postmenopausal osteoporosis

Question 1

high risk for fracture

Answer 1

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

Question 2

very high risk for fracture

Answer 2

t <2.5 AND hx of fractures

Question 3

who should be on calcium? how much

Answer 3

all postmenopausal women

1000-1500 mg QD (about 300 come from non-dairy diet, 900 from diet w dairy)

Question 4

calcium dosage forms

Answer 4

calcium carbonate - better absorbed w foods
most common

calcium citrate - preferred in acid suppressing environment

Question 5

calcium AE

Answer 5

at high doses/renal impair

hyperCa, kidney stones, constipation

bind to other meds/impair absorption of other vitamins/minerals

Question 6

vitamin d requirements

Answer 6

1000-2000 IU/day

Question 7

vitamin D dosage forms

Answer 7

D2 - ergocalciferol
D3 - cholecalciferol

cholecalciferol preferred

renal dysfunction - give rocaltrol (calcitriol) w ergocalciferol

Question 8

vitamin D AEs

Answer 8

hypercalcemia

Question 9

first line therapy for osteoporosis prevention and treatment

Answer 9

bisphosphonates

kidney dysfunction - denosumab

Question 10

bisphosophonates MAO

Answer 10

inhibit bone resorption

bind to bone and is ingested by osteoclasts - inhibiting their action

half life is years long!!

Question 11

bisphosphonates admin

Answer 11

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

Question 12

bisphosphonates therapy duration

Answer 12

5 years

then recheck bone density

stopping does not stop cessation of action, so drug holidays up to 5 years if no fractures

Question 13

bisphosphonates AE

Answer 13

esophagitis, dysphagia, bone/joint/muscle pain

osteonecrosis of the jaw
fremur fracture
acute renal failure

GI AE increase w NSAIDs/aspirin

Question 14

denosumab MOA

Answer 14

monoclonal antibody

RANLK inhibitor

Question 15

denosumab AE

Answer 15

back/extremity pain, hypercholesterolemia, cystitis, arthralgia

osteonecrosis of jaw (higher than bisphosphonates)
hypocalcemia - ensure supplementation!!!!!!

use another agent immediately after stopping

Question 16

denosumab dosing

Answer 16

60 mg SC q 6mos

Question 17

parathyroid hormone analogues MOA

Answer 17

mimic pth or prarthyroid hormone-related protein

increase resorption of calcium from kidneys

Question 18

parathyroid hormone analogues AE

Answer 18

arthralgia, pain, nausea, orthostatic hTN

OSTEOSARCOM, hyperCa, urolithiasis

drug interactions - digoxin

Question 19

parathyroid hormone analogues dosage forms

Answer 19

teriparatide - 20 mg SQ QD

abaloperatide - 80 mg QD

Question 20

SERM modulators MAO

Answer 20

selective estrogen receptor modulators

estrogen receptor agonists (bones, lipids), estrogen receptor antagonists (breast, uterus)

Question 21

SERM modulators AE

Answer 21

related to estrogen blockage (like monopause)

hot flashes/sweating, leg cramps, peripheral edema, arthralgia

VTE/PE

Question 22

conjugated estrogen + SERM use

Answer 22

women <75 in perimenopause w vasomotor s/s

added prevention of osteoporosis

risk of VTE

Question 23

romosozumab use

Answer 23

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

Question 24

bisphosphonates examples

Answer 24

alendronate, risedronate, zoledronic acid

Question 25

which bisphosphonate does not need to be taken on an empty stomach?

Answer 25

atelvia