Treatment Options for Osteoporosis: Bisphosphonates and Denosumab (Nursing)

00:01 Now, I'd like to walk you through the treatment options for osteoporosis.

00:05 I'm going to kind of break it into two categories. Okay.

00:08 So the first category is biphosphonates and denosumab.

00:13 I know that is a funny one to say.

00:16 Now when you look at this slide, you'll see that we have biphosphonates and denosumab over on the side.

00:22 And then we have hormone related therapy, and bone building medications.

00:27 Now, the first three are generally oral medications, but the one on the right in the bottom, you'll notice that it's a syringe, because we wanted to remind you that bone building medications are often given as an injection.

00:42 Now, here are the two stars of our osteoporosis discussion.

00:46 You have the osteoblasts and the osteoclast.

00:51 Okay, why am I saying that so slowly? Because if you move through some of this material too quickly, it might not stick in your brain.

00:59 That's why we've got you covered.

01:01 We've got some study aids for you.

01:03 Osteoblasts have a B and are also, we've got it as a blue color there.

01:09 They are builders. See as little construction cap.

01:13 So osteoblast build bones.

01:16 Osteoclast, what's he holding? He's got a little broom there.

01:21 They're the cleaners.

01:22 They can kind of dissolve bones and get rid of the stuff in order make the osteoblast have the ability to build the bone back up.

01:30 So these two types of cells in your bones play a really important role in building new bone and cleaning out the old bone.

01:39 So, why do we care? So let's take a look.

01:43 You'll see on the bottom of your screen you've got a kind of a flesh colored area, that is bone.

01:50 It's lined with those blue cells that we just talked about.

01:54 See if you can remember the name of those blue cells.

01:58 Osteoblasts, right.

02:00 Now, what is an osteoblasts job? To build bone. Cool.

02:06 Look, you've already got that.

02:08 Stick with us, answer those spaced retrieval questions after the videos.

02:12 We're really going to help you supercharge your studying.

02:16 That was a picture of healthy and intact bone.

02:19 Now let's take a look at what happens in areas of osteoporosis.

02:23 Without this bone that is porous.

02:26 So when you look at this drawing, what do you see that's different than the intact one? Yeah, got that big pit. There, right? Exactly.

02:35 So that represents the porousness of the bone.

02:38 Now the medication that we're talking about is biphosphonate.

02:42 So remember, that is a pill, right? You swallow that in your mouth, and it's going to go through the patient's bloodstream.

02:48 So want you to see and watch that bihosphonate drug enter into the picture.

02:55 Okay, now, here's a cool thing about biphosphonates.

02:58 They target areas of higher bone turnover.

03:01 I mean, that is cool.

03:03 They actually deposit right into the bone.

03:06 Okay, so see them there.

03:07 We've got it right into the bone.

03:10 So we know that this patient has a history of osteoporosis.

03:14 That's why they're taking biphosphonates.

03:17 And when they take this medication, it deposits in areas of high bone turnover right into the bone.

03:24 So what happens next? Well, in come the osteoclast.

03:29 Remember, these are the cleaners.

03:30 And they kind of dissolve the bone.

03:32 When they dissolve this area, when they scoop it up, that's filled with biphosphonate.

03:38 So now they've absorbed the actual biphosphonate drug.

03:43 Is that a big deal? Yeah.

03:45 If you're an osteoclast, it's a big deal.

03:49 Here's what we know.

03:50 Biphosphonate seems to cause the osteoclast to die early.

03:55 That's why you see what the artists put there for you to make that visual in your mind.

04:00 When the biphosphonate is absorbed the osteoclast dies earlier than it would have if the patient wasn't taking biphosphonate.

04:10 If it dies early, it isn't able to dissolve as much of the bone as it would have.

04:16 Okay, so we know that's what the biphosphonate does to the osteoclast.

04:21 We also know that osteoporosis is the bones are being destroyed more than they can be rebuilt.

04:28 So it would be cool with this could just be a perfect world where you give them biphosphonates.

04:33 Now everything is back to normal, right? They can rebuild as quick as they destroyed.

04:38 Doesn't happen quite that good, but it still benefits your patient.

04:43 Because when the osteoclast is killed, a message gets sent to the osteoblasts.

