Flashcards in Osteoporosis Deck (54)
Age-Related osteoporosis results from deficiencies in what? Overall result?
1. Hormone (estrogen)
3. Vitamin D
*Leads to accelerated bone turnover and reduced osteoblast formation
List the Drugs Induced Osteoporosis
2. Antiseizure: Phenytoin, Phenobarbital
3. Thyroid hormone replacement
RF's for Osteoporosis
1. Advancing age
2. Previous Fx
3. Glucocorticoid therapy
4. Low body weight
5. Current Cigarette smoking
6. Excessive alcohol
What is the diagnostic standard for Osteoporosis?
DXA: Dual Energy X-ray Absorptiometry
The dx of osteoporosis is based on what?
-Low trauma fracture
-Central hip/spine DXA using WHO T-score thresholds
Dx of osteoporosis in postmenopausal women, perimenopausal women, and men >50 is based off what?
T score at or below -2.5
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
Low bone mass
T score between -1 and -2.5
List the antiresorptive therapies of choice
2. Vitamin D
What age group is the recommended dietary allowances (RDA) the highest for calcium? Amount recommended?
What age group is the recommended dietary allowances (RDA) the SECOND highest for calcium? Amount recommended?
What are the two basic forms of calcium?
1. Calcium Carbonate
2. Calcium Citrate
ADE's of BOTH Calcium forms
Calcium Carbonate ADE's
1. GI upset
4. Kidney stones (rare)
Vitamin D3: Cholecalciferol ADE's
1. Hypercalcemia: Cardiac rhythm disturbances, HA, weakness
When would you increase the dose of Vitamin D3: Cholecalciferol?
2. Anticonvulsants: Carbamazepine, Phenobarbital, Phenytoin
What is Cholecalciferol converted to in the liver?
25 (OH) Vitamin D
What is Cholecalciferol converted to in the kidneys?
1, 25 (OH) Vitamin D
Indications ofr Vitamin D2: Ergocalciferol?
Vitamin D deficiency
Indications for 1, 25 (OH) Vitamin D: Calcitrol
1. Renal osteodystrophy
3. Refractory Rickets
Biophosphonates have been FDA indicated in what groups?
1. Postmenopausal females
3. Glucocorticoid-induced osteoporosis
What Biophosphonate is indicated ONLY for postmenopausal osteoporosis?
Ibandronate: IV or Oral
Which Biophosphonate is 1st line treatment?
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?
Which Biophosphonates must you remain upright for 30 minutes after administration?
Which Biophosphonate must you remain upright for 1 hour after administration?
What are common Biophosphonate ADE's (Oral)?
What are common Biophosphonate ADE's (IV)?
Transient flu-like illness
What are RARE Biophosphonate ADE's
3. GI bleeding
4. Musculoskeletal pain
1. Creatinine clearance < 30-35ml/min
2. Serious GI conditions: esophagus abnormalities, delaying emptying-stricture or achalasia, esophageal varices, Barrett's esophagus
Biophosphonate Black Box warnings
1. Osteonecrosis of jaw: ONJ
2. Subtrochanteric femoral fx's: Atypical fx's
Who does ONJ and Atpical Fx's MCly occur in?
1. CA pt's
3. Glucocorticoid therapy
Receiving higher doses IV biophosphonate therapy
Define "Drug Holiday"
-Pt's are taken off their bisphosphonate therapy
-Followed serially w/ bone turnover markers and central DXA BMD
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
When would you consider using Calcitonin?
For possible pain relief in acute vertebral fx's in women are @ least 5 years postmenopausal
Last resort treatment
List the Mixed Estrogen Agonist/Antagonists (SERMs)
Raloxifene and Bazedoxifene
MOA/Result of Raloxifene and Bazedoxifene
-Decreases bone resorption
-Increasing bone mineral density
-Decreasing fracture incidence
Estrogen therapy indication
Management of menopausal sx's
What does testosterone replacement increase?
BUT no date on fx prevention
List Anabolic therapy
Teriparatide (anabolic therapy) MOA. How is it administered?
Recombinant product representing the first 34 amino acids in human PTH
Teriparatide (anabolic therapy) Clinical Indications
Very low bone density T score < -3.5 in:
1. Postmenopausal women
3. Patients on glucocorticoids at high risk
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
What have been the active trial results of Abaloparatide?
-Decreased new vertebral & non vertebral fx's
What should you consider starting when you discontinue Abaloparatide?
Antiresorptive tx to protect against bone loss
RANKL inhibitor: Denosumab MOA
Increases osteoclast apoptosis
RANKL inhibitor: Denosumab ADE's
1. Back, extremity, and musculoskeletal pain
2. Increased cholesterol
4. Decreased serum Ca++
In general, what is considered 1st line Osteoporosis Tx? Why?
2. Denosumab: RANKL Inhibitor
Decrease vertebral, nonvertebral fractures and hip fx's
What is a vertebroplasty & Kyphoplasty? Results?
Bone cement injected into fractured vertebral space
Reduces pain in 70-95%
Concerns with vertebroplasty & Kyphoplasty?
Cement leakage into spinal column: Nerve damage and vertebral fracturing around cement
Significant under mineralized bones seen in adults
What is the MC cause of Osteomalacia
Long-standing Vitamin D deficiency
1. Pathologic fx's
2. Deep bone pain
3. Proximal muscle weakness
4. Low BMD