Osteoporosis Medications PDF

ARMY MEDICINE One Team…One Purpose! Conserving the Fighting Strength Since 1775 Osteoporosis Medications Revised: 23 May 23  Enabling Learning Objectives...

ARMY MEDICINE One Team…One Purpose! Conserving the Fighting Strength Since 1775 Osteoporosis Medications Revised: 23 May 23  Enabling Learning Objectives Identify the properties and uses of medications for osteoporosis. Select an appropriate medication for osteoporosis based on patient presentation and comorbidities. Identify the daily calcium and vitamin D recommendation based on patient presentation and comorbidities. Describe the following for osteoporosis medications: – Mechanism of action/category – Clinical use/indications – Common/significant adverse reactions – Contraindications – Common/significant interactions – Routes of administration – Patient counseling information UNCLASSIFIED//FOUO Slide 2  Osteoporosis: Occurs when the creation of new bone does not keep up with the loss of old bone Osteoblast: cell that makes bone Osteoclast: large multinucleate cells that breaks down bone and is responsible for bone resorption – Resorption: the destruction, disappearance, or dissolution of a tissue or part by biochemical activity, as the loss of bone Parathyroid Hormone (PTH): – Parathyroid gland located in the neck, near or attached to the back side of the thyroid gland – Controls calcium, phosphorus, an d vitamin D levels in the blood an d bone – Release of PTH is controlled by the level of calcium in the blood Low blood calcium levels cause increased PTH to be released UNCLASSIFIED//FOUO Slide 3  DEXA scan T-score definition (WHO): UNCLASSIFIED//FOUO Slide 4  Osteoporosis Estrogens Denosumab UNCLASSIFIED//FOUO Slide 5  Osteoporosis Lifetime risk: W - 50%, M - 30% In U.S., ~10M people >50yo that have osteoporosis and ~34M have osteopenia Common in postmenopausal Asian and Caucasian women Risks: – Low estrogen (both men and women) – Increased age (reduction in Ca2+ absorption) – Ca2+ deficiency – Vitamin D deficiency – Increased PTH secretion (adenoma or Vitamin D deficiency) UNCLASSIFIED//FOUO Slide 6  Osteoporosis Treatment Options Lifestyle Modifications SERMs: act as estrogen agonists Calcium/Vitamin D in some tissues such as bone, and as estrogen antagonists in Hormone Therapy other tissues such as breast, – Selective Estrogen Receptor through specific, high-affinity Modulators (SERMs) binding to the estrogen receptor Raloxifene (Evista) Conjugated estrogens/ Parathyroid Hormone bazedoxifene (Duavee) – Teriparatide (Forteo) Bisphosphonates: – Alendronate (Fosamax) Binosto: Alendronate Calcitonin-Salmon Nasal Effervescent tablet Spray/Injection – Risedronate (Actonel) – Ibandronate (Boniva) Denosumab (Prolia) – Zoledronic Acid IV (Reclast) – Full human monoclonal antibody UNCLASSIFIED//FOUO Slide 7  Lifestyle Changes Encourage adolescents and young women to build bone early in life Consume recommended dietary calcium & vitamin D (from food and/or supplements) Ca2+ ~1000 mg – for adults Ca2+ ~1200 mg - for females 51 years and older and males 71 years and older – Bone Health & Osteoporosis Foundation recommends: Vitamin D 400 - 800 IU daily for adults