Slide Bonviva 1

8/16/2019 Slide Bonviva 1

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Diagnosis Dan TerapiOsteoporosis Dengan

Ibandronat


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Objectives1. To understand BMD in osteoporosis.

2. To calculate fracturerisk (using FRAX).3. To understand te use of

!isposponate in osteoporosis

treat"ent.


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Osteoporotic fracture

Vertebrae>66% trabecular

Distal radius

>95% cortical

Femoral neck 75% cortical 25%trabecular

Te "ost fre#uent site of fracturedue to

osteoporosis


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one Densit! " #$e vs Fracture &#$e

5' ('7'

)'

*en +ear ,'

Fracture-robabilit! 2'

.%/

0'

'

0 '5' ''

1 1 105 1

'5 0' 2'Femoral eck *1 score

6'

5'

125 1 1 1,' ,5 )'

robabilit! of 3rst fracture of 4ip distal forearm proimal 4umeruss!mptomatic vertebral fracture in omen of 8alm :eden

Adapted fro" $anis %A et al. &steoporosis

'nt. 2112*+,+-++.


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&isk factor for osteoporosi


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one 8ineral Densit!

.8D/


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;


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D?# *ec4nolo$!

Detector (detects 2 tissue types and - bonesoft tissue)

/er0 lo radiation to patient.

/er0 little scatter radiation to

atienttecnologist

otons

X-ra0 ource

4olli"ator (pinhole for pencil beam, slit for fan

beam)

(produces 2 photon energies with dierent attenuation proles)


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&e$ion of interest (R&')

:pine @01 Femoral eck

@)5l Magraoui A. 'nterpreting aDXA scan in clinical practice. 'n * Dual energ0 6-ra0 a!sorptio"etr0. 'nTec7212.


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Distal Forearm *otal od!

/erte!ral Fracture

Assess"ent


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*1score

Patient’s BMD - Young-Adult Mean BMD

1 SD of Young-Adult Mean BMD

Example:

0.7 g!m" - 1.0 g!m"

#-s!o$e % % - &.00.1 g!m"


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ABO Dia$nostic Classi3catio

Classi3cation *1score

8or"al -1. or greater

&steopenia Beteen -1. and -2.

Osteoporosis 125 or lesse9ere -2. or less and fragilit0

&steoporosis fracture


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Calculatin$ fracturerisk

(using FRAX )


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Osteoporotic fracture

BMD is "a=or deter"inant for fracture


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*4e role of F? for treatmen

Ten 0ear pro!a!ilit0 of fracture

Ma=or osteoporotic fracture > 2'%

>ip fracture > ,%


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*4e used of bisp4osponat

: keletal disorder in cildren (e.g.

osteogenesis i"perfecta)

:-ostmenopausal osteoporosis

:lucorticoid1induced osteoporosis: Bone "etastases

: aget disease of te !one

: >0percalce"ia: Multiple "0elo"a

: &steoartritis (?)


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isp4osp4onate

Basic structure of Bisposponate


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one cells

&steoclast and osteo!last pla0 "a=orrole in !one "eta!olis".

Role of osteoc0tes?


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steoclast1tar$ettedt4erap!

canning electron "icrograp on an

osteoclast resor!ing !one


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ole of calcium and vitamin

Assuring ade#uate 9ita"in D and

calciu" intake !efore and after starting

!isposponate terap0- &pti"al seru" le9el of 2-&>-9it D * 3

ng@"l (


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Oral bisp4osp4onate

: oor a!sorption (generall0 1)

: ort-ter" !ioa9aila!ilit0

: 5sopageal irritationre9ention *

- uprigt posture for 3-; "inutes after

ingestion

- afull glass of ater - e"pt0 sto"ac

- do nottake togeter it calciu" or

oter drugs


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3 Montl0 i.9. i!andronate (Bon9i9a)


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Euarterl!


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Euarterl!


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one micro1arc4itecture

Bisposponate terap0 increases !one densit0 and reducesfracture risk !0 i"pro9e tra!ecular connecti9it0 and increase

!one structural unit tatreaca "a6i"u" degree of

"ineraliIation.

Boi9in JK et al# $one 2


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Clinical concerns tobisp4osp4onate t4erap!

: &steonecrosis of te =a

: Atrial fi!rillation

: &9ersuppression of !one turno9er

: >0pocalce"ia: Acute infla""ator0 response

: Musculoskeletal pain

Diffuse osteol0tic lesions on panora"ic 9ie

in patient it osteonecrotic of =a("andi!le)


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*ake Bome 8essa$es

: 4linical conditions and risk factors are

i"portant in interpreting BMD test.

: Decision to treat can !e !ased on

BMD (T-score) and@or FRAX asses"ent

: Bisposponate is drug of coice for

treat"ent of osteoporosis .

Teri"a kasi7 se"oga

! f t

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