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Therapy: year 3 > osteoporosis > Flashcards

osteoporosis Flashcards

1
Q

What non-param can we advise in osteoporosis?

A
  • regular exercise
  • fall prevention (minimize falling hazards and drugs that may lead to falling like benzos)
  • smoking cessation
  • diet measures (lots of protein, calcium and vitamin D, limit alcohol, 2 glasses, and limit caffeine 4 glasses)
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2
Q

what numbers of vitamin D do we need?

A

over 50 800- 2000 International units

under 50 400-1000 international units

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3
Q

do cancdians usualy have enough vitamin D in their diet?

A

no

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4
Q

when do we measure the serum 25-OH-D4?

A

it is measured for those who have impaired inetstinal absorption and those with osteoporosis requireing therapy?

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5
Q

what are the different types of vitamin D and which is preferred?

A

D3(cholecalciferol) and D2(ergocalciferol)

D3 is preferred

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6
Q

how often do we measure 25-OH-D4 levels once initiaing therapy?

A

once when beginning then in 3 months after starting therpay

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7
Q

what are some sideeffects of vitamin D

A

it is pretty well tolerated however we can get hypercalcemia, hypercalciuria, renal calcification and renal stones (usualy at high doses since it’s a fat soluble vitamin and doesn’t get peed out)

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8
Q

what is the daily intake of calcium for individuals over 50?

A

1200mg

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9
Q

can calcium be taken as one dose?

A

no has to be divided doses of 500

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10
Q

what are the calcium slats from most potent to least potent?

A

carbonate, citrate, gluconate, lactate

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11
Q

if we have decreased stomach acid or are on a PPi which calcium salt shoudl we take?

A

citrate

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12
Q

what calcium slat needs an acidic environment?

A

carbonate

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13
Q

Which salt is preferred and what’s a common side effect of it?

A

carbonate and it’s constipating

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14
Q

what is of note concerning when we take calcium?

A

it can affect the absorption of other meds so should be spaced out by 2 hours

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15
Q

empty or full stomach for calcium?

A

empty but with food if having sideeffcts

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16
Q

what are some side effects of calium

A

constipating, nausea, hypercalcemia, hypercaluria, ranal calcification, renal stones

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17
Q

what are some possible drugs it could affect absoprtion of it not spaced?

A

bisphosphates, cirpfloxacin, iron, levothryoine, and tetracycline

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18
Q

describe how initial BMD testing determines pharamcotherpay or not?

A

BMD testing can give us

  • low risk (10-year fracture risk is < 10%)
    no therpay reasses in 5 years
  • moderate risk is 10-20%
    maybe therpay
  • high risk is >20%
    evidence for pharamacotherpay
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19
Q

what factors could make you think that somone with moderate risk needs therpay?

A

long term use of systemic corticosteroids

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20
Q

what are the first line therapies with evidence for fracture prevention in postmensual women?

A

Antiresorptive therapies?
bisphosphates
-alendronate
-risedronate
-zoledronic acid

denusamab - prolia

SERM - rafloxifene

Hormone therpay - estrogen

Bone formation therpay:

Teriparatide

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21
Q

what types of fractures do most of the therpies prevent agasint?

A

vertebral (all)
hip (not raloxifene and teriparatide)
and non-vertabral ( not raloxifene)

22
Q

whihc bisphosphates are oral and whihc are IV?

A

oral - alendronate and risedronate
IV - zoledronic acid

23
Q

when are IV bisphophates indicated?

A
  • can’t tolerate oral GI effcts
  • aren’t adherenect on oral meds
  • when oral therpy fails
24
Q

what is a big concern with bisphoptaes ?

A

adherenece - when adherence falls below 80% the protection faades

25
Q

MOA of bisphophates

A

they coat bones and unbale bone reabsorption

26
Q

what adminstering oral bisphophates what should we counsel on?

A
  • empty stocmach at least 30 mins before food
  • take with a full glass of water and reman if an upright position for 30 minutes after
27
Q

discuss Zoldonic acid administration and side effects

A

viatmin D must be given for 2 weeks before z.acid

may get flu-like symptoms after infusion for up to 48 hours after so can take acetaminophen before hand

if eldery encourage to dink 500 mL of water prior to infusion

28
Q

when are bisphosphates CI?

A

hypocalcmia and those with CrCl < 35 mL/min

oral bisphopsphates - esophageal disorders

29
Q

SE of bisphophates

A

common - GI upset, altered taste and nighttime leg cramps

uncommon
- reflux, esophagitic and esophagela ulcers (shouldn;t occur if taking oral correctly)
-osteonecrososi of jaw (ONJ)
- Atypical femoral shaft fractures(AFSF)

30
Q

what are some risk factors for reflux, esophagitic and esophagela ulcers?

A

prior GI disases, concimtant NSAID use, receiving anti-reflux meds

31
Q

what is an important counseling point for those taking oral bisphosphates?

A

if any pain in mouth or ahcnge in gums let HCP know!

32
Q

what puts people at increased risk for AFSF?

A

long term bisphosphate use (more then 2 years)

benfit still outweights risk

33
Q

what should we do if a patient has a AFSF while on bisphosphates?

A

swithc to anabolic agent like teriparatide

34
Q

detail when a bisphosphates drug holiday should and should not be taken

A

after 5 years on therpay can consider one:

if high risk continue with therpay

if moderate risk:
1-3 year holiday with alendronte
1 year holdiay with risedronate

after holiday remeasure BMD and recaltualte the 10 year fractiue risk to determine therapy, we can continue therapy for 3-5 years if needed

35
Q

how do we proceed after a drug holdiay?

A

after holiday remeasure BMD and recalculate the 10 year fracture risk to determine therapy, we can continue therapy for 3-5 years if needed

36
Q

what is denusamab - prolia?

A

ist a biological injected

37
Q

MOA of denosumab (prolia)

A

inhibtis RANKL whihc decrease osteoclast function and survival

38
Q

denosumab CI

A

hypocalcemia and CrCl< 15 ml/min

39
Q

denosumab SE

A

rare: ONJ, AFSF

40
Q

first line for menopausal women?

A

serm; raloxifene

41
Q

what population serm; raloxifene most used in

A

breat cancer patients

42
Q

serm; raloxifene CI

A

pregancncy, history of VTE (actice or past), over 65 years old due to stroke /VTE risk

43
Q

talk about hormone therpay such as estrogen and progesterone

A

risk outweight beneifits
not recommended due to CVA and VTE risk

44
Q

When is PTH analog (anabolic): teriparatide used?

A

first line for post menuposal woemn for secondray prevention of vertebral and non-vetebral fractures

  • when oral bisphsophates not tolerated or are CI
44
Q

MOA of teriparatide?

A

mimics PTH so increase osteoblast activity

45
Q

when is teriparatide CI?

A

pregenancy/ nursing
increase Ca2+
CrCL<30mL/min

46
Q

what dose of steroid induced osteoporosis is dangerous

A

> =3 months of 2.5-7.5mf/ day po prednisone

47
Q

when on long-term steroids what should we do?

A

all adults - should take calcium and vitamin D(600-8000 IU)

adults at moderate fracture risk
- should take oral bisphosphate and calcium and vitamin

48
Q

How should we monitor patients on therapy

A

baseline - 3 months after starting therapy and repeated measurements after 1-3 years

49
Q
A

Therapy: year 3 (14 decks)

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