Osteoporosis Flashcards
medications that increase OP risk
anticonvulsants (phenytoin), SSRIs, PPIs, glucocorticoids, heparin, aluminum, lithium
osteopenia
-1 to -2.5
osteoporosis
<-2.5
DEXA test
> /= women at 65, men at 70
younger with risk
fracture after age 50
condition ass with low bone mass/loss
OP prevention
calcium and vitamin D iintake
men 50-70 calcium 1k / day
men 71+ and women 51+ calcium 1.2k/day
50+ vitamin D 800-1000/day
adequate exercise
RF
avoid smoking
alcoholism treatment
osteoporosis drugs
biphosphonates (-dronate), raloxifene, calcitonin, teriparatide, HRT, conjugated estrogens/bazedoxifene, denosumab
Who should be treated for OP?
hip/vertebral fractures
T score </= -2.5 at femoral neck, hip, spine
postmenopausal women and men >50 with:
t score between -1 and -2.5 AND
10 year hip fracture probability >/= 3% OR
10 year probability >/= 20%
bind to hydroxyapatite in bone inhibiting osteoclasts, inhibiting bone resorption, decreasing fractures (lowered with coffee or OJ), half life past 10 years!
bisphosphonates: alendronate, risedronate, ibandronate, zoledronic acid
1st line for OP and no CIs
bisphosphonates – must be taken in morning on empty stomach at least 30-60 minutes before eating, must take with at least 6-8oz of H20 and remain upright for 30-60 min
ADRs of bisphosphonates
decreased calcium, acid reflux, GERD, dyspepsia, gastritis, esophageal/gastric ulcers
CIs of bisphosphonates
abnormalities of the esophagus, inability to sit upright for 30 minutes
precautions with atypical femur fractures, osteonecrosis of jaw, bone/joint/muscle pain
do NOT TAKE with acid suppressing meds, nor recommended in CrCl <30
ibandronate does/does not have approval for use of steroid-induced OP
does not
risedronate has a —- dosage form taken immediately AFTER breakfast
delayed
zoledronic acid is a once yearly
infusion – can have flu-like symptoms
selective estrogen receptor modulator to mimic estrogen, decreases bone resorption, but cannot restore bone, reduces risk of vertebral fractures (but not elsewhere)
works in POSTMENOPAUSAL WOMEN, less effective than bisphosphonates
raloxifene
CIs of raloxifene
DVT, PE, stroke (boxed warnings!!!), retinal vein thrombosis
ADRs of raloxifene
hot flashes, flu-like symptoms, arthralgias, weight gain, peripheral edema, depression, insomnia
pregnancy category X
human monoclonal antibody to RANKL cytokine involved in mediation of osteoclast activity, reducing risk of all fractures
approved for treatment in men and POSTMENOPAUSAL women, reserved for intolerant or unresponsive, SQ every 6 months
denosumab
denosumab has caution with
renal impairment (CrCl <30) bc of risk of hypocalcemia
ADRs of denosumab
arthralgias, myalgias, bone pain, cellulitis, eczema, osteonecrosis, atypical femur fractures
naturally produced by thyroid gland, antagonizes PTH, inhibits bone resorption, increases kidney calcium excretion, reduces risk of vertebral fractures
only for post menopausal osteoporosis, improves bone pain, limited research
calcitonin
ADRs of calcitonin
nasal symptoms, risk of malignancy, hypocalcemia, hypersensitivity
recombinant parathyroid hormone stimulating osteoblast function, increasing BMD, bone mass, strength, reducing risk of vertebral and nonvertebral fractures
treatment for OP in men, postmenopausal women, steroid OP
daily SC injection
reserved for severe hip or spine osteoporosis with T score and related fracture, safety not established
teriparatide
ADRs of teriparatide
hypercalcemia (transient), orthostasis, nausea, dizziness, HA, arthralgias, muscle cramps, hyperuricemia, osteosarcoma (boxed warning)
