Safety of Bisphosphonates in the Treatment of Osteoporosis

School of Medicine, Creighton University, Omaha, Nebraska, USA.
The American journal of medicine (Impact Factor: 5). 03/2009; 122(2 Suppl):S22-32. DOI: 10.1016/j.amjmed.2008.12.004
Source: PubMed


In this review 4 experts consider the major safety concerns relating to bisphosphonate therapy for osteoporosis. Specific topics covered are skeletal safety (particularly with respect to atypical fractures and delayed healing), gastrointestinal intolerance, hypocalcemia, acute-phase (i.e., postdose) reactions, chronic musculoskeletal pain, renal safety, and cardiovascular safety (specifically, atrial fibrillation). (C) 2009 Published by Elsevier Inc. The American Journal of Medicine (2009) 122, S22-S32

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    • "In these two controlled studies, the profile was safe, with a number of serious adverse events or deaths not significantly different in the groups treated with ZA or with PBO. A major problem with ZA was the postinfusion syndrome, which is classical with all intravenous BP following the first infusion, usually mild, and can be reduced by acetaminophen [66]. Intriguingly, an unexpected number of episodes of atrial fibrillation described as severe adverse events occurred in the ZA-treated group. "
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    ABSTRACT: During the past 2 decades, many interventions were proven effective in the management of postmenopausal osteoporosis. The objective of an anti-osteoporosis treatment is to reduce fracture rates, ideally at all skeletal sites (i.e. spine, hip, and other non-spine). The armamentarium against osteoporosis includes anti-resorptive agents (i.e. bisphosphonates, selective estrogen receptor modulators and denosumab), bone-forming agents (i.e. peptides from the parathyroid hormone family) and one agent with a dual mechanism of action (i.e. strontium ranelate). All these medications combine anti-fracture efficacy with a reasonable benefit/risk profile. However, the choice of a particular chemical entity, in one individual patient is based on the knowledge and expertise of the physician. Prioritization of drugs should be based on the individual profile of the patient, the severity of osteoporosis and the specific contraindications, warnings and precautions of use of the various available medications.
    Full-text · Article · Dec 2014 · Best Practice & Research: Clinical Endocrinology & Metabolism
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    • "Bisphosphonates taken orally, once a week or once a month, include alendronate (Fosamax), ibandronate (Boniva), and risedronate (Actonel). Bisphosphonates given through a vein (intravenously) are taken less often (Gass and Dawson-Hughes, 2006; Recker et al., 2009; Society, 2003). Bisphosphonates inhibit bone resorption and are therapeutically effective in diseases of increased bone turnover, such as Paget's disease and hypercalcemia of malignancy (Hughes et al., 1995). "
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    ABSTRACT: Osteoporosis is one of the most common bone diseases that occur due to imbalance during bone formation and bone resorption. About half of all women over the age of 50 will have a fracture on the hip, wrist, or vertebra. Research and treatment of osteoporosis are challenging for researchers and physicians. There are several types of treatments for osteoporosis including most famous bisphosphonates, estrogen agonists/antagonists, parathyroid hormone, estrogen therapy, hormone therapy, and recently developed RANKL inhibition. In the recent days, much attention has been paid for marine algal extracts and compounds for osteoporosis treatment. In this chapter, we extensively deal with marine algae compounds and their rich mineral constituents for osteoporosis treatment.
    Full-text · Article · Dec 2011 · Advances in food and nutrition research
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    • "Hypocalcemia, usually subclinical but sometimes symptomatic, with associated increases in serum PTH levels, has been observed with the use of potent antiresorptive agents, including bisphosphonates62 and denosumab.29 "
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    ABSTRACT: Denosumab is a fully human monoclonal antibody to receptor activator of nuclear factor kappa-B ligand (RANKL), a cytokine member of the tumor necrosis factor family that is the principal regulator of osteoclastic bone resorption. Postmenopausal osteoporosis (PMO) is a systemic skeletal disease associated with high levels of RANKL, resulting in a high rate of bone remodeling and an imbalance of bone resorption over bone formation. By inhibiting RANKL in women with PMO, denosumab reduces the rate of bone remodeling, thereby increasing bone mineral density, improving bone strength, and reducing the risk of fractures. In clinical trials of women with osteoporosis and low bone mineral density, denosumab has been well tolerated, with overall rates of adverse events and serious adverse events in women treated with denosumab similar to those receiving placebo. In the largest clinical trial of denosumab for the treatment of women with PMO, there was a significantly greater incidence of cellulitis reported as a serious adverse event, with no difference in the overall incidence of cellulitis, and a significantly lower incidence of the serious adverse event of concussions with denosumab compared with placebo. The evidence supports a favorable balance of benefits versus risks of denosumab for the treatment of PMO. Assessments of the long-term safety of denosumab are ongoing. Denosumab 60 mg subcutaneously every 6 months is an approved treatment for women with PMO who are at high risk for fracture.
    Preview · Article · Dec 2011 · Drug, Healthcare and Patient Safety
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