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38 Cards in this Set

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Osteoporosis is defined as a BMD T score of ?
-2.5 or less
What is the minimum supplement requirement for vit D3 in pts >60?
700IU/d
Adults 19-50 should have daily Ca intake of at least what? >50?
1000mg; 1200mg
What are the common side effects of calcium suppplements?
constipation
itestinal bloating/gas
What is the MOA of raloxifene?
selective estrogen receptor modulator

- estrogen-like effects on bone and antiestrogen effects on the uterus and breast
What are the other benefits of raloxifene besides reduction of vertebral fxrs, etc?
reduction in incidence of invasive breast CA in postemenopausal women

lower LDL

lower risk of CV events
What are the adverse effects of raloxifene?
hot flashes
leg cramps
inc risk of thromboembolic events
Name 3 bisphosphonates.
Alendronate
Ibandronate
Risedronate
What nonhormonal osteoporosis drugs work by decreasing bone resorption and binding to active sites of bone remodeling and inhibiting osteoclasts?
bisphosphonates
What may interfere with absorption of oral bisphosphonates?
food
Ca supplements
antacids
iron
Which bisphosphonate is IV - usually used to tx hypercalcemia of malignancy?
IV Zoledronic acid
What are the adverse effects of bisphosphonates?
heartburn, esophageal irritation, esophagitis, abd pain, diarrhea
How should bisphosphonates be taken?
empty stomach after overnight fast; take in upright position w/8oz plain water; NPO for 30 minutes; avoid lying down!
Which bisphosphonate has less esophageal adverse effects?
etidronate
What serious SE can occur with high dose IV bisphosphonate and rarely oral alendronate?
osteonecrosis of the jaw
(and loss of teeth)
What osteoporosis drug works by inhibiting osteoclasts - and is given SC or intranasally only?
calcitonin
What is an additional benefit of calcitonin?
analgesia
What are the common adverse effects of calcitonin?
Nausea and flushing
rhinitis and occaisional epistaxis (with intranasal)
Which osteoporosis drug works by stimulating bone formation rather than decreasing bone turnover?
teriparatide
What is hip fracture mortality most often due to?
DVT/PE
What are the risk factors for osteoporosis?
female
race
slight build
positive family hx
early menopause
immobilization
excess alcohol
cigarette use
Ca and vit D deficiency
meds
gastrectomy
intestinal surgery/disease
What drugs inc risk of osteoporosis?
corticosteroids
heparin
anticonvulsants
What is the gold standard BMD test?
DEXA
What is considered osteopenia?
BMD 1-2.5 SD below mean
When is is considered "severe osteoporosis"?
low BMD + fragility fx
What is the difference between a T score and a Z score?
T scores compare to the norm
Z scores compare to age-matched population
What are secondary causes of osteoporosis?
cushing's
chronic glucocorticoid rx
MM
MGUS
anticonvulsants
heparin
malabsorption
gastric surgery
alcohol
hypogonadism
primary hyperpara
COPD
hyperthyroid
idiopathic hypercalciuria
OI
mastocytosis
osteomalacia
what occurs when 25D is <20-30?
PTH levels increase (secondary hyperparathyroidism)
What is the goal for 25D levels?
30-40ng/mL
What osteo drugs are FDA approved for prevention?
estrogen
raloxifene
alendronate
risedronate
ibandronate
What osteoporosis drugs are FDA approved for treatement?
raloxifene
alendronate
risedronate
ibandronate
calcitonin
teriparatide
What osteoporosis drugs are FDA approved for both treatment and prevention?
raloxifene (SERM)
bisphosphonates
What is the main issue with raloxifene?
hot flashes
Is calcitonin for prevention or tx?
treatment
What are considered anabolic therapies for osteoporosis?
fluouride (NOT recommended)
PTH/PTHrP
GH (only if deficient)
DO not use teriparatide in these pts b/c osteosarcoma risk.
- 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
Teriparatide should only be used for ____ years.
2
Which pts should not get teriparatide?
osteosarcoma risk pts
pre-existing hypercalcemia or hyperparathyroidism