Osteoporosis Flashcards
What are patient characteristics that are risks for osteoporosis?
Advacned age
Ethnicity (white or asian)
Family history
Sex (F > M)
Low body weight
What are medical conditionals that make someone at risk for osteoporosis?
Diabetes
Eating disoreders
GI issues (malabsorption)
Hyperthroidism
Hypogonadism in men
MENOPAUSE!!!!!
Rheumatoid arthritis
What are some lifestyle factors that make someone more at risk for osteoporosis?
Smoking
Excessive alcohol
Low calcium intake
low vitamin intake
Physical inactivity
Medications that increase risk of osteoporosis?
Anticonvulsants (carbamazepine, phenytoin, phenobarbital)
Depo shot
GnRH agonist
Lithium
PPI (long term use)
Steroids (>/= pred 5 mg for >/= 3 months)
Thyroid hormones
Loop
SSRIs
What is the GOLD standard to measure bone mineral density?
DEXA scan will give you a T scor or Z score
Normal T score >/= -1
Osteopenia -1 to -2.4
Osteoporosis </= -2.5
What can you use to measure the osteoporotic fracture risk over the next 10 years?
FRAX tool
Who should have their bone mineral density measured?
Women >/= 65 years old
Men >/= 70 years old
Younger patients with high risk for fracture
What are some medications that could put an osteoporosis patient at high risk for falls?
Benzos
meds that cause sedation (opioids, hypnotics, sedatives)
What supplementation can be used to prevent osteoporosis?
Calcium 1000-1200 mg elemental calcium daily
Vitamin D (to help absorb the calcium)
Which calcium supplementation is acidic dependent and SHOULD beb taken with food?
Calcium Carbonate
40% elemental calcium
What calcium supplementation is not acidic dependent and can be taken with or without food?
Calcium citrate
21% elemental calcium
What is the 1st line treatment and prevention in most osteoporosis patients?
Bisphosphonates
- stay upright for 30 minutes after and drink with 6-8 oz of water
What is an alternative prophylaxis for osteoporosis if a patient cannot tolerate bisphosphonates and has a VERY high risk for vertebral fractures?
Raloxifene (evista)
Bazedoxidene/estrogens(Duvee)
What is an alternative to bisphonates for medium risk patient?
Denosumab (Prolia)
What is an alterative to bisphosphonates in very high risk patients?
Parathyroid hormone analogs
Teriparatide (Forteo)
Abaloparatide (Tymlos)
What are the injectable bisphosphonates?
Ibandronate (Boniva) every 3 months
Zoledronic Acid (Reclast) yearly
***these are preferred if esophagitis is present
Fosamax SE
Aldendronate
CI: hypocalcemia
Warning: ONJ jaw decay or necrosis (dental procedures!)
Esophagitis!!!! esophageal ulcers, erosdions
***hypocalcemia MUST be corrected before use
Do not use if CrCl < 35
SE: dyspepsia, dysphagia, heartburn, N/V, hypocalcemia, hypophosphatemia
***separate antacids, calcium, iron, magnesim by at least 2 hours
Boniva
Ibandronate
CI: hypocalcemia
Warning: ONJ, femur fractures, esophagitis (tablet), hypocalcemia, renal impairment CrCl < 30
**separate from antacids, calcium, magnesium, iron for at least 2 hours
Reclast
Zoledronic Acid
CI: hypocalcemia
CrCl < 35
Warning: renal impairment
**no esophageal symptoms due to IV injection
Raloxifene (Evista)
Used for prevention and treatment of Osteo
BW: VTE risk
CI: pregnancy!!!!!!!!
SE: hot flashes, peripheral edema, arthralgia, leg cramps
**separate from levothyroxine for several hours!
Conjugated estrogens/ Bazedoxifene (Duavee)
Prevention of osteoporosis for postmenopausal women WITH a uterus
BW: endometrial cancer (estrogen), DVT risk
CI: breast cancer and pregnanct, active VTE
SE: nausea, diarrhea, dyspepsia
*****not used in cancer!!! Contraindicated in breast cancer!!!!
Calcitonin (Miacalcin)
inhibits bone resorption by osteoclasts
Warning: hypocalcemia, risk of malignancy, Salmon-derived product
nasal spray OR injection
Which bisphosphonate ONLY reduces vertebral fractures?
Ibandronate (Boniva)
What drugs used for osteoporosis is a RANKL inhibitor to prevent osteoclast formation?
Denosumab (Prolia)
