Treatment of Osteoporosis

Question 1

Prevnetion of bone loss

Answer 1

Exercise
Vit D
Calcium

Question 2

Osteoporosis and osteopenia initiate tx

Answer 2

Porosis - diagnosis

Osteopenia - must detemrine fracture risk using FRAX

If FRAX>3% ten year hip or >20% ten year any, then tx

Question 3

Premenopausal women and men under 50

Answer 3

Most have secondary…not much data on them

Question 4

2 types of meds

Answer 4

Antiresorptive- stops resorption but also formation

Anabolic - increase formation, but also resortpion

Question 5

Bisphos MOA

Answer 5

LA meds that depost and bind to surfase

Imapir ability of osteoclast to adhere and dissolve bone

Question 6

Route, fracture prevention unqiue

Answer 6

Zoledronic is IV

Ibandroante is vert only

Question 7

Bisphos Admin

Answer 7

Poorly abosrbed

Don’t take with food

Stand 30 min to prevent reflux and don’t eat for 90

If GI sx, then IV form

Question 8

Bisphos contraind

Answer 8

Renal insufficiency
Esophagela disorders
Inabiity to stay upright

Hypocalcemia, VIt D def

Question 9

SE of Bisphos

Answer 9

Hypocalcemia
Upper GI
Flu-like sx
Acute kidney injury

Question 10

Bisphos and atypical femur fractures

Answer 10

incidence is low…decreases when BP’s stopped

Subtrochanteric femur

Presnt iwht thigh or groin pian…get bilateral x-rays

Question 11

Bisphos and osteonecrosis of the jaw

Answer 11

Exposed mandibular bone in oral cavity

More with IV

Concern is extraction

Question 12

Monitoriing of osteoporosis tx

Answer 12

DXA every 1-2 yrs

Expect stability

Bone tunrover makrer

Question 13

Bispohs drug holiday

Answer 13

Allows bone turnover to increase

Decrease SEs

Long acting so should be alright

Question 14

Denosumab

Answer 14

RANKL monoclonal antibody

SubQ every 6 mos

Use in renal dysfuntion

Question 15

Denosumab adverse effects and monitoring

Answer 15

Hypocalcemia
Cellulitis
OSteonecorsis of the jaw

Calcium 10 days after

Question 16

Adv and disadv of denosumab

Answer 16

Potent
Not as long acting
2X per year
Renal insufficenty

Hypocalcemia
Bone loss 6-12 mos after stopping
Limited data
Expensive

Question 17

Selective estrogen receptor modulators

Answer 17

Raloxifene

Binds to estrogen receptor

NO hip fracture protection
SE_ venous thrombosis and hot flashes

Reduced breast cancer risk

Question 18

Teriparatide

Answer 18

only anabolic agent

SQ injection (daily)

acts PTH receptor of osteoblast

with intermittent exposure - increased osteoclast and blast so more bone formtion…more effect on spines

Continuous exposure will cause bone loss

Question 19

Terparatide uses and contraindicated

Answer 19

Patients at highest risk

Hypercalcemia
Gout
OSteocarcoma or increased risk (radiation, Paget’s, alakaline phsophatase elevations)

Question 20

Adverse effects of teriparatide

Answer 20

Hypercalcemia
Muscle pain
Osteosarcoma

Question 21

Adv and disadv of teriparatide

Answer 21

Only anabolic
No long term effects of bone turnover

Daily
Only 2 year use
BOne loss after stopped
Expensive

Question 22

Estrogen replacement for osteoporosis

Answer 22

Reduces both types of fractures

Good for premenopausal with estrogen deficiency

Not approved for post bc increase breast cancer risk