Term
| What is the goal of OP Tx? |
|
Definition
- Prevent fractures
- Relieve symptoms if a fracture occurs
- Maximize physical Fxn |
|
|
Term
| What is the MoA of bisphosphonates? |
|
Definition
Decrease bone resorption by inhibiting osteoclasts - antiresorptive agents
Slow bone loss
increase BMD
**Efficacy greatest through year 1, plateau at year 5 |
|
|
Term
| What are bisphosphonates also used to treat? |
|
Definition
- Hypercalcemia
- Paget's disease
- Malignancy |
|
|
Term
How should bisphosphonates be taken?
What are contraindications? |
|
Definition
W/o food or any other medication - chelates divalent cations. Drink water
Contraindications: Esophageal dysmotility, untreated hypocalcemia, unable to be upright for 30 min, CrCl < 35. BE CAREFUL WITH GI DISORDERS. |
|
|
Term
| What are AEs of bisphosphonates? |
|
Definition
- GI: Nausea, heartburn, ulceration.
- Muscle pain, transient flu-like s/x w/ IV formulation -- pretreat w/ APAP
- ONJ with some formulations
**D/c most after 5 years, Reclast after 3. |
|
|
Term
|
Definition
Osteonecrosis of the jaw. More common w/ IV formulations - in the mandible.
** Regular exams and inform dental surgeon. |
|
|
Term
| What type of cancer can bisphosphonates cause? |
|
Definition
Esophageal cancer w/ PO agents
Important to remain upright |
|
|
Term
| Why is it important to stop bisphosphonate therapy after 5 years? |
|
Definition
Therapy over 5 years associated with femur fracture.
- high risk for OP - continue therapy |
|
|
Term
| What are the indications and specifics for Alendronate? |
|
Definition
- Prophylaxis: 35 mg QW. Tx: 70 mg QW
- Fosamax + D exists - only for Tx
- Binosto - effervescent tablets. 70 mg QW |
|
|
Term
| What are the indications and specifics for Risendronate? |
|
Definition
- Actonel - 150 mg QM or 35 mg QW. Prevention and Tx.
- Atelvia - 35 mg, EC and delayed release. contains EDTA. ONLY indicated for TX. DIFFERENT inst: take AFTER breakfast w/ water. Do not fast. Remain upright
** Atelvia interacts w/ PPIs |
|
|
Term
| What are the indications and dosing for Ibandronate? |
|
Definition
- Boniva - 150 mg QM for prevention and Tx. Comes in IV formulation q3m.
- More AEs from IV - pretreat w/ APAP
- Different directions: remain upright for 60 minutes. |
|
|
Term
| What is the indication and dosing for Zoledronic Acid? |
|
Definition
- Reclast: 5 mg IV once yearly. Pretreat w/ APAP. Not good in Afib.
**DO NOT USE if CrCl < 35. Check before each dose. |
|
|
Term
| Which OP meds show no effect at the hip? |
|
Definition
Ibandronate/Boniva
Teriparatide/Forteo
Raloxifene/Evista
Calcitonin/Fortical |
|
|
Term
| What is the MoA of Denosumab/Prolia? |
|
Definition
| A human monoclonal antibody - binds to RANKL, RANKL cannot bind to RANK --> osteoclasts cannot be activated. Increase in bone mass, decrease in resorption |
|
|
Term
| What is the indication for Denosumab/Prolia? |
|
Definition
2nd line: Tx of postmenopausal women at high risk for fracture. 60 mg SQ Q6M
- Bring to room temp before use. Do not use in hypocalcemia.
Caution in CrCl < 30. Can cause ONJ. |
|
|
Term
| What formulations for OP can cause ONJ? |
|
Definition
- Denosumab/Prolia
- Bisphosphonates (3rd gen), especially IV. |
|
|
Term
| What is the MoA and indication for Teriparatide/Forteo? |
|
Definition
- MoA: Anabolic, increases osteoblast activity.
- Tx of OP in post-menopausal women and men: 20 mcg SQ QD. $$$$
** DO NOT EVER USE W/ BISPHOSPHONATES. Therapy can follow, but not together.
- use in very low T score
- AE: orthostatic hypotension, black box for osteosarcoma |
|
|
Term
| When can calcitonin/Fortical be considered? |
|
Definition
| When patient can't take anything else. Store in the fridge, upright |
|
|
Term
| What is the indication and dose for Raloxifene/Evista? |
|
Definition
Anti-resorptive, for prevention and Tx of OP: 60 mg QD. No significant BMD seen in hip
- also decreases LDL and risk of breast cancer. Increased risk of VTE |
|
|
Term
| What foods are high in calcium? |
|
Definition
Dairy products
Breakfast cereals
Fortified OJ and cranberry juice
Salmon, sardines w/ bones
Beans, broccoli, greens, almonds |
|
|
Term
| What age group needs the most calcium? |
|
Definition
|
|
Term
| When should calcium supplements be considered? |
|
Definition
If dietary calcium is not being met. Divide doses and take w/ meals.
Causes GI upset, kidney stones. |
|
|
Term
| What calcium salts are available? |
|
Definition
- Calcium Carbonate - better abs w/ food, poor choice in the elderly, w/ PPI
- Calcium Citrate - more expensive, can take w/o food. A better choice in the elderly or w/ PPIs |
|
|
Term
| What are concerns w/ calcium supplements? |
|
Definition
- Decreases absorption of quinolones, tetracyclines, levothyroxine, bisphosphonates, phenytoin, iron
- Absorption is decreased w/ fiber
- Carbonate formulation - do not take w/ PPIs
** Hypercalcemia - rarely seen unless in renal failure. |
|
|
Term
| What are some hot topics associated w/ calcium supplements? |
|
Definition
| - May increase risk of MI by 30%. Keep within RD |
|
|
Term
| What foods contain vitamin D? |
|
Definition
- Fortified milk and OJ
- Fatty fish
- Eggs |
|
|
Term
| What causes Vit D deficiency? |
|
Definition
- Limited exposure to the sun
- Adults >70 cannot convert to D3
- Decreased renal function |
|
|
Term
| What are the ranges for Vit D? |
|
Definition
- Deficiency - < 20 --> hypocalcemia and demineralization of bones
- Preferred - 30-60
- Normal - 20-100
- Toxic >150 |
|
|
Term
| What is ergocalciferol and how is it used? |
|
Definition
Vit D2
- 800 IU/day for prevention
- 50,000 IU QW for deficiency for 6-8 weeks |
|
|
Term
| What is cholecalciferol and how is it used? |
|
Definition
D3, the otc product. 400-50,000 IU
400 IU recommended for children
- Dose for prevention - 800 - 1000 IU |
|
|
Term
| What can Vit D help prevent? |
|
Definition
- Falls/Fractures - at least 800 IU
- Cancer
- Heart Disease |
|
|
