Podcast
Questions and Answers
What is the primary mechanism of action of romosozumab?
What is the primary mechanism of action of romosozumab?
- Increasing bone resorption rate
- Reducing inhibition of the Wnt pathway (correct)
- Targeting RANKL to reduce osteoclastogenesis
- Inhibiting osteoclast activity
Which of the following therapies is recommended after a one-year course of teriparatide?
Which of the following therapies is recommended after a one-year course of teriparatide?
- Switch to calcium and vitamin D supplementation
- Use another anabolic agent without interruption
- Continue teriparatide indefinitely
- Start an anti-resorptive therapy (correct)
What is the primary risk associated with the use of romosozumab?
What is the primary risk associated with the use of romosozumab?
- Development of atypical femoral fractures
- Chronic kidney disease development
- Increased risk of myocardial infarction and stroke (correct)
- Overactive osteoblast function leading to fractures
Which cell type is primarily inhibited by bisphosphonates, such as alendronate?
Which cell type is primarily inhibited by bisphosphonates, such as alendronate?
For which situation is teriparatide primarily recommended?
For which situation is teriparatide primarily recommended?
Which of the following therapies is classified as anti-resorptive?
Which of the following therapies is classified as anti-resorptive?
What is the role of calcium and vitamin D in osteoporosis management?
What is the role of calcium and vitamin D in osteoporosis management?
When should a drug holiday be considered for bisphosphonate therapy?
When should a drug holiday be considered for bisphosphonate therapy?
What is the primary mechanism of action of teriparatide?
What is the primary mechanism of action of teriparatide?
How do anti-resorptive drugs stabilize bone mass?
How do anti-resorptive drugs stabilize bone mass?
Which anabolic therapy requires monthly subcutaneous injections?
Which anabolic therapy requires monthly subcutaneous injections?
Which statement about teriparatide and osteosarcoma is accurate?
Which statement about teriparatide and osteosarcoma is accurate?
What should be done with a patient after two years on teriparatide who has gained BMD?
What should be done with a patient after two years on teriparatide who has gained BMD?
What condition is teriparatide primarily recommended for?
What condition is teriparatide primarily recommended for?
Which of the following is a consequence of sustained PTH signaling?
Which of the following is a consequence of sustained PTH signaling?
Which therapy is the preferred option when bisphosphonates have failed?
Which therapy is the preferred option when bisphosphonates have failed?
What is the major function of osteoblasts in bone formation?
What is the major function of osteoblasts in bone formation?
Which of the following correctly describes the activity of osteoclasts?
Which of the following correctly describes the activity of osteoclasts?
According to the National Osteoporosis Foundation guidelines, who is recommended to receive pharmacotherapy for osteoporosis?
According to the National Osteoporosis Foundation guidelines, who is recommended to receive pharmacotherapy for osteoporosis?
Which of the following medications is classified as an anabolic therapy for osteoporosis?
Which of the following medications is classified as an anabolic therapy for osteoporosis?
What is a major characteristic of anti-resorptive medications in osteoporosis treatment?
What is a major characteristic of anti-resorptive medications in osteoporosis treatment?
In assessing the case of a 54-year-old female with a femoral neck T-score of -1.1, how is her bone density categorized?
In assessing the case of a 54-year-old female with a femoral neck T-score of -1.1, how is her bone density categorized?
Which medication targets an osteocyte-derived protein in the treatment of osteoporosis?
Which medication targets an osteocyte-derived protein in the treatment of osteoporosis?
What is the primary concern for individuals with a T-score between -1 and -2.5 and a 10-year probability of a hip fracture of ≥3%?
What is the primary concern for individuals with a T-score between -1 and -2.5 and a 10-year probability of a hip fracture of ≥3%?
Study Notes
Bone Resorption and Therapy
- After withdrawing teriparatide, "rebound" bone resorption may occur.
- Switching to an antiresorptive therapy like alendronate or denosumab is generally recommended.
Case #4: Osteoporosis
- 88-year-old African American female
- Height: 168 cm (about 5'6"), Weight: 53 kg (about 115 lbs)
- Previous fracture: yes, Parental hip fracture: yes, Current smoker: no, Glucocorticoid use: no, Rheumatoid Arthritis: no, Second Opinion: no, Excess alcohol: no.
- Femoral neck T-score: -4.0
- This indicates osteoporosis, and pharmacotherapy may be justified.
Romosozumab
- Monoclonal antibody that targets Sclerostin, reducing Wnt pathway inhibition.
- Primarily increases bone formation and has some effect on decreasing bone resorption.
- Contraindicated in patients with a history of myocardial infarction within the preceding year.
- Costly and cannot be used for longer than 1 year.
- Should be followed by an anti-resorptive therapy after discontinuation.
Major Osteoporosis Therapies Summary
- National Osteoporosis Foundation (NOF) provides guidelines for initiating pharmacotherapy.
- Calcium and Vitamin D supplementation is recommended for patients with insufficient dietary intake.
- American Association of Clinical Endocrinologists (AACE) recommends bisphosphonates (like alendronate) and denosumab as first-line therapies, reserving teriparatide for patients with very low BMD or those unresponsive to bisphosphonates.
- Bisphosphonates (e.g., alendronate) and denosumab are anti-resorptive therapies.
- Bisphosphonates selectively incorporate into bone matrix, inhibiting osteoclast activity.
- Denosumab is a neutralizing antibody targeting RANKL, reducing osteoclastogenesis.
- Bisphosphonate therapy requires a drug holiday due to the risk of atypical femoral fractures and osteonecrosis of the jaw (ONJ). Denosumab does not have a similar recommendation.
- Teriparatide, abaloparatide, and romosozumab increase bone formation by activating osteoblasts. Romosozumab also inhibits osteoclasts.
Anabolic Therapies
- Teriparatide, abaloparatide, and romosozumab are FDA-approved anabolic therapies in the U.S.A.
- Teriparatide and abaloparatide are administered daily via subcutaneous injection (SQ).
- Romosozumab is delivered via monthly SQ injection.
- AACE recommends teriparatide for patients with very low BMD (or high fracture risk) or when bisphosphonates have failed.
- Further advice on abaloparatide and romosozumab is expected in the future.
Teriparatide
- Active form of Parathyroid Hormone (PTH).
- Sustained PTH signaling leads to bone loss (e.g., primary hyperparathyroidism) by promoting osteoclastogenesis.
- Intermittent PTH (iPTH) signaling preferentially activates osteoblasts to increase bone formation.
Case #3: Osteopenia
- 54-year-old Asian female
- Height: 165 cm (about 5'5"), Weight: 59 kg (about 130 lbs)
- Previous fracture: yes, Parental hip fracture: yes, Current smoker: no, Glucocorticoid use: yes, Rheumatoid Arthritis: yes, Second Opinion: no, Excess alcohol: no.
- Femoral neck T-score: -1.1
- This indicates osteopenia.
- Pharmacotherapy may be justified depending on the patient's individual risk factors.
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Description
This quiz covers key information about osteoporosis, including case studies and treatment strategies like teriparatide, alendronate, and romosozumab. Assess your understanding of bone resorption, therapy recommendations, and patient management approaches for osteoporosis. Gain insights into the implications of treatment choices based on patient history and condition.
