Lower Lumbar spine

YES! Hip fractures occur within more severe disease (or bad falls) and can be debilitating. A hip fracture in a woman has a 25% risk of mortality at one year, and is higher in men, since men with osteoporosis are often using long-term steroids or androgen blockers and may be sicker at baseline.

Osteopenia is lower bone density than normal, but not as low as osteoporosis. Osteopenia is defined by a T-score between?

All prescription medicines for low bone density require _____ and ____ supplementation taken concurrently.

Vitamin D is required for calcium absoprtion, and low levels contribute to various health conditions

Caclium! There is an increased risk of heart attack should Vitamin D be used alone!

Steroid Use (long term): is the major drug-contributing factor to poor bone health.

Other medications include:

Anticonvulsants

Warfarin & heparin

Excess thyroid hormone

Loop diuretics

Aromatase inhibitors use for breast CA

Androgen blockers used for prostate CA

Proto Pump inhibitors chornically (decrease calcium absorption due to decreased gastric pH)

Yes. Calcium absorption is saturable; dose should be divided

Better absoprtion

Larger pill to swallow

Can be taken without food

Preferable to little or not stomach acid (such as those taking PPIs which have been shown to increase fracture risk due to impaired calcium carbonate absorption)

Oscal, Tums

Acid-dependent absorption and should be taken with meals

(So, one wouldn't give this with calcium citrate)

YES! Both forms (calcium citrate and calcium carbonate) come in chewable formulations

The 50,000 unit vitamin D2 supplement (the green capsules) are used in ___ ____ or short-term in adults with deficiency to replenigh stores

Vitamin D3

Note: vitamin D2 is often the type in supplements and will provide benefit

Bisphosphonates: increase bone density more than estrogen and raloxifene, and reduce fracture risk

in patients with osteoporosis who are at high risk for having fractures, or have already had an osteoporotic fracutre, or have OP and need to take long-term steroids, or who cannot tolerate bisphophonates

So, basically, it is not first line!

most likelyl not; it is expensive and administered in a doctor's office

NO, not for osteoporosis because of health risks

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If on weekly schedule and missed one dose, take the following morning (but not 2 doses in 1 day)

If on daily schedule missed one dose, skip until next dose

If on monthly Boniva and miss a dose, take it as soon as your remember (in the morning before eating) except if it less than one week to the next dose, skip it (can't take 2 doses in one wek)

Make sure patient is NOT using Zometa since it is the same drug. Immediately after injection, low serum calcium can occur. This is aggravated if on aminoglycosides, and these should not be used concurrently.

It is necessary to take 1500 mg calcium in divided doses (2-3 doses daily) for the 2 weeks after the injection and 1200 mg the rest of the year, and 800 IU vitamin D throughout the year