metabolic bone disorder

Question 1

What are the three main types of metabolic bone disease?

Answer 1

Osteoporosis, Osteomalacia, Paget Disease

Question 2

What is the primary characteristic of osteoporosis?

Answer 2

Bone demineralization and decreased bone density

Question 3

Who is more likely to develop osteoporosis?

Answer 3

Women (4x more likely than men)

Question 4

What is the gold standard for diagnosing osteoporosis?

Answer 4

Dual-energy x-ray absorptiometry (DEXA)

Question 5

What characterizes osteomalacia?

Answer 5

Softening of bone due to vitamin D deficiency

Question 6

What is osteomalacia called in children?

Answer 6

Rickets

Question 7

Who is at highest risk for osteomalacia?

Answer 7

Older adults, premature infants, strict vegetarians

Question 8

What global trend has contributed to a resurgence of rickets?

Answer 8

Promotion of breastfeeding over vitamin D–fortified formulas

Question 9

What characterizes Paget disease?

Answer 9

Accelerated bone remodeling → enlarged and softened bones

Question 10

What is the cause of Paget disease?

Answer 10

Unknown

Question 11

What medications are used to treat Paget disease?

Answer 11

Bisphosphonates and calcitonin

Question 12

What is the role of Vitamin D in the body?

Answer 12

Needed to absorb calcium from the GI tract; stored in the body as a fat-soluble vitamin

Question 13

What conditions is Vitamin D used to treat?

Answer 13

Hypocalcemia, hypophosphatemia, osteoporosis, osteomalacia, hypoparathyroidism

Question 14

Why are calcium supplements often combined with Vitamin D?

Answer 14

Vitamin D is required to absorb calcium effectively

Question 15

What are the forms of Vitamin D?

Answer 15

Ergocalciferol, Cholecalciferol, Calcitriol

Question 16

How does Ergocalciferol work?

Answer 16

Once activated, it acts like calcitriol

Question 17

How is Cholecalciferol produced?

Answer 17

Synthesized in the skin from UV exposure; converted to calcitriol

Question 18

What is Calcitriol?

Answer 18

The active form of Vitamin D

Question 19

What are bisphosphonates used to treat?

Answer 19

Osteoporosis, Paget disease, hypercalcemia of malignancy

Question 20

How do bisphosphonates work?

Answer 20

Bind to bone (hydroxyapatite), suppress osteoclasts, increase bone density

Question 21

What are common side effects of bisphosphonates?

Answer 21

GI upset (nausea, vomiting, abdominal pain), esophageal irritation

Question 22

What are serious adverse effects of bisphosphonates?

Answer 22

Osteonecrosis of the jaw (ONJ), atypical femur fracture, atrial fibrillation

Question 23

What are examples of bisphosphonates?

Answer 23

Alendronate, Ibandronate, Pamidronate, Risedronate, Tiludronate, Zoledronate

Question 24

What are the therapeutic uses of alendronate (Fosamax)?

Answer 24

Osteoporosis (post-menopausal and male), glucocorticoid-induced osteoporosis, Paget disease

Question 25

What is the mechanism of action of alendronate?

Answer 25

Inhibits osteoclast-mediated bone resorption to minimize bone density loss

Question 26

What instructions should be given for alendronate administration?

Answer 26

Take with full glass of water, remain upright for 30–60 min, take in the morning before food, drink, or meds

Question 27

What are mild side effects of alendronate?

Answer 27

Nausea, diarrhea, dyspepsia, flatulence, constipation

Question 28

What are serious adverse effects of alendronate?

Answer 28

Bone pain, fractures, hypocalcemia, esophagitis, GI irritation, liver/renal impairment, myalgias, osteomalacia

Question 29

What is the role of Selective Estrogen Receptor Modulators (SERMs)?

Answer 29

Bind to estrogen receptors to increase bone density and prevent fractures

Question 30

What conditions are treated with SERMs?

Answer 30

Osteoporosis and prevention of breast cancer in postmenopausal women

Question 31

What is the SERM prototype drug?

Answer 31

Raloxifene (Evista)

Question 32

What is the mechanism of action of raloxifene?

Answer 32

Decreases bone resorption, increases bone mass by activating estrogen receptors

Question 33

What are therapeutic uses of raloxifene?

Answer 33

Osteoporosis prevention and prophylaxis of invasive breast cancer in high-risk postmenopausal women

Question 34

What are common adverse effects of raloxifene?

Answer 34

Hot flashes, leg cramps, weight gain, nausea, dyspepsia, fever

Question 35

What are serious risks of raloxifene?

Answer 35

Deep vein thrombosis (DVT), pulmonary embolism (PE), stroke, fetal harm (Pregnancy Category X)

Question 36

What nursing assessments are needed for raloxifene?

Answer 36

Monitor lipid/calcium levels, bone density, height/weight, signs of thromboembolism

Question 37

What are contraindications for raloxifene?

Answer 37

Pregnancy, lactation, history of venous thromboembolism

Question 38

When should raloxifene be discontinued?

Answer 38

At least 72 hours before prolonged immobilization