Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

3154 Finals > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

Explain how Vit D deficiency may cause osteoporosis

A

o In Vit D deficient state, calcium absorption decreases

o Calcium-sensing receptor on parathyroid cells detects low serum calcium, and PTH production increases. PTH then increases calcium reabsorption by the kidney. If calcium resorption from kidney alone is insuffient to make up for low serum Ca, Ca within bone is mobilised via bone resorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

MOA of Bisphosphonates

A

Decreases rate of bone resorption by increasing osteoclast cell death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

ADR of Bisphosphonates (6)

A

o Significant:
- Atypical femoral fractures (prolonged use); severe bone, joint or muscle pain;
- Upper gastrointestinal mucosa irritation
- Ocular effects (e.g., iritis, uveitis),
- Hypocalcaemia, osteonecrosis of the jaw and external auditory canal.

o Oral:
- Nausea, abdominal pain and heartburn-like symptoms.

o Intravenous:
- Flu-like symptoms

Just rmb the GI, ONJ and Atypical fractures and hypoCa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

MOA of Denosumab

A

Binds to RANKL and inhibits development of osteoclasts hence decreasing bone resorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

ADR of Denosumab (6)

A

o Muscle, back, bone or joint pain,
o nausea or vomiting, constipation or diarrhoea,
o slight tiredness,
o increased cholesterol levels

o Rarely:
- Osteonecrosis of the jaw, or atypical femur fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

State when Oestrogen therapy may be indicated for Osteoporosis

A

o (i) Bone health in younger women (prevention of osteoporosis) or

o (ii) In women whose other menopausal symptoms also require treatment (Recall: not used solely for TREATMENT of osteoporosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

State the MOA of Raloxifene

A
  • Mixed oestrogen receptor agonism and antagonism
  • Mimics effects of oestrogen on bone density in postmenopausal women.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

State effects of Raloxifene on the following (incr/decr risk/ no effect):

a) Breast cancer
b) VTE/ Stroke
c) Hot flushes

A

a) Decrease risk of certain types

b) Increase risk

c) Increase risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

MOA of Calcitonin

A

Reduces blood calcium by inhibiting osteoclastic bone resorption, opposing effects of parathyroid hormone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

ADR of Calcitonin (1)

A

Red streaks on skin; injection site reaction; feeling of warmth; redness of the face, neck, arms, and occasionally, upper chest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

MOA of Romosozumab

A

o Removes sclerostin inhibition of the canonical Wnt signalling pathway that regulates bone growth
o Increases bone formation and decreases bone resorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

ADR of Romosozumab (~5)

A

1) CVS: MI, increased risk of CV death, stroke,
2) transient hypoCa
3) hypersensitivity reactions (e.g., angioedema, erythema multiforme, urticaria, dermatitis, rash).

o Rarely, osteonecrosis of the jaw, and atypical femur fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

MOA of Teriparatide

A

o Similar structure to PTH -> PTH effects:

Stimulates new bone formation and increase bone strength via increasing osteoblast function

+ also incr renal resorption of Ca and GI absorption of Ca (from UTD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

ADR of Teriparatide (3)

A

o Serious calciphylaxis and worsening of previous stable cutaneous calcification (accumulation of Ca in skin)

o Transient orthostatic hypotension

o Transient and minimal elevations of serum Ca or hypercalcaemia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

CI of PTH therapies (3 impt, 4 not so)

A

o Severe renal impairment (< 30mL/min) (impt)
o Pre-existing hypercalcaemia (impt)
o Other metabolic bone diseases (e.g. Paget’s disease, hyperparathyroidism)/ History of bone radiation/ Bone cancer (impt)

o Hypersensitivity
o Unexplained elevations of alkaline phosphatase
o Hereditary disorders predisposing to osteosarcoma.
o Pregnancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

CI of Romosozumab

A

History of CV event/ stroke (incr risk of CV death, MI, stroke as ADR)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

CI of Bisphosphonates (5)

A

o Hypocalcaemia
o Severe renal impairment (CrCl < 30 mL/min; 35mL/min for IV Zoledronic acid formulation)

Only for PO:
o Abnormalities of the oesophagus or stomach which may delay emptying (e.g gastric ulcer, achalsia aka swallowing disorder, uncontrolled GERD, erosive esophagitis)
o Cannot stand/ sit upright for at least 30mins
o Aspiration risk (cannot swallow liquid)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

CI of Denosumab

A

Hypocalcemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which Osteoporosis therapy is CI in HYPERcalcemia?

A

Teriparatide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

CI of Raloxifene (1 most impt, 3 others)

A

o Severe renal impairment (< 30mL/min) (most impt)
o Hepatic impairment.
o History of or current VTE.
o Pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which Osteoporosis tx is DOC for those with CrCl, 30ml/min?

