Osteoporosis alendronate

Osteoporosis (alendronate, risedronate, ibandronate) (alendronate/cholecalciferol treatment only) ... 

In men-To increase bone mass in men with osteoporosis (alendronate, alendronate/cholecalciferol). 

Osteoporosis (alendronate) Consider causes other than estrogen deficiency and aging consider glucocorticoid use. 

Osteoporosis Alendronate Raloxifene Reduced spine, hip, and wrist fractures Reduced spine fractures Alendronate Phase III FIT 1 and 2 MORE >15,000 18,19... 

Schnitzer T, Bone HG, Crepaldi G, et al. Therapeutic equivalence of alendronate 70 mg once-weekly and alendronate 10 mg daily in the treatment of osteoporosis. Alendronate Once-Weekly Study Group. Aging (Milano) 2000 12 1-12. 

The bisphosphonates deaease bone resorption and slow the progress of osteoporosis. Alendronate is effective for treatment of postmenopausal and steroid-induced osteoporosis. The principal potential side effects are gastrointestinal distress and esophageal ulcers. 

Alendronate, etidronate, and risedronate act primarily on the bone by inhibiting normal and abnormal bone resorption. This results in increased bone mineral density, reversing the progression of osteoporosis. 

Alendronate should be considered hrst-line treatment for primary osteoporosis in men owing to its proven benefit in reducing fractures and relative safety. 

Bisphosphonates Alendronate 5-, 1 0-, 35-, 70-mg Postmenopausal osteoporosis or Take after an overnight fast with 70 for 70-mg... 

Rised ronate 5-, 35-mg tablet Osteoporosis or glucocorticoid-induced Same as alendronate 68 for 35-mg... 

Compared with postmenopausal osteoporosis, few clinical trials have been conducted evaluating therapies in men. Although alendronate and calcitonin have both been studied, only alendronate reduces fracture rates in men. Teriparatide also has been studied, but no data are available yet on fracture rates. At this time, alendronate and teriparatide are approved by the FDA for the treatment of osteoporosis in men. Owing to proven benefit in reducing fractures and relative safety, alendronate should be considered first-line treatment for primary osteoporosis in men. Teriparatide should be reserved as alternate therapy in this population. 

Alendronate, risedronate, and oral ibandronate are FDA approved for prevention and treatment of postmenopausal osteoporosis. IV ibandronate and zoledronic acid are indicated only for treatment of postmenopausal women. Risedronate and alendronate are also approved for male and glucocorticoid-induced osteoporosis. 

Black DM, Greenspan SL, Ensrud KE, Palermo L, McGowan JA, Lang TF, et al. (2003) The effects of parathyroid hormone and alendronate alone or in combination in postmenopausal osteoporosis. N Engl J Med 349 1207-1215... 

Chavassieux PM, Arlot ME, Reda C, Wei L, Yates J, Meunier PJ (1997) Histomor-phometric assessement of the long term effects of alendronate on bone quality and remodelling in patients with osteoporosis. J Clin Invest 100 1475-1480... 

Johnell O, Scheele WH, Lu Y, Reginster JY, Need AG, Seeman E (2002) Additive effects of raloxifene and alendronate on bone density and biochemical markers of bone remodeling in postmenopausal women with osteoporosis. J Clin Endocrinol Metab 87 985-992... 

Black DM, Thompson DE, Bauer DC, Ensrud K, Musliner T, Hochberg MC et al. (2000) Fracture risk reduction with alendronate in women with osteoporosis the Fracture Intervention Trial. FIT Research Group. J Clin Endocrinol Metab 85 4118-4124... 

These results indicated osteoporosis. In this condition, which often appears secondary to another pathology such as an endocrinopathy, chronic renal failure or following long term immobilization, bone architecture is normal hut its mass is reduced relative to its volume, that is there is normal mineralization hut the amount of osteoid matrix is reduced. Treatment is with bone resorption inhibitors such as the bisphosphonate group of drugs, for example alendronate. 

Bisphosphonates structurally mimic endogenous pyrophosphate, which inhibits precipitation and dissolution of bone minerals. They retard bone resorption by osteoclasts and, in part, also decrease bone mineralizatioa Indications include tumor osteolysis, hypercalcemia, and Paget s disease. Qinical trials with etidronate, administered as an intermittent regimen, have yielded favorable results in osteoporosis. With the newer drugs clodronate, pamidronate, and alendronate, inhibition of osteoclasts predominates a continuous regimen would thus appear to be feasible. 

Henry G, Hosking D, Devogelaer J-P, et al. Ten years experience with alendronate for osteoporosis in postmenopausal women. N Engl Med 2004 350 1189-99. 

Uses Rx prevent osteoporosis male female, Rx steroid-induced osteoporosis, Paget Dz Action -1- N1 abnormal bone resorption Dose Osteoporosis Rx 10 mg/d PO or 70 mg qwk Fosamax plus D 1 tab qwk Steroid-induced osteoporosis Rx 5 mg/d PO Prevention 5 mg/d PO or 35 mg qwk Paget Dz 40 mg/d PO Caution [C, ] Not OK if CrCl <35 mLAnin, w/ NSAID use Contra Esophageal anomalies, inability to sit/stand upright for 30 min, X Ca Disp Tabs, soln SE GI disturbances, esophageal irritation, HA, pain, jaw osteonecrosis (w/ dental procedures, chemo) Interactions -1- Absorption W7 antacids, Ca supls, Fe, food T risk of upper GI bleed W/ ASA NSAIDs EMS May cause cardiac conduction abnormalities d/t T Ca T risk of jaw fractures esp w/ dental procedures OD May cause hypocalcemia and adverse upper-GI effects milk or antacids can be given to bind alendronate... 

Agents include etidronic acid, pamidronic acid, clodronic acid, alendronic acid, ibandronic acid, rise-dronic acid, zoledronic acid and tiludronic acid. Formulations of clodronic acid and pamidronic acid are available for intravenous administration. The indications for the use of bisphosphonates include treatment of postmenopausal osteoporosis, hypercal-caemia of malignancy and Paget s disease. 

Finally, bisphosphonates have an important place in treatment of osteoporosis of all causes, including steroid-induced osteoporosis. Disodium etidronate, alendronate and clodronate all have potent effects to restore bone mass, and this effect persists for several years of therapy. Newer drugs such as zoledronic acid can be administered by infrequent (once-yearly) infusion, which can help compliance and reduce side effects. 

Multiple bisphosphonates compounds are available for both oral and intravenous use. Some [alendronate (Fosamax) and etidronate (Didronel)] are used for osteoporosis, others [etidronate, tirludronate (Skelid), risedronate Actonel) for Paget s disease, and yet others [pamidronate Aredia), zoledronic acid] for the hypercalcemia of malignancy. 

Li, Chines and Meredith (2004) quote three clinical trials evaluating the effectiveness of alendronate, risedronate and raloxifene in increasing BMD and reducing fracture risk in osteoporosis. These treatments are seen to reduce fracture risk by similar amounts 47 per cent, 49 per cent and 46 per cent respectively, yet their effects on increasing BMD are somewhat different 6.2 per cent, 5.8 per cent and 2.7 per cent respectively. Drawing conclusions on the relative effectiveness of these treatments based solely in terms of the surrogate BMD would clearly be misleading. 

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