Osteoporosis and the Use of Biphosphonates

Explore the latest insights on osteoporosis screening, diagnosis, and treatment in this comprehensive medical grand rounds presentation. Learn when to screen for osteoporosis, identify clinical risk factors, and understand the significance of low-impact fractures. Discover the causes of bone loss, evaluation methods for secondary osteoporosis, and how to assess fracture risk in osteopenic patients using FRAX. Examine available osteoporosis medications, their efficacy in fracture protection, and criteria for treatment failure. Delve into the topic of subtrochanteric fractures, their relationship with bisphosphonates, and the importance of bone turnover. Investigate the possibility of discontinuing bisphosphonate treatment, referencing the FLEX trial. Finally, analyze the effects of Denosumab on bone density and fracture risk, along with associated safety concerns.

Intro
Learning objectives
When to screen for osteoporosis?
Clinical risk factors
Low impact fractures and osteoporosis
Following a hip fracture...
Causes of bone loss to be considered in the workup of osteoporosis
Evaluation for secondary osteoporosis
Fracture risk in patients with osteopenia FRAX
Available osteoporosis medications
Fracture protection seen even in patients who lose bone on treatment
What is considered treatment failure?
It depends on why the treatment failed...
Subtrochanteric fractures Definition
Why do they happen with BP? Let's review bone turnover
Risk of SF decreases after stopping bisphosphonates
Can we stop bisphosphonates? FLEX trial
Effect of Denosumab on bone density
Effect of Denosumab on fracture
Safety concerns