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68 Cards in this Set
- Front
- Back
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characteristics of cortical (compact) bone
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-dense outer shell
-long bones |
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characteristics of trabeccular (cancellous, or spongy) bone
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-porous interior in honeycombed pattern
-higher surface area -higher degree of remodeling |
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There is age-related ______ bone loss in both genders
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cortical
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___________ bone loss begins during the perimenopausal period
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trabecular
-phase of accelerated trabecular bone loss, lasting for about the 1st 2-3 yrs after onset menopause |
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trabecular bone is affected to a greater extent than cortical bone during menopause since it has?
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-a larger surface-to-volume ratio and faster remodeling rate
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accelerated early trabecular bone loss in conjunction with postmenopausal decreases in cortical bone may lead to ?
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-increased vertebral and distal forearm fractures which predominate early after menopause
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in late menopause, combined age-related trabecular and cortical bone losses result in ?
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hip fractures predominating
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estrogen deficiency effects on bone
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-allows cytokines to activate osteoclasts and increase bone resorption
-increased bone demineralization and increased serum calcium |
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Type 1 Osteoporosis
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-accelerated trabecular bone loss for 2-3 yrs post menopause
-decline in serum estrogen initiates accelerated rate of bone loss -increased bone demineralization and increased serum calcium |
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Type 2 Osteoporosis
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-senile osteoporosis
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Type 3 Osteoporosis
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-secondary osteoporosis due to drug use or dz process
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endogenous risk factors for osteoporosis
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-gender::female>male due to lower bone mass
-small stature |
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exogenous risk factors for osteoporosis
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-immobility
-calcium deficiency -smoking -drugs -dz states |
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what drugs are associated with increased risk of osteoporosis
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-glucocorticoids::most common drug induced cause
-phenytoin -GnRH agonists |
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what disease states are associated with increased risk of osteoporosis
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-hyperthyroidism, hypercortisolism
(hyperadrenalism, Cushing's dz) -primary hyperparathyroidism |
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prophylactic calcium intake in women should include ______mg per day elemental calcium from _______
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1. 1000mg/d
2. both diet and supplements |
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DOC for calcium supplementation
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calcium carbonate
-highest calcium content of common supplements -cheap |
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40% of calcium carbonate is ________
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elemental calcium
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when should you take calcium carbonate?
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after meals
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calcium absorption in pts with achlorhydria
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-decreased calcium absorption from insoluble calcium carbonate
-calcium absorption normal when ingested with a meal rather than fasting |
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1.dosing for vit D
2. safe upper limit |
1. 800-1000 IU/d for adults >/=50 yrs
2. safe upper limit is 2000 IU/d |
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vit D products
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1. ergocalciferol
2. cholecalciferol 3. calcitrol |
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ergocalciferol is approved for _____, __________, and ___________
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1. refractory rickets
2. familial hypophosphatemia 3. hypoparathyroidism |
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cholecalciferol indicated for ?
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-vit D deficiency states (rickets in kids, osteomalacia in adults)
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calcitrol indicated for management of ?
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-hypocalcemia in pts on chromic renal dialysis
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which vitamin D product is the most active form and most expensive?
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calcitrol
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vit D products officially approved for prophylaxis/tx?
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none
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postmenopausal women who are not deficient in vit D should take _____ IU/d
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800-1000 IU/day
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postmenopausal women are recommended to take ________mg/day of calcium
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1200mg/d
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estrogen replacement therapy in prevention of osteoporosis in postmenopausal women
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-may bind directly with estrogen receptors to inhibit resorption by decreasing osteoclast recruitment/activity
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current role of estrogen in prevention of osteoporosis in postmenopausal women
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-a choice for short-term prevention of bone loss in women on ET for acute menopausal Sx
-HRT no longer considered 1st line for long term option b/c risks outweigh benefits after </=5yrs |
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absolute contraindications of estrogen replacement as prevention of osteoporosis in postmenopausal women
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-hx or existing thromboembolic dz
-past, known, or suspected breast orendometrial cancer -undiagnosed abnormal genital bleeding -gall bladder dz |
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raloxifene
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-selective estrogen receptor modulator (SERM)
(estrogen agonist/antagonist) |
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raloxifene is approved for __________
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-both prevention and treatment of osteoporosisin postmenopausal women
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where does raloxifene act as estrogen agonist and antagonist?
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-agonist in bone, lipids, and coagulation Sx
-antagonist in breast and uterus |
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Is concomitant progesterone needed in raloxifene therapy?
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nope
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describe the estrogen agonistic effects of raloxifene
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-exerts an estrogen-like positive effect on all markersof bone turnover and the bone remodeling process
-increases bone density, but not as much as estrogen |
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what affect has been shown in use of raloxifene and fracture risk?
