CCFP Exam 2023 WITH 100% CORRECT ANSWERS

Alendronate = Bisphosphonate Trade Fosamax Oral osteoporosis tx either daily or weekly Evidence for prevention of vertebral, hip, non-vertebral fractures Dose details: Osteoporosis in postmenopausal females: prophylaxis 5mg po once daily or 35mg po once weekly, treatment: 10mg po once daily or 70mg po once weekly Osteoporosis in males: 10mg po once daily or 70mg po once weekly Osteoporosis secondary to glucocorticoids in males and females: 5mg po once daily; a dose of 10mg once daily should be used in postmenopausal females who are not receiving estrogen Risedronate = Bisphosphonate Trade Actonel Oral osteoporosis tx either daily or weekly Evidence for prevention of vertebral, hip, non-vertebral fractures Dose details: Osteoporosis (postmenopausal): Immediate release tablet: Prevention and treatment: 5mg po once daily or 35mg po once weekly or 150mg po once a month. Delayed release tablet: Treatment: 35mg po once weekly Osteoporosis (males) treatment: Immediate release tablet: 35mg po once weekly Osteoporosis (glucocorticoid-induced) prevention and treatment: Immediate release tablet: 5mg po once daily 00:02 01:28 Zoledronic Acid = Bisphosphonate Trade Aclasta IV osteoporosis tx once a year Evidence for prevention of vertebral, hip, non-vertebral fractures Dose details: Osteoporosis prevention: 5mg IV as a single (one-time) dose Osteoporosis treatment: 5mg IV once a year Osteoporosis, glucocorticoid-induced, treatment and prevention: 5mg IV once a year Denosumab = Monoclonal antibody RANK, for osteoporosis tx Trade Prolia SubQ osteoporosis tx once every 6 months Evidence for prevention of vertebral, hip, non-vertebral fractures Dose details: Osteoporosis in men or postmenopausal women treatment: 60mg SubQ as a single dose, once every 6 months Osteoporosis Screening Guidelines ALL patients 65 yrs Patients 50-64yrs with: • Fragility fracture after age 40 • Prolonged use of glucocorticoids or other highrisk medications • Parental hip fracture • Vertebral fracture or osteopenia identified on radiography • High alcohol intake (3/day) or current smoking • Low body weight ( 60 kg) or major weight loss ( 10% of body weight at age 25) • Other disorders strongly associated with osteoporosis Patients 50yrs with: • Fragility fractures • Use of high-risk medications • Hypogonadism • Malabsorption syndromes • Chronic inflammatory conditions • Primary hyperparathyroidism • Other disorders strongly associated with rapid bone loss or fractures Osteoporosis Management Encourage basic bone health for all individuals over age 50, including regular active weight-bearing exercise, calcium (diet and supplements) 1200 mg daily, vitamin D 800-2000 IU (20-50 μg) daily and fall-prevention strategies Calculate risk using one of two tools: FRAX (WHO) CAROC (Canadian Association of Radiologists and OP Canada Risk Assessment Tool) - both comparable - both use only femoral neck T-score Classifies patients into: Low/Mod/High risk for 10 year fracture risk Low = r/a in 5 years Mod = consider other risk factors (listed), to determine if pharmacotherapy. R/a in 1-3 yrs to monitor for rapid bone loss High = usually pharmacotherapy Note: when starting pharmacotherapy, repeat BMD in 1-3 yrs to assess tx effect (if unchanged or improved = good response to therapy), otherwise consider poor compliance, tx failure, secondary cause of OP