A somewhat disastrous start to PCN osteoporosisPCN骨质疏松症有些糟糕的开始.ppt

下载文档 降价啦

2
0
约3.89千字
约 25页
2018-06-24 发布于四川
举报
版权申诉
保障服务

A somewhat disastrous start to PCN osteoporosisPCN骨质疏松症有些糟糕的开始.ppt

1、本文档共25页，可阅读全部内容。
2、有哪些信誉好的足球投注网站（book118）网站文档一经付费（服务费），不意味着购买了该文档的版权，仅供个人/单位学习、研究之用，不得用于商业用途，未经授权，严禁复制、发行、汇编、翻译或者网络传播等，侵权必究。
3、本站所有内容均由合作方或网友上传，本站不对文档的完整性、权威性及其观点立场正确性做任何保证或承诺！文档内容仅供研究参考，付费前请自行鉴别。如您付费，意味着您自己接受本站规则且自行承担风险，本站不退款、不进行额外附加服务；查看《如何避免下载的几个坑》。如果您已付费下载过本站文档，您可以点击这里二次下载。
4、如文档侵犯商业秘密、侵犯著作权、侵犯人身权等，请点击“版权申诉”（推荐），也可以打举报电话：400-050-0827(电话支持时间：9:00-18:30)。

A somewhat disastrous start to PCN osteoporosisPCN骨质疏松症有些糟糕的开始

Questions? OSTEOPOROSIS 2011 Gregory Kline MD FRCPC Clinical Associate Professor University of Calgary Disclosures (12 months) none Risk Assessment WHO FRAX CAROC Reporting issues What level of risk? case 58 year old woman Brca (2005 – chemo, rad, tamoxifen to 2007) AML – allo stem cell Tx 2008 Ankle fracture 10 yrs ago running Prednisone x few months 2007 Ht 152.6 cm wt 61 kg. Labs normal. BMD Sept 2010: spine -1.5 hip -1.1, no change vs 2008 BMD report “pt gives a history of prednisone use and low trauma fracture” CAROC “estimated risk of fracture is high, 20-30%, drug therapy is recommended. CARJ 2005;56:178-88. FRAX or CAROC? FRAX Easy, intuitive, free web-based tool The whole world is using it Multi-factorial (controversy) Fun modeling during counseling Doesn’t include spine BMD CAROC Original Canadian data Simple Maybe just as good as FRAX at predicting # Maybe over-selects pts for Rx Depends on accuracy of radiology questionnaire! What risk to treat? Canada (implied) 10 % - nothing 10-20% - discretion 20 % - treat US 10 yr hip risk 2% 10 yr total risk 20% Or BMD -2.5 Let’s think about this Do we prescribe drugs to prevent wrist #? Do we prescribe drugs to prevent vert #? Do we prescribe drugs to prevent hip #? How to reconcile 10 yr risks with 3-5 yr trials? Assume we care mostly about hip #... Assume a RRR of 40% over 5 yrs Baseline risk (5 yr) 20% ? 12% = 63 person years to prevent # 15% ? 9% = 83 person years to prevent # 10% ? 6% = 125 person years 5% ? 3% = 250 person years 3% ? 1.8% = 417 person years 2% ? 1.2% = 625 person years 0.5% ? 0.3% = 2500 person years Assume we care mostly about hip #... Assume a RRR of 30% over 5 yrs Baseline risk (5 yr) 20% ? 14% = 83 person years to prevent # 15% ? 10.5% = 111 person years to prevent # 10% ? 7% = 167 person years 5% ? 3.5% = 333 person years 3% ? 2.1% = 555 person years 2% ? 1.4% = 833 person years 0.5% ? 0.35% = 3333 person years Overall, 32% reduction in all fractures in women over 50 Subgroups: 39