Osteoporosis, Menopause & Testosterone Use Flashcards
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Drug-Drug/Food interactions:
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
Osteoporosis:
- “porous bones”
- is a condition that causes bones to become weaker and fragile.
- can occur in both men and women of all races
- most common in postmenopausal females.
- about 1 in 2 women AND 1 in 5 men will have an osteo porosis-relate fracture during their lifetime.
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- vertebrae (spine)
- proximal femur (hip)
- distal forearm (wrist)
—- Vertebral fractures can occur without a fall and can initially be painless (the only clue may be a gradual loss of height).
—- Hip fractures are the most devastating type of fracture, with higher costs, disability and mortality than all other fractures combined. More common after age 75
—- Wrist fractures, and other types of fractures, appear in younger people and serve as an early indicator of poor bone health.
Osteoporosis can occur as a result of:
- normal age-related bone loss
- women and men lose bone starting around age 30 every year
- menopausal females lose bone at an accelerated rate for 10 years (~1-5% per year)
**Select Patient Characteristics with Osteoporosis Risk:
- Advanced age
- Ethnicity (Caucasian and Asian are at INCREASED Risk)
- Family History
- Sex (FEMALES > Males)
- Low body weight
**Select Medical Conditions/ Diseases with Osteoporosis Risk:
- Diabetes
- Eating Disorders (e.g. anorexia)
- Gastrointestinal diseases (e.g. IBD, celiac disease, gastric bypass, malabsorption syndrome)
- Hyperthyroidism
- Hypothyroidism in men
- Menopause
- Rheumatoid arthritis, autoimmune diseases
- Others [e.g. epilepsy, HIV/AIDs, Parkinson disease]
**Select Lifestyle Factors with Osteoporosis Risk:
- Smoking
- Excessive alcohol intake (> or = 3 drinks per day)
- Low calcium intake
- Low Vitamin D intake
- Physical activity
**Select Medications with Osteoporosis Risk:
- ## Anticonvulsants (e.g. carbamazepine, phenytoin, phenobarbital)
- ## Aromatase inhibitors—- for breast cancer {2 types of treatment: tamoxifen in premenopausal women OR aromatase inhibitors in postmenopausal women}.. tamoxifen is protective for bone. Aromatase inhibitors are not.
- Depo-medroxyprogesterone
- GnRH (gonadotropin-releasing hormone) agonists
- Lithium
- PPis (increased gastric pH deceases Ca absorption)
- Steroids* (> or = 5mg daily of prednisone OR prednisone equivalent for greater than or equal to 3 months)
[*Long-term use of steroids is a major drug contributing factor to poor bone health.] - thyroid hormones (in excess)
- Others: (e.g. Loop diuretics, SSRIs, TZDs)
WITHOUT ___________ you cannot absorb Calcium.
Vitamin D
Background:
- Bone is not “dead tissue” it is living and undergoes constant remodeling.
- Osteoblasts = “cells blast bone on” are cells involved in bone formation.
- ## Osteoclasts = are the cells involved in bone resorption; they break down tissue in the bone.
- Bone health is evaluated by measuring bone mineral density (BMD).
The GOLD Standard to measure BMD and Diagnose osteoporosis is ______1______.
-1 DEXA or DXA scan (Dual-Energy X-ray Absorptiometry scan
[Osteoblasts, building it backup]
- bisphosphonates make Osteoblasts Build quicker BUT STOP the osteoclasts.
{Osteoclasts, Collecting bone for themselves}
Background:
A DEXA or DXA scan measures Bone Mineral Density (BMD) of the spine AND hip. This then calculates a _________ and ________
T-score
AND
Z-score
Who should have there (BMD) Bone Mineral Density measured?
What patients are at High risk for a fracture and can have their BMD checked at an earlier age?
