management of osteoporosis

Question 1

what is the mechanism of action of bisphosphonates

Answer 1

decrease osteoclastic bone resorption mainly through an increase in osteoclastic apoptosis and inhibition of the cholesterol biosynthetic pathway important for osteoclast function.

Question 2

what is the best way to administer bisphosphonates

Answer 2

avoid Oral route, take on empty stomach without any other drugs
DO NOT ADMINISTER TO PATIENTS WITH RENAL IMPAIRMENT

Question 3

what type of bisphosphonates do we use for the following diseases

• pagets disease
• hypercalcemia
• bony metastasis

Answer 3

pagets:

• pamidronate
• alendronate
• risedronate
• zoledronate

hypercalcemia:

• pamidronate
• zoledronate

bony metastasis:

• pamidronate
• zoledronate

Question 4

what are some adverse effects of bisphosphonates

Answer 4

• Diarrhea
• abdominal pain
• musculoskeletal pain.
• esophagitis
• esophageal ulcers.

Question 5

what is the mechanism of raloxifene

Answer 5

It has estrogen-like (partial agonist) effects on bone and CVS, but estrogen antagonist effects on breast and endometrial tissue.

Question 6

why is raloxifene the best SERMS to use to prevent osteoperosis

Answer 6

It increases bone density without increasing the risk of endometrial cancer. It decreases the risk of invasive breast cancer and reduces levels of total and LDL cholesterol.

Question 7

what are the side effects of raloxifene

Answer 7

include hot flashes, leg cramps, and a risk of venous thromboembolism like estrogen

Question 8

who do doctors suggest calcitonin for

Answer 8

It is indicated for the treatment of osteoporosis in women who are at least 5 years postmenopausal.

Question 9

what is the mechanism of action of calcitonin

Answer 9

It inhibits bone resorption by direct action on osteoclasts—decreasing their ruffled surface which forms contact with the resorptive pit. The drug reduces bone resorption, but it is less effective than BIS

Question 10

who do we use denosumab on

Answer 10

Approved for the treatment of postmenopausal osteoporosis in women at high risk of fracture.
S.C injection every 6 months

Question 11

what is teriparatide and who uses it

Answer 11

Recombinant form of human PTH, administered s.c daily
First approved treatment for osteoporosis that stimulates bone formation by stimulating osteoblastic activity.

It should be reserved for patients at high risk of fractures and those who have failed or cannot tolerate other osteoporosis therapies