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Pharmacy 255 > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

What is a fragility fracture? What age with osteoporosis are we worried?

A

a fracture that wouldnt damage a normal bone
>40 years with osteoporosis

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2
Q

Where do fragility fractures happen?

A

hip, vertebra, humerus and forearm

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3
Q

Which gender gets more osteoporosis? Which get more fractures?

A
  1. Women
  2. Men
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4
Q

What are the two types of bone and distinguish between them?

A

Cortical- most, dense outer shell
Cancellous (trabecular)- 20%, porous, internal

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5
Q

What are the 3 types of bone cells?

A

Osteoblast- build bone
Osteoclast- resorb bone
Osteocyte= mineralize

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6
Q

What is the role of PTH and calcitonin?

A

PTH- resorb Ca and phosphate
Calcitonin- excrete it

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7
Q

Where is calcitonin made?

A

parafollicular cells in thyroid

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8
Q

What happens to bone cells as we age?

A

cytes die and the mineralization gets weaker

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9
Q

When does bone mass peak?

A

age 30

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10
Q

What is the most common fracture?

A

vertebral

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11
Q

What risk factors put you at risk of Osteoporosis?

A

White/Asian
Calcium intake
menopause
sex
Small
Underweight

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12
Q

True or false Obese patients are more at risk of osteoporosis than underweight?

A

False- weight bearing= good

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13
Q

How long does it take to fully remodel the skeleton?

A

10 years

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14
Q

What medical conditions can cause osteoporosis?

A

Hyper parathyroid
Hyper thyroid
Cushings
menopause
chronic inflammatory diseases-RA

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15
Q

What drugs are we concerned about causing osteoporosis?

A

Anticoags
Antidepressants- lower blast activity
antiepileptics

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16
Q

Which anticoag is worse for osteoporosis?

A

heparin

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17
Q

How does PPIs effect osteoporosis?

A

lower Ca absorption

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18
Q

When is a corticosteroid causing bone issues?

A

> 3months of 7.5 mg/day

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19
Q

What are symptoms of osteoporosis?

A

asymptomatic until fracture

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20
Q

How can you diagnose Osteoporosis?

A

Vertebral compression fracture, hip fracture, or >1 fragility fracture over 50 years

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21
Q

WHht BMD score says osteoporosis vs osteopenia?

A

OP- <-2.5
osteopenia- -1 to - 2.5

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22
Q

Who should be screened?

A

> 50 years

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23
Q

What is significant weight loss?

A

> 10 % since age 25

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24
Q

What height loss both historic and recent is indicative?

A

H->6 cm
R- >2 cm

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25
Q

What is bad rib to pelvis distance?

A

< 2 fingers

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26
Q

When is DXA not reliable for diagnosis?

A

< 50 years

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27
Q

When do you use T score and Z score with DXA?

A

T- >50
Z<50

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28
Q

When should you do a BMD testing?

A

> 50 IF previous fracture or >2 risk factors
65 if 1 risk factor
70

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29
Q

What is incorporated in a CAROC?

A

age, sex and t score at femoral neck

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30
Q

For CAROC, which gender sees a sharp increase in risk with age?

A

women

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31
Q

What are the caveats for fracture risk tools?

A

Cant monitor therapy
risk for Treatment NAIVE
no for <50

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32
Q

How often should you repeat BMD for each fracture risk?

A

> 15= 3 years
10-15= 5 years
<10= 10 years

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33
Q

What lifestyle modifications can we do?

A

exercise, smoke cessation
reduce alcohol

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34
Q

How does exercise help? How much exercise?

A

stims blasts
> 2x weekly

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35
Q

What are functional exercises?

A

improve daily tasks

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36
Q

Is impact exercise good?

A

Yes if SAFE

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37
Q

True or false: quitting smoking allows BMD to return

A

True

38
Q

What is calcium intake amounts for the years?

A

Men 50-70= 1000 mg
Men >70 = 1200 mg
Women >50= 1200mg

39
Q

What are the calcium supplements and their percentages?

A

Carbonate= 40
Citrate= 21
Lactate= 13
gluconate= 9

40
Q

What is the issue with bone meal as a supplement?

A

contaminants

41
Q

When would we use citrate?

A

if on PPI or super old

42
Q

When is safety an issue with calcium?

A

> 2000 mg/ day

43
Q

How can we estimate calcium intake?

