Overview of drug treatments of osteoporosis

Question 1

What is a bisphosphonate, and what is its mechanism of action in treating osteoporosis?

Answer 1

Pyrophosphate analogue that binds tightly to crystals in bone matrix, inhibiting osteoclasts from bone resorption

Question 2

What is the best established agent for osteoporosis?

Answer 2

Bisphosphonates

Question 3

Give 2 examples of bisphosphonates?

Answer 3

Alendronic acid

Zolendronic acid

Question 4

How is zolendronic acid administered to treat osteoporosis?

Answer 4

Annual IV injection

Question 5

How is alendronic acid administered to treat osteoporosis, and what is the dosage?

Answer 5

Oral tablet or liquid

Either 10 mg daily or 70 mg weekly

Question 6

How efficacious are bisphosphonates for treating osteoporosis?

Answer 6

Very good efficacy

Question 7

What is the main side effect of bisphosphonates?

Answer 7

Increases risk of GI problems

Question 8

Are bisphosphonates suitable for short and long term use?

Answer 8

Suitable for short-term use as they are widely used and inexpensive

Can be difficult to take long-term

Question 9

What is denosumab, and what is its mechanism of action in the treatment of osteoporosis?

Answer 9

Monoclonal antibody that acts as a RANKL inhibitor and reduces osteoclast activation, differentiation, survival

Question 10

How efficacious is denosumab for treating osteoporosis?

Answer 10

Very good efficacy

Question 11

Which patients are suitable to take denosumab for treatment of osteoporosis?

Answer 11

Patients who can’t take bisphosphonates

Question 12

What is the dosage, duration and administration route of denosumab for treating osteoporosis?

Answer 12

1 subcutaneous injection every 6 months

Question 13

Give 2 examples of NICE-approved drugs that are less widely used to treat osteoporosis?

Answer 13

Raloxifene: Oestrogen-like molecule

Teriparatide: Recombinant form of PTH hormone, that stimulates osteoblast activity, suitable for intermittent use