Osteoporosis_Medications

Question 1

Bisphosphonates 
1/ mechanism of action
2/ side effects?
3/ Contraindications 
4/ Administration and drugs to avoid when taking bisphosphonates

Answer 1

1/ decreases bone resorption
2/ nausea, constipation, diarrhoea, dyspepsia, oesophagitis
3/ Uveitis
Barrett’s esophagus
4/ Empty stomach, sit up for 30mins following –> Avoid calcium, antacids, magnesium

Question 2

What are the contraindications for IV Bisphosphanate

Answer 2

Calcium <2.10
Vit D deficiency
eGFR <35

Question 3

1/ What is Denosumab?

Answer 3

1/ RANK Ligand, decreases osteoclast activity

Question 4

Which medication can be used in CKD for osteoporosis?

Answer 4

Denosumab
–> Nil dose adjustment required in CKD
(Ref etg & RACGP article)

Question 5

1/ What is Raloxifene?

2/ Side effects?

Answer 5

1/ SERM (Selective Estrogen Receptor Modulator)
–> acts as a agonist at some estrogen receptor e.g. increases mineralisation

Antagonist at others e.g. breast/uterus –> prevents breast and endometrial hyperplasia

2/Increases risk of VTE, and hot flushes
(Ref etg & RACGP article)

Question 6

Which medication for osteoporosis does not protect against non-vertebral fractures?

Answer 6

Raloxifene

Ref etg & RACGP article

Question 7

Teriparatide
1/ what is the duration of treatment?
2/ what is the risk associated with longer term use of teriparatide?

Answer 7

1/ 18 months
2/ osteosarcoma

(Ref: AMH)