Osteoporosis Medical Management

8/8/2019 Osteoporosis Medical Management

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OSTEOPOROSIS

Medical Management


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PRIMARY MEDICAL

MANAGEMENT

Drug Therapy

Surgical Management, Casts,

Moulds(Possibly due toFractures)


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SECONDARY MEDICALMANAGEMENT

The principles of management are :

1. Prevention and control of risk factors. 2. Management of menopause.

3. Musculoskeletal rehabilitation

(Weight Bearing exercises)

4. Lifestyle Modificationhttp://medind.nic.in/jac/t02/i2/jact02i2p128.pdf


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Drug therapy

The drugs used in the treatment can be

classified into two main groups:

Antiresorptive drugs

Formation stimulating drug


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ANTIRESORPTIVE DRUGS These agents act by decreasing bone resorption

Calcium and vitamin D

They act by increasing mineralization of bone, and they are effectiveeven if started very late.

Calcium and vitamin D are more effective if taken in combination.

Calcium alone is effective, but vitamin D is not.

If vitamin D deficiency is due to lack of exposure to sunlight thendietary vitamin D supplementation with ergocalciferol or

cholecalciferol will suffice. But if defect is in the renal synthesis of I-25

dihydroxy vitamin D (calcitrol) then exogenous

calcitrol may be required.


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Calcitonin Osteoclasts have calcitonin receptors.

Calcitonin rapidly inhibits the action of osteoclasts resulting in

decreased bone resorption. It is also effective in steroid induced osteoporosis in men.

Calcitonin is commonly used in post-traumatic situationsbecause of its inherent centrally acting analgesic effect, whichis comparable to NSAIDs

and other strong analgesics. It is less effective in preventing cortical bone

loss than cancellous bone loss

Side effsct are few, such as, flushing of face and nausea

ANTIRESORPTIVE DRUGS


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Bisphosphonate increases cell death and decreases bone resorption

leading to increased BMD and reduced fracture rate. They cause esophagitis and gastrointestinal irritationwhich can be avoided by taking it with large amountof water and remaining upright for at least 30 minutesand usually taken half

an hour before mealtime. The optimal period of therapy is not

known but should be given on long term basis.

ANTIRESORPTIVE DRUGS


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Sodium fluoride

. It acts by stimulating osteoblast proliferation

and function. Gastric irritation and painful extremities are

common side effects.

FDA does not as yet approve them for treatingosteoporosis.

Formation Stimulating Drugs


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Parathyroid hormone (PTH)

It prevents bone loss associated with estrogen

deficient state. PTH has been shown to increase bone formation by

decreasing the apotosis of osteoblast

New onset or worsening of backache was also

reduced. Loss of height was also less with PTH therapy



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Anabolic steroids

: The androgenic properties of these agents are

responsible for effect on bone formation



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Management protocolsPain relief and general measures after fracture : The general measures include adequate bed rest, local heat, analgesics,

calcitonin, avoiding constipation, and lumbar support corset.

Once pain subsides, initiate the patient into an exercise programme to

correct postural deformity and increase muscle tone and BMD.

Life-style modification :

It includes identification and elimination/correction of modifiable riskfactors.

Avoid lifting heavy weights and forward bending.

All patients should be given calcium and vitamin D

supplementation and encouraged to join regular exercise

or rehabilitation programme


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KEY POINTS

Type I or post-menopausal Antiresorptive

Drugs

Alternative: Calcitonin, SERMs, andbisphosphonate

Type II or age related calcium and vitamin D

and analogues

Note: Calcitonin can be given for analgesic

effect


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Idiopathic osteoporosis in premenopausal

women Calcium and Vitamin D

Young or middle-aged men

If testosterone is low, give testosterone

enanthate IM at 4 week intervals. Calcium, vitamin D supplementation, and risk

factors modification


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Glucocorticoid-induced osteoporosis Maintain calcium and vitamin D intake, askpatient to do regular exercise, and target risk

modification.

Musculoskeletal and psychological

Rehabilitation : refer to a trained physicaltherapist, psychologist, and

nutritionist for consultation


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End of Slideshow

Primary reference: Osteoporosis Medical

Management by Umesh Kansra

Osteoporosis Medical Management

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