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Board Review > Osteoporosis and hormone therapy > Flashcards

Osteoporosis and hormone therapy Flashcards

1
Q

the most common location of fracture

A

lower lumbar spine

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2
Q

a T score of what is indicative of osteoporosis

A

< -2.5

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3
Q

a T score of what is indicative of osteopenia

A

-1 to - 2.5

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4
Q

a T score of what indicates normal bone health

A

> -1

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5
Q

what are Z scores

A

compare a pt BMD to the mean BMD of a pt of their age and gender

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6
Q

what are T scores

A

compare a pt BMD to the BMD of a normal young adult of the same gender

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7
Q

cells involved in bone formation

A

osteoblast

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8
Q

break down bone, resorption

A

osteoclast

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9
Q

what are the high risk areas that a DEXA scan looks at

A

hips, lumbar vertebrae

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10
Q

at what age should ALL women get a DEXA scan

A

65

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11
Q

what is the purpose of the FRAX tool

A

estimates risk of fracture in the next 10 years

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12
Q

what steroid use is considered a risk of osteoporosis

A

prednisolone greater than 5mg or prednisone equivalent for > = 3 months

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13
Q

genetic factors for osteoporosis are most important with what races

A

white, asian

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14
Q

what are some risk factors for low bone density

A

> 2 alcoholic drinks a day, smoking, low vit d and ca intake over life, roid use for >= 3 months at > 5 mg prednisone equivalent dose, previous fracture, < 127 lbs, low physical activity for life, decrease estrogen (menopaus, hypogonadism, lactation, anorexia)

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15
Q

what are drugs that put you at risk for osteoporosis

A

long term steroid use ( >= 3 months @ > 5mg prednisolone or prednisone equivalent), warfarin, heparin, anticonvulsants (carbamazepine, phenytoin, fosphenytoin, phenobarbital), aromatase inhibitors (tx breast cancer), androgen blockers (treat prostate cancer), loop diuretics, excess thyroid hormone

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16
Q

bone accumulates until what age

A

30

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17
Q

when is calcium intake very important

A

childhood, pregnancy, menopause

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18
Q

vit d deficiency in children causes

A

rickets

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19
Q

vit d deficiency in adults causes

A

osteomalacia

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20
Q

recommended daily Ca intake for 14-18 y/o

A

1300 mg

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21
Q

recommended daily Ca intake for 19-50 y/o

A

1000 mg

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22
Q

recommended daily Ca intake for > 50 y/o

A

1200 mg

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23
Q

how much elemental Ca is in Ca-citrate

A

21%

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24
Q

how much elemental Ca is in Ca-carbonate

A

40%

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25
Q

daily Vit D recommendation for up to 70 y/o

A

600 IU

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26
Q

daily Vit D recommendation for > 70 y/o

A

800 IU

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27
Q

what is the preferred source of Vit D

A

cholicalciferol (Vit D3)

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28
Q

what is used 1st line in treatment of osteoporosis

A

bisphosphonates

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29
Q

what are the bisphosphonates (generic)

A

zolidronic acid, ibandronate, risedronate, alendronate

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30
Q

what agent will increase a patients fracture risk due to it decreasing calcium carbonate absorption

A

PPI

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31
Q

fosamax

A

alendronate

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32
Q

reclast

A

zoledronic acid injection

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33
Q

actonel

A

risedronate

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34
Q

boniva

A

ibandronate

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35
Q

dose of fosamax for prevention and treatment

A

5mg prevention 10mg treatment qd

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36
Q

daily dose of actonel

A

5 mg daily

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37
Q

monthly dose of boniva

A

150 mg

38
Q

monthly dose of actonel

A

150 mg

39
Q

Atelvia

A

long acting risedronate

40
Q

what are the contraindication for oral bisphosphonates

A

inability to stand or sit upright for 30 mins, hypocalcemia, severe renal impairment (CrCl < 30)

