Tx of Osteoporosis

Question 1

Osteoporosis and Osteopenia: Significant Public Health Problem ?

Answer 1

Structural deterioration of bone mass

Increase propensity of bone fractures

Post menopausal women

Women 5 times more likely to develop Osteoporosis

Women10% to 15% more likely die from hip fracture in one year

Men 25% likely

Half a million vertebral fractures yearly

Question 2

Osteoporosis and Osteopenia confirmed by ?

Answer 2

Confirmed by hip or spiral bone mineral density (BMD) or DEXA scan

Question 3

Osteoporosis and Osteopenia: Once treatment is initiated

Answer 3

Assess successful treatment

Based on either lack of fractures

Increased bone mineral density scores.

Question 4

Osteoporosis and Osteopenia: Medication Goals ?

Answer 4

Achieve optimal peak bone mass

Minimize further bone loss

Decrease falls and fractures

Question 5

____ required for vascular contraction and dilation, nerve transmission, intracellular signaling, hormonal secretion

Answer 5

Ca++

Question 6

_______ required for uptake of calcium and phosphorus from GUT and absorption into bone

Answer 6

Vitamin D

Question 7

Calcium and Vitamin D: Human requirements ?

Answer 7

Ergocalciferol (vitamin D2 from plants)

Cholecalciferol (vitamin D3 synthesized in skin from sunlight and converted in liver to active form)

Question 8

Calcium needs ?

Answer 8

1,000 mg/day males

1,200 mg/day females

Question 9

Vitamin D needs ?

Answer 9

600IU for females

800 IU/day males

Question 10

The lighter a person’s skin the more__________ they make

Answer 10

vitamin D

caution on side of skin cancer risk

Question 11

Some people may have genetic predisposition against __________ absorption

Answer 11

vitamin D

Question 12

People in _____________ may not get enough vitamin D

Answer 12

northern climates

Question 13

Consider a well-rounded _____________ with adequate calcium

Answer 13

health diet

Question 14

Calcium intake in males ?

Answer 14

1,000 mg/day males

Question 15

Calcium intake in females ?

Answer 15

1,200 mg/day females

Question 16

Bisphosphonates reduction of __________________ in postmenopausal women (40–70% effective)

Answer 16

vertebral fractures

Question 17

Bisphosphonates challenges ?

Answer 17

correct administration

avoid serious GI upset

poor bioavailability

Question 18

Bisphosphonates: Bone undergoes constant _________

Answer 18

turnover

homeostasis by osteoblasts creating bone and osteoclasts destroying bone

Question 19

Bisphosphonates MOA ?

Answer 19

Inhibit both normal and abnormal bone resorption and slow down bone remodeling in postmenopausal women

Question 20

Bisphosphonates indications ?

Answer 20

osteoporosis,

Paget’s disease of the bone

Bone conditions involving fragile, breakable bones

Question 21

Bisphosphonates two types ?

Answer 21

non- nitrogenous

nitrogenous

Question 22

Non-nitrogenous ?

Answer 22

Non-N-containing bisphosphonates

Question 23

Nitrogenous ?

Answer 23

N-containing bisphosphonates:

Question 24

Nitrogenous bisphosphonates examples ?

Answer 24

Alendronate (Fosamax)

Ibandronate (Boniva)

Risedronate (Actonel)

Question 25

Alendronate (Fosamax) | dosing ?

Answer 25

PO form 5mg, 10mg, 35mg, 40 mg tab, 70/75 mL oral soln Osteoporosis 70 mg PO qwk

Question 26

Ibandronate (Boniva) dosage ?

Answer 26

Dose: 150 mg PO qmo

Question 27

Ibandronate (Boniva) considerations ?

Answer 27

give w/ water 60min before first food/drink/med avoid lying down x60min calcium and vitamin D supplementation recommended if inadequate dietary intake periodically reassess need for treatment consider D/C after 3-5y in low-risk pts

Question 28

Ibandronate (Boniva) | adverse effects ?

Answer 28

osteonecrosis, jaw musculoskeletal pain, severe hypersensitivity rxn Stevens-Johnson syndrome Anaphylaxis hypocalcemia Uveitis scleritis acute renal failure (IV use)

Question 29

Bisphosphonates patient / family education ?

Answer 29

Warn patient of joint, muscle, bone jaw pain Advise to take with full glass of water Use food if need to offset upper GI distress IV forms for 3 months or once a year administration

Question 30

Bisphosphonates Conscientious Prescribing ?

Answer 30

Use cautiously in patients with renal impairment Watch for jaw bone necrosis Watch for abnormal diagnostic imaging Monitor serum calcium and phosphorus

Question 31

SERMs AKA?

Answer 31

Selective estrogen receptor modulators

Question 32

SERMs examples ?

Answer 32

Raloxifene (Evista)

Question 33

Raloxifene (Evista) MOA ?

Answer 33

Mimic estrogen antagonists and provide estrogen resorption effects without need for estrogen

Question 34

Raloxifene (Evista) pharmacokinetics ?

Answer 34

60% absorbed from GI Metabolized liver Excreted in feces Half-life is 27–32 hours.

Question 35

Raloxifene (Evista) black box warning ?

Answer 35

Risk of death from stroke in postmenopausal women w/ documented CHD or risk factors for major coronary events consider risk/benefit in women w/ stroke risk

Question 36

Raloxifene (Evista) adverse effects: CV ?

Answer 36

thromboembolism

Question 37

Raloxifene (Evista) adverse effects: MS ?

Answer 37

leg cramps

Question 38

Raloxifene (Evista) adverse effects: MISC ?

Answer 38

hot flashes

Question 39

Raloxifene (Evista) adverse effects: NEURO ?

Answer 39

dizziness

Question 40

Raloxifene (Evista) patient / family education ?

Answer 40

Advise weight-bearing exercise is helpful Advise of adequate vitamin D and calcium intake Avoid prolonged sitting as leg cramps could be risk of venous thrombosis Take medicine for the full course of therapy Do not double dose if patient misses a dose Drug will not reduce incidence of hot flashes

Question 41

Hormone therapy: Synthetic form of calcitonin found in ______ ?

Answer 41

salmon

Question 42

Calcitonin - hormone therapy | ?

Answer 42

Promotes new bone formation by unknown method Administered as a nasal spray Watch for rhinitis, allergic reaction, and bone pain Not considered a first-line treatment Periodic nasal exams are needed