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Female and Male Health > Osteoporosis, Menopause and Testosterone Use > Flashcards

Osteoporosis, Menopause and Testosterone Use Flashcards

1
Q

Osteoblasts definition?

A

Bone formation

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2
Q

Osteoclast definition?

A

Bone resorption, break-down

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3
Q

What is the golden standard for measuring BMD

A

Dual energy X-ray absorptiometry (DEXA or DXA)

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4
Q

How is Osteoporosis diagnosed?

A

T-score or Z-score

T-score: compares the patient’s measured BMD to the average peak BMD of a healthy, young white adult of the same age

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5
Q

What patient population should have BMD measured

A

Women ≥ 65 years

Men ≥ 70 years

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6
Q

Interpreting T-score

A

Normal: ≥ -1
Osteopenia (low bone mass): -1 to -2.4
Osteoporosis: ≤ - 2.5

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7
Q

What is the recommendation of daily Calcium intake for most adults?

A

1,000 - 1,200mg elemental calcium

MDD: 500 - 600mg elemental calcium per dose

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8
Q

How much elemental calcium dose Calcium Carbonate have?

What is the brand names?

Clinical pearls?

A
  • 40%
  • 1g of calcium carbonate = 400 mg elemental
  • Tums, Oscal
  • Must take with meals
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9
Q

How much elemental calcium dose Calcium Citrate have?

What is the brand names?

Clinical pearls?

A
  • 21%
  • 1g of calcium citrate = 210 mg elemental
  • Citracal
  • Can take with or without food
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10
Q

What is considered serum vitamin D deficient?

A

25(OH)D < 30 ng/ml

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11
Q

What is the first line therapy for Osteoporosis?

A

Bisphosphonates

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12
Q

Bisphosphonates clinical pearl

A
  • Stay upright for 30 minutes

- Drink 6 - 8 oz of plain water

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13
Q

Bisphosphonates ADE

A
  • Esophagitis
  • Musculoskeletal symptoms
  • Hypocalcemia

Rare but serious:

  • Osteonecrosis of the jaw (ONJ)
  • Atypical femur fractures
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14
Q

When is Denusumab (Prolia) recommended?

A

It is recommended as an alternative to Bisphosphonates

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15
Q

Denusumab (Prolia) dosing

A

SubCu every 6 months

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16
Q

Denusumab (Prolia) ADE

A

Hypocalcemia

17
Q

When are Teriparatide (Forteo) and Abaloparatide (Tymlos) recommended?

A

They are recommended in very high risk patients only

18
Q

Teriparatide (Forteo) and Abaloparatide (Tymlos) dosing

A

SubCu daily

19
Q

Teriparatide (Forteo) and Abaloparatide (Tymlos) ADE

A

Hypercalcemia

Because they are Parathyroid Hormone 1-34 agents, just like Sensipar which also causes hypercalemia.

20
Q

When Raloxifene (Evista) recommended?

A

Recommended as an alternative to bisphosphonates for:

***High risk patients of Vertebral fracture

and

***Low-risk of VTE or High-risk of breast cancer

Note: Also used for breast cancer

21
Q

Criterial for initiating treatment:

What is considered Osteopenia if high risk

A

Low bone density (T-score b/w -1 and -2.5) at the femoral neck, total hip or lumbar spine

AND

FRAX score indicates a 10 year probability of ≥ 20% for a major osteoporosis-related fracture
OR
a 10 year hip fracture probability ≥ 3%

22
Q

When is Bazedoxifene/Estrogens (Duavee) recommended?

A
  • Recommended as an alternative to bisphosphonates for high risk patients of Vertebral fracture
  • Only in patients with intact uterus
23
Q

Bisphosphonates agents

A
  • Alendronate (Fosamax); PO
  • Risedronate (Actonel); PO
  • Ibandronate (Boniva); PO and SubCu
  • Zoledronic Acid (Reclast); SubCu
24
Q

Estrogen agonist/antagonist contining agents

A
  • Raloxifene (Evista)
  • Bazedoxifene/Estrogens (Duavee)

Note: Both are of the class SERM

25
Q

Parathyroid Hormone 1-34 agent

A
  • Teriparatide (Forteo)

- Abaloparatide (Tymlos)

26
Q

What is the FRAX score?

A

It is a tool which estimates the risk of osteoporotic fracture in the next 10 years

27
Q

Why is vitamin D important in osteoporosis therapy management?

A

Because it is needed for Calcium absorption

28
Q

What drug class is Denusumab (Prolia) in

A

Receptor Activator of Nuclear Factor kappa-B Ligand (RANKL) inhibitor

*** RANKL Inhibitor

29
Q

What is the most effective treatment for vasomotor symptoms of Osteoporosis?

A
  • Estrogen

* **Must be taken with Progestin to decrease the risk of endometrial cancer

30
Q

Criteria for the use of estrogen hormone therapy in Osteoporosis treatment?

A

All of the following

  • Healthy symptomatic women who are within 10 years of menopause
  • Aged 60 years or younger
  • Have no contraindication

(Extending treatment beyond age 60 years may be acceptable if using lowest possible dose)

31
Q

What are some common hormone therapy uses in Menopause?

A

Topical Hormoe Therapy:

  • 17-Beta-Estradiol
  • Conjugated Equine Estrogens (Premarin)

Systemic Hormone Therapy:

  • Estradiol (Alora, Climara, Vivelle-Dot)
  • 17-Beta-Estradiol
  • Conjugated Equine Estrogens (Premarin)
  • Conjugated Equine Estrogens + Medroxyprogesterone (Prempro)
  • Medroxyprogesterone (Provera)
  • Micronized progesterone (Prometrium)

Female and Male Health (6 decks)

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