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Osteoporosis

Terms in this set (36)

What is Paget Disease?
disorganized bone formation. It results in enlarged or mishappen bones and is limited to one or a few bones. Patients experience bone pain, deformities, and fractures.
What is osteomalacia? (what is it called in children?)
softening of the bones that is typically due to Vitamin D deficiency. In children this is referred to a rickets. "Soft" bones loose strength and bow under the weight of the body.
Bone resorption occur via what type of cells?
Osteoclasts
Bone building occurs via what type of cells?
Osteoblasts
MOA of Bone Mineralization
crystals of calcium phosphate (hydroxyapatite) are deposited in the matrix.
Prevention of Osteoporosis (Supplements)
•Adequate intake of Calcium (1200 mg) & Vitamin D (800 IU)
•Calcium carbonate or Calcium citrate
Drugs that cannot be taken with Calcium
Iron, thyroid replacement, FQ & tetracycline ABs - separate by a few hours
Vitamin D supplements
cholecalciferol (D3), ergocalciferol (D2)
Prevention of Osteoporosis lifestyle modifications
•Exercise
•Smoking cessation & limited alcohol
•Avoid drugs that increase bone loss
When is pharmacologic therapy for osteoporosis indicated?
•in postmenopausal women or men > 50 with:
•Previous osteoporotic fracture
•Bone mineral density 2.5 SD below a healthy young adult
Osteopenia with high probability of future fractures
MOA of Bisphosphonates
•Bind to Hydroxyapatite crystals & decrease bone resorption
•Modest increase in bone mass
DOC for postmenopausal osteoporosis
Bisphosphonates
DOC for osteoporosis in men
Bisphosphonates
Name the Bisphosphonates
Alendronate
Risedronate
Ibandronate
Zoledronic acid
Pamidronate
RF for Osteoporosis in Men
Hypogonadism

Testosterone can be used to improve BMD in patients with deficiency.
Bisphosphonates that can be given IV
Iban and Zole
Instructions on how to take Bisphosphonates
•With 6-8 ounces of water
•At least 30 minutes BEFORE any food, other drink, or meds (60 min for iban) .... Risedronate: take immediately AFTER breakfast.
•Remain upright for 30 minutes after taking (60 min for iban)
How are bisphosphonates cleared?
By the kidney - avoid in severe renal impairment
What factors significant effect absorption of bisphosphonates?
Food and medications - compliance is important
Which bisphosphonates are associated with gastric ulcers and esophagitis?
Alendronate
Ibandronate
Risedronate
How to minimize the possibility of developing esophagitis when taking Ibandronate?
Remain upright for 60 minutes (30 minutes for others)
When is a drug holiday recommended for bisphosphonates?
After 5 years of therapy (3 with Zoledronic acid)
Rare ADE of Bisphosphonates
Osteonecrosis of jaw and atypical fxs

Associated with long term use
MOA of Denosumab
•Monoclonal antibodies that inhibits RANKL (Receptor Activator of Nuclear factor Kappa-B Ligand)
•Inhibits Osteoclast formation and function
Indications for Denosumab
•Use: 1st line for postmenopausal osteoporosis in women at high risk of fracture
Administration of Denosumab
Subcutaneous injection every 6 months
ADE of Denosumab
•Increased risk of infection, dermatologic reactions, hypocalcemia
•Rarely Osteonecrosis of the jaw & Atypical fractures
What are the Parathyroid Agents
include Teriparatide & Abaloparatide
MOA of Teriparatide & Abaloparatide
•Agonists at the Parathyroid hormone receptor
•Stimulate activity of Osteoblasts
Indications for Teriparatide & Abaloparatide
•Postmenopausal osteoporosis, osteoporosis in men, Osteoporosis d/t glucocorticoids
Reserved for patients at high risk for fracture who cannot tolerate or have failed other therapies

Not first line
Why are Teriparatide & Abaloparatide limited to 2 years use?
Possibly carcinogenic
Teriparatide & Abaloparatide ADE
•Hypercalcemia, orthostatic hypotension - administer first dose lying down
MOA of Raloxifene
•Estrogen-like effects on bone
•Estrogen-antagonist on breast & endometrial tissue
Indications for Raloxifene
•Alternative in postmenopausal osteoporosis
ADE of Raloxifene
Hot flashes, leg cramps, increased risk of VTE
Why is Estrogen replacement no longer used for osteoporosis?
Increased risk for Endometrial cancer, Breast cancer, VTE, Stroke, Coronary events
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