Sherpath: Chapter 17, Drugs for Osteoporosis and Hormonal Problems: Drug Therapy for Osteoporosis

Question 1 of 24

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Which response would the nurse provide when a patient asks, “How did I get osteoporosis?”

• • “It’s because you don’t drink enough milk.”A low intake of calcium is not the only risk factor for the development of osteoporosis.
• • “Your body doesn’t process vitamin D the right way.”Although vitamin D is necessary to prevent the development of osteoporosis, problems with processing vitamin D do not cause its development.
• • “It’s because you ingest too much calcium in the diet.”A calcium deficiency contributes to the development of osteoporosis. It will not develop because of an excess amount of calcium in the diet.
• Correct
  • “Your body breaks down bone faster than it builds it up.”Old bone cells are continually removed by a process known as osteoclastic activity, and new bone cells are continually added by a process known as osteoblastic activity. Osteoporosis results when osteoclastic activity occurs at a faster rate than osteoblastic activity.

Question 2 of 24

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Which response would the nurse provide when asked what occurs in osteoporosis? Select all that apply. One, some, or all responses may be correct.

• Correct
  • “The bones become weaker.”The bones become weaker and thinner in osteoporosis because the body breaks down bone faster than it is made.
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  • “Calcium is lost from the bones.”The primary mineral lost from the bones in osteoporosis is calcium.
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  • “The loss of bone causes changes in height.”When the bones become thinner, the spine begins to bend leading to a loss of body height.
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  • “There is an increased risk for bone fractures.”The development of thinner, weaker bones in osteoporosis increases the risk for bone fractures.
• • “The muscles can no longer support the bones.”Osteoporosis does not affect the action of the muscles to support the bones.

Question 3 of 24

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Which factor increases a patient’s risk of developing osteoporosis? Select all that apply. One, some, or all responses may be correct.

• Correct
  • Being postmenopausalOsteoporosis is commonly more severe in women after menopause because of a decline in estrogen levels.
• Correct
  • Limited physical activityWeight-bearing activity reduces the risk of developing osteoporosis. A person who engages in limited physical activity would be more at risk for the condition.
• Correct
  • A vegan dietA diet poor in calcium, other minerals, vitamin D, and protein increase the risk of developing osteoporosis. A vegan eating plan might be deficient in the nutrients that prevent the development of this condition.
• • Taking hormone replacement therapyHormone replacement therapy would help prevent the development of osteoporosis. It would not increase the patient’s risk for the condition.
• Correct
  • Frequent cigarette smokingCigarette smoking is a risk factor for the development of osteoporosis.

Question 4 of 24

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Which information would the nurse include when teaching a patient with osteoporosis about a prescribed estrogen agonist/antagonist drug?

• • “It is used when all other drugs have failed to promote new bone growth.”A sclerostin inhibitor, not an estrogen agonist/antagonist, is used for patients at high risk for fracture or who failed other therapies. It is a glycoprotein from osteocytes that, when inhibited, stimulates osteoblast activity and formation of new bone.
• • “It moves blood calcium into the bone to prevent bone cells from being destroyed.”A bisphosphonate, not an estrogen agonist/antagonist, reduces the rate of osteoporosis by moving blood calcium into the bone, binding to calcium in the bone, and preventing osteoclasts from destroying bone cells and resorbing calcium.
• • “It binds to some white blood cells (WBCs) and prevents them from attacking bone tissue.”Osteoclast monoclonal antibodies bind receptors on immature osteoclasts and on certain WBCs, preventing them from becoming mature and attacking bone tissue. The result is decreased bone loss and increased bone density and strength. This is not true of estrogen agonists/antagonists, which reduce calcium resorption and increase bone density.
• Correct
  • “It slows the rate of osteoporosis by reducing calcium resorption and increases bone density.”Estrogen agonists/antagonists slow the rate of osteoporosis by activating estrogen receptors in the bone, which leads to reduced calcium resorption and increased bone density. They also block (antagonize) estrogen receptors in breast tissue and uterine tissue.

Question 5 of 24

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Which response would the nurse make when a patient with osteoporosis asks, “Why do I need to take vitamin D with calcium?”

