mod 8. Menstrual concerns + Osteoporosis Flashcards
what vitamins are important in the treatment and prevention of osteoporosis?
calcium
magnesium
vitamin D
Vitamin K
Why is vitamin D important for osteoporosis? and where do we get it from?
Vitamin D helps in the absorption of calcium in the small intestine
what is the first line treatment for osteoporosis?
Biphosphates such as alendronate and risedronate
They must be taken on an empty stomach with a glass of water
what is a Biphosphonate drug holiday?
Prolonged use of biphosphonate can be linked to the development of an aypical femur fracture (doesnt heal properly)
If a patient is not considered high risk for osteoporotic fractures they should stop taking biphosphonate after 5 years of oral therapy or after 3 years of IV therapy
the duration of how long this “holiday” is is TBD
for which patients are drug holidays of alendronate, risedronate, and zoledronate not advised?
Drug holidays are not recommended in patients with a history of a previous fracture of spine or hip, as these individuals are at higher risk for recurrent fractures and the benefit of ongoing therapy is greater than potential risks
How does calcitonin treat osteoporosis?
Calcitonin reduces pain associated with acute vertebral fractures
How does Teriparatide work to treat osteoporosis?
Teriparatide is a parathyroid hormone analoge, it activates bone reabsorption and it in the kidneys it cause calcium to be reabsorbed
it is effective at treating coticosteroid induced osteoporosis
for the prevention of osteoporosis in early postmenopause women, what agent can you prescribe?
estrogen or estrogen/progesterone
but it should not be used as a treatment for osteoporosis its just preventative
When is it appropriate to start pharmacological treatment for osteoporosis ?
The patient must be considered high risk
(FRAX score is above 20%)
or they have had prior fragility fracture of the hip/spine
or they have had more than one fragility fracture
what medication would you prescribe for the prevention and treatment of steroid induced osteoporosis?
same first line, bisphoshonates
if an adolescent or premenopausal adult presents with OVULATORY abnormal uterine bleeding what are their first line treatments options and how long should they trial it for?
first line tx for ovulatory abnormal uterine bleeding in premenopausal/adolescent
- TXA
- NSAID
- oral contraceptive
- levenorgestrel intrauterine device
- progestin 21 days
re-evaluate @ 3-6months
if an adolescent or premenopausal adult presents with ANVULATORY abnormal uterine bleeding what are their first line treatments options and how long should they trial it for?
- Oral contraceptives
- levenorgestrel intrauterine device
3.Depo-Provera - Progestin 21
What vitamin supplementation would you advise for vasomotor symptoms or menopause?
Calcium 1200mg/day
Vitamin D 800-2000units/day
What are the nonpharm treatment options for vasomotor symptoms
cooling techniques, dressing in layers, fans
avoid triggers like spicy food
weight loss
smoking cessation
CBT
exercise 150min/week
for women who enter menopause early (before 45) or premature (before 40) what treatment would you prescribe and why?
you would start them on hormone therapy because early menopause is associated with osteoporosis and cardiovascular disease
Continue the treatment till the age of 50
In hormone therapy for menopause what is estrogen indicated for and what is progestogen indicated for?
Estrogen reduces the reduction of the frequency and severity of hot flashes in VMS
Progestogen is indicated in patients with an intact uterus using systemic estrogen to reduce the risk of endometrial hyperplasia
explain how estrogen progestogen therapy is taken by a patient?
with EPT the estrogen is taken continuously everyday and the progestogen can be taken continuously everyday (continous EPT)
Or cyclically for 12-14 consecutive days in a calendar month
continous EPT is more effective at preventing endometrial hyperplasia
in estrogen treatment for vasomotor symptoms what is the benefit of using transdermal (patch) estrogen compared to oral?
the non oral route eliminates its first pass through the liver resulting less of an increase of triglycerides and CRP
it can reduce risk of VTE, has more consistent systemic estrogen levels compared with oral therapy
select this in patient with migraine, high triglycerides, HTN, malabsorption syndrome, low libido, and shift workers
what are the absoblute contraindications to estrogen
ABCD
Acute liver disease
undiagnosed vaginal Bleeding
Cancer, Cardiovascular disease
DVT
and pregnancy
what are contraindications to progesten?
undiagnosed vaginal bleeding
known or suspected carcinoma of the breast
pregnancy
when would you consider starting a patient on hormone therapy?
hormone therapy treats VMS and is used for patients less than 60 years of age OR its been less than 10 years since the start of menopause
there is a “window” of when to start hormone therapy. Cardiovascular risk increases when hormone therapy is started further away from the onset of menopause
AND ITS first line treatment for both osteoporosis and VMS
what non-hormonal pharmaceutical treatment can you offer for VMS treatment?
SSRI and SNRI can be used as first line treatment (nonhormonla) in patients with VMS who also have significant perimenopausal/menopausal mood and anxiety concerns.
also:
gabapentin, pregabalin, clonidine, oxybutin
What natural health products can be used to treat VMS?
soy isoflavones may improve hot flash scores and vaginal dryness but not night sweats.
Black cohosh is dangerous advise against it can cause liver damage
why use vaginal estrogen for VMS?
it can treat vaginal atrophy/dryness
reduces UTI incidence
you dont need to use progestogen with it
