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Statement: The North
Carolina Rheumatology Association recommends that intravenous
bisphoshonate therapy, when prescribed by rheumatologists
after thorough evaluation, be available, utilized and
appropriately reimbursed by health insurers for the
treatment of osteopenia, osteoporosis, and/or low-trauma
fractures (fragility fractures), in appropriate patients
who cannot tolerate or are refractory to treatment with
estrogen replacement therapy, raloxifene (Evista), alendronate
(Fosamax), risedronate (Actonel), or oral ibandronate
(Boniva). Use of parenteral bisphoshonates is also not
inappropriate in these same patients after successful
treatment with teraperitide in specific cases. We believe
that this represents the standard of care for these
seriously ill patients.
Discussion: The NIH
Consensus Statement on Osteoporosis Prevention, Diagnosis,
and Therapy defines osteoporosis as "a skeletal
disorder characterized by compromised bone strength
predisposing to an increased risk of fracture. Bone
strength reflects the integration of two main features:
bone density and bone quality." Osteoporosis is
a silent disease until bones become so weak that fractures
occur. Osteoporosis is a major health problem in the
United States, affecting approximately 10 million people.
Approximately 18 million people have osteopenia. One
of every three women over the age of 50 has osteoporosis
and nearly half of all women over 50 will break a bone
in her lifetime due to osteoporosis. Approximately one
in every eight men over the age of 50 will have an osteoporotic
fracture in his lifetime. Ultimately, in an extremely
elderly population, one in every six men will have a
hip fracture.
Appropriate therapeutic alternatives
for the prevention and treatment of osteoporosis include
calcium, vitamin D, estrogen replacement therapy, raloxifene
(Evista), alendronate (Fosamax), risedronate (Actonel),
calcitonin (Miacalcin), oral and parenteral ibandronate
(Boniva), and teraperitide (Forteo). Unfortunately,
some patients have contraindications to taking these
medications, develop intolerable side effects, or are
refractory to therapy. An alternative to these routine
medications is intravenous bis-phosphonate therapy,
such as pamidronate (Aredia) or ibandronate (Boniva).
Pamidronate has been shown to inhibit bone resorption
and improve bone density in patients with osteoporosis.
Ibandronate is FDA approved for IV administration for
treatment of osteoporosis.
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