Osteoporosis Pharmacology Flashcards
Anti-resoprtive therapy
Bisphosphonates
SERMs
Calcitonin
Anabolic therapy
Teriparatide
Promote new bone formation
Vitamin D
Needed in those with limited sun exposure
Maximize Ca reabsorption
Dihydrotachysterol
Test question
Synthetic Vit D
Does NOT required renal hydroxylation!!!!
Rapid onsetm greater effects minieralization of bone salts
Bishphosphates
PCP analogs of pyrophosphate
Alendronate
Risendronate
ANTIRESORPTIVES
Bisphosphates First gen MOA
Increase clast cell death and decrease function
Bisphosphate 2/3rd gen MOA
Interfere with isoprenoid lipid biosynthesis
Nitrogen Containing Bisphosponates
Test question
Inhibit Farnesyl Diphosphate Synthase
Lead to inadequate prenylation which compromises clast function and apoptosis!!!!!
Teriparatide
Recombinant version of human PTH
Activates blast (new bone formation and increased BMD)
Does NOT change calcium absorption
2 years MAX
Calcitonin
Test question
Reduction in the ruffled border surface of osteoclast diminishing their resorption activity –> decrease resorption
Salmon Clacitonin
Anti-resorptive
RANKL
Osteoblast precursor
RANK
Clast precursor
RANKL and RANK signalling lead to?
Differentiation, activation and enhanced survival of clasts –> resorption
Osteoprotegerin
Decoy receptor for the RANKL –> preventing binding to its RANK
Denosumab
Pharmacologic agent that essence acts like osteoprotegerin as a decoy receptor for osteoblastic RANKL
Denosumab uses
Severe osteoporosis
Inhibits resorption and suppresses bone turnover
Androgens
Increase BMD
ADRs increased secondary sex characteristics
Prostate cancer!!
Estrogen Pros
Strengthens bones
Lower LDL and higher HDL
Estrogen Cons
Breast cancer risk
Uterine cancer risk
Blood clot risk
SERM Reloxifene
Estrogen agonists in bone
Antagonists in breast
Antiresorptive
Ca supplements can
decrease absorption of iron and drugs (TC and phenytoin)
