Bisphosphonates

Background

• Analogues of inorganis pyrophosphate.  Inhibit bone resorption by inducing apoptosis of osteoclasts (>osteoblasts)
  • Used in the treatment of osteoporosis (including secondary to steroid use) (mainly alendronate) as well as Paget’s (risedronate) and bone destruction due to malignancy

Side effects/safety

• GI adverse effects (mainly oesophagitis; also gastritis, dyspepsia, oesophageal reflux, nausea, abdominal pain, diarrhoea)
  • Recommend taking with a large glass of water either sitting up or standing; no food or other medications should be taken around that time if at all possible
  • Contraindicated if there are oesophageal motility disorders; inability to stand or sit upright; hypocalcaemia- (this must be corrected prior to starting)
    • Most patients on bisphosphonates should be co-prescribed calcium and vit D supplementation
• Musculoskeletal pain, rash and headache are not uncommon
• Uveitis/Iritis is a rare side effect
• Osteonecrosis of the jaw is a very rare but serious side effect (more likely in patients on high doses e.g. cancer patients)
  • Dental procedures must be considered with caution
• Atypical fractures (particularly of the hip) are also rare but serious, and patients who develop new hip/tight/groin/leg pain should be considered for an x-ray to evaluate this possibilit
• NB IM injection may cause flu-like illness- co-prescribe paracetamol or ibuprofen may help

Measure bone mass density at 3-5 years

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