Term
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Definition
| low bone mass & structural deterioration of bone tissue --> bone fragility --> increased fractures (spine, hip, & wrist); fractures occur from falls or in very serious cases even from sneezes |
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Term
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Definition
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Term
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Definition
| structural support, protects organs, contains Ca & PO4 stores |
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Term
| trabecular/cancellous bone |
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Definition
| metabolic; found more in smaller bones; supplies initial amounts of minerals when deficient |
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Term
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Definition
| structural bone; main part of large bones; constitutes outer part of bone, makes up 80% of skeleton |
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Term
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Definition
| Purposes: repaire microfractures, adapts to weight bearing, provides access to mineral stores; Performed by osteoblasts (bone formation) & osteoclasts (bone resorption, "breakdown"); In childhood, bone resporption < bone formation, reaches pk BMD at age 25-30 yrs; Aging/menopause &/or dx/drugs create imbalances --> bone resorption > bone formation --> bone loss |
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Term
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Definition
| bone quality = stregth & mass; regulated by vitamin D & PTH --> vitamind D helps in Ca absorption, synthesized in skin when exposed to sunlight; PTH converts vitamin D to active calcitriol; PTH & calcitriol work to release Ca from bone; low Ca --> increased PTH --> increased calcitriol --> bone resorption (Ca released from bone) |
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Term
| Clinical Presentation of Osteoporosis |
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Definition
| called "silent dx"; pts unaware they have it until fracture occurs; Signs: shortened stature, fracture, kyphosis (hump back) or lordosis (hollow back or saddle back); Symptoms: pain, immobility |
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Term
| Fracture Complications associated with Osteoporosis |
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Definition
| Pain: acute - lasts 2-3 months, chronic - deep, dull, nagging; Functioning: w/in 1st yr of hip fracture, 60% not functioning at pre-fracture level, 10-20% die, 10% have another related fracture, 25% sent to nursing home; limits bending, reaching, ADLs; Psychological issues: depression, low self esteem, anxiety, fear, anger |
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Term
| Non-modifiable Risk Factors for Osteoporosis |
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Definition
| gender, age, race, family hx of dx/fracture in 1st degree relative; age @ menarche, menopause |
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Term
| Lifestyle Risk Factors for Osteoporosis |
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Definition
| low Ca intake; vitamin D deficiency; alcohol (>2 drinks/day); inadequate physical activity; smoking; falling; thinness; high thyroxine intake; minimal sun exposure; glucocorticoids (>5 mg/day of prednisone >3 months) |
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Term
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Definition
| value that represents pt's BMD compared to peak/optimal bone density for a young adult of same sex (# of SD below); used for postmenopausal women & men > 50 yrs old |
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Term
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Definition
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Term
| osteopenia (low bone mass) T-score |
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Definition
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Term
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Definition
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Term
| severe/established osteoporosis |
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Definition
| < or = -2.5 and a history of fracture |
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Term
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Definition
| value that represents pt's BMD compared to what is expected for someone w/ same age & sex (# of SD below); used for premenopausal women, men < 50 yrs old, & children |
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Term
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Definition
| lab values useful to identify a secondary cause of bone loss - best indicator of total vitamin D status |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
| Nonpharm Tx for Osteoporosis |
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Definition
| Calcium & Vitamin D; Exercise (weight bearing & muscle strengthening); Fall Prevention; Good Habits (smoking cessation, reduce soda intake, minimize EtOH) |
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Term
| Daily Calcium Requirements for Adults >50 yrs old |
