BISPHOSPHONATES

Question 1

What are they?

Answer 1

are analogues of pyrophosphate, a molecule which decreases demineralisation in bone. They inhibit osteoclasts by reducing recruitment and promoting apoptosis.

Question 2

clinical uses

Answer 2

prevention and treatment of osteoporosis
hypercalcaemia
Paget’s disease
pain from bone metatases

Question 3

adverse effects

Answer 3

oesophageal reactions

osteonecrosis of the jaw

atypical stress fractures of proximal femoral shaft - alendronate

acute phase response - fever, myalgia and arthralgia

hypocalcaemia

Question 4

what should be corrected before taking bisphosphonates?

Answer 4

Hypocalcemia/vitamin D deficiency

Question 5

duration

Answer 5

5 years but depends on several factors:

patient is < 75-years-old
femoral neck T-score of > -2.5
low risk according to FRAX/NOGG