00 Osteoporosis and HRT Flashcards
What is the definition of Osteoporosis?
T-score < -2.5
What is Osteopenia?
Lower bone density than normal, but not as low as osteoporosis (T-score between -1 and -2.5)
What are some drugs that can increase the risk of Osteoporosis?
Long-term steroid use, Anticonvulsants, Warfarin/heparin, Loop diuretics, PPIs, etc.
What is important about calcium absorption?
Calcium absorption is saturable; doses should be divided. Requires vitamin D for absorption
What drug treatment is often used first line for osteoporosis?
Bisphosphonates. PO or IV
How long should bisphosphonates be used for?
D/t the risk of atypical femur fracture, esophageal cancer, and osteonecrosis of the jaw, bisphosphonates should be stopped after 3-5 years
Why is estrogen no longer used first line?
Health risks, however, if used for menopausal symptoms, estrogen does increase bone density
What is most commonly used for women who are at risk or have fear of breast cancer?
Raloxifene
What is the generic name of Fosamax?
Alendronate (Bisphosphonate) - PO
How is Fosamax (Alendronate) usually dosed?
70mg PO weekly (or 10mg PO daily)
What is the generic name of Actonel, Atelvia?
Risedronate (Bisphosphonate) - PO
What is the generic name of Boniva?
Ibandronate (Bisphosphonate) - PO
What are the contraindications of Bisphosphonates?
Inability to stand or sit upright for at least 30 minutes (60 minutes w/ once-daily Boniva). Hypocalcemia. CrCl < 35
What are some commonly seen side effects with Bisphosphonates?
Hypocalcemia (mild, transient), back pain, arthralgias, dyspepsia, N/V, dysphagia, heartburn, esophagitis
What is the generic name of Reclast?
Zolendronic Acid (Injectable Bisphosphonate)
What is the generic name of Evista?
Raloxifene (Estrogen agonist/antagonist, SERM)
What is the BBW with Evista (Raloxifene)?
Increased risk of DVT/PE/MI/Stroke
What are the commonly seen side effects with Evista (Raloxifene)?
Hot flashes, peripheral edema, hot flashes, arthralgia, leg cramps/muscle spasms, flu-like syndrome, infection, amenorrhea, vaginal bleeding/discharge, skin changes
What is important about the Calcitonin Nasal Spray?
Inhale 1 spray daily (alternate nostril daily)
What is the generic name of Forteo?
Teriparatide (Injection - stimulates bone formation)
When is Forteo (Teriparatide) used?
For patients who are at very high risk for fracture, or have already had a fracture d/t osteoporosis
How is Forteo (Teriparatide) dosed?
20mcg SC inj daily for MAX of 2 years!
What is the BBW with Forteo (Teriparatide)?
Osteosarcoma (bone cancer)
What is the generic name of Prolia?
Denosumab (Monoclonal antibody)
What are the contraindications for Prolia (Denosumab)?
Hypocalcemia
What are the side effects with Prolia (Denosumab)?
Fatigue, Hypocalcemia (correct), Eczema, Rash, Weakness, Arthralgia/weakness/limb pain, nausea, dyspnea, cough
For HRT, when should Estrogen be used/not be used?
In women with a uterus, estrogen should not be given alone
What are the risks of using estrogen w/ progestin?
Increases breast cancer risk, and the use of this combination should be limited to 3-5 years
What are some natural products used for vasomotor symptoms of menopause?
Black cohosh, Red clover, Soy, Flaxseed
Which antidepressant is approved for menopause symptoms?
Brisdelle (Paroxetine): not recommended, especially in older people. Do not use with warfarin (increased risk of bleeding)
What is the generic name of Vivelle?
Esradiol transdermal system twice weekly patch for menopause
Besides the Vivelle patch, what are some other hormonal products used for menopause?
Provera, Premarin (tab and cream), Prempro
How is Evista (Raloxifene) dosed?
60mg/day
How is Alendronate (Fosamax) dosed for prevention?
35mg once a week
How is Risedronate dosed?
35mg QWeek or 150mg QMonth for prevention or treatment
How is Reclast (Zolendronic acid) dosed for post-menopausal osteoporosis?
5mg IV once yearly infused over 15 minutes
What is the generic name of Miacalcin?
Calcitonin (nasal spray for osteoporosis)