• Correct
  • “Vitamin D is needed for calcium to be absorbed from the intestinal tract.”Bone density requires a constant supply of calcium, and dietary calcium requires activated vitamin D for absorption from the intestinal tract.
• • “Vitamin D is lost through the urine every day.”Vitamin D is not lost through the urine. It is needed to absorb calcium from the intestines.
• • “Vitamin D is needed to release calcium from the adipose tissue.”Vitamin D is a fat-soluble vitamin and would be stored in the adipose tissue. Calcium is not stored in the adipose tissue.
• • “Vitamin D stops the breakdown of bone in the body.”Vitamin D alone does not stop the breakdown of bone in the body.

Question 6 of 24

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Which statement would the nurse make to explain the mechanism of action of bisphosphonates? Select all that apply. One, some, or all responses may be correct.

• Correct
  • “They bind calcium in the bone.”Bisphosphonates are calcium-modifying drugs that are used to prevent and treat osteoporosis. Bisphosphonates act by binding to calcium in the bone.
• • “They prevent immature osteoclasts from maturing.”Osteoclast monoclonal antibodies, not bisphosphonates, target immature osteoclasts to prevent them from maturing and reducing bone density.
• Correct
  • “They prevent some white blood cells from harming bone.”Bisphosphonates are calcium-modifying drugs that are used to prevent and treat osteoporosis. They prevent certain white blood cells from damaging or destroying bone.
• • “They target immature osteoclasts to prevent the reduction in bone density.”Osteoclast monoclonal antibodies, not bisphosphonates, target immature osteoclasts to prevent them from maturing and reducing bone density.
• Correct
  • “They prevent osteoclasts from destroying bone cells and resorbing calcium.”Bisphosphonates are calcium-modifying drugs that are used to prevent and treat osteoporosis. They prevent osteoclasts from destroying bone cells and resorbing calcium.

Question 7 of 24

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For which reason would a patient be prescribed a bisphosphonate? Select all that apply. One, some, or all responses may be correct.

• Correct
  • To treat Paget diseaseAll bisphosphonates increase bone density and can be used to treat Paget disease.
• • To prevent cancer-induced hypercalcemiaBisphosphonates are used to treat cancer-induced hypercalcemia, but not prevent the development of cancer-induced hypercalcemia.
• Correct
  • To prevent fractures because of bone metastasisAll bisphosphonates increase bone density and are used to prevent skeletal fractures in patients with bone metastasis.
• Correct
  • To reduce the risk of fractures of the spine and hipAll bisphosphonates increase bone density, reducing the risk of fractures of the spine, hip, and other bones.
• Correct
  • To limit the risk of fractures because of multiple myelomaAll bisphosphonates increase bone density and are used to prevent fractures in patients with multiple myeloma.

Question 8 of 24

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Which assessment finding indicates to the nurse that a patient is experiencing a side effect from a bisphosphonate? Select all that apply. One, some, or all responses may be correct.

• Correct
  • NauseaNausea is a common side effect from bisphosphonates.
• • Bone painBone pain is not a common side effect from bisphosphonates.
• Correct
  • HeadacheA headache is a common side effect from bisphosphonates.
• • Muscle spasmsMuscle spasms are not a common side effect from bisphosphonates.
• Correct
  • Esophageal refluxEsophageal reflux is a common side effect from bisphosphonates.

Question 9 of 24

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Which statement indicates that teaching provided to a patient about a bisphosphonate was effective? Select all that apply. One, some, or all responses may be correct.

• Correct
  • “I will take the drug after breakfast.”The patient should be instructed to take the bisphosphonate immediately after breakfast.
• Correct
  • “I will take the drug with a full glass of water.”The patient should be instructed to take the drug with a full glass of water.
• • “I will expect my gums to develop redness and pain.”The patient should be instructed to report any signs of redness or pain in the gums as this could indicate the development of osteonecrosis of the jaw.
• Correct
  • “I will avoid tobacco products while taking this drug.”The patient should be instructed to avoid smoking or using nicotine products to reduce the risk of blood clots.
• Correct
  • “I will remain upright for 30 minutes after taking the drug.”The patient should be instructed to remain in the upright position for at least 30 minutes after taking a dose to prevent the development of esophageal irritation and reflux.

