Osteoporosis

: Prepared by
Rawbi Bakrman •
Sarah Bahshwan supervision :D/Hassin Bayashot•
 : Definition
Osteoporosis : is a bone disorder characterized by •
low bone density, impaired bone architecture, and
.compromised bone strength predisposing to fracture

: pathophysiology •
.an imbalance in bone remodeling •
.osteoclastic activity is enhanced ==> overall bone loss •
a reduction in osteoblastic activity and reduced bone •
.formation
.decrease in endogenous estrogen during menopause •
: risk factors •

advanced age •
race : white more than black •
.gender : female more than male •
previous fragility fracture •
parent history of hip fracture •
BMI⬇ •
current smoking, alcohol •
RA •
early menopausal before 45years •
Classification

Secandary )2 :primary osteoporosis )1

: osteoporosis .no known cause •
caused by • postmenopausal •
drugs : • .women and aging men
anticonvulsants
,antiacids
.,glucocorticoids
other diseases : •
hyperthyroidism
,hypogona
 Diagnosis
Physical examination : bone pain, kyphosis, loss of )1
.height (>1.5 in [3.8 cm])

Laboratory testing: CBC, creatinine, BUN, calcium, )2

phosphorus, alkaline phosphatase, albumin, TSH, free
testosterone, 25-hydroxyvitamin D, and 24-hour urine
.concentrations of calcium and phosphorus

DXA : is the diagnostic standard for measurement of ) 3

.central (hip and spine) BMD
 skeletal T-score
disorder

normal Greater than

−1

osteopenia to −2.4 1−

osteoporosis at or Less
than −2.5
: treatment
: goals of treatment •
.preventing fractures and their complications )a( •
.maintaining or increasing BMD )b( •
.preventing secondary causes of bone loss )c( •
:nonpharmacological treatment •
:lifestyle -1 •
.adequate dietary intake of calcium and vitamin D •
.limit caffeine, smoking cessation •
exercises -2 •
falls prevention: balance training,Use of hip -3 •
.protectors
 :pharmacological treatment •
•
Bisphosphonates •
Alendronate, risedronate, IV zoledronic acid : for •
.postmenopausal, male, and glucocorticoid-induced osteoporosis
.ibandronate : only for postmenopausal osteoporosis •
m.o.a : inhibit bone resorption ==> long biologic half-lives of up •
.to 10 years
.higher BMD increases and fracture risk reductions •
? How to take •
oral tablet taken in the morning with only tap water at least 30 •
minutes (60 minutes for oral ibandronate) any food or
.medication
upright sitting for at least 30 min after alendronate and •
risedronate and 1 hour after ibandronate to prevent esophageal
.irritation and ulceration
 : missing dose •
.weekly dose ==> next day •
.more than 1 day has elapsed ==> skipp until the next dose •
.monthly dose ==> taken up to 7 days before the next dose •
: adverse effects •
.nausea, abdominal pain, dyspepsia ,irritation, ulceration •
.osteonecrosis of the jaw (rare) •
: alendronate -1 •
.prevention 5 mg po daily or 35 mg po weekly •
.treatment 10 mg po daily or 70 mg po weekly •
: C/l •
.Crcl < 35 ml/min •
 : zoledronic acid -2 •
.Prevention :5 mg IV inf every 2 years •
.treatment : 5 mg IV inf yearly •
: C/I •
pregnancy •
.Crcl < 35ml/min •
: ibandronate -3 •
.Prevention 150 mg po monthly •
.treatment 150 mg po monthly; 3mg IV every 3 months •
: C/I •
.Crcl < 30ml/min •
: Risedronate •
Prevention and treatment: 5 mg po daily, 35 mg po weekly, 150 •
.mg po monthly
C/I •
 : Vitamin D supplementation -2 •
.maximizes intestinal calcium absorption and BMD •
the goal : to maintain vitamin D3 concentration at •
.30 ng/mL (75 nmol/L) or higher
.IU daily 1000 •
.IU every another day 2000 •
.IU weekly 5000 •
.monitor vit D conc. q 3 mo •
: calcium carbonate -3 •
. elemental calcium 40% •
with meals to enhance absorption in an acidic •
.environment
.dose : 1-1.2 g PO qDay or divided q6-12hr •
 :Denosumab -4 •
m.o.a : RANK ligand inhibitor; inhibits osteoclast formation and •
.increases osteoclast apoptosis
.for osteoporosis in women and men at high risk for fracture •
.dose : 60 mg SC once every 6 mo •
.C/I : hypocalcemia until correct •
: Raloxifene -5 •
.estrogen agonist in bone •
.for prevention and ttt of postmenopausal osteoporosis •
.S/E : Hot flushes, leg cramps, and muscle spasms •
: C/I •
pregnancy •
lactation •
.active or past history of venous thromboembolic disease •
.dose : 60 mg PO qDay (safe for kidney) •
.Onset: 8 wk •
: Calcitonin -6 •
.for women at least 5 years past menopause •
.Intranasal dose : 200 units daily, alternating nares every other day •
.Teriparatide : parathyroid hormone analoge -7 •
increases bone formation, bone remodeling rate, and osteoblast •
.number and activity
.dose : 20 mcg SC once daily for up to 2 years only •
Onset: 3 months •
.lying or sitting, in case orthostatic hypotension •
: C/I •
Hypersensitivity •
.High risk for osteosarcoma •
•
alendronate + levothyroxine , alendronate in early morning , •
.levothyroxine 30 min before breakfast
. alendronate +calcium carbonate, separate by 30 min •