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55 Cards in this Set
- Front
- Back
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what are predicotors of low bone mass in women and men
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WOMEN:
femal gender <127 lbs estrogen deficiency MEN: hypogonadism glucocorticoid use hyperparathyroidism in both you have: alcohol use smoking family history |
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what is the loss of trabecular and corticol bone due to
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trabecular - loss due to hormone deficiency
corticol - loss due to aging or immobilization |
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what type of bone "once lost cannot be replaced"
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trabecular
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what are some drugs that can cause secondary osteoporosis
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anticonvulsants
glucocorticoids thyroxine depo provera excessive EtOH GnRH agonist |
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what is the greatest predictor of fracture risk
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bone density
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what type of score (T score or Z score), compares pt BMD to that of normal young adults
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T score
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what are the T score values for
normal osteopenia osteoporosis |
normal >=-1
osteopenia -1.1 to -2.4 osteoporosis <-2.5 |
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what type of score (T score or Z score), compares pt BMD to that of subjects of the same age and sex
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Z score
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A Z score of what should make you suspect 2ndary cause of osteoporosis
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-2
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whose BMD should be tested
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all women > 65
post menopausal women <65 all men > 70 |
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DEXA scan measure BMD in what bones
Ultrasound measure BMD in what bones |
DEXA scan measures BMD in:
spine, hip, wrist Ultrasound measures BMD in: heal, patella, wrist, fingers |
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under the WHO criteria what are some RF for osteoporosis
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excessive alcohol intake
smoking glucocorticoid use rheumatoid arthritis race/ethnicity sex age BMI parent history of hip fracture |
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what are the FRAX percentiles that classify a patient as being osteoporotic
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10 year risk of hip fracture > 3%
10 year risk of any type of fracture > 20% |
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what are non pharmacological preventive measures for osteoporosis
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smoke cessation
minimize caffeine (<2 servings) minimize EtOH (1/d women 2/d men) minimize sodium (<2400mg/d) fall prevention |
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what are the nonpharmacologic therapy for osteoporosis
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bone healthy lifestyle
healthy diet exercise NUTRITION -protein (too much increases Ca excretion too little increases PTH) -vegeterian (tend not to get enough protein) -phosphates (too much decreases Ca and increases PTH) VitK (low intake ^ fracture risk) Vit A (excess ^ fracture risk) |
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why is swimming and water aerobics not recommended as non pharmacologic therapy
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no impact on bones to slow mineral loss
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what is the recommended dietary intake of Vit D
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birth - 12 months 400 IU/d
1 year - 70 years 600 IU/d >70 years 800 IU/d |
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what is hte recommended dietary calcium intake for
birth - 6 months 6 months - 12 months 1 years - 3 years 4-8 years 9-18 years 19-50 years 51-70 years > 70 years |
birth - 6 months: 200 mg/day
6 months - 12 months 260 mg/day 1 years - 3 years 700 mg/day 4-8 years 1000 mg/day 9-18 years 1300 mg/day 19-50 years 1000 mg/day 51-70 years 1200 mg/day (1000mg/day men) > 70 years 1200 mg/day |
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what source of calcium must be given with food and what form of calcium may be taken by patients on PPI or H2 blockers
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Calcium carbonate must be taken with food to increase absorption
Calcium citrate may be taken by patients on PPI or H2 blockers or have low acid secretions (elderly) |
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what is the max amount of Ca that can be taken at a time and what is the max daily amount
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500 mg max at one time
2000 mg max daily |
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if a patient presents with Vit D concentration of 30-100 ng/ml what is the recommended therapy
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OTC therapy: Vit D3 600-800 IU/day
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if a patient presents with Vit D concentrations of 21-29 ng/ml what is the recommended therapy
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OTC therapy: Vit D3 1000-4000 IU/day
Rx therapy: Vit D2 50,000 IU/week for 8-12 weeks |
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if a patient presents with Vit D concentrations <20 what is the recommended therapy
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Rx therapy: Vit D2 50,000 IU 1-2 weeks for 8-12 weeks
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a bottle reads 5% Vit D per serving what is the amount of Vit D/serving in IU
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5% x 4 = 20 IU/serving
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what T scores would require treatment
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T score < -2.5
T score of -1 to -2.5 with: 10 year risk of hip fracture >3% or 10 year risk of any fracture > 20% |
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what drugs are used to prevent osteoporosis
