Week 12 - Drugs for Osteoporosis (Bisphosphonates and Vitamins/Minerals)

Question 1

Alendronate (Fosfamax) and Ibandronate (Boniva) belong to which medication class?

Answer 1

Bisphosphonates

Question 2

What is the mechanism of action of the bisphosphonates?

Answer 2

Reduce osteoclastic activity
* decreased normal and abnormal bone resorption

Question 3

Alendronate has been shown to reduce ___________ fractures

Answer 3

non-vertebral fractures

Question 4

absorption of bisphosphonates is __________ by the presence of food

Answer 4

significantly reduced

Question 5

To enhance the absorption of bisphosphonates, the patient should be instructed to take the drug with __________

Answer 5

8 oz of water
* they should also remain upright for 30-60 minutes

Question 6

What are the absolute contraindications to bisphosphonate use?

Answer 6

• uncorrected hypocalcemia
• documented barrett esophagus
• renal insufficiency

Question 7

All bisphosphonates share an adverse reaction of _________

Answer 7

musculoskeletal pain

Question 8

All bisphosphonates can potentially cause what GI ADRs?

Answer 8

• esophagitis
• gastric irritation

The risk for these is increased if a patient does not take the drugs with enough water, or does not remain upright for the recommended amount of time

cautious use of these drugs in patients with pre-existing GI disorders

Question 9

Due to the risk for osteonecrosis of the jaw after invasive dental procedures, it is recommended that bisphosphonates are stopped for ___________ to reduce the risk

Answer 9

3 months before and after

Question 10

What cardiac ADR is associated with bisphosphonates?

Answer 10

Atrial fibrillation

Question 11

Concurrent administration of __________ may double alendronate bioavailability

Answer 11

H2RAs

Question 12

The risk for GI bleeding is increased when _________ are taken concurrently with bisphosphonates

Answer 12

aspirin and NSAIDs

Question 13

Bisphosphonate absorption is decreased when administered within 1 hours of _________

Answer 13

calcium supplements and antacids

Question 14

The bisphosphonates are used for the treatment and prevention of __________

Answer 14

osteoporosis

Question 15

__________ is a second-line drug for the treatment and prevention of osteoporosis

Answer 15

Ibandronate

Question 16

Additional bone disorders that may be treated by bisphosphonates include:

Answer 16

Paget disease
* weak bone patches of high turnover

Question 17

What is the role of calcium and vitamin D supplementation in the treatment/prevention of osteoporosis?

Answer 17

Complementary agents
* Calcium is critical to bone formation
* Vitamin D is necessary for the intestinal uptake of calcium

Question 18

Hypervitaminosis is a potential risk of vitamin d supplementation - what are possible complications from this?

Answer 18

Increased risk for:
* prostate cancer
* kidney stones

Question 19

Calcium supplementation may increase the risk of _____, as well as decrease effectiveness of __________

Answer 19

• kidney stones
• statin therapy (calcium deposits in vascular plaque)

Question 20

Older patients taking anticoagulants should be cautioned that ________ supplements may have high vitamin K levels

Answer 20

calcium