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45 Cards in this Set

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What are the Four Strongest factors that predict fracture risk?
Low peripheral bone mineral Density (BMD)

Prior fragility fracture

Advanced Age

Family History of Osteoporosis
This injectable has a Black Box warning of sagnificant loss of BMD
Depo-Prevera
(medroxyprogesterone)
Name a couple drugs that may lead to Osteoporosis
Phenobarbital and Phenytoin :interfere with Vitamin D metabolism

Systemic Glucocorticoids (Exceding > 5mg of prednisone daily) b/c of decreased Ca absorption and dec estrogen and testosterone
what is the drug of choice for glucocorticoid induced osteoporosis
Bisphosphonates
What is the gold standard assessment method for Osteoporosis?
Dual Energy x-ray absorptiometry
This score is the number of standard deviations from the mean BMD of a healthy young female
T-score
This score compares bone mass to a group matched for age, sex, weight, and race
Z-Score
Who are candidates for BMD assessments?
ALL women >65

postmenopausal women <65 with 1 or more risk facors

postmenopausal women with fractures without severe trauma

Men at high risk
What is the diagnosis for a BMD calue within 1 SD of the young adult mean
Normal
What is the diagnosis for a BMD value between -1 SD and -2.5 SD below the young adult mean
Osteopenia
What is the diagnosis for BMD value at least -2.5 SD below the young adult mean?
OSTEOPOROSIS!!
C-terminal and N-terminal telopeptides are biomarkers of what?
bone resorption
Byproducts of collagen degredation such as urine deoxypyridinoline are biomarkers of what?
Bone resorption
Bone-specific alkaline phosphatase and osteocalcin are biomarkers of what
Bone Formation
How would you assess a patient with a Z score of <-2?
Work-up for secondary osteoporosis:
PTH TSH CBC..etc
this form of calcium must be taken with food and can cause constipation
Ca carbonate
this for of calcium has good absorption even in an acidic environment
callcium citrate
Bisphosphosponates are pregnancy category __
C
what is the MOA of Bisphosphonates?
supress osteoclast mediated bone resorption
How must Bisphosphonates be administered?
30-60min before first food

drink w 6-8 oz of water

avoid gastroesophageal irritation by standing or sitting upward for at least 30 min
what are classic SE for Bisphosphonates?
Abdominal pain, dyspepsia,
In what circumstances would you NOT consider using a bisphosphonate?
CrCl <35ml/min
Active Bleeding Ulcer
GERD
Inability to sit up for 30 min
HRT may increase the risk of ________
Cardiovascular events
T/F Conjugated estrogens have a bone sparing effect when combined with calcium and Vit D and can increase BMD
TRUE
T/F studies have proven the use of Fosomax and conjugated estrogens combined unsafe
FALSE
HRT is Pregnancy Cetegory __
X
T/F HRT must be taken on an empty stomach
FALSE
what are the SE of HRT?

BBW
edema, leg cramps, migraine

BBW for increased risk of MI, stroke, DVT/PE in postmenopausal women 50-79
When would you not administer HRT to a patient?
CrCl<35

Active DVT/PE

Pregnant

Arterial Vascular Disease Risk
SERM is pregnancy category ___
X
what is the MOA of teriperatide (forteo)?
stimulates new bone formation of trabecular and cortical bone. stimulates osteoblast activity over osteoclast activity
Teriperatide SE and BBW
BBW: Osteosarcoma in rats

Orthostatic hypotension after first dose (take at night)
What would you recommend to a male patient with opteoporosis who can not take Bisphosphonates?
Teriperatide
What would you recommend for a woman who can not take bisphosphonates?
SERM

If cant take SERM, give Teriperatide (Forteo)
Fosomax dose for Prevention
35mg once weekly
Fosamax treatment dose
70mg once a week or 10mg once daily
Fosamax dose for Tx glucocorticoid Osteoporosis
5mg QD

Except 10mg QD for postmenopausal women NOT on HRT
Actonel dose for Tx osteoporosis in men
35mg once weekly
Actonel dose for Tx and prevention of Glucocorticoid Osteoporosis
5mg QD
How much elemental Calcium in calcium Carbonate gets absorbed?
40%
How much elemental calcium gets absorbed in Calcium Citrate?
24%
Up to how much Vitamin D is recommended daily?
2000mg daily
what is the recommended Calcium in an adult <50?
1000mg
What is the recommended Calcium intake in adults >50?
1200mg daily
what is the recommended Vitamin D intake in adults <50?
400-800IU