Osteoporosis treatment in patients with comorbidities

Alexandra Papaioannou, MD, MSc, is a professor of medicine in the Divisions of Geriatric Medicine & Rheumatology at McMaster University and the lead investigator for the Long-term Care Ontario Osteoporosis Strategy. She has expertise in clinical practices that involve osteoporosis and frailty in older adults.

Which comorbidities influence the treatment of osteoporosis?

Alexandra Papaioannou, MD, MSc: There are many comorbidities, especially in internal medicine. However, in FRAX, the model that we use for fracture risk estimation, the secondary causes are type 1 diabetes, osteogenesis imperfecta in adults, untreated hypothyroidism, hypogonadism, premature menopause at an age <45 years, chronic malnutrition, malabsorption, and chronic liver disease. And when you look at FRAX, rheumatoid arthritis has its own separate category, and these secondary causes have their own. There’s a new FRAXplus® that also includes higher-dose steroids, falls, and imminent fracture risk. That’s a new concept, so if [there’s] somebody who has had a fracture within a year, think of them just like having had a heart attack, or stroke, or a bone attack. Their risk is much higher.