Bone metabolism disorders Flashcards
(18 cards)
1st line therapy for all patient groups in osteoporosis (corticoid steroid induced, post-menopausal women, and men)
Alendronic acid or Risedronate
2nd line therapy for all patient groups in osteoporosis
Parental biphosphonates and Denosumab
Describe the licensing of teriparatide for osteoporosis in post-menopausal women
Reserved for severe cases of osteoporosis at very high risk of vertebral fractures in particular
When should biphosphonate treatment be reviewed?
5 years with oral treatment and 3 years with IV treatment
When should Teriparatideor Romosozumab be recommended over biphosphonates?
In post-menopausal women who have had ONE severe vertebral fracture or TWO moderate-low trauma vertebral fractures
Counselling points for biphosphonates
- On empty stomach- 30 minutes before food and other medications
- Must be sat upright for 30 minutes after taking
- Take whole with full glass of water
- Take standing or sitting upright
- 70mg weekly or 10mg daily
Maximum number of years treatment for biphosphonates
10 years- no evidence of benefit beyond this
Which age groups is osteoporosis most common in for males and females?
Post-meonpausal for women and aged >50 for men.
Describe the licensing of tibolone in osteoporosis
Used in menopausal women, usually younger, who are experiencing symptoms.
Renal cut-offs for bisphosphonates
Alendronic acid <35ml/min
Ibandronic + Risedronate <30ml/min
SEs of biphosphonates
Oesophageal disorders e.g., strictures, ulcers and oesophagitis
Necrosis of auditory canal
Atypical femoral fractures
Osteonecrosis of the Jaw
SEs of strontium ranelate
Severe cardiovascular disease (MI and VTE) and severe allergic reactions
Complications post hip fracture
Increased risk of VTE and increased mortality
Calcium supplementation dosing for osteoporosis
10 micrograms (400u) vitamin D plus at least 1g calcium daily for most patients
20 micrograms (800u) vitamin D plus at least 1g for the elderly who are housebound and/or living in a nursing home
Vitamin D may be given in those with insufficient sun exposure regardless of Calcium intake.
How long a gap should be left between biphosphonate and calcium administration?
2 hours
Which bisphosphonate can cause flu-like symptoms after the 1st infusion?
Zoledronate
List of drugs that can cause osteoporosis
PPIs
Steroids
Lithium
Medroxyprogesterone
Aromatase inhibitors
GHRAs
Pioglitazone
Anti-epileptics (Specifically inducers)
Long-term heparin
Co-morbidities that increase risk of osteoporosis
Endocrine disorders e.g., T2DM, Rheumatoid arthiritis, some GI disorders (decreased absorption)
