Osteoporosis, Menopause & Testosterone use Flashcards
define osteoblasts
cells involved in bone formation
define osteoclasts
cells involved in bone resorption; they breakdown tissue in bone
At what age should men and women get a BMD test
women > 65
men >70
what is the FRAX tool
estimates the risk of osteoporotic fracture in the next 10 years
What is a T-score
compares the patient’s measured BMD to the average peak BMD of a healthy young white adult of the same sex
T-score > -1
normal
T-score: -1 to -2.4
osteopenia
T-score:
osteoprosis
Vitamin D deficiency in children causes
rickets
Vitamin D deficiency in adults causes
osteomalacia: softening of the bones
What is the recommended dose of Vit D
800-2000 IU daily
How should Ca be taken
it is saturable
doses above 500-600 of elemental Ca should be divded
Ca citrate has better absorption when
gastric pH is increased
recommended intake of Ca
1000-1200 mg daily
Ca carbonate has how much elemental ca
40%
Ca citrate has how much elemental ca
21%
Medications of osteoporosis prevention
bisphosphonates
estrogen-based therapies
raloxifene
Medications for treatment of osteoporosis
Bisphosphonates
denosumab
parathyroid hormone analogs
calcitonin
1st line treatment or prevention of osteoporosis
bisphosphonates
administration instructions for bisphosphonates
stay upright for 30 minutes
drink 8oz water
Denosumab SE
hypocalcemia
parathyroid hormone analogs
teriparatide
abaloparatide
Raloxifene indication
alternative to bisphosphonates in high risk patients of vertebral fractures
bisphosphonates MOA
increase bone density by inhibiting osteoclast activity and bone resorption in vertebral and hip fractures
List bisphosphonates
alendronate
risedronate
ibandronate
zoledronic acid
which bisphosphonates only reduce vertebral factures
ibandronate
Warning of bisphosphonates
ONJ: osteonecrosis of the jaw
Raloxifene MOA
estrogen agonist/antagonist (SERM) that decrease bone resorption
Calcitonin MOA
inhibits bone resorption by osteoclasts
Parathyroid hormone 1-34 MOA
stimulates osteoblast activity and increases bone formation
used for treatment of osteoprosis when there is a very high risk of fractures
restriction to parathyroid hormone analogs
treatment duration is restricted to 2 years
Receptor Activator of Nuclear Factor kappa-B Ligand (RANKL) inhibitor MOA
monoclonal antibody that binds to RANKL and blocks its interaction with RANK ( a receptor of osteoclasts) to prevent osteoclast formation this leads to decreased bone resorption and increased bone mass
Define menopause
the last menstrual period was over 12 months ago
a decrease in estrogen and progesterone causes an increase in FSH resulting in vasomotor symptoms
define vasomotor symptoms
recurrent transient episodes of flushing and sensation of heat in the upper body and face, sometimes followed by chills
treatment for vasomotor symptoms
estrogen to cause a decrease in LH and more stable temperature control
to treat menopause with estrogen what needs considered
uterus
-needs a combo with progesterone this is b/c unopposed estrogen increases the risk of endometrial cancer
treatment for menopause vaginal symptoms only
local estrogen
natural products used for vasomotor symptoms
black cohosh
evening primrose oil
red clover soy
non-hormonal treatment for vasomotor symptoms
paroxetine
medications that can lower testosterone
methadone
chemotherapy
cimetidine
spironolactone
