Therapeutics - Osteoporosis 1
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Who should be assessed for screening needs for osteoporosis?
All postmenopausal women and men over 50 years
What are the medications that increase osteoporosis risk?
- Armoatase inhibitors
- GNRH Agonists
- Chemo drugs
What is the recommended calcium intake for a 19-50 year old male or female?
What is the recommended calcium intake for a 51-70 year old male?
What is the recommended calcium intake for a 51-70 year old female?
What is the recommended calcium intake for a 71+ year old male or female?
What are the non-drug interventions for osteoporosis?
- Calcium supplementation
- Vitamin D supplementation
- Weight bearing/resistance exercise
- Fall prevention (assess vision/neuro deficits, add assistive devices)
- Limit alcohol, tobacco and Caffeine
Does Calcium supplementation increase BMD?
Does Calcium supplementation decrease fracture risk?
Why should Viactiv be cautioned in patient’s taking warfarin?
It contains vitamin K
Which Calcium salt requires stomach acid for absorption?
Which Calcium salt does NOT require stomach acid for absorption?
Gluconate or Citrate
How much Calcium can be given at once?
What is the goal 25(OH) Vitamin D levels in a patient?
What is the recommended dose of Vitamin D?
800-1000 IU Cholecalceferol (D3) daily
Which type of Vitamin D is not used as much and why?
Ergocalciferol (D2) because of decreased absorption, especially with intermittent dosing
What type of Vitamin D would you use in renally compromised patients?
What group of patients needs a higher than normal Vitamin D dose?
Homebound, chronically ill and Renally impaired
What is the dose of Replesta?
- 50,000 IU wafer
- 1-2 wafers per week for up to 12 weeks
What is the dose of Ergocalceferol (D2)/Cholecalceferol?
- 50,000 capsule
- 1-2 capsules per week at first
- Then, once monthly
What is the dose of Calcitrol?
0.25 mcg/day orally
What type of vitamin D would you use in a patient with CKD or is on Dialysis?
What is the general repletion dose of Vitamin D?
50,000 IU per week for 8-12 weeks
What is the general maintenance dose of Vitamin D?
50,000 IU monthly or 800-1000 IU daily
When should you recommend pharmacological treatment of osteoporosis?
- Hip or vertebral fracture
- T-score less than or = to 2.5 at neck
- Osteopenia and FRAX greater than or = to 3% at hip or greater than or= to 20% risk of major OP fracture
What is the MOA of bisphosphonates?
Inhibit bone reabsorption and osteoclastic activity
What are the Bisphosphanates?
- Zoledronic acid
What benefit do bisphosphonates impart?
- 4-6.2% increase in BMD
- Best effect on BMD and greatest reduction in fracture rates
What dosage forms is Alendronate (Fosamax and Binosto) available in?
- With Vitamin D3
What dosage forms is Ibandronate (Boniva) available in?
Oral and IV
What dosage forms is Risedronate (Actonel) available in?
- Available with Calcium
What dosage forms is Zoledronic acid (Reclast) available in?
Alendronate brand name
Fosamax and Binosto
Ibandronate brand name
Risedronate brand name
Zoledronic acid brand name
What is the indication for Bisphosphanates?
- Alendronate, Risedronate and Reclast = Treatment and Prevention of PM, Male and GC induced OP
- Ibandronate = treatment and prevention of PM OP
What is the bioavailability of bisphosphonates?
What decreases absorption of bisphosphonates?
Food or drinks other than water
How should you take bisphosphonates?
- With a full glass of water on an empty stomach upon waking
- Sit upright for 30 minutes for all except ibandronate
- Ibandronate = sit upright for 60 minutes after taking
How can you prevent acute reactions to bisphosphonates?
APAP or IBU
What are the AE of bisphosphonates?
- Osteonecrosis of the jaw
- Visual disturbances
- Bone pain
- Atypical fracture
- Atrial fibrillation (zoledronic acid)
- Atypical fractures after 5 years of use
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