Fracture

Question 1

What medications can be given for fractures

Answer 1

Bisphosphonates (Alendronaate/Risedronate), RANK ligand inhibitor (Denosumab), Parathyroid hormone analogue (Teriparatide)

Question 2

MOA of Bisphosphonates

Answer 2

Structural analogue of pyophosphate - inhibit bone breakdown
Most benefit in increasing bone density in 1st yr of tx, plateau effect on subsequent years

Question 3

AE of Bisphosphonates

Answer 3

Nausea, dyspepsia/indigestion, diarrhoea, bone & back pain

Question 4

MOA of RANK Ligand inhibitors (Denosumab)

Answer 4

Very targeted & new drug
Monoclonal antibody targeting RANK - impt for bone resorption pathway

Question 5

Who is RANK ligand inhibitors/Denosumab for

Answer 5

Post menopausal women & Pt with bone tumor (high risk of fractures)

Question 6

AE of RANK ligand inhibitors/Denosumab

Answer 6

Hypophosphatemia, Hypercholestrolemia, Nausea, Fatigue, Asthenia/weakness, MSK pain, Cystitis + Hypocalcaemia

Question 7

MOA of parathyroid hormone analogue/teriparatide

Answer 7

Like endogenous OTH - increase bone formation

Question 8

What is a disadvantage of parathyroid hormone analogue/teriparatide

Answer 8

Need to give daily SC

Question 9

Who is parathyroid hormone analogue for

Answer 9

Reserved for pts with high risk of bone fracture

Question 10

AE of parathyroid hormone/teriparatide

Answer 10

Dizziness, depression, insomnia, vertigo, rash, increased cough, leg cramp, arthralgia/joint pain, nausea