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| first line, second line, and third line |
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• 1st line: oral bisphosphonate (alendronate, risedronate, ibandronate)
• 2nd line: intravenous bisphosphonate (zoledronic acid)
• 3rd line: teriparatide
• 4th line: raloxifene
• 5th line: intranasal calcitonin |
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forteo
first line in patients with a T-score < -3.5 or if there’s multiple low trauma fractures |
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Inhibit osteoclasts
most common side effect – GI complaints/reflux/dyspepsia, muscle aches. Can cause atypical fractures after long term use >5yr |
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antagonizes PTH, directly inhibits osteoclasts, promotes the renal excretion of calcium, phosphate, magnesium and potassium
most common – nasal irritation, however can cause allergic reactions due to salmon origin |
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Binds to estrogen receptors and has an agonist role at those receptors involved with bone but an antagonist role at others (i.e. the breast)
can cause hot flashes, edema, muscle spasm/aches. Can cause DVT |
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The pharmacologic activity of teriparatide, which is similar to the physiologic activity of PTH, includes stimulating osteoblast function, increasing gastrointestinal calcium absorption, and increasing renal tubular reabsorption of calcium.
hypercalcemia, orthostatic hypotension, nausea, dizziness, arthralgia |
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Binds to RANKL and prevents it from interacting with RANK. This down regulates osteoclast activity
dermatitis, rash, eczema, hypophosphatemia. Can cause atypical fractures |
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