Osteoporosis Tx

Question 1

Vitamin D 3 supplements called

Answer 1

cholecalciferol

Question 2

Vitamin D2 supplements called

Answer 2

ergocalciferol

Question 3

is D3 or D2 more potent

Answer 3

D3 at higher concentrations

Question 4

when is vit D toxic?

Answer 4

over 500 nmol/L of 25 OH vit D

Question 5

Signs of vit d toxic

Answer 5

anorexia, weight loss, arrhythmias, polyuria, hypercalcemia

Question 6

when over 125 nmol/L of 25 OH vit D what risks are there?

Answer 6

increased risk of mortality, cancer, CVE, falls/ fractures

Question 7

what do corticosteroids do if taken with vit d?

Answer 7

impair vit D metabolism

reduces calcium absorption

Question 8

orlistat, cholestyramine with vit d?

Answer 8

decreases absorption of fat soluble vitamins (vit D)

Question 9

phenobarbital and phenytoin with vit D?

Answer 9

increase liver metabolism of vit D

reduces calcium absorption

Question 10

what is MORES 2016

Answer 10

male osteoporosis risk estimation score

Question 11

when should men get DXA screening?

Answer 11

men with MORE score over 6

Question 12

what is FRAX?

Answer 12

online fx risk calculator
only works for tx naïve pts
10 yr probability of hip and major osteoporotic fx

Question 13

when does FRAX recommend tx ?

Answer 13

when osteopenic pts have a risk for hip fx over 3%, or a major osteoporosis fracture risk over 20%

Question 14

T/F calcium / vit D should be an adjuvant therapy for all individuals over 65

Answer 14

TRUE!!

Question 15

is carbonate or citrate absorbed better?

Answer 15

citrate! can take whenever in regards to food

Question 16

Calcium carbonate must be __

Answer 16

taken with food

and its cheaper :)

Question 17

why need to take vit D BID?

Answer 17

body can only absorb so much vitamin D at one time.. take BID to get full absorption

Question 18

4 bisphosponates

Answer 18

Alendrontae
Risedronate
Ibandronate
Zolendronic acid

Question 19

T/F bisphosphonates treat and prevent osteoporosis?

Answer 19

TRUE

Question 20

bisphosphonate MOA

Answer 20

interrupt osteolytic cycle

increase bone mass, reduce incidence of fx by stopping osteoclast activity

Question 21

complication bsiphos?

Answer 21

osteonecrosis of jaw (seen mostly with IV use)

Question 22

warning bisphosphates

Answer 22

Avoid pill induced esophagitis
Take on empty stomach and sit up for 30-60 min
avoid in childbearing age

Question 23

why avoid bisphosphate in childbearning age women?

Answer 23

bind to bone for 10 years questionable what can occur to a fetus down the road

Question 24

4 things to monitor in bp use

Answer 24

DXA, BAP, urine NTX and CTX, watch for uveitis and scleritis in first time users

Question 25

black box warning for all bisphosphonates

Answer 25

thigh or groin pain | requires XRAY order to look for atypical trochanteric fx

Question 26

alendronate main ADR

Answer 26

more GI side effects than other bp | also..hypocalcemia

Question 27

alendronate brand

Answer 27

Fosamax.. if on too long can actually cause osteoporosis / fx

Question 28

ibandronate reduces ___ by 50% over 3 years

Answer 28

spine fractures | pt wait 60 min before eating or drinking

Question 29

zoledronate is a yearly ___

Answer 29

5 mg IV for more than 15 min | REDUCED spine fx by 70% over 3 years and hip by 41% over 3 yr

Question 30

zoledronic acid indication

Answer 30

hypercalcemia of malignancy, MM and bone metasis

Question 31

___ bp is the one with highest incidence of ONJ

Answer 31

zolendronic acid

Question 32

monitor __ with zolendronic acid

Answer 32

renal fx | esp pts over 65 y

Question 33

pamidronate is similar to ___ but less potent

Answer 33

zoledronic acid

Question 34

BP concerns

Answer 34

``` GI side effects infusion rxn ONJ arrhythmias bone quality uveitis/ scleritis ```

Question 35

men and women rates OP fx

Answer 35

women one in two men one in 4 over 50 yo will get fx

Question 36

SERM MOA

Answer 36

selective modulators?

Question 37

MOA Teriparatide

Answer 37

helps stmulate osteoblast activity for postmenopausal women with OP and high fx risk male primary or hypogonadal OP with high fx risk

Question 38

chemical name teriaparatide

Answer 38

N1-34 PTH

Question 39

teriaparatide good for pts who..

Answer 39

have blunted bp effects

Question 40

teriaparatide black box

Answer 40

osteosarcoma - don't give to anyone who had prior RT or skeletal malignancies ..this drug builds bone.. if had previous problems not a good idea

Question 41

CI teriaparatide

Answer 41

pagest dz, preg and nursing, peds, young adults, prior radiation, bone mets, skeletal malignancies, hypercalcemia

Question 42

max length of teriparatide tx

Answer 42

2 yrs only

Question 43

compliance issues with teriparatide?

Answer 43

a lot like insulin, have to carry and keep cold

Question 44

teriparatide adr

Answer 44

hypercalcemia, HA< myalgia, arthralgia

Question 45

abaloparatide is a ___ analong

Answer 45

parathyroid hormone analog

Question 46

abaloparatide ADR

Answer 46

``` hypercalciuria dizzy n HA palpitations fatigue upper abd pain vertigo ```

Question 47

___ is monoclonal ab that blocks RANK ligand

Answer 47

Denosumab

Question 48

what does RANK ligand do?

Answer 48

stimulates osteoclasts

Question 49

RANKL is a member of what cytokine family?

Answer 49

TNF

Question 50

indications denosumab

Answer 50

treatment of postmenopausal with OP and high fx risk

Question 51

how is denosumab delivered?

Answer 51

sub Q injections every 6 mo

Question 52

what should pt take with denosumab?

Answer 52

calcium and vit d

Question 53

denosumab indications

Answer 53

more for pt with unresectable giant cell tumor of bone | or at risk for rx: pts on ADT or AI therapy for prostate or breast cancer

Question 54

denosmab can prevent___

Answer 54

Skeletal related events in pts with bone metases from solid tumors

Question 55

ADR denosumab

Answer 55

cellulitis, eczema, flatulence, fatigue, asthenia, hypophosphatemia, N/ dyspnea, arthralgia, HA

Question 56

warnings densoumab

Answer 56

hypocalcemia, ONJ, rash, infection, atypical fx | - similar to bp meds

Question 57

denosumab is pregger class___

Answer 57

D: associated with fetal loss and deformity in animal studies

Question 58

calcitonin

Answer 58

inhibits bone resorption

Question 59

indications calcitonin

Answer 59

for women who cannot take estrogen and are 5 yrs or more post menopause

Question 60

calcitonin effective?

Answer 60

not really.. mild increase in vertebral BMD .. but fx risk help? no..

Question 61

OP first line tx options (4)

Answer 61

alendronate, risedronate, zoledronic acid, or denosumab

Question 62

T/F advise against combo OP tx?

Answer 62

TRUE!