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- Bone physiology
-
1. Pathways regulating bone resorption
- Prof. Tim Arnett
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2. Pathways regulating bone formation
- Dr. Michaela Kneissel
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3. The osteocyte
- Prof. Lynda F. Bonewald
- Osteoporosis
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4. Epidemiology of osteoporosis
- Prof. Cyrus Cooper
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5. Pharmacotherapy of osteoporosis 1
- Dr. Michael McClung
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6. Pharmacotherapy of osteoporosis 2
- Dr. Michael McClung
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7. Current concepts for the management of patients with osteoporosis
- Dr. Michael Lewiecki
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8. Combination and sequential therapy for the treatment of osteoporosis
- Prof. Felicia Cosman
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9. Osteoporosis in men
- Prof. Peter R. Ebeling
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10. Glucocorticoids, inflammation and bone loss
- Prof. Christian Roux
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11. Atypical femoral fractures
- Dr. Angela Cheung
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12. How long to treat osteoporosis
- Prof. Robert A. Adler
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13. Osteoporosis: calcium and vitamin D
- Prof. Bo Abrahamsen
- Archived Lectures *These may not cover the latest advances in the field
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14. New and emerging treatments for osteoporosis
- Dr. Michael Lewiecki
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15. Osteoporosis: how long to treat?
- Prof. Robert A. Adler
Printable Handouts
Navigable Slide Index
- Introduction
- Disclosures
- Objectives
- Osteoporotic fractures
- Anti-resorptive: bisphosphonates
- Bisphosphonates in practice
- Bisphosphonate side effects
- Osteonecrosis of the Jaw (ONJ)
- Osteonecrosis of the Jaw (ONJ): image
- American Dental Association recommendations
- Atypical subtrochanteric fractures
- Atypical Femoral Fracture (AFF)
- Pathogenesis of AFF
- AFF and femoral geometry
- Single energy image of femur by densitometer
- Predicting/preventing AFF
- Two RCTs of long-term bisphosphonate Rx
- FLEX: ALN or placebo after 5 years of ALN
- HORIZON: 3 vs. 6 years of zoledronate
- Summary of vertebral fracture reductions for FLEX and HORIZON
- Bisphosphonate drug holiday/interruption
- ASBMR: suggested approach
- Drug holiday/interruption
- Prevention of fracture with ZOL
- Fracture outcomes: ZOL vs. placebo
- Bisphosphonate rx-Adler modification
- Continue treatment at 5 years?
- Adherence vs. harms in persons on alendronate
- Effect of drug holiday on fracture risk
- Increased fracture risk after discontinuation?
- NIH: 4 studies of bisphosphonate treatment
- Alternative treatments for oral bisphosphonates
- ∆BMD: Dmab/ZOL in women on bisphosphonates
- SubQ denosumab
- Anti-resorptive: denosumab 8 year
- Quick 'off' after stopping denosumab
- ZOL after denosumab?
- Denosumab withdrawal
- New paradigm: Rx for high-risk patients
- DATA-switch trial in women
- VERO trial in women
- Head-to-head: ROMO vs. ALN
- New treatment paradigms
- New paradigm: ROMO/Dmab/ZOL?
- Recent network meta-analysis
- One year mortality after hip fracture
- Long-term osteoporosis treatment: summary
- Thank you for your time
Topics Covered
- Osteoporosis
- Anti-resorptive treatments
- Osteonecrosis of the jaw
- Atypical femoral fracture
- Current RCT’s for long-term bisphosphonate treatment
- Evidence for bisphosphonate drug holiday
- Alternative treatments for oral bisphosphonates
- Sequence of therapies matters
- New treatment paradigms for osteoporosis
Talk Citation
Adler, R.A. (2024, June 30). How long to treat osteoporosis [Video file]. In The Biomedical & Life Sciences Collection, Henry Stewart Talks. Retrieved November 1, 2024, from https://doi.org/10.69645/OIKI4538.Export Citation (RIS)
Publication History
Financial Disclosures
- For talk published in 2024: Dr. Robert A. Adler has no financial matters to disclose. For archived talk published in 2015: Dr. Robert A. Adler, Consultant: Research consultant for Amgen. Grant/research Support (Principal Investigator): Merck, Novartis, Genentech.
A selection of talks on Clinical Practice
Transcript
Please wait while the transcript is being prepared...
0:00
Hello. This is Robert Adler.
I am Chief of Endocrinology at
the Richmond Veterans
Affairs Medical Center
in Richmond Virginia in the US.
I'm also Professor of
Internal Medicine at Virginia
Commonwealth University.
The topic today is how long
to treat osteoporosis.
0:22
Here are my disclosures.
0:25
Our objectives today
are to provide
an approach to long-term
treatment of osteoporosis with
bisphosphonates and also to
provide some information
about denosumab and
anabolic osteoporosis
treatment as well and provide
a potential new way to approach
osteoporosis treatment.
0:47
Here are some facts
that are I think
underappreciated. There are
more than two million
osteoporotic fractures
in the US every year.
Around the world as
our populations age it'll
be even more fractures.
We know that vertebral fractures
lead to increased
mortality and morbidity.
But hip fractures are even worse
and that an older woman
with a hip fracture has
about a 15-20% chance of dying
within a year after
the fracture and it's
even worse for men.
A older man with a
hip fracture has
a one out of three chance of
being dead within a year.
Of those who survive about half
never regain their previous
level of independence.
Many people believe that
osteoporosis isn't the
reason for their fracture.
They just fell,
but it really is.
Fracture is a sentinel event
and requires attention.
The most commonly
used medications for