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Pharmacology part B > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

define osteoporosis

A

chronic skeletal disorder of compromised bone strength associated with low bone density and deterioration of bone quality which often results in fractures

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2
Q

what does bone strength depend on

A

bone mass and bone microarchitecture

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3
Q

in healthy bones reabsorptions is equal to formation what causes reabsorption to be greater than formation

A

menopause
aging
disease
drugs

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4
Q

what is a compression fracture

A

loss of >/= 25%vertebral height with end plate disruption

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5
Q

what is kyphosis

A

extreme curvature of spine

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6
Q

why is op called the silent theif

A

steals bone density over many years without signs until a bone breaks

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7
Q

what are tht consequences of fractures

A 
increased riskof additional fractures
chronic pain 
immobility 
decreased quality of life
loss of independence
institutionalization 
cost to health care
death
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8
Q

common sites for fractures

A

hip
spine
wrist

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9
Q

how is bone mineral density assessed

A

dual xray absorptiometry at the hip and spine

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10
Q

what bmd t score is considered op

A

= -2.5

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11
Q

expected z score for people under 50

A

above -2

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12
Q

what is a normal t score fro someone over 50

A

> /= -1

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13
Q

can BMD alone determine fracture risk

A

no

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14
Q

who under 50 years of age should have their BMD tested

A 
fragility fractures
prolonged use of glucocorticoids 
use of high risk meds
hypogonadism 
early menopause
malabsorption 
hyperparathyroidism
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15
Q

who over 50 should have their BMD tested

A 
anyone over 65 
fragility fracture after age 40 
high risk meds
rheumatoid arthritis 
smok
prolonged glucocorticoid use 
high alcohol intake 
low body weight or major weight loss
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16
Q

what is the frax fracture risk assessment tool

A

computes the 10 year absolute risk for hip fracture along or major osteoporotic fracture

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17
Q

what is the decision to treat independent of

A

BMD result

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18
Q

the decision to treat is based on fracture history, what does that include

A

1) fragility fracture of hip?
2) spine?
3) if had >/= 2 non spine, non hip fragility fracture
4) if had one non spine, non hip fragility fraction after age 40 and prolonged glucocorticoid use in the previous year

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19
Q

who should receive treatment

A

high risk and maybe some moderate risk patients

not those at low risk

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20
Q

what is recommended for basic bone health

A 
exercise 
fall prevention 
calcium 
vitamin D
smoking cessation 
limit alcohol 
good nutrition
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21
Q

which medications increase risk of falls

A

sleep, anxiety, depression, mood, hypertension, allergies, pain, muscle spasm

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22
Q

calcium sources

A

300 mg in 250ml of cows milk, almond soy, rice beverage, fortifiec orange juice, 3/4 yogurt

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23
Q

what dose of calcium maximizes absorption

A

= 500mg

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24
Q

types of calcium supplements

A

calcium carbonate

calcium citrate

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25
Q

side effects of calcium over supplementation

A

kidney stones

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26
Q

what does vit d do

A

helps body absorb and use calcium/phophorus to build and maintain strong bones and teeth

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27
Q

sources of vit d3

A

UVB light

fish, meat, eggs, fortified milk, plant speciies

28
Q

sources of vit d2

A

wild mushrooms
fungi
yeast

29
Q

how is vit d converted into the active form

A

liver and kidneys

30
Q

what is the result of excess vit d

A

hypercalcemia, increased calcium depositions in body causes calcification of kidney, heart, lungs, blodd vessels

31
Q

result of low serum vit d

A

increased reabsorption from bones
balance problems
high fall rates
low bmd and muscle weakness

32
Q

optimal serum levels of 25-OH

A

> 75nmol/L

33
Q

anti resorptive agents

A

bisphosphonates
monoclonal antibody
SERM
hormone therapy

34
Q

anabolic agents

A

PTH analogue

35
Q

benefits of OP medications

A

reduce fracture risk by 50%
bone density improvment
high risk patients benefit the most

36
Q

bisphosphonates

A

bind to bone and inhibit osteoclasts

analogs of pyrophosphate

37
Q

teriparatide

A

PTH analog

38
Q

raloxifene and estrogen

A

reduce RANK ligand

39
Q

denosumab

A

RANK ligand inhibitor

40
Q

what is first line for OP

A

bisphosphonates

41
Q

MOA of first gen bisphosphonate

A

bind directly to bone hydroxyapatite crystals and are taken up by osteoclasts during remodeling and are incorporated in ATP
ATP analogues accumulate in osteoclasts and induce cell death through inhibition of ATP utilizing enzymes

42
Q

MOA of nitrogen containing bisphosphonates

A

bind to bone hydroypatite crystals and are taken up by osteoclasts during remodelling and inhibit enzymes in mevalonate path and can lead to osteoclast death

43
Q

how should bisphosphonates be taken - when, separation from other thigns

A

first thing in morning on empty stomach with water
beverages decrease absorption
must separate from everything by 30 min after dose and dairy 2-3 hours

44
Q

half life elimination of bisphosphonates

A

months to years

released with process of bone utrnover

45
Q

excretion of bisphosphonates

A

urine

feces

46
Q

denosumab MOA

A

human monoclonal antibody that targets RANKL in bloodstream preventing it from binding to receptors on osteoclasts in the circulation preventing development, activation, and survival of osteoclasts

47
Q

denosumab adverse effects

A 
ONJ 
atypical fractures
hypocalcemia 
severe infection 
dermatitis, eczema, rashes
musculoskeletal pain 
hypersensitivity
48
Q

why does denosumab cause an increased risk of infection

A

activated T and B lymphocytes and lymph nodes express RANKL, denosumab inhibits this

49
Q

what is teriparatides anabolic action

A

stimulats osteoblast actibity ie increase GI calcium absorption, increase renal reabsorption of calcium

50
Q

result of teriparatide activity

A

increased bone mineral density, bone mass, and strength

decreased fractures

51
Q

difference between intermittent and prolonged PTH

A

intermittent promotes bone formation

prolonged causes bone reabsorption

52
Q

what is teriparatide indicated for

A

severe osteoporosis in men, postmenopausal women, and glucocorticoid induced

53
Q

adverse reactions for teriparatide

A 
transient hypercalcemia 4-6 hours postdose
orthostatic hypotension 
dizziness
headache
nausea
arthralgia
54
Q

who is estrogen indicated for

A

postmenopausal osteoporosis with concomitant vasomotor symptoms

55
Q

how does estrogen work

A

decreases bone reabsorption, reduces RANKL

56
Q

what must estrogen be prescribed wiht if uterus is intact

A

progestin

57
Q

adverse effects of estrogen

A

increased risk of breast cancer
increased risk of stroke
DVT

58
Q

example of a SERM

A

raloxifene

59
Q

indication of SERMs

A

osteoporosis in postmenopausal women

60
Q

SERM effects

A

decreases bone reabsorption, reduces RANKL, increases BMD, reduces fractures at spine

61
Q

SERM MOA

A

agonist on bone

antagonist at breast and endometrium

62
Q

adverse effects of SERM

A

increase risk of DVT or PE
hot flashed
leg cramps, muscle spasms

63
Q

how do glucocorticoids affect the bones

A

increase osteoclast and decrease osteoblast proliferation

decrease the amount of calcium

64
Q

how to aromatase inhibitors affect the bone

A

blocka estrogen synthesis

65
Q

how does androgen deprivation therapu in males affect the bones

A

increase bone turnover

Pharmacology part B (17 decks)

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