Flashcards in Osteoporosis Deck (54)
Loading flashcards...
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
