Osteoporosis

Question 1

osteoporosis

Answer 1

reduced bone mass and altered microarchitecture

Question 2

types of osteoporosis

Answer 2

primary

secondary

Question 3

primary osteoporosis type I

Answer 3

loss of trabecular bone with estrogen loss

Question 4

primary osteoporosis type II

Answer 4

loss of trabecular and cortical bone with inefficient remodeling

Question 5

secondary osteroporosis

Answer 5

due to systemic illness or medication

Question 6

therapy goals of osteoporosis (4)

Answer 6

limit bone mass
delay prevention
recent fracture
balance osteoclastic and plastic activity

Question 7

osteoclastic

Answer 7

resoprtion

Question 8

osteoblastic

Answer 8

deposition

Question 9

bone healthy lifestyle consists of

Answer 9

calcium and vitamin D

Question 10

1st line osteoporosis treatment

Answer 10

bisphosphonates

Question 11

second line osteoporosis tx

2

Answer 11

teriparatide

raloxifene

Question 12

3rd line osteoporosis tx

2

Answer 12

raloxifene

calcitonin

Question 13

nutrients as tx

uses

Answer 13

prevention

treatment

Question 14

biphosphonates as tx

uses

Answer 14

prevention

treatment

Question 15

calcitonin as tx

uses

Answer 15

treatment

Question 16

estrogen tx

uses

Answer 16

prevention

Question 17

selective estrogen receptor modulators as tx

use

Answer 17

prevention

treatment

Question 18

PTH analogs like teriparatide

use

Answer 18

treatment

Question 19

calcium products: elemental dosages

Answer 19

vary with age

1000mg/day to 1500mg/day with vit D

Question 20

calcium ____ or _____ is preferred to salts

Answer 20

carbonate

citrate

Question 21

supplements <500mg should be

Answer 21

taken with meals

Question 22

calcium product elimination

Answer 22

eliminated unabsorbed by GI tract

Question 23

AE of calcium product

Answer 23

nausea

constipation

Question 24

calcium products may interact with

Answer 24

FQs

tetracyclines

Question 25

ways to get vitamin D

Answer 25

diet UV exposure supplements

Question 26

vit D supplement examples

Answer 26

cholecalciferol calcitriol ergocalciferol

Question 27

normal serum vitamin D levels

Answer 27

~32 ng/mL

Question 28

adverse effects of vit D

Answer 28

hypercalcemia bc of promoted absorption from small intestine, thereby increasing serum Ca.

Question 29

hypercalcemia causes

Answer 29

decreased PTH | bone resorption

Question 30

bisphosphonates

Answer 30

first line therapy | prevention and treatment

Question 31

biphosphonates MoA

Answer 31

inhibits breakage. binds to bone and inhibits osteoclast activity

Question 32

pt education for bisphosphonates

Answer 32

take at least 30 min before meal with full glass of water

Question 33

excretion of bisphosphonates

Answer 33

renal

Question 34

AEs of bisphosphonates

Answer 34

nausea | abdominal discomfort

Question 35

when to avoid bisphosphonates?

Answer 35

severe renal impairment | hx esophageal obstruction

Question 36

bisphosphonates will interact with

Answer 36

antacids | divalent cations

Question 37

bisphosphonate examples

Answer 37

alendronate risedronate ibandronate zoledronic acid

Question 38

zoledronic acid is given how often

Answer 38

yearly as an injection

Question 39

bisphosphonates can be given

Answer 39

daily, weekly, orally, injected.

Question 40

bone demineralization with bisphosphonates

Answer 40

rare: jaw necrosis potential for femur fracture.

Question 41

PTH analog drug

Answer 41

teriparatide

Question 42

MoA teriparatide

Answer 42

PTH analog stimulates osteoblast function also increases renal tubular reabsorption of calcium, leading to inc bone mass/density

Question 43

dosing of teriparatide

Answer 43

SQ for 18-24 months

Question 44

excretion of teriparatide

Answer 44

renal

Question 45

when to avoid teriparatide

Answer 45

hypercalcemia skeletal malignancy bone mets

Question 46

AE teriparatide

Answer 46

``` HA lightheaded hypoTN palpitations transient hypercalcemia ```

Question 47

SERMS: raloxifene | use

Answer 47

prevention and treatment

Question 48

MoA SERM: raloxifene

Answer 48

estrogen receptor agonist (bone) and antagonist (breast, uterus) to slow the rate of bone loss

Question 49

SERMS: raloxifine | protein binding

Answer 49

highly protein bound

Question 50

ADR of SERM: Raloxifene

Answer 50

``` HA hot flash flushing leg cramp thromboembolism ```

Question 51

when to avoid SERM: Raloxifene

Answer 51

hx venous thrombosis | women of childbearing age (estrogen related)

Question 52

SERM: raloxifene interaction

Answer 52

cholestyramine | estrogens

Question 53

Calcitonin

Answer 53

treatment only | strictly 3rd line

Question 54

MoA Calcitonin

Answer 54

inhibits osteoclasts

Question 55

estrogen products for tx

Answer 55

used to alleviate peri menopausal symptoms or to prevent osteoporosis in high risk patients. recommended to be used for short term symptom management.

Question 56

AEs estrogen

Answer 56

``` HA depression N/V cramps HTN thrombosis bleeding edema breast tenderness breast cancer ```

Question 57

absolute contraindications to estrogen

Answer 57

``` cancers thromboembolic disease acute liver disease pregnancy tobacco use ```

Question 58

osteoporosis tx that increases deposition

Answer 58

nutrient | teriparatide

Question 59

osteoporosis tx that decreases resorption

Answer 59

bisphosphonates calcitonin estrogen SERMs

Question 60

monitoring osteoporosis pt newly started on meds

Answer 60

followup in 1-2 months, then 3-6 | DEXA q2 years

Question 61

if pt is using estrogen for osteoporosis

Answer 61

do a full annual workup and discuss with patient before renewing Rx