Bones

Question 1

Osteoporosis

Answer 1

Fragility of the skeleton due to loss of bone architecture
Common in postmenopausal woman type one and older adults type two
Caused by bone reabsorption are passing bone formation
Can be due to secondary issues such as hyperthyroidism or long-term use of medication‘s like steroids
Lifestyle modifications include adequate calcium, vitamin D intake, weight, exercise, smoking sensation and alcohol avoidance

Question 2

Drugs that can cause bone loss

Answer 2

Aluminum antacids, anti-convulsants, antipsychotics, aromatase inhibitors, furosemide in high doses, glucocorticoids, heparin, proton pump inhibitors, SSRI, actos, excessive doses of levothyroxine

Question 3

Therapy for osteoporosis

Answer 3

Bone density scan DEXA compares bone thickness to normal ranges to diagnose osteoporosis
First line agents include biphosphonates, secondary agents like estrogen receptor modulators, calcitonin, teripararide, RANKL inhibitors

Question 4

Biphosphonates

Answer 4

Decrease osteoclast activity leading to gain in bone mass
Common drugs-prototype- alendronate (fosamax, binosto ), risesronate (actonel), ibrandronate (Boniva), zoledronic acid (reclast)
Not used in those with severe renal disease
Adverse effects include G.I. distress, no recumbant 30 minutes post taking, esophagitis osteon necrosis of the jaw atypical fractures
Not to take longer than 3 consecutive years
Approved for hip and spine disease

Question 5

Selective estrogen receptor modulators

Answer 5

Raloxifene (evista),
Lowers LDL, good for breast and endometrium
conjugated estrogen and bazedoxifene (duavee)
Effective for the prevention of postmenopausal bone loss, may increase the risk of endometrial cancer, stroke, clots coronary events, hot flashes, do not give to those with intact uterus

Question 6

RANKL inhibitors

Answer 6

Denosumab (prolia)
Monoclonal antibody that targets receptor activator a nuclear factor B lie again prevents activation of rank receptors on osteoclast by inhibiting osteoclast formation and function and reducing bone reabsorption
For those high-risk fractures
Associated with G.I. issues bone pain increased risk of infection, low calcium, atypical fractures

Question 7

Parathyroid agent

Answer 7

Teriparatide (forteo)
Agonist at the parathyroid hormone stimulates osteoblasts
Can cause high calcium increase risk osteosarcoma so contraindicated with those with bone CA
Needs to be followed with another anti reabsorption so they don’t lose bone they make
Can only be used for two years

Question 8

Osteomalacia

Answer 8

Soft or mushy bones with intact architecture but impaired strength
Caused by vitamin D deficiency and secondary hyper parathyroidism
Check 25 hydroxyvitamin D level particularly in patients with renal disease or hypercalcemia, range 20-80, 40 is optimal, if less than 10 must replace with prescription vitamin D, calcitriol 0.5 mcg until at acceptable range, vitamin D2 can also be used
When in normal range can switch to OTC vitamin D 800 per day with daily sun exposure 25-30 minutes per day X5
Close monitoring of calcium, phosphate, and vitamin D needed
Known as ricketts in kids

Question 9

Miacalcin (calcitonin)

Answer 9

Another anti reabsorption agent
Can be used for acute pain post fracture
Approved to treat in women 5 years post menopausal
Can be used for vertebral osteoporosis not hip
Nasal spray cannot fix hip through nose
Nose bleeds, rhinitis

Question 10

Paget’s disease

Answer 10

Disorder of the bone remodeling leading to disorganized bone formation typically affecting one or few bones in arms, skull
Treatment- calcium carbonate 500 mg BID with vitamin D3 400 units Daily, high dose biphodphonates, calcitonin

Question 11

FRAX score

Answer 11

A tool used to assess risk for fracture in adults with osteoporosis