All::Rheumatology::Pharmacology::Bisphosphonates
Intro
What is the mechanism of action of bisphosphonates in bone?
Bisphosphonates inhibit osteoclasts by reducing recruitment and promoting apoptosis, mimicking the action of pyrophosphate.
What are the clinical uses of bisphosphonates?
Prevention and treatment of osteoporosis, hypercalcaemia, Paget's disease, and pain from bone metastases.
What are the adverse effects associated with bisphosphonates?
Oesophageal reactions (oesophagitis, ulcers), osteonecrosis of the jaw (higher risk with IV use in cancer treatment), atypical stress fractures (especially with alendronate), and acute phase response.
What counseling is recommended for patients taking oral bisphosphonates, according to the BNF?
Tablets should be swallowed whole with plenty of water on an empty stomach, at least 30 minutes before breakfast, and the patient should remain upright for at least 30 minutes after taking the tablet.
When should hypocalcemia/vitamin D deficiency be corrected before giving bisphosphonates?
Hypocalcemia/vitamin D deficiency should be corrected before giving bisphosphonates. However, calcium is only prescribed when starting bisphosphonate treatment for osteoporosis if dietary intake is inadequate.