Bisphosphonates

Question 1

What contraindications should be excluded before prescribing bisphosphonates?

Answer 1

• Pregnancy
• Dysphagia/abnormalities of the oesophagus
• Recent peptic ulcer
• Significant renal impairment
• Unable to sit upright for 30 mins

Question 2

How would you explain the MOA of bisphosphonates to a patient?

Answer 2

• Prevents bone from being broken down and helps to rebuild new bone
• Lifestyle factors can also help with this such as exercise, not smoking (can help with this), and eating a well-balanced diet

Question 3

How should bisphosphonates be taken?

Answer 3

• Once daily or once weekly tablet
• Swallow tablet with a full glass of water
• Take at least 30 minutes before food or anything other than water
• Be upright for 30 minutes after swallowing
• Taken long-term

Question 4

What monitoring is required with bisphosphonates?

Answer 4

Correct disturbances of calcium and mineral metabolism (e.g. vitamin-D deficiency, hypocalcaemia) before starting treatment.

Monitor serum-calcium concentration during treatment.

Regular dental check-ups (risk of osteonecrosis of the jaw)

Question 5

What side effects of bisphosphonates should patients be made aware of?

Answer 5

• Headache
• Heartburn, bloating, indigestion
• GI (diarrhoea/constipation, abdominal pain)
• Seek urgent medical advice if symptoms of osteonecrosis of jaw, dysphagia/odynophagia, upper GI bleeding/black stools