Pharmacology of Osteoporosis

Question 1

Fragility fracture definition

Answer 1

Fracture that occurs spontaneously or following a minor trauma such as:
A fall from standing height or less
Fall from sitting
Fall from supine
Fall after missing 1-3 steps
After a movement outside the typical plane of motion or coughing

Question 2

Who is high risk automatically?

Answer 2

Hip fracture
1 or more vertebral fractures
2 or more non-vertebral, non-hip fractures

Question 3

Mild or unavoidable side effects of bisphosphonates

Answer 3

GI (take on an empty stomach, no food for 30-60 mins, remain upright)
Acute phase rxn (flu like sx)
Hypocalcemia
MSK pain

Question 4

Adverse effects of bisphosphonates

Answer 4

Iritis/uveitis/conjunctivitis
Afib
Esophageal cancer
Jaw osteonecrosis
Atypical femur fractures

Question 5

3 benefits and 3 risks to bisphosphonates

Answer 5

Benefits: vertebral fracture reduction, non vertebral fracture reduction, mortality reduction
Risks: osteonecrosis of the jaw, atypical femoral fracture, esophageal cancer

Question 6

Adverse effects of denosumab

Answer 6

Eczema
Cellulitis
Flatulence
Hypocalcemia
ONJ and atypical fractures

Question 7

Chronic PTH elevation effects

Answer 7

Increases osteoclast activation vis RANK/RANKL

Bone resorption

Question 8

Intermittent PTH exposure

Answer 8

Promotes osteoblast activation

Anabolic effect

Question 9

Romosozumab

Answer 9

Sclerostin antibody

Increases bone formation and decreases bone resorption

Question 10

Strontium ranelate

Answer 10

Increases bone formation and decreases resorption