13 Osteoporosis Ma

Question 1

What are the calcium regulating hormones that can be part of the cause for Osteoporosis?

Answer 1

Parathyroid hormone. Calcitrol (Vitamin D). Calcitonin

Question 2

What are some common medications that can contribute to osteoporosis?

Answer 2

SSRIs. PPIs. Anticoagulants. Anticonvulsants. Cyclosporine, Tacrolimus. Depo-medroxyprogesterone

Question 3

What are some indications for Bone Mineral Density testing?

Answer 3

Women age > 65. Women discontinuing estrogen. Men > 70

Question 4

How long does a patient need to be taking a corticosteroid before considering doing a BMD test?

Answer 4

i.e. 5mg prednisone for 3 months or more

Question 5

What is a normal T-score and what does it mean?

Answer 5

T-score > -1. BMD w/in one SD of a young healthy adult

Question 6

What T-score is considered Osteopenia?

Answer 6

-1 > T > -2.5, BMD is between 1 and 2.5 SD of a young healthy adult

Question 7

What T-score is considered Osteoporosis?

Answer 7

T < 2.5, which means the patient is 2.5 SD or more below a young healthy adult

Question 8

What does a Z-score show?

Answer 8

Compares patients BMD to the expected BMD in a patient of the same age, sex, and body weight. Used to evaluate pre-menopausal women

Question 9

What action should be given for a normal T-score?

Answer 9

Lifestyle advice

Question 10

What action should be taken for an Osteopenia T-score?

Answer 10

Lifestyle advice. Calcium and Vitamin D supplementation

Question 11

What action should be taken for an Osteoporosis T-score?

Answer 11

Lifestyle advice. Treat with Bisphosphonates. Calcium and Vitamin D supplementation

Question 12

What action should be taken for an Osteoporosis T-score PLUS 1 or more fractures (established osteoporosis)?

Answer 12

Lifestyle advice, pain control. Treat with Bisphosphonates/Calcitonin/Teriparatide. Calcium and Vitamin D supplementation

Question 13

What is the recommended Calcium and Vitamin D intake for age 50+?

Answer 13

Ca: 1200mg/day (max of 500-600 absorbed at one time, divide doses). Vitamin D: 800-1000 IU/day

Question 14

Which type of Calcium MUST be taken with food for absorption?

Answer 14

Calcium Carbonate

Question 15

What are some DDIs with calcium supplementation?

Answer 15

Decreased absorption of TCN, FQ, and Levothyroxine

Question 16

What are the possible treatment options for Osteoporosis?

Answer 16

Bisphosphanate. Calcitonin. Parathyroid hormone. Estrogen/Hormone Replacement. Selective estrogen receptor modulator (SERM)

Question 17

What is the MOA of Bisphosphanates?

Answer 17

Inhibits osteoclasts (antiresorptive) thus inhibiting further decline in BMD. Possibly increase BMD?

Question 18

What are the different bisphosphanates?

Answer 18

Alendronate (Fosamax). Ibandronate (Boniva). Risendronate (Actonel). Risendronate DR (Atelvia). Zoledronic Acid (Reclast)

Question 19

Which Bisphosphanate is administered every 12 months?

Answer 19

Zoledronic acid (Reclast)

Question 20

What is the Bisphosphanate counseling?

Answer 20

Advise patient to take only upon rising for the day, not taken at bedtime. Take at least 30 minutes before the first food, beverage, or medication of the day. Take tablet w/ a full glass of water while in upright position. Do not lie down for at least 30 minutes after dose

Question 21

What is a rare but serious side effect of Bisphosphanates?

Answer 21

Osteonecrosis of the jaw. Ulcers, Esophageal cancers

Question 22

What is the MOA of Calcitonin?

Answer 22

Natural hormone involved in Calcium regulation and bone metabolism. Slows bone loss and increases bone density. Spine fractures only

Question 23

What is the MOA of Parathyroid Hormone?

Answer 23

Rebuilds bones and significantly increases BMD (spine). Given SQ QD

Question 24

What is the recommendation for HRT in the treatment of osteoporosis?

Answer 24

Lowest possible dose for the shortest period of time and not a first line prevention option

Question 25

What is Raloxifene (Evista)?

Answer 25

Selective Estrogen Receptor Modulator (SERM)

Question 26

What is the MOA of Raloxifene (Evista)?

Answer 26

Provides positive effects of estrogen without their potential disadvantages. Increases bone density. Reduces the risk of spine fractures only