Bisphosphonates fractures

BMD will increase and the risk of fractures will decrease in women taking HRT. However, when therapy is discontinued, a decline in BMD will resume at the same rate as in women not on HRT. Therefore, therapy for osteoporosis prevention should be considered long term. Since HRT should be maintained only for the short term, alternative therapies such as bisphosphonates or raloxifene should be considered as first-line therapy for the prevention of postmenopausal osteoporosis, in addition to appropriate doses of calcium and vitamin D. Because of the risks associated with HRT, it should not be prescribed solely for the prevention of osteoporosis. 

Bisphosphonates are hrst-line therapy for postmenopausal osteoporosis owing to their established efficacy in preventing hip and vertebral fractures. 

For women whose breast cancer has metastasized to bone, bisphosphonates are recommended, in addition to chemotherapy or endocrine therapy, to reduce bone pain and fractures.28,64 Pamidronate (90 mg) and zoledronate (4 mg) can be given intravenously once each month. These bisphosphonates are given in combination with calcium and vitamin D. 

Bone disease is a common manifestation of multiple myeloma. Bisphosphonates should be initiated in symptomatic patients with bone lesions to slow osteopenia and reduce the fracture risk associated with the disease. Pamidronate and zolendronic acid have equivalent efficacy in the management of osteolytic lesions, but because of relative ease of administration, zolendronic acid is used most frequently.43 The use of zolendronic acid decreases pain and bone-related complications and improves quality of life. The suggestion that bisphosphonates have direct antimyeloma activity, based on the ability to inhibit NF-kB signaling, remains controversial. Recent cases of osteonecrosis of the jaw have been a major concern. Risk factors are unclear, but osteonecrosis of the jaw is more common in patients receiving intravenous administration of bisphosphonates and having dental procedures performed. It is recommended that patients... 

Of the antiresorptive agents available, bisphosphonates provide the greatest BMD increases and fracture risk reductions. Fracture reductions are demonstrated as early as 6 months, with the greatest fracture reduction seen in patients with lower initial BMD and in those with the greatest BMD changes with therapy. 

Raloxifene decreases vertebral fractures and increases spine and hip BMD, but to a lesser extent than bisphosphonates. After discontinuation, the beneficial effect is lost and bone loss returns to age- or disease-related rates. 

Teriparatide is FDA approved for postmenopausal women and men who are at high risk for fracture. Candidates for therapy include patients with a history of osteoporotic fracture, multiple risk factors for fracture, very low bone density (e.g., T-score <—3.5), or those who have failed or are intolerant of previous bisphosphonate therapy. 

Bisphosphonates such as pamidronate and zoledronic acid may prevent skeletal morbidity, such as pathologic fractures and spinal code compression, when used for hormone-refractory prostate cancer in patients with clinically significant bone loss. Usual dosages are pamidronate, 90 mg every month, and zoledronic acid, 4 mg every 3 to 4 weeks. 

Prevention of osteoporosis and fracture can be achieved through limiting the resorption-remodeling process. Four main families of products can be effective in controlling bone resorption estrogens, SERMs, bisphosphonates, and calcitonin. Large, prospective randomized trials have proven the effectiveness... 

When diet and exercise have not been adequate to maintain good bone mineral density, the bisphosphonates are frequently prescribed. These molecules are actually incorporated into bone where they inhibit the action of osteoclasts. The biochemical consequence is an improvement in bone mineral density over time and the clinical consequence is a lessened frequency of bone fractures. 

Fracture rate in osteoporosis Bone mineral density Bisphosphonates, HRT, etc. 

Once bone loss is sufficient to result in a compression fracture, pharmacological therapy is much less effective. However, even after fractures have occurred, the use of the bisphosphonates and rPTH has been shown to increase bone densities and reduce the rate of subsequent fractures. Nasal calcitonin (200 units daily) is effective in promoting fracture healing and also exhibits an analgesic effect by reducing pain in persons with acute lumbar compression fractures. Whatever compound is used for prophylaxis or treatment of osteoporosis, calcium and Ds supplementation are required for maximum benefit. 

These individuals have areas of increased bone resorption and other areas of abnormal new bone formation. The abnormal bone formation can result in pain, deformity, and fracture of affected bones. The bisphospho-nates and calcitonin are most commonly used in the treatment of this disease. Long-term continuous use of bisphosphonates can be associated with the induction of osteomalacia through a direct impairment of new bone formation. Therefore, the bisphosphonates are given in a cyclic pattern to treat Paget s disease. 

Teriparatide, the recombinant form of PTH 1-34, is approved for treatment of osteoporosis. Teriparatide is given in a dosage of 20 meg subcutaneously daily. Like fluoride, teriparatide stimulates new bone formation, but unlike fluoride, this new bone appears structurally normal and is associated with a substantial reduction in the incidence of fractures. Teriparatide is approved for use for only 2 years. Trials examining the sequential use of teriparatide followed by a bisphosphonate after 1 or 2 years are in progress and look promising. Giving teriparatide with a bisphosphonate has not shown greater efficacy than the bisphosphonate alone. 

Calcitonin is approved for use in the treatment of postmenopausal osteoporosis. It has been shown to increase bone mass and reduce fractures, but only in the spine. It does not appear to be as effective as bisphosphonates or teriparatide. 

Bisphosphonates are potent inhibitors of bone resorption. They increase bone density and reduce the risk of fractures in the hip, spine, and other locations. Alendronate, risedronate, ibandronate, and zoledronate are approved for the... 

Aromatase inhibitors increase bone turnover by near complete estrogen depletion, leading to reduced bone mineral density and an increased risk of fractures. Bisphosphonates plus calcium and vitamin D supplementation mitigate this (26). In an open, multicenter, randomized study in 602 women with early-stage breast cancer taking letrozole 2.5 mg/day, zoledronic acid 4 mg every 6 months prevented bone loss (27). 

Bisphosphonates are potent inhibitors of bone resorption. They increase bone density and reduce the risk of fractures in the hip, spine, and other locations. Alendronate and risedronate are approved for the treatment of osteoporosis, using either daily dosing schedules alendronate 10 mg/d, risedronate 5 mg/d or weekly schedules alendronate 70 mg/wk, risedronate 35 mg/wk. These drugs are effective in men as well as women and for various causes of osteoporosis. 

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