Adverse Effects of Bisphosphonates: Implications for Osteoporosis Management

Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN 55905, USA.
Mayo Clinic Proceedings (Impact Factor: 5.81). 08/2009; 84(7):632-7; quiz 638. DOI: 10.1016/S0025-6196(11)60752-0
Source: PubMed

ABSTRACT Bisphosphonates are widely prescribed and highly effective at limiting the bone loss that occurs in many disorders characterized by increased osteoclast-mediated bone resorption, including senile osteoporosis in both men and women, glucocorticoid-associated osteoporosis, and malignancies metastatic to bone. Although they are generally well tolerated, potential adverse effects may limit bisphosphonate use in some patients. Optimal use of bisphosphonates for osteoporosis requires adequate calcium and vitamin D intake before and during therapy. The World Health Organization fracture risk assessment algorithm is currently available to determine absolute fracture risk in patients with low bone mass and is a useful tool for clinicians in identifying patients most likely to benefit from pharmacological intervention to limit fracture risk. This fracture risk estimate may facilitate shared decision making, especially when patients are wary of the rare but serious adverse effects that have recently been described for this class of drugs.

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    ABSTRACT: Osteoporosis is a progressive bone disease that is characterized by a decrease in bone mass and density and deterioration of bone structure which can lead to bone fragility which might increase the risk of fracture. Fractures can be prevented by using osteoporosis drugs. This will save society from accommodation expenses in the hospital, nursing homes and save patients from the loss of quality of life and premature death. Various therapies are available for osteoporosis. The most common are bisphosphonates, raloxifene, calcitonin, teriparatide and denosumab. Bisphosphonates are a widely utilized class of drugs used in the management of disorders of calcium and bone metabolism. The major disadvantage concerning clinical use of bisphosphonate drugs is their poor and variable absorption after oral administration. Therefore, several strategies have been developed to increase their intestinal absorption either by changing the permeability properties of the intestinal absorptive cells or by modifying the structure of the drug through altering the physicochemical properties of the drug itself. Raloxifene is the only selective estrogen receptor modulator that was approved worldwide for the prevention and treatment of postmenopausal osteoporosis, but its low bioavailability limited its use. It has been well established that calcitonin when administered by parental or intranasal routes are effective in preventing postmenopausal bone loss. Recently, oral formulation of calcitonin has been developed to enhance its clinical usefulness and many attempts have been made to enhance its oral bioavailability. The recombinant human parathyroid hormone fragment, rhPTH(1-34) (teriparatide), is a potent anabolic agent used in the treatment of postmenopausal with severe osteoporosis, as well as for persons with established glucocorticoid-induced osteoporosis who are receiving long term glucocorticoids. Teriparatide was shown to reduce fracture risk and is now available for the treatment of patients with osteoporosis who are at high risk of fracture due to its ability to stimulate osteoblast activity to a greater extent than osteoclast. Denosumab offers an alternative approach for the treatment of osteoporosis by decreasing bone resorption and increasing bone mineral density through the inhibition of receptor activator of nuclear factor kappa-B ligand (RANKL).
    Commonly Used Drugs - Uses, Side Effects, Bioavailability & Approaches to Improve it, 1 edited by Rafik Karaman, 01/2015: chapter 7: pages 219-247; Nova Science Publishers., ISBN: 978-1-63463-828-9
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    ABSTRACT: Drugs (medicines) are considered either the primary therapy or an adjunct to another modality. Physicians of all specialties prescribe drugs on a daily basis, and therefore they need to understand the mode and action by which drugs exert their therapeutic effects. Written records of the use of natural products as medicinal agents date back thousands of years. However, it was not until the early 1800s that the active principles from plants were isolated. Since then thousands of drugs have been introduced to the drugs market. With advances in drug design, molecular biology and genetics, the rate of developing new potent drugs is accelerated. Due to the vast progress in drug development and discovery, medical and pharmacy students, doctors, nurses and pharmacists in training need to learn the principles of therapeutics in order to follow up with the frequent changes in the therapeutics and adapt to them. With contributions from some of my colleagues, this book provides a clear and concise overview of the most important commonly used drugs with emphasis on the pharmacology aspects necessary for a basic understanding of the subject. It reviews the concepts, clinical applications, dosage forms, bioavailability, pharmacokinetics and side effects of a large number of drugs used to alleviate pain, lower cholesterol levels, and treat bacterial infections, diabetes, osteoporosis, bleeding, psoriasis and multiple Sclerosis. This book, with over 750 references, is an excellent pharmacology text for the student who is looking to broaden his/her strengths prior to the exam. The beauty of this text is that it includes essential pharmacology concepts in a compact book that can be quickly referenced and read multiple times during the course of a student's studies. In addition, this guide assists scientists trained in molecular biology, medicinal chemistry and related fields who need to know the basic theories, principles and practical applications of pharmacology. With the addition of pharmacokinetics coverage, ways to improve the bioavailability of commonly used drugs and sections on therapeutics that will help readers identify with diseases and drug treatments, this book provides better preparation of researchers in the basics of pharmacology.
    1 edited by Rafik Karaman, 01/2015; Nova Science Publishers, Inc., NY, USA., ISBN: 9781634638289
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    The Human Mission to Mars: Colonizing the Red Planet, Edited by Joel S. Levine, Rudy E. Schild, 01/2010: chapter 48: pages 803-849; Cosmology Science Publishers, Cambridge, MA., ISBN: 0982955235

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