PHARMACOLOGICAL MANAGEMENT OF OSTEOPOROSIS

Osteoporosis is a common problem encountered inprimary care. Mortality and long-term morbidity isassociated with almost all types of symptomaticosteoporotic fractures. Local data suggests thatosteoporosis remains undiagnosed and undertreated.Primary care physicians play a central role in closing thegap for osteoporosis treatment with the opportunity todiagnose, investigate, and treat these patients effectively.In this article, we explore different pharmacologicaloptions in the treatment of osteoporosis, including therole of calcium and vitamin D, antiresorptive agents,hormonal therapy, and anabolic treatment options.

Comparación entre score de frax sin densidad mineral ósea y los criterios propuestos por la sociedad Argentina de osteoporosis para el uso de tratamiento antirresortivo en mujeres postmenopáusicas

Identificar pacientes con alto riesgo de fractura utilizando factores de riesgo clínicos podría reducir los gastos en salud derivados de la realización de una densitometría ósea. El objetivo de este estudio fue comparar el score de FRAX sin determinación de densidad mineral ósea (DMO) con los criterios propuestos por la Sociedad Argentina de Osteoporosis (SAO), para considerar el inicio de tratamiento antirresortivo. Realizamos un estudio observacional, transversal. Se incluyeron 330 mujeres postmenopáusicas entre 40 y 90 años de edad. Se determinó la cantidad de tratamientos indicados según se utilice la herramienta FRAX sin DMO, o los criterios de la SAO. Utilizando los criterios de la SAO, 85 (25.8%) pacientes recibirían tratamiento, mientras que si se utilizara la herramienta FRAX sin DMO, lo harían 15 (4.5%) pacientes (p = 0.0019). De los 67 pacientes con diagnóstico de osteoporosis por densitometría ósea, todas recibirían tratamiento utilizando los criterios de la SAO y solo 10 (15%) lo harían si utilizáramos el score de FRAX sin DMO (p = 0.011). La utilización del score de FRAX sin DMO reduce en forma significativa la cantidad de pacientes tratables en comparación con los criterios actuales de la SAO. En pacientes con diagnóstico de osteoporosis por DMO, el score de FRAX subestima los pacientes a tratar.

To identify patients at high risk of fracture using clinical risk factors could reduce health costs arising from the realization of a bone densitometry. The aim of this study was to compare the FRAX score without bone mineral density (BMD) with the criteria proposed by the Argentine Society of Osteoporosis (SAO) to consider starting antiresorptive treatment. We conducted an observational, cross-sectional study where 330 postmenopausal women between 40 and 90 years of age were included. The number of treatments given if the FRAX tool without BMD had been followed was compared with the number of treatments indicated using the SAO criteria. Using the SAO criteria, 85 (25.8%) patients would initiate antiresorptive treatment compared with 15 (4.5%) using the FRAX without BMD (p = 0.0019). Among the 67 patients with a diagnosis of osteoporosis by BMD determination, all of them (100%) would have received treatment by using the SAO criteria compared with 10 (15%) using the FRAX score (p = 0.011). The use of FRAX without BMD significantly underestimates the number of patients who should receive antiresorptive treatment. In patients diagnosed with osteoporosis by BMD, the FRAX score underestimates the number of patients to be treated.

Diagnosis and treatment of Paget's disease of bone: a mini-review / Diagnóstico e tratamento da doença de Paget dos ossos: uma minirrevisão

Paget's disease of bone (PDB) is a chronic progressive disorder of bone metabolism that may go undetected for many years, and endocrinologists should be alert to its clinical signs and promptly diagnose and treat PDB before it results in irreversible complications, such as deformity, fracture or neurological sequelae. Most commonly, PDB is suspected upon the incidental finding of elevated serum alkaline phosphatase levels or a radiographic abnormality in an otherwise healthy individual above 55 years of age. Some of these individuals may have symptoms such as bone pain or enlargement with increased warmth. In general, a basic laboratory evaluation of bone metabolism, plain radiographies of affected bones and bone scintigraphy are sufficient to corroborate the diagnosis. Antiresorptive therapy with bisphosphonates is the mainstay of treatment of symptomatic PDB, and intravenous zoledronic acid has emerged as an effective and safe treatment option, leading to sustained remission and improved quality of life. It is extremely important, though, to ensure calcium and vitamin D sufficiency before and during treatment in order to prevent hypocalcemia. The benefit of treating all asymptomatic patients is not clear, but treatment is warranted if the pagetic lesion is located in a site where progression to fracture, deformity, or compression would significantly impair the patient quality of life. This mini-review focuses on important aspects of the diagnosis and treatment of PDB.

A doença de Paget dos ossos (PDB) é uma doença progressiva e crônica do metabolismo ósseo que pode passar despercebida por muitos anos. Os endocrinologistas devem ficar alertas aos seus sinais clínicos e diagnosticar e tratar a PDB imediatamente, antes que ela gere complicações irreversíveis, como deformidade, fratura ou sequelas neurológicas. Mais comumente, suspeita-se da PBD após o achado incidental de níveis elevados de fosfatase alcalina no soro, ou anormalidades radiográficas em indivíduos aparentemente saudáveis com mais de 55 anos de idade. Alguns desses indivíduos podem apresentar sintomas, como a dor ou aumento ósseo com temperatura aumentada. Em geral, a avaliação laboratorial básica de metabolismo ósseo, radiografias simples dos ossos afetados e cintilografia óssea são suficientes para corroborar o diagnóstico. O tratamento antirreabsortivo com bifosfonatos é o principal tratamento da PDB sintomática, e o ácido zoledrônico intravenoso passou a ser uma opção de tratamento segura e eficiente, levando à manutenção da remissão e à melhora da qualidade de vida. É extremamente importante, entretanto, garantir níveis adequados de cálcio e vitamina D antes e durante o tratamento para se evitar a hipocalcemia. O benefício de se tratar todos os pacientes assintomáticos não está claro, mas o tratamento é recomendado se a localização da lesão pagética sugerir progressão para fratura, deformidade ou compressão que comprometam a qualidade de vida. Esta minirrevisão concentra-se em importantes aspectos do diagnóstico e tratamento da PDB.