Osteoporosis medications

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Osteoporosis medications


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USMLE® Step 1 questions

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Osteoporosis medications

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USMLE® Step 1 style questions USMLE

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USMLE® Step 2 style questions USMLE

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A 60-year-old woman comes to her primary care physician for a wellness checkup. The patient recently had a dual-energy X-ray absorptiometry (DEXA) scan that placed her at two standard deviations below the mean for bone density and is following up today to discuss the results. Past medical history is notable for asthma, anxiety, irritable bowel syndrome, and radial fracture that occurred 5-months ago following a ground-level fall. Current medications include clonazepam and albuterol. Vitals are within normal limits. The patient is started on raloxifene in addition to weight-bearing exercise and vitamins. This patient is at increased risk of developing which of the following?  

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Alendronate p. 499


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.


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