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23 Cards in this Set
- Front
- Back
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mechanisms of glucocorticoid-induced osteoporosis
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1.increased bone resorption: enhanced osteoclastic activity
2.decreased bone formation: -suppression of osteoblast activity -vit D independent, dose dependent inhibition of intestinal calcium absorption -decreased collagen production |
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clinical significance of glucocorticoid-induced osteoporosis pertaining to dosage
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-most significant effects occur with daily doses of po prednisone
-alternate-day dosing does not decrease risk -higher inhaled doses also may pose risk |
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what are the management guidelines for treatment of glucocorticoid-induced osteoporosis?
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1. calcium plus vit D supplementation
2. biphosphonates (data suggests should be 1st line therapy) 3. teriparatide is an alternative to biphosphonates |
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what is the recommended daily calcium intake for pts with glucocorticoid-induced osteoporosis?
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1200-1500 mg elemental calcium (dietary plus supplement) for all pts at risk
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what is the recommended daily intake of vit D for pts with glucocorticoid-induced osteoporosis?
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800-1000 IU/day (dietary+supplement)
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pharmacologic measures in glucocorticoid-induced osteoporosis
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1. correct hypogonadism in premenopausal women and men
2. biphosphonates as 1st line therapy in eugonadal pts 3. teriparatide as alternate |
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____________ is indicated in the tx of glucocorticoid-induced osteoporosis in men and women receiving glucocorticoids
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alendronate
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in what ways are biphosphonates potent inhibitors of bone resorption and turnover
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-bind to hydroxyapite crystals in bone and antagonize osteoclast activity
-increase osteoblast proliferation -increase intestinal calcium absorption |
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what is the 2nd most common bone disease in the US? and the cause?
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Paget's Dz
-cause unknown |
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what are the most commonly affected sites in Paget's dz?
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skull and weight-bearing bones
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what are the lab findings in Paget's dz?
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-increased serum alkaline phosphates, increased urinary excretion of hydroxyproline
-serum calcium, phosphate, and PTH levels usually normal |
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treatment approach to Paget's dz
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-NSAIDs may be used for asymptomatic pts or those with minimal Sx
-biphosphonate are considered 1st-line agents -calcitonin may be used if biphosphonate not tolerated |
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what biphosphonates are indicated in the tx of Paget's dz?
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-alendronate
-pamidronate -etidronate: tx of symptomatic Paget's dz |
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contraindications to biphosphonate tx of Paget's dz?
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-esophageal abnormalities or active UGI problems
-unable to remain upright for 30 min after dosing -hypocalcemia -renal impairment -allergic rxns (associated with bronchoconstriction in ASA-sensitive pts) |
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MOA of calcitonin salmon in tx of Paget's dz
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-inhibits osteoclastic bone-resorption activity
-on prolonged use there is a persistent decrease in the rate if bone resorption (decreased resorptive activity and number of osteoclasts) |
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indications of calcitonin salmon
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tx of Paget's dz of the bone (injection only)
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____________ occur after 2-3 yrs of calcitonin salmon tx in 25% of pts
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circulating Ab to calcitonin
-resistance to calcitonin effects may limit its usefulness |
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what is increased in Paget's disease and has to be differentiated from Pagetic lesions?
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osteogenic sarcoma
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warnings/ADR of calcitonin use
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-development of Ab to calcitonin after 2-3 yrs
-increased risk of osteogenic sarcoma -hypocalcemic tetany |
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In hypercalcemia of malignancy, increased bone resorption occurs due to ________________
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osteoclastic hyperactivity in neoplastic tissue
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_________ is indicated for hypercalcemia of malignancy inadequately managed by dietary modification or oral hydration, or that persists after adequate hydration has been restored
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Etidronate disodium
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_____________ is a biphosphonate derivative
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Zoledronic acid
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dosing of Zoledronic acid in tx of hypercalcemia of malignancy
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-single dose or IV infusion over >/= 15 min in conjunction with adequate saline hydration
-no retreatment until after 7 days |
