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Meet the Professor
Controversies in
treatment of osteoporosis
Friday 12 May 2006
13.00-14.00
We aim to apply evidence from randomized trials and longitudinal
studies, and a little bit of logic, to discuss several common issues
that arise
in patient care and guidelines for treatment. Topics may change, depending
on recent findings and new important issues. The current plan is to address
as many (one, two or three) of the following issues that time allows.
- After how many years of treatment should you stop a bisphosphonate?
There have been concerns about adverse effects of long-term treatment
with bisphosphonates on 'bone quality' and strength. There has
been very little information about long-term effects. Two analyses
of
long-term effects of alendronate suggest that 10 years of treatment
does not
increase fracture risk. However, should you consider putting some
patients on a drug holiday after 5 years?
- When has a patient 'failed'
therapy? When should you switch or add?
Do 'non-responders' exist? If so, how do you recognize them?
Should you change treatments for patients who have lost BMD during
treatment?
Had a fracture? If time permits, we will discuss a slightly different
way of thinking about the problem: reaching treatment goals.
- Which patients with 'osteopenia' should receive drugs?
There is developing consensus that decisions about whether to
treat with a pharmacologic agent should be made on the basis
of a patient's
absolute risk of fracture. Does this approach identify those
who will benefit most from treatment? How does this apply to
treatments,
like
SERMs that may have other effects on health.
Educational objectives:
- Understand both absolute risk and absolute benefit (such
as NNT)
- Understand how multiple benefits and risks
of treatment changes the 'treatment threshold' for osteoporosis.
- Understand
the recent studies of 10 year effects of bisphosphonate treatment.
- Understand
ways to define 'non-response' and evidence about hon-response
to bisphosphonates.
Who should attend: Clinical investigators, clinical
epidemiologists, clinicians who may want to
think differently about clinical
issues.
Method: Illustrative case followed by brief
summary of evidence then discussion for
about half of
the session.
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