- 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.