Tx of Osteoporosis Flashcards
Osteoporosis and Osteopenia: Significant Public Health Problem ?
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
Osteoporosis and Osteopenia confirmed by ?
Confirmed by hip or spiral bone mineral density (BMD) or DEXA scan
Osteoporosis and Osteopenia: Once treatment is initiated
Assess successful treatment
Based on either lack of fractures
Increased bone mineral density scores.
Osteoporosis and Osteopenia: Medication Goals ?
Achieve optimal peak bone mass
Minimize further bone loss
Decrease falls and fractures
____ required for vascular contraction and dilation, nerve transmission, intracellular signaling, hormonal secretion
Ca++
_______ required for uptake of calcium and phosphorus from GUT and absorption into bone
Vitamin D
Calcium and Vitamin D: Human requirements ?
Ergocalciferol (vitamin D2 from plants)
Cholecalciferol (vitamin D3 synthesized in skin from sunlight and converted in liver to active form)
Calcium needs ?
1,000 mg/day males
1,200 mg/day females
Vitamin D needs ?
600IU for females
800 IU/day males
The lighter a person’s skin the more__________ they make
vitamin D
caution on side of skin cancer risk
Some people may have genetic predisposition against __________ absorption
vitamin D
People in _____________ may not get enough vitamin D
northern climates
Consider a well-rounded _____________ with adequate calcium
health diet
Calcium intake in males ?
1,000 mg/day males
Calcium intake in females ?
1,200 mg/day females
Bisphosphonates reduction of __________________ in postmenopausal women (40–70% effective)
vertebral fractures
Bisphosphonates challenges ?
correct administration
avoid serious GI upset
poor bioavailability
Bisphosphonates: Bone undergoes constant _________
turnover
homeostasis by osteoblasts creating bone and osteoclasts destroying bone
Bisphosphonates MOA ?
Inhibit both normal and abnormal bone resorption and slow down bone remodeling in postmenopausal women
Bisphosphonates indications ?
osteoporosis,
Paget’s disease of the bone
Bone conditions involving fragile, breakable bones
Bisphosphonates two types ?
non- nitrogenous
nitrogenous
Non-nitrogenous ?
Non-N-containing bisphosphonates
Nitrogenous ?
N-containing bisphosphonates:
Nitrogenous bisphosphonates examples ?
Alendronate (Fosamax)
Ibandronate (Boniva)
Risedronate (Actonel)
Alendronate (Fosamax)
dosing ?
PO form 5mg, 10mg, 35mg, 40 mg tab, 70/75 mL oral soln
Osteoporosis
70 mg PO qwk
Ibandronate (Boniva) dosage ?
Dose: 150 mg PO qmo
Ibandronate (Boniva) considerations ?
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
Ibandronate (Boniva)
adverse effects ?
osteonecrosis, jaw
musculoskeletal pain, severe
hypersensitivity rxn
Stevens-Johnson syndrome
Anaphylaxis
hypocalcemia
Uveitis
scleritis
acute renal failure (IV use)
Bisphosphonates patient / family education ?
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
Bisphosphonates Conscientious Prescribing ?
Use cautiously in patients with renal impairment
Watch for jaw bone necrosis
Watch for abnormal diagnostic imaging
Monitor serum calcium and phosphorus
SERMs AKA?
Selective estrogen receptor modulators
SERMs examples ?
Raloxifene (Evista)
Raloxifene (Evista) MOA ?
Mimic estrogen antagonists and provide estrogen resorption effects without need for estrogen
Raloxifene (Evista) pharmacokinetics ?
60% absorbed from GI
Metabolized liver
Excreted in feces
Half-life is 27–32 hours.
Raloxifene (Evista) black box warning ?
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
Raloxifene (Evista) adverse effects: CV ?
thromboembolism
Raloxifene (Evista) adverse effects: MS ?
leg cramps
Raloxifene (Evista) adverse effects: MISC ?
hot flashes
Raloxifene (Evista) adverse effects: NEURO ?
dizziness
Raloxifene (Evista) patient / family education ?
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
Hormone therapy: Synthetic form of calcitonin found in ______ ?
salmon
Calcitonin - hormone therapy
?
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
