Osteoporosis Flashcards
t score
T -1 or higher = Normal
T -2.5 to -1 = Osteopenia
T below -2.5 = Osteoporosis
T below -2.5 + bone fragility/ fracture risks = Severe osteoporosis
- t score shows where the patient is compared to the population
osteoporosis prevention considerations
Calcium Vitamin D Magnesium Strontium Bisphosphonates SERMs - selective estrogen-receptor modulators Synthetic calcitonin hormone PTH analogs Estrogen Monoclonal antibodies/Anti-RANK Ab Calcium Supplementation
vitamin D
- nec, for absorption of ca2+ in the GI tract and maintaining adequate ca2+ and phos livels in serum= normal bone mineralization
- must undergo 2 hydroxylatios inthe body for activation
1. liver converts D to 5-hydroxyvit d( calcidiol)
Calcitriol
prescription form of vitamin D that can increase bone mass and decrease rate of spinal fracture
however it increases serum calcium therefor this needs to be monitored
magnesium
can assist with diminished bone loss when taken in conjunction with vit D and calcium
strontium
body absorbs as if it where calcium and acts to improve osteoblastic activity
strontium and ranelic acid
aid bone growth increase bone density and lessen vertebral, peripheral, and hip fractures
generally safe and free of SE
Excess intake can cause bone weakening
what are the two different effects strontium has on bone?
- it is incorportated in small amount into the hydroxyapatite crystal lattice, where it remains bound for years or decades
- absorbed into the surface of hydroxyapatite crystals, the probable site at which they stimulate bone formation, inhibit resorption and increase BMD
what 2 drugs are approved for tx in both men and women with glucocorticoid induced osteoporosis
Alendronate
Risedronate
raloxifene (evista)
selective estrogen receptor modulator which has been approved for both the prevention and treatment
calcitonin ( mialcin)
used for tx but not yet approved for prevention
teriparatide
synthetic PTH analogue
tx of postmenopausal osteoporosis and in high risk men
Estorgen/hormone replacement therapy
approved for prevention of porstmenopausal osteoporosis
denosumab
human monoclonal antibodiy used for TX
Bisphosphonates
- inhibit osteoclasts- induces apoptosis
- have 2 phosphonare groups symilar to pyrophosphate
-reduce fractures in those who have had fractures in the past ( not those who have not)
Se: upset stomach, inflammation and erosion of esophagus 9 prevent by remaining standing)
what are the uses of bisphosphonates
osteoporosis
osteitis deformans ( paget's) bone metastasis
multiple myloma
primary hyperparathyroidism
osteogenisis imperfecta
Alendronatw/ fosamax
Class: Bisphosphonates
Indication: Prevention and treatment of osteoporosis
MOA: Inhibition of osteoclast activity
Char: PO. Once daily. Instructions for taking Alendronate are noted under side effects.
Raloxifene/ Evista
- SERM (selective estrogen-receptor modulator)
- moa:Binds select estrogen R sites – maintains beneficial estrogenic activity on bone & lipids, & anti-estrogenic activity on endometrial & breast tissue
- se:Hot flashes, arthralgia, myalgia, edema, pruritis, small but definite increased risk for DVT
I: Increases bone mass & reduces risk of vertebral fx
Significantly reduces incidence of breast CA
PO, 1x/day
CI: pregnancy/lactation, active/past hx DVT/PE/retinal vein thrombosis
Calcitonin/ Miacalcin
- Synthetic hormone
- Inhibits osteoclastic activity
SE:Nasal spray: nose bleeds, sinusitis
HA, dizziness, edema, anorexia, diarrhea, skin rash
I: Osteoporosis tx (not prevention)
Nasal spray, IV
Teraparatide/ Forteo
- PTH analog
- Activates bone turnover w/ osteoblasts activated much more than osteoclasts
Stimulates bone formation in both spine & hip
-Se:Nausea, leg cramps, dizziness
I: postmenopausal women & men with osteoporosis at high risk for having fx – reduces risk of vertebral & non-vertebral fx in postmenopausal women
SQ, 1x/day – can be used for up to 24 months
Denosumab/ Prolia
- Human mAb ,Alpha-TNF agent
- Targets RANKL (protein that acts as primary signal to promote bone removal) – inhibits maturation of osteoclasts, protecting bone from degradation
Se:Increased susceptibility to infection
URI, UTI, cataracts, constipation, rash, joint pain
One study: slight increased risk of CA & severe infections, but not statistically significant
I: osteoporosis (tx), bone mets, RA, multiple myeloma, giant cell tumors of bone
SQ, 1x/6 months