*Women that are Greater than or equal to 65 years old
*Men that are greater than or equal to 70 years old
_____________________________________________________________________________
Patients with:
-A History of a fragility fracture (e.g. a fall from standing height or lower that results in a fracture) that happened after age 50.
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- Risk for disease or drug-induced bone loss
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- a parental Hx of Hip fracture or other clinical risk factors (e.g. smoking, alcoholism, low body weight).
Background:
What is a T-score?
How do we interpret?
A T-score compares the patients measured BMD to the average peak BMD of a healthy, young, white adult of the same sex.
T-scores are negative: a score at or above -1 correlates with STRONGER (DENSER) bones, which are less likely to fracture.
[NORMAL]-a T-score of -1 to 2 indicates NORMAL Bone Density [ a T-score greater than or = to -1]
[OSTEOPENIA]-a T-score of -1.1 to -2.4 indicates OSTEOPENIA (low bone mass).
[OSTEOPOROSIS]-a T-score of less than or equal to -2.5 indicates OSTEOPOROSIS. = Diagnosis**
_____________________________________________________________________________
Scores less than -1 reflect the standard deviation from the comparator group. (e.g. A T-score of less than < -2.5 means the patients BMD is at least 2.5 standard deviations below the average BMD for healthy young white adults).
Background:
What is a Z-score?
How do we interpret?
A Z-score compares the patients measured BMD to the mean BMD of an age, sex, and ethnicity-matched population.
(FRAX) Fracture Risk Assessment Tool:
- is a computer based algorithm developed by the (WHO) World Health Organization that estimates _______________
Who is the FRAX Tool intended for?
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= the risk of osteoporotic fracture in the next 10 years.
- The (FRAX) Fracture Risk Assessment Tool is intended for postmenopausal women AND men > greater than 50 years of age.
Clinical risk factors include:
- patients age
- sex
- weight
- height
- previous fracture
- parental hip fracture
- femoral neck BMD
- smoking status
- steroid use (**greater than or equal to 5mg prednisone [or an equivalent] per day for 3 months.
- alcohol intake (3 or more drinks/day)
- Disorders strongly associated with osteoporosis [e.g. Type 1 diabetes, Chronic liver disease, premature menopause and rheumatoid arthritis.]
Lifestyle Modifications:
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- weight-bearing exercises (e.g. walking, jogging, Tai-Chi)
- muscle-strengthening exercises (e.g. weight training, yoga)
- Stop Smoking**
- Vitamin D and Calcium supplementation**
- Reduce alcohol intake*
- Adopt fall prevention strategies**
Fall Prevention Measures:
If the bone density is low, care MUST be taken to avoid falls.
[Factors that put a patient at increased fall risk include:]
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- Hx of falls
- medications that cause sedation or orthostasis (antihypertensives, sedatives, hypnotics, narcotics analgesics*, psychotropics).
-neurologic disorders - conditions causing physical instability or poor coordination (e.g. Parkinson’s Disease, dementia, prior stroke, peripheral neuropathy)
- impaired vision or hearing
- poor health/frailty
- urinary or fecal urgency
Fall Prevention Measures:
If the bone density is low, care MUST be taken to avoid falls.
With a Home safety assessment, what measures should be used to prevent future falls?
- Adequate lighting
- stairs are well-lit with non-skid treads or carpet
- Safe floors (non-skid) and (throw rugs/clutter/cords have been removed)
- Handrails/safety bars in bathrooms and all stairs
- storage is at reasonable heights
- Vision adequate
Prevention:
Calcium AND Vitamin D Supplementation
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_____________________________________________________________________________
Dietary intake of calcium is preferred, with supplements used if needed.
Excess intake of the recommended allowances may contribute to kidney stones, cardiovascular disease, and stroke.
- children (who can build bone stores)
- pregnancy (when the fetus can deplete the mother’s store’s)
- during the years around menopause when bone loss is rapid.
Prevention:
Calcium AND Vitamin D Supplementation
_________ is required for Calcium absorption.
Vitamin D
