• Calcium
  • Thiazide
  • Vitamin D
  • Calcitonin
  • PTH
  • Bisphosphonate
  • Hormone

These all are used in osteoporosis.

Vitamin D,Calcitonin,PTH all affect serum calcium,phosphate concentration.

Affect on serum calcium and serum phosphate:-

       serum calcium                                                                 serum phosphate 

VITAMIN D     Increased                                                             Increased

CALCITONIN  decreased                                                            Decreased

PTH                   Increased                                                            Decreased

 

  • vitamin D increase serum calcium level and increase level of bone calcium .
  • PTH increase  serum calcium level and decrease bone calcium levels .
  • calcitonin decrease serum calcium level and increase bone calcium level.
  • vitamin D increase gastric calcium absorption and decrease calcium absorption from kidney.
  • PTH work on clast cell.

Bisphosphonate example:-Alendronate

Risedronate

Zolendronate:-it is given in once a year.it affect the kidney.

Bhisphosphonate do esophageal toxicity.it cause ulcer in esophagus.

caution during taking bisphosphonate:-

  • Empty stomach
  • Plenty of water intake
  • Donot lie down for 30 minutes after meal.
  • stomach emptying time is 30 minutes.
  • if any one lie down can regurgitate and food can come back to esophagus and cause ulcer.

Post menopausal osteoporosis:-

  • Estrogen help in making blast cell.
  • Estrogen action on :-Blood-increase HDL level.
  •                                       Bone-increase bone formation.
  •                                       Breast-increases chance of cancer.
  •                                       Liver-increases clotting factor.
  •                                       Endometrium-increases chance of cancer.
  • Peptide cannot be given orally.
  • estrogen +progesterone is helpful in hormone replacement therapy.
  • progestrone act opposite to estrogen.
  • Estrogen+progestrone act on breast and increases chance of cancer.
  • Estrogen+progestrone act on endometrium decreases chance of cancer.
  • Estrogen+progestrone act on Liver increases clotting factor cause thrmboembolism.

SERM:- selective estrogen receptor modulator.                                                                                                         example:-reloxiferm

Newer drug for osteoporosis:-

Teriparatide:- cannot be given orally.

  • act on PTH and stimulate blast cell.
  • PTH is made up of 84 amino acid.

Abaloparatide:-

Denosumab:-it act against rank ligand.

  • Stimulate osteoclasts and cause resorption.

strontium ranelate:-it has dual action decrease osteoclasts and increase osteoblast action.

Romosozumab: increase clast action and decrease blast action.

calcimimetic:- stimulate clast action.