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Questions and Answers
What characterizes primary osteoporosis?
What characterizes primary osteoporosis?
Which condition is NOT associated with producing osteoporosis?
Which condition is NOT associated with producing osteoporosis?
What role does vitamin D play in bone health?
What role does vitamin D play in bone health?
Which of the following is a preventive measure for osteoporosis?
Which of the following is a preventive measure for osteoporosis?
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What is the function of osteoblasts?
What is the function of osteoblasts?
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Which medication class is known to produce osteoporosis?
Which medication class is known to produce osteoporosis?
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What are low-impact fractures often associated with?
What are low-impact fractures often associated with?
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How does parathyroid hormone affect calcium levels in the blood?
How does parathyroid hormone affect calcium levels in the blood?
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Which of the following factors is believed to contribute to the development of Paget's disease of the bone?
Which of the following factors is believed to contribute to the development of Paget's disease of the bone?
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What is NOT a common symptom of Paget's disease of the bone?
What is NOT a common symptom of Paget's disease of the bone?
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Which class of drugs primarily inhibits bone resorption in the treatment of Paget’s disease?
Which class of drugs primarily inhibits bone resorption in the treatment of Paget’s disease?
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What is a recommended preventive measure for osteoporosis?
What is a recommended preventive measure for osteoporosis?
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What common side effect is associated with bisphosphonates?
What common side effect is associated with bisphosphonates?
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After taking bisphosphonates, how long should a patient remain upright?
After taking bisphosphonates, how long should a patient remain upright?
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Which of the following agents is more potent for treating Paget's disease?
Which of the following agents is more potent for treating Paget's disease?
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What dietary recommendations should be followed when taking bisphosphonates?
What dietary recommendations should be followed when taking bisphosphonates?
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What is a significant role of Selective Estrogen Receptor Modulators (SERMs) in osteoporosis management?
What is a significant role of Selective Estrogen Receptor Modulators (SERMs) in osteoporosis management?
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Which of the following correctly describes the mechanism of action of calcitonin?
Which of the following correctly describes the mechanism of action of calcitonin?
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What is an expected adverse reaction of Raloxifene?
What is an expected adverse reaction of Raloxifene?
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What class of drugs is Denosumab and its primary function?
What class of drugs is Denosumab and its primary function?
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Which of the following is a primary factor leading to an increase in osteoclast activity?
Which of the following is a primary factor leading to an increase in osteoclast activity?
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What is the main purpose of Hormone Replacement Therapy (HRT) in relation to bone health?
What is the main purpose of Hormone Replacement Therapy (HRT) in relation to bone health?
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What should be avoided immediately after taking certain osteoporosis medications?
What should be avoided immediately after taking certain osteoporosis medications?
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What effect does estrogen have on bone health?
What effect does estrogen have on bone health?
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Which of the following describes Paget's disease?
Which of the following describes Paget's disease?
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Which of the following statements accurately reflects the benefit of anabolic agents in osteoporosis treatment?
Which of the following statements accurately reflects the benefit of anabolic agents in osteoporosis treatment?
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Study Notes
Pharmacology for Pharmacy Technicians, 4th Edition
- Book authored by Kathy Moscou PhD RPh MPH and Karen Snipe CPhT AS BA MEd
- Copyright 2025, Elsevier Inc.
Chapter 14: Treatment of Osteoporosis and Paget's Disease of the Bone
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This chapter focuses on the treatment of osteoporosis and Paget's disease.
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Lesson 14.1 (part 1 of 2) covers terminology, signs/symptoms of osteoporosis and causes, signs/symptoms of Paget's, medications used in treatment.
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Lesson 14.1 (part 2 of 2) explains mechanism of action, drug look-alike and sound-alike issues, warning labels/precautionary messages.
Key Terms
- Bone mineral density: A test measuring bone loss.
- Bone resorption: The process of breaking down bone into minerals like calcium.
- Osteoblasts: Bone-forming cells responsible for mineralization of the collagen matrix.
- Osteoclasts: Cells that resorb bone.
- Osteoporosis: A chronic, progressive bone disease causing reduced bone density and strength, increasing fracture risk.
- Remodeling: The continuous process of bone formation and loss.
Osteoporosis (1 of 2)
- A chronic, progressive bone disease marked by loss of bone density and strength, increasing fracture risk.
Osteoporosis (2 of 2)
- Low-impact fractures: Result from falls or trauma.
- Fragility fractures: Occur without trauma, such as coughing or sneezing.
Pathophysiology of Osteoporosis (1 of 3)
- Primary osteoporosis: Related to aging. Before age 30/40, bone formation exceeds bone loss. After menopause, bone loss exceeds bone formation for women. By age 65/70, the rates of bone loss for both men and women are roughly similar.
Pathophysiology of Osteoporosis (2 of 3)
- Remodeling: The process of bone formation and loss.
- Osteoblasts: Responsible for bone formation, deposition, and mineralization of collagen matrix.
- Osteoclasts: Responsible for bone resorption.
- Osteolysis: Bone break down into minerals like calcium.
Pathophysiology of Osteoporosis (3 of 3)
- Calcium levels: Controlled by hormones.
- Parathyroid hormone: Secreted when calcium absorption is low; transfers calcium from bone to blood, increasing blood calcium levels.
- Calcitonin: Stores excess calcium in bone.
- Vitamin D: Enhances calcium absorption; involved in osteoclast formation.
