Pharmacology, part 29: Musculoskeletal Medications for Osteoporosis

by Cathy Parkes March 25, 2021

In this video

Bisphosphonates - Alendronate

  • Indications
  • Mode of action
  • Side effects
  • Patient teaching
  • Tip for remembering

Selective estrogen receptor modulator - Raloxifene

  • Indications
  • Mode of action
  • Side effects
  • Patient teaching
  • What to monitor
  • Tip for remembering

Hypocalcemic agent - Calcitonin

  • Indications
  • Mode of action
  • Side effects
  • Patient teaching
  • What to monitor
  • Tip for remembering

Full Transcript

Okay, in this video we are going to continue with our coverage of key musculoskeletal medications that you should know. And specifically in this video, we will be covering medications used for osteoporosis. If you are following along with your cards, I am on card 93 in our Pharmacology Flashcards edition 2.0.

Okay, so let's talk about first medication class which are bisphosphonates. And the key medication that falls within this class in alendronate.

Alendronate can be used for postmenopausal osteoporosis as well as Paget's disease, which is a rare form of breast cancer.

The mode of action of alendronate is to prevent bone resorption by inhibiting the activity of osteoclasts. So normally, osteoclasts are breaking down the bone and taking calcium from the bone into the bloodstream. And we don't want that, right? We want that calcium to stay in the bones. So that's what alendronate helps to do, right? It prevents the osteoclasts from breaking it down, so we are keeping that calcium in the bones.

In terms of the side effects, the key side effect that's going to be important for you to remember is esophagitis. So this is where we have inflammation of the esophagus. Other side effects include GI upset, muscle pain and visual disturbances.

There are some key teaching points that you need to provide your patient and they are listed on this card here, card 93 in bold and red. So definitely review those things.

We want to advise our patient to take this on an empty stomach in the morning with a full glass of water, and then after they take this medication, we do not want the patient lying down because that can really result in that esophagitis. So after they take this medication, they need to sit upright or ambulate for 30 minutes to prevent that esophageal ulceration that can occur. So that's going to be very important.

Also we're going to want to encourage our patient to increase their intake of calcium and vitamin D, because vitamin D is needed for calcium absorption and they should also engage in weight-bearing exercises to help preserve their bone mass. And then we're going to want to monitor their bone density regularly during therapy.

So my little trick for remembering this, if you look at the word alendronate, I think alen, some guy name Alan drones on and on about his esophagitis. The other little trick that you might use to remember this is after you take your alendronate, maybe go out and fly your drone, right? Like you're usually standing up when you fly your drone. Maybe you're sitting up but usually not laying down flying your drone, right? So if you fly your drone for 30 minutes after you take alendronate, then that will help prevent that esophageal ulceration.

Right. Now let's talk about a selective estrogen receptor modulator which is raloxifene. So raloxifene is used for post-menopausal osteoporosis. It can also help reduce the risk for breast cancer.

The mode of action is that it binds estrogen receptors which decreases bone resorption.

In terms of the side effects, the key side effect I would remember includes an increased risk for embolic events. So this includes things like a DVT, a PE, or a stroke. This medication does carry a black box warning for just this reason because of the increased risk for clots. In addition, hot flashes and leg cramps are also common.

For teaching, you want to make sure your patient is increasing their intake of calcium and vitamin D, and we want to encourage weight-bearing exercises as well.

And then we want to monitor the patient's bone density.

In terms of how I remember this medication, if you look at the name raloxifene, and you look at it backwards, it has fix and then the letter O. So I think that raloxifene will fix your osteoporosis. So it's kind of spelled backwards there, and that helps me to remember what it's for.

Okay. Finally, let's talk about a hypocalcemic agent, meaning an agent that helps to bring down calcium levels in the blood. So the medication that falls within this class is calcitonin.

Calcitonin is used for post-menopausal osteoporosis as well as hypercalcemia, meaning we have too much calcium in the bloodstream.

It works to prevent bone resorption by inhibiting the activity of osteoclasts. It also increases renal excretion of calcium.

In terms of the side effects, GI upset is common and if you are taking it through the intranasal route, then nasal irritation or dryness is also common.

In terms of teaching, we're going to do the same type of teaching. Make sure you're getting enough calcium and vitamin D, weight-bearing exercises, and monitoring the patient's bone density will be important.

In terms of how I remember this medication, if you look at the word calcitonin, you think ‘tone it down,’ meaning tone down that calcium. Bring those calcium levels down in the bloodstream.

So that is it for our osteoporosis medications. In my next video, we will cover medications for gout. So hang in there with me and we'll get through these meds together!


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