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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?

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
What is the alendronate dosing?
10mg daily or 70mg weekly
25
What is the efficacy of bisphosphonates?
1. All prevent vertebral fractures 2. Alendronate, risedronate, and zoledronic acid prevent nonvertebral and hip fractures
26
What are the adverse effects of bisphosphonates?
1. Abd. pain/dyspepsia 2. arthralgias
27
How should oral bisphosphonates be taken?
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
At what point does bisphosphonate therapy have an unclear benefit?
>5 years
29
Estrogen replacement MOA?
Estrogen deficiency leads to excessive bone resorption and inadequate bone formation
30
Efficacy of estrogen replacement?
Reduced risk of vertebral fractures
31
How is estrogen replacement given?
QD oral dosing or transdermal patch
32
Adverse effects of estrogen replacement?
1. Breast discomfort 2. HA 3. Vaginal bleeding 4. VTE
33
Safety of estrogen replacement?
Risk of adverse events using hormone replacement therapy can exceed fracture prevention benefits
34
How should hormonal replacement be done if pt has intact uterus?
estrogen + progesterone
35
How should hormonal replacement be done is hysterectomy?
Estrogen given unopposed by progesterone
36
MOA of SERMs
Selectively binds to estrogenic and antiestrogenic receptors
37
What is a SERM
Raloxifene (evista)
38
What are the adverse effects of SERMs
1. Arthralgias 2. Hot flashes 3. Peripheral edema 4. Sweating
39
VTE relationship to SERMs?
Rate of venous thromboembolism = rate of clinical vertebral fracture prevention
40
What is a parathyroid hormone medication?
Teriparatide (fortero)
41
Adverse effect of parathyroid hormone?
influenza-like syndrome
42
What to know about parathyroid hormone efficacy?
Efficacy is decreased if used in conjunction with bisphosphonates
43
What is a RANKL antagonist?
Denosumab (Prolia)
44
What is a benefit of RANKL antagonist?
subcut injection every 6 months - good for patients who don't show up often
45
Safety of RANKL antagonist?
1. Cellulitis - most common 2. infections
46
How is calcitonin administered?
Nasal administration

Fall 2024 (34 decks)

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