Paget Disease Overview

What is the recommended dosage for retreatment with strong bisphosphonates?

There is no recommended dosage for retreatment
A higher dose than for initial treatment
A lower dose than for initial treatment
The same as for initial treatment (correct)

What is the main contention regarding the use of strong bisphosphonates?

They are too expensive for most patients
They are not effective in treating Paget's disease
They have a short half-life
They have a long half-life and potential for side effects (correct)

What is the recommended treatment for heterotopic ossification following total hip replacement?

Teriparatide for 6 months
Etidronate at 20 mg/kg/d for 1 month preoperatively and 20 mg/kg/d for 3 months postoperatively (correct)
No specific treatment is recommended
Etidronate at 20 mg/kg/d for 2 weeks, followed by 10 mg/kg/d for 10 weeks

Which of the following is NOT a reason for monitoring patients on bisphosphonate therapy?

Bone mineral density (C) Signup and view all the answers

What is the main reason for using bisphosphonates to treat hypercalcemia of malignancy?

Bisphosphonates have an antiresorptive property that can help reduce high calcium levels (D) Signup and view all the answers

Which bisphosphonate has the highest adverse drug reaction profile?

Risedronate (B) Signup and view all the answers

What is the main difference between the efficacy of alendronate and etidronate in suppressing alkaline phosphatase levels?

Etidronate is less effective than alendronate (D) Signup and view all the answers

What is the recommended treatment for patients with Paget's disease who have inadequate dietary calcium and vitamin D intake?

Combination of bisphosphonate therapy and calcium/vitamin D supplementation (D) Signup and view all the answers

Which of the following is NOT a reason for the contention surrounding the use of strong bisphosphonates?

They are not effective in treating Paget's disease (D) Signup and view all the answers

What is the main reason for the limited impact of the combination of estrogens and bazedoxifene (Duavee) on bone health?

It is a limited impact medication for bone health (B) Signup and view all the answers

What is a characteristic of Paget disease?

Bone enlargement and deformities (A) Signup and view all the answers

When are all bisphosphonates used to treat Paget disease?

When the alkaline phosphatase is at least twice the upper limit of normal (C) Signup and view all the answers

What is the traditional treatment for symptomatic Paget disease?

Etidronate (A) Signup and view all the answers

What is the initial recommended dose of Etidronate for treating Paget disease?

11 to 20 mg/kg/d for up to 6 months (D) Signup and view all the answers

When is retreatment for relapse in Paget disease considered acceptable?

After more than 90 drug-free days (C) Signup and view all the answers

What effect does Etidronate have on bone turnover in Paget lesions?

It slows accelerated bone turnover (B) Signup and view all the answers

What is a contraindication for the use of SERMs and estrogens?

History of venous thromboembolic events (C) Signup and view all the answers

What is the key difference in the effects of alendronate and estrogen on BMD after stopping therapy?

Alendronate maintained BMD, while estrogen decreased BMD (D) Signup and view all the answers

Which of the following statements about the effects of adding progestin to estrogen therapy is correct?

The addition of progestin did not produce a significant difference in BMD (A) Signup and view all the answers

How do the adverse reactions of raloxifene compare to those of estrogen and progesterone?

Raloxifene has more adverse reactions (A) Signup and view all the answers

What is the primary reason the WHI findings have led to a recommendation against using estrogen as first-line therapy for osteoporosis prevention and treatment?

Estrogen was found to have an unacceptable risk-benefit profile (C) Signup and view all the answers

What is the key difference in the effects of alendronate and estrogen on BMD when used in combination compared to alone?

The combination was more effective than either alone (D) Signup and view all the answers

What is the recommended approach for using low-dose estrogen therapy for osteoporosis?

Low-dose estrogen can produce a positive effect on BMD, but has lower risks (A) Signup and view all the answers

What is the key difference in the effects of raloxifene and bazedoxifene on bone health?

Raloxifene works better in younger patients, while bazedoxifene works better as fracture risk increases (A) Signup and view all the answers

What is the recommended approach for monitoring patients taking estrogen or SERM medications for osteoporosis?

Patients should be monitored the same as for ERT or HRT (C) Signup and view all the answers

What is the key difference in the effects of stopping alendronate versus stopping estrogen therapy on BMD?

Stopping alendronate led to an increase in BMD, while stopping estrogen led to a decrease (B) Signup and view all the answers

What is the recommended serum creatinine level or creatinine clearance (CrCl) for administering bisphosphonates without dosage alterations or contraindications?

Serum creatinine ≤ 2.5 mg/dL or CrCl ≥ 30 mL/min (C) Signup and view all the answers

Which electrolytes should be monitored during bisphosphonate therapy?

Calcium, phosphate, magnesium, and potassium (C) Signup and view all the answers

Which test is used to rule out hyperparathyroidism before initiating bisphosphonate therapy?

Serum calcium and albumin (C) Signup and view all the answers

Which test is used as a major indicator of Paget's disease and its reduction as an indicator of treatment efficacy?

Alkaline phosphatase (B) Signup and view all the answers

What is the recommended frequency of DEXA scans for monitoring bone mineral density (BMD) once treatment for osteoporosis has been established?

Every 1 to 2 years until findings are stable (D) Signup and view all the answers

Which of the following statements about taking oral bisphosphonates is incorrect?

If a daily dose is missed, the patient should take a double dose the next day. (D) Signup and view all the answers

What is the recommended dosage adjustment for bisphosphonates if renal function remains between 35 and 60 mL/minute?

No dosage adjustment is necessary (C) Signup and view all the answers

Which of the following statements about generic bisphosphonates is true according to the text?

Reports suggest generic bisphosphonates, especially alendronate, may cause more GI side effects than branded versions (B) Signup and view all the answers

Which group of women is most in need of protection from osteoporosis?

Women in the immediate postmenopausal years (D) Signup and view all the answers

Which of the following statements about the use of estrogen and SERMs (Selective Estrogen Receptor Modulators) for osteoporosis treatment is true?

Estrogen and SERMs are not first-line therapy for bone loss and should never be used as a therapy solely for bone loss (A) Signup and view all the answers

What is the main benefit of estrogens for postmenopausal women?

Preventing vertebral fractures (D) Signup and view all the answers

Why are SERMs like raloxifene preferred over estrogen for postmenopausal osteoporosis?

They have a lower risk of uterine cancer development (B) Signup and view all the answers

What is a key reason why premenopausal women should avoid taking SERMs?

They increase natural estrogen levels (B) Signup and view all the answers

Which statement is true regarding the use of raloxifene for osteoporosis prevention?

It is recommended for women with a history of thrombotic events (A) Signup and view all the answers

What effect does bazedoxifene have on the uterus when in combination with estrogen?

It provides protection from the estrogen component (D) Signup and view all the answers

Why do most SERMs cause hot flashes in women?

They have anti-estrogen effects on the breasts (A) Signup and view all the answers