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38 Cards in this Set
- Front
- Back
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Osteoporosis is defined as a BMD T score of ?
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-2.5 or less
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What is the minimum supplement requirement for vit D3 in pts >60?
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700IU/d
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Adults 19-50 should have daily Ca intake of at least what? >50?
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1000mg; 1200mg
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What are the common side effects of calcium suppplements?
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constipation
itestinal bloating/gas |
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What is the MOA of raloxifene?
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selective estrogen receptor modulator
- estrogen-like effects on bone and antiestrogen effects on the uterus and breast |
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What are the other benefits of raloxifene besides reduction of vertebral fxrs, etc?
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reduction in incidence of invasive breast CA in postemenopausal women
lower LDL lower risk of CV events |
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What are the adverse effects of raloxifene?
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hot flashes
leg cramps inc risk of thromboembolic events |
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Name 3 bisphosphonates.
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Alendronate
Ibandronate Risedronate |
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What nonhormonal osteoporosis drugs work by decreasing bone resorption and binding to active sites of bone remodeling and inhibiting osteoclasts?
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bisphosphonates
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What may interfere with absorption of oral bisphosphonates?
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food
Ca supplements antacids iron |
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Which bisphosphonate is IV - usually used to tx hypercalcemia of malignancy?
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IV Zoledronic acid
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What are the adverse effects of bisphosphonates?
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heartburn, esophageal irritation, esophagitis, abd pain, diarrhea
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How should bisphosphonates be taken?
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empty stomach after overnight fast; take in upright position w/8oz plain water; NPO for 30 minutes; avoid lying down!
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Which bisphosphonate has less esophageal adverse effects?
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etidronate
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What serious SE can occur with high dose IV bisphosphonate and rarely oral alendronate?
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osteonecrosis of the jaw
(and loss of teeth) |
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What osteoporosis drug works by inhibiting osteoclasts - and is given SC or intranasally only?
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calcitonin
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What is an additional benefit of calcitonin?
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analgesia
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What are the common adverse effects of calcitonin?
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Nausea and flushing
rhinitis and occaisional epistaxis (with intranasal) |
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Which osteoporosis drug works by stimulating bone formation rather than decreasing bone turnover?
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teriparatide
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What is hip fracture mortality most often due to?
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DVT/PE
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What are the risk factors for osteoporosis?
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female
race slight build positive family hx early menopause immobilization excess alcohol cigarette use Ca and vit D deficiency meds gastrectomy intestinal surgery/disease |
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What drugs inc risk of osteoporosis?
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corticosteroids
heparin anticonvulsants |
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What is the gold standard BMD test?
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DEXA
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What is considered osteopenia?
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BMD 1-2.5 SD below mean
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When is is considered "severe osteoporosis"?
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low BMD + fragility fx
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What is the difference between a T score and a Z score?
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T scores compare to the norm
Z scores compare to age-matched population |
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What are secondary causes of osteoporosis?
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cushing's
chronic glucocorticoid rx MM MGUS anticonvulsants heparin malabsorption gastric surgery alcohol hypogonadism primary hyperpara COPD hyperthyroid idiopathic hypercalciuria OI mastocytosis osteomalacia |
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what occurs when 25D is <20-30?
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PTH levels increase (secondary hyperparathyroidism)
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What is the goal for 25D levels?
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30-40ng/mL
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What osteo drugs are FDA approved for prevention?
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estrogen
raloxifene alendronate risedronate ibandronate |
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What osteoporosis drugs are FDA approved for treatement?
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raloxifene
alendronate risedronate ibandronate calcitonin teriparatide |
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What osteoporosis drugs are FDA approved for both treatment and prevention?
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raloxifene (SERM)
bisphosphonates |
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What is the main issue with raloxifene?
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hot flashes
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Is calcitonin for prevention or tx?
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treatment
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What are considered anabolic therapies for osteoporosis?
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fluouride (NOT recommended)
PTH/PTHrP GH (only if deficient) |
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DO not use teriparatide in these pts b/c osteosarcoma risk.
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- Paget’s disease of bone
- Unexplained elevated alkaline phosphatase - Pediatric populations - Prior XRT to the skeleton - Bone metastases/skeletal malignancies - Metabolic bone disease other than osteoporosis |
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Teriparatide should only be used for ____ years.
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2
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Which pts should not get teriparatide?
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osteosarcoma risk pts
pre-existing hypercalcemia or hyperparathyroidism |
