OP and Paget's Disease - Chapter 16

Question 1

Osteoporosis

Answer 1

-Chronic, progressive disease of bone with loss of bone density and bone strength which leads to bone fragility

Question 2

Primary Osteoporosis

Answer 2

-Associated with the aging process

Question 3

Secondary Osteoporosis

Answer 3

-Associated with disease or drugs

Question 4

Disease Causes for Secondary Osteoporosis

Answer 4

• Hyperthyroidism
• Hyperparathyroidism
• Rheumatoid Arthritis
• IBD
• Parkinson’s disease
• MS
• AIDS

Question 5

Drug Causes for Secondary Osteoporosis

Answer 5

• Corticosteroids
• Antiandrogens
• GnRH agonists
• Lithium
• Methotrexate
• Phenytoin
• Aromatase inhibitors
• Medroxyprogesterone

Question 6

Prevention of Osteoporosis

Answer 6

• Mild weight-bearing exercise
• Diet rich in vitamin D and calcium
• Reduced smoking and alcohol
• Start the above early to prevent bone loss

Question 7

Paget’s Disease of the Bone

Answer 7

• Progressive disease of bone

- Irregular activity of osteoblasts and osteoclasts

Question 8

Treatment of Osteoporosis and Paget’s Disease

Answer 8

The goal of treatment is to increase bone density and decrease the risk of fractures

Pharmacological agents are:

• Antiresorptive agents
• Anabolic agents

Question 9

Antiresorptive Agents MOA

Answer 9

• Suppress bone turnover and loss

- Inhibit bone resorption

Question 10

Different Types of Antiresorptive Agents

Answer 10

• Bisphosphonates
• Calcitonin
• Estrogen Agonist
• RANK ligand inhibitor

Question 11

Anabolic Agents MOA

Answer 11

-Promote bone formation

Question 12

Types of Anabolic Agents

Answer 12

-PTH analogs

Question 13

Bisphosphonates MOA

Answer 13

-Inhibit osteoclast activity

Question 14

Bisphosphonates Examples

Answer 14

• alendronate
• etidronate
• risedronate
• zoledronic acid

Question 15

Brand: Fosamax

Answer 15

Generic: alendronate

Question 16

Brand: Didronel

Answer 16

Generic: etidronate

Question 17

Brand: Actonel, Actonel DR

Answer 17

Generic: risedronate

Question 18

Brand: Aclasta

Answer 18

Generic: zoledronic acid

Question 19

Bisphosphonates Combination Examples

Answer 19

• alendronate/vitamin D
• risedronate/calcium
• etidronate/calcium carbonate

Question 20

Brand: Fosavance

Answer 20

Generic: alendronate/vitamin D

Question 21

Brand: Actonel Plus Calcium

Answer 21

Generic: risedronate/calcium

Question 22

Brand: Didrocal

Answer 22

Generic: etidronate/calcium carbonate

Question 23

Bisphosphonate ADR’s

Answer 23

• Painful swallowing
• Heartburn
• Diarrhea
• Nausea/vomiting

Question 24

Bisphosphonate Warning Labels

Answer 24

• STAND OR SIT UPRIGHT FOR AT LEAST 30 MINUTES AFTER TAKING DOSE; DO NOT LIE DOWN
• TAKE 30 MINUTES BEFORE FIRST MEAL, BEVERAGE OR MEDICATIONS WITH AT LEAST 120 ML OF WATER
• AVOID DAIRY, CALCIUM, MULTIVITAMIN SUPPLEMENTS, IRON, OR ANTACIDS WITHIN 2 HOURS

Question 25

Selective Estrogen Receptor Modulators (SERM's)

Answer 25

-Indicated for the treatment of osteoporosis in postmenopausal women

Question 26

SERM's for Osteoporosis Examples

Answer 26

-raloxifene

Question 27

Brand: Evista

Answer 27

Generic: raloxifene ADR's: - hot flashes - leg cramps - peripheral edema - stroke - DVT

Question 28

Calcitonin

Answer 28

- Inhibits the rate of bone turnover and causes excess calcium to be stored in the bone - Only used for Paget's Disease - Increased bone Mineral Density

Question 29

Brand: Calcimar

Answer 29

Generic: calcitonin

Question 30

HRT for Osteoporosis

Answer 30

-Used for prevention NOT treatment - Estradiol - Estradiol/norethindrone - estradiol/norgestimate - estrogens/medroxyprogesterone - conjugated estrogens - esterified estrogens and estropipate

Question 31

RANK Ligand Inhibitors

Answer 31

- Causes inhibition of osteoclast activation - decreases bone resorption - reverses bone remodelling

Question 32

RANK Ligand Inhibitors Examples

Answer 32

-denosumab

Question 33

Brand: Prolia

Answer 33

Generic: denosumab -given SC twice yearly

Question 34

Anabolic Agents: Parathyroid Hormone Analogs

Answer 34

- Increase the rate of bone remodeling - Thicken structural units of bones - Decrease osteoblast cell death

Question 35

PTH Analogs Examples

Answer 35

-teriparatide

Question 36

Brand: Forteo

Answer 36

Generic: teriparatide