Chapter: Osteoprosis/ Menopause Flashcards
Define Osteoporosis
Osteoporosis weakens bones, affecting over a quarter of U.S. adults, especially those over 50, with higher prevalence in postmenopausal women. Fractures, often from falls, are common in the spine, hip, and wrist. Vertebral fractures can occur without falling and may be painless initially. Hip fractures are severe, with significant costs and mortality, particularly in those over 75. Wrist fractures and others can signal poor bone health, even in younger individuals.
Osteoporosis: Risk Factors
What methods are used to assess bone health, and what factors influence the timing of bone mineral density (BMD) measurements?
Bone health is assessed through bone mineral density (BMD) measurements, typically using a dual energy X-ray absorptiometry (DEXA or DXA) scan, which evaluates bone formation and resorption. Osteoblasts build bone, while osteoclasts break it down. BMD is crucial for diagnosing osteoporosis, with T-scores or Z-scores calculated from spine and hip measurements. Individuals over 65 (women) or 70 (men) should have BMD checked, with earlier assessment for those with fragility fractures after age 50, risk factors for bone loss, or parental history of hip fractures.
Fracture Risk Assessment Tool (FRAX)
The FRAX tool, developed by the WHO, estimates the 10-year risk of osteoporotic fracture.
Osteoporosis Prevent
Fall Prevention Measures
To prevent falls in individuals with low bone density, it’s crucial to address factors that increase fall risk. These include recent falls, medications causing sedation or orthostasis (e.g., antihypertensives, sedatives, hypnotics, narcotic analgesics, psychotropics), neurologic disorders, physical instability, impaired vision or hearing, frailty, and urinary or fecal urgency. A home safety assessment should ensure appropriate lighting, clutter-free floors, safe storage heights, bathroom safety features, handrails on stairs, and non-skid surfaces.
Osteoporosis Prevent
Fall Prevention Measures
To prevent falls in individuals with low bone density, it’s crucial to address factors that increase fall risk. These include recent falls, medications causing sedation or orthostasis (e.g., antihypertensives, sedatives, hypnotics, narcotic analgesics, psychotropics), neurologic disorders, physical instability, impaired vision or hearing, frailty, and urinary or fecal urgency. A home safety assessment should ensure appropriate lighting, clutter-free floors, safe storage heights, bathroom safety features, handrails on stairs, and non-skid surfaces.
Osteoporosis Prevent
Lifestyle Measures
Patients with low bone density should exercise regularly with weight-bearing activities like walking or jogging, along with muscle-strengthening exercises such as yoga or weight training. They should quit smoking, limit alcohol, and take steps to prevent falls.
Osteoporosis Prevent
Calcium and Vitamin D intake
Adequate calcium intake is crucial throughout life, especially in children, during pregnancy, and around menopause. Dietary calcium is preferred, with supplements if necessary, although excessive intake may have risks like kidney stones and cardiovascular issues. Vitamin D is essential for calcium absorption, with low levels linked to various health issues including autoimmune conditions and cancer. Deficiency can cause rickets in children and osteomalacia in adults. Recommendations vary, with adults typically advised 800-1000 IU of vitamin D daily, although some suggest higher doses up to 2000 IU, with a safe upper limit of 4000 IU.
Calcium Supplements: Names, dosing, how much elemental calcium in each, SEs, notes
Drug Therapy: What are the FDA-approved options for preventing and treating osteoporosis? and what are the criteria for initiating treatment?
FDA-approved treatments for osteoporosis prevention include bisphosphonates (excluding IV ibandronate), estrogen-based therapies like raloxifene and Duavee. For treatment, options include bisphosphonates, denosumab, parathyroid hormone analogs (e.g., teriparatide, abaloparatide), and calcitonin. These medications are primarily studied in postmenopausal women, with limited data in men or those with glucocorticoid-induced osteoporosis. Adequate calcium and vitamin D intake, along with pre-treatment evaluation of levels, are essential regardless of the chosen medication.
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Criteria for starting tx:
- Osteoporosis: T-Score -2.5 or less than -2.5 in the spine, femoral neck, total hip or 1/3 radius OR presence of a fragility fracture (regardless of BMD)
- Osteopenia if high risk: Low bone density (T Score between -1 and -2.5 AND FRAX score indicates a 10 year propbability of a major osteoporosis related fractures > 20% or a 10 year hip fracture probabiity >3%
Study tip gal: Drug Summary For Osteoprosis Tx and PPX
BISPHOSPHONATE
Study tip gal: Drug Summary For Osteoprosis Tx and PPX
DENOSUMAB (Prolia)
■ Alternative to bisphosphonates
■ SC administration every 6 months
■ Side effect: hypocalcemia
Study tip gal: Drug Summary For Osteoprosis Tx and PPX
TERIPARATIDE (FORTEO), ABALOPARATIDE (TYMLOS)
■ Recommended fo r very high risk patients only
(e.g., history of severe vertebra l fractures)
■ SC administration daily
■ Side effect hypercalcemia
Study tip gal: Drug Summary For Osteoprosis Tx and PPX
RALOXIFENE (EVISTA), BAZEDOXIFENE/ESTROGENS (DUAVEE)
Study tip gal: Drug Summary For Osteoprosis Tx and PPX
TERIPARATIDE (FORTEO), ABALOPARATIDE (TYMLOS)
■ Recommended fo r very high risk patients only
(e.g., history of severe vertebra l fractures)
■ SC administration daily
■ Side effect hypercalcemia
What are the criteria outlined by the North American Menopause Society (NAMS) and the American Association of Clinical Endocrinologists (AACE) for using estrogen in controlling vasomotor symptoms, and what safety considerations are important before initiating systemic hormone therapy with estrogen?
Systemic hormone therapy with estrogen is the most effective treatment for vasomotor symptoms. It decreases luteinizing hormone (LH) levels and stabilizes temperature control. While it also improves bone density, there are safety considerations before starting treatment. Guidelines from NAMS and AACE outline criteria for estrogen use in managing vasomotor symptoms.
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Formulations like transdermal, topical, and low-dose oral estrogen are associated with lower risks of venous thromboembolism (VTE) and stroke compared to standard oral doses. While estrogen is generally well-tolerated, it may cause side effects such as nausea, dizziness, headaches, and mood changes. Topical formulations bypass first-pass metabolism, allowing for lower doses and potentially fewer side effects. Local estrogen products are preferred for patients with vaginal symptoms only, such as dryness or painful intercourse. Common over-the-counter (OTC) lubricants and moisturizers like Replens and Luvena can help alleviate symptoms, while Astroglide, marketed for dyspareunia, is safe for condom use.
