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
Ospemifene
Osphena
oral estrogen agonist/antagonists indicated for dyspareunia (painful intercourse)
moderate to severe symptoms of vaginal dryness
not indicated for mild symptoms
testosterone
cause prostate growth and use is restricted in men w/ severe BPH
testopel
small SC pellet that is implanted under the skin
jatenzo
testosterone undecanoate oral formulation
FDA- approved for hypogonadism
androgel
applied to the upper body. need to let dry prior to dressing and be careful not to let others touch the application area
“early virilization”
box warning:
child could have enlarged genitals organs, aggressive behavior and premature public hair growth
