Osteoporosis

Question 1

Recommended calcium dose

Answer 1

1000-1500mg elemental calcium daily

(Take in two divided doses)

Question 2

Why should a single dose of elemental calcium not exceed 500-600mg?

Answer 2

To reduce the risk:

Kidney stone

CVD

Stroke

Question 3

Types of calcium formulation

Answer 3

Carbonate

Citrate

Question 4

Os-Cal
Tums
Caltrate
Maalox
Oysco

Answer 4

Calcium Carbonate

Question 5

40% elemental calcium

Requires acid for absorption

Take with food

Answer 5

Calcium Carbonate

Question 6

Calcitrate

Citracal

Answer 6

Calcium Citrate

Question 7

21% elemental calcium

Good with elderly and PPI (increased gastric absorption at high pH)

+/- food

Answer 7

Calcium citrate

Question 8

ADR calcium supplements

Answer 8

Constipation

Hypercalcemia

Question 9

Vit. D recommended daily dose

Answer 9

20-25 mcg/day (800-1000 IU)

Osteoporosis dose

Question 10

Vit D deficiency treatment dose

Answer 10

125 - 175 mcg (5000-7000 IU) daily or 1250mcg (50000 IU) weekly for 8-12 weeks

Then maintenance dose:
25-50 mcg (1000-2000 IU) daily

Question 11

Vit. D level for deficiency

Answer 11

< 30 ng/ml

Question 12

Cholecalciferol

Answer 12

D3

Question 13

Ergocalciferol

Answer 13

D2

Question 14

Medications for Osteoporosis prophylaxis

Answer 14

Bisphosphonate

Estrogen based therapy (Raloxifene, Duavee)

Question 15

Medications for osteoporosis treatment

Answer 15

Bisphosphonate

Denosumab

Parathyroid hormone analogs

Calcitonin

Question 16

Levels must be adequate prior to treatment initiation

Answer 16

Vit. D

Calcium

Question 17

Criteria for initiating treatment if osteoporosis

Answer 17

T score <= -2.5 in the spine, fermoral neck, total hip or 1/3 radius

Or

Any osteoporosis related fracture regardless of BMD

Question 18

Criteria for initiating treatment if osteopenia

Answer 18

T score of -2.5 — -1 and 10 yrs risk of 20% or greater osteoporosis major fracture or 3% or greater hip fracture

Question 19

Inhibits osteoclast and bone resorption

Answer 19

Bisphosphonate

Question 20

Vertebral and hip fx risk reduction

Answer 20

All Bisphosphonate except ibandronate (verterbal only)

Question 21

Bisphosphonate drug holiday timeframe

Answer 21

After 3-5 years of treatment

Question 22

Other Bisphosphonate indications

Answer 22

Paget disease

Glucocorticoid induced osteoporosis

Hypercalcemia o f malignancy

Question 23

Fosamax

Binosto

Answer 23

Alendronate

Question 24

Alendronate dose:

Prophylaxis postmenopausal women

Glucocorticoid induced osteoporosis

Answer 24

5 mg daily

Question 25

Alendronate dose: Treatment (male and female)

Answer 25

10mg daily or 70mg weekly

Question 26

Actonel Atelvia (DR)

Answer 26

Risedronate

Question 27

Risedronate dose: Prophylaxis

Answer 27

5 mg daily or 35mg weekly or 150mg monthly

Question 28

Risedronate dose: Treatment (male and female)

Answer 28

35mg weekly

Question 29

Risedronate dose: GIO

Answer 29

5 mg daily

Question 30

Boniva

Answer 30

Ibandronate

Question 31

Ibandronate prophylaxis formulation

Answer 31

PO option only

Question 32

Ibandronate treatment formulation

Answer 32

IV and PO

Question 33

Ibandronate IV dose (male and female)

