osteoporosis

Question 1

calcium citrate

Answer 1

may be better absorbed than other forms of calcium.

avoid calcium sourced from oyster shells

Question 2

vitamin D

Answer 2

necessary for absorption of calcium in stomach & GI
but large doses may precipitate the production of kidney stones
recommended doses:
600IU for ages 1-70
800IU aged >70
-data suggests these doses should be at least doubled- a more appropriate dose would be 2000IU

Question 3

calcitriol/ rocaltrol

Answer 3

prescription vitamin D to increase bone mass & supposedly decrease spinal fractures
- increases serum cacium levels and must be monitored

Question 4

magnesium

Answer 4

helps to assist with diminishing bone loss with concurrent vitamin D & calcium supplementation

Question 5

protos

Answer 5

a salt form of strontium
not approved in US
but you can get strontium supplements here
absorbed as if it were calcium & acts to improve osteoblastic activity

Question 6

strontium/ strontium ranelate

Answer 6

aids bone growth, inc bone density, lessens vertebral fracture & peripheral hip fractures
500mg- 1gm QD fro prevention
2gm QD to tx osteoporosis
-excessive intake(>2gm QD) may weaken bone by replacing the calcium with strontium
may cause mild GI upset

Question 7

bisphosphonates

Answer 7

-act to inhibit osteoclast activity= inc bone mass
-among the primary drugs to tx osteoporosis
SE- upset stomach, inflammation or erosion of the esophagus
**to prevent damage to the esophagus- remain standing or seated upright for 30-60min after taking medication- pts who cannot follow this protocol should not take bisphosphonates
- take away from food, use only water, or it reduces the bioavailability

Question 8

alendronate/ fosamax

Answer 8

bisphosphonate
for prevention & tx of osteoporosis
MOA- inhibition of osteoclast activity
PO QD, taken with ony water and must be able to remain upright without eating for 30-60 minutes after ingesting to avoid esophageal erosions
SE- GI, heartburn, stomach ache, nausea, erosive esophagitis, rarely osteonecrosis of the jaw
**causes odd fracture sites- mid femur or humerus

Question 9

SERMS (selective estrogen-receptor modulators)

Answer 9

designed to produce the same effect on bone density as estrogen, to lower cholesterol levels w/o increasing risk of hormone related CA

Question 10

raloxifene/ evista

Answer 10

SERM
to inc bone mass & reduce risk of vertebral fracture. reduce the risk of breast CA
MOA- binds to select estrogen receptors sites to maintain beneficial effects of estrogen on bone & lipids while having an “anit-estrogenic” effect on endometrial & breast tissue
PO QD
SE- hot flashes, arthralgias, myalgias, edema, pruitis, small chance of inc DVT.
CI in pregnent & lactating women or women with active or past thromboembolic events(DVT, PE, retinol vein thrombosis)

Question 11

calcitonin/ miacalcin

Answer 11

synthetic hormone to decrease serum Ca2- derived from salmon
for tx of osteoporosis
**not approved for prevetntion of osteoporosis
MOA- inhibits osteoclastic activity
nasal spray or IV
SE- nose bleeds, sinusitis, HA, dizziness, edema, anorexia, diarrhea, skin rashes

Question 12

parathyroid hormone

Answer 12

Tx only
persistent high lvls may cause osteoporosis, daily injections of low or intermittant doses my stimulate bone production
beneftis appear to persist after tx stops

Question 13

teriparatide/ forteo

Answer 13

synthetic PTH analogue
approved for tx of men & women with osteoporosis who have high risk for fracture
second drug of choice after bisphosphonates
MOA- activates bone turnove- osteoblasts activated to a greater extent than osteoclasts- stimulates new bone formation
SQ QD- approved for 24month use
SE- nausea, leg cramps, dizziness

Question 14

estrogen/ HRT

Answer 14

for prevention of post-menopausal osteoporosis
has been shown to red bone loss, inc bone density in spine & hip w/red fractures
pill or patch
**estrogen taken alone(premarin) can inc a women’s chance of developing endometrial CA- prevented by given a combo of estrogen & progestin(prempro)
-SE - vaginal bleeding, breast tenderness, venous blood clot inc risk for gallblader dz
prempro assoc. with small inc in risk of breast CA, stroke & MI
**should only be considered for those women as highest risk of post-menopausal osteoporosis- non-estrogen meds should be considered first
-topical application avoids the first pass metabolism in the liver

Question 15

premarin

Answer 15

For prevention
conjugated equine estrogen
associated with an inc in risk of stroke

Question 16

prempro

Answer 16

For prevention
combination of estrogen & progestin
small inc in risk of breast CA, stroke & MI

Question 17

denosumab/ prolia

Answer 17

human monoclonal AB
for tx of osteoporosis, bone mets, rheumatoid arthritis, multiple myeloma, giant cell tumor of the bone
**not approved for prevention of osteoporosis
MOA- targets RANKL (RANK ligand)- a protein that signals bone removal
SQ every 6 months
SE- inc susceptibility of infx

Question 18

Statins

Answer 18

some studies have reported lowered risk of hip & other fractures in people taking statins (lovastatin, simvastatin)
few clinical trials have been published- more work needed to confirm possible benefit on bone density

Question 19

ipriflavone

Answer 19

synthetic isoflavone

• has shown promise in bone conservation in postmenopausal women
• recent study of 400 women shows that is does not prevent bone loss
• ongoing studies happening