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Osteoporosis Flashcards

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1
Q

What is osteoporosis?

A

low bone mass and structural deterioration of bone tissue.

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2
Q

What does osteoporosis lead to?

A

Bone fragility and fractures in the spine, wrist, and hip

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3
Q

What are the functions of the skeleton?

A

Structural support, protect organs, contain calcium and phosphorus stores

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4
Q

What are the types of bone?

A
  1. trabecular/cancellous - metabolic; supplies minerals when deficient
  2. cortical - structural; outer bone 80% of skeleton
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5
Q

What are the purposes of bone remodeling?

A
  1. Repair microfractures
  2. adapt to weight bearing
  3. provide access to mineral stores
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6
Q

What performs bone remodeling?

A
  1. osteoclasts - bone resorption

2. osteoblasts - bone formation

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7
Q

What is an important part of bone remodeling?

A

RANKL - receptor activated of nuclear factor kappa b ligand

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8
Q

When is peak bone mineral density reached?

A

age 25-30 years

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9
Q

What is bone quality equal to?

A

bone quality = bone mass and strength

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10
Q

What regulated calcium homeostasis?

A

Regulated by vitamin D and parathyroid hormone

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11
Q

Explain the relationship among vitamin D, PTH, and calcium.

A

PTH converts vitamin D to calcitriol when calcium levels are low. PTH and calcitriol work to release calcium from bone.

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12
Q

What are the types of osteoporosis?

A
  1. postmenopausal - decline estrogen production
  2. age-related - hormone, vitamin D, calcium deficiency
  3. secondary cause.
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13
Q

How much bone loss can occur following menopause?

A

10-25% bone loss in 10 years following menopause

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14
Q

What are the clincial signs of osteoporosis?

A

Short stature, kyphosis, lordosis, fracture

pain, immobility

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15
Q

What are the complications of fractures?

A

Pain, deep, dull, aching.
Decrease functioning
psychological issues

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16
Q

What are some factors that can contribute to osteoporosis?

A
  1. female, family history, >50, menopause, low calcium, vitamin d intake, 3 drinks/day of alcohol, smoking, lack of exercise, high salt, high caffeine intake.
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17
Q

What diseases are factors for osteoporosis?

A

RA, prior fracture, hypogonadism, IBS, hyperPTH, epilepsy, diabetes, depression

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18
Q

What medications are factors for osteoporosis?

A

glucocorticoids, cyclosporine, chemotherapy, anticonvulsants, depo-medroxyprogesterone,

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19
Q

Who should be tested for osteoporosis?

A
  1. Women >65 Men >70
  2. 50-69 with risk factors
  3. adults w/fracture >50
  4. Disease or medication that can cause secondary
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20
Q

What does a central DXA measure?

A

Measures hip, spine, total body

Non-invasive, emits low radiation, lasts 10 mins

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21
Q

What does a peripheral DXA measure?

A

Measures finger, forearm, heel

Screening only

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22
Q

What unit is bone mineral density measured in?

A

g/cm2

Amount of mineralized tissue in the area scanned

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23
Q

What are T-scores comparing? what are the values?

A

Postmenopausal women and men >50 compared to younger adult of same sex.
Normal > -1
osteopenia >-2.5 <-2.5

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24
Q

What are Z-scores comparing? what are the values?

