Chapter 49: Osteoporosis, Menopause & Testosterone Use Flashcards
(117 cards)
1
Q
What is osteoporosis?
A
A condition that causes bones to become weak and fragile
2
Q
In which population is osteoporosis most common?
A
Postmenopausal females
3
Q
Can vertebral fractures occur without a fall?
A
Yes, they can occur and can initially be painless
A gradual loss of height may be the only clue.
4
Q
What type of fractures are considered the most devastating?
A
Hip fractures
5
Q
What patient charcteristics are a risk factor for osteoporosis?
A
- Advanced age
- Ethnicity (Caucasian and asian)
- Family history
- Female sex
- Low bone weight
6
Q
What medical conditions are a risk factor for osteoporosis?
A
- Diabetes
- Eating disorders
- GI diseases
- Hyperthyroidism
- Hypoginadism in male
- Menopause
- RA, autoimmune disease
7
Q
What medications are a risk factor for osteoporosis?
A
- Antiseizures medications
- Aromatase inhibitors
- Depo-medroxyprogestrone
- GnRH agonists
- Lithium
- PPIs
- Steroids
- Thyroid hormones
- Loop diuretics
- SSRIs
8
Q
What are osteoblasts?
A
Cells involved in bone formation
9
Q
What are osteoclasts?
A
Cells involved in bone resorption; they break down tissue in the bone
10
Q
How is bone health evaluated?
A
By measuring bone mineral density (BMD)
11
Q
What is the gold standard to measure BMD and diagnose osteoporosis?
A
Dual-energy X-ray absorptiometry (DEXA or DXA) scan
12
Q
What does a DEXA scan calculate?
A
A T-score or a Z-score
T-scores compare an individual’s BMD to a healthy young adult, while Z-scores compare to age-matched peers.
13
Q
Who should have their BMD measured?
A
All women ≥ 65 years and men ≥ 70 years
Regular BMD assessments are recommended for these age groups to monitor bone health.
14
Q
What is measured to evaluate bone health?
A
Bone mineral density (BMD)
BMD is essential for diagnosing conditions like osteoporosis and osteopenia.
15
Q
What is the significance of T-scores and Z-scores?
A
They help in diagnosing osteoporosis and osteopenia
T-scores indicate how much BMD deviates from the norm, aiding in risk assessment.
16
Q
What does the FRAX tool estimate?
A
The risk of osteoporotic fractures in the next 10 years
17
Q
What lifestyle measures should patients with low bone density adopt?
A
- Regular weight-bearing exercise
- Muscle-strengthening exercise
- Stop smoking
- Avoid secondhand smoke
- Reduce alcohol intake
- Adopt fall prevention strategies
18
Q
What is the importance of calcium intake?
A
Calcium is critically important throughout life, especially in children, during pregnancy, and around menopause.
19
Q
What are the recommended calcium intakes for most adults?
A
1,000-1,200 mg elemental calcium daily.
20
Q
What can excessive calcium intake contribute to?
A
- Kidney stones
- Cardiovascular disease
- Stroke
21
Q
What is the role of Vitamin D in the body?
A
Vitamin D is required for calcium absorption.
22
Q
What are the consequences of Vitamin D deficiency in children and adults?
A
- Children: Rickets
- Adults: Osteomalacia (softening of the bone)
23
Q
What are the two main forms of calcium supplements?
A
- Calcium carbonate
- Calcium citrate
24
Q
What treatment is recommended for Vitamin D deficiency?
A
- Vitamin D2 (ergocalciferol): 1250 mcg (50,000 IU) weekly
- Vitamin D3 (cholecalciferol): 125-175 mcy (5000-7000 IU) daily
for 8-12 weeks.
25
What is the recommended maintenance therapy for Vitamin D after treating deficiency?
25 - 50 mcg (1,000 - 2,000 IU) daily.
26
List the absorption characteristics of calcium carbonate and calcium citrate.
* Calcium carbonate: acid-dependent, must take with meals
* Calcium citrate: not acid-dependent, can take with or without food
27
List the elemental calcium percentage of calcium carbonate and calcium citrate.
* Calcium carbonate: 40%
* Calcium citrate: 21%
28
List medications approved for the prevention of osteoprosis?
1. Bisphosponates
2. Estrogen-based therapies
3. Raloxifene
4. Duavee
29
List medications approved for the treatment of osteoprosis?
1. Bisphosphonates
2. Denosumab
3. Parathyroid hormone analogs (teriparatide)
4. Calcitonin
30
What T-score indicates osteoporosis?
T-score ≤ -2.5
31
What is required for treatment initiation in patients with osteopenia?
* High risk
* T-score between -1 and -2.5
* High FRAX score
32
What is required for treatment initiation in patients with osteopenia?
