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Advanced Immunology > osteoporosis > Flashcards

osteoporosis Flashcards

1
Q

medications that are a risk factor for osteoporosis

A

corticosteroids, long term PPI, calcineurin inhibitors, heparin/LMWH, TZDs, SGLT2i’s, GnRH agonists, anticonvulsants, aromatase inhibitors

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2
Q

who to screen for osteoporosis

A
  • all women >65, men >70
  • postmenopausal women <65, men 50-69 in high risk: glucocorticoid therapy (prednisone >5 mg/day x 3 months), recent low trauma facture, other risk factors
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3
Q

indications for treatment

A
  1. osteoporosis (t score -2.5)
  2. osteopenia with FRAX >3% hip, >20% major osteoporotic fracture
  3. any history of low trauma spine or hip fracture
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4
Q

recommendations for adults taking prednisone >2.5 mg/day x 3 months

A

optimize calcium (1000-1200 mg/day) and vitamin D (600-800 IU/day) and lifestyle modifications

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5
Q

when do we consider osteoporosis prophylaxis with bisphosphonates, in patients taking prednisone >5 mg/day x 3 months

A
  1. osteopenia
  2. 10 yr risk of major osteoporotic fracture of 10-19%
  3. 10 yr risk of hip fracture 1-3%
  4. very high prednisone doses >30 mg/day
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6
Q

vitamin D maintenance dose

A

800-1000 IU daily

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7
Q

vitamin D repletion dose

A

50,000 IU weekly x 8-12 weeks

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8
Q

calcium dose <50 years

A

1000 mg daily

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9
Q

calcium dose >50 years

A

1200 mg daily

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10
Q

which calcium requires acidic environment/taken with meals?

A

calcium carbonate

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11
Q

which vitamin D may be more effective for reducing fracture risk

A

cholecalciferol

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12
Q

secondary causes of osteoporosis?

A

hyperparathyroidism, hyperthyroidism, RA, MS, liver disease, celiac disease, adrenal insufficiency

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13
Q

name of selective estrogen receptor modulator

A

raloxifene

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14
Q

name of RANKL inhibitor

A

denosumab

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15
Q

name of PTH analogs

A

teraparatide, abaloparatide

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16
Q

mechanism of bisphosphonates

A

mimic pyrophosphate, an endogenous bone resorption inhibitor: bind to bone and inhibit osteoclasts

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17
Q

bisphosphonates, renal consideration

A

contraindicated in severe renal impairment

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18
Q

which bisphosphonate is not indicated to prevent/treat hip or nonvertebral fractures

A

ibandronate (vertebral fractures only)

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19
Q

zoledronic acid dosing

A

5 mg IV yearly treatment.
5 mg IV q2 years prevention.

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20
Q

bioavailability of bisphosphonates

A

<1%, even more reduced with coffee or OJ

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21
Q

adverse effects of bisphosphonates

A

esophagitis or acid reflux, hypocalcemia, abdominal pain, constipation, diarrhea, atypical femur fracture, ONJ

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22
Q

risk factors for ONJ

A

malignancy
use of chemo and corticosteroids
>65 yo
h/o periodontal and dental abscesses
bacterial infections
dental procedures
IV bisphosphonates

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23
Q

signs/symptoms of ONJ

A

tissue loss, exposed bone, jaw pain, odontalgia, swelling

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24
Q

bisphosphonate counseling

A

take on empty stomach with a full glass of water and sit upright for 30 minutes. do not take with any other medications. supplemental calcium/vitamin D if deficiency

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25
Q

denosumab mechanism

A

binds to RANKL which inhibits osteoclastogenesis and increases osteoclast apoptosis

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26
Q

when is denosumab used

A

patients with high risk of fracture or have failed/intolerant/ contraindicated bisphosphonates

