osteoporosis menopause testosterone Flashcards
osteoporosis is most common in
postmenopausal females
what patient characteristics are associated with osteoporosis risk
adv age, caucasian or asian, family history, female, low body weight
what medical diseases/conditions are associated with osteoporosis risk
diabetes, eating disorder, GI diseases, hyperthyroidism, hypogonadism in men, menopause, RA or autoimmune disease (also epilepsy, HIV/AIDS, PD)
what lifestyle factors are associated with osteoporosis risk
smoking, excessive alcohol, low calcium, low vit D, physical inactivity
what medications are associated with osteoporosis risk
anticonvulsants, aromatase inhibitors, DMPA, Li, GnRH agonists, PPI, steroids (>5mg prednisone), thyroid hormone (also loop diuretics, SSRI, TZDs)
gold standard for measuring BMD
DXA scan
when should you have BMD measured
65 yo females, 70 yo males (earlier if history of fractures after 50yo)
FRAX estimates
risk of osteoporosis fracture in next 10 years
calcium absorption is aided by
vitamin D
vitamin D deficiency causes
rickets in kids, osteomalacia in adults
recommended calcium intake in adults is
1000-1200 mg
calcium carbonate contains what percent of elemental calcium
40%
calcium citrate contains what percent of elemental calcium
21%
important counseling points for calcium carbonate
take with food (requires acidic environment), do NOT use with PPI
cholecalciferol
D3
ergocalciferol
D2
how much cholecalciferol is recommended for vitamin D deficiency
5000-7000 IU daily
how much ergocalciferol is recommended for vitamin D deficiency
50000 IU weekly
tums
calcium carbonate
major side effect of calcium supplement
constipation
which drugs are indicated for prevention of osteoporosis
All bisphosphonates except ibandronate IV (PO okay), estrogen-based therapy, ralosifene, Duavee
which drugs are indicated for treatment of osteoporosis
bisphosphonates, denosumab, PTH analogs, calcitonin
important counseling for bisphosphonates
remain upright for 30 min (60 for ibandronate) and drink 6-8oz water
denosumab route of administration
SC
Side effects of bisphosphonates
esophagitis, hypocalemia
side effect of denosumab
hypOcalcemia
how frequently is denosumab dosed
every 6 months
teriparatide is given how and how often
SC daily
which osteoporosis treatment can cause hypERcalcemia
teraparatide, abaloparatide
bisphosphonate contraindication
hypOcalcemia, cannot sit upright for 30 min
a patient requires prevention of osteoporosis regimen. 60 yo female. Ca is 9 mg/dL and healthy. CrCl is 36 mL/min. the doctor wants to know which oral bisphosphonate to recommend?
alendronate (do not use if CrCl<35; risedronate and ibandronate <30)
boniva
ibandronate
fosamax
alendronate
actonel, altevia
risendronate
reclast
zoledronic acid
zolendroic acid contraindications
hypOcalcemia, CrCl<35
which injectable bisphosphonate takes the longest to administer
zoledronic acid (15 min vs boniva which is 15-30 sec)
risendronate can be given how often in females
daily, weekly, or monthly
risedronate can be given how often in males
weekly
boniva PO is given how often
monthly
Boniva IV injection is given how often
every 3 months
Reclast for treatment is given how often
yearly
reclast is given how often
every 2 years
what bisphosphonate should be recommended in a patient with esophagitis
injectables (boniva or reclast)
raloxifene MOA
SERM, dec bone resorption
duavee can only be used in female patients with
a uterus
evista contraindications
VTE, pregnancy
duavee contraindications
VTE, pregnancy, uterine bleeding, breast cancer
calcitonin MOA
inhibit bone resorption by osteoclasts
administration route for calcitonin
nasal spray, SC, IM
calcitonin has a warning against hypersensitivity to
salmon-derived products
teriparatide is indicated when
very high risk of fracture
denosumab binds to
RANKL
prolia
denosumab
denosumab is indicated when
very high risk of fracture
denosumab is contraindiacted in
pregnancy (bc antibody) and hypOcalcemia
denosumab may dec levels of which chemical
PO4
romosozumab duration of therapy
12 months
which bisphosphonate is administered as an oral solution
binosto
parathyroid hormones may cause
dizziness, orthostasis
astroglide is used as
lubricant for dyspareunia
local estrogen products
estrace, estring, vagifem, premarin
estradiol patch brand names
alora, climara, vivelle dot
a patient with dementia should not use
systemic hormone therapies
vivelle dot is applied how often
twice weekly
climara is applide how often
once weekly
medroxyprogesterone brand
provera
micronized progesterone brand
prometrium
where should estrogen progestin patch be applied
lower abdomen
what natural products may help with menopause
black cohosh, evening primrose oil, red clover, soy
non-hormonal drug used to treat menopause
paroxetine
ospemifene is indicated in
dyspareunia
which medications can lower testosterone
opioids, chemotherapy, cimetidine, spironolactone
testosterone side effects
baldness, acne, gynecomastia
what is the least preferred testosterone formulation
injection (painful, inc hematocrit)
boxed warning for topical testosterone
secondary exposure causing early virilization