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