Osteoporosis 101: Basic Concepts in Osteoporosis Diagnosis & Biphosphonates

Explore the fundamentals of osteoporosis diagnosis and bisphosphonate treatment in this comprehensive physician grand rounds lecture. Delve into bone turnover processes, examine the efficacy of bisphosphonates in improving bone density and reducing fracture risk, and understand their mechanism of action. Learn about potential side effects such as atypical subtrochanteric fractures and osteonecrosis of the jaw. Investigate the concept of low peak bone mass, bone accrual, and the importance of proper timing in bone density testing. Analyze the FRAX tool for fracture risk assessment and discuss the controversies surrounding "osteopenia" diagnosis. Gain insights into bisphosphonate drug holidays, including when to consider them and their impact on bone density and fracture risk. Conclude with practical take-home points for managing osteoporosis patients and optimizing bisphosphonate therapy.

Intro
Objectives
But first, let's review bone turnover
Bisphosphonates- How they work
Change in bone architecture
Alendronate and bone density The FIT trial
Bisphosphonates and osteoporotic fractures
The good...
However... back to bone physiology
Microcracks
Decreased elasticity
Atypical subtrochanteric fractures Definition
Subtrochanteric fractures Epidemiology
Osteonecrosis of the jaw
Do not test too early
The concept of low peak bone mass Bone accrual
Not all T scores are the same...
"Osteopenia" is not a disease-FRAX
Back to case 1
Limit duration of exposure if possible
Can we stop bisphosphonates? FLEX trial
Changes in bone density with drug holiday
Changes in fractures with drug holiday
Who should take a drug holiday?
Back to case 2
Take home points