Target Audience:

Who should attend:

• Clinical faculty from the University of Pittsburgh School of Pharmacy
• Clinical staff pharmacists employed by the University of Pittsburgh Medical Center and deployed throughout the hospital campus in unit based roles and centrally in the department of pharmacy's main pharmacy
• Student pharmacy interns currently working within the department of pharmacy
• Certified Pharmacy Technicians

Abstract
Osteoporosis is disease that results in approximately fifty-seven billion health care dollars (2018) and 1.6 million fractures among Medicare beneficiaries (2015) each year. Postmenopausal women are at an increased risk for developing osteoporosis and thus also at risk for having a life-ending or debilitating fracture. Oral bisphosphonates remain the mainstay of therapy and are the preferred first line agents for patients with osteoporosis. However, with administration difficulties and resulting low adherence rates, patients often see weakening of bones leading to fractures. The development of injectable agents for osteoporosis has been a substantial benefit for patients. Given the administration difficulties with oral bisphosphonates, the injectable agents (particularly zoledronic acid and denosumab) offer better adherence, low risk of side effects, and great outcomes with regards to reducing fracture risk and improving bone strength. Unfortunately, the 2020 AACE/ACE Osteoporosis guidelines and the 2020 Endocrine Society Osteoporosis guidelines are vague in their recommendations for second line agents in postmenopausal women who fail oral bisphosphonate therapy. There is limited data on the comparable safety and efficacy of zoledronic acid and denosumab. This presentation will review the literature relevant to choosing zoledronic acid versus denosumab in a postmenopausal woman previously treated with an oral bisphosphonate.

Educational Objectives:

Upon successful completion of this continuing pharmacy education program, the participant should be able to:

• Identify candidates for osteoporosis treatment  

• Recall the unique characteristics of denosumab and zoledronic acid and how these impact treatment decisions  .
• Develop a personal, evidence-based practice to recommend zoledronic acid or denosumab as second line osteoporosis treatment when presented with a post-menopausal woman previously treatment with oral bisphosphonates .

Pharmacy Continuing Education Credits In support of improving patient care, the University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. The assigned universal program number(s) is JA4008223-0000-23-107-H01-P.  This knowledge-based activity provides 1  contact hours of continuing pharmacy education credit.

Suggested Additional Reading & Joint Accreditation Statement - Note: This Accreditation Statement Supersedes All Other Statements:

Suggested Additional Reading

1. Camacho PM, Petak SM, Binkley N, et al. American association of clinical endocrinologists/American college of endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis 2020 update. Endo Practice. 2020; 26(1): 1-46.
2. Black DM, Delmas PD, Eastell R, et al. Once-yeary zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med. 2007; 356(18): 1809-22
3. Shoback D, Rosen CJ, Black DM, Cheung AM, Murad MH, Eastell R. Pharmacological management of osteoporosis in postmenopausal women: An Endocrine Society Guideline update. J Clin Endocrinol Metab. 2020; 105(3): 587-594.
4. Miller PD, Pannacciulli N, Brown JP, et al. Denosumab or Zoledronic acid in postmenopausal women with osteoporosis previously treated with oral bisphosphonates. J Clin Endocrinol Metab. 2016; 101(8): 3163-3170.
5. Miller PD, Pannacciulli N, Malouf-Sierra J, et al. Efficacy and safety of denosumab vs. bisphosphonates in postmenopausal women previously treated with oral bisphosphonates. Osteoporosis International. 2020; 31:181-191.
6. Choi NK, Solomon DH, Tsacogianis TN, Landon JE, Song HJ, Kim SC. Comparative safety and effectiveness of denosumab versus zoledronic acid in patients with osteoporosis: a cohort study. J Bone Miner Res. 2017; 32(3): 611-617.
7. Cummings SR, Martin JS, McClung MR, et al. Denosumab for Prevention of Fractures in postmenopausal women with osteoporosis. N Engl J Med. 2009; 361:756-765

Joint Accreditation Statement - this statement supersedes any other statement on this page
In support of improving patient care, the University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Pharmacy (CPE) This knowledge-based activity provides 1.0 contact hours of continuing pharmacy education credit.

Other Healthcare Professionals: Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.