Osteoporosis drugs-Resorption inhibitors

Question 1

Resoprtion blocking Drugs useful in treatment of Osteoporosis

Answer 1

Bisphosphonates “-Dronate” suffix
Pamidronate
Alendronate
Zoledronate
(“DONATion box”)

Raloxifene
(entrance lady holding “Relax” sign)

Calcitonin
(“Curator toning it down”)

Denosumab
(“Dino suit man grabbing crank drill”)

Question 2

Bisphosphonates **MOA

Pamidronate
Alendronate
Zoledronate**

Answer 2

-bisphosphonates attach to hydroxyapatite in the bone
(“Large T-Rex appetite”)

-osteoclasts bind to the bisphosphonate, inhibiting their adherence to the bony surface
(“Classmate stuck in donation box”)

-bisphosphonates decrease the development and recruitment of osteoclast precursors
(“Preventing osteo-Class waiting to enter from entering”)

-bisphosphonates induce osteoclast apoptosis
(“Classmates popping balloon”)

Question 3

Bisphosphonates can treat …

Answer 3

-bisphosphonates are useful in the acute treatment of hypercalemia
(“Elevated calci-yum ice cream”)

• hypercalcemia of malignancy is a common cause of _severe hypercalcemi_a requiring acute treatment with bisphosphonates and
  calcitonin

(“Massive calcified rock with metastatic crab fossils “)

​——————————————————————————–
​-Bisphosphonates and calcitonin are useful in the management of pagets disease

(“Disorganized bone homo paget display”)

• uncontrolled osteoclast resorption with secondary disorganized bone formation

Question 4

Bisphosphonates Side Effects

Answer 4

• can cause upper GI side effect
• acid reflux, esophagitis, esophageal ulcers sit upright 30 min and drink water to treat
• bisphosphonates can cause osteonecrosis of the jaw
  (“Crumbling jaw bone”)

-bisphosphonates can cause hypocalcemia
(“Falling calci-yum ice cream”)

(“Corroded neck of dinosaur”)

Question 5

postmenopausal osteoporosis can be treated and prevented with …

Answer 5

Estrogen therapy

• estrogen therapy will inhibit osteoclast and osteoclast precursors differentiation

(“pre historic Female guarding class entrance”)

(“Female symbol”)

Question 6

Estrogen therapy is NOT recommended because ..

Answer 6

-due to increased risk of breast cancer and other side effects

Question 7

since Estrogen therapy is NOT recommended as a treatment of postmenopausal Osteoporosis , what other drug can be Administered to treat this condition? and why ?

Answer 7

Raloxifene since its an estorgen agonist in bone and estrogen antagonist in Breast and Uterus , it can treat postmenopausal osteoporosis while not increasing the risk for breast or uterine cancer seen with estrogen therapy.

Question 8

Raloxifene MOA

(lady at entrance holding sign “RELAX”)

Answer 8

SERM - Selective Estrogen Receptor Modulator
(“Relaxing the waiting classmates”)

• has estrogen agonist activity in bone
• inhibits osteoclast differentiation
• and estrogen antagonist activity in breast and uterus
• reduced risk of breast cancer

Question 9

Denosumab MOA

(“Dino suit Man”)

Answer 9

• PTH stimulates osteoBLASTS to express RANKL which then binds RANK on osteoCLASTS and activated them
• Denosumab is a monoclonal Antibody against RANKL

(“Dino suit man grabbing crank drill”)
(“Antibody spikes on dino suit man”)

Question 10

Calcitonin MOA

(“Curator toning it down”)

Answer 10

• released from the parafollicular cells of the thyroid
• Calcitonin inhibits osteoclasts􏰀
• decreased bone resorption
  (“Curator grabbing classmate”)

-calcitonin promotes Ca2+ excretion by the kidney
(“Calci-Yum ice cream pouring down flank”)

Question 11

Calcitonin clinical uses

Answer 11

-Used in the same clinical scenarios as
bisphosphonates but not 1st line [osteoporosis]

• hypercalcemia of malignancy is a common cause of sever hypercalcemia requiring acute treatment with bisphosphonates and calcitonin

(“Massive calcified rock with crab fossils”)

Question 12

Calcitonin Side Effects

Answer 12

can cause hypocalcemia

(“Falling calci-yum ice cream”)