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PHAR 255 > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

Cortical bone description?

A

80% of bone wt
dense outer shell

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2
Q

Cancellous bone description?

A

20% bone wt
porous interior structure

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3
Q

Osteoblast?

A

build bone through synthesis of collagen matrix

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4
Q

group of osteoblasts?

A

hydroxyapatite

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5
Q

Osteoclast?

A

reabsorbs bone
homeostasis control of acid-base, Ca, and PO4

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6
Q

Osteocyte?

A

regulate rate of bone mineralization

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7
Q

What happens when remodeling balance becomes negative?

A

BMD declines

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8
Q

what does Vit D regulate?

A

Ca

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9
Q

what does osteocyte death lead too?

A

increased surface remodeling
replacement with weaker mineralized connective tissue
disruption in repair signaling
decrease in bone vascularity

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10
Q

most common fracture?

A

vertebral fracture followed by hip then distal forearm

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11
Q

Risk factors for osteoporosis?

A

age
race
Ca intake during growth
menopause
family history
sex
small stature
wt
medications, lifestyle, previous falls and fractures

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12
Q

Medical condition risk factors for osteoporosis?

A

oophorectomy
hypogonadism or premature menopause
hyperparathyroidism
hyperthyroidism
cushings
multiple myeloma
malabsorption sydromes
chronic inflammatory disease

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13
Q

Drug risk factors for Osteoporosis?

A

androgen deprivation therapy
anticoagulants
antidepressants
antiepileptics
antineoplastics
antiretrovirals
calcineurin inhibitors
glucocoticoid therapy > 3 months
loop diuretics
PPIs
thyroid supplementation excess
Vit A excess/ retinoids
SGLT2i
thiazolidinediones

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14
Q

Presentation of osteoporosis?

A

no symptoms until fracture occurs
unexplained pain and height loss idicative of vetebral fracture

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15
Q

Diagnosis of osteoporosis?

A

vetebral compression fracture , hip fracture, > 1 fragility fracture over 50 years of age.

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16
Q

Differentiation of osteopenia and osteoporosis?

A

osteoporosis: BMD T-score <= 2.5 SD normal peak
osteopenia: BMD T-score -1–2.5 SD normal peak

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17
Q

Who should be screened for osteoporosis?

A

over 50
low risk reassessment in 5 years
moderate risk reassess in 1-3 years

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18
Q

what to assess for fracture risk and osrteoporosis?

A

history
physical exam
biochemical tests
BMD in some
Risk assessment tools
Vertebral imaging for some

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19
Q

Major wt loss %?

A

> = 10% of wt at age 25

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20
Q

Biochemical tests to be done?

A

Ca, corrected for albumin
PO4
SCr
alkaline phosphatase
TSH
23-OH-D

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21
Q

tool used to measure BMD?

A

dual-energy X-ray absorptiometry (DXA)

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22
Q

What age to use T score vs Z score?

A

under 50 Z score
over 50 T score

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23
Q

Who is indicated for a BMD test?

A

postmenopausal women
over age 70
over age 65 w/ 1 clinical risk factor
age 50-64 w/ previous osteoporotic related fractures or 2+ clinical risk factors for fractures

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24
Q

risk factors indicated for BMD?

A

previous fracture after age 40
glucocorticoid use > 3 months in last year
falls >= 2 in last year
BMI of <20
smoker
alcohol use of >=3 drinks/d

