Pharmacologic Treatment Fig 561

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^^ The NOF recommends that all men and women over age 50 be considered for pharmacologic treatment if they meet any of the following criteria: history of hip or vertebral fracture, T-score less than or equal to -2.5 at femoral neck or spine, or osteopenia and at least a 3% 10-year probability of hip fracture or at least a 20% 10-year probability of major osteoporosis-related fracture as determined by FRAX.1

•'Major nsk factors: low body we«ght. personal history of fracture as an adult (alter age 45 years), history of low-trauma fracture in a first-degree relative, and rheumato»d arthritis.

e Bone-healthy lifestyle: smoking cessation, vetl-balanced diet, resistance exercise, and fall prevention for seniors. cTenparatide can be considered first-Une op»on in patients with a T-scofe less than -3.5.

Presence of a low-trauma Induro [vortobrao. hip, wrist, Ot roffftarm)

• Bona-healthy lifEilyler

* Drug therapy

• FiiSI lint»: Bisphosphonate

« Seconfl une: Tetiparalido17 ■ Thircf line: flalöiufenö

• Fourth line: intranasal calcitonin Obtain basEliria (entrai BMD tesUng It* monitoring lostonic 10 lharapy Reevaluate BMD in 1 to Z years

PatiertTs tharaderiElic

• SO lo 70 ywrs of apo win mtflipie risk facfot tor rract-une"

• /nfcnnrm al peripheral BUD test

• Raaographic evidence of osiaopenia

' Mescal conn:1ionf, or mediialiens knM 1o increase Ihn risk lor bor» loss and Irajaupe le.-y.. rheumatoid arlhribs)

Sand lor central OJtA iMling

FFlAX 10-year fracture nsk:

CHlwpnnotiç

* Bone-hesiihy ifestyie"

* Vflamln D 400-1,000 unitedly Usevaiuale m 5 years or as apprr^riale

* Investigate lor h secondary cause and trWLl as aperopnate13

* Bone-tieaflhy Irie-stylE"

* Vrianwn D 800-1,000 units/day

* Firsl line: Aiandronato or ris8dronalei » Second line: Tenparatide'

* TTiina-iino: intranasal calcitonin" FtEevafuatE BUD in 1 to 2 years

''Major nsfc radars; eunenl wnoheri personal nistory ot Inclure ai an adu« (alter age 45 years}. history ot lowtrauma iraclure in a lirEl-degree relative, and rtieumalmd artfinlis.

LlJiis&J on a normal mal» relerance database.

^BociE-heallh.y hieEtyte: smoking cessation, well-balanced diet, resjslanoe exErcise, and lall prevEnlior for seniors.

"CxjliipluH of SMOndâry causes induré hypogonadism, rheumatoid arthritis, chronic obstructive puKtOriery disease. Systemic giiicnoorticoias.

"Alendronate and risedroriale art; FDA approved in men. IV bispitosptioriales are an option if patient cannot tolerate oral tusptioephiinities or has signihcani adherence prcwems.

teriparalide is FDA approved for usa in man and can b« tons-deed a tira-hne option in man with a T-sosret le-sa than -3 5.

^Csralonm is not FDA approved for use m men.

FIGURE 56-1. Algorithm for management of osteoporosis in postmenopausal women (A) and in men (B). (BMD, bone mineral density; DXA, dual-energy x-ray absorptiometry.) (Adapted from

DiPiro JT, et al., eds. Pharmacotherapy: A Pathophysiologic Approach, 7th ed. New York: McGraw-

Hill, 2008:1490-1491, Figure 93-3, with permission; updated with information from Ref.1.)

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