Osteoporosis and minimal-trauma fracture Flashcards
What are 4 antiresorptive drugs for osteoporosis?
- Alendronate
- Risedronate
- Zoledronic acid
- Denosumab
What are 2 advantages of alendronate as an antiresorptive drug for osteoporosis?
- Oral dosing
- Low cost
What are 4 disadvantages of alendronate as an antiresorptive drug for osteoporosis?
- Can cause or exacerbate upper gastrointestinal tract irritation
- Absorption reduced by food, antacids, calcium, magnesium and iron
- Requires more frequent dosing than intravenous options
- Not recommended in severe kidney disease
What are 3 advantages of risedronate as an antiresorptive drug for osteoporosis?
- Oral dosing
- Low cost
- Enteric-coated formulation available (may have a lower incidence of gastrointestinal adverse effects, and absorption less affected by food, antacids, calcium, magnesium and iron)
What are 5 disadvantages of risedronate as an antiresorptive drug for osteoporosis?
- Can cause or exacerbate upper gastrointestinal tract irritation
- Absorption reduced by food, antacids, calcium, magnesium and iron
- Requires more frequent dosing than intravenous options
- Not recommended in severe kidney disease
- Enteric-coated formulation only available as a weekly dose (non–enteric-coated formulation available as a monthly dose)
What are 2 advantages of zoledronic acid as an antiresorptive drug for osteoporosis?
- Intravenous administration avoids gastrointestinal adverse effects
- Yearly dosing can improve adherence
What are 5 disadvantages of zoledronic acid as an antiresorptive drug for osteoporosis?
- Intravenous administration not acceptable to some patients
- Not recommended in severe kidney disease
- Can cause transient influenza-like symptoms
- Can cause uveitis (uncommon)
- Can cause hypocalcaemia (particularly in patients with impaired kidney function)
What are 3 advantages of denosumab as an antiresorptive drug for osteoporosis?
- Subcutaneous administration avoids gastrointestinal adverse effects
- Dose adjustment not required in kidney disease
- 6-monthly dosing can improve compliance
What are 5 disadvantages of denosumab as an antiresorptive drug for osteoporosis?
- Subcutaneous dosing not acceptable to some patients
- Adherence to 6-monthly dosing regimen is essential to prevent loss of bone mineral density between doses
- Therapy must be either indefinite, or replaced by a bisphosphonate if stopped
- Late doses (more than 4 weeks) are associated with an increased risk of multiple spontaneous vertebral fracture
- Can cause hypocalcaemia (particularly in patients with impaired kidney function, vitamin D deficiency or a malabsorption disorder)
What is the first site where bone density starts to fall in osteoporosis?
The spine
What are the 3 main fragility sites in which fractures may be suggestive of osteoporosis?
- Spine
- NOF
- Wrist
What should you always consider in a patient who has a fracture?
The possibility of osteoporosis (especially if the fracture was from minimal impact)
What monitoring is required before starting anastrozole?
Measure BMD at baseline; calcium and vitamin D supplementation is recommended for all women; further monitoring and treatment depends on baseline BMD and other risk factors for osteoporosis
What are 4 key points to cover when counselling on denosumab?
- It is very important that you have your injection every 6 months (or as close to this as possible), or this medication may lose its effect
- It is very important that you regularly take your calcium and vitamin D supplements to make sure your level in the body doesn’t get too low
- Make sure you tell your dentist you have these injections, as this can affect certain dental procedures.
- Tell your doctor if you have symptoms of low blood calcium (e.g. muscle spasms, twitches, cramps, numbness or tingling in fingers, toes or around your mouth).
What is an important counselling point regarding the timing of denosumab?
It is very important that you have your injection every 6 months (or as close to this as possible), or this medication may lose its effect
