Osteoporosis (copy)

Osteoporosis Risk

Osteoporosis dx

Normal: T 1+

Osteopenia: -1 to -2.4

Osteoporosis < -2.5

Ca and Vit D supplementation

What is Os-Cal?

Calcium Carbonate

40% elemental Ca (1g - 400mg elemental)

SEs: sonstipation

take with food, no PPIs

What is Tums?

Calcium Carbonate

40% elemental Ca (1g = 400mg elemental)

SEs: sonstipation

take with food, no PPIs

What is Calcitrate?

calcium citrate

21% elemental Ca (1g = 220 mg elemental Ca)

can take w/ or w/out food

SEs: conspipation

What is Citracal?

calcium citrate

21% elemental Ca (1g = 220 mg elemental Ca)

can take w/ or w/out food

SEs: conspipation

Ostoporosis tx

1) bisphosphonates

2) denosumab (Prolia)

3) Very high risk:

- teriparatide (Forteo)

- abaloparatide (Tymlos)

- raloxifine (Evista)

- benzedoxifene/estrogens (Duavee)

4) estrogen +/- progestin (ppx only if + menopause sx)

5) calcitonin (only if other options don't work high risk cancer)

What is Fosamax?

alendronate

PO bisphosphate - inhibiting osteoclast activity and bone resorption

ppx for post menopausal

tx for males and post menopausal

PO daily or weekly

PO Bisphosphonates

Alendronate

Risedronate

Ibandronate

CIs: Hypocalcemia; inability to stand or sit upright for at least 30 minutes

Warnings: osteonecrosis of the jaw, atypical femur fractures, Esophagitis, esophageal ulcers, erosions

SEs: Dyspepsia, dysphagia, heartburn, N/V, hypocalcemia,

PO Bisphosphonate: Counseling

- get dental work before initiating

- separate from antacids, Ca, Fe, Mg by 2+h

- must stay upright for 30 minutes (60 minutes for ibandronate) and drink 6-8 oz of plain water

What is Boniva?

ibandronate

PO and Inj bisphosphonate - inhibiting osteoclast activity and bone resorption

PO monthly

IV q3 months

What is Reclast?

zoledronic acid for osteoporosis

Inj bisphosphonate - inhibiting osteoclast activity and bone resorption

tx given once yearly

What is Zometa?

zoledronic acid for hypercalcemia of malignancy

Inj bisphosphonate - inhibiting osteoclast activity and bone resorption

Injectable Bisphosphonates

ibandronate and zoledronic acid

CIs: hypocalcemia

Warnings: renal impairment

preferred if esophagitis is present due to risk esophageal cancer

What is raloxifene?

elective estrogen receptor modulator (SERM) that decreases bone resorption

BBW: increased risk VTE, increased risk death from stroke

CIs: VTE, pregnancy

SEs: Hot flashes, peripheral edema, arthralgia, leg cramps

What is Miacalcin?

calcitonin

nasal spray (one nostril QD, alternating daily) and injection

MOA: inhibits bone resorption by osteoclasts

Warnings: hypocalcemia, increased risk malignancy, hypersensitivity rxns to salmon-derived products

What is Prolia?

Denosumab

MOA: monoclonal antibody that binds to RANKL and blocks its interaction with RANK (a receptor on osteoclasts) to prevent osteoclast formation; this leads to decreased bone resorption and increased bone mass.

Inj q6 months

CIs: hypocalcemia, pregnancy

Warnings: osteonecrosis of the jaw, atypical femur fractures, hypocalcemia

SEs: Hypertension, fatigue, edema. dyspnea, headache, N/V/D, decreased PO4

What is Atelvia

risedronic acid (bisphosphonate)