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CORE IM @coreimpodcast.bsky.social · 7d

8/ Thanks to all for breaking (pun-intended) this down!

By: Dr. Sarah Gorey, Dr. Clem Lee Dr. Greg Katz and @shreyatrivedimd.bsky.social
Experts: Dr. Annie Garment and Dr. Ole-Petter R. Hamnvik
Graphic: Dr. Jimin Hwang
Audio: Kathreene Gala RN

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CORE IM @coreimpodcast.bsky.social · 7d

7/ 🦴 Guidelines have not yet changed to recommend that we treat all postmenopausal women with one dose of IV zoledronate

🦴 There is huge potential for both cost savings and reduction of important fractures

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CORE IM @coreimpodcast.bsky.social · 7d

6/

🦴 Control was placebo
🦴 Results ➡️LOWER fracture risk in BOTH arms receiving zoledronate (vs control)
🦴 NNT: 21 to prevent 1 vertebral fracture
🦴 NO osteonecrosis of jaw or atypical femoral fractures ‼️

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CORE IM @coreimpodcast.bsky.social · 7d

5/ Can infrequent zoledronate (IV bisphosphonate) be used as primary prevention for osteoporosis in women?

🦴 RCT
🦴 1054 women aged 50-60 from New Zealand
🦴 Intervention: zoledronate: 2 doses, one at baseline and one at 5 yr OR 1 dose at baseline, followed by placebo at 5 yrs

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CORE IM @coreimpodcast.bsky.social · 7d

4/ Some v rare side effects of bisphosphonates:

🦴 Osteonecrosis of the jaw
🦴 Atypical femoral fractures

🤔

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CORE IM @coreimpodcast.bsky.social · 7d

3/ Meds for osteoporosis:

🦴 Bisphosphosphonates
- FIT & HORIZON trials
🦴 Denosumab (Prolia)
- FREEDOM trial
🦴 Romosozumab (Evenity)
- FRAME & ARCH trial
🦴 Teriparatide (PTH analogue)

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CORE IM @coreimpodcast.bsky.social · 7d

2/
Osteoporosis:

🦴 ⬇️ bone density ➡️ fractures
🦴 Dx w/ DEXA and/or fragility fracture

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CORE IM @coreimpodcast.bsky.social · 7d

1/ 🚨 NEW #BeyondJournalClub w/ @NEJMGroup: The Bolland study

Question: Does infrequent zoledronate therapy in patients without osteoporosis prevent fractures?

Answer: ⤵️

www.coreimpodcast.com/2025/10/01/b...

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CORE IM @coreimpodcast.bsky.social · 23d

4/ Thanks to all!!

Atuhors: Dr. Alexa Wilden, Dr. Sean Burke, Dr. Alexandra Sheridan @shreyatrivedimd.bsky.social

CORE IM @coreimpodcast.bsky.social · 23d

3/ Chronic therapies fall into two buckets:

1️⃣ Antifibrotics
- slows decline in fibrosis
2️⃣ Immunosuppressants
- NOT for patients with IPF

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CORE IM @coreimpodcast.bsky.social · 23d

2/ Think of ILD as PRIME

P- post-infectious
R- rheumatologic
I- idiopathic (IPF, NSIP, COP)
M- medication induced
E- environmental (birds, asbestos, silica, coal, tobacco)

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CORE IM @coreimpodcast.bsky.social · 23d

1/ 🚨 NEW #WhiteboardAnimation: ILD 🫁

Let’s talk ILD classification & management ⤵️

🎥: www.youtube.com/watch?v=GjBg...
🖥️: www.coreimpodcast.com/2025/09/14/i...

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Reposted by CORE IM

Zaven Sargsyan @sargsyanz.bsky.social · 27d

This episode is good stuff

CORE IM @coreimpodcast.bsky.social · 28d

1/ 🚨 NEW #GrayMatters: Orthostatics part 1️⃣

Orthostatic hypotension is VERY common ‼️
✨ 20% of those over 60 years old
✨ 50% in nursing homes

Causes:
✨ Decreased venous return
✨ Neurogenic

🖥️: www.coreimpodcast.com/2025/09/11/o...
Sponsor: Oakstone CME

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Reposted by CORE IM

Shreya P. Trivedi MD, MHPE @shreyatrivedimd.bsky.social · 27d

Learned a ton of specific, practical strategies and the WHY from some wonderful neurologists 🤗

CORE IM @coreimpodcast.bsky.social · 28d

5/ There are some non-pharmacologic ways to manage orthostatic hypotension ‼️
✨ Hydrate
✨ Compression
✨ Mobility
🛑 Avoid standing quickly
🛑Avoid high carb meals
🛑 Don’t forget to address culprit meds!

