Osteoporosis

Question 1

Builds new bone

Answer 1

Osteoblasts

Question 2

Reabsorbs bone

Answer 2

Osteoclasts

Question 3

Medications that increase the risk of Osteoporosis

Answer 3

PPIs
Heparin
Anticonvulsants
Glucocorticoids
Lithium
Aluminum
SSRIs

Question 4

What T-Score indicates Osteopenia

Answer 4

-1 to -2.5

Question 5

What T-Score indicates Osteoporosis

Answer 5

Less than -2.5

Question 6

Universal Recommendations for Osteoporosis Prevention

Answer 6

Adequate Calcium and Vitamin D
Exercise
Avoid Smoking
Avoid Alcohol

Question 7

Drugs for Osteoporosis

Answer 7

Bisphosphonates
- Alendronate
- Risedronate
- Ibandronate
- Zoledronic Acid

Raloxifene
Calcitonin
Teriparatide
HRT
Conjugated Estrogens + Bazedoxifene
Denosumab

Question 8

Binds to hydroxyapatite in bone and inhibits osteoclasts

Answer 8

Alendronate (Fosamax)
- weekly oral
- half life in bone exceeds 10 years

Question 9

What can decrease the oral bioavailability of Alendronate by up to 60%

Answer 9

Coffee + Orange Juice

Question 10

How should you take Bisphosphonates?

Answer 10

Morning
Empty Stomach
6-8 oz of Water and Remain Seated Upright for 30 - 60 mins

Question 11

Which Bisphosphonates should be taken at least 30-60 minutes before eating or taking any other medications?

Answer 11

Risedronate

Question 12

Adverse Drug Reactions of Bisphosphonates

Answer 12

↓ Calcium
Acid Reflux
Dyspepsia + Gastritis
Esophageal + Gastric Ulcers

Question 13

Warnings and Precautions of Bisphosphonates

Answer 13

Atypical Femur Fracture
Osteonecrosis of the Jaw

Question 14

What medication class should you not take with Bisphosphonates?

Answer 14

Antacids

Question 15

Contraindications of Bisphosphonates

Answer 15

Esophageal Abnormalities
Inability to sit upright for 30 minutes
CrCl < 30 mL/min

Question 16

Bisphosphonate that does NOT have approval for treatment of glucocorticoid induced osteoporosis

Answer 16

Ibandronate

Question 17

Bisphosphonate that has a delayed release dosage form that is taken immediately BEFORE breakfast

Answer 17

Risedronate

Question 18

Bisphosphonate that is given as a once year infusion.

Infusion related flu-like symptoms can occur after the first dose.

Administration of NSAIDs may help with symptoms

Answer 18

Zoledronic Acid

Question 19

Selective estrogen receptor modulator
(SERM)

Decreases bone resorption.
CANNOT RESTORE BONE.

Reduces risk of vertebral fractures.
NO evidence of reduced non-vertebral fractures.

Answer 19

Raloxifene (Evista)

Question 20

Clinical Use of Raloxifene (Evista)

Answer 20

Prevention + Treatment of Osteoporosis in Postmenopausal Women

Less effective in preventing bone loss vs. bisphosphonate

Question 21

Contraindications of Raloxifene (Evista)

Answer 21

DVT
Pulmonary Embolism
Stroke
Retinal Vein Thrombosis

Question 22

Adverse Drug Reactions of Raloxifene

Answer 22

Hot Flashes
Flu-Like Symptoms
Depression

Pregnancy Category X

Question 23

Human Monoclonal Antibody to RANKL

Involved in mediation of Osteoclast Activity.

Reduces the risk of Vertebral + Non-Vertebral fractures

Answer 23

Denosumab (Prolia)
- SQ every 6 months

Question 24

Who is Denosumab (Prolia) approved for?

Answer 24

Men + Postmenopausal Women

Reserved for those who are intolerant or unresponsive to Bisphosphonates

Question 25

What types of patients should you exercise caution with when using Denosumab (Prolia)

Answer 25

Renal Impairment - risk of hypocalcemia

Question 26

Adverse Drug Reactions of Denosumab (Prolia)

Answer 26

Arthralgia Myalgia Bone Pain Cellulits Eczema Atypical Femur Fractures Osteonecrosis of the Jaw

Question 27

Naturally produced by the thyroid gland. Antagonizes the effects of parathyroid hormone (PTH) Inhibits bone resorption and increases kidney calcium excretion.

Answer 27

Calcitonin (Miacalcin)

Question 28

What types of fractures does Calcitonin reduce the risk of?

Answer 28

Vertebral

Question 29

What is the clinical use of Calcitonin

Answer 29

ONLY for Postmenopausal Women IMPROVES BONE PAIN Intranasal Spray

Question 30

Adverse Drug Reactions of Calcitonin

Answer 30

Nasal Symptoms Malignancy Hypocalcemia Hypersensitivity - made of salmon derivative

Question 31

Recombinant parathyroid hormone Stimulates osteoblast function Increases bone mineral density

Answer 31

Teriparatide (Forteo)

Question 32

What types of fractures does Teriparatide (Forteo) reduce the risk of?

Answer 32

Vertebral + Non-Vertebral

Question 33

Clinical Use of Teriparatide (Forteo)

Answer 33

Men Postmenopausal Women Glucocorticoid induced Osteoporosis Revered for patients with SEVERE hip or spine osteoporosis Safety and Efficacy > 2 years not established

Question 34

Adverse Drug Reactions of Teriparatide (Forteo)

Answer 34

Hypercalcemia - usually transient (4-6 hours post dose) Orthostasis - administer first dose laying down Hyperuricemia Osteosarcoma - in animal studies

Question 35

Considered 1st line therapy for prevention and treatment of osteoporosis in postmenopausal women. Presumed to prevent or delay cardiovascular disease.

Answer 35

Estrogen + HRT

Question 36

Who should receive Estrogen + Progestin?

Answer 36

Only for women at HIGH RISK who are not candidates for other osteoporosis medications

Question 37

Estrogen alone can increase the incidence of what?

Answer 37

Uterine Cancer

Question 38

Decreases bone resorption through action on estrogen receptors but cannot restore bone. Increased lumbar spine and hip bone mineral density

Answer 38

Conjugated Estrogens + Bazedoxifene

Question 39

Clinical Use of Conjugated Estrogens + Bazedoxifene

Answer 39

Prevention Only Only for Postmenopausal women with a UTERUS Consider all other alternatives first

Question 40

Adverse Drug Reactions of Conjugated Estrogens + Bazedoxifene

Answer 40

Nausea + Diarrhea Dyspepsia Dizziness Muscles Spasms and Neck Pain