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Clin Med- Endo > Osteoporosis Lecture > Flashcards

Osteoporosis Lecture Flashcards

1
Q

Take 30 mins before AM meal

Take with 8 oz cup of water

Remain upright for 30 mins

**can cause esophagitis

A

Alendronate (Fosamax) instructions

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2
Q

Cornerstone therapy for osteoporosis

A

Bisphosphonates

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3
Q

MOA for bisphosphonates

A

Inhibits osteoclastic bone resorption

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4
Q

Half life of bisphosphonates once in bone?

A

~10 years

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5
Q

How are bisphosphonates excreted?

A

In urine!

(must adjust dose if CC <35 mL/min)

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6
Q

If a pt has esophagitis but needs Bisphosphonates…what do you do?

A

Can give IV!

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7
Q

Side effects of Bisphosphonates?

A

Muscle, bone, joint pain

Dental concerns: non healing jaw post tooth extraction
**dental care is important for these pts!!!

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8
Q

Which bisphosphonates has less GI side effects..

Alendronate (Fosamax) or Risedronate (Actonel)?

A

Risedronate (Actonel)

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9
Q

Bisphosphonate tx duration should not exceed….

A

5 years

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10
Q

1st line osteoporosis tx?

2nd line?

A

Start with calcium/vitamin D

Then bisphosphonates (no more than 5 years)

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11
Q

Which drug is a nasal spray that inhibits osteoclast action

A

Calcitonin

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12
Q

What happens to intake and GI absorption of Ca with age?

A

Decreases!

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13
Q

should have 400-600 IU daily

A

Vitamin D2

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14
Q

If taken above recomended daily amount, can increase risk of MI and stroke, especially women >70 with CHD

A

Calcium

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15
Q

daily dose= 1200-1500 mg

A

Calcium

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16
Q

Pts taking calcium who are also on thiazide diuretics or glucocorticoids

..beware of?

A

hypercalcemia

17
Q

a skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture.

A

Osteoporosis

18
Q

Most common metabolic bone disease

Decreased bone matrix and mineral→ “thin bones”.

Women>Men, often asymptomatic early; later, bones fail structurally→fractures.

A

Osteoporosis

19
Q

Increases dramatically in puberty in response to gonadal steroids.

Peaks in young adults (early 20’s)

Determinants: age, race, genetics, gonadal steroids, timing of puberty, exercise, calcium intake and diet.

A

Bone density

20
Q

Begins before menses cease.

Accelerated loss in 1st _____ yrs post menopause.

Trabecular (cancellous)> Cortical (compact) bone loss.

A

5-10 years

21
Q

Sex hormone deficiency: post menopause; hypogonadism- M&W

Excess glucocorticoids (Cushing’s)

Hyperparathyroidism- ↑PTH

Thyrotoxicosis- ↑bone metabolism

Alcoholism, anorexia nervosa, Vit D deficiency.

A

Causes of bone loss (increased risk)

22
Q

bone mineral density 1.0 to 2.5 standard deviations (SD) below peak bone density

A

Osteopenia

23
Q

bone mineral density >2.5 standard deviations below peak bone density.

A

Osteoporosis

24
Q

Peak bone density = young healthy adult of same _____ and _____

A

gender and race

25
Q

It has been estimated that 1 out of 5 people with osteoporosis are….

A

MEN

26
Q

If a man appears to have multiple risk factors for osteoporosis..above which age should you consider getting a DEXA scan?

A

over 65

27
Q

typically looks at spinal bone, proximal femur and other bones at risk for fracture; includes eval of trabecular and cortical bone.

A

DEXA

28
Q

Rapid exam time

Useful for F/U changes in BD; response to Rx

Relatively inexpensive

Limited radiation exposure

A

Advantages of DEXA

29
Q

number of SD by which patient BD differs from peak BD of young healthy adults of same gender/race.

A

T score

30
Q

Osteoporosis: BMD > 2.5 SD below peak BD of young adults.

Presence of “Fragility” Fracture (spontaneous Fx, no trauma); means “severe osteoporosis” regardless of Dexa score)

Severe osteopenia: BMD of > 2 SD below peak BD of young adults (prophylaxis). Controversies regarding Rx (see below).

A

Initiate treatment for these!

31
Q

Can you reverse established osteoporosis?

A

NO

can ↑BD, ↓fractures, halt or slow progression.

32
Q

Use in patients with hypogonadism or premature menopause for prevention.

Inhibits osteoclastic bone resorption.

Prevents bone loss, fractures.

Problems (dose related): ↑risk breast Ca, ↑risk endometrial cancer (if not coupled with progestins), ↑thromboembolic events, ↑in coronary events (when combined with progesterone).

A

Estrogen replacement

33
Q

All patients at ↑risk for osteoporosis (fam hx, malnourished, alcoholism, renal failure)
including early postmenopause + risk factors, or age >65.

A

Should be screened!

34
Q

Inhibit osteoclastic bone resorption; ↑bone density, ↓fractures (vertebral and elsewhere).

Very long T½ once in bone (≈ 10 years!)

first line tx!

A

Bisphosphonates

35
Q

Prior fractures

FH of osteoporosis related fractures

Low body weight

Cigarette consumption

Excessive ETOH use

Chronic inflammation: RA

Patients at risk for falls or frailty

A

Risk factors for fractures in women with osteoporosis

36
Q

Alternative to estrogen in post-menopausal woman with ↓risk of adverse effects; decrease bone loss, ↑bone density (less than estrogen), ↓ vertebral fractures.

A

SERMS

37
Q

blocks estrogen effects on breast and uterus.

Does not cause endometrial hyperplasia, cancer or uterine bleeding.

↓↓’s incidence of breast cancer; ↑risk of thromboembolism (like estrogen).

Increases hot flashes

A

Raloxifene (Evista)

drug class: SERMS

38
Q

New- monoclonal antibody that deceases bone resorption by inhibiting osteoclasts. Increases BD in men and post menopausal women, ↓’s spine and hip fractures. SC injection 2x/yr.

MOA: Antibody to receptor activator of the nuclear factor-kappa B ligand, which is a key mediator of the resorptive phase of bone remodeling

A

Denosumab (Prolia)

39
Q

Indication for patients:

With prior osteoporotic fractures

Who cannot tolerate other meds

Who developed fracture in spite of other Rx

With multiple risk factors for fractures

With autoimmune or inflammatory disease (ulcerative colitis)– 1st line therapy

A

Denosumab

Clin Med- Endo (7 decks)

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