Supportive care

Question 1

Bisphosphonate mechanism of action

Answer 1

• attach to and enter osteoclasts where they disrupt intracellular enzymatic functions needed for bone resorption
• more specifically – binding and blocking the enzyme farnesyl diphosphate synthase (FPPS) in the HMG-CoA reductase pathway

Question 2

Denosumab mechanism of action

Answer 2

Inhibits maturation of osteoclasts by binding to and inhibiting RANKL.

Question 3

Denosumab SE to know

Answer 3

Rebound increase in bone fracture risk when stopping

Question 4

Denosumab and renal function

Answer 4

• not contraindicated for CrCl less than 30 but does now carry a black box warning for severe hypocalcemia for CrCL less than 30

Question 5

Denosumab dosing

Answer 5

120 mg every 4 weeks