Osteoporosis

Question 1

3 classes of drugs for Osteoporosis

Answer 1

1.Vitamin supplementation
Calcium, Vitamin D

2.Drugs that decrease bone resorption (osteoclast activity = bone breakdown)
Calcitionin-Salmon
Biphosphonates:alendronate (Fosamax) 
Estrogen replacement (Premarin)
SERMs
Denosumab (Prolia)

3.Drugs that increases bone formation
Parathyroid Hormone (Forteo)

Question 2

Osteopenia vs osteoporosis T score

Answer 2

Osteopenia- low bone mass T-score -1 to -2.5

Osteoporosis- T score -2.5 or more

Question 3

what is a fraxx score?

what is a fraxxx score?

Answer 3

• FRAXX score: 10-year risk of experiencing a fracture

- FRAXXX score: 10 year risk of experiencing awesome sex

Question 4

Vitamins for OP?

Answer 4

Calcium, Vitamin D

Question 5

Drugs that decrease bone RESORPTION

Answer 5

(resorption = osteoclast activity = bone breakdown)

Calcitionin-Salmon
Biphosphonates:alendronate (Fosamax) 
Estrogen replacement (Premarin)
SERMs
Denosumab (Prolia)

Question 6

Drug that increases bone formation?

Answer 6

Parathyroid Hormone (Forteo)

Question 7

Vitamin supplementation for prevention or treatment of OP?

Answer 7

both!

Question 8

Ca dose?

Answer 8

At least 1200mg/day

–> Divided doses b/c only absorb so much @ 1 time - only absorb 600 mg @ one time

Question 9

Ca food interactions? what we gonna do about it?

Answer 9

(oxalic acid) spinach, rhubarb, swiss chard, beets, (phytic acid) bran, whole grain cereals
–>separate 1 hour from Ca supplement

Question 10

Vitamin D dose?

Answer 10

Oral supplementation : 800mg-1000mg daily

Question 11

How does vitamin D help OP?

Answer 11

increases plasma Ca level by increase absorption from bone, kidney, intestine

Question 12

This OP treatment has characteristics of a hormone

Answer 12

vitamin D

Question 13

drug that Keeps calcium in the bone and prevents pulling calcium into the bloodstream

Answer 13

Calcitonin-Salmon

Question 14

Calcitonin-Salmon route?

Answer 14

Intranasal or SQ forms

Question 15

SE of calcitonin salmon

Answer 15

nausea, nasal drying, increased malignancies? (Canada)

Question 16

drug that Undergoes incorporation into the bone & decrease osteoclast activity

Answer 16

Biphosphonates –> Prototype: alendronate (Fosamax)

Question 17

biophosphonates end in

Answer 17

onate!

Question 18

How do we give biophosphonates/alendronate (Fosamax) ? what do you do after you take it?

Answer 18

• take it first thing in morning before eaten or drink anything for 30 minutes
• remain upright for 30 minutes to prevent esophagitis

Question 19

once in the bone this drug stays there for decades

Answer 19

biophosphonate/alendronate (Fosamax)

Question 20

side effects of alendronate (Fosamax)

Answer 20

-Esophagitis*, atypical fractures of the femur, musculoskeletal pain, ocular inflammation and osteonecrosis of the jaw

Question 21

patient teaching for alendronate?

Answer 21

• Take on empty stomach 1st thing in morning
• Nothing to eat or drink for 30 min
• Remain upright for 30 min
• Take with full glass of water
• Don’t chew or suck tablets
• take with Ca and Vit D

Question 22

how does estrogen replacement therapy work for OP?

Answer 22

Suppress osteoclast proliferation

Question 23

prototype for estrogen replacement for OP?

Answer 23

conjugated equine estrogens (Premarin)

Question 24

side effects of conjugated equine estrogens (Premarin)

Answer 24

Increased risk of breast cancer and endometrial cancer, cholecystitis, myocardial infarction and stroke

Question 25

What does SERM stand for? - 10 points if you get it!

Answer 25

Selective estrogen-receptor modifiers (SERM)

Question 26

SERM prototype

Answer 26

raloxifene (Evista)

Question 27

How does raloxifene fxn?

Answer 27

(SERM)

Block estrogen receptors on breast cancer cells, but have estrogen effects on non-breast cells

Question 28

side effect of raloxifene?

Answer 28

DVT and PE risk (stroke)

Question 29

raloxifene and pregnancy?

Answer 29

preg category X

Question 30

other uses for raloxifene?

Answer 30

(SERM)

breast cancer

• Improve bone density
• Reduces spinal fractures
• Improve lipid profiles and improves cardiovascular risk

Question 31

what kind of drug is Denosumab (Prolia)?

Answer 31

Monoclonal Antibody

Question 32

how does Denosumab fxn?

Answer 32

-RANKL inhibitor
–>RANK= receptor stimulates formation of osteoclasts
-this drug prevents receptor activation and inhibits osteoclast formation
Receptor activation of nuclear factor kappa-B ligand

Question 33

route for denosumab?

Answer 33

SQ / 6 months

Question 34

Side effects and rare side effects of denosumab?

Answer 34

SE: back pain, MS pain, pain in extremities, UTI, hypercholesterolemia

Rare/serious SE: serious infections, derm reactions, osteonecrosis of the jaw

Question 35

before taking denosumab you need to correct …..

Answer 35

hypocalcemia

Question 36

how does teriparatide fxn?

Answer 36

Increases bone deposits by osteoblasts

Question 37

route for teriparatide?

Answer 37

SQ monthly

Question 38

teriparatide costs _____

Answer 38

$1500/month

Question 39

side effects of teriparatide?

Answer 39

Generally well tolerated
Nausea, headache, back pain, leg cramps
Orthostatic hypotension-initially
Increased risk of osteosarcoma

Question 40

which OP drug causes orthostatic hypotension initially?

Answer 40

teriparatide

Question 41

which OP drug has risk of osteonecrosis pf jaw

Answer 41

denosumab

Question 42

SQ route for OP

Answer 42

1. Calcitonin-Salmon
2. Denosumab (Prolia) : Monoclonal Antibody (ever 6 mo)
3. teriparatide (Forteo) (1/month)