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CORE IM @coreimpodcast.bsky.social · 28d

6/ Thanks to all!

Hosts: Dr. Nick Villano, @shreyatrivedimd.bsky.social
Experts: Dr. Lewis Lipsitz, Dr. Cyndya Shibao and Dr. Sharon Gorman
Graphic: Dr. Jesse Powell

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CORE IM @coreimpodcast.bsky.social · 28d

5/ There are some non-pharmacologic ways to manage orthostatic hypotension ‼️
✨ Hydrate
✨ Compression
✨ Mobility
🛑 Avoid standing quickly
🛑Avoid high carb meals
🛑 Don’t forget to address culprit meds!

1 1

CORE IM @coreimpodcast.bsky.social · 28d

4/

Signs of neurogenic:
✨ Insufficient heart rate response upon standing
✨ Comes on after a delay of 5+ minutes (early disease)
✨ Comes suddenly (late disease)
✨ Concomitant symptoms of neurogenic/autonomic disease

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CORE IM @coreimpodcast.bsky.social · 28d

3/ Definition:

✨ Sustained reduction of
- Systolic blood pressure of at least 20 mmHg
- Diastolic blood pressure of 10 mmHg

within either 3 minutes of standing or 3 minutes of assuming a head-up position of at least 60 degrees on a tilt table

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CORE IM @coreimpodcast.bsky.social · 28d

2/ How to measure:

1️⃣ Have the patient lie down for at least 5 minutes
2️⃣ Once the patient stands, measure (1) BP, (2) HR, (3) Symptoms at
- One minute
- Three minutes
- Five minutes of standing

**if the patient can tolerate

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CORE IM @coreimpodcast.bsky.social · 28d

1/ 🚨 NEW #GrayMatters: Orthostatics part 1️⃣

Orthostatic hypotension is VERY common ‼️
✨ 20% of those over 60 years old
✨ 50% in nursing homes

Causes:
✨ Decreased venous return
✨ Neurogenic

🖥️: www.coreimpodcast.com/2025/09/11/o...
Sponsor: Oakstone CME

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CORE IM @coreimpodcast.bsky.social · 28d

6/ Thanks to all!

Hosts: Dr. Nick Villano, @shreyatrivedimd.bsky.social
Experts: Dr. Lewis Lipsitz, Dr. Cyndya Shibao and Dr. Sharon Gorman
Graphic: Dr. Jesse Powell

1

CORE IM @coreimpodcast.bsky.social · 28d

5/ There are some non-pharmacologic ways to manage orthostatic hypotension ‼️
✨ Hydrate
✨ Compression
✨ Mobility
🛑 Avoid standing quickly
🛑Avoid high carb meals
🛑 Don’t forget to address culprit meds!

1 3

CORE IM @coreimpodcast.bsky.social · 28d

4/

Signs of neurogenic:
✨ Insufficient heart rate response upon standing
✨ Comes on after a delay of 5+ minutes (early disease)
✨ Comes suddenly (late disease)
✨ Concomitant symptoms of neurogenic/autonomic disease

1

CORE IM @coreimpodcast.bsky.social · 28d

3/ Definition:

✨ Sustained reduction of
- Systolic blood pressure of at least 20 mmHg
- Diastolic blood pressure of 10 mmHg

within either 3 minutes of standing or 3 minutes of assuming a head-up position of at least 60 degrees on a tilt table

1

CORE IM @coreimpodcast.bsky.social · 28d

2/ How to measure:

1️⃣ Have the patient lie down for at least 5 minutes
2️⃣ Once the patient stands, measure (1) BP, (2) HR, (3) Symptoms at
- One minute
- Three minutes
- Five minutes of standing

**if the patient can tolerate

1