A

Give 300 mg to each source
then another 300 if dairy

44
Q

How much to supplement vitamin D?

A

everyone 400 IU

45
Q

Which version of vitamin D is preferred?

A

D3-cholcalciferol

46
Q

What food is high in vitamin D?

A

fatty fish, eggs, fortified food

47
Q

When would we monitor Vitamin D? What values indicate, toxicity, deficiency, and adequate?

A

if need HIGH doses
toxic >125
Adequate >50
Low= <30

48
Q

What is first line for osteoporosis?

A

bisphosphanates

49
Q

How does bisphosphonates work?

A

halts decline by stoping clasts and killing them

50
Q

What are the bisphosphonates?

A

‘dronates’
zoledronic acid- IV

51
Q

When can we get EDS for the bisphosphonates?

A

risk greater than 20% or due to to fragility fracture or CS

52
Q

When is zoledronic acid covered?

A

unable to take oral
2 of:
>75
fracture
or score <-2.5

53
Q

What is the dosing for dronates?

A

daily, weekly or monthly

54
Q

How often is zoledronic acid?

A

yearly

55
Q

How should you take the dronates?

A

NOT NEAR OTHER MEDS
30 min before food and upright for 30 min

56
Q

When do we see benefit with dronates?

A

years

57
Q

S/e of dronates?

A

Gi, osteonecrosis of jaw, femur fracture

58
Q

How can we fix Gi/ esophagus side effects of dronates?

A

upright for 30 min

59
Q

Who generally gets osteonecrosis of jaw?

A

cancer, immunosuppressed, high doses, smokers

60
Q

If a patient wants to become pregnant but is on a dronate what do they do?

A

need to be off it for 1 year because lasting effects

61
Q

How long do patients go on dronates for?

A

3-6 years

62
Q

How does denosumab work?

A

stops RANKL and stops clasts activation

63
Q

When is denosumab covered?

A

if fail on bisphosphonates

64
Q

When do you see benefit and how long are you on denosumab?

A

1 month
indefinite

65
Q

True or false: Denosumab benefits lasts after d/c

A

False

66
Q

At what renal is denosumab not indicated?

A

<30

67
Q

S/e of denosumab?

A

well tolerate but same as dronates REBOUND FRACTURES THO

68
Q

How do we limit rebound fractures with denosumab?

A

if stopping put on dronate for 6 months

69
Q

How does raloxifene work? Who is it for?

A

a SERM to decrease bone resorb
3rd line for prevention for postmenopausal

70
Q

What is duration of raloxifene?

A

lifelong

71
Q

S/E of raloxifene?

A

flushing, flu like, edema, VTE, stroke

72
Q

What drug interaction with raloxifene are we worried about?

A

Levothyroxine

73
Q

What is the efficacy for raloxifene?

A

Not as good
useless for pre menopausal

74
Q

What role is there for HRT? What happens after d/c?

A

with persistant menopausal symptoms
loss accelerates

75
Q

S/E of HRT?

A

VTE risk and stoke, cancer

76
Q

Efficacy of teriparatide? What is role?

A

VERY potent
only for highest risk

77
Q

MOA of teriparatide?

A

stims osteoblast

78
Q

WHat drug options are SC?

A

Teriparatide
romosozumab

79
Q

What options are IV?

A

Zaledronic acid

80
Q

S/E of teriparatide?

A

hypercalcemia, renal stones, Gi, hypotension

81
Q

Efficacy of romosozumab and role ?

A

more potent
highest risk

82
Q

MOA of romosozumab?

A

Mab against sclerostin= stops the inhibitory agent that stops bone formation

83
Q

An issue with the potent agents is that after d/c you lose the benefits. How can we fix this?

A

add dronate to maintain

84
Q

What are the benefits of combo therpay?

A

better for BMD no impact on fractures

85
Q

What combos is actually bad for you?

A

estrogen and dronates= atypical fracture increase

86
Q

What is considered treatment failure?

A

decreasing BMD or fractures despite adherence and adequate therapy for 1 year

87
Q

How often should you follow up with people on therapy for osteoporosis?

A

every 3 years

88
Q

If a patient has a fracture while on dronates what is the play?

A

nothing only small delay in healing

89
Q

If a patient has a fracture and is not on dronate what is the play?

A

start 2-12 weeks post fracture

90
Q

WHat do you do if a patient has an atypical femur fracture while on dronates?

A

d/c

Pharmacy 255 (16 decks)

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