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RHEUM / MSK Shapcott > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

Adequate Ca++ intake

A

1200 mg daily

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2
Q

Dosing supplemental Ca++

A

500-1000 mg divided in doses through-out the day

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3
Q

Recommended dose vit d

A

800 IU daily

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4
Q

Celiac dz & osteoporosis

A

When celiac is major contributor to osteopenia, follow gluten free diet

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5
Q

Smoking & osteoporosis

A

Accelerates bone loss

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6
Q

Indications for treatment osteoporosis

A

–postmenopausal, fragility Fx, T 3% or combined MDR osteoporotic Fx > 20%

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7
Q

Check prior to Tx osteoporosis

A

Vit D, Ca++

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8
Q

1st line PO bisphosphonates

A

Alendronate
Risendronate

*both=efficacy in reducing vertebral 7 hip Fx

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9
Q

Severe osteoporosis

A

T

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10
Q

Contra bisphosphonates

A
  • -no PO ~ if esophageal disorder (Can use IV formulation)
  • -cannot stay upright for at least 30-60 min
  • -GFR
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11
Q

IV bisphosphonates of choice

A

Zoledronic acid: demonstrated to reduce vertebral & hip Fx

Ibandronate also available, but no data of proven efficacy

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12
Q

Pt with severe osteoporosis & GFR

A

Denosumab

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13
Q

Indication to stop bisphosphonates

A

Severe bone pain

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14
Q

Teriparatide dosing interval

A

SQ daily

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15
Q

Denosumab dosing frequency

A

Q 6 months SQ

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16
Q

Postmenopausal osteoporosis & no Hx of fragility fx, but intolerant of bisphosphonates OR increased risk breast CA

A

Raloxifene–antiresorptive effects are less than bisphosphonates

17
Q

What is teriparatide

A

Recombinant PTH

18
Q

Monitoring response to therapy

A

*DEXA misses most of the changes that reduce risk fx

Repeat DEXA @ 2 yrs. if stable/improved, less frequently thereafter

Don’t use markers of bone turnover

Test more frequently in conditions associated with more rapid bone loss (ex: glucocorticoid )

19
Q

Pt on bisphosphonates has worsening T score or fragility Fx

A 
Compliance?
GI absorption?
Inadequate Ca++/vit. D
Development of other bone dz / secondary causes of bone loss
Consider repeat DEXA in 1 year
20
Q

Pt on bisphosphonates and has

A

Continue same drug, repeat DEXA in 2 yrs

21
Q

Pt on bisphosphonates and has > 5% DECREASE in bone density

A

Switch from PO to IV bisphosphonates (usu zolendronic acid)

Otherwise, consider switching to denosumab or teriparatide

22
Q

Pt with severe osteoporosis who continues to Fx 1 year after bisphosphonates

A

Teriparatide

23
Q

SERM of choice

A

Raloxifene

Inhibit bone resorption, reduce risk vertebral Fx. Reduces risk breast CA. Increased VTE & hot flashes. No apparent effect on CAD or endometrium
*Tamoxifen for breast CA likely provides same benefit, but no data to back it up

24
Q

Why is HRT no longer recommended for osteoporosis

A

Increased risk breast CA, stroke, VTE, CAD

25
Q

Calcitonin & osteoporosis

A

Relatively modest effects on bone density

Long term use may increase risk CA

26
Q

Esophageal risks of bisphosphonates

A

Can lead to pill esophagitis, esophageal ulcers

May be disabling, lead to hospitalization. NSAID increases risk

27
Q

Higher rate of UGIB… Risendronate vs alendronate

A

Neither /same risk

28
Q

Potential ADE of bisphosphonates… Particularly IV formation

A

Hypocalcemia, magnitude & duration worse in those with hypoparathyroidism, Vit D deficiency, or inadequate Ca++ intake

29
Q

What should be taken in pt on bisphosphonates

A

Ca++, vit D…. But Ca++ should NOT be taken WITH the bisphosphonates b/c will interfere with absorption

30
Q

Pain and bisphosphonates

A

May occur years later… Myalgias, arthralgias. If pt still on bisphosphonates & these occur, stop the bisphosphonates

31
Q

Renal function and bisphosphonates

A

No go if GFR

32
Q

Eye ADE of bisphosphonates

A

Pain, blurred vision, conjunctivitis, uveitis, scleritis

33
Q

Bisphosphonates and arrhythmia

A

Usu related to hypocalcemia. Unclear if the Rx causes AF

34
Q

Pt in bisphosphonates develops jaw pain

A

Eval for exposed bone, osteonecrosis of the jaw. STOP bisphosphonates. Highest risk: MM, metastatic breast CA treated with high dose IV bisphosphonates, duration therapy, dental extractions, poorly fitting dentures, glucocorticoid , smoking, DM,

35
Q

How address pt who requires bisphosphonates but has dental extractions necessary?

A

Delay bisphosphonates by at least a few months; discuss risk and Sn/Sx with pt in detail

36
Q

Is a dental visit prior to bisphosphonates necessary

A

Not mandatory

37
Q

What if pt is taking bisphosphonates and it is discovered that a dental extraction is required

A

Course of action not clear

38
Q

Bisphosphonates and femur FX

A

Atypical femur fx = rare complication of bisphosphonates , associated with prolonged use (>7 yrs). Tx up to 5 yrs typically not associated with Fx, so do not defer bisphosphonates in those at high risk of osteoporotic fx

Absolute risk of fx is low3-50 per 100k treated
*pt with atypical fx in one leg is at increased risk for same in contra lateral leg

39
Q

Pt on bisphosphonates develops groin pain or pain in thigh

A

Worry about atypical femoral fx–is a stress fx, but bisphosphonates inhibit NML intracortical remodeling. When bisphosphonates are stopped, the risk of atypical fx declines

RHEUM / MSK Shapcott (2 decks)

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