Unit 4 (20): Drugs Affecting Calcium Levels And Bone Mineralization

Vitamin D deficiency is noted when 25 OH is ↓ than:

20 ng/mL --> Many sources and labs use 30 ng/mL as the cutoff for deficiency

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)

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 ↓ the mean

When would bisphosphonates be contraindicated?

In individuals that cannot sit up for 30 minutes or have esophageal disorders

What are the uses for selective estrogen receptor modulators (SERMs) such as raloxifene (Evista)?

Postmenopausal osteoporosis Breast cancer

What disorders are associated with deficits in Vitamin D?

Rickets and osteomalacia.

What are the adverse effects of SERMs?

Venous embolism Fetal harm Hot flashes

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 - ↑ 3 drinks/day - Femoral neck bone mineral density

Name lifestyle measures aimed to promote bone health.

- Avoid smoking and ETOH - Regular weight-bearing exercise prevents bone loss

What is the recommended amount of vitamin D?

- Children under age 1 year need 400 IU/day - Ages 1-7 need 600 IU day - Those older than age 71 need 800 IU day --> This information is evolving

What is the recommended daily intake of calcium for adults 19-50 years old?

1,000 mg/day or ↑ --> 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 FRAX score?

A Fracture Risk Assessment tool that can identify individuals with risk fracture from the WHO

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

Why is it important to separate some drugs when taking calcium supplementation?

Calcium can interfere with the absorption of some drugs such as levothyroxine

What is the adverse effect of greatest concern when using bisphosphonates for the treatment of osteoporosis?

Esophagitis is the greatest concern

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