Bisphosphonates

Question 1

Describe how bisphosphonates work

Answer 1

analogues of pyrophosphate (decreases demineralisation in bone)

• reduce recruitment of and cause apoptosis in osteoclasts (which normally break down bone)

Question 2

What are bisphosphonates used to treat?

Answer 2

osteoporosis
hypercalcaemia
Paget’s disease
pain from bone metastases

Question 3

Adverse effects of bisphosphonates

Answer 3

• oesophagitis/ oesophageal ulcers
• osteonecrosis of the jaw
  -increased risk of atypical stress fractures of the proximal femoral shaft (alendronate)
• acute phase response: fever, myalgia and arthralgia may occur following administration
• hypocalcaemia

Question 4

When should calcium/vitamin D be given in relation to starting bisphosphonates?

Answer 4

• Correct Hypocalcaemia/vitamin D deficiency before giving bisphosphonates
• In osteoporosis, calcium should only be prescribed if dietary intake is inadequate

Question 5

In what groups are bisphosphonates recommended to be stopped at 5 years?

Answer 5

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