Underdiagnosis and Undertreatment of Osteoporosis · Underdiagnosis and Undertreatment of...
Transcript of Underdiagnosis and Undertreatment of Osteoporosis · Underdiagnosis and Undertreatment of...
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Underdiagnosis and
Undertreatment of
Osteoporosis
P-L Westesson, RK Lee, MA Ketkar, EP Lin
University of Rochester New York
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Osteoporosis •! 55% of the US population over 50 years
•! 44 million US women and men
•! 17 billions direct medical cost per year Normal
Osteoporosis
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Risk factors •! Age •! Gender •! Family history •! Race •! Small body size •! Early menopause •! Cigarette, alcohol, no exercise •! Steroids, anticonvulsant,
methotrexate, cyclosporin, heparin
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Purpose
Study the recognition and treatment of patients with severe osteoporosis
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Patients
•! 40 patients referred for vertebroplasty •! Age 46-93 years; mean 76 years •! 19 men and 21 women •! Acute compression fractures by MRI
and physical assessment
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Methods
•! Review of medical history and chart –!Medication
•! Fosamax; biposphonate/alendronate
–!Bone densitometry –!Regularly seen by PCP
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Results
•! All 40 patients had been seen regularly by their family doctor
•! 39 patients with severe osteoporosis were not diagnosed or treated
•! 1 patient Dexa scan •! 1 patient treated for osteoporosis
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Conclusion •! Osteoporosis is which is typically •! Underdiagnosed •! Undertreated
•! Despite availability of preventive drugs
What can we do?
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Prevention •! Calcium •! Vitamin D •! Exercise •! Bone mineral density test - DEXA
•! Medication to prevent resorption of bone •! Biphosphonate (alendronate and risendronate) •! Calcitonin •! Estrogen replacement
•! Medication to increase bone formation •! Parathyroid hormone •! Teriparatide (parathyroid hormone analog)
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Thank you
P-L Westesson, RK Lee, MA Ketkar, EP Lin
University of Rochester New York
The Lancet 2002;360:1891
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