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Pnt Exam 1 > Osteoporosis > Flashcards

Osteoporosis Flashcards

(136 cards)

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1
Q

most common skeletal disorder

A

osteoporosis

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2
Q

What is osteoporosis

A

a disease characterized by low bone density and weakening of bone tissue associated with an increase in fragilty and vulnerability to fracture

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3
Q

most common fracture sites with osteoporosis

A

hip, spine, wrist

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4
Q

osteoporosis most common in what gender

A

female - postmenopausal

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5
Q

What race/s have most risk for osteoporosis

A

caucasian, asian > hispanic> African american

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6
Q

osteoclast function

A

bone resoption

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7
Q

osteoblast function

A

bone formation

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8
Q

rank is on what

A

osteoclast

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9
Q

rank L is on what

A

osteoblast

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10
Q

OPG function

A

inhibition Rank L (regulates bone resorption)

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11
Q

6 stages of bone remodeling

A

initiation, activation, resorption, reversal, formation, quiescence

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12
Q

Initiation stage what occurs

A

PTH and low calcium in blood signal bone remodeling to begin

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13
Q

What occurs in activation phase

A

RankL binds to Rank shifting osteoclast precursors to mature osteoclasts

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14
Q

Resorption phase what occurs

A

a cavity in bone is created

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15
Q

what occurs in reversal phase

A

resorption stops, OPG binds to rankL

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16
Q

what occurs in formation phase

A

osteoblasts deposit in cavity

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17
Q

What is quiescence

A

rest

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18
Q

Populations at risk of low vitamin D intake

A

malnourished/obese, long term care facility, northern latitudes

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19
Q

Vitamin D 2

A

ergocalciferol

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20
Q

vitamin D3

A

cholecalciferol

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21
Q

active vitamin D

A

calcitriol

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22
Q

when to give active vitamin D

A

kidney disease may impair activation

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23
Q

Major Risk factors for osteoporosis

A 
low bone mineral density
female
elderly
caucasian/asain
history of fractures
family history of fracture
low body mass
past or present glucocorticoid use (5+ mg Prednisone for > 3 months) 
cigarette smoking
excessive alcohol use (3+ /day)
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24
Q

