Osteoporosis Pharmacotherapy Atanda

Question 1

Limit caffeine to how many servings/day?

Answer 1

two

excessive caffeine consumption can cause calcium excretion

Question 2

Limit alcohol to how many drinks/day for women?

Answer 2

1 to 2

Question 3

Limit alcohol to how many drinks/day for men?

Answer 3

2 to 3

Question 4

Most older pts consume about __mg of dietary calcium daily.

Answer 4

600

Question 5

Which therapies show evidence of reduction in both hip and vertebral fracture risk?

Answer 5

• calcium and vitamin D
• bisphosphonates
• denosumab

these are the drugs of choice

Question 6

Goal vitamin D level is __ to __ ng/mL

Answer 6

30, 50

Question 7

Which form of calcium should not be given with meals?

Answer 7

calcium citrate

Question 8

Some examples of drugs that have interactions with calcium:

Answer 8

tetracyclines
fluoroquinolones
levothyroxine

Question 9

What is main AE of calcium supplementation?

Answer 9

constipation

Question 10

Which form of calcium has the highest elemental %?

Answer 10

calcium carbonate

Question 11

Should bisphosphonates be administered with calcium and vitamin D?

Answer 11

no

do not administer with any other meds/supps

administer in morning on empty stomach

Question 12

For zolendronate consider drug holiday after __ years in high risk or until fracture risk no longer high

Answer 12

3

can continue for 6 years in high risk pts

Question 13

Which bisphosphonate has highest bone absorption?

Answer 13

zolendronic acid

zolendronic acid > alendronate > ibandronate > risedronate

Question 14

Which two bisphosphonates are not recommended if CrCl < 35?

Answer 14

alendronate

zolendronic acid

Question 15

Which two bisphosphonates are not recommended if CrCl < 30?

Answer 15

ibandronate

risedronate

Question 16

Can premedicate with acetaminophen to decrease infusion rxns of which bisphosphonate?

Answer 16

zolendronic acid

Question 17

Bisphosphonate drug holiday:

What are criteria for high risk?

Answer 17

T-score <= -2.5
fracture
6-10yr duration of use

need 1-2 year drug holiday

Question 18

Bisphosphonate drug holiday should last for __ or fewer years with intermittent BMD assessment

Answer 18

5

Question 19

Bisphosphonate drug holiday:

What are criteria for low risk?

Answer 19

T-score above -2.5
no fracture
5 years duration of use

monitor BMD with drug holiday

Question 20

What is dose of denosumab (antiresorptive)?

Answer 20

60mg subQ once every 6 months

Question 21

2 CIs for denosumab?

Answer 21

hypocalcemia

pregnancy

Question 22

2 main aEs of denosumab?

Answer 22

peripheral edema

HTN

Question 23

Which osteoporosis agent can be used in pts with renal impairment?

Answer 23

denosumab

Question 24

2 recombinant PTH drugs?

Answer 24

teriparatide

abaloparatide

Question 25

Duration of teriparatide (anabolic) is limited to __ years

Answer 25

2

Question 26

There is a concern for __ with teriparatide ad abaloparatide

Answer 26

hypercalcemia

Question 27

What is dose of teriparatide?

Answer 27

20mcg subQ once daily

Question 28

Teriparatide is indicated for __ osteoporosis a. postmenopausal b. male c. glucocorticoid induced select all that apply

Answer 28

all of them

Question 29

Which recombinant PTH is only used for postmenopausal women at high risk for fractures?

Answer 29

abaloparatide

Question 30

Duration of abaloparatide use is limited to __ years

Answer 30

two

Question 31

Abaloparatide dose?

Answer 31

80mcg subQ once daily

Question 32

Mixed estrogen agonist/antagonists (SERMs) are indicated for who?

Answer 32

postmenopausal women with osteoporosis

Question 33

All mixed estrogen agonist/antagonists (SERMs) are contraindicated with what two conditions?

Answer 33

VTE | pregnancy

Question 34

Which mixed estrogen agonist/antagonist (SERM) is contraindicated with Hx of uterine bleeding, arterial thromboembolic disease, carcinoma of breast, hepatic impairment, and thrombophilic disorders?

Answer 34

bazedoxifene

Question 35

Which SERM is only indicated for postmenopausal women with a uterus?

Answer 35

bazedoxifene

Question 36

Is romosozumab an anabolic of antiresorptive?

Answer 36

anabolic

Question 37

Romosozumab is indicated for use in what pt population?

Answer 37

postmenopausal females at high risk for fracture approved in 2019

Question 38

Romosozumab dose?

Answer 38

210mcg subQ once monthly two consecutive injections of 105mcg each

Question 39

Duration of romosozumab is __ months

Answer 39

12 anabolic effects wane after 12 months

Question 40

Calcitonin is not preferred therapy a. true b. false

Answer 40

a. true

Question 41

Calcitonin is indicated for postmenopausal pts at least __ years past menopause

Answer 41

5

Question 42

What is dose of IM and subQ calcitonin?

Answer 42

100 units daily

Question 43

What is dose of intranasal calcitonin?

Answer 43

200 units (1 spray) in one nostril once daily

Question 44

What drug has an interaction with calcitonin and increases its urinary clearance?

Answer 44

lithium lithium concentration decreases

Question 45

Should calcitonin be refrigerated?

Answer 45

yes

Question 46

Which osteoporosis agent has suggested link to malignancies?

Answer 46

calcitonin

Question 47

Which drug is indicated for osteoporosis prevention?

Answer 47

estrogen

Question 48

Estrogen dose?

Answer 48

0.3mg daily or cyclical (adjusted based on response)

Question 49

Osteoporosis is postmenopausal women and men > 50 with __ or __ fracture

Answer 49

hip, vertebral

Question 50

Osteoporosis is postmenopausal women and men > 50 with T-score <= __ at femoral neck, hip, or lumbar spine

Answer 50

-.25

Question 51

Osteopenia high risk is T-score between __ and __ AND 10yr probability of hip fracture >= __% OR 10 yr probability of major osteoporosis related fracture >= __ %

Answer 51

-1, -2.5, 3, 20

Question 52

consider calcium and vitamin D supplementation if steroid therapy >= __ months.

Answer 52

3