Therapeutics Of Osteoprosis

Question 1

Define osteoporosis

Answer 1

Skeletal disorder defined by low bone density, decreased bone strength and deterioration of bone architecture that results in increased bone fragility and risk of fracture

Question 2

Which fracture is the most devastating for osteoporosis and has the highest mortality

Answer 2

Hips fracture

Question 3

Characterize or group osteoporosis

Answer 3

Primary and secondary

Question 4

Characterize primary osteoporosis

Answer 4

Type 1: post menopausal osteoporosis . Type 2: age related osteoporosis. Type 3: idiopathic, due to unknown causes in juveniles and adults

Question 5

What are the two ways we can diagnose osteoporosis

Answer 5

1. Atraumatic fractures to the spine, distal radius or femur after small falling. 2. DXA scan to interpret bone mineral density

Question 6

What is the T score for osteoporosis diagnosis

Answer 6

Less than or equal to -2.5

Question 7

When do we consider treatment for osteoporosis

Answer 7

1. History of hip or vertebral fracture 2. T score less than -2.5 at neck, hip or spine by DXA. 3. Post menopausal women or men more than 50 with a T score between -1 and -2.5 with a FRAX score more than 20% OR 10 year hip fracture pro Aliyu greater than 3 percent

Question 8

What is the counter indications for bisphosphonates

Answer 8

Hypocalcemia. Renal insufficiency( less than 30-35 crcl). Pregnancy or breast feeding. Esophageal insufficiency. Avoid after bariatric surgery

Question 9

Which bisohosphonate is not good for hips and non vertebrae

Answer 9

Ibandronate

Question 10

Mention the drug interactions with bisphosphonates

Answer 10

Antacids Mineral acids. Increase GI side effects of NSAIDS

Question 11

What bisphosphaonates is the most convenient for patients adherence wise and why

Answer 11

IV zolendronic acid. Patients get it every 2 years for treatment and once 3 years for prevention

Question 12

True or false menopausal hormonal therapy is used to treat osteoporosis

Answer 12

False it is only use for prevention of osteoporosis in post menopausal women that are high risk

Question 13

What are the SERMS used for osteoporosis in post menopausal women

Answer 13

Raloxifene: can treat and prevent osteoporosis in post menopausal women Banzedoxifene + Duavee: can only prevent osteoporosis in women with uterus

Question 14

Counter indications for SERMS

Answer 14

Pregnancy or lactating. Active or previous history of pulmonary embolism or thrombosis

Question 15

What type of fractures can SERMS not treat at all

Answer 15

Hips and non vertebrae fractures

Question 16

What are the black box warnings for raloxifene

Answer 16

Increases risk of deep vein thrombosis(DVT) and pulmonary embolism(PE). Increases risk of stroke

Question 17

Women with what post menopausal symptom should not take Raloxifene

Answer 17

Women with Vaso motor symptoms like hot flashes

Question 18

What is the counter indication for calcitonin

Answer 18

Women with allergies to salmon should not take it

Question 19

What does calcitonin not work on

Answer 19

Doesn’t work for hips and non vertebral

Question 20

Indication for calcitonin

Answer 20

Treatment in Only for post menopausal women. Not used by men

Question 21

Adverse effects of calcitonin

Answer 21

If you use intranasally for more than 6 months you can get cancer

Question 22

What is the counter indication for denosumab

Answer 22

Hypocalcemia

Question 23

What is the problem with denosumab therapy

Answer 23

You have to be on it for life. If you stop treatment you will have rebound vertebrae fractures. Only stop treatment if you will be on bisphosphonates

Question 24

What drugs cannot work on hips, and non vertebra fractures

Answer 24

Ibandronate. Calcitonin. SERMS

Question 25

Which one of the PTH anabolic drugs has approval only for men and steroid induced osteoporosis

Answer 25

Teriparatide

Question 26

What is the black box warning for PTH hormone analogs

Answer 26

Osteocarcinoma

Question 27

What is the black box warning for PTH hormone analogs

Answer 27

Osteocarcinoma

Question 28

What are the counter indications for PTH analogs

Answer 28

Paget’s disease. Prior radiation therapy for the skeleton Increase base like for osteocarcinoma.

Question 29

What part of the body can PTH analogs not work on at all

Answer 29

Hips

Question 30

What are the adverse effects of PTH analogs

Answer 30

Orthostatic hypotension: give only when they are sitting or lying down. Hypercalcemia: reduce calcium intake to less than 1000 mg/day.

Question 31

Mention the four drugs that are first line treatment for osteoporosis in terms of efficacy and safety

Answer 31

Alendronate, risendronate, zoledronic acid, denosumab

Question 32

Which drug is a second line treatment for osteoporosis

Answer 32

Ibandronate cos it doesn’t treat hips and non vertebrae. Calcitonin.

Question 33

What is the third line treatment for osteoporosis

Answer 33

Raloxifene

Question 34

What is the 4th line treatment for osteoporosis

Answer 34

Calcitonin

Question 35

Problem with romosozumab therapy

Answer 35

If discontinued, you can get a rebound effect is bone loss to pretreatment level. Use bisphosphonates or denosumab after stopping

Question 36

What is the black box warning for romosozumab

Answer 36

Increases risk of myocardial infarction, stroke and cardiovascular death

Question 37

What type of disease state patients cannot take bisphosphonates

Answer 37

Patients with chronic kidney disease cos the drug is excreted in the kidney