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-reduction in hip and other nonvertebral fracture risk has NOT been demonstrated
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describe the estrogen antagonistic effects of raloxifene
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-does not have same beneficial effects as estrogen or acute postmenopausal Sx
-no increased risk of breast or endometrial CA -concurrent progestins not required due to lack of endometrial stimulation |
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___________is indicated for the reduction of risk of invasive breast CA in postmenopausal women with osteoporosis
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raloxifene
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ADR of raloxifene
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-most common: 6% increase in hot flushes compared to estrogen
-leg cramps -venous thromboembolism: increased risk of blood clots 3-fold |
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contraindications for raloxifene
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-active or past venous thromboembolic events
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biphosphonates approved for both prevention and treatment of osteoporosis
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alendronate, risendronate, and ibandronate
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supplementation in the tx of osteoporosis
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1. calcium
->/=5oyrs 1200 mg/d 2. vit D (not approved for this indication) ->/=50yrs 800-1000IU/day |
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calcium absorption and supplementation in the elderly
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-may have decreased calcium absorption due to decreased gastric acid secretion and decreased formation of the active form of vit D
-calcium carbonate should be taken with meals or use a more soluble calcium product such as calcium citrate |
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anti-resorptive agents to decrease bone mass demineralization
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1. raloxifene (estrogen alternative)
2. biphosphonates (1st line agents) 3. calcitonin (injection or nasal spray) |
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____________is a good med choice for women without vasomotor Sx who are concerned about the long term effects of HRT
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Raloxifene
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pharmacological actions of biphosphonates
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-inhibit osteoclast-induced normal and abnormal bone resorption
-reduces serum calcium and phosphate concentrations |
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which biphosphonate is the most potent and by how much?
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alendronate is 100-500x more potent than other biphosphonates
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prototype biphosphonate for use in osteoporosisis ___________
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alendronate sodium (Fosamax)
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use of aldronate sodium (Fosamax)
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-tx of osteoporosis in postmenopausal women
-prevention of osteoporosis in postmenopausal women -tx of decreased bone mass in men with osteoporosis |
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ADR of alendronate
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GI::acid regurgitation, esophageal irritation/erosion/ulceration, abdominal distention, and gastritis
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warnings for admin of alendronate
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-must correct hypocalcemia before starting therapy
-avoid in pts with severe renal dz, difficulty swallowing, or inability to sit or stand up for at least 30-60 min |
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dosing instructions for alendronate
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-take in am with glass water only
-take at least 30 min prior to 1st meal or beverage -wait 1hr before taking any other meds -do not lie down for at least 30min -can be dosed once-daily or once-weekly |
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why must a pt not lie down for 30 min after taking alendronate
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-to improve delivery to stomach and decrease potential for esophageal irritation
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MOA of calcitonin
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-interferes with osteoclast function, reverses rapid bone turnover, and increased bone mass; suppresses bone resorption
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calcitonin is recommended for pts who cannot take or failed__________
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alendronate or raloxifene therapy
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indications for calcitonin
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-tx of postmenopausal osteoporosisin conjunction with adequate calcium and vit D intake to prevent the progressive loss of bone mass
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there is an increased incidence of ADR in the _______ form of calcitonin. what are they?
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injectable form
-allergic rxns -hypocalcemic tetany |
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what are the two forms availabe for calcitonin?
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-injectable
-nasal spray |
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calcitonin nasal spray is indicated for?
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tx of postmenopausal osteoporosis in women > 5yrs postmenopause with low bone mass relative to healthy premenopausal females
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calcitonin injectable form is indicated for?
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tx of postmenopausal osteoporosis in conjunction with adequate calcium and vit D intake to prevent the progressive loss of bone mass
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stimulant of bone formation in the tx of osteoporosis
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teriparatide (Forteo)
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teriparatide (Forteo)
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-recombinant (rDNA) form of human PTH consisting of the incidental sequence of 34 amino acids in the biologically active region of human PTH
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dosing for teriparatide (Forteo)
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-once daily dosing stimulates new bone formation on trabecular and cortical bone surfaces by preferrential stimulation of osteoblastic activity aver osteoclastic activity
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indications for teriparatide (Forteo)
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-tx of postmenopausal women with osteoporosis who are at increased risk of fx
-to increase bone mass in males with primary or hypogonadal osteoporosis who are at highrisk for fx |
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avoid teriparatide in pts with __________ or __________
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hypercalcemia disorder or pts at risk for osteosarcoma
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what is the BLack box warning for teriparatide?
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-avoid in pts at risk for osteosarcoma (including Paget's dz)
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