41
Q

at what CrCl is PO bisphosphonate use contraindicated

A

< 30

42
Q

how long should bisphosphonates be used

A

3-5 years

43
Q

why is there a time limit on how long bisphosphonates can be used

A

risk of atypical femur fracture, esophageal cancer, jaw necrosis

44
Q

what are SE of bisphosphonates

A

back pain, joint pain, dyspepsia, dysphagia, esophagitis, GI issues, N/V

45
Q

what must you notify the patient about taking Atelvia

A

no H2RA or PPI, seperate from Mg, Ca, Fe supplements

46
Q

why should patients get dental work done before starting bisphosphonates

A

risk of jaw necrosis

47
Q

Zometa

A

zoledronic acid injection

48
Q

Reclast treats

A

osteoporosis, paget’s disease

49
Q

zometa treat

A

hypercalcemia of malignancy

50
Q

what is the dose and frequency of Reclast

A

5mg infusion yearly (treatment) or every 2 years (prevention)

51
Q

what are the SE of Reclast

A

flu like syndrome: aches, runny nose, headache

52
Q

what can be done to prevent the transient post dose syndrome seen with reclast

A

NSAID before and after infusion

53
Q

at what CrCl is Reclast contraindicated

A

< 35

54
Q

what are the lipid effects of raloxifene

A

decrease cholesterol and LDL

55
Q

what is the black box warning for raloxifene

A

increase risk of thromboembolic events (DVT, PE, MI, stroke)

56
Q

when is Raloxifene contraindicated

A

previous thromboembolism, hepatic dysfunction, pregnancy

57
Q

what are the SE of Raloxifene

A

hot flashes, vaginal bleed/dischcarge, flushing, mood changes, htn

58
Q

raloxifene is used most frequently in which women

A

that have fear of breast cancer or at risk

59
Q

Evista

A

Raloxifene

60
Q

Fortical

A

calcitonin

61
Q

when is calcitonin contraindicated

A

salmon allergy

62
Q

Forteo

A

teriparatide

63
Q

what agents are used in patients at HIGH RISK for fracture

A

teriparatide, denosumab

64
Q

what is the dose and frequency for teriparatide

A

20 mcg SQ injection daily

65
Q

how long can a patient be on teriparatide

A

2 years

66
Q

what is the black box warning for teriparatide

A

osteosarcoma

67
Q

2/2 the black box warning of teriparatide caution must be used when using this agent in patients that have

A

paget’s disease, bone metastasis, hypercalcemia

68
Q

what are the SE of teriparatide

A

dizziness, increase HR (especially with first few doses), injection site pain

69
Q

Prolia

A

Denosumab

70
Q

Xgeva

A

Denosumab

71
Q

Prolia treats

A

osteoporosis

72
Q

Xgeva treats

A

hypercalcemia of malignancy

73
Q

when is use of denosumab contraindicated

A

hypocalcemia

74
Q

what agents have a risk of atypical femur fractures and jaw necrosis

A

bisphosphonates, denosumab

75
Q

if a patient is on a weekly schedule of bisphosphonate and they miss one dose what should they do

A

take the following morning (not 2 doses in 1 day)

76
Q

if a patient is on a daily schedule of bisphosphonate and they miss one dose what should they do

A

skip until next dose

77
Q

if a patient is on a monthly schedule of bisphosphonate and they miss one dose what should they do

A

take as soon as you remember (DON’T TAKE 2 IN ONE WEEK!!)

78
Q

Zometa

A

zolidronic acid

79
Q

Reclast treats

A

osteoporosis

80
Q

Zometa treat

A

hypercalcemia of malignancy

81
Q

Reclast is the same drug as

A

Zometa

82
Q

what should you counsel the patient on taking teriparatide

A

may feel dizzy or have increased HR for first few doses so inject where you can sit or lie down right away

83
Q

where should the pen for the teriparatide injection be kept

A

fridge

84
Q

discard the teriparatide pen after

A

28 days

85
Q

where do you inject teriparatide

A

thigh or abdomen (lower stomach)

86
Q

how long can a patient take teriparatide

A

2 years

87
Q

how long must you be sitting/standing upright when taking bisphosphonates

A

30 MINUTES, 60 minutes with monthly Boniva

88
Q

when should Atelvia be taken

A

after breakfast

89
Q

what should you not use w/ Atelvia

A

H2Ra, PPI, Mg, Ca, Iron supplements

90
Q

what is the dose of raloxifene

A

60 mg qd

91
Q

if a patient is experiencing nausea on fosamax or actonel what are you option

A

Switch to Atelvia (taken after breakfast) or Zoledronic acid (injection)

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