Question 10 of 24

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Which physiological response would the nurse emphasize as an advantage when reviewing the use of an estrogen agonist/antagonist with a patient who has osteoporosis?

• • It controls blood pressure.Common side effects of an estrogen agonist/antagonist include increased blood pressure.
• • It reduces the risk of developing blood clots.Common side effects of an estrogen agonist/antagonist include an increased risk of thrombotic events, which include deep vein thrombosis.
• Correct
  • It prevents excessive growth of breast tissue.An estrogen agonist/antagonist is a drug for osteoporosis that activates (agonizes) estrogen receptors in the bone to help calcium remain in the bone and blocks (antagonizes) estrogen receptors in breast tissue. These opposing responses increase bone density and prevent excessive growth of breast tissue.
• • It enhances the development of uterine endometrial tissue.The antagonizing effect of estrogen agonists/antagonists is the prevention of overgrowth of uterine endometrial tissue.

Question 11 of 24

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Which assessment finding indicates to the nurse that a patient taking an estrogen agonist/antagonist as treatment for osteoporosis is experiencing a side effect? Select all that apply. One, some, or all responses may be correct.

• • RashA rash is a common side effect from osteoclast monoclonal antibodies. This is not a common side effect associated with an estrogen agonist/antagonist.
• Correct
  • Hot flashesA common side effect of estrogen agonist/antagonist therapy is the development of hot flashes. This occurs because of the effect of estrogen.
• Correct
  • Weight gainA common side effect of estrogen agonist/antagonist therapy is weight gain. This occurs because of the effect of estrogen.
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  • Muscle painA common side effect of estrogen agonist/antagonist therapy is muscle pain. This occurs because of the effect of estrogen.
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  • Lower extremity edemaA common side effect of estrogen agonist/antagonist therapy is lower extremity edema. This occurs because of the effect of estrogen.
• Correct
  • Trouble sleepingDifficulty sleeping is a common side effect of estrogen agonist/antagonist therapy.

Question 12 of 24

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Which information would the nurse include when instructing a patient with osteoporosis about the estrogen agonist/antagonist therapy? Select all that apply. One, some, or all responses may be correct.

• Correct
  • “Limit your intake of dietary salt.”The patient should be instructed to reduce or limit the intake of dietary sodium to prevent the development of lower extremity edema.
• • “Have a dental examination every 6 months.”The patient should be instructed to have a dental examination every 6 months if taking an osteoclast monoclonal antibody, not an estrogen agonist/antagonist.
• Correct
  • “Do not smoke when taking this drug.”The patient should be instructed to not smoke while taking this drug to reduce the risk of developing blood clots, heart attacks, or a stroke.
• • “Take this drug first thing in the morning.”The patient should be instructed to take a bisphosphonate, not necessarily an estrogen agonist/antagonist, first thing in the morning.
• • “Remain upright for 30 minutes after taking this drug.”The patient should be instructed to remain upright for 30 minutes after taking a bisphosphonate, not an estrogen agonist/antagonist.

Question 13 of 24

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For which reason would a patient be prescribed an osteoclast monoclonal antibody as treatment for osteoporosis?

• • Patient’s preference for dosingOsteoclast monoclonal antibody therapy is only for use in patients who have tried other treatments that were not effective, not in patients who prefer the dosing regimen.
• • Less risk of severe allergic reactions to the drugOsteoclast monoclonal antibodies can cause severe allergic reactions.
• • Side effects from other drugsOsteoclast monoclonal antibodies can cause severe allergic reactions and would not be prescribed because of adverse effects from other drugs.
• Correct
  • Other treatments were not effectiveOsteoclast monoclonal antibodies are laboratory-made drugs that are designed to serve as substitute antibodies to target immature osteoclasts. This drug has some dangerous side effects and is recommended only to treat severe osteoporosis in patients who have tried other treatments that were not effective.

Question 14 of 24

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Which information would the nurse emphasize when instructing a patient with osteoporosis about an osteoclast monoclonal antibody?

