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Muscoskeletal > Osteoporosis Day 2 > Flashcards

Osteoporosis Day 2 Flashcards

1
Q

What is the clinical presentation of OP?

A 
asymptomatic (diagnosed by BMD)
fractures
widow's hump
chest wall changes
loss in ht
back pain
indigestion
difficulty breathing
depression
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2
Q

What is a normal T score?

A

> -1

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3
Q

What is the T score of osteopenia?

A

-1- -2.5

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4
Q

What is the t score of osteoporosis?

A

</= -2.5

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5
Q

What is the t score of severe osteoporsis?

A

</= -2.5 with a previous fracture

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6
Q

What is the z score to diagnose OP?

A

</= -2 in combination with other risk factors or fracture

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7
Q

What are the goals of therapy?

A

Achieve highest peak bone mass
maintain BMD and minimize bone loss
if had history of fracture- schieve adequate pain control, maximize rehabillitation and restore independence

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8
Q

What is the non pharm treatment of OP?

A

exercise (wt bearing and resistance activities)
smoking cessation
decreased caffine intake
calcium and vitamin D

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9
Q

What is the role of supplement calcium?

A

serum calcium does not reflect dietary intake of calcoum since homeostasis is controlled
more affective when reactive peak bone mass when bone loss begins (less effective in 1st 5 years of menopause)
increased absorption with normal vitamin D levels

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10
Q

What are the different formulations of calcium?

A

calcium carbonate

calcium citrate

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11
Q

What is the ADRs of calcium?

A

constipation

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12
Q

how should calcium be given?

A

in divided doses no longer than 500-600 mg/dose

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13
Q

What is the role of supplement vitamin D?

A

controversy regarding need with 400-600 iu
sunlight exposure of 5% of skin = 4.35 IU (for fare skin it will reach in 20 min all need or up to 2 hours in darker skin)
D3 OTC
D2- RX

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14
Q

Who are the candidates for Pharmacological Treatment?

A

postmenopausal womwn and men >50 based on a hip or vertebral fracture
T score <-2.5 at femoral neck or spine
Low bone mass and a 10yr probability of hip fracture or op related fracture
clinicians judement and or pt preference

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15
Q

What are the pharmacological therapy options of OP?

A 
bisphosphates
SERM
HRT
SERM/HRT
PTH
Calcitonin 
RANKL inhibitors
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16
Q

What is the MOA of bisphosphates?

A

inhibit bone resorption by inhibiting osteoclast formation

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17
Q

where does bisphosphates provide benefit?

A

at all sites

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18
Q

What is bisphosphates approved for?

A

prevention and treatment

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19
Q

when does BMD of bisphosphates peak and plateaus?

A

1 year and 3

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20
Q

What are the contraindications of bisphosphates?

A 
renal insufficiency (CrCl<35)
hypocalcaemia
upper GI problems
unable to sit upright for 30-60 min
category C
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21
Q

What is the AE of bisphosphates?

A

nausea, dydpepsia, constipation

rare- esophageal ulcers or erosions, osteonecrosis of jaw, atypical femorral fractures

22
Q

What are the bisphosphates?

A

Alendronate
Risendronate
Ibandronate
Zoledronic

23
Q

What is the dosing of Alendronate?

A

prevention- 5 mg PO daily or 35 mg weekly

treatmen- 10 mg daily or 70 mg daily

24
Q

What is the dosing of Risendronate?

A

Prevention and treatment- 5 mg daily or 35 a week or 150 monthly

25
Q

What is the dosing of Ibandronate?

A

prevention and treatment 150 mg a month

or treatment- 3 mg IV q3mon

26
Q

What is the dosing of Zoledronic?

A

prevention- 5 mg IV every 2 yrs

treatment of 5 mg iv yearly

27
Q

What is the MOA of SERM?

A

reduces bone resorption and increases BMD; acts similar to estrogen better in spine than hip

28
Q

What are the contraindications of SERM?

A

woman pregnant or becoming , active or history of venous thromembolic event

29
Q

What are the AE of SERM?

A

increased risk of venous thromboembolic disease, increased risk of hot flashes, increased stroke risk

30
Q

What is the MOA of HRT?

A

same physiolgic reaction as endogenous estrogen

31
Q

What is the dose of HRT?

A

conjugated estrogen .3 mg daily

32
Q

What is HRT approved for?

A

only prevention

33
Q

What is the controvery of HRT?

A

increased risk of CV events seen with combo therapy
increased risk of stroke with estrogen alone
weigh risk vs benefit

34
Q

What are the AE of HRT?

A 
vaginal bleeding
nasea
HA
Breast cancer
breast tenderness
bloating
wt gain
DVT/PE
35
Q

What are the contraindications of HRT?

A 
history of breast cancer or FH
PE/DVT
migraines
liver disease
abnormal vaginal bleeding
endometriosis
preg X
36
Q

What drug is SERM/HRT?

A

Bazedoxifene/estrogen

37
Q

what is the dose of Bazedoxifene/estrogen?

A

prevention only 20mg/.45 mg daily

38
Q

What is the MOA of PTH?

A

recombant formulation of endogenous PTH, stimulates osteoblast function increases GI calcium absorption and increases reabsorption of calcium

39
Q

What is PTH approved for?

A

men and women who do not respond to other therapy

40
Q

What is the drug and dosig of the PTH?

A

Teriparatide 20 mgSUBQ in thigh or abdomen

41
Q

What are the contraindications of Teriparatide?

A

children, adolescents and pt with paget’s disease

and not used with bisphosphates

42
Q

What are the AE of Teriparatide?

A

hypercalcemia, leg cramps, nausea, osteonecrosis

43
Q

What is the MOA of calcitonin?

A

antagonizes the effects of PTH and directly inhibits bone resportion by ostoclasts

44
Q

What is calcitonin approved for?

A

treatment only and is 2nd line

45
Q

What is the dosing of calcitonin?

A

Calcitonin nasal spray 200 IU daily

Calcitonin injection 100 IU SC daily

46
Q

What is the AE of calcitonin?

A

NS- nasal symptoms. arthralgia, HA, back pain

I- flushing, N/V, irritation at site

47
Q

What is the MOA of Densoumab?

A

binds to RANKL, blocks the interation between RANKL and RANK and prevents osteoclast formation

48
Q

What is Densoumab approved for?

A

treatment

49
Q

What is the dosing of Densoumab?

A

60 mg SUBQ every 6 months

50
Q

What are the AE of Densoumab?

A

flactulance, eczema, cellulitis, infection

serious- malignancy, serious infections, ostonecrosis of jaw

51
Q

Wht are the contraindications of Densoumab?

A

hypocalcemia and pregnacy

52
Q

What is children OP called

A

low BMD for chronological age

Muscoskeletal (9 decks)

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