Should be reserved for patients for high risk for fractures and those who have failed or cannot tolerate other osteoporosis therapies

Bisphosphonate that is taken orally (daily or weekly); effervescent tab (taken weekly)

72 y/o woman with a history of vertebral compression fracture and a DEXA T score of -2.7 in the left hip. What is the best initial therapy for this patient?

Cumulative therapy should not last more than 2 years, and following therapy another anti-resorptive agent for osteoporosis should be initiated to maintain bone density and prevent loss

Which of the following is correct reguarding the pharmacokinetics of the bisphosphonates?

Bisphosphonate that is taken yearly by IV

A 56 year old womand who has been diagnosed with postmenopausal ostoeporosis has no history of fractures and no other pertinent medical conditions. Which of the following is most appropriate for the management of her osteoporosis?

Adverse effects of Denosumab

Contraindications of Bisphosphonates

Hyperuricemia can occur with?

Analog of parathyroid hormone-related peptide

A Bisphosphonate that where Beneficial effects increase exponentially over several years of therapy, but discontinuation needs to gradual loss of effects

First Line Therapy for Paget’s Disease r/t high efficacy and once-yearly dosing. Has very high affinity for mineralized bone and decreases bone resorption up to 1 year after a single IV dose.

Preferred Bisphosphonates for Osteoporosis

Use of which agent for osteoporosis should be limited to no more than 2 years?

How many years of Bisphosphonate Zolendronic Acid IV therapy until a drug holiday?

How many years of Bisphosphonate oral therapy until a drug holiday?

Parathyroid agent that is a recombinant form of human parathyroid hormone

Patients unable to tolerate oral Bisphosphonates receive?

A 52-year old woman has a history of RA, DM, HTN, and heartburn. Her medications include methotrexate, prednisone, metformin, hydrochlorothiazide, lisiniopril and calcium carbonate. She is worried about the risk of osteoprosis as she approaches menopause. Which of her medications is most likely to contribute to the risk of developing osteoporosis?

Drugs that contribute to bone loss

Which of the following best describes the mechanism of action of Denosumab in the treatment of osteoporosis?

A patient has been taking Alendronate for postmenopausal osteoporsis for 5 years with slight increase in bone mineral density and no occurrence of fracures. Risk of which adverse effect might warrant consideration of a drug holiday from Alendronate in this patient?

Suffix for Parathyroid Agents

A 55 year old woman with postmenopausal osteoporosis has a past medical history of alcohol use disorder, alcoholic liver disease, erosive esophagitis, and hypothyroidism. Which is the primary reason oral Bisphosphonates should be used with caution in this patient?

What are one of two criteria needed to be met for a diagnosis of osteoporosis?

How is Denosumab administered?

68 y/o man with several risk factors for osteoporosis— cigarette smoking, drinking 3-5 alcoholic drinks/day, low body weight and sedentary lifestyle. Labs reveal a 25 Vitamin D level of 18 mcg. Of the following, what will you recommend?

Contraindications for SERMs

How much water should you take with Risedronate ER?

Preferred Bisphosphonates for Osteoporosis

SERMs for postmenopausal women with osteoporosis

Alternative first line RANKL for postmenopausal osteoporosis, particularly with patients with higher risk of fractures, and osteoporosis in men and glucocorticoid-induced osteoporosis

Monoclonal antibody and inhibitor of Sclerostin

Drugs that contribute to bone loss

Absorption is poor (<1%) and food and other medications interfere with its absorption

How long should you remain upright after taking Bisphosphonates?

Bisphosphonate therapy should not be discontinued in women who are high risk of

Indicated for postmenopausal women at high risk of fractures. Two SQ injections are given yearly.

Suffix associated with Bisphosphonates

A 55 year old man is diagnosed with Paget disease. He has no other significant medical history. Which agent would be most appropriate for treatment of Paget disease in this patient?

53 y/o woman with history of esophageal stricture—recently treated successfully with dilatation—from longstanding GERD, and vasomotor symptoms of menopause. A recent DEXA showed a T score of -2.5 of the LS spine and -2.6 in the left hip. Which therapy is MOST appropriate?

Injection site reactions, hypercalcemia, and orthostatic hypotension

38 y/o woman who is at a health fair. She asks what she can do to maintain her bone health. Her mum had sever osteoporosis with vertebral fractures, spinal kyphosis, hip fracture and limited mobility. Your patient is 64 inches tall and weighs 115 pounds. She is postmenopausal. Her meds include OCP and a multivitamin daily; her DEXA scan shows a T score of -1.3 and a Z score of -.8. which exercise regimen is going to be most helpful to improve her bone health?

