Case Studies – Bone and Calcium Medications

00:01 Let’s move on to a question.

00:03 A 54-year-old woman with a history of recurrent fractures presents to you with the following picture.

00:10 You wish to start her on a medication. Which is a reasonable choice? Would we use risedronate, ramipril, rivaroxaban, or ritonavir? So you can see here that this patient has blue sclera and I already told you that this is actually my patient and we know that she has osteogenesis imperfecta.

00:32 So it makes sense that we would use risedronate.

00:35 Why wouldn't we use the other agents? Ramipril is a blood pressure agent, rivaroxaban is a blood thinner, and ritonavir is used in HIV and hepatitis treatment so those are not appropriate choices - risedronate is the answer.

00:52 This is, I think, personally, I think this is an unfair question but you will see it sometimes in your pharmacology sections because they want you to know that each of these drugs are prototypical drugs in their different drug classes.

01:07 Ramipril for example is one of the prototypical ace inhibitors so you do need to know drug generic names for your exams.

01:17 Remember that I only pointed out three of the bisphosphonates for you to memorize.

01:23 The other ones you don’t really need to know but they are there and they are available and they're pretty effective drugs, too.

01:30 Let’s go on to the next question.

01:32 Denosumab is - A, a monoclonal antibody that decreases osteoclast activity; B, a monoclonal antibody that increases osteoclast activity; C, a monoclonal antibody that increases osteoblast activity; or D, a monoclonal antibody that decreases osteoblast activity.

02:00 Good! You chose a monoclonal antibody that decreases osteoclast activity.

02:06 So why did we pick this answer? Remember that osteoclasts are the ones that we're inhibiting in the treatment of osteoporosis.

02:14 We're not going to be affecting osteoblast activity.

02:17 Even the RANKL inhibitors, when you think about it, are not really affecting mature osteoblasts.

02:23 What you are doing is you're reducing the maturation of osteoclasts, so remember that our treatments in osteoporosis are mostly focused on osteoclasts.

02:35 How do you remember that? Well, remember that we are talking about calcium metabolism, osteoclast has a c in it, it’s not osteoblast that we're affecting - that’s how I remembered it when I was a medical student.

02:47 Hopefully, that will help you with your memory cues.

02:51 Okay, there you have it! You survived the bone and mineral homeostasis portion of this series.

02:58 I know that you're going to do well on your exams.

03:00 Go in there with confidence and show them what you know.