Male & Female Health: Osteoporosis, Menopause & Testosterone Use

Question 1

Cells involved in bone formation

Answer 1

Osteoblasts

Question 2

Cells involved in bone reabsorption

Answer 2

Osteoclasts

Question 3

Gold standard to measure BMD and diagnose osteoporosis

Answer 3

Dual energy X-ray absorptiometry (DEXA or DXA scan)

Question 4

Who should have BMD measured?

Answer 4

women > 65
men > 70

Question 5

FRAX tool

Answer 5

estimates the risk of osteoporotic fracture in the next 10 years

Question 6

Interpreting T-score

Answer 6

> -1 = normal
- 1 to -2.4 = Osteopenia (Low bone mass)
< -2.5 = Osteoporosis

Question 7

Vitamin D daily recommended intake

Answer 7

800-2000 IU, up to 4000 IU safe for adults and adolescence

Question 8

Calcium Saturability

Answer 8

doses over 500-600 mcg should be dividend

Question 9

Calcium carbonate vs Calcium citrate

Answer 9

Carbonate = more elemental calcium per unit than citrate, but req acidic environment

Question 10

Ergocalciferol is

Answer 10

Vitamin D2

Question 11

Cholecalciferol is

Answer 11

Vitamin D3

Question 12

Daily calcium recommendation adults

Answer 12

1000-1200mg elemental

Question 13

How to treat Vit D deficiency?

Answer 13

Vit D2 or D3 for 8-12 wks followed by maintenance dosing

Question 14

1g Calcium carbonate = how much elemental

Answer 14

400mg

Question 15

1g Calcium citrate = how much elemental

Answer 15

210mg

Question 16

Calcium side effects

Answer 16

constipation

Question 17

Calcium Citrate & carbonate notes

Answer 17

Citrate = take w/ or w/o food
Carbonate = take w/ food, no PPIs

Question 18

Criteria for initiating treatment Osteoporosis

Answer 18

T-score < -2.5 OR presence of fragility fracture

Question 19

Criteria for initiating treatment Osteopenia if high risk

Answer 19

T score = -1 to -2.4
and FRAX > 20% major related fracture or >3% hip fracture

Question 20

First line osteoporosis txm for most patients?

Answer 20

Bisphosphonates

Question 21

How do bisphosphonates work

Answer 21

inc bone density by inhibiting osteoclast activity and bone reabsorption

Question 22

When and who should get drug holiday from bisphophonates

Answer 22

3-5 yrs of treatment
low-risk patients

Question 23

Alendronate dosing

Answer 23

usually weekly, can be daily

Question 24

Risedronate (Atelvia) dosing

Answer 24

can be daily, weekly and monthly

Question 25

Ibandronate dosing

Answer 25

usually monthly

Question 26

Bisphosphonate CI

Answer 26

Hypocalcemia inability to sit/stand for atleast 30min (60min for ibandronate)

Question 27

Bisphosphonate Warnings

Answer 27

Osteonecrosis of Jaw (ONJ) atypical femur fractures Esophagitis, esophagel ulcers, erosions Hypocalcemia dont use CrCl < 35 (alendronate) CrCl < 30 others

Question 28

Bisphosphonate side effects

Answer 28

Dyspepsia dysphagia heartburn N/V hypocalcemia

Question 29

Bisphosphate notes

Answer 29

Do dental work before starting due to inc risk of ONJ caution aspirin/NSAID due to GI irritation Separate from Ca, antacids, iron and mg atleast 2hrs

Question 30

Risedronate (Altevia) should not be used with

Answer 30

H2RAs and PPIs requires acidic gut

Question 31

Injectable Bisphosphonates

Answer 31

Ibandronate (Boniva) Zoledronic Acid (Reclast)

Question 32

Injectable Bisphosphonates preferred if.....

Answer 32

esophagitis is present, due to risk of esophageal cancer

Question 33

Reclast

Answer 33

Dosing ranges from Q 2yrs for prevention, to once yearly

Question 34

Raloxifene is a...

