OSTEOPOROSIS-MANAGEMENT (BISPHOSPHONATES)

SUMMARY

1. Bisphosphonates (alendronate, risedronate, etidronate, zoledronate) inhibit osteoclastic bone resorption via a mechanism that differs from that of other antiresorptive agents.

2. Bisphosphonates attach to hydroxyapatite binding sites on bony surfaces, especially surfaces undergoing active resorption.

3. They must be taken in the morning with at least 8 oz of water 40 minutes prior to eating in an upright position to ensure proper absorption (Fitzgerald, 2014).

4. Oral side effects: abdominal pain, nausea, dyspepsia, difficulty swallowing, inflammation of the esophagus, and risk of ulceration, osteonecrosis of jaw, visual disturbances, and musculoskeletal pain.

5. IV side effects: flu-like symptoms, fever, muscle and joint pain, headache, osteonecrosis of jaw, visual disturbances.

6. Patients should have a dental review prior to instituting, to rule out dental abscesses or other pathologies.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].