recommended risk stratification strategy for osteoporosis therapy Low/Moderate-risk patients Oral bisphosphonates (alendronate, risedronate, ibandronate) Zoledronic acid Denosumab High-risk patients aa High-risk patients: old age, prior fracture, very low BMD (T-score <–3), high fall risk, GC use. Zoledronic acid Denosumab Teriparatide Abaloparatide
Summarize the benefits and risks of pharmacologic osteoporosis medications Benefits Fracture reduction (significant for all FDA-approved agents). Risks Common side effects: Upper GI symptoms: oral bisphosphonates Acute-phase reactions: IV bisphosphonates (first dose) Transient decrease in serum calcium: zoledronic acid, denosumab Transient increase in serum and urine calcium: teriparatide, abaloparatide Uncommon/Rare side effects: ONJ: antiresorptive agents …
How effective are the currently available anabolic bone agents? Teriparatide (Forteo) is a 34 amino acid fragment of intact PTH that retains the ability to bind to and activate PTH receptors on osteoblasts and osteoblast precursors. It is self-administered daily at a 20 mcg/day dose SC for 18 to 24 months. In trials, teriparatide increased lumbar …
role of testosterone for the treatment of osteoporosis? Men with osteoporosis and symptoms of hypogonadism may benefit from testosterone replacement therapy (TRT), especially if the serum testosterone level is <150 ng/dL. TRT increases bone mass in men with baseline low testosterone levels, but there has been no fracture reduction data reported; therefore, it is not …
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What precautions should be considered prior to prescribing teriparatide or abaloparatide? • Teriparatide and abaloparatide are contraindicated in patients at increased risk for osteosarcomas: Paget’s disease, unexplained alkaline phosphatase elevation, children and young adults with open epiphyses, prior external beam or implant radiation therapy involving the skeleton. • In patients without contraindications, teriparatide does not cause an …
How can parathyroid hormone (PTH) and parathyroid hormone-related peptide (PTHrP) be anabolic agents for treating osteoporosis? Persistently elevated serum PTH levels (hyperparathyroidism) or PTHrP levels promote osteoclastic bone resorption, hypercalcemia, and bone loss. In contrast, intermittent daily pulses of exogenous PTH or PTHrP actually stimulate osteoblast differentiation, proliferation, and survival, resulting in osteoid formation and …
Use of selective estrogen receptor modulators in osteoporosis SERMS are agents that function as estrogen agonists in some tissues (bone) and estrogen antagonists in other tissues (breast). Raloxifene (Evista) is a SERM that has been shown to improve bone mass and to reduce spine (not hip) fractures; it is FDA-approved for the treatment of postmenopausal osteoporosis. Raloxifene …
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