Osteoporosis Drugs

Question 1

Effect of PTH on kidneys:

Answer 1

Increase Ca reabsorption (decreased phosphate reabsorption)

Increased calcitriol production (active form of Vit D).

Question 2

Effect of PTH on intestines:

Answer 2

Via calcitriol, increased Ca absorption.

Question 3

Effect of PTH on Bone:

Answer 3

Bind to a receptor on blasts–> express RANKL–> increase osteoclasts–> increase remodeling.

Question 4

Low conc. of PTH has more effect on ____. = more bone ______.

Answer 4

blasts

growth

Question 5

High conc. of PTH has more effect on____. = More bone_____.

Answer 5

Clasts

Resorption

Question 6

Release stimulated by low Ca levels:

Answer 6

PTH

Question 7

Release stimulated by high calcium levels

Made by parafollicular cells of the thyroid gland:

Answer 7

Calcitonin

Question 8

Effect of calcitonin on kidneys, intestines and bone:

Answer 8

Kidneys: increased Ca elimination
Intestines: decreased Ca absorption
Bone: inhibits osteoclast activity–> prevents bone resorption.

Question 9

Where are calcitonin receptors found?

Answer 9

On osteoclasts

Question 10

Ca supplement

Drug interactions with Abx, bisphosphonastes, CCBs, Vit D:

Answer 10

Calcium carbonate

Question 11

Vit D2 supplement

Promotes bone resorption through induction of RANKL.

Answer 11

Ergocalciferol

Question 12

Vitamin D3 supplement:

Answer 12

Cholecalciferol

Question 13

Active Vit D:

Answer 13

Calcitriol

Question 14

Antiresorptive med
Estrogens inhibit osteoclasts and reduce osteoporosis.
Increase OPG and RANK binding
HRT
No longer 1st line tx.

Answer 14

Premarin

Prempro

Question 15

Antiresorptive med, SERM
Antagonist at estrogen receptors in breast and uterus.
Partial agonist at estrogen receptors that regulate resorption.
Reduces risk for breast cancer and reproductive cancer:

Answer 15

Raloxifene

Question 16

Antiresorptive med
Longer half life.
Inhibits osteoclasts
Discontinue use in U.S? (5 yr cancer risk)

Answer 16

Salmon calcitonin (inhaled)

Question 17

Antiresorptive drugs
Analogs of pyrophosphate.
Inhibit bone resorption by osteoclasts.
1st choice for osteoporosis (also Paget’s disease).

Answer 17

Bisphosphanates:
Alendronate (po)
Risedronate (po)
Ibandronate (po or IV)
Zoledronic acid (IV annually)

Question 18

Antiresorptive med
Monoclonal antibody that targets RANKL and binds to RANK instead so you don’t get differentiation of osteoclasts.
2 injections annually.
Equal efficacy with bisphosphs and teriparatide.
Increased risk for infection and skin rx.

Answer 18

Denosumab

Question 19

Anabolic drug
Recombinant PTH 1-34
Increases bone density(only one to do this)
Injection SC once daily (peptide)
Avoid in Paget's disease.

Answer 19

Teriparatide