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25
what dose of prednisone is a risk factor for osteoporosis?
> 5mg/d
26
Risk assessment tools used in Canada?
CAROC FRAX
27
How is CAROC stratified? what is it assessing?
3 zones; low: <10% moderate High >20% 10 year risk of fracture
28
Non-pharm strategies to prevent fracture?
Lifestyle modification: - exercise - fall prevention - smoking cessation - alcohol reduction - reduced caffeine - Ca - Vit D
29
Pharmacological options for osteoporosis?
Primary: Bisphosphonates, Denosumab Secondary: Raloxifene, Teriparatide, Hormone THerapy Last options: Calcitonin, combo therapy
30
Calcium daily intakes for men and women?
Men: 51-70: 1000mg/d >70: 1200mg/d Women: >50: 1200mg/d
31
Ca supplement %'s?
Carb: 40% Citrate: 21% Lactate: 13% gluconate: 9%
32
WHat Ca supplement is prefered if pt on a PPI?
citrate
33
Dosing of Ca w/ potential saftey issues?
over 2000mg/d associated w/ CVD, dyspepsia, constipation, nephrolithiasis
34
Vit D daily intake?
Men and women: <= 70: 600 IU/d >70: 800 IU/d
35
Is routine monitoring of Vit D needed?
No
36
When is pharmacotherapy recommended flr females and males above 50 yrs old for fracture risk?
if high risk (>20%) or T-score <= -2.5 and older than 70
37
How to bisphosphonates work?
bind strongly to hydroxyapatite undergoing remodeling; inhibt osteoclast activity, second gen promote osteoclast apoptosis
38
Are bisphosphonates covered?
EDS drugs
39
What is the difference between Fosamax and Fosavance alendronate?
Fosavance has Vit D
40
WHich bisphosphonate is administered via IV oncer yearly?
zoledronic acid, 5mg/100mL
41
Dosing of alendronate?
10mg OD or 70mg once weekly
42
Dosing for risedronate?
5mg OD 35mg once weekly or 150mg once a month
43
How do you take IR bisphosphonate tablets?
spaced from all other meds b/c low F, take w/ one cup of water before food, other liquids, and meds and remain upright for 30 minutes
44
How do you take DR bisphosphonate tablets?
spaced from all other meds b/c low F, take w/ one cup of liquid right after breakfast and remain upright for 30 minutes
45
How is zoledronic acid given?
once yearly via 15 minute IV infusion
46
Onset of bisphosphonates?
weeks to see bone changes, years to obseve clinical benefit
47
SEs of bisphosphonates?
GI, abdominal pain, NDC, dyspepsia, headache, dizziness, musculoskeletal pain
48
Difference in SEs with zoledronic acid?
infusion reaction, NO GI issues
49
What does bisphosphonate do to Ca?
transient decrease in blood Ca levels
50
Major jaw SE w/ bisphosphonates?
Osteonecrosis of the jaw Usually seen in cancer pts, immunocompromised, high dose zoledronic acid, invasive dental procedures, smokers, daibetes
51
Serious SE of bisphosphonates seen around 7 years of therapy?
Atypical sub-trochanteric fractures
52
Other serious SEs of bisphosphonate?
severe musculoskeletal pain AKI Afib esophagitis, reflux, and ulcers esophageal cancer
53
Precautions w/ bisphosphonates?
pregnancy --> can accumulate in fetal bones
54
CI's of bisphosphonates?
esophageal abnormalities inability to stand/sit for 30 minutes hypocalcemia CrCl under 35mL/min
55
Duration of therapy for bisphosphonates?
3-6 years suggested but, needs to be individualized
56
What kind of drug is denosumab? (prolia)
biologic
57
Role of denosumab?
when pts can't adhere to bisphosphonates Intolerant to oral bisphosphonate Severe renal impairment
58
Onset of denosumab?
maximal reduction at 1 month, some seen at day 3
59
Duration of therapy for denosumab?
indefinite b/c benefits lost rapidly upon d/c of drug
60
Dosage form of denosumab?
pre-filled SQ syringes
61
At what GFR is denosumab not used?
not recommended below 15mL/min
62
SE to worry about for denosumab?
hypocalcemia; drug causes a major transient decrease of Ca levels
63
Serious SEs of denosumab?
osteonecrosis of the jaw atypical fractures Rebound fracture risk upon d/c
64
CI's of denosumab?
hypocalcemia Pregnancy and lactation
65
difference between bisphosphonate and denosumab efficacy?
similar efficacy but, A/E risk slightly higher with denosumab
66
Raloxifene MOA?
selective estrogen receptor modulator
67
Raloxifene onset and duration?
Years to observe maximum BMD changes lifelong therapy usually
68
Dosing for Raloxifene?
Tablet once daily, cautioned in under 50mL/min
69
SE's of Raloxifene?
flushing, flu-like, leg cramps, peripheral edema, increase in triglycerides
70
Serious SEs of Raloxifene?
Venous thromboembolism, Stroke
71
Highest risk for thromboembolism with raloxifene?
in first 4 months of therapy
72
CI w/ raloxifene?
pregnancy history of clots
73
Raloxifene DI's?
decreases absorption of levothyroxine bile acid sequesterants decrease absorption of raloxifene
74
Monitoring for raloxifene?
same as bisphosphonates + lipid profile to monitore hypertriglyceridemia
75
Who is raloxifene ineffective in?
premenopausal women
76
Duration of therapy for raloxifene?
longterm
77
What is the place for hormone therapy?
to prevent menopausal associated bone loss
78
Dosing forms for hormone therapy?
oral, patch
79
Risks w/ hormone therapy?
increased endometrial/ breat cancer risk clots CHD risk increase stroke risk urinary incontinence
80
Why is teriparatide not 1st line?
very expensive
81
When is teriparatide used?
very low BMD prior fragility fractures who continue to have fractures w/ other therapies BMD continues to decrease w/ other treatments
82
dosage form of teriparatide?
SQ injection once daily in thigh or abdomen
83
length of therapy for teriparatide?
2 years --> but recently changed by FDA
84
SEs of teriparatide?
Nausea dizziness leg cramps orthostatic hypotension
85
Serious SEs of teriparatide?
hypercalcemia hypercalciuria osteosarcoma
86
Precautions of teriparatide?
history of renal stones moderate renal impairment pre-existing orthostatic hypotension
87
CI's of teriparatide?
pre-existing hypecalcemia severe renal dysfunction hyperparathyroidism history of bone cancers pergnancy or lactation
88
Monitoring of teriparatide?
Ca, SCr, PO4, ALP, Ca monitored every 3-6 months
89
Romosozumab dosage form?
SQ injection monthly
90
duration of therapy for romosozumab?
12 months
91
When is romosozumab used?
for men and women with highest fracture risk
92
SE's of romosozumab?
musculoskeletal/ joint discomfort headache injection site pain
93
serious SEs of romosozumab?
osteonecrosis of the jaw atypical fractures MI stroke
94
CI's of romosozumab?
pre-existing hypocalcemia pregnancy and lactation
95
What needs to be monitored w/ romosozumab?
Ca
96
What benefits does combo therapy provide?
provides benefits to BMD but not to additinal fracture benefit
97
what may the combo of estrogen and bisphosphonate increase?
risk of atypical fractures
98
Main thing to assess for with treatment failure?
adherence
99
when is BMD testing repeated when a pt is on pharmacotherapy?
3 years

PHAR 255 (14 decks)

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