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Definition
| 1200 mg/day; typical diet gets 600-700 mg/day |
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Term
| Daily Vitamin D3 requirement for adults >50 yrs old |
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Definition
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Term
| Pts who need Pharmacological Tx for Osteoporosis |
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Definition
| postmenopausal women & men >50 yrs old with following: hip or vertebral fracture, prior fractures & low bone mass, T-score < or = -2.5 at femoral neck, total hip or spine, low bone mass & 2ndary causes, low bone mass & 10-yr probability of hip fracture |
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Term
| Pts who need Pharmacological Tx for Osteoporosis |
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Definition
| postmenopausal women & men >50 yrs old with following: hip or vertebral fracture, prior fractures & low bone mass, T-score < or = -2.5 at femoral neck, total hip or spine, low bone mass & 2ndary causes, low bone mass & 10-yr probability of hip fracture |
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Term
| WHO Fracture Risk Algorithm (FRAX) |
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Definition
| algorithm estimates likelihood of a person to break a bone due to low bone mass or osteoporosis over a period of 10 yrs; applies to untreated pts to help decide when to treat; calculated to be a 10-yr probability of hip fracture > or = 3% and any major osteoporosis-related fracture > or = 20% |
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Term
| Calcium Carbonate (TUMS, Caltrate, Oscal) |
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Definition
| antiresorptive; supplement; 1000 mg = 400 mg elemental; Limit single doses to < or = 600 mg elemental; Take w/ food; Preferred form (least expensive, least # of tabs to achieve daily goal); Dose in AM & PM |
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Term
| Calcium Citrate (Citracal) |
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Definition
| antiresorptive; supplement; 1000 mg = 210 mg elemental; Take with or without food; Separate by 2 hrs from taking other Rxs |
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Term
| Side Effects & D-D Interactions w/ Ca supplements |
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Definition
| Decreases Iron absorption; decreases absorption of quinolone antibiotics (levofloxacin [Levaquin]); decreases absorption of tetracycline, separate by 3-4 hrs; w/ levothyroxine; SEs: CONSTIPATION, gas, stomach upset, kidney stones (rare) |
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Term
| Vitamin D supplements - cholecalciferol (Delta-D, Vitamin D3, Maximum D), ergocalciferol (Calciferol drops, Drisdol capsules) |
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Definition
| 1 IU = 0.025 mcg (1 mg = 40,000 units) |
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Term
| bisphosphonates (Rx only) |
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Definition
| approved for prevention & tx of post-menopausal osteoporosis; drugs of choice to tx osteoporosis --> decreases vertebral, hip, & nonvertebral fractures; |
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Term
| Administration pearls for Bisphosphonates |
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Definition
| Take 1st thing in AM, at least 30 min prior to any foods, beverages, or other meds; Take tablet w/ at least 8 oz plain water; Pt must remain sitting or standing for at least 30 min after taking medication to prevent esophageal irritation & maximize absorption |
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Term
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Definition
| Oral: abdominal pain, dyspepsia, nausea; IV: fever, flu-like symptoms, injection site rxns; Less common: esophagitis, constipation, diarrhea, esophageal/gastric ulcers; Rare: osteonecrosis of jaw (ONJ); Do NOT use in pts w/ CrCl <35 mL/min |
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Term
| Clinical Pearls for Bisphosphonates |
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Definition
| 1) greatest increase in BMD & decrease in fracture risk of all antiresorptive agents; 2) greatest BMD increase in 1st yr of tx, increase continues for yrs 2-3 then plateaus; 3) Before starting, make sure serum Ca levels are normal |
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Term
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Definition
| Treatment: 10 mg PO daily; 70 mg PO weekly; Approved for women & men; GIO: 5 mg PO daily, 10 mg post-menopausal not using estrogen, approved for men & women |
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Term
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Definition
| Treatment: 5 mg PO daily, 35 mg PO weekly, 75 mg PO x 2 consecutive days per month, 150 mg PO monthly |
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Term
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Definition
| Treatment: 150 mg PO monthly; 2.5 mg PO daily; 3 mg IV PUSH q3 months, approved for Women only; Must check serum Ca, SCr, & Vit D; Must separate from food, beverages, or other meds by at least 60 min; Pt must remain sitting or standing for at least 60 min after taking medication; IV: 15 - 30 second bolus |
