Osteoporosis

Question 1

Which form of calcium supplementation has the highest percentage of elemental calcium per dose?

Answer 1

Carbonate

Question 2

Describe the differences between cholecalciferol and ergocalciferol.

Answer 2

Vitamin D2 (ergocalciferol) (PPT): Comes from plant sources

Vitamin D3 (cholecalciferol): Produced by the skin in humans

Question 3

How much calcium can a patient take from a supplement at one time?

Answer 3

500-600 IU at a time as the body cannot absorb anymore

Question 4

Describe the mechanism of action of bisphosphonates.

Answer 4

inhibit osteoclast functions

Question 5

List the 3 bisphosphonates that have been shown to reduce the risk of vertebral and non-vertebral fractures.

Answer 5

Alendronate (Fosamax), risedronate (Actonel), zoledronic acid (Reclast)

Question 6

Describe “osteonecrosis of the jaw” and how you would advise a patient about this risk.

Answer 6

Osteonecrosis of the jaw (ONJ) is a condition where the jawbone is exposed & not covered by gums -> bone weakens & dies -Bisphosphonates may raise ONJ risk

Question 7

What medication would you select for an elderly patient with osteoporosis and a CrCl below 30 mL/min?

Answer 7

Biphosphoneate alternative such as Raloxifene

Question 8

Describe the mechanism of action and adverse effects of raloxifene.

Answer 8

MOA: estrogen agonist in bone and antagonist in breast

ADE: increased risk of stroke. DVT and hot flashes reported

Question 9

Describe the mechanism of action and adverse effects of denosumab.

Answer 9

MOA: monoclonal antibody which inhibits the RANK ligand, thereby inhibiting osteoclast formation, function, and survival.

ADE: Back, extremity & MSK pain; hypercholesterolemia; pancreatitis reported in clinical trials -Serious skin infx -Hypocalcemia must be corrected p/t initiation

Question 10

Which medications are indicated for men with osteoporosis?

Answer 10

Bisphosphonates, teriparatide & denosumab