Bisphosphonates Flashcards
What are examples of bisphosphonates?
- Alendronate
- Risedronate
- Pamidronate
- Zolindronate
What are indications for bisphosphonate use?
- Osteoporosis (treatment and prevention)
- Paget’s disease of bone
- Treatment of hypercalcaemia of malignancy
- Treatment of bony metastases (pain reduction and fracture prevention)
What contraindications would you want to check for when using bisphosphonates?
- Oesophageal abnormalities which prolong emptying time (e.g. stricture or achalasia)
- Hypocalcaemia
- Pregnancy and breast-feeding
- Peptic ulcers
- Significant renal impairment
- Unable to sit upright for 30 minutes
When would you want to be cautious when using Bisphosphonates?
- Upper GI disorders
- Renal impairment
What is the mechanism of action of bisphosphonates?
Analogues of pyrophosphate, which are incoporated into bone where they can exert their action. They interfere with osteoclasts by blocking the mevalonate pathway, acting to reduce bone resorption. The overall effect is an arrest in bone loss
Why are bisphosphonates used in malignancy?
Increased osteoclast activity is seen due to PTH-related peptide or metastasis to bone. This activity is reduced by bisphosphonates
What are adverse reactions to bisphosphonates?
- Gastrointestinal disturbance
- Gastric and oesophageal ulceration
- Renal toxicity (ensure adequate hydration)
- Rarely - rash, pruritis, erythema, photosensitivity, uveitis, scleritis
- Hypophosphataemia
- Osteonecrosis of jaw is rare but serious (normally only occurring if given IV)
What drugs can bisphosphonates react with?
- Calcium salts
- NSAIDs
How should individuals take bisphosphonates?
Once/twice daily tablet - Standing upright, on an empty stomach and with plenty of water, not before bed. Need to be upright for 30 mintues following ingestion. Adequate Vit D and calcium supplementation are needed
What monitoring would you consider doing in someone with osteoporosis who was receiving bisphosphonates?
DEXA bone scan annually
What things would you monitor in terms of safety for use of bisphosphonates?
- Symptoms of adverse side effects
- Calcium and phosphate levels
What monitoring would you want to do in someone using bisphosphonates?
Regular dental check ups - osteonecrosis of the jaw
What are GI symptoms which you would advise someone to watch out for in someone using bisphosphonates?
- Diarrhoea/constipation
- Abdominal pain
