Biphosphonates

Question 1

indications for bisphosphonates

Answer 1

osteoporosis,
high fracture risk,
hypercalcemia, metastatic bone disease,
paget’s disease,

Question 2

pharmacodynamics of bisphosphonates

Answer 2

inhibit (reducing) bone reabsorption by reducing osteoclast (chewing) number and function

Question 3

bisphosphonates education

Answer 3

poorly absorbed orally. best to take on empty stomach with water.
stay upright for 60 minutes.
can cause gastritis and gastric irritation.

Question 4

contraindications of bisphosphonates

Answer 4

moderate to severe kidney disease.

hypocalcemia, delated esophageal emptying (stricture, achalasia), inability to sit upright, increase risk for aspiration.

avoid with CrCl under 35.
caution in upper GI pathology or bariatric surgery.

Question 5

adverse effets of bisphosphonates

Answer 5

atypical femur fracture(with longterm use.. >5 yrs), 
severe bone, 
joint muscle pain, 
upper GI irritation, 
hypocalcemia,
 jaw osteonecrosis (IV formulation).

discontinue before oral surgery.

Question 6

Risedronate (actonel)

Answer 6

inhibits bone reabsorption without inhibiting bone formation.
35 mg oral one a week
150 mg oral q month.

Question 7

Alendronate (fosamax)

Answer 7

highly selective inhibitor of bone reabsorption.

70 mg once a week

Question 8

ibandronate (boniva)

Answer 8

lack of evidence for prevention of hip fx

Question 9

zoledronic acid (reclast)

Answer 9

IV form. 5mg once yearly.
risk for renal toxicity. check CrCl before dose.

push fluids before and after each dose.

acetaminophen can be given after infusion to prevent flu like reaction.

Question 10

duration of bisphosphonate therapy

Answer 10

if fracture risk is high after 5 years, take a holiday.

can cause increased risk for atypical femur fracture.
ensure adequate calcium and vitamin D supplement while taking.