ENDO + REPRO: BISPHOSPHONATES

Question 1

BISPHOSPHONATES: INDICATIONS

Answer 1

• Osteoporotic fragility fractures (AA)
• Severe hypercalcemia of malignancy (P+Z)
• Myeloma and BC with bone mets (P+Z) reduce the risk of pathologic fractures
• Pagets Dx

Question 2

BISPHOSPHONATES: MOA

Answer 2

• Bisphosphonates reduce bone turnover by inhibiting the action of osteoclasts
• Bisphosphonates have a similar structure to naturally occurring pyrophosphate, hence are readily incorporated into bone
• As bone is resorbed, bisphosphonates accumulate in osteoclasts, where they inhibit activity and promote apoptosis
• The net effect is reduction in bone loss and improvement in bone mass.

Question 3

BISPHOSPHONATES: ADVERSE EFFECTS

Answer 3

• Oesophagitis
• Hypophosphatemia
• Osteonecrosis of the jaw
• Atypical femoral fracutre

Question 4

BISPHOSPHONATES: WARNINGS

Answer 4

• Renally excreted drugs so should be avoided in those with:
• Severe renal impairment
• CI in context of hypocalcemia
• Upper GI disorders
• Care exercised in smokers and major dental dx

Question 5

BISPHOSPHONATES: INTERACTIONS

Answer 5

• Bind calcium, so effect is reduced in those taking calcium salts as well as antacids and iron salts

Question 6

BISPHOSPHONATES: EXAMPLES

Answer 6

• alendronic acid
• disodium pamidronate
• zoledronic acid