Chapter 14 - Osteoporosis and Paget’s Disease of the Bone PDF

Pharmacology for Pharmacy Technicians, 4th Ed by Kathy Moscou PhD RPh MPH and Karen Snipe CPhT AS BA MEd 1  Chapter 14 Treatment of Osteoporosis and Paget’s Disease of the Bone...

Pharmacology for Pharmacy Technicians, 4th Ed by Kathy Moscou PhD RPh MPH and Karen Snipe CPhT AS BA MEd 1  Chapter 14 Treatment of Osteoporosis and Paget’s Disease of the Bone 2  Lesson 14.1 Osteoporosis and Paget’s Disease of the Bone (1 of 2) 1. Learn the terminology associated with osteoporosis and Paget’s disease of the bone. 2. Describe the signs and symptoms of osteoporosis. 3. List causes of osteoporosis. 4. Describe the signs and symptoms of Paget’s disease of the bone. 5. List and classify medications used in the treatment of osteoporosis and Paget’s disease of the bone. 3  Lesson 14.1 Osteoporosis and Paget’s Disease of the Bone (2 of 2) 6. Describe the mechanism of action for each class of drug used in the treatment of osteoporosis and Paget’s disease of the bone. 7. Identify significant drug look-alike and sound-alike issues. 8. Identify warning labels and precautionary messages associated with medications used to treat osteoporosis and Paget’s disease of the bone. 4  Key Terms ⬤ Bone mineral density: Test measurement that is taken to determine the degree of bone loss. ⬤ Bone resorption: Process during which bone is broken down into mineral ions (e.g., calcium). ⬤ Osteoblasts: Cells responsible for bone formation, deposit, and mineralization of the collagen matrix of bone. ⬤ Osteoclasts: Cells responsible for bone resorption. ⬤ Osteoporosis: Chronic, progressive disease of bone characterized by loss of bone density and bone strength and resulting in increased risk for fractures. ⬤ Remodeling: Process of continual turnover of bone. 5  Osteoporosis (1 of 2) ⬤ Chronic, progressive disease of bone ⬤ Loss of bone density and bone strength ⬤ Increased risk for fractures 6  Osteoporosis (2 of 2) ⬤ Low-impact fractures: Result of falls or trauma ⬤ Fragility fractures: May occur in the absence of trauma Coughing or sneezing 7  Pathophysiology of Osteoporosis (1 of 3) ⬤ Primary osteoporosis: Associated with the aging process Age 65 or 70 years, rates of bone loss for men and women about equal 8  Pathophysiology of Osteoporosis (2 of 3) ⬤ Remodeling: process of bone formation and loss ⬤ Osteoblasts: responsible for bone formation, deposition, and mineralization of collagen matrix of bone ⬤ Osteoclasts: responsible for bone resorption ⬤ Osteolysis: bone is broken down into mineral ions (calcium) 9  Pathophysiology of Osteoporosis (3 of 3) ⬤ Calcium levels controlled by hormones ⬤ Parathyroid hormone: Secreted when absorption of calcium is low Transfers calcium from bone to blood Increases levels of calcium in blood ⬤ Calcitonin: Stores excess calcium in bone ⬤ Vitamin D: Enhances calcium absorption Involved in formation of osteoclasts 10  Conditions That Produce Osteoporosis (1 of 2) ⬤ Hyperthyroidism ⬤ Hyperparathyroidism ⬤ Rheumatoid arthritis ⬤ Systemic lupus erythematosus ⬤ Multiple myeloma ⬤ Inflammatory bowel disease ⬤ Renal insufficiency ⬤ Parkinson disease ⬤ Multiple sclerosis ⬤ COPD ⬤ AIDS 11 Conditions That Produce Osteoporosis (2 of 2) ⬤ Prevention of osteoporosis: Mild weight-bearing exercise Diet rich in vitamin D and calcium Reduced smoking and alcohol consumption 12  Drugs That Can Produce Osteoporosis ⬤ Antiadrogens ⬤ Aromatase inhibitors ⬤ Cyclosporine ⬤ Depo-medroxprogesterone acetate ⬤ Gonadotroin-releasing hormone agonists ⬤ Glcocorticosteroids ⬤ Lithium ⬤ Methotrexate ⬤ Anticonvulsants ⬤ Thiazolidinediones 13 ⬤ Poll questions 1 and 2 Copyright © 2019 by Elsevier, Inc. All rights reserved. 