhance safety within the home environment for fall prevention?

    <p>Formal home safety evaluations</p> Signup and view all the answers

    In patients with low Bone Mineral Density (BMD), what is a potential benefit of longer treatment beyond initial osteoporosis management?

    <p>Mitigation of fracture risk</p> Signup and view all the answers

    What is a key factor in assessing bone health and treatment strategies for at-risk patients?

    <p>Assessment of risk factors for osteoporosis</p> Signup and view all the answers

    Which of the following actions should be prioritized to enhance the treatment and management of osteoporosis?

    <p>Improving adherence to treatment protocols</p> Signup and view all the answers

    What is a primary benefit of engaging in regular weight-bearing exercises?

    <p>Increases bone density and reduces fall risk</p> Signup and view all the answers

    Which food source is known for being high in vitamin D?

    <p>Fortified milk</p> Signup and view all the answers

    What is the recommended treatment protocol for vitamin D deficiency in older adults?

    <p>50,000 IU vitD weekly for 6-8 weeks, then reassess</p> Signup and view all the answers

    How does vitamin D contribute to the reduction of fall risk?

    <p>By enhancing coordination and muscle function</p> Signup and view all the answers

    What is a misconception regarding daily calcium and vitamin D intake?

    <p>It should only be obtained through supplements</p> Signup and view all the answers

    Which of the following activities is specifically classified as a weight-bearing exercise?

    <p>Stair climbing</p> Signup and view all the answers

    What is an appropriate method to assess calcium and vitamin D intake?

    <p>Reviewing food and supplement labels</p> Signup and view all the answers

    Which preventive step is crucial for maintaining bone health?

    <p>Engaging in daily physical activity</p> Signup and view all the answers

    What is the recommended minimum duration for a drug holiday after 10 years of bisphosphonate treatment in higher risk patients?

    <p>2-3 years</p> Signup and view all the answers

    Which adverse effect is most commonly associated with the use of bisphosphonates?

    <p>Osteonecrosis of the jaw</p> Signup and view all the answers

    What is the proper way to administer a bisphosphonate tablet for optimal absorption?

    <p>With a full glass of water while remaining upright</p> Signup and view all the answers

    What is the primary route of administration for zoledronic acid used in osteoporosis treatment?

    <p>Intravenous infusion once yearly</p> Signup and view all the answers

    How long can bisphosphonates be safely administered according to the provided information?

    <p>5-10 years</p> Signup and view all the answers

    Which of the following is a recommended supplement for patients taking bisphosphonates?

    <p>Calcium and vitamin D</p> Signup and view all the answers

    Which gastrointestinal side effect is associated with bisphosphonates?

    <p>Abdominal pain</p> Signup and view all the answers

    What potential benefit exists from the long-term retention of bisphosphonates in bone?

    <p>Continuous benefit after therapy is stopped</p> Signup and view all the answers

    Study Notes

    Osteoporosis and Bone Health

    • Osteoporosis is a condition characterized by weakened and brittle bones, increasing the risk of fractures.
    • Fractures in individuals with osteoporosis are more likely to occur in the wrist, spine, and hip.
    • Risk factors for osteoporosis can be classified as modifiable and non-modifiable.
    • Modifiable risk factors can be altered through changes in lifestyle and habits.
    • Non-modifiable risk factors cannot be changed.
    • Five simple steps for bone health and osteoporosis prevention include:
      • Getting adequate daily intake of calcium and vitamin D.
      • Engaging in regular physical activity, especially weight-bearing exercises.
      • Avoiding smoking and excessive alcohol consumption.
      • Regularly discussing bone health with a healthcare professional.
      • Getting a bone density test and taking appropriate medications as recommended.
    • Vitamin D plays a crucial role in bone health, and deficiency can contribute to osteoporosis.
      • Adequate vitamin D levels can help reduce fall risk by improving muscle function.
      • Main dietary sources of vitamin D include:
        • Fortified milk
        • Fortified cereals
        • Cold saltwater fish
        • Calcium and vitamin/mineral supplements
    • Sunlight exposure is a natural source of vitamin D production in the skin.

