Osteoporosis Meds Flashcards
how many women and men over 50 will be affected by osteoporosis and experience a fx?
1 out of every 2 women and 1 out of every 4 men
majority are vertebral fxs
risk of different T scores associated with fx risk? What T score indicates osteopenia vs osteoporosis?
T score -1 = 2x risk
T score -2 = 4x the risk
T score -3 = 8x the risk
osteopenia T score -1 to -2.5
osteoporosis T score less than -2.5
*T score compares your pt to the entire population
*Z score compares your pt to ppl w/in their age group
RFs for osteoporosis?
gender - women generally have lower bone mass and lose bone more rapidly relative to men
body size - small statured women and thinner women
age - increasing age increases risk of developing osteoporosis
ethnicity - caucasian and asian women are at higher risk
Family hx - may be hereditary
diet low in Ca2+ and vit D
Sex hormones - low estrogen
inactive lifestyle or extended bed rest
excessive use of EtOH
use of certain meds like glucocorticoids and some anticonvulsants (phenytoin, dilantin), barbiturates, gonadotropin releasing hormone analogs, excessive use of aluminum-containing antacids, certain cancer txs, excessive thyroid hormones
eating disorders
main tx recommendation for osteoporosis?
lifestyle modifications - diet and exercise
variety of supplements and drugs are also available to help prevent and/or tx osteoporosis
osteoporosis prevention and tx considerations?
calcium vit D magnesium strontium bisphosphonates SERMs synthetic calcitonin hormone PTH analogs estrogen monoclonal abs/Anti-RANK ab
recommended amount of Ca intake for those 50 yo or less and for those over 50 yo? how much Ca2+ should breastfeeding women intake daily?
less than 50 yo is 1000 mg of Ca2+ per day
over 50 yo is 1200-1500 mg of Ca2+ per day
breastfeeding women should intake 2000 mg of Ca2+ a day
does calcium supplementation afford future fracture protection for women whom have already experienced a fracture?
not w/o the addition of other bone-building tx options
problem with calcium carbonate from oyster shells?
has been shown to have detectable levels of lead
soy can protect against fx at what levels?
those who ate 5 g a day decreased their fx levels, but even greater protection came at 13 grams (60 mg of soy isoflavones)
Vit D’s effect on bone health? how does it get activated?
Vit D is necessary for the absorption of Ca2+ in the stomach and GI tract
Vit D from sun exposure, food, supplements are biologically inert and have to undergo 2 hydroxylations - first occurs in the liver
recommended dosage for Vit D for individuals 1-70 yo; after 70 yo? how much do infants need per day?
1-70 yo need 600 IU a day
over 70 yo need 800 IU a day
infants need to be supplemented with 400 IU per day
what vitamins and minerals can you supplement with to help prevent osteoporosis?
magnesium
calcium
strontium
vit D
average dose of magnesium needed per day? SEs if take too much?
300 mg to 1000 mg per day
excessive magnesium intake can cause loose stool
how does strontium improve bone density?
improves osteoblastic activity (more bone getting laid down)
- strontium is incorporated in small amounts into hydroxyapatite crystal lattice where it remains bound for years or decades and may improve bone quality
- strontium atoms are adsorbed onto the surface of hydroxyapatite crystals, the probable site at which they stimulate bone formation, inhibit resorption and increase BMD
possible SEs of strontium? if taken in dosing over 2 g/d?
usu free of SEs other than mild GI upset and possible diarrhea
if more than 2 g/d taken can lead to weakened bone as it replaces bone’s calcium with strontium
medications approved by FDA for preventing and treating postmenopausal osteoporosis and in men and women with glucocoritcoid-induced osteoporosis? what class is each a part of?
bisphosphonates (alendronate)
raloxifene (a SERM)
medications approved for the tx of osteoporosis but not the prevention?
calcitonin/mialcin
teriparatide (synthetic PTH analogue) - can also be used in men who are at high risk for fracture
denosumab (human monoclonal ab approved by the FDA for tx)
medications approved for the prevention of postmenopausal osteoporosis?
estrogen or HRT