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Flashcards in Osteoporosis Deck (54)
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1

Age-Related osteoporosis results from deficiencies in what? Overall result?

Deficiency in:
1. Hormone (estrogen)
2. Calcium
3. Vitamin D

*Leads to accelerated bone turnover and reduced osteoblast formation

2

List the Drugs Induced Osteoporosis

1. Steroids
2. Antiseizure: Phenytoin, Phenobarbital
3. Thyroid hormone replacement

3

RF's for Osteoporosis

1. Advancing age
2. Previous Fx
3. Glucocorticoid therapy
4. Low body weight
5. Current Cigarette smoking
6. Excessive alcohol

4

What is the diagnostic standard for Osteoporosis?

DXA: Dual Energy X-ray Absorptiometry

5

The dx of osteoporosis is based on what?

-Low trauma fracture
-Central hip/spine DXA using WHO T-score thresholds

6

Dx of osteoporosis in postmenopausal women, perimenopausal women, and men >50 is based off what?

T score at or below -2.5

7

Dx of osteoporosis in children, premenopausal women, and men under 50 is based off what?

Z score at or below -2.0 + other RF's or Fx's

8

Define Osteopenia

Low bone mass
T score between -1 and -2.5

9

List the antiresorptive therapies of choice

1. Calcium
2. Vitamin D
3. Biophosphonates

10

What age group is the recommended dietary allowances (RDA) the highest for calcium? Amount recommended?

9-18 y.o
1,300-3,000 mg

11

What age group is the recommended dietary allowances (RDA) the SECOND highest for calcium? Amount recommended?

51-70 y.o.
1,000-2,000: Men
1,200-2,000: Women

12

What are the two basic forms of calcium?

1. Calcium Carbonate
2. Calcium Citrate

13

ADE's of BOTH Calcium forms

1. Hypophosphatemia
2. Hypercalciumia

14

Calcium Carbonate ADE's

1. GI upset
2. Gas/Bloating
3. Constipation
4. Kidney stones (rare)

15

Vitamin D3: Cholecalciferol ADE's

1. Hypercalcemia: Cardiac rhythm disturbances, HA, weakness
2. Hypercalcuria

16

When would you increase the dose of Vitamin D3: Cholecalciferol?

1. Malabsorption
2. Anticonvulsants: Carbamazepine, Phenobarbital, Phenytoin

17

What is Cholecalciferol converted to in the liver?

25 (OH) Vitamin D

18

What is Cholecalciferol converted to in the kidneys?

1, 25 (OH) Vitamin D

19

Indications ofr Vitamin D2: Ergocalciferol?

Vitamin D deficiency

20

Indications for 1, 25 (OH) Vitamin D: Calcitrol

1. Renal osteodystrophy
2. Hypoparathyroidism
3. Refractory Rickets

21

Biophosphonates have been FDA indicated in what groups?

1. Postmenopausal females
2. Males
3. Glucocorticoid-induced osteoporosis

22

What Biophosphonate is indicated ONLY for postmenopausal osteoporosis?

Ibandronate: IV or Oral

23

Which Biophosphonate is 1st line treatment?

Alendronate

24

Which is the only Biophosphonates you must you drink 6 oz. of plan water 60 minutes (others are 30 minutes) prior to any food/meds?

Ibandronate

25

Which Biophosphonates must you remain upright for 30 minutes after administration?

Alendronate
Risedronate

26

Which Biophosphonate must you remain upright for 1 hour after administration?

Ibandronate

27

What are common Biophosphonate ADE's (Oral)?

Nausea
Dyspepsia

28

What are common Biophosphonate ADE's (IV)?

Transient flu-like illness

29

What are RARE Biophosphonate ADE's

1. Perforation
2. Ulceration
3. GI bleeding
4. Musculoskeletal pain

30

Biophosphonate CI's?

1. Creatinine clearance < 30-35ml/min
2. Serious GI conditions: esophagus abnormalities, delaying emptying-stricture or achalasia, esophageal varices, Barrett's esophagus
3. Pregnancy

31

Biophosphonate Black Box warnings

1. Osteonecrosis of jaw: ONJ
2. Subtrochanteric femoral fx's: Atypical fx's

32

Who does ONJ and Atpical Fx's MCly occur in?

1. CA pt's
2. Chemotherapy/Radiation
3. Glucocorticoid therapy

Receiving higher doses IV biophosphonate therapy

33

Define "Drug Holiday"

-Pt's are taken off their bisphosphonate therapy
-Followed serially w/ bone turnover markers and central DXA BMD

34

Who can be considered for "Drug Holiday" therapy?

1. No hx of low-trauma fracture 2. Have responded well to Bisphosphonate therapy (approx. 5 years)
3. T-score > –2

35

When would you consider using Calcitonin?

For possible pain relief in acute vertebral fx's in women are @ least 5 years postmenopausal
Administered nasally
Last resort treatment

36

List the Mixed Estrogen Agonist/Antagonists (SERMs)

Raloxifene and Bazedoxifene

37

MOA/Result of Raloxifene and Bazedoxifene

-Decreases bone resorption
-Increasing bone mineral density
-Decreasing fracture incidence

38

Estrogen therapy indication

Short-term therapy
Management of menopausal sx's

39

What does testosterone replacement increase?

BMD
BUT no date on fx prevention

40

List Anabolic therapy

Teriparatide

41

Teriparatide (anabolic therapy) MOA. How is it administered?

Recombinant product representing the first 34 amino acids in human PTH
SubQ injection

42

Teriparatide (anabolic therapy) Clinical Indications

Very low bone density T score < -3.5 in:
1. Postmenopausal women
2. Men
3. Patients on glucocorticoids at high risk

43

What drug was FDA approved in June 2017 for the treatment of high risk postmenopausal osteoporosis? What is it?

Abaloparatide (Tymols): Synthetic Anaol of PTH, Anabolic Agent

44

What have been the active trial results of Abaloparatide?

-Decreased new vertebral & non vertebral fx's
-Increased BMD

45

What should you consider starting when you discontinue Abaloparatide?

Antiresorptive tx to protect against bone loss

46

RANKL inhibitor: Denosumab MOA

Inhibits osteoclatogenesis
Increases osteoclast apoptosis

47

RANKL inhibitor: Denosumab ADE's

1. Back, extremity, and musculoskeletal pain
2. Increased cholesterol
3. Cystitis
4. Decreased serum Ca++

48

In general, what is considered 1st line Osteoporosis Tx? Why?

1. Biophosphonates:
Alendronate
Risedronate
Zoledronic acid
2. Denosumab: RANKL Inhibitor

Decrease vertebral, nonvertebral fractures and hip fx's

49

What is a vertebroplasty & Kyphoplasty? Results?

Bone cement injected into fractured vertebral space
Reduces pain in 70-95%

50

Concerns with vertebroplasty & Kyphoplasty?

Cement leakage into spinal column: Nerve damage and vertebral fracturing around cement

51

Define Osteomalacia

"Soft bones"
Significant under mineralized bones seen in adults

52

What is the MC cause of Osteomalacia

Long-standing Vitamin D deficiency

53

Osteomalacia presentation

1. Pathologic fx's
2. Deep bone pain
3. Proximal muscle weakness
4. Low BMD

54

Osteomalacia Treatment

High dose Vitamin D replacement therapy: oral ergocalciferol + Chronic Vitamin D maintenance