    Diagnosis and Assessment of Osteoporosis

    • Diagnosis of osteoporosis is primarily based on:
      • Bone mineral density (BMD) measurement using a DEXA scan
      • History of fragility fractures regardless of BMD.
    • BMD measurement with DEXA scan determines bone density at the hip and lumbar spine.
    • WHO criteria define osteoporosis based on T-score, which compares individual BMD to young adult values.
      • T-score above -1.0 indicates normal bone density.
      • T-score between -1.0 and -2.5 indicates low bone mass (osteopenia).
      • T-score below -2.5 indicates osteoporosis.
    • Fracture prediction tools such as FRAX can estimate the 10-year risk of major osteoporotic fractures and hip fractures.

    Treatment and Prevention Strategies

    • Treatment of osteoporosis aims to:
      • Identify patients at risk of fractures.
      • Reduce the incidence of fractures.
      • Maintain quality of life.
    • Treatment options for osteoporosis include:
      • Lifestyle modifications such as diet, exercise, and avoiding smoking and excessive alcohol.
      • Medications such as bisphosphonates, calcitonin, parathyroid hormone (PTH), selective estrogen receptor modulators (SERMs), and estrogen/hormone therapy (ET/HT).
    • Bisphosphonates are a class of drugs that reduce bone resorption and increase bone density.
      • They are FDA-approved for various indications, including prevention and treatment of osteoporosis in different populations.
    • Secondary fracture prevention is crucial after a fracture in people over 50, as it is a strong predictor of future fractures.
    • Fall prevention is essential, especially in elderly individuals, and includes measures such as:
      • Improving home safety by removing tripping hazards.
      • Engaging in physical therapy for balance and strength.
      • Avoiding medications that affect alertness and balance.

    Dual-energy X-ray Absorptiometry (DEXA) Scan

    • DEXA Scan measures bone mineral density at the hip and lumbar spine

    Investigations for Possible Causes

    • Full blood count is used to check for Anemia
    • Bone profile checks for calcium and alkaline phosphate levels
    • Vitamin D levels are important to assess
    • Parathyroid hormone levels are important for bone turnover
    • Thyroid function tests are helpful as hyperthyroidism can lead to osteoporosis
    • Cortisol levels can be indicative of exogenous steroids

    Plain Film X-Rays for Lumbar Spine

    • Used to assess for thoracic and lumbar vertebral fractures

    Bone Density Test Recommendations

    • Women aged 65 and above, and men aged 70 and above should have a bone density test
    • Younger postmenopausal women and men ages 50-69 with clinical risk factors should be tested
    • Adults who have experienced a fracture after 50 should undergo a bone density test

    Fracture Prediction Tools

    • The Fracture Risk Assessment Tool (FRAX) can calculate the 10-year probability of a major osteoporotic fracture and hip fracture
    • Treatment becomes cost-effective when the 10-year fracture risk is over 4%

    WHO Criteria for Postmenopausal Osteoporosis

    • The T-score compares an individual's BMD with the mean value for young adults, expressed in standard deviation scores
    • Normal: T-score above -1.0
    • Low bone Mass (osteopenia): T-score between -1.0 and -2.5
    • Osteoporosis: T-score below -2.5

    Vitamin D Intake

    • Vitamin D intake should be 800 - 1000 IU per day, with supplementation necessary for individuals aged 50 and above
    • Vitamin D intake can be obtained through sun exposure (10-15 minutes twice a week) but clothing, sunscreen and pollution reduce vitamin D production

    Calcium Requirements for Individuals Over 50

    • Calcium intake should be at least 1,200 mg per day for individuals over 50

    Calcium Supplements

    • Calcium carbonate needs stomach acid for absorption
    • Calcium citrate does not require stomach acid for absorption, making it more suitable for individuals with less stomach acid

    Vitamin D's Role in Calcium Absorption

    • Vitamin D is essential for calcium absorption
    • Calcium and Vitamin D do not need to be consumed simultaneously to benefit from enhanced calcium absorption