04:49 The builders, those messages are reduced.

04:52 So along with killing off the osteoclast early biphosphonates can cause a slight reduction in osteoblastic activity.

05:01 That's why you can possibly be at a risk for that atypical fracture we've talked about in the series.

05:08 Remember what that one is? Did you guess that transverse fracture across the femur.

05:16 It's very atypical, but some patients on biphosphonates are at risk for that to happen.

05:22 So the good things about biphosphonates, it can help us reduce bone pain for our clients.

05:27 So it clearly improves their quality of life.

05:30 And it reduces or it relays delays, the skeletal complications, like those vertebral compression fractures that we talked about.

05:38 That's a very long way to say we can reduce a patient's bone and make them stronger than if they hadn't received biphosphonates.

05:47 Okay, I have a lot of information here.

05:50 Pause and jot yourself a couple notes that you want to add about how do biphosphonates work? What do they do to osteoclast? What they do to osteoblasts? And what benefit are they to the patient's quality of life? Take a look at the picture that we have there for you.

06:10 We've got a stomach, we've got a circle around it where the esophagus is, and we've got a clock.

06:15 Why would we draw that with something like biphosphonate? Because we want to remind you of this really weird side effect, okay.

06:23 This seems to be an area that students see pop up on exams every once in a while.

06:28 biphosphonates can cause erosive esophagitis.

06:33 So that's why we put a stomach there with a circle around the esophagus.

06:37 If a patient lays down after taking the medication, then they can risk erosive esophagitis.

06:44 Now, if you haven't seen this in a patient, or if you haven't experienced it, it's brutal.

06:49 Okay. It's the worst sore throat you've ever had.

06:54 I mean, when you think about swelling, your own spit, you will cry, or at least want to cry.

06:59 Because it is really, really painful.

07:03 So we've got the esophagus there to remind you biphosphonates, watch for erosive esophagitis.

07:09 How can we prevent that? By educating our patients.

07:12 Let them know, "Hey, this isn't a good medication for you to take at bedtime.

07:17 Because most of us lie down when we're going to sleep.

07:20 You don't want to take the biphosphonate at nighttime." Well, do patients take medications at nighttime? Yeah, all the time.

07:28 You may not be aware of this.

07:29 But no matter what the medication is, if it's once a day, oftentimes patients have gotten the habit of putting their medication bottle by their toothbrush and they take it at night.

07:38 So don't assume that everyone takes medication the same time, you would.

07:42 So super important.

07:44 Make sure your patient knows at least 30 minutes.

07:47 You don't want to lie down after taking this medication.

07:50 I would want to wait longer than that, because I don't want to risk it.

07:54 But that is the minimum, that they cannot lie down after taking this medication, or biphosphonate.

08:01 This group of patients is at risk if they take biphosphonates.

08:05 So why don't we have a kidney with a big line through it.

08:08 But what's different about that kidney? Yeah, it's got two band aids.

08:12 We wanted to remind you, you don't want a patient to take biphosphonates, who has significant renal failure. Why? Because it's the kidneys that excrete the drug.

08:22 That's the primary mode of excretion.

08:24 So if a patient has severe renal failure, and we give them biphosphonates, they're going to end up toxic on that medication because their body just can't get rid of it.

08:35 So as you're preparing for your test, and more important to me, as you're preparing for real life practice, these are important things to teach your patient.

08:44 These are things for you to be aware of that if your patient develops renal failure, you would hold this medication and contact the healthcare provider.

08:55 Now, this drug is just fun to say. Denosumab.

08:59 I love that one.

09:01 It's kind of fun, but not some fun for the patient.

09:03 Now, this has similar bone density results of biphosphonates.

09:07 But you have to give it by injection.

09:10 And most people are not big fans have that right? So it's injection every six months, which is why we put the number six there just to help you remember.

09:20 So biphosphonates can be taken an oral route.

09:23 Denosumab is an injection and it's done every six months.

09:27 Now, this may not be something that you can discontinue.

09:31 Here's why.

09:32 If a patient discontinued this medication that might increase their risk of spinal column fractures.

09:39 So this may be a medication that once they start taking it every six months, they're going to continue to have to take it every six months for the rest of their life.