Bisphosphonates

Question 1

MoA

Answer 1

Slows rate of bone growth and dissolution by absorbing onto the hydroxyapatite crystals in bone.

Question 2

Drugs of choice

Answer 2

Alendronic acid
Risendronate sodium

Question 3

Others

Answer 3

Ibandronic acid
Sodium clodronate

Question 4

Choice for bone metastases in breast cancer/severe hypercalcaemia of malignancy

Answer 4

Pamidronate (IV)
Zolendronic acid
- IV
- most potent
- highest risk of osteonecrosis of jaw

Question 5

Counselling - alendronic acid

Answer 5

70 mg weekly OR 10 mg daily
- Swallow whole with plenty of water
- Whilst standing or sitting upright
- On an empty stomach, 30 minutes before breakfast or other meds
- Remain upright 30 mins after

Question 6

Risendronate

Answer 6

35 mg weekly OR 5 mg daily
Can be taken like alendronic acid or at any time or day
- 2 hour gap between risendronate and food, drink, antacids, calcium containing products e.g. milk, iron or mineral supplements.
- Stand or sit upright for 30 mins
- Avoid at bedtime/before rising.

Question 7

Side effects

Answer 7

Oesophageal reactions
Atypical femoral fractures
Osteonecrosis of jaw
Osteonecrosis of auditory canal

Question 8

Oesophageal reactions

Answer 8

• Oesophagitis
• Strictures
• Ulcers
• Erosions

Pt counselling = stop and report dysphagia, new or worsening heartburn or retrosternal pain

Question 9

Atypical femoral fractures

Answer 9

• Greater risk with long term therapy
• Review after 5+ years use

Pt counselling = report hip, thigh or groin pain

Question 10

Osteonecrosis of jaw

Answer 10

Pt counselling = report any oral symptoms to a dr/dentist
- Before starting = dental checkup + necessary remedial dental work.
- Good oral hygiene and routine dental checkups

Question 11

Dental symptoms

Answer 11

Dental mobility
Pain
Swelling
Non-healing sores
Discharge

Question 12

Osteonerosis of jaw - HIGH RISK

Answer 12

Zoledronic acid!!!
Also high risk with IV administration in malignancy

Question 13

IV bisphosphates

Answer 13

Patient reminder card
Inform of risk
Advise patients to inform their dr/dentist they are taking IV bisphosphonates
Ensure dentures fit properly

Question 14

Osteonecrosis of auditory canal

Answer 14

Long-term therapy - 2+ years

Pt counselling = report ear pain, discharge or infection

Question 15

Osteonecrosis of auditory canal - risk factors

Answer 15

Ear operation
Chemo
Steroid use
Cotton bud use