Osteoporosis, Menopause & Testosterone Flashcards
Osteoporosis
Osteoblasts
bone formation
Osteoporosis
Osteoclasts
bone resorption
Osteoporosis
What is the gold standard for evaluating bone health?
Bone Mineral Density (BMD)
Osteoporosis
What is the gold standard to measure BMD and diagnose osteoporosis?
DEXA or DXA
Which drugs require DEXA scan?
Osteoporosis
How are T-score values intrepreted?
- Normal: ≥ -1
- Osteopenia: -1 to -2.4
- Osteoporosis: ≤ -2.5
Osteoporosis
What______ estimates the risk of osteoporosis in the next 10 years?
FRAX tool
Osteoporosis
Which medications are approved for prevention of osteoporosis?
Bisphosphonates
Estrogen-based therapies
Osteoporosis
Which medications are indicated for treatment of osteoporosis?
Bisphosphonates
Denosumab
Parathyroid hormone analogs
Calcitonin
Osteoporosis
Counseling for oral bisphosphonates
- Must stay upright for 30 minutes
- Drink 6-8 oz of plain water
- Separate from Ca, Mg, Fe, & antacids
- Dental work should be performed prior ro starting treatment
Osteoporosis
CI, warnings & SE of oral bisphosphonates
CI
* hypocalcemia
* inability to sit up for 30 minutes
Warnings
* ONJ
* femur fractures
* esophagitis
SE
* dyspepsia, dysphagia
* heartburn
* n/v
* hypocalcemia
Osteoporosis
How long is treatment duration on bisphosphonates?
3-5 years
Osteoporosis
Which agent is preferred if esophagitis is present (due to risk of esophageal cancer)?
Ibandronate (Boniva)
Zoledronic acid (Reclast)
Boniva: dose every 3 months
Reclast: dose yearly
CI: hypocalcemia
Warnings: renal impairment
Osteoporosis
Bisphosphonates MOA
inhibit osteoclast activity & bone resorption
Osteoporosis
Raloxifene MOA
SERM that ↓bone resorption
Osteoporosis
Raloxifene Boxed Warning
↑ risk of VTE (↑ risk of death due to stroke)
CI: VTE & pregnancy
Osetoporosis
Raloxifene SE
- hot flashes
- peripheral edema
- arthalgia
- leg cramps
CI: VTE, pregnancy
Osteoporosis
Calcitonin MOA
inhibits bone resportion by osteoclasts
Brand: Miacalcin
Osteoporosis
Calcitonin Warnings
- hypocalcemia
- ↑ risk of malignancy
- hypersensitivity rxns to salmon-derived products
nasal spary
one nostril daily (alternate nostril daily)
Osteoporosis
Parathyroid hormone MOA
analogs of human parathyroid hormone and increases bone formation
Osteoporosis
Parathyroid hormone analog cumulative lifetime treatment duration
2 years or less
Osteoporosis
Parathyroid hormone analogs warnings & side effects
Warnings
* Osteosarcoma
* hypocalcemia
SE
* Arthalgias
* leg cramps
* nausea
* orthostasis/dizziness
Osteoporosis
Prolia MOA
mab that binds to RANKL to prevent osteoclast formation
Denusomab
