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Pharm Exam 2 > Osteoprosis > Flashcards

Osteoprosis Flashcards

1
Q

Secondary Osteoporosis

A
  • Oral Glucocorticoid induced
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2
Q

FRAX

A
  • online fracture risk calculator
  • Treat if osteopenic pts with 10 yr hip fracture risk > 3% or major osteoporotic fracture risk >20%
  • Only for treatment naive pts
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3
Q

Medication Management

A
  • Calcium and Vit D
  • Bisphosphonates (most common)
  • HRT (horomone replacement therapy)
  • Raloxifene
  • Calcitonin
  • N 1-34 PTH (teriparatide)
  • Denosumab
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4
Q

Calcium/Vit D

- Adjuvant therapy for all individuals (esp >65 yrs old)

A
  • Statistically significant only with FULL doses and in older population
  • Otherwise: small increase in bone density with small decrease in hip fractures
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5
Q

Ca and Vit D requirements

A

Children

  • Age 4-8: 1000mg/day Ca; 600IU/day Vit D
  • Age 9-18: 1300mg/day Ca; 600IU/day Vit D

Adult

  • Women 50 and men>70: 1200mg/day Ca
  • 70: 800IU/day Vit D
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6
Q

Cacium carbonate vs calcium citrate

- Take both with food, then doesn’t matter if pt taking carbonate or citrate

A
  • calcium citrate better absorption
  • calcium carbonate better absorption with food
  • Need to split the dose, 500-600 each dose
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7
Q

Treatment

A

FIRST LINE: Alendronate, Risedronate, Zoledronic acid, Denosumab

SECOND LINE: Ibandronate

SECOND-THIRD LINE: Raloxifene

LAST LINE: Calcitonin

Very high fracture risk/Bisphosphonate failed: Teriparatide

Advise against the use of combination therapy

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8
Q

Bisphosphonates

Alendronate (Fosamax)
Risedronate (Actonel)
Ibandronate (Moniva)
Zoledronate (Reclast)
Zoledronic acid
Pamidronate (Aredia)
A
  • MOA: Increase bone mass, reduce incidence of fractures by inhibiting osteoclast activity (slower breakdown, but does not build bone)
  • USE: Effective for treatment and prevention of osteoporosis
  • ADR: GI, infusion rxn, Osteonecrosis of the jaw, arrhythmia, bone quality, Uveitis/scleritis
  • COMPLICATION: osteonecrosis of the jaw (seen mostly in cancer pts getting IV bisphosphonates)
  • PRECAUTIONS: can induce esophagitis (reflux, FERD, other esophageal abnomalities); Uveitis/scleritis in first time users
  • MUST be taken on empty stomach and remain upright for 30-60 mins
  • Preg category X
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9
Q

Bisphosphonate monitoring

A
  • DXA

- Bone turnover markers: Formation (Alk phos), Resorption (urine NTX, urine CTX)

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10
Q

Alendronate (Fosamax)

A
  • Also indicated for treatment of Paget’s Dz
  • More GI ADRs than other bisphosphonates: DYSPEPSIA, abd pain, acid reflux, C/D/N, musculoskeletal pain
  • OTHER ADR: hypoCa, thigh or goin pain (requires eval for atypical trochanteric fracture)
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11
Q

Osteonecrosis of the jaw

A
  • Usually after dental extraction
  • More common with IV bisphosphonates
  • Need regular dental checkups
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12
Q

Risedronate (Actonel, Atelvia)

A
  • Wait/sit up for 30 mins
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13
Q

Ibandronate (Boniva)

A
  • IV or PO

- Pts must wait/sit up 60mins before eating or drinking

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14
Q

Zoledronate (Reclast)

A
  • IV annually
  • Reduced spine fractures/hip fractures
  • ADR: flu like infusion rxn
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15
Q

Zoledronic Acid (Zometa)

A
  • Indicated for hyperCa of malignancy, multiple myeloma and bone mets (ONJ incidence higher)
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16
Q

Pamidronate (Aredia)

A
  • IV
17
Q

Hormones
- NOT first line for pt in postmenopause (due to risk of breast cancer, stroke, VTEs, CAD)

  • Estrogen + Medroxyprogesterone
A
  • Reduces hop and vertebral fractures, overall fractures

- INDICATIONS: persistent menopausal sx, inability to tolerate other options, failure to response to other options

18
Q

SERMs

  • Raloxifene (Evista)
  • NOT good for hip fractures, FOR vertebral fractures
A
  • Mixed estrogenic and antiestrogen properties depending on tissue
  • Lowers risk of breask Ca w/o stimulating endometrial hyperplasia
  • Increased risks of DVTs and increased vasomotor sx (hot flashes)
  • Black box for DVT, stroke risk
19
Q

Calcitonin (Miacalcin, Fortical)

A
  • Inhibits bone resorption
  • Indicated for women > 5yrs post menopause who cannot take estrogen
  • Not effective for osteoporosis: increases vertebral BMD modestly, not really for fractures risk
20
Q

Teriparatide–N 1-34 PTH (Forteo)

  • Decreased spine fractures and non spine fractures
  • Not first line normally, But might be first line if very high fracture risk
A
  • MOA: Helps build bone by stimulating osteoblast activity
  • Female: postmenopausal OP with high fracture risk
  • Male: primary or hypogonadal OP with high fracture risk
  • ADR: transient/persistent hyperCa, HA, transient myalgia/arthralgia
  • CONTRAINDICATIONS: Paget’s dz, pregnant/nursing, pediatrics/young adults, PRIOR RADIATION THERAPY, BONE METS, SKELETAL MALIGNANCIES, hyperCa
  • WARNING: potential risk of osteosarcoma
  • 2 yrs only
  • Effects blunted in pts on bisphosphonates (start with teriparatide x2yrs, then start on bisphosphonates)
  • IV
21
Q

Denosumab (Prolia, Xgeva)

A
  • Monoclonal antibody that blocks RANK ligand which stimulates osteoclasts
  • ADR: cellulitis, eczema, flatulence, fatigue, asthenia, hypophosphatemia, N, dyspnea, arthralia, HA
  • WARNING: hypocalcemia, ONJ, rash, infection, atypical fractures
  • Preg category D
22
Q

Prolia

A
  • INDICATION: postmenopausal women with osteoporosis at high risk for fracture
  • Reduces non-vertebral fractures, vertebral fractures
  • SubQ injections
  • Take with Ca and Vit D
23
Q

Xgeva

A
  • INDICATION: cancer

- giant cell tumor of bone, androgen deprivation therapy for prostate cancer, bone metastases from solid tumors

24
Q

Osteoporosis treatment

A
  • Postmenopausal women and men > 50 yrs old

- Bone mineral density T score of

25
Q

Monitoring

A
  • Obtain baseline DXA, repeat every 1-2yrs until findings are stable
  • follow up DXA every 2 yrs
  • Monitor changes in spine or total hip bone mineral density
  • Follow up of pts should be in the same facility, with the same machine, and if possible, with the same technologist
  • Bone turnover markers may be used at baseline to identify pts with high bone turnover and can be used to follow the response to therapy

Pharm Exam 2 (7 decks)

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