Osteoporosis, menopause, testosterone use - osteoporosis
19 important questions on Osteoporosis, menopause, testosterone use - osteoporosis
Osteopenia (low bone mass) T score
1st line for treatment and prevention in most patients
Consider for low risk patients after 3-5 years of treatment with bisphosphonates
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Risedronate (Actonel, Atelvia)
Treatment in males
Glucocorticoid induced
Ibandronate (Boniva) IV
Zoledronic acid (Reclast) IV
Treatment in males & POST-menopause: 5 mg IV once yearly
Glucocorticoid induced
Type of bisphosphonate preferred if esophagitis is present (due to risk of esophageal cancer)
Bisphosphonate alternative when there is a high risk of fracture- mab that binds RANKL to prevent osteoclast formation
-Prolia
-Xgeva: used for hypercalcemia of malignancy, bone cell tumor, prevent bone matastasis
Denosumab (Prolia) injection
What needs corrected before starting Denosumab?
Analogs of human PTH, which stimulates osteoblasts and increase bone formation. For very high risk of fracture, such as previous history of vertebral fracture)
Teriparatide (Forteo) pre-filled injection
Glucocorticoid induced
Abaloparatide (Tymlos) pre-filled injection
Warnings/side effects of Teriparatide (Forteo) and Abaloparatide (Tymlos)
Arthralgias, leg cramps, nausea, orthostasis/dizzy
Counseling points for Teriparatide and Abaloparatide
Keep refrigerated
Forteo: protect from light
High risk of vertebral fractures and can be used if low VTE risk or high breast cancer risk
High risk of vertebral fractures and can be used in women with an intact uterus for osteoporosis prevention
Main side effects of raloxifene (Evista)
For prevention only in POST- menopause women with vasomotor symptoms
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- A unique study and practice tool
- Never study anything twice again
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- 100% sure, 100% understanding
