Osteoporosis (Chen) Flashcards
what are bisphosphonates?
- treatment AND prevention of osteoporosis
- 1st line
what are some pharmacokinetic features about bisphosphates?
- take on empty stomach
- not good for people with renal problems
–> eFGR < 35 mL/min/1.73m2
what are bisphosphonate drugs?
alendronate, risendronate, zoledronic acid, ibandronate
what are some adverse effects of bisphosphonates?
headache, musculoskeletal pain, nausea, abdominal pain, esophageal irritation, ect.
what are some counseling tips with bisphosphonates?
- must be taken on empty stomach
- drink full glass og plain water (6-8 oz)
- do not lie down for at least 30 minutes after indigestion AND until after first food of the day
- do not chew
what types of SERMs are used for osteoporosis?
- raloxifene
- bazedoxifene + conjugated estrogen
what is raloxifene used for?
- prevention AND treatment of osteoporosis
- breast cancer prophylaxis
what is bazedoxifene + conjugated estrogen used for?
Prevention with a uterus in postmenopausal women
tell me about MHT therapy in postmenopausal women with significant risk?
PREVENTION and has estrogen and progestin
what is special about ibandronate?
it is a bisphosphonate but it only protects against vertebra fractures and not hip
what is salmon-calcitonin used for?
TREATMENT >5 yr menopause
what is the dosing for ibandronate?
150 mg monthly
what is the dosing for alendronate?
- 5 mg daily for prevention
- 10 mg daily for treatment
what is the dosing for risedronate?
5 mg daily for both
what is the dosing for zoledronic acid?
- 5mg IV q2yr for prevention
- 5mg IV qyr for treatment
what is the dosing for raloxifene?
60mg daily
what is the dosing for bazedoxifene/ estrogen?
20mg/0.45mg daily
what is the dosing for calcitonin nasal spray?
200 mg in 1 nostril daily
what is denosumab?
- RANK ligand inhibitor
- TREATMENT for men and women
what is bad about denosumab?
rebound effect is caused by an increase in vertebral fracture after discontinuation of denosumab
–> consider indefinite treatment or
–> consider bisphosphate after discontinuation for exit strategy
what is a major side effect of denosumab and what should you do. or advised to do by the FDA?
- severe hypocalemia
- supplement at least 1000mg and Vitamin D 400 IU daily
what is the dosing of denosumab?
60mg SQ every 6 months
what is the teriparatide/ abaloparatide used for?
- parathyroid hormone
- TREATMENT in women
what is a black box warning for parathyroid hormones?
increased incidence of osteocarcinoma
–> 1 case/30000 but causality not observed
what are parathyroid hormones targeted for?
non-vertebral and vertebral
what does denosumab target?
both (hip/vertebral)
what does calcitrion target?
vertebral only
what do the SERMs target?
only vertebral
what is the max lifetime duration for parathyroid hormone and their dosing?
- teriparatide
–> 20mcg SQ daily
–> 2 years (may repeat) - abaloparatide
–> 80 mcg daily
–> 18 months
what is the list of treatment therapy for osteoporosis?
- alendronate, risendronate, zoledronic acid, denosumab
- ibandronate
- raloxifene
- calcitonin
- parathyroid hormones
what is romosozumab?
- Monoclonal anti-sclerostin antibody
- TREATMENT
what does romosozumab treat?
both vertebral and hip
what is an important note about romosozumab?
discontinuation results in bone loss and return of BMD to pre-treatment levels
–> consider subsequent treatment with bisphosphonate or denosumab
what is an adverse effect with romosozumab we need to watch out for?
it has an increased risk of stroke and MI so we need to avoid with people that have a history of HA or stroke within a yeaar
what is the dosing for romosozumab and lifetime max duration?
210 mg monthly (2 inj) & 12 months
when are treatments contraindicated in people with chronic kidney disease (CKD)? what is contraindicated when eGFr < 35?
alendronate, risendronate, ibandronate
what is considered low risk for osteoporosis treatment?
normal NMD above -1.0 and no prior fractures
what is considered moderate risk for osteoporosis treatment?
no prior fractures and BMD above -2.5
what is considered high risk for osteoporosis treatment?
prior fracture and BMD below -2.5
what is considered very high risk for osteoporosis treatment?
many fractures and BMD below -2.5
what is the treatment plan for all cases as discussed in the last slides of the lecture?
what is the algorithm for glucocorticoid induced osteoporosis in low risk?
ensure adequete calcium and vitamin D
what is the algorithm for glucocorticoid induced osteoporosis in mod-high risk?
- ensure adequate calcium and vtamin D
- high dose = prednisone > or equal to 30mg daily > 30 days
what is the fracture risk reduction breakdown of the medications on the fracture areas?