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Term
| Missed Doses of Oral Bisphosphonates |
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Definition
| for "Daily Dosing" -> take next day, first thing in AM; for "Weekly Dosing" -> take next day, first thing in morning. if >1 day elapsed, skip dose for that wk & start over following week; for "Monthly" --> choose same date each month as 'dosing day', if >7 days away from next scheduled dose, take missed dose next AM after it is remembered then go back to original date the following month, DO NOT take >1 monthly tab in a 7 day span |
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Term
| zoledronic acid (Reclast) |
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Definition
| dose for osteoporosis & GIO: 5 mg IV every year (diluted in 100 mL infused over 15 min); Check Cr before each dose; SEs: FEVER, HA, muscle/joint pain, FLU-LIKE SYMPTOMS, fatigue, atrial fibrillation; also tx of Paget's dx |
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Term
| Advantages of IV Bisphosphonates |
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Definition
| less risk of GI adverse effects; improved bioavailability; increased pt adherence; good for pts who cannot remain sitting/standing for 30-60 min |
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Term
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Definition
| mixed estrogen agonist/antagonist; 2nd line agent; Approved for prevention & tx of post-menopausal osteoporosis; Dose: 60 mg PO daily; ADRs: hot flashes, peripheral edema, leg cramps, 3-fold increased risk of thromboembolic dx; CPs: decreases vertebral fractures by 30-50%, less potent than bisphosphonates, decreases LDL & TC levels, does NOT increase risk for breast or endometrial cancer, D/C 72 hrs prior to & during prolonged immobilization |
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Term
| calcitonin (Fortical, Miacalcin) |
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Definition
| 2nd line agent derived from salmon; Tx of osteoporosis in women at least 5 yrs post-menopause who cannot take other agents; Intranasal or injectable (SC or IM); Dose: 200 mcg intranasally daily, 50-100 mcg SC or IM daily; ADRs: rhinitis, epistaxis, nasal irritation; CPs: EXPENSIVE, less effective than bisphosphonates, positive effect on fracture pain, possible resistance w/ long term use, store unopened bottles in fridge, prime before first use, once opened may be left open at room temp for 35 days |
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Term
| hormone therapy - estrogen (Premarin, Estratab, Orthoest, Climara), combination estrogen & progestin (Premphase, Prempro, FemHRT) |
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Definition
| approved for prevention of postmenopausal osteoporosis in women; receptors found on both osteoblasts & osteoclasts; decrease osteoclast activity, inhibit PTH, increase Ca absorption, decrease Ca excretion; both decrease fracture rate & increase BMD; NOT RECOMMENDED THERAPY because positive effects on bone MAY NOT OUTWEIGHT negative effects of cardiovascular events |
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Term
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Definition
| recombinant parathyroid hormone; approved for tx of osteoporosis for up to 2 yrs, reserved for pts w/ severe osteoporosis at highest risk of fractures; Dose: 20 mcg SC daily into thigh or abdomen available as pre-filled 3 mL pen injector; ADRs: leg cramps, dizziness, nausea; C/Is: hypercalcemia, Paget's dx, pregnant or nursing women, hx of bone cancer, hx of cancer that has metastasized to bone, radiation; CPs: MOST EXPENSIVE, decreases vertebral fractures, orthostatic hypotension, possible risk of osteosarcoma |
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Term
| Glucocorticoid-Induced Osteoporosis (GIO) |
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Definition
| 2nday osteoporosis caused by glucocorticoids, greatest bone loss occurs in 1st 6-12 months; MoA: decreased bone formation, increased bone resorption, decreased Ca absorption, increased Ca excretion, decreased estrogen & testosterone conc.; At risk: > or = 5 mg/day ORAL prednisone, long term, high dose inhaled steroids |
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Term
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Definition
| D/C glucocorticoid if possible; use lowest dose & shortest duration; Check baseline BMD; Give adequate daily Ca (1500 mg) & vitamin D (1200 IU); bone-healthy lifestyle; Start antiresorptive tx if steroid tx continues > or = to 3 months --> bisphosphonates are drugs of choice, continue for up to 3 yrs following d/c of steroid |
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Term
| Role of Clinician in Tx of Osteoporosis |
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Definition
| 1) get daily recommended amts of Ca & vitamin D; 2) engage in regular weight-baring & muscle-strengthening exercise; 3) avoid smoking & excessive alcohol; 4) talk about bone health; 5) bone density test & take meds when appropriate; 6) Counsel on risk of osteoporosis & related fractures; 7) Check for 2ndary causes; 8) Advise on non-pharm therapies; 9) Recommend BMD testing; 10) Initiate & monitor tx when needed |
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