Osteoporosis – newer treatments Dr A K Bhalla ConsultantRheumatologist Royal National Hospital for Rheumatic Diseases, Bath

WHO Criteria of Osteoporosis (2) Normal: T-Score -1 SD or more Osteopenia: T-Score between –1 SD to –2.5 SD Osteoporosis: T-Score below –2.5 SD Established Osteoporosis: T-Score below –2.5 SD, with one or more fragility fractures

Age-related fractures 4,000 3,000 2,000 1,000 35–39>85 MENWOMEN Age group, year Incidence/100,000 person-year Colles' Vertebrae Hip Vertebrae Colles' Hip >85 Cooper and Melton (1992)

Risk of subsequent fracture after initial vertebral fracture Cumulative incidence (%) Years following vertebral fracture Men Women Melton LJ 3rd, et al. Osteoporos Int. 1999;10(3):214–21.

PHARMACOLOGICAL 1. Anti-Resorptive Drugs HRTBisphosphonates Denosumab Denosumab SERM (Raloxifene) CalcitoninCalcitriol 2. Anabolic Drugs Parathyroid hormone Strontium Sodium Fluoride

Calcium +or- Vit. D and CVS Recent article in BMJ Bolland et al suggest increase CVS with Ca and or Vit. D. Recent article in BMJ Bolland et al suggest increase CVS with Ca and or Vit. D. Hot issue, debates in many journals. Hot issue, debates in many journals. Overall issue has not been settled. Overall issue has not been settled. Much depends on the stats used. Much depends on the stats used. Encourage dietary intake. Encourage dietary intake. Ulikely to resolve issue with intervention study. Ulikely to resolve issue with intervention study.