Answer 34

SERM dec bone reabsorption

Question 35

Conjugated estrogens/bazedoxifene (Duavee) is a.....

Answer 35

Equine (horse) estrogen/SERM combo used for osteoporosis prevention in postmenopausal women with a uterus

Question 36

Raloxifene (Evista) boxed warnings

Answer 36

inc risk of DVT/PE inc risk of death due to stroke in women w/ CHD

Question 37

Raloxifene contraindications

Answer 37

hx or current VTE and pregnancy

Question 38

Raloxifene side effects

Answer 38

hot flashes peripheral edema arthralgia legt cramps/muscle spasm

Question 39

Conjugated estrogens/Bazedoxifene (Duavee) boxed warnings

Answer 39

Endometrial cancer inc risk of DVT and stroke

Question 40

Duavee contraindications

Answer 40

Breastcancer pregnancy undiagnosed uterine bleeding hx of or active VTE

Question 41

Duavee warnings

Answer 41

Inc risk of breast cancer and ovarian cancer

Question 42

Calcitonin works by...

Answer 42

inhibiting bone reabsorption by osteoclasts less effective than other agents, barely used

Question 43

Calcitonin warnings

Answer 43

Hypocalcemia inc risk of malignancy w/ long term use hypersensitivity reactions to Salomon-derived products

Question 44

Human Parathyroid analogs

Answer 44

Teriparatide (Forteo) Abaloparatide (Tymlos)

Question 45

human Parathyroid analog warnings

Answer 45

Osteosarcoma (bone cancer) hypercalcemia

Question 46

human parathyroid analog side effects

Answer 46

Arthralgias leg cramps nausea orthostasis & dizziness

Question 47

Human parathyroid analog notes

Answer 47

protect from light and keep in fridge

Question 48

RANKL inhibitor

Answer 48

Denosumab (Prolia) used for txm of osteoporosis when high risk of fracture

Question 49

Denosumab (Prolia) Contraindications

Answer 49

Hypocalcemia - correct before using pregnancy

Question 50

Denosumab (Prolia) warnings

Answer 50

ONJ atypical femur fractures hypocalcemia infections

Question 51

Denosumab (Prolia) side effects

Answer 51

HTN fatigue edema dyspnea headache N/V/D dec PO4

Question 52

How long is Romosozumab (Evenity) used for treatment

Answer 52

Max of 12 months decreased efficacy after

Question 53

Menopause is reached when

Answer 53

last menstraul period was 12 months ago usually occurs ages 40-58, avg 52

Question 54

Which type of estrogen associated with lower VTE risk?

Answer 54

transdermal local (topical) low dose oral estrogen products

Question 55

Local estrogens preferred when....

Answer 55

pt has vaginal only symptoms

Question 56

Systemic Estrogen Hormone therapies Boxed warnings

Answer 56

Endometrial cancer dementia inc risk of VTE and stroke breast cancer

Question 57

Systemic Estrogen Hormone therapy contraindications

Answer 57

Breast cancer uterine bleeding active VTE pregnancy

Question 58

Systemic Estrogen Hormone therapy warnings

Answer 58

inc risk of breast cancer

Question 59

Vivelle-Dot and Minivelle patches are applied

Answer 59

twice weekly

Question 60

Climate and Menostar patches are applied

Answer 60

once weekly

Question 61

Natura products used for vasomotor symptoms of menopause include

Answer 61

black cohos evening primrose oil red clover soy flax seed

Question 62

Ospemifene is oral estrogen agonist/antagonist indicated for...

Answer 62

painful intercourse and moderate-severe vag dryness

Question 63

Which SSRI can be used for menopause symptoms?

Answer 63

Paroxetine dosing is lower than for depression

Question 64

Testosterone Boxed warnings

Answer 64

For gel/ solutions = secondary exposure to children can case virilization

Question 65

Testosterone side effects

Answer 65

inc appetite acne edema hepatotoxicity reduced sperm count roid rage