Osteoporosis Flashcards
What is metabolic bone disease
Any bone disorder resulting from chemical aberrations
What are two examples of metabolic bone disease
Osteopenia
osteoporosis
What determines the difference between osteopenia and osteoporosis
Severity of the bone disease
What are the two different types of osteopenia & osteoporosis
Primary: post menopausal (most common)
Secondary: presence/ treatment of other disease
Why are women at greater risk for developing osteopenia or osteoporosis
Hormones… estrogen plays a big role with bone density
What other hormone disorders can lead to osteopenia / osteoporosis
Cushing
Thyroid disorder
Hyperparathyroidism
DM
When is peak bone mass achieved
Around age 30
Is osteoporosis / osteopenia a qualitative or quantitative disorder
Quantitative… the mechanism to make bone is working fine, just not making enough
What does impaired bone mineralization lead to
osteomalacia
What presentations may be seen with osteoporosis / osteopenia
Height loss
Kyphosis
*Compression fractures lead to both
What is a fragility fracture
Any fracture that results from low energy
What are the results from a DEXA scan
T score
Z score
When is a T score used
Most patients
When is a Z score used
pre-menopausal women
young males
What T score indicated osteoporosis
< -2.5
What T score indicates osteopenia
-1- -2.5
If a patient has a T score less that -2.5 and has a fracture, what does this mean
severe osteoporosis
How often does a patient need to follow up with a T score of -1 to -1.5
every 5 years
How often does a patient need a follow up with a T score of -1.5 to -2
Every 3-5 years
How often does a patient need to follow up with a T score under -2
Every 1-2 years
What is the best measurement of a vitamin D deficiency and why
25-hydroxyvitamin D
(25(OH)D)
Measures active vitamin D
What is the first line treatment for osteoporosis
Risk reduction and prevention
Which patients are given pharmacological treatment for osteoporosis
T score less than -2.5
Osteopenic patients with a 10yr hip fracture risk of 3+%
Osteopenic patients with a 10yr major hip fx risk of 10+%
Any patient with a fragility fracture
What are the pharmacological treatment options for osteoporosis
Vitamin D + calcium
Bisphosphonates
Denosumab
Teriperatide
SERMs
Calcitonin
Why is Vitamin D + calcium given as an osteoporosis treatment
Adequate levels of both are required for optimal health and medication efficacy… give to ALL patients
How much calcium can be absorbed at a time
500mg
Why does calcium carbonate need to be taken with food and without any H2 receptors
Requires acid for absorption
What is the first line pharmacological option for osteoporosis
Bisphosphonates
What is the MOA for bisphosphonates
Inhibit bone resorption via osteoclasts
What are some bisphosphonates that can be used
Alendronate
Risedronate
Zolendronate
Ibandronate
When is alendronate used
For non-vertebral fx
When is ibandronate used
Prevention / treatment of post-menopausal osteoporosis
Which patients will be given zolendronate
Those who can’t tolerate PO medication
What are some side effects of bisphosphonates
Erosive pharyngitis (oral)
Osteonecrosis of the jaw (IV)
Fever/chills/flushing (IV)
Myalgias (IV)
How should bisphosphonates be administered
Taken in the am with 8oz of water and 40min before food
Remain upright
Who do you need to be cautious with in regards to bisphosphonates
CrCl<35
Elderly, diabetics, CKD
What is the MOA of denosumab
Inhibits osteoclast maturation (RANK L) inhibitor
Reduces vertebral fx > hip fx
Which patients is denosumab indicated in
High risk fx with breast CA, prostate CA, hormone deprivation tx
What are the side effects of denosumab
Hypocalcemia
Hypercholesterolemia
Eczema/dermatitis
Pancreatitis
Osteonecrosis of the jaw
What is Teriperatide and what is the MOA
PTH analog
Decreases osteoblast apoptosis and promotes production of new bone matrix
When is Teriperitide indicated
Treatment for osteoporosis and atypical fractures
How long can teriperatide be given
2 years only
What is the BBW of teriperatide
Increased risk of osteosarcoma
Which patients should NOT be given teriperatide
Pagets
Skeletally immature
h/o sarcoma
significant radiation
How do SERMs work
Bind estrogen receptor (protective effects)
Will reduce vertebral fx only
What is the indication for SERMs
Prevention, not treatment
Post-menopausal women
What are example of SERMs
Tamoxifen
Raloxifene
When is tamoxifen indicated
After breast cancer treatment
What are the side effects of SERMs
hot flashes
thromboembolism
reduced LDL
reduced breast CA risk
What is the MOA of calcitonin
Decrease bone resorption
*inhilation
What is the indication for calcitonin
Primarily for pain associated with vertebral compression fractures
