Osteoporosis

Question 1

What kind of drug is Teriparatide (forteo)

Answer 1

PTH- synthetic formulation

used to prevent bone breakdown

Question 2

lifestyle modifications for pts with osteoporosis

Answer 2

30 min weight bearing exercise

reduce/ stop caffeine, ETOH, smoking

Question 3

when/ where is calcitonin produced

Answer 3

Thyroid Gland in response to elevated calcium levels

Question 4

what happens with intermittent PTH stimulation?

Answer 4

Bone Anabolism

Question 5

AE: increased risk of CV disease and breast cancer and increased risk of thromboembolism

Answer 5

HRT

Hormone Replacement Therapy

Question 6

At high concentrations increases trabecular bone mass. when is it useful?

Answer 6

Fluoride

- useful in BMD > 3 SD below normal

Question 7

MOA: localizes to sites of bone resorption, inhibit osteoclast , concentrate ini mineralized bone matrix

Answer 7

Bisphosphonates

Question 8

outline a treatment plan for pt with oosteoporosis

Answer 8

Risedronate (Actonel) 
Ibandronate (Boniva) 
Zoldedronate (Reclast) 
Calcium 2,000 mg daily- watch for constipation 
Vit D3 -5,000 IU

Question 9

how does chronic kidney disease affect bone mineral homeostasis via ______?

Answer 9

secondary hyperparathyroidism

Question 10

Who is 2nd line for Teriparatide (forteo) ?

Answer 10

Postmenopausal women and men with significant bone loss

Question 11

AE: reflux, esophageal ulcers, jaw osteonecrosis*

Answer 11

Bisphosphonates

Question 12

Drug that decreases PTH and calcium levels

for tx of secondary hyperthyroidism

Answer 12

Cinacalcet (Sensipar)

Question 13

what is clinical use for calcitriol and paricalcitol ?

Answer 13

calcitriol is active form of vit D (does not need to be converted) *

paricalcitol is synthetic analogue of vit D *

Question 14

MOA: suppresses transcription of genes encoding cytokines that induce osteoclast proliferation, differentiation, amd activation

Answer 14

HRT

Hormone Replacement Therapy

Question 15

MOA: increase BMD via estrogen receptor agonism in bone

Answer 15

SERMs

Question 16

AE: postmenopausal osteoporosis: back pain, pain in extremity, hypercholesterolemia, musculoskeletal pain and cystitis
Bone loss due to hormone ablation for cancer: arthralgia musculoskeletal pain

Answer 16

Denosumab (Prolia)

Question 17

preventative therapy for glucocorticoid induced osteoporosis

Answer 17

calcium/ vitamin D, bisphosphonates, lifestyle modifications

Question 18

fully human monoclonal antibody that inhibits RANKL
*always check creatinine and Ca before administration
Preg Cat X
SQ every 6 months

Answer 18

Denosumab (Prolia)

Question 19

AE: Increased risk of thromboembolism

Answer 19

SERMs

Question 20

MOA: activates receptor on osteoclasts, decreasing resorptive activity

Answer 20

Calcitonin

Question 21

What is a benefit of Renvela over Renagel?

What pts would benefit from use of sevelamer?*

Answer 21

Renagel can cause metabolic acidosis
Renvela is buffered so it avoids metabolic acidosis

pts with Hypercalcemia

Question 22

MOA for glucocorticoid induced osteoporosis

Answer 22

inhibition of osteoblast activity, stimulation of osteoclast proliferation, decreased intestinal Ca absorption, increased renal Ca excretion

Question 23

From salmon, given SQ, IM or intranasal

Answer 23

Calcitonin

Question 24

In what pts would calcitriol and paricalcitol be used instead of cholecalciferol (B3) and Ergocalciferol (B2)?

Answer 24

Hypoparathyroidism pts

Question 25

what kind of pt would benefit from ca based phosphate binders?*

Answer 25

Hyperparathyroid pt with hyperphosphatemia and HYPOcalcemia*

Question 26

1st line drug of choice for osteoporosis? What shoudl you tell pts?

Answer 26

Bisphosphonates

Stay upright for 30 min after taking to avoid reflux*

Question 27

How does PTH increase plasma Ca levels

Answer 27

increasing osteoclastic activity, increasing Ca absorption in intestine, and increasing vit D hydroxylation

Question 28

Greatest risk for osteoporosis

Answer 28

Long term steroid use

Question 29

How to dose Teriparatide (Forteo)?

Answer 29

SubQ
Once a day (or less) favors bone anabolism (growth)

higher doses continuously favors bone catabolism