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IPFC 1 Final > Osteoporosis Therapeutics > Flashcards

Osteoporosis Therapeutics Flashcards

1
Q

When can you get a bone mineral density BMD test?

A
  • Age 70+
  • Age 65-69 with 1 risk factor
  • Age 50-64 with 2+ risk factors or previous OP fracture
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2
Q

What are risk factors for low BMD

A
  • Previous fracture in 40+
  • Glucocorticoids (3 months/yr at 5mg)
  • 2+ falls in the past year
  • BMI less than 20
  • Smoking
  • Alcohol 3+ drinks/day
  • Secondary osteoporosis
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3
Q

When to use CAROC? What does it use to calculate risk?
What is a low, moderate, high risk %? For how long?

A

CAROC 50+
- uses sex, age, femoral neck T-score

Risk in the next 10 years
Low: less than 10%
Moderate: 10-20%
High: greater than 20%

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4
Q

What is considered a major OP fracture?

A
  • Vertebra
  • Hip
  • Wrist
  • Upper humerus
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5
Q

When should you go up a risk category in the CAROC? When are patients considered high risk?

A
  • Prior fragility fracture after age 40
  • Prednisone over 7.5mg/dose for 3 mos

Are considered high risk if they have both

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6
Q

When to use FRAX? What does it use to calculate risk?

A

FRAX (40+)
- Age, sex, BMI
- Parental hip fracture, prolonged glucocorticoid use, RA
- Smoking, 3+ drinks/day
- Secondary osteoporosis risk factors

**OPTIONAL femoral neck T-score

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7
Q

In the physical assessment of body weight, what is associated with higher risk? (2)

A

In men 50+ and post-menopausal women
- Low body weight <60kg
- Major weight loss (10%+ of weight at age 25)

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8
Q

In the physical assessment of height, what is associated with higher risk? (2)

A

Inc risk of vertebral fracture if:
- Historical height loss over 6 cm
- Measured height loss over 2 cm

  • use a lateral thoracic and lumbar spine x-ray
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9
Q

Explain the reasoning and interpretation of the following tests for a high risk
Rib-pelvis distance
Occiput-to-wall distance

A

Rib-pelvis distance
- identify lumbar fractures
- 2+ fingerbreadths line is a risk

Occiput-to-wall distance
- identify thoracic spine fractures
- 5+ cm is a risk

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10
Q

Explain the indications of VIt D tests. Normal value? When to test again?

A

25-hydroxyvitamin D good for measuring Vit D stores
Normal: 75+ nmol/L

Indications
- planning to give OP drug therapy
- Recurrent fractions or bone loss despite therapy
- Vit D malabsorption

Test 3-4 months again after

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11
Q

What other lab work can be used to see if there are secondary causes of patients osteoporosis?

A
  • Creatinine
  • Calcium (corrected)
  • Alkaline phosphate
  • TSH
  • CBC
  • Vit D
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12
Q

What intake of calcium and vitamin D should be given to osteoporosis patients

A

Calcium
51-70 years: 1000mg/day
70+: 1200mg/day
Women 50+: 1200mg/day
**Always try to take calcium from diet

Vitamin D
- less than 70: 600IU/day
- 70+: 800 IU
**Patients over 50 should supplement with 400IU/day

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13
Q

What are the bisphosophonate drugs?
MOA?
How long is it used?

A

Oral: Alendronate, Risedronate
IV: Zoledronic acid

MOA: increase bone mass throughout skeleton, reduce risk fracture

Used for 3-6 years then take a drug holiday
for 3 years
- use 6 years if they have more risk factors
- going from 5-10 years of treatment has minimal positive effects

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14
Q

How to take oral bisphosphonates, exceptions?

A

Administration
- take on empty stomach 30 min before food, sit upright for 30 min
- EXCEPT risedronate DR, take with food

Mostly well tolerated

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15
Q

What are the contraindications for oral bisphosphonates?

A
  • Esophageal abnormalities
  • Inability to be upright for 30 min
  • Hypocalcemia
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16
Q

How to take zoledronic acid? What needs to be checked before each infusion? Why?

A

Once a year IV infusion
- do not give if patient has renal impairment

Monitor
- serum calcium, vit D, creatinine to be checked before each infusion
- bc of higher risk of IV hypercalcemia

17
Q

What are serious side effects of bisphosphonates

A
  • Esophogeal ulceration (PO only)
  • Ocular effects, hypocalcemia
  • Osteonecrosis of the jaw
  • Atypical femur fractures
18
Q

What drug class is Denosumab (Prolia)?
MOA?
How long is it used for?
Who can take?

A

RANK ligand inhibitors
MOA:
- Monoclonal antibody that neutralizes RANKL
- Not retained in the skeleton.. rapid loss of BMD after stopped

  • Used for 10 years

Who can take
- can’t tolerate/ineffective bisphosphonates

19
Q

What drug class is Raloxifene (Evista)?
Indication?
Side effects?
MOA

A

Selective estrogen receptor modulators (SERMS)

Indication:
- prevention of vertebral fractures in postmenopausal women

Side effects:
- increase risk of blood clotting, VTE, stroke, hot flashes

MOA
- Agonist on bone density
- Antagonist for breast cancer

20
Q

Drug class of teriparatide (Forteo)?
MOA?
Treatment regimen?
When to consider as first line?

A

Synthetic parathyroid hormone –> stimulates osteoblast –> direct anabolic effect
- Not retained in the skeleton, rapid loss after stopped

Treatment: 20mcg SC daily for 2 years then any antiresorptive med after

Consider as first line:
- Patients with history of vertebral fracture and T-score less than 2.5

21
Q

What drug class is Romosozumab (Evenity)
MOA?
Indication?
Treatment?
Efficacy?
When to consider as first line?

A

Sclerostin inhibitor –> increases bone growth AND decreases bone breakdown

Indication
- Treatment for OP in Post-menopausal women

Treatment
- 210mcg SC for 1 year then antiresorptive med
- not retained in the skeleton

Efficacy
- more effective than forteo at improving density
- more effective than alendronate at reducing fractures with PRIOR fracture

Consider as first line:
- Patients with history of vertebral fracture and T-score less than 2.5

22
Q

What medication to give if CrCl is less than 30

A

Do not give bisphosponate
- consider denosumab (prolia)

23
Q

When to:
Not recommend therapy
suggest therapy
Recommend therapy

A

Do not recommend therapy
- Fracture risk <15% OR
- t-score -2.5+

Suggest therapy
- Fracture risk 15-19.9% OR
- T score below -2.5 AND age less than 70

Recommend therapy
- Fracture risk 20%+ OR
- T- score below 2.5 and age 70+
- Previous hip or spine fracture OR
- 2+ fracture events

24
Q

When do you follow up for treatment OP?
When do you follow up for no treatment with risk factor of
less than 10%
10-15%
15%+

A

Treatment: BMD in 3 years

No treatment:
less than 10%: 5-10 years
10-15%: 5 yrs
15%+: 3 years

IPFC 1 Final (13 decks)

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