Clinical Pharmacology_pathophysiology, recent advances in management of Osteoporosis_Dr_SSD.pptx
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A short presentation covering salient features of pathophysiology, diagnosis, clinical pharmacology of management of osteoporosis. Covers in short diagnostics, most of the drugs used in osteoporosis management, with Denosumab example with a clinical trial covered as example. This presentation serves as a model answer to prepare for pharmacology exam questions.
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Clinical Pharmacology_pathophysiology, recent advances in management of Osteoporosis_Dr_SSD.pptx
- 1. Pathophysiology Of Osteoporosis And Clinical Pharmacology Of Drugs Used For Osteoporosis (Including Recent Advances) Dr. Shakeeb Dhorajiwala
- 2. Meeting etiquettes: • Standard behavior expected during work meetings • It prompts you to behave professionally and respect others’ time and efforts 17-11-2022 2
- 3. Presentation Disclaimer • This presentation is intended for educational purpose only & serves as a model answer to attempt MUHS university question and should not replace independent professional judgment. • This presentation will NOT aid to contemplate a clinical trial and if attendees wish to do so, should do so on their own discretion. 17-11-2022 3
- 4. Outline One example Recent advances Pharmacological aspects Diagnosis Patho-physiology Introduction 17-11-2022 4
- 5. Introduction Defn: Reduction in strength of bone leading to increased risk of fractures Loss of bone tissue- deterioration in skeletal microarchitecture WHO operational defn: Bone density < mean for young healthy adults - 2.5 standard deviations (SDs) • same sex and race • T-score of –2.5 Postmenopausal women-T-score <–1.0 Functional defn : Fractures of any bone in adults occurring in setting of trauma < fall from standing height (fingers, toes, face, and skull being exceptions) 17-11-2022 5
- 7. Symptomatology Thoracic Restrictive lung disease and symptoms Lumbar Abdo complaints- distention, early satiety & constipation 17-11-2022 7 f r a c t u r e s
- 8. Risk factors & Modifications 17-11-2022 8
- 10. 17-11-2022 10
- 12. Diagnosis SXA DXA qCT USG Trabecular bone score 17-11-2022 12
- 13. Biochemical Markers of Bone Metabolism Bone formation • Serum bone-specific alkaline phosphatase • Serum osteocalcin • Serum propeptide of type I procollagen Bone resorption • Urine and serum cross-linked N- telopeptide • Urine and serum cross-linked C- telopeptide 17-11-2022 13
- 14. Diseases with Increased Risk of Osteoporosis Hypogonadal states • Turner’s syndrome • Klinefelter’s syndrome Endocrine disorders • Hyperparathyroidism • Diabetes mellitus (both type 1 and 2) Rheumatologic disorders • Rheumatoid arthritis • Ankylosing spondylitis Hematologic disorders/malignancy • Multiple myeloma • Lymphoma and leukemia Selected inherited disorders • Osteogenesis imperfecta • Marfan’s syndrome 17-11-2022 14
- 15. Drugs Associated with an Increased Risk of Generalized Osteoporosis in Adults Glucocorticoids Cyclosporine Anticonvulsants Aromatase inhibitors Excessive thyroxine Heparin Lithium Protein pump inhibitors 17-11-2022 15
- 16. Pharmacotherapy Antiresorptive agents • Estrogen • SERMs • Bisphosphonates • Denosumab • Calcitonin Anabolic • Teriparatide • Abaloparatide • Romosozumab 17-11-2022 16
- 18. Denosumab Indications: • High risk postmenopausal women & men • women with breast Ca on aromatase inhibitors • men with prostate CA on androgen deprivation treatment ADR • ONJ, Atypical femur #, • Hypersensitivity reactions, and skin reactions including dermatitis • Hypocalcemia • Rebound increase in bone turnover & accelerated bone loss • Rx-single infusion of zoledronic acid helps maintain BMD for 1– 2 years 17-11-2022 18
- 19. Recent Advances Raloxifene: 1st SERMs: approved for the prevention of osteoporosis Bisphosphonates Calcitonin Strontium ranolate Denosumab, Romosozumab Teriparatide Odanacatib Eldecalcitol 17-11-2022 Katzung 19
- 20. 17-11-2022 20
- 21. Bibliography ClinicalTrials.gov Available from: https://clinicaltrials.gov/ct2/show/NCT01465568?term=Denosumab&cond=Osteoporosis&draw=2&rank=4 Last accessed on 16-Nov-2022 Textbook referred: • Harrison's Principles of Internal Medicine (22nd ed.) • Basic & Clinical Pharmacology (14th ed.) 17-11-2022 21
- 22. 17-11-2022 22 Q& A- Presenter’s Grilling Time
Editor's Notes
- This presentation is intended for educational purposes only and should not replace independent professional judgment. Statements of fact and opinions expressed are those of the participants individually and, unless expressly stated to the contrary, are not the opinion or position of the Society of Actuaries, its cosponsors, or its committees. The Society of Actuaries does not endorse or approve, and assumes no responsibility for, the content, accuracy or completeness of the information presented. Attendees should note that sessions are audio-recorded and may be published in various media, including print, audio and video formats without further notice.
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