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51 Cards in this Set
- Front
- Back
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What is osteopenia?
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BMD between -1 and -2.5 SD below young adult mean
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What is osteoporosis?
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BMD of at least -2.5 SD below the young adult mean
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What are risk factors for osteoporosis?
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female, white, poor nutrition, early menopause, prolonged premenstrual amenorrhea,estrogen deficiency, low BMI, family Hx,decrease Calcium and Vit D. smoking, sedentary lifestyle, Alcholism,dementia, previous fractures, hx of falls, drugs
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What drugs can cause osteoporosis?
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glucocorticoids, heparin, anticonvulsants, excessive levothyroxine
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Who should have BMD done?
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All females 65 and older
All postmenopausal women with medical cause of bone loss Post menopausal women younger than 65 with: -previous fracture after menopause other than skull, facial bone, ankle, finger, toe -BMI less than 21 or 127 pounds, hx of hip fracture in parent, current smoking -any osteoporosis risk factor |
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What are the treatment goals for osteoporosis?
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-optimize skeletal development and maximize peak bone mass at skeletal maturity
-prevent age-related and secondary causes of bone loss -preserve structural intergrity of the skeleton -prevent fractures -maximize physical function |
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What is the non-pharmacological treatment for osteoporosis?
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-avoid smoking
- consume alcohol in moderation -adequate Calcium and Vit D intake -regular weight-bearing and muscle-strengthing exercise |
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What are the ADEs of calcium?
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flatulence, constipation, hypercalciuria( dose >2g/day)
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What is the recommended dose of calcium for post menopausal women (>5 years)?
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500-1000mg/day
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What is the recommended dose of calcium fro those aged 19-50? >50?
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19-50: 1000mg
> 5om: 1200mg |
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What is the recommended dose of calcium for those with established osteoporosis, >65, and on glucocorticoids?
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1500mg
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What is Vit D MOA?
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It increases the absorption of calcium into bone
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What is the recommended dose of Vit D?
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400-800 IU/day
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How long should Vit D be taken?
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indefinately
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When do you treat osteoporosis?
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BMD score < -2.5 in absence of risk factors
BMD score <-1.5 with at least one risk factor -THIS IS CONTROVERSIAL |
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When is estrogen indicated in osteoporosis?
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for the treatment of moderate to severe menopause symptoms
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How much does it reduce hip fracture? Vertebral fracture?
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Hip: 25%
Vertebral 50% |
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Does estrogen restore bone loss?
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It reduces the rate of resorption but does not restore bone loss
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What is a risk of estrogen?
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It increases the risk of CV outcomes
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Why is progesterone used in the treatment of osteoporosis?
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It enhances estrogen prophylaxis of osteoporosis
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The combo of progesterone/estrogen (Prempro) reduces hip fracture by how much? other fractures?
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Hip: 33%
others: 24% |
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What are the bisphosphonates used to treat osteoporosis?
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alendronate
risedronate ibandronate zoledronic acid |
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What are bisphosphonates MOA?
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they inhibit osteoclast-mediated bone resorption and activity
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What are bisphosphonates ADEs?
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N/V/D/C , abdominal ain, indigestion, H/A, HTN(Ibandronate)
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What is the bisphosphonates absorption, metabolism, and elimination?
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Absorption: fee dec. oral bioavailability
Meta: NONE Elimination:Renal |
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What are bisphosphonates drug interactions?
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No severe/significant ones; though calcium can decrease absoprtion of risedronate and ibandronate
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How must a bisphosphonate be taken?
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On an empty stomach 30min prior to meals with 6-8oz of water; then the patient must remain upright for at least 30 min after adminstrtation and until after 1st meal of the day
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What is the dosing for alendronate and risedronate?
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Orally in daily or once weekly formulation
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What is the dosing fro ibandronate?
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Orally (daily or monthly)
IV(q 3 months) |
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What is Zoledronic Acids MOA?
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inhibits osteoclastic bone resorption
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What is Zoledronic Acid ADE?
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Inj. site rxn, asthenia, H/A, fever, flu-like symptoms,
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What are Zoledronic Acid's pharmacokinetics?
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Metasbolism: hepatic
Elimination: Renal |
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What are the drug interactions of Zoledronic acid?
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No significant ones ID'd
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How is Zoledronic Acid dosed?
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IV infusion once yearly
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What is Raloxifene MOA?
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Selectively activates and blocks estrogenic pathways by binding to specific estrogen receptors , reduces bone resorption and increases BMD, lowers TC and LDL
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What are the ADEs of Raloxifene?
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Hot sweats
Leg cramps |
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What are the pharmacokinetics of Raloxifene?
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Absorption: Rapid
Metabolism: Hepatic Elimination: Fecal |
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What are the drug interactions of Raloxifene?
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No significant ones
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Why is there a BBW with Raloxifene?
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inc. risk of DVT/ PE
there is an increased risk of death due to stroke in postmenopausal women w. hx of CHD or at inc. risk for major coronary events |
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Who should Raloxifene be avoided in?
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Women with active hx of VTE,
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What is Calcitonin MOA?
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recombinant parathyroid hormone, reduces the number of osteoclasts and prevents resorptive activity of the bone -> decreased bone turnover rate, inc bone formation by inc osteoblastic activity
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What is Calcitonin ADEs?
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Flushing, N/V (inj)
rhinitis (nasal) |
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What are the pharmacokinetics of calcitonin?
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Absorptopn (Nasal peak in 30 min) (Injection peak in 20 min)
Metabolism: Renal and blood Elimination: Renal |
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What are the drug interactions of calcitonin?
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No significant ones
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What is Teriparatide MOA?
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Stimulates new bone formation by stimulating osteoblastic activity and inc bone formation markers
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What are the ADEs of Teriparatide?
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Hypotension, syncope, rash, sweating symptom, hyperuricemia, N/V/D/C, indigestion, arthralgia, pharyngitis, rhinitis
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What aret he pharmacokinetics of Teriparatide?
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Absorption: systemic
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What are the drug interactions of teriparatide?
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None ID'd yet
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How is teriparatide adminstered?
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SubQ qday
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What is the BBW for teriparatide?
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Inc incidence of osteosarcoma dependant on dose and treatment duration in rat studies
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Who should not recieve teriparatide?
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patients at increased risk for osteosarcoma, (Pagets dz, unexplained AlkPhos elevations)
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