GeneralG15OsteoporoticFxsMGEdited幻灯片.pptVIP

* * * * * * * * * * * * * * * * * * * * * * * * * Sliding hip screws are not the ideal implant for proximal subtrochanteric fracture patterns secondary to sliding parallel to the plane of the primary fracture line. The same goes for reverse oblique patterns. * * * * * * * * * * * * * * * * * * * * * * * * Prevention Strategies focus on controlling factors that predispose to recurrent fracture Consider bone mineral density test Rule out secondary causes of osteoporosis Initiate and monitor therapy, or refer Fall prevention Prevention Multidisciplinary programs Medical adjustment Behavior modification Exercise classes Controversial Prevention and Treatment of Bone Fragility Well established link between decreasing bone mass and risk of fracture Prevention/treatment options Bisphosphonates SERMs Alendronate (Fosamax ?) - Raloxifene (Evista ?) Risedronate (Actonel ?) Ibandronate (Boniva ?) Stimulators of bone formation Zolendronate (Aclasta ?) - rh-PTH (Forteo ?) Hormone Therapy/Replacement Other - Estrogen/progestin - Calcitonin Prevention and Treatment of Bone Fragility Estrogen/progestin FDA approved for prevention, not treatment of osteoporosis 3-5% bone loss/year with menopause Unopposed or combined therapy has been shown to reduce hip fracture incidence in women aged 65-74 by 40-60% (Henderson et al. 1988) However, the Women’s Health Initiative (2009) concluded reduction in hip fracture not offset by increased risk of breast endometrial cancers, thromboembolism, dementia, and coronary heart disease Prevention and Treatment of Bone Fragility Calcium/Vitamin D Supplementation Recommended for most men and women 50 years Calcium Age 50 -- 1,000 mg/day Age 50 -- 1,200 mg/day Vitamin D Age 50 – 400-800 IU/day Age 50 – 800-1000 IU/day Combining Vitamin D and calcium supplementation has been shown to increase bone mineral density and reduce the risk of fracture Prevention and Treatment of Bone Fragility Calcitonin Inhibits bone resorption by inhibiting