Osteoporosis Meds

Question 1

Bisphosphonate N-containing

Answer 1

Blocks farnesyl enzyme used in cholesterol synthesis pathway --> cytoskeletal abnormalities in osteoCLasts --> detach from bone = decreased bone resorption
Pamidronate
Alendronate 
Risedronate 
Zoledronic Acid
Neridronate 
Ibandronate

Question 2

Bisphosphonate non-N-containing

Answer 2

Incorporated into ATP –> non-hydrolyzable ATP –> osteoCLast apoptosis = decreased bone resorption
Etidronate
Clodronate
Tiludronate

Question 3

N-containing or Non-N-containing safer?

Answer 3

N-Containing

Question 4

SEs of Bisphosphonates

Answer 4

Hypocalcemia
Osteonecrosis of jaw
Atypical femoral fractures
Oral ($): poor absorbed, take on empty stomach, GERD, esophagitis
IV ($$): acute-phase rxn (fever, muscle/joint pain)

Not good for long-term use

Question 5

Denosumab

Answer 5

$$$
Decoy RANKL receptor
Sub-Q, generally better for long-term use but still has some SEs associated

Question 6

SEs of Denosumab

Answer 6

Generally well-tolerated

Increased freq of eczema, cellulitis, faltulence, hypocalcemia, ONJ and AFF possible

Question 7

HRT SEs

Answer 7

Small but significant increase in CV events, stroke, PE, invasive breast CA
Do NOT use in elderly patients with CV risk
Best for pre-menopausal woman

Question 8

Teriparatide

Answer 8

\$\$\$\$
Sub-Q 1/d for 2 yrs 
Anabolic agent 
Reserved for more severe cases 
Portion of human PTH --> intermittent PTH causes increased stimulation of osteoblasts

Question 9

Teriparatide SEs and CIs

Answer 9

Risk of osteosarcoma
CI in patients with radiation tx, Paget’s, young patients with growing bones, pregnancy, severe renal impairment, hypercalcemia, skeletal malignancies
SEs: nausea and headache, dizziness and leg cramps, mild hypercalcemia