Issue link: https://viewer.e-digitaledition.com/i/71333
+++++++++++++++++++++++++++++++++++++++++ +++ +++ +++++++++++++++++++++++++++++++++++++++++ SPECIAL SECTION: WOMEN'S HEALTH + + New Approaches to the Treatment of Type 2 Diabetes and Osteoporosis Fracture Risk Assessment T Type 2 Diabetes The old notion that a patient with Type 2 diabetes taking more than 30 units of insulin per day meant the patient was insulin dependent is simply no longer true. In clinical practice, the new diabetes therapies, Victoza or Bydureon, have been capable of replacing upwards of 60 units of insulin per day in insulin-dependent type 2 diabetics. When basal insulin is required, addition of Victoza or Bydureon, instead of prandial insulin, has been quite successful in getting patients' HbA1C to goal. These newer therapies have not only improved the glycemic control in patients, but they have also led to a decrease in the number/frequency of injections (by replacing or negating the need for prandial insulin) and have assisted with weight loss. Patients who have had long-standing poorly-controlled DM-2, and require insulin therapy, often benefit from this approach. Glycemic control can also be successfully obtained with the use of these medications earlier on in the disease course [in patients taking 1-2 oral anti-diabetic medications who are still not at goal (HbA1C <7%)]. The all-too common methods of simply continuing to add additional oral anti-diabetic therapies or large doses of basal insulin to patients with poor glycemic control (and who are already taking 1-2 oral agents) should no longer be the approach to diabetes management. This approach has historically failed; studies have demonstrated that with the use of traditional therapies, nearly 50% of patients are not at the recommended HbA1C goal. A shift in the paradigm of diabetes management is clearly needed. There are new approaches and medications available which not only assist in achieving better glycemic control, but also have the added benefits of weight loss and potentially a decrease in the burden of disease management for the patient. By Kevin M. Pantalone, DO, ECNU, CCD, and Jennifer Wojtowicz, DO, MS WO NEW APPROACHES are now available for two com- mon endocrine-related disorders facing a large portion of the population. Fracture Risk Assessment A new approach to fracture risk assessment has been brought to the fore as America continues to "grey." An increasingly aging population means the incidence of osteopenia and osteoporosis will continue to increase, and with it comes an increase in the risk of fractures. A risk calculator developed by the World Health Organization (WHO) known as FRAX, not only quantifies a patient's risk of developing a hip or other osteoporotic fracture, but it also helps in determining when and in whom the appropri- ate intervention should occur. The assessment calculates two numbers: 1) a patient's 10-year probability of having specifically a hip fracture, and 2) a patient's 10-year probability of sustaining any major osteoporotic fracture. The broad range of indicators in the FRAX tool leads to a better risk assessment for the patient. FRAX indicators include age, sex, weight, height, previous fracture history, parents with a fractured hip, smoking history, glucocorticoids, secondary osteoporosis, alcohol consumption and rheumatoid arthritis. FRAX allows physicians to target patients' interventions to those individuals which would benefit the most. Until recently, the results of bone mineral density testing alone has been the main driver in the decision making process regarding whether or not to offer therapy to patients with a low bone mineral density. Treatment is the recommended course for those patients with osteoporosis (defined as a T score <-2.5). However, in patients with a T-score in the range of -1.0 to -2.5 (known as "osteopenia") a direction for treatment is not as clear. This is a larger group, and those at the highest risk to fracture are more likely to benefit from an intervention; using FRAX allows for identification of that high-risk group more effectively than simply utilizing the bone densitometry results alone. Dr. Kevin M. Pantalone and Dr. Jennifer Wojtowicz are board- certified endocrinologists affiliated with Summa Western Reserve Hospital Physicians, Inc. Offices are located in Hudson and Streetsboro. ■ JULY-AUGUST 2012 ■ MDNEWS.COM ■ MD NEWS Cleveland-Akron-Canton | 21