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PowPak MTM > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

What is the most common bone disorder in the US?

A

Osteoporosis

  • 8 million women
  • 2 million men
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2
Q

How is osteoporosis defined?

A

A reduction in bone strength that leads to increased fracture risk

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3
Q

Why is osteoporosis considered a silent disease?

A

Patients are often asymptomatic until a fracture occurs

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4
Q

What are signs and symptoms of osteoporosis if they do occur?

A 
Fracture related
-pain
-lack of mobility
-depressed mood due to physical limitations 
-decreased height 
—greater than 1.5 inch loss
-rounding of the spine
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5
Q

What does osteoporosis result from?

A

Imbalance in bone remodeling
-osteoclast activity (bone resorption) exceeds osteoblast activity (bone formation)
—causes decreased bone mineral density (BMD)

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6
Q

When does the imbalance in bone modeling occur?

A

A normal age related process

  • begins around age 30
  • for women: becomes more apparent after menopause
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7
Q

What are important ways to develop and maintain adequate BMD?

A
  • physical activity

- adequate vitamin D and calcium intake

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8
Q

What are other factors that can contribute to low BMD or osteoporotic fracture?

A

-low body weight
-premature menopause
-chronic disease
-smoking
-alcohol use
—3 or more drinks per day
-medications
—corticosteroids

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9
Q

How is osteoporosis diagnosed clinically?

A

Presence of a fracture without major trauma

-known as a fragility fracture

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10
Q

What scan is used to diagnose osteoporosis based on BMD?

A

-DXA
—dual energy x-ray absorptiometry
—measures bone density at the hip and spine

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11
Q

What does the DXA report include?

A
  • actual bone density
  • T score
  • Z score
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12
Q

What is the T score?

A
  • used for diagnosis
  • compares the patient’s bone density to the peak bone density of a healthy 20-29 year old adult
  • is the number of standard deviations from the mean reference population
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13
Q

What is the Z score?

A

Compares the patient’s bone density to that of an individual of the same:

  • age
  • sex
  • ethnic background
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14
Q

When are Z scores used?

A

To help diagnose osteoporosis in:

  • men younger than age 50
  • children
  • premenopausal women
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15
Q

What organization has defined bone density levels?

A

The World Health Organization (WHO)

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16
Q

What tool calculates the estimated risk of fracture based on BMD and individual patient factors, developed by the WHO?

A

The Fracture Risk Assessment Tool (FRAX)

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17
Q

How can the incidence of osteoporosis be reduced?

A
  • by optimizing skeletal development and peak bone mass early in life
  • prevention of age related and secondary causes of bone loss
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18
Q

What are the goals once osteoporosis develops?

A
  • prevent fractures
  • stabilize the skeletal system
  • improve strength and bone mass
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19
Q

What organizations provide recommendations for the prevention and management of osteoporosis using both lifestyle modifications and pharmacologic therapies?

A
  • American Academy of Clinical Endocrinologists (AACE)
  • American College of Rheumatology (ACR)
  • National Osteoporosis Foundation (NOF)
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20
Q

What organizations provide additional guidelines that focus on the pharmacologic treatment of osteoporosis?

A
  • Endocrine Society
  • American Society for Bone and Mineral Research (ASBMR)
  • American College of Physicians
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21
Q

What can reduce the risk of fractures?

A

-maintenance of a bone healthy lifestyle

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22
Q

What is adequate calcium intake essential for?

A
  • development of bone mass during childhood

- maintenance of bone mass throughout life

23
Q

How should calcium be primarily obtained?

A

Through a patient’s diet

24
Q

When is calcium supplementation recommended?

A

When dietary intake is inadequate?

25
Q

What are calcium intake recommendations based on?

A

Amount of elemental calcium in each product?

26
Q

How much elemental calcium is in calcium carbonate?

A

40% elemental calcium

-1250mg contains 500mg of elemental calcium

27
Q

When is pharmacologic treatment recommended for osteoporosis?

