Term
| WHO Osteoporosis Definitions |
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Definition
Normal- Bone mineral density (BMD) within 1 SD of young adult mean
osteopenia- BMD between -1 SD and -2.5 SD below the young adult mean
osteoporosis- BMD at least -2.5 below the young adult mean |
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Term
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Definition
• Reducetheriskoftotalfractures,butdonot prevent hip fractures
• Adverseeffects:kidneystones,gastrointestinal disturbances, and may cause small increase in risk of myocardial infarction and stroke
• Dietarysourcesofcalciumhavenotbeen associated with cardiovascular risk
• **Emphasize dietary sources of calcium over supplementation |
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Term
| Calcium Supplements types and info |
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Definition
Calcium Carbonate
• Least expensive
• Take with food
• H2-antagonists and proton pump inhibitors may impair
absorption
• 1250mg tablet contains 500mg elemental calcium
Calcium Citrate
• Take irrespective of meals
• 950mg tablet contains 200mg elemental calcium |
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Term
| Diuretic Effects on Calcium |
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Definition
Thiazide Diuretics ↑ Ca Increase in bone density causes a reduction in incidence of hip fractures (less sodium will be going into the cell so less Ca will leave)
Loop Diuretics ↓ Ca Decrease in bone density and increase risk of hip fractures (dec Na, K, Cl into cell, divalent ion loss) |
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Term
| Vitamin D Metabolites and Analogs MOA AE Monitoring |
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Definition
• MOA: stimulate intestinal absorption of calcium and phosphate, renal resorption of phosphate
• Adverse effects: hypercalcemia, hypercalciuria
• Monitoring: bone mineral density (BMD), serum calcium, phosphorus, SCr, BUN |
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Term
| Vitamin D Metabolites and Analogs agents |
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Definition
| Cholecalciferol/ Vitamin D3, Ergocalciferol/ Vitamin D2 |
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Term
| Bisphosphonates MOA Monitoring |
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Definition
• MOA: inhibit bone resorption by suppressing osteoclasts
• Monitoring: BMD, calcium level
• Avoid in renal failure
• Oral bisphosphonates irritate gastrointestinal mucosa— patients should take on an empty stomach and must stay upright for at least 30–60 minutes after dose and until first meal of the day
• Space out from calcium supplements |
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Term
| bisphosphonate agents and comments |
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Definition
| Fosamax (alendronate-i draw on nate, Actonel (risedronate- rice drawn on nate), Boniva (ibandronate- iBand on nate)- only approved for postmenopausal females), Reclast (zoledronate- zoey desconele or nate) only IV + least frequent administration, mostly for post menopausal females except reclas |
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Term
| Miacalcin (Calcitonin) MOA Monitoring |
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Definition
for postmenopausal females
• MOA:similartoendogenouscalcitonin,inhibits osteoclasts, decreases renal absorption of calcium, phosphate, magnesium, potassium
• Monitoring: BMD, serum calcium, phosphorus |
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Term
| Recombinant Parathyroid Hormone agent |
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Definition
| Forteo (teriparatide- terrible party time) |
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Term
| Forteo (teriparatide) MOA Monitoring |
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Definition
• MOA: recombinant parathyroid hormone, which stimulates osteoblasts, increases GI absorption of calcium, renal reabsorption of calcium
• Monitoring: BMD, serum calcium, phosphorus, uric acid, blood pressure
• Administer first dose with patient sitting or laying down due to risk of orthostasis |
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Term
| Selective Estrogen Receptor Modulators agent |
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Definition
| Evista (Raloxifene- ralph ox if needed) |
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Term
| Evista (Raloxifene) MOA Monitoring |
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Definition
| • MOA: inhibits bone resorption through modulation of some estrogen receptors• Monitoring: BMD, lipid profile |
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Term
| Hormones agents and comments |
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Definition
Forteo (teriparatide- terrible party time) Hypercalcemia and hypercalciuria;
osteosarcoma reported in animals; administer first dose with patient sitting or laying down (risk of orthostasis)
Miacalcin (calcitonin) Rhinitis with nasal spray
Evista (raloxifene- ralph ox if needed) Peripheral edema, rare venothromboembolism |
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Term
