osteoporosis Flashcards
(50 cards)
What non-param can we advise in osteoporosis?
- regular exercise
- fall prevention (minimize falling hazards and drugs that may lead to falling like benzos)
- smoking cessation
- diet measures (lots of protein, calcium and vitamin D, limit alcohol, 2 glasses, and limit caffeine 4 glasses)
what numbers of vitamin D do we need?
over 50 800- 2000 International units
under 50 400-1000 international units
do cancdians usualy have enough vitamin D in their diet?
no
when do we measure the serum 25-OH-D4?
it is measured for those who have impaired inetstinal absorption and those with osteoporosis requireing therapy?
what are the different types of vitamin D and which is preferred?
D3(cholecalciferol) and D2(ergocalciferol)
D3 is preferred
how often do we measure 25-OH-D4 levels once initiaing therapy?
once when beginning then in 3 months after starting therpay
what are some sideeffects of vitamin D
it is pretty well tolerated however we can get hypercalcemia, hypercalciuria, renal calcification and renal stones (usualy at high doses since it’s a fat soluble vitamin and doesn’t get peed out)
what is the daily intake of calcium for individuals over 50?
1200mg
can calcium be taken as one dose?
no has to be divided doses of 500
what are the calcium slats from most potent to least potent?
carbonate, citrate, gluconate, lactate
if we have decreased stomach acid or are on a PPi which calcium salt shoudl we take?
citrate
what calcium slat needs an acidic environment?
carbonate
Which salt is preferred and what’s a common side effect of it?
carbonate and it’s constipating
what is of note concerning when we take calcium?
it can affect the absorption of other meds so should be spaced out by 2 hours
empty or full stomach for calcium?
empty but with food if having sideeffcts
what are some side effects of calium
constipating, nausea, hypercalcemia, hypercaluria, ranal calcification, renal stones
what are some possible drugs it could affect absoprtion of it not spaced?
bisphosphates, cirpfloxacin, iron, levothryoine, and tetracycline
describe how initial BMD testing determines pharamcotherpay or not?
BMD testing can give us
- low risk (10-year fracture risk is < 10%)
no therpay reasses in 5 years - moderate risk is 10-20%
maybe therpay - high risk is >20%
evidence for pharamacotherpay
what factors could make you think that somone with moderate risk needs therpay?
long term use of systemic corticosteroids
what are the first line therapies with evidence for fracture prevention in postmensual women?
Antiresorptive therapies?
bisphosphates
-alendronate
-risedronate
-zoledronic acid
denusamab - prolia
SERM - rafloxifene
Hormone therpay - estrogen
Bone formation therpay:
Teriparatide
what types of fractures do most of the therpies prevent agasint?
vertebral (all)
hip (not raloxifene and teriparatide)
and non-vertabral ( not raloxifene)
whihc bisphosphates are oral and whihc are IV?
oral - alendronate and risedronate
IV - zoledronic acid
when are IV bisphophates indicated?
- can’t tolerate oral GI effcts
- aren’t adherenect on oral meds
- when oral therpy fails
what is a big concern with bisphoptaes ?
adherenece - when adherence falls below 80% the protection faades
