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Summer Pharm Exam 1 > Osteoporosis > Flashcards

Osteoporosis Flashcards

(47 cards)

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1
Q

What is osteoporosis

A

low bone density (weak bones) leading to increased fracture risk

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2
Q

Why do men and women start losing bone density in 3-4 decade

A

Women: Menopause= estrogen deficiency= increased osteoclast activity= bone resorption>formation
Men: aging and secondary causes; occurs later 2/2 larger bone size and mass

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3
Q

What can all individuals do to reduce risk of osteoporosis

A

Incorporate healthy bone lifestyle from birth
Regular exercise, nutritious diet, avoid tobacco, minimize alcohol consumption
Fall prevention

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4
Q

RF of osteoporosis are

A

age, Hx of fracture, glucocorticoids, parent Hx of hip Fx, low body weight, cigarette smoking, excess alcohol, RA

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5
Q

Secondary osteoporosis RF are

A 
hypogonadism
premature menopause 
malabsorption 
chronic liver disease 
IBD
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6
Q

Age related osteoporosis results from

A

hormone, calcium, and vitamin D deficiency

leads to accelerated bone turnover and reduced osteoblast formation

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7
Q

Drug induced osteoporosis results from

A

systemis corticosteroids, thyroid hormone replacement, AED (phenytoin, phenobarbitol), depot medroxyprogesterone acetate

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8
Q

What is the FRAX tool

A

WHO created tool to assess probability of Fx in the next 10 years
-age, race, sex, Hx of fragile fx, BMI, glucocorticoids, current smoking, alcohol (3+/day), RA, femoral neck or total hip bone mineral density

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9
Q

What is the Garvan calculator

A

Uses 4 RF (age sex low trauma Fx and falls) +/- BMD to calculate 5 and 10 year risk estimates
Better than FRAX bc it includes falls and # of previous Fx instead of a bunch of other random RF

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10
Q

What is the standard diagnostic test fro BMD

A

DXA (dual energy x-ray absorptiometry)

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11
Q

Diagnosis of osteoporosis is based on

A

low trauma Fx OR
central hip/spine DXA using WHO T-score threshold
*For kids, pre-menopause women, and men <50, Dx based on Z score

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12
Q

What are T scores indicative of

A

Osteopenia (low bone mass): -1 to -2.5
Osteoporosis: Less than -2.5
(T scores applied to perimenopausal women, men 50+, and other races)

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13
Q

Absorptive therapies (keep it in the bone) include

A

*Calcium
*Vitamin D
**Bisphosphanates
calcitonin
Estrogen agonists
Estrogen
Testosterone
Teriparatide
Denosumab

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14
Q

What age group needs the most calcium and vitamin D

A

9-18 years old

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15
Q

What are the tow forms of calcium

A
  • Calcium carbonate (can cause bloating, gas, constipation, hypercalcemia, hypophosphatemia; rarely, stones)
  • Calcium citrate (hypercalcemia, hypophosphatemia)
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16
Q

What are the forms of vitamin D

A

D3: Cholecalciferol (not active, natural form)
D2: Ergocalciferol (plant derived)
D: Calcitriol, AKA 1,25 OH vitamin D (active)

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17
Q

When would you need to increase the dose of D3 (cholecalciferol)

A

In malabsorption

If taking anticonvulsants (carbamazepine, phenobarb, phenytoin)

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18
Q

What are the ADE of D3 (cholecalciferol)

A

Hypercalcemia (HA, weakness, cardiac disturbance)

Hypercalcuria

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19
Q

When would you Rx Ergocalciferol (D2)

Study These Flashcards
A

if Vitamin D deficient

20
Q

How is Calcitriol formed

Study These Flashcards
A

D3 is hydroxylated in the liver and other tissues to make calcifediol (25 OH-D)
That is then metabolized in the kidneys to make calcitriol

21
Q

Indications for using exogenous Calcitrol

Study These Flashcards
A

renal osteodystrophy
hypoparathyroid
refractory rickets

22
Q

What are the bisphosphanates (first line for osteoporosis)

Study These Flashcards
A

Alendronate
Risedronate
IV Zoledronic acid (Reclast) (IV infusion q2 years)
(first line for post-menopause women, man and glucocorticoid induced osteoporosis)
-IV and oral Ibandronate only for post-menopausal women

23
Q

What is the MOA of bisphosphonates

Study These Flashcards
A 
Mimic pyrophosphate (endogenous bone resorption inhibitor)= decrease osteoclast maturation, #, recruitment, and life span 
Half life is up to 10 years (becomes incorporated into bone)
24
Q

Important notes for each bisphosphonate

Study These Flashcards
A

Alendronate: Take in AM on empty stomach w/ 6=8 oz water. Dont eat and Stay upright for 30 min. Dont take w/ any other supplements
Ibandronate: same as Alendronate, but stay upright for 60 min
Risendronate: Same as Alendronate, but ER tab (Atelvia) is taken right AFTER breakfast
Zoledronic acid: DO NOT take if CrCl <35

