Therapeutics Of Osteoprosis Flashcards
Define osteoporosis
Skeletal disorder defined by low bone density, decreased bone strength and deterioration of bone architecture that results in increased bone fragility and risk of fracture
Which fracture is the most devastating for osteoporosis and has the highest mortality
Hips fracture
Characterize or group osteoporosis
Primary and secondary
Characterize primary osteoporosis
Type 1: post menopausal osteoporosis . Type 2: age related osteoporosis. Type 3: idiopathic, due to unknown causes in juveniles and adults
What are the two ways we can diagnose osteoporosis
- Atraumatic fractures to the spine, distal radius or femur after small falling. 2. DXA scan to interpret bone mineral density
What is the T score for osteoporosis diagnosis
Less than or equal to -2.5
When do we consider treatment for osteoporosis
- History of hip or vertebral fracture 2. T score less than -2.5 at neck, hip or spine by DXA. 3. Post menopausal women or men more than 50 with a T score between -1 and -2.5 with a FRAX score more than 20% OR 10 year hip fracture pro Aliyu greater than 3 percent
What is the counter indications for bisphosphonates
Hypocalcemia. Renal insufficiency( less than 30-35 crcl). Pregnancy or breast feeding. Esophageal insufficiency. Avoid after bariatric surgery
Which bisohosphonate is not good for hips and non vertebrae
Ibandronate
Mention the drug interactions with bisphosphonates
Antacids Mineral acids. Increase GI side effects of NSAIDS
What bisphosphaonates is the most convenient for patients adherence wise and why
IV zolendronic acid. Patients get it every 2 years for treatment and once 3 years for prevention
True or false menopausal hormonal therapy is used to treat osteoporosis
False it is only use for prevention of osteoporosis in post menopausal women that are high risk
What are the SERMS used for osteoporosis in post menopausal women
Raloxifene: can treat and prevent osteoporosis in post menopausal women Banzedoxifene + Duavee: can only prevent osteoporosis in women with uterus
Counter indications for SERMS
Pregnancy or lactating. Active or previous history of pulmonary embolism or thrombosis
What type of fractures can SERMS not treat at all
Hips and non vertebrae fractures
What are the black box warnings for raloxifene
Increases risk of deep vein thrombosis(DVT) and pulmonary embolism(PE). Increases risk of stroke
Women with what post menopausal symptom should not take Raloxifene
Women with Vaso motor symptoms like hot flashes
What is the counter indication for calcitonin
Women with allergies to salmon should not take it
What does calcitonin not work on
Doesn’t work for hips and non vertebral
Indication for calcitonin
Treatment in Only for post menopausal women. Not used by men
Adverse effects of calcitonin
If you use intranasally for more than 6 months you can get cancer
What is the counter indication for denosumab
Hypocalcemia
What is the problem with denosumab therapy
You have to be on it for life. If you stop treatment you will have rebound vertebrae fractures. Only stop treatment if you will be on bisphosphonates
What drugs cannot work on hips, and non vertebra fractures
Ibandronate. Calcitonin. SERMS
Which one of the PTH anabolic drugs has approval only for men and steroid induced osteoporosis
Teriparatide
What is the black box warning for PTH hormone analogs
Osteocarcinoma
What is the black box warning for PTH hormone analogs
Osteocarcinoma
What are the counter indications for PTH analogs
Paget’s disease. Prior radiation therapy for the skeleton Increase base like for osteocarcinoma.
What part of the body can PTH analogs not work on at all
Hips
What are the adverse effects of PTH analogs
Orthostatic hypotension: give only when they are sitting or lying down. Hypercalcemia: reduce calcium intake to less than 1000 mg/day.
Mention the four drugs that are first line treatment for osteoporosis in terms of efficacy and safety
Alendronate, risendronate, zoledronic acid, denosumab
Which drug is a second line treatment for osteoporosis
Ibandronate cos it doesn’t treat hips and non vertebrae. Calcitonin.
What is the third line treatment for osteoporosis
Raloxifene
What is the 4th line treatment for osteoporosis
Calcitonin
Problem with romosozumab therapy
If discontinued, you can get a rebound effect is bone loss to pretreatment level. Use bisphosphonates or denosumab after stopping
What is the black box warning for romosozumab
Increases risk of myocardial infarction, stroke and cardiovascular death
What type of disease state patients cannot take bisphosphonates
Patients with chronic kidney disease cos the drug is excreted in the kidney
