Osteoporosis

Question 1

Define osteoporosis (3)

Answer 1

• Loss bone mass
• distortion bone microstructure
• t score < -2,5 (SD)

Question 2

Name 7 drugs that can be used to treat osteoporosis

Answer 2

• Bisphosphonates:alendronate , risedronate, zoledronate, pamidronic acid, ibandronic acid
• calcium salts
• vitamin D:ergocalciferol
• Hrt (et or ept)
• SERM (raloxifen)
• calcitonin
• strontium ranelate

Question 3

Moa bisphosphonates?

Answer 3

Prevent bone resorption by interfere with anchoring of cell surface proteins to osteoclast membrane - osteoclast toxic

Question 4

Name 3 bisphosphonates

Answer 4

• Alendronate
• zoledronate
• ibandronic acid
• risedronate
• pamidronic acid

Question 5

What are difficulties of taking bisphosphonates orally and what can be done to overcome it? (2)

Answer 5

• Poorly absorbed so take on empty stomach

* git disturbance (œsophagitis): stay upright 30 min after drink meds

Question 6

Name example vit D preparation

Answer 6

Ergocalciferol

Question 7

Ergocalciferol adverse effect?

Answer 7

(Vitamin D ) ( fat soluble) (give in combination with bisphosphonates and calcium salts)
Excessive cause hypercalcaemia and there therefore kidney stones.

Question 8

Recommended dosage calcium salts postmenopausal women?

Answer 8

If on hrt, 1000 mg/day

If not, 1500.

Question 9

Side effect calcium salts?

Answer 9

Git upset

Question 10

What SERM can be used for osteoporosis?

Answer 10

Raloxifen

Question 11

Is HRT indicated in osteoporosis? Why? (4)

Answer 11

Yes. Unless contraindications.
• halt bone loss
• gain bone mass 5-10% if on treatment for 1-3 years
• 5 years treatment decrease probability vertebral fractures by 50-80% and hip and wrist fractures by 25%

Question 12

What is a SERM? (4)

Answer 12

• Selective estrogen receptor modulator
• estrogenic effects in some tissue and anti-estrogenic in other.
• prevent harmful estrogenic effects: breast and uterus
• beneficial estrogenic: bone and liver

Question 13

Name 3 SERMs

Answer 13

• Tamoxifen
• raloxifen
• clomiphene citrate

Question 14

Tamoxifen indication?

Answer 14

breast cancer treatment

Question 15

Clomiphene citrate indication?

Answer 15

Ovulation induction to treat infertility

Question 16

Name 3 side effects tamoxifen

Answer 16

• increased risk endometrial cancer
• hot flushes
• dvt and pe

Question 17

Name 3 adverse effects clomiphene citrates

Answer 17

• Ovarian hyperstimulation syndrome OHSS
• multiple pregnancies
• hot flushes

Question 18

What is a STEAR? (3)

Answer 18

• Selective tissue estrogen activity regulator
• inhibit steroid metabolising enzymes
• does not possess antagonistic biological effects via Er in tissue.

Question 19

Name example STEAR

Answer 19

Tibolone

Question 20

Indications tibolone? (4)

Answer 20

• Postmenopausal symptoms
• osteoporosis
• endometriosis
. Female sexual dysfunction

Question 21

Tibolone adverse effects? (3)

Answer 21

(Stear)
• infrequently produce androgen side effects: acne, increased facial hair growth
• unscheduled vaginal bleeding
• increased risk CvA and cv events
(Breast cancer contraindicated)