Bone Homeostasis Flashcards
Your patient is a 62 year old women, post menopausal, who is being seen for arthralgia in the hands, complains of bone pain, and shoulder pain bilateral. What condition is she most likely suffering from and what medication is used to treat this patient?
Hyperparathyroidism!
Calcitonin is the medication.
This disease can lead to trunk weakness and involves the excess release of bone calcium into bloodstream.
Hyperparathyroidism- PTH
*this disease may also present with Pseudogout, pathologic fractures, and impaired joint mobility and muscle weakness.
Your patient suffers from chronic renal failure (renal osteodystrophy). Which combination of drugs is this patient likely on?
Calcium and Vit D supplements!
*This pt has a decrease in calcium absorption (excessive bone resorption), manifesting bone pain, fractures, and weakness. Vit D increases mineral absorption.
What is the disease that results in the excessive breakdown and formation of bone, commonly found in pts over 70, which makes them prone to fractures, especially in the shoulder and lumbar, and complain of pain, stiffness, deformity, stenosis and paresis? What is the drug of choice to treat them?
Pagets disease! Treated with Calcitonin or Bisphophonates.
*The disease effects pelvis, lumbar, sacrum, femur, tibia, skull, shldr, thoracic, cervical, and ribs
What is the treatment for Osteomalacia (adult form of Rickets), which is a deficiency of Vitamin D, effecting calcium absorption?
Vitamin D and Calcium supplementation.
Vit-D aids with the absorption of calcium
Your patient hands you a lab report and it gives you her bone mineral density, which is scored as -1.3 measured by DEXA scan. What is the significance of this score?
She is considered at risk for Osteoporosis. Osteopenia is diagnosed by a score of -1.0 to -2.5 and is considered precursor to osteoporosis.
Your pt presents with fair skin, hunched over with extra thoracic kyphosis, and has an ectomorphic body. Which condition do you suspect she has?
Osteoporosis. Vit-D with calcium supplementation
This drug is a synthetic parathyroid hormone with good efficacy, used to treat osteoporosis in postmenopausal women.
FORTEO
This drug increases the intestinal calcium and phosphorus absorption, decrease renal excretion of minerals, and is used in combination with calcium in the prevention and treatment of osteoporosis.
Vitamin D
This drug reduces the rate of bone loss by inhibiting osteoclastic activity and bone resorption and lowering serum calcium. Effective in treating Paget’s disease and hypercalcemia, and is used in RA, post menopausal and steroidal induced osteoporosis.
Calcitonin
*AKA- Cibacalcin, Calcimar
This drug increases bone density by decreasing bone resorption and reduces incidence of fractures. Can have adverse side effects such as breast cancer and increasing cardiovascular events.
Estrogen
This drug reduces bone resorption, preventing bone loss and reducing spinal fractures, but less effective than estrogen, and may reduce breast cancer risk. Side effect includes blood clotting.
SERMS (selective Estrogen Receptor modulators)
*Raloxifene, Tamoxifen
This drug inhibits osteocalstic activity, restoring balance of bone remodeling and reducing bone turnover to levels seen in healthy young adults. Used to prevent bone loss, prevent fractures, and treat Paget’s.
Bisphosphonates
*Alendronate, Risendronate (onate)
This drug is commonly used to slow osteoporosis and reduce fracture.
Bisphosphonates
*(Fosomax) Alendronate, Risendronate (actonel) “onate”
Your patient is taking pharmaceutical agents to help induce bone formation. What is an intervention that you can do to help enhance this process?
Resistive Training. Produces the strongest stimulus for bone remodeling and formation.
