Osteoporosis Pharmacology

Question 1

What is the MOA of bisphosphonates?

Answer 1

-binds to bone hydroxyapatite
-inhibits osteoclast activity

Question 2

What is the half-life of bisphosphonates?

Answer 2

10 years

Question 3

What are the common ADR of bisphosphonates?

Answer 3

-Nausea/dyspepsia
-flu-like illness (injectable)
-atypical fractures
-ONJ

Question 4

What are the DDIs of bisphosphonates?

Answer 4

-calcium and other cations

Question 5

Which bisphosphonate is given IV?

Answer 5

Zoledronic acid (yearly treatment)

Question 6

Avoid bisphosphonates if CrCl is less than _______.

Answer 6

30-35 mL/min

Question 7

What are the CIs of bisphosphonates?

Answer 7

-esophogeal cancer
-CrCl <30-35 mL/min
-PO therapy: if esophageal stricture, inability to remain upright 30-60 mins

Question 8

Which bisphosphonate is approved for use in women only?

Answer 8

Ibandronate

Question 9

Which bisphosphonate can you take after your first meal?

Answer 9

Risedronate DR

Question 10

What increases your chance of developing ONJ from bisphosphonate?

Answer 10

-invasive dental procedures
-cancer
-corticosteroids

Question 11

Which area of the bone do atypical fractures occur in?

Answer 11

-subtrochanteric
-diaphyseal (shaft)

Question 12

What is the MOA of RANKL inhibitors?

Answer 12

-human MoAb that binds to RANKL, which inhibits osteoclast formation

Question 13

How is RANKLi given?

Answer 13

-60mg SQ every 6 months
-administered by healthcare professional

Question 14

Which agent is RANKLi?

Answer 14

Denosumab

Question 15

What are the ADRs of Denosumab?

Answer 15

-musculoskeletal pain
-skin rxns
-HYPOCALCEMIA
-ONJ
-atypical fractures
-serious infections

Question 16

What is the boxed warning for Denosumab?

Answer 16

-may cause severe hypocalcemia in patients with CKD (eGFR<30) and on dialysis

Question 17

Estrogen therapy is restricted to use in which patient population?

Answer 17

-female patients only

Question 18

What is the concern with long-term estrogen treatment?

Answer 18

increased risk of:
-MI
-Stroke
-breast cancer
-PE
-DVT

Question 19

Which drug class is Raloxifene?

Answer 19

estrogen agonist + antagonist (SERM)

Question 20

How is Raloxifene taken?

Answer 20

-60 mg PO QD

Question 21

What are some ADRf of Raloxifene?

Answer 21

-hot flashes
-leg cramps
-peripheral edema
-gallbladder disease
-cataracts

Question 22

What is the boxed warning for Raloxifene?

Answer 22

-increased risk of VTE and death from stroke

Question 23

What is Duavee?

Answer 23

TSEC: Bazedoxifene/conjugated equine estrogen

Question 24

Which patient population is Duavee indicated for?

Answer 24

-women who suffer from mod-sev vasomotor menopause symptoms
-prevention of osteoporosis after menopause

Question 25

How is Duavee taken?

Answer 25

PO

Question 26

What are the ADRs of Duavee?

Answer 26

-muscle spasms -N/D/Dyspepsia -dizziness

Question 27

What is the boxed warning with Duavee?

Answer 27

-endometrial cancer -CV disease (increased risk of stroke and DVT) -dementia

Question 28

How is salmon calcitonin taken?

Answer 28

-nasal spray OR -SQ injections

Question 29

Salmon calcitonin can only be used exclusively in which patient population?

Answer 29

WOMEN who are at least 5 years post-menopausal when alternative tx no available

Question 30

What are the ADRs of salmon calcitonin?

Answer 30

-nasal: rhinitis, epistaxis -HA -arthralgia -back pain

Question 31

What is the MOA of PTH analogues?

Answer 31

-stimulates bone formation on travecular and cortical bone surfaces

Question 32

PTH analogue can only be used up to how many months?

Answer 32

24 months

Question 33

What is the warning that comes with PTH analogue use?

Answer 33

-Osteosarcoma observed in animal studies

Question 34

Which agents are PTH analogues?

Answer 34

1. Teriparatide 2. Abaloparatide

Question 35

Which PTH analogue is approved for use in women only?

Answer 35

Abaloparatide

Question 36

How is PTH analogue given?

Answer 36

SQ QD

Question 37

Which osteoporosis agent has the ADR of hypercalcemia?

Answer 37

PTH analogues

Question 38

What are the ADR of Teriparatide?

Answer 38

-leg cramps -dizziness/orthostatic hypotension -cough -pain/athralgia -injection site rxn -hypercalcemia

Question 39

What are the ADR of Abaloperatide?

Answer 39

-dizziness/orthostatic hypotension -hyperURICEMIA -hypercalciURIA -hypercalcemia

Question 40

What is the MOA of sclerostin inhibitors?

Answer 40

-human MoAb, binds to sclerostin -decreases resorption AND increases formation

Question 41

What is the maximum duration of Romosozumab use?

Answer 41

12 months

Question 42

What is the boxed warning that comes with Romosozumab?

Answer 42

-risk of MI, stroke, and CV death -do not initiate in patients with MI or stroke within the past year

Question 43

How is Romosozumab taken?

Answer 43

-SQ injections monthly by HCP

Question 44

What are the ADR of Romosozumab?

Answer 44

-nasopharyngitis -arthralgia -injection site rxns -hyPOcalcemia -ONJ -atypical bone fracture

Question 45

Which agents have the ADR of ONJ and atypical bone fracture?

Answer 45

-bisphosphonates -denosumab -romosozumab

Question 46

Which agents have ADR of hypocalcemia?

Answer 46

-denosumab -romosozumab

Question 47

Which agents are the only ones that show a significant decrease in hip fractures?

Answer 47

-bisphosphonates -denosumab