secondary causes of osteoporosis

A

disease states

medications

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25
disease states that cause osteoporosis
``` genetic diseases hormonal deficiency (premature menopause < 45 y/o) Endocrine disorders GI disorders Autoimmune diseases CNS disorders Alcholism COPD ```
26
Medications that cause osteoporosis
``` aluminum anticoagulants anticonvulsants aromatase inhibitors barbituates chemotherapy cyclosporine and tacrolimus depo-medroxyprogesterone glucocorticoids GnRH antagonists and agonists lithium methotrexate PPI SSRI tamoxifen (premenopausal use) TZDs excess thyroid hormones parenteral nutrition ```
27
fall risk factors
``` loose throw rugs low lighting obstacles in path slippery conditions lack of assistive devices ```
28
Clinical presentation of osteoporosis
no warning signs pain/immobility kyphosis height loss > 2 cm
29
FRAX score tells what
10 year probability of hip fracture, major fracture (vertebral, forearm, proximal humerus)
30
limitations of FRAX
men 50+ and postmenopausal females only for those not currently receiving Rx osteoporosis treatment does not consider cumulative effect
31
Risk factors included in FRAX
``` age gender prior osteoporotic fracture femoral neck BMD low body mass oral glucocorticoids RA type 1 DM hyperthyroidism hypogonadism premature menopause malnutrition chronic liver disease parental history of hip fracture smoking alcohol intake ```
32
What should vitamin D levels be?
30 ng/ml
33
Use of a peripheral bone mineral density
screening
34
perpiheral bone mineral density site area
forearm, heel, finger
35
best candidates for peripheral bone mineral density
postmenopausal women without major risk factors
36
benefits of peripheral bone mineral density
less expensive than DXA easy to use, portable, fast project general fracture risk
37
Central DXA site use
diagnosis of osteoporosis and osteopenia
38
Central DXA areas
lumbar spine and hip
39
Central DXA results
bone density value, T score and Z score
40
DXA scans for who
women 65+, men 70+ postmenopausal women, women in menopause, and men 50-69 with risk factors adults with fractures after 50 adults with conditions or medications associated with low bone mass or bone loss
41
Use of actual bone density
therapy response
42
T-score use
diagnosis of osteoporosis
43
What is T score
pt BMD compared to BMD of healthy, young, sex match white reference population
44
What is Z score
pt BMD compared to BMD of age matched, sex matched reference population
45
Z score is used for what populations
children, premenopausal women, men <50 y/o
46
Osteopenia T score
-1.1 to -2.5
47
Osteoporosis T score
<-2.5
48
Goals of therapy for osteopenia or no h/o of fracture
improve bone mass | prevent fracture
49
Goals of therapy for osteoporosis with fracture
eliminate/decrease pain maintain funcitonal status improve QOL prevent future falls or fractures
50
NON pharm therapy for osteoporosis
nutrition - increase calcium and vitamin D Exercise - weight bearing and resistance training Smoking cessation Limit alcohol consumption sun exposure
51
Non pharm therapy for fall prevention
``` throw rugs assistive devices in bathrooms good lighting clear walking paths avoid slippery condiitons proper eye wear avoid medications affecting balance ```
52
Who gets pharm treatment for osteoporosis
postmenopausal females or males 50+ with: - hip or vertebral fracture - central BMD T score 3% or 2. 10 year probability of major osteoporotic fracture > 20%
53
Calcium better from diet or supplement
diet
54
MAx dose of calcium that can be absorbed per dose
600 mg elemental
55
daily intake of calcium for men/women ages 19-49
1000 mg/day
56
daily intake of calcium for men 50-70
1000 mg/day
57
daily intake of calcium for women 50+
1200 mg/day
58
daily intake of calcium for men 71+
1200 mg/day
59
MAX elemental caclium per day
1500 mg/day
60
% elemental calcium in calcium carbonate
40%
61
Benefits of calcium carbonate
low cost, needs to be taken with food
62
products containing calcium carbonate
tums, oscal
63
% elemental calcium in calcium citrate
24%
64
calcium citrate benefits
absorption is food independent
65
products containing calcium citrate
citrical
66
% elemental calcium in tricalcium phosphate
39%
67
products containing tricalcium phosphate
posture
68
tricalcium phosphate benefits
less calcium absorption, good for pts with low phosphate
69
Vitamin D efficacy
increases calcium absorption, BMD, improves muscle strength, balance and reduces fall risk
70
Dose of vitamin D for adults 50 +
800-1000 IU/day
71
Max dose of vitamin D per day
4000 IU/day
72
Dose for vitamin D deficiency
50,000 IU x 8 weeks, then 1500-2000 IU to maintain
73
monitoring for vitamin D
recheck levels after 3 months
74
AEs of vitamin D
usually well tolerated hypercalcemia constipation
75
Bisphosphonates MOA
a bone resorption inhibitor that leads to decreased osteoclast maturation, number of osteoclasts, and osteroclast life span
76
First line treatment for osteoporosis
bisphosphonates
77
Bisphosphonate indications
women: osteoporosis treatment and prevention men: osteoporosis treatment
78
Bisphosphonates
ibandronate alendronate risedronate zoledronic acid
79
Ibandronate dosing
150 mg PO monthly | 3mg IV q 3 months
80
Alendronate dosing for treatment
70 mg PO QW | 10 mg QD PO
81
Alendrontate dosing for prevention
35 mg QW PO
82
