IC18 Osteoporosis

Question 1

Meds that cld reduce bone mass

Answer 1

GC, PPI, ASM, Immunosuppressant, aromatase inhibitors, heparin, cancer chemo, GnRH agonist & antagonist

Question 2

Who shld be assessed for osteoporosis & fracture risk

Answer 2

o Post-menopausal women
o Men > 65 yo

Question 3

When to Treat osteoporosis?

Answer 3

1. present with fragility #
2. DXA BMD T-scores of </= -2.5
3. DXA BMD T-scores > -2.5 but < -1 + FRAX > 3% hip # risk OR > 20% major osteoporotic #

Question 4

Dosing of PO alendronate

Answer 4

70 mg q week

Question 5

1st line for osteoporosis

Answer 5

PO alendronate / risedronate

Question 6

Labs to check prior initiation

Answer 6

serum calcium & 25-hydroxyvitamin D levels

**Serum 25(OH) vitamin D should be > 20-30 ng/mL (50-75 nmol/L) but < 50-100 ng/mL (125-250 nmol/L)

Question 7

Labs to monitor during tx

Answer 7

• Serum creatinine
• Serum calcium
• Serum 24(OH) vitamin D

Question 8

Dosing for risedronate PO

Answer 8

35mg once a week

Question 9

Dosing for IV zoledronic acid

Answer 9

5mg every year, for 30 mins infusion

Question 10

Advice to patient to minimise ONJ

Answer 10

1. smoking cessation
2. avoid invasive dental procedures
3. maintain good oral hygiene

Question 11

When to start bisphosphonate for those with fragility fracture (typical fracture) since there is risk of atypical femoral fracture?

Answer 11

After 2-4 weeks / can sit upright for 30 mins/ healed

Question 12

when to give Ca supplements

Answer 12

dietary Ca intake < 700mg/day