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Osteo, Menopause & Testosterone

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munsele's version from 2016-06-29 17:50

Section 1

Question Answer
OsteoporosisT score < or = to -2.5
OsteopeniaT score between -1 and -2.5
Osteoporosis riskGenetic factors (caucasian and asian), advance age, IBD/bypass/celiac, alcohol abuse. epilepsy, parkinson's, stroke, MS, HIV, excessive thinness, decline in adult estrogen levels from menopause, anorexia nervosa, lactation, hypgonadism, RA and lupus, smoking, low level of physical activity
Meds with Oseto riskSteroid use long term, anticonvulsants, Heparin, lithium, excessive thyroid hormone, phenytoin, loops, aromatase inhibitors, Nafarelin/Goserelin, androgen blockers, PPIs, SSRIs, TZDs
Gold started to diagnose osteoBone scan of the hip and spine performed by a DEXA or DXA
When should DXA scans be performed Women at age 65 and men at age 70
FRAX toolestimates the risk of osteporotic fracture in the next 10yrs
Lifestyle modificationslighting appropriate, floors safe, storage at reasonable ht, bathroom safety ars, handrails
Exercisewt bearing exercise and muscle strengthening exercise along with adequate Vit D and calcium
Preferred source of calciumdietary
Key ages for calcium intakeChildren, PG, during the years around menopause
Vit D defRicketts in children and osteomalacia in adults
Calcium citrate absorptionbetter absorption than the others, can be taken with or without food (21% elemental)
Calcium carbonate absorptionAcid dependent absorption, take with meals (40% elemental calcium)
Vitamin D RDA for up to 70600 IU
RDA of vit D is >70800 IU
D2 or D3 preferredD3 is preffered source
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Section 2

Question Answer
Reason to stop BP after 3-5 years due to rare risk of atypical femur fracture and osteonecrosis of the jaw
Teriparatide injectionForteo
Forteo place in therapypts at high risk for having fractures or whom have already had fracture while taking BP
Calcitonin place in therapyfallen out of facor d/t reducing ony vertebral fractures and has cancer risk, use when alt not suitable
AlendronateFosamax, Binosto
RisedronateActonel, Atelvia
IbandronateBoniva
Zoledronic acidReclast
Raloxifene Evista
Oral BP SEhypocalcemia, muscolskeletal pain, abdominal pain, dyspepsia, N/v, dysphagia, heartburn, esophagitis
Reclast dosing intervalonce yearly (or every other year if for prevention)
Boniva dosing intervaldaily, monthly, or q 3 mo
Reclast SEno gut problems as it bypasses gut, but flu like sx
Reclast CICrCl<35
Raloxifene warningsIncreased risk of thromboembolic events
Evista SEhot flashes, peripheral edema, arthralgia
Conjugated equine estrogens/bazedoxifeneDuavee
Duavee place in therapyfor women with a uterus
TeriparatideForteo
Forteo SEhypercalcemia, arthralgias, pain, nausea, orthostasis/dizziness, and increased HR
DenosumabProlia
Denosumab CIhypocalcemia
Denosumab SEback pain, limb pain, dermatitis, eczema, rash, skin infxns, hypocalcemia, increased serum cholesterol
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Section 3

Question Answer
DenosumabProlia
Denosumab CIHypocalcemia
Prolia SEback pain, limb pain ,dermatitis, eczema, rash, skin infections, hypocalcemia, increased serum cholesterol
How to take BPfirst thing in the morning with 6-8oz of water, stay sitting/standing for at least 30min
Atelvia administrationAfter breakfast with 4oz water
Teriparatide administrationmay feel dizzy or lightheaded after first fwe doses. Injection where you can sit or lie down right away if needed, inject into thigh or abdomen, keep in refrigerator for 28days
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Section 4

Question Answer
Natural products used for vasomotor sxBlack cohosh, red clover, soy, flaxseed, dong quai, St. John's Wort
BrisdelleParoxetine
Brisdelle place in therapyfirst non-homral agents FDA approved for tx of mod-severe vasomotor sx assoc with meopause
Estrogen effects for menopauseCause a decrease in LH and more stable temperature control
OspemifeneOsphena
Osphena usefor dysparenunia (painful intercourse)
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Section 5

Question Answer
Things that can lower testosteroneMethadone, Chemo, cimetidine, sprionolactone
Common SE of testosteronebaldness, acne, and gyecomastia, increased appetite, hepatotoxicity
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