OP and Paget's Disease - Chapter 16 Flashcards
Osteoporosis
-Chronic, progressive disease of bone with loss of bone density and bone strength which leads to bone fragility
Primary Osteoporosis
-Associated with the aging process
Secondary Osteoporosis
-Associated with disease or drugs
Disease Causes for Secondary Osteoporosis
- Hyperthyroidism
- Hyperparathyroidism
- Rheumatoid Arthritis
- IBD
- Parkinson’s disease
- MS
- AIDS
Drug Causes for Secondary Osteoporosis
- Corticosteroids
- Antiandrogens
- GnRH agonists
- Lithium
- Methotrexate
- Phenytoin
- Aromatase inhibitors
- Medroxyprogesterone
Prevention of Osteoporosis
- Mild weight-bearing exercise
- Diet rich in vitamin D and calcium
- Reduced smoking and alcohol
- Start the above early to prevent bone loss
Paget’s Disease of the Bone
- Progressive disease of bone
- Irregular activity of osteoblasts and osteoclasts
Treatment of Osteoporosis and Paget’s Disease
The goal of treatment is to increase bone density and decrease the risk of fractures
Pharmacological agents are:
- Antiresorptive agents
- Anabolic agents
Antiresorptive Agents MOA
- Suppress bone turnover and loss
- Inhibit bone resorption
Different Types of Antiresorptive Agents
- Bisphosphonates
- Calcitonin
- Estrogen Agonist
- RANK ligand inhibitor
Anabolic Agents MOA
-Promote bone formation
Types of Anabolic Agents
-PTH analogs
Bisphosphonates MOA
-Inhibit osteoclast activity
Bisphosphonates Examples
- alendronate
- etidronate
- risedronate
- zoledronic acid
Brand: Fosamax
Generic: alendronate
Brand: Didronel
Generic: etidronate
Brand: Actonel, Actonel DR
Generic: risedronate
Brand: Aclasta
Generic: zoledronic acid
Bisphosphonates Combination Examples
- alendronate/vitamin D
- risedronate/calcium
- etidronate/calcium carbonate
Brand: Fosavance
Generic: alendronate/vitamin D
Brand: Actonel Plus Calcium
Generic: risedronate/calcium
Brand: Didrocal
Generic: etidronate/calcium carbonate
Bisphosphonate ADR’s
- Painful swallowing
- Heartburn
- Diarrhea
- Nausea/vomiting
Bisphosphonate Warning Labels
- STAND OR SIT UPRIGHT FOR AT LEAST 30 MINUTES AFTER TAKING DOSE; DO NOT LIE DOWN
- TAKE 30 MINUTES BEFORE FIRST MEAL, BEVERAGE OR MEDICATIONS WITH AT LEAST 120 ML OF WATER
- AVOID DAIRY, CALCIUM, MULTIVITAMIN SUPPLEMENTS, IRON, OR ANTACIDS WITHIN 2 HOURS
Selective Estrogen Receptor Modulators (SERM’s)
-Indicated for the treatment of osteoporosis in postmenopausal women
SERM’s for Osteoporosis Examples
-raloxifene
Brand: Evista
Generic: raloxifene
ADR’s:
- hot flashes
- leg cramps
- peripheral edema
- stroke
- DVT
Calcitonin
- Inhibits the rate of bone turnover and causes excess calcium to be stored in the bone
- Only used for Paget’s Disease
- Increased bone Mineral Density
Brand: Calcimar
Generic: calcitonin
HRT for Osteoporosis
-Used for prevention NOT treatment
- Estradiol
- Estradiol/norethindrone
- estradiol/norgestimate
- estrogens/medroxyprogesterone
- conjugated estrogens
- esterified estrogens and estropipate
RANK Ligand Inhibitors
- Causes inhibition of osteoclast activation
- decreases bone resorption
- reverses bone remodelling
RANK Ligand Inhibitors Examples
-denosumab
Brand: Prolia
Generic: denosumab
-given SC twice yearly
Anabolic Agents: Parathyroid Hormone Analogs
- Increase the rate of bone remodeling
- Thicken structural units of bones
- Decrease osteoblast cell death
PTH Analogs Examples
-teriparatide
Brand: Forteo
Generic: teriparatide
