Bisphosphonates osteoporosis

Bisphosphonates are the best therapeutic choice for patients with glucocorticoid-induced osteoporosis. Bisphosphonates generally produce greater BMD increases than do other agents used to treat osteoporosis. They increase spine (4.3%) and femoral neck (2.1%) BMD, but to a lesser extent than in bisphosphonate users who do not take glucocorticoids. They also likely reduce the risk of vertebral fractures by approximately 50%. ... 

Bisphosphonates have been shown to be highly effective in osteoporosis, cancer bone metastasis, multiple myeloma, and Paget s disease of bone. While generally very well tolerated, these drugs do have potential adverse effects. Recently, the association of long-term high dose bisphosphonate treatment with osteonecrosis of the jaw has been described. This is a potentially serious side effect seen mostly in patients with multiple myeloma or... 

The bisphosphonates are drags used to treat musculoskeletal disorders such as osteoporosis and Fhget s disease. This chapter will discuss the use of these drugs in the treatment of osteoporosis. 

The bisphosphonates are used to treat osteoporosis in postmenopausal women, Paget s disease of the bone, and postoperative treatment after total hip replacement (etidronate). 

BRENCKMANN 0 and PAPAIOANNOU A (2001) Bisphosphonates for osteoporosis in people with cystic fibrosis. Cochrane Database Syst Rev. 4 CD002010. 

Patients with IBD, particularly those with CD, are also at risk for bone loss. This may be a function of malabsorption or an effect of repeated courses of corticosteroids. Patients with IBD should receive a baseline bone density measurement prior to receiving corticosteroids. Vitamin D and calcium supplementation should be used in all patients receiving long-term corticosteroids. Oral bisphosphonate therapy may also be considered in patients receiving prolonged courses of corticosteroids or in those with osteopenia or osteoporosis. 

Hormone-replacement therapy is also indicated for the prevention of osteoporosis but is not recommended for longterm use. Alternatives such as bisphosphonates or raloxifene should be considered as first-line therapy for the prevention of osteoporosis, in addition to appropriate doses of calcium and vitamin D. 

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. 

Osteoporosis Oral calcium supplementation (1000-5000 mg/day) Oral vitamin D Calcifediol (1000 lU/day) Calcitriol (0.5 mcg/day) Hormone-replacement therapy Calcitonin or oral bisphosphonates If daily intake less than 1000 mg elemental calcium Documented deficiency If kidney functioning If kidney not functioning Post-menopausal women without contraindications Documented loss in bone mineral density greater than 3% Data lacking for bisphosphonates in patients with Rl... 

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

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

Osteoporosis Encourage patients to ingest adequate amounts of calcium and vitamin D, encourage smokers to discontinue tobacco use, and consider initiation of medications for osteoporosis (e.g., bisphosphonates, calcitonin, and parathyroid hormone) if the patient is taking glucocorticoids for an extended period of time or if the patient has evidence of low bone mineral density.15,41... 

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... 

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. 

Bonviva consists of ibandronic acid, a bisphosphonate and is available as 150 mg tablets and 1 mg/mL injection. Patients receiving the oral formulation for the treatment of postmenopausal osteoporosis are advised to take one tablet once a month. Absorption of bisphosphonates from the gastrointestinal tract may be effected by food or other administered drugs. Therefore patients are advised to take the Bonviva 150 mg tablet at least 1 hour before breakfast or another oral medicine and to continue standing or sitting upright for at least 1 hour after administration. 

Ibandronic acid is classified as a bisphosphonate and is used in the management of osteoporosis. It acts selectively on the bone mass, decreasing the osteoclast activity and hence resulting in an increase in bone mass, including the spine cavity. 

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. 

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

Ibandronate (Boniva) [Bone Resorption Inhibitor/ Bisphosphonate] Uses Rx prevent osteoporosis in postmenopausal... 

Bisphosphonates such as etidronate are often coprescribed with calcium supplements in the treatment of osteoporosis. If these are ingested concomitantly, the bioavailability of both is significantly reduced with the possibility of therapeutic failure. This may be avoided by allowing a sufficiently long dosage interval a possible approach is to give etidronate for 2 weeks and calcium supplements for 10 weeks in a 12-week period. 

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. 

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