Wolff: Osteoporosis Drugs

Question 1

What is the MOA of calcitonin-salmon?

Answer 1

Inhibits the activity of osteoclasts to ↓ bone resorption

Question 2

What are the 2 main clinical applications of calcitonin-salmon?

Answer 2

• Tx of established osteoporosis
• Used for Paget disease of bone

Question 3

Bisphsphonates are structural analogs of what; what is their MOA?

Answer 3

• Structural analogs of pyrophosphate, normal component of bone
• Incorporated into bone, then inhibit bone resorption by ↓↓ both the number and activity of osteoclasts

Question 4

Bisphosphonates are the drugs of first choice for what 5 conditions?

Answer 4

• Postmenopausal osteoporosis
• Osteoporosis in men
• Glucocorticoid-induced osteoporosis
• Paget disease of bone
• Hypercalcemia of malignancy

Question 5

What are the AE’s associated with bisphosphonates?

Answer 5

• Esophagitis: minimized by taking meds with 8oz of water
• Osteonecrosis of the jaw
• Atypical femur fractures

Question 6

Which bisphosphonate has been most commonly associated with osteonecrosis of the jaw and also dose-dependent kidney damage and rarely atrial fibrillation?

Answer 6

Zolendronic acid (IV)

Question 7

Which SERM can be used to prevent and treat postmenopausal osteoporosis?

Answer 7

Raloxifene

Question 8

Where is the SERM, Raloxifene an agonist and antagonist of estrogen effects?

Answer 8

• Blocks in breast and uterus
• Agonist in the bone

Question 9

What is the drug of choice for prevention and treatment of postmenopausal osteoporosis in pt at risk of estrogen-dependent breast cancer?

Answer 9

Raloxifene

Question 10

The SERM, Raloxifene increases the risk for what AE’s?

Answer 10

• DVT’s
• Pulmonary embolism
• Stroke

Question 11

What is the only drug for osteoporosis that increases bone formation?

Answer 11

Teriparatide

Question 12

When Teriparatide is administered in which fashion it increases bone deposition by osteoblasts?

Answer 12

Given as a daily pulsed therapy

Question 13

What is the MOA and effect of Denosumab?

Answer 13

• Monoclonal antibody that is a RANKL inhibitor
• Binds to RANKL and ↓ formation and function of osteoclasts –> ↓ bone resorption

Question 14

What are the clincial uses of Denosumab; what should it be taken with?

Answer 14

• Tx osteoporosis in postmenopausal women at high risk for fractures
• Prevention of skeletal-related events in pt’s with bone metastases from solid tumors
• Should be taken with calcium and vitamin D supplement to prevent hypocalcemia

Question 15

What are some serious AE’s associated with Denosumab?

Answer 15

• ↑ risk of new fractures
• Osteonecrosis of the jaw

Question 16

What is an important part of the therapy when treating osteoporosis in men; what are the 2 agents most commonly used?

Answer 16

• Testosterone replacement is important part of therapy
• Bisphosphonates (i.e., alendronate) = agent of choice
• Denosumab is an alternative

Question 17

What is the MOA of cinacalet?

Answer 17

• Binds to CaSR on parathyroid gland —> ↑ sensitivity to extracellular Ca²⁺
• Leads to ↓ PTH secretion

Question 18

What are the clinical uses of Cinacalet?

Answer 18

• Primary hyperparatyroidism (parathyroid carcinoma)
• Secondary hyperparathyroidism due to CKD

Question 19

Which drugs can be used for non-inflammatory vs. inflammatory OA?

Answer 19

• Acetaminophen was for non-inflammatory OA, but no longer recommended
• NSAIDs if inflammatory OA
• Duloxetine for treatment resistant pain

Question 20

Which topical NSAID is widely used for OA pain relief?

Answer 20

1% Diclofenec gel

Question 21

What are 4 effective oral antibiotics used for osteomyelitis; how long should tx be administered for?

Answer 21

• Clindamycin
• Rifampin
• TMP-SMX
• Fluoroquinolones
• Consists of 4-6 week course… time needed for bone revascularization after debridement