Bone Densitometry Basics: Treatment and Prevention

The national osteoporosis foundation recommends women 50 and younger, and men 70 and younger consume _______ calcium daily

1,000 mg

The national osteoporosis foundation recommends women 51 and older, men 71 and older to consume _____ calcium daily

1,200 mg

How much vitamin D Should be consumed daily for all under age 50?

400-800 IU

How much vitamin D should be consumed daily for all people older than age 50?

800-1000 IU

Food rich in vitamin D

Saltwater fish, liver, milk, juice, cereal

Food labels that list % calcium based off of _____ mg/day

1,000

What 3 substances decrease calcium absorption?

1) Alcohol

2) Caffeine

3) Sodium

What should the alcohol limit be per day?

2 servings

What should the caffeine limit be per day?

3 servings

What should your sodium level limit be per day?

2,300 mg/day

Supplements should have what mark to indicate it is a good supplement to take?

USP verified

What are the two most common calcium supplements?

calcium carbonate and calcium citrate

Which calcium supplement is more expensive, better absorption, and has fewer side effects?

Calcium Citrate

Calcium is optimized with absorption by taking _____ mg at a time

500-600 mg

Calcium is optimized when it is taken in conjunction with what?

food

Calcium needs what other supplement in order to be properly absorbed?

Vitamin D

What side effects occur with sudden increase in calcium intake?

Gas and constipation

How can you ease the side effects of increased calcium intake?

Increase intake gradually and drink more water

How is vitamin D produced in the body?

Sun exposure

What are the two types of vitamin D?

D2 ergocalciferol and D3 cholecalciferol

Which type of vitamin D is made from plants so vegans can consume?

D2 ergocalciferol

Which type of vitamin D lasts longer in the body but is more expensive?

D3 cholecalciferol

What tests should be used to track response to vitamin D in the body?

1) blood serum test

2) 25-Hydroxy vitamin D test

Adults can be prescribed _______ IU of vitamin D once a week for 8-12 weeks

50,000 IU

5 examples of weight bearing training

1) walking

2) jogging

3) Hiking

4) Dancing

5) Climbing Stairs

What is resistance training?

Forces muscles to contract against opposing external forces.

3 examples of resistance training

1) Lifting weights

2) Water exercises

3) Resistance Bands

What is the most effective exercise plan for fall prevention according to the NOF

Exercise twice per week for 6 months

What does the American Academy of Orthopedic surgeons recommend for exercise?

30 minutes, WB 4 days per week, resistance training each muscle group 2x a week.

Long term cessation of tobacco 10+ years lower ____ risk

Fracture

Tobacco use ____ recovery time from fractures

increases

Short term cessation of tobacco _______ markers related to bone resorption.

decreases

What is the number one cause of fragility fractures?

Falls

What percent of women aged 50 or older will experience a fragility fracture?

40%

List 8 falls risks

1) poor vision

2) Poor balance

3) Obstacles

4) Slippery Surfaces

5) Rugs

6) Uneven surfaces

7) Sedative medications

8) Urinary incontinence

List 4 osteoblast bone markers

1) Alkaline Phosphatase

2) C-terminal propeptide of type 1 procollagen

3) Osteocalcin

4) N-terminal propeptide of type 1 procollagen

List 4 osteoclast bone markers

1) N-telepeptide of type 1 collagen

2) Pyridinoline

3) Deoxypyridinoline

4) C-terminal telopeptide of Type 1 collagen

What is the best bone marker for bone formation?

N-terminal propeptide of type 1 procollagen

What is the best bone marker for bone resorption?

C-terminal telopeptide of type 1 collagen

Why use biochemical markers?

Provides an analytical reference to the rate of bone loss and risk of fractures

Biochemical markers are used to gauge a response to treatment. When should these markers be tested?

Once before starting treatment. Again in 3-6 months for a follow up

What does NOF stand for?

National Osteoporosis Foundation

The NOF recommends pharmacy therapies for which two populations?

1) Men above age 50 and postmenopausal women that have had a hip/vertebral fracture

2) Men above age 50 and postmenopausal women with a T-score of -2.5 of the lumbar spine, total hip, or femoral neck

When do we consider a fracture risk assessment for men older than 50 and postmenopausal women? (Tscore)

-1.0 to -2.5 at the lumbar spine, total hips, and femoral neck

What is a class of medications designed to limit bone loss by affecting osteoclast function?

Antiresorptive drugs

Give 5 examples of Antiresorptive drugs

1) Biophosphonates

2) RANKL inhibators

3) Estrogen or Hormone replacement therapy

4) Calcitonins

5) Selective estrogen receptive modulators (SERMS)

What are steroid therapies designed to promote new bone formation?

Osteoanabolic Drugs

Give two examples of osteoanabolic drugs

1) Analogues of parathyroid hormone

2) Forteo Teriparatide

Bisphosphonates bind to what surface of bone?

Hydroxyapatite

Bisphosphonates slow the process of bone ___________

resorption

How do bisphosphonates decrease osteoclasts production?

Osteoclasts adhere to bone and absorb the bisphosphonate on the hydroxyapatite surface which prevents the formation of proteins that break down the bone.

List 4(5) FDA approved bisphosphonate mediations

1) Alendronate (fosamax)

2) Ibandronate (Boniva)

3) Risedronate (Actonel + Atelvia)

4) Zoledronic Acid (Reclast)

The brand name for the FDA approved drug Alendronate is

Fosamax

What are Alendronate/Fosamax available forms?

Pill or an oral solution

How often is Alendronate taken?

Daily or once per week

How must Alendronate be administered for efficacy

In the morning, on a empty stomach with at least 8 oz of water.

Once you have taken alendronate, what must you do to avoid reflux?

Avoid food or meds for 30 minutes and remain upright for 30 minutes after eating food.

Alendronate reduces hip and spine fractures by what percent of over 3 years in patients who have osteoporosis of the hip and already experienced a vertebral fracture

50%

What is the brand name for Ibandronate?

Boniva

Ibandronate/Boniva is what type of mediation?

Bisphosphonate

What are the available forms of Boniva/ibandroante?

A pill daily or monthly, or an injection every 3 months

Boniva/ibandronate must be taken how by pill form?

In the morning, on an empty stomach with at least 8oz of water.

Once a patient has taken Boniva/Ibandronate by pill what must they do?

Avoid food/meds x1 hour and remain upright for one hour after consuming food.

How is the IV injection ibandronate given?

3mL of solution over 10-30 seconds

Daily oral use of ibandronate/ Boniva is not used where?

Not used in the United States

Monthly and quarterly IV Ibandronate/Boniva decreases vertebral fracture rate by ____ % over 3 years

50%

What is the brand name of Risedronate?

Actonel and Atelvia

Risedronate is what type of medication?

Bisphosphonate

What are the available forms for Risedronate/ Actonel?

Pills daily, weekly, or monthly