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S3 Case 3 - Musculoskeletal > Pharmaceutical Care of Osteoporosis > Flashcards

Pharmaceutical Care of Osteoporosis Flashcards

1
Q

What is osteoporosis?

A

Progressive, systemic skeletal disorder characterised by loss of bone tissue + disruption of bone micro architecture
= increased fragility + fracture

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2
Q

What are the stages of osteoporosis?

A

Normal bone density
Osteopenia
Osteoporosis
Severe osteoporosis

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3
Q

What is osteopenia?

A

Loss of bone mass + density BUT bone loss is not yet severe

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4
Q

What builds bones?

A

Osteoblasts

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5
Q

What crushes bones?

A

Osteoclasts

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6
Q

What are osteocytes?

A

Former osteoblasts that lie in the matrix they form

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7
Q

What are the non-modifiable risk factors?

A

Previous fractures
Parental history
Early menopause

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8
Q

What are the modifiable risk factors?

A

Low BMI
Smoking
Low BMD
Alcohol intake

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9
Q

What are the coexisting diseases that contribute?

A

Diabetes
RA
IBD/malabsorption
Moderate-severe CKD

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10
Q

What drug therapies contribute?

A

Long-term antidepressants
Antiepileptics
Aromatase inhibitors
PPIs
Oral corticosteroids

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11
Q

What are the complications?

A

Fractures
= often result from low-level trauma

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12
Q

Where are fractures most common?

A

Spine (vertebral)
Hip
Wrist

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13
Q

What are the causes?

A

Primary = multifactorial = idiopathic
Secondary = conditions

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14
Q

What is the initial investigations for diagnosis?

A

Blood tests = vitD, thyroid test, U+Es
DXA scan
X-ray = suspect fracture

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15
Q

How do you assess fracture risk?

A

QFracture
FRAX score

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16
Q

When do you consider a fracture assessment?

A

In all women aged 65 years + over + in all men aged 75 years + over
In all women under 65 + men under 75 with risk factors

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17
Q

When do you warrant for investigation for QFracture + FRAX?

A

When score is over 10%

18
Q

What is DXA scan?

A

Dual x-ray
Measures bone mineral density

19
Q

When does the DXA scan warrant for investigation?

A

T Score
Osteopenia =-1-2.5
Osteoporosis = less than -2.5
Severe = Less than -2.5 + fracture

20
Q

How do you target reversible risk factors?

A

Exercise = outdoors, strength training, balance of exercises
Diet
Smoking cessation
Alcohol intake limited

21
Q

If calcium + VitD inadequate what is given?

A

Ca = 1000mg
VitD = 800 units
BUT double if house bound or in nursing home

22
Q

What do bisphosphonates do?

A

Bind to, + stabilise bone by inhibiting osteoclast activity

23
Q

What needs to be monitoring with bisphosphonates?

A

Kidney function = renally excreted

24
Q

What are the drug choices for bisphosphonates?

A

Alendronic acid
Risedronate

25
Q

What are the counselling points for bisphosphonates?

A

Take once weekly
Take with plenty of H2O
Take whilst standing up
Take on empty stomach
Remain upright for 30mins after taking
Do not take at night
Do not crush

26
Q

What are the side effects of bisphosphonates?

A

Oesophageal reactions = counselling points
Atypical fractures
Osteonecrosis

27
Q

How do you manage osteonecrosis of the jaw?

A

Report any oral symptoms
Encourage good oral hygiene
Increased risk with IV formulations + malignancies

28
Q

How do you manage osteonecrosis of the ear?

A

Report any ear pain, discharge or infections
Associated with long term use

29
Q

What is denosumab?

A

Monoclonal Ab
S/C injection given for 6 months

30
Q

When is denosumab given?

A

When patient cannot tolerate bisphosphonate therapy

31
Q

What must be ensured before starting denosumab?

A

Ca + VitD levels are adequate

32
Q

What are the side effects of denosumab?

A

Osteonecrosis jaw + ear
Atypical fractures
Increased risk of infections at injection site
Hypocalcaemia

33
Q

What is Raloxifene?

A

Selective oestrogen receptor modulator (SERM)

34
Q

What does Raloxifene do?

A

Partial agonists of oestrogen receptors within bone tissue = induce osteoblast activity

35
Q

What is Raloxifene licensed for?

A

Postmenopausal osteoporosis

36
Q

What is an example of a parathyroid hormone analogue?

A

Teriparatide
Daily S/C injection

37
Q

What does Teriparatide do?

A

Mimic effects of PTH = increase bone formation pathway

38
Q

What must be ensured first before starting Teriparatide?

A

Adequate Ca + VitD levels

39
Q

What are the side effects of Teriparatide?

A

Post doe orthostatic hypotension

40
Q

How long is PO bisphosphonate treatment?

A

5 years
Then assess if improvement if no longer above treatment threshold = “bisphosphonate holiday”
Then review after 2 years

S3 Case 3 - Musculoskeletal (14 decks)

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