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Questions and Answers
Glucocorticoids, phenytoin, carbamazepine, Depo-medroxyprogesterone, PPI are all associated with bone (growth/loss).
Glucocorticoids, phenytoin, carbamazepine, Depo-medroxyprogesterone, PPI are all associated with bone (growth/loss).
loss
What is a major lifestyle modification that is recommended for patients for the prevention of osteoporosis?
What is a major lifestyle modification that is recommended for patients for the prevention of osteoporosis?
- Decrease of Vitamin D intake
- Increased Alcohol Use
- Smoking Cessation (correct)
- Limiting weight-bearing exercise
What are adverse effects associated with calcium?
What are adverse effects associated with calcium?
- Kidney stones (correct)
- Gallstones
- Headaches
- Gatroparesis
Citrate is the preferred calcium supplement over Carbonate when taking with a PPI.
Citrate is the preferred calcium supplement over Carbonate when taking with a PPI.
What vitamin is needed to be able to absorb calcium?
What vitamin is needed to be able to absorb calcium?
The recommended daily intake of Vitamin D intake (in international units) is _______________ for prevention.
The recommended daily intake of Vitamin D intake (in international units) is _______________ for prevention.
Vitamin D3 (cholecalciferol) is the most commonly recommended source of Vitamin D and it is source from animal product and available OTC.
Vitamin D3 (cholecalciferol) is the most commonly recommended source of Vitamin D and it is source from animal product and available OTC.
What is the dosing for Vitamin D for a patient that is DEFICIENT or INSUFFICIENT in vitamin D? This patient's baseline labs showed vitamin D levels less than 29 ng/mL.
What is the dosing for Vitamin D for a patient that is DEFICIENT or INSUFFICIENT in vitamin D? This patient's baseline labs showed vitamin D levels less than 29 ng/mL.
Who qualifies for pharmaceutical treatment of osteoporosis?
Who qualifies for pharmaceutical treatment of osteoporosis?
What are contraindications for Bisphosphonates (alendronate, risendronate, zolendronic acid)
What are contraindications for Bisphosphonates (alendronate, risendronate, zolendronic acid)
Bisphosphonate MUST be taken first thing in the morning, on an empty stomach, while sitting upright.
Bisphosphonate MUST be taken first thing in the morning, on an empty stomach, while sitting upright.
What are rare adverse reactions related to Bisphosphonate administration?
What are rare adverse reactions related to Bisphosphonate administration?
When should a patient take a holiday from Bisphosphonate when they are at moderated or high risk based on their T-score (FRAX)?
Note: Moderate risk is defined as a patient with a T-score >-2.5 that remained free of fractures.
When should a patient take a holiday from Bisphosphonate when they are at moderated or high risk based on their T-score (FRAX)? Note: Moderate risk is defined as a patient with a T-score >-2.5 that remained free of fractures.
What is NOT a contraindication for Prolia (denosumab)? This is also a good reason to use this medication!
What is NOT a contraindication for Prolia (denosumab)? This is also a good reason to use this medication!
What is the MOST common adverse effect of Prolia (denosumab)?
What is the MOST common adverse effect of Prolia (denosumab)?
Compare the Bisphosphonates options for your patient.
Compare the Bisphosphonates options for your patient.
What are the second line options for osteoporosis?
What are the second line options for osteoporosis?
What adjunct medication can be administered subQ to maintain BMD gains followed by denosumab or bisphosphonate by inhibits regulatory factor in bone metabolism?
What adjunct medication can be administered subQ to maintain BMD gains followed by denosumab or bisphosphonate by inhibits regulatory factor in bone metabolism?
Alternative agents matching PROS
Alternative agents matching PROS
Alternative agents CONS
Alternative agents CONS
Alternative therapies reserved for high-risk patients unresponsive to first-line treatments or those with concomitant indications
Alternative therapies reserved for high-risk patients unresponsive to first-line treatments or those with concomitant indications
MOA - Alternative therapies
MOA - Alternative therapies
Bisphosphonates can have acute phase IV reactions in the first hour. What should you pre-treat with?
Bisphosphonates can have acute phase IV reactions in the first hour. What should you pre-treat with?
Prolia (denosumab) is a first line treatment option given as a subq injection every ___ months.
Prolia (denosumab) is a first line treatment option given as a subq injection every ___ months.
Adults ≥ 50 years should intake _____ mg (elemental) calcium daily. This should be spread into two or three doses.
Adults ≥ 50 years should intake _____ mg (elemental) calcium daily. This should be spread into two or three doses.
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Study Notes
Medications affecting Bone Health
- Glucocorticoids, phenytoin, carbamazepine, Depo-medroxyprogesterone, and PPI are associated with bone loss.
Osteoporosis Prevention
- Major lifestyle modification for osteoporosis prevention: regular exercise and adequate calcium intake.
- Calcium intake recommendation for adults ≥ 50 years: 500-700 mg (elemental) daily, divided into 2-3 doses.
Calcium Supplements
- Citrate is the preferred calcium supplement over Carbonate when taking with a PPI.
- Vitamin D is necessary for calcium absorption.
Vitamin D
- Recommended daily intake of Vitamin D: 600-800 IU for prevention.
- Vitamin D3 (cholecalciferol) is the most commonly recommended source, available OTC, and sourced from animal products.
Vitamin D Deficiency Treatment
- Dosing for Vitamin D deficiency: individualized based on baseline labs; deficient patients have levels < 29 ng/mL.
Pharmaceutical Treatment of Osteoporosis
- Qualifications for pharmaceutical treatment: high-risk patients, those with a T-score ≤ -2.5, or those who have experienced a fracture.
- Contraindications for Bisphosphonates: hypocalcemia, abnormal renal function, esophageal achalasia, and inability to sit upright.
Bisphosphonates Administration
- Bisphosphonates must be taken first thing in the morning, on an empty stomach, while sitting upright.
- Rare adverse reactions: esophageal ulcers, osteonecrosis of the jaw, and atrial fibrillation.
Bisphosphonate Holiday
- Patients with moderate risk (T-score > -2.5, no fractures) should take a Bisphosphonate holiday after 5 years of treatment.
Prolia (Denosumab)
- Not a contraindication: hypocalcemia.
- Most common adverse effect: skin reactions.
- Administered as a subQ injection every 6 months.
Alternative Agents
- Second-line options for osteoporosis: teriparatide, romosozumab, and abaloparatide.
- Adjunct medication for maintaining BMD gains: teriparatide (subQ).
- Alternative therapies for high-risk patients: romosozumab, abaloparatide, and hormone therapy.
Bisphosphonate Acute Phase Reactions
- Pre-treat with acetaminophen or corticosteroids to prevent acute phase IV reactions.
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