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Classification of Drugs Used in Osteoporosis

Osteoporosis is a condition characterized by low bone mass and structural deterioration. The treatment involves various drugs that either prevent bone resorption or promote bone formation.

1. Bisphosphonates

  • Mechanism of Action: Inhibit osteoclast-mediated bone resorption by binding to bone and inducing osteoclast apoptosis.
  • Therapeutic Uses: Treatment and prevention of osteoporosis in postmenopausal women, men, and glucocorticoid-induced osteoporosis.
  • Adverse Effects: Gastrointestinal issues, osteonecrosis of the jaw, atypical femoral fractures.
  • Contraindications: Severe renal impairment, esophageal disorders, hypocalcemia.

2. Selective Estrogen Receptor Modulators (SERMs)

  • Mechanism of Action: Estrogen agonists in bone, promoting bone formation and reducing resorption.
  • Therapeutic Uses: Prevention and treatment of osteoporosis in postmenopausal women.
  • Adverse Effects: Risk of venous thromboembolism, hot flashes, leg cramps.
  • Contraindications: History of venous thromboembolism, pregnancy.

3. Denosumab

  • Mechanism of Action: Monoclonal antibody that inhibits RANKL, decreasing osteoclast function.
  • Therapeutic Uses: Treatment of osteoporosis in postmenopausal women and men at high fracture risk.
  • Adverse Effects: Hypocalcemia, infections, osteonecrosis of the jaw.
  • Contraindications: Hypocalcemia, active infections, pregnancy.

4. Parathyroid Hormone (PTH) Analogues

  • Mechanism of Action: Stimulates osteoblast activity to promote bone formation.
  • Therapeutic Uses: Severe osteoporosis in patients at high fracture risk.
  • Adverse Effects: Hypercalcemia, nausea, dizziness.
  • Contraindications: Hypercalcemia, bone metastasis, skeletal malignancies.

5. Calcitonin

  • Mechanism of Action: Inhibits osteoclast activity, reducing bone resorption.
  • Therapeutic Uses: Treatment of osteoporosis in postmenopausal women, especially for pain relief.
  • Adverse Effects: Nasal irritation, nausea, flushing.
  • Contraindications: Fish allergies (due to source of calcitonin).

6. Calcium and Vitamin D Supplements

  • Mechanism of Action: Calcium helps with bone matrix, and vitamin D enhances calcium absorption.
  • Therapeutic Uses: Adjunctive therapy to maintain bone health and prevent bone loss.
  • Adverse Effects: Hypercalcemia, constipation.
  • Contraindications: Hypercalcemia, renal failure.