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1. Pharm II > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

Osteoporosis is a bone disorder of… (4)

A
  • low density
  • impaired architecture
  • compromised strength
  • increased fx risk
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2
Q

Men & women begin to lose bone mass starting in what decade?

A

3rd-4th bc of reduced bone formation

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3
Q

What 4 lifestyle factors should you recommend to your pts?

A
  • regular exercise
  • nutritious diet
  • avoid tobacco/alcohol
  • fall prevention
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4
Q

What causes age-related osteoporosis?

A

Hormone, Ca, Vit D deficiencies –> accelerated bone turnover & reduced osteoblasts

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5
Q

What causes drug-induced osteoporosis?

A

steroids, TRH, antiepileptics

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6
Q

What are 8 RFs for fx?

A
  • advancing age
  • previous fx
  • steroid therapy
  • low body weight
  • parental hx of hip fx
  • excessive alcohol
  • smoking
  • RA
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7
Q

What are 2 predictive tools used for osteoporosis?

A
  • FRAX tool

- Garvan calculator

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8
Q

What is the T score for osteoporosis?

A

At or below -2.5

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9
Q

What is the T score for osteopenia?

A

Btwn -1 & -2.5

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10
Q

How do you dx osteoporosis in children, premenopausal women, & men under 50?

A

Based on z-score at or below -2.0 in combo w/ other RFs or fx

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11
Q

What is the medication of choice in regards to antiresorptive therapy?

A

Bisphosphonates, along w/ Ca & Vit D

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12
Q

What are the 2 basic forms of Ca?

A
  • Ca carbonate

- Ca citrate

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13
Q

What are the ADEs of carbonate?

A
  • Gas, upset stomach, bloating, constipation

- Kidney stones

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14
Q

What are the ADEs of both carbonate & citrate?

A
  • Hypophosphotemia

- Hypercalciumia

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15
Q

What are ADEs of Vit D3?

A
  • Hypercalcemia –> cardiac rhythm disturbance, HA, weakness

- Hypercalcuria

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16
Q

What is considered the natural vitamin D form vs the plant-derived form?

A
  • Vit D2 = plant form

- Vit D3 = natural form

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17
Q

Where is Vit D hydroxylated? What does it form?

A 
In the liver
Forms 25(OH)D
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18
Q

What are indications for exogenous vit D?

A
  • renal osteodystrophy
  • hypoparathyroidism
  • refractory rickets
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19
Q

What are 4 examples of bisphosphonates?

A
  • Alendronate
  • Ibandronate
  • Risedronate
  • IV Zoledronic acid
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20
Q

When is IV & oral ibandronate indicated?

A

Only for postmenopausal osteoporosis

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21
Q

Bisphosphonates: MOA

A

Mimic pyrophosphate (bone resorption inhibitor)

22
Q

When & how is alendronate administered?

A

In the AM on empty stomach w/ 6-8 ounces of water

23
Q

What precautions should you take w/ alendronate & risedronate?

A
  • Do not eat
  • Remain upright for at least 30 mins following dose
  • Do not coadminister w/ any other meds
24
Q

What precautions should you take w/ ibandronate?

A

Delay eating & remain upright for at least 60mins

25
Q

How should you take “delayed-release” risedronate?

A

Immediately following breakfast

26
Q

What are common ADEs of bisphosphonates? (oral vs IV)

A
  • Oral: Nausea, dyspepsia

- IV: flu-like illness

27
Q

What are bone turnover markers?

A
  • Resorptive: Type 1 collagen degradation, enzymes

- Formation: matrix proteins, enzymes

28
Q

What are rare ADEs of bisphosphonates?

A
  • perforation, ulceration, GI bleed
  • musculoskeletal pain
  • atypical fx
  • ONJ
  • subtrochanteric femoral fx
29
Q

What are the contraindications of bisphosphonates?

A
  • CrCl < 30-35
  • Serious GI conditions
  • Pregnancy
30
Q

ONJ black box warning

A

Occurs more commonly in pts w/ CA, chemo, radiation, &/or steroid therapy receiving higher-dose IV bisphosphonate therapy

31
Q

Who is applicable to go on a “drug holiday”?

A
  • women w/out evidence of low-trauma fx who have responded well to bisphosphonate therapy
  • those w/ BMD increasing into osteopenic range can be considered
32
Q

What is a “drug holiday”?

A

Bisphosphonate therapy is removed & pt is followed serially w/ bone turnover markers & central DXA BMD

33
Q

What did the FLEX study demonstrate?

A

Maintenance of BMD in postmenopausal women after cessation of alendronate therapy

Therefore pts should have long-term benefits, despite cessation. However, continue to monitor.

34
Q

What is calcitonin? What may it provide pain relief w/?

A
  • Endogenous hormone released from thyroid gland when Ca is elevated
  • 3rd line tx for those at least 5 yrs post menopause
  • relief w/ acute vertebral fx
35
Q

What drug classes does both raloxifene & bazedoxifene belong to?

A
  • 2nd gen mixed estrogen agonist/antagonist (EAA)

- Selective estrogen receptor modulators (SERMs)

36
Q

Who is bazedoxifene used for?

A

Postmenopausal women w/ a uterus

No progestogen needed

37
Q

What is teriparatide?

A

Recombinant product representing 1st 34 amino acids in PTH

38
Q

Who is teriparatide used for?

A
  • Postmanopausal women, men, & pts on steroids at high risk
  • Very low bone density T score < -3.5
39
Q

What are surgical options for those w/ pain btwn 6-52 wks after a vertebral fx?

A
  • Vertebroplasty
  • Kyphoplasty

*Cement is injected into fx

40
Q

What are ADEs of a vertebroplasty or kyphoplasty?

A

Cement leakage into SC –> nerve damage & vertebral fx around the cement

41
Q

What is abaloparatide? What does it do? Who is it used for?

A
  • Synthetic analog of PTH
  • Stimulates bone formation
  • Postmenopausal w/ osteoporosis at high risk for fx or who failed other therapies
42
Q

What did the ACTIVE trial demonstrate?

A

Reduced vertebral & nonvertebral fractures, & increased bone density w/ abaloparatide

43
Q

What is denosumab? MOA?

A
  • RANKL Inhibitor

- Binds to RANKL inhibiting osteoclatogenesis

44
Q

Who is denosumab used for?

A

postmenopausal women & chemo induced osteoporosis

45
Q

What are ADEs of denosumab?

A
  • musculoskeletal pain

- increased cholesterol, cystitis, decreased Ca, skin problems

46
Q

Define osteomalacia

A
  • Soft bones, bone is undermineralized

- Rickets is equivalent

47
Q

What causes osteomalacia?

A
  • prolonged vit D deficiency
  • disorders that cause hypophosphatemia
  • meds (anticonvulsants)
48
Q

What are consequences of osteomalacia?

A
  • Fx
  • Deep bone pain
  • proximal weakness
  • low BMD
49
Q

What are the Vit D levels like in osteomalacia?

A

Extremely low 25(OH)

50
Q

How do you tx osteomalacia?

A

Oral ergocalciferol

1. Pharm II (11 decks)

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