7 - Osteoporosis Flashcards
Is this a long chapter?
No, thank the gods
What does PTH do in the blood and bone?
It controls calcium, phosphorus and vitamin D levels
Rundown of osteoporosis tx options
Lifestyle changes Calcium and vitamin D Hormone therapy Biphosphates SERMS PTH Calcitonin-salmon nasal spray Denosumab
Name the biphosphate drugs
nate’s and Nic
Aldenodronate
Risedronate
Ibandronate
Zoledronic acid IV
What are teh SERMS?
Estrogen agonist
Roloxifene
Bazedoxifene
What is teriparatide?
Parathyroid hormone
What is denosumab?
Full human monoclonial antibody
What is the MOA of estrogen replacement therapy? (ERT)
ERT MOA: inhibits bone resorption and promotes bone formation
Use the lowest dose possible
What are the contraindications of ERT?
Women with VTE, hx of VTE (even while pregnant)
Biphosphates MOA?
Remember they are the nates and nic
MOA: decrease osteoclast action, bone resorption, and increase bone density
What is the 1st line tx for oseoporosis?
Nates and nic
Alendronate, risedronate, ibandronate, zoledronic acid
(Biphosphates)
What is the 1/2 life of biphosphates?
10 yrs
Who cant take biphosphates?
People with bad kidneys
CrCl <30mL/mil
What are the AE’s associated with biphosphates?
Nates and nic
GI: dont lie down for 30-60 min and take w water
Osteonecrosis of jaw
Atypical fractures and esophageal cancer (NBD)
But I have to take my pills with food?
Too bad, the nates and nic (i keep putting this here b/c i’m dumb and need repetition) must be taken on an empty stomach w water and no eating for 30 min before eating/drinking anything else
Alendronate and Risedronate
Biphosphates:
Not recommended for:
kidney failure
Swallowing issues
Need good vitamin D
Ibandronate and Zoleddronic acid (recast)
Biphosphates
Preferred for Pts unable to take oral biphosphates b/c GI issues
What is denosumab (prolia) sub q used for?
Osteoporosis
Initial therapy in pts at high risk for fracture
MOA for denosumab (prolia)
Binds to RANKL inhibiting osteoclast formation and activity
What are the adverse reactions associated with denosumab (prolia)
MC: back/muscle/extremity pain
Serious but less common: hypocalcemia, osteonecrosis of jaw, immune suppression
What drug is given to antagonize the effects of PTH?
Calcitonin
Teriparatide (PTH 1-34) has a weird way of working, what is it?
It uses continuous exposure to PTH which somehow stimulates bone formation more than resorption
Who is the target audience for teriparatide (PTH 1-34)?
Pts who are unable to tolerate biphosphate, are high risk and have lots of money
Will you ever be able to perscribe PTH 134?
Fuck no its 42k/yr
But fortunately it maxes out at 84K bc it causes cancer if you use it more than 2 yrs so it has a limit
