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This video simply explains all of the medications used for treating osteoporosis. These include bisphosphonates (alendronate), anabolic agents (denosumab, abaloparatide, teriparatide, and romosozumab, estrogen, testosterone, and thiazides.

Hello and welcome to my channel this video is going to be about treating osteoporosis with medications made easy before watching this video unless you already understand osteoporosis i recommend watching my other video covering the subject the link will be in the description there i discuss what causes osteoporosis and how it is diagnosed also in another video i

Go over the prevention and treatment of osteoporosis besides the medications but really quickly the idea of osteoporosis is that we are losing bone and as a result the bones become more porous as shown here porous bone is fragile bone fragile bone is at high risk of breaking and broken bones are no bueno when it comes to prescribing medications for osteoporosis

Your doctor is going to be thinking about the chances of you breaking a bone there are two tools doctors use to make this decision one is the fracture risk assessment survey as shown here the second is the dexa scan which is an x-ray shown here here are three results that will make your doctor recommend medications if the dexa scan shows a t-score less than

Negative 2.5 a 10-year risk greater than 20 percent for a major bone fracture or three percent for hip fracture and last if you have already fractured your hip from falling at a standing height now let’s discuss the available medications first we will cover the group of medications called bisphosphonates these medications have the suffix dronate we have two

Cells that involve bone one is the osteoblasts which build bone and osteoclasts which cleave bone real quick you will find that each medication in some way influences our osteoblasts or our osteoclasts or both now then the main cause of osteoporosis involves creating an imbalance between the two that ends up favoring osteoclasts this results in osteoclasts

Having more time with our bones and weakening them here’s the thing in order for osteoclasts to interact with the bone they have to bind now let’s bring in bisphosphonates bisphosphonates interrupt the ability of osteoclasts to bind to the bone thus disrupting their effects also they cause osteoclast cells to die here’s what’s good they’re cheap have been

Around for over 20 years and so they’re well understood and the treatment lasts 5 years what’s bad is that they damaged esophagus in the kidneys now damage to the esophagus happens when we take bisphosphonates orally if we inject them iv then we avoid damaging the esophagus having them injected is pricier but still a relatively cheaper treatment compared to

Those we will discuss later also a nurse has to administer them and there’s always a risk of infection with any needle stick next we have the anabolic agents these are injected under the skin as opposed to into a vein they have the strongest effect and they also don’t injure any of our organs the cons are they are expensive need to be injected depending on

The specific agent some aren’t two years old yet also depending on the specific agent some still require bisphosphonate treatment let’s go into greater detail with the anabolic agents the first one we’ll cover is denosumab their influence is on osteoclasts the idea is that there are chemicals in the body that increase osteoclast activity denosumab comes in and

Prevents that from happening next we have teriparatide and a baloperatide their influence is on osteoblasts the way they work is by copying hormones in our body that affect osteoblasts for teriparatide it is parathyroid hormone for a baloperate it’s parathyroid related hormone now if you’ve watched my prior video then you might remember that these two hormones

Can increase osteoclast activity as well the actions of these two hormones change depending on the duration of their presence in short bursts they increase osteoblast activity in prolonged durations they increase osteoclast activity one thing that’s unfortunate is that these two medications need to be injected daily compared to our next medication romozozumab

Which is injected monthly romosozumab increases osteoblast activity the idea is that there are chemicals in the body that decreases osteoblast activity romozozumab comes in and prevents that from happening we are done with the anabolic agents i made this list that covers some of the pros and cons with each one i want to note though that since romozuzumab

Was fda approved two years ago its long-term side effects are uncertain two more and we’re finished estrogen it increases osteoblast activity and decreases osteoclast activity we have a medication called reloxifene that acts like estrogen real quick testosterone supplementation is also used for treatment for men but only the man has a testosterone level less

Than two hundred one pro with reluctane is that it can prevent breast cancer which is helpful in certain populations the cons are not as effective as other medications for restoring bone hasn’t proven useful in preventing specifically hip fractures causes hot flashes and increases the risk for blood clots in the leg last we have the thiazide medications these

Are medications for blood pressure but can help out with osteoporosis the reason is that they cause calcium in the urine to be reabsorbed into the bloodstream preventing some of the body’s calcium from being peed out the thigh side medications lower a person’s blood pressure which is helpful for patients with high blood pressure the cons are that they can’t

Be taken by people with diabetes high cholesterol or gout research has shown that using more than one medication at once doesn’t help much or at least doesn’t justify the extra side effects and financial costs once you’ve been put on medications your doctor may want to make sure the medications are working some people may not absorb the medications as well as

Others your doctor will do this by measuring some chemicals in your blood for changes in addition your doctor will see how your bones are doing with the dexa skin one to two years after starting if the person’s bones lose more than five percent of their bone density then a different medication may be needed this concludes the video thank you for watching comment

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Transcribed from video
OSTEOPOROSIS Medications Made EASY By Doctor Q’s Family Medicine