Osteoporosis medications

  1. raloxifene
    • SERM
    • less potent than bisphosphonates and denosumab
    • estrogen agonist in bone - inhibits osteoclasts; improves BMD, dec. fracture risk
    • estrogen antagonist in breast tissue - reduce risk of breast cancer
    • neutral effect on CV system and endometrium
    • adverse effects: DVT, hot flashes
  2. alendronate, risedronate, ibandronate, zoledronic acid
    • bisphosphonate
    • impair osteoclast fn, dec differentiation and inc apoptosis = inc BMD, dec fracture risk
    • adverse effects: esophagitis with orals, flu-like sx with IV, bone and m pain (rare), hypocalcemia, long term use assoc with atypical subtrochanteric fractures and ONJ
    • drug holidays every 4-5 years
    • contraindicated in creatinine clearance <30
  3. denosumab
    • anti RANKL monoclonal antibody¬†
    • inc BMD and dec fractures
    • SC injection every 6 mo
    • adverse effects: hypocalcemia, infections?, concern with neoplasm?, concern with subtrochanteric fracture and ONJ
  4. calcitonin
    • not a potent antiresorptive
    • some effect on acute pain control with vertebral fractures
    • may be used in Paget's dz of the bone
  5. teriparatide
    • anabolic agent: human recombinant PTH
    • induces differentiation and maturation of osteoblast precursors, inc preexisting osteoblast fn, reduces osteoblast apoptosis
    • increase BMD and dec fractures
    • $$$ + daily injection SC
    • for most severe cases or antiresorptive failure
    • adverse effects: inc uric acid (gout attack), hypercalcemia, osteosarcoma
Card Set
Osteoporosis medications
MOHD keystone lecture 2