Rav Endocrinology Osteoporosis

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patient with corticosteroid-induced osteoporosis should be treated with

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patient with corticosteroid-induced osteoporosis should be treated with risedronate.

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Bone loss induced by exogenous corticosteroids is the most common form of

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Bone loss induced by exogenous corticosteroids is the most common form of secondary osteoporosis. The extent is determined by the dose and duration of therapy

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should be performed at the initiation of corticosteroid therapy

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A dual energy x-ray absorptiometry scan to assess BMD should be performed at the initiation of corticosteroid therapy

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been shown to increase bone mineral density (BMD) in patients treated with corticosteroid

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Both risedronate and alendronate have been shown to increase bone mineral density (BMD) in patients treated with corticosteroid

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annual intravenous infusion of ....also approved by the FDA as therapy of corticosteroid-induced osteoporosis.

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annual intravenous infusion of zoledronate was also approved by the FDA as therapy of corticosteroid-induced osteoporosis.

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All patients also should receive

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All patients also should receive appropriate calcium and vitamin D therapy.The prevention and treatment of corticosteroid-induced osteoporosis includes oral calcium supplementation (1500 mg/d) and oral vitamin D (800 U/d).

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Osteoporosis is a silent skeletal disorder characterized by

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Osteoporosis is a silent skeletal disorder characterized by compromised bone strength and an increased predisposition to fractures. The following risk factors are associated with osteoporosis in men:

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The following risk factors are associated with osteoporosis in men:

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* Prolonged exposure to certain medications, such as corticosteroids, anticonvulsants, some cancer drugs, and aluminum-containing antacids
* Chronic disease affecting the kidneys, lungs, stomach, and intestines
* Hypogonadism
* Smoking, excessive alcohol use, low calcium intake, and inadequate physical exercise
* Older age (bone loss with increasing age)
* Heredity and race (with white men seeming to be at greatest risk)

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Teriparatide

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Teriparatide is a recombinant human parathyroid hormone and a potent anabolic bone agent. Teriparatide is FDA-approved for treatment of postmenopausal osteoporosis in women at high risk of fracture and for treatment of hypogonadal or primary osteoporosis in men with high risk of fracture. Teriparatide is more expensive then bisphosphonates and requires subcutaneous injection. Treatment with teriparatide is limited to a maximum of 2 years (concerns related to risk of osteosarcoma) and is contraindicated in patients with a history of bone malignancy, Paget disease of bone, hypercalcemia, or history of skeletal irradiation. Given its cost, subcutaneous route of administration, long-term safety concerns, and the availability of other agents, teriparatide is generally not used as a first-line drug for treatment of osteoporosis.

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first-line drugs for treating postmenopausal women with osteoporosis

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Bisphosphonates are first-line drugs for treating postmenopausal women with osteoporosis. Alendronate and risedronate reduce the risk of both vertebral and nonvertebral fractures.

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Some patients with osteoporosis may be intolerant of oral bisphosphonates because of aggravation of underlying gastroesophageal reflux disease. For these patients, once yearly

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Some patients with osteoporosis may be intolerant of oral bisphosphonates because of aggravation of underlying gastroesophageal reflux disease. For these patients, once yearly intravenous infusion of zoledronate is a potent and effective alternative.

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An injectable bisphosphonate, such as zoledronate, should also be considered when

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An injectable bisphosphonate, such as zoledronate, should also be considered when oral bisphosphonates are unsuccessful, contraindicated (as in esophageal stricture or achalasia), or likely to be poorly absorbed (as in uncontrolled celiac disease and inflammatory bowel disease) and when a patient is unable to remain upright for 30 to 60 minutes after dosing.

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ibandronate

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Whereas oral ibandronate is associated with a reduction in vertebral fracture rates, neither oral nor intravenous ibandronate is associated with a reduction in hip fracture rate. Therefore, ibandronate would not be the best choice in this patient with reduced bone density in the hip.

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patient had a clinically nonfunctioning pituitary adenoma with secondary hypogonadism and osteoporosis. He should be treated with

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This patient had a clinically nonfunctioning pituitary adenoma with secondary hypogonadism and osteoporosis. He should be treated with testosterone replacement therapy.

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is a prevalent secondary cause of male osteoporosis.

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Hypogonadism is a prevalent secondary cause of male osteoporosis.

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Hypogonadism increases the skeletal sensitivity to parathyroid hormone and decreases

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Hypogonadism increases the skeletal sensitivity to parathyroid hormone and decreases intestinal calcium absorption. Because testosterone is aromatized to estradiol, it can be regarded as a prohormone for estradiol in the bone.

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Low bone mass in men with hypogonadism can be improved with


what can increase bone mineral density.

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Low bone mass in men with hypogonadism can be improved with androgen replacement, and bisphosphonates are effective in men regardless of their gonadal status. Anabolic therapy with teriparatide can likewise increase bone mineral density. Supplementation with calcium and vitamin D is also advisable.