A

Denosumab

22
Q

State when Osteoporosis treatment should be initiated (3)

A

o Patients presenting with fragility fracture OR
o Patients without fragility fracture, but DXA BMD T-scores of < -2.5 OR
o Osteopenic (DXA BMD T-scores -1 to -2.5 SD) without a fragility fracture, but with high fracture risk (e.g. FRAX ≥ 3% hip fracture risk or ≥ 20% major osteoporotic fracture)

23
Q

Dose of Alendronate

A

70mg once a wk

24
Q

Dose of Risendronate

A

35mg once a wk

25
Q

State the counselling points for Bisphosphonate wrt administration instructions, ADRs that may occur and how the patient may minimise chances of ADR occuring. (3)

A

1) Take this medication 1/2- 1 hour before breakfast (on an empty stomach), with a full glass of water, and remain upright for at least 30 mins.

2) Some ADRs you might experience are nausea, abdominal pain and heartburn-like symptoms

3) Rarely, this might cause osteonecrosis of the jaw. If you experience any pain in the mouth, and/or jaw, swelling or sores inside the mouth, numbness or a feeling of heaviness in the jaw, or loosening of a tooth, these could be signs of bone damage in the jaw. To minimise this,
o Smoking cessation
o Avoid invasive dental procedures during bisphosphonate treatment
o Maintain good oral hygiene
Abnormal fractures of the femur may also occur hence inform your doctor if you have any pain in thighs/ hips/ groin

26
Q

State the non-pharmacological management for Osteoporosis (7)

A

1) Exercises: weight-bearing (30 mins “daily”), muscle-strengthening & balance (2-3 x weekly)
- e.g. Tai Chi, elastic band exercises, walking

2) Smoking cessation

3) ? Limit caffeine intake (≤ 2 cups/day)

4) Limit alcohol intake (≤ 2 units/day)

5) Reduce risks for fall
- Patient education on minimizing fall risks: multifactorial patient-specific interventions for impaired vision/cataract, footwear, home modifications
* Modify intrinsic and extrinsic fall factors in patient specific way
- Medication review (switch out drowsy meds where possible)

6) Ensure adequate calcium intake
- Consider giving supplementation if dietary intake < 700 mg/day
- Split into multiple doses
- Appropriate calcium intake:
* 1000mg/day elemental Calcium for those age ≥ 51
* 800mg/day for those aged 19-50

7) Maintain Vit D status
- Give 800 IU/day cholecalciferol to those at risk of/has Vit D insufficiency
* Take with food
- Recommended intake:
* 51-70 year old = 600 IU/day
* > 70 year old = 800IU/day

27
Q

Risk factors for ONJ development (6)

A

o Use of Zolendronic acid
o Tooth extraction or other invasive dental procedures
o History of cancer, radiotherapy
o Poor oral hygiene
o Concomitant therapy (eg: angiogenesis inhibitors, bisphosphonates, chemotherapy, corticosteroids, denosumab)
o Comorbid disorders (e.g. anemia, coagulopathy, infection, pre-existing dental or periodontal disease)

28
Q

DDI of Ca supplement (7)

A
  • PPI & fibre (decrease calcium absorption) -> absorption require acidic environment
  • Decrease absorption of iron, tetracyclines, fluoroquinolones, bisphosphonates, thyroid supplements.

DDI are mostly drugs that cannot take with food at all (bisphos, thyroid) or those antibiotic that absorption affected by ions (Tetra and FQ)

29
Q

DDI of Vit D (5)

A
  • Rifampin
  • Anticonvulsants (phenytoin, valproic acid, carbamazepine),
  • Cholestyramine
  • Orlistat (binds to fat and Vit D is fat soluble)
  • Aluminum-containing products

Potent enzyme inducers/inhibitor, drugs that bind fat and incr excretion, Alum

30
Q

What should be done prior to starting pharmacotherapy for osteoporosis?

List the ideal range where applicable.

A
  • Check serum calcium & 25-hydroxyvitamin D levels prior to starting pharmacologic therapy
    • Serum 25(OH) vitamin D should be ≥ 20-30 ng/mL (50-75 nmol/L) but < 50-100 ng/mL (125-250 nmol/L)
31
Q

State monitoring parameters for Osteoporosis (4)

A

1) BMD once every 2 yrs
2) SCr
3) Serum Ca
4) Serum Vit D

32
Q

State the treatment duration of Bisphosphonate for those with low and high fracture risk.

Also list what is defined as high fracture risk for bisphosphonates.

For low risk, state when tx may be restarted.

