MED: Osteoperosis

Question 1

What is the active form of Vit D?

Answer 1

1,25 (OH) - D3 calcitriol

Question 2

What are some indications to screen for osteoperosis?

Answer 2

Starting a drug (glucocorticoid, anti-convulsant, loop diuretic, heparin), pt found to have GI malabsorption, elderly pt

Question 3

I’m asked to assess a T-score on a pt, how is that calculated? What does it mean?

Answer 3

(Pt’s BMD - Young Adult BMD) / 1 SD of Young Adult BMD

A T-score below -2.5 = osteoperosis
A T-score from -1 to -2.5 = osteopenia

Question 4

Loss of what in menopausal women causes osteoperosis? Why?

Answer 4

Estrogen

Encourages osteoclast apoptosis

Question 5

What are some risk factors associated w/ taking Estrogen?

Answer 5

Thrombotic events (stroke, MI)
Inc CA risk (breast, endometrial)

Question 6

What is the front-line tx for Osteoperosis? What group is it in?

Answer 6

Raloxifene

SERM

Question 7

If Raloxifene is a SERM, what’s the selectivity? Tamoxifen?

Answer 7

Agonist: Osteoclast ER, Endometrial ER (conveys little/no risk though)

Antagonist: breast ER

Tamoxifen is the same, except its Endometrial activity DOES convey inc risk of endometrial bleeding and CA

Question 8

What are the SERMs?

Answer 8

Raloxifene

Tamoxifen

Question 9

What are the supplements?

Answer 9

Ca Carbonate (cheap w/ meals)

Ca Citrate (expensive anytime)

Vid D

Question 10

What is shared by Bisphosphonates?

Answer 10

“…dronate” in the name

Question 11

Where do the ‘dronates accumulate and why?

Answer 11

Osteoclasts

They aren’t metabolized, either bind hydroxyapatite or get secreted in urine

Question 12

What enzyme do ‘dronates target and where? What does this do?

Answer 12

FPP synthase inside osteoclasts

Limits prenylated G proteins required for osteoclasts signaling (and thus survival)

Question 13

What is a contra-indication to ‘dronate use? SE?

Answer 13

Pre-existing hypocalcemia

Esophagitis and esophageal ulcers

Question 14

Which medications do you take w/ water? Sitting up?

Answer 14

‘Dronates (BPs)

Question 15

What is a rare but serious complication of ‘dronate usage? In what scenario is it most common?

Answer 15

Osteonecrosis of the Jaw

IV delivery

Question 16

What are the ‘dronates?

Answer 16

Zolendronate
Alendronate
Pamidronate
Ibandronate
Riseddronate

Question 17

What are the biologicals used for Osteoperosis tx?

Answer 17

Teriparatide

Calcitonin

Question 18

Which drug is used in high risk pts? Why is it reserved for this use?

Answer 18

Teriparatide (biological)

Inc risk of Osteosarcoma and high cost

Question 19

Which drug falls under “anabolic tx”, activating osteoblasts instead of interacting w/ clasts?

Answer 19

Teriparatide