PHAR3913 - Osteoporosis

What is Osteoporosis?

disease of the bones characterised by fragility, weakness, and susceptibility to breakage

what are the consequences of osteoporosis?

easily broken bones, morbidity, loss of independence, fear of falling, isolation, financial

what is the role of the pharmacist in osteoporosis management?

fracture risk assessment

access to medication

information/ education

OTC/supplement advice

polypharmacy

medicine lists

what are the risk factors for osteoporosis?

age, female, MTF, family Hx, fall Hx, low weight, height loss, smoking, alcohol, deficiencies

what are drugs that can affect bone homeostasis?

glucocorticoids

medication for prostatic/ breast cancer

HRT

heparin

SSRI

what is a FRAX score?

fracture assessment tool

T-score, age, gender, history, lifestyle etc

what is the process of bone turnover?

resting -> damage/injury/ natural process ->activation -> resorption -> reversal (new bone) -> formation

what is the MOA of bisphosphonates?

antiresorptive

bind to site on bony surface undergoing resorption -> inhibit osteoclastic resorption

what are the pros and cons of bisphosphonates?

pros: oral, safe, effective, after Prolia

cons: GI SE, less convenient, interactions

what is the MOA of denosumab?

inhibit RANKL -> prevent bone resorption

what are the pros and cons of denosumab?

pros: 6m inj, tolerated, not renally cleared

cons: life-long, hypocalcemia, cost, fridge

what are TWO skeletal adverse effects of osteoporosis Tx?

osteonecrosis of the jaw (bisphosphonates and denosumab)

atypical fractures

what is the MOA of teriparatide?

anabolic agent -synthetic parathyroid hormone -> increases osteoblast survival number -> increases bone growth

what is the use of exogenous estrogenic agents in osteoporosis?

estrogen and tibolone in post-menopausal women >60

raloxifene in young post-menopausal women if breast cancer risk

what are key barriers to osteoporosis Tx?

low priority disease

financial

communication

fragmented care

what is the benefit of calcium in osteoporosis Tx?

prevent side effects of OP medication

limited efficacy in healthy individuals

what is the benefit of vit D in osteoporosis Tx?

improves calcium absorption

what criteria is necessary before starting osteoporosis Tx?

vit D + Ca levels are normal