DRUG THERAPY IN OSTEOPOROSIS

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Calcium and Vit D supplementation

The primary role of calcium supplements is to assure adequate intake and adequate absorption of calcium. Calcium supplementation does not increase the formation of new bone but only helps minimize the resorption of calcium from preexisting bone.

It is recommend to start calcium supplements to the high-risk patient. Patients undergoing any treatment for osteoporosis should have sufficient calcium intake, as should patients who have not yet reached their peak bone mass. Calcium supplementation only retard bone loss.

1000 to 1500mg of elemental calcium is needed per day for prevention of bone loss.

Vit D helps in increasing the intestinal absorption of calcium and also the renal tubular absorption of calcium in the kidney.

Dose- Vitamin D 400- 500i.u. per day is usually necessary

Fluoride

Fluoride works by stimulating osteoblastic activity and promoting the formation of new bone; however, this new bone may be poorly mineralized and as a result, be weaker than normal.

To help promote proper bone mineralization, fluoride should be given with adequate calcium. Doses of calcium and fluoride should be separated by one to two hours.

The major disadvantage associated with fluoride therapy is the GI upset associated with its use. There is also a significant occurrence of pain in weightbearing joints in patients taking fluoride supplements.

The usual doses of fluoride in the treatment of OP are 50-75mg of sodium fluoride daily in divided doses. These doses should be given with meals .

Other possible targets

Novel anti-resorptives

1)Cathepsin K inhibitors, such as odanacatib.

2)Src kinase inhibitors

are in the early phases of development

Parathyroid hormone is the only approved anabolic agent for the treatment of osteoporosis

Recent discoveries have demonstrated that the Wnt/beta-catenin signaling pathway plays a central role in osteoblastic cell differentiation. Anabolic approaches being developed include the use of neutralizing antibodies to Wnt antagonists, such as sclerostin.

Regards

Dr Ankush Gaikwad