Osteoporosis, menopause & testosterone use Flashcards
What patient characteristics can increase osteoporosis risk?
advanced age ethnicity (white and asians) family history females>males low body weight
What medical conditions and diseases increase osteoporosis risk?
anorexia diabetes GERD hyperthyroidism hypogonadism in men menopause RA, autoimmune diseases epilepsy, HIV, PD
What lifestyle factors increase osteoporosis risk?
smoking excessive alcohol low calcium intake low vitamin d intake physical inactivity
What medications can increase osteoporosis risk?
anticonvulsants aromatase inhibitors depo-medroxyprogesterone GnRH lithium PPIs steroids thyroid hormones in excess herpain, loops, SSRIs, TZDs
What is the recommended daily intake of elemental calcium for most adults?
1000-1200mg elemental (500mg per dose)
Brand: Oscal
generic: calcium carbonate
What is a vitamin d deficiency
<30
what is vitamin d dose weekly
50,000IU
What is first line treatment or prevention in most patients
oral bisphosphonates
What is the PO administration of oral bispphosphonates
must stay upright for 30 minutes and drink 6-8oz of plain water
What are the side effects of oral bisphosphonates
esophagitis
hypocalcemia
gi effects
How often are oral bisphosphonate given
monthly or weekly
IV bisphosphonates are given
quarterly or yearly
This is an alternate to bisphosphonates, SC, given every 6 months and the side effect is hypocalcemia
denosumab (prolia)
These medications are only recommended for very high risk patients only, SC administration daily
teriparatide (Forteo)
abaloparatide (Tymlos)
Which osteoporosis drug can cause hypercalcemia?
teriparatide (Forteo)
abaloparatide (Tymlos)
the rest cause hypocalcemia
these are an alternate to bisphosphonates if high risk of vertebral fractures; however increased risk for VTE/stroke
raloxifene (Evista)
Bazedoxifene/estrogens (Duavee)
Which drug can be used if low risk VTE or high risk breast cancer?
rolexifene (Evista)
Which can be used in women with an intact uterus for prevention of osteoporosis
Duavee
What is used as treatment for vasomotor symptoms in those with an intact uterus
Duavee
*inc risk of breast cancer
Is estrogen used with progestin for prevention in postmenopausal women with vasomotor symptoms?
with or without
Duavee is the one that’s MUST have a uterus (unopposed estrogen = endometrial cancer)
What are prevention options for osteoporosis
alendronate (Fosamax) PO daily/weekly
Ibandronate (Boniva) PO monthly
Zoledronic acid (Reclast) IV every 2 years
Raloxifene (Evista) - PO daily
Duavee - with a uterus - PO daily
What is the most effect treatment for vasomotor symptoms?
estrogen
what should women with a uterus use for menopause?
use estrogen in combination with progesterone because unopposed estrogen increases risk of endometrial cancer
What are the progestins
norethindrone
levonorgesterol
drospirenone
What is considered to be the safer progestin option?
Prometrium>medroxyprogestin
What is the criteria for hormone therapy in menopause?
healthy
symptomatic women who are within 10 years of menopause
<60
no contraindications
Local hormone options
Estring, Estrace, Vagifem
conjugated equine estrogens - Premarin
Brand: Vivelle-Dot
generic: estrogen
Brand: Alora
generic: estrogen
Brand: Climara
generic: estrogen
How can you tell if an option has progestin?
“Pro”
When do you use progestin again?
a women with a uterus!!
Natural products for menopause
black cohosh
evening primrose oil
red clover
soy
What is the name of the non hormonal treatment for moderate to severe vasomotor symptoms associated with menopause?
Brisdelle (paroxtine)
What schedule is testosterone?
III
