Osteoporosis Drugs

Question 1

bisphosphonates (oral)

Answer 1

• inhibit osteoclast mediated bone resorption → increases bone density
• Example: Alendronate
• Primary drug
• Contraindications
  
  • drug allergy, hypocalcemia, esophageal dysfunction, and the inability to sit or stand upright for at least 30 minutes
• Side effects
  
  • headache, GI upset, and joint pain.
• Rare case reports of osteonecrosis of the jaw
• Given in early morning before other drugs

Question 2

bisphosphonates (IV)

Answer 2

• Example: Zoledronic Acid
• Treatment: IV: 5 mg once every 12 months

Adverse effects can include:
- acute phase reaction post-infusion, hair loss, hypotension, dehydration, GI effects, anemia, headache, joint pain, renal insufficiency, hypocalcemia, -hypersensitivity reactions, case reports of osteonecrosis of jaw & bone fractures (others exist)

For those who:
- Have a high fracture risk
- have esophageal disorders (can’t tolerate oral meds)
- gastrointestinal intolerance to oral bisphosphonates
- history of Roux-en-Y gastric bypass
- an inability to follow the dosing requirements of oral bisphosphonates, including - an inability to sit upright for 30 to 60 minutes and/or to swallow a pill
- Can tolerate an IV administration annually

Question 3

Raloxifene

Answer 3

• selective estrogen receptor modulators (SERMs)
• stimulate the estrogen receptors on bones and increases bone density
• Raloxifene: Primarily used for the treatment of prevention of postmenopausal osteoporosis
• Contraindications - known allergies to drugs, pregnancy, hypokalemia, kidney impairment, and past blood clot issues
• Side effects - hot flashes and leg cramps. They can also increase the risk of blood clots and leukopenia (low WBC count)

Question 4

Forteo

Answer 4

• SERM
• Only drug available that acts by stimulating bone formation
• Derivative of parathyroid hormone that works to modulate the body’s calcium and PO4 metabolism
• Used for a small subset of individuals at high risk for osteoporosis
• Rarely used
• Contraindicated for those with a known drug allergy
• Adverse effects
  
  • hypercalcemia, hypotension, chest pain, renal stones, GI effects, and joint pains (among others)

Question 5

Prolia (denosumab)

Answer 5

• SERM
• Mechanism of action: Monoclonal antibody that blocks osteoclast activation and prevents bone resorption
• Sub q injection given every 6 months
• Used for those at high risk for osteoporosis that are unable to tolerate first line therapies
• Contraindications: hypocalcemia, allergy to drug, kidney impairment/failure and current infection
• Adverse effects include: edema, hypocalcemia, GI upset, anemia, fatigue, joint pain, increased risk of infection, case reports of osteonecrosis of the jaw, among others