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Calcium + Vit D
ERT/HRT Risendronate Ibandronate Alendronatae Zoledronic acid Raloxifene |
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what drugs are used to treat osteoporosis
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calcium + vit d
risendronate ibandronate alendronate raloxifene denosumab teriparatide |
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what are the disadvantages of ERT
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increase risk of uterine cancer
increased risk of thromboembolic events |
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what are the advantages of Raloxifene
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can be used in women with estrogen dependent cancers
good alternative for women who can't take bisphosphonates |
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what are the disadvantages of raloxifene
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risk of thromboembolic events
doesn't treat post menopausal symptoms |
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due to Raloxifene black box warning (slight increase in fatal strokes) what women would be bad candidates
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high risk for stroke
coronary artery disease A fib |
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what bisphosphonates are indicated to treat male osteoporosis
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zolidronic acid
alendronate risendronate |
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how are bisphosphonates taken
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1st thing in the morning with no food or other meds for 30 mins (1hr for monthly ibandronate)
delayed release risendronate (activa) should be taken right after breakfast |
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what are some pt counseling points for bisphosphonate use
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don't lie down for 30 mins (1hr with month ibandronate) after taking
avoid Ca, Al, and Mg meds for 4 hrs |
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Jane missed her weekly dose of Alendronate when should she take it
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weekly - take the next day
-need 5 days between doses so changes dosing schedule |
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Jane missed her monthly dose of Ibandronate when should she take it
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monthy - take as soon as remembered
-need 7 days between doses so no need to change dosing schedule |
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what drug for treatment of osteoporosis is contraindicated in ESRD
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bisphosphonates
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what drugs have a black box warning of OSTEONECROSIS OF THE JAW
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bisphosphonates
denosumab |
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how long is calcitonin treatment
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4 weeks
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who is eligible for calcitonin treatment
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given within 5 years of a woman starting menopause
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what is the duration of therapy of denosumab
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3 years
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what are the contraindications for use of Teriparatide
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hypercalcemia
paget's disease bone cancer |
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what is the duration of therapy of teriparatide
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2 years
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what is the black box warning of teriparatide
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osteosarcoma
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what agent can't be used to treat post menopausal w/ osteoporosis
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ERT/HRT
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what agents can't be used to prevent postmenopausal osteoporosis
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calcitonin
denosumab teriperitide |
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what agent can treat hypogonadal osteoporosis in men
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teriparatide
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what agents can treat osteoporosis in men
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zolidronic acid
alendronate risendronate |
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what agents can treat glucocorticoid induced osteoporosis in men
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zolidronic acid
alendronate risendronate teriparatide |
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what agents can be used to prevent glucocorticoid induced osteoporosis
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zolidronic acid
risendronate |
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what agent can be used in secondary prevention
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zolidronic acid
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based on the treatment algorithm
patient has a T score > -1.0 what do you do |
bone healthy lifestyle
calicum 1200 mg/day Vit D 800-1000 mg/day |
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based on the treatment algorithm
T score -1.1 to -2.4 10 year risk of hip fracture <3% 10 year risk of other fractures < 20% |
bone healthy lifestyle
calicum 1200 mg/day Vit D 800-1000 mg/day preventive therapy can be considered |
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based on the treatment algorithm
patient has a T score <-2.5 or T score -1.1 to -2.4 w/ 10 year risk of hip fractures > 3% 10 year risk of other fractures >20% |
bone healthy lifestyle
calicum 1200 mg/day Vit D 800-1000 mg/day 1st line: oral bisphosphonates 2nd line: IV bisphosphonates 3rd line: teriparatide or raloxifene 4th line: intranasal calcitonin |
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based on the treatment algorithm
presence of low trauma fracture (vertebrae or hip) |
bone healthy lifestyle
calicum 1200 mg/day Vit D 800-1000 mg/day 1st line: oral bisphosphonates 2nd line: IV bisphosphonates 3rd line: teriparatide 4th line: raloxifene 5th line: intranasal calcitonin |
