The drugs not used for treatment of osteoporosis are-
, Ans. is 'b' i.e., Steroids Management of osteoporosisNon trharmacolosical therapyo Calcium and vitamin D supplementationo Important additional lifestyle measures includeExerciseSmoking cessationAvoidance o f heavy alcoholCounselling on fall preventionPharmacologic therapyEstrogenso A large body of clinical trial data indicates that various types of estrogens (conjugated equine estrogens, estradiol, estrone, esterified estrogens, eihinylestradiol and mestranol) reduce bone turnover, prevent bone loss and induce small increase in bone mass of spine, hip and total body.o The effect of estrogen are seen in women with natural or surgical menopause and in late menopausal women.Biphosphonate (Alendronate, risedronate, ibandronaie, Zoledronic acid)o First line therapy1 because of their efficacy, favourable cost and availability of the long term data.o Atendronate or risedronate are preferred.Denosumabo An alternative for patient who cannot tolerate biphosphonate or who have difficulty with dosing requirements and have impaired renal function.o Denosumab is a humanized monoclonal antibody against RANKL that reduces osteoclastogenesis.o RANKL is a member of TNF superfamily of ligands and receptors and is essential for the function of bone resorbing osteoclasts.o RANKL accelarates osteoclastogenesis when it binds to its receptor RANK.o Denosumab improve bone mineral density and reduce the incidence of new verierbral hip and non vertebral fractures by acting against RANKL.Raloxifeno Raloxifen is given for patients who cannot tolerate or are not candidates for any biphosphonates.o Raloxifen and tamoxifen are tissue selective estrogen receptor modulator.o Their characteristic feature is that they do not have pure agonist or antagonistic action on estrogen receptors.o SERMS are "selective" that means SERM blocks estrogen in some tissues and activates estrogen action in others.o Raloxifen increases bone mineral density and reduces the risk of vertebral fractures.o Raloxifen also appears to lower the risk of breast cancer and itdoes not stimulate endometrial hyperplasia or vaginal bleeding.o Tamoxifen is another SERM used primarily for the prevention and management of breast cancer. It is not typically used for osteoporosis but postmenopausal women who are receiving treatment with tamoxifen for breast cancer are probably receiving bone protection.o Raloxifen is considered the first line drug for t/t of osteoprosis. However, it is somewhat less effective than estrogen and biphosphonates.Parathyroid hormone therapyo PTH therapy is suggested for patients with severe ostoporosis who are unable to tolerate any of the available biphosphonates or to those who continue to have fractures even after one year of biphosphonate therapy.o Parathyroid hormone seems an unlikely candidate for the treatment of osteoporosis because of its well described deleterious effect on bone. However, intermittent administration of recombinant human PTH stimulates bone formation more than resorption and is effective for fracture reduction.Exogenous vitamin Ko Exogenous vitamin K is required for the carboxylation of osteocalcin which in turn allows osteocalcin to bind to hydroxyapatite mineral.o A vitamine K2 preparation (menatetrone) is widely used for the treatment of osteoporosis in Japan.Strontium renelateo Strontium ranelate increases bone mass throughout the skeleton. It appears to be moderately antiresorptive while at the same time not causing much decrease in hone formation.o Pharmacological agents used to manage osteoporosis either act by : -Decreasing the rate of bone resorption fantiresorptive therapy)Promoting bone formation (anabolic therapy)o Since bone remodelling is a coupled process antiresorptive drugs ultimately decrease the rate of bone formation and therefore do not promote substantial gains in BMD.o Thus strontium renelate is unique because it decreases osteoclastosis as well as promote bone formation.o Strontium ranelate has a novel mechanism of action for an osteoporotic drug as it acts on bone resorption to reduce the rate of bone decay but also acts on bone formation preventing the growth of new bone.
Biphosphonates
Steroids
Denosumab
Calciam
Osteoporosis and Osteomalacia