IC14 Drugs for Osteoporosis Flashcards
What are the 3 ways to treat osteoporosis?
- Lifestyle & diet
- Antiresorptive agents
- Anabolic agents
What are examples of lifestyle and diet that we can incorporate to help treat osteoporosis?
- Weight bearing exercises
- Calcium
- Vitamin D
What are some examples of antiresorptive agents?
- Bisphosphonates
- Denosumab
- Oestrogens
- Calcitonin
What are the 4 lab tests we should conduct in pts w osteoporosis?
- Sr Creatine
- Vitamin D levels
- FBC
- Corrected calcium
What is the effect of biphosphonates and what are some examples of bisphosphonate agents?
Bisphosphonates help to slow down bone loss by increasing osteoclast death.
Osteoclasts - cells that degrade bone to initiate normal bone remodeling and mediate bone loss in pathologic conditions by increasing their resorptive activity.
Examples of bisphosphonates:
- Alendronate (PO)
- Risedronate (PO)
- Zoledronic acid (IV)
How should oral bisphosphonates be taken?
It should be taken 1st thing in the morning, with a full glass of water, at least 30minutes before taking food.
What are some ADRs associated with oral bisphosphonates’ use?
- *Upper GI irritation - nausea, abdominal pain
- *Hypocalcaemia
- *Osteonecrosis of the jaw
- Atypical femoral fractures (prolonged use)
- *Flu-like symptoms - for IV bisphosphonates only
Which special populations are contraindicated in the use of bisphosphonates?
- Pregnant & breastfeeding patients
- Pt w severe renal impairment (CrCL < 30ml/min)
- Hypocalcaemia
- Pt w oesophageal abnormalities
What is Denosumab and what is its mechanism of action?
Denosumab is a RANKL antibody.
The MOA of denosumab is to prevent the development of osteoclast.
How is denosumab administered?
It is administered subcutaneously, every 6 months.
Calcium and Vit D supplements are co-administered with denosumab.
Do not discontinue as it can increase risk of spinal column fractures.
What are the things that should be done before we initiate SC denosumab?
- Check Cr levels & 25 OH vitamin D levels
- Restore back Vitamin D levels if levels are depleted
- Give Ca supplement if pt is renally impaired
What are the ADRs of denosumab?
- N&V
- Constipation of diarrhoea
- Osteonecrosis of the jaw
- Atypical femoral fractures
Which special populations are contraindicated with denosumab’s use?
- Hypocalcaemia
- Pregnancy.
How does oestrogen help in osteoporosis?
Oestrogen helps to maintain bone density.
What are the downsides of oestrogens?
Oestrogen can increase the risk of breast cancer, and blood clots that can lead to strokes.
What is an oestrogen alternative that can be used?
Raloxifene
Raloxifene is a selective oestrogen receptor modulator.
Raloxifene can help to maintain bone density, with reduced risk in breast cancer.
However, it still increases risk of blood clots and hot flashes.
What is the effect of calcitonin and how is it administered?
Calcitonin helps to inhibit osteoclastic bone resorption.
Calcitonin is often administered by injection or nasal spray.
What are examples of anabolic agents?
- Romosozumab
- Parathyroid hormone therapies
What is the general MOA of anabolic agents?
They help to increase bone growth & bone strength.
What is Romosozumab?
It is a monoclonal antibody that stops sclerostin.
Sclerostin is a gene product that reduces osteoblastic bone formation.
By inhibiting sclerostin, bone formation increases while bone resorption decreases.
Who should Romosozumab be used for?
Romosozumab should be used in female patient with high risk of fracture OR who have failed other osteoporosis therapies
How is romosozumab given?
It is given once a month, for 12 months.
What are the ADRs of romosozumab?
- History of MI*
- History of Stroke*
- Increased risk of CV death
- Hypersensitivity reactions
What is an example of parathyroid hormone therapy?
Teriparatide is an example of parathyroid hormone therapy.
How does parathyroid hormone therapy work?
Intermittent high dose to PTH will increase bone growth.
If left at the basal level of PTH, bone resorption is favoured to increase plasma calcium levels.
What is the effect of giving vitamin D to a patient?
Vitamin D helps to increase dietary calcium absorption.
When vitamin D intake increases, more calcium will be absorbed.
What is the effect of parathyroid hormones?
Parathyroid hormone helps to:
1. Increase activation of Vitamin D
2. Cause break down of bone and mobilize calcium.
What is the maximum treatment duration of PTH therapy?
2 years
