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What does osteopenia mean?
low bone mass
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What do osteoclasts do?
Build and reabsorb bone.
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When does osteoporosis develop?
when osteoclasts absorb more than they build
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Bone mass is at its maximum at ___ years. After this bone mass is removed faster than it is formed.
30
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What are some risk factors for developing osteoporosis?
- 1. smoking
- 2. ETOH
- 3. Lack of estrogen
- 4. Body weight <127, BMI <21
- 5. thyroid replacement therapy
- 6. diet low in CA and Vit D
- 7. hx of organ transplant
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What is the standard diagnostic tool that provides the most precise T-scores?
- DXA
- dual energy x-ray absorptiometry
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What is a T-score?
It is the number of SDs (standard deviations) above the mean BMD (bone mineral density) for women younger than 35
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What would a t-score of -1 mean?
10-12% loss of bone mass
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What would be your diagnosis based on these t-scores?
> or equal to -1 _______
< or equal to -1 to -2.5 _______
< or equal to -2.5 _______
< or equal to -2.5 with fractures ______
- 1. normal
- 2. osteopenia
- 3. osteoporosis
- 4. severe osteoporosis
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What is the newest biphosphanate?? and How often is it taken?
Boniva (ibandronate)
taken monthly
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What is the MOA of biphosphanates?
they inhibit activity of osteoclasts to normalize rate of bone turnover...they cause an increase in bone mineral density
in other words...they prevent the loss of bone mass!
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Biphosphanates deduce the risk of what types of fractures?
vertebral and nonvertrebal
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Which bisphosphonate has not be proven to prevent hip fractures?
Boniva
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Name some bisphosphonates?
Boniva, Fosamax, Actonel
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Name a selective estrogen receptor modulator?
Evista (Raloxifen)
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What kind of fractures do SERMs reduce the risk of??
Vertebral but NOT NONVERTEBRAL
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What is Calcitonin's MOA?
blocks bone reabsorption by inhibiting osteoclasts. it lowers the number of osteoclasts
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How does Calcitonin affect serum Ca levels?
It decreases them
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Which is greater... salmon calcitonin or human calcitonin...??
salmon is 50-100 times as potent as human
remember.... calcitonin is a protein and it can not be taken orally
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What is Teriparatide(Forteo)?? What is its MOA?
- 1. synthetic human PTH
- 2. stimulates new bone formation
given once daily, increases skeletal mass, improves strength, prevents bone loss
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What is the first line treatment for osteoporosis??
bisphosphonates.
don't forget that even with med interventions, nonpharmacological treatments are important as well
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What is given as an alternative to bisphosphonates??
Raloxifen (Evista)
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What is used for prevention of osteoporosis??
Bisphosphonates and Evista
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What is used as a secondary line of prevention?? often used for those who have very low BMD of <-4 and history of fractures???
Teriparatide (Forteo)
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What is the dose of Ca and Vit D that should be administered daily?
- 1200mg/day of Ca
- 400-800 IU/day of VitD
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Postmenopausal women and men >65 years old should have how many mg of Ca a day?
1500
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What are the recommendations for taking osteoporosis medications???
- Take them first thing in the AM
- on an empty stomach
- patient must be upright
- can not eat or drink for 30-60 mins after taking
Evista can be taken without regard to food
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List side effects of Raloxifine (Evista) (3)
- 1. hot flashes
- 2. leg cramps
- 3. 3x increase risk of venous thrombosis
Therefore..teach your patient that they MUST be ambulatory. This risk is why it is generally used as a second line treatment.
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What is normally used if patients refuse to take other treatments (such as biphosphanates or evista)??
calcitonin
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It is not recommended to take Calcitonin for the _____________.
first 5 years after menopause.
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How is forteo given??
SQ daily
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Forteo is generally given to patients with ____ osteoporosis who can not take other therapies.
SEVERE
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How long can Forteo be used??
2 years max
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NTx is a urine test completed to monitor bone loss... when should it be obtained??
at the 2nd void of the day
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Calcitonin can be given nasally..therefore.. it is important to do nasal exams!!
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Routine ______ ____ should be completed while on biphosphanates.
dental screening
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When should drug holidays be done on patients with osteoporosis treatment??
after 4-5 years of meds...
if low risk of developing complications..may wait till after 10 years of treatment and hold for 1-2 years.
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Can children be prescribed these medications???
NO
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Evista should not be given to ___.
men
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Forteo (teriparatide) is absorbed 20-30x more with which patient population?
women in comparison to men
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How long is calcitonin nasal spray good once it is opened??
two weeks only!
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Forteo must be refrigerated!! Don't use if cloudy or discolored. One pen lasts 28 days.
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