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CNSLF Med - Osteoporosis (ii) Tx (Bisphosphonates (alendronate (primary…
CNSLF Med - Osteoporosis (ii) Tx
Ca + Vit D supplements
not tx
poor compliance as patients don't see immediate benefits
better to recommend 3 portions of dairy per day
Weight-bearing exercise + good diet
Correct secondary causes where possible
Discourage smoking + excessive alcohol
minimise modifiable risk factors
Bisphosphonates
analogues of natural compound pyrophosphate
PCP backbone of bisphosphonates more stable than POP backbone of pyrophosphate + bonds to bone
cause apoptosis of clasts - less bone resorption
also inhibits blasts - so new bone formed
SE = GORD
empty stomach NB - or won't be absorbed
low bioavailability
alendronate
primary nitrogen terminal bisphosphonate
70mg once wkly dose
5-7% gains in BMD + 40% reduced fracture rate
long T1/2 of elimination - yrs - can stop after 5 yrs
residronate
bisphosphnate with heterocyclic ring
35 mg po once wkly
5% gain in BMD + 40% reduced fracture rate
T1/2 of excretion about 20 days
ibandronate 150mg orally once monthly
zoledronic acid IV 5 mg once yrly
rare comps: osteonecrosis of jaw, oesophagitis
Rank ligand i
HRT
only if main reason is for menopause symptom control (not OP only)
effective
SERMs
cancer + cardiac risk
raloxifene 90 mg/d
proven to reduced vertebral fractures
Anabolic agents
strontium ranelate
dual action - anti-resorptive + anabolic
cardiac risk limits use - rarely used now
teriperatide (PTH 1-35)
synthetic PTH
20 mcg subcut injection daily for 18 months - must stop after this due to cancer risk
most potent
10% increase in BMD seen often
used for most severe OP
intermittent PTH exposure inhibits clasts + blasts
Testosterone for deficient men