Osteoporosis Flashcards
osteoporosis
reduced bone mass and altered microarchitecture
types of osteoporosis
primary
secondary
primary osteoporosis type I
loss of trabecular bone with estrogen loss
primary osteoporosis type II
loss of trabecular and cortical bone with inefficient remodeling
secondary osteroporosis
due to systemic illness or medication
therapy goals of osteoporosis (4)
limit bone mass
delay prevention
recent fracture
balance osteoclastic and plastic activity
osteoclastic
resoprtion
osteoblastic
deposition
bone healthy lifestyle consists of
calcium and vitamin D
1st line osteoporosis treatment
bisphosphonates
second line osteoporosis tx
2
teriparatide
raloxifene
3rd line osteoporosis tx
2
raloxifene
calcitonin
nutrients as tx
uses
prevention
treatment
biphosphonates as tx
uses
prevention
treatment
calcitonin as tx
uses
treatment
estrogen tx
uses
prevention
selective estrogen receptor modulators as tx
use
prevention
treatment
PTH analogs like teriparatide
use
treatment
calcium products: elemental dosages
vary with age
1000mg/day to 1500mg/day with vit D
calcium ____ or _____ is preferred to salts
carbonate
citrate
supplements <500mg should be
taken with meals
calcium product elimination
eliminated unabsorbed by GI tract
AE of calcium product
nausea
constipation
calcium products may interact with
FQs
tetracyclines
ways to get vitamin D
diet
UV exposure
supplements
vit D supplement examples
cholecalciferol
calcitriol
ergocalciferol
normal serum vitamin D levels
~32 ng/mL
adverse effects of vit D
hypercalcemia bc of promoted absorption from small intestine, thereby increasing serum Ca.
hypercalcemia causes
decreased PTH
bone resorption
bisphosphonates
first line therapy
prevention and treatment
biphosphonates MoA
inhibits breakage.
binds to bone and inhibits osteoclast activity
pt education for bisphosphonates
take at least 30 min before meal with full glass of water
excretion of bisphosphonates
renal
AEs of bisphosphonates
nausea
abdominal discomfort
when to avoid bisphosphonates?
severe renal impairment
hx esophageal obstruction
bisphosphonates will interact with
antacids
divalent cations
bisphosphonate examples
alendronate
risedronate
ibandronate
zoledronic acid
zoledronic acid is given how often
yearly as an injection
bisphosphonates can be given
daily, weekly, orally, injected.
bone demineralization with bisphosphonates
rare: jaw necrosis
potential for femur fracture.
PTH analog drug
teriparatide
MoA teriparatide
PTH analog
stimulates osteoblast function
also increases renal tubular reabsorption of calcium, leading to inc bone mass/density
dosing of teriparatide
SQ for 18-24 months
excretion of teriparatide
renal
when to avoid teriparatide
hypercalcemia
skeletal malignancy
bone mets
AE teriparatide
HA lightheaded hypoTN palpitations transient hypercalcemia
SERMS: raloxifene
use
prevention and treatment
MoA SERM: raloxifene
estrogen receptor agonist (bone) and antagonist (breast, uterus) to slow the rate of bone loss
SERMS: raloxifine
protein binding
highly protein bound
ADR of SERM: Raloxifene
HA hot flash flushing leg cramp thromboembolism
when to avoid SERM: Raloxifene
hx venous thrombosis
women of childbearing age (estrogen related)
SERM: raloxifene interaction
cholestyramine
estrogens
Calcitonin
treatment only
strictly 3rd line
MoA Calcitonin
inhibits osteoclasts
estrogen products for tx
used to alleviate peri menopausal symptoms or to prevent osteoporosis in high risk patients. recommended to be used for short term symptom management.
AEs estrogen
HA depression N/V cramps HTN thrombosis bleeding edema breast tenderness breast cancer
absolute contraindications to estrogen
cancers thromboembolic disease acute liver disease pregnancy tobacco use
osteoporosis tx that increases deposition
nutrient
teriparatide
osteoporosis tx that decreases resorption
bisphosphonates
calcitonin
estrogen
SERMs
monitoring osteoporosis pt newly started on meds
followup in 1-2 months, then 3-6
DEXA q2 years
if pt is using estrogen for osteoporosis
do a full annual workup and discuss with patient before renewing Rx
