Osteporosis by siva 2013

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Osteoporosis :

Osteoporosis Prepared & Presented by Dr. Siva Reddy Challa, Professor & HOD, Dept. of Pharmacology KVSR Siddhartha College of Pharmaceutical Sciences, Siddhartha Nagar, Vijayawada-520010 Andhra Pradesh, INDIA Email: sivareddypharma@gmail.com

Treatment Preventive Measures:

Treatment Preventive Measures Calcium Vitamin D (400-800 IU) Regular weight bearing exercise Weight lifting, salsa dancing, walking, jogging, tennis Smoking cessation Minimize etoh Fall prevention

Calcium Requirements:

Calcium Requirements Recommended elemental calcium needs by age in mg/ca/day Children 800 Up to age 24 1200-1500 Women 25 –50 1000 Pregnant and breast feeding 1200-1500 Women over 50 Taking ERT 1000 Not taking ERT 1500 Women over 65 1500 Men 25 to 65 1000 Men over 65 1500

Sources of Calcium:

Sources of Calcium Dietary 8oz milk or yogurt = 300mg 2oz cheese = 400mg Calcium carbonate – Ingest with meals Generic = 200-600mg Caltrate = 600mg TUMS Ultra = 400mg Calcium citrate – Independent absorption; use of pt. is taking H2 blocker or proton pump inhibitor Citrical = 500mg Calcium gluconate Generic = 60mg * All above values represent mg of elemental calcium

Treatment Estrogen Replacement Therapy (ERT):

Treatment Estrogen Replacement Therapy (ERT) Indication : Used to prevent and treat osteoporosis (FDA indication is for prevention) Mechanism: Decreases osteoclast activity Dose : Estrogen: 0.625mg qd, 0.3mg offers bone protection as well; Progesterone 2.5mg qd (if uterus present)


ERT Advantages Increases bone density (1-5%) and decreases risk of fracture (25%) Relief of hot flashes, vaginal dryness Decreases LDL, increases HDL ?Prevention of Alzheimer’s disease Relatively inexpensive ($30/30 day supply) Disadvantages Accelerated bone loss after stopping Increased risk of uterine ca (if unopposed) Increased risk of thromboembolic events Possible increased risk of breast cancer Side effects: breast tenderness, breakthrough bleeding Increased risk of coronary events in women with known CAD in first year of use (HERS trial)

Selective Estrogen Receptor Modulators (SERMs):

Selective Estrogen Receptor Modulators (SERMs) Indication : Treatment and prevention of osteoporosis Mechanism : Decreases bone resorption Dose: Raloxifene (Evista) 60mg qd


SERMS Advantages Increases bone density (2%) and decreases fracture risk (30%) No stimulation of breast or endometrial tissue No need for progestin in women with uterus Decrease LDL Disadvantages Increased risk of thromboembolic events Doesn’t treat post-menopausal sx May increase hot flashes No effect on HDL $60.90/30 day supply


Bisphosphonates Approved agents – Alendronate (Fosamax), Risedronate (Actonel) Indication Approved for prevention and treatment of osteoporosis including steroid-induced osteoporosis Mechanism – Bind to hydroxappetite at sites of active bone resorption inhibiting osteoclast function Dose Prevention Alendronate 5mg qd or 35mg qweek Risedronate 5mg qd or 30mg qweek Treatment Alendronate 10mg qd or 70mg qweek Risedronate 5mg qd or 30mg qweeek


Bisphosphonates Take first thing in am, no food or meds for 30 minutes Take with 8oz glass of water Don’t lie down for at least 30 minutes Separate Ca, Al, and Mg containing meds by at least 4 hours


Bisphosphonates Advantages Increases BMD by 1-4%, decreases fracture risk by 41-44% No increased risk of breast, uterine ca or thromboembolic events Weekly dosing Disadvantages Risk of gastrointestinal sx Cost $61.20/30 day supply Complex dosing instructions Contraindicated in ESRD; need to adjust dose according to creatinine clearance


Calcitonin Indication: Treatment only Decreases bone resorption Dose: Nasal (Miacalcin) 200IU alternate nostrils qd SC, IM increased risk of anaphylaxis Advantage – May provide analgesic effect on bone pain associated with fractures Disadvantage – Inconsistent effects on BMD and fracture risk

Parathyroid Hormone:

Parathyroid Hormone Daily SC injections of 40mcg of PTH increased BMD by 9-13% and decreased risk of vertebral fractures by 65 to 69 % Side effects: Occasional headache and nausea Pending FDA approval

Thank You :

Thank You

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