Osteoporosis Medications

Question 1

Bisphosphonates - indications

Answer 1

• Osteoporosis
• Paget disease of the bone
• Hypercalcemia
• Metastatic cancer: osteolytic bone lesion

Question 2

Bisphosphonates - adverse effects

Answer 2

Esophageal erosion

Atypical femur fractures

Osteonecrosis of the jaw

Question 3

Bisphosphonates - contraindications/precautions

Answer 3

severe GERD or esophagitis - use caution with oral formulations

creatinine clearance <30

hypocalcemia

Question 4

Bisphosphonates - MOA

Answer 4

Absorb hydroxyapatite and become permanent parts of the bone structure (terminal half life is 10 years). Inhibits osteoclast activity by preventing them to attach to bone

Question 5

Bisphosponate administration

Answer 5

Oral:

low bioavailability.

Taken in morning on empty stomach

Weekly or daily dosing

IV (ibandronate - q 3mos and zoledronic acid - yearly infusion)

flu like symptoms common after zolendronic acid infusion

Question 6

Calcium supplementation - indications

Answer 6

Hypocalcemia Osteoporosis

Question 7

Calcium supplements - interactions

Answer 7

Decreased absorption of ciprofloxacin, fluoride, phenytoin, levothyroxine, tetracycline, iron

Question 8

Calcium supplements (2 drugs)

Answer 8

Calcium carbonate

Calcium citrate

Question 9

How does calcium citrate differ from calcium carbonate?

Answer 9

It is not dependent on gastric acid for absorption, well suited for old people or pt using PPIs

Question 10

Vit D recommended daily allowance for over 50 years old

Answer 10

600units (max 4000units)

Question 11

What other drugs may protect bones (apart from supplements and bisphosphonates)?

Answer 11

Raloxifene (SERM)

Calcitonin

Denosumab

Teriparatide

Question 12

Raloxifene - MOA

Answer 12

Activates estrogen receptors in bone while having antiestrogen effects in breast and uterine tissues

Question 13

Raloxifene - adverse effects

Answer 13

Intensify postmenopausal symptoms (hot flashes)

DVT Stroke, pulmonary embolism

leg cramps

Question 14

Raloxifene - indications

Answer 14

Postmenopausal osteoporosis, especially in women at high risk for breast cancer

Question 15

Calcitonin nasal spray adverse effects

Answer 15

nasal stuffiness

increased cancer risk

Question 16

Denosumab - MOA

Answer 16

Inactivation of osteoclastic gene transcription by inhibition of RANKL (transmembrane protein).

Question 17

Denosumab administration

Answer 17

SQ injection q6months

Question 18

Teriparatide - contraindications/cautions

Answer 18

Avoid rapid cessation of the drug.

Risk of osteosarcoma

caution if hypercalcemia, CV disease, renal insufficience, urolithiasis

risk for dig toxicity

Question 19

Which drug increases the risk of osteosarcoma?

Answer 19

Teriparatide

Question 20

Calcium and vit D supplements are important in treatment with which drugs? (2 drugs)

Answer 20

Calcitonin

Denosumab

Question 21

Only available anabolic (bone building) osteoporosis medication?

Answer 21

teriperatide

Question 22

Bisphosphonate patient instructions

Answer 22

• Not with food in your stomach
• Not with tea, coffee or chocolate milk
• Not with a little sip of water-drink at least 6oz
• Not before you go to bed
• Do not bend over or lie down immediately after administration

Question 23

recommended daily dose of calcium for postmenopausal females and those over 70

Answer 23

1200mg/day (max 2000mg)

Question 24

Raloxifene contraindications

Answer 24

• Active or past history of venous thromboembolic events
• Lactating women
• Pregnancy

Question 25

Teriperatide adverse effects

Answer 25

• Nausea
• leg cramps
• dizziness
• orthostatic hypotension
• transient hypercalcemia