Osteoporosis Treatment and Risk Factors

Bone Resorption and Osteoporosis

• Bone resorption outpaces bone deposition, increasing the risk of osteoporosis.
• Risk factors: menopause, high ethanol intake, anorexia, tobacco, inactivity, low vitamin D or calcium in diet, and long-term use of proton pump inhibitors (PPIs).
• Identification of best course of treatment: bone density scan (DEXA).

Bisphosphonates

• Most common treatment for osteoporosis.
• Block bone resorption by inhibiting osteoclast activity to increase bone density.
• Prototype: Alendronate (Fosamax).
• Administration: take on an empty stomach with a full glass of plain water, at least 30 minutes before first food or beverage of the day.
• Adverse effects: dysphagia, esophageal irritation, and interference with antacids.

Selective Estrogen Receptor Modulators (SERMs)

• Used for postmenopausal osteoporosis.
• Prototype: Raloxifene (Evista).
• Contraindications: patients with a history of venous thromboembolism.
• Adverse effects: menopausal symptoms like hot flashes and night sweats.

Other Treatments

• Calcitonin: decreases bone resorption by inhibiting osteoclast activity.
• Oral calcium modifiers: miscellaneous treatment for osteoporosis.
• Monoclonal antibody denosumab (Prolia): miscellaneous treatment for osteoporosis.
• Human PTH teriparatide: miscellaneous treatment for osteoporosis.

Rickets and Osteomalacia

• Softening of bones due to demineralization.
• Most common cause: deficiency of vitamin D and calcium in diet.
• Most prevalent in older adults, premature infants, and strict vegans or vegetarians.
• If it occurs in children, it is called rickets.

Osteoarthritis

• Chronic condition characterized by accelerated remodeling of the skeleton.
• Process of bone resorption and deposition occur simultaneously at a high rate.
• Signs and symptoms: localized pain and stiffness, joint and bone enlargement, and reduced range of motion.
• Treatment: Acetaminophen, NSAIDs, topical medications (Capsaicin cream), and Sodium Hyaluronate (Hyalgan) injections into joints.

Rheumatoid Arthritis

• Systemic autoimmune disorder; autoantibodies activate an inflammatory response.
• Treatment: NSAIDs, corticosteroids, Tumor Necrosis Factor Blocker (TNF Blocker), and Disease Modifying Antirheumatic Drugs (DMARDs).
• Adverse effects: increased risk of infections, liver problems, stomach pain, hair loss, and ocular toxicity.

Gout

• Form of acute arthritis caused by a buildup of uric acid crystals in joints and tissues.
• Treatment: NSAIDs, corticosteroids, and prophylactic therapy (Uricosurics and Xanthine Oxidase Inhibitors).
• Prophylactic therapy: increase excretion of uric acid or inhibit formation of uric acid.
• Prototype: Allopurinol.