Flashcards in 13 Osteoporosis Ma Deck (26):
What are the calcium regulating hormones that can be part of the cause for Osteoporosis?
Parathyroid hormone. Calcitrol (Vitamin D). Calcitonin
What are some common medications that can contribute to osteoporosis?
SSRIs. PPIs. Anticoagulants. Anticonvulsants. Cyclosporine, Tacrolimus. Depo-medroxyprogesterone
What are some indications for Bone Mineral Density testing?
Women age > 65. Women discontinuing estrogen. Men > 70
How long does a patient need to be taking a corticosteroid before considering doing a BMD test?
i.e. 5mg prednisone for 3 months or more
What is a normal T-score and what does it mean?
T-score > -1. BMD w/in one SD of a young healthy adult
What T-score is considered Osteopenia?
-1 > T > -2.5, BMD is between 1 and 2.5 SD of a young healthy adult
What T-score is considered Osteoporosis?
T < 2.5, which means the patient is 2.5 SD or more below a young healthy adult
What does a Z-score show?
Compares patients BMD to the expected BMD in a patient of the same age, sex, and body weight. Used to evaluate pre-menopausal women
What action should be given for a normal T-score?
What action should be taken for an Osteopenia T-score?
Lifestyle advice. Calcium and Vitamin D supplementation
What action should be taken for an Osteoporosis T-score?
Lifestyle advice. Treat with Bisphosphonates. Calcium and Vitamin D supplementation
What action should be taken for an Osteoporosis T-score PLUS 1 or more fractures (established osteoporosis)?
Lifestyle advice, pain control. Treat with Bisphosphonates/Calcitonin/Teriparatide. Calcium and Vitamin D supplementation
What is the recommended Calcium and Vitamin D intake for age 50+?
Ca: 1200mg/day (max of 500-600 absorbed at one time, divide doses). Vitamin D: 800-1000 IU/day
Which type of Calcium MUST be taken with food for absorption?
What are some DDIs with calcium supplementation?
Decreased absorption of TCN, FQ, and Levothyroxine
What are the possible treatment options for Osteoporosis?
Bisphosphanate. Calcitonin. Parathyroid hormone. Estrogen/Hormone Replacement. Selective estrogen receptor modulator (SERM)
What is the MOA of Bisphosphanates?
Inhibits osteoclasts (antiresorptive) thus inhibiting further decline in BMD. Possibly increase BMD?
What are the different bisphosphanates?
Alendronate (Fosamax). Ibandronate (Boniva). Risendronate (Actonel). Risendronate DR (Atelvia). Zoledronic Acid (Reclast)
Which Bisphosphanate is administered every 12 months?
Zoledronic acid (Reclast)
What is the Bisphosphanate counseling?
Advise patient to take only upon rising for the day, not taken at bedtime. Take at least 30 minutes before the first food, beverage, or medication of the day. Take tablet w/ a full glass of water while in upright position. Do not lie down for at least 30 minutes after dose
What is a rare but serious side effect of Bisphosphanates?
Osteonecrosis of the jaw. Ulcers, Esophageal cancers
What is the MOA of Calcitonin?
Natural hormone involved in Calcium regulation and bone metabolism. Slows bone loss and increases bone density. Spine fractures only
What is the MOA of Parathyroid Hormone?
Rebuilds bones and significantly increases BMD (spine). Given SQ QD
What is the recommendation for HRT in the treatment of osteoporosis?
Lowest possible dose for the shortest period of time and not a first line prevention option
What is Raloxifene (Evista)?
Selective Estrogen Receptor Modulator (SERM)