Osteoporosis & Menopause Flashcards
1
Q
T-Scores
A
- DEXA measures BMD for T-score
- Should be tested in women >= 65 yo, men >= 70 yo, and younger patients with high-risk for fracture
- Normal >= -1
- Osteopenia -1 to -2.4
- Osteoporosis =< -2.5
2
Q
Medications with Osteoporosis Risk
A
- Anticonvulsants (carbamazepine, phenytoin, phenobarbital)
- Aromatase inhibitors
- Depo-medroxyprogesterone
- GnRH
- Lithium
- PPIs
- Steroids (>= 5 mg/d of prednisone or equivalent for >= 3 months)
- Thyroid hormones (excess)
- Other: heparin, loop diuretics, SSRIs, TZDs
3
Q
Calcium
A
- Recommended Daily: 1000-1200 mg elemental calcium/d
- Don’t exceed 500-600 mg of Ca per dose
- Calcium carbonate - 40% elemental, acid-dependent (DON’T use with PPIs), take with meals
- Calcium citrate - 21% elemental, not acid-dependent, take at any time
- SE: constipation
4
Q
Citamin D
A
- Required for calcium absorption
- Deficient when Vitamin D < 30 ng/mL
- Treat deficiency with 5000-7000 IU/d OR 50,000 per week
- Take for 8-12 weeks then reduce to maintenance dose (1000-2000 IU/d)
- SE: constipation
5
Q
Fosamax
A
- Alendronate
- Bisphosphonate: first-line for osteoporosis treatment and prevention
- Treatment: 10 mg PO QD or 70 mg PO Qweek (men and postmenopausal females)
- Prevention in postmenopausal women ONLY (half doses)
6
Q
Actonel
A
- Risedronate
- Prevention/Tx postmenopausal women: 5 mg PO QD, 35 mg PO Qweek, 75 mg PO x2d/month
- Treatment in males is weekly dose
- Atelvia (DR) - requires acidic gut, DON’T use with PPIs or H2RAs
7
Q
Boniva
A
- Ibandronate
- Postmenopausal women only, prevention and tx
- Dose: 150 mg PO Qmonthly
- OR 3 mg IV Q3months
8
Q
Bisphosphonate Information
A
- CI: Hypocalcemia, inability to sit up or stand for 30 minutes (60 for Boniva)
- Warning: ONJ, femur fracture, esophagitis/ulcers/erosions, hypocalcemia, renal impairment (DON’T use if CrCl < 35 for alendronate, 30 for others)
- SE: Dyspepsia, dysphagia, heartburn, N/V, hypocalcemia
- Dental work should be done BEFORE starting treatment due to ONJ risk
- Separate from calcium, iron, antacids, and magnesium by at least 2 hours
9
Q
Reclast
A
- Zoledronic Acid
- Zometa - for hypercalcemia of malignancy
- Tx (male and postmenopausal women) - 5 mg IV once yearly
10
Q
Injectable Bisphosphonate Information
A
- CI: Hypocalcemia
- Warning: Same as oral bisphosphonates (don’t use zoledronic acid if CrCl < 35)
- Preferred if esophagitis is present due to increased risk of esophageal cancer
11
Q
Evista
A
- Raloxifene: SERM (decreases bone resorption)
- Used for prevention and tx (postmenopausal women only)
- Box warning: increased stroke and VTE risk
- CI: VTE and preggo
- SE: Hot flashes, peripheral edema, arthralgia, leg cramps
12
Q
Duavee
A
- Conjugated estrogens/bazedoxifene
- Used for prevention in postmenopausal women WITH a uterus
- Equine SERM/estrogen combination
- Box Warning: endometrial cancer (unopposed estrogen), increased DVT/stroke risk
- CI: Breast cancer, pregnancy, uterine bleeding, hx/active VTE
- Warning: increased breast and ovarian cancer risk (unopposed estrogen)
13
Q
Miacalcin
A
- Calcitonin: inhibits bone resorption by osteoclasts
- Nasal spray or injection
- Spray in one nostril daily (alternate)
- Warning: Hypocalcemia, increased malignancy risk, allergic reaction to salmon-derived products
14
Q
Forteo
A
- Teriparatide
- Analog of PTH which stimulants osteoblasts and bone formation
- Injection (needles not included)
- Box warning: osteosarcoma (bone cancer)
- Warning: HYPERcalcemia
- SE: Arthralgia, leg cramps, nausea, orthostasis/dizziness
- Keep refrigerated and protect from light
15
Q
Prolia
A
- Denosumab
- Monoclonal antibody that binds to RANKL and percent osteoclast formation
- Used for osteoporosis patients with high-risk of fracture
- Injection: 60 mg SQ Q6months
- CI: hypocalcemia, preggo
- Warning: ONJ, femur fractures, hypocalcemia
- SE: Hypotension, fatigue, edema, dyspnea, HA, N/V/D, decreased phosphate
- Xgeva - used for hypercalcemia of malignancy and bone tumor
