Pharmacological Treatments for Osteoporosis

Selective Estrogen Receptor Modulators (SERMs)

The prototype for this class is raloxifene (Evista). SERMs act by activating estrogen receptors specifically in the bone, which helps reduce calcium resorption and increase bone density. These are primarily used for post-menopausal women at risk for vertebral fractures.

Nursing Tip: Always confirm a patient's post-menopausal status before administering SERMs. Patients should also be advised to avoid smoking and must combine these drugs with Vitamin D and calcium supplements.

Calcitonin

Calcitonin-salmon (Miacalcin) is used for post-menopausal osteoporosis. It works by decreasing the breakdown of bone by osteoclasts. It is typically administered nasally.

Adverse Reactions: While often causing only mild nausea, rhinitis, or injection-site reactions, it can cause serious allergic reactions, hypertension, or heart dysrhythmias, particularly in older clients.

Osteoclast Monoclonal Antibodies

Denosumab (Prolia) is a monoclonal antibody that prevents the development of immature osteoclasts and certain white blood cells, thereby decreasing bone loss. It is used for osteoporosis and for managing hypercalcemia in cancer patients.

Nursing Implications:

• Monitor calcium and Vitamin D levels.
• Ensure dental visits every six months.
• Be aware of increased risks for infection and osteonecrosis.

Anabolic Agents (Bone Builders)

Unlike antiresorptive drugs, anabolic agents focus on stimulating the body to build new bone tissue.

Parathyroid Hormone (PTH) and PTH-Related Protein Analogs

The prototype for this class is teriparatide (Forteo). These analogs work by stimulating osteoblasts to build bone. They are indicated for both men and post-menopausal women with osteoporosis.

Safety Warnings:

• Administration: These must be administered by a healthcare provider (HCP) and cannot be taken for more than two years.
• Side Effects: Patients may experience nausea, weakness, fatigue, orthostatic hypotension, hypercalcemia, or hypercalciuria.

Sclerostin Inhibitors

Romosozumab (Evenity) is a monoclonal antibody that stimulates osteoblast activity and new bone formation. It is reserved for high-risk clients for whom other treatments have failed.

Clinical Monitoring:

• Because of the risk of cardiovascular events, clinicians must assess the patient's history for myocardial infarction (MI) or stroke.
• Monitor for hypersensitivity reactions and osteonecrosis of the jaw.

Essential Nutrients for Bone Health

Regardless of the pharmacological agent used, certain nutrients are fundamental to the process of bone formation.

Calcium and Vitamin D

Calcium and Vitamin D (such as cholecalciferol) are essential nutrients for bone health. They are often used as supplements alongside primary osteoporosis medications.

Nursing Implications:

• Monitor serum Vitamin D and calcium levels.
• Be aware of side effects including nausea, vomiting, constipation, bone pain, muscle weakness, and increased thirst.