Risedronate dosing for treatment and prevention
35 mg QW PO | 5 mg QD PO
83
Zolendronic acid treatment dose
5 mg IV yearly
84
zolendronic acid prevention dose
5 mg IV every 2 years
85
ibandronate only bisphosphonate not effective where
hip and nonvertebral fracture
86
Length of treatment for bisphosphonates
5-10 years
87
Bisphosphonate CIs
CrCl < 30-35 Hypocalcemia esophageal complications - PO only Inability to sit or stand for 30 minutes - PO only
88
Common AEs with bisphosphonates
GI related issues | flu like symptoms (IV)
89
RARE AEs with bisphosphonates
Esophageal ulceration osteonecrosis of the jaw bone, joint, muscle pain atypical femur fractures
90
Delayed release risedronate dosing precautions
after breakfast with 4 oz water | do not lie down or take meds for 30 minutes
91
Effervescent alendronate tablet dosing
dissolve in 4 oz water 5 minutes after effervescent stops, stir for 10 seconds 30 minutes before food do not lie down/take meds for 30 minutes
92
Minimum days between weekly doses of bisphosphonates
5
93
minimum days between monthly bisphosphonates
7
94
bisphosphonate drug interctions
antacids, calcium, iron, magnesium | Risedronate delayed release - PPIs and H2RAs
95
Raloxifene MOA
selective estrogen receptor modulator = mixed estrogen agonist/antagonist to decrease bone resorption agonist in bone antagonist in breast tissue
96
Raloxifene brand name
evista
97
ibandronate brand name
boniva
98
alendronate brand name
fosamax
99
risedronate brand name
actonel
100
Zoledronic acid brand name
reclast
101
Denosumab brand name
prolia
102
Teriparatide brand name
forteo
103
Calcitonin brand name
miaclcin, fortical
104
Raloxifene does not reduce which fracture risk/s
non vertebral | hip
105
Raloxifene indications
prevention and treatment of postmenopausal osteoporosis | risk reduction of invasive breast cancer in postmenopausal osteoporosis
106
AEs of raloxifene
hot flashes/flushing peripheral edema leg cramps
107
Black box warning of raloxifene
increased risk of DVT,PE | increased risk of fatal stroke in women with CAD or increased risk for coronary evetns
108
CIs of raloxifene
current of history of thrombotic disorders
109
calcitonin MOA
antagonizes the parathyroid hormone to inhibit osteoclast activity and bone resorption
110
Calcitonin showed no risk reduction in what area/s
hip and nonvertebral
111
calcitonin indications
osteoporosis in women >5 years postmenopausal
112
Calcitonin AEs
nasal irritation, rhinitis, congestion | injection site reactions, GI symptoms, flushing, anaphylaxis reactions, increased risk for malignancy
113
teriparatide MOA
recombinant parathyroid hormone analog to increase bone formation through osteoblast activity
114
teriparatide showed no risk reduction in what fracture area/s
hip
115
teriparatide indications
treatment of osteoporosis in men or postmenopausal women at high risk for fracture
116
Good candidates for teriparatide
history of osteoporotic fracture multiple risk factors for fracture very low BMD (<-3.5) failed or intolerance of bisphosphonates
117
teriperatide length of treatment
2 years followed by another agent
118
AEs of teriperatide
``` dizziness leg cramps orthostatic hypotension hypercalcemia arthralgias ```
119
black box warning for teriperatide
avoid in patients with increased baseline risk for osteosarcoma
120
Denosumab MOA
human monoclonal antibody binds to RANKL and blocks its ability to bind to osteoclast precursors 1. inhibits formation of osteoclasts 2. increases osteoclast apoptosis
121
Denosumab indications
treatment of osteoporosis in men or postmenopausal women at high risk of fracture treatment of bone loss for patients recieving therapy for certain cancers and tumors
122
AEs of denosumab
GI upset, back pain, arthralgias, dermatologic reactions | Osteonecrosis of the jaw, infection, atypical fractures, hypocalcemia, hypophophatemia, dysnea
123
CIs to denosumab
hypocalcemia
124
Estrogen MOA
- decreases proliferation and activation of osteoclasts - increase osteoclast apoptosis - decreases production of rank L - Increases production of OPG
125
estrogen efficacy
increases BMD, reduces fracture risk
126
Indications for estrogen
prevention of osteoporosis in postmenopausal females
127
Estrogen AEs
breast discomfort, GI symptoms, HA, vaginal bleeding, increased risk of stroke, DVT, PE, MI, breast cancer
128
CIs to estrogen
history of VTE coronary heart disease estrogen dependent tumor active liver disease
129
Treatment for T score > -1
risk reduction calcium Vitamin D re-evaluate in 5 years
130
Treatment for T score -1.1 to -2.4 with FRAX hip fracture risk <20%
risk reduction calcium vitamin D re-evaluate in 2 years
131
Treatment for T score -1.1 to -2.4 with FRAX hip fracture risk > 35 or Major fracture risk > 20 %
``` risk reduction clacium vitamin D drug therapy re-evaluate in 1-2 years ```
132
Treatment for T score <-2.5
risk reduction calcium vitamin D drug therapy re-evaluate in 1-2 years
133
1st line medications for osteoporosis
Alendronate Risendronate Zolendronic Acid Denosumab - high risk of fracture
134
2nd line medications for osteoporosis
ibandronate
135
2/3rd line medications for osteoporosis
raloxifene - high risk of breast cancer | teriparatide - high risk of fracture
136
last line medications for osteoporosis
calcitonin - limit use due to risk of malignancy

Pnt Exam 1 (6 decks)

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