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Fall 2024 > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

Social history related to OP?

A

Smoking
Alcohol

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1
Q

Risk factors of osteoporosis?

A

Women > 65
Men >70
Estrogen deficiency in women

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2
Q

Medical history of OP?

A

RA
CVD
T2DM

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3
Q

Drug-induced causes of OP?

A
  1. Antiepileptic agents
  2. immunosuppressant drugs
  3. PPI
  4. Systemic corticosteroids
  5. SSRI
  6. Warfarin
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4
Q

What are some additional factures contributing to OP?

A
  1. Anorexia nervosa
  2. Medroxyprogesterone depot use
  3. GI Malabsorption syndrome
  4. Parenteral history
  5. Loop diuretic use
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5
Q

How to prevent OP in individuals over 50?

A

Calcium intake, Vit D intake, Exercise, Smoking cessation, limit alcohol use

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6
Q

What should be done if T-score if 0 to -1

A
  1. Assess risk factors annually
  2. Repeat DXA every 5 years
  3. Recommend Calcium and Vit D
  4. Recommend exercise and fall prevention counseling
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7
Q

What should be done if T-score is from -1 to -2.5

A

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

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8
Q

If T-score <-2.5

A

Same as osteopenia + significant frax

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9
Q

What agents are used for calcium supplementation?

A

Calcium carbonate (tums)
Calcium citrate

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10
Q

What is the efficacy of calcium supplementation?

A

improves/maintains bone mineral density

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11
Q

Adverse effects of calcium supplementation?

A

Constipation and GI discomfort

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12
Q

How to take calcium citrate?

A

on empty stomach or with meals

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13
Q

How to take calcium carbonate?

A

better absorption with meals

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14
Q

How much calcium is recommended per day?

A

1000-1500 elemental mg per day

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15
Q

What should calcium be taken with?

A

Vit D

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16
Q

MOA of Vit D?

A

fat-soluble vitamin

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17
Q

What is the main source of vit D?

A

sun exposure

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18
Q

What are the vit D agents?

A

Vit D2 - ergocalciferol
Vit D3 - cholecalciferol

19
Q

Adverse effects of Vit D supplementation?

A

Hypercalcemia
Constipation

20
Q

Is vit D alone without calcium effective for fracture prevention?

A

Unclear

21
Q

What are the bisphosphonates MOA?

A

Inhibit osteoclastic bone resorption

22
Q

What are the oral options for bisphosphonates?

A

Alendronate and risedronate

23
Q

What are the IV agents for bisphosphonates? What are they used to treat?

A

Zoledronic acid
Pamidronate
Ibandronate
Treat hypercalcemia of malignancy; cancer metastatic to bone

24
Q

What is the alendronate dosing?

A

10mg daily or 70mg weekly

25
Q

What is the efficacy of bisphosphonates?

A
  1. All prevent vertebral fractures
  2. Alendronate, risedronate, and zoledronic acid prevent nonvertebral and hip fractures
26
Q

What are the adverse effects of bisphosphonates?

A
  1. Abd. pain/dyspepsia
  2. arthralgias
27
Q

How should oral bisphosphonates be taken?

A
  1. Take with 6-8 ounces of water at least 30-6- minutes before food, drink, or other medications
  2. Remain upright for at least 30 minutes after
28
Q

At what point does bisphosphonate therapy have an unclear benefit?

A

> 5 years

29
Q

Estrogen replacement MOA?

A

Estrogen deficiency leads to excessive bone resorption and inadequate bone formation

30
Q

Efficacy of estrogen replacement?

A

Reduced risk of vertebral fractures

31
Q

How is estrogen replacement given?

A

QD oral dosing or transdermal patch

32
Q

Adverse effects of estrogen replacement?

A
  1. Breast discomfort
  2. HA
  3. Vaginal bleeding
  4. VTE
33
Q

Safety of estrogen replacement?

A

Risk of adverse events using hormone replacement therapy can exceed fracture prevention benefits

34
Q

How should hormonal replacement be done if pt has intact uterus?

A

estrogen + progesterone

35
Q

How should hormonal replacement be done is hysterectomy?

A

Estrogen given unopposed by progesterone

36
Q

MOA of SERMs

A

Selectively binds to estrogenic and antiestrogenic receptors

37
Q

What is a SERM

A

Raloxifene (evista)

38
Q

What are the adverse effects of SERMs

A
  1. Arthralgias
  2. Hot flashes
  3. Peripheral edema
  4. Sweating
39
Q

VTE relationship to SERMs?

A

Rate of venous thromboembolism = rate of clinical vertebral fracture prevention

40
Q

What is a parathyroid hormone medication?

A

Teriparatide (fortero)

41
Q

Adverse effect of parathyroid hormone?

A

influenza-like syndrome

42
Q

What to know about parathyroid hormone efficacy?

A

Efficacy is decreased if used in conjunction with bisphosphonates

43
Q

What is a RANKL antagonist?

A

Denosumab (Prolia)

44
Q

What is a benefit of RANKL antagonist?

A

subcut injection every 6 months - good for patients who don’t show up often

45
Q

Safety of RANKL antagonist?

A
  1. Cellulitis - most common
  2. infections
46
Q

How is calcitonin administered?

A

Nasal administration

Fall 2024 (34 decks)

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