The treatment of osteoporosis

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MSc. Clinical Pharmacology Class Presentation

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The treatment of osteoporosis

  1. 1. THE TREATMENT OF OSTEOPOROSIS Vincent Chang
  2. 2. Osteoporosis = porous boneMost commonly affected are thebones of the spine, hip, and wrist.
  3. 3. Osteoporosis Pathogenesis- Bone is constantly renewing itself- Old bone tissue is broken down by cells called osteoclasts andreplaced by new bone material produced by cells called osteoblasts.- The balance
  4. 4. Morbidity and Mortality "dowagers hump."
  5. 5. Therapeutic options for osteoporosisMoA:Inhibit osteoclastic activity, decrease bone reabsorption orStimulate osteoblastic activity, increase bone formation 1. Drugs preventing resorption (Anti-resorptive treatment) 2. Drugs Stimulating new bone formation (Anabolic therapy)
  6. 6. 1.Drugs preventing resorption (Anti-resorptive) Bisphosphonates • First line therapy – Alendronate – Etidronate – Risedronate – Ibandronate – Zelodronate – new, administrated once per year Calcitonin – Miacalcic Selective estrogen receptor modulators (SERMs) • Second line therapy – for patients do not tolerate bisphosphonates – Raloxifene (2nd Gen) – Bazedoxifene (3rd Gen, Recently approved in EU)
  7. 7. 2. Drugs Stimulating new bone formation (Anabolic Therapy)Recombinant Parathyroid hormone (PTH)• significantly more expensive than Bisphosphonates• reserve for high risk fracture patient – Teriparatide- the latest in the series and the most promising results. – Preotact
  8. 8. Emerging drugs that combine 1+2• Strontium ranelate i – 37% decrease risk of vertebral fracture in treated population on 2g strontium ranelate for 3 years• Amgen’s new mAb – denosumab (FDA approved June 2010) RANFL Osteoclast Bone destruction• Cathepsin K inhibitor - Cathepsin K produced by activated osteoclast – Odanacatib (Phase III Trial)Other potential new drug:• CIC 7 Inhibitor• Wnt-ß-catenin pathway targets: sclerostin, DKK1 antagonists, lithium.
  9. 9. The FutureDrawback of First line therapy Small molecule drugs or mAb • Better safety profile – less side effects • Reliable biomarker for prevention Typical Atypical fracture osteoporosis after many years fracture bisphosphonate therapy.
  10. 10. Q?

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