Osteoporosis (Chen)

Question 1

what are bisphosphonates?

Answer 1

1. treatment AND prevention of osteoporosis
2. 1st line

Question 2

what are some pharmacokinetic features about bisphosphates?

Answer 2

1. take on empty stomach
2. not good for people with renal problems
   –> eFGR < 35 mL/min/1.73m2

Question 3

what are bisphosphonate drugs?

Answer 3

alendronate, risendronate, zoledronic acid, ibandronate

Question 4

what are some adverse effects of bisphosphonates?

Answer 4

headache, musculoskeletal pain, nausea, abdominal pain, esophageal irritation, ect.

Question 5

what are some counseling tips with bisphosphonates?

Answer 5

1. must be taken on empty stomach
2. drink full glass og plain water (6-8 oz)
3. do not lie down for at least 30 minutes after indigestion AND until after first food of the day
4. do not chew

Question 6

what types of SERMs are used for osteoporosis?

Answer 6

1. raloxifene
2. bazedoxifene + conjugated estrogen

Question 7

what is raloxifene used for?

Answer 7

1. prevention AND treatment of osteoporosis
2. breast cancer prophylaxis

Question 8

what is bazedoxifene + conjugated estrogen used for?

Answer 8

Prevention with a uterus in postmenopausal women

Question 9

tell me about MHT therapy in postmenopausal women with significant risk?

Answer 9

PREVENTION and has estrogen and progestin

Question 10

what is special about ibandronate?

Answer 10

it is a bisphosphonate but it only protects against vertebra fractures and not hip

Question 11

what is salmon-calcitonin used for?

Answer 11

TREATMENT >5 yr menopause

Question 12

what is the dosing for ibandronate?

Answer 12

150 mg monthly

Question 13

what is the dosing for alendronate?

Answer 13

1. 5 mg daily for prevention
2. 10 mg daily for treatment

Question 14

what is the dosing for risedronate?

Answer 14

5 mg daily for both

Question 15

what is the dosing for zoledronic acid?

Answer 15

1. 5mg IV q2yr for prevention
2. 5mg IV qyr for treatment

Question 16

what is the dosing for raloxifene?

Answer 16

60mg daily

Question 17

what is the dosing for bazedoxifene/ estrogen?

Answer 17

20mg/0.45mg daily

Question 18

what is the dosing for calcitonin nasal spray?

Answer 18

200 mg in 1 nostril daily

Question 19

what is denosumab?

Answer 19

1. RANK ligand inhibitor
2. TREATMENT for men and women

Question 20

what is bad about denosumab?

Answer 20

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

Question 21

what is a major side effect of denosumab and what should you do. or advised to do by the FDA?

Answer 21

1. severe hypocalemia
2. supplement at least 1000mg and Vitamin D 400 IU daily

Question 22

what is the dosing of denosumab?

Answer 22

60mg SQ every 6 months

Question 23

what is the teriparatide/ abaloparatide used for?

Answer 23

1. parathyroid hormone
2. TREATMENT in women

Question 24

what is a black box warning for parathyroid hormones?

Answer 24

increased incidence of osteocarcinoma
–> 1 case/30000 but causality not observed

Question 25

what are parathyroid hormones targeted for?

Answer 25

non-vertebral and vertebral

Question 26

what does denosumab target?

Answer 26

both (hip/vertebral)

Question 27

what does calcitrion target?

Answer 27

vertebral only

Question 28

what do the SERMs target?

Answer 28

only vertebral

Question 29

what is the max lifetime duration for parathyroid hormone and their dosing?

Answer 29

1. teriparatide --> 20mcg SQ daily --> 2 years (may repeat) 2. abaloparatide --> 80 mcg daily --> 18 months

Question 30

what is the list of treatment therapy for osteoporosis?

Answer 30

1. alendronate, risendronate, zoledronic acid, denosumab 2. ibandronate 3. raloxifene 4. calcitonin 5. parathyroid hormones

Question 31

what is romosozumab?

Answer 31

1. Monoclonal anti-sclerostin antibody 2. TREATMENT

Question 32

what does romosozumab treat?

Answer 32

both vertebral and hip

Question 33

what is an important note about romosozumab?

Answer 33

discontinuation results in bone loss and return of BMD to pre-treatment levels --> consider subsequent treatment with bisphosphonate or denosumab

Question 34

what is an adverse effect with romosozumab we need to watch out for?

Answer 34

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

Question 35

what is the dosing for romosozumab and lifetime max duration?

Answer 35

210 mg monthly (2 inj) & 12 months

Question 36

when are treatments contraindicated in people with chronic kidney disease (CKD)? what is contraindicated when eGFr < 35?

Answer 36

alendronate, risendronate, ibandronate

Question 37

what is considered low risk for osteoporosis treatment?

Answer 37

normal NMD above -1.0 and no prior fractures

Question 38

what is considered moderate risk for osteoporosis treatment?

Answer 38

no prior fractures and BMD above -2.5

Question 39

what is considered high risk for osteoporosis treatment?

Answer 39

prior fracture and BMD below -2.5

Question 40

what is considered very high risk for osteoporosis treatment?

Answer 40

many fractures and BMD below -2.5

Question 41

what is the treatment plan for all cases as discussed in the last slides of the lecture?

Answer 41

Question 42

what is the algorithm for glucocorticoid induced osteoporosis in low risk?

Answer 42

ensure adequete calcium and vitamin D

Question 43

what is the algorithm for glucocorticoid induced osteoporosis in mod-high risk?

Answer 43

1. ensure adequate calcium and vtamin D 2. high dose = prednisone > or equal to 30mg daily > 30 days

Question 44

what is the fracture risk reduction breakdown of the medications on the fracture areas?

Answer 44