Osteoporosis Day 2

Question 1

What is the clinical presentation of OP?

Answer 1

asymptomatic (diagnosed by BMD)
fractures
widow's hump
chest wall changes
loss in ht
back pain
indigestion
difficulty breathing
depression

Question 2

What is a normal T score?

Answer 2

> -1

Question 3

What is the T score of osteopenia?

Answer 3

-1- -2.5

Question 4

What is the t score of osteoporosis?

Answer 4

</= -2.5

Question 5

What is the t score of severe osteoporsis?

Answer 5

</= -2.5 with a previous fracture

Question 6

What is the z score to diagnose OP?

Answer 6

</= -2 in combination with other risk factors or fracture

Question 7

What are the goals of therapy?

Answer 7

Achieve highest peak bone mass
maintain BMD and minimize bone loss
if had history of fracture- schieve adequate pain control, maximize rehabillitation and restore independence

Question 8

What is the non pharm treatment of OP?

Answer 8

exercise (wt bearing and resistance activities)
smoking cessation
decreased caffine intake
calcium and vitamin D

Question 9

What is the role of supplement calcium?

Answer 9

serum calcium does not reflect dietary intake of calcoum since homeostasis is controlled
more affective when reactive peak bone mass when bone loss begins (less effective in 1st 5 years of menopause)
increased absorption with normal vitamin D levels

Question 10

What are the different formulations of calcium?

Answer 10

calcium carbonate

calcium citrate

Question 11

What is the ADRs of calcium?

Answer 11

constipation

Question 12

how should calcium be given?

Answer 12

in divided doses no longer than 500-600 mg/dose

Question 13

What is the role of supplement vitamin D?

Answer 13

controversy regarding need with 400-600 iu
sunlight exposure of 5% of skin = 4.35 IU (for fare skin it will reach in 20 min all need or up to 2 hours in darker skin)
D3 OTC
D2- RX

Question 14

Who are the candidates for Pharmacological Treatment?

Answer 14

postmenopausal womwn and men >50 based on a hip or vertebral fracture
T score <-2.5 at femoral neck or spine
Low bone mass and a 10yr probability of hip fracture or op related fracture
clinicians judement and or pt preference

Question 15

What are the pharmacological therapy options of OP?

Answer 15

bisphosphates
SERM
HRT
SERM/HRT
PTH
Calcitonin 
RANKL inhibitors

Question 16

What is the MOA of bisphosphates?

Answer 16

inhibit bone resorption by inhibiting osteoclast formation

Question 17

where does bisphosphates provide benefit?

Answer 17

at all sites

Question 18

What is bisphosphates approved for?

Answer 18

prevention and treatment

Question 19

when does BMD of bisphosphates peak and plateaus?

Answer 19

1 year and 3

Question 20

What are the contraindications of bisphosphates?

Answer 20

renal insufficiency (CrCl<35)
hypocalcaemia
upper GI problems
unable to sit upright for 30-60 min
category C

Question 21

What is the AE of bisphosphates?

Answer 21

nausea, dydpepsia, constipation

rare- esophageal ulcers or erosions, osteonecrosis of jaw, atypical femorral fractures

Question 22

What are the bisphosphates?

Answer 22

Alendronate
Risendronate
Ibandronate
Zoledronic

Question 23

What is the dosing of Alendronate?

Answer 23

prevention- 5 mg PO daily or 35 mg weekly

treatmen- 10 mg daily or 70 mg daily

Question 24

What is the dosing of Risendronate?

Answer 24

Prevention and treatment- 5 mg daily or 35 a week or 150 monthly

Question 25

What is the dosing of Ibandronate?

Answer 25

prevention and treatment 150 mg a month | or treatment- 3 mg IV q3mon

Question 26

What is the dosing of Zoledronic?

Answer 26

prevention- 5 mg IV every 2 yrs | treatment of 5 mg iv yearly

Question 27

What is the MOA of SERM?

Answer 27

reduces bone resorption and increases BMD; acts similar to estrogen better in spine than hip

Question 28

What are the contraindications of SERM?

Answer 28

woman pregnant or becoming , active or history of venous thromembolic event

Question 29

What are the AE of SERM?

Answer 29

increased risk of venous thromboembolic disease, increased risk of hot flashes, increased stroke risk

Question 30

What is the MOA of HRT?

Answer 30

same physiolgic reaction as endogenous estrogen

Question 31

What is the dose of HRT?

Answer 31

conjugated estrogen .3 mg daily

Question 32

What is HRT approved for?

Answer 32

only prevention

Question 33

What is the controvery of HRT?

Answer 33

increased risk of CV events seen with combo therapy increased risk of stroke with estrogen alone weigh risk vs benefit

Question 34

What are the AE of HRT?

Answer 34

``` vaginal bleeding nasea HA Breast cancer breast tenderness bloating wt gain DVT/PE ```

Question 35

What are the contraindications of HRT?

Answer 35

``` history of breast cancer or FH PE/DVT migraines liver disease abnormal vaginal bleeding endometriosis preg X ```

Question 36

What drug is SERM/HRT?

Answer 36

Bazedoxifene/estrogen

Question 37

what is the dose of Bazedoxifene/estrogen?

Answer 37

prevention only 20mg/.45 mg daily

Question 38

What is the MOA of PTH?

Answer 38

recombant formulation of endogenous PTH, stimulates osteoblast function increases GI calcium absorption and increases reabsorption of calcium

Question 39

What is PTH approved for?

Answer 39

men and women who do not respond to other therapy

Question 40

What is the drug and dosig of the PTH?

Answer 40

Teriparatide 20 mgSUBQ in thigh or abdomen

Question 41

What are the contraindications of Teriparatide?

Answer 41

children, adolescents and pt with paget's disease | and not used with bisphosphates

Question 42

What are the AE of Teriparatide?

Answer 42

hypercalcemia, leg cramps, nausea, osteonecrosis

Question 43

What is the MOA of calcitonin?

Answer 43

antagonizes the effects of PTH and directly inhibits bone resportion by ostoclasts

Question 44

What is calcitonin approved for?

Answer 44

treatment only and is 2nd line

Question 45

What is the dosing of calcitonin?

Answer 45

Calcitonin nasal spray 200 IU daily | Calcitonin injection 100 IU SC daily

Question 46

What is the AE of calcitonin?

Answer 46

NS- nasal symptoms. arthralgia, HA, back pain | I- flushing, N/V, irritation at site

Question 47

What is the MOA of Densoumab?

Answer 47

binds to RANKL, blocks the interation between RANKL and RANK and prevents osteoclast formation

Question 48

What is Densoumab approved for?

Answer 48

treatment

Question 49

What is the dosing of Densoumab?

Answer 49

60 mg SUBQ every 6 months

Question 50

What are the AE of Densoumab?

Answer 50

flactulance, eczema, cellulitis, infection | serious- malignancy, serious infections, ostonecrosis of jaw

Question 51

Wht are the contraindications of Densoumab?

Answer 51

hypocalcemia and pregnacy

Question 52

What is children OP called

Answer 52

low BMD for chronological age