Osteoporosis Current guidelines and their application to patients - - PowerPoint PPT Presentation
Osteoporosis Current guidelines and their application to patients with developmental disabilities Meg Gemmill Family Medicine, PGY2 Women's College Hospital University of Toronto Objectives Review the definition and epidemiology of
Meg Gemmill Family Medicine, PGY2 Women's College Hospital University of Toronto
Current guidelines and their application to patients with developmental disabilities
decreased bone strength increased risk of fractures
Harrison’s Principles of Internal Medicine, 2008
As many as 2 million Canadians 1 in 4 women > 50 y.o. 1 in 8 men > 50 y.o.
Prevalence varies 21% of community-dweling adults, 40-60 y.o.
Osteoporosis Canada, 2010 ; Management Guidelines: Developmental Disability, 2005
Measured by DEXA scan Spine, femoral neck and total hip High specificity but low sensitivity T-score
Compares results to the average for young, healthy
Z-score
Compares results to age-, race- and sex-matched
Harrison’s Principles of Internal Medicine, 2008; New osteoporosis guidelines for Canada, CMAJ 2010, 182(17): 1829-1930
Updated from 2002 For women and men > 50 y.o. Shift from treating low bone mineral density to
Indications for BMD Clinical tools Recommended diagnostic algorithm
Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada, CMAJ 2010.
Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada, CMAJ 2010.
Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada, CMAJ 2010.
Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada, CMAJ 2010.
Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada, CMAJ 2010.
Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada, CMAJ 2010.
Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada, CMAJ 2010.
Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada, CMAJ 2010.
Osteoporosis and osteoporotic fractures are
Osteoporosis is commonly unrecognized and
Screening threshold should be lower If results are not used to make treatment
Management Guidelines: Developmental Disabilities, 2005; Primary Care of Adults with Developmental Disabilities: Canadian Consensus Guidelines (2011)
Severity of DD Low body weight Impaired mobility and impaired weight bearing Impaired nutritional intake Propensity to fall Hypogonadism Hyperprolactinemia Hypothyroidism Amenorrhea Specific genetic syndromes Long-term use of specific drugs
Primary Care of Adults with Developmental Disabilities: Canadian Consensus Guidelines (2011)
Monitor weight and height regularly and assess risk
Periodically assess risk for developing osteoporosis in
Recommend early and adequate intake or
Primary Care of Adults with Developmental Disabilities: Canadian Consensus Guidelines (2011 )
Management Guidelines: Developmental Disabilities, 2005
Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada, CMAJ 2010.
sedatives, drugs altering gait or causing
rails, walking aids
Management Guidelines: Developmental Disabilities, 2005
Shift in screening from treating low BMD to
BMD indications FRAX, CAROC assessment tools
Guidelines need interpretation for DD
Assess other risk factors if BMD unhelpful
medications, frequent falls, underlying conditions Serial BMD to monitor for rapid bone loss
Balance the benefits and risks of
Fauci, Anthony S. et al. Harrison’s Principles of Internal Medicine. USA: McGraw-Hill 2008. 17th ed.
Kanis, J.A. New Osteoporosis guidelines for Canada. Canadian Medical Association Journal 2010. 182(17): 1829-1830.
Lennox, N. et al. Management guidelines: Developmental Disabilities. State of Victoria: Therapeutic Guidelines 2005. 2nd ed.
What is osteoporosis? www.osteoporosis.ca, Osteoporosis Canada, 19 December 2010.
Papaioannou, A. et al. 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. Canadian Medical Association Journal 2010. 182(17): 1864-1873.
Rubin, I. L. and Crocker, A.C. Medical Care for Children and Adults with Developmental Disabilities. Maryland: Paul H. Brookes Publishing 2006. 2nd ed.
Sullivan, W.F. et al. Primary care of adults with developmental disabilities: Canadian consensus guidelines. Canadian Famly Physician 2011. 57(5):541-553.