Osteoporosis Flashcards
What kind of drug is Teriparatide (forteo)
PTH- synthetic formulation
used to prevent bone breakdown
lifestyle modifications for pts with osteoporosis
30 min weight bearing exercise
reduce/ stop caffeine, ETOH, smoking
when/ where is calcitonin produced
Thyroid Gland in response to elevated calcium levels
what happens with intermittent PTH stimulation?
Bone Anabolism
AE: increased risk of CV disease and breast cancer and increased risk of thromboembolism
HRT
Hormone Replacement Therapy
At high concentrations increases trabecular bone mass. when is it useful?
Fluoride
- useful in BMD > 3 SD below normal
MOA: localizes to sites of bone resorption, inhibit osteoclast , concentrate ini mineralized bone matrix
Bisphosphonates
outline a treatment plan for pt with oosteoporosis
Risedronate (Actonel) Ibandronate (Boniva) Zoldedronate (Reclast) Calcium 2,000 mg daily- watch for constipation Vit D3 -5,000 IU
how does chronic kidney disease affect bone mineral homeostasis via ______?
secondary hyperparathyroidism
Who is 2nd line for Teriparatide (forteo) ?
Postmenopausal women and men with significant bone loss
AE: reflux, esophageal ulcers, jaw osteonecrosis*
Bisphosphonates
Drug that decreases PTH and calcium levels
for tx of secondary hyperthyroidism
Cinacalcet (Sensipar)
what is clinical use for calcitriol and paricalcitol ?
calcitriol is active form of vit D (does not need to be converted) *
paricalcitol is synthetic analogue of vit D *
MOA: suppresses transcription of genes encoding cytokines that induce osteoclast proliferation, differentiation, amd activation
HRT
Hormone Replacement Therapy
MOA: increase BMD via estrogen receptor agonism in bone
SERMs
AE: postmenopausal osteoporosis: back pain, pain in extremity, hypercholesterolemia, musculoskeletal pain and cystitis
Bone loss due to hormone ablation for cancer: arthralgia musculoskeletal pain
Denosumab (Prolia)
preventative therapy for glucocorticoid induced osteoporosis
calcium/ vitamin D, bisphosphonates, lifestyle modifications
fully human monoclonal antibody that inhibits RANKL
*always check creatinine and Ca before administration
Preg Cat X
SQ every 6 months
Denosumab (Prolia)
AE: Increased risk of thromboembolism
SERMs
MOA: activates receptor on osteoclasts, decreasing resorptive activity
Calcitonin
What is a benefit of Renvela over Renagel?
What pts would benefit from use of sevelamer?*
Renagel can cause metabolic acidosis
Renvela is buffered so it avoids metabolic acidosis
pts with Hypercalcemia
MOA for glucocorticoid induced osteoporosis
inhibition of osteoblast activity, stimulation of osteoclast proliferation, decreased intestinal Ca absorption, increased renal Ca excretion
From salmon, given SQ, IM or intranasal
Calcitonin
In what pts would calcitriol and paricalcitol be used instead of cholecalciferol (B3) and Ergocalciferol (B2)?
Hypoparathyroidism pts
what kind of pt would benefit from ca based phosphate binders?*
Hyperparathyroid pt with hyperphosphatemia and HYPOcalcemia*
1st line drug of choice for osteoporosis? What shoudl you tell pts?
Bisphosphonates
Stay upright for 30 min after taking to avoid reflux*
How does PTH increase plasma Ca levels
increasing osteoclastic activity, increasing Ca absorption in intestine, and increasing vit D hydroxylation
Greatest risk for osteoporosis
Long term steroid use
How to dose Teriparatide (Forteo)?
SubQ
Once a day (or less) favors bone anabolism (growth)
higher doses continuously favors bone catabolism