Conditions That Produce Osteoporosis (1 of 2)
- A list of conditions that can lead to osteoporosis, including hyperthyroidism, hyperparathyroidism, rheumatoid arthritis, systemic lupus erythematosus, multiple myeloma, inflammatory bowel disease, renal insufficiency, Parkinson's disease, multiple sclerosis, COPD, and AIDS.
Conditions That Produce Osteoporosis (2 of 2)
- Prevention of osteoporosis: Mild weight-bearing exercise, a diet rich in calcium and vitamin D, and reduced smoking and alcohol consumption.
Drugs That Can Produce Osteoporosis
- A list of drugs that can contribute to osteoporosis, including antiadrogens, aromatase inhibitors, cyclosporine, depo-medroxprogesterone acetate, gonadotropin-releasing hormone agonists, glucocorticosteroids, lithium, methotrexate, anticonvulsants, and thiazolidinediones.
Poll Questions 1 and 2
Paget's Disease of the Bone
- Progressive bone disease.
- Irregular activity of osteoclasts and osteoblasts.
- Localized effects.
- Cause is unknown; genetics, viral infections, and environmental factors are possible contributors.
Pathophysiology of Paget's Disease of the Bone
- Excessive bone resorption followed by increased bone formation.
- Enlarged, structurally weak bones.
- Bowed legs.
- Constant or intermittent pain.
- Arthritis.
- Deafness.
- Cranial nerve palsies.
Drugs Used for the Treatment of Osteoporosis and Paget's Disease of the Bone
- Antiresorptive: Suppresses bone turnover and loss; inhibits bone resorption (e.g., bisphosphonates, calcitonin, estrogens).
- Anabolic: Promotes bone formation.
Antiresorptive Agents: Bisphosphonates
- Most bisphosphonates used.
- Not all are approved for both Paget's and osteoporosis.
- Nitrogen-containing bisphosphonates are more potent than non-nitrogen containing types.
Look-Alike/Sound-Alike Drugs
- Fosamax and Flomax.
- Aredia and Adriamycin.
- Actonel and Actos.
Bisphosphonates: MOA
- Inhibit osteoclast activity.
- Interfere with recruitment, differentiation, action of osteoclasts.
- Between 50-80% eliminated unchanged in urine within 24 hours.
- Remainder binds permanently to bone.
Bisphosphonates: Adverse Reactions
- Common side effects: painful swallowing, heartburn, diarrhea, nausea, and vomiting.
Bisphosphonates: Precautions
- Discontinue in patients with femoral shaft fractures.
- Patients should remain upright for 30-60 minutes after taking the medication.
- Take with water; avoid iron, calcium supplements, and antacids within 2 hours of bisphosphonates.
- Zoledronic acid (Reclast) may increase risk for renal failure in patients with renal impairment.
Poll Question 3
Antiresorptive Agents: Selective Estrogen Receptor Modulators (SERMS)
- Treatment and prevention of osteoporosis in postmenopausal women.
- Reduces the incidence of vertebral fractures.
- Raloxifene.
Selective Estrogen Receptor Modulators: MOA
- Bind to estrogen receptors.
- Agonist effect in bone and lipid metabolism.
- Antagonist effect in breast and uterus.
Selective Estrogen Receptor Modulators: Adverse Reactions
- Raloxifene: increased risk for venous thromboembolism and increased risk for death from stroke.
Antiresorptive Agents: Calcitonin
- Hormone secreted by the thyroid gland.
- Used in treatment of Paget's disease of the bone.
- Increases bone mineral density (BMD).
Calcitonin: MOA
- Inhibits rate of bone turnover stimulated by release of parathyroid hormone.
- Lowers serum calcium levels: Decreases intestinal absorption of calcium; increases renal elimination of calcium.
Look-Alike/Sound-Alike Drugs
- Calcitonin and Calcitriol.
- Alora and Aldara.
- Estraderm and Testoderm.
- Estratab and Estratest.
Hormone Replacement Therapy (1 of 4)
- Estrogen deficiency: Occurs with onset of menopause; increases osteoclast activity.
- Estrogens: Decrease bone turnover, bone loss, and fractures, indicated for osteoporosis prevention rather than treatment.
Hormone Replacement Therapy (2 of 4)
- Restores estrogen levels.
- Inhibits effects of estrogen deficiency on cytokines that regulate osteoclast formation.
- Beneficial effects on BMD (higher doses = increased BMD).
- Reduces risk for vertebral and hip fractures.
Hormone Replacement Therapy (3 of 4)
- Anabolic agents: Parathyroid hormone analogues.
- Increase rate of bone remodeling; thicken structural units of bone (osteons); produce bone architecture that closely resembles normal bone; decrease osteoblast cell death.
Hormone Replacement Therapy (4 of 4)
- Black box warning: Teriparatide: benefit must outweigh risk; use is limited.
Receptor Activator of Nuclear Factor Kappa-Beta Ligand Inhibitors (1 of 2)
- Denosumab: Monoclonal antibody; reverses bone remodeling to bone formation.
Receptor Activator of Nuclear Factor Kappa-Beta Ligand Inhibitors (2 of 2)
- Denosumab: Binds to RANKL; inhibits osteoclast activation; decreases bone resorption; reverses bone remodeling from destruction to bone formation.
Warning Labels
- Stand/sit upright for at least 30 minutes after dosing; do not lie down.
- Take 1 hour before the first meal of the day.
- Take on an empty stomach.
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Description
Explore Chapter 14 of 'Pharmacology for Pharmacy Technicians' which focuses on the treatment of osteoporosis and Paget's disease. This chapter delves into the terminology, symptoms, causes, and medications used in the management of these conditions. Additionally, it discusses the mechanisms of action and important precautions related to treatments.
