Pharm2 8 Osteoporosis pt1

Question 1

Osteoporosis Defined

Definition via t-score

Answer 1

A skeletal disorder characterized by compromised bone strength predisposing to increased risk of fracture
Bone density T-score ≤2.5 standard deviations
below normal peak values for young adults

Question 2

What is bone density? and its components

Answer 2

Bone density = bone density + bone quality

Bone density = grams of mineral per area or volume
Bone quality = architecture, turnover, damage accumulation, and mineralization

Question 3

Once upon a time __% of ppl who fractured their hip died within a year.

Answer 3

50%. not true anymore.

Question 4

3 key major risk factors for osteoporotic fracture

2 moderate risk factors

Answer 4

Hip fracture in parents
Glucocorticoids
Malabsorption

Smoking, excess alcohol

Question 5

What is a fragility fracture?

Answer 5

fall from a standing height that results in a fracture
Shots of cortisone repeatedly for asthma really puts you at risk.
Being an astronaut also puts you at risk.

Question 6

What does it mean if a hypogonadal state leads to secondary osteoporosis?

Answer 6

AACE guidelines: someone is symptomatic and has testosterone below 200.

Question 7

How much sun for adequate vit d?

What’s a normal lvl? Deficient? Insufficient?

Answer 7

15-20 minutes a day of sunlight on face & arms
Normal: >31
Insufficient: 31-21
Deficient: <21

Question 8

Who should have a bone density test? (8)

Answer 8

Women >65 years of age, men >70 years of age
Younger postmenopausal women and men 50-69 with risk factors
Menopausal women with risk factors associated with increased fracture risk, (i.e., low body weight, prior low-trauma fracture, or high-risk medication [aromidase inhibitor – these ppl are 50, at increased risk…])
Adults who have a fracture after age 50
Diseases/conditions/drugs associated with low bone mass or bone loss
Anyone receiving treatment for osteoporosis
Anyone considering therapy for osteoporosis
Anyone not receiving therapy in whom evidence of bone loss would lead to treatment

Question 9

Where is NOF located? (National Osteoporosis Foundation)

Answer 9

Portland, Oregon.

Question 10

What T-Score applies to the WHO/NOF criteria for diagnosis of osteoporosis?

Answer 10

T-score ≤ –2.5

Question 11

WHO/NOF Criteria for Classification of Bone Status (normal, low bone mass, osteoporosis, severe or established osteoporosis)

Answer 11

Normal: T score >-1
Low bone mass: T-score btwn -1 and -2.5
Osteoporosis: <-2.5 + fragility fracture(s)

Question 12

FRAX indications for treatment of postmenopausal osteoporosis. (two percentages we need to know)

Answer 12

10 year hip fracture risk is >3%

10 year all major osteoporosis-related fracture risk >20%

Question 13

Behavioral/Lifestyle Measures to Prevent Osteoporosis (6)

Answer 13

Adequate intake of dietary calcium, vitamin D, and protein throughout life
Regular physical activity; load-bearing exercise
Minimize alcohol intake
Stop smoking
Take measures to prevent falls
Use of hip protectors by patients prone to falling

Question 14

Oral vitamin D reduces risk of hip fractures by 26%. Why?

Answer 14

b/c it improves balance and muscle strength** - ppl fall less in the first place if they have enough Vit D!

Question 15

NOF recommends at least ___ Vitamin D. however, these recommendations may be too low and will likely be revised

Best sources for Vitamin D

Answer 15

800-1000 IU

Milk, salmon, canned tuna, sardines, eggs, liver
Sunlight

Question 16

Vit D is also found to reduce the risk of __

Answer 16

cancers

Question 17

Best laboratory indicator of vitamin Dadequacy

What’s sufficient? Insufficient? Deficient?

Answer 17

Serum 25(OH)D Concentration
Sufficient: 31
Insufficient: <20

Question 18

NIH Recommendations for calcium intake by age range:

Answer 18

1-3: 500 mg
4-8: 800
9-18: 1300
19-50: 1000
>51: 1200
>65: 1500

Question 19

95% of the market for Osteoporosis tx is:

Answer 19

Bisphosphonates: Alendronate, risedronate, ibandronate, zoledronic acid

Question 20

Bisphosphonates seem to end in -____

Answer 20

-dronate

Question 21

All Bisphosphonates are probably about equivalently helpful for Vertebral fractures, Nonvertebral fractures, and hip fractures.

Why might a patient not stay on it?

Answer 21

patients rarely stay on ‘em >6 months. Why? b/c they don’t see an immediate benefit after a month. The benefit is not getting a fracture, but they can’t really acknowledge that’s working. Can be expensive too.

Question 22

How to take bisphosphonates. Why?

Answer 22

Can cause pill-esophagitis – must be sitting upright, don’t walk around too much after it’s taken?

Question 23

Why are there “Call 1-800-BAD-PILL commercials against Bisphosphonates?

Answer 23

these drugs increase the risk of specific atypical types of fractures. – Chalkstick fractures.
Chalkstick fractures – these drugs increase the risk for this after 6-7 years. So put ppl on them for 5 years, then pull ‘em off and do a ‘Drug Holiday’. Keep ‘em pulled off for ~3 years, check mineral bone density, and if you need to put them back on, but put them back on a different drug like RankL Inhibitors.

Question 24

All of these Bisphosphonate drugs are also related to:

Who does this happen to?

Answer 24

BONJ – bisphosphonate Osteon necrosis of the jaw.
– Cancer patients on injectable forms of medication, who then concurrently has a dental manipulation (tooth extraction or dental implant).

Question 25

What do you do if there’s a cancer patient on an injectable form of a bisphosphonate that wants to get a tooth pulled or dental implant?

What’s the actual half life of bisphosphonates?

Answer 25

You need to know the half life of this drug is 5 months in the serum, but that’s not what’s important (if taken once per month…5 doses) – but this is stored in the bone, and the ACTUAL HALF LIFE IS 1-10 years (more like 1-2 years)?
The dentist can’t just pull them off this drug for a week, that’s like spitting in the ocean. You need to rank your priorities. Not dying from cancer > getting a tooth pulled.