Osteoporosis Flashcards
What are the causes and common risk factors of osteoporosis
Most common in postmenopausal women and in those taking long term oral corticosteroids
(Greatest bone loss rate first 6-12 months of therapy)
Risk factors: low body weight Smoking Family history Early menopause Lower risk in Afro-Caribbean women
Calcium and vitamin D deficiency has to be corrected by ⬆️dietary intake or supplements
Therapeutic options
Bisphosphonate (risendronate/alendrnic acid)
HRT in women/testosterone in men(unlicensed)
(most benefit in prophylaxis if started early and continue for 5 years during menopause)
Calcitriol (unlicensed) or strontium renelate (in severe osteoporosis)
Teriparatide (recombinant fragment of parathyroid hormone) used in men+women
Raloxifene licenced for the prophylaxis and treatment in postmenopausal women (secondary prevention)
Role of calcitonin
Is involved with parathyroid hormone in the regulation of bone turnover and hence in the maintenance of calcium balance and homeostasis
Synthetic salmon recombinant- lowers calcium plasma conc in patients with hypercalceamia associated with malignancy
Also licensed for pager’s disease of bone if other treatment ineffective
How do Bisphosphonates work
They are absorbed onto hydroxyapatite crystals in bone (part of mineral matrix of bones), slowing sown their rate of growth and dissolution and thus reducing rate of bone turnover
They slow down osteoclasts (cells breaking down bone) allowing bone building cells to work more effectively (osteoblasts)
➡️slow down bone loss and this decrease the risk of vertebral fractures
What is Paget’s disease of bone
It disrupts the normal cycle of bone renewal (recycling), causing bones to become weakened and potentially deformed.
Especially common in legs, spine, skull and pelvis
MHRA/CHM ADVICE includes
Safety information and warnings
Product specific information and advice
Interactive drug analysis profiles
How long does the therapy lasts and what is the risk of fractures
Atypical femoral fractures are rare while on bisphosphonate therapy
Re-evaluate after 5 years of therapy the risks and benefits
Report any thigh,hip or groin pain during treatment
What are the symptoms of osteonecrosis of the bone
Pain
Swelling
Redness
And other signs of infection in the gums
Loose teeth, healing not complete after dental work
Bone becomes visible in the mouth
Safety advice for osteonecrosis of the jaw
Mainly common after IV bisphosphonates for cancer treatment rather than oral dose for pagets or osteoporosis
▶️Often dental check-ups before and during treatment
▶️Maintain good oral hygiene
▶️give reminder card to patients informing about risks of therapy
▶️inform doctor of any symptoms (pain, swelling, discharge, non-healing sores)
▶️any dental work finish before start of treatment
Safety advice on osteonecrosis of external auditory canal
Very rare but most common in long term therapy (<2yrs)
Increased risk factor in steroid use, ear operation , chemo, infection and cotton-bud use
Report any ear pain and discharge or ear infection during treatment
Contraindications and cautions of alendronic acid
Contra:
abnormality in oesophagus, hypoCa+2, factors delaying emptying of stomach
Cautions: GI bleed active Ulcer (within 1year) Dysphagia Gastritis/duodenitis Atypical femoral fractures
Alendronic acid dose
10mg/dayor 70mg once a week for women postmenopause
10mg/day for men or women corticosteroid prevention when not receiving HRT
Side effects of alendronic acid
Abdominal pain/distension Alopecia Constipation/diarrhoea/flatulence Dyspepsia Dizziness/headache/vertigo Joint swelling/musculoskeletal pain
Nausea/vomiting Dusgeusia Hypocalceamia Photosensitivity Osteonecrosis of jaw Osteonecrosis of auditory canal
🔴stop taking medicine if oesophageal reactions presenting symptoms like dysphasia, worsening heartburn or pain on swallowing
Pregnancy and alendronic acid
Avoid
Monitoring requirements for alendronic acid
Correct calcium and mineral metabolism (vit D) before starting treatment
Monitor calcium during
Directions of administration of alendronic acid
Swallow whole
Take dose with plenty of water
Sit or stand to take it
Empty stomach 30min before breakfast or another medicine
Wait 30min after sitting upright or standing
If not taken first thing in the morning the wait 2hours before and after taking bisphosphonate
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Medicinal forms of alendronic acid
Tablets 10mg/70mg
Effervescent sf tablets (binosto)
Oral solution (700micro per ml)
Risendronate sodium indications
Pagets disease
30mg daily for 2months and repeated if needed after at least 2 months (very expensive formulation)
Postmenopausal women
5mg per day or 35mg once a week
Like alendronic for the rest of information
Other related medications to alendronic acid
Ibandronic acid
Pamidronate disodium
Sodium clodronate
Zoledronic acid
Used in hypercalceamia, bone damage related to breast cancer and multiple myeloma cancer, paget’s disease IV
Calcitonin indications
Hypercalceamia of malignancy
Paget’s disease
Prevention of acute bone loss of sudden immobility
Calcitonin (salmon) side effects
Abdominal pain
Diarrhoea
Headache, fatigue, nausea and vomiting
Musculoskeletal pain
Avoid in pregnancy and breastfeeding
Strontium ranelate class and indication
Bone resorption inhibitors
treats severe osteoporosis in postmenopausal women and men at high risk of fracture
2g once daily with water at bedtime
Strontium side effects
Severe allergic reactions - DRESS starts with rash, fever, swollen glands, increased WBCs and affects liver,kidneys and lungs
Eczema, diarrhoea, MI , nausea and thromboembolism
Abdominal pain, dyspepsia, constipation, vomiting and GI reflux
Strontium contraindications and cautions
Cerebrovascular disease, heart disease and uncontrollable hypertension
Caution in predisposition to CV diseases and assess risk 6-12 months during treatment
