RxPrep Osteoporosis, Menopause, & Testosterone Use Part 1 (Osteoporosis)

postmenopausal

Osteoporosis is common in (postmenopausal/premenopausal) females.

vertebral

________ fractures can occur without a fall and can initially be painless.

loss of height

What is sometimes the only clue of a vertebral fracture in patients with osteoporosis?

hip

________ fractures are the most devastating type of fractures, with higher costs, disability, and mortality than all other fractures combined.

wrist

________ fractures appear in younger people and serve as an early indicator of poor bone health.

age-related bone loss

Osteoporosis can occur as a result of normal ________.

advanced age,

Caucasian or Asian ethnicity,

family hx,

female,

low body weight

What are 5 patient characteristics that carry osteoporosis risk?

autoimmune diseases, diabetes, eating disorders, epilepsy, GI diseases, HIV/AIDS, hyperthyroidism, hypogonadism in men, menopause, Parkinson disease, rheumatoid arthritis

What are 11 conditions that carry osteoporosis risk?

anorexia

What's an example of an eating disorder that carries osteoporosis risk?

celiac disease, IBD, gastric bypass, malabsorption syndromes

What are 4 GI diseases that carry osteoporosis risk?

≥3 alcoholic drinks/day, low calcium intake, low vitamin D intake, physical inactivity, smoking

What are 5 lifestyle factors that carry osteoporosis risk?

anticonvulsants, aromatase inhibitors, depo-medroxyprogesterone, GnRH agonists, lithium, loop diuretics, PPIs, SSRIs, steroids, thiazolidinediones, thyroid hormones

What are 11 drugs/classes that carry osteoporosis risk?

carbamazepine, phenobarbital, phenytoin

What are 3 anticonvulsants that carry osteoporosis risk?

increased

A(n) (decreased/increased) gastric pH decreases Ca absorption.

≥5; ≥3 months

Taking ________ mg daily of prednisone or prednisone equivalent for ________ can lead to osteoporosis.

osteoblast

cell involved in bone formation

osteoclast

cell involved in bone resorption; breaks down tissue in the bone

BMD

Bone health is evaluated by measuring ________.

bone mineral density

What does BMD stand for?

DEXA scan

What is the gold standard to measure BMD and diagnose osteoporosis?

dual-energy X-ray absorptiometry

What does DEXA stand for?

T-score, Z-score

A DEXA scan measures BMD of the spine and hip and calculates a(n) ________ or a(n) ________.

T-score

compares the patient's measured BMD to the average peak BMD of a healthy, young, white adult of the same sex

Z-score

compares the patient's measured BMD to the average BMD of an age, sex, and ethnicity-matched population

negative

T-scores are (negative/positive) numbers.

≥ -1

A T-score of ________ is normal.

-1 to -2.4

A T-score of ________ indicates osteopenia (low bone mass).

≤ -2.5

A T-score of ________ indicates osteoporosis.

≥65 years; ≥70 years

Women who are ________ old and men who are ________ old should have their BMD measured.

BMD is at least 2.5 standard deviations below the average

What does a T-score of -2.5 indicate?

FRAX tool

The ________ is a computer-based algorithm developed by WHO that estimates the risk of osteoporotic fracture in the next 10 years.

fracture risk assessment

What does FRAX stand for?

orthostasis, sedation

Medications that cause ________ or ________ put patients at an increased risk for falls.

hypnotics, narcotic analgesics, sedatives

What are 3 examples of drug classes that can put patients at an increased risk for falls?

muscle-strengthening, weight-bearing

Patients with low bone density should perform regular ________ and ________ exercise.

children, pregnancy, years around menopause

At what 3 points in life is adequate calcium intake critically important?

dietary intake

What is preferred for calcium, dietary intake or supplementation?

vitamin D

________ is required for calcium absorption.

rickets

What does vitamin D deficiency cause in children?

osteomalacia

What does vitamin D deficiency cause in adults?

800-2000

Many endocrinologists suggest a daily vitamin D intake of ________ IU.

1000-1200

The recommended daily intake of calcium for most adults is ________ mg elemental calcium.

500-600

You should not exceed ________ mg of elemental calcium per dose.

Os-Cal, Tums

What are 2 brand names for calcium carbonate?

40

Calcium carbonate is ________% elemental calcium.

carbonate

Calcium (carbonate/citrate) absorption is acid-dependent.

carbonate

Calcium (carbonate/citrate) must be taken with meals.

Cal-citrate, Citracal

What are 2 brand names for calcium citrate?

21

Calcium citrate is ________% elemental calcium.

<30

Vitamin D deficiency is indicated by a serum vitamin D [25(OH)D] of ________ ng/mL.

