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PR - ENDOCRINE > OSTEOPOROSIS > Flashcards

OSTEOPOROSIS Flashcards

1
Q

What is osteoporosis?

A
  • Progressive bone disease
  • Reduction of bone mass and density causing increased risk of fractures
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2
Q

Signs and symptoms

A
  1. fracture
  2. reduced bone density on DEXA scan
  3. pain
  4. reduced mobility
  5. reduced height
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3
Q

RF

A

Postmenopausal women/ females
Men over 50
Patients taking long-term oral corticosteroids (glucocorticoids)

Vit D and Calcium Deficiency
Long term CS treatment
Lack of exercise, smoking, drinking
Low BMI
History of fractures
Early menopause

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4
Q

Lifestyle changes

A

Increase Exercise
Smoking Cessation
Maintain an Ideal BMI
Reduce Alcohol Intake
Increase intake of Vitamin D and Calcium (supplements if needed)

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5
Q

Which drugs can lower Vit D?

A

Carbamazepine
Phenytoin

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6
Q

What are the two main types of osteoporosis?

A
  1. Postmenopausal (PM)
    osteoporosis
    And
  2. Glucocorticoid-induced
    osteopororis
    - “Corticosteroid” induced
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7
Q

Treatment of osteoporosis (post-menopausal)

A
  1. Bisphosphonates
    - 1st = alendronic acid
    - 2nd = risendronate

Oral CI
- IV bisphosphonates (ibandronic, zoledronic)
- Denosumab
- Raloxifene

  1. HRT/ tibolone (not used in older women = increase CVD, cancer)
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8
Q

MoA of bisphosphonates

A

Slows rate of bone growth and dissolution by absorbing onto the hydroxyapatite crystals in bone.

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9
Q

Teripatide

A
  • reserved for postmenopausal women
  • severe osteoporosis
  • very high risk of fractures
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10
Q

Osteoporosis in men

A
  1. PO
  2. IV
  3. Denosumab
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11
Q

Glucocorticoid-Induced osteoporosis - treatment

A
  1. PO bisphosphonates
    - alendronic acid
    - risedronate
  2. IV bisphophonates
    - Zoledronic acid
    - Teriparatide
  • Densosumab
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12
Q

Choice for bone metastases in breast cancer/severe hypercalcaemia of malignancy

A

Pamidronate (IV)
Zolendronic acid
- IV
- most potent
- highest risk of osteonecrosis of jaw

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13
Q

Start prophylaxis at onset of glucocorticoid treatment in the following

A

Women
- 70 years or over
- Previous fragility fracture
- Large doses of glucocorticoids (prednisolone ≥7.5 mg daily or equivalent)

Men aged ≥70 or over AND either:
- Previous fragility fracture
- Large doses of glucocorticoids

Large dose corticosteroids for >3 months

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14
Q

What should you ensure before starting bisphosphonates?

A
  • Correcting Hypocalcaemia and Vitamin D deficiency
  • Monitor these levels as well as serum electrolytes
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15
Q

Which electrolytes can bisphosphonates
effect?

A
  1. Calcium
    - cause HYPOcalcaemia
    - most important
  2. Magnesium
    - cause HYPOmagnesia
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16
Q

What is the main
electrolyte to monitor for bisphosphonates?

A

Ca

17
Q

Which Bisphosphonate can be given orally?
And how often?

A
  1. Alendronic acid
    - Tablet 10mg (daily) or 70mg (weekly)
    - Oral solution
  2. Ibadronic acid
  3. Risedronate
    - Tablet 5mg (daily) or 35mg
    (weekly)
18
Q

Which bisphosphonate is given via injection and how often?

A
  1. Ibandronic acid
    - Every 3 months
  2. Zoledronic acid
    - every 12 months

Note: Pamidronate is IV but not licensed for osteoporosis

19
Q

Bisphosphonate SE

A

Atypical Femoral Fractures
Osteonecrosis of the Jaw
Osteonecrosis of the External Auditory Canal
Bone, joint, muscle pain
Oesophageal irritation

20
Q

Atypical Femoral Fractures

A

Report any thigh, hip or groin pain

Greater risk with long term therapy
Review after 5+ years use

21
Q

Osteonecrosis of the Jaw

A

Report any dental pain, swelling, non-healing sores or discharge
- Before starting = dental checkup + necessary remedial dental work.
- Good oral hygiene and routine dental checkups

22
Q

Osteonecrosis of the Jaw high risk

A

zolendronic acid

23
Q

Osteonecrosis of the External Auditory Canal

A

Report ear pain, discharge or ear infection
Long-term therapy - 2+ years

24
Q

Osteonecrosis of auditory canal - risk factors

A

Ear operation
Chemo
Steroid use
Cotton bud use

25
Q

Counselling - alendronic acid

A

70 mg weekly OR 10 mg daily
- Swallow whole with plenty of water
- Whilst standing or sitting upright
- On an empty stomach, 30 minutes before breakfast or other meds
- Remain upright 30 mins after

26
Q

Risendronate

A

35 mg weekly OR 5 mg daily
Can be taken like alendronic acid or at any time or day
- 2 hour gap between risendronate and food, drink, antacids, calcium containing products e.g. milk, iron or mineral supplements.
- Stand or sit upright for 30 mins
- Avoid at bedtime/before rising.

27
Q

Oesophageal reactions

A
  • REPORT dysphagia, new or worsening heartburn or retrosternal pain
  • Medication should be take with a full glass of water whilst standing and should remain upright for 30 mins after
28
Q

What happens if dysphagia or heartburn occurs with bisphosphonates?

A
  • stop taking bisphosphonates
  • seek medical attention
29
Q

How often should bisphosphonates be reviewed?

A

Every 3 years:
- Zoledronic acid
Every 5 years:
- Alendronic acid
- Risedronate
- Ibandronic acid

30
Q

Can bisphosphonates be taken in pregnancy?

A

AVOID
So if child bearing age, they must use contraception

31
Q

How often is denosumab administered?

A

s/c
every 6m

PR - ENDOCRINE (25 decks)

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