Osteoperosis

Question 1

Osteoblasts

Answer 1

bone formation

Question 2

Osteoclasts

Answer 2

bone resorption (break down bone)

Question 3

how bone mineral density is measured and diagnosed

Answer 3

DEXA/DXA scan which spits out a T or Z score

Question 4

What age should BMD be measured?

Answer 4

All women> 65 or men > 70

Question 5

what is the FRAX tool

Answer 5

estimates the risk of osteoperotic fracture in the next 10 years

Question 6

how do you interpret a T score

Answer 6

normal is > -1, -1–2.4 is low bone mass, and less than 2.5 is osteoperosis

Question 7

what are medications that can cause sedation or orthostasis

Answer 7

sedatives, narcotic analgesics, hypnotics

Question 8

what are the exercise people with osteoporosis should do

Answer 8

weight bearing exercise and muscle strengthening exercise

Question 9

when is it important calcium be adequare

Answer 9

in pregnancy, children, years around menopause

Question 10

what is required for calcium absorption

Answer 10

vitamin D

Question 11

what does vitamin D deficiency cause in kids and adults

Answer 11

in children, it can cause rickets and in adults, it can cause osteomalacia

Question 12

recommended calcium

Answer 12

800-2000 IU daily

• 1000-1200 elemental caldium

carbonate 40% elemental

citrate 21% elemental

Question 13

which calcium is acid dependant must be taken with meals

Answer 13

calcium carbonate

Question 14

cholcalciferol

Answer 14

d3

Question 15

ergocalciferol

Answer 15

d2

Question 16

dosing of vitamin d

Answer 16

daily: 5000-7000 IU or weekly 50,000 IU for 8-12 weeks

Question 17

max daily elemental calcium

Answer 17

500 units

Question 18

oscal

Answer 18

calcium carbonate

Question 19

tums

Answer 19

calcium carbonate

Question 20

what is indicated for treatment of osteoporosis

Answer 20

bisphosphonates (also prevention) desomab (RANKL), teriparatide (parathyroid), calcitonin

Question 21

what is indicated for prevention of osteoporosis

Answer 21

bisphosphonates (except IV alendronate, also used for tx), estrogen-based therapies (raloxifene)

Question 22

What is the criteria for tx osteoperosis

Answer 22

Either:

1) presence of a fragility fracture
2) post-menopausal people with a BMD score of less than -2.5

Question 23

1st line for osteoperosis

Answer 23

bisphosphonates

Question 24

PO administration of bisphosphenates

Answer 24

must stay upright for 30 minutes and drink water, usually given weekly or monthly

Question 25

Side effects of bisphosphentes

Answer 25

esophagitis, hypocalcemia, GI serious: atypical femur fractures, osteonecrosis of the jaw

Question 26

Treatment duration with bisphosphenates

Answer 26

3-5 years in patients with a low risk of fracture

Question 27

fosamax

Answer 27

alendronate (oral bisphosphonate, given daily or weekly)

Question 28

Boniva

Answer 28

Ibandronate (IV bisphosphonates every 3 months and oral given every month)

Question 29

Reclast

Answer 29

Zoledronic Acid (IV, once yearly)

Question 30

What is Zometa

Answer 30

an injectable bisphosphonates

Question 31

risendronate is given how often

Answer 31

daily, weekly, or monthly

Question 32

Are bisphosphonates indicated in renal impairment?

Answer 32

no - they deplete calcium

Question 33

which form of bisphosphonate is preferred in esophogitis

Answer 33

IV

Question 34

what is raloxifene, SE, boxed warning/contraindications

Answer 34

a SERM that decreases bone resorption increases risk of VTA and death due to stroke (do not use in VTA) contraindicated in pregnancy side effects *think estrogen* hot flashes, peripheral edema, arthralgia, leg cramps

Question 35

boxed warning for conjugated estrogen/Serm combo

Answer 35

also increases risk of VTA and stroke (do not use in VTA) just like raloxifene but additionally endometrial cancer due to the unopposed estrogen also contraindicated in pregnancy just like raloxifene but additionally breast cancer

Question 36

how does calcitonin (miacalcin) work?

