Bisphosphonates

Question 1

Indications

Answer 1

1 Alendronic acid is used as the first-line treatment for patients at risk of pathological fractures.

2. Pamidronate and zolendronic acid are used in the treatment of severe hyperglycaemia of malignancy after IV rehydration
3. For patients with myeloma and breast cancer with bone metastases, pamidronate and zolendronic acid reduce the risk of pathological fractures.
4. Metabolically-active Paget’s disease

Question 2

Mechanism of action

Answer 2

Reduce bone turnover by inhibiting the action of osteoclasts, the cells responsible for bone resorption.

Question 3

Adverse effects

Answer 3

Oesophagitis
Hypophosphataemia
Osteonecrosis of jaw

Question 4

Warnings

Answer 4

Renally excreted

Contraindicated in hypocalcaemia

Question 5

Interactions

Answer 5

Bisphosphonates bind calcium so their absorption is reduced if they are taken with calcium.

Question 6

Prescribing

Answer 6

Alendronic acid orally once weekly for oseoporosis

IV infusions are used for severe mets

Question 7

Administration

Answer 7

Poor oral absorption enhanced by correct administration (30 mins before food, patient to remain upright for 30 mins)

Question 8

Communication

Answer 8

The medicine is meant to help strengthen bones.

Question 9

Monitoring

Answer 9

Check and replace calcium and vit D before treatment for osteoporosis.

Monitor efficacy using DEXA every 2 years