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Endocrine Two > Fitzpatrick - Osteoporosis > Flashcards

Fitzpatrick - Osteoporosis Flashcards

1
Q

Define T-score

A

Expression of Bone mass density (BMD) determined by a radiographic procedure (DEXA) is essential for surveillance & diagnosis of osteoporosis.

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2
Q

T-Score and % for BMD of women 30-40 years old:

  • Osteoporosis
  • Osteopenia
  • Normal
A
  • Osteoporosis = Less than -2.5; 0-6%
  • Osteopenia = -1 to -2.5; 6-15%
  • Normal = 4 to -1; 15-100%
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3
Q

What does T-score compare and equation.

A

“T-score” compares the patient’s BMD with young-normal mean BMD and expresses the difference as a standard deviation (SD) score:
(Patient’s BMD – Young-Adult Mean BMD) / (1 SD of Young-Adult Mean BMD)

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4
Q 
T-Score Significance:
Every 1 SD less than normal =
\_\_\_% drop in BMD =
\_\_\_ risk of vertebral
fracture
A

Every 1 SD = 10-20% drop in BMD = 2x risk of vertebral fracture

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5
Q

Calcium carbonate

  1. What % Ca2+?
  2. What does it need to dissolve?
  3. Take it when?
  4. Potential disadvantage with increasing age of person.
A
  1. 40%
  2. Needs ACID to dissolve.
  3. Take “at” or “after” meals
  4. Less stomach acid with aging.
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6
Q

Calcium citrate

  1. What % Ca2+?
  2. What does it need to dissolve?
  3. Take it when?
  4. Potential problem disadvantage.
A
  1. 20% Calcium
  2. No need for stomach acid for absorption
  3. May be taken between meals
  4. Higher cost
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7
Q

The “sufficient” % of Dietary Calcium absorbed - and what Vitamin promotes intestinal absorption?

A
  • 30-40%

- 1,25 (OH)3 Vitamin D3 promotes intestinal Ca2+ absorption.

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8
Q

Normal Vitamin D requirement.

A

400-800 IU/day

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9
Q

Vitamin D requirement exceeds 800IU/day in persons… (four)

A

• With GI malabsorption disorders
• Receiving corticosteroids, certain anticonvulsants, loop diuretics, heparin
• Who are elderly or who have
-less exposure/response to sunlight
-less hydroxylation in liver & kidney

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10
Q

Name the 6 drugs that lower serum Ca (2dary causes of osteoporosis).

A
  • GC: Prednisone, methylprednisolone; inhaled Budesonide
  • Anticonvulsants: Carbamazepine; phenytoin
  • Loops: Furosemide
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11
Q

Use and adverse effect of (GC) Prednisone and methylprednisolone

A
  • Use: Severe inflammation asthma, COPD, bronchitis, ulcerative colitis, etc
  • AE: Impairs vitamin D absorption & impairs metabolic activation in liver & kidney
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12
Q

Use and adverse effect of (GC) inhaled Budensonide

A
  • Use: Asthma, COPD

- AE: Impairs vitamin D absorption & impairs metabolic activation in liver & kidney

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13
Q

Use and adverse effect of (anticonvulsants) Carbamazepine and phenytoin

A
  • Use: epileptic seizures

- AE: Induction fo cytochrome p450 hepatic INACTIVATION of vit D

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14
Q

Use and adverse effect of Furosemide

A
  • Use: HTN, HF

- AE: Calcium wasting

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15
Q

Indication for bone density testing

A
  • To diagnose osteoporosis
  • To predict fracture risk
  • To monitor therapy like before initiation of systemic GC therapy –> induces bone loss w/in 6mo)
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16
Q

Name the MOA of SERMs, Bis-Posphonates, Antibodies, and Biologicals (Calcitonin)

A

Anti-Resorptive Therapy - These drugs inhibit osteoclasts, cells in bone responsible for resorption of bone matrix ….cells that eat hydroxyapatite (Ca2+)

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17
Q

Name the MOA of the biologicals (Teraparatide)

A

Anabolic Therapy - Activate osteoblasts, cells in bone that deposit hydroxyapatite (Ca 2+)

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18
Q

Name the drugs in Selective Estrogen-Receptor Modulators class/SERMs (two)

A

Raloxifene, Tamoxifen

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19
Q

Name the drugs in Bis-Phosphonate class (five)

A

Alendronate, Ibandronate, Pamidronate, Risedronate, Zolendronate

20
Q

Name the drugs in Biologicals class (two)

A

Teraparatide, Calcitonin

21
Q

Name the drug in the Antibody class (one)

A

Denosumab

22
Q

Peak bone mass in women.

