Osteoporosis Overview and Treatment

Osteoporosis Overview

• Osteoporosis increases risk of fragility fractures, most commonly in hips, spine, and wrists.
• Diagnosis aided by fragility fractures and low bone mineral density (BMD), determined by DEXA scans.
• Treatment targets bone resorption; includes bisphosphonates, peptide hormones, calcium, vitamin D, estrogen, and SERMs.
• Bisphosphonates effective in reducing vertebral, non-vertebral, and hip fractures, recommended for postmenopausal women.
• Calcium and vitamin D supplements may also be used but fracture prevention effectiveness is uncertain.

Types of Osteoporosis

• Primary osteoporosis: age-related bone loss.
• Secondary osteoporosis: medication- or disease-induced (e.g., chronic steroids, androgen deficiency, hypogonadism, anorexia/bulimia, celiac disease, hyperthyroidism, ankylosing spondylitis).

Pharmacologic Treatment

• Bisphosphonate treatment duration: typically 5 years.
• Benefits may extend beyond 5 years; ongoing treatment should be considered after weighing risks and benefits.
• Drug holidays may be recommended for extended treatment (>5 years) to mitigate atypical fracture risk.
• Bone density monitoring during 5 years of treatment isn't necessary.
• Consider treatment for osteopenia in high-risk patients (age 65+).
• Bisphosphonates recommended for men with osteoporosis to reduce vertebral fracture risk.

Preventive Strategies

• Diet high in calcium, regular bone-strengthening exercises.
• Daily calcium (1200-1500mg) and vitamin D (800-1000 IU) supplementation as needed.
• Reduce modifiable risk factors like smoking, excessive alcohol, high caffeine, low calcium&vitamin D, and physical inactivity.

Types of Medications for Osteoporosis

• Antiresorptive drugs: decrease osteoclast activity (e.g., bisphosphonates, hormones, SERMs, RANKL inhibitors).
• Parathyroid hormone analogs: stimulate osteoblast function (e.g., teriparatide).

Bisphosphonates

• Mechanism of action: structural analogs of pyrophosphate, incorporated into bone, inhibit osteoclast activity.
• Recommended for postmenopausal patients at high fracture risk.
• Five-year treatment duration is standard; benefits often last longer.
• Crucial to screen for low serum calcium and sufficient kidney function before treatment.
• Supplement with calcium and vitamin D for maximum effect.
• Possible side effects: upper GI tract irritation (esophagus), atypical femur fractures, esophageal cancer, and jaw osteonecrosis.
• Contraindications: inability to sit upright, esophageal motility disorders, or severe renal dysfunction.

Monoclonal Antibody/RANKL Inhibitor (Denosumab)

• Mechanism of action: inhibits osteoclast formation, function, and survival, decreasing bone resorption.
• Administered via injection every six months.
• Potential side effects: serious infections, skin reactions, musculoskeletal pain, atypical femur fractures, hypocalcemia.

Parathyroid Hormone Analogs (Teriparatide)

• Mechanism of action: stimulates osteoblast function, increases calcium absorption and reabsorption.
• Increases skeletal mass and strength.
• Approved for 2 years; safety beyond that is unclear.
• Reserved for severe cases with a high fracture risk.

Selective Estrogen Receptor Modulators (SERMs)

• Mechanism of action: bind to estrogen receptors, reducing osteoclast activity and potentially breast cancer risk.
• Alternative for patients unsuitable for bisphosphonates or denosumab, those at high fracture risk with a high breast cancer risk.
• Risk of deep vein thrombosis.
• May be less effective than bisphosphonates and teriparatide, possibly increasing venous thromboembolism risk particularly early in treatment.
• Black box warning for thromboembolic events.
• Contraindicated for patients with previous venous thromboembolic disorders or risk.

Hormone Replacement Therapy (HRT)

• Mechanism of action: inhibits osteoclast-driven bone resorption.
• Use depends on individual patient's benefit/risk; review risks (e.g., stroke, blood clots, breast cancer).
• May reduce fractures in postmenopausal patients.
• Use at lowest effective dose and shortest duration.
• High-risk side effects: stroke, blood clots, breast cancer.
• Contraindicated with a history of venous thromboembolism.
• Black box warning: endometrial cancer, cardiovascular disease, breast cancer, and dementia.

This quiz covers the key aspects of osteoporosis, including its types, diagnosis, and treatment options. Learn about the role of bisphosphonates, calcium, and vitamin D in managing this condition. Understand the differences between primary and secondary osteoporosis along with important treatment guidelines.