Osteoporosis LOs

Cards (25)

  • What meds are considered antiresorptive?
    Calcitonin, denosumab, estrogen, raloxifene, bisphosphonates
  • What meds are considered anabolic?
    Teriparatide, Abaloparatide
  • What meds exhibit BOTH antiresorptive and anabolic properties?
    Romosozumab
  • Osteoblasts role is formation of new bone
  • Osteoclasts role is to break down bone and promote resorption
  • How does PTH lead to increased extracellular Ca2+
    • Stimulating resorption of Ca and decreasing resorption of phosphate by renal tubules
    • Stimulates hydroxylation of vitamin D in kidneys
    • Increases bone resorption by stimulating osteoclasts
  • Calcitonin inhibits bone resorption (by inhibiting osteoclasts) and leads to decreased extracellular Ca
  • Sclerostin roles

    • Inhibit formation of osteoblasts
    • Inhibit function of mature osteoblasts
    • Inhibit formation of new bone by the process of modeling (bone formation w/o prior resorption)
    • Reduces bone resorption to a lesser extent
  • Oral meds for osteoporosis
    Risedronate (Actonel), Alendronate (fosamax), vitamins/minerals
  • Parenteral meds for osteoporosis
    IV: Zoledronic acid
    SubQ: Teriparatide, Romosozumab
  • What osteoporosis med is available as both oral and parenteral
    Ibandronate (Boniva)
  • Proper admin for calcium citrate
    Does NOT require acidic environment
  • Proper admin for calcium carbonate
    Requires acidic environment
  • Proper admin for oral bisphosphonates
    Should be taken with 6-8 ounces of water at least 30-60 mins before food, drink or other meds
    • If risedronate delayed release → take right after breakfast
    • Pt should remain upright for at least 30 mins after takingg (60 if ibandronate)
  • Proper admin for nasal calcitonin
    Administer to ONE nostril and alternate nostrils each day
  • What oral bisphosphonate is NOT required to be taken on an empty stomach
    Risedronate because you take it immediately after breakfast
  • First line tx for postmenopausal woman at low risk of fracture
    Reassess fracture risk in 2-4 years
  • First line tx for postmenopausal women at moderate risk
    Reassess fracture risk in 2-4 years OR start bisphosphonates
  • First line tx for women at high to very high risk
    Start bisphosphonate, denosumab, teriparatide or abaloparatide
  • Who is an appropriate candidate for Romosozumab and who has contraindications

    Postmenopausal women w/ osteoporosis at very high risk of fracture (severe osteoporosis w/ T score <2.5 or multiple vertebral fractures) can take romosozumab tx for up to 1 year
    • Contraindicated: high risk of CV disease and stroke
    • Caution if prior MI or stroke
  • What is appropriate duration for Teriparatide or Abaloparatide
    Limited to 2 years
  • How to manage duration of therapy
    Need for continued medication to tx osteoporosis should be reviewed ANNUALLY
    • No pharm therapy should be considered indefinite
    • Non-bisphosphonate meds may produce temporary effects that may disappear after discontinuing
    • Bisphosphonates may allow residual effects even after discontinuation
  • Explain drug holidays for bisphosphonates
    Duration of holiday based on individual patient
    During holiday, consider use of teriparatide or raloxifene for higher risk pt
    • ORAL bisphosphonates: after 5 years of stability in moderate risk pt or after 6-10 years in higher risk pt
    • IV zoledronic acid: after 3 annual doses in moderate risk or after 6 in high risk
  • Define combination therapy
    Use of more than one agent at the same time
  • Define sequential therapy
    Anabolic therapy (w/ teriparatide) followed by antiresorptive therapy