Bone Disorders

Question 1

What type of medication are alendronate, risedronate, pamidronate, and zoledronate?

Answer 1

Aminobisphosphonates

Question 2

What type of medication are etidronate and clodronate?

Answer 2

Non-aminobisphosphonates

Question 3

How do bisphosphonates work?

Answer 3

Amino: disrupt mevalonate pathway — osteoclast apoptosis
Non-amino: increase cytotoxic metabolites within osteoclasts — cell death

Question 4

What are bisphosphonates indicated for?

Answer 4

Osteoporosis
Paget’s disease
Hypercalcemia
Malignancy
Primary hyperthyroidism
Bone metastasis causing osteolysis
Multiple myeloma
Bone metastases of malignant tumors

Question 5

What are side effects of bisphosphonate use?

Answer 5

Nausea
Dyspepsia
Esophagitis or esophageal erosion
Osteonecrosis of the jaw (high doses)
Transient flu-like symptoms (aminoBPs, mostly with IV administration)

Question 6

What class of medication does raloxifene belong to?

Answer 6

Selective estrogen receptor modulators

Question 7

What effect do selective estrogen receptor modulators have?

Answer 7

Stimulate osteoblasts and inhibit osteoclasts

Question 8

What side effects are associated with selective estrogen receptor modulator use?

Answer 8

Hot flashes
Leg cramps
Flu-like symptoms
Peripheral edema
Thrombophlebitis
Thromboembolism

Question 9

When are selective estrogen receptor modulators used?

Answer 9

To prevent osteoporotic fractures in populations that cannot tolerate a bisphosphonate

Question 10

What natural hormone is teriparatide an analog of?

Answer 10

Parathyroid hormone

Question 11

What is teriparatide indicated for?

Answer 11

Osteoporosis (severe cases, patients where other treatment has failed, or secondary to corticosteroid use)

Question 12

What contraindications exist for use of teriparatide?

Answer 12

Children or young adults
Hypercalcemia patients
Active Paget’s disease
Skeletal metastases
History of radiation to the skeleton
Pregnancy and lactation

Question 13

What side effects exist for treatment with teriparatide?

Answer 13

Hypercalcemia
Leg cramps
Nausea
Orthostatic hypotension

Question 14

Calcitriol, ergocalciferol, calcipotriene, doxercalficerol, and paricalcitol are all used for what?

Answer 14

Vitamin D replacement

Question 15

What is vitamin D replacement therapy used for?

Answer 15

Osteoporosis
Hyperparathyroidism
Osteomalacia
Rickets

Question 16

What side effects are seen with vitamin D replacement therapy?

Answer 16

Side effects are usually induced by hypercalcemia, which causes GI pain, renal stones, and psychiatric disturbances

Question 17

What type of medication is denosumab?

Answer 17

Receptor activator of nuclear kappa ligand inhibitor

Question 18

How does denosumab work?

Answer 18

Binding of RANKL, inhibiting osteoclast activity

Question 19

What are RANKL inhibitors indicated for?

Answer 19

Osteoporosis

Question 20

What side effects are seen in RANKL inhibitor treatments?

Answer 20

Eczema
Hypocalcemia
Increased risk of infection
ONJ and atypical fractures

Question 21

What is salcatonin?

Answer 21

Synthetic salmon calcitonin

Question 22

What effect does treatment with calcitonin have?

Answer 22

Decreases the reabsorption of calcium and phosphate in the kidney, inhibits bone resorption by osteoclasts

Question 23

What is calcitonin treatment indicated for?

Answer 23

Hypercalcemia
Paget’s disease
Postmenopausal and corticosteroid-induced osteoporosis