Drugs affecting calcium levels and bone mineralization
Vitamin D deficiency is noted when 25 OH is less than?
20 ng/mL. Many sources and labs use 30 ng/mL as the cutoff for deficiency 20-100 normal
Which drugs have been associated with osteonecrosis of the jaw and atypical long bone fractures?
Bisphosphonates.
How is osteoporosis defined?
Bone marrow density (BMD) value 2.5 SD below the mean. T score > -2.5 dictates treatment
Treatment would be recommended if the FRAX 10 year major osteoporosis fracture risk was ____% and the ten year risk of hip fracture is _____%?
> 20% and > 3%
What is a normal 25 OH vitamin D level?
> 30 ng/mL "sufficient"
The following instructions apply to_ ? Take in the morning before breakfast on an empty stomach, no food including orange juice or coffee for at least 30 minutes after administration. Take with a full glass of water. Remain upright (sitting or standing) for at least 30 minutes.
Bisphosphonates such as alendronate (Fosamax).
What are some of the endocrine disorders that can increase the risk of osteoporosis?
Hyperthyroidism, hyperparathyroidism, hypogonadism, hyperprolactinemia, DM, adrenal insufficiency, and Cushing's syndrome
When would bisphosphonates be contraindicated?
In individuals that cannot sit up for 30 minutes or have esophageal disorders.
Name two medications that can increase calcium levels
Lithium and thiazide diuretics
What are the two major causes of hypercalcemia?
Malignancy and hyperparathyroidism.
Name some hematologic disorders that can increase the risk of osteoporosis.
Muitipie myeioma, ieukemia
What are the uses for selective estrogen receptor modulators (SERMS) such as raloxifene (Evista)?
Postmenopausal osteoporosis, and breast CA
What are some immunologic disorders that increase the risk of osteoporosis?
RA and SLE
What disorders are associated with deficits in Vitamin D?
Rickets and osteomalacia.
What are the adverse effects of SERMS?
Venous embolism, fetal harm, and hot flashes.
Why is it important to get a vitamin D level prior to starting bisphosphonates?
Very low levels of vitamin D can render the medications ineffective
hyperparathyroidism
hypersecretion of the parathyroid glands, usually caused by a tumor
Name drugs that can cause osteoporosis.
i.Anticonvulsants ii.Glucocorticoids iii.Levothyroxine (over replacement) iv.Cytotoxic drugs v.Lithium vi.Long term use of heparin
Hypercalcemia
muscle weakness, lack of coordination, abdominal pain, confusion, absent tendon reflexes, shallow respirations, emergency!
What is the recommended daily intake of calcium for adults 19-50 years old?
1,000 mg/day or more. 1,200 mg/day if> age 50 and female.
How many mg of calcium are in an 8-ounce glass of milk?
300 mg.
What is the maximum daily dose of vitamin D?
4,000 IU however, when low, higher amounts are used initially
What is the recommended treatment time for patient with osteoporosis?
4-5 years if mild and 10 years if severe
Is there a desired goal level to achieve when replacing vitamin D?
60. ng/dL.
if the fracture risk on the FRAX is >_____%, a DXA scan is ordered?
9.3%.
What is the FRAX score?
A Fracture Risk Assessment tool that can identify individuals with risk fracture from the WHO
What are the components of the FRAX tool?
Age, sex, weight, previous fracture, parent with a hip fracture, smoking, use of glucocorticoids, RA, secondary osteoporosis, more than 3 drinks/day, femoral neck bone mineral density
How is osteopenia or low bone mass defined?
AT score of -1.0 to -2.5. The favored term is "low bone mass."
At what age do women experience accelerated bone loss?
After menopause with continued loss for several years (2%-3% per year).
When should adults be screened for osteoporosis?
Age 65 or if risk factors are present
Name lifestyle measures aimed to promote bone health.
Avoid smoking and ETOH. Regular weight-bearing exercise prevents bone loss.
Name lifestyle measures aimed to promote bone health.
Avoid smoking, ETOH, excessive caffeine. Regular weight-bearing exercise prevents bone loss.
Why is it important to separate some drugs when taking calcium supplementation?
Calcium can interfere with the absorption of some drugs such as levothyroxine
Name GI disorders that can increase the risk of osteoporosis.
Celiac disease anti-inflammatory bowel disease
What is the recommended amount of vitamin D?
Children under age 1 year need 400 IU/day. Ages 1-7- need 600 IU day and those older than age 7 need 800-1200 IU D2. Pt w osteoporosis may need more. This information is evolving
Hypocalcemia S/S
Diarrhea, Numbness, Tingling of extremities and around mouth, Convulsions, Positive Chvostek sign, Positive Trousseau sign, *Pt at risk for tetany.
What is the adverse effect of greatest concern when using bisphosphonates for the treatment of osteoporosis?
Esophagitis is the greatest concern.
hyperparathyroidism symptoms
Sx of hypercalcemia, anorexia, n/v, constipation, fatigue, weakness, confusion, polyuria, polydipsia, bone pain, kidney stones
Which gland regulates calcium balance in the body?
The parathyroid gland.
Why is it important to ask a patient about their dental condition prior to the initiation of bisphosphonates?
There is an association between osteonecrosis of the jaw and the use of bisphosphonates. It recommended that major dental procedures be done before starting these drugs