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NRS 271B > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

WHO definition of Osteoporosis:

A
  • Definition:
    • low bone density & weakening of bone tissue
      • increased fragility & vulnerability of fracture
  • Most common skeletal disorder
  • Only 1/3 are diagnosed
    • >70% of fractures occur in women
      • spine, hip, & wrist
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2
Q

Primary vs Secondary Osteoporosis

A
  • Primary:
    • no known cause
  • Secondary:
    • caused by drugs or other diseases
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3
Q

What are the impacts of osteoporosis?

A
  • pain both acute & chronic
  • loss of mobility
    • → esp after a vertebral fracture → restrictive lung disease & altered abdominal anatomy
  • depression
  • nursing home placement
  • height loss/ kyphosis
  • death
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4
Q

Risk Factors of Osteoporosis

A
  • low bone mineral density; low Ca2+ intake
  • female
  • advanced age
  • ethnicity – caucasian, asian
  • h/o of trauma
  • 1st degree family hx
  • low body wt
  • premature menopause (<45 yo)
  • secondary osteoporosis
    • i.e. RA
  • PO steroid tx
  • current smoking or EtOH ≥ 3 drinks/day
  • low physical activity
  • low sun exposure
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5
Q

Bone Structure

A
  • Cortical:
    • dense & compact
      • responsible for bone strength
      • 80% of skeleton
      • on surface of long
  • Trabecular (aka cancellous bone)
    • sponge-like appearance
      • inner surfaces of long bones, vertebrate, pelvis & ribs
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6
Q

Bone Resorption occurs for two reasons:

A
  1. liberate calcium and other ions
  2. clear out worn skeleton and promote the deposition of newer, better material
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7
Q

Z-scores vs T-scores in Bone Mineral Density results

A
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8
Q

When to screen for osteoporosis?

A
  • all post-menopausal women ≥ 50 yo
  • Men > 70 yo
  • FRAX: fracture risk assessment tool
    • evaluate 10-yr chance of developing hip & major osteoporotic fracture
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9
Q

What is the suggested role of FRAX in the assessment of risk of fracture?

A
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10
Q

What labs do you order to r/o secondary causes of osteoporosis?

A
  • 25-OH vitamin D level
    • to assess for hyperparathyroidism
  • TSH level
    • to assess for hyperthyroidism
  • Testosterone level
    • to assess for hypogonadism
  • SCr
  • Ca2+
  • Phosphorous
  • CBC
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11
Q

What are the goals of tx for osteoporosis?

A
  • prevent fractures & other complications
  • maintaining or increasing BMD
  • Prevent secondary bone loss
  • reduce morbidity & mortality associated with osteoporosis
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12
Q

What are the bone turnover biomarkers and what do they demonstrate?

A
  • S-CTX (C-terminal telopeptide) - aka beta-CTX
    • levels are high during high bone resorption/turnover
    • specific marker for degradation of mature type I collagen (90% of which is located in the bone)
    • Draw a fasting level before 10am
      • a decrease ≥ 25% from baseline 3-6 months after therapy = adequate therapeutic response
  • PINP (Procollagen I Intact N-Terminal) serum
    • carboxy-terminal of propeptide type I collagen
    • Most sensitive marker of bone FORMATION
    • The Trimeric form is the predominant type in normal renal funx
    • useful for monitoring BONE FORMATION & antiresorptive therapies
    • Baseline level before starting therapy then repeat 3-6months later
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13
Q

Postmenopausal osteoporosis tx algorithm

A
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14
Q

What calcium intake level in mg/d increases risk of kidney stones or CVD?

A

> 1200 mg/day

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15
Q

Calcium Supplements & % of Elemental Calcium

A
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16
Q

Bisphosphonates

A

MOA: taken up by osteoclasts during bone resorption → inhibit the funx of the osteoclasts by disrupting the ATP metabolic pathway

“Bisphosphonates Always IRritate & cause generaliZed pain” Z = zoledronic acid, irritate = heartburn & stomach irritation (need to take it correctly), pain = premedicate zoledronic acid with acetaminophen

  • Drugs:
    • Alendronate (Fosamax)
      • prevention and tx
        • do not lie down for 30 min after admin, do not take with other meds or fluids and take after an overnight fast with plain water
    • Ibandronate (Boniva)
      • only approved for Postmenopausal osteoporosis
        • admin is same as alendronate but 1 hour before morning meal and do not lie down for 1 hour after taking
    • Risedronate (Actonel)
      • tx osteoporosis
    • Zoledronic Acid (Reclast)
      • prevent PM osteoporosis & tx osteoporosis in men & women
        *
17
Q

Denosumab (Prolia)

A

Monoclonal antibody used to tx postmenopausal osteoporosis

  • injection: SQ q 6 months
    • need to keep refrigerated
  • SEs
    • hypocalcemia
    • infx
    • severe bone pain
      • esp extremities/back
      • sciatica
      • myalgias
      • angina
    • osteonecrosis
      • (esp of the jaw)
    • pancreatitis
18
Q

What are the function of the parathyroid glands?

