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Competency > Menopause & Osteoporosis > Flashcards

Menopause & Osteoporosis Flashcards

1
Q

Definition of menopause?

A

No more menstrual periods for 1 year

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2
Q

Common symptoms of menopause?

A
  • vasomotor sx (VMS): hot flashes
  • genitourinary syndrome of menopause (GSM): dryness, UI, UTI etc
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3
Q

Types of HRT?

A
  • estrogen only (for those without uterus)
  • combi of estrogen & progesterone (for those with uterus): either both continuous or continuous (E) -cyclic (P)
  • tibolone
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4
Q

Will VSM and GSM improve over time?

A

VSM yes, GSM no

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5
Q

Topical options for VMS?

A
  • Premarin (estrogen) cream
  • vagifem (estrogen) tablet for vaginal insert
  • lubricants, moisturisers
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6
Q

Possible supplements for menopause?

A
  • isoflavones (soy)
  • black cohosh
  • evening primrose oil
  • vitamin E
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7
Q

Is progestin-only HRT recommended?

A

Possible but no long term studies

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8
Q

Which progesterone is natural?

A

utrogestan (micronised progesterone)

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9
Q

Advantage of systemic topicals compared to PO?

A

Bypass hepatic 1st pass effect

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10
Q

Can tibolone be used in women with uterus? Need additional progesterone?

A

Yes, no need progesterone as tibolone sufficiently suppresses endometrial proliferation & estrogen activation

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11
Q

Can tibolone protect against bone loss?

A

Yes

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12
Q

Non-hormonal therapy for VMS?

A
  • SSRI: paroxetine, escitalopram
  • SNRI: venlafaxine
  • gabapentin, pregabalin
  • clonidine
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13
Q

BMD t-score cut-offs?
- normal
- osteopenia
- osteoporosis

A
  • normal: ≥-1
  • osteopenia: -2.5<x<-1
  • osteoporosis: ≤-2.5
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14
Q

Pathophysiology of osteoporosis?

A

osteoclastic >osteoblastic

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15
Q

How does menopause cause osteoporosis?

A

reduce estrogen -> more bone resorption, more Ca excretion

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16
Q

Meds a/w osteoporosis?

A

glucocorticoids, PPI, immunosuppressants, ASM

17
Q

What tool to use to screen post-menopausal women for osteoporosis?

Scores for high, medium and low risk and follow-up actions?

A

osteoporosis self-assessment tool for asians
- low: <0, can defer DXA
- medium: 0-20, consider DXA if have other risk factors
- high: >20, consider DXA

18
Q

What height loss is considered a risk factor for osteoporosis?

A

> 2cm within 3y

19
Q

How to calculate 10 year probability of having fracture? What is the threshold for major osteoporotic fracture and hip fracture?

A

FRAX score

  • major osteoporotic fracture ≥20%
  • hip fracture ≥3%
20
Q

Vitamin D intake requirements for:
- 51-70y
- >70y

A
  • 51-70y: 600 IU/day
  • > 70y: 800 IU/day
21
Q

What Z-score suggests that osteoporosis is due to secondary causes?

A

≤ -2

22
Q

How to diagnose osteoporosis?

A

either one
- history of fragility fracture
- BMD measurement using DXA hip +/ spine (T score ≤ -2.5)

23
Q

When to start treatment for osteoporosis?

A
  • fragility fracture
  • no fragility fracture but BMD ≤ -2.5
  • osteopenic with high fracture risk (FRAX ≥3% hip or ≥20% major osteoporotic fracture)
24
Q

Calcium intake requirements per day? Maximum calcium absorption per dose?

A

800-1000mg

Body can absorb 500mg max, give in divided doses if more than that per dose

25
Q

Nonpharm for osteoporosis?

A
  • exercise (weight bearing, muscle strengthening)
  • smoking cessation
  • reduce alcohol, caffeine
  • eat more calcium rich foods
  • fall prevention
26
Q

Possible treatment options for osteoporosis?

A

antiresorptive
- bisphosphonates
- denosumab (RANK ligand inhibitor)
- raloxifene (estrogen agonist/antagonist)
- calcitonin

anabolic
- teriparatide (PTH analog)
- romosozumab (sclerostin inhibitor)

27
Q

Calcium percentage content?
- calcium carbonate
- calcium citrate
- calcium acetate

A
  • calcium carbonate: 40%
  • calcium citrate: 21%
  • calcium acetate: 25%
28
Q

Is vitamin D water or fat soluble?

A

Fat soluble

29
Q

Available bisphosphonates and dose?

A
  • alendronate (PO): 70mg Q1w or 10mg OD
  • risedronate (PO): 35mg Q1w or 150mg Q1m
  • zoledronic acid (IV): 5mg Q1y as 15min IV infusion
30
Q

Counselling points for PO bisphosphonates? (4)

A
  • take on empty stomach with full glass of PLAIN water (no mineral water -> affect absorption)
  • wait ≥30min before taking food
  • space apart from other meds ≥2h
  • do not lie down after taking med, stay upright for ≥30min
31
Q

Duration of treatment for PO and IV bisphosphonates, and denosumab? Max duration?

A

PO: 5y (max 10y)
IV: 3y (max 6y)
Denosumab: up to 10y

32
Q

Rare but serious SE of bisphosphonates?

A
  • atypical femoral fractures (thigh, groin)
  • osteonecrosis of the jaw
33
Q

CrCl cut off for bisphosphonates?

A
  • <30 for risedronate
  • <35 for alendronate & zoledronic acid
34
Q

Common SE of bisphosphonates?

A
  • GI: flatulence, heartburn, N/D, abd pain
  • HA, MSK pain, rash
  • hypoCa (transient)
  • IV: flu-like sx
35
Q

MOA of:
- bisphosphonates
- denosumab
- raloxifene
- calcitonin
- romosozumab
- PTH

A
  • bisphosphonates: increase osteoclast death
  • denosumab: prevent osteoclast development (RANKL inhibitor)
  • raloxifene: selective estrogen receptor modulator (reduce resorption)
  • calcitonin: inhibit osteoclast activity
  • romosozumab: inhibit sclerostin -> anabolic & antiresorptive
  • PTH: stimulate osteoblast activity
36
Q

Dosing regimen of denosumab? What else should be given to patient while on denosumab?

A

SC 60mg Q6m, give Ca & vit D

37
Q

Difference between calcium carbonate and calcium citrate?

A

calcium carbonate must be taken with food, calcium citrate can be taken regardless of food

Competency (30 decks)

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