14  Paget’s Disease of the Bone ⬤ Progressive disease of bone ⬤ Irregular activity of osteoclasts and osteoblasts ⬤ Localized effects ⬤ Cause of Paget’s disease of the bone is unknown ⬤ Genetics, viral infection, and environmental factors are believed to be involved 15  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 16 Drugs Used for the Treatment of Osteoporosis and Paget’s Disease of the Bone ⬤ Antiresorptive: Suppress bone turnover and loss Inhibit bone resorption Bisphosphonates Calcitonin Estrogens ⬤ Anabolic: Promote bone formation 17  Antiresorptive Agents: Bisphosphonates ⬤ Most bisphosphonates used ⬤ Not all approved for both Paget’s disease of the bone and osteoporosis ⬤ Nitrogen-containing bisphosphonates (more potent) ⬤ Non–nitrogen-containing bisphosphonates 18  Look-Alike/Sound-Alike Drugs ⬤ Fosamax and Flomax ⬤ Aredia and Adriamycin ⬤ Actonel and Actos 19  Bisphosphonates: MOA ⬤ Inhibit osteoclast activity ⬤ Interfere with recruitment, differentiation, and action of osteoclasts ⬤ Between 50% and 80% eliminated unchanged in urine within 24 hours ⬤ Remainder binds permanently to bone 20  Bisphosphonates: Adverse Reactions ⬤ Common side effects: Painful swallowing Heartburn Diarrhea Nausea Vomiting 21  Bisphosphonates: Precautions ⬤ Discontinue in patients with femoral shaft fracture ⬤ Patients should remain upright for 30 to 60 minutes after taking medicine ⬤ Medicine should be taken with water ⬤ Calcium and vitamin D supplements recommended ⬤ No iron, calcium supplements, and antacids within 2 hours of bisphosphonate ⬤ Zoledronic acid (Reclast) may increase risk for renal failure in patients with renal impairment 22 Poll Question 3 Copyright © 2019 by Elsevier, Inc. All rights reserved. 23 Antiresorptive Agents: Selective Estrogen Receptor Modulators (SERMS) ⬤ Treatment and prevention of osteoporosis in postmenopausal women ⬤ Reduces incidence of vertebral fractures Raloxifene 24 Selective Estrogen Receptor Modulators: MOA ⬤ Bind to estrogen receptors ⬤ Agonist effect in bone and lipid metabolism ⬤ Antagonist effect in breast and uterus 25  Selective Estrogen Receptor Modulators: Adverse Reactions ⬤ Raloxifene ⬤ Increased risk for venous thromboembolism ⬤ Increased risk for death from stroke 26  Antiresorptive Agents: Calcitonin ⬤ Hormone secreted by the thyroid gland ⬤ Used in treatment of Paget’s disease of the bone ⬤ Increases bone mineral density (BMD) 27  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 28  Look-Alike/Sound-Alike Drugs ⬤ Calcitonin and Calcitriol ⬤ Alora and Aldara ⬤ Estraderm and Testoderm ⬤ Estratab and Estratest 29  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 prevention rather than treatment 30  Hormone Replacement Therapy (2 of 4) ⬤ Restores estrogen levels ⬤ Inhibits the effects of estrogen deficiency on cytokines that regulate the formation of osteoclasts ⬤ Beneficial effects on BMD (higher doses = increased BMD) ⬤ Reduces risk for vertebral and hip fractures 31  Hormone Replacement Therapy (3 of 4) ⬤ Anabolic agents: Parathyroid hormone analogues Increase the rate of bone remodeling Thicken structural units of bone (osteons) Produce bone architecture that closely resembles normal bone Decrease osteoblast cell death 32  Hormone Replacement Therapy (4 of 4) ⬤ Black box warning: Teriparatide Limited in use Benefit must outweigh risk 33 Receptor Activator of Nuclear Factor Kappa-Beta Ligand Inhibitors (1 of 2) ⬤ Denosumab ⬤ Monoclonal antibody ⬤ Reverses bone remodeling to formation 34 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 35  Warning Labels ⬤ Stand or sit upright for at least 30 minutes after taking dose; do not lie down ⬤ Take 1 hour before first meal of the day ⬤ Take on an empty stomach 36 Questions? 37