-
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
-
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
-
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
-
calcitonin
- not a potent antiresorptive
- some effect on acute pain control with vertebral fractures
- may be used in Paget's dz of the bone
-
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
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