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CDM 4 Exam 1 > Lecture 8 - Osteoporosis > Flashcards

Lecture 8 - Osteoporosis Flashcards

1
Q

Endocrine or Metabolic risk factors for Osteoporosis

A

Diabets
Hyperthyroidism
Hyperparathyroidism

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2
Q

Nutrition/GI conditions risk factors for Osteoporosis

A

Alcholism
Malabsorption syndromes
Vit D/Ca deficiences
Anorexia/bulimia

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3
Q

Disease related risk factors for Osteoporosis

A

Leukemia, lymphoma, myeloma
Rheumatoid Arthritis

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4
Q

Meds that are risk factors for osteoporosis

A

Corticosteroids >5mg/day prednisone

Anticonvulsants = phenobarbital, phenytoin, valproate, carbamazepine
SSRIs
TZDs
PPIs

Meds that inc risk for falls

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5
Q

Risk assessment for falls/osteoporosis?

A

FRAX

10yr probability of fractures

ages 40-90

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6
Q

FRAX risk factors

A

age
Gender
Low BMI
Personal/parental history of fractures

Modifiable = smoking or > 3 drinks per day

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7
Q

Heel ultrasound

A

predicts fracture risk

T score doesn’t correlate with DXA, not used for diagnosis

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8
Q

DXA scan

A

Used for diagnosis and monitoring therapy

Results = g/cm2
T scores, shows how mane SD you are from where you should be

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9
Q

When should men > 50 get DXA scan?

A

Clinical risk factor
Fragility factor

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10
Q

DXA scan age cut offs

A

Women > 50 and men > 70 usually

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11
Q

Who should be screened earlier with DXA?

A

Rheumatoid Arthritis
Glucocorticoids = > 5mg prednisone for > 3 months

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12
Q

clinical Risks factors for DXA screening

A

BMI < 20
Smoking
Family history of spine or hip fracture
menopause < 40
Secondary osteoporosis

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13
Q

how to diagnose osteoporosis?

A

T-sore = less than -2.5

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14
Q

3 ways to get osteoporosis diagnosis

A

T-score < 2.5
Hip or vertebral fracture
Low bone mass and one of the following…. > 3% hip fracture 10yr prob, > 20% osteoporosis related fracture prob, fragility fracture of humerus, pelvis or distal forearm

**Post menopausal women or men >50 **

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15
Q

Lab tests we want

A

CBC
TSH
Intact PTH
Serum Vit D
CMP = cal + renal function
Phosphate
Mag
Iron/Ferritin if anemia risk

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16
Q

Universal recommendations for > 50yrs old

A

Muscle strengthening exercises
Weight bearing exercises
Review meds for fall risks

Specific recs if you have Osteoporosis

overall = Stop smoking and reduce drinking

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17
Q

Calcium recommendations

A

Men 51-70 = 1000mg, Max 2000mg

Women > 51 - 70 + Adults > 70 = 1200mg, Max 2000mg

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18
Q

Calcium limits

A

> 1200-1500mg per day have limited benefit and inc risk of side effects such as kidney stones, etc

Diet = best source

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19
Q

When to divide calcium doses?

A

If greater than 600mg, saturated around 500-600mg

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20
Q

Acid dependent and independent calcium?

A

Carbonate = dependent
citrate = independent

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21
Q

Vitamin D recommendations

A

Adults 9-70 = 600IU/15mcg, Max 4000IU or 100mcg

Adults > 70 = 800IU/20mcg, Max 4000IU or 100mcg

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22
Q

Vitamin D lvls

A

Deficient < 12
Insufficient = 12-20
Goal > 30

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23
Q

Vit D treatment to get lvls up

A

1250mcg/week for 6-8 weeks

24
Q

Vit D maintenance dosing

A

1000-2000IU daily to keep lvls

Higher doses maybe necessary Obesity, bariatric surgery, malabsorption, older age, darker skin