• • “Expect to develop hot flashes.”Hot flashes are not a side effect of osteoclast monoclonal antibodies, but can occur with an estrogen agonist/antagonist.
• • “Take this drug every day.”Osteoclast monoclonal antibodies are given through a subcutaneous injection every 6 months and not taken every day.
• • “This drug may cause problems with sleeping.”LEstrogen agonist/antagonists may cause difficulty sleeping. This is not an adverse effect of osteoclast monoclonal antibodies.
• Correct
  • “Report signs of gum infection to the healthcare provider.”The patient should be directed to report any swelling, pain, redness, or other signs of infection in the gums that may be signs of osteonecrosis.

Question 15 of 24

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Which response would the nurse provide when asked to explain the mechanism of action of a sclerostin inhibitor?

• • “It binds calcium in the bone.”Bisphosphonates, not sclerostin inhibitors, act by binding to calcium in the bone, and preventing osteoclasts from destroying bone cells and resorbing calcium.
• Correct
  • “It stimulates osteoblasts to produce new bone.”Sclerostin is a glycoprotein that is produced by osteocytes. When sclerostin is inhibited, osteoblast activity becomes stimulated and results in the formation of new bone.
• • “It activates estrogen receptors to keep calcium in the bone.”An estrogen agonist/antagonist, not a sclerostin inhibitor, is a drug for osteoporosis that activates estrogen receptors in the bone to help calcium remain in the bone and blocks estrogen receptors in breast tissue and uterine tissue.
• • “It is a synthetic hormone that promotes rapid bone growth.”Teriparatide is a synthetic form of the natural human parathyroid hormone that promotes rapid bone growth. This is not the mechanism of action of a sclerostin inhibitor.

Question 16 of 24

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For which reason would the nurse withhold giving a patient a dose of a sclerostin inhibitor as prescribed?

• • High risk for a fractureSclerostin inhibitors are used for patients who are at high risk for fracture.
• Correct
  • Low serum calcium levelSclerostin inhibitors are contraindicated for patients who have hypocalcemia (low serum calcium levels). Hypocalcemia must be corrected before these drugs can be given.
• • Other drugs for osteoporosis have failedSclerostin inhibitors are used for patients whose other treatments for osteoporosis have failed.
• • Unable to sit up for 30 minutes after receiving a doseA sclerostin inhibitor is given through the subcutaneous route. The patient does not need to sit upright for 30 minutes after receiving a dose. This would be important with bisphosphonate therapy.

Question 17 of 24

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Which assessment finding indicates that a patient is experiencing a hypersensitivity reaction to a sclerostin inhibitor? Select all that apply. One, some, or all responses may be correct.

• Correct
  • RashA rash indicates a hypersensitivity reaction to a sclerostin inhibitor.
• • NauseaNausea is a common side effect of a bisphosphonate, not a sclerostin inhibitor.
• • HeadacheHeadache is a common side effect of a bisphosphonate, not a sclerostin inhibitor.
• • Epigastric refluxEpigastric reflux is a common side effect of a bisphosphonate, not a sclerostin inhibitor.
• Correct
  • Swelling of the mouth and lipsSwelling of the mouth and lips or angioedema is a hypersensitivity reaction to a sclerostin inhibitor.

Question 18 of 24

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Which action would the nurse perform when giving a patient a sclerostin inhibitor? Select all that apply. One, some, or all responses may be correct.

• Correct
  • Give the injection in the thigh, abdomen, or upper arm.A sclerostin inhibitor is given in the thigh, abdomen, or upper arm.
• Correct
  • Tell the patient to have a dental examination every 6 months.Dental examinations are needed every 6 months because the drug can cause jawbone osteonecrosis.
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  • Remind the patient that injections occur once a month for 12 months.The drug is given through two subcutaneous injections every month for 12 months.
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  • Teach the patient to inform the dentist about taking this drug.The dentist needs to be aware of this drug because it can cause jawbone osteonecrosis.
• • Instruct the patient to seek medical attention if they develop diarrhea.Diarrhea is not a serious adverse reaction or side effect of sclerostin inhibitors, so this would not be included in patient teaching.

Question 19 of 24

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For which reason is teriparatide classified as an anabolic drug?

