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Informatics in Pharmacy

Osteoporosis

August 13, 2018 By Dr. G, PharmD

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All women over 65 and men over 70 should have bone mineral density (BMD) testing.  If fractures or risks, test sooner.

Initiate therapy if:

  • Hip or spine fracture and BMD T-score -2.5 or below at hip, spine or femoral neck
  • T-score is between -1.0 and -2.5 at femoral neck or spine and the 10-year probability of hip fracture (FRAX score) is 3% or greater
  • The 10-year probability of major fracture (FRAX score) is 20% or greater according to

Treatment:

  • Bisphosphonates: Standard.
    • Alendronate and risedronate are first line
    • Zoledronic acid, ibandronate and pamidronate are available in IV forms.
  • Calcium is recommended for all patients with osteoporosis. Give 1000-1200 mg/day
  • Vitamin D is recommended for all patients. Give 800-1000 IU daily
  • Raloxifene (SERM) reduces bone resorption
  • Conjugated estrogen and bazedoxifene is like a SERM.
  • Calcitonin is not first-line, but can be useful in bone pain.  Nasal route.
  • Teriparatide is reserved for high-risk patients.  Increases calcium concentration, but also increases digoxin toxicity
  • Denosumab inhibits bone resorption, alternate to first-line, can lead to cellulitis (subQ) and hypocalcemia

Filed Under: Geriatrics, Women's Health

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acid base acidosis acute coronary syndrome alkalosis analgesics anaphylaxis aortic dissection arrhythmia Beta-Blockers biostatistics blood pressure cardiac markers CHA2DS2-VasC cocaine COVID-19 diabetes diabetes inspidius Guidelines heart failure Heparin hypersensitivity hypertension hypovolemic shock intubation ionotropes journal club lipids LMWH medication safety morphine conversions myocardial infarction needs work NOAC NSTEMI obstructive shock pharmacoeconomics pheochromocytoma pressors reference materials right mi sedation septic shock shock STEMI Updated 2020