Osteoporosis

Question 1

what is osteoporosis?

Answer 1

changes in bone mass with age, bone mass increase until we are 30, goes stagnant, and then decreases

Question 2

disease related osteoporosis

Answer 2

hypogonadism, hyperparathyroidsim, hypertyroidism

Question 3

drug induced osteoporosis

Answer 3

gluccocorticoids (3rd leading cause), thyroid replacements, GnRH agonists/antagonists, aromatase inhibitors (breast cancer)

Question 4

how fast can osteoporosis occur

Answer 4

fast, can deteriorate in 3-6 years

Question 5

bone remodeling cycle

Answer 5

resting surface
osteoclast-mediated resorption
recruitment of osteoblasts
secretion of new matrix
calcification of said matrix

Question 6

creating an osteoclast?

Answer 6

rankl binds to rank on an osteoclast precursor developing it into a mature osteoclast, this also secretes factors that allow osteoblast precursors to mature into osteoblasts

Question 7

remember the drugs

Answer 7

abcder t

Question 8

antiresorptive agents

Answer 8

bisphosphonates (alendronate zoledronate ibandronate)
calcitonin
denosumab
estrogen
raloxifen

Question 9

bisphosphonates

Answer 9

alendronate(oral daily)
zoledronate(iv yearly)
ibandronate(oral daily, monthly or iv 3 mo.)

Question 10

mechanism of action for bisphosphonates

Answer 10

high affinity for bone, ca chelator, incorporates and stabilizes structure. Inhibits bone resorption by decreasing osteoclast function and increasing their apoptosis

Question 11

uses and admin of bisphophonates

Answer 11

osteoporosis due to aging, PMW, steroids

oral admin, less than 10 percent absorbed; water only; upright position to prevent heartburn, and esophageal irritation

Question 12

high doses of bisphosphonates puts you at risk for ______.

Answer 12

osteonecrosis of the jaw

Question 13

Toxicity of zoledronate

Answer 13

renal toxicity

Question 14

Denosumab

Answer 14

binds to RANKL (receptor for activating NFKB ligand) thus decreasing activation of rank and thus decreasing osteoclast formation/activation

Question 15

Admin and adverse effects of denosumab

Answer 15

admin: sc injection every 6 mo

adverse effects: increase infection risk?

Question 16

calcitonin

Answer 16

thyroid gland hypocalcemic hormone

decrease bone resorption by decreasing osteoclast surface area

Question 17

vitamin d and calcium supplements

Answer 17

increase calcium absorption in small intestine (increase bone mineralization)

at large doses however it act in bone resorption

Question 18

uses of calcitonin

Answer 18

PMW, steroids, low efficacy(fracture prevention?)

Question 19

estrogen

Answer 19

decrease bone reabsorption by decreasing rank L and cytokines thus decreasing osteoclasts proliferation and activation, and decreases osteroBLAST apoptosis

Question 20

Long term risks of estrogen

Answer 20

In pmw: breast cancer, thromboembolism, stroke, cv risk

LIMITED USE: NON RESPONDERS TO OTHER TX

Question 21

Raloxifen

Answer 21

selective estrogen receptor modulator
estrogen receptor agonist in breast endometrium
decreases osteoclast formation and activation thus decreasing resorption and fractures in PMW

Question 22

Uses of raloxifen

Answer 22

osteoporosis in PMW w/ breast cancer or family history

Question 23

administration of ralozifen

Answer 23

oral daily

Question 24

adverse effects of raloxifen

Answer 24

risk of venous thrombosis, pulmonary embolism

Question 25

bone forming agents

Answer 25

teriparatide

Question 26

teriparatide

Answer 26

active peptide of parathyroid hormone
hyper parathyroidism= bone resorption
low, intermittent PTH (teriparatide) = bone growth
increases osteoblast number and activation

Question 27

uses of teriparatide

Answer 27

severe osteoporosis, high fracture risk

Question 28

admin of teriparatide:

Answer 28

daily s.c, injection for 2 years

Question 29

adverse effects of teriparatide:

Answer 29

may increase risk of osteosarcoma (rats?)