* Postmenopausal women or men > 50 yo with a BMD T-score =< -2.5
* Presence of a fragility fracture, regardless of BMD
33
Which class of medications is the first line for both prevention and treatment of osteoprosis?
Bisphosphonates
34
What is an important patient counseling regarding PO administration of bisphosphonates?
Must stay upright for 30 min (60 for ibandronate) and drink 6-8oz of plain water
35
What is the treatment duration for bisphosphonates?
3-5 years
36
What is the route of administration of Denosumab and how often it's given?
SC every 6 months
37
How do bisphosphonates increase bone density?
by inhibiting osteoclast activity
38
What conditions are bisphosphonates used to treat?
* Osteoporosis
* Paget's disease
* Glucocorticoid-induced osteoporosis
* Hypercalcemia of malignancy
39
Alendronate brand name?
Fosamax
40
How often is Alendronate administered for treatment in male and postmenopausal females?
Daily or Weekly
41
How often is Ibandronate administered for prevention and treatment in postmenopausal females?
Monthly
42
What is the administration schedule for Zoledronic Acid in the treatment of osteoporosis?
IV Once yearly
43
Brand name Zolendronic acid indicated for osteoporosis?
Reclast
44
What are the contraindications for bisphosphonates?
* Hypocalcemia
* Inability to stand or sit upright for at least 30 minutes (PO)
45
What are some warnings associated with bisphosphonates?
* Osteonecrosis of the jaw (ONJ)
* Atypical femur fractures
* Esophagitis and esophageal ulcers
* Hypocalcemia
* Renal impairment
46
What are common side effects of bisphosphonates?
* Dyspepsia
* Dysphagia
* Heartburn
* Nausea/Vomiting
* Hypocalcemia
* Musculoskeletal pain
47
____ should be completed before starting bisphosphonate treatment.
Dental work
48
What is a unique requirement for Atelvia (delayed-release Risedronate) regarding absorption?
Requires an acidic gut, should not be used with H2RAs and PPIs.
49
When is IV bisphosphonates are preferred over oral?
If esophagitis present
50
What is Raloxifene classified as?
A selective estrogen receptor modulator (SERM)
## Footnote
Raloxifene is an estrogen agonist/antagonist that reduces bone resorption.
51
What is the indication for Conjugated estrogens/bazedoxifene (Duavee)?
Osteoporosis prevention in postmenopausal women with a uterus
52
Raloxifene brand name
Evista
53
What is a boxed warning associated with Raloxifene?
Risk of VTE (DVT/PE) and risk of death due to stroke in women with CHD or at risk for coronary events
54
What are the contraindications for Raloxifene?
Pregnancy, history of or current VTE
55
What are some side effects of Raloxifene?
* Hot flashes
* Peripheral edema
* Arthralgia
* Leg cramps/muscle spasms
56
What should be noted about the timing of Raloxifene and levothyroxine?
Separate by several hours
57
How long before and during prolonged immobilization should Raloxifene be discontinued?
72 hours
58
What is a boxed warning for Conjugated Estrogens/Bazedoxifene (Duavee)?
Endometrial cancer due to unopposed estrogen and risk of DVT and stroke in postmenopausal women aged 50-79
59
What are the contraindications for Conjugated Estrogens/Bazedoxifene (Duavee)?
* Breast cancer (any history)
* Pregnancy
* Undiagnosed uterine bleeding
60
What warnings are associated with Conjugated Estrogens/Bazedoxifene (Duavee)?
* Risk of breast cancer and ovarian cancer
61
What is the primary function of Calcitonin?
Inhibits bone resorption by osteoclasts
62
What is the brand name of Calcitonin?
Miacalcin
63
What is the dosing for Calcitonin nasal spray?
1 spray (200 units) in one nostril daily (alternate nostril daily)
64
What are the warnings associated with Calcitonin?
* Hypocalcemia
* Increased risk of malignancy with long-term use
* Hypersensitivity reactions to salmon-derived products
65
What are teriparatide and abaloparatide?
Analogs of human parathyroid hormone that stimulate osteoblast activity and increase bone formation
66
What condition are teriparatide and abaloparatide used to treat?
Osteoporosis when there is a very high risk of fracture
67
What is the maximum cumulative lifetime treatment duration for teriparatide and abaloparatide?
Two years or less
68
What is the brand name for teriparatide?
Forteo
69
How is the dose for teriparatide in males and postmenopausal females given?
SC daily
70
What is a major safety warning associated with teriparatide and abaloparatide?
* Risk of osteosarcoma (bone cancer)
* Hypercalcemia
71
What are some side effects of teriparatide?
Arthralgias, leg cramps, nausea, orthostasis/dizziness
72
How should teriparatide be stored?
Keep refrigerated and protect from light
73
What is menopause defined as?
Menopause is reached when the last menstrual period was over 12 months ago.
74
What hormonal changes occur during menopause?
