Drugs for Osteoporosis

Question 1

osteoporosis

Answer 1

decreased bone density
increased Fx risk
bone more porous and less dense

Question 2

risk factors for osteoporosis

Answer 2

postmenopause
old age
medications
endocrine disorders
inflammatory arthopathy
hematopoietic disorders
nutrition disorders

Question 3

DEXA scan

Answer 3

measure bone density with x ray beam

Question 4

agents affected bone mineralization

Answer 4

para thyroid hormone
Ca
vitamin D
calcitonin

Question 5

How does parathyroid hormone affect bone mineralization?

Answer 5

promotes bone resorption by stimulating osteoclasts
enhance renal production of vitamin D and retentino of Ca

Question 6

How does Ca affect bone mineralization?

Answer 6

regulator of PTH secretion
binds ca sensor on PT gland regulating PTH secretion
excess PTH increases bone
resorption
direct role in bone structure

Question 7

How does vitamin D affect bone mineralization?

Answer 7

stimulate intestinal absorption of Ca
regulate PTH: low vit D stimulates PTH causing bone resorption

Question 8

How does Calcitonin affect bone mineralization?

Answer 8

lowers blood levels of Ca, opposing PTH activity
inhibit osteoclast activity

Question 9

osteoanabolic agents MOA

Answer 9

increase osteoblasts
PTH analog allowing intermittent exposure increasing bone formation

Question 10

romosozumab MOA

Answer 10

monoclonal antibody
activate osteoblasts and inhibit osteoclasts

Question 11

biphosphonates MOA

Answer 11

kill osteoclasts, reduce bone resorption

Question 12

denosumab MOA

Answer 12

inhibit osteoclasts
monoclonal antibody vs RANKL NZ

Question 13

biphosphonates side effects

Answer 13

GI disturbances - take w water and sit up
osteonecrosis of jaw
femur Fxs

Question 14

biphosphonates clinical use

Answer 14

first line treatment for post menopausal osteoporosis/glucocorticoid induced osteoporosis

Question 15

biphosphonate names

Answer 15

alendronate/fosamax

Question 16

SERMs MOA

Answer 16

mimic estrogen, reduce bone resorption without stimulating breat/uterine tissue

Question 17

SERMS common names

Answer 17

raloxifene/evista

Question 18

SERMs side effects

Answer 18

hot flashes
leg cramps
increased risk of venous thromboembolism

Question 19

SERMs clinical utility

Answer 19

prevent/treat post menopausal osteoporosis
safe for ppl with breast cancer risk

Question 20

Calcitonin common medications

Answer 20

Miacalcin/Salmon

Question 21

Calcitonin MOA

Answer 21

decrease blood Ca level
inhibit osteoclast activity
to reduce bone resorption

Question 22

Calcitonin side effects

Answer 22

nasal irritation
hot flashes

Question 23

Calcitonin clinical use

Answer 23

less commonly used bc less effective than others
analgesic effect in acute vertebral fractures

Question 24

PTH analogs common medications

Answer 24

teriparatide/Forteo
abaloparatide

Question 25

PTH analog MOA

Answer 25

stimulate osteoblast promote bone formation

Question 26

PTH analog side effects

Answer 26

leg cramps dizzy nausea

Question 27

PTH analog clinical use

Answer 27

for high risk pts like prev Fxs, subcutaneous daily injections

Question 28

monoclonal antibodies common medications

Answer 28

denosumab/Prolia, Xgeva

Question 29

Monoclonal antibodies MOA

Answer 29

bind/inhibit RANKL to reduce osteoclast formation/survival

Question 30

monoclonal antibodies side effects

Answer 30

skin reaction at injection site osteonecrosis of jaw hypocalcemia

Question 31

monoclonal antibodies clinical use

Answer 31

used in postmenopausal women at high risk of Fx and intolerant of other osteoporosis treatments

Question 32

vitamin D supplementation

Answer 32

ensure adequate absorption from gut cholecaciferol D3 and ergocalciferol D2

Question 33

vitamin C supplementation

Answer 33

dairy, leafy grees, fortified

Question 34

PT considerations for bisphosphonates

Answer 34

Gi side effects take at least 1 hr before session monitor for atypical femur fracture or jaw osteonecrosis

Question 35

PT considerations for SERMs

Answer 35

hot flashes, cramps monitor for clots

Question 36

PT considerations for PTH analogs

Answer 36

leg cramps dizziness

Question 37

PT considerations for monoclonal antibodies

Answer 37

joint/back/arm/leg pain low calcium