Osteoporosis & Thyroid

Question 1

Which osteoporosis drug is only approved for postmenopausal osteo?

Answer 1

Ibandronate; also available IV

Question 2

Which first line therapy could be given to someone with a CrCl of less than 30?

Answer 2

Denosumab

Question 3

First line therapy for high risk/no prior fractures?

Answer 3

Alendronate, risedronate, zoledronate, denosumab

Question 4

Alternate therapy for high risk/no prior fractures?

Answer 4

Ibandronate, raloxifene (SERM)

Question 5

First line therapy for very high risk/prior fractures?

Answer 5

Denosumab, romosuzumab, teriparatide, abaloparatide, zoledronate

Question 6

Alternate therapy for very high risk/prior fractures?

Answer 6

Alendronate, risedronate

Question 7

Drug holiday rec for high risk?

Answer 7

PO after 5 years

IV after 3 years

Question 8

Drug holiday rec for very high risk?

Answer 8

Denosumab: continue until pt is no longer high risk, then transition

Romosuzumab: 1 yr, then Sequential therapy

Abaloparatide or teriparatide: 2 years, then sequential therapy

Zoledronate: if stable, continue for 6 years. Switch if necessary

Question 9

What is a high FRAX risk?

Answer 9

> 20% for major osteoporotic fracture

>3% for hip fracture

Question 10

Osteoporosis screening?

Answer 10

All postmenopausal women >50

Men >70

Question 11

DEXA measures?

Answer 11

Lumbar spine and hip

Question 12

Bone turnover markers?

Answer 12

S-CTX: high level = high resporption. Adequate response to therapy: Decrease of 25% or more from baseline.

PINP: measure of bone formation

Question 13

Pt taking 1500mg/day of Ca2+. Risk?

Answer 13

Kidney stones or CVD

Question 14

Recommendation for Vit D dietary intake?

Answer 14

General: between 600-1000 IU

Over 70: 800 (IOM), 800-1000 (Osteo Foundation)
50-70: 600 (IOM), 800-1000 (Osteo Foundation)

Question 15

Recommendation for Ca2+ dietary intake?

Answer 15

IOM for men 50-70: 1000

Everyone else, both IOM and Osteo Foundation: 1200

Question 16

Denosumab Side Effects:

Answer 16

Angina, myalgia, sciatic, anemia, pancreatitis, osteonecrosis, severe bone/extremity/back pain

Hypocalcemia, infection, edema, rash/pruritis

Question 17

PTH analog with higher dose AND longer T1/2?

Answer 17

Abaloparatide

Question 18

PTH analog SEs?

Answer 18

Teriparatide:
Hypersensitivity, calciphylaxis, hypotension, depression
Hypercalcemia, dizziness, consitpation, insomnia, hyperuricemia, leg cramps, syncope

Abaloparatide: Anaphylaxis, hypotension, hypercalcemia, hypercalciuria, tachycardia, HA, dizziness, palpitations

Question 19

Preferred Iodide for thyroidectomy:

Answer 19

Potassium Iodide

Question 20

Side effects of iodides:

Answer 20

Potassium: Agranulycytosis, thrombocytopenia, aplastic anemia
Pneumonitis, exfoliative dermatitis, hepatotoxicity
Rash, N/V, hyperpigmentation

Sodium: hypothyroidism