Bisphosphonates

Question 1

What are the 5 main types of oral bisphosphonates

Answer 1

Alendronate 
Sodium clodronate 
Disodium etidronate 
Ibandronate 
Risedronate

Question 2

What are the three types of IV bisphosphonates

Answer 2

Ibandronate (can also be given orally)
Disodium pamidronate
Zoledronic acid

Question 3

How often is zoledronic acid given and at what dose

Answer 3

5mg once yearly as a single dose

Question 4

Before the first infusion of zoledronic acid what do you coprescribe

Answer 4

Vitamin D 50000-125000units

Question 5

What are the three huge complications to consider with bisphosphonates

Answer 5

Atypical femoral fractures (advise patients to report any thigh hip or groin pain)
Osteonecrosis of the jaw (patients should be given a patient reminder card and informed of the risk)
Osteonecrosis of the external auditory canal (usually in patients who have had treatment for two years or longer - patients should be advised to report any ear pain discharge or infection during treatment)

Question 6

What increases the risk of osteonecrosis of the jaw

Answer 6

IV greater risk than oral
Zoledronic acid worse
Smoking can increase this risk

Question 7

Risk factors for developing osteonecrosis of the external auditory canal

Answer 7

Steroid use 
Chemo 
Infection 
Ear op
Cotton bud use

Question 8

What is the huge caution to consider with bisphosphonates

Answer 8

Oesophageal disease or upper GI bleeding

Also consider bleeding risk

Question 9

What are three specific cautions specific to zoledronic acid

Answer 9

Atypical Femoral fractures
Cardiac disease (avoid fluid overload)
Coprescribing with meds that affect renal fn

Question 10

When are bisphosphonates contraindicated

Answer 10

Hypocalcaemia

Oesophageal problems

Question 11

What is the typical dose of aledronate for osteoporosis

Answer 11

10mg daily or women can have 70mg weekly

Question 12

If preventing osteoporosis in people on steroids what is the dose of aledronate

Answer 12

10mg daily

Question 13

What are the monitoring requirements for bisphosphonates

Answer 13

Treat calcium and vitamin d deficiency before treatment then monitor serum calcium levels during treatment

Question 14

How should a patient take a bisphosphonates

Answer 14

Swallow whole

Plenty of water while sitting or standing on an empty stomach at least 30 mins before breakfast