A

Low risk:
- 5 year for PO
- 3 year for IV
Restart after 2 yr if BMD decrease by > 4-5% or if tx criteria met again

High risk (T ≤ -3):
- 10 year for PO
- 6 years for IV

High risk = low risk duration x 2

33
Q

Z-score values < -2 SD suggests ______? State what should be done

A

Coexisting problems (eg, glucocorticoid therapy or
alcoholism) that can contribute to osteoporosis.

Do labs to identify potential secondary causes.

34
Q

State the potential causes of decreased bone mass (8)

A
  • Age
  • Menopause
  • Low serum calcium
  • Alcohol consumption
  • Smoking
  • Physical inactivity
  • Medication use
  • Secondary to other diseases
35
Q

State potential drug induced causes of osteoporosis (7)

A

1) Steroids
2) Immunosuppressants (Ciclosporin)
3) ASMs (Phenobarb, Phenytoin) -> affect Vit D
4) Aromatase inhibitor -> affect estrogen
5) GnRH agonist and antagonist
6) Heparin
7) Chemo

36
Q

State who should be screened for osteoporosis (2)

A

1) Post-menopausal women
2) Men ≥ 65 year old

Especially if have risk factor present:
o Family history of osteoporosis or fragility fractures
o Previous fragility fracture
o Ageing
o Low body weight
o Certain medications
o Low calcium intake
o Excessive alcohol intake
o Smoking
o Height loss (>2cm within 3 years)
o Prolonged immobility
o Early menopause (45 years and younger)
o History of falls
o Presence of diseases that can lower bone density or increase fracture risk

37
Q

State where fragility fractures tend to occur (3)

A

Spine (vertebral compression) = compression fracture
o Height loss
o Kyphosis (more and more bent)

Hip (Neck of femur fracture, intertrochanteric fracture)

Wrist (Colles fracture)

38
Q

State the screening tool that can be used for women only to determine need for further examination to determine whether they have osteoporosis. And state the risk score(s) that they should be sent for DXA

A

OSTA Risk categories (for women ONLY):
- High-risk = score > 20
* Consider DXA (a type of xray) scan
- Medium risk = score 0-20
* Consider DXA scan if any other risk factor present

39
Q

BMD T-score of ≤ -2.5 SD indicates?

A

Osteoporosis

40
Q

BMD T-score of -1 to -2.5 SD indicates?

A

Osteopenia

41
Q

Should bisphosphonates be used for more than 10 years?

A

No. Once duration of treatment with bisphosphonates hit 10 years, discontinue as there is no evidence for further benefit if continued beyond 10 years

42
Q

State the management of ONJ in those who:

o For those who develop ONJ:

o For those who have dental problems and haven’t start Bisphosphonate:

o For those who have dental problems but already started Bisphosphonate:

A

o For those who develop ONJ:
 *Patients developing ONJ during bisphosphonate treatment should receive care by an oral surgeon/dentist (refer) & consider discontinuation of treatment based on risk/benefit assessment

o For those who have dental problems and haven’t start Bisphosphonate:
 If got dental problems, delay starting bisphosphonate, go for dental treatment then start once fully healed

o For those who have dental problems but already started Bisphosphonate:
 Consider stopping treatment for a few months depending on risk of ONJ

43
Q

a) If fragility fracture occur on bisphosphonate, ______

b) If fragility fracture occur before starting bisphosphonate, _____

A

a) re-evaluate efficacy and consider alternatives

b) start treatment 2-4 weeks after fragility fracture or as soon as patient can sit upright

44
Q

State the route, dosing freq and tx duration if Romosozumab is used

A

SC injection, once a month for 1 year

45
Q

State the route, frequency and tx duration if Teriparatide is used

A

SC injection, once daily for less than 2 years

46
Q

List the antiresorptive agents (5)

A

Bisphosphonate, Calcitonin, Raloxifene (SERM), Estrogen, Denosumab

47
Q

List the anabolic agents (2)

A

Romosozumab, Teriparatide

48
Q

When is FRAX typically used to determine if osteoporosis tx is to be started/ continued?

A

When patient is osteopenic (T score between -1 and -2.5) and no fragility fracture present

49
Q

List the recommended level of daily Vit D intake for the various age groups

What dose of Vit D is used as supplementation? State any special administration instructions as well

A

51-70 y.o: 600IU/d
>70 y.o: 800IU/d

800IU/d. Take with food

50
Q

What is considered adequate calcium intake for various age groups?

When to supplement Ca

A
  • 1000mg/day elemental Calcium for those age ≥ 51
  • 800mg/day for those aged 19-50
  • Consider giving supplementation if dietary intake < 700 mg/day

3154 Finals (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions