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Phar 508 > Pathophysiology of Osteoporosis > Flashcards

Pathophysiology of Osteoporosis Flashcards

1
Q

What is osteoporosis

A

Decreased bone mass with normal mineralization of remaining bone

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2
Q

T/F: Osteoblasts form new bone and osteoclasts resorb old bone

A

True

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3
Q

What are the three types of osteoporosis,cause

A

Postmenopausal: Due to loss of estrogen production
Senile: multifactoral and related to changes seen with normal aging
Secondary: Disease/drug inducing

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4
Q

What drug is most associated with causing osteoporosis, others

A

Corticosteroids/ long-term heparin, Gn-RH agonists and Aromatase inhibitors, Depo, Anti-retrovirals, PPIs, AEDs, furosemide

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5
Q

What are clinical presentations of vertebral fractures, wthat causes distal forearm fractures

A

Back pain, loss of height/ associated with falls

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6
Q

Why are hip fractures treated with such urgency

A

only 40% regain pre-fracture mobility, 10-20% excess mortality within the 1st year of fracture

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7
Q

What is the most common way diagnose osteoporis, gold standard

A

Bone mineral Density, DEXA

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8
Q

T/F: BMD tests how much bone is present but not how strong

A

True

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9
Q

What scores are found in BMD tests and how are they

A

T score: Standard deviation difference from peak BMD of comparison population
Z score: Bone density in comparison to age and gender matched adults

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10
Q

What are the types of T scores

A

Normal: Greater than -1.0
Osteopenia: -1.0 to -2.5
Osteoporosis: Lower than -2.5
Severe Osteoporosis: Lower than -2.5 PLUS a history of nonviolent atraumatic fracture

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11
Q

What are risk factors for osteoporosis

A

Age, thin small frame, white or asian race, female gender, postmenpausal, history of ataumatic fracture,smoking, 3 or more drinks a day, family history

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12
Q

What disease state associated to osteoporosis

A

Rheumatoid arthritis

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13
Q

What diet and personal habits contribute to osteoporosis

A

Low calcium intake, high phosphorus intake, tobacco use, alcohol use, inactive/sedentary lifestyle

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14
Q

What are drugs that are protective of osteoporosis

A

Estrogen, thiazide diuretics

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15
Q

What exercises can aid in prevention in osteoporosis and how

A

Weight-bearing exercise: increases/maintains bone mass (most important)
Muscle-strength exercise: improve balance reducing risk of falls
Balance training: Reduce risk of falls

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16
Q

What supplement is controversial in treatment of osteoporosis, what are the ways to get it and which is the best way

A

Calcium (500-1000mg or 1200 after menopause), supplement and diet (best way)

17
Q

T/F: Evidence shows that Vitamin D supplementation is always the best for a patient no matter their levels

A

False: Vitamin D supplementation decreases fracture risk ONLY in patients with low vitamin D levels, negligible in people with adequate vitamin D levels

18
Q

What are risk factors for low Vitamin D levels

A

Housebound, corticosteriods and anticonvulsants, CKD/Renal failure, winter months in northern climates

19
Q

What is the age where ALL adults should receive Vitamin D supplementation ,What is the recommended dose for Vitamin D3 for all

A

50 years or older, 800-1000 IU

20
Q

What is vitamin D deficiency, how should it be treated

A

Less than 30 ng/mL, Ergocalciferol 50,000 int units weekly every 12 weeks THEN 1000-2000 daily

21
Q

When should a patient be started on Osteoporosis

A

T score less than -2.5, Hip or vertebral fracture, T- score -1 to -2.5 AND secondary cause, -1 to -2.5 AND 10 year risk for hip fracture GREATER than 3% OR 10 year risk of other osteoportic fracture GREATER than 20%

22
Q

T/F: If a patient is anticipated to use 2 months or more glucocorticoid therapy they should be started on anti-osteoporosis drugs

A

False: If a patient is anticipated to use 3 months or more glucocorticoid therapy they should be started on anti-osteoporosis drugs

23
Q

T/F: All patients on pharmacologic therapy should ALSO be receiving adequate calcium and vitamin D supplementation

A

True

24
Q

What are the anti-resorptive agents that are considered first-line, can only be used in women

A

Bisposphanates, Denosumab/ Estrogen, SERMS, TSEC, Calcitonin

25
Q

T/F: Estrogen can be used for long-term osteoporosis prevention

A

False: Estrogen is only used short term (less than 5 years) for osteoporosis prevention due to risks

26
Q

What are the bisphosphonates

A

Alendronate, Risedronate, Zoledronic acid, Ibandronate

27
Q

Which bisposhonate is not indicated for osteoporosis in men or glucocortico-induced osteoporosis (prevention or tereatment)

A

Ibandronate

28
Q

What are tips for taking bisphosphonates, who shouldn’t take bisphosphonates

A

Take at least 30 minutes prior to eating, take with 6-8 oz of plain water, should NOT recline for at least 30 minutes after ingestion, patients with CrCl less than 30

29
Q

What are the adverse effects of bisphosphonates

A

Esophageal irritation/ulceration (avoid ORAL if patient got GERD), osteonecrosis of jaw and atypical femur fractures (rare, increased risk with longer term use)

30
Q

When zoldronic acid is infused what can be given to prevent an infusion reaction, how often after the infusion reactions

A

Pretreat with acetaminophen, most common after the first dose

31
Q

What is the monoclonal antibody used in osteoporosis, what is the MOA, adverse effects

A

Denosumab: blocks receptor activation of nuclear factor kappa B ligand (RANKL)/ Hypocalcemia, serious infections, dermatologic osteonecrosis of jaw and atypical femur fractures (rare)

32
Q

What SERM is approved for prevention/treatment of osteoporosis along with reduction for risk of breast cancer, what are the adverse effects

A

Raloxifene/ Thromboembolism, hot flashes, leg cramps, joint pains

33
Q

T/F: Patients taking Raloxifene cannot take this medication if they have uterus

A

False: Raloxifene does NOT cause endometrial hyperplasia

34
Q

What FDA approved TSEC can be used in women WITH a uterus to aid in osteoporosis AND moderate to severe vasomotor symptoms

A

Conjugated Estrogen PLUS Bazedoxifene

35
Q

What osteoporotic drug is FDA approved for treatment in women greater than 5 years postmenopausal, formulations

A

Calcitonin (Not a first or second line therapy)/ IM or SC administration

36
Q

What are the anabolic agents

A

PTH analogs (Teriparatide, Abaloparatide), Romosozumab

37
Q

T/F: Anabolic agents should be followed up with antiresorptive agents since bone loss is rapid after discontinuation

A

True

38
Q

What are adverse effects of PTH analogs

A

Orthostatic hypotension, increased serum calcium, osteocarcomas (greater than 2 years of use), increase in urine calcium excretion, increase in serum uric acid

39
Q

What is the MOA of Romosozumab, contraindications, length of therapy

A

Sclerostin inhibitor/ Heart attack, stroke within the past 12 months, high risk of stroke and heart attack, hypocalcemia, (12 months)

Phar 508 (21 decks)

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