00 Osteoporosis and HRT

Question 1

What is the definition of Osteoporosis?

Answer 1

T-score < -2.5

Question 2

What is Osteopenia?

Answer 2

Lower bone density than normal, but not as low as osteoporosis (T-score between -1 and -2.5)

Question 3

What are some drugs that can increase the risk of Osteoporosis?

Answer 3

Long-term steroid use, Anticonvulsants, Warfarin/heparin, Loop diuretics, PPIs, etc.

Question 4

What is important about calcium absorption?

Answer 4

Calcium absorption is saturable; doses should be divided. Requires vitamin D for absorption

Question 5

What drug treatment is often used first line for osteoporosis?

Answer 5

Bisphosphonates. PO or IV

Question 6

How long should bisphosphonates be used for?

Answer 6

D/t the risk of atypical femur fracture, esophageal cancer, and osteonecrosis of the jaw, bisphosphonates should be stopped after 3-5 years

Question 7

Why is estrogen no longer used first line?

Answer 7

Health risks, however, if used for menopausal symptoms, estrogen does increase bone density

Question 8

What is most commonly used for women who are at risk or have fear of breast cancer?

Answer 8

Raloxifene

Question 9

What is the generic name of Fosamax?

Answer 9

Alendronate (Bisphosphonate) - PO

Question 10

How is Fosamax (Alendronate) usually dosed?

Answer 10

70mg PO weekly (or 10mg PO daily)

Question 11

What is the generic name of Actonel, Atelvia?

Answer 11

Risedronate (Bisphosphonate) - PO

Question 12

What is the generic name of Boniva?

Answer 12

Ibandronate (Bisphosphonate) - PO

Question 13

What are the contraindications of Bisphosphonates?

Answer 13

Inability to stand or sit upright for at least 30 minutes (60 minutes w/ once-daily Boniva). Hypocalcemia. CrCl < 35

Question 14

What are some commonly seen side effects with Bisphosphonates?

Answer 14

Hypocalcemia (mild, transient), back pain, arthralgias, dyspepsia, N/V, dysphagia, heartburn, esophagitis

Question 15

What is the generic name of Reclast?

Answer 15

Zolendronic Acid (Injectable Bisphosphonate)

Question 16

What is the generic name of Evista?

Answer 16

Raloxifene (Estrogen agonist/antagonist, SERM)

Question 17

What is the BBW with Evista (Raloxifene)?

Answer 17

Increased risk of DVT/PE/MI/Stroke

Question 18

What are the commonly seen side effects with Evista (Raloxifene)?

Answer 18

Hot flashes, peripheral edema, hot flashes, arthralgia, leg cramps/muscle spasms, flu-like syndrome, infection, amenorrhea, vaginal bleeding/discharge, skin changes

Question 19

What is important about the Calcitonin Nasal Spray?

Answer 19

Inhale 1 spray daily (alternate nostril daily)

Question 20

What is the generic name of Forteo?

Answer 20

Teriparatide (Injection - stimulates bone formation)

Question 21

When is Forteo (Teriparatide) used?

Answer 21

For patients who are at very high risk for fracture, or have already had a fracture d/t osteoporosis

Question 22

How is Forteo (Teriparatide) dosed?

Answer 22

20mcg SC inj daily for MAX of 2 years!

Question 23

What is the BBW with Forteo (Teriparatide)?

Answer 23

Osteosarcoma (bone cancer)

Question 24

What is the generic name of Prolia?

Answer 24

Denosumab (Monoclonal antibody)

Question 25

What are the contraindications for Prolia (Denosumab)?

Answer 25

Hypocalcemia

Question 26

What are the side effects with Prolia (Denosumab)?

Answer 26

Fatigue, Hypocalcemia (correct), Eczema, Rash, Weakness, Arthralgia/weakness/limb pain, nausea, dyspnea, cough

Question 27

For HRT, when should Estrogen be used/not be used?

Answer 27

In women with a uterus, estrogen should not be given alone

Question 28

What are the risks of using estrogen w/ progestin?

Answer 28

Increases breast cancer risk, and the use of this combination should be limited to 3-5 years

Question 29

What are some natural products used for vasomotor symptoms of menopause?

Answer 29

Black cohosh, Red clover, Soy, Flaxseed

Question 30

Which antidepressant is approved for menopause symptoms?

Answer 30

Brisdelle (Paroxetine): not recommended, especially in older people. Do not use with warfarin (increased risk of bleeding)

Question 31

What is the generic name of Vivelle?

Answer 31

Esradiol transdermal system twice weekly patch for menopause

Question 32

Besides the Vivelle patch, what are some other hormonal products used for menopause?

Answer 32

Provera, Premarin (tab and cream), Prempro

Question 33

How is Evista (Raloxifene) dosed?

Answer 33

60mg/day

Question 34

How is Alendronate (Fosamax) dosed for prevention?

Answer 34

35mg once a week

Question 35

How is Risedronate dosed?

Answer 35

35mg QWeek or 150mg QMonth for prevention or treatment

Question 36

How is Reclast (Zolendronic acid) dosed for post-menopausal osteoporosis?

Answer 36

5mg IV once yearly infused over 15 minutes

Question 37

What is the generic name of Miacalcin?

Answer 37

Calcitonin (nasal spray for osteoporosis)