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  • It promotes rapid bone growth.Teriparatide injection is a synthetic form of the natural human parathyroid hormone (PTH). It is classified as an anabolic drug because it promotes rapid bone growth. When PTH is given, new bone forms soon afterward because osteoblast formation is increased and the cell death of the osteoblasts is prevented, resulting in new bone formation.
• • It enhances muscle development.Teriparatide does not impact muscle development.
• • It facilitates vitamin D to be used by calcium.Teriparatide does not impact the use of vitamin D in the body.
• • It reduces the loss of calcium from the bone.Teriparatide does not reduce the loss of calcium from the bone.

Question 20 of 24

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Which teaching point would the nurse provide to a patient who is prescribed teriparatide?

• Correct
  • Subcutaneous self-injection techniqueTeriparatide is given through subcutaneous injections. It is given once per day for 28 days. Because of this, the patient will need to learn how to give themselves the injections.
• • Limit the intake of sodium in the diet.Limiting the intake of sodium would be to reduce the risk of lower extremity edema when taking an estrogen agonist/antagonist, not teriparatide.
• • Take each dose with a full glass of water.A bisphosphonate, not teriparatide, are to be taken with a full glass of water. Teriparatide is also given as a subcutaneous injection and not by mouth.
• • Need to sit upright for 30 minutes after each doseSitting upright for 30 minutes after a dose would be applicable for a bisphosphonate, not teriparatide.

Question 21 of 24

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Which action would the nurse take after giving a patient a dose of teriparatide?

• • Provide a snack.Teriparatide does not need to be given with food as it is a subcutaneous injection.
• • Assist with ambulation.The patient does not need to ambulate after receiving teriparatide.
• • Palpate peripheral pulses.There is no need to palpate peripheral pulses after giving the patient a dose of teriparatide.
• Correct
  • Assess for orthostatic hypotension.Because orthostatic hypotension can occur with the first few doses of teriparatide, the patient’s blood pressure should be monitored in lying, sitting, and standing positions.

Question 22 of 24

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Which assessment finding indicates that a patient is experiencing a side effect from teriparatide? Select all that apply. One, some, or all responses may be correct.

• Correct
  • NauseaNausea is a common side effect of teriparatide.
• Correct
  • DizzinessDizziness is a common side effect of teriparatide.
• Correct
  • Bone painBone pain is the most commonly reported side effect of teriparatide.
• • Esophageal refluxEsophageal reflux is a side effect of bisphosphonates, not teriparatide.
• Correct
  • Injection site reactionInjection site reactions are a common side effect of teriparatide.

Question 23 of 24

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Which assessment finding indicates to the nurse that a patient is experiencing a side effect of calcium and vitamin D supplements? Select all that apply. One, some, or all responses may be correct.

• Correct
  • ThirstIncreased thirst is a side effect of calcium and vitamin D supplements.
• Correct
  • NauseaNausea is a side effect of calcium and vitamin D supplements.
• Correct
  • VomitingVomiting is a side effect of calcium and vitamin D supplements.
• Correct
  • Bone painBone pain is a side effect of calcium and vitamin D supplements.
• Correct
  • ConstipationConstipation is a side effect of calcium and vitamin D supplements.
• Correct
  • Muscle weaknessMuscle weakness is a side effect of calcium and vitamin D supplements.

Question 24 of 24

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Which teaching would the nurse provide to a patient who is prescribed calcium and vitamin D supplements? Select all that apply. One, some, or all responses may be correct.

• Correct
  • “Take the supplements with food.”The patient should be instructed to take the supplements with food to reduce the risk of gastrointestinal upset.
• Correct
  • “Take the drug twice a day if nausea occurs.”The patient should be instructed to split the dose of the supplements over two meals if nausea occurs.
• • “Expect to feel dizzy after taking the supplements.”Calcium and vitamin D do not cause dizziness as a side effect.
• Correct
  • “Do not crush extended-release forms of the supplements.”Extended-release forms of the supplements are to be swallowed whole and not crushed.
• Correct
  • “Do not swallow a chewable form of the supplement whole.”Chewable forms of the supplement should be chewed thoroughly and now swallowed whole.