Osteoporosis Drugs

Question 0

Supplemental Support for Osteoporosis

Answer 0

Vitamin D, Calcium, Magnesium, Strontium

Question 1

Risk factors for osteoporosis

Answer 1

Female gender, small body habitus, advancing age, caucasian or asian ethnicity, family hx, diet low in Ca++ and Vit D, low estrogen levels, sedentary lifestyle, cigarette smoking, excessive EtOH use, glucocorticoid or anticonvulsant useage.

Question 2

Alendronate (Fosamax)

Answer 2

Bisphosphate. Used to prevent and treat osteoporosis. PO, taken qd. Take with plain water ONLY, no soft drinks, carbonated water, or juice.
MOA - inhibits osteoclast activity.
SFx - stomach upset and GI distress. Pt MUST stay upright and NPO for 30-60’ after PO administration to prevent erosive esophagitis. Other severe sfx include atypical diaphyseal fx in femur and osteonecrosis of the jaw.

Question 3

Raloxifene (Evista)

Answer 3

Selective estrogen receptor modulator (SERM). Used to increase bone mass and reduce risk of vertebral fx.
MOA - binds to select estrogen receptor sites; maintains estrogenic effect on bone, but anti-estrogenic effect on endometrial and breasts.
SFx - Hot flashes, arthralgias, myalgias, edema, pruritis, small increased risk of clots and DVT. CI in pg!

Question 4

Calcitonin (Miacalin)

Answer 4

Synthetic hormone. Treats osteoposis, not approved to prevent osteoporosis. Nasal inhaler or IV forms.
MOA - inhibits osteoclast activity
SFx - none bleeds and sinusitis (inhaler form), HA, dizziness, edema, anorexia and skin rash.

Question 5

Teriparatide (Forteo)

Answer 5

Injectable PTH hormone. Large amounts increase bone loss but small doses seem to decrease fx risk. Benefits last long after injections are stopped. Used SQ qd, up to 12 months.
MOA - activates bone turnover. Stimulates new bone formation in thigh and hips.
SFx - nausea, leg cramps, dizziness.

Question 6

Estrogen / HRT

Answer 6

Hormone therapy has been shown to reduce bone loss and increase bone density and reduce the risk of fx in postmenopausal women. When taken alone it increases risk of breast and endometrial CA. To reduce these risks, estrogen should be given with progestin.
SFx - vaginal bleeding, breast tenderness, venous clots, increased risk of gallbladder dz.
USE FOR AS SHORT A TIME AS POSSIBLE

Question 7

Denosumab (Prolia)

Answer 7

Human monoclonal antibody. Treats osteoporosis, bone mets, multiple myeloma and giant cell bone CA. SQ injection, q6 months.
MOA - targets RANKL ligand, which if unblocked targets bone for removal.
SFx - increased susceptibility to infx.