Osteoporosis

Question 1

Prolonged use of which drug class can be a secondary cause of osteoporosis?

Answer 1

Corticosteroids (e.g. asthma or COPD patients)

Question 2

Which drug class puts you at risk of a fall (particularly in the elderly)

Answer 2

Benzodiazepines

Question 3

Name 2 non-pharmacological treatment options for osteoporosis

Answer 3

• exercise (particularly strength / high impact)

- diet (increased calcium and VitD intake, reduce caffeine, alcohol and smoking)

Question 4

Main goal of osteoporosis treatment?

Answer 4

To prevent fractures

Question 5

Name the 3 classes of anti-resorptive drugs used in osteoporosis

Answer 5

Denosumab
Bisophosphonates
SERMs

Question 6

Name 2 bisphosphonates

Answer 6

Alendronate
Riseseonate
Zoledronic acid

Question 7

Briefly explain MOA of bisphosphonates

Answer 7

They are incorporated into the bone matrix and inhibit bone resorption

Question 8

Main ADRs of bisphosphonates?

Answer 8

GI irritation, renal impairment, musculoskeletal pain, ONJ, AFF

Question 9

Define ONJ and briefly explain

Answer 9

Osteonecrosis of the jaw
Bisphosphonates and denosumab reduce the ability of the bone to respond to injury, therefore dental related trauma can lead to necrosis of the jaw

Question 10

Counselling points specific to the GI irritation ADR of bisphosphonates?

Answer 10

Due to poor bioavailability, 
- take with a full glass of water (prevents esophageal irritation)
- remain upright until you eat 
- take it half an hour before food
No antacids within 30 minutes

Question 11

How often is denosumab administered?

Answer 11

60mg every 6 months

Question 12

Why are drug holidays not advised for denosumab?

Answer 12

Cessation causes a very quick decline in BMD and increase in fracture risk. If stopping, need to switch to an alternative

Question 13

Which anti-resorptive is better for patients in renal failure?

Answer 13

Denosumab

Question 14

Common ADRs of denosumab?

Answer 14

Nasopharyngitis (can use saline spray)
Infections 
Nausea
GORD
Headache

Question 15

Rare side effect of denosumab?

Answer 15

ONJ

Question 16

Raloxifene is an example of which type of drug?

Answer 16

SERM

Question 17

MOA + relevant receptors of SERMs?

Answer 17

Selective estrogen receptor modulators …
Act as agonists for estrogen receptors on bone and lipids
Act as antagonists for estrogen receptors on breast and uterine tissue (meaning reduced risk of cancer and it is ok for those at high risk)

Question 18

Common ADR of SERMs?

Answer 18

Menopausal like Sx - hot flushes and night sweats

Question 19

Which drug, used in osteoporosis, is recombinant parathyroid hormone?

Answer 19

Teriparatide

Question 20

Teriparatide is indicated in mild cases of osteoporosis. True or false? Explain.

Answer 20

False. Only indicated in severe cases.

Lifetime maximum of 18 months due to risk of developing osteosarcoma