A

Premenopausal women, men -2

Below <-2

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25
What labs are useful to identify secondary causes of bone loss?
25(OH) D - normal >30ng CBC, CHEM, ESR, PTH, Ca, Scr, thyroid, testosterone Bone turnover markers
26
What is the goal of therapy for age birth - 30?
obtain highest bone mass possible and optimize bone quality
27
What is the goal of therapy for age >30?
Maintain BMD, minimize bone loss, prevent falls/fractures
28
What is the goal of therapy for those with fractures?
Control pain, restore independence and quality of life, prevent further fractures
29
What is the recommended amount of daily calcium and vitamin D for adults >50?
Calcium 1200mg | Vitamin D 800-1000IU
30
What is the difference between Vitamin D2 and D3?
D2- ergocalciferol more potent, used in fortified foods | D3 - cholecalciferol found in OTC
31
Who should be treated?
Postmenopausal women or men >50 1. hip, spine fracture 2. prior fracture and low bone mass 3. T-score 3% hip fracture 6. low bone mass and 10yr >20% any fracture
32
What does the FRAX algorithm tell?
Estimates likelihood of a person to break a bone due to low bone mass or osteoporosis over a 10 year period. *does not include spinal, cannot use on patients already on medications
33
What is the difference between calcium carbonate and citrate?
``` Calcium carbonate 1000mg = 400mg elemental Take with food to enhance absorption Calcium citrate 1000mg = 210 elemental Take with or without food ```
34
What drugs interact with calcium carbonate/citrate?
Iron, quinolone antibiotics, tetracyclines, levothyroxine
35
What is the preferred vitamin D supplement?
Cholecalciferol D3 | 1mg=40,000units
36
What are bisphosphonates mechanism of action?
Decrease osteoclast activity increase/maintain BMD reduce fracture risk
37
Which bisphosphonate does not help with hip fractures?
Boniva - ibandronate
38
What are the rules for administration?
Take in morning, 30 minutes prior to food, with 8 ounces of plain water, sit or stand for 30 minutes. *exception: Boniva - ibandronate
39
What is the dosing for Fosamax?
Aldendronate 10mg daily po, 70mg week po
40
What else is Fosamax approved to treat?
Paget's disease Accelerated osteoclast activity Elevated alkaline phosphatase
41
What is the dosing for Actonel?
Risedronate 5mg daily po, 35mg week po, 150mg month po
42
What is special about actonel?
Risedronate - do not need to wait 30 minutes to eat
43
What is the dosing for Boniva?
Ibandronate 150mg month po, 2.5mg daily po | 3mg IV push q 3 months
44
If a patient is on daily dosing and misses a dose, when should they take the next?
Take the next morning.
45
If a patient is on weekly dosing and misses a dose, when should they take the next?
Take the next morning, unless >1 day then skip for that week.
46
What is the dosing for zoledronic acid?
Reclast 5mg IV once a year
47
What needs to be checked before each dose of Reclast?
Zoledronic acid | Creatinine
48
What are the advantages of IV formulations?
Less GI adverse effects Improved bioavailability, increased adherence, For patients that can't sit/stand for 30-60minutes
49
What is the mechanism of action of Evista?
Raloxifene estrogen agonist on bone estrogen antagonist on breast/uterus
50
What is the dosing for Raloxifene?
60mg po daily
51
What is the dosing for Miacalcin?
Calcitonin 200mcg intranasally, 50mcg SC/IM daily
52
What is estrogens affect on bone?
Decrease osteoclast activity, inhibit PTH, increase calcium absorption, decrease calcium excretion
53
What drug binds to RANKL?
Denosumab (prolia)
54
What is Prolia mechanism of action?
inhibits osteoclastogenesis and increases osteoclast apoptosis
55
How is denosumab dosed?
Prolia 60mg subq once every 6 months
56
Which drug can cause eczema and cellulitis?
Denosumab (prolia)
57
Which product is a recombinant parathyroid hormone?
Teriparatide (forteo)
58
What is the mechanism of action of Teriparatide?
Forteo | Increase bone formation, osteroblast activity
59
What is considered high risk patient?
1. previous osteoporotic fracture 2. multiple risk factors 3. low BMD <-3 4. failed or intolerant to other therapies
60
How is Forteo dosed?
20mcg SC daily
61
What are the contraindications to using teriparatide?
Hypercalcemia, paget's disease, history of bon cancer
62
Which drugs are available IV?
Ibandronate - Boniva 3mg IV push q3mths | Zoledronic acid - Reclast 5mg IV year
63
Which drugs are available SC?
Denosumab - Prolia 60mg q 6months | Teriparatide - Forteo 20mg daily
64
When does the greatest bone loss occur when taking glucocorticoids?
first 6-12 months of therapy
65
When should DXA be repeated?
Osteoporosis - 2 years Osteopenia - 5 years Normal/mild - 15 years

Pharmacotherapeutics (12 decks)

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