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16 Cards in this Set

  • Front
  • Back
Osteoporosis

Definition
low bone mineral density

deterioration of bone tissue

increasing fragility of bone

risk of fracture

osteoblasts - build bone
osteoclasts - clear bone
Osteoporosis

diagnosis Tscores
WHO T scores
osteopenia -1 to -2.5
osteoporosis < 2.5

AACE (am ass of clinical endocrinolgst)
- initiate tx when
*t score < -2 and no RFs
*t score < -1.5 w/ RFs
Osteoporosis

Risk Factors
advanced age
cigarette smoking
estrogen deficiency
fam hx
longterm CS use
low testosterone in med
small frame
plus a ton more
Osteoporosis

Treatment principles
adequate Ca and vit D intake
- Ca 1 to 1.5g/day
* can absorb 500mg at a time
* Carbonate has most elemental Ca
* Carbonate absorbed better w/food
* Citrate w/ or w/o food
- Vit D 800IU/day
Osteoporosis

Drug Tx
Ca + Vit D

Bisphosphonates
- alendronate (Fosamax)
- risedronate (Actonel)

ERT
- many, many preps
- estrogen alone or combo w/progestin

Selective Estrogen R Modulator
- raloxifene (Evista)

Others
- calcitonin (Miacalcin) IN, SC, IM (qd)
- teriparatide (Forteo) injection (qd)
Osteoporosis

bisphosphonates

moa, pt counseling, interactions
MOA
- incorporates into bone to stabilize

Pt counseling
- take w/full glass of water 30 min b/f
first meal
- stay uproght for 30 min

Interactions
- separate from Ca sups and
antacids by 1 hour
- ranitidine inc absorb 2 fold
Osteoporosis

ERT - CIs
VTE

breast or endometrial cancer

pregnancy

genital bleeding
Osteoporosis

SERM (raloxifine)

moa, pt counseling
Evista

MOA
- dec resorption of bone and turnover

pt counseling
- take w or w/o food
- will not treat postmenopausal SX
Osteoporosis

Calcitonin

MOA, pt counseling
MOA - inhibits bone resorption

PT couneling
- injection or nasal spray
- take qd
- store in fridge
Osteoporosis

teriparatide (Para thyroid hormone) PTH

moa
inc rate of bone formation by inc birth rate of osteoblasts
osteoporosis

should do wt bearing exercises?
yes

will reduce falls and fractures
Does calcium prevent fractures?
No

WHI
-builds bone
-doesn't reduce fractures
When should BMD testing be recommended?
-all post menopausal women > 65
- < 65 if have 1 or more RFs
Should Ca supp be recommended if pt taking Rx Tx for osteoporosis?
Yes - if diet not adequate
What are first line treatments (RX)?
bisphosphonates

raloxifene

calcitonin

PTH
What is the indication for ERT wrt to osteoporosis?
Prevention NOT treatment