Osteoporosis & Hip fracture

Question 1

Osteopenia means

Answer 1

low bone mass

term used for thinning of the trabecular matrix of the bone before osteoporosis.

Question 2

osteoporosis means

Answer 2

pourous bone

Question 3

severe osteoporosis means

Answer 3

osteoporosis with Hx of a fragility fracture

Question 4

T scores bone density

Answer 4

Normal - 1 or greater
osteopenia between -1 and -2.5
osteoporosis and severe <= -2.5

Question 5

hos is osteoporosis measured

Answer 5

DEXA scan

Question 6

Osteoporosis: Characteristics (4)

Answer 6

Low bone mass

Micro-architectural deterioration

Increase in bone fragility

Susceptibility to fracture

Question 7

Major Risk Factors of osteoporosis (9)

Answer 7

Older
Female
Asian/white
Hx fractures
family
<127 lbs
smoking
alcohol
Corticosteriods and immune suppression drugs

Question 8

Other risk factors of osteoporosis

Answer 8

Thin and small frame
Lack of weight bearing exercises
Lack of calcium and vitamin D
Eating disorders, gastric bypass surgery
Lack of estrogen/testosterone
Excess caffeine

Question 9

What is bone remodeling

Answer 9

process of resorption and formation

Question 10

What causes bone resorption or breakdown

Answer 10

osteoclasts

Question 11

what causes bone formation

Answer 11

osteoblasts

Question 12

ostoeporosis is caused when…

Answer 12

failure to make new bone

incresed resorption

or BOTH

Question 13

Clinical Manifestations osteoporosis

Answer 13

+Early
None

\+Late
Fractures
Pain
Loss of height
Stooped posture

Question 14

3 common fractures caused by osteoporosis

Answer 14

Hip : femur neck
wrist
Vertebrae: compression fracture

Question 15

Risk Factors of hip fractures

Answer 15

Age:  >65
Gender:  Female
Typical Medical Hx?
Osteoporosis 
Frequent falls

Question 16

most common fracture location

Answer 16

Femoral neck

Question 17

Hip Fracture Clinical presentation

Answer 17

Sudden onset of hip pain before or after a fall

Inability to walk

Severe groin pain

Tenderness

Affected leg is externally rotated

Affected extremity is shortened

Question 18

2 Complications of hip fracture and immobility

Answer 18

infection

venous thromboembolism

Question 19

goal of pharm for osteoporosis

Answer 19

Reduce fractures

Question 20

primary prevention supplements in osteoporosis

Answer 20

Calcium

Vitamin D

Question 21

Treatment of osteoporosis

Answer 21

Promote bone formation

Decrease bone resorption** (most common)

Question 22

Osteoporosis prevention regimine

Answer 22

Calcium
Diet + supplement (elemental Calcium)= 1200 to 2000 mg daily

Vitamin D
Diet + supplement = 800 to1,000 IU daily

Women’s Health Initiative Study
30% reduction in fractures

Exercise – at least 30 min 3 x’s/week

Question 23

3 classes and drugs in treatment of Osteoporosis

Answer 23

Bisphosphonates (bis PHOS phon ates )
++Alendronate (Fosamax)

Selective estrogen receptor modulators
++Raloxifene (Evista)

Hormone therapy
++Calcitonin

Question 24

Bisphosphonate Drug

Answer 24

Alendronate (Fosamax)

Question 25

Alendronate is FDA approved for what

Answer 25

prevention and treatment Reduces fractures by 50%

Question 26

MOA of alendronate

Answer 26

Binds permanently to surfaces of bones Inhibit osteoclasts

Question 27

SE of alendronate

Answer 27

Most common: GI Nausea, discomfort, diarrhea Some risk of esophageal ulceration

Question 28

Teaching regarding alendronate

Answer 28

Take with water Do not lie down for ½ hour after taking No food, drink, calcium or vitamins for 2 hours (b/c only 1% bioavailability) Drug holiday – after 5 years take a break to reduce risk of jaw necrosis and esophageal cancer

Question 29

Selective Estrogen Receptor Modulators (SERMs) Drug

Answer 29

Raloxifene (Evista)

Question 30

MOA of raloxifene

Answer 30

mimics estrogen inhibits bone resorption

Question 31

What is the use of raloxifene

Answer 31

prevention and treatment reduces risk of spinal fractures by 50%

Question 32

SE of raloxifene

Answer 32

hot flashes leg cramps

Question 33

raloxifene patient teaching

Answer 33

Important to take adequate Calcium and vitamin D Discontinue at least 72 hrs before and during Prolonged immobilization  Reason?? No tobacco or alcohol Cannot use if pregnant Black box – stroke seen in some

Question 34

Hormone: bone resorption inhibitor

Answer 34

Calcitonin-salmon (Miacalcin)

Question 35

MOA of calcitonin-salmon

Answer 35

inhibits bone removal by osteoclasts

Question 36

what is calcitonin-salmon used for

Answer 36

treatment only Reduces spinal fractures by 30% have to take for 5 years to see benefit

Question 37

Drug effects of calcitonin-salmon

Answer 37

Slows down bone loss Increases spinal bone density

Question 38

SE of callcitonin

Answer 38

can cause nasal irritation stong safety profile