ChemInform Abstract: Adverse Reactions and Drug-Drug Interactions in the Management of Women with Postmenopausal Osteoporosis

Division of Bone Disease, Department of Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
Calcified Tissue International (Impact Factor: 3.27). 06/2011; 89(2):91-104. DOI: 10.1007/s00223-011-9499-8
Source: PubMed


The pharmacological management of disease should involve consideration of the balance between the beneficial effects of treatment on outcome and the probability of adverse effects. The aim of this review is to explore the risk of adverse drug reactions and drug-drug interactions with treatments for postmenopausal osteoporosis. We reviewed evidence for adverse reactions from regulatory documents, randomized controlled trials, pharmacovigilance surveys, and case series. Bisphosphonates are associated with gastrointestinal effects, musculoskeletal pain, and acute-phase reactions, as well as, very rarely, atrial fibrillation, atypical fracture, delayed fracture healing, osteonecrosis of the jaw, hypersensitivity reactions, and renal impairment. Cutaneous effects and osteonecrosis of the jaw are of concern for denosumab (both very rare), though there are no pharmacovigilance data for this agent yet. The selective estrogen receptor modulators are associated with hot flushes, leg cramps, and, very rarely, venous thromboembolism and stroke. Strontium ranelate has been linked to hypersensitivity reactions and venous thromboembolism (both very rare) and teriparatide with headache, nausea, dizziness, and limb pain. The solidity of the evidence base depends on the frequency of the reaction, and causality is not always easy to establish for the very rare adverse reactions. Drug-drug interactions are rare. Osteoporosis treatments are generally safe and well tolerated, though they are associated with a few very rare serious adverse reactions. While these are a cause for concern, the risk should be weighed against the benefits of treatment itself, i.e., the prevention of osteoporotic fracture.

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    • "With the aging of the world's population , osteoporosis has become a serious global health problem. Several drugs are used to reduce bone loss in osteoporosis, including oestrogen, bisphosphonates, and parathyroid hormone, and many studies show that longterm use of these drugs might cause many adverse reactions , such as increasing the risk of endometrial and ovarian cancer [2] [3], atypical femoral fractures [4], osteonecrosis of the jaw [5], venous thromboembolism [6], and nervous system disorders [7]. Consequently, it is necessary to develop an alternative with promising efficiency and fewer undesirable side effects to prevent or reverse postmenopausal osteoporosis. "
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    • "Because rats and humans share similarities in skeletal responses to estrogen deficiency, the mature OVX rat is considered to be a suitable animal model for studying early postmenopauseinduced bone loss [4]. Estrogen, bisphosphonates, parathyroid hormone (PTH), or selective estrogen receptor modulators (SERMs) have been used to prevent the postmenopausal bone loss [5], but many lines evidence indicate that long-term treatments with those drugs might cause adverse reactions, such as an increased risk of ovarian and endometrial cancer [6– 9], osteonecrosis of the jaws [10], nervous system disorders [11], and venous thromboembolism [12]. Thus, an alternative therapeutic strategy with a proven efficacy and safety should be developed to prevent and treat osteoporosis. "
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