Pharmacology Exam 6

- Loss of bone density
- Most common form of bone disease
- May be caused by genetics, nutrition, or other lifestyle issues

1- Primary: senile and postmenopausal
2- Secondary: anything that causes a Ca2+ deficiency (renal disease, dec Ca2+ in diet, vit. D deficiency, drugs-glucocorticoids & heparin)

Uncontrolled osteoclast activity

1- Alendronate*
2- Risedronate*
3- Tiludronate^
4- Ibandronate*
5- Etidronate^
6- Pamidronate*
7- Zoledronate*
* Aminobisphosphonate
^ Bisphosphonate

- High affinity for Ca2+ so they incorporate into bone
- Directly inhibit osteoclast activity
- Bis. dec ATP production in osteoclasts
- Aminobis. inhibit an enzyme in a pathway to cholesterol synthesis (farnesyl pyrophosphate synthetase)

SE: GI upset, joint and muscle pain, eye inflammation, IV infusions (first dose effect), osteonecrosis of the jaw (BRONJ)

- PTH analog; stimulates bone growth
- Inc osteoblast activity => long term is an inc in osteoclast
- Give in short Tx periods => Ca2+ deposition

- Ca2+ mimetic, sensitizes PTH Ca2+ receptors => dec PTH secretion

- Estrogen analog; receptor modulator
- Inhibits osteoclast activity
- SE: pulmonary emboli, category X

Vitamin D analog

- Stimulates osteoblasts

- Opposite effects of PTH
- Tx for Paget's disease- inhibits osteoclasts
- SE: nausea, metallic taste

- Inhibit osteoblasts
- Heparin activates osteoclasts

- Blocks a receptor of NFkB (required for osteoclast activity)