Bisphosphonates

Question 1

Indications for Bisphosphonates

Answer 1

1- Hypercalcemia
2- prevention of skeletal events (pathological fractures and need for radiotherapy)
3- Management of bone pain (no clear benefit in research and not strongly supported)

Question 2

Contraindications for Bisphosphonates

Answer 2

1- renal impairment is a relative contraindication

risk lessens with hydration and lower dose

Question 3

Dosing of Bisphosphonates

Answer 3

1- Clodronate PO 1600 mg OD
2- Clodronate IV/SC - 1500 mg every 2-3 weeks
(the only one SC)
3- Pamidronate 90 mg IV every 4-6 weeks
4- Zoledronic acid 4 mg every 4-6 weeks (shortest infusion time: 15-30 mins)

Question 4

Which malignancies should Bisphosphonates be used in mts to bone?

Answer 4

1- Multiple myeloma
2- Breast Cancer
(in these 2 - reduce skeletal events by 30%)
3- Prostate cancer (specifically Zoledronic acid)
Other malignancies might also benefit like: lung and colon, there is not sufficient clinical data.

Question 5

Side effects of Bisphosphonates?

Answer 5

1- flu-like symptoms for a few days
2- Renal impairment (2-4%)
3- Esophagitis (in PO form)
4- Osteonecrosis of the jaw (reported with pamidronate and zoledronic acid)