    FDA-Approved Medications for Osteoporosis

    • Bisphosphonates:
      • Alendronate, Alendronate plus D (Fosamax, Fosamax Plus D)
      • Rideosronate, Risedronate with Calcium (Actonel)
      • Ibandronate (Boniva)
    • Calcitonin (Miacalcin, Fortical, Calcimar)
    • Parathyroid Hormone (PTH(1-34), Teriparatide) (Forteo)
    • Selective Estrogen Receptor Modulators (SERMs): Raloxifene (Evista)
    • Estrogen/Hormone Therapy (ET/HT): Premarin, Estrace, Prempro

    Bisphosphonates - Antiresorptive Agents

    • FDA-approved for:
      • prevention and treatment of osteoporosis in postmenopausal women
      • treatment for increasing bone mass in men with osteoporosis
      • treatment for glucocorticoid-induced osteoporosis
      • treatment for Paget's Disease of bone
    • They reduce osteoclastic activity and bone resorption by binding bone mineral, being absorbed by osteoclasts, inducing apoptosis and suppressing resorption

    Clinical Benefit of Bisphosphonates

    • 3 years of bisphosphonate treatment in postmenopausal women with osteoporosis show relative risk reduction for fractures:
      • Vertebrae: significant reduction
      • Hip: significant reduction

    Bisphosphonates - Administration

    • Must be taken at least 30 minutes before the first food, beverage, or medication of the day with water only.
    • Should only be taken upon waking up
    • Should be taken with a full glass of water
    • Patients should remain upright (walking, standing, or sitting) for at least 30 minutes (for monthly ibandronate, 60 minutes)
    • Should supplement with calcium and Vitamin D if dietary intake is inadequate

    Bisphosphonates - Adverse Effects

    • Hypocalcemia
    • Hypophosphatemia
    • Musculoskeletal pain, crams (FDA warning)
    • Gastrointestinal:
      • Abdominal pain
      • Acid reflux
      • Dyspepsia
      • Esophageal ulcer
      • Gastritis
    • Osteonecrosis of the jaw (IV bisphosphonates)
    • Visual disturbances (rare)

    Zolendronic Acid (Reclast, Aclasta)

    • Approved for treatment of osteoporosis in postmenopausal women
    • Single 5 mg infusion given IV over 15 minutes, once yearly
    • Should still supplement with calcium and vitamin D
    • May be ideal for those with GI contraindications to oral formulations

    Duration of Bisphosphonate Treatment

    • Bisphosphonates have a long residence time in bone
    • Long-term treatment raises questions about safety concerns
    • It is unclear if long-term treatment leads to a reservoir of the drug in bone, providing a continuing benefit after therapy is stopped
    • 5-10 years appears to be safe for most patients
    • Risk assessment is important for determining the length of treatment:
      • Lower risk: drug holiday after 3-5 years
      • Higher risk: drug holiday after 10 years
      • Factors to consider for treatment length:
        • Adherence to medication
        • Drug pharmacokinetics
        • Underlying disorders that need to be addressed

    Secondary Fracture Prevention

    • A fracture is a sentinel event
    • A fracture in a person over 50 is a significant risk factor for a future fracture
    • Many high-risk patients receive successful fracture treatment but do not receive subsequent medical assessments and treatment to prevent further fractures

    Fall Prevention

    • Improve lighting in the home
    • Remove loose rugs
    • Install grab bars near bathtubs, toilets, and stairways
    • Consider a formal home safety evaluation
    • Incorporate physical therapy for core strength and balance
    • Avoid medication that can affect alertness and balance
    • Get an assistive device evaluation and training

    Take Home Message

    • Clinicians should improve their ability to assess risk factors for osteoporosis and apply evidence-based screening recommendations to at-risk patients
    • Doctors should develop strategies to improve the treatment of patients with osteoporosis
    • Clinicians should utilize tools and information (patient education materials and system-based approaches) to facilitate improved assessment and care for patients with osteoporosis

