Module 12: Osteoporosis (b) Flashcards
1
Q
Osteoporosis
-Info
A
- Occurs most commonly in Postmenopausal women
—Bone loss r/t estrogen deficiency and/or age - Refer to Endocrinologist & Rheumatologist
2
Q
Causes of Accelerated Bone Loss?
A
- Chronic glucocorticoid use (>/= 5 mg prednisone for >/= 3 months
- (Depo-provera) — Max 2 yrs and encourage calcium and vitamin D — Eval BMD after 2 yrs of use
- Some Cancer drugs
- Excess thyroid hormone
- Other drugs that are implicated — TZDs, PPIs, anticonvulsants, SSRIs, and some SGLT2i, ART, look diuretics
3
Q
Med Class that minimizes Bone loss?
A
- Thiazide diuretics minimize bone los
4
Q
Bisphosphonates
A
- First Line treatment for osteoporosis in Postmenopausal women — Preferred initial therapy
- Inhibit bone resorption, slow down excessive bone loss, stabilize BMD and reduce fracture risk
- Example Meds: Alendronate (Fosamax) or Risedronate (Actonel) — Initial choice for oral bisphosphonate
—May be taken daily or weekly — Some are monthly - Check renal function**
5
Q
Bisphosphonates
-Patient Education
A
- Take on an empty stomach — First thing in the morning w/ 8 oz of plain water
- Must remain upright for 30 minutes (60 minutes w/ boniva) — During that time DO NOT eat or drink anything
- D/C if Sx’s of esophagitis develop — look for an option outside of an oral bisphosphonate
6
Q
IV Bisphosphonates
A
- Zoledronic Acid (Reclast) — Dosed YEARLY
2. A/E’s include RENAL effects — Monitor renal function
7
Q
Bisphosphonates
-A/E’s
A
- Hypocalcemia
- GI effects (oral) — Esophageal disease — D/C if this occurs
- Atypical femur fractures? — R/T longer duration of medication >5 years — D/C if this occurs
- Osteonecrosis of the jaw
—Higher risk if pt has dental issues or poor oral hygiene — IV admin, CA therapy and glucocorticoids also contribute to A/Es
8
Q
Bisphosphonates
-Holidays?
A
- Consider holiday in 5 years if bone density is stable
2. Continue using medication for 10 years (oral) or 6 years (IV) if risk is still high
9
Q
Medications that Inhibit bone resorption
A
- Denosumab (Prolia)
- Raloxifene (Evista)
- Estrogen-Progestin — NOT recommended
10
Q
Anabolic Agents for Osteoporosis
A
- Teriparatide (Forteo)
- Abaloparatide (Tymlos)
- Romosozumab (Evenity)
11
Q
Denosumab (Prolia)
A
- RANK Ligand inhibitor
- Inhibits osteoclast formation, decreases bone resorption, increases bone mineral density
- SubQ injection q6 months
- Higher cost
- NOT usually an initial therapy for most Postmenopausal women
A/E’s
- May cause Hypocalcemia — monitor calcium and check prior to initiating therapy
- Osteonecrosis of the Jaw & atypical femur fractures
Treatment Length
- Need INDEFINITE administration
- Increased fracture risk when stopping medication
12
Q
Raloxifene (Evista)
-Estrogen Agonist/Antagonist
A
- Inhibits bone resorption
- Consider in women at high risk for breast cancer
- LESS effective than bisphosphonates and denosumab
—Reduces risk of vertebral fractures — No demonstrated benefit for other fracture reduction - BBW — Venous thromboembolism risk — FATAL stroke risk
—Avoid w/ active/previous venous thromboembolism — Caution with CV risk
13
Q
Estrogen-Progestin Therapy
A
- NOT a first-line approach for Tx of osteoporosis — Increases risk of breast CA, CVA< venous thromboembolism, & coronary dz.
- May be considered in women w/ persistent menopausal Sx’s & failed on other Tx’s
14
Q
Anabolic Agents
-Examples
A
- Teriparatide or Abaloparatide
- Romosozumab
- Anabolic agents stimulate bone formation and activate bone remodeling
- LIMIT amount of time of therapy to 1-2 years MAX
15
Q
Anabolic Agents
-Teriparatide (Forteo) & Abaloparatide (Tymlos)
A
- Parathyroid hormone analog — Stimulates bone formation and activates bone remodeling
- SQ injection daily
- Most Expensive
A/Es
-Hypercalcemia/calciúria
- Only approved for MAX of 2 years
- BBW — osteosarcoma
16
Q
Anabolic Agents
-Teriparatide (Forteo) — Who can take it?
A
- Men or Postmenopausal women w/ severe osteoporosis
- Pt’s unable to tolerate bisphosphonates
- Pt’s who fail other osteoporosis therapies (Fx despite medications)
17
Q
Anabolic Agents
- Romosozumab
A
- Monoclonal anti-sclerostin antibody — newer anabolic agent for tax of osteoporosis in postmenopausal women at high risk for Fx
- NOT initial therapy — Severe cases
- A/Es — Serious CV events in a trial — AVOID in hx of MI or CVA
- Injected once monthly — Induces GREAT BMD response — LIMITED to 12 monthly doses*
18
Q
Osteoporosis treatment
-Combo treatment?
A
- Combination therapy NOT recommended at this time.
19
Q
Osteoporosis
-Calcium and Vitamin D
A
- Pt’s treated w/ Pharmacologic therapy for osteoporosis should have:
- NORMAL serum calcium and vitamin D-25 (OH) levels prior to starting a therapy - Calcium — 1200 mg/day
- Vitamin D — 800 IU daily
