Osteoporosis Rx

Question 1

Definition of OP by BMD

Answer 1

Normal: >/= -1
Osteopenia -1 to -2.5
Osteoporosis </= -2.5 with at least one fragility fx

Question 2

Fx RFs

Answer 2

 Current age
 Gender
 Rheumatoid arthritis
 Secondary osteoporosis
 Previous osteoporotic fracture
 Femoral neck BMD
 Low body mass index (kg/m2)
 Oral glucocorticoids ≥ 5 mg/d of prednisone for ≥ 3 mo (ever)
 Parental history of hip fracture
 Current smoking
 Alcohol intake 3 or more drinks/day

Question 3

Meds that can dec bone mass

Answer 3

AEDs
depo-medroxyprogesterone
PPIs
SSRIs

Question 4

Elemental Ca dose

Answer 4

anyone less than 50yrs: 1000mg
Women >50yrs: 1200mg
Men >70: 1200mg

Question 5

Vit D dose

Answer 5

Everyone

50: 800-1000 IU

Question 6

WNL serum vit. D

Answer 6

> 30ng/ml

Question 7

Antiresorptive Therapy

Answer 7

Bisphosphonates
SERMs
Calcitonin
Denosumab

Question 8

Bisphosphonates

Answer 8

MOA: bind hydroxyapetite in bone and dec resoprtion by inhibiting osteoclast adherence to bone surfaces

Make sure to take with water and greater than 30min before food or other meds

Jaw osteonecrosis: MC after tooth extraction or denture trauma that exposes bone; impedes healing ==> check with dentist before starting

Femur fx: fragility fx (from low ht) because microcracks aren’t able to heal themselves

Can usually d/c after 3-5yrs of tx if modest risk (continue if high risk)

Question 9

Raloxifene

Answer 9

Dec OP fx in postmenopausal women

Question 10

Calcintonin

Answer 10

Inhibits osteoclastic bone resportion

Question 11

Teriparatide

Answer 11

analog of parathyroid hormone ==> stimulates bone formaiton

SQ qd

Question 12

Denosumab

Answer 12

can use in postmenopausal women who don’t respond to other OP meds

Very expensive

higher risk for jaw osteonecrosis

Question 13

Efficacy

Answer 13

Bisphosphonates most effective at preventing hip and femur fxs (zoledronic acid best - IV q year)