Osteoporosis, menopause & testosterone use

Question 1

medical disease/ conditions increase osteoporosis risk

Answer 1

diabetes
eating disorder (anorexia)
GI disease
hyperthyroidism
hypogonadism in men
menopause
arthritis, autoimmune diseases

Question 2

meds that increase osteoporosis risk

Answer 2

anticonvulsants
aromatase inhibitors
depo-medroxyprogesterone
GnHR agonists
lithium
PPIs
steroids
thyroid hormones in excess
others (loop diuretics, SSRIs, TZDs)

Question 3

whats a T-score

Answer 3

measures BMD to the average peak of BMD of healthy, young, white adults of same age

A DEXA measures BMD so a T-score can be determined
t-score are negative: a score at or above -1 correlates w/ stronger (denser) bones

Question 4

t-score ranges

Answer 4

normal: >= -1
osteopenia (low bone density): -1 to - 2.4
osteoporosis: <= -2.5 (0r presence of fragility facture, regardless of BMD)

Question 5

Ca recommendation

Answer 5

1,000-1,200mg elemental Ca

do not exceed 500-600 mg of elemental Ca per dose

Question 6

Ca carbonate

Answer 6

tums, oscal
40% elemental Ca
acid-dependent absorption
must take w/meals

Question 7

Ca citrate

Answer 7

citracal
21% elemental Ca
not acid-dependent absorption
can take w/or w/out meals

Question 8

vitamin D

Answer 8

required Ca absorption
deficiency: <30ng/ml
tx:
vitamin D3 or D2: 125-175 (5000-7000 IU) daily or 1250 (50,000 IU) weekly

Question 9

Bisphosphonates

Answer 9

inhibits osteoclast activity and bone resorption
1st line in most pts
PO admin: stay upright 30 ming (60min for ibandronate) and drink 6-8oz of H2O
PO: weekly/monthly
IV: quarterly/yearly
max duration 3-5 years due to rare SE

alendronate
risedronate
ibandronate

Question 10

bisphosphonates SE

Answer 10

SE: esophagitis, hypoCa, GI effects
Rare but serious:
- Atypical femur fractures
- osteonecrosis of the jaw- can not heal (why dental work should be completed prior to tx)

Question 11

alendronate

Answer 11

fosamax
PO
- bisphosphonates

Question 12

risedronate

Answer 12

atelvia
PO
- bisphosphonates

Question 13

ibandronate

Answer 13

Boniva
PO and IV (3 months)
- bisphosphonates

Question 14

zoledronic acid

Answer 14

Reclast
Zometa for hypercalcemia of malignancy!
IV- yearly
- bisphosphonates

Question 15

Raloxifene

Answer 15

Evista
- SERM

Question 16

Conjugated Estrogens/ Bazedoxifene

Answer 16

Duavee
prevention (postmenopausal female w/ a uterus)

• equine (horse) estorgen/SERM

Question 17

SERM & equine (horse) estorgen/SERM

Answer 17

decrease bone resorption

Question 18

calcitonin

Answer 18

Miacalcin
nasal- one nostril daily
inhibit bone resorption by osteoclast

Question 19

Teriparatide
abalopartide

Answer 19

Teriparatide (Forteo)
abalopartide (Tymlos)
stimulates osteoblast activity and increases bone formation
warning: osteocarcemonia… w/ frequency of use

-Parathyroid Hormone 1-34

Question 20

Denosumab

Answer 20

Prolia
Xgeva- higher dose, hypercalcemia of malignancy, bone cell tumor, prevention of bone metastasis

• RANKL inhibitor

Question 21

Romosozumab

Answer 21

Evenity
inhibits sclerostin a protein that blocks bone formation
max tx 12 months due to decreased efficacy

Question 22

menopause

Answer 22

Estrogen: help w/ hot flash and etra.
USE W/ Progestin in women w/ uterus or risk of endometrial cancer
Progestin: can cause mood disturbances…
Micronized progestin is safer than synthetic progestin

Question 23

natural products for menopause

Answer 23

black cohosh
evening primrose oil
soy, red clover

Question 24

Paroxetine

Answer 24

Brisdelle
non-hormonal tx for moderate-severe vasomotor symptoms.
DO NOT use w/ warfarin or tamoxifen

Question 25

Ospemifene

Answer 25

Osphena
oral estrogen agonist/antagonists indicated for dyspareunia (painful intercourse)
moderate to severe symptoms of vaginal dryness
not indicated for mild symptoms

Question 26

testosterone

Answer 26

cause prostate growth and use is restricted in men w/ severe BPH

Question 27

testopel

Answer 27

small SC pellet that is implanted under the skin

Question 28

jatenzo

Answer 28

testosterone undecanoate oral formulation
FDA- approved for hypogonadism

Question 29

androgel

Answer 29

applied to the upper body. need to let dry prior to dressing and be careful not to let others touch the application area

Question 30

“early virilization”

Answer 30

box warning:
child could have enlarged genitals organs, aggressive behavior and premature public hair growth