postmenopausal osteoporosis Flashcards
high risk for fracture
t <2.5 OR prior fracture (hip, spine), OR to yr probability of hip fracture >3% or other fracture >20%
def of osteoporosis = t<2.5
very high risk for fracture
t <2.5 AND hx of fractures
who should be on calcium? how much
all postmenopausal women
1000-1500 mg QD (about 300 come from non-dairy diet, 900 from diet w dairy)
calcium dosage forms
calcium carbonate - better absorbed w foods
most common
calcium citrate - preferred in acid suppressing environment
calcium AE
at high doses/renal impair
hyperCa, kidney stones, constipation
bind to other meds/impair absorption of other vitamins/minerals
vitamin d requirements
1000-2000 IU/day
vitamin D dosage forms
D2 - ergocalciferol
D3 - cholecalciferol
cholecalciferol preferred
renal dysfunction - give rocaltrol (calcitriol) w ergocalciferol
vitamin D AEs
hypercalcemia
first line therapy for osteoporosis prevention and treatment
bisphosphonates
kidney dysfunction - denosumab
bisphosophonates MAO
inhibit bone resorption
bind to bone and is ingested by osteoclasts - inhibiting their action
half life is years long!!
bisphosphonates admin
must be taken on an empty stomach w full glass of water
upright for 30 minutes
dental checkup before starting therapy
also admin calcium and vitamin D
bisphosphonates therapy duration
5 years
then recheck bone density
stopping does not stop cessation of action, so drug holidays up to 5 years if no fractures
bisphosphonates AE
esophagitis, dysphagia, bone/joint/muscle pain
osteonecrosis of the jaw
fremur fracture
acute renal failure
GI AE increase w NSAIDs/aspirin
denosumab MOA
monoclonal antibody
RANLK inhibitor
denosumab AE
back/extremity pain, hypercholesterolemia, cystitis, arthralgia
osteonecrosis of jaw (higher than bisphosphonates)
hypocalcemia - ensure supplementation!!!!!!
use another agent immediately after stopping
denosumab dosing
60 mg SC q 6mos
parathyroid hormone analogues MOA
mimic pth or prarthyroid hormone-related protein
increase resorption of calcium from kidneys
parathyroid hormone analogues AE
arthralgia, pain, nausea, orthostatic hTN
OSTEOSARCOM, hyperCa, urolithiasis
drug interactions - digoxin
parathyroid hormone analogues dosage forms
teriparatide - 20 mg SQ QD
abaloperatide - 80 mg QD
SERM modulators MAO
selective estrogen receptor modulators
estrogen receptor agonists (bones, lipids), estrogen receptor antagonists (breast, uterus)
SERM modulators AE
related to estrogen blockage (like monopause)
hot flashes/sweating, leg cramps, peripheral edema, arthralgia
VTE/PE
conjugated estrogen + SERM use
women <75 in perimenopause w vasomotor s/s
added prevention of osteoporosis
risk of VTE
romosozumab use
pt w severe postmenopausal osteoprosis and hx of fracture, other risk factors & cant take other meds
inhibits sclerostin
can cause major CV events - MI/stroke
change agents after 1 yr
SC monthly 12
bisphosphonates examples
alendronate, risedronate, zoledronic acid
