A - 15. Agents affecting bone mineral homeostasis (calcium, vitamin D, parathyroid hormone, calcitonin, etc.). Pharmacotherapy of osteoporosis

Question 1

Osteporosis can be drug induced by what drug class?

Answer 1

Corticosteroids

Question 2

Osteoblast/osteoclast interaction

Answer 2

Osteoblast -> Rank L -> monocyte -> osteoclast secretes collagenase and HCl- (release down Ca++ and phosphate from bones)

Question 3

Parathyroid hormone effects

Answer 3

Low concentration - osteoBlast stim

High concentration - Bone reabsorption

Question 4

Calcitonin effect

Answer 4

Inhibits osteoclasts -> reduces Ca++ in blood

Inhibits Ca++ reabsorption in kidneys

Question 5

Non-hormonal osteoporosis drugs names

Answer 5

Bisphosphonates: 
Alendronate
Zolendronate 
-----------------------
Denosumab

Question 6

Hormonal osteoporosis drugs names

Answer 6

Raloxifen

Teriparatide

Question 7

Bisphosphonates action

Answer 7

Binds to hydroxyapatite (mineralized form of Ca++) -> osteoclasts take them up -> disrupts cholesterol synthesis in osteoclasts

Question 8

Bisphosphonates indications

Answer 8

• Osteoporosis
• Pagets Disease
• Osteogenesis imperfecta
• Metastatic bone disease
• Hypercalcemia

Question 9

Bisphosphonates SE

Answer 9

Oral - upper GI problems, irritation
IV - osteonecrosis

All - bone, joint or muscle pain

Question 10

Denosumab action

Answer 10

Human monoclonal AB

Binds to Rank-L - no osteoclast activation

Question 11

Denosumab indications and frequency of administration

Answer 11

• Postmenopausal osteoporosis - subcutanously every 6th month
• Bone metastasis - every month

Question 12

Denosumab SE

Answer 12

• Hypocalemia, hypophosphoremia
• Infections
• Osteonecrosis of jaw

Question 13

Teriparatide action

Answer 13

Parathyroid hormone analouge

Stimulates osteoblasts -> reduces apoptosis -> bone formation increased

Osteosarcoma risk

Question 14

Raloxifene action

Answer 14

Agonistic effect on estrogen receptors

SE: hot flashes

Question 15

Vitamin D deficiency drug

Answer 15

cholecalciferol

Is a natural vitamin D3 suppliment

Question 16

Vitamin D role in bone formation

Answer 16

Vitamin D -> Calcitriol
Increases blood Ca++
- Increased Rank-L secretion from osteoblasts
- Increased kidney reabsorption
- Inhibition of calcitonin (inhibitor of osteoclasts)
- Promotes absorption of dietary vitamin D from GI