7 - Osteoporosis

Question 1

Is this a long chapter?

Answer 1

No, thank the gods

Question 2

What does PTH do in the blood and bone?

Answer 2

It controls calcium, phosphorus and vitamin D levels

Question 3

Rundown of osteoporosis tx options

Answer 3

Lifestyle changes
Calcium and vitamin D
Hormone therapy
Biphosphates
SERMS
PTH
Calcitonin-salmon nasal spray
Denosumab

Question 4

Name the biphosphate drugs

Answer 4

nate’s and Nic

Aldenodronate
Risedronate
Ibandronate
Zoledronic acid IV

Question 5

What are teh SERMS?

Answer 5

Estrogen agonist

Roloxifene
Bazedoxifene

Question 6

What is teriparatide?

Answer 6

Parathyroid hormone

Question 7

What is denosumab?

Answer 7

Full human monoclonial antibody

Question 8

What is the MOA of estrogen replacement therapy? (ERT)

Answer 8

ERT MOA: inhibits bone resorption and promotes bone formation

Use the lowest dose possible

Question 9

What are the contraindications of ERT?

Answer 9

Women with VTE, hx of VTE (even while pregnant)

Question 10

Biphosphates MOA?

Answer 10

Remember they are the nates and nic

MOA: decrease osteoclast action, bone resorption, and increase bone density

Question 11

What is the 1st line tx for oseoporosis?

Answer 11

Nates and nic

Alendronate, risedronate, ibandronate, zoledronic acid

(Biphosphates)

Question 12

What is the 1/2 life of biphosphates?

Answer 12

10 yrs

Question 13

Who cant take biphosphates?

Answer 13

People with bad kidneys

CrCl <30mL/mil

Question 14

What are the AE’s associated with biphosphates?

Nates and nic

Answer 14

GI: dont lie down for 30-60 min and take w water

Osteonecrosis of jaw

Atypical fractures and esophageal cancer (NBD)

Question 15

But I have to take my pills with food?

Answer 15

Too bad, the nates and nic (i keep putting this here b/c i’m dumb and need repetition) must be taken on an empty stomach w water and no eating for 30 min before eating/drinking anything else

Question 16

Alendronate and Risedronate

Answer 16

Biphosphates:

Not recommended for:
kidney failure
Swallowing issues
Need good vitamin D

Question 17

Ibandronate and Zoleddronic acid (recast)

Answer 17

Biphosphates

Preferred for Pts unable to take oral biphosphates b/c GI issues

Question 18

What is denosumab (prolia) sub q used for?

Answer 18

Osteoporosis

Initial therapy in pts at high risk for fracture

Question 19

MOA for denosumab (prolia)

Answer 19

Binds to RANKL inhibiting osteoclast formation and activity

Question 20

What are the adverse reactions associated with denosumab (prolia)

Answer 20

MC: back/muscle/extremity pain

Serious but less common: hypocalcemia, osteonecrosis of jaw, immune suppression

Question 21

What drug is given to antagonize the effects of PTH?

Answer 21

Calcitonin

Question 22

Teriparatide (PTH 1-34) has a weird way of working, what is it?

Answer 22

It uses continuous exposure to PTH which somehow stimulates bone formation more than resorption

Question 23

Who is the target audience for teriparatide (PTH 1-34)?

Answer 23

Pts who are unable to tolerate biphosphate, are high risk and have lots of money

Question 24

Will you ever be able to perscribe PTH 134?

Answer 24

Fuck no its 42k/yr

But fortunately it maxes out at 84K bc it causes cancer if you use it more than 2 yrs so it has a limit

Question 25

What is a SERM?

Answer 25

Selective estrogen receptor modulator

Raloxifen

Question 26

What is raloxifen used for?

Answer 26

Prevention and tx of osteoporosis in postmenopausal women

Question 27

What are the DI’s for raloxifen?

Answer 27

Bile acid resins
Warfarin
Thyroid hormones

So basically all the shit old women are on

Question 28

Every day one person on earth unknowingly does something what is it?

Answer 28

Takes the biggest poo of the day