Osteoporosis & Hip fracture Flashcards
Osteopenia means
low bone mass
term used for thinning of the trabecular matrix of the bone before osteoporosis.
osteoporosis means
pourous bone
severe osteoporosis means
osteoporosis with Hx of a fragility fracture
T scores bone density
Normal - 1 or greater
osteopenia between -1 and -2.5
osteoporosis and severe <= -2.5
hos is osteoporosis measured
DEXA scan
Osteoporosis: Characteristics (4)
Low bone mass
Micro-architectural deterioration
Increase in bone fragility
Susceptibility to fracture
Major Risk Factors of osteoporosis (9)
Older Female Asian/white Hx fractures family <127 lbs smoking alcohol Corticosteriods and immune suppression drugs
Other risk factors of osteoporosis
Thin and small frame Lack of weight bearing exercises Lack of calcium and vitamin D Eating disorders, gastric bypass surgery Lack of estrogen/testosterone Excess caffeine
What is bone remodeling
process of resorption and formation
What causes bone resorption or breakdown
osteoclasts
what causes bone formation
osteoblasts
ostoeporosis is caused when…
failure to make new bone
incresed resorption
or BOTH
Clinical Manifestations osteoporosis
+Early
None
\+Late Fractures Pain Loss of height Stooped posture
3 common fractures caused by osteoporosis
Hip : femur neck
wrist
Vertebrae: compression fracture
Risk Factors of hip fractures
Age: >65 Gender: Female Typical Medical Hx? Osteoporosis Frequent falls
most common fracture location
Femoral neck
Hip Fracture Clinical presentation
Sudden onset of hip pain before or after a fall
Inability to walk
Severe groin pain
Tenderness
Affected leg is externally rotated
Affected extremity is shortened
2 Complications of hip fracture and immobility
infection
venous thromboembolism
goal of pharm for osteoporosis
Reduce fractures
primary prevention supplements in osteoporosis
Calcium
Vitamin D
Treatment of osteoporosis
Promote bone formation
Decrease bone resorption** (most common)
Osteoporosis prevention regimine
Calcium
Diet + supplement (elemental Calcium)= 1200 to 2000 mg daily
Vitamin D
Diet + supplement = 800 to1,000 IU daily
Women’s Health Initiative Study
30% reduction in fractures
Exercise – at least 30 min 3 x’s/week
3 classes and drugs in treatment of Osteoporosis
Bisphosphonates (bis PHOS phon ates )
++Alendronate (Fosamax)
Selective estrogen receptor modulators
++Raloxifene (Evista)
Hormone therapy
++Calcitonin
Bisphosphonate Drug
Alendronate (Fosamax)
Alendronate is FDA approved for what
prevention and treatment
Reduces fractures by 50%
MOA of alendronate
Binds permanently to surfaces of bones
Inhibit osteoclasts
SE of alendronate
Most common: GI
Nausea, discomfort, diarrhea
Some risk of esophageal ulceration
Teaching regarding alendronate
Take with water
Do not lie down for ½ hour after taking
No food, drink, calcium or vitamins for 2 hours (b/c only 1% bioavailability)
Drug holiday – after 5 years take a break to reduce risk of jaw necrosis and esophageal cancer
Selective Estrogen Receptor Modulators (SERMs) Drug
Raloxifene (Evista)
MOA of raloxifene
mimics estrogen
inhibits bone resorption
What is the use of raloxifene
prevention and treatment
reduces risk of spinal fractures by 50%
SE of raloxifene
hot flashes
leg cramps
raloxifene patient teaching
Important to take adequate
Calcium and vitamin D
Discontinue at least 72 hrs before and during
Prolonged immobilization
Reason??
No tobacco or alcohol
Cannot use if pregnant
Black box – stroke seen in some
Hormone: bone resorption inhibitor
Calcitonin-salmon (Miacalcin)
MOA of calcitonin-salmon
inhibits bone removal by osteoclasts
what is calcitonin-salmon used for
treatment only
Reduces spinal fractures by 30%
have to take for 5 years to see benefit
Drug effects of calcitonin-salmon
Slows down bone loss
Increases spinal bone density
SE of callcitonin
can cause nasal irritation
stong safety profile
