Osteoporosis Drugs

Question 1

Which drugs have a MOA on osteoclasts?

Answer 1

• Bisphosphonates
• Denosumab
• Calcitonin
• SERM
• Estrogen

Question 2

Which drug has an MOA on osteoblasts?

Answer 2

Teriparatide

Question 3

Bisphosphonates

Answer 3

• First line therapy

- Anti-resorptive, binds to bone, inhibits osteoclast activity and promotes osteoclast death

Question 4

Adverse events of Bisphosphoates

Answer 4

• GI: difficulty swallowing, inflammation of esophagus and gastric ulcers
• Inc in creatinine
• Flu like illness

Long term:

• Atypical fracture of femur
• Osteononecrosis of the jaw

Question 5

Denosumab

Answer 5

Can be first line (2010)
Human monoclonal antibody
Antiresorptive, inhibits osteoclast formation, inhibits RANKL (which activates osteoclasts and promotes their formation)
-->LOOKS LIKE OPG
NOT renally excreted

Question 6

Adverse effects of denosumab

Answer 6

Hypocalcemia, infectious and skin reactions

Question 7

Teriparatide

Answer 7

• Moderate to severe second line therapy
• Anabolic agent, inc osteoblast activity
• Can follow with antiresorptive agent
• PTH analog
• Balance…in first two years, bone formation>bone destruction

Question 8

Teriparatide: adverse events

Answer 8

• Nausea, headaches, leg cramps, hypercalcemia, orthostatic hypotensions, palpitations
• Osteosarcoma
• AVOID in paget’s dis, high alk phos, hypercalcemia, h/o skeletal malignancy, radiation or mets