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45 Cards in this Set
- Front
- Back
What are the Four Strongest factors that predict fracture risk?
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Low peripheral bone mineral Density (BMD)
Prior fragility fracture Advanced Age Family History of Osteoporosis |
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This injectable has a Black Box warning of sagnificant loss of BMD
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Depo-Prevera
(medroxyprogesterone) |
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Name a couple drugs that may lead to Osteoporosis
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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 |
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what is the drug of choice for glucocorticoid induced osteoporosis
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Bisphosphonates
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What is the gold standard assessment method for Osteoporosis?
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Dual Energy x-ray absorptiometry
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This score is the number of standard deviations from the mean BMD of a healthy young female
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T-score
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This score compares bone mass to a group matched for age, sex, weight, and race
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Z-Score
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Who are candidates for BMD assessments?
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ALL women >65
postmenopausal women <65 with 1 or more risk facors postmenopausal women with fractures without severe trauma Men at high risk |
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What is the diagnosis for a BMD calue within 1 SD of the young adult mean
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Normal
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What is the diagnosis for a BMD value between -1 SD and -2.5 SD below the young adult mean
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Osteopenia
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What is the diagnosis for BMD value at least -2.5 SD below the young adult mean?
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OSTEOPOROSIS!!
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C-terminal and N-terminal telopeptides are biomarkers of what?
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bone resorption
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Byproducts of collagen degredation such as urine deoxypyridinoline are biomarkers of what?
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Bone resorption
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Bone-specific alkaline phosphatase and osteocalcin are biomarkers of what
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Bone Formation
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How would you assess a patient with a Z score of <-2?
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Work-up for secondary osteoporosis:
PTH TSH CBC..etc |
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this form of calcium must be taken with food and can cause constipation
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Ca carbonate
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this for of calcium has good absorption even in an acidic environment
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callcium citrate
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Bisphosphosponates are pregnancy category __
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C
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what is the MOA of Bisphosphonates?
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supress osteoclast mediated bone resorption
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How must Bisphosphonates be administered?
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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 |
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what are classic SE for Bisphosphonates?
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Abdominal pain, dyspepsia,
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In what circumstances would you NOT consider using a bisphosphonate?
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CrCl <35ml/min
Active Bleeding Ulcer GERD Inability to sit up for 30 min |
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HRT may increase the risk of ________
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Cardiovascular events
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T/F Conjugated estrogens have a bone sparing effect when combined with calcium and Vit D and can increase BMD
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TRUE
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T/F studies have proven the use of Fosomax and conjugated estrogens combined unsafe
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FALSE
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HRT is Pregnancy Cetegory __
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X
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T/F HRT must be taken on an empty stomach
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FALSE
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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 |
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When would you not administer HRT to a patient?
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CrCl<35
Active DVT/PE Pregnant Arterial Vascular Disease Risk |
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SERM is pregnancy category ___
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X
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what is the MOA of teriperatide (forteo)?
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stimulates new bone formation of trabecular and cortical bone. stimulates osteoblast activity over osteoclast activity
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Teriperatide SE and BBW
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BBW: Osteosarcoma in rats
Orthostatic hypotension after first dose (take at night) |
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What would you recommend to a male patient with opteoporosis who can not take Bisphosphonates?
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Teriperatide
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What would you recommend for a woman who can not take bisphosphonates?
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SERM
If cant take SERM, give Teriperatide (Forteo) |
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Fosomax dose for Prevention
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35mg once weekly
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Fosamax treatment dose
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70mg once a week or 10mg once daily
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Fosamax dose for Tx glucocorticoid Osteoporosis
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5mg QD
Except 10mg QD for postmenopausal women NOT on HRT |
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Actonel dose for Tx osteoporosis in men
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35mg once weekly
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Actonel dose for Tx and prevention of Glucocorticoid Osteoporosis
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5mg QD
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How much elemental Calcium in calcium Carbonate gets absorbed?
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40%
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How much elemental calcium gets absorbed in Calcium Citrate?
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24%
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Up to how much Vitamin D is recommended daily?
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2000mg daily
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what is the recommended Calcium in an adult <50?
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1000mg
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What is the recommended Calcium intake in adults >50?
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1200mg daily
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what is the recommended Vitamin D intake in adults <50?
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400-800IU
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