Osteoporosis Study Guide

Question 1

Vitamin D supplement for renal insufficiency

Answer 1

Calcitriol (activated form)

Question 2

Vitamin D Supplement Amounts when > 30 ng/mL

Answer 2

400-1000 units 1-2x daily

Question 3

Vitamin D Supplement Amounts when < 30 ng/mL

Answer 3

50,000 units 1-2x weekly until improved, then 400-1000 QD

Question 4

3 Vit. D forms

Answer 4

Ergocalciferol; Cholecalciferol; Calcitriol

Question 5

Vitamin D2

Answer 5

Ergocalciferol; OTC & Rx formulations

Question 6

Vitamin D3

Answer 6

Cholecalciferol; OTC only - best for raising levels

Question 7

Activated 1,25 dihydroxy

Answer 7

Calcitriol; Rx; Use with ESRD pts

Question 8

Preferred Calcium Supplement

Answer 8

Calcium citrate; slightly more expensive than carbonate

Question 9

Calcium Drug Interactions

Answer 9

Calcium decreases effectiveness of the following: Iron; Tetracyclines; FQs; Levothyroxine; Bisphosphonates; Phenytoin

Question 10

1st Line Tx for Osteoporosis

Answer 10

Bisphosphonates

Question 11

2nd Line Tx for Osteoporosis

Answer 11

Raloxifene (Evista)

Question 12

Bisphosphonates MoA

Answer 12

Bind to bone matrix and reduce osteoclas activity (decrease resorption)

Question 13

Types of fractures reduced by Bisphosphonates

Answer 13

Hip & Vertebral

Question 14

Oral Bisphosphonate Contraindications

Answer 14

Esophageal abnormalities; Inability to sit up for 30 min

Question 15

Oral & IV Bisphos Contraindications

Answer 15

Renal impairment; Hypocalcemia

Question 16

Long term safety concerns for Bisphos

Answer 16

Osteonecrosis of jaw; atypical femoral fx; Esophageal CA; Limit to 5 yrs

Question 17

Side Effects of All Bisphos

Answer 17

Hypocalcemia; MS pain; Flu-like s/sx

Question 18

4 Bisphosphonates

Answer 18

Alendronate (Fosamax/Binosto); Ibandronate (Boniva); Risedronate (Actonel); Zoledronic Acid (Reclast/Zometa)

Question 19

Alendronate (Fosamax/Binosto) dosing

Answer 19

PO daily or weekly

Question 20

Ibandronate (Boniva) dosing

Answer 20

PO monthly or IV q3months

Question 21

Risedronate (Actonel) dosing

Answer 21

PO qd; q1week; or q1month

Question 22

Zoledronic acid (Reclast)

Answer 22

IV q1yr

Question 23

Raloxifen (Evista) MoA

Answer 23

SERM = Selective estrogen-receptor modulator

Question 24

Drug to avoid with Evista

Answer 24

Tamoxifen - same MoA

Question 25

Types of fractures reduced by Raloxifene (Evista)

Answer 25

Vertebral fx only

Question 26

Raloxifen (Evista) Route

Answer 26

PO qd

Question 27

3rd line Osteoporosis tx

Answer 27

Calcitonin

Question 28

Calcitonin MoA

Answer 28

Inhibits osteoclasts

Question 29

Calcitonin Route

Answer 29

Intranasal spray qd; SC & IM also available

Question 30

Newer Osteoporosis Drugs

Answer 30

Teriparatide (Forteo); Denosumab (Prolia)

Question 31

Teriparatide (Forteo) MoA

Answer 31

PTH analogue; Stimulates osteoblasts to form new bone

Question 32

Teriparatide (Forteo) Drawbacks

Answer 32

Route (SC qd); Length of use (2 yrs); Contraindications (Cancer; kids; ^ Alk phos; prior skeletal radiation; hypercalciuria); AEs (Leg cramps)

Question 33

Denosumab (Prolia) MoA

Answer 33

Prevents resorption - Monoclonal AB inhibiting RANKL protein

Question 34

Denosumab (Prolia) Advantages

Answer 34

q6mo administration; Reversible

Question 35

Denosumab (Prolia) Drawbacks

Answer 35

Associated with (atypical fx, osteonecrosis of jaw); Contraindications (Hypocalcemia, Pregnancy, CrCl <30 ml/min)