Osteoperosis Flashcards
Osteoblasts
bone formation
Osteoclasts
bone resorption (break down bone)
how bone mineral density is measured and diagnosed
DEXA/DXA scan which spits out a T or Z score
What age should BMD be measured?
All women> 65 or men > 70
what is the FRAX tool
estimates the risk of osteoperotic fracture in the next 10 years
how do you interpret a T score
normal is > -1, -1–2.4 is low bone mass, and less than 2.5 is osteoperosis
what are medications that can cause sedation or orthostasis
sedatives, narcotic analgesics, hypnotics
what are the exercise people with osteoporosis should do
weight bearing exercise and muscle strengthening exercise
when is it important calcium be adequare
in pregnancy, children, years around menopause
what is required for calcium absorption
vitamin D
what does vitamin D deficiency cause in kids and adults
in children, it can cause rickets and in adults, it can cause osteomalacia
recommended calcium
800-2000 IU daily
- 1000-1200 elemental caldium
carbonate 40% elemental
citrate 21% elemental
which calcium is acid dependant must be taken with meals
calcium carbonate
cholcalciferol
d3
ergocalciferol
d2
dosing of vitamin d
daily: 5000-7000 IU or weekly 50,000 IU for 8-12 weeks
max daily elemental calcium
500 units
oscal
calcium carbonate
tums
calcium carbonate
what is indicated for treatment of osteoporosis
bisphosphonates (also prevention) desomab (RANKL), teriparatide (parathyroid), calcitonin
what is indicated for prevention of osteoporosis
bisphosphonates (except IV alendronate, also used for tx), estrogen-based therapies (raloxifene)
What is the criteria for tx osteoperosis
Either:
1) presence of a fragility fracture
2) post-menopausal people with a BMD score of less than -2.5
1st line for osteoperosis
bisphosphonates
PO administration of bisphosphenates
must stay upright for 30 minutes and drink water, usually given weekly or monthly
Side effects of bisphosphentes
esophagitis, hypocalcemia, GI
serious: atypical femur fractures, osteonecrosis of the jaw
Treatment duration with bisphosphenates
3-5 years in patients with a low risk of fracture
fosamax
alendronate (oral bisphosphonate, given daily or weekly)
Boniva
Ibandronate (IV bisphosphonates every 3 months and oral given every month)
Reclast
Zoledronic Acid (IV, once yearly)
What is Zometa
an injectable bisphosphonates
risendronate is given how often
daily, weekly, or monthly
Are bisphosphonates indicated in renal impairment?
no - they deplete calcium
which form of bisphosphonate is preferred in esophogitis
IV
what is raloxifene, SE, boxed warning/contraindications
a SERM that decreases bone resorption
increases risk of VTA and death due to stroke (do not use in VTA)
contraindicated in pregnancy
side effects think estrogen hot flashes, peripheral edema, arthralgia, leg cramps
boxed warning for conjugated estrogen/Serm combo
also increases risk of VTA and stroke (do not use in VTA) just like raloxifene
but additionally endometrial cancer due to the unopposed estrogen
also contraindicated in pregnancy just like raloxifene but additionally breast cancer
how does calcitonin (miacalcin) work?
by inhibiting osteoclasts which break down bone
Miacalcin
Calcitonin
Warnings for calcitonin
hypersensitivity to salmon derived products, increased risk of malignancy with long-term use, hypocalcemia
What is teraperatide and abaloparatide moa
analogs of PTH which stimulates osteoblasts and increases bone formation
what is teraperatide and abaloparatide used for
high risk of fractures but has cumulative lifetime duration of two years or less
What is the boxed warning for the PTH analaogs (teraperatide and abaloperatide) and how do you store
osteosarcoma
other warnings include hypercalcemia
side effects: arthralgias, leg cramps,nausea/orthostasis
Notes: Keep refrigerated, protect from light
What is denosumab (prolia)
a monocolonial antibody injection that binds to RANKL and prevents osteoclast activity which is given every 6 months via IV
Don’t confuse with Xgeva which is used to treat hypercalcemia of malignancy but has same MOA
anything that prevents osteoclast formation has what effect on calcium
hypocalcemia because you aren’t breaking bone to make calcium
anything that stimulates osteoblasts cause what
hypercalcemia
which two medication classes can cause ONJ?
bisphosphonates and denosumab (a rankl)
when is menopause reached? What causes it?
When last period was 1 year ago, caused by a decrease in estrogen and progesterone
what are the vasomotor symptoms in perimenopause
hot flashes, night sweats, vaginal dryness
most effective tx for menopause and how it works
estrogen therapy which causes a decrease in LH
why is estrogen combined with progestin in women with a uterus
because unopposed estrogen can cause endometrial cancer
when are local estrogen products used
dry vagina only
17 beta estradiol formulations
estrace (cream), vaginal ring (estring), vaginal tablet (vagifem),
premarin
conjugated equine estrogens (comes in tablet, cream, injection)
alora
estradiol
climera
estradiol
vivelle-dot
estradiol
what is conjugated equine estrogens with medroxyprogesterone
a systemic hormone therapy
provera
medroxyprojesterone
prometrium
micronized progesterone
how often is vivelle dot and olora applied
twice weekly
how often is climera applied
once weekly
what natural products are used for vasomotor sx
black cohash, evening primrose oil, soy, red clover
What is paroxetine for and what is the major DDI?
for vasomotor, a CYPP450 2D6 inhibitor therefore blocks effectiveness of tamoxifen and increases risk of bleeding in warfarin
what is used to treat dyspareunia (painful intercourse
Ospemifene is a oral estrogen agonist/antagonist for severe (not mild) dyspareunia. Astroglide is a lubricant marketed for dyspareunia.
What medications can lower testosterone and cause hypogonadism
methadone, chemo, cimetitidne, spironolactone
what does testosterone increase
hematocrit (clotting risk)
what are the risks and boxed warnings of testosterone
can cause prostate growth and restricted in severe BPH, baldness, acne, gynocomastia, increased appetite, reduced sperm count
boxed warning do not exposekids
what control is testosterone
A CII
