Therapeutics of Osteoporosis

Question 1

Non-Pharm Prevention

Answer 1

Increase peak bone mass 
Usually peak around 25-30
Diet rich in calcium and vit D
Smoking cessation
Decrease alcohol and caffeine
Fall prevention
Med review

Question 2

Fall prevention includes

Answer 2

Strengthening exercises

Safe home environment

Question 3

Calcium dosing

Answer 3

Men 50-70: 1000 mg orally daily
Women 51+: 1200 mg orally daily
Men 71+ 1200 mg orally daily
NOT all at once, multiple doses of 500 or less
NEED Vit d in combo to see decreased fracture risk

Question 4

Best Calcium Supps

Answer 4

Carbonate and Citrate

Question 5

Insoluble Calcium Salts

Answer 5

Carbonate
Take with meals to enhance absorption
Require acidic pH
1 tablet per dose
Cheap

Question 6

Soluble Calcium Salts

Answer 6

Citrate, Lactate, gluconate
Preferred in patients with achlorhydria (low acid)
2 tablets per dose
Expensive but without regard to meals

Question 7

Vitamin D needs to

Test question

Answer 7

be replete prior to initiation of osteoporosis therapy

GOAL OF 30!!!!

Question 8

RF for Vit D deficiency

Answer 8

Limited sun
malabsorption
meds
darker skinned
obese
lack in diet
kidney disease

Question 9

Vit D Need

Answer 9

> 50 yo - 800-1000 units/d

Question 10

Calcium and Vit D Pearls

Answer 10

Higher dose decrease fracture risk
Constipation
Interacts with drugs

Question 11

Bisphosphonates

Answer 11

FIRST LINE
Decrease vertebral and hip fractures
Zoledronic decreases mortality

Question 12

Bisphosphonate special properties

Answer 12

Empty stomach for 30 minutes
Upright for 30 minutes
Full class of water
Adequate Ca and Vit D

Question 13

Bisphosphonate AE

Answer 13

Osteonecrosis of the jaw
Severe musculoskeletal pain
Atypical femur fractors (holiday from drug)

Question 14

Teriparatide

Answer 14

SQ daily MAX 2 yrs
Used in very high risk who can’t tolerate bisphosphonates
BEFORE bisphosphonates

Question 15

Denosumab

Answer 15

MEN
SQ q6 months in doctors office
Suppresses bone turnover
ONJ!!

Question 16

Oral Bisphosphonates that require upright 30 minutes

Answer 16

Alendronate

Risdronate

Question 17

Estrogen

Answer 17

Prevention
Utilize with progestin in thos with intact uterus
Breast cancer and CV so not used much

Question 18

Raloxifene SERM

Test question

Answer 18

Agonist at the bone
Antagonists at the breast
May increase risk of hot flash
INCREASE RISK OF CLOTS

Question 19

Calcitonin

Answer 19

SQ and intranasal (alternate nostrils)
NEED adequate Calcium and Vit D
Limited data

Question 20

OP in Men

Answer 20

Higher mortality

Testosterone plays a role but not good treatment

Question 21

Monitoring

Answer 21

DXA Q2 yrs

Biochemical markers of bone turnover Q3-6 months

Question 22

Bisphosphonates do what?

Answer 22

Suppress bone turnover!!!