NAPLEX Question of the Week: Osteoporosis

Osteoporosis is a very common condition treated in clinical practice as the morbidity associated with a fracture, especially a hip fracture, is tremendous. Today's question focuses on knowing frequency of dosing of common agents.

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Rank the following agents in order of most frequent dosing to least frequent dosing when treating osteoporosis.

A. Evista

B. Boniva

C. Prolia

D. Reclast

Answer with rationale: The correct answer is A-B-C-D. There are a number of agents involved in the treatment of osteoporosis with a variety of dosage frequencies given orally, IV, and SQ. Answer A is first as Evista (raloxifene) is dosed once daily. It is not a first line agent due to lack of data demonstrating hip fracture prevention. Next is Boniva which is a bisphosphonate that can be dosed once monthly (orally) or IV q 3 months. Bisphosphonates are typically first line options for osteoporosis due to excellent data demonstrating decreased overall fracture risk including hip fractures. Boniva however is not a first line option compared to other bisphosphonates as its data for hip fracture prevention is not as robust as others such as alendronate. Next is Prolia (denosumab) which is dosed 60mg SQ q 6 months. Finally Reclast (zoledronic acid) is dosed once yearly for the treatment of osteoporosis (every 2 years for prevention). Zoledronic acid is also used for other indications such as multiple myeloma and hypercalcemia of malignancy under the brand name Zometa.

Christopher M. Bland

Clinical Professor, University of Georgia College of Pharmacy

Dr. Christopher M. Bland is a Clinical Professor at the University of Georgia College of Pharmacy at the Southeast GA campus in Savannah, GA. Dr. Bland has over 20 years of academic and clinical experience in a number of clinical areas. He is a Fellow of both the Infectious Diseases Society of America as well as the American College of Clinical Pharmacy. He is co-founder of the Southeastern Research Group Endeavor, SERGE-45, with over 80 practitioners across 14 states involved. Dr. Bland serves as Associate Editor for the NAPLEX Review Guide 4th edition as well as Editor-In-Chief for the Question of the Week. He has provided live, interactive reviews for more than 10 Colleges/Schools of Pharmacy over the course of his career.