A
  • they monitor & regulate serum calcium levels
  • When calcium levels are low → increase release of PTH
    • promote bone resorption (i.e. remove calcium from bone) → increase calcium levels in the blood
      • PTH stimulates osteoblasts to express RANKL
      • RANKL bind to RANK on the osteoclasts → increases the osteoclastic activity
  • when calcium levels are too high → lower PTH
  • T½ of PTH = 3-5min (short!)
19
Q

Parathyroid Hormone Analogs

A
  • “PTH Analogs Always Terminate in ”-paratide””
    • Always = abaloparatide
    • Terminate = teriparatide
  • Do NOT use more than 2 years!
  • SEs:
    • Osteosarcoma
  • Teriparatide (Forteo)
    • Recombinant N-terminal human PTH → increases cAMP release → increased bone formation
    • SEs:
      • hypersensitivity, calciphylaxis, hypotension, depression
      • hypercalcemia, constipation, insomnia, hyperuricemia, leg cramps, syncope, dzz (dizziness)
  • Abaloparatide (Tymlos)
    • SEs:
      • anaphylaxis, hypotension, hypercalcemia, hypercalciuria, tachycardia, HA, palpitations, dzz (dizziness?)
20
Q

Function of Calcitonin

A

CalcitonIN → calcium INto the bone

  • Hormone from C-cells of thyroid gland
  • released in response to increased calcium levels
    • → this is protective against hypercalcemia
  • stimulate production of active form of vitamin D
  • decrease osteoclast activity
21
Q

Calcitonin-salmon (Miacalcin)

A
  • nasal spray or injx
  • used for osteoporosis
  • SEs:
    • hypersensitivity, anaphylaxis, bronchospasm, severe hypocalcemia
    • HA, sinusitis, epistaxis, rhinitis arthralgia, back pain
  • DDI:
    • drugs that induce hypocalcemia
      • loop diuretics, bisphosphonates, tobramycin → causes increased hypocalcemia
22
Q

What converts T4 to T3?

A

Deiodinases in the peripheral tissues → this ensures that end organs are able to produce enough T3 locally for metabolic funx

this also catabolizes T3 & T4 to inactive metabolites

23
Q

Half-life of T4 vs T3

A
  • T4: 7-10 days
    • 99.97% = protein bound
  • T3: 24 hours
    • 99.7% = protein bound
24
Q

Diagnostic Tests for Thyroid disorders

A
  • Labs:
    • TSH, Free T4, Free T3
  • RAIU:
    • radioactive iodine uptake
      • hyperthyroidism = elevated levels of RAIU
  • Autoimmune antibodies:
    • Hypothyroidism:
      • antithyroid peroxidase antibodies (anti-TPOAb)
      • antithyroglobulin antibodies (anti-TGAb)
    • Grave’s Disease
      • TSH receptor-stimulating antibodies (TSHR-SAb)
      • Antithyroid peroxidase antibodies (anti-TPOAb)
25
Q

Common Causes of Hypothyroidism

A
26
Q

Monitoring LT4 therapy

A
  • Serum TSH:
    • q6-12 months or if change in clinical status
    • 6-8 weeks after any dose/product change
    • ASAP in pregnancy; then monthly
27
Q

Calcitonin-Salmon

A
  • Nasal spray or injectable
  • used for osteoporosis
  • SEs:
    • Hypersensitivity, anaphylaxis, bronchospasm, severe hypocalcemia
    • HA, sinusitis, epistaxis, arthralgia, back pain, rhinitis
  • DDI:
    • Drugs that induce hypocalcemia
      • loops, bisphosphonates, tobramycin → additive hypocalcemia
28
Q

Hypothalamic-Pituitary-Thyroid Axis

A
29
Q

Post-menopausal osteoporosis tx algorithm

A
30
Q

Raloxifene (Evista)

A
  • Selective Estrogen receptor modulators
  • PO
  • for PM osteoporosis
31
Q

Thyroid Hormone Supplements

A
32
Q

Tx algorithm of Hyperthyroidism

A
33
Q

PTU vs MMI

A
  • Methimazole = preferred over PTU b/c it has a longer half life and a lower incidence of adverse effects
    • BUT cannot be used during 1st trimester of of pregnancy → teratogenic
  • PTU = agranulocytosis and hepatotoxicity

NRS 271B (10 decks)

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