IBANDRONATEHigh Efcacy to Reduce Fracture Risk in OsteoporosisDisclaimer This scienti!c in"ormationand e#entsupported $y %T& Roche IndonesiaDe!nition Osteoporosis1). Old definition: a reduced amount of bone that is qualitatively normal. (Albright F. Ann Intern Med. 1!"# $":%&1)$). Modern definition: 'A systemic s(eletal disease characteri)ed by lo* bone mass and microarchitectural deterioration of bone tissue+ *ith a consequent increase in bone fragility and susce,tibility to fracture-. (11).). /e*est definition: 'Osteo,orosis is a s(eletal disorder characteri)ed by com,romised bone strength ,redis,osing to an increased ris( of fracture.0one strength reflects the integration of t*o main features: bone density and bone quality.- ($111)%re#alensi Osteoporosis'HO 200.000.000 orang menderita Osteoporosis di seluruh dunia. Tahun 2050, angka hip fracture meningkat dua kali lipat pada wanita dan tiga lipat pada pria. Di dunia, 1 dari 3 wanita usia 50tahun akan mengalami fraktur akiat osteoporosis dandi pria adalah 1 dari 5.%ERO(I )*++,- meningkat 23! pada usia 50"#0 tahun dan men$adi 53! usia %0"#0 tahun(istem In"ormasi Rumah (akit )(IR(- *+.+, insiden fraktur tulang paha atas sekitar 200&100.000 kasus pada wanita dan pria usia '0 tahun50! fraktur tulang paha atas( cacat seumur hidup, angka kematian sampai 30! akiat komplikasi imoilisasi (belum termasuk patah tulang belakang dan lengan bawah tanpa perawatan RS)As 2omen Age+ 0M3 3ecreases and Fracture 4is( Increases0100020003000400035-39 85+AgeFracture Incidenceper 100,000 Person-Yearso!!es"#pine$ip#pine %&'(g)c*2+Economic cost o" OsteoporosisDirect cost( estimated )13.# illion *1++5, for hospitali-ation, rehailitation, and nursing home care. .n 2003 will e )1% illion.ndirect cost due to loss of producti/it0 and wages are di1cult to measure ut it will /er0 sustantial things20 2025 is e3pected to e 25 illion annual011Burge R et al J Bone Miner Res, 2007 22!"#$%"7$,-,-./01/%0A2 F0A130/ 4#A13 1A$3, #/1/2A$ PA1A$ 132A,5 PA,5532ooper , A* 6 &ed, 19978103(2A+412#-17#4095ida( da,at ber6alan sendiri3097acat teta,209Meninggal dalam 1 tahun8098asien (9)5ida( da,at mela(u(an ,aling tida( 1 (egiatan sehari:hariThe ultimate treatment goal for isphosphonates in osteoporosis /FractureriskBonestrengthIncreasingB0DReducing$one remodelling0aintainingstructural propertiesB0D / $one mineral densityIbandronate7om,lete fracture ,rotection%-,/.I%/&eta-Ana!:sesIbandronate7om,lete fracture ,rotection%-,/8rimary end,oint: Ibandronate significantly reduces vertebral fracture ris( at . years000 ; re!atiidence interractures at 3 :ears (9+n;975 n;977Incidence o> non-ractures at 3 :ears (9+n;124 n;12320151050&9 444 p;0?012DPost-Boc suAgroup ana!:sis%&' ; Aone *inera! densit:Besnut $, et al. 6 %one &iner 0es 200481941241@12490aseline femoral nec( 0M3 5:score C ?5@3A: /on:Bertebral Fracture 4is( 4eduction0one quality maintenance has also been demonstrated *ith ibandronate8lacebo 0ec=er 0, et al. 6 !in 'ensito* 2009812471@7CBesnut $, et al. 6 %one &iner 0es 200481941241@9Eualitative histological analysis of bone bio,siesIbandronateIbandronate7om,lete fracture ,rotection&eta-Ana!:ses/on:vertebral fracture data5*o se,arate meta:analyses confirm non:vertebral ,rotection *ith ibandronate$arris et al? 20081@'ata >ro* %-,/, I. Piro* eigBt rando*ised tria!s re/?>3DA/ ; annua! cu*u!atior ora! iAandronate ;0?C9%arrett 6, et al? 6 !in PBar*aco! 20048444951@9C5$arris #1, et al. urr &ed 0es -pin 20088244237@245ranne: A, et al? -steoporosis Int 20098204291@297(A/D 10?8*g+(A7>D ;.;mg)7ranney8lacebo8laceboFarris'ai!: iAandronate (A/;5?5*g+$igB-dose iAandronate (A/H10?8*g+1i*e (da:s+/sti*ated >racture rate (9+389 re!ati 11.%mg vs. lo* doseAdacBi 6', et al. A#%&0Annua! &eeting, 1C@19 #epte*Aer20078 $ono!u!u, $I? Poster &428?ranne: A, et. al. -steoporos Int 20098204291@297P!aceAoFarris et al.5ime to non:vertebral fracture is eItended *ith ibandronate A7> 11.%mg vs. ,lacebo$arris #1, et al. urr &ed 0es -pin 20088244237@245108C53100 150 350 450 C501i*e (da:s+9742550 50 250 750Patients EitB >racture (9+IAandronateBigB doses (A/H10?8*g+p;0?025 (2og-ran=+Meta:analyses: Ibandronate significantly reduced the ris( of non:vertebral fracturesIAandronate at BigBer dose !e non-racturesIAandronate is tBe >irst AispBospBonate to de*onstrate non-racture e>>icac: EitB doses used in c!inica! practice Bip and non-ractures >or *ontB!: iAandronate and Eee=!: AispBospBonates1Be rates o> ractures Eere statistica!!: signi>icant!: !oEer EitB *ontB!: iAandronate isman NA+ et al. Osteo,oros Int $11"(?u,,l. $)#?$1$ (Abstract 8.1&?A)# &He*iec(i M+ et al. 0one $11"#!1(?u,,l. $):?.1$ (Abstract .15h)# "He*iec(i M+ et al. 0one $11"#!1(?u,,l. $):?.11 (Abstract .1"5h)# IbandronatPs su,erior renal safety ,rofile enables to be given as IB 0olus(ummaryOsteoporosis is a signi!cant pro$lem.andronate as a complete fracture protection.andronate is pro/en for long term fracture protection.andronate is