27
Q

denosumab dosing

A

60 mg SQ q6 months admin by healthcare professional

28
Q

denosumab indications

A

postmenopausal, males and glucocorticoid induced: prevention and treatment of vertebral, nonvertebral and hip fractures

29
Q

denosumab, renal considerations

A

no dose adjustment necessary, but if CrCL<30 watch closely for hypocalcemia

30
Q

denosumab adverse effects

A

nausea, diarrhea, constipation, fatigue, asthenia, arthralgia, hypocalcemia, ONJ, serious skin infections, atypical femur fractures

31
Q

denosumab counseling

A

take supplemental calcium and vitamin D

32
Q

denosumab monitoring

A

SCr, Ca, Phos, Mg

33
Q

PTH analog mechanism

A

stimulate osteoblasts, increase GI absorption & renal tubular reabsorption of calcium
(cling onto calcium)

34
Q

PTH analog indications

A

postmenopausal, males: prevent and treat vertebral, nonvertebral

35
Q

typical dosing PTH analogs

A

teriparatide 20 mcg SQ daily
abaloparatide 80 mcg SQ daily

36
Q

PTH analog, renal considerations

A

no dose adjustment

37
Q

when are PTH analogs used

A
  1. severe osteoporosis (T score -3.5)
  2. unable to tolerate bisphosphonates
  3. fail other therapies
38
Q

PTH analog adverse

A

ORTHOSTATIC HYPOTENSION, hypercalcemia, arthralgia, asthenia, dyspepsia, metastases, history of skeletal malignancies

39
Q

PTH analog counseling

A

rise slowly from sitting position, rotate injection sites

40
Q

PTH analog pearl/duration

A

not to exceed 2 years due to osteosarcoma risk

41
Q

romosozumab mechanism

A

binds to sclerostin, an inhibitor of bone formation

42
Q

romosozumab indication

A

postmenopausal, treat vertebral, nonvertebral and hip fractures

43
Q

when is romosozumab used

A

in postmenopausal women at high risk for fracture or intolerant to/failed other therapies

44
Q

romosozumab dosing

A

2 consecutive SQ injections (total dose 210 mg) monthly

45
Q

romosozumab duration

A

not to exceed 12 months

46
Q

romosozumab, renal considerations

A

no renal adjustments

47
Q

romosozumab warning

A

avoid in patients with significant CV history: increases risk of MI, stroke– do not initiate in patients who had a MI or stroke

48
Q

mechanism of raloxifene

A

selective estrogen receptor modulator: prevents bone loss, decreases bone resorption

49
Q

raloxifene indications

A

postmenopausal, treat and prevent vertebral fractures
reduce risk of invasive breast cancer in postmenopausal women

50
Q

when to consider raloxifene

A

younger postmenopausal women at high risk for osteoporosis and breast cancer

51
Q

raloxifene renal considerations

A

caution CrCL<50

52
Q

raloxifene dosing

A

60 mg once daily

53
Q

raloxifene common adverse effects

A

hot flashes, leg cramps, peripheral edema, flu like, arthralgias, swetting

54
Q

raloxifene serious adverse

A

increased risk for VTE and stroke

55
Q

raloxifene contraindication

A

history of/current VTE

56
Q

raloxifene drug interactions

A

warfarin, cholestyramine, diazepam, diazoxide, lidocaine

57
Q

calcitonin MOA

A

antagonizes PTH which inhibits osteoclast formation + analgesic effect

58
Q

calcitonin indication

A

women >5 years post menopause as last line, short term treatment + pain relief for vertebral fractures

59
Q

calcitonin dosing

A

intranasally 1 puff daily, 4 weeks

60
Q

when to repeat DXA in healthy postmenopausal

A

every 10 years unless risk factors change

61
Q

when to repeat DXA while on therapy

A

every 2 years

62
Q

when to take drug holiday if low risk

A

5 years PO, 3 years IV

63
Q

when to take drug holiday if high risk

A

10 years PO, 6 years IV

Advanced Immunology (6 decks)

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