Answer 36

by inhibiting osteoclasts which break down bone

Question 37

Miacalcin

Answer 37

Calcitonin

Question 38

Warnings for calcitonin

Answer 38

hypersensitivity to salmon derived products, increased risk of malignancy with long-term use, hypocalcemia

Question 39

What is teraperatide and abaloparatide moa

Answer 39

analogs of PTH which stimulates osteoblasts and increases bone formation

Question 40

what is teraperatide and abaloparatide used for

Answer 40

high risk of fractures but has cumulative lifetime duration of two years or less

Question 41

What is the boxed warning for the PTH analaogs (teraperatide and abaloperatide) and how do you store

Answer 41

osteosarcoma other warnings include hypercalcemia side effects: arthralgias, leg cramps,nausea/orthostasis Notes: Keep refrigerated, protect from light

Question 42

What is denosumab (prolia)

Answer 42

a monocolonial antibody injection that binds to RANKL and prevents osteoclast activity which is given every 6 months via IV Don't confuse with Xgeva which is used to treat hypercalcemia of malignancy but has same MOA

Question 43

anything that prevents osteoclast formation has what effect on calcium

Answer 43

hypocalcemia because you aren't breaking bone to make calcium

Question 44

anything that stimulates osteoblasts cause what

Answer 44

hypercalcemia

Question 45

which two medication classes can cause ONJ?

Answer 45

bisphosphonates and denosumab (a rankl)

Question 46

when is menopause reached? What causes it?

Answer 46

When last period was 1 year ago, caused by a decrease in estrogen and progesterone

Question 47

what are the vasomotor symptoms in perimenopause

Answer 47

hot flashes, night sweats, vaginal dryness

Question 48

most effective tx for menopause and how it works

Answer 48

estrogen therapy which causes a decrease in LH

Question 49

why is estrogen combined with progestin in women with a uterus

Answer 49

because unopposed estrogen can cause endometrial cancer

Question 50

when are local estrogen products used

Answer 50

dry vagina only

Question 51

17 beta estradiol formulations

Answer 51

estrace (cream), vaginal ring (estring), vaginal tablet (vagifem),

Question 52

premarin

Answer 52

conjugated equine estrogens (comes in tablet, cream, injection)

Question 53

alora

Answer 53

estradiol

Question 54

climera

Answer 54

estradiol

Question 55

vivelle-dot

Answer 55

estradiol

Question 56

what is conjugated equine estrogens with medroxyprogesterone

Answer 56

a systemic hormone therapy

Question 57

provera

Answer 57

medroxyprojesterone

Question 58

prometrium

Answer 58

micronized progesterone

Question 59

how often is vivelle dot and olora applied

Answer 59

twice weekly

Question 60

how often is climera applied

Answer 60

once weekly

Question 61

what natural products are used for vasomotor sx

Answer 61

black cohash, evening primrose oil, soy, red clover

Question 62

What is paroxetine for and what is the major DDI?

Answer 62

for vasomotor, a CYPP450 2D6 inhibitor therefore blocks effectiveness of tamoxifen and increases risk of bleeding in warfarin

Question 63

what is used to treat dyspareunia (painful intercourse

Answer 63

Ospemifene is a oral estrogen agonist/antagonist for severe (not mild) dyspareunia. Astroglide is a lubricant marketed for dyspareunia.

Question 64

What medications can lower testosterone and cause hypogonadism

Answer 64

methadone, chemo, cimetitidne, spironolactone

Question 65

what does testosterone increase

Answer 65

hematocrit (clotting risk)

Question 66

what are the risks and boxed warnings of testosterone

Answer 66

can cause prostate growth and restricted in severe BPH, baldness, acne, gynocomastia, increased appetite, reduced sperm count boxed warning do not exposekids

Question 67

what control is testosterone

Answer 67

A CII