25
Post-menopausal women (High risk/no prior fractures) treatment
Alendronate, risdronate, zoledronate, denosumab
26
Post-menopausal women, high risk, if inc or stable BMD & no fractures then....
consider drug holiday after 5yrs oral or 3 yrs of IV bisphosphonates Resume therapy if fractures occur, BMD declines, or pt meets initial treatment criteria
27
Post menopausal women, high risk, dec BMD or fractures then......
Assess compliance switch to injectable if on oral therapy Switch to abaloparatide, teriparatide or romosozumab if on inject bisphosphonate
28
Post menopausal women, high risk, dec BMD or fractures then......
Assess compliance switch to injectable if on oral therapy Switch to abaloparatide, teriparatide or romosozumab if on inject bisphosphonateis
29
Bisphosphonate MOA
Binds to hydroxyapatite in bone (1/2 life 7-10yrs) and inhibits osteoclasts effects outer layer and becomes incorporated into bone itself and continues to work
30
preferred oral bisphosphonates
alendronate (Fosamax) = 70mg weekly Risedronate (Actonel) 35mg QW, 150mg QMonthly
31
Zoledronate info
Recast = bone = 5mg IV Q yearly...15min infusion and premedicate Zometa = cancers = 4mg IV Q3-4wk Most SE associated with higher cancer dose
32
SE Bisphosphonates
Irritating to GI tract, high risk ulceration Rare: Atypical fractures, Iritis, Esophageal perforation/cancer, Osteonecrosis of Jaw = box warning
33
Bisphosphonate counseling
Take on empty stomach, no other food or meds due to low bioavailability Take with 8oz plain water Dont lie down, eat or drink for 30min If need serious dental work then do before starting meds
34
Bisphosphates CI
GERD H/o GI bleed CrCL < 30-35
35
Denosumab (Prolia) MOA
Binds to and inhibits RANKL, inhibiting osteoclasts Doesnt have longer term effects like bisphosphanates
36
Denosumab SE
Back, extremity and muscle pain Mild inv in cholesterol Rare: atypical femur fracture, infections, worsen eczema and rash
37
Denosumab Dosing
60mg SC every 6 months Must be admin by medical professional $$$
38
Denosumab CI
Hypocalcemia
39
Denosumab considerations
Medicare Part D/B depending who admin Bone lass can be rapid when stopped
40
What is Estrogen indicated for?
Has FDA indication for prevention but not really used not used for treatment of osteoporosis
41
Raloxifene Agonist/Antagonist
Agonist = Bone Antagonist = breast/uterus
42
Raloxifene Adverse effects
inc risk of DVT Hot flashes Leg cramps ** Dont use pts with risk factors for DVT/Stroke **
43
raloxifene Dosing
60mg PO QD
44
What makes post-menopausal women Very High Risk?
Fracture also 12 months while on therapy or drug causing skeletal harm High risk for falls injurious falls very high FRAX > 30% osteoporosis fracture, > 4.5% hip
45
Post menopausal women, very high risk, treatments inc
Denosumab Zoledronate Teriparatide or Abaloparatide (bone building) Romosozumab (bone building)
46
Parathyroid Hormone Receptor Agonists
Teriparatide (Fortet) Abaloparatide (Tymlos) both indicated in men and women Both subQ but different dosages in each pen Tymlos < $$ than Fortet
47
How long can use use Parathyroid Hormone Receptor Agonists
> 2yrs for Forteo, expanded Tymlos = < 2yrs, no studies beyond that
48
CI of Parathyroid Hormone Receptor Agonists
Hypercalcemia Hyperparathyroidism H/o bone cancer or metastases ** Warning = avoid use in pts with inc risk of osteosarcoma **
49
Adverse effects of Parathyroid Hormone Receptor Agonists
Generally well tolerated Muscle cramps (legs) Dizziness Arthralgias Headache Inc Uric Acid Hypotension/Tachycardia w/ 1st few doses ** = sit when given and dont stand
50
What happens if use Bisphosphonate 1st before Parathyroid Hormone Receptor Agonists?
Might have a blunted effect and not as good of an response Loss of Hip BMD if use after Denosumab
51
Sclerostin inhibitor
Romosozumab aqqg (event) indicated women only who are at high risk and failed other therapies
52
Evenity Dosing
Req 2 injections once a month
53
Evenity CI
Stroke/MI in past year Hypocalcemia
54
SE of Evenity
** Inc risk of MACE, MI/stroke/death ** Atypical femur fracture Hypersensitivity reactions Osteonecrosis of the jaw
55
Calcitonin info
Not rec any guidelines potential use, slight pain relief after vertebral fractures losses effectiveness over time found inc Malignancies, removed from guidelines sometimes used short periods of time

CDM 4 Exam 1 (12 decks)

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