Strategies for Osteoporosis Care-Section 2 - Guideline-based Management

Video Transcription

Video Summary

The transcript reviews guideline-based osteoporosis management, emphasizing universal measures, lab evaluation, risk stratification, and medication selection. All patients should receive adequate calcium and vitamin D, weight-bearing exercise, fall prevention, and avoidance of tobacco and excess alcohol. Recommended labs include metabolic panel, PTH, phosphate, vitamin D, TSH, testosterone in selected men, 24-hour urine calcium in some cases, and vertebral fracture assessment with height loss.<br /><br />Treatment is increasingly “goal-directed,” aiming to reduce fracture risk and raise bone density to individualized targets. Patients are grouped into very high/imminent risk, those with T-scores ≤ -2.5, and those with higher T-scores but elevated FRAX risk.<br /><br />Therapies fall into three categories: anabolic agents, antiresorptives, and dual-action therapy. Bisphosphonates are the most commonly used antiresorptives; they reduce vertebral and nonvertebral fractures, with zoledronic acid and alendronate being especially effective. Side effects include GI irritation with oral forms and acute flu-like reactions with IV use. Denosumab is highly effective and can be used in CKD, but caution is needed in severe renal disease due to hypocalcemia risk. Raloxifene benefits spine bone density and lowers breast cancer risk, but does not prevent hip fractures and increases VTE risk.<br /><br />Anabolic options include teriparatide and abaloparatide, while romosozumab offers dual anabolic/antiresorptive effects and requires follow-up antiresorptive therapy. For a recent-fracture, high-risk patient, an anabolic-first strategy may be best.

Asset Subtitle

Bridging the Gap: Comprehensive Osteoporosis Care in Primary Practice

Meta Tag

Concept Osteoporosis Management

Concept Bone Mineral Density T-score

Concept FRAX Model

Concept Bisphosphonate Therapy

Concept Denosumab

Keywords

osteoporosis

fracture risk

bisphosphonates

denosumab

anabolic therapy

romosozumab

calcium vitamin D

Osteoporosis Management

Bone Mineral Density T-score

FRAX Model

Bisphosphonate Therapy

Denosumab