Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

pr3154 finals > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

What are the bisphosphonate drugs and what are their routes of administration?

A

risendronate, alendronate - PO
zolendronic acid - IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are bisphosphonates MOA

A

slow bone loss by increasing osteoclast cell death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is an important counselling point for taking oral bisphosphonates?

A

take on an empty stomach with at least 240ml of plain water and wait at least 30 minutes before taking food (F impaired with food or drink)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How long does bisphosphonate therapy usually last

A

typically does not exceed 5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are side effects of bisphosphonates?
(significant, oral, IV)

A
  • Significant: atypical femoral fractures (w prolonged use), severe bone, joint or muscle pain, upper GI mucosa irritation, ocular effects (eg iritis, uveitis), hypocalcemia, ONJ/EAC
  • Oral: nausea, abdominal pain, heartburn-like symptoms
  • IV: flu-like symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are CI to bisphosphonates? (4)

A

pre-existing hypocalcemia
abnormalities of the esophagus (may delay emptying)
severe renal impairment (CrCl < 30)
pregnancy and lactation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What type of drug is denosumab and what is its MOA?

A

human monoclonal antibody against RANKL that prevents the development of osteoclasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is denosumab’s route and frequency of administration?

A

administered as SC injections every 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What should be given together with denosumab

A

co-administer 1000mg Ca + ≥ 400 IU vitamin D daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are side effects of denosumab

A

muscle, back, bone or joint pain,
nausea and vomiting
constipation or diarrhea
slight tiredness
increased cholesterol levels

rare: atypical femur #, ONJ/EAC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why should denosumab not be discontinued?

A

may cause increased risk of spinal column fractures when discontinued

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are CI to denosumab? (2)

A

hypocalcemia, pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

In which populations is estrogen usually indicated

A

for bone health in younger women or in women whose menopausal symptoms also require treatment (has beneficial effects on both)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What type of drug is raloxifene and what is its MOA?

A

selective estrogen receptor modulator (SERM) with mixed estrogen receptor agonism and antagonism

Mimics the effects of estrogen on bone density in postmenopausal women and reduces rather than increases the risk of some types of breast cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is calcitonin’s MOA

A

It reduces serum Ca, hence opposing the effects of PTH and therefore inhibits osteoclastic bone resorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is calcitonin’s routes of administration?

A

IV, SC, IM or nasal spray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are side effects of calcitonin

A

red streaks on skin
injection site reaction
feeling of warmth,
redness of the face, neck and arms and occasionally upper chest

18
Q

What are contraindications for calcitonin

A

hypersensitivity, hypocalcemia

19
Q

What is romosozumab’s MOA?

A

It removes sclerostin inhibition of the canonical Wnt signialling pathway that regulates bone growth therefore increasing bone formation while decreasing bone resorption

20
Q

In which population is romosozumab indicated in?

A

women at high risk of fractures or those who have failed or are intolerant to other osteoporosis therapies

21
Q

What are side effects of romosozumab?

A
  • Significant: MI, increased risk of CV death, stroke, transient hypocalcemia, hypersensitivity reactions (eg. angioedema, erythema multiforme, urticaria, dermatitis, rash)
  • Rare: atypical femur fractures, ONJ
22
Q

What are CI to romosozumab?

A

hypersensitivity
uncorrected hypocalcemia
history of MI or stroke (within the preceding year)

23
Q

What is teriparatide’s MOA

A

Teriparatide stimulates new bone formation and increases bone strength

24
Q

How should teriparatide be administered and how long should treatment be given?

A

OD SC injection with a maximum treatment duration of 24 months in a lifetime

25
Q

What are side effects of teriparatide

A

serious calciphylaxis and worsening of previous stable cutaneous calcification
transient orthostatic hypotension
transient and minimal elevations of serum Ca or hypercalcemia

26
Q

What are CI to teriparatide?

A

hypersensitivity
pre-existing hypercalcemia
skeletal malignancies or bone metasteses
other metabolic bone diseases (eg. Paget’s disease, hyperparathyroidism)
unexplained elevations of alkaline phosphatase
previous implant or external beam radiation therapy to the skeleton
hereditary disorders predisposing to osteosarcoma
severe renal impairment
pregnancy

27
Q

What are causes for decrease in bone mass

A

Age, menopause, low serum Ca, alcohol abusers, smoking, physical inactivity, medication use (eg. use of PPI or long-term systemic glucocorticoid), secondary to other diseases

28
Q

Which drugs are possible secondary causes for osteoporosis

A

glucocorticoids, immunosuppressants (ciclospirin), ASM (phenobarbital and phenytoin), aromatase inhibitors, GnRH agonists and antagonists, heparin and cancer chemotherapy

29
Q

How does osteoporosis usually present

A

usually asymptomatic and often undiagnosed until the patient resents with a fragility fracture (low-trauma)

30
Q

Which 2 populations should be assessed for osteoporosis and fracture risk

A

(1) Post-menopausal women
(2) Men ≥ 65 yo

31
Q

What are risk factors for osteoporosis? (FLASHME)

A
  • Family history of osteoporosis or fragility fractures; history of falls, fracture risk
  • Low calcium intake (< 500mg/day), low body weight
  • Ageing, early menopause (45 years or younger)
  • Smoking and alcohol consumption
  • Height loss (>2cm within three years)
  • Medication use
32
Q

Which assessment can be used for post-menopausal women?

A

Osteoporosis Self-Assessment Tool for Asians (OSTA)

33
Q

What are the OSTA score stratifications and what do they indicate?

A

High risk (> 20) → consider DXA scan as the risk of finding osteoporosis (low BMD) is high in this group
Medium risk (0-20) → consider DXA scan if there are other risk factors
Low risk (< 0) → consider deferring DXA

34
Q

What diagnosis does each T-score refer to?

A
  • T-score ≤ -2.5 SD → osteoporosis
  • T-score -1 to -2.5 SD → osteopenia
  • T-score ≥ -1 SD → normal bone density
35
Q

Compare between T and Z score and what they tell us

A

T-score compares BMD against a young adult reference population (aids in the diagnosis)

Z-score compares BMD against the expected BMD for the patient’s age and sex (predicts treatment response)

36
Q

What are DXA scans for

A

DXA scans at the spine and hip can be predictive for fractures and it is therefore good to assess the treatment benefit there

37
Q

When should osteoporosis treatment be initiated? (3)

A

(1) patients present with fragility fracture
(2) patients without fragility fracture byt DXA BMD T-score ≤ -2.5
(3) osteopenic (T-score -2.5 to -1) without fragility fracture but high fracture risk (eg. FRAX > 3% hip or > 20% major OP)

38
Q

What are risk factors for ONJ

A

tooth extraction or other invasive dental procedures
history of cancer or radiotherapy
poor oral hygiene
concomitant therapy (angiogenesis inhibitors, bisphosphonates, chemotherapy, corticosteroids, denosumab)
comorbid disorders (anemia, coagulopathy, infection, pre-existing dental or periodental disease)

39
Q

How should patients be counselled for ONJ

A

smoking cessation, avoiding invasive dental procedures during bisphosphonate treatment and maintaining good oral hygiene

40
Q

What should be done to bisphosphonate therapy if patient suffers atypical femur #?

A

discontinue bisphosphonate therapy and consider continuing after 2-4 weeks or when the wound has healed (patient can sit up for 30 mins)

Investigate as to why the bisphosphonate therapy isn’t preventing fragility fractures, and condsider switching to a newer agent with more evidence

41
Q

What should serum 25(OH) vitamin D levels be prior to starting pharmacologic treatment

A

≥ 20-30 ng/mL

pr3154 finals (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions