Treatment of Osteoporosis Flashcards
Prevnetion of bone loss
Exercise
Vit D
Calcium
Osteoporosis and osteopenia initiate tx
Porosis - diagnosis
Osteopenia - must detemrine fracture risk using FRAX
If FRAX>3% ten year hip or >20% ten year any, then tx
Premenopausal women and men under 50
Most have secondary…not much data on them
2 types of meds
Antiresorptive- stops resorption but also formation
Anabolic - increase formation, but also resortpion
Bisphos MOA
LA meds that depost and bind to surfase
Imapir ability of osteoclast to adhere and dissolve bone
Route, fracture prevention unqiue
Zoledronic is IV
Ibandroante is vert only
Bisphos Admin
Poorly abosrbed
Don’t take with food
Stand 30 min to prevent reflux and don’t eat for 90
If GI sx, then IV form
Bisphos contraind
Renal insufficiency
Esophagela disorders
Inabiity to stay upright
Hypocalcemia, VIt D def
SE of Bisphos
Hypocalcemia
Upper GI
Flu-like sx
Acute kidney injury
Bisphos and atypical femur fractures
incidence is low…decreases when BP’s stopped
Subtrochanteric femur
Presnt iwht thigh or groin pian…get bilateral x-rays
Bisphos and osteonecrosis of the jaw
Exposed mandibular bone in oral cavity
More with IV
Concern is extraction
Monitoriing of osteoporosis tx
DXA every 1-2 yrs
Expect stability
Bone tunrover makrer
Bispohs drug holiday
Allows bone turnover to increase
Decrease SEs
Long acting so should be alright
Denosumab
RANKL monoclonal antibody
SubQ every 6 mos
Use in renal dysfuntion
Denosumab adverse effects and monitoring
Hypocalcemia
Cellulitis
OSteonecorsis of the jaw
Calcium 10 days after
Adv and disadv of denosumab
Potent
Not as long acting
2X per year
Renal insufficenty
Hypocalcemia
Bone loss 6-12 mos after stopping
Limited data
Expensive
Selective estrogen receptor modulators
Raloxifene
Binds to estrogen receptor
NO hip fracture protection
SE_ venous thrombosis and hot flashes
Reduced breast cancer risk
Teriparatide
only anabolic agent
SQ injection (daily)
acts PTH receptor of osteoblast
with intermittent exposure - increased osteoclast and blast so more bone formtion…more effect on spines
Continuous exposure will cause bone loss
Terparatide uses and contraindicated
Patients at highest risk
Hypercalcemia
Gout
OSteocarcoma or increased risk (radiation, Paget’s, alakaline phsophatase elevations)
Adverse effects of teriparatide
Hypercalcemia
Muscle pain
Osteosarcoma
Adv and disadv of teriparatide
Only anabolic
No long term effects of bone turnover
Daily
Only 2 year use
BOne loss after stopped
Expensive
Estrogen replacement for osteoporosis
Reduces both types of fractures
Good for premenopausal with estrogen deficiency
Not approved for post bc increase breast cancer risk
