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MSK II Midterm > Fitzy: Osteoporosis > Flashcards

Fitzy: Osteoporosis Flashcards

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1
Q

What is the definition of osteoporosis?

A
  • 2.5 standard deviations from the mean bone density on DEXA scan
  • 1-5 to 2.5 is osteopenia
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2
Q

How T-score is calculated

A

(Patient’s BMD- young adult mean BMD)/(1 SD of young-adult Mean BMD)
-<2.5 is osteoporosis

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3
Q

What does the drugs’ efficacy for prevention and tx of osteoporosis depend on?

A

-adequate intake of Vit D and calcium

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4
Q

What are the 2 calcium supplements that a person can take?

A
  • Calcium carbonate

- calcium citrate

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5
Q

Describe calcium carbonate

A
  • 40% calcium, needs acid to dissolve and for absortion
  • take “at” or “after” meals
  • less stomach acid with aging
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6
Q

describe Calcium citrate

A
  • 20% calcium, no need for stomach acid for absorption
  • may be taken between meals
  • higher cost
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7
Q

What does 1,25 (OH)3 Vit D promote?

A

-intestinal Ca2+ absorption

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8
Q

What is the sufficient level of serum Vit D3

A

30-50

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9
Q

What are the drugs that lower serum Ca2+?

A
  • prednisone, methylprednisolone
  • budesonide, inhlaed
  • carbamazepine
  • phenytoin
  • Furosemide
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10
Q

So, if we are going to initiate glucocorticoid therapy, what would we have to do first?

A
  • a Bone densitometry and T-score

- glucocorticoids can impair Vit D absorption and metabolic activation n liver and kidney

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11
Q

What does Vit D make us do?

A

-absorb Ca2+ in the GI tract

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12
Q

what are the SERMs?

A
  • Raloxifene

- Tamoxifen

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13
Q

What are the Bisphosphonates

A
  • alendronate
  • ibandronate
  • pamidronate
  • resedronate
  • zolendronate
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14
Q

Biologicals

A
  • teraparatide

- calcitonin

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15
Q

Antibodies

A

-denosumab

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16
Q

What cells do osteoclasts come from?

A

-HSC’s

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17
Q

What cells do osteoblasts come from?

A

-Mesenchymal stem cells

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18
Q

What drugs inhibit osteoclasts?

A
  • SERMs
  • Bisphosphonates
  • calcitonin
  • Antibodies: denosumab
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19
Q

What causes osteoporosis in older women?

A
  • loss of estrogen during the aging process and at menopause

- E deficit leads to incrased rate ofbone resorption by osteoclasts

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20
Q

What does estrogen normally do?

A

-it’s usually a restrain on osteoclastic activity

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21
Q

Why is thrombosis such a big deal with estrogens?

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A

-they stimulate the liver to make procoagulants

22
Q

What class of drugs do we use for prevention and tx of osteoporosis?

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A
  • selective estrogen receptor modulators
  • Raloxifene
  • tamoxifen
23
Q

Which drugs are for tx only?

Study These Flashcards
A
  • Calcitonin
  • teriparatide
  • denosumab
24
Q

Where are the receptors that SERMS are estrogen agonists at?

Study These Flashcards
A

-the ER in OSTEOCLASTS

25
Where are SERMS antagonists at ER's
- the breast epithelium | - the ER's there are occupied by RIx
26
When is Raloxifene usually chosen for osteoporosis prevention?
-when there is an independent need for breast cancer prophylaxis
27
What is the risk with using tamoxifen?
- increased uterine bleeding and cancer | - Raloxifene is not associated with vaginal bleeding or an increased risk of endometrial hyperplasia or cancer
28
What other class of drugs do we use for prevention and tx of osteoporosis?
-aminobisphosphonates
29
What do bisphosphonates do?
- bind to hydroxyapatite crystals in bone and inhibit bone resorption through effects on osteoclasts - not metabolized, but either bind to hydroxyapatite in bone or are excreted unchanged into urine
30
What is the required for the release of bisphosphonates from the body?
- bone resorption | - they inhibit that... so they have a long time in bone
31
What is the amino bisphosphonate prototype?
-alendronate
32
What does alendronate accumulate in?
- osteoCLASTS - sequestered by bone near remodeling sites - remember they just go into osteoclasts and make them do apoptosis
33
What does osteoclast survival require?
- G protein prenylation (for signal transduction) - FPP synthase does this - BP's block FPP.. there ya go - more specifically, blocks conversion of Geranyl-PP to Farnesyl-PP
34
What is a contraindication for BP's?
- pre-existing hypocalcemia | - we need bone, but we might also need the calcium from bone
35
What are well recognized adverse events associated with oral bisphosphonates?
-Esophagitis and esophageal ulcer
36
What do all of the BP's end in?
-"dronate"
37
Why do you NOT want to eat or drink anything for at least 30 min after taking BP's -you also do NOT want to lie down for at least 30 minutes
-you want to avoid esophagitis
38
What is a rare but serious complication of BP's that mainly happens in pts recieving it IV?
-Osteonecrosis of the Jaw (ONJ)
39
What are the treatment only anti resorption therapies?
- Calcitonin | - Denosumab
40
Denosumab
- monoclonal antibody - against RANKL - inhibits osteoclast formation b/c RANKL is a receptor activator of NFKB which is an osteoclast differentiating factor - so, normally, RANKL on the osteoblast will bind to RANK on a pre-osteoclast to make it turn into an actual osteoclast
41
Calcitonin
- inhibits osteoclast action... anti-resorptive - modest effect< BP - decreases pain with acute vertebral compression fracture***
42
What is the Anabolic therapy that is used for tx only?
-Teriparatide (PTH fragment)
43
What does teriparatide do?
- stimulated osteoblast activity | - intermittent administration
44
What is teriparatide reserved for?
- high risk patients | - it has a greater increase in bone density as compared to alendrolate
45
What are the indications for teriparatide?
- postmenopausal women with osteoporosis at high risk for frature - high risk for fracture - high frisk for fracture!!!
46
What fractures are more common in older men?
-incidence of hip fractures increases exponentially with age
47
What drugs are effective in men?
-BP's
48
What is Cinacalcet?
-A Calcium sensing receptor (CaSR) activator
49
What is Cinacalcet?
- a calcimimetic agent | - lowers PTH levels by increasing the sensitivity of the CaSR to extracellular Ca2+
50
What is Cinacalcet used for?
- treating an overactive parathyroid gland in dialysis pts with chronic kidney disease - it is also used to treat high blood Ca2+ levels in pts with parathyroid cancer

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