Osteoporosis Management and Treatments

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Questions and Answers

What is the primary role of Denosumab in the treatment of osteoporosis?

To increase estrogen production in postmenopausal women

To enhance the absorption of calcium in the intestines

To prevent RANK activation and decrease osteoclast activity (correct)

To directly stimulate bone mineralization without affecting osteoclasts

What is the recommended treatment regimen for Prolia®?

Once a month at 120mg

Once every 3 months at 80mg

Once every 6 months at 60mg (correct)

Once a year at 100mg

How does Teriparatide affect the risk of nonvertebral fragility fractures based on the reported results?

It reduces the risk of fractures with a relative risk of 0.46 (correct)

It doubles the incidence of nonvertebral fractures

It increases the risk of fractures by 54%

It has no significant effect on fracture risk

What physiological change at menopause leads to increased RANKL release?

Drop in estrogen levels Signup and view all the answers

What is the purpose of Denosumab (Xgeva®) in cancer patients?

To prevent skeletal-related events in patients with bone metastases Signup and view all the answers

What characterizes osteoporosis?

Low bone mass and disrupted bone architecture Signup and view all the answers

How is osteoporosis classified?

Primary and secondary Signup and view all the answers

What is the clinical definition of osteoporosis?

Predisposition to fractures after minimal trauma Signup and view all the answers

What T-score indicates osteoporosis according to WHO guidelines?

-2.5 Signup and view all the answers

What is the primary effect of Vitamin D related to calcium?

Increased absorption of calcium Signup and view all the answers

What can lead to hypercalcemia when considering Vitamin D's effects?

Increased absorption of calcium Signup and view all the answers

What does a T-score above -2 indicate?

Normal bone density Signup and view all the answers

What is the estimated skeletal status of white women at age 60, according to the data?

20% normal, 50% osteopenia, 30% osteoporosis Signup and view all the answers

What is the main effect of calcitonin?

Inhibition of bone resorption Signup and view all the answers

Which of the following preparations of calcitonin is NOT available?

Oral calcitonin tablets Signup and view all the answers

What is a common side effect of bisphosphonates when taken orally?

Esophagitis Signup and view all the answers

Which bisphosphonate is specifically mentioned for patients with multiple myeloma?

Zoledronic Acid Signup and view all the answers

What is the relative risk reduction percentage for new fractures with a 200 IU dose of intranasal calcitonin compared to placebo?

36% Signup and view all the answers

For patients with creatinine clearance greater than 60 mL/min, what is the recommended dosage of Zoledronic Acid?

4 mg every 4 weeks Signup and view all the answers

Which of the following statements about the efficacy of bisphosphonates is true?

They inhibit osteoclast action. Signup and view all the answers

What effect does alfacalcidol have on calcium levels?

It leads to hypocalcemia. Signup and view all the answers

Study Notes

Drugs Affecting Calcium Metabolism and Bone Turnover

This presentation discusses drugs that impact calcium metabolism and bone turnover, including hormones, osteoporosis, and treatment options.

Hormones Regulating Calcium Metabolism

Low calcium levels trigger the parathyroid gland to release parathyroid hormone (PTH).
PTH increases calcium levels by stimulating calcium absorption from food and releasing calcium from bone.
Vitamin D plays a role in calcium absorption from the digestive tract.
High calcium levels trigger the release of calcitonin (CT) from the thyroid (C cells), which reduces calcium in the blood by inhibiting bone resorption.

Calcium Homeostasis

Vitamin D and PTH increase calcium absorption from the gastrointestinal tract.
Calcitonin decreases calcium levels by reducing bone resorption.
Estrogens and glucocorticoids influence calcium balance in bone.
Increased calcium excretion into urine is regulated by PTH.

Diseases of Calcium Metabolism: Osteoporosis

Osteoporosis results from low bone density, causing frequent fractures with minimal trauma.
Classification: Primary (likely related to aging) and Secondary (often related to other diseases or medications).

Definition of Osteoporosis

Pathology: A decrease in both bone mineral density and matrix, reducing mechanical strength.
Radiology: Bone density measurements show a significant reduction compared to a young adult of the same gender, often more than 30%.
Clinical: Patients are predisposed to fractures after minimal trauma.

World Health Organization (WHO) Guidelines

The WHO categorizes osteoporosis severity based on T-scores.
T-score > -1: Normal
T-score between -1.0 and -2.5: Osteopenia
T-score <-2.5: Osteoporosis
T-score <-2.5 with fractures: Severe osteoporosis

NOF/WHO Criteria for Assessing Disease Severity

T-scores categorize osteoporosis severity.
Bone mass T-scores are standard deviations from a young adult's bone mineral density (BMD).

Change in Bone Mass for Men and Women

Bone mass increases throughout youth and then plateaus.
Menopause significantly impacts women's bone mass, causing a rapid decline.

Estimated Skeletal Status of US White Women, 1990

The prevalence of osteoporosis and osteopenia increases with age in white women.
The graph showcases the percentage of women with different skeletal statuses (normal, osteopenia, osteoporosis) by age.

Vitamin D

Vitamin D's main effect is increasing calcium absorption.
Hypercalcemia is the net effect.
Vitamin D, in its active forms, is available for oral and intramuscular administration.
Alfacalcidol is an active Vitamin D metabolite produced by the liver and osteoblasts.

