Term
| Which organ activates vitamin D |
|
Definition
|
|
Term
| What is the active form of vitamin D called |
|
Definition
|
|
Term
| How is vitamin D involved in calcium homeostasis |
|
Definition
| Increases Ca and Phosphorus absorption from gut; stimulates bone formation; acts on kidney to reduce Ca excretion in urine |
|
|
Term
| Which two hormones stimulate osteoclast differentiation, promoting bone resorption |
|
Definition
| PTH and 1,25-dihydroxy vitamin D |
|
|
Term
| What does the WHO define as normal bone density |
|
Definition
| Within 1 SD of young adult mean |
|
|
Term
| What does the WHO define as osteopenia |
|
Definition
| BMD between -1.0 and -2.5 SD from the young adult mean |
|
|
Term
| What does the WHO define as osteoporosis |
|
Definition
| BMD below -2.5 SD from the young adult mean |
|
|
Term
| Does calcium supplementation reduce the risk of hip fractures |
|
Definition
|
|
Term
| What are some adverse fx of Ca supplementation |
|
Definition
| Kidney stones, GI distress, possible increased risk of MI and stroke |
|
|
Term
| What is the maximum dose of Ca per day |
|
Definition
|
|
Term
| Which calcium salt should be taken with meals |
|
Definition
|
|
Term
| What effect do thiazide diuretics have on Ca concentration in the blood |
|
Definition
|
|
Term
| What effect do loop diuretics have on Ca concentration in the blood |
|
Definition
|
|
Term
| Commonly used vitamin D products |
|
Definition
| cholecalciferol and ergocalciferol |
|
|
Term
| Adverse fx of vitamin D supp |
|
Definition
| Hypercalcemia, hypercalciuria |
|
|
Term
| What is the MOA of bisphosphonates |
|
Definition
| Inhibits osteoclast differentiation -> prevents bone resorption |
|
|
Term
| Adverse fx of bisphosphonates |
|
Definition
| Dyspepsia, arthralgia, back pain, adynamic bone, rare osteonecrosis and fractures |
|
|
Term
| How should pts be counseled to take bisphosphonates |
|
Definition
| On an empty stomach & stay upright 30-60 mins after dose until 1st meal of the day; space from Ca supplements (binds Ca) |
|
|
Term
| What is an additional indication (besides osteoporosis) for bisphosphonates, and which one should be prescribed |
|
Definition
| Hypercalcemia; zoledronic acid (injectable) |
|
|
Term
| Which pharmaceutical agent is first line for osteoporosis |
|
Definition
|
|
Term
| Examples of bisphosphonates |
|
Definition
| alendronate, risendronate, ibandronate, zoledronic acid |
|
|
Term
|
Definition
| Inhibit osteoclasts; inhibit renal absorption of calcium, phosphate, magnesium, potassium |
|
|
Term
|
Definition
| Nausea, flushing, rhinitis w nasal spray |
|
|
Term
| What type of medication is teriparatide |
|
Definition
| Recombinant PTH -> stimulates osteoblasts, increases GI and renal absorption of Ca |
|
|
Term
|
Definition
| Dizziness, insomnia, depression, nausea, arthralgia, weakness, rhinitis, hypercalcemia, hypercalciuria, orthostasis, osteosarcoma reported in animals |
|
|
Term
| What do we monitor in pts with teriparatide that is unique among osteoporosis agents? |
|
Definition
| Uric acid; blood pressure |
|
|
Term
| What is an important factor when administering teriparatide for the 1st time? |
|
Definition
| Have pt sitting or lying down in your office due to risk of orthostasis |
|
|
Term
| What is the MOA of raloxifene? |
|
Definition
| Selective Estrogen Receptor Modulator (SERM) -> inhibits bone resorption |
|
|
Term
|
Definition
| Similar to menopause: hot flashes, arthralgia, periph edema, rare venous thromboembolism |
|
|
Term
| What unique lab value do we monitor in raloxifene pts? |
|
Definition
|
|
Term
|
Definition
| Monoclonal antibody- RANKL inhibitor: prevents osteoblasts from differentiating into osteoclasts |
|
|
Term
|
Definition
| Skin reactions (dermatitis/rash/eczema) |
|
|
Term
|
Definition
| Monitor for chronic back pain, use caution in severe renal impairment (monitor SCr) |
|
|
Term
|
Definition
| Increase osteoblast activity/ new bone formation (weak/abnormal bone!) |
|
|
Term
| Why are pts less likely to want to adhere to teriparatide therapy? |
|
Definition
|
|
Term
| What medication classes are associated w/ osteoporosis? |
|
Definition
| Corticosteroids; SSRIs; lithium; PPIs; methotrexate |
|
|
Term
| What does DXA stand for? (DXA-scan) |
|
Definition
| dual-energy x-ray absorptiometry |
|
|
Term
| What treatment options should we consider in our higher-risk patients? |
|
Definition
|
|
