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Pharmacotherapeutics > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

What is osteoporosis?

A

low bone mass and structural deterioration of bone tissue.

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2
Q

What does osteoporosis lead to?

A

Bone fragility and fractures in the spine, wrist, and hip

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3
Q

What are the functions of the skeleton?

A

Structural support, protect organs, contain calcium and phosphorus stores

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4
Q

What are the types of bone?

A
  1. trabecular/cancellous - metabolic; supplies minerals when deficient
  2. cortical - structural; outer bone 80% of skeleton
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5
Q

What are the purposes of bone remodeling?

A
  1. Repair microfractures
  2. adapt to weight bearing
  3. provide access to mineral stores
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6
Q

What performs bone remodeling?

A
  1. osteoclasts - bone resorption

2. osteoblasts - bone formation

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7
Q

What is an important part of bone remodeling?

A

RANKL - receptor activated of nuclear factor kappa b ligand

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8
Q

When is peak bone mineral density reached?

A

age 25-30 years

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9
Q

What is bone quality equal to?

A

bone quality = bone mass and strength

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10
Q

What regulated calcium homeostasis?

A

Regulated by vitamin D and parathyroid hormone

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11
Q

Explain the relationship among vitamin D, PTH, and calcium.

A

PTH converts vitamin D to calcitriol when calcium levels are low. PTH and calcitriol work to release calcium from bone.

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12
Q

What are the types of osteoporosis?

A
  1. postmenopausal - decline estrogen production
  2. age-related - hormone, vitamin D, calcium deficiency
  3. secondary cause.
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13
Q

How much bone loss can occur following menopause?

A

10-25% bone loss in 10 years following menopause

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14
Q

What are the clincial signs of osteoporosis?

A

Short stature, kyphosis, lordosis, fracture

pain, immobility

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15
Q

What are the complications of fractures?

A

Pain, deep, dull, aching.
Decrease functioning
psychological issues

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16
Q

What are some factors that can contribute to osteoporosis?

A
  1. female, family history, >50, menopause, low calcium, vitamin d intake, 3 drinks/day of alcohol, smoking, lack of exercise, high salt, high caffeine intake.
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17
Q

What diseases are factors for osteoporosis?

A

RA, prior fracture, hypogonadism, IBS, hyperPTH, epilepsy, diabetes, depression

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18
Q

What medications are factors for osteoporosis?

A

glucocorticoids, cyclosporine, chemotherapy, anticonvulsants, depo-medroxyprogesterone,

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19
Q

Who should be tested for osteoporosis?

A
  1. Women >65 Men >70
  2. 50-69 with risk factors
  3. adults w/fracture >50
  4. Disease or medication that can cause secondary
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20
Q

What does a central DXA measure?

A

Measures hip, spine, total body

Non-invasive, emits low radiation, lasts 10 mins

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21
Q

What does a peripheral DXA measure?

A

Measures finger, forearm, heel

Screening only

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22
Q

What unit is bone mineral density measured in?

A

g/cm2

Amount of mineralized tissue in the area scanned

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23
Q

What are T-scores comparing? what are the values?

A

Postmenopausal women and men >50 compared to younger adult of same sex.
Normal > -1
osteopenia >-2.5 <-2.5

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24
Q

What are Z-scores comparing? what are the values?

A

Premenopausal women, men -2

Below <-2

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25
Q

What labs are useful to identify secondary causes of bone loss?

A

25(OH) D - normal >30ng
CBC, CHEM, ESR, PTH, Ca, Scr, thyroid, testosterone
Bone turnover markers

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26
Q

What is the goal of therapy for age birth - 30?

A

obtain highest bone mass possible and optimize bone quality

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27
Q

What is the goal of therapy for age >30?

A

Maintain BMD, minimize bone loss, prevent falls/fractures

28
Q

What is the goal of therapy for those with fractures?

A

Control pain, restore independence and quality of life, prevent further fractures

29
Q

What is the recommended amount of daily calcium and vitamin D for adults >50?

A

Calcium 1200mg

Vitamin D 800-1000IU

30
Q

What is the difference between Vitamin D2 and D3?

A

D2- ergocalciferol more potent, used in fortified foods

D3 - cholecalciferol found in OTC

31
Q

Who should be treated?

A

Postmenopausal women or men >50

  1. hip, spine fracture
  2. prior fracture and low bone mass
  3. T-score 3% hip fracture
  4. low bone mass and 10yr >20% any fracture
32
Q

What does the FRAX algorithm tell?

