Osteoporosis Flashcards by Kat Che

What is the primary goal of osteoporosis treatment

reduce risk of fractures

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What are 4 big points of dietary recommendations for patients with osteoporosis

enough calories, Ca2+, VitD, avoid excess alcohol

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Vitamin D deficiency can contribute to both ___ and _____

osteoporosis, fall risk

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What are some weight bearing exercise?

jogging, walking, tai chi

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what are muscle strengthening exercise

weight training, pilates, yoga

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For patients with osteoporosis, it is recommended for smoking cessation because ____

smoking accelerates bone loss and is detrimental to health

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What are the 3 categories for initiating pharmacologic therapy (50 y.o. and)

hip or vertebral fracture

T score 3% hip or >20% overall

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What is the difference between antiresorptive and anabolic pharmacotherapy for osteoporosis

antiresorptive prevent bone loss

anabolic promote bone building

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Bisphosphonates MOA

bind to hydroxyapatite binding sites on bone surface-> enter osteoclast-> apoptosis
also inhibit cholesterol biosynthetic pathway-> abnormalities in osteoclast

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What are 4 different bisphosphonates? (What do they end in)

“dronate”

Alendronate, ibandronate, risedronate, zoledronic acid

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Take oral bisphosphonates on an ______ because ____. Which is the exception

empty stomach, food and cations impair absorption

- delayed release risedronate (take after meal)

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After taking oral bisphosphonates remain ____ for over 30 minutes, which will reduce ____

upright

risk of reflux/esophageal irritation

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Bisphosphonates are contraindicated in

upper GI dz or esophageal abnormalities, can’t be upright, hypocalcemia, renal impairment

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Bisphosphonates AEs

GI: mucosa irritation, esophagitis, dysphagia

Osteonecrosis of jaw, atypical femur fracture, hypocalcemia, acute phase rxn

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What to monitor with bisphosphonates

BMD, renal fxn, serum Ca2, VitD

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How long are bisphosphonates indicated for? What do you do after?

Oral 5 years, IV 3 years
low fracture risk- stop
high fracture risk- continue up to 10 years

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What is the name of the RANKL/RANK inhibitor used for osteoporosis

denosumab

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How does RANKL/RANK inhibitor work?

RANKL-> RANK receptor on osteoclast-> activates it.

Inhibitor blocks that-> inhibit osteoclast differentiation, activation, survivial

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Two groups indicated for RANKL/RANK inhibitors

osteoporosis and glucocorticoid induced osteoporosis

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What drug is first line for osteoporosis

bisphosphonates

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What to monitor in someone taking denosumab

serum Ca2+ 10 days after dose in someone hypocalcemia, renal fxn, BMD

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What are AE of RANKL/RANK inhibitor

hypocalcemia, infection (RANK is involved in immune system), osteonecrosis of jaw, atypical femur fracture, MSK pain

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there will be a rapid ___ in BMD and increase in _____ upon stopping denosumab

decrease, vertebral fractures

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What are the available antiresorptive pharmacotherapy for osteoporosis

bisphosphonates, RANKL inhibitor, selective estrogen receptor modulator, estrogen/hormone therapy, calcitonin

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What are the available anabolic pharmacotherapy for osteoporosis

PTH analogs, sclerotin inhibitor

When given _______, PTH stimulates bone formation more than resorption

intermittently

Ordinarily, PTH causes:

bone resorption renal tubule Ca2+ resorption renal calcitriol production

What are the two parathyroid hormone analogs used for osteoporosis

teriparatide (forte), abaloparatide

How do parathyroid hormone analogs work for osteoporosis

bind to PTH1R on osteoblast-> stimulate osteoblast

The parathyroid hormone analogs have been associated with _____

osteosarcoma

AEs of parathyroid hormone analogs

dizziness, orthostatic hypotension, heart pals, arthralgia, hypercalcemia, urolithiasis

Counterindications for PTH analogs

hypercalcemia, hyperparathyroidism, Paget, renal stone, radiation therapy, bone mets, open epiphysis

What is the sclerostin inhibitor used for osteoporosis

romosozumab

How do sclerostin inhibitors works

Normal: activate Wnt/β-catenin-> bone formation | sclerostin prevents Ant from binding to β-cat, inibitor prevents binding so more bone formation

Romosoxumab should be used in individuals ______

who are a high risk of fracture or failed/can't take other 1st line options

Black box warning for sclerostin inhibitor

increase risk of mI, stroke, CV death

What are AEs for sclerostin inhibitors

arthralgia, hypocalcemia, atypical femur fracture, osteonecrosis of jaw

Selective estrogen receptor modulator MOA

estrogen agonist-> stimulate osteoblast -> cytokines-> osteoclast apoptosis

What is the selective estrogen receptor modulator used for osteoporosis

Raloxifene

In addition to treatment and prevention of post menopausal osteoporosis, SERMs also

reduce risk of breast cancer

Two black box warnings for SERMs

increased risk of thromboembolic events | increased risk of fatal stroke in coronary heart dz

Estrogen-progestin can be used for ___ and ___

prevent post menopausal OP and relief of sx

POA of calcitonin as a treatment for osteoporosis

PTH antagonist, inhibit osteoclasts and bone resorption promotes excretion of Ca, phos, Na, Mg, and K

Calcitonin is indicated for who?

OP in women >5 years postmenopausal when alt treatments no good. decreased pain with vertebral fractures, treat hyperCa2+

Cannot used the market place calcitonin with a ____

salmon allergy

AE of calcitonin

increased risk of malignancy, rhinitis, epistaxis, hypocalcemia

in someone with renal impairment avoid ____R

bisphosphonates

in someone with an infection risk avoid ____

RANKL inhibitor

In someone with a recent hx of MI or stroke, avoid ___

sclerostin inhibitor

in someone with severe OP/prior fragility fractures

anabolic therapy, PTH analog, sclerostin inhibitor

What can be used for glucocorticoid induced OP

certain bisphosphonates, denosumab, PTH analog (teriparatide)

What can be used in men

bisphosphonates, denosumab, PTH analog (teriparatide)

Bisphosphate is incorporated _____ and released when _____

into the bone | osteoclasts start to resorb it

All bisphosphonates can be used for ____

prevention and treatment

Bisphosphonates work mostly for ___ fractures

vertebral

Do not use bisphosphonates if CrCl is

30-35

Denosumab is a ___ and needs to be given by a healthcare provider every ___

subQ injection | 6 months

PTH analogs should be taken for _ years and then followed up with ___

2 years, anti-resorptive therapy

sclerostin inhibitors have both ____ and ____ properties

antiresorptive and anabolic. It is considered stronger for anabolic

sclerostin inhibitors are given ____ as a ____

monthly, SQ injection

SERM act as an antagonist in

breast and uterine tissue -> reduce cancer