Exam 2 - Osteoporosis management

Question 1

What is key in osteoporosis prevention?

Answer 1

Lifestyle changes (e.g. weight bearing and resistance exercises)

• Smoking cessation (including tobacco)
• Moderate alcohol intake (fewer than 2 drinks/day)

Question 2

When would you enccourage dietary supplementation for patients at risk for osteoporosis?

Answer 2

• T score of -2.5 or less
• Patients with hip or vertebral fracture

Question 3

What supplements and dosage is recommended for osteoporosis prevention?

Answer 3

• 1200 mg calcium/day or 600-800 IU vitamin D
• Weekly dosing better for compliance than daily dosing

Question 4

What six medication groups can be prescribed for osteoporosis prevention?

Answer 4

• Bisphosphonates
• Calcitonin
• Hormone therapy (e.g. estrogen)
• Selective estrogen receptor modulator (SERM)
• Parathyroid hormone
• Bone modifying agent

Question 5

What patient education would you give to patients taking bisphosphonates?

Answer 5

Examples: alendronate, zoledronic acid, ibandronate)

• Caution with upper GI disease (associated with esophagitis and ulcers)
• Take first thing in the morning, on an empty stomach with 8 oz of water
• Remain upright after
• Take no food/drink for 30 min after
• Take 2 hours before antacids and/or calcium

Question 6

Patient eduction for calcitonin

Answer 6

• MOA: inhibits calcium absorption and promotes calcium deposits into bone
• Used 5 years after menopause
• FDA approved for vertebral osteoporosis

Question 7

Patient education for SERMs

Answer 7

• Example: raloxifene (Evista)
• MOA: inhibits bone resorption and decreases risk of breast/uterine cancer, reduces risk of vertebral fractures
• Can cause hot flashes
• Contraindicated for patients with VTE

Question 8

When could providers consider prescribing parathyroid hormone and bone modifying agents (e.g. denosumab)?

Answer 8

After failure of first line medications