Thread by @rheum_cat

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Dr Bobo Tanner - Osteoporosis

🦴

Trying to think of the last time I tweeted this topic. 2018?

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When to order DXA? The old, standard rules per Medicare

3 & 5 are particularly pertinent to us in rheum

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What are the definitions of osteoporosis beyond T score =< -2.5?

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What labs should we order for osteoporosis?

👉Phos: can lead you towards rare bone dz

👉24 hour urine for Cr, calcium to understand Ca++ balance

❗️Biotin supplements can interfere with tests

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Helpful table for osteoporosis tx options (FDA toolbox)

Bisphosphonates & Denosumab: fellows, memorize this slide for the rheum boards and ITE

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Duration of therapy? Drug holiday?

Most benefit 3 yrs (IV), 5 yrs (PO) for bisphosphonates

❗️Drug holiday can bring risk of AEs down. Drug holiday is "not a drug retirement"

👉If doing dental extraction, target 3-4m into denosumab

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A modified version of this figure would be helpful for helping pts weigh risks/benefits when considering ONJ risk

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Guidance on how to deal with rebound fx risk after stopping denosumab

Consider dosing IV zoledronic acid 6 months after stopping denosumab

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Treatment failure?

Review adherence, review the diagnosis

THEN consider switching tx

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Very high risk pt (e.g., elderly and severe osteoporosis): go the anabolic route

Considerations of tx for different life stages

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