Osteoporosis Treatments

Question 1

What are bisphosphonates?

Answer 1

= analogue of pyrophosphate and are incorporated into the bone
- when bone is broken down, bisphosphonates are toxic to osteoclasts -> inhibiting their activity and reducing bone resorption
- =antiresorptive agent

Question 2

What are 2 examples of bisphosphonates?

Answer 2

• Alendronate
• Risedronate

Question 3

What are some advantages/disadvantages of oral bisphosphonates?

Answer 3

Advantages:
- low cost
- enteric-coated formulation (risedronate) may have lower incidence of gastric irritation
Disadvantages:
- absorption reduced by food, calcium, magnesium, iron
- oesophageal and gastric irritation

Question 4

Bisphosphonates administration to limit GIT side effects

Answer 4

To limit GIT side effects:
- take first dose early morning
- take on an empty stomach
- patient must remain upright for 30min-1hour

Question 5

What are some advantages/disadvantages of intravenous bisphosphonates?

Answer 5

Advantages:
- lower incidence of gastric irritation
Disadvantages:
- transient flu-like symptoms (ppl w impaired kidney function)
- hypocalcaemia

Question 6

What is Denosumab?

Answer 6

= monoclonal Ab against RANKL which reduces the number and function of osteoclasts
- = antiresorptive agent

Question 7

What do oestrogen and SERMs for Osteoporosis? and an example

Answer 7

= anti-resorptive agent
- increases bone density
- decreases risk of vertebral fractures
- e.g Raloxifene

Question 8

How does PTH help with osteoporosis? and an example?

Answer 8

= bone anabolic agent
- example -> Teriparatide
- typically PTH increases bone breakdown