Osteoporosis medications
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Osteoporosis medications
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Osteoporosis medications
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Content Reviewers
Yifan Xiao, MDContributors
Filip Vasiljević, MD
Ursula Florjanczyk, MScBMC
Sam Gillespie, BSc
Osteoporosis medications are medications used to treat osteoporosis, which is a condition where decreased bone strength increases the risk of a broken bone.
Osteoporosis is most commonly associated with the elderly, menopause, hyperparathyroidism, malabsorption, and with the use of some medications, like corticosteroids.
So, the underlying cause of osteoporosis is an imbalance between bone resorption and bone formation, which are normal processes of bone remodeling.
Now in bone remodeling, the process begins when osteoblasts sense micro fractures near their location.
The osteoblasts produce a substance called RANKL, or receptor activator of nuclear factor κβ ligand, which binds to RANK receptors on the surface of nearby monocytes.
RANKL induces those monocytes to fuse together to form a multinucleated osteoclast cell.
RANKL also helps the osteoclast mature and activate so that they can start resorbing bones.
The osteoclast starts secreting lysosomal enzymes, mostly collagenase, which digests the collagen protein in the organic matrix. This drills pits on the bone surface known as the Howship’s lacunae.
Osteoclasts also start producing hydrochloric acid, or HCl, which dissolves hydroxyapatite into soluble calcium – Ca2+ and phosphate – PO42- ions, and these ions get released into the bloodstream.
Moreover, osteoblasts and osteoclasts are controlled by two hormones: parathyroid hormone, which is released by parathyroid glands; and calcitonin, which is released by the thyroid gland.
At low concentrations, parathyroid hormone works by stimulating the activity of osteoblasts, thereby promoting bone formation; while at high concentrations, parathyroid hormone stimulates bone resorption.
Sources
- "Katzung & Trevor's Pharmacology Examination and Board Review,12th Edition" McGraw-Hill Education / Medical (2018)
- "Rang and Dale's Pharmacology" Elsevier (2019)
- "Goodman and Gilman's The Pharmacological Basis of Therapeutics, 13th Edition" McGraw-Hill Education / Medical (2017)
- "Teriparatide for osteoporosis: importance of the full course" Osteoporosis International (2016)
- "Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society* Clinical Practice Guideline" The Journal of Clinical Endocrinology & Metabolism (2019)
- "Osteoporosis" Clin Orthop Relat Res (2000)
- "Bisphosphonates" Endocrinol Metab Clin North Am (2003)
- "Understanding bisphosphonates and osteonecrosis of the jaw: uses and risks" Eur Rev Med Pharmacol Sci (2015)
- "Pharmacology of bisphosphonates" Bone (2011)
- "Denosumab: Prevention and management of hypocalcemia, osteonecrosis of the jaw and atypical fractures" Asia Pac J Clin Oncol (2017)
- "Author Correction to: Denosumab: A Review in Postmenopausal Osteoporosis" Drugs Aging (2018)
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