So now we move in and talking about drug therapy for osteoporosis we’ll talk first about the bisphosphonates the bisphosphonates are medications such as alendronate resonate ab and renee and zoledronic acid these are medications they’re considered i like to think of these as the workhorses of treatment for osteoporosis they have the best clinical data and also
They’ve been they’ve in general showing the greatest impact on fracture incidents in our patients with osteoporosis actually let’s talk a little bit about bisphosphonates further so these medications have variable dosing alendronate procedure nate can be taken daily they also can be taken weekly zoledronic acid is given as a periodic infusion so this is a what’s
Once monthly infusion and i badger nate is taken once a month so these medications have very long half-lives and that’s the reason that their can be administered so far apart we know once a week or even once a month these other medications are calcitonin or mya calcine nasal spray estrogen a conjugated estrogen combination with bazin dr. thayne which is a selective
Estrogen receptor modifier raloxifene or avista which is another selective estrogen modifier teriparatide or dinozzo map the goal of drug therapy in treatment of osteoporosis is as follows to prevent additional bone loss so in these patients who have osteoporosis we know they’ve already sustained a significant decrease in their native bone mets we’d like to
Prevent that from worsening we’d also like to increase their bone mass if possible to start to rebuild their bones a bit and hopefully increase that t score and make it higher and then of course to reduce the risk of fractures because fractures as we saw earlier what confer that significant morbidity and mortality so if we look a little bit more specifically at
Bisphosphonates who’s phosphonates mechanism of action is to inhibit osteoclast mediated resorption so they decrease the breakdown of bone bone tissue has a variety of different types of cells but there are two key cells with respect to treatment of osteoporosis so osteoblasts are cells that actually work to make new bone tissue and osteoclasts are cells that
Work to sort of break down that bone tissue and when someone younger in life that’s an ongoing process however as as we age the process slows down so what this is what these medications do is inhibit the activity of osteoclasts so they’re not breaking down the bone tissue as quickly they also bind to the mineral salts in bone and that’s why they had such a long
Half-life alendronate as an example has a half-life of years so once these medications are in the system they’re in there for quite some time however that does mean that we can administer them much less often so they don’t have to be taken daily they be can be taken weekly monthly etc these medications have good evidence to support they’re used to increase bone
Mineral density at the spine at the hip and i have that emphasized because that’s where the most concerning factors occur hip fractures and they have been shown to reduce risk of hip fractures they can actually reduce hip fractures by about 20% bisphosphonates unfortunately have extremely poor oral absorption most of them are actually formulated as an oral you
Know as an oral tablet or even an oral solution the bioavailability of these medications is less than 1% in most cases that’s very very low if these medications are taken with food or concomitant with other medicines then that can reduce the viability by another 50% so if it’s less than 1% and you cut them in half even further then there’s very very little of these
Medications being absorbed there are many many different formulations as i’ve mentioned they can be taken by mouth daily weekly monthly or can be even given as an intravenous annual infusion
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Drug Therapy for Osteoporosis By TeachGlobal
