Osteoporosis Flashcards
Social history related to OP?
Smoking
Alcohol
Risk factors of osteoporosis?
Women > 65
Men >70
Estrogen deficiency in women
Medical history of OP?
RA
CVD
T2DM
Drug-induced causes of OP?
- Antiepileptic agents
- immunosuppressant drugs
- PPI
- Systemic corticosteroids
- SSRI
- Warfarin
What are some additional factures contributing to OP?
- Anorexia nervosa
- Medroxyprogesterone depot use
- GI Malabsorption syndrome
- Parenteral history
- Loop diuretic use
How to prevent OP in individuals over 50?
Calcium intake, Vit D intake, Exercise, Smoking cessation, limit alcohol use
What should be done if T-score if 0 to -1
- Assess risk factors annually
- Repeat DXA every 5 years
- Recommend Calcium and Vit D
- Recommend exercise and fall prevention counseling
What should be done if T-score is from -1 to -2.5
Get the FRAX score
1. If FRAX score not significant, strongly recommend Calcium and Vit D
2. If FRAX score significant, calcium & vit D + first line - bisphosphonates, alternative - Denosumab
- second line therapy: SERM, teriparatide, calcitonin, estrogen
If T-score <-2.5
Same as osteopenia + significant frax
What agents are used for calcium supplementation?
Calcium carbonate (tums)
Calcium citrate
What is the efficacy of calcium supplementation?
improves/maintains bone mineral density
Adverse effects of calcium supplementation?
Constipation and GI discomfort
How to take calcium citrate?
on empty stomach or with meals
How to take calcium carbonate?
better absorption with meals
How much calcium is recommended per day?
1000-1500 elemental mg per day
What should calcium be taken with?
Vit D
MOA of Vit D?
fat-soluble vitamin
What is the main source of vit D?
sun exposure
What are the vit D agents?
Vit D2 - ergocalciferol
Vit D3 - cholecalciferol
Adverse effects of Vit D supplementation?
Hypercalcemia
Constipation
Is vit D alone without calcium effective for fracture prevention?
Unclear
What are the bisphosphonates MOA?
Inhibit osteoclastic bone resorption
What are the oral options for bisphosphonates?
Alendronate and risedronate
What are the IV agents for bisphosphonates? What are they used to treat?
Zoledronic acid
Pamidronate
Ibandronate
Treat hypercalcemia of malignancy; cancer metastatic to bone
What is the alendronate dosing?
10mg daily or 70mg weekly
What is the efficacy of bisphosphonates?
- All prevent vertebral fractures
- Alendronate, risedronate, and zoledronic acid prevent nonvertebral and hip fractures
What are the adverse effects of bisphosphonates?
- Abd. pain/dyspepsia
- arthralgias
How should oral bisphosphonates be taken?
- Take with 6-8 ounces of water at least 30-6- minutes before food, drink, or other medications
- Remain upright for at least 30 minutes after
At what point does bisphosphonate therapy have an unclear benefit?
> 5 years
Estrogen replacement MOA?
Estrogen deficiency leads to excessive bone resorption and inadequate bone formation
Efficacy of estrogen replacement?
Reduced risk of vertebral fractures
How is estrogen replacement given?
QD oral dosing or transdermal patch
Adverse effects of estrogen replacement?
- Breast discomfort
- HA
- Vaginal bleeding
- VTE
Safety of estrogen replacement?
Risk of adverse events using hormone replacement therapy can exceed fracture prevention benefits
How should hormonal replacement be done if pt has intact uterus?
estrogen + progesterone
How should hormonal replacement be done is hysterectomy?
Estrogen given unopposed by progesterone
MOA of SERMs
Selectively binds to estrogenic and antiestrogenic receptors
What is a SERM
Raloxifene (evista)
What are the adverse effects of SERMs
- Arthralgias
- Hot flashes
- Peripheral edema
- Sweating
VTE relationship to SERMs?
Rate of venous thromboembolism = rate of clinical vertebral fracture prevention
What is a parathyroid hormone medication?
Teriparatide (fortero)
Adverse effect of parathyroid hormone?
influenza-like syndrome
What to know about parathyroid hormone efficacy?
Efficacy is decreased if used in conjunction with bisphosphonates
What is a RANKL antagonist?
Denosumab (Prolia)
What is a benefit of RANKL antagonist?
subcut injection every 6 months - good for patients who don’t show up often
Safety of RANKL antagonist?
- Cellulitis - most common
- infections
How is calcitonin administered?
Nasal administration