A

Estimates likelihood of a person to break a bone due to low bone mass or osteoporosis over a 10 year period.
*does not include spinal, cannot use on patients already on medications

33
Q

What is the difference between calcium carbonate and citrate?

A 
Calcium carbonate
1000mg = 400mg elemental
Take with food to enhance absorption
Calcium citrate
1000mg = 210 elemental
Take with or without food
34
Q

What drugs interact with calcium carbonate/citrate?

A

Iron, quinolone antibiotics, tetracyclines, levothyroxine

35
Q

What is the preferred vitamin D supplement?

A

Cholecalciferol D3

1mg=40,000units

36
Q

What are bisphosphonates mechanism of action?

A

Decrease osteoclast activity
increase/maintain BMD
reduce fracture risk

37
Q

Which bisphosphonate does not help with hip fractures?

A

Boniva - ibandronate

38
Q

What are the rules for administration?

A

Take in morning, 30 minutes prior to food, with 8 ounces of plain water, sit or stand for 30 minutes.
*exception: Boniva - ibandronate

39
Q

What is the dosing for Fosamax?

A

Aldendronate 10mg daily po, 70mg week po

40
Q

What else is Fosamax approved to treat?

A

Paget’s disease
Accelerated osteoclast activity
Elevated alkaline phosphatase

41
Q

What is the dosing for Actonel?

A

Risedronate 5mg daily po, 35mg week po, 150mg month po

42
Q

What is special about actonel?

A

Risedronate - do not need to wait 30 minutes to eat

43
Q

What is the dosing for Boniva?

A

Ibandronate 150mg month po, 2.5mg daily po

3mg IV push q 3 months

44
Q

If a patient is on daily dosing and misses a dose, when should they take the next?

A

Take the next morning.

45
Q

If a patient is on weekly dosing and misses a dose, when should they take the next?

A

Take the next morning, unless >1 day then skip for that week.

46
Q

What is the dosing for zoledronic acid?

A

Reclast 5mg IV once a year

47
Q

What needs to be checked before each dose of Reclast?

A

Zoledronic acid

Creatinine

48
Q

What are the advantages of IV formulations?

A

Less GI adverse effects
Improved bioavailability, increased adherence,
For patients that can’t sit/stand for 30-60minutes

49
Q

What is the mechanism of action of Evista?

A

Raloxifene
estrogen agonist on bone
estrogen antagonist on breast/uterus

50
Q

What is the dosing for Raloxifene?

A

60mg po daily

51
Q

What is the dosing for Miacalcin?

A

Calcitonin 200mcg intranasally, 50mcg SC/IM daily

52
Q

What is estrogens affect on bone?

A

Decrease osteoclast activity, inhibit PTH, increase calcium absorption, decrease calcium excretion

53
Q

What drug binds to RANKL?

A

Denosumab (prolia)

54
Q

What is Prolia mechanism of action?

A

inhibits osteoclastogenesis and increases osteoclast apoptosis

55
Q

How is denosumab dosed?

A

Prolia 60mg subq once every 6 months

56
Q

Which drug can cause eczema and cellulitis?

A

Denosumab (prolia)

57
Q

Which product is a recombinant parathyroid hormone?

A

Teriparatide (forteo)

58
Q

What is the mechanism of action of Teriparatide?

A

Forteo

Increase bone formation, osteroblast activity

59
Q

What is considered high risk patient?

A
  1. previous osteoporotic fracture
  2. multiple risk factors
  3. low BMD <-3
  4. failed or intolerant to other therapies
60
Q

How is Forteo dosed?

A

20mcg SC daily

61
Q

What are the contraindications to using teriparatide?

A

Hypercalcemia, paget’s disease, history of bon cancer

62
Q

Which drugs are available IV?

A

Ibandronate - Boniva 3mg IV push q3mths

Zoledronic acid - Reclast 5mg IV year

63
Q

Which drugs are available SC?

A

Denosumab - Prolia 60mg q 6months

Teriparatide - Forteo 20mg daily

64
Q

When does the greatest bone loss occur when taking glucocorticoids?

A

first 6-12 months of therapy

65
Q

When should DXA be repeated?

A

Osteoporosis - 2 years
Osteopenia - 5 years
Normal/mild - 15 years

Pharmacotherapeutics (12 decks)

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