Bone mineral homeostasis

Question 1

Parathyroid Hormone

phosphate trashing hormone

Answer 1

Effect: Increase Ca, Decrease PO4
bone resporption - receptor on osteoblast make RANKL to connect to osteoclast to release Ca and PO4

Also makes OPG that binds to RANKL but not enought to inhibit resorption

lose PO4 by kidney and help Vit D substraits

Question 2

Vita D

Good guy

Answer 2

both Ca and PO4
increase bone formation
need 25 and 1 hydroxylase to make active form

Gut more reabsorption of Ca and PO4 into blood and bones

Question 3

Calcitonin

Answer 3

Inhibit oestoclast activity and decrease bone resorption

Question 4

Teriparatide

Hormonal

end in -paratide, Hormonal

Answer 4

MOA: Bind to PTH-R and makes OPG and overcome RANKL to dont loose calcium
USE: osteroporosis ( not for over 2 years)
AE: Hypercalcemia, Osteosarcoma, first dose hyperpotension
Note: BBW OSTEOSARCOMA (CANCER)
Route : SC

Question 5

Chalecalciferol, ergocalciferol, Calcitrol

Vita D

Hormonal

Answer 5

MOA: D3, D2(rx), Active form | regulate gene transcription
Use: Dietary supplement not treatment
AE: Hypercalcemia(rare)

Question 6

Calcium carbonate, Calcium Citrate

Answer 6

always take with vita D
Calcium supplments, Hormonal
carbonate with meals (like carbanara), Citrate can be take alont
Use: osteoprorosis phrophylaxis
AE: constipation
DDI: space drugs > 2hrs apart

Question 7

Salmon Calcitonin

Hormonal

Answer 7

MOA: agonist at Calcitonin-R
Dose: intranasal (only osteoporosis), IM and SC
Use: Osteoprosis, hypercalcemia, paget’s disease
AE: rhinitis, allergic rxn, (nasal) flushing of face and hands (IM and SC), malignacy, Hypocalcemia
CI: fish hypersensitivity

Fallen out of favor

Question 8

Raloxifene

SERMs, Hormonal

Answer 8

MOA: Estrogen modulator (+ bone and liver, - breast, uterus and brain)
Uses: osteoporosis
AE: hot flash and night sweats risk of THromboembilism
BBW: stroke and thromboembilism
DDI: levothryoxine 12hrs

Question 9

Bisphosphonate

end in -dronates, nonhormonal

Answer 9

MOA: binds to hydroxyapatite in bone (inhibits osteoclastic, benefints osteroblast) long binding
Notes: poor po absportion and GI upsetting (need water and on empty stomach, 30min wait before food) need to sit up
Uses: osteo, hypercalcemia, paget diseas
AE: upper GI effect for oral, Flu like abnd musculoskeletal pain IV

Rare AE: hypocalcemia, osteonecrosis of the jaw ONJ, atypical femur factures (stable part of bone has fractures)more than 5 years only

CI: renal impairment, hypocalcemia, Esophageal disorders

DDI: take apart from cationic agents, NSAIDS

LABS: serum creatinite, serum calcium

Ibandronate only for vertebral fractures

Question 10

Desnosumab

nonhormonal

Answer 10

MOA: fully humanized moncolonal to Rank-L (pretends to be OPG)
Uses:osteoporosis, hyper calcemia
AE: Back pain, ONJ, atypical femer
dose: sq 2x a year

Question 11

First line osteoprosis meds

Answer 11

1. -dronates and Denosumab treat all (vertebral, non-vertebral and hip) expect ibrandornate
2. Teriaratibe all except hip
3. Raloxifene just vetebral