Osteoporosis

Question 1

meds that increase fracture risk

Answer 1

aromatase inhibitors
HAART
cyclosporin
corticosteroids >3mths
loop diuretics
PPIs
SSRIs
thiazolidinediones
chemo
high doses of Vit A
depo medroxy progesterone

Question 2

Calcium and vitamin D recommendations for osteoporosis

Answer 2

calcium through diet
vit d 800-2000IU/day for individuals who are >50 years of age and at risk for osteoporosis

Question 3

bisphosphonates

Answer 3

alendronate, risedronate, zolendronate
mainstay of tx, 40-60% reduction in frcture risk
MOA: inhibit osteoclast bone resorption, retained in bone and benefits maintain after dc
take on empty stomach, 30 min before food, full glass water, don’t lie down 30min after (ACTONEL DR IS RECOMMENDED AFTER BREAKFAST)
AE: GI upset, taste disturbance, nighttime leg cramps, ONJ (do dental work before), atypical femoral bone fractures
Drug holidays after 3-5y may be considered unless high risk (previous spine/hip fracture), to resume in 1-3y after remeasuring BMD

Question 4

Denosumab

Answer 4

Biologic RANK-Ligand inhibitor - reduces osteoclast formation
BMD goes back down upon D/C so drug holidays not rec
AE: eczema, serious infections, hypocalcemia in impaired renal function, ONJ

Question 5

Raloxifene

Answer 5

SERM; E antagonist in breast and uterus, agonist in
bone and lipid
prevents postmenopausal bone loss
AE: leg cramps, hot flashes
Caution: inc VTE risk

Question 6

Teriparatide

Answer 6

anabolic agent (parathyroid hormone analogue) SC
max 24mth use due to inc osteosarcoma risk
AE: ortho hypo

Question 7

tools to estimate fracture risk

Answer 7

FRAX, CAROC

Question 8

definition of osteoporosis

Answer 8

low BMD; T-score<2.5 and fracture risk factors

Question 9

medications associated with increased risk of fractures:

Answer 9

aromatase inhibitors, anticoagulants (unfractionated and low molecular weight heparins), antiretroviral
therapy, cyclosporine, corticosteroid therapy (>3 mths/y cumulative at a prednisone-equivalent dose ≥7.5 mg daily), loop
diuretics, PPIs, SSRIs, thiazolidinediones, chemotherapy and high doses of vitamin A.

Question 10

non-pharms

Answer 10

exercise
fall prevention measures
smoking cessation
avoid alcohol (>2 /day) and caffeine (>4/day)
adequate protein, calcium and vitamin D intake

Question 11

why is hormone therapy no longer recommended for prevention of fractures?

Answer 11

due to increased risk of breast cancer and heart disease

Question 12

first line options for OP

Answer 12

Bisphosphonates, denosumab, estrogen and
teriparatide are all considered first-line options. Raloxifene is more second line.