Answer 33

3mg IV every 3 months

Question 34

Reclast Zometa

Answer 34

Zoledronic acid

Question 35

Zoledronic acid dose: Treatment and GIO

Answer 35

5mg IV yearly

Question 36

Zoledronic acid prophylaxis

Answer 36

5mg IV every 2 years

Question 37

Bisphosphonate contraindications

Answer 37

Hypocalcemia Inability to stand upright for 30 mins or more

Question 38

Bisphosphonate warnings

Answer 38

ONJ Esophagitis Atypical femur fracture Hypocalcemia GI2

Question 39

Bisphosphonate renal contraindications

Answer 39

< 30 ml/min: risedronate and ibandronate < 35 ml/min: alendronate and zoledronic acid

Question 40

Bisphosphonate and polyvalent ions

Answer 40

Separate by 2 hours

Question 41

Bisphosphonate and food and beverage except water

Answer 41

Seperate by 30 mins

Question 42

Bisphosphonate requires acid for absorption Avoid PPI and H2RA

Answer 42

Atelvia DR (Risedronate)

Question 43

Caution in aspirin induced asthma patient (bronchoconstriction) Teratogenic

Answer 43

Zoledronic acid

Question 44

Preferred formulation for esophagitis to reduce risk of esophageal cancer

Answer 44

IV Bisphosphonate

Question 45

Estrogen based products

Answer 45

Raloxifene Duavee

Question 46

Evista

Answer 46

Raloxifene

Question 47

Duavee

Answer 47

Conjugated estrogen + Bazedoxifene

Question 48

Increased risk of VTE Avoid if Hx/current VTE or pregnant

Answer 48

Raloxifene

Question 49

Seperate from levothyroxine

Answer 49

Raloxifene

Question 50

Hot flash Peripheral edema Arthralgia Leg cramp

Answer 50

Raloxifene

Question 51

Risk of endometrial, breast and ovarian cancer and VTE Avoid if: breast cancer, pregnancy, uterine bleeding, hx/active VTE

Answer 51

Duavee

Question 52

Indicated if > 5 yrs post-menopausal

Answer 52

Calcitonin

Question 53

Nasal spray (200 units) or injection (100 units)

Answer 53

Calcitonin

Question 54

Hypocalcemia Risk of malignancy Hypersensitivity to salmon products

Answer 54

Calcitonin

Question 55

Injections and unopened nasal spray refridgerated

Answer 55

Calcitonin

Question 56

Parathyroid hormone agonists (increases osteoblast) Injection only

Answer 56

Teriparatide Abaloparatide

Question 57

Forteo

Answer 57

Teriparatide

Question 58

Tymlos

Answer 58

Abaloparatide

Question 59

High risk fx Use 2yrs or less

Answer 59

Parathyroid agonists

Question 60

Increased risk of osteosarcoma

Answer 60

Parathyroid agonists

Question 61

Hypercalcemia Arthralgia Leg cramp Nausea Orthostasis/Dizziness

Answer 61

Parathyroid

Question 62

Parathyroid injection storage

Answer 62

Keep refrigerated

Question 63

Parathyroid hormone requires light protection

Answer 63

Teriparatide (Forteo)

Question 64

SC prefilled pens

Answer 64

Parathyroid agonists

Question 65

Monoclonal antibody blocks RANKL and RANK interactions preventing osteoclast formation

Answer 65

Denosumab

Question 66

Prolia Xgeva

Answer 66

Denosumab

Question 67

Denosumab dose

Answer 67

60mg SC q6 months

Question 68

Denosumab CI

Answer 68

Hypocalcemia

Question 69

Denosumab warnings

Answer 69

ONJ Atypical femur fracture Hypocalcemia

Question 70

Denosumab ADR

Answer 70

Hypertension Fatigue Edema Dyspnea Headache GI2 Hypophosphotemia

Question 71

Inhibits sclerostin (protein which inhibits bone formation)

Answer 71

Romosozumab

Question 72

Evenity

Answer 72

Romosozumab

Question 73

Duration limited to 12 months

Answer 73

Romosozumab

Question 74

Treatment option if high risk of fracture

Answer 74

Parathyroid analogs Denosumab Romosozumab

Question 75

Increased risk of MI, stroke and death

Answer 75

Romosozumab