Osteoporosis

Question 1

Vitamin D/Calcitriol:

Answer 1

facilitates absorption of calcium in the intestines. Promotes calbindin.

Question 2

PTH:

Answer 2

increase in osteoclast production if continuous
Pulsatile: triggers osteoblast activity

Question 3

Hypercalcemia

Answer 3

We want to decrease PTH levels, calcium resorption and also calcitriol.

Question 4

Paget Disease:

Answer 4

uncontrolled osteoclast resorption with disorganized bone formation.

Question 5

Hypocalcemia:

Answer 5

decrease in serum calcium due to CKD,excess glucocorticoids, and secondary hyperparathyroidism.

Question 6

Osteoporosis:

Answer 6

Secondary can be caused by excessive glucocorticoid use, reducing calcium resorption. Pimarily seen in postmenopausal women or those low on vit D.

Question 7

Bone Mineralization Promoters:

Answer 7

supports osteoblast activity, but does not necessarily block osteoclasts.

Question 8

Recombinant human PTH/Teriparatide acetate (Forteo®

Answer 8

daily sub Q injections for intermittent
exposure. Increases osteoblast activity. Non CYP. cannot exceed two years of treatment, otherwise
osteosarcoma. AA: dizziness, injection rxn, nausea, cramps. For older ppl

Question 9

Calci-mimetic Cinacalcet (Sensipar®):

Answer 9

increases sensitivity of PT gland calcium sensing
receptors to activate, inhibiting PTH secretion.good for CKD pts. Interacts with CYP drugs,
dont use with liver pts, AA: upset stomach, chest pain, hypocalcemia, seizure

Question 10

Vitamin D/calcitriol:

Answer 10

overall bone turnover, promotion of mineralization.(NOTE: need a
functioning kidney if giving vitamin d vs calcitriol).AA; ectopic calcification, cardiac arrhythmias,
hypercalcemia. Good for secondary hyperparathyroidism pts.

Question 11

Burosumab(crysvita)

Answer 11

binds FGF23 to increase tubular reabsorption of phosphate, increasing calcitriol as well. Cleared via RES. AA: hyperphosphatemia, ectopic mineralization, risk of infection, injection rxns

Question 12

Calcium gluconate:

Answer 12

binds to excess K+ or Mg2+ in the blood, so serum calcium levels
increase. Bc of its MOA, also good for excessive potassium levels and mg levels caused by
cardio issues or even preeclampsia. Can competitively reverse calcium channel blockers. Oral or IV

Question 13

Bone Resorption Inhibitors:

Answer 13

modest increase in bone density, prevention of bone loss.Can also directly inhibit aspects that increase serum calcium levels

Question 14

Bisphosphonates:Dronates

Answer 14

risedronate: binds to HAP in bone, so when osteoclasts try to bind
themselves they can’t move to resorb more calcium elsewhere.Also prevention from entering precursors as well as osteoclast apoptosis.HYPO AND HYPER.(first line)AA: ab pain, arthralgia, dyspepsia. Antacids reduce it, TAKE ON EMPTY STOMACH

Question 15

Recombinant human Calcitonin

Answer 15

inhibition of osteoclast activity, inhibits effects of bone resorption.
Also promotes ca excretion via kidneys. No bomco with bisphosphonates.increases excretion of lithium

Question 16

SERMs/Raloxifine:

Answer 16

Osteoclast differentiation inhibition, best given for post menopausal
women(second line). AA: hot flashes, dizziness, thrombus

Question 17

Monoclonal antibodies Denosumab (Xgeva®),:

Answer 17

inhibits RANKL, preventing osteoclast
(last line tx, good for bone cx)AA: cystitis, infection, pancreatitis, MS pain, hypercholesterolemia.
Good for CKD patients due to bone loss.

Question 18

FGF23:

Answer 18

suppresses calcitriol production. Increases phosphate excretion.