Osteoporosis & Hormone Therapy Flashcards
What’s osteopenia?
Defined as a T-score btw -1 & -2.5
What’s Osteoblasts?
Cells involved in bone formation
OsteoBlast - Build Bones
What’s Osteoclasts?
Break-down of bone
OsteoClasts - Crack bone
What’s DEXA or DXA?
Bone scan performed by a dual energy x-ray absorptiometry machine
Risk factors for low bone density? Which is most important?
Genetic factors (most imp), Caucasians and Asian American women at highest risk
Advanced age
Low bone mineral density
Previous fracture (other than skull, facial bone, ankle, finger or toe)
More than 2 alcoholic drinks per day
Oral or IM glucocorticoid use > 3 months (daily dose of >= 5mg prednisone or equivalent)
Body wt < 127 pounds
Or low BMI < 21 kg/m^2
A decline in adult estrogen levels
Rheumatoid arthritis & lupus
Low level of physical activity & adequate nutrition - low over life span
Ca + Vit. D intake low over life span
Smoking
Drugs that put u at risk of osteoporosis risk?
Steroids (>= 5mg/d of prednisone equivalent for >= 3 months)
Depot medroxyprogesterone acetate
Anticonvulsants (CBZ, Fosphenytoin, phenobarbital, PHT, Primidone)
Warfarin & Heparin
Excess thyroid hormone
Loop diuretics
Aromatase inh
Nafarelin (Synarel) - used in endometriosis
Androgen blockers used for prostate CA
Proton pump inh used chronically (reduced Ca absorption due to reduced gastric PH)
Fall prevention measures?
Appropriate lighting
Floors are safe (thrips rugs/clutter/cords have been removed)
Storage (at reasonable heights)
Bathrooms have safety bars
Handrails are present on all stairs
Stairs are well-lit with non-skid treads or carpets
What’s req for all low bone density rx meds?
Ca + Vit. D
What should be accessed first in to presenting with low bone density?
Dietary intake of Ca
When’s adequate Ca intake most critical?
Children
In pregnancy
During yrs around menopause
Results of Vit D deficiency in children? Adults?
Children - Rickets
Adults - Osteomalacia
How should Ca be dosed? Why?
Ca doses should be divided
Ca absorption is saturable
Which Ca has a better absorption? Issue with this Ca?
Calcium citrate (Citracal, others) - tab has 315mg Ca
Larger tablet to swallow
Ca citrate absorption and PPIs?
Ca citrate may be preferred with little or no stomach acid
May use with PPIs
Disadvantage of Ca carbonate (Oscal, Tums etc)? How does this affect how it’s taken?
Ca carbonate has acid-dependent absorption
Should be taken with meals
What’s the NIH recommended Vit. D intake for people up to 70 yrs?
600 IU daily
What’s the NIH recommended Vit. D intake for people 71+ yrs?
800 IU daily
What’s the preferred source of Vit. D2 in renal dx or short-term in adults with deficiency to replenish stores?
Cholecalciferol or Vit. D3
What’s the 1st line in most pts with low bone density?
Bisphosphonates
Alt to oral Bisphosphonates with those with GI problems?
Injectable Bisphosphonates
Alt. in adherence issues?
Annual infusion of Zoledronic acid (Reclast)
What’s the duration of Bisphosphonates use? Why?
Stop after 3-5 yrs
Due to risk of atypical femur fracture, esophageal CA & osteonecrosis of the jaw
Role of Teriparatide inj (Forteo) in therapy?
In pts with osteoporosis with HIGH risk for fracture, or have already had an osteoporotic fracture, or have OP + need to take long-term steroids, or who can’t tolerate Bisphosphonates
Role of estrogen in therapy?
No longer first line for osteoporosis
May be useful short-term, in younger women w/o CI, esp due to time limit on Bisphosphonates
What’s used most commonly in women who are at risk or have fear of breast CA?
Raloxifene (Evista)
MOA of Bisphosphonates?
Work by inhibiting osteoclast activity
Uses of Bisphosphonates?
Prevention (osteopenia)
Tx (osteoporosis)
Paget’s dx
Glucocorticoid-induced osteoporosis
Zoledronic acid - used for hypercalcemia of malignancy
List Bisphosphonates
Alendronate (Fosamax, Binosto)
Risedronate (Actonel, Atelvia)
Ibandronate (Boniva)
Brand name of Alendronate?
Fosamax
Binosto
Brand name of Risedronate?
Actonel
Atelvia
Brand name of Ibandronate?
Boniva
Hows Alendronate (Fosamax, Binosto) dosed for osteoporosis?
70 mg PO weekly
SEs of Bisphosphonates?
Hypocalcemia (mild, transient)
Back pain
Arthralgias
Dyspepsia
N/V
Dysphagia
Heartburn
Esophagitis
Injectable Bisphosphonates?
Zoledronic acid (Reclast)
Brand name of Zoledronic acid (injectable Bisphosphonates)?
Reclast
MOA of Raloxifene?
An Estrogen agonist/Antagonist, also called selective estrogen receptor modulator (SERM) and reduced bone resorption
Brand name of Raloxifene?
Evista