Day 4- Osteoporosis Flashcards
How do corticol and trabecular bone differ?
How do osteoblasts and osteoclasts differ?
What are your risk factors for fractures?
Corticol is known as compact bone and is 75-80% of bone. Trabecular is known as spongy or cancellous bone and is lighter/more energy absorbing.
Osteoblasts are the cells involved in bone formation and express RANKL on extracellular surface(this combines with RANK from osteoclasts to mature osteoclasts) while osteoclasts are the cells involved in the breakdown of bone and are involved in mineral reabsorption.
Age(>65 females, >70 males),Race(white or asian), Low trauma fracture as an adult, Low estrogen levels at menopause, low calcium intake and physical activity, minimal sun exposure and systemic glucocorticoid therapy.
What are secondary pharmacologic causes?
What is normal BMD score?
What is osteopenia vs osteoporosis BMD score?
Glucocorticoids(>5mg/day of prednisone for >3 months)(increased osteoclast and lower osteoblast activity), Long term(> 1 year) use of PPI, Pioglitazone and Rosiglitazone. Anticonvulsants(increase vitamin D metabolism).
BMD within 1 standard deviation of the young adult mean or T-score of -1 and above.
Penia- BMD between -1 and -2.5 SD below young adult mean or T score between -1 and -2.5. Porosis is -2.5 for both.
What are non pharmacologic treatment for osteoporosis?
What are your oral bisphosphonates?
What is your IV bisphosphonates?
Lower caffeine, alcohol, sodium, carbonated beverages, increase calcium, increase vitamin D.
Alendronate(10 daily or 70 weekly treatment, 5 daily or 35 weekly for prevention), Risendronate(5 mg once daily or 35 weekly or 150 mg monthly)., Ibandronate(only postmenopausal women)(150 mg once monthly).
Zoledronic Acid(5 mg once per year or 5 mg once every 2 years). You can’t interchange Zometa(bone metastases) with Reclast (osteoperosis).
What are your A/E’s with bisphosphonates?
What are your absorption pearls with bisphophanates?
When can you consider a bisphophanate holiday?
CrCl <35, Pregnancy, Esophagus abnormalities, Nausea and dyspepsia for oral and flu like illness for IV, osteonecrosis of jaw, a typical fractures.
Poorly absorbed if given with food, do not co administer with any other medicines or supplements, take with at least 6 oz of water 30 minutes before food, remain standing for 30 minutes and only give 2 oz’s for oral solution.
May consider one after 3-5 years of treatment in someone with low fracture risk. If high risk after 6-10 years.
What are calcitonin’s forms and what to know about it?
What are raloxifene’s A/E’s effects and how does it work?
What special things to know about zoledronic acid?
Intranasal, SubQ. Can be used for women who are at least 5 years post menopause(2nd or 3rd line therapy). Increased risk of malignancy with long term use(6 months to 5 years). Stored in fridge, nasal spray is primed before first use only, room temp 1st for nasal then room temp after.
SERM(60 mg daily), Prevention and treatment of postmenopausal osteoporosis. Can cause hot flashes, rare endometrial bleeding, stroke, CI’d in history of PE/DVT/ pregnant, can take anytime.
IV infusion over 15 minutes. Can give acetaminophen 1-2 hours before infusion occurs to help prevent acute phase reactions.
What are big things to know about denosumab?
What things to know about Teriparatide and Abaloparatide?
What are the paratide’s bbw?
60 mg subq every 6 months, no renal adjustments,CI’d in hypocalcemia or drug sensitivity, 1st line therapy, do not shake, refrigerate, keep out of light, warm to room temp before administration. Watch for osteonecrosis and atypical fractures, also serious infections and dermatologic reations. Works on RANKL.
PTH receptor antagonists. T is 20 mcg subq daily and can treat glucocorticoid induced, A is 80 mcg subq daily. T is thigh or ab wall and fridge always, A is fridge at first than room temp for 30 days and perilumbical region of abdomen.
Increased risk of osteosarcoma(dose dependent), use not recommended beyond two years.
Does decreased vitamin D result in increased PTH?
What are your recommend levels of elemental calcium and vitamin D for osteoporosis prevention?
What are the NOF’s three steps to bone health recommendations?
YES, exerts effects on intestine, kidney, and bone.
Elemental Calcium >1200 mg/day(not more than 2000), 800-1000 IU/day(not more than 2000).
1: get calcium you need from food first and may need supplement for vitamin D. 2: Eat fruits and veggies, exercising, and not smoking or drinking too much. 3: if diagnosed then have treatment plan that includes medicine, calcium, and vitamin D.
How does PTH affect bone?
What is treatment failure with bisphosphonates?
Which meds build up the bone or have anabolic properties?
Activates osteoblasts which stimulates premature osteoclasts to mature which leads to decreased bone.
continuing decrease of 4-5% per year in BMD with treatment, developing a fracture while being treated, failure of bone turnover markers to decline, secondary causes should be evaluated
PTH analogs.(Paratides). Only use for 2 years.
Should combination therapy be used?
When do ONJ and atypical fracture risk increase?
Do the paritide’s help with hip fractures and where is the only place Calcitonin can work and how long can you use it?
NO
After 5 years. If low-moderate risk you can discontinue 3-5 years.
NO. Verterbral fractures, 4-12 months.