How much water should you take with Bisphosphonates?

GI upset, bone pain, increased risk of infection, skin reactions, hypocalcemia

Diarrhea, Abdominal and Musculoskeletal Pain are common side effects

Indicated for postmenopausal women who are at least five years postmenopausal but is less effective than other osteoporosis medications

Bisphosphonates that treat post menopausal osteoporosis, osteoporosis in men, glucocorticoid-induced osteoporosis, Paget disease, as well as treatment of bone metastases and hypercalcemia of maligancy.

68 y/o post menopausal woman with a history of T2DM, CAD, dyslipidemia, GERD, OA of knees, stage 3 CKD. Recent EGD was unremarkable. DEXA scan showed t score of -3 of the left hip. Which of the following precludes the used of a bisphosphonate?

Estrogen-like affects on bone and estrogen antagonist, affects on breast and endometrial tissue causing increases in bone density without increasing of endometrial cancer, and decreases risk of invasive breast cancer

Binds to Sclerostin (regulator factor that inhibits bone formation) and inhibits it’s action, thereby promoting osteoblast activity and bone formation. Secondry action - to decrease bone resorption.

Monoclonal antibody targets receptor activator of nuclear factor kappa-B ligand (RANKL). By binding to RANKL, it prevents activation of RANK receptors on onsteoclasts, thereby inhibiting osteoclast formation and reducing done resorption.

Acts as an agoinist at the parathyroid hormone receptor in stimulation of osteoclastic activity thereby increasing bone formation and strength

75 y/o woman with newly diagnosed osteoporosis, being discharged after total hip replacement due to right hip fracture. She has never been medication for osteoporosis. PMH is significant for severe GERD, DVT [20 years ago], atrial fibrillation and family history of breast cancer. Which therapy may offer the MOST benefit in this patient?

Adverse drug effects include arthralgias, headache, and injection site reactions

Bisphosphonate that is taken orally (monthly); IV (taken every 3 months)

Higher dose, longer duration of therapy, IV administration, dental extractions or implants, use of glucocorticoids, diabetes, and smoking put patients on bisphosphonates at increased risk for?

Rhinitis and injection site reactions are adverse reactions

They are cleared rapidly from the plasma (r/t binding of hydroxyapatite). Once bound to bone, they are cleared via kidneys over a period of hours to years.

Given intranasally or by injection (IM or SQ). For postmenopausal women who are at least 5 years postmenopausal. Is less effective than other osteoporosis medications, and should only be used if other agents not tolerated or appropriate. Has higher risk of new malignancy with long term use.

How is Risedronate delayed-release tablet taken?

Which of the following characteristics would make a patient the most appropriate candidate for Abaloparatide treatment for postmenopausal osteoporosis?

Bind to hydroxyapatite in decrease Osteoclastic bone resorption causing small increase in bone mass and decrease risk of fractures

Suffix for SERMs

Peptide secreted by the thyroid gland that binds to osteoclasts inhibits their resorptive activity thereby by reducing bone resorption

Because it has not been shown to reduce non-vertebral or hip fractures, this drug should be used as an alternative for postmenopausal women who cannot take Bisphosphonates or Denosumab

ONJ and Atypical Femur Fractures are uncommon adverse effects

A 67 year old woman complains of severe back pain and is found to have multiple verterbral fractures related to osteoporosis. The patient has a past medical history of HTN, CKD, and MI 6 months ago. Which of the following would exclude the use of Romosozumab in this patient?

Bisphosphonates that are dosed daily, weekly, or monthly depending on the drug.

Hot flashes, leg cramps, and increased risk of DVT

How long should you remain upright with Ibandronate?

Contraindications for Sclerostin Inhibitors

45 year old African American woman who was a previous smoker has a BMI of 32 kg/m2. She is currently on a 1 week taper of Prednisone for an asthma flair. She is also taking Lisinopril 20 mg for HTN. Which of the following is associated with the most INCREASED risk for her developing osteoporosis in this patient?

Esophagitis and Esophageal Ulcers are common side effects

Contraindications for Teriparatide and Abalparatide

Long term use of bisphosphonates put patients at increased risk for?