3; 2

Cholecalciferol is vitamin D(2/3), and ergocalciferol is vitamin D(2/3).

125-175; 5000-7000; daily

When treating vitamin D deficiency, cholecalciferol is dosed at ________ mcg (________ IU) (daily/weekly).

1250; 50,000; weekly

When treating vitamin D deficiency, ergocalciferol is dosed at ________ mcg (________ IU) (daily/weekly).

saturable

Calcium absorption is (saturable/unsaturable).

increased

Calcium citrate has better absorption with a(n) (decreased/increased) gastric pH.

cholecalciferol, ergocalciferol; 8-12 weeks

Vitamin D deficiency can be treated with high doses of ________ or ________ for ________.

400

1 g calcium carbonate = ________ mg elemental calcium

210

1 g calcium citrate = ________ mg elemental calcium

constipation

What's a side effect of calcium supplements?

PPIs

Do not use calcium carbonate with ________.

bisphosphonate, raloxifene

What 2 drugs/classes are approved for the prevention of osteoporosis?

bisphosphonates, calcitonin, denosumab, parathyroid hormone analogs

What 4 drugs/classes are approved for the treatment of osteoporosis?

calcium, vitamin D

Regardless of drug selection, osteoporosis treatment must include adequate ________ and ________ intake.

presence of fragility fracture OR T-score ≤ -2.5

What are 2 criteria for initiating osteoporosis treatment?

(FRAX score ≥3% for 10-year hip fracture OR FRAX score ≥20% for major osteoporosis-related fracture) AND T-score -1 to -2.5

What are 3 criteria for initiating osteopenia treatment?

bisphosphonate

What drug class is first-line for treatment or prevention of osteoporosis in most patients?

30 minutes; ibandronate; 60 minutes

When bisphosphonates are administered orally, you must stay upright for ________, except for ________ in which you should stay upright for ________.

6-8; plain water

When bisphosphonates are administered orally, you must drink ________ oz of ________.

esophagitis, GI effects, hypocalcemia

What are 3 side effects of bisphosphonates?

atypical femur fractures, jaw osteonecrosis

What are 2 rare (but serious side effects) of bisphosphonates?

decreased blood supply

Bisphosphonate-induced jaw osteonecrosis occurs when jaw bone becomes exposed and cannot heal due to ________.

IV, oral

What 2 routes of administration are used for bisphosphonates for osteoporosis?

weekly or monthly

How often are oral bisphosphonates typically administered for osteoporosis?

quarterly or yearly

How often are IV bisphosphonates typically administered for osteoporosis?

3-5 years

In patients with a low risk of fracture, the typical duration of osteoporosis treatment with bisphosphonates is ________.

Prolia

What's the brand name for denosumab for osteoporosis?

denosumab

What drug is used as an alternative to bisphosphonates when treating osteoporosis?

SC

What route of administration is used for denosumab for osteoporosis?

every 6 months

How often is denosumab administered for osteoporosis?

hypocalcemia

What's a side effect of denosumab?

Forteo

What's the brand name for teriparatide?

Tymlos

What's the brand name for abaloparatide?

parathyroid hormone analogs

What drug class is only recommended to treat osteoporosis in very high-risk patients?

SC

What route of administration is used for parathyroid hormone analogs for osteoporosis?

daily

How often are parathyroid hormone analogs administered for osteoporosis?

hypercalcemia

What's a side effect of parathyroid hormone analogs?

Evista

What's the brand name for raloxifene?

Duavee

What's the brand name for bazedoxifene/estrogens?

SERM

What drug class is used as an alternative to bisphosphonates for osteoporosis if the patient has a high risk of vertebral fractures?

selective estrogen receptor modulator

What does SERM stand for?

stroke, VTE

Patients using SERMs to prevent or treat osteoporosis are at an increased risk for ________ or ________.

raloxifene

What SERM can be used for osteoporosis if the patient has a low VTE risk or high breast cancer risk?

vasomotor symptoms

What's a side effect of raloxifene?

bazedoxifene/estrogens

What SERM can be used for osteoporosis prevention in women with an intact uterus?

vasomotor symptoms

Other than osteoporosis prevention, bazedoxifene/estrogens can also be used as a treatment for ________.

increased breast cancer risk

What's a side effect of bazedoxifene/estrogens?

estrogen w/ or w/out progestin

What treatment is used for osteoporosis prevention only in postmenopausal women with vasomotor symptoms?

calcitonin

What osteoporosis treatment is used only if other options are not suitable (last-line)?

bisphosphonate

drug class that increases bone density by inhibiting osteoclast activity and bone resorption

ibandronate

Bisphosphonates reduce both vertebral and hip fracture risk, except for ________, which only reduces vertebral fractures.