Osteoporosis and hormone therapy Flashcards
the most common location of fracture
lower lumbar spine
a T score of what is indicative of osteoporosis
< -2.5
a T score of what is indicative of osteopenia
-1 to - 2.5
a T score of what indicates normal bone health
> -1
what are Z scores
compare a pt BMD to the mean BMD of a pt of their age and gender
what are T scores
compare a pt BMD to the BMD of a normal young adult of the same gender
cells involved in bone formation
osteoblast
break down bone, resorption
osteoclast
what are the high risk areas that a DEXA scan looks at
hips, lumbar vertebrae
at what age should ALL women get a DEXA scan
65
what is the purpose of the FRAX tool
estimates risk of fracture in the next 10 years
what steroid use is considered a risk of osteoporosis
prednisolone greater than 5mg or prednisone equivalent for > = 3 months
genetic factors for osteoporosis are most important with what races
white, asian
what are some risk factors for low bone density
> 2 alcoholic drinks a day, smoking, low vit d and ca intake over life, roid use for >= 3 months at > 5 mg prednisone equivalent dose, previous fracture, < 127 lbs, low physical activity for life, decrease estrogen (menopaus, hypogonadism, lactation, anorexia)
what are drugs that put you at risk for osteoporosis
long term steroid use ( >= 3 months @ > 5mg prednisolone or prednisone equivalent), warfarin, heparin, anticonvulsants (carbamazepine, phenytoin, fosphenytoin, phenobarbital), aromatase inhibitors (tx breast cancer), androgen blockers (treat prostate cancer), loop diuretics, excess thyroid hormone
bone accumulates until what age
30
when is calcium intake very important
childhood, pregnancy, menopause
vit d deficiency in children causes
rickets
vit d deficiency in adults causes
osteomalacia
recommended daily Ca intake for 14-18 y/o
1300 mg
recommended daily Ca intake for 19-50 y/o
1000 mg
recommended daily Ca intake for > 50 y/o
1200 mg
how much elemental Ca is in Ca-citrate
21%
how much elemental Ca is in Ca-carbonate
40%
daily Vit D recommendation for up to 70 y/o
600 IU
daily Vit D recommendation for > 70 y/o
800 IU
what is the preferred source of Vit D
cholicalciferol (Vit D3)
what is used 1st line in treatment of osteoporosis
bisphosphonates
what are the bisphosphonates (generic)
zolidronic acid, ibandronate, risedronate, alendronate
what agent will increase a patients fracture risk due to it decreasing calcium carbonate absorption
PPI
fosamax
alendronate
reclast
zoledronic acid injection
actonel
risedronate
boniva
ibandronate
dose of fosamax for prevention and treatment
5mg prevention 10mg treatment qd
daily dose of actonel
5 mg daily
monthly dose of boniva
150 mg
monthly dose of actonel
150 mg
Atelvia
long acting risedronate
what are the contraindication for oral bisphosphonates
inability to stand or sit upright for 30 mins, hypocalcemia, severe renal impairment (CrCl < 30)
at what CrCl is PO bisphosphonate use contraindicated
< 30
how long should bisphosphonates be used
3-5 years
why is there a time limit on how long bisphosphonates can be used
risk of atypical femur fracture, esophageal cancer, jaw necrosis
what are SE of bisphosphonates
back pain, joint pain, dyspepsia, dysphagia, esophagitis, GI issues, N/V
what must you notify the patient about taking Atelvia
no H2RA or PPI, seperate from Mg, Ca, Fe supplements
why should patients get dental work done before starting bisphosphonates
risk of jaw necrosis
Zometa
zoledronic acid injection
Reclast treats
osteoporosis, paget’s disease
zometa treat
hypercalcemia of malignancy
what is the dose and frequency of Reclast
5mg infusion yearly (treatment) or every 2 years (prevention)
what are the SE of Reclast
flu like syndrome: aches, runny nose, headache
what can be done to prevent the transient post dose syndrome seen with reclast
NSAID before and after infusion
at what CrCl is Reclast contraindicated
< 35
what are the lipid effects of raloxifene
decrease cholesterol and LDL
what is the black box warning for raloxifene
increase risk of thromboembolic events (DVT, PE, MI, stroke)
when is Raloxifene contraindicated
previous thromboembolism, hepatic dysfunction, pregnancy
what are the SE of Raloxifene
hot flashes, vaginal bleed/dischcarge, flushing, mood changes, htn
raloxifene is used most frequently in which women
that have fear of breast cancer or at risk
Evista
Raloxifene
Fortical
calcitonin
when is calcitonin contraindicated
salmon allergy
Forteo
teriparatide
what agents are used in patients at HIGH RISK for fracture
teriparatide, denosumab
what is the dose and frequency for teriparatide
20 mcg SQ injection daily
how long can a patient be on teriparatide
2 years
what is the black box warning for teriparatide
osteosarcoma
2/2 the black box warning of teriparatide caution must be used when using this agent in patients that have
paget’s disease, bone metastasis, hypercalcemia
what are the SE of teriparatide
dizziness, increase HR (especially with first few doses), injection site pain
Prolia
Denosumab
Xgeva
Denosumab
Prolia treats
osteoporosis
Xgeva treats
hypercalcemia of malignancy
when is use of denosumab contraindicated
hypocalcemia
what agents have a risk of atypical femur fractures and jaw necrosis
bisphosphonates, denosumab
if a patient is on a weekly schedule of bisphosphonate and they miss one dose what should they do
take the following morning (not 2 doses in 1 day)
if a patient is on a daily schedule of bisphosphonate and they miss one dose what should they do
skip until next dose
if a patient is on a monthly schedule of bisphosphonate and they miss one dose what should they do
take as soon as you remember (DON’T TAKE 2 IN ONE WEEK!!)
Zometa
zolidronic acid
Reclast treats
osteoporosis
Zometa treat
hypercalcemia of malignancy
Reclast is the same drug as
Zometa
what should you counsel the patient on taking teriparatide
may feel dizzy or have increased HR for first few doses so inject where you can sit or lie down right away
where should the pen for the teriparatide injection be kept
fridge
discard the teriparatide pen after
28 days
where do you inject teriparatide
thigh or abdomen (lower stomach)
how long can a patient take teriparatide
2 years
how long must you be sitting/standing upright when taking bisphosphonates
30 MINUTES, 60 minutes with monthly Boniva
when should Atelvia be taken
after breakfast
what should you not use w/ Atelvia
H2Ra, PPI, Mg, Ca, Iron supplements
what is the dose of raloxifene
60 mg qd
if a patient is experiencing nausea on fosamax or actonel what are you option
Switch to Atelvia (taken after breakfast) or Zoledronic acid (injection)