A decrease in estrogen and progesterone causes an increase in follicle stimulating hormone (FSH).
75
What are vasomotor symptoms associated with menopause?
Vasomotor symptoms include hot flashes and night sweats.
76
What is the genitourinary syndrome of menopause?
Vaginal dryness, burning, and dyspareunia (painful intercourse) due to a decline in estrogen in the vaginal mucosa.
77
What is the most effective treatment for vasomotor symptoms?
Systemic hormone therapy with estrogen.
78
What does estrogen do in relation to luteinizing hormone (LH)?
Estrogen causes a decrease in luteinizing hormone (LH) and more stable temperature control.
79
What formulations of estrogen are assocated with lower risk of VTE and stroke?
* Transdermal
* Local (topical)
* Low-dose oral
80
Which estrogen formulation is preferred in patients with vaginal symptoms only?
Local estrogen
81
What must be considered when using estrogen for women with a uterus?
It must be used in combination with a form of progesterone to reduce the risk of endometrial cancer.
82
What are micronized progestins considered safer than?
Synthetic progestins.
83
What are the criteria for hormone therapy use in women?
Healthy, symptomatic women within 10 years of menopause, ≤ 60 years of age, with no contraindications.
84
Name local hormone therapy products that contain 17-Beta-Estradiol.
* Vaginal cream (Estrace)
* Vaginal ring (Estring)
* Vaginal tablet (Vagifem)
* Vaginal insert (Imvexxy)
85
Brand name for
estradiol patch?
* Vivelle Dot
* Climara
86
The oral tablet _______, contains conjugated equine estrogens.
Premarin
87
What are the boxed warnings associated with estrogen use?
* Endometrial cancer (if estrogen used without progestin in women with a uterus)
* Dementia (women ≥ 65 years)
* Risk of VTE and stroke
* Breast cancer
88
What are contraindications for estrogen-containing products?
* Breast cancer (any history)
* Undiagnosed uterine bleeding
* Active VTE or arterial thromboembolic disease
* Pregnancy
89
What should be done prior to an MRI when using transdermal patches?
Remove transdermal patches.
90
How often are Vivelle-Dot and Minivelle patches applied?
Twice weekly.
91
How often is Climara patches applied?
once weekly
92
Medroxyprogesterone brand name?
Provera
93
Micronized progesterone brand name?
Prometrium
94
What is the application method for topical gels for systemic absorption?
Apply once daily; wash hands after applying.
95
Where should Divigel be applied?
To the upper thigh (alternate legs daily).
96
What is the application area for Elestrin?
To the upper arm and shoulder.
97
How should Estrogel be applied?
To the entire arm from wrist to shoulder.
98
What is the application method for Evamist spray?
Spray on the inside of the forearm (between elbow and wrist) every morning.
99
Where should the patch be applied?
To the lower abdomen, below the waistline.
100
What is ospemifene MOA?
it is an oral estrogen agonist/antagonist
101
What is Ospemifene (Osphena) indicated for?
Dyspareunia and moderate-severe vaginal dryness.
102
What is the function of Paroxetine (Brisdelle)?
Approved for the treatment of moderate-severe vasomotor symptoms associated with menopause.
103
What is the dosing consideration for Paroxetine compared to depression treatment?
The dose used is lower than the recommended dose for depression.
104
What is a contraindication for using Paroxetine?
Should not be used with tamoxifen or warfarin.
105
What is Fezolinetant (Veozah)?
A neurokinin B antagonist for treating moderate to severe vasomotor symptoms.
106
Name three medications that can lower testosterone levels.
* Opioids (especially methadone)
* Chemotherapy drugs for prostate cancer
* Cimetidine
* Spironolactone
107
What warning has the FDA released regarding testosterone use?
Cardiovascular risks associated with testosterone use
108
What does the FDA recommend regarding testosterone treatment?
Treatment only in men with low testosterone levels caused by certain medical conditions confirmed by laboratory tests
109
What is a potential risk associated with testosterone therapy?
Increased clotting risk
110
What condition can testosterone increase that poses a clotting risk?
Hematocrit, leading to polycythemia
111
In which condition is testosterone use restricted?
Severe Benign Prostatic Hyperplasia (BPH)
112
List common side effects of testosterone.
* Increased male pattern baldness
* Acne
* Gynecomastia
113
What are the risks associated with anabolic androgenic steroids (AAS)?
Abuse potential and risk of serious adverse events
114
What is the brand name for testosterone gel?
AndroGel
115
What is the name of injectable testosterone?
Testostereone cypionate
116
Testosterone boxed warnings?
* Reports of virilization of children due to testosterone exposure are serious and counseling is required.
* breast/prostate cancer risk.
* BPH symptoms would be expected to worsen with testosterone treatment.
117
Common side effects of testosterone
* Increased appetite
* Acne
* Edema
* Hepatotoxicity
* reduced sperm count