    Bone Health & Osteoporosis

    • Hip fractures can lead to nursing home placement for 1 in 5 people within a year
    • Some people with hip fractures may never walk again
    • The most common breaks in weak bones are in the wrist, spine, and hip
    • People start to lose bone mass after their mid-30s, with women losing bone mass faster after menopause
    • There are modifiable and non-modifiable risk factors for weak bones
    • Modifiable risk factors include diet, smoking, alcohol intake, physical activity, and medical conditions
    • Non-modifiable risk factors include family history of osteoporosis, age, small body build, and medical conditions

    Osteoporosis Diagnosis

    • Osteoporosis is diagnosed by bone mineral density tests and/or a history of fragility fractures
    • Fragility fractures can happen from a fall from standing height or less
    • Signs of osteoporosis include loss of height, kyphosis (Dowager's hump), and back pain on palpation.

    Patient Care Goals

    • The main goals of osteoporosis management are to identify patients at risk for fractures, reduce the incidence of fractures, and maintain quality of life

    Osteoporosis Prevention

    • Five simple steps to bone health and osteoporosis prevention:
      • Get your daily recommended amount of calcium and Vitamin D
      • Be physically active everyday
      • Avoid smoking and excessive alcohol
      • Talk to your doctor about bone health
      • Have a bone density test and consider taking medication if appropriate

    Vitamin D

    • Vitamin D is manufactured in the skin from sunlight exposure
    • Dietary sources of vitamin D include fortified milk, fortified cereals, cold saltwater fish, and supplements
    • Vitamin D may reduce fracture risk through improved muscle function and reduced fall risk
    • Maintaining a 25-hydroxyvitamin D3 level greater than 40 ng/mL is beneficial for older adults
    • Vitamin D deficiency is prevalent in older adults and may require treatment with 50,000 IU of Vitamin D weekly for 6-8 weeks, followed by monthly therapy as needed

    Osteoporosis Medications

    • FDA-approved medications for osteoporosis include:
      • Bisphosphonates
      • Calcitonin
      • Parathyroid hormone (PTH)
      • Selective estrogen receptor modulators (SERMs)
      • Estrogen/Hormone therapy (ET/HT)

    Bisphosphonates

    • Bisphosphonates are antiresorptive agents that reduce osteoclastic activity and bone resorption by binding bone mineral
    • Bisphosphonates can prevent and treat osteoporosis in postmenopausal women, men with osteoporosis, glucocorticoid-induced osteoporosis, and Paget’s disease of bone
    • These medications must be taken on an empty stomach with water and patients should remain upright for 30-60 minutes after taking them
    • Common side effects include hypocalcemia, hypophosphatemia, musculoskeletal pain, gastrointestinal issues, osteonecrosis of the jaw, and visual disturbances

    Zolendronic Acid (Reclast®/Aclasta®)

    • A single 5mg infusion given IV once yearly
    • May be ideal for patients with gastrointestinal contraindications to oral bisphosphonate formulations

    Bisphosphonate Treatment Duration

    • Bisphosphonates have a long residence time in bone
    • 5-10 years of treatment appears safe for most patients
    • Drug holiday assessment should be considered after 3-5 years for lower risk patients and after 10 years for higher risk patients

    Secondary Fracture Prevention

    • A fracture is a sentinel event indicating high risk of future fractures
    • High-risk patients often have fractures successfully treated, but do not receive further assessment and treatment to prevent future fractures

    Fall Prevention

    • Strategies for fall prevention:
      • Improve lighting
      • Remove loose rugs
      • Add grab bars near bathtubs, toilets, and stairways
      • Formal home safety evaluation
      • Physical therapy for core strength and balance
      • Eliminate medications that can affect alertness and balance
      • Assistive device evaluation and training

    Take Home Message

    • It is important to improve the ability to assess risk factors for osteoporosis and apply evidence-based screening recommendations to at-risk patients
    • Develop strategies to improve the treatment of patients with osteoporosis
    • Utilize available tools and information, including patient education resources and systems-based approaches, to enhance the assessment and care provided to patients with osteoporosis

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