1 / 8

The International AIDS Society USA

1. Pathophysiology and Risk Factors. HIV Disease FactorsMedication Factors2-6% decrease in BMD with ART initiationTDF, PIs, AZTPatient-Related FactorsLow Body WeightSmokingAlcohol UseOpiate UseHypogonadismPhysical InactivityLow Vitamin D (EFV). 2. 2008 US National Osteoporosis Foundation

louie
Download Presentation

The International AIDS Society USA

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    2. 1 Pathophysiology and Risk Factors HIV Disease Factors Medication Factors 2-6% decrease in BMD with ART initiation TDF, PIs, AZT Patient-Related Factors Low Body Weight Smoking Alcohol Use Opiate Use Hypogonadism Physical Inactivity Low Vitamin D (EFV)

    3. 2 2008 US National Osteoporosis Foundation (NOF) Guidelines for DXA Screening Those with a history of fragility fracture Women = 65 yrs, Men = 70 Postmenopausal women and men 50-70 years, if there is concern based on risk factor profile

    4. 3 2008 US NOF Guidelines: Who to Treat* Those with hip or vertebral fractures Those with BMD T-scores = -2.5 at the femoral neck, total hip, or spine by DXA Those with T-score b/t -1 and -2.5 (osteopenia) at above sites AND 10-year hip fracture probability = 3% or 10-year all major osteoporosis-related fracture = 20% based on FRAX model

    5. 4 What if the patient has low BMD? Evaluate for secondary causes Vitamin D deficiency? 25 OH Vit D Hyperparathyroidism? PTH, Ca++ Subclinical Hyperthyroidism? TSH Hypogonadism? Males: Testosterone; Females: Menstrual History Phosphate wasting? Serum Phosphate Idiopathic Hypercalciuria? 24 h urinary calcium Celiac Sprue? Tissue Transglutaminase Multiple Myeloma? Serum Protein Electrophoresis Mastocytosis ? Serum tryptase Cushing’s Syndrome ? 24 hr urinary free cortisol

    6. 5 Osteomalacia Impaired bone mineralization Accompanied by weakness, fracture, pain, anorexia, and weight loss Severe vitamin D deficiency and phosphate wasting most common causes Treated with Vitamin D, Ca++, +/- phosphate, not bisphosphonates Most important differential diagnosis for low BMD

    7. Treatment of Vitamin D Deficiency Replacement Ergocalciferol (D2) 50K units 1-2 times/week for 8-12 weeks OR Cholecalciferol (D3) 2000 IU/d Maintenance Ergocalciferol 50K units 1-2 times/month OR Cholecalciferol 1000-2000 IU/d 6

    8. 7 Treatment Options Bisphosphonates Actonel (risedronate) 150 mg each month Fosamax (alendronate) 70 mg each week (generic) Ibandronate (oral or IV) Zolendronic Acid 5 mg IV q year Work by inhibiting osteoclast function

    9. 8 Considerations When Choosing Between Bisphosphonates

More Related