AE: constipation, GI discomfort, watch for hypercalcemia
CI: increase in risk of MI when used w/o vit. D supplement, decreases absorption of some meds (cipro, fluoride, phenytoin, levothyroxine, tetracycline)
Monitoring for calcium meds
Serum calcium levels
Corrected calcium: 0.8 * (norm. albumin - pt albumin) + serum Ca
Vitamin D meds
Cholecalciferol (D3) and Ergocalciferol (D2)
MOA: stimulates Ca transport in intestines, its resorption in bone, and tubular reabsorption in kidney; also suppressedPTH secretion/synthesis
AE: hypercalcemia, hypercalciuria, constipation
CI: space cholestyramine by 2 hours, phenytoin and barbiturates can lead to vit. D deficiency
MOA: human immunoglobulinG2 monoclonal antibody, binds and inactivates transmembrane protein (RANKL) that's required for formation/function of osteoclasts and their rols in bone resorption
Pt. C: subcutaneous once every 6 months, pt should be getting Ca2+ and vit. D
Clinical use: osteoporosis, hypercalcemia, bone metastases, giant cell tumor of bone
Estrogen med info
MOA: reduces bone resorption by inhibiting production of bone cell cytokines, leads to reduced formation/activation of osteoclasts
CI: not 1st line, when stopped bone loss can be rapid so consider alternative agents
BBW: increased risk of MI, stroke, PE, DVT, and breast CA so use LOWEST effective dose
Clinical use: relief of vasomotor sx and vulvovaginalatrophy in menopause, and prevention of osteoporosis
Estrogen agonist/Antagonist info
Raloxifene
MOA: selective estrogen receptor modulator that activates estrogenic pathways in some tissues (agonism) and blockade of pathways in others (antagonism); also mimics effects of estrogen on bone (reduce bone resorption and increase BMD)
AE: arthralgias, hot flashes, peripheral edema, swelling, increased risk of PE/SVT and death d/t stroke in postmenopausal women w/ documented CHD or risk of major coronary events
CI: hx of active venous thromboembolic events, pregnant, or nursing
Use: postmenopausal osteoporosis, breast CA
Teriparatide
MOA: recombinant form of PTH, stimulate osteoblast mediated bone formation, short term use stimulate osteoblasts more than osteoclasts; long term use can stimulate resorption more than formation
AE: flu like sx, hypercalcemia, injection site pain and/or rash
CI: do not use more than 2 years
BBW: avoid in pt w/ increased risk of osteosarcoma (unexplained alkaline phosphate elevation, paget disease, open epiphyses, prior radiation)
Pt. C: once daily, subcutaneous
Use: not as effective if used w/ bisphosphonates, effects disappear upon, follow d/c of this w/ antiresorptive
Sclerostin inhibitor
Romosozumab
MOA: parenteral humanized IgG3 monoclonal antibody, inhibit action of sclerostin (regulatory factor in bone metabolism) which leads to increased bone formation and decreased bone resorption (lesser extent)