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PHA 551 > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

Risk factors for age related osteoporosis

A

deficiency of:

  • hormones
  • calcium
  • vitamin D
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2
Q

Risk factors for drug induced osteoporosis

A 
systemic corticosteroids
thyroid hormone replacement
antiepileptic drugs (phenytoin, phenobarbital)
depot medroxyprogesterone acetate
etc.
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3
Q

Lifestyle and diet changes to maintain healthy bones

A 
regular exercise
nutritious diet 
tobacco avoidance
minimal alcohol use
fall prevention
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4
Q

What is the diagnostic standard for bone mineral density and osteoporosis?

A

dual energy x ray absorptiometry (DXA)

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5
Q

What is the diagnosis of osteoporosis based on?

A

low trauma fracture
OR
central hip/spine DXA using WHO T score thresholds

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6
Q

What T score defines osteopenia or low bone mass?

A

-1 and -2.5

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7
Q

What T score defines osteoporosis?

A

below -2.5

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8
Q

What score and value diagnoses osteoporosis in children, premenopausal women, men under 50?

A

Z score at or below -2.0 (w/ other RF or fx)

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9
Q

What is the first line therapy in the treatment of osteoporosis?

A

bisphosphonates (along w/ Ca and vitamin D)

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10
Q

Antiresportive Therapies

A 
Calcium
Vitamin D
Bisphosphonates
Calcitonin
Estrogen agonists-antagonists
Estrogen
Testosterone
Teriparatide
Denosumab
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11
Q

Dosing of Ca supplementation is based on…

A

elemental calcium

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12
Q

Supplemental Calcium: ADEs

A

hypophosphotemia
hypercalciumia

w/ carbonate:

  • gas, upset stomach, bloating, constipation
  • kidney stones
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13
Q

Cholecalciferol:

  • what is it
  • ADE’s
A

natural form vitamin D3

hypercalcemia (cardiac rhythm disturbance, HA, weakness)
hypercalcuria

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14
Q

Cholecalciferol: when to inc dose

A

malabsorption

anticonvulsants

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15
Q

When is ergocalciferol indicated?

A

vitamin D deficiency

*ergocalciferol = plant derived vitamin D2

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16
Q

Indications for calcitriol

A

renal osteodystrophy
hypoparathyroidism
refractory rickets

*calcitriol = 1,25 vitamin D

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17
Q

Bisphosphonates: agents

A

alendronate
ibandronate
risedronate
IV zoledronic acid

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18
Q

Which bisphosphonate is indicated only for postmenopausal women?

A

ibandronate

19
Q

Bisphosphonates: ADEs

A

Oral:
dyspepsia
nausea

IV:
transient flu like illness

Rare:
Perforation, ulceration, GI bleeding
Musculoskeletal pain
Atypical fractures (subtrochanteric femur fx)
ONJ (osteonecrosis of the jaw)
20
Q

Bisphosphonates: special instructions

A

administered in the morning
take on an empty stomach w/ plain water
remain upright 30-60min

21
Q

Bisphosphonates: MOA

A

inhibits bone resportion

**half life up to 10yrs

22
Q

Bisphosphonates: contraindications

A

CrCl < 30-35
serious GI conditions
pregnancy

23
Q

Bisphosphonates: drug holiday indications

A
  • w/o evidence of low trauma fx
  • responded well to therapy
  • BMD T score >-2
24
Q

Bisphosphonates: drug holiday (what is it)

A

stopping bisphosphonate therapy after 5 years in low risk patients (wait 10yrs in higher risk pts)

25
Q

Calcitonin: what is it

A

hormone released from thyroid gland in response to elevated serum Ca

antagonizes effects of PTH

3rd line tx for osteoporosis

26
Q

Calcitonin: what does it do

A

provides pain relief w/ acute vertebral fx

27
Q

Estrogen Agonist/Antagonist: agents

A

raloxifene, bazedoxifene

28
Q

Estrogen Agonist/Antagonist: MOA

A

dec bone resorption
inc bone mineral density
dec fx incidence

29
Q

What anabolic therapy is a recombinant product related to human PTH?

A

teriparatide

30
Q

Teriparatide: effects

A

inc bone formation
inc bone remodeling rate
inc osteoblast number, activity
improves bone mass/architecture

31
Q

Which drug therapy for osteoporosis is a synthetic analog of human PTH?

A

abaloparatide

32
Q

Abaloparatide: ADEs

A

dose dependent inc in incidence of osteosarcoma

33
Q

Which drug therapy for osteoporosis is a RANKL inhibitor?

34
Q

Denosumab: effects

A

inhibits osteoclatogenesis

inc osteoclast apoptosis

35
Q

Denosumab: ADEs

A 
msk pain
inc cholesterol
cystitis
dec serum Ca
skin problems
36
Q

Bisphosphonates: fracture effects

A

dec vertebral AND hip fx

37
Q

Denosumab: fracture effects

A

dec vertebral fx

38
Q

Teriparatide: fracture effects

A

dec vertebral fx

39
Q

First line osteoporosis treatments

A

alendronate
risedronate
zoledronic acid
denosumab

40
Q

Last resort agent for osteoporosis

A

calcitonin

41
Q

Additional treatment for osteoporosis

A

vertebroplasty/kyphoplasty

  • inject cement into fractured vertebral space
  • reduces pain
42
Q

Osteomalacia: etiology

A

MCC: sev prolonged vitamin D deficiency

  • diseases that cause hypophosphatemia
  • long term anticonvulstant therapy
43
Q

Osteomalacia: treatment

A

high dose vitamin D replacement therapy

PHA 551 (9 decks)

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