A

-postmenopausal women or men who are at least 50 years of age with:
—T scores less than 2.5 in the:
—

28
Q

What determines the choice of pharmacologic therapy for osteoporosis?

A

Based on anti-fracture benefits demonstrated in clinical studies

29
Q

What are first line agents recommended by the AACE for osteoporosis?

A
  • alendronate
  • risedronate
  • zoledronic acid
  • denosumab
30
Q

What agents are recommended for patients at low or moderate risk of fractures?

A

Oral agents

31
Q

For which patients are injectable medications preferred as initial therapy for osteoporosis?

A
  • very high fracture risk
  • GI concerns
  • difficulty remembering or adhering to a medication schedule
32
Q

What do the 2019 guidelines from the Endocrine society recommend as first line therapy in postmenopausal women at high risk of fractures?

A

Bisphosphonates

33
Q

Which bisphosphonate is not recommended by the Endocrine Society and for which patients?

A

Ibandronate
-not recommended to reduce:
—nonvertebral fractures
—hip fractures

34
Q

When is denosumab recommended?

A

Alternative initial treatment

35
Q

When are parathyroid hormone analogs (teriparatide and abaloparatide) recommended?

A

Reserved for postmenopausal women at very high risk of fracture?

36
Q

When are the selective estrogen receptor modulators (raloxifene and bazedoxifene) recommended?

A

Can be used in patients who have a low risk of thromboembolism
—when bisphosphonates or denosumab are inappropriate
-reduce the risk of vertebral fractures

37
Q

When is calcitonin recommended?

A

Last line agent

-recommended only in patients who do not tolerate any other therapy

38
Q

When is romosozumab recommended?

A

Not yet addressed in clinical practice guidelines

39
Q

What is one of the most significant adverse effects of glucocorticoid therapy?

A

Osteoporosis

40
Q

Who published guidelines in 2017 for the prevention and treatment of osteoporosis in patients who are treated with glucocorticoids?

A

ACR

41
Q

Describe the 2017 ACR guidelines for osteoporosis related to glucocorticoids.

A

-all patients practice a bone healthy lifestyle
-optimize calcium and vitamin D
-specific pharmacologic agents recommended based on age and risk factors
-oral bisphosphonate recommended for patients:
—at least 40 years of age with:
—

42
Q

What is an important consideration with bisphosphonate therapy?

A

Duration of therapy to:

  • maximize benefits
  • minimize adverse effects
43
Q

How long is bisphosphonate therapy recommended to be continued in patients at high risk of fractures?

A
  • oral therapy for up to 10 years

- IV therapy for up to 6 years

44
Q

How long is bisphosphonate therapy recommended to be continued in patients at lower risk of fractures?

A

Initially, 3 to 5 years

-then drug holiday for 2 or 3 years

45
Q

How is oral bisphosphonate therapy administered?

A

NOT at the same time as food or other medications

46
Q

What are the dosing instructions for the administration of bisphosphonates?

A

-first thing in the morning
-on an empty stomach
-with 6 to 8 ounces of plain (not mineral) water
-do NOT eat or drink (except water) and remain upright for at least 30 minutes
—60 minutes with ibandronate

47
Q

Coadministration with what drugs may increase the risk of GI effects with bisphosphonates?

A
  • aspirin

- NSAIDs

48
Q

Which osteoporosis medication is highly protein bound?

A

Raloxifene

-caution when coadministering with other highly protein bound drugs

49
Q

What drug interaction with Raloxifene must be closely monitored?

A

Warfarin

-can decrease the prothrombin time by 10%

50
Q

Describe the drug interaction potential of denosumab.

A

Minimal drug interactions
-may enhance the adverse effects of immunosuppressant medications
—

51
Q

Describe the drug interaction potential of teriparatide.

A

Digoxin

-risk of hypercalcemia due to teriparatide may cause toxicity in patients taking Digoxin

52
Q

Describe the drug interaction potential of abaloparatide or romosozumab.

A

No known drug interactions

53
Q

What are the Focus Points for MTM in osteoporosis?

A

-goals of treatment are to:
—prevent loss of BMD
—

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