36.4 Bisphosphonates, Calcium Preparations, Vitamin D, and Estrogen Receptor Modulators

Osteoporosis meds work to strengthen bones and prevent fractures. From bisphosphonates that slow bone loss to calcium and vitamin D that build bone, these drugs tackle the problem from different angles. Understanding how they work helps us use them safely and effectively.

Nurses play a key role in managing osteoporosis treatment. We assess risk factors, monitor for side effects, and educate patients on proper med use and lifestyle changes. By staying on top of bone density tests and lab work, we can help patients maintain strong bones and avoid fractures.

Mechanisms of Action and Indications

Bisphosphonates, calcium, vitamin D, estrogen receptor modulators for osteoporosis

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• Bisphosphonates
  • Inhibit osteoclast activity reducing bone resorption and increasing bone mineral density (BMD)
  • Bind to hydroxyapatite crystals in bone preventing dissolution (alendronate, risedronate)
• Calcium preparations
  • Provide essential mineral for bone formation and maintenance (calcium carbonate, calcium citrate)
  • Promote mineralization of bone matrix supporting bone strength and density
• Vitamin D
  • Increases intestinal absorption of calcium and phosphate enhancing mineral availability for bone
  • Stimulates osteoblast differentiation and activity promoting bone formation (cholecalciferol, calcitriol)
  • Regulates calcium and phosphate homeostasis maintaining optimal levels for bone health
• Estrogen receptor modulators (SERMs)
  • Selectively bind to estrogen receptors in bone tissue mimicking estrogenic effects
  • Increase bone mineral density by reducing bone resorption and stimulating bone formation
  • Raloxifene is the primary SERM used for osteoporosis treatment in postmenopausal women

Adverse Reactions, Drug Interactions, and Patient Care

Indications, adverse reactions, drug interactions for osteoporosis medications

• Bisphosphonates (alendronate, risedronate, ibandronate, zoledronic acid)
  • Indications: Prevent and treat postmenopausal osteoporosis, glucocorticoid-induced osteoporosis, Paget's disease
  • Adverse reactions: GI irritation, esophageal inflammation, osteonecrosis of the jaw, atypical femoral fractures
  • Drug interactions: Antacids, calcium, iron reduce absorption; take on empty stomach with plain water
• Calcium preparations (calcium carbonate, calcium citrate)
  • Indications: Prevent and treat osteoporosis, supplement inadequate dietary intake
  • Adverse reactions: Constipation, gas, bloating, rarely hypercalcemia
  • Drug interactions: May decrease absorption of bisphosphonates, tetracyclines, quinolones; space apart
• Vitamin D (cholecalciferol, calcitriol)
  • Indications: Prevent and treat osteoporosis, vitamin D deficiency
  • Adverse reactions: Hypercalcemia, hypercalciuria, rarely nephrocalcinosis at high doses
  • Drug interactions: Thiazide diuretics may increase risk of hypercalcemia; monitor levels
• Estrogen receptor modulators (raloxifene)
  • Indications: Prevent and treat postmenopausal osteoporosis
  • Adverse reactions: Hot flashes, leg cramps, increased risk of venous thromboembolism
  • Drug interactions: Cholestyramine and colestipol may decrease absorption; take at different times

Nursing care plan for patients taking osteoporosis medications

• Assessment
  • Evaluate risk factors (age, gender, family history, lifestyle)
  • Assess baseline BMD using DEXA scan to guide treatment
  • Monitor for adverse reactions and drug interactions to ensure safety
• Interventions
  • Administer medications as prescribed ensuring proper timing and administration
  • Encourage adequate calcium and vitamin D intake through diet (dairy, leafy greens) and supplements
  • Promote weight-bearing exercise (walking, resistance training) and fall prevention (home safety, balance training)
  • Provide patient education on medication use, lifestyle modifications, potential side effects
• Monitoring
  • Regularly assess BMD to evaluate treatment efficacy; adjust therapy as needed
  • Monitor serum calcium, phosphate, vitamin D levels to avoid deficiency or excess
  • Assess for signs and symptoms of adverse reactions (GI discomfort, jaw pain, thigh/groin pain)
  • Evaluate patient adherence to medication regimen and lifestyle modifications; address barriers

Patient education materials on osteoporosis medications

• Proper administration
  • Bisphosphonates: Take on empty stomach with plain water, remain upright for 30-60 min after
  • Calcium and vitamin D: Take as directed with or without food; do not exceed recommended dose
  • Raloxifene: Take as directed with or without food; report signs of blood clots (swelling, pain)
• Lifestyle modifications
  • Engage in regular weight-bearing and resistance exercises (walking, lifting weights) to strengthen bones
  • Maintain a balanced diet rich in calcium (dairy, leafy greens) and vitamin D (fatty fish, fortified foods)
  • Avoid smoking and excessive alcohol consumption which can weaken bones
  • Implement fall prevention strategies (remove tripping hazards, install grab bars, wear supportive shoes)
• Potential side effects
  • Bisphosphonates: GI discomfort, esophageal inflammation, jaw pain, thigh/groin pain; report to provider
  • Calcium and vitamin D: Constipation, gas, bloating, rarely hypercalcemia; do not exceed recommended dose
  • Raloxifene: Hot flashes, leg cramps, increased risk of blood clots; report signs to provider
  • Encourage patients to report any adverse reactions for prompt management and adjustments as needed