Osteoporosis Medications

Cards (17)

  • Calcium Medication info
    Calcium carbonate and calcium citrate
    • MOA: improves and/or sustains BMD
    • 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 suppressed PTH secretion/synthesis
    • AE: hypercalcemia, hypercalciuria, constipation
    • CI: space cholestyramine by 2 hours, phenytoin and barbiturates can lead to vit. D deficiency
    • Clinical use: osteoporosis, hyperparathyroidism, hypocalcemia, psoriasis, rickets
  • Monitoring for vit. D meds
    25-hydroxyvitamin D [25(OH)D] serum concentrations
  • Cholecaliferol (D3) is synthesized by the body via UV and obtained via diet
  • Ergocalciferol (D2) does NOT naturally occur in humans
  • Bisphosphonates drug names
    Ibandronate (Boniva), Risedronate (Actonel), Alendronate (Fosamax), and Zoledronic acid
  • Bisphosphonates brand names
    Ibandronate (Boniva), Risedronate (Actonel), Alendronate (Fosamax)
  • Bisphosphonate med info
    4 of them
    • MOA: inhibit osteoclast-mediated bone resorption
    • AE: esophageal erosion, GI distress, diarrhea, bone pain, myalgias, atypical femur fx (esp. if >5 years), jaw osteonecrosis
    • CI: uncorrected hypocalcemia, hypersensitivity, pt w/ esophageal abnormalities or can't sit upright for 60 mins after taking (oral form)
    • BBW: 1st gen not used d/t osteomalacia
    • Clinical use: osteoporosis, Paget's disease, hypercalcemia
  • What bisphosphonates are 2nd gen
    Alendronate (Fosamax) and Risedronate (Actonel)
  • What bisphosphonates are 3rd gen
    Ibandronate (Boniva) and Zoledronic acid
  • Calcitonin med info
    • MOA: binds to receptor on osteoclast to inhibit activity, also lowers serum Ca concentrations by inhibiting bone resorption
    • AE: injection site rxn, rhinitis, nasal congestion, mucosal irritation, GI sx, flushing
    • CI: hypersensitivity to fish (b/c comes from salmon)
    • Pt. C: IM, nasal spray, subcutaneous
    • Clinical use: postmenopausal (>5 years) osteoporosis, Paget's disease, hypercalcemia
  • Denosumab med info

    • MOA: human immunoglobulin G2 monoclonal antibody, binds and inactivates transmembrane protein (RANKL) that's required for formation/function of osteoclasts and their rols in bone resorption
    • AE: back/extremity/MSK pain, jaw osteonecrosis, hypercholesterolemia, cystitis, skin rxn (cellulitis, eczema, dermatitis)
    • CI: hypocalcemia, pregnancy
    • 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 vulvovaginal atrophy 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)
    • AE: common = arthralgia, headache; serious = MI, hypocalcemia, hypersensitivity rxn, femur shaft fracture, jaw osteonecrosis, CVA
    • CI: hypocalcemia, hx of hypersensitivity, MI/stroke in previous 12 months, pregnancy/breastfeeding, renal impairment, anemia
    • BBW: potential risk of MI, stroke and CV death so don't initiate if had one in previous year