Drugs affecting bone Flashcards
What does denosumab do?
RANK-L inhibitor
Reduces osteoclast activity
Increases bone density in post-menopausal women
What does raloxifene do?
Agonist at oestrogen receptors in bone and CV tissue
Antagonist at oestrogen receptors in breast and uterus
What is a common RANK-L inhibitor?
Denosumab
What is a common oestrogen receptor modulator used in bone disorders?
Raloxifene
What do bisphosphonates do?
Incorporated into bone ECM during mineralisation
Inhibit recruitment of oestoclases
Promote apoptosis of osteoclasts
What are the disadvantages of bisphosphonates?
Poorly absorbed
Oesophagitis risk
Do oestrogen receptor modulators increase bone mass?
No
They just maintain mass and slow loss
What is the acute effect of PTH?
Promotes osteoblast development and activity
What is the chronic effect of PTH?
Promotes oesteoclast activity
What are oral calcium salts used for?
As adjunctive therapy in osteoporisis
What are the side effects of oral calcium salts?
GIT disturbances
What is VitD used in the treatment of?
Deficiency states (Rickets and osteomalacia)
Endocrine dysfunction (hypoparathyroidism)
Chronic renal disease (inability to generate calcitriol)
What are the 2 available forms of VitD as a therapeutic?
VitD2 (for liver conversion)
Calcitriol (biologically active)
When is synthetic calcitonin (salcatonin) given?
In hypercalcaemia associated with neoplasia
What is salcatonin?
Synthetic calcitonin
What do processes that affect bone remodelling preferentially affect?
Trabecular bone
E.g. femoral neck and vertebral bodies
Where is VitD converted to calcitriol?
Kidney
What are the effects of calcitriol?
Increased intestinal absorption Ca2+
Decreased renal excretion Ca2+
Increased osteoclast activity
How does PTH increase plasma Ca2+
Increases calcitriol synthesis and reduces renal Ca2+ excretion
What is osteoporosis?
Reduction in bone mass more than 2.5 standard deviations below the norm for healthy 30 year old woman
What is osteopaenia?
Reduction in bone mass 1-2.5 standard deviations below the norm for healthy 30 year old woman
What are the 3 bone antiresorptive agents?
Bisphosphonates
Selective oestrogen receptor modulators
RANKL inhibitors
What are the 4 bone anabolic agents?
PTH
Oral calcium
Oral vitamin D analogues
Calcitonin