25
How do you monitor bisphosphonates
Generally 1-2 years s/p initiation (determine efficacy) | Then q2 years with bone turnover markers
26
What are ADE of bisphosphonates
oral: Nausea, Dyspepsia IV: Flu-like illness rare: perforation, ulceration, GI bleeding, MSK pain, atypical Fx, sub-trochanteric femoral fracture BBW: ONJ
27
What are the bone turnover markers of resorption
Type 1 collagen degradation (PYD, DPD, C and N nucleopeptides) TRACP 5b, Cathepsin K, Matrix metalloproteinases
28
What are the bone turnover markers of formation
Procollagen type 1 propeptides (PICP, PINP, osteocalcin) | BALP
29
DO NOT USE bisphosphonates if
CrCl <30-35 Serious GI conditions (barrett's esophagus, achalasia, esophageal varicies) Pregnant
30
What is ONJ
osteonecrosis of jaw; more common in those w/ cancer, chemo, radiation, and glucocorticoid therapy on higher dose IV bisphosphonate
31
What is a "drug holiday"
Patients taken of bisphosphanates and followed w/ bone turnover markers and central DXA BMD AKA, 5 years after being taken off Alendronate therapy, post-menopause women showed prolonged suppression of bone turnover and maintenance of BMD
32
Who meets criteria for a drug holiday
Women w/o evidence of low rtauma Fx who repsonded well to bisphosphanates who's T score is in "osteopenic" range (> -2) *Best results if women are low risk (T score > -2.5). NOT for high risk women w/ T score < -3.5
33
What is calcitonin
third line med; for women 5 years post-menopause Tx for pain relief w/ acute vertebral Fx refrigerate and prime nasal spray
34
What is endogenous calcitonin
hormone released from thyroid when calcium is high | promotes deposition of calcium into bone (inhibits osteoclasts, stimulates osteoblasts)
35
What are the second gen estrogen agonist/antagonist
Raloxifen, Bazedoxifene (selective estrogen receptor modulators) decrease bone resorption= increased BMD and decreased fractures *Bazedoxifen is for post-menopausal women w/ a uterus, no progesterone needed!!
36
What hormone therapy can you give for osteoporosis
``` Estrogen therapy (short term for women who need to manage menopause Sx) Testosterone (or methyltestosterone for women) increase BMD ```
37
What is Teriparatide (anabolic Tx)
Recombinant product that acts like first 34 AA in PTH | Good for post-meno women, men, and pt on glucocorticoids at high risk (T score < -3.5)
38
What is the MOA of teriparatide
increases bone formation, bone remodeling rate, and osteoblast number and activity leads to improved bone mass and architecture
39
How do you take teriparatide
It is a pre-filled pen (subQ injection into thigh or abdomen w/ site rotation- 20mcg daily up to 2 years) 1st dose pt should sit or lie down (orthostatic hypo) Refrigerate before and after use Use new needle w/ each dose Throw away after 28 days
40
What is Abaloparatide
Synthetic analog of human PTH that stimulates bone formation FDA approved for high risk postmenopausal osteoporosis -consider antiresorptive Tx to protect against bone loss after d/c abaloparatide
41
What is Denosumab
binds to and inhibits RANKL os surface of osteoclast precursor cells and mature osteoclasts Inhibits osteoclastogenesis Good for postmenopausal women and chemo induced osteoporosis Dissipates when d/c **Give 60 mcg subQ q6 months
42
ADE of Denosumab are
back, extremity, and MSK pain | increased cholesterol, cystitis, low serum calcium, skin problems
43
What should be used FIRST vs LAST when treating osteoporosis
First line: Alendronate, Risedronate, Zoledronic acid, and Denosumab (decrease vertebral, hip, and other Fx)- second are Ibandronate, raloxifen, and teriparatide Last resort: Calcitonin
44
What is Vertebroplasty and Kyphoplasty
bone cement is injected into fractured vertebral space to alleviate debilitating pain 6-52 weeks s/p vertebral Fx ADE: cement leakage= nerve damage, Fx around cement
45
What is osteomalacia
soft bones; undermineralized adult bones (same as rickets in kids) Caused by severe, prolonged VD deficiency (MC), d/o causing hypophosphatemia, and long term anticonvulsants
46
What do osteomalacia patients present with
pathologic Fx and/or deep bone pain, proximal muscle weakness; BMD and no other Sx Extremely low 25 (OH) vitamin D (calcifediol)
47
How do you treat osteomalacia
``` high dose (50,000 units q1 wk for 8 wks) Ergocalciferol (D2) When you reach Calcifediol level >30, change to chronic VD maintenance therapy (D2 50,000 q 1-2x month OR OTC D3 1000-2000 units qd) ```

Summer Pharm Exam 1 (8 decks)

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