Osteoporosis Therapy: Bisphosphonates

Question 1

Bisphosphonate drugs

Answer 1

Alendronate, risedronate, ibandronate, zolendronate

Question 2

Alendronate brand name

Answer 2

Fosamax, Binosto

Question 3

Risedronate brand name

Answer 3

Actonel, Atelvia

Question 4

Ibandronate brand name

Answer 4

Boniva

Question 5

Zolendronate brand name

Answer 5

Reclast

Question 6

Alendronate dosing

Answer 6

5-10mg PO QD, or 35-70mg PO weekly

Question 7

Risedronate dosing

Answer 7

IR: 5mg PO QD, 35mg PO weekly, 75mg on 2 consecutive days/month, or 150mg/month

DR: 35mg PO weekly

Question 8

Ibandronate dosing

Answer 8

2.5mg PO QD, 150mg PO monthly, 3mg IV every 3 months

Question 9

Bisphosphonate MoA

Answer 9

Inhibits osteoclast activity by binding to bone hydroxyapatite

Question 10

BP ADEs

Answer 10

Nausea/dyspepsia/transient influenza-like illness with injectable

Rare: ONJ, atypical fractures, GI perforation/ulceration/bleeding

Question 11

BP pearls

Answer 11

1st-line agents!
Half-life is 10 years
Poor PO F

Question 12

BP CI

Answer 12

CrCl <30-35 mL/min

Question 13

Alendronate and Risedronate IR counseling

Answer 13

Taken on an empty stomach with 8 oz. of water first thing in the morning, wait at least 30 minutes before eating/drinking, must remain upright for 30 minutes

Question 14

Risedronate DR counseling

Answer 14

Take with 4 oz. of water immediately after breakfast, remain upright for 30-60 minutes

Question 15

Ibandronate counseling

Answer 15

Same as alendronate and risedronate IR, but wait 60 minutes before eating/drinking and remain upright for 60 minutes