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Exam 11 > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

What is the primary goal of osteoporosis treatment

A

reduce risk of fractures

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2
Q

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

A

enough calories, Ca2+, VitD, avoid excess alcohol

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3
Q

Vitamin D deficiency can contribute to both ___ and _____

A

osteoporosis, fall risk

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4
Q

What are some weight bearing exercise?

A

jogging, walking, tai chi

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5
Q

what are muscle strengthening exercise

A

weight training, pilates, yoga

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6
Q

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

A

smoking accelerates bone loss and is detrimental to health

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7
Q

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

A

hip or vertebral fracture

T score 3% hip or >20% overall

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8
Q

What is the difference between antiresorptive and anabolic pharmacotherapy for osteoporosis

A

antiresorptive prevent bone loss

anabolic promote bone building

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9
Q

Bisphosphonates MOA

A

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

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10
Q

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

A

“dronate”

Alendronate, ibandronate, risedronate, zoledronic acid

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11
Q

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

A
  • empty stomach, food and cations impair absorption

- delayed release risedronate (take after meal)

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12
Q

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

A

upright

risk of reflux/esophageal irritation

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13
Q

Bisphosphonates are contraindicated in

A

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

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14
Q

Bisphosphonates AEs

A

GI: mucosa irritation, esophagitis, dysphagia

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

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15
Q

What to monitor with bisphosphonates

A

BMD, renal fxn, serum Ca2, VitD

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16
Q

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

A

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

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17
Q

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

A

denosumab

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18
Q

How does RANKL/RANK inhibitor work?

A

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

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

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19
Q

Two groups indicated for RANKL/RANK inhibitors

A

osteoporosis and glucocorticoid induced osteoporosis

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20
Q

What drug is first line for osteoporosis

A

bisphosphonates

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21
Q

What to monitor in someone taking denosumab

A

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

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22
Q

What are AE of RANKL/RANK inhibitor

A

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

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23
Q

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

A

decrease, vertebral fractures

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24
Q

What are the available antiresorptive pharmacotherapy for osteoporosis

A

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

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25
Q

What are the available anabolic pharmacotherapy for osteoporosis

A

PTH analogs, sclerotin inhibitor

26
Q

When given _______, PTH stimulates bone formation more than resorption

A

intermittently

27
Q

Ordinarily, PTH causes:

A

bone resorption
renal tubule Ca2+ resorption
renal calcitriol production

28
Q

What are the two parathyroid hormone analogs used for osteoporosis

A

teriparatide (forte), abaloparatide

29
Q

How do parathyroid hormone analogs work for osteoporosis

A

bind to PTH1R on osteoblast-> stimulate osteoblast

30
Q

The parathyroid hormone analogs have been associated with _____

A

osteosarcoma

31
Q

AEs of parathyroid hormone analogs

A

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

32
Q

Counterindications for PTH analogs

A

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

33
Q

What is the sclerostin inhibitor used for osteoporosis

A

romosozumab

34
Q

How do sclerostin inhibitors works

A

Normal: activate Wnt/β-catenin-> bone formation

sclerostin prevents Ant from binding to β-cat, inibitor prevents binding so more bone formation

35
Q

Romosoxumab should be used in individuals ______

A

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

36
Q

Black box warning for sclerostin inhibitor

A

increase risk of mI, stroke, CV death

37
Q

What are AEs for sclerostin inhibitors

A

arthralgia, hypocalcemia, atypical femur fracture, osteonecrosis of jaw

38
Q

Selective estrogen receptor modulator MOA

A

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

39
Q

What is the selective estrogen receptor modulator used for osteoporosis

A

Raloxifene

40
Q

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

A

reduce risk of breast cancer

41
Q

Two black box warnings for SERMs

A

increased risk of thromboembolic events

increased risk of fatal stroke in coronary heart dz

42
Q

Estrogen-progestin can be used for ___ and ___

A

prevent post menopausal OP and relief of sx

43
Q

POA of calcitonin as a treatment for osteoporosis

A

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

44
Q

Calcitonin is indicated for who?

A

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

45
Q

Cannot used the market place calcitonin with a ____

A

salmon allergy

46
Q

AE of calcitonin

A

increased risk of malignancy, rhinitis, epistaxis, hypocalcemia

47
Q

in someone with renal impairment avoid ____R

A

bisphosphonates

48
Q

in someone with an infection risk avoid ____

A

RANKL inhibitor

49
Q

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

A

sclerostin inhibitor

50
Q

in someone with severe OP/prior fragility fractures

A

anabolic therapy, PTH analog, sclerostin inhibitor

51
Q

What can be used for glucocorticoid induced OP

A

certain bisphosphonates, denosumab, PTH analog (teriparatide)

52
Q

What can be used in men

A

bisphosphonates, denosumab, PTH analog (teriparatide)

53
Q

Bisphosphate is incorporated _____ and released when _____

A

into the bone

osteoclasts start to resorb it

54
Q

All bisphosphonates can be used for ____

A

prevention and treatment

55
Q

Bisphosphonates work mostly for ___ fractures

A

vertebral

56
Q

Do not use bisphosphonates if CrCl is

A

30-35

57
Q

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

A

subQ injection

6 months

58
Q

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

A

2 years, anti-resorptive therapy

59
Q

sclerostin inhibitors have both ____ and ____ properties

A

antiresorptive and anabolic. It is considered stronger for anabolic

60
Q

sclerostin inhibitors are given ____ as a ____

A

monthly, SQ injection

61
Q

SERM act as an antagonist in

A

breast and uterine tissue -> reduce cancer

Exam 11 (5 decks)

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