| Rank Ligand Inhibitor agent |
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Definition
| Prolia (Denosumab- dens are for mobs) |
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Term
| Prolia (Denosumab) MOA Monitoring |
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Definition
• MOA: monoclonal antibody which prevents RANKL- stimulated osteoclast differentiation and function
• Monitoring: BMD, SCr, serum calcium, phosphorus, magnesium, chronic back pain
• Use caution in severe renal impairment (CrCl <30ml/min) |
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Term
| Monoclonal Antibodies agent and comments |
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Definition
| Prolia (denosumab- dens are for mobs) Monoclonal antibody; dermatologic reactions |
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Term
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Definition
• Historically used as an anabolic agent for treatment of postmenopausal osteoporosis
• MOA:
• Stimulate osteoblast activity and increase bone formation
-narrow therapeutic window |
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Term
AE:
• Long-term toxicities:
• Skeletal fluorosis
• Abnormal bone mineralization
• Treatment of osteoporosis with monotherapy fluoride does not reduce fracture risk |
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Definition
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Term
| osteoporosis treatment efficacy graph |
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Definition
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Term
| Medication-Induced Bone Loss |
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Definition
• Corticosteroids
• Selective serotonin release inhibitors (SSRI)
• Enzyme-inducing anticonvulsants (e.g., phenytoin)
• Proton pump inhibitors (PPI)
• Aluminum
• Lithium
• Calcineurin inhibitors
• Methotrexate
• Thiazolidinediones (e.g. pioglitazone) |
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Term
| General Recommendations: Postmenopausal Women and Men >50 Years Old |
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Definition
• Emphasizefruitsandvegetablesandensure adequate calcium in diet
• EnsureadequatevitaminDintakebydietary supplements if necessary
• Recommendweight-bearingandmuscle- strengthening exercises
• Assessfallriskandmitigateanyrisksidentified
• Avoidtobaccouseandexcessivealcoholintake
• Measure height annually |
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Term
| Initiation of osteoporosis treatment |
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Definition
• Osteopenia or history of hip or vertebral fractures (including asymptomatic)
• T-score • Postmenopausal women or men over 50 years old with T- score -1 to -2.5 at femoral neck, total hip or lumbar spine as measured by DXA who have a 10-year hip fracture probability of at least 3% or a 10-year major osteoporosis-related fracture probability of at least 20%
• Use US-adapted WHO absolute fracture risk model (FRAX®):www.NOF.org |
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Term
| osteoporosis treatment algorithm diagram |
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Definition
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Term
| Which medication below is the most effective treatment for osteoporosis as measured by the relative increase in lumbar spine bone mineral density? |
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Definition
| Teriparatide (terrible party time) |
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Term
| • Adverse effects: dyspepsia, arthralgia, back pain, adynamic bone, rare osteonecrosis and fractures |
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Definition
Bisphosphonates
Fosamax (alendronate, Actonel (risedronate), Boniva Fosamax (alendronate-i draw on nate, Actonel (risedronate- rice drawn on nate), Boniva (ibandronate- iBand on nate)- only approved for postmenopausal females), Reclast (zoledronate- zoey desconele or nate) only IV + least frequent administration, mostly for post menopausal females except reclas |
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Term
| • Adverseeffects:nausea,flushing,rhinitiswith nasal spray |
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Definition
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Term
| • Adverse effects: dizziness, insomnia, depression, nausea, arthralgia, weakness, rhinitis, hypercalcemia, hypercalciuria, orthostasis, osteosarcoma reported in animals |
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Definition
| Forteo (teriparatide- terrible party time) |
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Term
| • Adverse effects: peripheral edema, hot flashes, arthralgia, rare venous thromboembolism |
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Definition
| Evista (Raloxifene- ralph ox if needed) |
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Term
• Adverse effects: dermatitis, eczema, rash, arthralgia, may increase risk of infection, rare osteonecrosis
of the jaw |
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Definition
| Prolia (Denosumab- dens are for mobs) |
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