A

30 to 50(ish) years old.

23
Q

Estrogen deficit at menopause does what to bone resorption and formation?

A

IMBALANCES - excess bone resorption and less bone formation

24
Q

Five risks of HRT (estogens +/- medroxyprogesterone)

A

Increased risk of: Breast Cancer, Uterine Cancer, MI, stroke, thrombosis

25
Q

MOA of Estrogen HRT

A

Full agonists at estrogen receptors in ALL tissues.

26
Q

FDA Approved Options:

- Name the two classes of “prevention and treatment”

A

SERMs and Bisphosphonates

27
Q

FDA Approved Options:

- Name the three drugs for “Treatment only”

A

Calcitonin, Teriparatide, Denosumab

28
Q

MOA of SERMs at Estrogen Receptors in osteoclasts v. breast epithelium

A

Estrogens & SERMs are:

- AGONISTS at ERs in Osteoclasts - ANTAGONISTS in breast epithelium

29
Q

MOA of SERMs at Estrogen Receptors in osteoclasts

A 
ER receptor
 Occupied
 Dimerized
 Nuclear transport
 Gene transcription
30
Q

What is the SERM of choice and why?

A
  • Raloxifene (v. Tamoxifen) bc of its safety and
    efficacy. Usually chosen when there is an independent need for breast cancer prophylaxis.
  • Raloxifene is not associated with
    vaginal bleeding or an increased risk of endometrial hyperplasia or cancer
31
Q

Adverse effect of all HRT estrogens and SERMs

A

Increased risk of VENOUS thromboembolic events.

32
Q

Describe bisphosphonates - where do they accumulate?

A

Chemically related to Ca2+ phosphate(s); Analogs of pyrophosphate
•Sequestered by bone NEAR REMODELING SITES
• Accumulate into bone matrix/osteoCLASTS –> EATS THE BP AND BP then inhibits their fxn

33
Q

Key enzyme in osteoclast activation that Bisphosphonates inhibit

A

Farnesyl Pyrosphosphate Synthase (FPP) synthase

34
Q
  • Contraindication of bisphosphonate.

- Half life of BP

A
  • pre-existing hypocalcemia

- Half-Life = 12 years

35
Q

Bisphosphonate administration.

If non-compliant, what adverse effect results?

A

 Take with a full glass of water in
morning
 Do NOT eat or drink anything for at least 30 minutes after taking (Ibandronate: 60 min)
 Do NOT lie down for at least 30 minutes (Ibandronate: 60 min)

Non-compliance = ESOPHAGITIS

36
Q

What BP has the highest affinity for bone? Most potency for FPP-synthase inhibition?

A

Zoledronate

37
Q

A major adverse effect of BPs and the type of pt this AE occurs in (three).

A

Osteonecrosis of the Jaw
 Receiving i.v. bisphosphonates, ~ 90%
 Diagnosed with multiple myeloma, breast cancer, and prostate cancer, ~85%
 Having tooth extractions, dental trauma ~60%

38
Q

FDA about BP

A

Bc they remain in bone for decades, consider periodic reevaluation of continued therapy in people treated for >5 years LONG TERM SAFETY

39
Q

MOA of denosumab

A

Inhibits osteoCLAST formation/lineage expansion. It is a humanized monoclonal antibody against RANKL (osteoclast RANK cannot bind to osteoBLAST RANKL)

40
Q

Use of calcitonin

A

Decreases pain with acute vertebral compression fracture.

-Inhibits osteoclast action (anti-resorptive)

41
Q

MOA of teriparatide (PTH fragment)

A

Intermittent administration that

Stimulates osteoblast activity (anabolic)

42
Q

Contrast teriparatide to BPs

A
  • Very short t ½

* No deposition in bone

43
Q

Teriparatide is reserved for what type of patients?

A

Treatment of:
-postmenopausal F with
osteoporosis at high risk for fracture
-increase bone mass in M with primary or hypogonadal osteoporosis at high risk for fracture
- Treatment of M/F with osteoporosis associated with sustained, systemic glucocorticoid therapy at high risk for fracture

high cost and risk of osteosarcoma + injection daily

44
Q

MOA of cincalcet

A
  • A calcimimetic agent; lowers PTH levels by

* increasing the sensitivity of the Ca2+-sensing receptor to extracellular Ca2+*

45
Q

Use of cincalcet

A
  • Treats overactive parathyroid gland in dialysis patients with CKD (secondary hyperparathyroidism).
  • Treat high blood Ca2+ levels in patients with parathyroid cancer.
46
Q

Use of denosumab

A

When adverse effects of BP (esophagitis) cannot be tolerated.

Endocrine Two (16 decks)

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