Osteoporosis, menopause & testosterone use Flashcards
medical disease/ conditions increase osteoporosis risk
diabetes
eating disorder (anorexia)
GI disease
hyperthyroidism
hypogonadism in men
menopause
arthritis, autoimmune diseases
meds that increase osteoporosis risk
anticonvulsants
aromatase inhibitors
depo-medroxyprogesterone
GnHR agonists
lithium
PPIs
steroids
thyroid hormones in excess
others (loop diuretics, SSRIs, TZDs)
whats a T-score
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
t-score ranges
normal: >= -1
osteopenia (low bone density): -1 to - 2.4
osteoporosis: <= -2.5 (0r presence of fragility facture, regardless of BMD)
Ca recommendation
1,000-1,200mg elemental Ca
do not exceed 500-600 mg of elemental Ca per dose
Ca carbonate
tums, oscal
40% elemental Ca
acid-dependent absorption
must take w/meals
Ca citrate
citracal
21% elemental Ca
not acid-dependent absorption
can take w/or w/out meals
vitamin D
required Ca absorption
deficiency: <30ng/ml
tx:
vitamin D3 or D2: 125-175 (5000-7000 IU) daily or 1250 (50,000 IU) weekly
Bisphosphonates
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
bisphosphonates SE
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)
alendronate
fosamax
PO
- bisphosphonates
risedronate
atelvia
PO
- bisphosphonates
ibandronate
Boniva
PO and IV (3 months)
- bisphosphonates
zoledronic acid
Reclast
Zometa for hypercalcemia of malignancy!
IV- yearly
- bisphosphonates
Raloxifene
Evista
- SERM
Conjugated Estrogens/ Bazedoxifene
Duavee
prevention (postmenopausal female w/ a uterus)
- equine (horse) estorgen/SERM
SERM & equine (horse) estorgen/SERM
decrease bone resorption
calcitonin
Miacalcin
nasal- one nostril daily
inhibit bone resorption by osteoclast
Teriparatide
abalopartide
Teriparatide (Forteo)
abalopartide (Tymlos)
stimulates osteoblast activity and increases bone formation
warning: osteocarcemonia… w/ frequency of use
-Parathyroid Hormone 1-34
Denosumab
Prolia
Xgeva- higher dose, hypercalcemia of malignancy, bone cell tumor, prevention of bone metastasis
- RANKL inhibitor
Romosozumab
Evenity
inhibits sclerostin a protein that blocks bone formation
max tx 12 months due to decreased efficacy
menopause
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
natural products for menopause
black cohosh
evening primrose oil
soy, red clover
Paroxetine
Brisdelle
non-hormonal tx for moderate-severe vasomotor symptoms.
DO NOT use w/ warfarin or tamoxifen