Calcitonin

Main function: Inhibits bone resorption, leading to hypocalcemia.
Preparations include salmon calcitonin and synthetic human calcitonin.
Available for subcutaneous and intramuscular injections, as well as nasal sprays.

Effects of Intranasal Calcitonin on New Vertebral Fractures

The study evaluated the effects of intranasal calcitonin on vertebral fractures.
Some doses (e.g., 200 IU) showed significant fracture reduction compared to placebo.

Bisphosphonates

Inhibit bone resorption, leading to hypocalcemia.
Include alendronate, tiludronate, risedronate, etidronate, and pamidronate.
Oral absorption is poor, and esophageal irritation can be a side effect.

FOSAMAX (Alendronate Sodium)

Alendronate sodium increases bone strength by attaching a phosphate group to the bone.
Available in tablet and oral solution forms.

ACTONEL (Risedronate Sodium)

Contains risedronate sodium, a bisphosphonate used to treat osteoporosis.

Bisphosphonates: Long-Term Inhibitors of Bone Resorption

Bind to hydroxyapatite in bone.
Inhibit osteoclast action.
Lead to long-term skeletal retention.
Poorer gastrointestinal (GI) absorption compared to other bisphosphonates.

Bisphosphonates: Pharmacokinetics

Food and calcium interfere with absorption.
Intestine absorption is very low (0.5–10%).
Fast and complete uptake in bone.
Urine is the primary route of elimination.

Osteoporosis Indications for Actonel

Actonel 35 mg once weekly is prescribed for postmenopausal osteoporosis prevention and treatment.
Actonel 5 mg daily is also indicated for prevention and treatment of glucocorticoid-induced osteoporosis in men and women on long-term glucocorticoid therapy.

Effect of Risedronate on Clinical Vertebral Fractures at 1 Year

Risedronate significantly reduced the risk of vertebral fractures, beginning within 6 months (as early as 6 months).

Head-to-Head Studies Demonstrating Gastric Ulcers

Studies comparing alendronate and risedronate show a lower incidence of gastric ulcers with risedronate.

Actonel 35 mg Once-a-Week Dosage and Administration

Take with a full glass of water 30 minutes before the first food or drink of the day.

Actonel 5 mg Daily Dosage

Similar instructions to the weekly dosage form, but taken once daily.

Bisphosphonates Post-marketing: Osteonecrosis of the Jaw

Bone exposure, swelling and loosening of teeth, dental procedures worsening lesions, and prolonged intravenous therapies at high doses have been linked to this complication, which is frequently associated with infection.

Hormone Replacement Therapy (HRT)

HRT (estrogen and derivatives) was shown to reduce hip and vertebral fractures by 34% and 24%, respectively.
HRT use was linked to a slight increase in the risk of cardiovascular events and invasive breast cancer by 25%.

The Decrease in Breast Cancer Incidence in 2003

Breast-cancer incidence declined slightly in 2003..

Selective Estrogen Receptor Modulators (SERMS)

Raloxifene reduces bone loss, a significant effect, and is independent of dose.
Raloxifene helps with osteoporosis while minimizing estrogen's undesirable effects on other tissues, notably the uterus and breasts.

Forms of Human PTH Preparations

hPTH (1-84) is an intact human parathyroid hormone.
hPTH (1-34), also known as teriparatide, is a synthetic form.

Effect of Teriparatide on Lumbar Spine BMD

Teriparatide significantly improved lumbar spine bone mineral density (BMD).

Effect of Teriparatide on the Risk of New Vertebral Fractures

Teriparatide reduced the risk of new vertebral fractures.

Effect of Teriparatide on Nonvertebral Fragility Fractures

Teriparatide reduced the risk of nonvertebral fractures.

Denosumab: Prolia/Xgeva

Denosumab, a RANKL inhibitor, is a medication used in osteoclast prevention.
It reduces bone loss and improves bone density, useful for osteoporosis and bone metastases.

Denosumab: Prolia/Xgeva Indications and Treatment Regimen

Prolia (denosumab) is indicated for treating and preventing osteoporosis in postmenopausal women and men with increased fracture risk.

Prevention and Treatment

Calcium supplementation, vitamin D, and preventing bone calcium mobilization are key for osteoporosis prevention.
Calcitonin, bisphosphonates, estrogen/progestin, SERMs, teriparatide, and denosumab are medications used in this strategy.

Diseases of Calcium Metabolism: Hypocalcemia

Causes: Dietary calcium deficiency, vitamin D deficiency, and hormonal imbalances (hypoparathyroidism).

Treatments for Hypocalcemia

Calcium salts, and vitamin D.

Diseases of Calcium Metabolism: Hypercalcemia

Causes: Increased parathyroid gland activity, ectopic hormone production, vitamin D excess, or body immobilization.
Treatments: Calcitonin, bisphosphonates, glucocorticoids.

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Description

This quiz explores various aspects of osteoporosis, including the roles of medications such as Denosumab and Teriparatide, treatment regimens, and classifications of the disease. Participants will also learn about physiological changes, clinical definitions, and key T-score indicators relevant to osteoporosis. Test your knowledge on these critical aspects of bone health!