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50 Cards in this Set

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What is the definition of osteoporosis?
loss of bony tissue, resulting in bones that are brittle and liable to fracture
What are the usual sites for osteoporosis?
• distal radius
• hips
• vertebrae
What are risk factors for osteoporosis?
• age
• Cushings
• early menopause
• excessive alcohol intake
• heredity
• hyperthyroidism
• low calcium intake
• medications
• race
• renal failure
• sex
• small stature
• smoking
• thin
Who is recommended to have bone mineral density test performed?
• all women greater than 65
• post-menopausal less than 65 w/ risk factor
• everyone greater than 40 w/ history of fracture
When do you start therapy for a patient with osteoporosis?
• BMD T-score less than -2.0 in absence of risk factors
• BMD T-score below -1.5 in presence of risk factors
What are complications of osteoporosis?
• complications from hip fractures:
- decreased independent living
- depression
- disability
- prolonged hospitalization

• complications from vertebral fractures:
- abdominal protrusion
- chronic back pain
- kyphosis
- loss of height
What are reasons for bone loss in osteoporosis?
• osteoclasts create an excessively deep cavity
• osteblasts fail to refull a normal resorption cavty

* more osteoclast activity than osteoblast activity
What are the 2 essential mineral components of bone?
• calcium
• phosphate
Calcium and phosphate are absorbed and secreted in what portions of the GI tract?
• calcium is absorbed from the upper GI tract (duodenum & upper jejunum) and secreted into the ileum
• phosphate enter systemic ciruculation from the jejunum
What are the major hormones involved in calcium and phosphate regulation?
• Major hormones:
- parathyroid hormone (PTH)
- vitamin D

• Others:
- calcitonin
- glucocorticoids
- gonadal steroids
- growth hormone
- insulin
- prolactin
- thyroid hormone
Hypocalcemia stimulates PTH release from the parathyroid glands. What are the effects of PTH on the body?
• activates osteoclasts and release calcium into the blood, increasing serum Ca++
• increases calcium abdorption through intestine
• enhances activation of vitamin D in the kidney and increases calcium resorption
What are actions of Vitamin D?
• increases intestinal absorption of Ca++ and Phosphate
• decreases excretion through kidney
• increase bone resorption and bone formation
What are effects of Calcitonin?
secreted by thyroid and keeps Ca++ level down
What are effects of glucocorticoids on calcium levels?
stops vitamin D stimualted intestinal transport of Ca++
What are effects of estrogen on bone?
reduces or inhibits action of PTH in stimulating bone resorption
Name and describe the 3 classifications of osteoporosis
• Type I: Postmenopausal
- occurs 3-6 years post menopause
- vertebral, distal radium and increased tooth loss

• Type II: Senile Osteoporosis
- occurs in elderly (age > 70)
- hip, pelvic, & vertebral fractures common
- 2x more common in women

• Type III: Drug or Disease induced Osteoporosis
What are some non-pharmacologic methods of preventing and treating osteoporosis?
• diet
• D/C smoking
• D/C alcohol
• exercise
What is the gold stardard for the prevention and treatment of osteoporosis?
estrogen replacement
What are benefits of estrogen replacement therapy?
• decreases risk of fractures by 50%
• decreases LDL
• effective in prevention
• increases HDL
• prevents resorption
• promotes osteoblasts
What are risks of estrogen replacement therapy?
• bleeding
• breast tenderness
• edema
• headache
• increase risk of endometrial cancer (if used alone w/out progestin)
• increase risk of breast cancer
• stroke
What are contraindications for estrogen replacement therapy?
• abnormal bleeding
• active thromboembolic disease
• known or suspected breast cancer
• liver disease
• migraine headaches
• pregnancy
What are some the different types of estrogen replacement therapies available?
• Conjugated estrogen (Premarin): 0.625 mg for last 12 days of month; use progrestin (metdroxyprogesterone) in women with intact uterus

• Ethinyl estradiol (Estrace): 0.05 mg QD

• Transdermal Estradiol (Climara, Estraderm)
What is the MOA of calcium supplementation therapy?
antiresorptive agent that decrease bone demineralization
What is the recommended dose of supplemental calcium?
• Premenopausal (age 25-50): 1000 mg
• Postmenopausal (age > 50): 1500 mg
What are the different types of calcium supplements and how much calcium is absorbed from each?
• Calcium Carbonate (Oscal): 40%
• Calcium Chloride: 27%
• Calcium Citrate (Citrocal): 21%
• Calcium Gluconate: 9% (less incidence of constipation)
What are adverse effects of calcium supplementation?
• w/ mild hypercalcemia:
- anorexia
- constipation
- fatigue
- nausea/vomiting
- thirst

• w/ serum calcium > 12:
- confusion
- delirium
- EKG changes
- stupor
What are drugs that interact with calcium supplements?
• quinolones (bind to Ca++)
• tetracyclines
What is the MOA of Calcitonin?
inhibits osteoclastic bone resorption
What are available formulations of calcitonin?
• available in human and salmon formulation
• available intranasal or injection
What is the dose of Calcitonin for treatment of osteoporosis?
50-100 IU sub-q/IM (must give w/ calcium)
What are adverse effects of calcitonin?
• anorexia
• diarrhea
• facial flushing
• nausea
What is the MOA of bisphosphonates?
inhibits bone resoprtion
Give examples of biphosphonates
• Alendonate (Fosamax)
• Etidronate
• Ibandronate
• Pamindronate
• Risedronate
Why should biphosphonates be taken on an empty stomach?
• biphosphonates are poorly absorbed because they are highly positively charged
• taking on an empty stomach will increase absorption
What are adverse effects of biphosphonates?
• esophageal ulcerations and erosions (seen most with alendronate)
• GI/diarrhea
• nephrotoxicty (seen w/ Pamindronate IV)
What are clinical uses for biphosphonates?
• hypercalcemia
• osteoporosis
• Paget's disease (etindronate)
Why should Alendronate (Fosamax) be taken with a full glass of water?
to avoid esophageal ulcers and erosions
What is the most active form of Vitamin D?
1,25-oh2D3
What is Calcitrol and when is it used?
• activated form of Vitamin D
• used in renal failure patients to manage hypocalcemia
What is the dose of Calcitrol?
0.23-1 mcg/day
What is the MOA of the Selective Estrogen Receptor Modulators (SERM)?
• partial estrogen agonist effects in bone and lipid metabolism
• partial estrogen antagonist in breast and uterine tissue
Give an example of a SERM
Raloxifene (Evista)
What are effects of Raloxifene (Evista)?
• reduces bone resorption
• reduces bone turnover
• no estrogen-like effects in breasts or uterus
• no change in HDL
• reduces serum LDL and total cholesterol
What is the usual dose of Raloxifene (Evista)?
60 mg QD
What are indications for using Raloxifene (Evista)?
used as an alternative to other forms of therapy, particularly women unable to take or unwilling to take hormone replacement therapy
What are adverse effects of Raloxifene (Evista)?
• chest pain
• hot flashes
• vaginal bleeding
What are contraindications for Raloxifene (Evista)?
• pregnancy
• venous thrombolic events
What is Teriparatide (Forteo) and what is its MOA?
• Teriparatide (Forteo) is an injectable form of human PTH
• MOA: stimulates bone formation in both spine and hip
What are indications for Teriparatide (Forteo)?
• approved for females and males at risk for fractures
• reduces risk of vertebral fractures
What are adverse reactions of Teriparatide (Forteo)?
• dizziness
• nausea/vomiting